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Landolf KM, Lemieux SM, Rose C, Johnston JP, Adams CD, Altshuler J, Berger K, Dixit D, Effendi MK, Heavner MS, Lemieux D, Littlefield AJ, Nei AM, Owusu KA, Rinehart M, Robbins B, Rouse GE, Thompson Bastin ML. Corticosteroid use in ARDS and its application to evolving therapeutics for coronavirus disease 2019 (COVID-19): A systematic review. Pharmacotherapy 2021; 42:71-90. [PMID: 34662448 PMCID: PMC8662062 DOI: 10.1002/phar.2637] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 01/08/2023]
Abstract
Data regarding the use of corticosteroids for treatment of acute respiratory distress syndrome (ARDS) are conflicting. As the coronavirus disease 2019 (COVID‐19) pandemic progresses, more literature supporting the use of corticosteroids for COVID‐19 and non‐COVID‐19 ARDS have emerged. Glucocorticoids are proposed to attenuate the inflammatory response and prevent progression to the fibroproliferative phase of ARDS through their multiple mechanisms and anti‐inflammatory properties. The purpose of this systematic review was to comprehensively evaluate the literature surrounding corticosteroid use in ARDS (non‐COVID‐19 and COVID‐19) in addition to a narrative review of clinical considerations of corticosteroid use in these patient populations. OVID Medline and EMBASE were searched. Randomized controlled trials evaluating the use of corticosteroids for COVID‐19 and non‐COVID‐19 ARDS in adult patients on mortality outcomes were included. Risk of bias was assessed with the Risk of Bias 2.0 tool. There were 388 studies identified, 15 of which met the inclusion criteria that included a total of 8877 patients. The studies included in our review reported a mortality benefit in 6/15 (40%) studies with benefit being seen at varying time points of mortality follow‐up (ICU survival, hospital, and 28 and 60 days) in the COVID‐19 and non‐COVID‐19 ARDS studies. The two non‐COVID19 trials assessing lung injury score improvements found that corticosteroids led to significant improvements with corticosteroid use. The number of mechanical ventilation‐free days significantly were found to be increased with the use of corticosteroids in all four studies that assessed this outcome. Corticosteroids are associated with improvements in mortality and ventilator‐free days in critically ill patients with both COVID‐19 and non‐COVID‐19 ARDS, and evidence suggests their use should be encouraged in these settings. However, due to substantial differences in the corticosteroid regimens utilized in these trials, questions still remain regarding the optimal corticosteroid agent, dose, and duration in patients with ARDS.
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Affiliation(s)
- Kaitlin M Landolf
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Steven M Lemieux
- Department of Pharmacy, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Christina Rose
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA
| | - Jackie P Johnston
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Piscataway, New Jersey, USA
| | - Christopher D Adams
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Piscataway, New Jersey, USA
| | - Jerry Altshuler
- Department of Pharmacy, Hackensack Meridian Health JFK University Medical Center, Edison, New Jersey, USA
| | - Karen Berger
- Department of Pharmacy, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Deepali Dixit
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Piscataway, New Jersey, USA
| | - Muhammad K Effendi
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Piscataway, New Jersey, USA
| | - Mojdeh S Heavner
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Diana Lemieux
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Audrey J Littlefield
- Department of Pharmacy, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Andrea M Nei
- Department of Pharmacy, Mayo Clinic Hospital - Rochester, Rochester, Minnesota, USA
| | - Kent A Owusu
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA.,Care Signature, Yale New Haven Health, New Haven, Connecticut, USA
| | - Marisa Rinehart
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Blake Robbins
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Ginger E Rouse
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
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Shah S, McManus D, Bejou N, Tirmizi S, Rouse GE, Lemieux SM, Gritsenko D, Topal JE. Clinical outcomes of baloxavir versus oseltamivir in patients hospitalized with influenza A. J Antimicrob Chemother 2021; 75:3015-3022. [PMID: 32712669 DOI: 10.1093/jac/dkaa252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To date, clinical trials evaluating baloxavir have excluded patients hospitalized with influenza infection and therefore this study sought to evaluate the efficacy of baloxavir in inpatients with influenza A. METHODS This study was a multicentre, retrospective chart review of adult patients admitted to the hospital within the Yale New Haven Health System who received oseltamivir or baloxavir for the treatment of influenza A. Patients were screened for inclusion between January 2018 and April 2018 in the oseltamivir group, while patients in the baloxavir group were screened for inclusion between January 2019 and April 2019. Influenza A diagnosis was confirmed by RT-PCR using a nasopharyngeal swab specimen. RESULTS Of the 2392 patients assessed, 790 met the inclusion criteria. There were 359 patients who received baloxavir and 431 patients who received oseltamivir. Patients who received baloxavir were younger compared with those who received oseltamivir [median = 69 (IQR = 57-81) years versus 77 (IQR = 62-86) years; P < 0.001]. Patients who received baloxavir had no significant difference in hospital length of stay [median = 4 (IQR = 3-6) days versus 5 (IQR = 3-6) days; P = 0.45] or 30 day all-cause mortality [12 (3.3%) versus 26 (6%); P = 0.079] compared with those who received oseltamivir. However, patients who received baloxavir had a significantly faster time to hypoxia resolution [median = 51.7 (IQR = 25.3-89.3) h versus 72 (IQR = 37.5-123) h; P < 0.001]. CONCLUSIONS The results of this study support the use of baloxavir for the treatment of influenza A in hospitalized patients with the potential benefit of a faster time to resolution of hypoxia.
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Affiliation(s)
- Sunish Shah
- Department of Pharmacy, Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, USA
| | - Dayna McManus
- Department of Pharmacy, Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, USA
| | - Nika Bejou
- Department of Pharmacy, Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, USA.,Janssen Scientific Affairs, Raritan, NJ, USA
| | - Samad Tirmizi
- Department of Pharmacy, Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, USA
| | - Ginger E Rouse
- Department of Pharmacy, Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, USA
| | - Steven M Lemieux
- Department of Pharmacy, Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, USA.,University of Saint Joseph, School of Pharmacy, Hartford, CT, USA
| | - Diana Gritsenko
- Department of Pharmacy, Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, USA
| | - Jeffrey E Topal
- Department of Pharmacy, Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, USA.,Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, USA
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Ammar MA, Tran LJ, McGill B, Ammar AA, Huynh P, Amin N, Guerra M, Rouse GE, Lemieux D, McManus D, Topal JE, Davis MW, Miller L, Yazdi M, Leber MB, Pulk RA. Pharmacists leadership in a medication shortage response: Illustrative examples from a health system response to the COVID-19 crisis. J Am Coll Clin Pharm 2021; 4:1134-1143. [PMID: 34230910 PMCID: PMC8250559 DOI: 10.1002/jac5.1443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/17/2022]
Abstract
As medication experts, clinical pharmacists play an active and dynamic role in a medication shortage response. Supplementing existing guidelines with an actionable framework of discrete activities to support effective medication shortage responses can expand the scope of pharmacy practice and improve patient care. Dissemination of best practices and illustrative, networked examples from health systems can support the adoption of innovative solutions. In this descriptive report, we document the translation of published shortage mitigation guidelines into system success through broad pharmacist engagement and the adaption and implementation of targeted strategies. The profound, wide‐reaching medication shortages that accompanied the coronavirus disease 2019 (COVID‐19) pandemic are used to highlight coordinated but distinct practices and how they have been combined to expand the influence of the pharmacy enterprise.
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Affiliation(s)
- Mahmoud A Ammar
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Lydia J Tran
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Bryan McGill
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Abdalla A Ammar
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Phu Huynh
- Corporate Pharmacy Services Yale New Haven Health New Haven Connecticut USA
| | - Nilesh Amin
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Michael Guerra
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Ginger E Rouse
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Diana Lemieux
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Dayna McManus
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Jeffrey E Topal
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Matthew W Davis
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - LeeAnn Miller
- Corporate Pharmacy Services Yale New Haven Health New Haven Connecticut USA
| | - Marina Yazdi
- Corporate Pharmacy Services Yale New Haven Health New Haven Connecticut USA
| | | | - Rebecca A Pulk
- Corporate Pharmacy Services Yale New Haven Health New Haven Connecticut USA
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Heck CC, Tichy EM, Vonderheyde R, Jaszczur GR, McManus D, Topal JE, Rogers ME, Rouse GE. Optimizing pharmacist-driven protocols and documentation of interventions using clinical decision support systems. Am J Health Syst Pharm 2021; 77:830-834. [PMID: 32426844 DOI: 10.1093/ajhp/zxaa061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cory C Heck
- Heart and Vascular Medicine Yale New Haven Hospital New Haven, CT
| | - Eric M Tichy
- Clinical Pharmacy Services Yale New Haven Health New Haven, CT
| | - Robyn Vonderheyde
- Information Technology Services Yale New Haven Health System New Haven, CT
| | - Gregory R Jaszczur
- Information Technology Services Yale New Haven Health System New Haven, CT
| | - Dayna McManus
- Infectious Diseases Yale New Haven Hospital New Haven, CT
| | - Jeffrey E Topal
- Department of Internal Medicine Section of Infectious Diseases Yale School of Medicine Yale New Haven Hospital New Haven, CT
| | - Mark E Rogers
- Lawrence and Memorial Hospital New London, CT Westerly Hospital Westerly, RI
| | - Ginger E Rouse
- Medical Intensive Care Yale New Haven Hospital New Haven, CT
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5
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Thompson Bastin ML, Berger K, Adams CD, Altshuler J, Dixit D, Effendi MK, Johnston JP, Lemieux DG, Lemieux SM, Littlefield AJ, Owusu KA, Rose C, Rouse GE, Heavner MS. Adapting clinical pharmacy staffing models during the
COVID
‐19 pandemic: Lessons learned and considerations for future disaster planning. J Am Coll Clin Pharm 2020. [DOI: 10.1002/jac5.1374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Melissa L. Thompson Bastin
- Department of Pharmacy Services University of Kentucky HealthCare Lexington Kentucky USA
- Department of Pharmacy Practice and Administration University of Kentucky College of Pharmacy Lexington Kentucky USA
| | - Karen Berger
- Department of Pharmacy NewYork‐Presbyterian Hospital/Weill Cornell Medical Center New York New York USA
| | - Christopher D. Adams
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Piscataway New Jersey USA
| | - Jerry Altshuler
- Department of Pharmacy Hackensack Meridian JFK Medical Center Edison New Jersey USA
| | - Deepali Dixit
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Piscataway New Jersey USA
| | - Muhammad K. Effendi
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Piscataway New Jersey USA
| | - Jackie P. Johnston
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Piscataway New Jersey USA
| | - Diana G. Lemieux
- Department of Pharmacy Services Yale New Haven Hospital New Haven Connecticut USA
| | - Steven M. Lemieux
- Department of Pharmacy Practice and Administration University of Saint Joseph West Hartford Connecticut USA
| | - Audrey J. Littlefield
- Department of Pharmacy NewYork‐Presbyterian Hospital/Weill Cornell Medical Center New York New York USA
| | - Kent A. Owusu
- Department of Pharmacy Services Yale New Haven Hospital New Haven Connecticut USA
- Clinical Redesign Yale New Haven Health New Haven Connecticut USA
| | - Christina Rose
- Department of Pharmacy Practice Temple University School of Pharmacy Philadelphia Pennsylvania USA
| | - Ginger E. Rouse
- Department of Pharmacy Services Yale New Haven Hospital New Haven Connecticut USA
| | - Mojdeh S. Heavner
- Department of Pharmacy Practice and Science University of Maryland School of Pharmacy Baltimore Maryland USA
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6
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Webb AJ, McManus D, Rouse GE, Vonderheyde R, Topal JE. Implications for medication dosing for transgender patients: A review of the literature and recommendations for pharmacists. Am J Health Syst Pharm 2020; 77:427-433. [PMID: 32012216 DOI: 10.1093/ajhp/zxz355] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Transgender patients face considerable healthcare disparities. Improved means of recognizing transgender patients and understanding their medical needs is important to provide optimal care. The electronic medical record (EMR) of our health system allows for differentiation of gender identity, legal sex, and sex at birth. With EMR recognition of transgender patients, a recommendation for estimating creatinine clearance (CLcr) and ideal body weight (IBW) was needed to standardize medication dosing. SUMMARY The literature was reviewed for evidence on the effect of gender-affirming hormone therapy on serum creatinine concentration and lean body mass. Findings informed a recommendation for drug dosing based on CLcr and IBW in transgender patients. Four studies that reported the effect of hormone therapy on biometric laboratory values were found. Three studies reported that values of transgender patients more closely resembled the standard values of their gender identity vs sex at birth after hormone therapy; 1 study reported a range of values that more closely resembled those associated with sex at birth while still overlapping with values associated with gender identity. Consequently, it was recommended that pharmacists dose medications based on CLcr and IBW calculations consistent with gender identity after a patient has been on hormone therapy for 6 months or longer. CONCLUSION Providing optimal care to transgender patients includes considering the effect of gender-affirming hormone therapy on overall physiology. Consistently using the appropriate CLcr and IBW calculations for each patient ensures safe and effective care. Additional studies are needed to confirm the effect of hormone therapy on renal clearance and lean body mass.
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Affiliation(s)
- Andrew J Webb
- Department of Pharmacy, School of Health Sciences, Mayo Clinic, Rochester, MN
| | - Dayna McManus
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT
| | - Ginger E Rouse
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT
| | - Robyn Vonderheyde
- Information Technology Services, Yale New Haven Health System, New Haven, CT
| | - Jeffrey E Topal
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT.,Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT
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Adams CD, Altshuler J, Barlow BL, Dixit D, Droege CA, Effendi MK, Heavner MS, Johnston JP, Kiskaddon AL, Lemieux DG, Lemieux SM, Littlefield AJ, Owusu KA, Rouse GE, Thompson Bastin ML, Berger K. Analgesia and Sedation Strategies in Mechanically Ventilated Adults with COVID‐19. Pharmacotherapy 2020; 40:1180-1191. [DOI: 10.1002/phar.2471] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Christopher D. Adams
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Piscataway New JerseyUSA
| | - Jerry Altshuler
- Department of Pharmacy Hackensack Meridian JFK Medical Center Edison New JerseyUSA
| | - Brooke L. Barlow
- Department of Pharmacy Services University of Kentucky HealthCare Lexington KentuckyUSA
| | - Deepali Dixit
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Piscataway New JerseyUSA
| | - Christopher A. Droege
- Department of Pharmacy UC Health – University of Cincinnati Medical Center Cincinnati OhioUSA
| | - Muhammad K. Effendi
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Piscataway New JerseyUSA
| | - Mojdeh S. Heavner
- Department of Pharmacy Practice University of Maryland School of Pharmacy Baltimore MarylandUSA
| | - Jackie P. Johnston
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Piscataway New JerseyUSA
| | - Amy L. Kiskaddon
- Department of Pharmacy Johns Hopkins All Children's Hospital St. Petersburg FloridaUSA
| | - Diana G. Lemieux
- Department of Pharmacy Services Yale New Haven Hospital New Haven ConnecticutUSA
| | - Steven M. Lemieux
- Department of Pharmacy Practice and Administration University of Saint Joseph Hartford ConnecticutUSA
| | - Audrey J. Littlefield
- Department of Pharmacy New York‐Presbyterian Hospital/Weill Cornell Medical Center New York New YorkUSA
| | - Kent A Owusu
- Department of Pharmacy Services Yale New Haven Hospital New Haven ConnecticutUSA
| | - Ginger E. Rouse
- Department of Pharmacy Services Yale New Haven Hospital New Haven ConnecticutUSA
| | | | - Karen Berger
- Department of Pharmacy New York‐Presbyterian Hospital/Weill Cornell Medical Center New York New YorkUSA
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8
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Webb AJ, McManus D, Rouse GE, Vonderheyde R, Topal JE. The authors’ reply: Assessment of renal function in transgender patients. Am J Health Syst Pharm 2020; 77:1461-1462. [DOI: 10.1093/ajhp/zxaa231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrew J Webb
- School of Health Sciences Department of Pharmacy Mayo Clinic Rochester, MN
| | - Dayna McManus
- Department of Pharmacy Services Yale New Haven Hospital New Haven, CT
| | - Ginger E Rouse
- Department of Pharmacy Services Yale New Haven Hospital New Haven, CT
| | - Robyn Vonderheyde
- Information Technology Services Yale New Haven Health System New Haven, CT
| | - Jeffrey E Topal
- Department of Pharmacy Services Yale New Haven Hospital Yale School of Medicine
- Department of Internal Medicine Section of Infectious Diseases New Haven, CT
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Shah S, Rouse GE, McManus D, Tichy EM, DeVaux L, Hutchins L, Topal JE. Optimizing the correct timing of vancomycin level collection utilizing a vancomycin medication administration record (MAR) level order. Int J Med Inform 2020; 143:104249. [PMID: 32957015 DOI: 10.1016/j.ijmedinf.2020.104249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Vancomycin, a commonly used antimicrobial, has a narrow therapeutic index; therefore, Therapeutic Drug Monitoring (TDM) is required. Although the Electronic Medical Record (EMR) may improve patient care, without appropriate optimization, it can contribute to incorrectly drawn vancomycin levels. For medication administration, nurses utilize the Medication Administration Record (MAR) for medication administration documentation and medication workflow guidance. Therefore, we hypothesized creating a MAR level order which would be incorporated into this already established medication workflow may improve the rate of correctly drawn vancomycin levels. MATERIALS AND METHODS This was a multicenter, retrospective, pre-and post-intervention study which evaluated the effect of a Medication Administration Record (MAR) level order within the EMR on the correct timing of vancomycin level collection. Vancomycin levels were classified into pre-and post-intervention groups. The primary endpoint was the rate of incorrectly drawn levels, defined as a level being drawn early, a level being drawn late, a level drawn while infusing, or a missed level. RESULTS A total of 1353 vancomycin levels were assessed, and 628 levels met inclusion criteria. Of the levels eligible for inclusion, 331 were in the pre-intervention period and 297 were in the post-intervention period. Levels in the post-intervention group utilizing the vancomycin MAR level order were less likely to be missed or drawn at an incorrect time (11.1 % vs 36 %, P < 0.01) and were less likely to require rescheduling (3.4 % vs 8.5 %, P < 0.01). CONCLUSION Utilization of a vancomycin MAR level order was associated with a significant decrease in incorrectly drawn vancomycin levels.
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Affiliation(s)
- Sunish Shah
- Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, United States.
| | - Ginger E Rouse
- Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, United States
| | - Dayna McManus
- Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, United States
| | - Eric M Tichy
- Mayo Clinic, Supply Chain Management, Rochester, MN, United States
| | - Laura DeVaux
- Yale New Haven Hospital, Department of Nursing, New Haven, CT, United States
| | - Leslie Hutchins
- Yale New Haven Hospital, Department of Clinical Informatics, New Haven, CT, United States
| | - Jeffrey E Topal
- Yale New Haven Hospital, Department of Pharmacy Services, New Haven, CT, United States; Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, United States
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10
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Heavner MS, Rouse GE, Lemieux SM, Owusu KA, Pritchard D, Yazdi M, Lee LA. Experience with integrating pharmacist documenters on cardiac arrest teams to improve quality. J Am Pharm Assoc (2003) 2018; 58:311-317. [DOI: 10.1016/j.japh.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
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11
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Rouse GE, Hardinger K, Tsapepas D, Tichy EM. A Comparison of Histamine Receptor Antagonists Versus Proton Pump Inhibitor Gastrointestinal Ulcer Prophylaxis in Kidney Transplant Recipients. Prog Transplant 2016; 27:4-9. [PMID: 27650918 DOI: 10.1177/1526924816669725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION There are several different agents that can be used for gastrointestinal (GI) ulcer prophylaxis in posttransplant recipients, such as histamine-2 receptor antagonists (H2RA) or proton pump inhibitors (PPIs). RESEARCH QUESTION This study was conducted to compare the incidence of adverse kidney events in transplant recipients who received prophylaxis with H2RAs or PPIs. DESIGN This retrospective study included all kidney transplant recipients from 3 transplant centers who were transplanted in 2009 through 2011. The primary objective was to compare the incidence of adverse events posttransplant, defined as the incidence of pneumonia, Clostridium difficile, hip fractures, GI bleeding, cytomegalovirus, organ rejection, and bacteremia. RESULTS A total of 211 patients were included in the study; of which 35 were included in the PPI group and 176 were included in the H2RA group. There were no significant differences between groups in regard to incidence of GI bleeding events or other adverse events. DISCUSSION These findings suggest there is a low incidence of GI ulcers and upper GI bleeding events after kidney transplantation with the use of H2RAs or PPIs. Additionally, there are similar rates of adverse events when comparing H2RAs versus PPIs for GI ulcer prophylaxis.
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Affiliation(s)
- Ginger E Rouse
- 1 Medical ICU, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA
| | - Karen Hardinger
- 2 Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Demetra Tsapepas
- 3 Department of Pharmacy, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Eric M Tichy
- 4 Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA
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Abstract
Plant fossils, including branched axes, foliar structures, fructifications, and dispersed spores have recently been discovered from the type section of the Ghost River formation. The megafossils, although commonly fragmentary, suggest a late Middle or early Upper Devonian age for the beds. This discovery suggests that equivalent strata in other regions may also contain plant remains, the discovery of which would add significantly to our knowledge of Devonian floras in western North America.
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Abstract
Four potassium-argon determinations from Tertiary rocks in the interior of British Columbia have yielded dates ranging from 45 to 49 million years. This suggests contemporaneity of three separate localities within the Middle Eocene epoch. Abundant plant micro- and macrofossils support this conclusion and indicate a flora quite different from floras of comparable age in western United States.
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