Describing and Comparing Patient Factors Associated with Use of Parenteral Iron before and after Implementation of an Order Set for Parenteral Iron (DECODE IRON).

Background: In select clinical scenarios, IV administration of iron is suitable for management of iron deficiency anemia; however, for most patients, oral administration of iron is the mainstay of treatment. At the Red Deer Regional Hospital Centre, in Red Deer, Alberta, high utilization of IV iron has resulted in limited access to this medication for the treatment of ambulatory patients, as well as significant usage of health care resources. Objectives: The primary objective was to compare patient characteristics, specifically pretreatment laboratory test results and previous use of oral iron, among those receiving IV iron therapy in an ambulatory setting before and after implementation of an iron sucrose order set. For secondary objectives, the aforementioned groups were compared with regard to meeting the diagnostic criteria for iron deficiency anemia, with or without pretreatment oral iron or blood transfusion, and the dosing characteristics for IV iron. Methods: A retrospective electronic chart review was performed for ambulatory patients who received IV iron between January 1, 2020, and January 31, 2022. Results: A total of 436 unique treatment courses were included in the analysis. The following pretreatment laboratory results were observed before and after implementation of the iron sucrose order set: mean hemoglobin 105.8 (standard deviation [SD] 21.9) g/L versus 102.2 (SD 18.5) g/L; mean of mean corpuscular volume (MCV) 82.2 (SD 9.4) fL versus 79.2 (SD 8.9) fL; and median ferritin 7 (interquartile range [IQR] 4-12) µg/L versus 6 (IQR 4-11) µg/L. Only the difference in MCV values was statistically significant (p = 0.001). Conclusions: The implementation of an iron sucrose order set for ambulatory patients did not have a significant effect on pretreatment laboratory parameters among patients for whom IV iron was prescribed. Further stewardship initiatives could be beneficial in improving the appropriateness of IV iron use.

Contexte: Dans certains scénarios cliniques, l'administration de fer par voie intraveineuse (IV) convient à la prise en charge de l'anémie ferriprive; cependant, pour la plupart des patients, l'administration de fer par voie orale constitue le pilier du traitement. Au centre hospitalier régional Red Deer, à Red Deer, en Alberta, l'utilisation élevée du fer par IV a entraîné un accès limité à ce médicament pour le traitement des patients ambulatoires, ainsi qu'une utilisation importante des ressources de santé. Objectifs: L'objectif principal consistait à comparer les caractéristiques des patients, en particulier les résultats de tests de laboratoire avant traitement et l'utilisation antérieure de fer par voie orale, chez ceux recevant un traitement de fer par IV en milieu ambulatoire avant et après la mise en oeuvre d'un protocole de prescription de fer sucrosé. Les objectifs secondaires, quant à eux, étaient la comparaison des groupes susmentionnés en ce qui concerne la satisfaction des critères diagnostiques de l'anémie ferriprive, avec ou sans prétraitement de fer administré par voie orale ou par transfusion sanguine, ainsi que les caractéristiques posologiques du fer administré par IV. Méthodes: Un examen rétrospectif des dossiers électroniques a été réalisé pour les patients ambulatoires ayant reçu du fer par IV entre le 1er janvier 2020 et le 31 janvier 2022. Résultats: Au total, 436 traitements uniques ont été inclus dans l'analyse. Les résultats suivants de tests de laboratoire avant traitement ont été observés avant et après la mise en oeuvre du protocole de prescription de fer sucrosé: hémoglobine moyenne 105,8 g/L (écart type [ÉT] 21,9) contre 102,2 g/L (ÉT 18,5); moyenne du volume corpusculaire moyen (VCM) 82,2 fL (ÉT 9,4) contre 79,2 fL (ÉT 8,9); et ferritine médiane 7 µg/L (intervalle interquartile [IIQ] 4­12) contre 6 µg/L (IQR 4­11). La seule différence statistiquement significative concernait les valeurs VCM (p = 0,001). Conclusions: La mise en oeuvre d'un protocole de prescription de fer sucrosé pour les patients ambulatoires n'a pas eu d'effet significatif sur les paramètres biologiques avant traitement chez les patients pour lesquels du fer par IV a été prescrit. D'autres initiatives de gestion pourraient être bénéfiques pour améliorer la pertinence de l'utilisation du fer IV.

Antimicrobial stewardship in rural nursing homes: Impact of interprofessional education and clinical decision tool implementation on urinary tract infection treatment in a cluster randomized trial.

OBJECTIVES: To measure the impact of an antimicrobial stewardship initiative on the rate of urine culture testing and antimicrobial prescribing for urinary tract infections (UTIs) between control and intervention sites. Secondary objectives included evaluation of potential harms of the intervention and identifying characteristics of the population prescribed antimicrobials for UTI. DESIGN: Cluster randomized controlled trial. SETTING: Nursing homes in rural Alberta, Canada. PARTICIPANTS: The study included 42 nursing homes ranging from 8 to 112 beds.Methods/interventions:Intervention sites received on-site staff education, physician academic detailing, and integrated clinical decision-making tools. Control sites provided standard care. Data were collected for 6 months prior to and 12 months after the intervention. RESULTS: Resident age (83.0 vs 83.8 years) and sex distribution (female, 62.5% vs 64.5%) were similar between the groups. Statistically significant decreases in the rate of urine culture testing (-2.1 tests per 1,000 resident days [RD]; 95% confidence interval [CI], -2.5 to -1.7; P < .001) and antimicrobial prescribing for UTIs (-0.7 prescriptions per 1,000 RD; 95% CI, -1.0 to -0.4; P < .001) were observed in the intervention group. There was no difference in hospital admissions (0.00 admissions per 1,000 RD; 95% CI, -0.4 to 0.3; P = .76), and the mortality rate decreased by 0.2 per 1,000 RD in the intervention group (95% CI, -0.5 to -0.1; P = .002). Chart reviews indicated that UTI symptoms were charted in 16% of cases and that urine culture testing occurred in 64.5% of cases. CONCLUSION: A multimodal antimicrobial stewardship intervention in rural nursing homes significantly decreased the rate of urine culture testing and antimicrobial prescriptions for UTI, with no increase in hospital admissions or mortality.

Association of Dissemination of an Educational Communication Tool With Docusate Administration.

Importance: A clear message and call to action can affect the use of a medication with limited efficacy. Objectives: To assess the association of the dissemination of an educational document about the lack of efficacy of docusate with docusate administration and whether changing docusate administration was associated with a change in administration of comparable laxatives. Design, Setting, and Participants: In this quasi-experimental, pre-post study of all acute care and continuing care facilities serviced by Alberta Health Services in Alberta, Canada, an interrupted time series analysis was performed to examine the association of an educational communication tool with docusate administration from June 1, 2014, through May 31, 2016. Interventions: A Drugs & Therapeutics Backgrounder was disseminated to all pharmacists in December 2014. Backgrounders are academic detailing tools to assist pharmacists in supporting drug stewardship and are supplemented by online, interactive webinars. Main Outcomes and Measures: This study examined whether a decrease in docusate administration across the organization occurred after release of the backgrounder. Messaging in the backgrounder stated that, unless clinically necessary, docusate should not be replaced by another medication. This study assessed whether that message was accepted by measuring administration of comparable laxatives. Study medication administration is reported as defined daily doses (DDDs) per 1000 inpatient-days (PDs). Rates were compared for the 6 months before the intervention and 3, 6, 12, and 18 months after intervention. Results: Among the 111 acute care facilities (8500 beds) and 24 000 long-term care beds of the Alberta Health Services, predicted docusate administration decreased from preintervention (474 DDDs/1000 PDs) to 3 months (321 DDDs/1000 PDs; 95% CI, 304-465 DDDs/1000 PDs), 6 months (296 DDDs/1000 PDs; 95% CI, 277-456 DDDs/1000 PDs), 12 months (251 DDDs/1000 PDs; 95% CI, 207-499 DDDs/1000 PDs), and 18 months (214 DDDs/1000 PDs; 95% CI, 148-536 DDDs/1000 PDs). Administration of the comparable laxatives did not statistically significantly change (preintervention: 627 DDDs/1000 PDs; 18 months after intervention: 702 DDDs/1000 PDs; 95% CI, 295-694 DDDs/1000 PDs; P = .13). Conclusions and Relevance: A communication document supported by live presentations was associated with decreased administration of docusate up to 6 months, with a leveling of the association after 1 year. Significant systemic change can be achieved without extensive and complex interventions if the evidence and messaging are aligned.

Interprofessional Peer Teaching of Pharmacy and Physical Therapy Students.

OBJECTIVE: To evaluate an interprofessional peer-teaching activity during which physical therapy students instructed undergraduate pharmacy students on 3 ambulatory devices (canes, crutches, walkers). DESIGN: The pre/post evaluation of 2 pharmacy undergraduate classes included 220 students, 110 per year. After pharmacy students completed a 10-point, knowledge-based pretest, they participated in a hands-on activity with physical therapy students teaching them about sizing, use, and safety of canes, crutches, and walkers. A 10-point posttest was completed immediately afterward. ASSESSMENT: The mean difference of pre/post scores was 3.5 (SD 1.9) for the peer-led teaching, and 3.8 (SD 2.2) for the peer learning group. Students had positive responses regarding the learning exercise and recommended further peer teaching. CONCLUSION: The peer-learning activity involving physical therapy students teaching pharmacy students was an effective method of improving knowledge and skills regarding basic ambulatory devices.