Overview of a pharmacist anticoagulation certificate program.

BACKGROUND AND PURPOSE: To describe the design of an ongoing anticoagulation certificate program and annual renewal update for pharmacists. EDUCATIONAL ACTIVITY AND SETTING: Components of the anticoagulation certificate program include home study, pre- and posttest, live sessions, case discussions with evaluation and presentation, an implementation plan, and survey information (program evaluation and use in practice). Clinical reasoning skills were assessed through case work-up and evaluation prior to live presentation. An annual renewal program requires pharmacists to complete home study and case evaluations. FINDINGS: A total of 361 pharmacists completed the anticoagulation certificate program between 2002 and 2015. Most (62%) practiced in ambulatory care and 38% in inpatient care settings (8% in both). In the past four years, 71% were working in or starting anticoagulation clinics in ambulatory and inpatient settings. In their evaluations of the program, an average of 90% of participants agreed or strongly agreed the lecture material was relevant and objectives were met. SUMMARY: Pharmacists are able to apply knowledge and skills in management of anticoagulation. This structured practice-based continuing education program was intended to enhance pharmacy practice and has achieved that goal. The certificate program in anticoagulation was relevant to pharmacists who attended the program.

Transitioning and adjusting insulin analog therapy in elderly patients.

OBJECTIVES: To identify and address issues specific to elderly patients with diabetes, including goal setting, prevention of hypoglycemia,and product and device selection, and to summarize recommendations for the addition and dosing of insulin to treatment regimens and the appropriate continuance or discontinuance of oral medications in elderly patients taking insulin. DATA SOURCES: Live symposium presentation based on clinical practice and research, and literature and published studies on the treatment and management of diabetes. CONCLUSIONS: Most patients with long-standing diabetes eventually will require insulin therapy of some sort. Insulin therapy typically is started as basal (long-acting insulin) as an adjunct to oral therapy. Prandial (rapid-acting insulin before meals) may be added an injection at a time. In its most sophisticated regimen, insulin is used as multiple, daily injections (a single injection of long-acting insulin and three injections of rapid-acting insulin before meals), with the subsequent discontinuation of oral therapy. Insulin analogs, though slightly more expensive than human and isophane insulin, provide much more physiologic insulin action, resulting in better glucose control and lower rates of hypoglycemia. Hypoglycemia is the major concern of using insulin in elderly patients; thus, a regimen that minimizes this risk shifts the risk/benefit ratio in favor of insulin analogs. The use of sliding scale insulin should be discouraged.