Propofol-induced interference with activated partial thromboplastin time-based monitoring of therapeutic heparin anticoagulation.

PURPOSE: The activated partial thromboplastin time (aPTT) is a coagulation assay commonly utilized for monitoring therapeutic heparin anticoagulation. aPTT methods based on optical detection are vulnerable to spectral interference from hemolysis, icterus, lipemia, and other substances. Intravenous lipid emulsions of primarily 20% have been shown to interfere with multiple clinical laboratory assays, including those measuring aPTT by optical methods, but there is limited data on propofol's effect. The primary objective of this study was to determine the rate of interference of propofol with aPTT measurements in patients receiving both propofol and intravenous heparin. METHODS: A retrospective observational cohort study of intensive care unit patients who received concomitant propofol and heparin infusions (N = 38 patients) and whose heparin therapy was monitored by aPTT (N = 531 aPTTs) was conducted. Review of the electronic medical record was completed to obtain relevant clinical and laboratory data, while the laboratory information system was queried for analytical interference with the aPTT assay. RESULTS: A total of 109 aPTTs (21%) spanning 21 patients (55%) had documented aPTT interference. All 21 patients had at least one aPTT requiring ultracentrifugation prior to reporting, and 12 aPTTs from 4 patients were unreportable due to interference. Patients with and without aPTT interference received similar doses of propofol. None of the cases of aPTT interference were caused by hemolysis or hyperbilirubinemia. CONCLUSION: A potential medication-assay interaction was observed in approximately half of patients who received concomitant propofol and heparin infusions and had aPTT measured for anticoagulation management. Sample ultracentrifugation removes the optical interference in most cases but significantly prolongs aPTT reporting and delays appropriate adjustments to heparin dosing.

A Review of the Most Impactful Published Pharmacotherapy-Pertinent Literature of 2019 and 2020 for Clinicians Caring for Patients With Thermal or Inhalation Injury.

Keeping abreast with current literature can be challenging, especially for practitioners caring for patients sustaining thermal or inhalation injury. Practitioners caring for patients with thermal injuries publish in a wide variety of journals, which further increases the complexity for those with resource limitations. Pharmacotherapy research continues to be a minority focus in primary literature. This review is a renewal of previous years' work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Sixteen geographically dispersed, board-certified pharmacists participated in the review. A MeSH-based, filtered search returned 1536 manuscripts over the previous 2-year period. After manual review and exclusions, only 98 (6.4%) manuscripts were determined to have a potential impact on current pharmacotherapy practices and included in the review. A summary of the 10 articles that scored highest are included in the review. Nearly half of the reviewed manuscripts were assessed to lack a significant impact on current practice. Despite an increase in published literature over the previous 2-year review, the focus and quality remain unchanged. There remains a need for investment in well-designed, high impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.

Reflections on a year-long student and pharmacist paired mentorship program.

BACKGROUND AND PURPOSE: Mentorship programs can play a significant role in the professional development of a variety of individuals, including student pharmacists and practitioners. Many mentorship programs have been described in the literature, but the literature pertaining to mentorship programs for student pharmacists specifically is varied. EDUCATIONAL ACTIVITY AND SETTING: A leadership society at one school of pharmacy established a formal mentorship program to aid the professional development of student pharmacists. This year-long program matched third-year student pharmacists with practicing pharmacists. This paper describes the development of the program, along with perceived benefits and challenges associated with implementation. FINDINGS: The mentor (n=8) and mentee (n=17) respondents provided positive feedback (100% and 94%, respectively) regarding the mentorship program. Most mentors and mentees noted they enjoyed having the opportunity to network and gained different perspectives on issues related to pharmacy. The challenges most noted by both the mentors and mentees were time limitations and scheduling conflicts. More consistent communication between mentors and mentees was noted as an area of improvement for future programs. DISCUSSION: The described program may create avenues to achieve professional development elements of the 2016 Accreditation Council for Pharmacy Education (ACPE) Standards and 2013 Center for Advancement of Pharmacy Education (CAPE) Outcomes. Continued, regular evaluation is important to help with process improvement, address challenges, and ensure the program is meeting desired objectives. Adjustments may be needed based on participant feedback, available resources, and student interest. SUMMARY: Overall, the program was successful, helping participants grow personally and professionally. With modifications, other institutions may utilize this data to develop similar programs.