Intravenous Immune Globulin Stewardship Program at a Tertiary Academic Medical Center.

BACKGROUND: In October 2010, a pharmacist-driven stewardship program was implemented at the Brigham and Women's Hospital to ensure continued adherence to the prescribing guideline, focusing on indications for intravenous immune globulin (IVIG) use and dosing per ideal body weight. OBJECTIVE: The primary objective was to describe an IVIG stewardship program at a tertiary academic medical center. METHODS: This was a prospective, observational study from January 2013 through December 2014. All patients ordered to receive IVIG during the defined study period were included. The intervention assessed describes a pharmacist-driven IVIG stewardship program for medication approval. The primary end point was guideline compliance based on indication, dose, dosing weight, and frequency. Secondary end points included the number of patients receiving IVIG, indications, orders discontinued as a result of guideline nonadherence, and total amount dispensed. RESULTS: A total of 418 patients were identified during the study time frame. The top indications were: hypogammaglobulinemia in bone marrow transplantation and hematological malignancy (50.7%), acute solid organ rejection (11.8%), and immune thrombocytopenia with bleeding (10.1%). In all, 12 patients (2.9%) received IVIG for an indication nonadherent with the IVIG prescribing guideline; 9 patients (2.2%) and 2 patients (0.5%), respectively, received a different dose or frequency per the prescribed indication; and 12 orders (2.9%) for indications nonadherent to the guideline were discontinued. A total of 26 033 g of IVIG were dispensed during the study period. CONCLUSIONS: An IVIG stewardship program, including an institution-specific prescribing guideline and a pharmacist-driven stewardship program, may ensure guideline compliance for appropriateness of indication and dose at an academic medical center.

Implementation of an Automated Dispensing Cabinet Stewardship Program at a Tertiary Academic Medical Center.

Automated dispensing cabinet (ADC) use within hospitals is designed to replace or partially replace medication cabinets or carts to allow for a more decentralized model of medication distribution. This project was designed to improve medication delivery by decreasing the burden of dispensing patient-specific medications from a centralized inpatient pharmacy while decreasing overall inventory cost. This single-center pilot analysis evaluated ADC inventory optimization in a mixed medical population. Data collected included inventory cost on ADC, medications removed from or added to ADC, patient-specific medications sent from central pharmacy, and the rate of medication stock outs on ADC.

Implementation of a dexmedetomidine stewardship program at a tertiary academic medical center.

BACKGROUND: Brigham and Women's Hospital implemented a dexmedetomidine stewardship program in October 2010 beginning with an institution-specific prescribing guideline. To ensure continued adherence to the prescribing guideline, a pharmacist-driven quality assurance program was implemented in November 2011. OBJECTIVE: The primary objective of this study is to describe the role and impact of a dexmedetomidine stewardship program on dexmedetomidine use at a tertiary academic medical center. METHODS: This is a prospective descriptive analysis of a dexmedetomidine stewardship program. Dexmedetomidine stewardship data were collected prospectively from January 2012 through June 2012, in all intensive care units (ICUs) at a single academic medical center. Adult patients (>18 years old) receiving dexmedetomidine therapy continuously for sedation and in the ICU were included in the analysis. RESULTS: A total of 99 patients were identified during the study time frame, during which 71 (71.7%) were identified as compliant with the institutional guideline. The total number of patients receiving dexmedetomidine for greater than 24 hours was 13 (13.1%), of whom 10 (76.9%) received targeted interventions; 15 (15.2%) targeted interventions were made on all patients receiving dexmedetomidine during the study time frame. The total use of dexmedetomidine during the study period was 1310 vials, compared with 5404 vials during the equivalent time frame in 2010-a 76% reduction. CONCLUSIONS: A dexmedetomidine stewardship program, including an institution-specific prescribing guideline and a pharmacist-driven quality assurance program may ensure guideline compliance and decreased use of dexmedetomidine at an academic medical center.