Implementing SBIRT to Address Maternal Marijuana Use.

A quality improvement project conducted at 3 Texas hospitals to implement a new systematic process to address maternal marijuana use among breastfeeding mothers. The new process was created using the evidence-based Screening, Brief Intervention, Referral to Treatment (SBIRT) model to address maternal marijuana use. Nurses screened all postpartum mothers for marijuana use at each of the 3 hospitals. Mothers who reported ever using marijuana were advised to abstain while breastfeeding and given educational materials and a treatment referral card. Among all 3 hospitals, the mean nurses' adherence to the SBIRT process was 69 percent, exceeding the project aim of 50 percent adherence. SBIRT, which has been used extensively with other populations and settings, was easily translated into practice for use with postpartum mothers who reported using marijuana. A systematic process using SBIRT may help mitigate the risk of harm for infants of mothers who use marijuana.

Medication utilization evaluation of dabigatran and rivaroxaban within a large, multi-center health system.

OBJECTIVE: The objective of this medication utilization evaluation (MUE) was to determine the appropriateness of dabigatran and rivaroxaban while also reviewing outcomes for safety and effectiveness within a large, multi-center health system. METHODS: A retrospective chart review was performed using the system's electronic medical record. A data inquiry was requested and generated for dabigatran usage from July 28, 2011 through July 28, 2012 and for rivaroxaban from March 1, 2012 to July 31, 2012 at eight health system hospitals. All patients receiving at least one dose were eligible for inclusion in the MUE. RESULTS: For dabigatran, 78 of 390 unique patient encounters were analyzed (20%). All 62 rivaroxaban encounters were included in the analysis. Dabigatran was used for appropriate indications in 94% of encounters and 82% for rivaroxaban. Based on indication and renal function, 87% of dabigatran patients and 92% of rivaroxaban patients received correct dosing. For patients transitioning to or from another anticoagulant, appropriate transitions occurred in 44% of dabigatran transitions and 48% of rivaroxaban transitions. At discharge, 83% of dabigatran and 86% of rivaroxaban therapy was continued. There were no reported strokes or systemic embolism with dabigatran, but one reported deep vein thrombosis occurred during hospitalization with rivaroxaban therapy. Documented bleeds in 5% of dabigatran and 3% of rivaroxaban patients. Patient education was documented for 37% of dabigatran and 26% of rivaroxaban patients receiving therapeutic anticoagulation. CONCLUSION: This MUE revealed the appropriate use of dabigatran and rivaroxaban therapy with few safety outcomes within a large, multi-center health system.