Hospital Pharmacy

Includes bibliographical references.

Patient Safety Risks Associated with Current Allergy-Related Clinical Decision Support -- Expanded Responsibilities of Pharmacy Residents in a COVID-19 Mass Vaccination Clinic -- Disaster Response Involving Pharmacists -- The Second Wave of COVID-19: Clinical Pharmacy Services During a Field Hospital Operation -- Implementation of Pharmacy Executive Quality and Safety Walkrounds at a Tertiary Academic Medical Center -- Critical Inhaler Administration Errors of Patients on Pressurized Meter Dose Inhaler (pMDI): A Hospital-Based Cross-Sectional Study in Malaysia -- Validation of Methicillin-Resistant Staphylococcus aureus (MRSA) Risk Factors in Predicting MRSA Community-Acquired Pneumonia at an Academic Medical Center -- Hidden Fluids in Plain Sight: Identifying Intravenous Medication Classes as Contributors to Intensive Care Unit Fluid Intake -- A Rare Pediatric Case of Cefixime Induced Toxic Epidermal Necrolysis -- Dabigatran-Induced Nephropathy and Gastrointestinal Bleeding and Its Successful Treatment with Idarucizumab: A Case Report -- Opioid-Free Anesthesia: Physico Chemical Stability Studies on Multi-Analyte Mixtures Intended for Use in Clinical Anesthesiology -- Comparison of Bleeding Rates between Oral Anticoagulants in Combination with Dual Antiplatelet Therapy (Triple Therapy) in a Real-World Cohort -- n Vitro Assessment for Dose Preparation and Simulated Administration of Azithromycin Suspensions via Enteral -- Conscientious Objection: A Review of State Pharmacy Laws and Regulations -- Productivity Tracking: A Survey of Critical Care Pharmacist Practices and Satisfaction -- Standard- versus High-Dose Dexmedetomidine for Sedation in the Intensive Care Unit -- Safety of Propofol When Used for Rapid Sequence Intubation in Septic Patients: A Multicenter Cohort Study -- Stability of Compounded Digoxin Solution 0.05 mg/mL for Injection -- Virtual Coaching Delivered by Pharmacists to Prevent COVID-19 Transmission -- Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test.

[Article Title: Patient Safety Risks Associated with Current Allergy-Related Clinical Decision Support/ Yuhong Liu, Megan Park, Mary Kate Anderson, and Jon Newbold, p. 197-199]

https://doi.org/10.1177/00185787211024223

[Article Title: Expanded Responsibilities of Pharmacy Residents in a COVID-19 Mass Vaccination Clinic/ Olga O. Vlashyn,Lauren M. Aschermann, and William M. Hammonds, p. 200-201]

nsibilities of Pharmacy Residents in a COVID-19 Mass Vaccination Clinic
Olga O. Vlashyn https://orcid.org/0000-0001-6910-5060 [email protected], Lauren M. Aschermann, and William M. Hammonds https://orcid.org/0000-0002-3654-4566View all authors and affiliations
Volume 57, Issue 2
https://doi.org/10.1177/00185787211025734

[Article Title: Disaster Response Involving Pharmacists/ Sondra Davis, Les Covington, Greg Johnson, Kathleen Morneau, Brett Noteware, Aaron D. Reich, and Nolan Toups, p. 202-204]

https://doi.org/10.1177/0018578721101016

[Article Title: The Second Wave of COVID-19: Clinical Pharmacy Services During a Field Hospital Operation/ Jessica Mazzone, Krysta Shannon, Richard Rovelli, Racha Kabbani, Angel Amaral, and Neil Gilchrist, p. 205-210]

Abstract: The second wave of COVID-19 emerged in the late fall months in the state of Massachusetts and inadvertently caused a rise in the number of cases requiring hospitalization. With a field hospital previously opened in central Massachusetts during the Spring of 2020, the governor decided to reimplement the field hospital. Although operations were effectively accomplished during the first wave, the reimplementation of the field hospital came with its new set of challenges for operating a satellite pharmacy. Experiences gathered include new pharmacy operation workflows, the clinical role of pharmacy services, introduction of remdesivir treatment, and pharmacy involvement in newly diagnosed diabetes patients requiring insulin teaching. Pharmacy services were successful in adapting to the rapidly growing number in patients with a total of over 600 patients served in a course of 2 months.

https://doi.org/10.1177/00185787211032361

[Article Title: Implementation of Pharmacy Executive Quality and Safety Walkrounds at a Tertiary Academic Medical Center/ Yazed Saleh Alsowaida, Mary P. Kovacevic, Caryn Belisle, Michael C. Cotugno, Tom Cooley, Lina Matta, John Fanikos, and Heather Dell’Orfano, p. 211-216]

Abstract: Background: Executive Quality and Safety WalkRounds (EWRs) is a tool that engages department leadership in discussion with the front-line employees to solicit feedback to improve quality and safety. The purpose of this study was to evaluate the impact of the implementation of pharmacy department specific EWRs on quality and safety at a tertiary academic medical center. Method: This was a single-center, retrospective analysis conducted at Brigham and Women’s Hospital between November 2016 and November 2019. This study aimed to analyze the implementation of EWRs conducted every other month throughout various service areas and satellites of the pharmacy department. Data evaluated included the number of EWRs conducted, the specific areas visited, the total number of action items recommended by the staff, along with the total number of action items that were completed or remained in process. Results: During the study period, 17 visits were completed in 12 different BWH pharmacy sub-departments. A total of 98 operational, technological, and environmental action items were recommended by staff to improve quality and safety. Of the 98 action items documented, 95 (96.9%) were completed by time of our analysis. Conclusion: Pharmacy department EWRs are an important and systematic process of communication between the pharmacy leadership and frontline staff. Pharmacy department EWRs have resulted in safety and quality improvements at different levels in the pharmacy department. The EWRs program at the pharmacy department was effective in identifying and completing safety initiatives to improve the safety culture of the department.

https://doi.org/10.1177/00185787211010155

[Article Title: ICritical Inhaler Administration Errors of Patients on Pressurized Meter Dose Inhaler (pMDI): A Hospital-Based Cross-Sectional Study in Malaysia/ Retha Rajah, Yi Woei Tang, Shien Chee Ho, Jo Lyn Tan, Muhamad Shuhaimi Mat Said,, and Lee Hwang Ooi, p. 217-222]

Abstract: Background: Inhaler technique errors can affect the disease outcome through reduced deposition of medication in the lungs with certain errors were more likely to deter the optimum drug from reaching the lung. The objective of this study was to evaluate the pressurized metered-dose inhaler (pMDI) critical technique errors among asthma and COPD patients, and to investigate the predictors of those errors. Methods: A cross-sectional, observational, and multi-centered study conducted in 3 major hospitals in the state of Penang, Malaysia. Asthma and COPD patients aged 18 years or older consented to the study were consecutively recruited if they were at least on 1 pMDI without mouthpiece spacer or facemask space. Direct observation of the patient’s technique was recorded using a standard checklist and certain steps in the checklist were pre-determined as critical steps. The number of patients missed or incorrectly performed the steps including the critical steps were documented. Using logistic regression, the factors associated with the critical errors were determined, and the correlation was evaluated between age and pMDI knowledge score with critical inhalation steps score. Results: Of 209 patients observed, only less than half (40.7%) could perform all the critical pMDI steps correctly. Low education level was the only factor associated with critical inhaler errors. The increased knowledge of their inhaled medication was found to positively correlate with the correct critical inhalation steps. The critical errors also increase with the increased age of patients. Conclusion: The majority of the study population make inhalation error particularly in critical steps. Training and education intervention programs may help patients with lower education level, as well as those of advanced age and lack of knowledge of their inhaled medication because those populations are at a greater risk of committing critical errors in their use of pMDI.

https://doi.org/10.1177/00185787211010164

[Article Title: Validation of Methicillin-Resistant Staphylococcus aureus (MRSA) Risk Factors in Predicting MRSA Community-Acquired Pneumonia at an Academic Medical Center/ Joelle Arieno, Robert Seabury, Wesley Kufel, William Darko, Christopher D. Miller, William Paolo, Gregory Cwikla, Scott Riddell, Luke A. Probst, and Jeffrey M. Steele, p. 223-229]

Abstract: Background: The 2019 Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines recommend antimethicillin- resistant Staphylococcus aureus (MRSA) therapy in patients with CAP based on previously identified risk factors for MRSA with an emphasis on local epidemiology and institutional validation of risk. Thus, we sought to assess the ability of guideline-recognized risk factors to predict MRSA CAP at our institution. Methods: This was a single-center, retrospective cohort study from January 2016 to March 2020. Patients were included if they were >18 years old, diagnosed with CAP, and had a MRSA nasal screen and respiratory culture obtained on admission. Patients were excluded if CAP diagnosis was not met, respiratory cultures were not obtained within 48 hours of antibiotic initiation, or they had cystic fibrosis. Sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios (LR) were calculated using Vasser Stats 2019. Pre/post-test odds and pre/post-test probabilities were calculated using Excel 2019. Results: Of 705 screened patients, 221 were included. MRSA prevalence in CAP patients at our institution was 3.6%. History of MRSA isolated from a respiratory specimen had high specificity (98%), high positive LR of 20 (95% CI 5.3–74.8), and high post-test probability of 42.8%. Receipt of IV antibiotics during hospitalization within the past 90 days had a positive LR of 1.9 (95% CI 0.74–4.84). A positive MRSA nasal screen on admission had a positive LR of 6.9 (95% CI 4.0–12.1), negative LR 0.28 (95% CI 0.08–0.93), positive post-test probability of 20.7%, and negative post-test probability of 1.04%. Conclusion: Our study utilized institutional data to validate guideline recognized risk factors for MRSA CAP specifically at our institution. Risk factors including history of MRSA isolated from a respiratory specimen, and positive post-admission MRSA nasal screen were validated as significant risk factors; receipt of IV antibiotics during hospitalization within the past 90 days was not shown to be a risk factor for MRSA CAP based on our institutional data. Validated risk factors may help providers discern which patients with CAP at our institution would benefit most from empiric MRSA treatment.

https://doi.org/10.1177/00185787211010149

[Article Title: Hidden Fluids in Plain Sight: Identifying Intravenous Medication Classes as Contributors to Intensive Care Unit Fluid Intake/ Kelly C. Gamble, Susan E. Smith, Christopher M. Bland, Andrea Sikora Newsome, Trisha N. Branan, and William Anthony Hawkins, p. 230-236]

Abstract: Fluid stewardship targets optimal fluid management to improve patient outcomes. Intravenous (IV) medications, flushes, and blood products, collectively referred to as hidden fluids, contribute to fluid intake in the intensive care unit (ICU). The impact of specific IV medications on fluid intake is unknown.

https://doi.org/10.1177/00185787211016339

[Article Title: A Rare Pediatric Case of Cefixime Induced Toxic Epidermal Necrolysis/ Tirin Babu, George Mathew Panachiyil, Prajwala Hassan Vasudev, and Mandyam Dhati Ravi, p. 237-240]

Abstract: Cefixime is a third-generation cephalosporin that has been used for the treatment of a wide range of infections in children and adults. The incidence of cefixime induced toxic epidermal necrolysis (TEN) is less than 2% in adults, but it is infrequent among pediatric patients. We report a rare case of cefixime induced TEN in a 7-year-old boy. In this case, the child presented with symptoms of TEN after 2 days of administration of cefixime. This case highlights the need to select structurally different antibiotics in case of antibiotic-induced severe cutaneous adverse reaction (SCAR) to avoid recurrence of SCAR. Furthermore, concluded that irrational use of antibiotics could be disastrous as it can result in TEN as the incidence of antibiotics induced TEN ranges from 29% to 42%.

https://doi.org/10.1177/00185787211016332

[Article Title: Dabigatran-Induced Nephropathy and Gastrointestinal Bleeding and Its Successful Treatment with Idarucizumab: A Case Report/ Francesca Marchesini, Andrea Ossato, Alberto Zendrini, Federica Arginelli, Teresa Zuppini, Nicola Realdon, Massimo Zamperini, and Roberto Tessari, p. 241-245]

Abstract: Recently, the atrial fibrillation treatment guidelines have been updated to now recommend Non-vitamin K antagonist oral anticoagulants (NOACs) as the preferred alternative to warfarin for systemic embolism and stroke prevention in patients with non-valvular atrial fibrillation. NOACs have major pharmacologic advantages over warfarin, although the most common complications are gastrointestinal bleeding and NOAC-induced nephropathy within 6 weeks after starting therapy, as several recent case-reports stated. We are reporting for the first time a chronic delayed adverse reaction (regularly reported to Authorities) observed in an 82-year-old woman 27 months after starting dabigatran (110 mg twice a day), characterized by concomitant gastrointestinal bleeding and nephropathy. Idarucizumab administration immediately improved both bleeding and renal parameters. Moreover, we are going to highlight the importance of the compliance, the adherence to the therapeutic plan and the supervision of the Hospital Pharmacy on drug prescriptions. In fact in our case, dabigatran was firstly prescribed by the neurologist and delivered by the hospital pharmacy, but the patient continued the treatment for 27 months, prescribed by general practitioner without any laboratory control. This lack of supervision certainly contributed to the onset of the adverse reaction reported.

https://doi.org/10.1177/00185787211016335

[Article Title: Opioid-Free Anesthesia: Physico Chemical Stability Studies on Multi-Analyte Mixtures Intended for Use in Clinical Anesthesiology/ Larissa Schenkel,Irene Vogel Kahmann, and Christian Steuer, p. 246-252]

Abstract: Opioid-free anesthesia is used increasingly often in hospitals around the world. In this type of anesthesia, opioids are replaced by other analgesics, such as ketamine, lidocaine, dexmedetomidine, and magnesium sulfate. Many clinicians prepare these agents as dual, triple, or quadruple admixtures within a single syringe. However, data on the stability of the individual substances within these preparations over time and in different storage conditions is very limited. Here, we aim to investigate various admixture of dexmedetomidine, ketamine, lidocaine, and magnesium sulfate with respect to the stability of the individual agents over time at different storage conditions.

https://doi.org/10.1177/00185787211016336

[Article Title: Comparison of Bleeding Rates between Oral Anticoagulants in Combination with Dual Antiplatelet Therapy (Triple Therapy) in a Real-World Cohort/ Maya R. Chilbert, Sarah E. Reidy, Collin M. Clark, Marissa Guszkowski, Emma Gargala, and Ashley E. Woodruff, p. 253-259]

Abstract: Triple antithrombotic therapy including an anticoagulant, P2Y12 inhibitor, and aspirin increases bleed risk up to 27%. The components of this regimen can vary, which may impact bleed risk.

https://doi.org/10.1177/00185787211024602

[Article Title: In Vitro Assessment for Dose Preparation and Simulated Administration of Azithromycin Suspensions via Enteral Feeding Tubes/ Matthew Santangelo, Julia A. Wood, Kimber L. Barnett, Fae Gwen G. Wooding, and Jeremy A. Bartlett, p. 260-267]

Abstract: Administration of medication via enteral feeding tubes (EFT) is common in cases where patients are unable to swallow the dosage form or a patient is intubated. The SARS-CoV-2 (COVID-19, coronavirus disease 2019) epidemic created a need to rapidly evaluate potential treatment options to address the global pandemic including evaluation of azithromycin (AZM) as a mono or combination therapy. Due to the complicating medical conditions of COVID-19, in some cases patients may be unable to take medication orally and could require medication administration by alternate routes such as an EFT. The aim of this study was an in vitro assessment for the dose preparation and simulated administration of AZM suspensions, prepared from tablets and capsules, via nasogastric feeding tubes (NGT). AZM tablets and capsules were used to prepare aqueous suspensions from 250 to 2000 mg for administration via NGT. NGT between 8 and 12 French (Fr), from common materials of construction and typical lengths were evaluated. About 20 mL syringes were used with water as the diluent. The preparation and simulated NGT administration steps for AZM suspensions were evaluated in the laboratory studies and included assessment of in-use stability of the aqueous suspensions, chemical compatibility of prepared aqueous suspensions with the syringe and NGT, ease of delivery and accuracy of simulated administration. Analysis of the prepared sample solutions for assay/impurities was performed using chromatographic conditions based on the USP-NF monograph. Verification of dose preparation and simulated administration was performed for intact tablets, crushed tablets, and capsules. Aqueous suspensions prepared from intact tablets and capsules were exposed to dosing materials (enteral syringe and NGT) for a period of up to 4 hours at ambient conditions. Assessment of the ease of dose delivery and analyses of the resulting samples for assay, purity and total degradation products were performed. The laboratory studies verified a procedure to reliably prepare suspensions from AZM tablets and capsules, over a range of 250 to 2000 mg, that can be accurately administered through NGT in sizes of 8 to 12 Fr. No incompatibilities of the prepared aqueous AZM suspension with dosing materials were observed and acceptable stability was demonstrated for up to 4 hours.

https://doi.org/10.1177/00185787211024216

[Article Title: Conscientious Objection: A Review of State Pharmacy Laws and Regulations/ Thomas S. Achey, and Ashley T. Robertson, p. 268-272]

Abstract: Most states have adopted conscience clauses since the Roe v. Wade paradigm in the 1970s; however, not all clauses are respective to pharmacists. The purpose of this report is to quantify the presence of conscientious objection among US states with respect to pharmacist’s right to refuse to dispense. Fifty Boards of Pharmacy administrative codes were consulted for review. If Web sites were ambiguous or undeterminable, E-mail requests were sent on active legislation per National Association of Boards of Pharmacy contact information. Eleven states have conscience clauses present in their pharmacy administrative code—nearly double than last published in 2006. Requirements vary throughout the states including drug-specific limitations, requirement in writing, or notification in advance. Some states alternatively require duty to dispense. Less than one-fourth of United States boards of pharmacy provide a conscience clause or similar intended language in laws or policies. Within those states, pharmacists have a right to refuse to perform certain services based on religious, ethical, or moral objections. Imprecise language throughout the nation allows the rights to vary widely.

https://doi.org/10.1177/00185787211024217

[Article Title: Productivity Tracking: A Survey of Critical Care Pharmacist Practices and Satisfaction/ Christy Cecil Forehand, Kathryn Fitton, Kelli Keats, Aaron Chase, Susan E. Smith, and Andrea Sikora Newsome, p. 273-280]

Abstract: The position paper on critical care pharmacy services describes two tiers of responsibilities: essential and desirable activities. Activities are categorized into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. Documentation of these activities can be important for justifying pharmacist positions, comparing pharmacy practice models, conducting performance evaluations, and tracking individual workload; however, limited recommendations are provided for standardized productivity tracking, and national practices remain largely uncharacterized.

https://doi.org/10.1177/00185787211024209

[Article Title: Standard- versus High-Dose Dexmedetomidine for Sedation in the Intensive Care Unit/ Megan Van Berkel PatelSpencer Bolton, and Cassie Hamilton, p. 281-286]

Abstract: Dexmedetomidine is a commonly used sedative in the intensive care unit (ICU), however the use of higher, off label dosing has yet to be elucidated. A dose limitation protocol was implemented at our institution allowing for comparison of dexmedetomidine doses.

https://doi.org/10.1177/00185787211029552

[Article Title: Safety of Propofol When Used for Rapid Sequence Intubation in Septic Patients: A Multicenter Cohort Study/ Jacob Marler, Rachel Howland, Lauren A. Kimmons, Kerry Mohrien, Joseph E. Vandigo, and G. Morgan Jones, p. 287-293]

Abstract: Septic patients are at risk for hypotension, and this risk may increase during rapid sequence intubation (RSI). Sedatives such as propofol must be used carefully due to its ability to reduce vascular sympathetic tone. Since the safety of propofol for RSI is not well described in sepsis, this was a study evaluating propofol and its effects on hemodynamics when used for RSI in a septic population.

https://doi.org/10.1177/00185787211029547

[Article Title: Stability of Compounded Digoxin Solution 0.05 mg/mL for Injection/ Mihaela Friciu, Ruth Bernine Marcelin, Pascal Bédard, Jean-Marc Forest, and Grégoire Leclair, p. 294-299]

Abstract: In 2015, commercial pediatric digoxin injection 0.05 mg/mL was discontinued, leaving only one adult concentration (0.25 mg/mL) for injection on the Canadian market. No published studies have documented the chemical stability over a long period of time of a diluted solution of digoxin for injection.

https://doi.org/10.1177/00185787211029545

[Article Title: Virtual Coaching Delivered by Pharmacists to Prevent COVID-19 Transmission/ Derar H. Abdel-Qader, Ahmad Z. Al Meslamani, Nadia Al Mazrouei,Asma A. El-Shara, Husam El Sharu Eman Merghani Ali, Samah Bahy Mohammed Ebaed, and Osama Mohamed Ibrahim, p. 300-308]

Abstract: While the role of pharmacists in the current pandemic control has been recognized worldwide, their coaching efforts to improve public’s behaviors that could prevent COVID-19 transmission has been rarely investigated.

https://doi.org/10.1177/00185787211032354

[Article Title: Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test/ Preeyaporn Sarangarm, Timothy A. Huerena, Tatsuya Norii, and Carla J. Walraven, p. 309-314]

Abstract: Group A Streptococcus (GAS) pharyngitis is the most common bacterial cause of acute pharyngitis and is often over treated with unnecessary antibiotics. The purpose was to evaluate if implementation of a rapid antigen detection test (RADT) for GAS would reduce the number of inappropriately prescribed antibiotics for adult patients presenting with symptoms of pharyngitis. Methods: This was a retrospective cohort study of adult urgent care clinic patients pre- and post-implementation of a GAS RADT. We included patients who had a diagnosis of GAS identified via ICD-10 codes and either a throat culture, GAS RADT, or antibiotic prescribed for GAS. Antibiotic prescribing was assessed as appropriate or inappropriate based on testing and IDSA guideline recommendations. Thirty-day follow-up visits related to pharyngitis or the prescribed antibiotics was also evaluated.

https://doi.org/10.1177/00185787211032365