Impact Of Pharmacist Interventions Research Articles

1993. Impact of Pharmacist Intervention in Response to Rapid Molecular Testing Results of Blood Cultures

BackgroundRapid diagnostic testing can identify bacterial pathogens and genetic markers of resistance. This information can aid in deescalating antimicrobial therapy based on local patterns prior to the return of final culture and susceptibility reports. In August of 2017 at our institution, pharmacists were incorporated in the review of these rapid diagnostic tests in real time with recommendations for changes to therapy paged to providers. The purpose of this study was to determine whether the inclusion of a pharmacist in this workflow reduces time to change in antimicrobial therapy.MethodsThis retrospective study over two periods in 2016 and 2018 analyzed the pre- and post-implementation of a workflow incorporating pharmacist review of positive blood cultures analyzed by rapid molecular assay. Patients were included if they were at least 18 years of age and were initiated on empiric antibiotics prior to test results. Patients were excluded if transitioned to hospice within 24 hours of test results, discharged prior to test results, if more than one infectious process or organism was identified, or if test results were positive for coagulase-negative staphylococci. The primary outcome of the study was the time to change to targeted antimicrobials. Secondary outcomes were rates of Clostridium difficile infection within 3 months and inpatient mortality. Categorical variables were evaluated using chi-squared or Fisher exact tests, and continuous variables were evaluated using Wilcoxon rank-sum tests.ResultsA total of 199 patients were included, with 98 and 101 patients in the pre- and post-implementation groups, respectively. The median time to change to targeted antimicrobials was significantly reduced with pharmacist intervention from 18.35 to 8.43 hours (P = 0.042). The groups had similar rates of C. difficile infection (1% vs. 0%, P = 0.492) and mortality (7.1% vs. 5%, P = 0.564). The post-group also had significant reductions in antibiotic days of therapy (10.5 vs. 9 days, P = 0.014) and intensive-care unit length of stay (3.04 vs. 1.44 days, P = 0.046).ConclusionIncorporating pharmacist review of rapid molecular results of blood cultures decreased time to change in antimicrobial regimen and reduced antibiotic days of therapy.Disclosures All authors: No reported disclosures.

179 Evaluating a Clinical Pharmacist Service in a Residential Care Unit

Abstract Background This study assessed the pharmacist role in an 80 bed residential care unit by: Quantifying the number and type of pharmacist interventions made and their acceptance rate.Assessing impact of pharmacist interventions on patient care.Assessing staff attitudes towards the clinical pharmacist service. Methods This was a non-blinded, non-comparative evaluation of the existing clinical pharmacist service in the unit. All residents were included. All pharmacist interventions over a 10-week period were recorded, then graded according to the Eadon scale1 by a consultant gerontologist and an experienced pharmacist to assess their impact on patient care. Results There were 615 pharmacist interventions. The most common interventions were: Drug Therapy Review, 34% (n=209) Technical Prescription, 26.5% (n=163) Administration, 15.3% (n=94) Drug Interaction, 10.4% (n=64) Medication Reconciliation, 8.5% (n=52) 98% (n=596) of interventions were rated as having significance to patient care, of which: 48.4% (n=298) and 41.8% (n=257) of the interventions rated as ‘significant and resulting in an improvement in the standard of care’1% (n=6) and 0.5% (n=3) rated as ‘very significant and preventing harm’. There was a statistically significant agreement between the evaluators, κw = 0.231 (95% CI, 0.156 to 0.307), p < .0005. The strength of agreement was fair. Of interventions requiring acceptance by medical team (n=335), 89.9% (n=301) were accepted. 95% (n=36) of staff who responded agreed or strongly agreed that improved patient safety resulted from the pharmacist’s involvement in multidisciplinary medication reviews. Over 92% (n=35) agreed or strongly agreed that their experience of the pharmacist was positive. Conclusion The pharmacist has an important role in our residential care unit. Their involvement in the medicines optimisation process positively impacts patient outcomes and prevents harm. Staff perceived a positive impact of the clinical pharmacist service provided on patient care and patient safety.

Impact of pharmacist intervention on glucagon prescribing patterns in an outpatient internal medicine teaching clinic

ObjectivesTo examine changes in the rate of glucagon prescribing within an internal medicine resident clinic following pharmacist-led interventions and to analyze glucagon prescribing patterns. SettingUrban, internal medicine residency teaching clinic. Practice descriptionProviders in the teaching clinic include internal medicine residents, supervised by faculty attending physicians. The pharmacy team consists of students, residents, and faculty pharmacists. Practice innovationThis uncontrolled quality improvement project consisted of a first analysis (September 2016 to August 2017) and a second analysis (September 2016 to January 2018) to determine the difference in rate of glucagon prescribing. Patients were at least 18 years old with a diagnosis of type 1 or type 2 diabetes mellitus (T1DM and T2DM) and managed with basal insulin plus at least one dose of bolus insulin or with premixed insulin. Pharmacist-led interventions included 2 distinct educational sessions about glucagon prescription for the residents and faculty members, and implementation of standardized written communication for recommendations. EvaluationData collected were analyzed with rates and descriptive statistics. ResultsOf the patients with T1DM and T2DM who were included and deemed eligible for glucagon, 9 of 188 (4.79%) during first analysis versus 27 of 203 (13.30%) during second analysis were prescribed glucagon—an 8.51% increase. Hypoglycemia not leading to hospitalization (44.44%) was the primary trigger for glucagon prescribing, and the peak prescribing month was October 2017 (25.93%). ConclusionPharmacist-led intervention was associated with an increased rate of glucagon prescribing for patients with T1DM and T2DM within the resident teaching clinic. To improve further on the results, the research team plans to perform subsequent Plan, Do, Study, Act cycles to continuously improve the rate of prescriptions for at-risk patients. Overall, this project could encourage other pharmacy teams to evaluate strategies to increase glucagon prescribing and to evaluate clinical outcomes within outpatient primary care clinics.

Impact of Pharmacist Interventions on the Long-Term Clinical Outcomes in Patients with Myocardial Infarction.

Controlling modifiable risk factors (MRFs) in patients with cardiovascular diseases has been shown to be effective in reducing re-hospitalization rates. The aim of this study was to investigate the rates of controlled MRFs and clinical outcomes after pharmacist interventions in patients with myocardial infarction (MI) after hospital discharge. This prospective randomized clinical study was conducted at one medical center in Taiwan, and enrolled patients with MI from January 1, 2012 to December 31, 2014. Patients received medication reconciliation and education from a pharmacist before hospital discharge. The intervention group (IG) received continuous consultations from the pharmacist after discharge, whereas the control group (CG) did not. Primary outcomes included achieving blood pressure < 140/70 mmHg, low-density lipoprotein-cholesterol (LDL-C) < 70 mg/dL, and hemoglobin A1c (HbA1c) < 7% targets. The secondary outcome was major adverse cardiac events (MACEs), defined as re-hospitalization due to MI, unstable angina and stroke. Two hundred and eight patients completed the study protocol (106 in the IG and 102 in the CG). The rate of achieving blood pressure goal was similar between the two groups. More patients in the IG achieved LDL-C and HbA1c goals than those in the CG at 1 year and 2 years post discharge. However, there was no significant difference in the cumulative incidence of MACEs between the two groups (5.7% vs. 9.8%) (p = 0.262). Diabetes was the only independent predictor of re-hospitalization due to a MACE. Pharmacist interventions led to a higher rate of optimal controlled MRFs but did not significantly reduce the MACE rate in the patients with MI.

Impact of hospital pharmacist interventions on the combination of citalopram or escitalopram with other QT-prolonging drugs

Background Citalopram and escitalopram can both induce dose-dependent QT prolongation. The risk of arrhythmia may be increased with concomitant use of other drugs that induce QT prolongation. Objective To evaluate the prevalence and impact of pharmacist interventions on the combination of citalopram or escitalopram with other drugs that induce QT prolongation. Setting A French hospital with 517 computerized beds. Method All cardiac adverse drug reactions (ADRs) related to citalopram or escitalopram reported to the French pharmacovigilance database (FPDB) were analyzed. Then, over a 6-month period, all computerized prescriptions including citalopram or escitalopram and drug-drug interactions (DDI) were analyzed by pharmacists using a computerized provider order entry system (DXCare®, Medasys). Results Only 27 cardiac ADRs related to citalopram or escitalopram were reported in the database. Among the 57,857 prescriptions and 2116 contraindicated DDIs (3.7%) that were analyzed. 444 DDIs (0.8%) were considered to be clinically relevant by pharmacists and physicians and 168 (i.e., approximately 30%) were related to a combination including citalopram or escitalopram. Most of the prescriptions related to DDIs including citalopram or escitalopram were discontinued in response to a pharmacist intervention when initiated during the hospital stay. Conclusion A high number of hospital prescriptions including citalopram or escitalopram with another QT-prolonging drug occurred, highlighting the importance of involvement of clinical pharmacists in prevention of potential ADRs related to such contraindications.

The Impact of Pharmacist Interventions on Quality Use of Medicines, Quality of Life, and Health Outcomes in People with Dementia and/or Cognitive Impairment: A Systematic Review.

Medication use in people with dementia and/or cognitive impairment (PWD/CI) is challenging. As medication experts, pharmacists have an important role in improving care of this vulnerable population. Systematically review evidence for the effectiveness of pharmacist-led interventions on quality use of medicines, quality of life, and health outcomes of PWD/CI. A systematic review was conducted using MEDLINE, EMBASE, PsycINFO, Allied and Complementary Medicine (AMED) and Cumulative index to Nursing and Allied Health Literature (CINAHL) databases from conception to 20 March 2017. Full articles published in English were included. Data were synthesized using a narrative approach. Nine studies were eligible for inclusion. All studies were from high-income countries and assessed pharmacist-led medication management services. There was great variability in the content and focus of services described and outcomes reported. Pharmacists were found to provide a number of cognitive services including medication reconciliation, medication review, and medication adherence services. These services were generally effective with regards to improving quality use of medicines and health outcomes for PWD/CI and their caregivers, and for saving costs to the healthcare system. Pharmacist-led medication and dementia consultation services may also improve caregiver understanding of dementia and the different aspects of pharmacotherapy, thus improving medication adherence. Emerging evidence suggests that pharmacist-led medication management services for PWD/CI may improve outcomes. Future research should confirm these findings using more robust study designs and explore additional roles that pharmacists could undertake in the pursuit of supporting PWD/CI.

A study on the impact of pharmacist interventions in anti-diabetic therapy

Aim & Objective: The aim of this study was to evaluate the impact of clinical pharmacist services in the proper management of diabetes mellitus. Methods: A retrospective observational study was conducted in 105 patients for a period of 1 year in Vivekananda Medical Care Hospital, Elayampalayam, Namakkal, Tamil Nadu. Approximately 105 patients were randomly selected after getting their consent informally. Total 50 patient records of age from 18-80 years, both male and female, diagnosed with Diabetes mellitus and on oral hypoglycemic therapy were included. Results: Majority of ADRs were found in the age group of 40-50 and 60-70 years which accounted to be 2 (33.33%) while that of others was found to be 1(16.66%). Sulfonylureas and Biguaideswere found to cause maximum number of ADRs 2 (33.33%) followed by dipeptidyl peptidase -4 inhibtors and injections 1 (16.66%). Causality assessment showed majority of cases to be probable 3(50.02%), followed by possible, highly probable and unlikely 1 (16.66%). 16 DRPs were found which comprised of 7 errors due to use of drug without indication, 8 due to drug -drug interaction and 1 drug – food interaction. Conclusion: The study shows that the observations of the pharmacist help out in identifying certain adverse reactions that could be avoided or taken care in a proper manner. The Pharmacists’ interventions may help the health care team to provide a rationale patient care and good patient compliance.

Impact of Pharmacist Interventions on the Treatment of Hepatitis C Patients at a Veterans Affairs Healthcare Facility

Purpose: The purpose of this project is to demonstrate the impact of pharmacy interventions and interdisciplinary care on the treatment of hepatitis C virus (HCV) within the outpatient liver clinic at VA Connecticut Healthcare System (VA CT). Methods: This project consisted of a retrospective analysis of patient data conducted from 1/1/2014 – 8/1/2016 within the outpatient liver clinic at VA CT. The following information was collected and analyzed for patients referred to the clinic through the initial consult notes within the VA’s Computerized Patient Record System (CPRS): HCV genotype, human immunodeficiency virus (HIV) status, cirrhosis status, treatment history, adherence pattern per refill histories and appointment attendance, initially requested therapy, pharmacist approved therapy, drug-drug interactions (DDIs) identified by a pharmacist, and sustained viral response at 12 weeks (SVR12). Patients excluded from the above data collection included those that were not chosen to begin treatment after referral to the clinic due to issues such as significant DDIs, history of non-adherence, etc. After data collection, pharmacist recommendations were quantified over the study population and compared to the primary endpoint of SVR12 status. All data was analyzed and presented as percentages in this frequency analysis, requiring no formal statistical analysis software. Results: After comparing the initially requested regimens to those prescribed, 20% of the total 510 regimens were adjusted by a pharmacist. Changes were made for various reasons, including guideline changes, resulting labs (i.e. hemoglobin, platelets, etc.), side effects, and adherence. Approximately 73% of patients had at least one drug interaction identified. Of these identified, 31% of the interacting medications were adjusted by the provider. Finally, SVR12 status through 3/2016 was achieved in 94% of the total patient population, excluding those who did not initiate or complete therapy. Conclusion: This study concludes that the pharmacists involved in patient care within the outpatient liver clinic at VA CT have been a valuable asset to patient care and should continue to provide pharmacy services in a provider role to patients.

Clinical and economic impact of pharmacist interventions on sampled outpatient prescriptions in a Chinese teaching hospital

BackgroundLimited studies have evaluated the effectiveness of pharmacist interventions on outpatient prescription. The goal of this study was to evaluate the clinical and economic impacts of pharmacist interventions on randomly sampled outpatient prescriptions.MethodOutpatient prescriptions of our hospital were sampled automatically and reviewed by pharmacists since 2011. Pharmacists intervened in inappropriate prescriptions (IPs) real-timely, and summarized and analyzed the information monthly. Cost-benefit analysis was performed to estimate the economic benefit of the pharmacist intervention.ResultsFrom 2011 to 2016, pharmacists reviewed 101,271 prescriptions and intervened in 5155 prescriptions. With the interventions of pharmacists, the number of IPs decreased from 1845 to 238, while the inappropriate percentage decreased from 12.60 to 1.22%. The inappropriate rates of different departments and the types decreased annually. IPs were mainly from the Department of Medicine and Department of Surgery and category 1 (Non-indicated medications) in all years. The benefit-to-cost ratios of pharmacist interventions were always more than 1. In the same years, the benefit-to-cost ratios in public payments were higher than those with insurance and self-payment.ConclusionThis form of pharmacist intervention constitutes a method that showed positive clinical and economic benefits and is worth expanding in large hospitals. Pharmacists should pay more attention on prescriptions in department of surgery or prescriptions with public payments.

Evidence of clinical and economic impact of pharmacist interventions related to antimicrobials in the hospital setting.

The purpose of this paper was to review the literature regarding the clinical and economic impact of pharmacist interventions (PIs) related to antimicrobials in the hospital setting. A PubMed literature search from January 2003 to March 2016 was conducted using the terms pharmacist* or clinical pharmacist* combined with antimicrobial* or antibiotic* or anti-infective*. Comparative studies that assessed the clinical and/or economic impact of PIs on antimicrobials in the hospital setting were reviewed. Outcomes were classified as: treatment-related outcomes (TROs), clinical outcomes (COs), cost and microbiological outcomes (MOs). Acceptance of pharmacist recommendations by physicians was collected. PIs were grouped into patient-specific recommendations (PSRs), policy, and education. Studies' risk of bias was analyzed using Cochrane's tool. Twenty-three studies were evaluated. All of them had high risk of bias. The design in most cases was uncontrolled before and after. PSRs were included in every study; five also included policy and four education. Significant impact of PI was found in 14 of the 18 studies (77.8%) that evaluated costs, 15 of the 20 studies (75.0%) that assessed TROs, 12 of the 22 studies (54.5%) that analyzed COs, and one of the two studies (50.0%) that evaluated MOs. None of the studies found significant negative impact of PIs. It could not be concluded that adding other strategies to PSRs would improve results. Acceptance of recommendations varied from 70 to 97.5%. Pharmacists improve TROs and COs, and decrease costs. Additional research with a lower risk of bias is unlikely to change this conclusion. Future research should focus on identifying the most efficient interventions.

Impact of pharmacist intervention on influenza vaccine assessment and documentation in hospitalized psychiatric patients.

Results of an initiative to improve assessment and documentation of the influenza vaccination status of adult psychiatric inpatients are reported. A prospective quality-improvement study was conducted at a large, tertiary care academic medical center with the aim of improving compliance with the Influenza Immunization (IMM-2) quality measure, which was added to the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program in 2015 and requires assessment and documentation of influenza vaccination status in specified groups of psychiatric inpatients. The primary objective was to improve the IMM-2 IPFQR compliance rate to 100% during the 2015-16 influenza season from a rate of 55% during the 2014-15 influenza season through pharmacist interventions; secondary objectives included analysis of types of pharmacist interventions, rates of influenza vaccination status assessment and ordering, and rates of vaccine refusal by psychiatric disease state. With pharmacist interventions, the IMM-2 IPFQR compliance rate was increased to 99% during the 2015-16 influenza season. Of the 1,413 patients included in the study population, 45% (n = 646) were targeted for pharmacist intervention. Influenza vaccine was ordered for 61% of the study population (n = 867 patients), with an overall refusal rate of 74% (n = 642). Differences in refusal rates by psychiatric diagnosis were not significant. Pharmacist-conducted education of nurses and interventions to ensure completion of influenza vaccine assessments and documentation led to an improved IMM-2 IPFQR compliance rate at the study site.

Impact of Pharmacist Intervention on Electrocardiogram Monitoring of Pediatric Patients on Multiple QTc Interval-Prolonging Medications.

To determine whether dedicated pharmacy services improve the rate of electrocardiogram (ECG) monitoring in patients at risk for medication-induced QTc interval prolongation. In addition, determine how pediatric institutions currently monitor patients at risk for medication-induced QTc interval prolongation. A pharmacist-driven monitoring protocol to detect medication-induced QTc interval prolongation was developed using published literature. If patients were prescribed 3 or more medications known to prolong the QTc interval, they were recommended to have a baseline ECG to assess the QTc interval. If 3 or more QTc interval-prolonging medications were administered for 5 or more days, a follow-up ECG was recommended. Patients prescribed medications known to prolong the QTc interval were identified. Prior to pharmacist intervention, electronic medical records were reviewed to determine if baseline and follow-up ECGs were obtained in patients meeting criteria for monitoring. A dedicated pharmacist then prospectively reviewed charts and recommended monitoring. The rate of monitoring during the intervention and baseline period was compared. To determine current practice at pediatric institutions, a survey was distributed to pharmacists. Pharmacist intervention improved the rate of ECG monitoring in patients at risk for medication-induced QTc interval prolongation from 47.8% to 100% (p = 0.0009). Of the 55 survey participants, 6 stated their institution had QTc interval monitoring procedures in place, 35 did not have any, and 3 had procedures in process. Targeted pharmacist intervention improved the rate of ECG monitoring in patients at risk for medication-induced prolonged QTc interval. Our research and survey data reveal that institutions could benefit from targeted pharmacist intervention to monitor patients for medication-induced QTc interval prolongation.

Impact of pharmacist-led medication management in care transitions

BackgroundWhen patients are discharged from hospital to home, it is a highlighted vulnerable period for which medication - related problems are prevalent. Researchers have proposed a telephone follow-up intervention as a means to reduce hospital readmissions. However, the outcome of the intervention with the engagement of pharmacists in managing patients’ medicines after discharge has not been well explored. The objectives of this study were (1) to determine whether a pharmacist telephone follow-up intervention focusing on patients’ medicines management support is associated with a reduction in 30-day readmission rates and (2) to describe the number and types of pharmacist interventions in care transitions.MethodsThis was a case-cohort study conducted in two acute hospitals in the UK. Pharmacists performed a telephone follow-up intervention to discharged patients to provide medicines management support. Patients who received pharmacist telephone follow-up calls within 14 days of discharge formed the intervention group. A subset of medical patient population discharged in the month of May 2013 formed the comparison group. During a series of two-telephone follow-up, pharmacists identified post-discharge pharmaceutical problems and provided patient-tailored interventions accordingly. The impact of pharmacist interventions was assessed using a risk assessment matrix tool by two senior pharmacists. Overall 30-day readmission rates in the intervention group were measured and compared with the comparison group using a chi-square test.ResultsBetween 5th and 25th June 2013, a total of 62 medical patients participated in the study. Pharmacists provided 192 interventions as a result of pharmacist telephone follow-up intervention. The most prevalent type of interventions was the provision of drug information (n=40), followed by screening patient adherence (n=30) and advising on adverse drug reactions (n=27). The impact of interventions was assessed, and 49.3% of the identified risks intervened by pharmacists were associated with moderate risk. The 30-day readmission rates in the intervention group were 11.3% compared to 9.0% in the control group (p = 0.376); this was not statistically significant.ConclusionsA pharmacist TFU intervention did not show a benefit in 30-day hospital readmissions. However, a pharmacist TFU intervention was an effective method to solve or avoid critical pharmaceutical problems. A future study using a larger scale trial is warranted.

The mental health community: An underserved and undertreated population: Encouraging research but challenges remain

The mental health community: An underserved and undertreated population: Encouraging research but challenges remain

Impact of a Pharmacist-Driven Respiratory Viral Panel Stewardship Program on Antibiotic Exposure Within a Multicenter Community Health System

BackgroundStrategies to ensure optimal use of multiplex polymerase chain reaction (mPCR) testing results for antimicrobial stewardship in acute respiratory infections remain to be elucidated. This study sought to assess the impact of pharmacist intervention (by means of prospective feedback to prescribers) on overall antibiotic exposure in patients with viral-positive mPCR Respiratory Viral Panel (RVP) laboratory test results.MethodsThis retrospective cohort study included patients ≥18 years of age admitted to an acute care hospital with a viral-positive nasopharyngeal FilmArray Respiratory Panel test result receiving antibiotics for a suspected respiratory tract infection. Immunocompromised patients, patients with RVP samples from bronchiolar lavage, patients in the intensive care unit when samples were obtained, and patients receiving antibiotics for non-respiratory infections were excluded. Antibiotic exposure days, antibiotic discontinuation at 72 hours, and culture-positive bacterial superinfection were compared in two cohorts of patients, before and after the rollout of an educational pharmacist RVP stewardship initiative.ResultsMedian antibiotic exposure days did not differ between the pre- and post-intervention groups (6 days vs. 7 days, P = 0.20). Antibiotic discontinuation at 72 hours was significantly lower in the post-intervention group (38% vs. 25%, P = 0.02). More patients in the post-intervention group had positive bacterial respiratory cultures (2.7% vs. 10%, P = 0.007) and chest radiographs suggestive of pneumonia (34.7% vs. 46%, P = 0.05). Patients with peak serum procalcitonin levels <0.25 ng/mL were more likely to have antibiotics discontinued at 72 hours than those with peak levels ≥0.25 ng/mL (36% vs. 0%, P = 0.02).ConclusionAn antimicrobial stewardship initiative by pharmacists among patients with viral-positive RVP results did not appear to impact antibiotic exposure days. Serum procalcitonin levels appeared to influence antibiotic discontinuation decisions. Alternative strategies for maximizing the antimicrobial stewardship impact of RVP testing should be explored.Disclosures All authors: No reported disclosures.

Impact of pharmacist intervention in patient counseling at point of hospital discharge in a specialized cardiac center in Saudi Arabia

Purpose: To determine the interventions associated with the pharmacist’s patient counseling and review of discharge prescriptions of patients from a specialized cardiac center in Saudi Arabia. Methods: This was a prospective interventional study conducted at Prince Sultan Cardiac Center (PSCC) in Riyadh, Saudi Arabia for a duration of 12 months. The pharmacist responsible for providing patient counseling reviewed the patient records, collected patient demographics and clinical data, as well as medical and medication history, diagnosis and discharge (treatment) plan. Results: The study included 2008 patients who met the inclusion criteria. The counseling pharmacist identified and provided interventions to 358 (18 %) patients for 508 (3.4 %) items. About half of counseling pharmacist interventions concerned involved the addition of a drug to treatment regimen followed by drug discontinuation (28.1 %). The most common reason for adding the drug during patient counseling was the omission of medications (35 %). Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs), antidiabetics and antihyperlipidemics were the classes of drugs often associated with counseling pharmacist interventions. The cost-saving interventions identified were 200 (39.4 %). Out of these, drug discontinuation (n = 143) was the most frequent suggestion provided by the intervening pharmacist, followed by a dose reduction resulting in cost savings of 66.5 % (US $ 6,590.10) and 8.9 % (US $ 882.32), respectively. Conclusion: The results indicate that discharge medication discrepancies decrease as a result of pharmacist-facilitated patient counseling at the point of hospital discharge. Keywords: Discharged patients, Cardiac, Counseling, Pharmacist-intervention, Coronary artery disease

Impact of Pharmacist Intervention on Selection and Timing of Appropriate Antimicrobial Therapy in Septic Shock

Background: Current guidelines for septic shock management recommend administration of appropriate, broad-spectrum antimicrobials within 1 hour of recognition. Objective: To evaluate the interventions pharmacists make as part of a sepsis response team and to determine if these interventions increase the proportion of patients with appropriate empiric antimicrobial therapy. Methods: A retrospective cohort study was undertaken reviewing adult patients in a large, academic medical center with confirmed septic shock who had an order for a “sepsis bundle,” which includes notification of a pharmacist to assess adequacy of empiric therapy. Pharmacist interventions with regard to selection of empiric antimicrobials were documented. The proportion of patients with initial successful selection of antimicrobial therapy (SSAT) before and after pharmacist intervention was assessed as well as the time to first antimicrobial administration and time to appropriate antimicrobial administration. Results: A total of 76 patients were included. Pharmacist intervention increased the proportion of patients with SSAT from 66% to 80% (P = .04). Median time to first antimicrobial administration was 43 minutes, and time to appropriate antimicrobial therapy was 1 hour, 34 minutes for the entire cohort, with pharmacist intervention decreasing the latter time significantly in patients without SSAT on initiation of the “sepsis bundle” (P < .001). Conclusion: Pharmacist assessment of patients in septic shock offers the opportunity to improve SSAT. Systems designed to use a pharmacist responder for the care of patients with septic shock maximize the selection of antimicrobials, facilitate rapid administration, and improve surrogate outcomes for mortality in septic shock.

Frequency and Impact of Pharmacist Interventions in Clinical Trial Patients With Diabetes

PurposeThe objective of this study was to describe the interventions and impact made by pharmacists during clinical trials. MethodsA specialty contract research organization that used clinical trial research pharmacists to communicate with patients to support clinical trial protocol adherence, retention, and health outcomes performed a retrospective, descriptive analysis of 12 clinical trials that involved 2 noninsulin glucose-lowering medications. Pharmacists called study participants at specific timepoints during the trials as per protocol. During each telephone call, the number and types of interventions were documented. Descriptive statistics (frequencies) were performed to determine the number and type of interventions by call and by patient across all noninsulin glucose-lowering medication drug A and drug B studies. FindingsOverall, 25,829 calls were made across all studies. Of these calls, 11,765 calls (45.5%) had at least one intervention that involved 3573 patients (92.3%). The most frequent interventions addressed adverse events (3774 [14.6%]), protocol violations for medication use (3341 [12.9%]), concurrent medications (1630 [5.9%]), and miscellaneous concerns (1269 [4.6%]). The greatest numbers of interventions were high-impact interventions (4772 [18.5%]) (eg, serious adverse events) that would seriously affect trial outcomes and patient adherence. ImplicationsPharmacists were able to identify, support, and address multiple types of interventions related to medication management during clinical trials, including those related to concurrent medication use, adverse events, and other medication-related issues. These pharmacist interventions can result in better patient outcomes and, ultimately, more reliable study results for review and approval by regulatory agencies.

Impact of Pharmacist Intervention on Appropriate Insulin Pen Use in Older Patients with Type 2 Diabetes Mellitus in a Rural Area in Iran.

Objective:The aim of this study was to evaluate the impact of pharmacist-conducted educational intervention on reducing errors related to inappropriate insulin pen use.Methods:This was a prospective, before-after study with an educational intervention component. The study was conducted on 122 elderly diabetic patients. Data were collected through interviews using researcher-administered questionnaires as well as patients’ medical records. Patients were asked about the preparation, injection, and storage techniques, they followed when using insulin pens. Blood glucose parameters were extracted from laboratory records. After the detection of errors, patients and their caregivers were instructed about the insulin pen use by the pharmacist. Patients were reevaluated after 12 weeks.Findings:Patients’ mean age was 67.2 ± 3.5 with male: female ratio of 71:51. Mean diabetes duration was 7.1 ± 2.8 years. Fifty-four patients (44.2%) stated that they had received instructions for insulin pen use previously. The majority of this group (24 cases, 44.4%) reported that the instructions were given by a pharmacist. The mean number of errors decreased from 3.99 ± 0.22 errors per patient to 1.49 ± 0.13 errors (odds ratio: 0.28, 95% confidence interval: 0.23–0.33,P < 0.05). Of eleven evaluated insulin pen-related medication error items, nine items experienced a significant decrease after patient education. Fasting plasma glucose (FPG) levels decreased significantly from 161.7 ± 12.5 to 147.3 ± 13.1 mg/dL (P < 0.05). However, glycated hemoglobin levels did not change significantly after 3 months (P = 0.18). Controlled FPG had a significant rise from 45% before education to 63.9% postintervention (P < 0.05).Conclusion:Pharmacists can play an important role in safe and efficient use of insulin pen in elderly diabetic patients by minimizing the likelihood of medication errors associated with insulin pen use.

PHS150 - The Impact of Pharmacist Intervention on Medication Errors In A Teaching Hospital Quetta, Pakistan

PHS150 - The Impact of Pharmacist Intervention on Medication Errors In A Teaching Hospital Quetta, Pakistan