Impact of a Bundle of Interventions on the Spectrum of Parenteral Drug Preparation Errors in a Neonatal and Pediatric Intensive Care Unit.

Background/Objectives: This study aimed to evaluate the impact of a bundle of interventions on the error rates in preparing parenteral medications in a neonatal and pediatric intensive care unit (NICU/PICU). Methods: We conducted a prospective interventional study in a NICU/PICU in a tertiary university hospital as a follow-up to a prior study in the same setting. A clinical pharmacist and a pharmacy technician (PT) analyzed the workflow of drug preparation on the ward, identified high-alert medications, and defined a bundle of five interventions, which include the following: Drug Labeling: 1. EN ISO-DIVI labeling; Training: 2. Standardized preparation process on the ward; 3. eLearning Program; 4. Expert Consultations; and Location of Preparation: 5. Transfer of the preparation of high-alert medications and standardized preparations to the central pharmacy. After implementing the bundle of interventions, we observed the preparation process on the ward to evaluate if the implementation of the interventions had an impact on the quality of the drug preparation. Results: We observed 262 preparations in the NICU/PICU. Each single step of the preparation process was defined as an error opportunity. We defined seven error categories with an overall error opportunity of 1413. In total, we observed 11 errors (0.78%). The reduction in the overall error rate from 1.32% in the former study to 0.78% per preparation opportunity demonstrated that the implemented interventions were effective in enhancing medication safety. Conclusions: This study provides evidence that a bundle of interventions, including standardizing drug labeling, enhancing training, and centralizing the preparation of high-alert medications, can reduce medication errors in NICU/PICU settings.

The Impact of the Clinical Pharmacist-Led Diabetes Education on the Knowledge and Attitude of Individuals with Type II Diabetes Mellitus: An Interventional Study.

BACKGROUND: Diabetes mellitus is a complex condition to manage. Patients with a greater understanding and knowledge of their condition might achieve better glycemic control than others. This study aimed to evaluate the impact of clinical pharmacist-led diabetes education on the knowledge and attitude of individuals with type II diabetes mellitus (T2DM). METHODS: This study was a quasi-experimental study which was conducted at a diabetes clinic in Khartoum, Sudan. The study population was adult individuals with T2DM who attended the diabetes clinic. The estimated sample size was 182 participants. The participants were selected randomly by a simple random sampling method. The knowledge and attitudes of the participants were assessed at baseline and at the end of the study after 12 months. The intervention was carried out through educational materials about diabetes and medications for its treatment. RESULTS: The majority of the participants were females. The mean age was 54.5 (±10) years. Most participants had a family history of diabetes (69.2%). The mean knowledge score after the intervention was increased by 1.4 (±0.1) from baseline, p value (<0.001), while the mean attitude score was increased by 1.7 (±0.2) from baseline, p value (<0.001). At baseline, 14.8% of the participants had a high level of knowledge and 18.7% had a negative attitude, while after intervention for 12 months, 28.5% of them had a high level of knowledge and 16.8% had a negative attitude (p values < 0.001, 0.032, respectively). CONCLUSIONS: The knowledge of and attitudes towards diabetes differed significantly as a result of the educational program provided by the clinical pharmacist.

Management and prognosis of acute Emamectin Benzoate poisoning in a human.

Emamectin Benzoate (EB) is a semi-synthetic insecticide which was primarily created to combat lepidopteron insects. EB disrupts the neurotransmitters Gamma Amino Butyric Acid (GABA) through enhancing permeability of membrane chloride ion, resulting in the loss of cell function progressing to irreversible paralysis in invertebrates. Poisoning with EB in humans is rare; till date with just about five reported cases, two of which resulted in fatalities. Scarcity of treatment management information may cause a delay in the initiation of treatment, which is often general therapy rather than specific. By reporting this rare case of poisoning in human, the researchers wish to add value to the existing information and aid in forming a standard management of EB poisoning in humans. Here within, we report an acute case of EB poisoning in an adult male with no history of co-morbidities, had allegedly consumed approximately 125 mL of EB 1.9 % and, presented with complaints of vomiting, profuse sweating and drowsiness. The patient was treated with gastric lavage, fluid replenishment, and other supportive as well as symptomatic measures. The prognosis of the patient was guarded and care has been taken not to administer any Central Nervous System (CNS) depressants. Fortunately, the patient was discharged from the hospital by day 4 without any sequelae.

Single-Center Retrospective Review of Standard Versus Minimal Monitoring for Hepatitis C Direct Acting Antiviral Therapy.

BACKGROUND: Highly effective direct acting antiviral (DAA) therapies have transformed the landscape of Hepatitis C Virus (HCV) treatment. However, there continues to be limited data regarding the efficacy and safety of required in-person clinic visits (standard monitoring) versus completely telehealth clinic visits (minimal monitoring) during HCV therapy, which could delay practice adoption. OBJECTIVES: This study aimed to assess the rates of undetectable HCV RNA in sustained viral load 12 weeks after therapy (SVR12) in standard versus minimal monitoring approaches during DAA. METHODS: A 12-month, single-center retrospective cohort study was conducted in treatment-naïve HCV-infected adults who received DAA therapy between 5/1/2020-4/30/2021. The standard monitoring group had > 1 in-person clinic visit with HCV RNA lab monitoring during DAA treatment. The minimal monitoring group had entirely telehealth visits without HCV RNA lab monitoring during treatment. Both groups received telephonic touchpoints throughout DAA treatment from a Clinical Pharmacist Practitioner and Nurse Care Coordinator. The primary outcome was SVR12. RESULTS: From May 2020 to April 2021, 133 HCV patients met inclusion criteria and were treated with DAA (Standard n=56; Minimal: n=77), with no differences in baseline demographics. Overall, total encounters during DAA treatment remained significantly higher in the standard versus minimal monitoring group (Standard: 2.1 ± 0.8, vs MInimal: 1.7 ± 0.9; p <0.01). Although minimal monitoring had higher loss to follow-up rates (Standard: 7.1% vs Minimal: 18.2%; p=0.06), the modified intention-to-treat analysis showed no differences in SVR between standard versus minimal monitoring approaches (Standard: 98.1%, n=51 vs Minimal: 95.3%, n=60; p=0.41). CONCLUSIONS: This single-center retrospective cohort study demonstrated that minimal monitoring during HCV treatment was as effective in achieving SVR cure rates as standard monitoring. Eliminating required in-person clinic visits during DAA therapy alongside a collaborative approach may play a major role in overcoming barriers to HCV care in select patients.

Clinical and economic impact of pharmacist interventions to identify drug-related problems in multidisciplinary cancer care: a prospective trial.

BACKGROUND: The prescription of antitumor drugs has often been associated with drug-related problems. Pretherapeutic multidisciplinary risk assessment programs including pharmaceutical care have been established to secure the initiation of injectable and oral antitumor therapies. This prospective cross-sectional double-center study evaluated the clinical and economic impact of the pharmacist in detecting drug-related problems in patients initiating antitumor therapies. MATERIALS AND METHODS: Following pharmaceutical consultations, pharmaceutical interventions were validated by a multidisciplinary team. A committee of independent clinical experts assessed the potential clinical impact of drug-drug interactions. The association of clinical variables with pharmaceutical interventions was tested using a multivariate logistic regression model. Pharmacist cost of the program was assessed by valuing pharmacists' time at their salaries and compared with potentially avoided costs. RESULTS: Four hundred thirty-eight patients with solid tumors were included: 62% males, mean age of 65 ±â€…13 years, and average of 6 medications. Half of the patients required at least one pharmaceutical intervention and independent factors associated with pharmaceutical interventions were the number of medications (5-9 vs <5: OR = 2.91 [95% CI 1.82-4.65], P < .001) and the type of antitumor treatment (immunotherapy vs intravenous chemotherapy: OR = 0.35 [95% CI 0.18-0.68], P = .002). One hundred seventy-four out of 266 pharmaceutical interventions (130 patients) involved clinically significant drug-drug interactions. Pharmacist costs were estimated to range between €4899 and €6125. Average costs were estimated at €11.4-14.3 per patient. Avoided hospitalization costs were estimated to be €180 633. CONCLUSION: Clinical pharmacists contribute to the cost-effective reduction of drug-related problems in pre-therapeutic assessment programs for patients with cancer.

Activities of the clinical pharmacist in the intensive care units. / Actividades del farmacéutico clínico en las unidades de cuidados intensivos.

The main objective of the activity carried out in an intensive care unit and in general in all hospitalization units, is to provide all the human and material resources to offer the best therapeutic care to admitted patients. Work in multidisciplinary teams, made up of specialists in Intensive Care Medicine as those responsible for the patients, doctors from other specialties, specialized nursing, physiotherapists, nutritionists and clinical pharmacists is an optimal approach to achieve the proposed objective. The activities of the clinical pharmacist can be developed at different levels (basic, intermediate and excellent) depending on the degree of involvement, the time dedicated, the training and the available resources. This article aims to establish an initial work guide, through recommendations aimed at the activity to be developed by the clinical pharmacist in the ICU in relation to critical patient care and quality improvement, which serves as a reference for those pharmacists who go to develop pharmaceutical care activities in critical patients.

Investigation on pharmaceutical care barriers perceived by clinical pharmacists in secondary and tertiary hospitals in China.

Objective: This study aimed to understand the current status of pharmaceutical care barriers perceived by clinical pharmacists in secondary and tertiary hospitals in China, and to provide a reference for further improving the quality of pharmaceutical care and perfecting the construction of pharmaceutical care system in China. Methods: The PCBS-CH scale (Pharmaceutical Care Barriers Scale in Chinese Hospitals) was used to measure the perceived pharmaceutical care barriers of clinical pharmacists, and descriptive statistical analysis was used to identify the main barriers faced by clinical pharmacists. The different barriers perceived by clinical pharmacists with various characteristics was investigated by subgroup analysis. Results: A total of 1266 clinical pharmacists from 31 provinces were finally included. The results revealed that the main barriers faced by clinical pharmacists in the process of implementing pharmaceutical care included lack of additional staffing, lack of time for pharmaceutical care provision and continuing education, and lack of an electronic information system and prescription evaluation system for pharmaceutical care. Subgroup analysis found that clinical pharmacists who are without training (P < 0.001), worked in tertiary hospitals (P = 0.036), and had other training certificates (P < 0.001) perceived higher pharmaceutical care barriers. Conclusion: Clinical pharmacists in secondary and tertiary hospitals in China have a low perception of overall pharmaceutical care barriers, but still face some important barriers. In order to promote the development of pharmaceutical care in China, the quality of clinical pharmacists should be improved, strict entry criteria should be established, clear responsibilities should be defined, the rights of female clinical pharmacists should be protected, and hospital facilities should be upgraded.

Enhancing Transitions of Care: A Cross-Sectional Observational Study on the Role of Clinical Pharmacists in Transition Management in a Latin American Hospital.

Background The seamless management of transitions of care (TOC) is necessary for patient safety, as it directly correlates with a heightened risk of medication errors and adverse effects. Clinical pharmacists emerge as key stakeholders in optimizing medication management during TOC, specifically during hospital admission and discharge, through the implementation of innovative programs that contribute significantly to the mitigation of medication errors and improve patient satisfaction. Aim This study aims to assess the benefits of pharmacist-led interventions in a Costa Rican private hospital's TOC program for polymedicated and high-risk patients during admission and discharge by identifying and addressing medication errors. Methods A cross-sectional observational study was conducted at Clínica Biblica Hospital in San José, Costa Rica, from February 2022 to May 2023 and focused on polymedicated patients with chronic therapy and high-risk medications. The TOC Medication Program was specifically implemented to focus on medication reconciliation during the admission and discharge processes. A clinical pharmacist documented interventions based on discrepancies found within each patient's medication and assessed the economic impact of interventions on healthcare personnel during discharge by projecting potential complications in the absence of such interventions, a process that was validated by an internist physician. Results During the medication reconciliation at admission, medication discrepancies, mostly intentional omissions, were successfully addressed by clinical pharmacist interventions with a 90.2% acceptance rate during the admission process. At discharge, 18.9% of medications were high-risk, and nearly 40% of discharges were linked to drug-related problems (DRPs), prompting pharmaceutical interventions. The economic analysis indicated potential savings of $21,010.20 during discharge, demonstrating the substantial impact of interventions in preventing emergency service visits, specialist consults, and hospital admissions. Conclusion Pharmacist-led TOC programs offer important clinical advantages by effectively preventing and rectifying medication discrepancies. These discrepancies, if left unaddressed, pose a potential threat to patient safety. Moreover, the implementation of such programs demonstrates promising economic benefits.

Cost-Effectiveness of a Pharmacist-Led Medication Therapy Management Clinic for Management of Type 2 Diabetes.

OBJECTIVES: This study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) compared to usual care for individuals with type 2 diabetes mellitus (T2DM), from a United States payer perspective. METHODS: A cohort simulation Markov model was developed including the effects of diabetes and major complications from diabetes. Transition probabilities, MTMC treatment effects, health state costs, and utilities, were based on data from electronic health records, and published literature. Outcomes evaluated were lifetime incremental costs, quality adjusted life-years (QALYs), and ratios. Sensitivity analyses were conducted on all model inputs; scenario analyses assessed the impact of preventing additional diabetes complications on economic outcomes and of reduced MTMC visit frequency. RESULTS: Over a lifetime, MTMC resulted in $160,145 total costs and 6.73 QALYs; usual care resulted in $152,806 total costs and 6.65 QALYs. The incremental cost-effectiveness ratio (ICER) of the MTMC compared to usual care was $93,375 per QALY gained, indicating cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY gained. Scenario analyses showed that modeling additional complications or reduced visit frequency lowered the ICER. The results were most sensitive to MTMC costs, and hazard ratios for occurrence of stroke, myocardial infarction, and renal failure, with an improvement in glycosylated hemoglobin and systolic blood pressure. CONCLUSIONS: The study demonstrates the potential cost-effectiveness of integrating clinical pharmacy services into comprehensive care strategies. Findings support the broader coverage and reimbursement of such services to optimize clinical outcomes and reduce long-term healthcare costs.

Drug Therapy Problems Identified by Clinical Pharmacists at a General Surgery Ward of an Academic Referral Hospital in Jordan.

Introduction: Drug therapy problems (DTPs) continuously occur in hospitalized patients. This study aims to emphasize the role of clinical pharmacists in evaluating the DTP's frequencies, causes, severity ratings, and contributing factors at a general surgery ward in Jordan. Methods: This prospective observational study was conducted at one of the major teaching and referral hospitals in Jordan. Data were collected through clinical pharmacist reviews of paper and electronic medical records as well as patient interviews. DTPs were identified using Cipolle's classification system and rated for severity on a scale of 10. Multiple linear regression was performed to identify factors contributing to DTPs. Drug classes primarily associated with DTPs were specified. Results: During enrollment, a total of 80 patients were recruited in this study. The mean age of the enrolled patients was 52.35 ± 14.82 years, and 49 (61.25%) of them were males. Within the study period, 192 DTPs were identified by clinical pharmacists in 87.5%of the total recruited patients. The mean number of DTPs per patient was 2.40 ± 1.83. The most common categories of DTPs were "needs additional therapy" 46 (23.96%), "unnecessary drug therapy" 45 (23.44%), and "dosage too low" 39 (20.31%). Of the total DTPs, 127 (66.15%) were rated as severe. Multiple linear regression revealed that patients' length of hospital stay and the number of current medications had a statistically significant effect on the number of DTPs identified during hospitalization. Endocrine and metabolic drugs 51 (26.56%) and cardiovascular drugs 36 (18.75%) were the most frequent classes of drugs contributing to DTPs. Conclusion: DTPs are common in the general surgery ward. Clinical pharmacists can provide medication reviews for surgical patients to identify DTPs and rate their severities. Detecting risk factors for DTPs and the most common drug classes associated with them can assist in decision-making relevant to reducing DTPs in the surgical ward.

Reducing medication errors in HIV-positive patients: Influence of a clinical pharmacist.

Background: The roll-out of antiretroviral medicines has improved life expectancy in people living with HIV (PLHIV). This has resulted in more patients being hospitalised for non-communicable diseases, increasing risk for medication errors (MEs). Pharmacists, through medication reconciliation, may identify and reduce MEs in this population. Objectives: To describe the importance of a pharmacist's involvement in identifying and quantifying types of MEs. Method: A quantitative, prospective observational study was conducted over 14 weeks. A pharmacist reviewed HIV-positive, hospitalised patients' files, using a data collection instrument, to determine the prevalence of MEs in PLHIV. The study pharmacist recommended appropriate actions to the prescriber to resolve MEs and documented resolution of the MEs. Results: The study population of n = 180 patient files were reviewed 453 times, identifying 466 MEs. Medication errors included incorrect medication reconciliation from history (19; 4.1%), prescription omission (17; 3.7%), duplication of therapy (10; 2.2%), missed doses (265; 57.1%), incorrect dosing (103; 22.2%), incorrect administration frequency (2; 0.4%), incorrect duration of therapy (15; 3.2%) and drug-drug interactions (18; 3.9%). More than half (58.2%) of the MEs were resolved in less than 24 h, with involvement of the pharmacist. Conclusion: This study demonstrates the magnitude of MEs experienced in hospitalised PLHIV and highlights the role clinical pharmacists play in identifying and resolving MEs to improve patient outcomes.

The Impact of Diabetes Education by Clinical Pharmacist on Quality of Life and Treatment Satisfaction of Sudanese Individuals With Type II Diabetes Mellitus: Randomized, Double-Blind, Controlled Trial.

BACKGROUND: Patients' satisfaction with their treatment directly impacts the control of their diabetes. Quality of life is crucial for patients with diabetes mellitus to maintain long-term health and minimize complications. The current study aimed to evaluate the impact of diabetes education on quality of life (QoL) and treatment satisfaction of patients with type 2 diabetes mellitus. METHODS: The current study was a randomized controlled trial. Patients with type 2 diabetes who were attending the diabetes clinic for 1 year were recruited. The overall sample in this study was 364 participants; 182 controls 182 cases. The interventional and control group participants were assigned randomly by simple random sampling technique. Controls were managed per usual care while cases were managed per usual care plus education done by the researcher. Pre-structured standardized questionnaires were used to collect the data. Data were processed and analyzed by using SPSS; version 28. RESULTS: More than three-fourth of the participants; 76.4% were females. The average (±SD) age of the cases was 54.5 (±10) years, while was 56 (±9.8) years for controls. The overall median (IQR) years of DM diagnosis for all participants was 8 (4-14) years. The results showed a statistically significant difference between the mean satisfaction score from baseline to 12 months in the cases compared the controls (P < .001). Furthermore, there are statistically insignificant differences between the changes of mean overall QoL score from baseline to 12 months among the 2 groups. CONCLUSION: The education provided improved self-reported treatment-satisfaction among individuals with diabetes .A statistically insignificant differences in QoL between the 2 groups compared to baseline have been shown at the study end.The trial registration number is PACTR202311766174946 which was registered by pan African clinical trials registry, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=26928.

Reducing Health Care Resource Utilization in COPD: A Retrospective Matched Control Analysis of a Digital Quality Improvement Program.

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that adds a significant economic burden to the health care system in the United States. Digital platforms integrated into clinical workflows have demonstrated success in improving patient outcomes in COPD, but few studies have explored the impact of an integrated digital and clinical approach on drivers of direct health care costs (COPD-related prescriptions, emergency department [ED] visits, and hospitalizations) in a real-world setting. Methods: We conducted a 6-month retrospective matched control analysis to assess the impact of a digital quality improvement (QI) program delivered by clinical pharmacists on health care resource utilization among people living with COPD. Results: Compared to matched controls at 6 months, participants in the digital QI program had a 66.7% relative reduction in COPD-related ED visits and hospitalizations (0.04±0.19 versus 0.12±0.44, p=0.044), as well as a 47% reduction in all-cause ED visits and hospitalizations (0.25±0.63 versus 0.47±1.09, p=0.059). Participants in the digital QI program also had higher rates of COPD-related prescription fills for antibiotics (0.43±0.93 versus 0.35±0.74, p=0.881) and oral corticosteroids (0.56±1.02 versus 0.36±0.91, p=0.045), as well as a greater number of COPD-related nonacute urgent care visits compared to matched controls (0.3±0.63 versus 0.14±0.44, p=0.027). Conclusion: Digital health platforms integrated into a virtual clinical pharmacist workflow can help reduce costly COPD-related ED visits and hospitalizations, and shift utilization to less acute care. Care models integrating digital platforms may also offer a scalable approach to managing COPD and should be explored in different clinical settings.

Lessons Pharmacy Practice in India Should Adopt From Advanced Nations: A Review.

In India, pharmacy practice is still at a developing stage with the majority of the graduates taking the industry pathway. Currently, there are only a few pharmacists who have been board-certified by the Board of Pharmacy Specialities (BPS), which is the most established pharmacist board certification program globally. Even though India is the largest global exporter of generic medications, pharmacy practice is yet to gain stronghold within its healthcare scenarios. In this article, we aim to examine the development of pharmacy practice from a global viewpoint and scale down to the recent modern practice, particularly in advanced nations. Furthermore, we assess the ways through which pharmacy practice can be enhanced in India. Notably, with several pharmacy practice graduates completing their studies in India yearly, pharmacy practice is projected to significantly grow in the coming years. Gaining a proper understanding of and embracing advanced clinical pharmacy practices will improve the domain of pharmacy practice among both junior and senior pharmacists. Moreover, enrolling in and receiving international accreditations such as the Board of Pharmacy Specializations (BPS) will validate the practice standards being offered in India as compared to other developed countries, i.e., the US. The main objective of this review is to assess various means through which pharmacy practice can be improved in India.

Comparison of clinical pharmacist practitioners' headache care roles across clinical contexts within the Veterans Health Administration: Optimizing pharmacist integration.

BACKGROUND: Studies show interdisciplinary treatment is highly effective for addressing chronic pain syndromes, including headache disorders. Increasingly, advanced practice pharmacists work collaboratively with physicians to apply their unique skills to enhance patient outcomes. OBJECTIVE: This qualitative study aimed to elucidate the potential in the Veterans Health Administration (VHA) for increased roles of clinical pharmacist practitioners (CPPs)-advanced practice pharmacists with a scope of practice-in collaborative, interdisciplinary headache care teams. Our research question was: How do CPPs integrate with interdisciplinary headache care teams in Headache Centers of Excellence (HCoE) and non-HCoE VHA facilities, and how can their roles be configured to optimize headache specialty care services? METHODS: This cross-sectional qualitative study used purposive sampling to recruit CPPs providing headache care within HCoEs and in non-HCoE VHA facilities for virtual, recorded, individual interviews. Multi-stage qualitative data analysis entailed: team discussions; immersion/crystallization for close reading of transcripts to identify emerging patterns of HCoE/non-HCoE comparison of CPPs' experiences; team data sorting using spreadsheets; and further immersion into sorted data for final identification of comparisons and interpretation of the data. RESULTS: A total of 15 CPPs involved in headache care were interviewed, with about half working in HCoEs and half in non-HCoE VHA facilities across the United States. CPPs' roles within and outside HCoEs have considerable overlap as both groups co-manage patients with headache with physicians. CPPs have independent and collaborative responsibilities as they extend headache specialists' services by providing direct patient care and referring to additional providers for headache treatment. When their roles differ within and outside HCoEs it is largely due to level of integration on interdisciplinary headache or pain teams. CPPs in HCoEs collaborate with headache neurologists and interdisciplinary teams; some outside HCoEs do as well, while others work with primary care. CPPs' weekly time dedicated specifically to headache tends to be greater in HCoEs. Nevertheless, most interviewees in both groups stated patient need exceeds CPP availability at their facilities for conducting detailed chart reviews, initial visits to understand the context of patients' headache, and scheduled follow-ups over time to monitor and adjust treatment. CPPs also consult with and educate physicians on headache pharmacy, particularly regarding appropriate use of non-formulary medications. CONCLUSION: Findings from this study suggest that CPPs' roles in headache care are valuable to clinical colleagues and their patients and should be leveraged and expanded within HCoEs and non-HCoE VHA facilities. When substantively integrated into interdisciplinary headache care teams, CPPs offer unique knowledge, headache management and patient behavior change skills, extend headache specialists' services, and provide both patient and physician education. These combined responsibilities contribute to enhancing patient outcomes and facilitating ongoing access to high quality, evidence-based headache care.

Assessment of drug-drug interactions among patients with hematologic malignancy: A clinical pharmacist-led study.

INTRODUCTION: Patients with hematologic malignancies often receive multiple medications, leading to potential drug-drug interactions (DDIs). Identifying and managing these DDIs is crucial for ensuring patient safety and effective care. This study aimed to identify and describe DDIs and associated factors in hematologic malignancy patients. METHODS: This prospective interventional study was conducted at a referral center and included hospitalized patients with hematologic malignancies who were receiving at least four concurrent medications. A pharmacist initially compiled a comprehensive list of all medications through patient interviews and medication reviews, and subsequently, identified and categorized potential DDIs using the Lexi-interact® and Micromedex® databases. The clinical pharmacist then evaluated the clinical impact of the identified DDIs in every individual patient and provided appropriate interventions to resolve them. RESULTS: A total of 200 patients met the inclusion criteria for the study, with 1281 DDIs identified across 337 distinct types. The majority of identified DDIs exhibited major severity (52.1%) and pharmacokinetic mechanisms (50.3%), with an unspecified onset (79.4%) and fair evidence (67%). Of the identified DDIs, 81.1% were considered clinically significant, prompting 1059 pharmacotherapy interventions by the clinical pharmacist. Additionally, a significant relationship was observed between the number of drugs used during hospitalization and the occurrence of DDIs (P < 0.001, r = 0.633). CONCLUSION: DDIs are highly prevalent among hospitalized patients with hematologic malignancies, with their occurrence increasing alongside the number of medications administrated. The intervention of a clinical pharmacist is crucial to evaluate the clinical impact of these DDIs and implement effective interventions for their management.

Evaluation of Drug-Related Problems of Intensive Care Unit Patients by Clinical Pharmacists: A Retrospective Study.

Objectives: The study aimed to identify drug-related problems (DRPs) and risk factors associated with the emergence of DRPs in intensive care unit (ICU) patients. Materials and Methods: This retrospective study included patients in the anesthesiology and reanimation ICU of a university-affiliated tertiary care hospital. DRPs identified by clinical pharmacists were classified using the Pharmaceutical Care Network Europe Classification for DRPs version 9.1. The association between various patient-related factors, and having DRPs were evaluated. Results: In total, 222 patients were included in the study, 128 of which were male (57.7%). The number of DRPs was 388 in 135 patients (1.75 ± 2.47 DRPs per patient). The group in which at least 1 DRP was identified, the duration of hospitalization was longer than in the group in which no DRP was identified (p < 0.001). In the groups in which there was the presence of mechanical ventilation support at admission or mortality, the mean DRP count was significantly higher than that in the other group (p < 0.05). Age, duration of hospitalization, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission had positive relationships with the DRP count, but the Glasgow Coma Scale (GCS) showed a negative relationship (p < 0.05). According to the binary logistic regression analysis (p < 0.001), in which the age of the patient, GCS score, APACHE II score at admission, duration of hospitalization, and presence of mechanical ventilation support at admission were included, only the APACHE II score at admission and duration of hospitalization significantly affected the emergence of DRPs. The major problem was related to treatment effectiveness (47.9%), followed by treatment safety problems (29.9%). The major causes of these problems were dose selection (44.0%) and drug selection (36.8). Interventions were made at the drug (97.2%) and prescriber level (2.3%). The acceptance rate of interventions and resolution rate of the DRPs were 93.6% and 85.1%, respectively. The top three medications that caused DRPs the most were as follows: meropenem, colistin, and piperacillin/tazobactam. Conclusion: Clinical pharmacists can detect and treat DRPs quickly. Our analysis shows that clinical pharmacy services are needed in high-DRP wards like ICU.

A Nomogram for Predicting the Effectiveness of Consultations on Multi-Drug Resistant Infections: An Exploration for Clinical Pharmacy Services.

Purpose: The increasing multi-drug resistance (MDR) is a serious threat to human health. The appropriate use of antibiotics can control the progression of MDR and clinical pharmacists play an important role in the rational use of antibiotics. There are many factors that influence the effectiveness of multi-drug resistant organisms (MDRO) infection consultations. The study aimed to establish a model to predict the outcome of consultation and explore ways to improve clinical pharmacy services. Patients and methods: Patients diagnosed with MDRO infection and consulted by clinical pharmacists were included. Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for MDRO infection consultation effectiveness, and then a nomogram was constructed and validated. Results: 198 patients were finally included. The number of underlying diseases (OR=1.720, 95% CI: 1.260-2.348), whether surgery was performed prior to infection (OR=8.853, 95% CI: 2.668-29.373), ALB level (OR=0.885, 95% CI: 0.805~0.974), pharmacist title (OR=3.463, 95% CI: 1.277~9.396) and whether the recommendation was taken up (OR=0.117, 95% CI: 0.030~0.462) were identified as independent influences on the effectiveness of the consultation. The nomogram prediction model was successfully constructed and the AUC of the training set and the verification set were 0.849 (95% CI: 0.780-0.917) and 0.761 (95% CI: 0.616-0.907) respectively. The calibration curves exhibited good overlap between the data predicted by the model and the actual data. Conclusion: A nomogram model was developed to predict the risk of consultation failure and was shown to be good accuracy and good prediction efficiency, which can provide proactive interventions to improve outcomes for potentially treatment ineffective patients.

Primary care team member's perceptions of credentialed and privileged clinic pharmacists and impact on clinic workload in a pediatric primary care network.

BACKGROUND: Pharmacists provide increased access to care, vaccinations, and medication management for patients. Credentialing and privileging of pharmacists allows pharmacists to practice at the top of their licenses and elevate pharmacy practice. OBJECTIVE: The primary objective of this study was to assess the perception of healthcare team members of credentialed and privileged pharmacists working in a pediatric primary care network before and after implementation of pharmacist privileges. The secondary objective was to determine team members' perceptions on the amount of time spent refilling medications, resolving medication access issues, and ordering vaccines before and after implementation of pharmacist privileges. METHODS: This was a prospective pre-post study utilizing surveys to capture healthcare team members' perceptions of credentialed and privileged ambulatory care pharmacists. Surveyed participants included attending physicians, advanced practice nurses, registered nurses, licensed practical nurses, medical assistants, and patient care assistants. Summary statistics are reported as frequencies and percentages. Statistical analysis was conducted using SAS version 9.4. RESULTS: Fifty-eight pre-privileging and 56 post-privileging surveys were distributed. The return rate was 79.3% (n=46) for pre-privileging and 80.4% (n=45) for post-privileging surveys. More than 90% of respondents had a favorable perception of credentialed and privileged pharmacists in the clinic. There was a significant difference in the perception of the amount of time spent on medication access issues after pharmacist privileges were implemented (p = 0.0296). CONCLUSION: Credentialed and privileged pharmacists in a pediatric primary care network are viewed favorably by clinic team members and can have a positive impact on clinic workload.

Implementation of a practice model for inpatient psychiatric clinical pharmacist practitioners with prescriptive authority at a veterans health care facility.

Clinical pharmacists play a valuable role on collaborative health care teams, especially in the field of mental health. However, there is a need to explore innovative practice models that optimize their potential in providing comprehensive medication management in inpatient psychiatric settings. This report aims to describe the implementation of a practice model using an inpatient psychiatric clinical pharmacist practitioner performing comprehensive medication management. The implementation of a practice model using a psychiatric clinical pharmacist practitioner was a feasible way to deliver comprehensive medication management and other clinical services in an inpatient psychiatric setting amid staffing challenges. Whereas limitations such as resource constraints must be considered, the success of this model highlights the value of a versatile psychiatric clinical pharmacist practitioner. These findings might offer insight to other health care facilities considering a similar approach to provide mental health care through the use of a psychiatric clinical pharmacist practitioner.