Leftover narcotic analgesics among emergency department patients and methods of disposal.

OBJECTIVE: Given the increase in narcotic addiction and diversion, understanding how patients use their opioid prescriptions and store or dispose of any remainders is important. We set out to determine the frequency in which patients had leftover opioid quantities from prescriptions received in the emergency department (ED). In addition, we sought to describe patients' reasons for taking or not taking all of their prescribed medications and their strategies to manage and/or dispose of any excess or leftovers. METHODS: This cross-sectional study took place at an academic center in an urban environment in mid-Missouri with an annual emergency department volume of 55,000 patients. Potential participants were identified using a patient discharge prescription log and consisted of adult patients who received opioid prescriptions. A single researcher recruited participants via phone and invited them to participate in the study by completing a short phone survey. RESULTS: The discharge log included 301 patient encounters; of those, 170 potential participants were successfully contacted by phone and 89 agreed to participate in the survey. A majority of the participants indicated that they did not take the full prescription amount. Only 4.1% of participants disposed of their leftover opioids according to U.S. Food and Drug Administration recommendations. Those who did not dispose of their leftover opioids most frequently stored their remaining medication in a medicine cabinet or box, and a majority (77%) indicated that this storage location was unlocked. CONCLUSIONS: A majority of patients discharged from the emergency department have leftover opioids, and almost all of these leftover medications were not disposed of or stored in compliance with US Food and Drug Administration recommendations. Future research to determine what interventions could increase proper storage and disposal of leftover opioids is recommended.

Use of Emergency Department Pharmacists in Emergency Medicine Resident Milestone Assessment.

INTRODUCTION: The use of competency-based milestones for emergency medicine (EM) was mandated by the Accreditation Council for Graduate Medical Education in 2013. However, clinical competency committees (CCC) may lack diverse, objective data to assess these new competencies. To remedy the lack of objective data when assessing the pharmacotherapy sub-competency (PC5) we introduced a unique approach that actively involves departmental clinical pharmacists in determining the milestone level achieved by the resident. METHODS: Our pharmacists assess the pharmacotherapy knowledge of the residents through multiple methods: direct observation of orders, communication with the residents while performing patient care within the emergency department (ED), and real-time chart review. This observation occurs informally on a daily basis in the ED and is incorporated into the routine work of the pharmacist. The pharmacists use the PC5 sub-competency as their standard evaluation tool in this setting to keep all assessments consistent. RESULTS: Since our residency program introduced pharmacist assessment of resident pharmacotherapy knowledge, the CCC has conducted seven biannual meetings. Of the 120 separate PC5 sub-competency assessments made during those meetings there was 100% agreement between the pharmacist's assessment and the CCC's final assessment of the trainee. A survey of the CCC members concluded that the pharmacists' assessments were useful and aided in accurate resident evaluation. CONCLUSION: The use of ED pharmacists in assessing the pharmacotherapy sub-competency provides important information used in resident assessment of the PC5 milestone.

Successful treatment with drotrecogin alfa (activated) in a pregnant patient with severe sepsis.

Sepsis remains one of the leading causes of mortality during pregnancy. Because of the inherent limitations of conducting scientific investigations during pregnancy, a great deal of clinical decision making is based on observational reports, an understanding of the physiologic changes of pregnancy, and consideration for risk to the fetus. We describe a 20-year-old pregnant woman at 20 weeks' gestation who was admitted to an obstetric ward for dehydration and a urinary tract infection. Approximately 36 hours later, the patient's clinical status deteriorated, with the development of mental status changes, acute respiratory failure, and renal failure. Drotrecogin alfa (activated) was started, as the patient's Acute Physiology and Chronic Health Evaluation II score was 27 (> 25 is the typical score required for drotrecogin alfa [activated] therapy); within 48 hours the patient's clinical status dramatically improved. The patient completed 96 uninterrupted hours of therapy and was subsequently discharged after a 15-day hospitalization, with no apparent sequelae. Approximately 17 weeks later, the patient gave birth to a 3.42-kg female infant with no congenital abnormalities. To our knowledge, this represents the second case report to describe the use of drotrecogin alfa (activated) along with the status of the mother and fetus both after completion of therapy and after subsequent delivery. Because of the threat of mortality from sepsis during pregnancy, combined with the inherent limitations associated with clinical research during pregnancy, further reports and investigation into the treatment of sepsis in the pregnant patient are warranted.

Basic life support and cardiopulmonary resuscitation training for pharmacy students and the community by a pharmacy student committee.

OBJECTIVE: To create a self-sufficient, innovative method for providing cardiopulmonary resuscitation (CPR) education within a college of pharmacy using a student-driven committee, and disseminating CPR education into the community through a service learning experience. DESIGN: A CPR committee comprised of doctor of pharmacy (PharmD) students at the University of Tennessee College of Pharmacy provided CPR certification to all pharmacy students. The committee developed a service learning project by providing CPR training courses in the community. Participants in the course were required to complete an evaluation form at the conclusion of each training course. ASSESSMENT: The CPR committee successfully certified more than 1,950 PharmD students and 240 community members from 1996 to 2009. Evaluations completed by participants were favorable, with 99% of all respondents (n = 351) rating the training course as either "excellent" or "good" in each of the categories evaluated. CONCLUSION: A PharmD student-directed committee successfully provided CPR training to other students and community members as a service learning experience.