Inpatient Pharmacists Research Articles

Inpatient pharmacists’ patient referrals to a transitions-of-care pharmacist: Evaluation of an automated referral process

ObjectivesTo evaluate the impact of a pharmacist screening and automated referral process that identifies patients at risk for readmission due to medication-related problems (MRPs). SettingUniversity of Wisconsin (UW) Hospital is 505-bed flagship hospital that is part of UW Health, an academic health system. Practice descriptionThe integrated pharmacy practice model at UW Health has inpatient pharmacists who perform discharge medication reconciliation. Before enhancing the screening and referral process, a transitions-of-care (TOC) pharmacist identified patients with the use of a low yield report and performed a second postdischarge medication reconciliation on selected patients. Practice innovationA screening process was developed to identify patients at risk for readmission due to MRPs and allow for direct referral from inpatient pharmacists to a TOC pharmacist for postdischarge follow-up. EvaluationPatient characteristics, readmission risk, and readmission rate were compared between inpatient only (before referral) and inpatient plus second medication reconciliation (after referral). MRPs identified during medication reconciliation were quantified and categorized as provider or patient-associated. ResultsBefore process improvement, 9 patients (5%) received a second medication reconciliation out of 175 patients who received standard-of-care inpatient medication reconcilation. After implementation, 45 patients (24%) received a second medication reconcilation out of 188 referrals. Patients referred for postdischarge follow-up with the TOC pharmacist had an average of 3.2 more medications and 2.7 more chronic conditions than before process implementation (P < 0.01). Both inpatient and TOC pharmacists identified at least 1 MRP in about two-thirds of patients (P = 0.60). Provider-associated MRPs were more commonly identified in both inpatient and postdischarge settings. ConclusionInpatient pharmacist screening is an effective method for identifying patients for referral to a TOC pharmacist to receive postdischarge follow-up. Despite the robustness of the inpatient medication reconciliation process in identifying provider-associated MRPs, patient-associated MRPs still emerged after discharge that warranted additional pharmacist intervention.

Patterns of Palliative Care Pharmacist Interventions and Outcomes as Part of Inpatient Palliative Care Consult Service.

Palliative care uses a team approach, including physicians, nurses, social workers, chaplains, and pharmacists. The pharmacist's role within palliative care teams is increasing and initial favorable outcomes have been reported. This retrospective study evaluated adult hospitalized patients seen by a part-time palliative care specialist pharmacist as part of the palliative care consultation team at an academic health system during a 15-month period between September 1, 2015, and March 30, 2017. Our study's objective is to identify patterns of an inpatient palliative care pharmacist's interventions and outcomes and evaluate the impact of pharmacist involvement on patient hospital length of stay (LOS), length from admission to palliative care consult (LTC), and time from consult to discharge or death (CTD). The palliative care pharmacist was on service 35% of the time and saw 26.4% of the patient seen by the palliative care team (n = 341 out of 1293). Each patient received an average of 3.5 interventions with an average of 4.1 documented outcomes. The most common interventions were optimizing palliative medication regimen and providing education; most common outcomes were implementation of a change in palliative medication regimen and education of healthcare professionals. Overall, patients seen by the palliative care pharmacist were younger (p < 0.05), more likely to be female (p < 0.05), and more likely to have a primary palliative consultation reason listed as "pain" (p < 0.005). LOS, LTC, and CTD were significantly longer for patients seen by palliative care pharmacist. Pharmacist interventions and outcomes were predominantly related to optimizing symptoms by changes in medication regimen and education of healthcare professionals. A subanalysis of patients with known date of first pharmacist visit found significantly improved LOS, LTC, and CTD for patients with early access to palliative pharmacy (in addition to the other members of the palliative team) compared to those without early access.

Evaluation of Standardization of Transfer of Accountability between Inpatient Pharmacists

A compelling body of evidence supports the notion that transfer of accountability (TOA) improves communication, continuity of care, and patient safety. TOA involves the transmission and receipt of information between clinicians at each transition of care. Without a notification system alerting pharmacists to patient transfers, pharmacists' ability to seek out and complete TOA may be hindered. A standardized policy and process for TOA, with automated workflow, was implemented at the study hospital in 2015, to ensure consistency and timeliness of documentation by pharmacists. To evaluate pharmacists' adherence to and satisfaction with the TOA policy and process. A retrospective audit was conducted, using a random sample of individuals who were inpatients between June 2014 and February 2016. Transition points for TOA were identified, and the computerized pharmacy system was reviewed to determine whether TOA had been documented at each transition point. After the audit, an online survey was distributed to assess pharmacists' response to and satisfaction with the TOA policy and workflow. Before the TOA workflow was implemented, TOA documentation by pharmacists ranged from 11% (10/93) to 43% (48/111) of transitions. Eight months after implementation of the workflow, the rate of TOA documentation was 87% (68/78), exceeding the institution's target of 70%. Of the 32 pharmacists surveyed, most were satisfied with the TOA policy and agreed that the standardized workflow was simple to use, increased the number of TOAs provided and received, and improved the quality of completed TOAs. Respondents also indicated that the TOA workflow had improved patient care (mean score 4.09/5, standard deviation 0.64). The standardized TOA policy and process were well received by pharmacists, and resulted in consistent TOA documentation and a TOA documentation rate that exceeded the institutional target.

Evaluating Clinical Pathway Typhoid Fever Monitoring at ABC Hospital Malang

ABC Hospital has implemented 15 Clinical Pathway, and Typhoid Fever is the most cases that can be served. The inaccuracy of the monitoring report on the implementation of Clinical Pathway has prevented the hospital from taking appropriate actions to improve the implementation of Clinical Pathway Typhoid Fever. This study aims to determine the obstacles of monitoring implementation of Clinical Pathway Typhoid Fever in ABC Hospital. This research is a case study and descriptive-explorative research, using document review, field observation, interview, and questionnaire for data collection. The research was conducted in the in-patient wards and medical records room of ABC Hospital during September 2017. The respondents of the research include room physicians, head of inpatient rooms, pediatric, internist, pharmacist, nutritionist, and medical record staff. The result show that factors which impeded implementation of Clinical Pathway monitoring in ABC Hospital were the absence of Clinical Pathway team, the incompatibility of the Clinical Pathway Guide content, the absence of SOP of Clinical Pathway filling form, and the lack of socialization. Suggestion for improving monitoring of Clinical Pathway Typhoid Fever are establish a Clinical Pathway team, revise the Guidance of Clinical Pathway, compile SOP of Clinical Pathway filling form, and do socialization.

Factors influencing pharmacists' intentions to use Pharmacy Information Systems

The Pharmacy Information System (PIS) is a sub-system of the hospital information system, which is designed to assist pharmacists in safely managing the medication process. To maximize the benefits of PIS, it is important to assess its impact on pharmacists' workflow and medication management processes. The PIS was implemented at King Abdulaziz Medical City-Riyadh (KAMC-Riyadh) 15 years ago. However, its impact on the work of pharmacists has not been satisfactorily explored. Our study was conducted at the Pharmaceutical Care Department of KAMC-Riyadh, and the data were collected from the inpatient pharmacist staff through a survey-based questionnaire. The majority of PIS users reported having a favorable experience with the technology, and to most of the items related to functionality. The present study identified potential key factors; those that are likely to influence pharmacists' personal intentions for using PIS. However, extended use of PIS would require reducing the rate of demotivated users.

Inpatient Medication Errors And Pharmacist Intervention At Ministry Of Health Public Hospital In Riyadh, Saudi Arabia

Inpatient Medication Errors And Pharmacist Intervention At Ministry Of Health Public Hospital In Riyadh, Saudi Arabia

Enhanced recovery after surgery (ERAS®) in gynecologic oncology - Practical considerations for program development.

Enhanced recovery after surgery (ERAS®) in gynecologic oncology - Practical considerations for program development.

In-patient and Out-patient Pharmacist Intervention in the Management of Diabetes Mellitus Conditions in Dubai, United Arab Emirates: A Qualitative Approach

There is a growing body of literature showing the importance of pharmacists’ involvement in the management of Diabetes Mellitus (DM) conditions. This study tried to explore the extent to which pharmacists in Dubai, United Arab Emirates intervene in the management and control of diabetic patients within different healthcare settings by using a qualitative approach method. Based on the sample pooled, our key findings pointed to the lack of pharmacists’ intervention in designing or altering DM drug therapy. In addition, hospital pharmacists in Dubai are not actively involved in the management and control of DM conditions. The only positive role of pharmacists were found in the primary healthcare setting where community pharmacists are consulted regularly on sudden or urgent complications related to DM conditions.

"Navigating Complexity: Experiences of Inpatient Pharmacists in Managing High-Risk Medications"

This qualitative study investigates the experiences of 20 inpatient pharmacists in managing high-risk medications, including anticoagulants, immunosuppressants, and chemotherapy agents. Through semi-structured interviews, pharmacists' strategies, challenges, and collaborative practices in medication management within hospital settings were explored. Thematic analysis identified key themes such as medication optimization, interdisciplinary collaboration, and professional development needs. The findings highlight the pivotal role of pharmacists in enhancing medication safety and patient outcomes. Recommendations include tailored education and support to equip pharmacists in effectively navigating complexities associated with high-risk medications.

Seamless integration of inpatient and outpatient pharmacist services reduces hospital readmissions

Seamless integration of inpatient and outpatient pharmacist services reduces hospital readmissions

Pharmacist-Provided Medication Management in Interdisciplinary Transitions in a Community Hospital (PMIT).

Medication management during transitions of care (TOC) impacts clinical outcomes. Published literature on TOC implementation is increasing, but data remains limited regarding the optimal role for the inpatient pharmacist, particularly in the community health setting. To evaluate the impact of a dedicated inpatient TOC pharmacist on re-presentations following discharge. This is a prospective study with historical control. All adult patients discharging home from study units were eligible. The TOC pharmacist (1) reviewed medication history and admission reconciliation, (2) met the patient/caregiver to assess barriers, (3) reviewed discharge reconciliation, (4) performed discharge education, and (5) communicated with next level of care. The primary outcome was 30 day re-presentation rate. Secondary outcomes included 60, 90, and 365 day re-presentation rates. IRB approval was obtained. Three hundred and eighty four patients met inclusion criteria. When compared to 1,221 control patients, the intervention had an 11% absolute and 50.2% relative reduction in 30 day re-presentation rate (OR 0.43, 95% CI 0.30-0.61, NNT 9). Reductions in re-presentations at 60, 90 and 365 days remained statistically significant. Utilization avoidance was $786,347. For every $1 invested in pharmacist time, $12 was saved. The TOC pharmacist made a total of 904 interventions (mean 2.4 per patient). This study provides new information from previous studies and represents the largest study with significant and sustained reductions in re-presentations. Integrating a pharmacist into an interdisciplinary team for medication management during TOC in a community health system is beneficial for patients and financially favorable for the institution.

Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial.

Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal. The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge. Randomized, controlled trial with concealed allocation and blinded outcome assessors Two tertiary care academic medical centers Adults hospitalized with a diagnosis of ACS and/or ADHF. Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported. A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95% CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95% CI 0.51-1.15; BWH aHR = 1.44 (95% CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95% CI 0.17-1.00). There was no difference in treatment effect by patient cognition. A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.

The Impact of a Pharmacy Resident Led Educational Sessions on Electronic Prescribing Errors on Surgical Wards

Medication errors present a significant worldwide problem in a healthcare setting. Prescribing errors were reported as the most common type of medication errors (44%) in a local study in Saudi Arabia. Although Computerized Prescriber Order Entry (CPOE) systems reduce prescribing errors, the magnitude of the problem has not yet been evaluated in our setting. Objectives: The primary objective of this study was to determine the proportion of prescribing errors before and after implementing pharmacy practice resident-led educational sessions to surgical residents. The secondary objectives were to identify the classes of medication(s) involved in errors, their categories, and the proportion of errors identified and corrected by pharmacist(s) or by the pharmacy resident. Methods: A quasi-experimental study was conducted to evaluate the effectiveness of educational sessions on the percentage of electronic prescribing errors at the King Abdulaziz Medical City Western Region (KAMC-WR) for 3 months. Orders by surgical residents were reviewed for prescribing errors before and after the intervention phase. A sample of 890 orders for the pre and post-education sessions was estimated to provide a power of 80% with an alpha of 5% to detect a 50% reduction in prescribing errors post the intervention phase. Results: A total of 890 orders in the pre and post educational sessions were reviewed. The interventional educational sessions had a 5.4% reduction (P = 0.41) in prescribing errors where 140 / 445 (31.4%) prescribing errors were reported in the pre-educational phase, and 116 / 445 (26%) prescribing errors were reported in the posteducational phase. All prescribing errors were identified and corrected by either in-patient pharmacists or the pharmacy practice resident. The most common class of medications involved was anti-infectives, with 59.3% and 61.2% in the pre and post intervention phase, respectively. The most common category of prescribing errors was the incorrect rate of drug administration with 45.9% and 53.4% in the pre and post intervention phase, respectively. Conclusion: Educational sessions were not shown to be effective as a single tool to reduce surgical resident’s prescribing errors. However, it may be added as a part of a multifaceted program to reduce electronic prescribing errors.

Addressing Medication Errors Involving HIV-Positive Inpatients: Development of a Clinician’s Guide to Assessing Antiretroviral Therapy

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Comparison of practice patterns between inpatient cardiology pharmacists with and without added qualifications in cardiology.

There is a paucity of data comparing practice patterns between board-certified specialists with added qualifications in cardiology (AQCV) and cardiovascular pharmacists without these credentials. The purpose is to characterize differences in practice between inpatient pharmacists with and without AQCV. We conducted a multicenter, retrospective, cross-sectional, case-controlled survey. An AQCV pharmacist list was extracted from the Board of Pharmacy Specialties Web site. Hospitals with AQCV pharmacists comprised the case group. Hospitals were excluded if the AQCV pharmacists did not provide direct patient care, practiced in the outpatient setting, or were in a Veterans Affairs hospital. Each case hospital was matched to hospitals without an AQCV pharmacist in a 1:3 ratio (case:control) by region, cardiovascular discharges, and teaching hospital status. Institutions completed a survey characterizing their pharmacy services. Fifty-six hospitals completed the survey (21 AQCV, 35 non-AQCV). More AQCV pharmacists participated on rounds (100% vs 82.9%, P = .04) and devoted more time performing administrative tasks (20.5% ± 15.3% vs 11.1% ± 8.1%, P = .001) than non-AQCV pharmacists. Conversely, AQCV pharmacists spent less time providing clinical care (52.4% ± 14.5% vs 66.2% ± 19.8%, P = .007), were less involved with drug protocol management (71.4% vs 91.4%, P = .05), and performed less order verification than non-AQCV pharmacists. Practice patterns differ between inpatient pharmacists with and without AQCV. Further research is needed to determine whether AQCV credentialing improves patient outcomes and to delineate what specific tasks performed by inpatient cardiology pharmacists may improve patient outcomes.

Comparison of Practice Patterns Between Inpatient Cardiology Pharmacists With and Without Added Qualifications in Cardiology

There is a paucity of data comparing practice patterns between board-certified specialists with added qualifications in cardiology (AQCV) and cardiovascular pharmacists without these credentials.The purpose is to characterize differences in practice between inpatient pharmacists with and without AQCV.We conducted a multicenter, retrospective, cross-sectional, case-controlled survey. An AQCV pharmacist list was extracted from the Board of Pharmacy Specialties Web site. Hospitals with AQCV pharmacists comprised the case group. Hospitals were excluded if the AQCV pharmacists did not provide direct patient care, practiced in the outpatient setting, or were in a Veterans Affairs hospital. Each case hospital was matched to hospitals without an AQCV pharmacist in a 1:3 ratio (case:control) by region, cardiovascular discharges, and teaching hospital status. Institutions completed a survey characterizing their pharmacy services.Fifty-six hospitals completed the survey (21 AQCV, 35 non-AQCV). More AQCV pharmacists participated on rounds (100% vs 82.9%, P = .04) and devoted more time performing administrative tasks (20.5% ± 15.3% vs 11.1% ± 8.1%, P = .001) than non-AQCV pharmacists. Conversely, AQCV pharmacists spent less time providing clinical care (52.4% ± 14.5% vs 66.2% ± 19.8%, P = .007), were less involved with drug protocol management (71.4% vs 91.4%, P = .05), and performed less order verification than non-AQCV pharmacists.Practice patterns differ between inpatient pharmacists with and without AQCV. Further research is needed to determine whether AQCV credentialing improves patient outcomes and to delineate what specific tasks performed by inpatient cardiology pharmacists may improve patient outcomes.

Clinical Availability of All-Trans Retinoic Acid (ATRA) for Patients with Suspected Acute Promyelocytic Leukemia – Why National Guidelines May Not be Followed

▪Background: All-Trans Retinoic Acid (ATRA, Tretinoin, Vesinoid, Teva Pharmaceuticals Industries, North Wales, PA) serves as a uniform backbone in the care and management of patients with acute promyelocytic leukemia (APL). While first investigated as a salvage therapy for patients with relapsed or refractory disease, current National Comprehensive Cancer Network (NCCN) and European LeukemiaNet (ELN) guidelines call for its early use in patients suspected of having APL even prior to the genetic confirmation of the disease. Because ATRA can significantly mitigate disseminated intravascular coagulopathy (DIC), one of the early complications of APL, the NCCN and ELN guidelines support the prescription of ATRA as soon as there is a clinical suspicion of the diagnosis. As a regional referral center for the care of patients with advanced myeloid malignancies, we receive numerous requests for the transfer of care for patients suspected of having APL. Yet many of the referring centers have not instituted treatment with ATRA, typically due to a lack of access to the medication in the referring hospital’s formulary. Therefore, we conducted an exploratory analysis of the clinical availability of ATRA for patients with a suspected diagnosis of APL and also to explore the potential hurdles limiting the availability of this drug.Methods: We divided the United States into six geographical regions: Northwest, Southwest, Central, Southeast, Northeast, and the Great Lakes. A state from each of these regions was selected (Washington, Arizona, Missouri, Georgia, Massachusetts, and Michigan). To select the 120 hospitals, an online hospital directory – American Hospital Directory (ahd.com) was utilized. We went to each state’s specific hospital list page and assigned a number to all hospitals with a bed capacity of greater than 100. We then entered these numbers into a random number generator and selected the first 20 hospitals to be generated (excluding repeats). We then asked the following set of questions to the inpatient pharmacist of the hospital: 1. Does your hospital treat Acute Leukemia or do they refer to other hospitals; 2. Do you have All Trans Retinoic Acid (oral) – 10 mg tablets on the formulary or available in stock as a non-formulary request; 3. If no, why not.Results: Based upon the responses we received, ATRA was available in less than half of the hospitals queried (46%) (Table 1). There were no identifiable differences in the percentages based upon hospital size (inpatient beds) or academic versus non-academic status of the hospital. Interestingly, of the hospitals that refer to other institutions for the care of their leukemia patients, only 19% (8/43) had ATRA on their formulary or available in stock as a non-formulary request that could act as a bridge prior to the transfer. The analysis identified three common barriers to the availability of ATRA in these hospitals including: a) that it has not been recently requested by a physician and therefore was not available, b) the inpatient pharmacist had never heard of the drug, and c) that the hospital relied on associated hospitals or cancer centers to provide the drug to the patient.Table 1Clinical Availability of All-Trans Retinoic Acid in Participating HospitalsRegionStatePercentage of Hospitals Possessing ATRANorthwestWashington65%SouthwestArizona45%MidwestMissouri35%Great LakesMichigan58%SoutheastGeorgia35%NortheastMassachusetts40%Conclusion: While national guidelines support the rapid introduction of ATRA as soon as there is a morphologic consideration for APL, the majority of hospitals caring for these patients can not rapidly institute therapy due to a lack of availability of the medication. Moreover, only 19% (8/43) of hospitals that we studied that refer patients to tertiary care centers can provide ATRA as a bridge prior to their transfer. While much has been written about the early 30-day mortality seen in patients with APL, we can not specifically comment on the impact of these findings on the rates of mortality of APL patients treated in hospitals without ready access to ATRA versus those with the medication available on formulary. However, we propose that these findings should spur an investigation of this possibility together with a call by hematologists nationwide to their formulary committees to ensure that this lifesaving medication is available to patients in as timely a manner as possible. DisclosuresOff Label Use: All Trans Retinoic Acid (ATRA) is indicated for the use in patients with acute promyelocytic leukemia (APL) who are refractory to, or who have relapsed from, anthracycline chemotherapy, or for whom anthracycline based chemotherapy is contraindicated. We will be discussing the availability of ATRA for the use in patients with newly diagnosed APL..

Drug-related problems and the clinical role of pharmacists in inpatient mental health: an insight into practice in Australia

Drug-related problems (DRPs) cause significant morbidity and mortality in healthcare. Clinical pharmacists have shown to reduce DRPs in the inpatient setting. In mental health the effects of clinical pharmacists on DRPs is relatively unknown. To explore the clinical role of inpatient mental health pharmacists and the factors affecting their role. Australian hospitals. Mixed methods. As the profile of the hospital mental health pharmacy workforce is unknown, surveys were distributed to all Australian hospitals with a pharmacy department. DRPs and recommendations were classified using an adaptation of the DOCUMENT system. In-depth semi-structured interviews were undertaken with members of the Society of Hospital Pharmacists Australia's Mental Health Committee of Specialty Practice. Types of DRPs identified by mental health pharmacists, the recommendations made to address them and the rate at which these recommendations were implemented. As well as mental health pharmacists' views on the factors which affect their clinical role. 277 clinical interventions were reported by 47 mental health pharmacists, with 332 DRPs identified and 355 recommendations made. Drug interactions were the most commonly identified DRP (13.9 %). DRPs ranged in severity and likelihood of occurring. Changes to therapy accounted for the vast majority of recommendations (60.8 %), with the most common being change of drug (29.9 %). In total 91.8 % of recommendations were implemented. On average pharmacists estimated 56.1 % of their clinical interventions focused on psychotropic medication issues. Sixteen pharmacists were interviewed. Their relationship with the medical officers, time constraints and a gap in the evidence base to guide practice were identified as the major factors affecting their role. Pharmacists play an important role in ensuring the quality use of medicines in inpatient mental health. However, significant factors need to be addressed to further expand clinical pharmacy services in inpatient mental healthcare in Australia.

Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors.

Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing.Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution.Setting. Prospective audit in a tertiary hospital in Malaysia.Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients’ demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI.Main Outcome Measure. Proportion of appropriate IV PPI prescriptions.Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027).Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization.

Hip-hop doc considers hiring pharmacist for innovative clinic

The doctor-rapper Zubin Dama- nia, MD—otherwise known as ZDoggMD—may soon be advertising for a medication therapy management expert well grounded in collaborative practice to join his primary care team at the newly minted Turntable Health clinic in downtown Las Vegas. “Having a pharmacist can be a real source of patient education,” Damania told Pharmacy Today. “If you allow pharmacists to handle the stuff they’re really good at and practice at the top of their license, they can be a tremendous asset to the team and to care coordination and costs and outcomes.” As an internist with nearly a decade of practice as a hospitalist at Stanford University Medical Center, the physician was speaking from firsthand knowledge. “The role of the inpatient pharmacist as an educator and sort of fail-safe systems person, especially on rounds, is invaluable,” Damania said. “The typical pharmacist knows a lot more about medications and how to take them than a lot of clinicians do, especially in the primary care setting where there is so much to know.” That team role can also be effective in an outpatient wellness setting such as Turntable Health, Damania said. But he is not quite ready to hang out a pharmacist-wanted sign yet. If he had an unlimited budget, he said, that is exactly what he would do, but he doesn’t, so the pharmacist hire will have to wait for the clinic’s membership rolls to reach a more financially viable level. So far, the signs are promising. Turntable Health, in partnership with the Cambridge, MA-based Iora Health, opened its spacious primary care and wellness clinic on December 16, 2013, and within a month had enrolled 200 individuals at the roughly $80 monthly membership fee for unlimited primary care visits plus an array of other wellness services. Several thousand more members are expected through contracts with large local employers and a major health plan. Damania said that the clinic’s eventual complement of primary care physicians, nurses, professional social workers, and personal health coaches will be capable of serving as many as 7,000 members. When that goal is realized, the plan is to immediately roll out several more clinics in various Las Vegas suburbs. “Then as we create a big network and a patient volume large enough to hire our own specialists, we can really transform health care because we’ll bring our culture and our rigorous practice to all phases of the medical interaction.” An onsite pharmacy may also be in the offing, he said. Turntable Health is unlike the vast majority of primary care clinics in the United States today. In addition to clinical consulting rooms, the airy, modernistic 7,000-square-foot street-level clinic contains a yoga studio, a community space with Wi-Fi access, and a live demonstration kitchen where members learn how to prepare healthy meals. As a membership organization, Turntable does not accept fee-for-service insurance payments, Damania said, but it is working with the not-for-profit health plan Nevada Health Co-Op to provide full insurance coverage as well as access to Turntable primary care for one price, potentially subsidized under the Affordable Care Act on the health insurance marketplaces. Damania’s electric online presence as ZDoggMD, the rapping physician with satirical lyrics about the current health care system, was partly what attracted the attention of Zappos CEO Tony Hsieh. Hsieh was looking for a fresh approach to the new health care clinic he envisioned for his Downtown Project, which aims to revive Las Vegas. “Hsieh was a friend,” Damania said, “and because he had gone to school with my wife and had watched my [YouTube] videos, he realized I was not in my right mind and so thought I’d be the perfect person to quit everything and move to Las Vegas to try to start something new.” For the free-spirited Damania, it was an offer he couldn’t refuse.