Clinical Pharmacy Research Articles

Interprofessional Coproduction of Diagnosis with Medical and Pharmacy Students: An Interactive Case-Based Workshop.

The Institute of Medicine and national competencies emphasize the importance of interprofessional education to reduce diagnostic error. Clinical pharmacists are increasingly integrated into clinical teams and participate in the diagnostic process. However, few educational resources explicitly teach medical and pharmacy students to collaborate on the production of diagnoses. We implemented a 2-hour, online, case-based workshop with 154 second-year medical students and third-year pharmacy students. After brief didactics on the diagnostic process and scope of practice of pharmacists, small groups of eight to 12 medical and pharmacy students with faculty facilitators worked through a case unfolding in two aliquots. Students were provided different but complementary information authentic to their profession. They had to communicate with each other to develop an appropriate differential diagnosis. Students then reflected on how communicating with the other profession impacted their diagnostic reasoning. Comments were coded and counted. The majority (99%) of students identified their data gathering and differential diagnoses were impacted by working through the case together. More pharmacy students commented on how medical students broadened their differential diagnosis (71%) and added information (72%), contextualizing information, such as past history, medication indications, and physical exam data. More medical students commented on how pharmacy students helped justify (54%) and clarify (22%) the differential diagnosis, often connecting the underlying mechanism of medications with clinical findings. This interactive case-based workshop was effective in teaching medical and pharmacy students to collaborate in the coproduction of diagnosis. It is feasible with minimal resources.

Serving as a professional association board member: Benefits to leaders and their employers

AbstractThis commentary, written by past presidents of the American College of Clinical Pharmacy, highlights the benefits of serving in leadership roles within professional associations to the leaders themselves, their employers, their colleagues, and the broader profession. Fostering the development of leaders is a necessary step to advance pharmacy's future. Leaders benefit not only from the reinvigoration and personal growth associated with their service effort but also from the further development of skills such as collaboration and consensus‐building, written and oral communication, critical thinking, leadership, and time management. The honing of these skills has benefits at the leader's workplace. Colleagues in businesses outside health care view this type of leadership experience as external training to develop and refine organizational communication and leadership skills and better prepare their employees for the future. The leader also learns best practices and new perspectives that, when shared locally, can energize the employer organization. Beyond the benefits to the leader and the leader's employer, there are holistic benefits of association service to the profession and interprofessional teams. With this in mind, we suggest that employers welcome opportunities to have their coworkers serve in elected or appointed positions within professional associations.

Development of an innovative clinical pharmacy service in a urology surgical unit: a new initiative from Qatar.

To provide an insight into the role of a clinical pharmacy initiative in a surgical urology unit through evaluating the nature, significance, associated medications, and acceptance rate of pharmacist interventions. A cross-sectional study was carried out at the Ambulatory Care Center (ACC), Doha, Qatar. Data related to clinical pharmacist interventions and associated rationale were classified according to the nature of the intervention using an adapted classification system. The assessment of the severity followed the National Patient Safety Agency (NPSA) Risk Matrix. Linear regression, Kruskal-Wallis, and post-hoc analyses were performed to determine the association between patient-related and medication-related characteristics on pharmacist interventions. A total of 3284 interventions (on 1486 patients) were analysed. Most patients (n = 1105; 74.4%) had 1-2 interventions. Age and gender showed a positive linear correlation with the number of interventions per patient (p < 0.01). Majority of interventions were related to pharmacological strategy (n = 1858; 56.6%) and quantity of drug (n = 821; 25%). Additional drug therapy (n = 748; 22.78%) was the most common subcategory followed by optimum dose/frequency (n = 691; 21.04%) and discontinuation of medications (n = 352, 10.72%). Anti-infectives were the most identified drug category (n = 798, 55.1%). Most interventions (59.4%) were of moderate significance; patients with moderate interventions were found to be older compared to patients with minor interventions (p = 0.032). Prescribers' acceptance rate was high (>90%), with a notable increase of 6.6% from 2021 to 2023. This study showed that the clinical pharmacy service in the urology surgical field was a fruitful initiative. The clinical pharmacist's role has expanded to include not only therapeutic optimisation while ensuring medication safety across the continuum of perioperative care but also the identification and management of untreated health problems. The dynamic and complexity of the urology patient population challenge clinical pharmacists; however, the practice concepts remain the same as in any other clinical setting.

Evaluation of knowledge and attitude concerning augmented renal clearance among physicians and clinical pharmacists in Al-Ain, UAE: A cross-sectional study

Background Kidney function assessment is crucial in critical illness patients and is required before administering renally excreted medication, especially antibiotics and antiepileptics. Conventional clinical practice often focuses on renal impairment with low creatinine clearance (CrCl) and overlooks the augmented renal clearance (ARC), which is defined by (CrCl) more than 130 ml/min. This typical demonstration neglects individuals who experience hyperfunctioning kidneys. Among critically ill patients, the prevalence of (ARC) is approximately 20% to 65% of cases. This study aims to evaluate physicians’ and clinical pharmacists’ knowledge about ARC-associated risk factors, antibiotic regimen modification in ARC patients, and attitudes towards ARC workshops and guidelines in Al-Ain, UAE. Methods A cross-sectional, online self-administered survey-based study was designed to achieve this study’s aim. The questionnaire was constructed on profound literature analysis, validated, and piloted. The survey was emailed to physicians and pharmacists working in two hospitals, private and governmental, and distributed through different social media platforms over three months, December 2022—February 2023. Results Of the 92 complete responses (32 clinical pharmacists, 60 physicians), 57 (61.9%), were aware of ARC, but 72 (78%) demonstrated poor knowledge overall. Clinical pharmacists had a higher mean rank of knowledge than the physician’s group. Meanwhile, 70 (76.1%) participants were unaware of the eGFR threshold to determine ARC. There is a noticeable positive attitude toward seeking more information about antibiotic dose adjustment in ARC patients at 85 (92%) of the respondents. Remarkably, only 28 (30.4%) were directly involved with ARC patients’ treatment plans. Conclusion In conclusion, clinical pharmacists showed better knowledge than physicians. However, overall, the participating healthcare providers lacked knowledge about ARC, so a reliable source of information regarding ARC should be utilized. Future research could explore the implementation of professional development workshops for healthcare providers and national guidelines and then assess their impact on patient outcomes.

A Pilot Project to Implement a Pharmacist-Managed Remote Blood Pressure Monitoring Service

Background: Clinicians often hesitate to adjust antihypertensive medications based solely on clinic blood pressure (BP) readings. Limitations to obtaining home readings include access to sphygmomanometers and ability to provide accurate, reliable readings upon follow-up. Objective: This study examined whether an online platform linked to remote BP monitoring improved BP management and facilitated effective clinical interventions by pharmacists. Methods: Thirty patients with uncontrolled hypertension were enrolled and provided a remote BP monitor for home use. BP data downloaded to an online platform were monitored by two clinic pharmacists. Daily BP checks were requested (up to twice daily), and pharmacists called patients approximately weekly for 6 months. Through approved protocols, pharmacists individualized interventions to improve patient care. Descriptive statistics were used for demographic and clinical data. Results: The average systolic BP reduction was 39 mmHg (IQR = 17-52.5) for the 21 patients included in analysis. A target BP &lt;140/&lt;90 was achieved by 67%, and 76% had improved BP control. Patients utilized the cuff 2-4 times (n = 10) or &gt;5 times weekly (n = 11). Through 261 patient contact attempts, the pharmacists requested more BP checks (n = 62), changed medications (n = 57), or provided non-pharmacologic counseling (n = 24) most often. Medication changes commonly included dose increases (n = 35) and additional agents (n = 17) for BP control. Spironolactone (n = 5) and thiazide diuretics (n = 5) were the most added medications. Conclusions: Most patients were willing to check their BP when provided with devices. The majority achieved a clinically significant decrease in home BP readings, demonstrating that pharmacist-driven home-monitoring programs can improve the optimization of hypertension regimens.

Establishment of an Antimicrobial Stewardship Program to Spare the Use of Oral Fluoroquinolones for Acute Uncomplicated Cystitis in Outpatients.

The increase in fluoroquinolone (FQ)-resistant Escherichia coli (EC) is a serious global problem. In addition, much of acute uncomplicated cystitis (AUC) cases are caused by EC. FQs have been selected for the treatment of cystitis in outpatients, and there is concern about treatment failure. It is therefore necessary to select appropriate antimicrobials to spare FQs. However, there are few reported effective antimicrobial stewardship programs (ASPs) for outpatients. We aimed to establish the effective ASP for outpatients diagnosed with AUC caused by EC, to spare the use of FQs, and to explore optimal oral antimicrobials for AUC. The study subjects were outpatients treated for AUC caused by extended-spectrum β-lactamase-non-producing EC (non-ESBL-EC). Based on the antibiogram results, we recommended cefaclor (CCL) as the initial treatment for AUC, and educated clinical pharmacists who also worked together to advocate for CCL or cephalexin (CEX) prescriptions. FQ usages decreased, and cephalosporin (Ceph) prescriptions increased in all medical departments. The Ceph group (n = 114; CCL = 60, CEX = 54) in the non-FQ group had fewer treatment failures than the FQ group (n = 86) (12.3% vs. 31.4%). Cephs, including CCL and CEX, were effective treatments for AUC caused by non-ESBL-EC. Antimicrobial selection based on antibiogram results and the practice of an ASP in collaboration with clinical pharmacists were useful for optimizing antimicrobial therapy in outpatients.

Pharmacoeconomic and clinical impact of pharmaceutical service in the intensive care unit: a systematic review

Clinical pharmacy is a fast-growing discipline in Europe, ensuring optimisation and a guarantee of safety in therapeutic management. Within a hospital the intensive care unit (ICU) typically admits the most...

Comparison of clinical pharmacist practitioners' headache care roles across clinical contexts within the Veterans Health Administration: Optimizing pharmacist integration.

Studies show interdisciplinary treatment is highly effective for addressing chronic pain syndromes, including headache disorders. Increasingly, advanced practice pharmacists work collaboratively with physicians to apply their unique skills to enhance patient outcomes. This qualitative study aimed to elucidate the potential in the Veterans Health Administration (VHA) for increased roles of clinical pharmacist practitioners (CPPs)-advanced practice pharmacists with a scope of practice-in collaborative, interdisciplinary headache care teams. Our research question was: How do CPPs integrate with interdisciplinary headache care teams in Headache Centers of Excellence (HCoE) and non-HCoE VHA facilities, and how can their roles be configured to optimize headache specialty care services? This cross-sectional qualitative study used purposive sampling to recruit CPPs providing headache care within HCoEs and in non-HCoE VHA facilities for virtual, recorded, individual interviews. Multi-stage qualitative data analysis entailed: team discussions; immersion/crystallization for close reading of transcripts to identify emerging patterns of HCoE/non-HCoE comparison of CPPs' experiences; team data sorting using spreadsheets; and further immersion into sorted data for final identification of comparisons and interpretation of the data. A total of 15 CPPs involved in headache care were interviewed, with about half working in HCoEs and half in non-HCoE VHA facilities across the United States. CPPs' roles within and outside HCoEs have considerable overlap as both groups co-manage patients with headache with physicians. CPPs have independent and collaborative responsibilities as they extend headache specialists' services by providing direct patient care and referring to additional providers for headache treatment. When their roles differ within and outside HCoEs it is largely due to level of integration on interdisciplinary headache or pain teams. CPPs in HCoEs collaborate with headache neurologists and interdisciplinary teams; some outside HCoEs do as well, while others work with primary care. CPPs' weekly time dedicated specifically to headache tends to be greater in HCoEs. Nevertheless, most interviewees in both groups stated patient need exceeds CPP availability at their facilities for conducting detailed chart reviews, initial visits to understand the context of patients' headache, and scheduled follow-ups over time to monitor and adjust treatment. CPPs also consult with and educate physicians on headache pharmacy, particularly regarding appropriate use of non-formulary medications. Findings from this study suggest that CPPs' roles in headache care are valuable to clinical colleagues and their patients and should be leveraged and expanded within HCoEs and non-HCoE VHA facilities. When substantively integrated into interdisciplinary headache care teams, CPPs offer unique knowledge, headache management and patient behavior change skills, extend headache specialists' services, and provide both patient and physician education. These combined responsibilities contribute to enhancing patient outcomes and facilitating ongoing access to high quality, evidence-based headache care.

Development of a medication review intervention by seconding a hospital pharmacist to primary care

BackgroundMedication reviews (MRs) are a well-described initiative that improves health outcomes for polypharmacy patients. However, there is limited knowledge about the performance of medication reviews carried out in general practice especially under the leadership of hospital clinical pharmacists. When developing complex interventions, such as MRs, it is essential to describe the development process to ensure transparency and avoid research waste. ObjectiveThus, this study aimed to describe the steps of developing a new MR intervention targeting general practice to ensure transparency and transferability. MethodsA stepwise approach inspired by the Medical Research Council framework was utilised in the process, covering two of the phases, i.e., development and feasibility, divided into four steps: 1) intervention drafting by a literature search, 2) expert opinion, 3) pilot testing in general practice clinics, and 4) evaluation of quantitative MR data. ResultsBased on the results from the first three steps, four main themes which influenced the success of the MR intervention were identified: general practitioner resources, patient involvement, implementation difficulties and interdisciplinarity. These themes guided the pilot evaluation in step four. ConclusionA new feasible, complex MR intervention utilising clinical pharmacists in general practice involving hospital clinical pharmacists in a real-life setting was developed.

Prevalence of inappropriate antibiotic doses among pediatric patients of inpatient, outpatient, and emergency care units in Bangladesh: A cross-sectional study.

The heterogeneous pediatric populations, their physiological differences, along with the necessity of performing additional dose calculation, make the pediatric population more vulnerable to the incidences of inappropriate antibiotic doses. This study was conducted to examine and evaluate the appropriateness of antibiotic doses. A cross-sectional study with a quantitative approach was conducted in three hospitals located in Savar from January 06, 2021 to October 17, 2022. This study had used a convenient sampling method to collect 405 filled prescription orders from heterogeneous pediatric patients prescribed by physicians from emergency, inpatient, and outpatient care units of various clinical settings. The Harriet Lane Handbook was used as reference to investigate inappropriate doses of antibiotics. Subsequently, all analyses were conducted using the RStudio 1.3.959 software. Binary logistic regression was used to assess the risk of inappropriate antibiotic prescription in pediatrics. The overall prevalence of inappropriate antibiotic dosing in pediatrics was 335 out of 545 (61.5%). Overdosing (36.3%) and oral antibiotic prescriptions (64%) were more common than underdosing (20.4%) and parenteral antibiotics (36%). The majority (230 out of 405, 56.8%) of pediatric patients had prescriptions with inappropriate antibiotic doses, with prevalence rates of 33.8% for inpatients, 86.7% for outpatients, and 50% for emergency pediatrics. The results also indicated that pediatric patients in outdoor and emergency care units, infants, toddlers, and early childhood, those prescribed two antibiotics simultaneously, and those receiving parenteral antibiotics, were less likely to have inappropriate antibiotic dosages in their prescriptions. This study demonstrated that about one out of every two prescriptions had inappropriate antibiotic doses; in particular, prescriptions containing only one antibiotic exhibited a substantial proportion of inappropriate antibiotic doses. Inappropriate antibiotic doses may result in therapeutic failure, patient harm, and antibiotic resistance. Good clinical pharmacy practice and careful adherence to pediatric dosing standards may minimize inappropriate antibiotic doses.

Enhancing Transitions of Care: A Cross-Sectional Observational Study on the Role of Clinical Pharmacists in Transition Management in a Latin American Hospital.

Background The seamless management of transitions of care (TOC) is necessary for patient safety, as it directly correlates with a heightened risk of medication errors and adverse effects. Clinical pharmacists emerge as key stakeholders in optimizing medication management during TOC, specifically during hospital admission and discharge, through the implementation of innovative programs that contribute significantly to the mitigation of medication errors and improve patient satisfaction. Aim This study aims to assess the benefits of pharmacist-led interventions in a Costa Rican private hospital's TOC program for polymedicated and high-risk patients during admission and discharge by identifying and addressing medication errors. Methods A cross-sectional observational study was conducted at Clínica Biblica Hospital in San José, Costa Rica, from February 2022 to May 2023 and focused on polymedicated patients with chronic therapy and high-risk medications. The TOC Medication Program was specifically implemented to focus on medication reconciliation during the admission and discharge processes. A clinical pharmacist documented interventions based on discrepancies found within each patient's medication and assessed the economic impact of interventions on healthcare personnel during discharge by projecting potential complications in the absence of such interventions, a process that was validated by an internist physician. Results During the medication reconciliation at admission, medication discrepancies, mostly intentional omissions, were successfully addressed by clinical pharmacist interventions with a 90.2% acceptance rate during the admission process. At discharge, 18.9% of medications were high-risk, and nearly 40% of discharges were linked to drug-related problems (DRPs), prompting pharmaceutical interventions. The economic analysis indicated potential savings of $21,010.20 during discharge, demonstrating the substantial impact of interventions in preventing emergency service visits, specialist consults, and hospital admissions. Conclusion Pharmacist-led TOC programs offer important clinical advantages by effectively preventing and rectifying medication discrepancies. These discrepancies, if left unaddressed, pose a potential threat to patient safety. Moreover, the implementation of such programs demonstrates promising economic benefits.

SP2.6 - Improvements in patient discharge efficiency and safety: the impact of a dedicated Clinical Pharmacist in an Emergency General Surgery team

Abstract Introduction Efficiency in management of acute surgical admissions is related to safe clinical practice combined with good patient flow, optimising use of limited capacity. Preventable morbidity and discharge delays may significantly compromise outcomes for Emergency General Surgery (EGS) teams managing increasing numbers of admissions. Aim To investigate the effectiveness of a prescribing pharmacist employed within an EGS team in a DGH, with specific focus on patient discharge times by facilitating discharge prescription efficiency, including venous thromboembolism (VTE) prophylaxis. Methods Data was collected for two separate 1-month time periods in 2021 (Period A), before the appointment of a pharmacist and in 2023 (Period B), after pharmacist appointment. Data was analysed for (i) differences in times related to ‘to take home’ (TTH) medication prescription and (ii) prescribing of post-operative extended enoxaparin prophylaxis (EEP) following discharge. Results Mean time for prescription of TTH medications during working hours in Period A was 100 minutes (n=133, range 0-433 minutes) compared with 67 minutes (n=120, range 0-416 minutes) in Period B. Pharmacist prescribing accounted for 51.6% of TTH prescriptions with a mean prescription time of 18.6 minutes (range 0-389 minutes). During Period A, 36% of patients (n=48) who had a VTE assessment mandating EEP received this on discharge compared to 100% in Period B (n=31). Conclusions This data highlights an improvement in prescribing of TTH medications since appointment of a dedicated EGS pharmacist. The consequences of such improvements include more rapid patient flow, better patient experience and heightened patient safety by prevention of post-operative VTE through EEP.

Primary care team characteristics associated with video use: a retrospective national study at the Veterans Health Administration

ObjectiveTo examine primary care (PC) team members’ characteristics associated with video use at the Veterans Health Administration (VA).MethodsVA electronic data were used to identify PC team characteristics associated with any video-based PC visit, during the three-year study period (3/15/2019-3/15/2022). Multilevel mixed-effects logistic regression models on repeated yearly observations were used, adjusting for patient- and healthcare system-level characteristics, and study year. We included five PC team categories: 1.PC providers (PCP), which includes physicians, nurse practitioners, physician assistants, 2.Nurses (RN/LVN/LPN/other nurses), 3.Mental health (MH) specialists, 4.Social workers (SW), and 5.Clinical pharmacists (PharmD).Population54,494 PC care team members nationwide (61,728,154 PC visits; 4,916,960 patients), including 14,422 PCPs, 30,273 nurses, 2,721 MH specialists, 4,065 SWs, and 3,013 PharmDs.ResultsThe mean age was 46.1(SD = 11.3) years; 77.1% were women. Percent of video use among PC team members varied from 24 to 84%. In fully adjusted models, older clinicians were more likely to use video compared to the youngest age group (18–29 years old) (example: 50–59 age group: OR = 1.12,95%CI:1.07–1.18). Women were more likely to use video (OR = 1.18, 95%CI:1.14–1.22) compared to men. MH specialists (OR = 7.87,95%CI:7.32–8.46), PharmDs (OR = 1.16,95%CI:1.09–1.25), and SWs (OR = 1.51,95%CI:1.41–1.61) were more likely, whereas nurses (OR = 0.65,95%CI:0.62–0.67) were less likely to use video compared to PCPs.ConclusionsThis study highlights more video use among MH specialists, SWs, and PharmDs, and less video use among nurses compared to PCPs. Older and women clinicians, regardless of their role, used more video. This study helps to inform the care coordination of video-based delivery among interdisciplinary PC team members.

Enhanced Pharmacy Service Delivery Through a Pharmacy Information System at a Medical Center: A Case Study.

A pharmacy information system (PIS) is a crucial tool for preventing errors and enhancing patient safety. This study aims to assess the influence of a PIS on workflow and medication errors (MEs) within the pharmacy department of a medical city in Saudi Arabia. The analysis encompasses an evaluation of the current workflow within pharmacy modules (in-patient, out-patient, and clinical pharmacy modules) and an exploration of associated challenges and inefficiencies. The study employed both qualitative and quantitative methodologies, incorporating structured interview techniques and the review of system records, such as logs, incident reports, and ME databases. Respondents recognized the benefits of the PIS, including the management of high-quality real-time data (26%), reduction of MEs (25%), acceleration of healthcare practices (23%), and absence of space-time constraints (14%). The study highlighted the role of PIS in addressing medication stock control and shortage issues, thereby improving overall medication availability. Furthermore, PIS significantly enhanced safety (93.3%), efficiency (80%), reliability, accuracy, ease of use (56.7%, 56.7%), and cost-effectiveness (53.7%). Following the implementation of the PIS, there was an increase in ME reporting, indicating improved error detection and management. The research revealed an increase in ME reporting rates in hospitals after PIS installation, attributed to improved medication management processes resulting in higher detection rates. As healthcare facilities increasingly embrace electronic medical records, the understanding of patient care quality will be significantly impacted. Consequently, further research is warranted to explore the role of PIS in reporting, detecting, analyzing, and mitigating MEs, as well as their influence on the work environment to promote a secure and efficient patient journey.

Current status and influencing factors of prophylactic use of proton pump inhibitors in internal medicine inpatients receiving glucocorticoid therapy.

The actual situation and influencing factors of prophylactic use of proton pump inhibitors (PPIs) in internal medicine inpatients receiving glucocorticoid therapy are rarely reported. This study aimed to investigate the current status and influencing factors of prophylactic use of PPIs in internal medicine inpatients receiving glucocorticoid therapy to provide a basis for rational prophylactic use of PPIs. Internal medicine inpatients receiving glucocorticoid therapy from February 2023 to September 2023 were included. Information on the prophylactic use of PPIs was collected and analyzed by clinical pharmacists. Associated factors with prophylactic use of PPIs were analyzed by univariable and multivariable logistic regression. 980 inpatients were finally included in our study, of which 271 (27.7%) inpatients received prophylactic use of PPIs. Among the inpatients prescribed PPIs, 90 inpatients received a standard dose of PPIs twice a day. Multiple logistic regression analysis showed that age ≥80years [OR = 7.009, 95% CI (1.424, 34.495), p = 0.017], history of gastroesophageal reflux disease (GERD) [OR = 2.047, 95% CI (1.338, 3.133), p = 0.001], low platelet count [OR = 0.997, 95% CI (0.994, 0.999), p = 0.004], number of concomitant diseases [OR = 1.104, 95% CI (1.056, 1.153), p < 0.001], junior doctors [OR = 1.755, 95% CI (1.248, 2.468), p = 0.001], glucocorticoid dose (higher than 50mg, measured by methylprednisolone) [OR = 2.455, 95% CI (1.371, 4.395), p = 0.003], antiplatelet agents [OR = 2.567, 95% CI (1.456, 4.524), p = 0.001], immunosuppressants [OR = 1.477, 95% CI (1.014, 2.153), p = 0.042], and betahistine [OR = 5.503, 95% CI (1.124, 26.950), p = 0.035] were associated with more prophylactic use of PPIs. The prophylactic use of PPIs in internal medicine inpatients receiving glucocorticoid therapy is common in China. Clinical pharmacists will take targeted measures to promote the rational use of PPIs according to the results of this study.

Clinical Pharmacist with DEA License: Efforts to Increase Access to Buprenorphine in a Veteran Population.

Opioid overdoses continue to rise in the United States. In 2021, a record 80,411 reported overdoses occurred in the US alone, nearly double that in 2017. Buprenorphine's pharmacology is ideal for management of patients with opioid use disorder (OUD) with or without chronic pain. Within the VA, clinical pharmacist practitioners (CPP) are uniquely equipped to operate with significant scope of practice to prescribe medications including controlled substances, an opportunity to vastly increase access to care for veterans suffering from OUD, complex opioid dependency or pain. The purpose of this case series is to describe how DEA licensed pain CPP safely and effectively manages 1) Suboxone home inductions to increase access for OUD 2) rotations from traditional full mu opioids to chronic pain buprenorphine products and 3) off label use of Suboxone for pain. Procedures/data/observations: Cases were collected in usual workload for clinical pharmacist. High rate of tolerability and efficacy noted with buprenorphine across all products. DEA licensed Pain CPPs can make an immediate positive impact for veterans with OUD and/or complex pain and may be more comfortable with buprenorphine than many other providers.

Effects of Clinical Pharmacist Intervention in a Saudi ICU: A Prospective, Cross-Sectional Study

Given their contributions to better patient outcomes, medication safety, and lower drug cost, critical care pharmacists are especially prepared to play a major role within the critical care interdisciplinary team in managing the therapeutic element. Consequently, this research set out to evaluate the ICU clinical pharmacist interventions' frequency, kind, and effect, as well as the acceptability of these interventions by the doctors who provide them. The research was prospective and cross-sectional in nature. Over the course of six months, from April 1, 2023, to October 1, 2023, data was collected daily from a minimum of 380 interventions. This research covered all patients hospitalized to the intensive care unit at Saudi Arabia throughout the specified time frame. Over the duration of the 6-month trial, 120 patients had a total of 500 interventions. Of these, 490 (98%) had physician approval for clinical pharmacist treatments. The majority of the recommendations (34.8%, or 174 out of 500) were related to safety concerns; among these, 48.27%, or 48 out of 174, were for medication cessation owing to extended duration, while 30.46%, or 53 out of 174, were for renal dosage modification. Coming up as a close second, another therapeutic intervention involving indication made up 22.8% (114/500). A total of 124 interventions, or 24.8 percent of the total, had some kind of cost-related component, according to the study's findings on cost-saving treatments. The results of this research showed that clinical pharmacists have the potential to improve quality treatment for critically ill patients and lower healthcare expenditures. Furthermore, it provides helpful information on the incorporation of clinical pharmacists in intensive care units, particularly in areas with limited resources.

The impact of clinical pharmacists on adherence to acute myocardial infarction guidelines: A controlled before-after Interventional study

In this controlled before-and-after interventional study, the clinical pharmacist evaluated the application of performance measures (PMs) and quality measures (QMs) in the control group and the intervention group in Al-Gurayat General Hospital (GGH) in Saudi Arabia. The total number of PMs applied in the intervention group (n = 445) was significantly higher than that in the control group (n = 407) (P-value =0.006). Considering individual PMs, only PM-4 (high-intensity statin prescription) was applied at a significantly higher frequency in the intervention group (n = 41, 82%) as compared to the control group (n = 29, 58%) (P-value = 0.009). After acceptance of 60 out of the 75 recommendations made by the clinical pharmacist for the intervention group (80% acceptance rate), the number of treatment-related problems (TRPs) left on discharge of the intervention group was significantly reduced to 15 as compared to 61 TRPs left on discharge of the control group (p &amp;lt;0.001). The clinical pharmacist-led interventions have a significant impact on ensuring adherence to PMs during the management of acute myocardial infarction (AMI) in GGH.

Assessment of drug-drug interactions among patients with hematologic malignancy: A clinical pharmacist-led study.

Patients with hematologic malignancies often receive multiple medications, leading to potential drug-drug interactions (DDIs). Identifying and managing these DDIs is crucial for ensuring patient safety and effective care. This study aimed to identify and describe DDIs and associated factors in hematologic malignancy patients. This prospective interventional study was conducted at a referral center and included hospitalized patients with hematologic malignancies who were receiving at least four concurrent medications. A pharmacist initially compiled a comprehensive list of all medications through patient interviews and medication reviews, and subsequently, identified and categorized potential DDIs using the Lexi-interact® and Micromedex® databases. The clinical pharmacist then evaluated the clinical impact of the identified DDIs in every individual patient and provided appropriate interventions to resolve them. A total of 200 patients met the inclusion criteria for the study, with 1281 DDIs identified across 337 distinct types. The majority of identified DDIs exhibited major severity (52.1%) and pharmacokinetic mechanisms (50.3%), with an unspecified onset (79.4%) and fair evidence (67%). Of the identified DDIs, 81.1% were considered clinically significant, prompting 1059 pharmacotherapy interventions by the clinical pharmacist. Additionally, a significant relationship was observed between the number of drugs used during hospitalization and the occurrence of DDIs (P < 0.001, r = 0.633). DDIs are highly prevalent among hospitalized patients with hematologic malignancies, with their occurrence increasing alongside the number of medications administrated. The intervention of a clinical pharmacist is crucial to evaluate the clinical impact of these DDIs and implement effective interventions for their management.

Pharmacists Impact on Promoting the Public Health

Because they can guarantee that patients receive safe and effective medications, pharmacists are essential members of the healthcare team. In an effort to maximize patient results, they work in tandem with other medical specialists to evaluate pharmacological therapy, dispense medication, counsel patients on drug interactions and side effects, and monitor medication schedules. Pharmacists also give patients advice on managing illnesses, changing lifestyles, and adhering to medication regimens. The range of work that pharmacists do has expanded with the emergence of numerous global health issues. Safe and efficient drug usage by community and clinical pharmacists is necessary to provide the best possible patient outcomes. The public is still ignorant about the pharmacist's contribution to national and international health, nevertheless. They also perform drug use assessments, act as drug information specialists, and offer advice on the proper choice and dosage of medications. Pharmacists play a critical role in healthcare organizations as they strive to reduce prescription errors, enhance patient safety, and manage costs. The pharmacist can improve public health in a beneficial way. Thus far, the rise in the importance of pharmacists has been more influenced by the expansion of patient services than by a population-based approach to health. Pharmacists may find that integrating the five public health core competencies—social and behavioral science, health policy and administration, epidemiology, biostatistics, and environmental health sciences—into their pharmacy practice increases their efficacy and influence.