The effect of body weight on intravenous diltiazem in patients with atrial fibrillation with rapid ventricular response.

WHAT IS KNOWN AND OBJECTIVES: To assess the effect of body weight on the total dose of intravenous (IV) diltiazem needed to reach goal heart rate (HR) for atrial fibrillation (Afib) with rapid ventricular response (RVR) in the emergency department (ED) setting. METHODS: A single-center retrospective cohort was ascertained using electronic medical record data from January 2013 to December 2016. Inclusion criteria consisted of new onset Afib with RVR, receipt of IV diltiazem in the ED, and age ≥18 years old. The primary outcome was the total dose of diltiazem needed to reach goal HR <100, stratified by patients who were <100 kg and those ≥100 kg. The secondary outcome was the total time required to reach goal HR. Demographic, clinical and medication-related data were collected, including selected safety endpoints. RESULTS AND DISCUSSION: A total of 328 patients were included. Patients required a mean of 30.1 mg (±24.6) of diltiazem and 2.3 hours (±2.9) to reach goal HR. The total dose of diltiazem was similar for patients <100 kg and ≥100 kg (28.7 vs 34.3 mg; P = .068) as was the time to reach goal HR (2.3 vs 2.3 hours; P = .949), respectively. No differences were noted in incidence of hypotension, bradycardia or need for additional rate control agents. WHAT IS NEW AND CONCLUSION: No difference in the total amount of diltiazem or time to reach goal HR was found in patients according to body weight stratification.

Antimicrobial-related medication safety incidents: a regional retrospective study in West of Scotland hospitals.

BACKGROUND: Medication-related incidents are an important consideration in enhancing patient safety in hospital care. The wide use of antimicrobial therapy in this population renders these medications particularly vulnerable to errors and adverse events. AIM: To analyse the characteristics of antimicrobial-related incident reports across a group of secondary care hospitals. METHODS: Reports for antimicrobial-related incidents from April 2010 to December 2013 were obtained from a regional area of hospitals in National Health Service Scotland. Reports were analysed as a full set, and with subset analyses of incidents resulting in patient harm/injury and those included in a multi-variable regression adjusted by occupied bed-days and defined daily doses to better ascertain areas to target for antimicrobial safety. FINDINGS: In total, 1345 incidents were reported at a crude rate of 0.98 reports/day [95% confidence interval (CI) 0.93-1.03 reports/day]. Penicillins (371 reports; 27.6%), aminoglycosides (358; 26.6%) and glycopeptides (210; 15.6%) were the most commonly involved classes of medications. Most incidents involved no injury/harm (514; 38.2%), but 72 reports (5.4%) did result in patient harm. The rehabilitation/assessment [relative rate (RR) 2.61, 95% CI 1.70-4.03] and women/childrens (RR 2.04, 95% CI 1.39-2.99) directorates had higher incident reporting rates compared with other directorates, likely as a function of at-risk patient populations. Among the types of incidents reported, those involving issues with administration/supply were most common (RR 2.07, 95% CI 1.51-2.84). CONCLUSION: Incident reporting for antimicrobials identified several key areas for quality improvement in the hospital setting, which can guide safety efforts.

Development of an obstetrics triage tool for clinical pharmacists.

WHAT IS KNOWN AND OBJECTIVES: Obstetrics services are a high-throughput and high-risk environment poised for pharmacist involvement, but determining how to ideally allocate services is difficult. There is recent interest in the development of tools for service prioritization, but none are specifically targeted to obstetrics. Therefore, the aim of this study was (i) to conduct a practice audit surveying the demographics of patients attending obstetrics wards at a high-capacity maternity hospital; and (ii) to evaluate a triage tool developed to prioritize pharmacy services. METHODS: A retrospective case review of women discharged after birth admissions was undertaken at a hospital in National Health Service (NHS) Scotland during June 2014. Demographic and admission data were collected, as well as pharmacist interventions and missed opportunities in patient care on post-natal wards. A pharmacy triage tool was developed and retrospectively applied to each case to ascertain a risk category that would trigger and target pharmacist review. Interventions/opportunities were classified as either clinical (medication related) or administrative (potential for error development). RESULTS AND DISCUSSION: One hundred and seventy-five cases were reviewed with a median age of 29 years old. Eighty-six patients (49·1%) were retrospectively classified with elevated risk using the triage tool. A total of 117 charts (66·9%) were identified with missed opportunities for pharmacist intervention, which was significantly greater among patients classified as higher risk (75·6 vs. 58·4%, P = 0·017). Compared to low-risk patients, patients with a higher-risk classification had lower rates of administrative missed opportunities (55·4 vs. 80·8%, P = 0·015), but numerically higher rates of clinical (26·2 vs. 9·6%, p=NS) and mixed clinical/administrative (18·5 vs. 9·6%, p=NS) missed opportunities, although this failed to reach statistical significance. WHAT IS NEW AND CONCLUSION: Evaluation of a triage tool for obstetric services demonstrated potential for prioritizing higher-risk patients for pharmacist review and addressing opportunities for clinical improvements.

A comparison of medication adherence/persistence for asthma and chronic obstructive pulmonary disease in the United Kingdom.

AIM: To describe and compare adherence and persistence with maintenance therapies in patients with asthma or chronic obstructive pulmonary disease (COPD) in the United Kingdom (UK). METHODS: A retrospective prescribing database cohort was obtained from 44 general practitioner surgeries in National Health Service Forth Valley Scotland. Patients with physician-diagnosed asthma or COPD who received maintenance therapy between January 2008 and December 2009 were included. Five classes of therapy were assessed: inhaled corticosteroids, long-acting beta-agonists, combination therapy inhalers, theophyllines and long-acting muscarinic antagonists. Adherence was calculated using the medication possession ratio (MPR) and persistence was determined using Kaplan-Meier survival analysis for the time to discontinuation (TTD) over 1 year. Two step-wise logistic regressions were performed to assess the contribution of diagnosis to adherence/persistence. RESULTS: A total of 13,322 patients were included in the analysis: 10,521 patients with asthma and 2801 patients with COPD. 25.2% of medication episodes for asthma and 45.6% of medication episodes for COPD were classified as having an adequate medication supply (MPR of 80-120%). The overall median TTD was 92 days (IQR, interquartile range: 50-186 days) for patients with asthma and 116 days (IQR: 58-259 days, comparison p < 0.001) for patients with COPD. Patients with COPD were found to be more likely to achieve an MPR of at least 80% (OR: 1.27, 95% CI: 1.15-1.40), but had a similar likelihood of persistence at 1 year to patients with asthma. CONCLUSION: Adherence and persistence with respiratory therapies in the UK is relatively low. There is suggestion that patients with COPD may display more adherent behaviours than patients with asthma.