Impact of Inpatient Initiation of Sodium-Glucose Cotransporter-2 Inhibitors on Prescription Rates in Patients With Heart Failure With Reduced Ejection Fraction.

Despite large, randomized controlled trials and guideline recommendations, patients with heart failure with reduced ejection fraction (HFrEF) continue to receive suboptimal guideline-directed medical treatment (GDMT). This study aimed to evaluate the potential effect of inpatient initiation of sodium-glucose cotransport-2 (SGLT2) inhibitors on postdischarge prescribing rates and the downstream impact on clinical outcomes. The INitiation of SGlt2i in Hospital for HFrEF (INSIGHT-HF) study was a retrospective analysis of hospitalized patients older than 18 years with a left ventricular ejection fraction (LVEF) ≤40% conducted from July 2020 and July 2021. Our primary outcome was SGLT2i prescription rates at 30 days. Among 2,663 eligible patients with documented HFrEF, 177 (6.6%) had SGLT2i initiated during their index hospitalization. The rate of SGLT2i prescriptions at 30 days was significantly higher in those with inpatient initiation of SGLT2i compared with those who did not start while inpatient (96% vs 14.7%, p <0.0001). The heart failure readmission rate in the first 30 days was significantly lower in those with inpatient initiation of SGLT2i compared with those who did not start during hospitalization. (9.3% vs 22.7%, p = 0.04). Cardiovascular mortality was numerically, but not significantly, different between groups (4% vs 10.7%, p = 0.21). Inpatient initiation of an SGLT2i was associated with a significantly higher postdischarge rate of SGLT2i prescriptions and significantly lower heart failure readmission rates at 30 days. In conclusion, these findings highlight the importance of initiating SGLT2i during inpatient hospitalization to improve the quality of care in patients with HFrEF.

Implementation of Debriefing Services for Pharmacy Residents in a 24-Hour, In-House Clinical Pharmacy On-Call Program: A Pilot Study.

Background: This clinical pharmacy on-call program (CPOP) is a 24-hour, in-house service provided by pharmacy residents. During shifts, challenging situations may arise, which may correlate with depression, anxiety, and stress. Objective: This pilot study aims to describe the implementation of a debriefing program and characterize mental health patterns of residents in the CPOP. Methods: A structured debriefing process was developed to provide support to residents in the CPOP. Over a 1-year period, twelve outgoing pharmacy residents and ten incoming pharmacy residents completed a modified Depression Anxiety Stress Scale (mDASS-21) questionnaire and received a stress perception score (SPS) during debriefing. Data from first and final on-call shifts were compared via a paired Wilcoxon signed-rank test. Residents were referred to an Employee Assistance Program (EAP) based on mDASS-21 and SPS results. Scores from final on-call shifts were compared between residency classes via a Wilcoxon rank sum test. Results: Following successful implementation, 106 debriefing sessions were completed. Pharmacy residents responded to a median number of 38 events per shift. Significant reductions in anxiety and stress scores were observed from the first and final on-call shifts. Six residents were referred to EAP. A lower incidence of depression, anxiety, and stress was observed in pharmacy residents who received debriefing compared to previous residents. Conclusion: The debriefing program provided emotional support to pharmacy residents participating in the CPOP. Implementation of debriefing demonstrated a reduction of anxiety and stress from the beginning to the end of the academic year and in comparison to the previous year.

Residency Applicant Perceptions of Multiple Mini Interviews in Post-Graduate Year 1 Residency Interviews.

Introduction: Residency interviews offer an opportunity for both candidates and programs to evaluate whether the pairing is a good fit. Multiple mini interviews (MMIs) have been incorporated into interviews for medical training as a way to evaluate non-cognitive abilities. Objectives: To determine how candidates perceived the interview process at our institution, specifically related to the MMIs. Methods: This retrospective review evaluated candidates' perceptions of traditional interviews and MMIs through post-interview surveys over a 3-year period. Candidates evaluated the interview activities, time allowed for MMIs, and overall impression of the program during the 2-week period between submitting rank lists and the release of match results. Survey results are reported using descriptive statistics. Candidate perceptions on their ability to showcase skills in different types of interviews was evaluated with chi-square test. Results: The interview day increased the desire to pursue residency at our institution for 88% of candidates. Candidates reported similar ability to showcase skills developed during pharmacy school through the clinical and patient education MMIs compared to traditional interviews; however, they did not feel the collaboration MMI showcased their abilities as well as traditional MMIs. Conclusion: The introduction of MMIs to the residency interview day were perceived positively by most candidates and allowed candidates to showcase abilities in a different manner from traditional interviews.

Point-of-care naloxone distribution in the emergency department: A pilot study.

PURPOSE: Opioid overdose education and naloxone distribution (OEND) for use by laypersons has been shown to be safe and effective, but implementation in the emergency department (ED) setting is challenging. Recent literature has shown a discouragingly low rate of obtainment of naloxone that is prescribed in the ED setting. We conducted a study to evaluate the feasibility of point-of-care (POC) distribution of naloxone in an ED, hypothesizing a rate of obtainment higher than prescription fill rates reported in previous studies. SUMMARY: A multidisciplinary team of experts, including pharmacists, physicians, nurses, and case management professionals used an iterative process to develop a protocol for POC OEND in the ED. The protocol includes 5 steps: (1) patient screening, (2) order placement in the electronic health record (EHR), (3) a patient training video, (4) dispensing of naloxone kit, and (5) written discharge instructions. The naloxone kits were assembled, labeled to meet requirements for a prescription, and stored in an automated dispensing cabinet. Two pharmacists, 30 attending physicians, 65 resident physicians, and 108 nurses were trained. In 8 months, 134 orders for take-home naloxone were entered and 117 naloxone kits were dispensed, resulting in an obtainment rate of 87.3%. The indication for take-home naloxone kit was heroin use for 61 patients (92.4%). CONCLUSION: POC naloxone distribution is feasible and yielded a rate of obtainment significantly higher than previous studies in which naloxone was prescribed. POC distribution can be replicated at other hospitals with low rates of obtainment.

Impact of a Nurse-Driven Diabetic Ketoacidosis Insulin Infusion Calculator on the Rate of Hypoglycemia.

OBJECTIVE: The aim of the study was to evaluate the impact of an insulin infusion calculator incorporated into electronic health record system in reducing the rate of hypoglycemia in diabetic ketoacidosis (DKA) management. METHODS: Retrospective chart review of patients with primary admission diagnosis of DKA was conducted in a university-affiliated academic medical center. End points including the rate of hypoglycemia, time to DKA resolution, rate of hypokalemia, time on insulin drip, and length of stay were measure before and after implementation of DKA calculator. RESULTS: Of 181 adult patients admitted for primary diagnosis of DKA, 103 were managed using the calculator. After implementation of the calculator, incidence of hypoglycemia and severe hypoglycemia were significantly reduced by 70% and 87%, respectively (P < 0.01). No difference was observed for time to DKA resolution, time on insulin drip, and length of stay. CONCLUSIONS: Implementation of DKA insulin infusion calculator significantly reduced the rate of hypoglycemia. Future improvements should focus on reducing time to DKA resolution and length of stay.