Drug Formulary Research Articles

Medication Errors and Error Chains Involving High-Alert Medications in a Paediatric Hospital Setting: A Qualitative Analysis of Self-Reported Medication Safety Incidents.

Paediatric patients are prone to medication errors, but an in-depth understanding of errors involving high-alert medications remains limited. We aimed to investigate incident reports involving high-alert medications to describe medication errors, error chains and stages of the medication management and use process where the errors occur in paediatric hospitals. A retrospective document analysis of self-reported medication safety incidents in a paediatric university hospital in 2018-20.The incident reports involving high-alert medications were investigated using an inductive qualitative content analysis and quantified (frequencies and percentages). A systems approach to medication risk management based on the Theory of Human Error was applied. Altogether, 560 medication errors were identified within the study sample (n = 426 incident reports). Most medication errors were associated with administration (43.1 %, n = 241/560) and prescribing (25.2 %, n = 141/560). Error chains involving two to four medication errors in one or more stages of the medication management and use process were present in 26.1% (n = 111/426) of reports, most of which originated from prescribing (62.2%; n = 69/111). The medication errors (n = 560) were classified into 14 main categories, the most common of which were wrong dose (13.9%; n = 78/560), omission of a drug (12.9%; n = 72/560) and documentation errors (10.0%; n = 56). Paediatric medication error chains often start from prescribing and pass through the medication management and use process. Systemic defences are especially needed for manual tasks leading to wrong doses, drug omission and documentation errors. Intravenous medications and chemotherapeutic agents, optimising drug formularies and handling, and high-alert drug use at home require further actions in paediatric medication risk management.

Drug utilisation study in hospitalised chronic kidney disease patients, using World Health Organisation prescribing indicators: an observational study.

Chronic kidney disease (CKD) is associated with comorbidities and altered pharmacokinetics, making appropriate prescribing, and monitoring necessary to minimise drug-related problems (DRPs). Therefore, this study aimed to describe the drug-utilisation pattern in hospitalised CKD patients. An observational study was conducted in hospitalised adult (≥18 years old) CKD patients in the UK using WHO prescribing indicators, from November 2021 to April 2022 in a large teaching hospital in England from admission until discharge. This study used STATA version 16 for analysis. The mean number of drugs per prescription was 11.1(±5), the percentage of encounters resulting in the prescription of an antibiotic was 62%, the percentage of drugs prescribed by generic name was 90%, the percentage of encounters resulting in the prescription of an injection was 94%, and the percentage of drugs prescribed from essential drugs list or formulary was 89%. The most frequent drug group prescribed Alimentary Tract and Metabolism was 22%. Longer hospital stays, admission to a renal ward, and the number of comorbidities were independently associated with polypharmacy. Not all prescribing indicators evaluated in this study were in full compliance with WHO recommendations. Polypharmacy was found in most participants which might require interventions to avoid DRPs. Further research is needed to evaluate factors associated with prescribing in the CKD population and prescriber perspectives on decision-making in the context of available guidelines and patient factors.

Can the Present Canadian Health Care System Provide Evidence-Based Pharmaceutical Care? Consideration of Two Important Cardiovascular Clinical Contexts.

Canada is the only country with universal health care lacking universal pharmaceutical care (pharmacare). Currently, a minority portion of the population has drug coverage. Furthermore, there may be discordance between provincial plans of medications that are covered. We aimed to evaluate present systems for drug coverage and ability to provide evidence-based care according to Canadian cardiovascular (CV) guidelines. The drug review process and formularies for provinces and territories were queried to evaluate concordance between guideline-recommended medications and present coverage. Two common cardiology scenarios, heart failure with reduced ejection fraction and antiplatelet drugs in acute coronary syndrome, were chosen as case studies because of recent Canadian-based CV practice guideline updates. Coverage criteria were extracted to assess for interprovincial variations and determine whether listing decisions are concordant with best evidence and guidelines. Multiple organisations are involved in drug review. Despite Canada's Drug and Health Technology Agency (CADTH) recommendations, there are extensive interprovincial variations in listing decisions for CV drugs, with CADTH recommendations followed only 33% of the time. Among 24 CV drugs reviewed, 23% of listing decisions were discordant from guidelines and best evidence. Novel drugs disproportionately carried the highest discordance from evidence. No systematic process exists for formulary updates based on new evidence, changes in guidelines, or drug pricing. Current Canadian drug review decisions are complex and coverage decisions vary widely, resulting in an inability to provide guideline-recommended CV evidence-based medicine. In developing future pharmacare programs, it is crucial to centralise the drug review process and integrate mechanisms to incorporate up-to-date evidence.

Impact of expediting formulary oncology drug approvals at a tertiary care safety net hospital.

410 Background: Advances in drug development and novel clinical trials have resulted in accelerated FDA approvals for oncology agents. These approvals often outpace the speed at which these agents are made “formulary” by hospitals. Non-formulary agents at most organizations need to undergo rigorous regulatory processes before their use and even after the approval for use, ordering them in the EMR poses a significant burden to both providers and pharmacists. Providers need to manually create treatment plans consisting of labs, medications, diluents, and infusion rates for non-formulary agents, consuming valuable time and leaving room for errors requiring extensive pharmacy review. Oncology agents can be considered non-formulary for at least 1 year post-FDA approval before they are approved by the pharmacy and therapeutics (P & T) committee and only 1 agent is approved per meeting. To expedite the formulary approval of oncology drugs, the 1 drug approval per meeting and 1 year post-FDA approval time limit rules were lifted within our institution. Methods: In September 2023, 8 oncology drugs were approved for formulary use by the P & T committee and their pre-built drug templates were established in the EMR. We obtained baseline data to order such non-formulary drugs through EMR prior to formulary approval and when drug templates were not pre-built, requiring manual order entry by providers and review by pharmacists. Baseline data was compared with data obtained post formulary approval and implementation of the pre-builtdrug template. We also created a process map to identify workflow inefficiencies in the formulary drug approval process for further optimization. Results: After the implementation of the pre-built oncology drug templatesand 8 simultaneous formulary drug approvals, the average total time required by physicians and pharmacists was reduced from 97 minutes to 12 minutes per order. The average number of edits made by pharmacists during order review changed from 21 to 4 per treatment order (Table). The use of pre-built drug templates resulted in an 87% reduction in time spent ordering and reviewing agents and an 81% reduction in edits made per drug order. Conclusions: Integration of treatment protocol building quickly into EMR by expediting formulary drug approval significantly reduced physician and staff burden in oncology care at a safety net hospital. Health systems should adopt innovative processes to streamline the formulary approval process and use pre-built drug templates, minimizing staff fatigue and increasing patient safety. Breakdown for provider order entry and pharmacist review with and without drug template. Manual Entry During Non-Formulary Period Template Entry after Formulary Approval Average provider order entry time (mins) 75 6 Average pharmacist review time (mins) 22 6 Average total time taken per order (mins) 97 12 Average edits/order by pharmacist 21 4 mins=time in minutes.

Analyzing the Impact of Drug Name Similarity on Dispensing Errors: An Examination Using a Drug Name Similarity Index.

Dispensing errors pose a significant health risk, with drug name similarity being a potential contributory factor. To determine the impact of drug name similarity on dispensing errors within clinical settings, we analyzed 563 dispensing errors at an acute hospital in Japan from April 2015 to June 2018. Drug name similarity between two drugs was classified into Name-Similar and Name-Dissimilar groups using the m2-vwhtfrag index, the value of the drug name similarity. Drug efficacy similarity was categorized into Efficacy-Same, Efficacy-Close, and Efficacy-Far. The drug name similarity and drug efficacy similarity of all possible pair combinations were obtained and similarly classified. The proportion of the number of pairs with dispensing errors per the total number of drug pairs in the hospital's drug formulary in each category was calculated. The highest proportion of the number of pairs with dispensing errors was 36% for the Efficacy-Same and Name-Similar group, and the lowest proportion was 0.022% for the Efficacy-Far and Name-Dissimilar group. The proportion of the number of pairs with dispensing errors was significantly higher in the Name-Similar category than in the Name-Dissimilar category for all drug efficacy categories. Our results indicate that drug name similarity increases the risk of dispensing errors, and that m2-vwhtfrag is a useful indicator to assess dispensing errors in clinical practice. Such drug name and efficacy similarity evaluations can help identify factors causing dispensing errors, and predict the risk of dispensing errors for newly adopted drugs, considering the relationship with the whole drug formulary in the hospital dispensary.

Analysis of the National Formulary Drug Supply Chain with Its Availability in the Pharmacy Installation of the Government General Hospital (RSUD) Dr. Sitanala Tangerang City

This study explores the pharmaceutical supply chain management of the National Formulary at RSUP Dr. Sitanala in Tangerang City, aiming to identify obstacles to drug availability and formulate effective and efficient solutions. Acknowledging quality healthcare as a fundamental human right and a critical investment for a nation's future, this research emphasizes the importance of high-quality healthcare services. These services encompass not only treatment but also health promotion and disease prevention through the adoption of clean and healthy living habits. Drug availability is a major pillar in the provision of quality healthcare services. Effective and efficient management of the pharmaceutical supply chain, particularly regarding National Formulary drugs, is crucial in ensuring the availability of medications at healthcare facilities. This research employs a comprehensive analysis of the supply chain processes at RSUP Dr. Sitanala, examining stages such as drug selection, demand planning, procurement, receipt, storage, distribution, drug control, therapy monitoring, prescription preparation, drug dispensation, and medication administration. The study's methodology involves a case study approach, integrating theoretical management principles and interdisciplinary pharmacy management with compliance to regulations, as outlined in Permenkes No. 76 of 2016. Findings from RSUP Dr. Sitanala indicate that the hospital's pharmaceutical management practices align with contemporary health and pharmacy management theories, emphasizing structured systems, stringent verification, and effective interprofessional communication to ensure medication safety and efficacy. The study identifies challenges in information technology and interdisciplinary coordination as areas needing improvement. Nonetheless, a commitment to continuous improvement and adherence to regulatory standards reflects RSUP Dr. Sitanala's dedication to enhancing the quality of pharmaceutical management and healthcare services. The implications of this research extend beyond RSUP Dr. Sitanala, offering valuable recommendations for improving drug supply chain management in other healthcare institutions in Indonesia. By enhancing access to and the quality of healthcare services, this study contributes to the broader goal of achieving the highest possible level of health for individuals, reflecting the perspective of human rights and investment in the nation's future health.

Factors affecting decisions of an HMO Drug Exemptions Committee on individual patient requests for coverage of non-formulary drugs

BackgroundIn Israel, coverage of health needs is delivered by four health maintenance organizations (HMOs), which are budgeted by the government according to the recommendations of the National Drug Formulary (NDF) Committee. For medications not listed in the NDF, individuals may request to cover the costs by the HMO Exemptions Committee (DEC). The objectives of the current study, a first of its kind, are to document the DEC decision process, to identify its components and to determine the decisions’ clinical outcome.MethodsThis retrospective cohort study included all members (≥ age 18) of the Maccabi Healthcare Service (MHS) who submitted a request to the DEC between June 2017 and December 2018. Collected data include patient demographics, clinical information and components of the decision process. Decision success (i.e., clinical outcome correlated with DEC decision) was determined by clinical outcome over at least one-year follow-up.ResultsA total of 335 requests were included. Strong evidence and rare disease were positively associated with approvals, while the availability of alternative treatments and costs were negatively associated. The majority of decisions (75%) met predicted clinical outcomes. Only estimated costs were found to be associated with decision success.ConclusionsFactors that reduce the potential costs of a requested drug are significantly associated with higher odds for drug approval, but only when the evidence supports potential benefit.

Views and experiences of non-medical prescribing: a national survey of prescribing physiotherapists

BackgroundPhysiotherapy non-medical prescribing (NMP) is a contemporary development whereby physiotherapists can prescribe medications within their scope of practice. Despite institutional and professional support for its implementation, data regarding physiotherapists’ views and experiences of NMP is limited. ObjectivesTo explore the views and experiences of NMP for UK prescribing physiotherapists. DesignCross-sectional study, using an anonymous, online survey. MethodsRecruitment involved non-probability sampling targeting UK physiotherapists with a NMP qualification. Data was gathered about the role, scope, and activity of prescribing physiotherapists via closed and open-ended questions. Descriptive statistics and inductive content analysis were undertaken. ResultsOf the 552 respondents, most worked in FCP roles (122/552, 22%) and 82% (450/552) prescribed medication. NSAIDs were the most prescribed drug class (267/450, 59%). Perceived benefits were enhanced patient care, reduced burden on other prescribers, and improved medication access. Challenges included restrictions on prescribing or deprescribing controlled drugs (CDs), limited scope of practice, and inadequate CPD. Themes identified to improve physiotherapy NMP were increasing the CDs that physiotherapists can independently prescribe and deprescribe, improving CPD and supervision, and increasing awareness amongst the public and healthcare professionals. ConclusionsThis study provides novel findings of the perceived benefits, challenges, and development areas for physiotherapy prescribing. There is a need to review and potentially expand the drug formulary for physiotherapists. Improving education and supervision is crucial for the sustainable growth of physiotherapy NMP. Increasing the awareness amongst the public and healthcare professionals may enhance the acceptance of physiotherapy prescribing. Contribution of the paper•This study provides novel insights into physiotherapy NMP in the UK and highlights future development needs.•The survey identifies that NMP physiotherapists perceive a need to review and expand the current drug formulary to allow physiotherapists to independently prescribe and deprescribe more CDs within their scope of practice.•Physiotherapy prescribing is rapidly increasing across the UK, improving the education, supervision, and awareness of physiotherapy NMP should be considered to enhance future practice.

The Usage Of Government Formulary For BPJS Inpatients With Ischemic Stroke In Indonesia

Introduction: Ischemic stroke patients tend to use some medicine. In National Health Security (JKN), the government has created a government formulary as quality control and cost control. The study aims to determine the percentage of government formulary in Hospitals and the affected factors. Method: It was cross sectional quantitative research. It used retrospective data from medical record and prescription of ischemic stroke inpatients from January to June 2019. The data collected include hospital characteristics, patient characteristics, supporting characteristics and treatment costs. Result: The data cames from 17 hospitals. Based on the inclusion and exclusion criteria, 257 medical records were analyzed. The average percentage of drug use was 73.22%. Its was influenced by the hospital class, the number of supporting examinations, the number of drug items. Type B and C hospitals used non government formulary. There were citicolin, mecobalamin, piracetam, neurotropic multivitamin, flunarizine. Conclusion: The average percentage of drug use was still less than 100%. There were still non government formulary drugs used for the therapy of inpatient ischemic stroke. The use of non government formulary drugs was influenced by the hospital class, the number of supporting examinations, the number of drug items.

Understanding how a non-National Institute for Health and Care Excellence technology appraisal drug is added to the hospital drug formulary

Abstract Introduction In England, only medications listed in a hospital formulary can be used to treat patients in a National Health Service (NHS) hospital. Medications approved by the National Institute for Health and Care Excellence (NICE) via technology appraisal (TA)1 are included in hospital formularies.[1] Non-NICE TA medications need to be reviewed by the hospital’s drug and therapeutics committee (DTC) for inclusion in the hospital formulary. Research shows that different DTCs make contrary decisions concerning the same non-NICE TA drug request for inclusion in the hospital formulary, contributing to postcode prescribing and inequality in medication access.[2] To understand how and why different DTCs make different decisions, it is vital to understand how a non-NICE TA drug is added to a hospital formulary. Aim To identify the process and variations when adding a non-NICE TA drug to a hospital formulary. Methods As part of a larger study, the DTC of a tertiary centre where this research was based developed and sent a questionnaire exploring DTC processes to Chief Pharmacists (via Microsoft Forms) of ten large tertiary centres in England. After completing the questionnaire, a semi-structured interview was conducted with each Chief Pharmacist to clarify ambiguity in the questionnaire responses. Only data regarding how a non-NICE TA is added to the hospital formulary was used in this study. A hierarchical task analysis (HTA) was developed; data were analysed using inductive thematic analysis to identify subgoals, tasks and subtasks required to add a non-NICE TA drug to the hospital formulary. The HTA was developed iteratively. Results A total of ten Chief Pharmacists (100% of those approached) completed both the questionnaire and interview. Adding a non-NICE TA drug starts with the applicant requesting and completing an application package, followed by obtaining approval to submit the application package for review. Once approval is granted, the application package goes through three review levels: initial, preliminary, and final review. The non-NICE TA drug is added to the formulary once the application package is clinically and financially approved. This process involves over 100 tasks and subtasks. The process described varied from one centre to another with the following main variations: 1. application package components, 2. how the application package is submitted for approval, 3. the depth of review the application package receives, and 4. how the final review is conducted. Conclusion Adding a non-NICE TA drug to a hospital formulary is complex and varied across each centre, indicating a lack of national standardisation in the process. The variations identified could contribute to health inequalities as all patients may not have equal access to the same medications. Therefore, further research is required to study the impact of these variations on patient access to medication via the NHS. Currently, there are no studies in the literature that described the process of adding a non-NICE TA drug to the hospital formulary across the tertiary centres in England. The study only included tertiary centres in England and there should be caution when considering the transferability of the findings to other types of hospitals.

Development of Hospital Formulary for an Emergency Drug List in Tertiary Care Teaching Hospital

Background: In an emergency situation, timing is an important factor that requires sound knowledge about the patient's health condition, diagnosis, and treatment, as well as the administration of an appropriate drug at the appropriate time, which helps save a patient’s life. To ease the workflow, we decided to develop an emergency drug formulary. The study aims to develop a hospital formulary for an emergency drug list and compare it with the WHO standard formulary and the National Formulary of India. Methods: A prospective observational study was carried out at Vivekananda General Hospital, Hubballi, for a period of six months. A monograph of emergency drugs was drafted based on the needs of the hospital and prepared by referring to various different sources of data. The developed hospital formulary was made into electronic copies and handbooks, and a review was obtained from healthcare professionals. Results: The results showed that there were 130 drugs in the emergency drug formulary. It includes various categories of medication given in the case of different emergency conditions (cardiac emergencies, neurological emergencies, endocrine emergencies, poisoning emergencies, respiratory emergencies, fluid and electrolyte emergencies, and miscellaneous emergency drugs). While comparing the contents of the monograph with other formulary monographs, we found that the formulary that we had developed was more effective. There were five fixed-dose combinations (FDCs), 27 drugs that are safe to use during pregnancy, 84 drugs that should be used with caution while pregnant, and 1 drug that was contraindicated. We also found that there were 59 drugs that were compatible with breastfeeding; 63 needed to be used with caution; and 12 should be avoided during breastfeeding. Conclusion: The developed emergency formulary acts as a quick reference, helps in selecting the appropriate drug at the appropriate dose and time, and also helps in selecting low-cost alternative brands.

Preferences and feasibility of long-acting technologies for treatment of hepatitis C virus in low- and middle-income countries: A survey of providers and policymakers.

Long-acting technologies (LATs) for hepatitis C virus (HCV) are under development as a strategy to improve linkage to care, treatment adherence and outcomes. We conducted a survey of HCV treatment prescribers and HCV policymakers in low- and middle-income countries (LMICs) regarding acceptability and feasibility of HCV LATs. We included one-time intramuscular injection, subdermal implant and transdermal patch as potential LAT options. We surveyed participants regarding optimal health system and patient characteristics, concerns, potential barriers, overall feasibility and preferences for HCV LAT as compared to daily oral medication. Overall, 122 providers and 50 policymakers from 42 LMICs completed the survey. Among providers, 93% (113/122) expressed willingness to prescribe LAT and 72% (88/120) of providers preferred LAT if provided at comparable efficacy, safety and cost as current oral treatments. Of providers preferring HCV LAT to daily oral medication, 67% (59/88) preferred injection, 24% (21/88) preferred patch and 9% (8/88) preferred implant. Only 20% (24/122) would prescribe LAT if it were more costly than oral treatment. In regression analysis, no provider characteristics were associated with preference for LAT over oral treatment. Policymakers reported high likelihood that LAT would be included in treatment guidelines (42/50; 84%) and national drug formularies (39/50; 78%) if efficacy, safety and cost were similar to oral treatment. HCV LATs could advance progress to HCV elimination in LMICs by diversifying treatment options to improve treatment coverage and outcomes. Provider preferences from LMICs are a critical consideration in the development of HCV LATs to ensure its early and equitable availability in LMICs.

Substance use disorder treatment carve outs in Medicaid managed care

IntroductionMedicaid managed care organizations (MCO) play a major role in addressing the nation's epidemic of drug overdose and mortality by administering substance use disorder (SUD) treatment benefits for over 50 million Americans. While it is known that some Medicaid MCO plans delegate responsibility for managing SUD treatment benefits to an outside “carve out” entity, the extent and structure of such carve out arrangements are unknown. This is an important gap in knowledge, given that carve outs have been linked to reductions in rates of SUD treatment receipt in several studies. To address this gap, we examined carve out arrangements used by Medicaid MCO plans to administer SUD treatment benefits in ten states. MethodsData for this study was gleaned using a purposive sampling approach through content analysis of publicly available benefits information (e.g., member handbooks, provider manuals, prescription drug formularies) from 70 comprehensive Medicaid MCO plans in 10 selected states (FL, GA, IL, MD, MI, NH, OH, PA, UT, and WV) active in 2018. Each Medicaid MCO plan's documents were reviewed and coded to indicate whether a range of SUD treatment services (e.g., inpatient treatment, outpatient treatment, residential treatment) and medications were carved out, and if so, to what type of entity (e.g., behavioral health organization). ResultsA large majority of Medicaid MCO plans carved out at least some (28.6 %) or all (40.0 %) SUD treatment services, with nearly all plans carving out some (77.1 %) or all (14.3 %) medications, mainly due to the carving out of methadone treatment. Medicaid MCO plans most commonly carved out SUD treatment services to behavioral health organizations, while most medications were carved out to state Medicaid fee-for-service plans. ConclusionsCarve out arrangements for SUD treatment vary dramatically across states, across plans, and even within plans. Given that some studies have linked carve out arrangements to reductions in treatment access, their widespread use among Medicaid MCO plans is cause for further consideration by policymakers and other key interest groups. Moreover, reliance on such complex arrangements for administering care may create challenges for enrollees who seek to learn about and access plan benefits.

Patient preference on once-daily oral versus injectable androgen deprivation therapy for Asian patients with advanced prostate cancer

PurposeThe study aimed at investigating prostate cancer patients’ choice of androgen deprivation treatment (ADT) and possible factors that would affect their preferences of ADT.MethodsThis was a single-centre cross-sectional study investigating the usage and preferences of ADT. Consecutives prostate cancer patients who were receiving injectable luteinizing hormone-releasing hormone (LHRH) agonist or antagonist were recruited from the prostate cancer clinic in a tertiary academic hospital. Patients who received bilateral orchidectomy or those who could not consent to the study were excluded. Disease characteristics, treatment information and patient background were documented. The survey collected information related to their change in ADT regimen, preferences on drug usage (routes and frequency of administration) and their reasons. A hypothetical set of three drug formularies was designed. Questions regarding patient preference and the contributing reasons raised in the format of questionnaire.Results100 patients completed the survey. Most patients started with more frequent injections (3-monthly, 54%; 1-monthly, 38%) and switched to 6-monthly injections (89%) at the time of the survey. Primary reasons for the change were healthcare opinion (72%) and less frequent treatment (51%).Three options of ADT (oral daily, 1-monthly and 6-monthly injection) with the same efficacies and side effect profile were offered: 61% preferred 6-monthly injection, 1% preferred 1-monthly injection and 38% preferred oral regimen. When patients were informed of lower cardiovascular side effects in 1-monthly injection or daily oral drug, patients’ preference was 56% (6-monthly), 6% (1-monthly), and 39% (oral). Patients with polypharmacy (more than 5 regular medications) were more inclined to choose injections (p = 0.025). Patient age, educational background, employment status, marriage status and disease status were not found to be statistically significant contributing factors to patient preference.Conclusion6-monthly ADT injection was the preferred ADT despite greater cardiovascular risks. Among 1-monthly or daily oral LHRH antagonist, more patients prefer oral option. Convenience factor was highly valued.

Adapting prescribing criteria for amyloid-targeted antibodies for adults with Down syndrome.

Prior authorization criteria for Federal Drug Administration (FDA) approved immunotherapeutics, among the class of anti-amyloid monoclonal antibodies (mAbs), established by state drug formulary committees, are tailored for adults with late-onset Alzheimer's disease. This overlooks adults with Down syndrome (DS), who often experience dementia at a younger age and with different diagnostic assessment outcomes. This exclusion may deny DS adults access to potential disease-modifying treatments. To address this issue, an international expert panel convened to establish adaptations of prescribing criteria suitable for DS patients and parameters for access to Centers for Medicare & Medicaid Services (CMS) registries. The panel proposed mitigating disparities by modifying CMS and payer criteria to account for younger onset age, using alternative language and assessment instruments validated for cognitive decline in the DS population. The panel also recommended enhancing prescribing clinicians' diagnostic capabilities for DS and initiated awareness-raising activities within healthcare organizations. These efforts facilitated discussions with federal officials, aimed at achieving equity in access to anti-amyloid immunotherapeutics, with implications for national authorities worldwide evaluating these and other new disease-modifying therapeutics for Alzheimer's disease.

A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy.

Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.

A Quality Improvement Initiative to Reduce Prescription Error in a Pediatrics Outpatient Department at a Secondary-Level Community Hospital.

Background Medication errors are common, especially by new trainees in primary care settings. Our study aimed at reducing the rate of prescription error in the pediatric outpatient department (OPD) of a secondary healthcare center in suburban north India using a quality improvement methodology. Methods Based on a survey and focused group discussion (FGD) involving all stakeholders, the identified problems and difficulties faced during outpatient prescriptions, interventions, and outcome parameters were drafted. The primary outcome measure was the prescription error rate evaluated by a senior resident (SR) of pediatrics, and the secondary outcome measures included the frequency of antibiotic prescriptions and investigations. Intervention Two cycles of Plan-Do-Study-Act (PDSA) were conducted on accessible drug formularies and standard treatment protocols for common pediatric conditions. Results The mean baseline prescription error was 72.2% (95% confidence interval (CI): 63.2-81.1). After the implementation of the first PDSA cycle, the mean error rate was 46.5% (95% CI: 36.6-56.5). There were eight consecutive points of prescription error below the control limit (63.2% and 81.1%) of the baseline. The PDSA-2 cycle showed the same shift to below the control limit (36.6% and 56.5%). The mean error rate found at the end of the PDSA-2 cycle was 22.5% (95% CI 15.7-29.5). There was no clinically significant difference in the number of investigations or antibiotics prescribed. Conclusion The application of standardized drug formularies and standard treatment protocols (STPs) can help reduce prescription errors, especially in a primary care setting. Expansion of such techniques to other centers could be particularly useful.

Comparing Drug Handling Efficiencies and Expenses for Short- Acting Granulocyte-Colony Stimulating Factor Injection Originators and Biosimilars from the Perspective of Hospital Resource Management in Formulary Decision-Making

Background/Aim: With the availability of biosimilars, hospital formulary drug selection among biologics extends beyond clinical and safety considerations when comes to hospital resource management, to factors like human resource allocation and financial sustainability. However, research assessing the time and cost of labor, supplies, and waste disposal of biologics from the standpoint of hospitals remains limited. This study focuses on short-acting granulocyte-colony stimulating factor originators (Granocyte® and Neupogen®) and biosimilar (Nivestim®), comparing them based on mean total handling times per dose and total annual expenses. Materials and Methods: Ten nursesfrom a Taiwanese cancer centerwere recruited; they each prepared three doses of each drug. Results: Findings showedthat the mean total handlingtimes per dose of Granocyte® and Neupogen® were significantly higherthan that of Nivestim®. Handling Nivestim® required the lowest total annual expense. Conclusion: Nivestim® is an advantageous alternative to Granocyte® and Neupogen®, benefiting hospital resource management.

Development of a Provincial Hospital Drug Formulary from 12 Former Regional Health Authority Formularies: Methods of Alignment.

Development of a Provincial Hospital Drug Formulary from 12 Former Regional Health Authority Formularies: Methods of Alignment.

Assessment of the hospital pharmacy quality assurance system in selected hospitals in the Amhara Regional State, Ethiopia.

Pharmacy services in hospitals are designed to meet the needs of all patients. This is undoubtedly one of the most complex services provided by hospitals. In government hospitals, including those in Ethiopia, pharmacies mainly serve as drug stores and dispensaries. To the best of our knowledge, this study is the first to assess and ensure better quality assurance for hospital pharmacy services in Ethiopia. Therefore, the objective of this article was to assess the current status of the quality assurance of pharmacy services in hospitals. A cross-sectional survey was conducted. The data were collected from hospital pharmacy heads using the Kobo Collect mobile application and then exported to the Statistical Package for Social Science (SPSS) version 25 for analysis. Descriptive statistics for categorical variables are presented as percentages and frequencies. All (100%) of the studied hospital pharmacies had a qualified pharmacy director and worked in the pharmacy full-time. Only 40% had a drug information center and a functional drug formulary committee. All pharmacies had their own disposal facilities but did not regularly dispose of expired or unfit medications. The results revealed that all hospital pharmacies did not have a responsible body delegated for quality evaluation. The findings of this study clearly show that quality assurance services in hospital pharmacies are compromised. The findings can be used to identify areas of improvement and develop strategies to enhance the quality of hospital pharmacy services.