Effect of early clopidogrel discontinuation on rehospitalization in acute coronary syndrome: Results from two distinct patient populations.
Am J Health Syst Pharm. 2011 Jun 1;68(11):1015-24
Authors: Ernst FR, Johnston S, Curke…

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Effect of bar-code-assisted medication administration on nurses’ activities in an intensive care unit: A time-motion study.
Am J Health Syst Pharm. 2011 Jun 1;68(11):1026-31
Authors: Dwibedi N, Sansgiry SS, Frost CP, Dasgupta …

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Iron replacement therapy in cancer-related anemia.
Am J Health Syst Pharm. 2011 May 15;68(10 Suppl 1):S4-S14
Authors: Baribeault D, Auerbach M
Purpose The incidence, etiology, and management of cancer-related anemia is…

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Nebivolol for the treatment of heart failure.
Am J Health Syst Pharm. 2011 May 15;68(10):879-86
Authors: Dery AS, Hamilton LA, Starr JA
Purpose The pharmacology, pharmacokinetics, efficacy, safety, and place in therapy…

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Substitution of a heparin correlation value for activated partial thromboplastin time in heparin nomograms.
Am J Health Syst Pharm. 2011 May 15;68(10):893-8
Authors: Miller AE, Montague D, Rodgers JE, Sanghvi S, Whinna HC, Kru…

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Effect of a pharmacist-managed culture review process on antimicrobial therapy in an emergency department.
Am J Health Syst Pharm. 2011 May 15;68(10):916-9
Authors: Randolph TC, Parker A, Meyer L, Zeina R
Purpose The i…

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Development and implementation of a pharmacist-managed inpatient anticoagulation monitoring program.
Am J Health Syst Pharm. 2011 May 15;68(10):934-9
Authors: Wellman JC, Kraus PS, Burton BL, Ensor CR, Nesbit TW, Ross PA, Thom…

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Efficacy and safety of 30-minute infusions of conivaptan in euvolemic and hypervolemic hyponatremia.
Am J Health Syst Pharm. 2011 May 1;68(9):818-27
Authors: Koren MJ, Hamad A, Klasen S, Abeyratne A, McNutt BE, Kalra S
…

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Ceftaroline: A new broad-spectrum cephalosporin.

Am J Health Syst Pharm. 2011 Mar 15;68(6):491-8

Authors: Lim L, Sutton E, Brown J

Purpose The pharmacokinetics, pharmacodynamics, clinical efficacy, and safety of ceftaroline are reviewed. Summary Ceftaroline, a new broad- spectrum antibiotic, is approved for the treatment of complicated skin and skin structure infections (cSSSIs) and community- acquired pneumonia (CAP). This ?-lactam antibiotic has extended activity against gram-positive organisms and has activity against common gram-negative organisms. The drug’s spectrum of activity includes both methicillin-resistant Staphylococcus aureus and multidrug-resistant Streptococcus pneumoniae. However, its activity against extended-spectrum ?-lactamase-producing bacteria is limited. These bacteria, particularly those that express AmpC ?-lactamase, greatly reduce the activity of ceftaroline. The prodrug of ceftaroline (ceftaroline fosamil) is rapidly converted to its active form (ceftaroline) in plasma. This dose-linear drug has been found to be pharmacodynamically best correlated with the percentage of time that free drug concentrations remain above the minimum inhibitory concentration. Ceftaroline’s safety profile is similar to that of the other cephalosporins, with minimal adverse drug reactions, most of which are considered mild. Currently available pharmacokinetic, animal, and clinical studies have found that ceftaroline has reasonable efficacy and tolerability but have also revealed that dosing regimen modifications may be needed in patients with moderate-to-severe renal impairment. The recommended dosage of ceftaroline for the treatment of cSSSIs and CAP is 600 mg infused intravenously over 60 minutes every 12 hours. The recommended duration of therapy is 5-14 and 5-7 days for cSSSIs and CAP, respectively. Additional Phase III studies are currently underway. Conclusion Ceftaroline is a new broad-spectrum cephalosporin indicated for the treatment of cSSSIs and CAP caused by susceptible gram-positive and gram-negative organisms.

PMID: 21378297 [PubMed - in process]

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Selection of drug-laboratory result pairs for an inpatient asynchronous alert program: Results of a Delphi survey.

Am J Health Syst Pharm. 2011 Mar 1;68(5):407-414

Authors: Yu S, Galanter WL, Didomenico RJ, Borkowsky S, Schiff GD, Lambert BL

Purpose Combinations of drugs and laboratory values ("drug-laboratory pairs") that represent practical high-priority targets for potential use in a daily asynchronous inpatient clinical decision-support (CDS) alert report were identified. Methods A list of 654 drug-laboratory pairs compiled through a literature review was evaluated by a multidisciplinary expert panel in a modified Delphi procedure. After initial evaluation to narrow the list to 89 drug-laboratory pairs, panelists used Likert scales to rate the remaining pairs on six dimensions (frequency of alert, likelihood of harm, severity of harm, preventability, ameliorability, and global impression of usefulness) in Delphi survey rounds until consensus emerged. Final selection of pairs for potential use as CDS tools was based on global-impression-of-usefulness scores. Correlations between impression of usefulness and other evaluative dimensions were determined. Results The Delphi process yielded a final list of 24 high-priority drug-laboratory pairs. The highest-ranked pairs were heparin- low platelet count, potassium supplement- high serum potassium, angiotensin-converting-enzyme inhibitor-high serum potassium, and heparin-positive heparin platelet factor 4 antibody test. Medications on the final list included nine anticoagulants, six cardiologic agents, four antimicrobials, and two electrolytes. Most of the selected drug-laboratory pairs related to renal function, serum potassium levels, hematologic results, or pregnancy. Panelists' impression of usefulness was significantly correlated with severity-of-harm ratings (p < 0.0001). Conclusion Expert review of drug- laboratory value pairs for potential inclusion in an asynchronous monitoring program yielded 24 high-priority and practical pairs for monitoring. About 25% of the pairs had not been the focus of previous laboratory-pharmacy CDS at the study panelists' home institutions.

PMID: 21330682 [PubMed - as supplied by publisher]

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Medication reconciliation standards on track for July.

Am J Health Syst Pharm. 2011 Mar 1;68(5):368-372

Authors: Traynor K

PMID: 21330673 [PubMed - as supplied by publisher]

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Antifungal use in hospitalized adults in U.S. academic health centers.

Am J Health Syst Pharm. 2011 Mar 1;68(5):415-418

Authors: Pakyz AL, Gurgle HE, Oinonen MJ

Purpose Use of antifungal agents and predictors of total antifungal use among adult inpatients at U.S. academic health centers was characterized. Methods Claims data obtained from a geographically representative sample of U.S. nonprofit academic health centers were analyzed to characterize use of systemic antifungals during the period 2004-08. Aggregate data were analyzed to identify trends in use of three antifungal classes (azoles, polyenes, echinocandins), as well as individual antifungal agents. Multivariate regression analysis was employed to investigate predictors of total antifungal use and interhospital variability in antifungal use. Results Aggregate antifungal use at health centers included in the data analysis increased from (mean ± S.D.) 82 ± 36 days of therapy (DOT) per 1000 patient-days in 2004 to 88 ± 39 DOT per 1000 patient-days in 2007 and then declined to 77 ± 36 DOT per 1000 patient-days in 2008. Use of voriconazole increased significantly during the study period (p < 0.0001), while use of caspofungin decreased significantly (p < 0.0001). Higher use of third- or fourth- generation cephalosporins was a significant predictor of higher total antifungal use (p = 0.0005); performance of more stem cell or bone marrow transplants was also significantly associated with greater antifungal use. Conclusion Total antifungal use at a sample of U.S. academic health centers increased from 2004 to 2007 but decreased to below baseline in 2008. Azoles were the most commonly used agents. In 2008, total antifungal use at the centers ranged from 29 to 334 DOT per 1000 patient-days.

PMID: 21330683 [PubMed - as supplied by publisher]

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Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system.

Am J Health Syst Pharm. 2011 Mar 1;68(5):434-441

Authors: Fitzhenry F, Doran J, Lobo B, Sullivan TM, Potts A, Feldott CC, Matheny ME, McCulloch G, Deppen S, Doulis J

Purpose Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration (BCMA) system were evaluated. Methods All patients receiving warfarin who were admitted to a university medical center between July 1, 2008, and February 6, 2009, in inpatient units with BCMA systems were candidates for inclusion in this study. Medication-error alerts displayed to the nurse administering the warfarin were reviewed to determine whether a true potential error was detected. Each alert was converted to a scenario, and its potential to require treatment or cause patient harm was rated using a validated severity scale of 0-10, where a score of 0 indicated no probable effect on the patient and 10 indicated that the error would likely result in patient death. A severity score was obtained by averaging the scores of four pharmacist reviewers. Results Of the 18,393 warfarin doses ordered during the study period for 2,404 patients, error alerts associated with only 99 warfarin doses were found to be clinically meaningful. The mean ± S.D. severity rating of these alerts was low (2.93 ± 1.42), with a standardized Cronbach’s coefficient alpha of 0.845. The mean ± S.D. warfarin dose attempted when the nurse received an alert was 4.10 ± 2.48 mg. The majority of doses with alerts (70%) were for patients who had an active order for warfarin. Conclusion Of the large number of medication-error alerts generated through a BCMA system, only a small proportion were considered clinically significant. This indicated that the rate of false-positive alerts was unexpectedly high, increasing the risk of alert fatigue.

PMID: 21330686 [PubMed - as supplied by publisher]

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Effect of serum sodium concentration and tolvaptan treatment on length of hospitalization in patients with heart failure.

Am J Health Syst Pharm. 2011 Feb 15;68(4):328-33

Authors: Cyr PL, Slawsky KA, Olchanski N, Krasa HB, Goss TF, Zimmer C, Hauptman PJ

Purpose The effect of serum sodium concentration and tolvaptan treatment on length of stay (LOS) in patients hospitalized with heart failure (HF) was evaluated. Methods Data for this study were derived from a large, international, Phase III trial of patients hospitalized for HF. Two distinct post hoc analyses were performed, analyzing the association between serum sodium concentration and index hospitalization LOS in normonatremic patients and hyponatremic patients treated with placebo plus standard of care versus tolvaptan. Analysis of covariance models were constructed to adjust for potential variation in care delivery and adjusted for hyponatremia status or treatment. Results Patients with a baseline serum sodium concentration of <135 meq/L who received placebo had an adjusted mean LOS that was 3.06 days longer than did normonatremic patients (p < 0.001). More severely hyponatremic patients had an adjusted mean LOS 5.18 days longer than did normonatremic patients (p < 0.001). In an analysis of all hyponatremic patients, those receiving tolvaptan had an adjusted mean LOS that was 1.72 days shorter than patients receiving placebo, though this difference was not significant. In more severely hyponatremic patients (serum sodium concentration of <130 meq/L), patients treated with tolvaptan had an adjusted mean LOS 2.12 days shorter than those receiving placebo, but this difference was not significant. Conclusion A secondary analysis of a large, international, Phase III trial of patients hospitalized for HF demonstrated that comorbid hyponatremia was associated with a significant increase in hospital LOS. Treatment of hyponatremia with tolvaptan was associated with reductions in LOS that were not significant.

PMID: 21289328 [PubMed - in process]

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Effects of therapeutic drug monitoring criteria in a computerized prescriber-order-entry system on the appropriateness of vancomycin level orders.

Am J Health Syst Pharm. 2011 Feb 15;68(4):347-52

Authors: Traugott KA, Maxwell PR, Green K, Frei C, Lewis JS

Purpose The effects of therapeutic drug monitoring (TDM) criteria in a computerized prescriber-order-entry (CPOE) system on the appropriateness of orders for vancomycin levels were evaluated. Methods Vancomycin TDM criteria were developed and implemented in a CPOE system. These criteria were displayed via a pop-up alert message when vancomycin levels were ordered and included directions for appropriate timing and justification for routine monitoring. Data for two groups of adult inpatients who had vancomycin levels ordered before and after criteria implementation were compared. Medical records were retrospectively reviewed for these patients to collect information regarding patient demographics, vancomycin dosage and indication, concurrent antibiotics and nephrotoxic agents during vancomycin therapy, length of stay, duration of vancomycin therapy, and number of vancomycin levels drawn. The primary outcome was the percent change in appropriate vancomycin levels ordered after criteria implementation. Results A total of 200 patients were analyzed, 100 in each group. The percentage of appropriate orders for vancomycin levels significantly increased after criteria implementation (from 58% to 68%, p = 0.02). The greatest effect on appropriateness occurred with the first level ordered (52% versus 70% in the preimplementation and postimplementation groups, respectively; p = 0.01). The majority of inappropriate levels were due to improper timing of sample collections, accounting for 55% of the inappropriate levels evaluated. Conclusion A significant increase in the number of appropriately ordered and drawn serum vancomycin levels occurred after implementation of TDM criteria in the hospital’s CPOE system. The majority of orders that were deemed inappropriate were due to improper timing of laboratory collection.

PMID: 21289330 [PubMed - in process]

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