Assessment of Granulocyte-Colony Stimulating Factors Use at a community-based teaching hospital and compliance with National Comprehensive Cancer Network guidelines.

OBJECTIVES: Approximately 60,000 patients are hospitalised annually due to chemotherapy-induced febrile neutropenia (FN) in the United States alone. Febrile neutropenia is primarily managed by antibiotics and granulocyte-colony-stimulating factors (G-CSFs). However, there are inconsistent recommendations regarding dose, frequency, and duration for G-CSF therapy. We conducted this study to assess the use of G-CSFs in a community-based teaching hospital in compliance with the National Comprehensive Cancer Network (NCCN) guidelines. METHODS: We retrospectively reviewed medical records of adult patients diagnosed with non-myeloid malignancies who received filgrastim in a community-based teaching hospital from November 2014 to April 2015. RESULTS: Of 90 patients, 77% received filgrastim for FN treatment, 19% for primary prophylaxis, and 4% for secondary prophylaxis. The dose of filgrastim was appropriate in 93% of patients, while 7% received a sub-optimal dose without the worsening of their clinical outcomes. We could not assess the duration of therapy for 38 patients who either died or were discharged before achieving the desired absolute neutrophil count (ANC). Of the 69 patients treated for FN, only 33% received filgrastim until they achieved the ANC goal (1,500-8,000/µL), while 36% continued to receive filgrastim treatment beyond the desired ANC goal. CONCLUSION: In our study, filgrastim was correctly prescribed; however, the ANC goal was not achieved in 47% of the patients. If the recommended ANC range had been targeted, a minimum of 28 doses could have been potentially avoided. This approach would have saved approximately $56,000. Therefore, future protocols should focus on pharmacist-led interventions to optimise G-CSF usage.

Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department.

Purpose: The study sought to determine whether the inclusion of a pharmacist on the emergency department (ED) resuscitation team was associated with improved compliance with the Advanced Cardiac Life Support (ACLS) guidelines and patient survival. The study also evaluated cost avoidance associated with a pharmacist providing clinical services to the ED. Methods: Cardiac arrest event records were evaluated for compliance with ACLS guidelines as well as for whether or not a pharmacist was involved as a member of the resuscitation team. Pharmacists documented all interventions performed while physically present in the ED which were utilized to associate cost avoidance. Results: When a pharmacist assisted as a member of the resuscitation team, a significant increase in the percentage of medications administered in compliance with the ACLS guidelines was noted (78% vs 67%, P = .0255). An increase in survival to hospital admission (25% vs 17.8%, P = .0155) was also noted though no significant increase in survival to hospital discharge (15% vs 4.4%, P = .6392) was observed. Over a 5-month period, pharmacists in the ED performed 1200 interventions, which created US$98 362 in cost avoidance. This extrapolates to approximately US$320 000 per year in cost avoidance. Conclusion: Inclusion of a pharmacist as a member of the resuscitation team improved compliance with medications administered according to the ACLS guidelines and increased survival to hospital admission, though survival to hospital discharge was unaffected. The presence of a pharmacist in the ED was associated with approximately US$320 000 in cost avoidance per year, if not more.

Ventricular Tachycardia Precipitated by the Use of the Diet Supplement Hydroxycut Gummies.

BACKGROUND: Dietary supplements have a long history of causing adverse effects. Ventricular arrhythmias have not been described with Hydroxycut Gummies. OBJECTIVE: To report a case of ventricular arrhythmia after prolonged use of a popular dietary supplement, Hydroxycut Gummies. CASE REPORT: An 18-year-old female with no significant past medical history presented with life-threatening ventricular arrhythmia following about 10 days of use of Hydroxycut Gummies, a legal dietary supplement previously unreported to cause this complication. The patient received external cardioversion due to progressive decline in mental status and persistent hypotension and was initiated on intravenous procainamide at an outside hospital. Left ventricular ejection fraction was 45% to 50%, and cardiac MRI showed no definite finding of infarct, myocarditis, or fibrosis. Beta-blocker therapy was initiated, and there was a progressive reduction in ventricular arrhythmia burden with an improvement of symptoms over the next few days. Two and a half months after the initial hospitalization, follow-up Holter monitor revealed occasional accelerated idioventricular rhythm events and a significant reduction in, but still occasional, long monomorphic ventricular tachycardia events. None of the ingredients listed in this product have been associated with cardiac dysrhythmias in the literature. One phytochemical potentially in the product is alpha-quinidine, which could be the cause of the adverse event. However, there was no other identifiable etiology for the ventricular tachycardia, which resolved after the discontinuation of supplement and the addition of beta-blocker therapy. CONCLUSION: Hydroxycut Gummies should be considered a probable cause of this patient's arrhythmia given the lack of another etiology and a Naranjo Scale score of 6.

Impact of prescription drug-monitoring program on controlled substance prescribing in the ED.

OBJECTIVE: In 2009, Florida initiated a statewide prescription drug-monitoring program (PDMP) to encourage safer prescribing of controlled substances and reduce drug abuse and diversion. Data supporting the utility of such programs in the emergency department (ED) is scarce. This study sought to determine the effect of PDMP data on controlled substance prescribing from the ED. METHODS: In this pre-post study utilizing a historical control, pharmacists in the ED provided prescribers with a summary of the PDMP data for their patients. The number of controlled substances prescribed in the intervention group was compared with that prescribed in the historical control to determine if the intervention resulted in a change in the average number of controlled substance prescribed. RESULTS: Among the 710 patients evaluated, providing prescribers with PDMP data did not alter the average number of controlled substance per patient prescribed (0.23 controlled substances per patient in the historical control compared with 0.28 controlled substances per patient in the intervention group; 95% confidence interval [CI], -0.016 to 0.116; P = .125). All prescribers surveyed indicated that having PDMP data altered their controlled substance prescribing and felt more comfortable prescribing controlled substances. CONCLUSIONS: Although the results did not demonstrate a change in the average number of controlled substances prescribed when prescribers were provided with PDMP data, results from the survey indicate that prescribers felt the data altered their prescribing of controlled substances, and thus were more contented prescribing controlled substances.