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Hospital Pharmacy

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October 2016: Hospital Pharmacy
Karen J Arthur, Ann Christine Catlin, Amanda Quebe, Alana Washington
Smart infusion pump technology is a mainstay in health care, and the integration and use of those pumps is crucial for patient safety. An institution purchasing smart infusion pumps has the ability to trial the various vendors before purchase, however literature that documents a conversion from one pump to another is lacking. This article describes the conversion from one smart infusion pump platform to another at a government institution and a large multisite facility. The differences in 2 smart infusion pumps are described as well as lessons learned following the conversion in both organizations...
October 2016: Hospital Pharmacy
Enrique Puertos, Greta Giles
Background: A shortage of indigotindisulfonate sodium has led to a search for an alternative visualizing agent. Objective: The primary objective of this study was to evaluate the potency and sterility of 10% sodium fluorescein, USP solutions stored in sterile polypropylene syringes and refrigerated. Methods: Four samples of 10% fluorescein injection, USP were aseptically drawn up in 3 mL polypropylene syringes and stored in a refrigerator at an average temperature of 3.9°C for 7 days. After 7 days, the samples were cultured for microbial growth...
October 2016: Hospital Pharmacy
Laura Meyer-Junco
Background: Nursing home-acquired pneumonia (NHAP) has been identified as one of the leading causes of mortality and hospitalization for long-term care residents. However, current and previous pneumonia guidelines differ on the appropriate management of NHAP in hospitalized patients, specifically in regard to the role of atypical bacteria such as Chlamydiae pneumonia, Mycoplasma pneumoniae, and Legionella. Objectives: The purpose of this review is to evaluate clinical trials conducted in hospitalized patients with NHAP to determine the prevalence of atypical bacteria and thus the role for empiric antibiotic coverage of these pathogens in NHAP...
October 2016: Hospital Pharmacy
C Whitney White, Angela R Thomason, Katie Boyd
Background: Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombosis or pregnancy loss with persistent positive antibodies. Standard treatment for APS with history of thromboembolism is heparin or low-molecular-weight heparin followed by a vitamin K antagonist (VKA). Novel oral anticoagulants (NOACs) could be effective in patients with APS, but none carry indications for treatment related to APS. Clinical Evidence: Five case reports or series with rivaroxaban and dabigatran suggest thrombotic events occur most often in the higher risk population (arterial thrombosis and/or triple positive antibodies) or in patients who had recurrent VTEs on warfarin therapy...
October 2016: Hospital Pharmacy
Mary E Eberly, Anna G Lockwood, Sean Lockwood, Kelly W Davis
Background: There are varying dosing strategies for the administration of benzodiazepines in the setting of alcohol withdrawal. In October 2014, a symptom-based alcohol withdrawal protocol (AWP) using the Clinical Institute Withdrawal Assessment of Alcohol, Revised (CIWA-Ar) scale was implemented at one institution. Objective: To evaluate the safety and efficacy of the AWP. Methods: Retrospective chart review was completed, including patients receiving at least one dose of diazepam for alcohol withdrawal pre- and post-protocol...
October 2016: Hospital Pharmacy
Hanlin Li, William Guffey, Laura Honeycutt, Timothy Pasquale, Nigel L Rozario, Angie Veverka
Objective: To evaluate the impact of a multifaceted, pharmacy-driven, unit-based transitions of care (TOC) program on all-cause 30-day readmission rates and to assess readmission rates in predefined subgroup patient populations. Methods: This prospective study included adult patients who were discharged from the pilot unit from January 5 to January 30, 2015. Patients who expired during hospitalization, left the hospital against medical advice, or transferred to another unit or nonaffiliated hospital were excluded...
October 2016: Hospital Pharmacy
Ruben D Santiago, Jose A Bazan, Nicole V Brown, Eric J Adkins, Mary Beth Shirk
Background: Accurate and timely review of microbiological test results is a core component of antimicrobial stewardship. There is documented success of these programs in the inpatient setting; however, emergency department (ED) patients are typically not included in these initiatives. Objectives: To assess the impact of an emergency medicine pharmacist (EMP)-facilitated review process of positive microbiological test results from patients discharged from the ED as measured by time to positive result review and number of indicated interventions completed...
October 2016: Hospital Pharmacy
Nwamaka Nwagbologu, Preeyaporn Sarangarm, Richard D'Angio
Background: Postoperative pain is managed with opioids, which are associated with adverse effects. The efficacy of intravenous (IV) acetaminophen in reducing opioid consumption has been studied with inconsistent results. The primary outcome of this study was to assess the effect of IV acetaminophen on opioid consumption 24 hours postoperatively. Secondary outcomes included the opiate consumption at 48 hours after the operation, opioid-related side effects 72 hours after the operation, discharge disposition, and length of stay...
October 2016: Hospital Pharmacy
Nathan S Bertsch, Ross J Bindler, Poppy L Wilson, Anne P Kim, Beverly Ward
Purpose: To determine the impact of a pharmacist-driven medication therapy management (MTM) program for patients receiving oral chemotherapy agents. Methods: We assessed the impact of MTM consultations with a pharmacist for patients who were receiving a new prescription for an oral chemotherapy agent. Data were assessed for outcomes including (1) number of medication errors identified in electronic medical records (EMRs), (2) number of interventions performed by the pharmacist, (3) time spent on the MTM process, and (4) patient satisfaction...
October 2016: Hospital Pharmacy
Carson Schlich, Frank Romanelli
Testosterone is derived from Leydig cells and exerts its effects on androgen receptors to influence growth, mood, voice, and several other bodily functions. As men age, their testosterone levels decline. Human immunodeficiency virus (HIV) infection has also been associated with lowered serum testosterone levels. Subtherapeutic levels of testosterone may lead to fatigue, loss of libido, and dysphoria. Exogenous replacement of testosterone can be accomplished by several modalities (oral, topical, injection), with each having distinct advantages and disadvantages...
October 2016: Hospital Pharmacy
Tristan T Timbrook, John M Hurst, John A Bosso
Background: Antimicrobial stewardship programs (ASPs) have the potential to improve patient outcomes, decrease microbial resistance, increase patient safety, and decrease costs. However, to justify the costs involved with providing an ASP, it is necessary to assess its impact in achieving these outcomes on an ongoing basis. Objective: The purpose of this study was to characterize the overall impact of the ASP at an Academic medical center. Methods: Quasi-experimental, before and after stewardship program implementation, retrospective analyses of quarterly antimicrobial utilization, bacterial susceptibilities, and antibiotic acquisition costs were utilized...
October 2016: Hospital Pharmacy
James S Wheeler, Nancy Borja-Hart, Tracy M Hagemann
No abstract text is available yet for this article.
October 2016: Hospital Pharmacy
Brent I Fox, Bill G Felkey
Pharmacy administrators are often tasked with a range of responsibilities, from strategic planning and human resources to information systems management. Because of this, tools to support administrators' efficient and appropriate attention to everything on their plate can be valuable. Identification and evaluation of the available tools should be guided by careful consideration of the department's needs.
September 2016: Hospital Pharmacy
Cristina Whalen Klafehn
As part of the US Food and Drug Administration's MedWatch program, safety labeling changes are reviewed and compiled monthly for drugs and therapeutic biologics where important changes have been made to the safety information. Boxed warnings ( are ordinarily used to highlight either adverse reactions so serious in proportion to the potential benefit from the drug that it is essential that it be considered in assessing the risks and benefits of using the drugs or serious adverse reactions that can be prevented/reduced in frequency or severity by appropriate use of the drug; or FDA approved the drug with restrictions to ensure safe use because FDA concluded that the drug can be safely used only if distribution or use is restricted...
September 2016: Hospital Pharmacy
(no author information available yet)
This monthly feature will help readers keep current on new drug, new indications, dosage forms and safety-related changes in labeling or use. Efforts have been made to assure the accuracy of this information; however, if there are any questions, please let us know at
September 2016: Hospital Pharmacy
Dennis J Cada, Anne P Kim, Danial E Baker
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers...
September 2016: Hospital Pharmacy
Daniel L Moellentin, Dale Stewart, James Barbour
A 39-year-old man presented with new onset right hemiparesis and aphasia within an hour of using approximately 120 mL lidocaine 4% topical solution intranasally. Lidocaine had been prescribed over a 3-week period for pain due to multiple debridements of the nasal septum. A total of 650 mL of 4% lidocaine (26 g) had been dispensed to the patient during this time. The patient had a significant history of drug abuse, including snorting crushed tablets. Otherwise he was a healthy man with no chronic diseases or conditions...
September 2016: Hospital Pharmacy
Duaa Alsulaiman, Katelyn Sylvester, Craig Stevens, Danielle Carter
Background: For patients on continuous IV unfractionated heparin (UFH), failing to achieve a therapeutic aPTT by 24 hours can be associated with increased morbidity. A pharmacy clinical surveillance system (PCSS) subtherapeutic aPTT alert was implemented at our institution to improve achievement of therapeutic aPTT goals by 24 hours. Objective: The primary objective was the time to achieve the minimum goal aPTT before and after the alert implementation. The secondary objectives were to examine the percentage of patients who achieved the minimum goal aPTT by 24 hours and the number of dose changes to achieve the minimum goal aPTT...
September 2016: Hospital Pharmacy
Jamin Engel, Nicole Lazar
To support compounding of products that are sterile and chemically stable, beyond use dating of admixtures must include a thorough evaluation of appropriate resources. In most instances, resources provide documentation of a specific compounded admixture, at a specific concentration and storage parameters, that does not coincide with current operations or patient-specific requirements. To meet the operational demands of a pharmacy, institutions employ a referenced guideline approach to guide decision making for safe sterile admixing...
September 2016: Hospital Pharmacy
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