Coagulation factor VIIa (recombinant) in nonhemophilic patients requiring neurosurgery.

PURPOSE: The clinical outcomes, safety, and use of resources associated with the administration of factor VIIa (recombinant) to nonhemophilic patients requiring neurosurgery were evaluated. METHODS: An interdisciplinary group created guidelines for the pharmacy and therapeutics committee for the unlabeled use of factor VIIa (recombinant). Nonhemophilic patients were eligible to receive the agent without approval from the hematology-coagulation service if they had an intracranial hemorrhage (ICH), were undergoing an emergency neurosurgical procedure, and had coagulopathy. A standard single dose of 40 microg/kg was recommended for these patients. Data were prospectively collected between March 2004 and March 2006 for all neurological surgery patients receiving factor VIIa (recombinant). RESULTS: A total of 92 nonhemophilic patients received single doses of factor VIIa (recombinant) under the guidelines during the two-year study period. The majority of patients had a baseline International Normalized Ratio (INR) of >2, underwent emergency neurosurgical procedures, and had an intracranial hemorrhage. All guideline criteria for indication and approval were followed for 48 patients. Eighty-seven patients received concomitant treatment for reversal of anticoagulation. A significant correction in the baseline INR after administration of factor VIIa (recombinant) was noted (p < 0.0001). Five patients experienced adverse events. Implementation of the guidelines decreased the annual cost of factor VIIa (recombinant) by 46%. CONCLUSION: A protocol calling for administration of factor VIIa (recombinant) 40 microg/kg in nonhemophilic patients with coagulopathy and ICH led to a rapid and significant decrease in the INR, allowing for emergency surgical intervention. Few adverse events were detected in these patients, and none were deemed to be directly related to factor VIIa (recombinant).

Role of student pharmacist interns in hospital-based standing orders pneumococcal vaccination program.

OBJECTIVE: To describe the role of student pharmacist interns in supporting a standing orders program (SOP) for pneumococcal polysaccharide vaccination in hospitalized patients. SETTING: University of Pittsburgh Medical Center (UPMC) Presbyterian, an academic teaching hospital in Pittsburgh. PRACTICE DESCRIPTION: The hospital-based Drug Use and Disease State Management (DUDSM) program designs, implements, and promotes evidence-based practice guidelines to ensure safe and cost-effective drug therapy. PRACTICE INNOVATION/INTERVENTIONS: Paid student pharmacist interns provide manpower for screening and maintaining the vaccination SOP. Student preparation includes classroom learning about immunization concepts, on-site SOP workflow training, and direct patient care activities. Students participate in the vaccination SOP by (1) screening daily admissions through computerized information systems, (2) reviewing databases for documented prior vaccination, (3) completing preprinted orders for pharmacists, (4) inserting orders into patient charts, (5) checking vaccine administration, (6) educating nurses, and (7) managing the databases. Pharmacists verify and sign vaccine orders. Nurses obtain patient history and consent and administer vaccines. MAIN OUTCOME MEASURES: Hospital vaccination rates as determined monthly for quality improvement reporting, and student time required to complete SOP functions. RESULTS: In 2005, an average monthly vaccination rate of 70% for hospitalized elderly was achieved by this inpatient SOP, with the highest rate (89%) occurring in March. On average, 800 patients were screened each month, with 480 vaccine orders placed into patient charts. CONCLUSION: A vaccination SOP is resource-intensive and requires a diligent effort from qualified personnel. In our institution, trained student interns in the DUDSM program perform the necessary daily functions, such as patient screening, that are instrumental in maintaining the SOP.