The vital role of clinical pharmacy services within the hospital at home interdisciplinary team.

PURPOSE: Hospital at home (HaH) program development, spurred by hospital congestion during the COVID-19 pandemic, is moving from a novel idea to a standard of inpatient practice. Understanding pharmacy's clinical role in the HaH patient care team is exceedingly important as programs across the country continue to develop, implement, and expand. The purpose of this study is to describe how clinical pharmacy services are currently provided for home hospital patients and to explain the vital role of pharmacists within the HaH care team. DESCRIPTION: A descriptive study was designed to evaluate pharmacy services provided for home hospital patients from January 1, 2023, to February 28, 2023. Prior to the study period, a focused group of pharmacists routinely active in HaH patient care met to define a standard process for documenting pharmacy services using an electronic documentation system (i-Vent) within the EHR. During the study period, a total of 221 patients were admitted to home hospital at either site representing 3,258 inpatient medication orders with 2,997 medication administrations. Pharmacists signed 903 progress notes and documented 561 interventions across all types. The top 3 pharmacy intervention types were drug administration change (37%), medication reconciliation (29%), and antimicrobial stewardship (15%). Each of the top 3 types were further evaluated by subtype. CONCLUSION: Documented pharmacy services encompassed a variety of intervention types. The overwhelming majority of patients admitted to the program received pharmacy consultative services, demonstrating how pivotal pharmacists are to the operational success of these programs and clinical care of HaH patients. More research is needed to expose pharmacy potential and facilitate growth for pharmacists practicing in HaH programs.

Bypassing the Brick-and-Mortar Hospital: Increasing Direct Admissions from the Emergency Department to Inpatient Hospital-at-Home.

Home hospital programs continue to grow across the United States. There are limited studies around the process of patient selection and successful acquisition from the emergency department. The article describes how an interdisciplinary team used quality improvement methodology to significantly increase the number of admissions directly from the emergency department to the Advanced Care at Home program.

Pushing the agenda for intravenous push administration in outpatient parenteral antimicrobial therapy.

Intravenous push (IVP) antimicrobial administration refers to rapid bolus infusion of medication. This drug delivery method offers improved patient convenience, superior patient and nursing satisfaction, and cost savings when used in outpatient parenteral antimicrobial therapy (OPAT). Antimicrobial agents must demonstrate optimal physiochemical and pharmacologic characteristics, as well as sufficient syringe stability, to be administered in this manner. Additionally, impacts on medication tolerability, patient safety, and effectiveness must be considered. This narrative review summarizes the available data and practical implications of IVP administration of antimicrobials in the OPAT setting.

PCP Pincer Complexes of Titanium in the +3 and +4 Oxidation States.

Ti(IV) and Ti(III) complexes using the tBuPCP ligand have been synthesized (tBuPCP = C6H3-2,6-(CH2PtBu2)2). The [tBuPCP]Li synthon can be reacted with TiCl4(THF)2 to form (tBuPCP)TiCl3 (1) in limited yields due to significant reduction of the titanium synthon. The Ti(III) complex (tBuPCP)TiCl2 (2) has been further characterized. This can have half an equivalent of halide abstracted to form [{(tBuPCP)TiCl}2{µ-Cl}][B(C6F5)4] (3) and can also be methylated, forming (tBuPCP)TiMe2 (4). All the Ti(III) complexes have been characterized using EPR and X-ray crystallography, giving insight into their electronic structures, which are further supported by DFT calculations.

Synthesis and reactivity of titanium 'POCOP' pincer complexes.

The 'POCOP' pincer ligand, [2,6-(OPR2)2C6H3], has been attached to titanium in both Ti(III) and Ti(IV) complexes for the first time. Using a lithium-halogen exchange route [2,6-(OPR2)2C6H3]Li ([RPOCOP]Li) can be synthesised. Both the iso-propyl and tert-butyl derivatives can be made, but only the latter isolated. These can be reacted with the Ti(III) and Ti(IV) synthons to make a range of [POCOP]TiClx species. In the presence of Ti(IV), THF and [RPOCOP]Li, an unprecedented ligand rearrangement occurs. (tBuPOCOP)TiCl2, 1, can be derivatised with alkylating agents to make bis-methyl, phenyl and neopentyl complexes. The last of these can activate H2 to make a rare example of a titanium chlorohydride, with the metal pincer fragment staying attached. EPR has been used to characterise the paramagnetic complexes and locate their electron spins, which is further validated with DFT calculations. This opens the door for this archetypical pincer ligand to be used with early transition metals.

Asymmetric bis-PNP pincer complexes of zirconium and hafnium - a measure of hemilability.

Asymmetrically-bound pyrrolide-based bis-PNP pincer complexes of zirconium and hafnium have been formed. The [κ2-PNPPh][κ3-PNPPh]MCl2 species are in direct contrast to previous zirconium PNP pincer complexes. The pincer ligands are fluxional in their binding and the energy barrier for exchange has been approximated using VT-NMR spectroscopy and the result validated by DFT calculations.