Availability of ulipristal acetate: A secret shopper survey of pharmacies in a metropolitan area on emergency contraception.

OBJECTIVES: To assess levonorgestrel (LNG) and ulipristal acetate (UPA) availability in pharmacies in a metropolitan area. METHODS: A cross-sectional survey was conducted of all identified pharmacies within 25 miles of an urban medical center in Kansas City, KS. We categorized the pharmacies as dedicated commercial (national chains), store-associated (affiliated with a general merchandise or grocery store), or independent. We assessed LNG and UPA availability or time to availability if not currently stocked. RESULTS: We contacted 165 pharmacies. Of the 165 pharmacies, few stocked UPA (12/165, 7%) whereas the majority stocked oral LNG (128/165, 78%). Dedicated commercial pharmacies were more likely to carry UPA than store-associated and independent pharmacies (11/84 [13%] vs. 1/61 [1%] vs. 0/20, respectively; P = 0.016). Most pharmacies that did not stock UPA reported that they could obtain it within 24 hours (94/153, 62%). Dedicated commercial pharmacies were most likely report the ability to obtain UPA in 24 hours (P = 0.016). CONCLUSION: Few pharmacies stock UPA, the most effective form of oral emergency contraception. Enhanced communication between medical providers and pharmacists within current laws and regulations could enhance patient access to UPA.

Development of an in vitro colonization model to investigate Staphylococcus aureus interactions with airway epithelia.

Staphylococcus aureus is a bacterial pathogen responsible for a wide range of diseases and is also a human commensal colonizing the upper respiratory tract. Strains belonging to the clonal complex group CC30 are associated with colonization, although the colonization state itself is not clearly defined. In this work, we developed a co-culture model with S. aureus colonizing the apical surface of polarized human airway epithelial cells. The S. aureus are grown at the air-liquid interface to allow an in-depth evaluation of a simulated colonization state. Exposure to wild-type, S. aureus bacteria or conditioned media killed airway epithelial cells within 1 day, while mutant S. aureus strains lacking alpha-toxin (hla) persisted on viable cells for at least 2 days. Recent S. aureus CC30 isolates are natural hla mutants, and we observed that these strains displayed reduced toxicity toward airway epithelial cells. Quantitative real-time polymerase chain reaction of known virulence factors showed the expression profile of S. aureus grown in co-culture correlates with results from previous human colonization studies. Microarray analysis indicated significant shifts in S. aureus physiology in the co-culture model toward lipid and amino acid metabolism. The development of the in vitro colonization model will enable further study of specific S. aureus interactions with the host epithelia.

Assessment of technician barcode scanning verification compared to pharmacist verification.

PURPOSE: This study aims to show the feasibility and sustainability of technician barcode scanning verification as an alternative to pharmacist visual verification of first dose medications in an acute care setting. METHODS: A two-phase, noninferiority, single-center study was conducted to compare the accuracy of technician barcode scanning verification to pharmacist visual verification of pre-packaged first dose medications within a large acute care medical center. In phase 1, a pharmacy technician utilized barcode scanning as a means of verification. These preparations were then re-verified for accuracy by pharmacist visual verification. In phase 2, the verification order was reversed, starting with pharmacist visual verification of first doses, which were subsequently re-verified by a technician utilizing barcode scanning. Accuracy and efficiency (first dose processing time) of each phase was analyzed via error logs and retrospective dose tracking. RESULTS: A total of 12,328 first dose preparations were included in the analysis and showed no difference between technician barcode scanning verification and pharmacist visual verification. Retrospective time study showed a 4-minute decrease in processing time when doses were verified by technician barcode scanning. Based on initial study outcomes, a variance was granted to pilot first dose tech-check-tech by the Wisconsin State Board of Pharmacy. CONCLUSION: This study determined that there is no difference in verification accuracy between technician barcode scanning verification and pharmacist visual verification of first doses in an acute care setting. Through leveraging technology and skill mix, Froedtert Hospital was able to provide the same level of patient safety while decreasing pharmacy processing time, developing our technician workforce, and reallocating pharmacist staff from distributive roles in central pharmacy to decentralized clinical activities.

Implementation of cystic fibrosis clinical pathways improved physician adherence to care guidelines.

INTRODUCTION: There is significant variability in clinical outcomes, including growth and lung function, between the various cystic fibrosis (CF) centers. No specific or unique therapeutic practices have been identified to account for these differences. However, more uniform care within centers was associated with better outcomes. The objective of this study was to implement clinical pathways for diagnosis and treatment of nutritional failure and lung inflammation in order to achieve better health care provider adherence to center-specific, agreed-on practices. METHODS: Agreed-on clinical pathway treatment plans for both nutrition and lower airway inflammation were implemented on January 1, 2010. The primary outcome measure was to evaluate if patients' diagnoses and treatments were consistent with the agreed-on clinical pathways. RESULTS: The proportion of clinic visits from baseline to 18 months post-intervention where the provider completely followed nutrition clinical pathway increased from 57.72% to 79.49% (P = 0.049) and the proportion for lower airway inflammation clinical pathway increased from 65.85% to 86.32% (P = 0.035). The use of nutritional diagnosis and documentation of associated clinical pathway in the clinical plan increased from 16.26% to 61.54% and 56.10% to 94.87%, respectively. Similarly, diagnosis of lower airway inflammation and documentation related to their treatment plans increased from 1.63% to 43.59% and 30.08% to 87.18%, respectively. CONCLUSION: Implementation of clinical pathways for nutrition and lower airway inflammation issues resulted in more uniform care of CF patients. Having objective criteria for diagnoses and agreed-on treatment plans for each of those diagnoses allowed for monitoring and individual feedback. Increases in utilization of correct diagnoses and discussion of specific therapeutic interventions in the clinic notes were associated with increased adherence to clinical pathways. Pediatr Pulmonol. 2017;52:175-181. © 2016 Wiley Periodicals, Inc.