Clinical Pharmacist Specialist Research Articles

Impact of an interdisciplinary patient care model and routine screening on clinical outcomes in patients with hepatitis C.

Testing for hepatitis C in hospital emergency departments (ED) and linkage to care to clinics have been reported to provide the most opportunity for screening patients and facilitating continuum of care. Treatment model initiatives have expanded to include telehealth services and open treatment capacity to non-physician providers, such as pharmacists. This study's objective was to assess the impact of implementing automated routine screening for hepatitis C virus (HCV) and a clinical pharmacist into the interdisciplinary care model on HCV diagnosis and treatment outcomes. This retrospective cohort study compared outcomes in a pre-intervention and post-intervention group. Patients were screened and diagnosed with HCV at Jersey City Medical Center (JCMC) and completed linkage to care at JCMC Center for Comprehensive Care. Interventions were the implementation of automated routine HCV screening in the ED and addition of a clinical pharmacist to the interdisciplinary patient care model. Primary endpoints analyzed the number of patients who have achieved sustained virologic response after 12 weeks of treatment (SVR12) and patients who have completed treatment with no reported record of SVR12. Secondary endpoints analyzed the number of patients lost to follow-up, appointment type, time spent in appointments, and clinical pharmacist specialist interventions. Data was collected as categorical variables and chi-squared tests assessed if there were differences between the two samples. Data was collected from 46 patients in the pre-intervention group and 37 patients in the post-intervention group. Patients consisted of mostly males. Ages ranged from 27 to 83 years old. Race included Black, White, Asian, and Other. This study's results showed the positive impact on implementation of routine screening, telehealth services, and an interdisciplinary team approach to HCV diagnosis and management. Given the timeframe, it also showed the potential positive impact on these interventions during a global pandemic.

Memantine associated with parkisonism in a patient with Alzheimer's disease: A case study and the review of the literature

The positive effect of memantine on parkinsonism has been reported widely, but there have not been reports in the literature of parkinsonism, tremor and bradykinesis, induced by memantine, in an Alzheimer's patient, who did not have Parkinson's disease or a history of antipsychotic agents. In this case study, we report parkinsonism, tremor and night bradykinesis induced by memantine use (5 mg daily) in a 83-year-old Slovenian female patient. After memantine discontinuation, suggested by a clinical pharmacist specialist, and switching to donepezil 5 mg, the adverse drug reactions disappeared the next day. This case study may serve to help clinicians and clinical pharmacists distinguish memantine-induced parkinsonism from more serious conditions.

Clinical pharmacist involvement in expanding naloxone distribution in a veteran population.

To describe the process used in a clinical pharmacist specialist (CPS)-led Opioid Overdose Education and Naloxone Distribution (OEND) program initiative to increase naloxone distribution to veterans at high risk for overdose via provider education and identification of barriers to naloxone distribution. Drug overdose is the leading cause of accidental death in the United States. One step toward counteracting the epidemic includes expanding access to and use of naloxone. The Veterans Health Administration has developed initiatives to target veterans at risk for opioid overdose, such as the Veterans Affairs (VA) OEND program. Pharmacists can play a unique role in OEND by both prescribing naloxone and educating patients and providers on risk mitigation strategies. Through provider education, patient education, and facility-wide initiatives, naloxone prescribing was increased by 9-fold from August 2016 to August 2018. In addition, the number of new naloxone prescribers increased by almost 7-fold during the intervention period. Naloxone distribution to high-risk groups drastically increased across all target groups. CPS involvement in promoting OEND at VAPHS drastically increased rates of prescribing of naloxone kits to veterans at risk for opioid overdose. This initiative showed that a CPS can play multiple roles in supporting OEND outreach at a large healthcare setting.

Evaluation of a Clinical Pharmacist Specialist Transition of Care Pathway to Manage Heart Failure Readmissions During a Provider Shortage

Background: Evidence supports scheduling early follow-up after heart failure (HF) hospitalization with a provider capable of managing hypervolemia. Often this service is provided by cardiologists or specialty nurse practitioners. Continuity or “familiar” providers may be better positioned to identify decompensating HF in patients who have advanced HF and/or multiple complicating medical problems. The objective of this study was to evaluate whether a clinical pharmacy specialist (CPS) service, covering the role of a “familiar” provider in an advanced HF specialty clinic (AHFC) during a staffing shortage, may prevent readmission metrics from worsening. Methods: We evaluated the entire, eligible concurrent cohorts, representing 175 AHFC-CPS and 273 control patient-admissions, respectively. Study- and disease-specific predictors for readmission were assessed. A matched cohort of 202 patient-admissions (101 AHFC-CPS:101 NO-CPS) were evaluated. Results: Subjects were predominantly white, elderly males. While overall “clinic [performance] profiling” outcomes for readmissions (p = 0.43) and mortality (p = 0.66) did not statistically differ between the AHFC-CPS and NO-CPS groups, an imbalance in severity of illness persisted. A survival curve and analysis were constructed, and the hazard ratio for all-cause mortality was 0.69 (p = 0.033). Conclusions: This retrospective project supports the premise that AHFC-CPS intervention may be a suitable alternative to maintain the volume status for AHFC patients during a staffing short-fall. More work needs to be done to determine intervention effect size, predictors for readmission, specifically in advanced cardiovascular disease, and to evaluate CPS opportunities in the provision of independent HF care, particularly for patients with advanced HF.

CDC issues guidance on exposure to HCV for health professionals

In late July, CDC released guidance on the testing and clinical management of health care personnel potentially exposed to hepatitis C virus (HCV). The agency noted that the incidence of acute HCV infections among patients is increasing in the United States as a result of risky behaviors such as injection drug use, placing providers at risk for HCV infections if exposed to the blood and other bodily fluids of infected patients. “Testing for occupational exposure for blood- or fluid-borne pathogens is standard practice for many years,” said Rima A. Mohammad, PharmD, FCCP, BCPS, clinical pharmacist specialist in general surgery/gastroenterology/nutrition at the University of Michigan. “This guideline outlines the steps to take specific to HCV occupational exposure, which is similar to any exposure to other blood- or fluid-borne pathogens. Baseline testing of the source patient and the health care provider should occur immediately, preferably within 48 hours of exposure. CDC notes that the source patient should be tested for HCV RNA using a nucleic acid test. However, for low-risk patients, screening for anti-HCV serology (i.e., antibodies) can be done as an alternative, followed by a nucleic acid test if the serology is positive. For providers, testing should include anti-HCV testing, and if positive, HCV RNA testing. If the HCV RNA is positive at baseline, then the provider is considered to have a preexisting HCV infection and should be referred for HCV treatment. If a patient is anti-HCV positive but HCV RNA negative, then follow-up testing for the provider is not required. However, if the patient is HCV RNA positive or if the RNA status of the patient is unknown, then the provider should have follow-up HCV RNA testing 3 to 6 weeks postexposure and a final anti-HCV test 4 to 6 months postexposure as there may be periods of aviremia during acute HCV infection. Postexposure prophylaxis for HCV is not recommended for health care providers who have occupational exposure to blood or other bodily fluids. It is estimated that only 0.2% of percutaneous exposures and 0% of mucocutaneous exposures result in HCV transmission. CDC recommends that curative antiviral regimens be reserved for treatment if confirmed HCV transmission occurs. “Compared to previous HCV treatments, HCV is much easier to treat with the newer therapies that are a shorter duration, [are] well tolerated, and have efficacy rates of more than 95% for a cure or sustained virologic response,” said Mohammad. “Therefore, we can delay HCV treatment until we confirm that the health care provider is positive for HCV. The key difference between hepatitis B virus (HBV) and HCV occupational exposure is that postexposure prophylaxis is recommended after HBV exposure in select situations. “Unfortunately, with other viruses, such as HBV, there is no ‘cure’ for the infection and health care providers may need to be on long-term treatment,” said Mohammad. “Therefore, it is important to treat providers with postexposure prophylaxis (if appropriate) as soon as we confirm that the patient has an HBV infection. Routine use of the HBV vaccination for health care providers, combined with standard precautions, has resulted in a 98% decline in HBV infections over the past 2 decades, according to CDC. For those who are exposed to HBV, CDC has specific recommendations based on the vaccination status of the provider, the anti-HBs levels of the provider (i.e., < or ≥10 mIU/mL), and the status of the source patient. Postexposure recommendations vary based on these factors, but administration of HBIG and the hepatitis B vaccines are listed as options. The HCV and HBV postexposure guidance documents are available on CDC's website. The new HCV information can be used to update procedures for postexposure testing and clinical management of providers potentially exposed to the virus.

Impact of an oncology clinical pharmacist specialist in an outpatient multiple myeloma clinic.

e14030 Background: Improvements in cancer treatment, supportive care, and the approval of oral chemotherapy medications over the past decade have resulted in an increasing number of cancer patients treated in outpatient settings. Transitioning cancer treatments to the outpatient setting places greater emphasis on proper medication counseling and optimal side effect management. Current literature demonstrates improvements in medication adherence and effective cancer related symptom management with the addition of an oncology pharmacist. Historically, the University of Chicago Medical Center (UCMC) has not employed pharmacists into their ambulatory oncology clinics. UCMC is evaluating pharmacist’s roles in these clinics. Methods: The primary objective of this project is to evaluate the clinical and financial impacts of an oncology clinical pharmacist specialist in an interdisciplinary multiple myeloma (MM) clinic. This will be evaluated by monitoring the interventions made by the pharmacist in clinic through a validated scoring tool. This tool associates a value for each type of intervention made based on current literature and internal evaluations at UCMC. The oncology clinical pharmacist specialist will be available for consult by the MM clinic staff. The pharmacist may be consulted for any medication related inquiry. Based on the consult the pharmacist will categorize their interventions into twelve predefined intervention categories. Results: Study results showed the implementation of a clinical pharmacist specialist into the MM clinic over 39 clinic days resulted in 241 patient consults and 474 interventions made by the pharmacist. The most frequent interventions made by the pharmacist were medication teaching (97), dose adjustments by pharmacist (82) and medication reconciliation (63). Based on the dollar values associated with each intervention type, the value of interventions made by the pharmacist during the study period was $189,441 with a predicted annual value of $757,764. Conclusions: An clinical pharmacist specialist in the MM clinic lead to dramatic and sustainable financial and clinical impacts. Further investigation into other oncology clinics is warranted.

Impact of an Oncology Clinical Pharmacist Specialist in an Outpatient Multiple Myeloma Clinic

IntroductionImprovements in cancer treatment and supportive care, as well as the approval of oral chemotherapy medications over the past decade, have resulted in an increasing number of cancer patients being treated in outpatient settings. Transitioning cancer treatments to the outpatient setting places greater emphasis on proper medication counseling and optimal management of adverse effects. We therefore evaluated the clinical and financial impact of an oncology clinical pharmacist specialist in an interdisciplinary multiple myeloma clinic by using a validated scoring tool. MethodsThe oncology clinical pharmacist specialist was available for consult by the multiple myeloma clinic staff. The pharmacist may be consulted for any medication-related inquiry. On the basis of the consult, the pharmacist categorized interventions into 12 predefined intervention categories. ResultsImplementation of a clinical pharmacy specialist into a multiple myeloma clinic over 39 clinic days resulted in 241 patient consults and 474 interventions made by the pharmacist. The most frequent interventions made by the pharmacist were medication teaching (n = 97), dose adjustments (n = 82), and medication reconciliation (n = 63). The value of interventions made by the pharmacist during the study period was $189,441, with a predicted annual value of $757,764. ConclusionThe addition of an oncology pharmacist to an outpatient multiple myeloma clinic can improve clinical and financial outcomes.

Polypharmacy as a Clinical Pharmacist Specialist Practice

The objective of this manuscript is to review an ambulatory care pharmacist service that evolved into a pharmacotherapy, polypharmacy service with multiple submodels. The practice is located in a multispecialty, tertiary care, destination medical clinic in Florida. Ambulatory care pharmacist services have evolved to demand expertise in multiple, specialized areas to address the more complex medical issues of the polypharmacy patient. Many of these patients are older than 65 years of age, with broad medical care needs. A number of changes have led to the need for these expanded services: the growth and diversification of pharmacists' ambulatory care services, the multitude of sophisticated medications, the continued direct-to-consumer commercialization, the growth of dietary supplements, and the implementation of pharmacogenomic testing, In addition, new advances in clinical and laboratory technologies make polypharmacy a viable pharmacist clinical specialty. With the broad knowledge base needed for these patients, a polypharmacy pharmacist may function as a pharmacology troubleshooter expert.

Intracranial Infection Mimics Acute Stroke in an Adolescent Male

An 18-year-old male adolescent was brought to the emergency department by ambulance from a residential substance use disorder treatment program. His chief complaint was weakness. Medics reported that approximately 2 hours prior to arrival at the emergency department, the patient told program staff that he had weakness in his right hand and a headache. The patient maintained normal vital signs during transport and demonstrated no objective neurologic deficits. The patient’s medical history included polysubstance use disorder (alcohol, marijuana, and benzodiazepines), migraine headaches, and a recent sinus infection. The patient reported that he recently completed treatment for the sinus infection with an unknown antibiotic. The medics reported that the patient had no known use of tobacco products, inhalants, cocaine, or methamphetamines but that previously he may have used IV drugs. The patient had no known history of immunosuppression, hospitalizations, surgeries, or trauma. Current medications included acetaminophen, ibuprofen, and gabapentin for chronic headache pain. Cristy L. Galvin, Member, Massachusetts ENA Mayflower Chapter, is Emergency Department Per Diem Staff Nurse, Tufts Medical Center and Floating Hospital for Children, Boston, MA, and Family Nurse Practitioner (MSN) Graduate, University of Massachusetts, Boston, MA. Patricia A. Normandin, Member, Massachusetts ENA Beacon Chapter, is Emergency Department Staff Nurse, Tufts Medical Center and Floating Hospital for Children, Boston, MA, and Adjunct Nursing Faculty, Massachusetts General Hospital Institute of Health Professions, Boston, MA. Karolyn S. Horn is Clinical Pharmacist Specialist, Tufts Medical Center and Floating Hospital for Children, Boston, MA. Justin C. Popso is Emergency Physician, Tufts Medical Center and Floating Hospital for Children, Boston, MA, and Member of the American College of Emergency Physicians.

New October 2018 Malignant Hyperthermia Guidelines: Is Your Emergency Department Prepared?

While working in the emergency department, you may be the nurse for a 6-year-old girl with status epilepticus who requires emergency intubation with weight-based etomidate or ketamine. 1 Agrawal D. Rapid sequence intubation (RSI) outside the operating room in children: approach. https://www.uptodate.com/contents/rapid-sequence-intubation-rsi-outside-the-operating-room-in-children-approach?search=rapid-sequence-intubation-rsi-outside-the-operating-room&source=search_result&selectedTitle=2∼150&usage_type=default&display_rank=2. Updated July 23, 2018. Accessed January 2, 2019. Google Scholar Later, the charge nurse assigns you a 9-year-old boy with status asthmaticus who requires intubation with weight-based succinylcholine. 1 Agrawal D. Rapid sequence intubation (RSI) outside the operating room in children: approach. https://www.uptodate.com/contents/rapid-sequence-intubation-rsi-outside-the-operating-room-in-children-approach?search=rapid-sequence-intubation-rsi-outside-the-operating-room&source=search_result&selectedTitle=2∼150&usage_type=default&display_rank=2. Updated July 23, 2018. Accessed January 2, 2019. Google Scholar Which intubation drugs will trigger malignant hyperthermia (MH)? Are you prepared to recognize, intervene, and provide follow-up care to children in the emergency department who are experiencing MH? Patricia A. Normandin, Member, Massachusetts ENA Beacon Chapter, is ED Staff Nurse, Tufts Medical Center, Boston, MA, and Adjunct Nursing Faculty, Massachusetts General Hospital, Institute of Health Professions, Boston, MA. Stacey A. Benotti is Clinical Pharmacist Specialist, Pediatric and Adult Emergency Department, Tufts Medical Center, Boston, MA.

PO499 Awareness of Cardiovascular Risk Factors In Patients With High/Very High Cardiovascular Risk

Comprehensive programs addressing tailored patient self-management and pharmacotherapy may reduce barriers to cardiovascular disease (CVD) risk reduction.This is a 2-arm (clinical pharmacist specialist–delivered, telehealth intervention and education control) randomized controlled trial including Veterans with poorly controlled hypertension and/or hypercholesterolemia. Primary outcome was Framingham CVD risk score at 6 and 12 months, with systolic blood pressure; diastolic blood pressure; total cholesterol; low-density lipoprotein; high-density lipoprotein; body mass index; and, for those with diabetes, HbA1c as secondary outcomes.Among 428 Veterans, 50% were African American, 85% were men, and 33% had limited health literacy. Relative to the education control group, the clinical pharmacist specialist–delivered intervention did not show a reduction in CVD risk score at 6 months (−1.8, 95% CI −3.9 to 0.3; P = .10) or 12 months (−0.3, 95% CI −2.4 to 1.7; P = .74). No differences were seen in systolic blood pressure, diastolic blood pressure, or low-density lipoprotein at 6 or 12 months. We did observe a significant decline in total cholesterol at 6 months (−7.0, 95% CI −13.4 to −0.6; P = .03) in the intervention relative to education control group. Among patients in the intervention group, 34% received at least 5 of the 12 planned intervention calls and were considered “compliers.” A sensitivity analysis of the “complier average causal effect” of intervention compared to control showed a mean difference in CVD risk score reduction of 5.7 (95% CI −12.0 to 0.7) at 6 months and −1.7 (95% CI −7.6 to 4.8) at 12 months.Despite increased access to pharmacist resources, we did not observe significant improvements in CVD risk for patients randomized to the intervention compared to education control over 12 months. However, the intervention may have positive impact among those who actively participate, particularly in the short term.

Utilizing Clinical Pharmacist Specialist to Manage Hepatitis C Virus Patients on Direct-Acting Antiviral Therapy

Objectives: To evaluate outcomes of a clinical pharmacist specialist (CPS)-managed hepatitis C virus (HCV) treatment clinic (HCVTC) in treating HCV-infected veterans with direct-acting antivirals (DAAs). Methods: We established a CPS-managed HCVTC under a collaborative practice agreement with our infectious disease physician (IDP). A total of 132 veterans were treated between November 1, 2014, and November 30, 2015. The CPS engaged in pretreatment screening, drug selection, patient education, medication counseling, drug therapy monitoring, drug utilization review, addressing issues on drug adherence, and routine and posttreatment follow-up of patients to assess sustained virologic response (SVR) after 12 weeks of treatment. Results: Of 132 patients managed by the CPS, 87 (66%) were treated with ledipasvir/sofosbuvir (LDV/SOF), 29 (22%) with paritaprevir/ritonavir/ombitasvir + dasabuvir (PrOD), and 16 (12%) with sofosbuvir (SOF)-based regimen. The corresponding regimens demonstrated a SVR rate of 92% (n = 80), 100% (n = 29), and 93.8% (n = 15), respectively. We achieved an SVR rate of 94% against HCV genotype 1 (GT-1) and 100% against GT-2 to GT-4. The overall SVR rate was 94% across regimens, showing 93% in treatment-naive patients and 96% in treatment-experienced patients, and 93% in noncirrhotic and 94% in compensated cirrhotic patients. The results were comparable to SVR data reported in pivotal trials for DAAs. Conclusion: The results suggest that CPS could be effectively utilized in drug therapy management of HCV-infected patients treated with DAAs.

Telemedicine cardiovascular risk reduction in veterans: The CITIES trial

BackgroundComprehensive programs addressing tailored patient self-management and pharmacotherapy may reduce barriers to cardiovascular disease (CVD) risk reduction. MethodsThis is a 2-arm (clinical pharmacist specialist–delivered, telehealth intervention and education control) randomized controlled trial including Veterans with poorly controlled hypertension and/or hypercholesterolemia. Primary outcome was Framingham CVD risk score at 6 and 12 months, with systolic blood pressure; diastolic blood pressure; total cholesterol; low-density lipoprotein; high-density lipoprotein; body mass index; and, for those with diabetes, HbA1c as secondary outcomes. ResultsAmong 428 Veterans, 50% were African American, 85% were men, and 33% had limited health literacy. Relative to the education control group, the clinical pharmacist specialist–delivered intervention did not show a reduction in CVD risk score at 6 months (−1.8, 95% CI −3.9 to 0.3; P = .10) or 12 months (−0.3, 95% CI −2.4 to 1.7; P = .74). No differences were seen in systolic blood pressure, diastolic blood pressure, or low-density lipoprotein at 6 or 12 months. We did observe a significant decline in total cholesterol at 6 months (−7.0, 95% CI −13.4 to −0.6; P = .03) in the intervention relative to education control group. Among patients in the intervention group, 34% received at least 5 of the 12 planned intervention calls and were considered “compliers.” A sensitivity analysis of the “complier average causal effect” of intervention compared to control showed a mean difference in CVD risk score reduction of 5.7 (95% CI −12.0 to 0.7) at 6 months and −1.7 (95% CI −7.6 to 4.8) at 12 months. ConclusionsDespite increased access to pharmacist resources, we did not observe significant improvements in CVD risk for patients randomized to the intervention compared to education control over 12 months. However, the intervention may have positive impact among those who actively participate, particularly in the short term.

Review of Clinical Handbook of Psychotropic Drugs for Children and Adolescents, 3rd Ed., edited by Dean Elbe, Kalyna Z. Bezchlibnyk-Butler, Adil S. Virani, and Ric M. Procyshyn

[Author Affiliation]Malgorzata Maria Relja. 1 Department of Psychiatry, Dalhousie University, Fredericton, New Brunswick, Canada.Mira Sachdev. 2 A4 - Private Practice, Titusville, Florida.ISBN: 0.88937.456.2. Boston, MA, Hogrefe Publishing, 2014, 362 pages.Address Correspondence to: Malgorzata Maria Relja, MD, Department of Psychiatry, Dalhousie University, 65 Brunswick Street, Fredericton, NB E3B 1G5, Canada, E-mail: margaret.relja@gnb.caMira Sachdev, MD, Private Practice, 860 Century Medical Drive, Titusville, FL 32796, E-mail: mira.sachdev@gmail.comFor most child and adolescent psychiatrists, psychopharmacology is challenging because of the need to stay current while new information is constantly added. Psychotropic medications are powerful agents that treat many disorders, but also can impose a great risk if not used accordingly. We need to keep dry minutiae in our knowledge base and, therefore, there is a great value of a book to serve as a practical resource guide to quickly access relevant information.Dean Elbe, PharmD, a Canadian clinical pharmacist specialist at British Columbia Children's Hospital and colleagues have written a user-friendly book about prescribing psychotropic medications for children and adolescents. This handbook contains prescribing information for the United States and Canada. It fills a void for Canadian practitioners since most other psychopharmacology books readily available in North America only contain prescribing information for the United States. This book is targeted toward multiple disciplines, including child and adolescent psychiatrists, pediatricians, and nurses. Also this book acknowledges indications for adults and is suitable as an adult reference. FDA-approved indications for children and adolescents are emphasized, but nonapproved indications are also included.This book makes dry material more interesting and is pleasing to the eye. There are several things that make this book different from other psychopharmacology resources as opposed to an online reference. As it is spiral bound with text written in landscape format, it is easy to lay the book flat and read both pages at once. As a book, it can be left open on the table; it does not require toggling between screens as with a computerized medical record. Thus, it is easy to highlight and make notations on paper. There are online resources available, but they do not have the easy digestibility of this color-coded volume.The majority of the book is organized into chapters per class of drugs, such as chapters on antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics/sedatives, and drugs for attention-deficit/hyperactivity disorder (ADHD). There are chapters dedicated to drugs/substances of abuse and its substance abuse treatment, electroconvulsive therapy, unapproved treatments of psychiatric disorders, and natural health products. In each chapter there are color-coded sections such as Indications, Dosing, Pharmacokinetics, Switching Formulations, Adverse Effects, Discontinuation Syndrome, Contraindications, Toxicity, Monitoring, Use in Pregnancy, and Nursing Implications. There is also a set of caregiver information sheets available online.Many of the chapters function as review articles about a class of medications. Basic psychopharmacology is covered well. For example, the chapter on antipsychotics contained an excellent clinical description of dopaminergic rebound in two sentences. If a high D2 affinity medication (e.g., risperidone) is abruptly replaced with a low D2 affinity medication or a rapid on/off fast-dissociating antipsychotic (e.g., quetiapine) or a partial D2 agonist (e.g., aripiprazole), dopaminergic rebound may result. In the mesolimbic tract, this could lead to supersensitivity psychosis; in the nigrostriatal tract, treatment-emergent EPS and TD may materialize (p. 194).The many tables in each chapter are one of the best features. …

Abstract WP327: Implementation of a Pharmacist Driven Comprehensive Stroke Education Program

Background: Stroke education (SE) is an important quality measure that has been shown to be inconsistently provided and ineffectively delivered. In response we have developed a pharmacist driven stroke education program (SEP) for patients admitted with stroke/TIA. Here, we describe the development, implementation, and encounters from this initiative. Methods: A stroke service team (SST) consisting of a board-certified cerebrovascular physician, cerebrovascular fellows, and a clinical pharmacist specialist (CPS) was established at the VA Greater Los Angeles Healthcare System. The CPS is alerted when any stroke/TIA patients are admitted and follows the patient until time of transfer/discharge. At that time, most diagnostic studies are complete and a likely stroke etiology has been determined, allowing for the development of a patient centered comprehensive stroke care and prevention plan based on individualized stroke risk factor analyses with input from interdisciplinary fields including the SST, rehabilitation specialists, and speech therapists. SE is provided at the time of discharge and addresses risk factors for stroke, stroke warning signs, activation of emergency medical services, need for follow-up after discharge and medications prescribed. The CPS also reviews stroke location, nature and quality of the stroke, and relays the initial patient centered comprehensive care plan to the patient in patient-level language. Visual aids assist in educating patients and a personalized education sheet is provided. The CPS is also responsible for documentation of SE for future evaluation of process measures. Results: Consistent implementation of the pharmacist driven comprehensive stroke education program (SEP) began in July 2013. To date, there have been 172 SE encounters documented. Quality improvement audits indicate close to 100% of all patients admitted for stroke receive SE. Conclusions: Here we show the successful implementation of a pharmacist driven comprehensive SEP designed to improve patient satisfaction/knowledge and improve hospital adherence to stroke quality measures. As pharmacists are trained to communicate with medical personnel and patients, they may be the ideal candidate to provide comprehensive and quality SE.

Detecting and managing drug-related problems in the neurology ward of a tertiary care teaching hospital in Iran: A clinical pharmacist's intervention.

Objective:Nowadays, the role of clinical pharmacists has become more prominent by more clinical pharmacists joining the health-care teams. This study was aimed to assess the role of a clinical pharmacist specialist in detecting and managing drug-related problems (DRPs) in the neurology ward of a tertiary care teaching hospital in Iran.Methods:This is a prospective cross-sectional study conducted on 123 hospitalized patients admitted to the neurology ward of a teaching hospital. The clinical pharmacist visited the patients and filled out the designed pharmacotherapy sheet for each patient. Then, the general pharmacist checked the patients' files and pharmacotherapy sheets and categorized DRPs using modified method of “The Pharmaceutical Care Network Europe classification, Version 5.01.”Findings:A total of 168 errors were found and 346 interventions were done by the clinical pharmacist during the study period. The most common form of errors in our study was “drug choice problems” (57.76%). The acceptance rate of interventions was 41.91% among physicians.Conclusion:The large number of interventions reported in several studies, as well as this study, revealed that clinical pharmacy services could contribute to a rationalization of drug therapy and may eventually lead to more medication safety.

Impact of a Multidisciplinary Heart Failure Post-hospitalization Program on Heart Failure Readmission Rates.

Specialized chronic heart failure (HF) clinics have demonstrated significant reductions in readmissions. Limited evidence is available regarding HF clinics in the immediate post-discharge period. To evaluate the effect of a multidisciplinary HF clinic on 90-day readmission rates and all-cause mortality in those recently discharged from a HF hospitalization. In this retrospective cohort study, patients discharged with a primary HF diagnosis who attended the HF postdischarge clinic in 2010-2012 were compared with controls from 2009. During 6 clinic visits, patients were seen by a physician assistant, clinical pharmacist specialist, and case manager, with care overseen by a cardiologist. The program focused on optimizing therapy, identifying HF etiology/precipitating factors, medication titration, education, and medication adherence. The primary outcome was 90-day HF readmission. A multivariate Cox proportional hazards model was used to compare outcomes. Among the 277 patients (144 clinic, 133 control) in the study, 7.6% of patients in the clinic and 23.3% of patients in the control group were readmitted for HF within 90 days (aHR (adjusted hazard ratio) = 0.17; 95% CI = 0.07-0.41; P < 0.001; ARR (absolute risk reduction) = 15.7%; NNT (number needed to treat) = 7). Clinic patients had lower 90-day time-to-first HF readmission or all-cause mortality (9.0% vs 28.6%; aHR = 0.28; 95% CI = 0.06-0.31; P < 0.001; ARR = 19.6%; NNT = 6). The multidisciplinary HF posthospitalization outpatient program was associated with a significant reduction in 90-day HF readmissions in patients who were recently discharged from a HF hospitalization.

PPAG 2012 Board Election Results

PPAG 2012 Board Election Results

Method to determine allocation of clinical pharmacist resources

An objective methodology to guide decisions by hospital pharmacy departments on the best use of clinical pharmacist personnel is described. To help determine the optimal deployment of state-licensed Clinical Pharmacist Specialist (CPS) staff, a task force led by the pharmacy department at University of North Carolina (UNC) Hospitals developed an objective approach to evaluating the relative need for and potential impact of CPS expertise within the medical center's many service units. After analyzing several years of patient census and medication-use data and using information from proprietary databases (Thomson Reuters) to calculate a "service-specific pharmacy intensity score" for each hospital service, the task force identified five staff-allocation metrics best suited to the medical center's service-based pharmacy coverage model. By applying the methodology, it was determined that CPS expertise was most needed in the UNC Hospitals adult medicine oncology service, the bone marrow transplant service, and the medical and neonatal intensive care units. The tool was initially used to validate the pharmacy department's existing human resource allocation and has since been used to guide budgeting for and deployment of newly added CPS positions. A novel tool to guide the application of pharmacy human resources incorporates the objective criteria of patient census, patient acuity, teaching involvement, drug expenditures, and use of high-risk medications. The tool can be used to determine the appropriate allocation and placement of clinical pharmacist resources in a service-based coverage model.

Pharmacist salaries and hiring practices in teaching hospitals

A survey of selected teaching hospitals was conducted in early 1990 to determine salary ranges for pharmacist positions, salaries at which pharmacists were typically hired for these positions, differences in salary between clinical practitioner and managerial positions, and geographic differences in these salaries. Surveys were mailed to 50 members of the University Hospital Consortium (UHC) and 50 other university-affiliated and non-university-affiliated hospitals believed to be comparable to the investigators' hospital. Hospital capacity and census data, numbers of pharmacist and support staff positions, qualifications preferred and required for those positions, and salary information were requested. Data from 22 UHC hospitals and 23 non-UHC hospitals were evaluated. Relative to average daily census, UHC hospitals indicated higher pharmacist staffing levels and non-UHC hospitals reported higher support staff levels. More non-UHC hospitals than UHC hospitals (69.2% versus 43.5%) used an integrated model for delivery of clinical and distributive services. Nationally, the reported annual salaries were as follows: staff pharmacist, $34,881 to $47,906; clinical pharmacist, $37,768 to $51,564; clinical specialist, $38,905 to $55,282; supervisor, $39,905 to $54,416; assistant director, $43,554 to $58,758. Overall, typical hire rates (THRs) exceeded mean minimum salaries by about 10%. The percentages by which THRs exceeded mean minimum salaries were greatest in the West for staff pharmacist, clinical pharmacist, and clinical specialist positions and greatest in the Midwest for supervisor and assistant director positions. THRs for supervisors and assistant directors exceeded those for clinical specialists. Respondents' preferences varied regarding advanced education and training, and their actual requirements did not match their stated preferences.(ABSTRACT TRUNCATED AT 250 WORDS)