Joint Commission Standards Research Articles

Exploration of Norepinephrine Dose-Capping Practices: Report From an International, Interprofessional Survey of Critical Care Clinicians

Purpose: The Joint Commission standards for titrated infusions require specification of maximum rates of infusion. This practice has led to the development of protocolized maximum doses that can be overridden by provider order (“soft maximums”) and to dose caps that cannot be superseded (“hard maximums”). The purpose of this study was to determine the prevalence of and attitudes towards dose capping of norepinephrine. Methods: A 20-item cross-sectional survey assessing norepinephrine dose capping practices, perceptions of norepinephrine protocols, and respondent and practice site demographics was distributed electronically to the mailing list of an international medical podcast. Responses were stratified according to use of weight-based dosing (WBD) or non-WBD of norepinephrine. The primary objective was to characterize norepinephrine dosing practices including protocolized maximum doses and/or dose capping. Categorical and continuous variables were compared using the Chi-square test and Mann-Whitney U test, respectively, with P < .05 indicating statistical significance. Results: The survey was completed by 586 physicians, nurses, pharmacists, and advanced practice providers. WBD was used by 51% and non-WBD by 47%. A standardized titration protocol was reported by 65% and dose capping was reported by 19%. The protocolized maximum dose ranged from 20-400 mcg/min for respondents using non-WBD (median [interquartile range] 30 [30-50]) and ranged from .2-10 mcg/kg/min for respondents using WBD (1 [.5-3]). The dose cap was 50 (40-123) mcg/min with non-WBD and 2 (1-3) mcg/kg/min with WBD. Conclusions: An international, multi-professional survey of critical care and emergency medicine clinicians revealed wide variability in norepinephrine dosing practices including maximum doses allowed.

Esthetic Clinic Management Software—Can we improve patient safety?

To evaluate the features of esthetic-specific Clinic Management Softwares (CMS) and scrutinize these against the General Medical Council (GMC) and Joint Commission (JC) guidance, an indicative CMS framework with GMC and JC compliant features is developed, to improve patient outcomes, service quality, and work toward a centralized database for complications to enable research analysis. A systematic search was performed to evaluate the CMS on the market tailored to esthetic clinics. An analysis was made of the GMC guidance for record keeping and the JC standards for Patient Safety Systems. The CMS features were each scrutinized against the GMC and JC guidance including complication capturing. Eighteen esthetic-specific CMS were identified and analyzed. None of the included CMSs were 100% compliant with both GMC and JC guidance. In 2022, the mean monthly cost of the basic packages for each of the CMS was £106.4, with a standard deviation of £83.3. The main users of the CMSs were doctors and nurses. CMS are a potentially powerful tool to form a centralized database that will allow for increased transparency on the number of procedures performed as well as complications.

Addressing Veteran Health-Related Social Needs: How Joint Commission Standards Accelerated Integration and Expansion of Tools and Services in the Veterans Health Administration

The Joint Commission recently named reduction of health care disparities and improvement of health care equity as quality and safety priorities (Leadership [LD] Standard LD.04.03.08 and National Patient Safety Goal [NPSG] Standard NPSG.16.01.01). As the largest integrated health system, the Veterans Health Administration (VHA) sought to leverage these new accreditation standards to further integrate and expand existing tools and initiatives to reduce health care disparities and address health-related social needs (HRSNs). A combination of existing data tools (for example, Primary Care Equity Dashboard), resource tools (for example, Assessing Circumstances and Offering Resources for Needs tool), and a care delivery approach (for example, Whole Health) are discussed as quality improvement opportunities to further integrate and expand how VHA addresses health care disparities and HRSNs. The authors detail the development timeline, building, limitations, and future plans for these tools and initiatives. Responding to new health care equity Joint Commission standards led to new implementation strategies and deeper partnerships across VHA that facilitated expanded dissemination, technical assistance activities, and additional resources for VHA facilities to meet new standards and improve health care equity for veterans. Health care systems may learn from VHA's experiences, which include building actionable data platforms, employing user-centered design for initiative development and iteration, designing wide-reaching dissemination strategies for tools, and recognizing the importance of providing technical assistance for stakeholders. VHA continues to expand implementation of a diverse set of tools and resources to reduce health care disparities and identify and address unmet individual veteran HRSNs more widely and effectively.

Reducing Therapeutic Duplication in Inpatient Medication Orders.

Therapeutic duplication, the presence of multiple agents prescribed for the same indication without clarification for when each should be used, can contribute to serious medical errors. Joint Commission standards require that orders contain clarifying information about when each order should be given. In our system, as needed (PRN) acetaminophen and ibuprofen orders are major contributors to therapeutic duplication. Design and evaluate effectiveness of clinical decision support (CDS) to reduce therapeutic duplication with acetaminophen and ibuprofen orders. This study was done in a pediatric health system with 3 freestanding hospitals. We iteratively designed and implemented two CDS strategies aimed at reducing the therapeutic duplication with these agents: (1) interruptive alert prompting clinicians for clarifying PRN comments at order entry and (2) addition of discrete "first line", "second line" PRN reasons to orders. Therapeutic duplications were measured by manual review of orders for 30-day periods before and after each intervention and 6 months later. Therapeutic duplications decreased from 1485 in the 30 days prior to the first alert implementation to 818 in the 30 days after but rose back to 1208 in the 30 days prior to the second intervention. After discrete reasons were added to the order, therapeutic duplication decreased to 336 in the immediate 30 days and 6 months later remained at 277. Alerts firing rates decreased from 76.0 per 1,000 PRN acetaminophen or ibuprofen orders to 42.9 after the second intervention. Interruptive alerts may reduce therapeutic duplication but are associated with high rates of user frustration and alert fatigue. Leveraging discrete PRN reasons for "first line" and "second line" produced a greater reduction in therapeutic duplication as well as fewer interruptive alerts and less manual entry for providers.

Hospital Ethics Practices: Recommendations for Improving Joint Commission Standards.

Hospital Ethics Practices: Recommendations for Improving Joint Commission Standards.

Improving emergency airway cart efficiency in compliance with Joint Commission standards

Background and objectiveEmergency Airway Carts (EAC) are essential for pediatric otolaryngologists to provide rapid bedside care for emergent airway scenarios. At many institutions, EAC bronchoscopy equipment is individually peal-packaged due to Joint Commission (JC) standards, creating significant inefficiency in equipment assembly during time sensitive clinical settings. The objective of this quality improvement initiative was to improve the efficiency of use of our emergency airway cart equipment. MethodsIndividually peel-packaged bronchoscope equipment was replaced with JC compliant sets. Otolaryngology trainees (N = 8) and pediatric otolaryngology attending physicians (N = 11) were tested in a simulated airway emergency scenario, requiring bronchoscope assembly. Complete bronchoscope assembly and time to tracheal visualization (TTV) was measured for each participant, which started with initial clinical scenario presentation and ended with successful visualization of the trachea using the rigid bronchoscope. ResultsPre-airway cart interventions, 68.4% of participants built a complete bronchoscope with no missing pieces, which improved to 100% with the new cart organization. Post-EAC interventions, all 19 participants reduced TTV significantly by a mean of 177.7 s (p < 0.001). Trainees reduced TTV by a mean of 251.2 s (46.2%, p < 0.0001) and attendings by 124.2 s (31.5%, p < 0.0022). All participants found the new airway cart sets easier to use and improved equipment setup efficiency. ConclusionsCompiling bronchoscope equipment into sterile sets allowed for improved TTV and bronchoscope quality for trainees and attending physicians while maintaining JC standards. Simulation improved confidence among both trainees and attending surgeons in providing optimal patient care in airway emergencies.

Proper Titration Orders Are Essential for Patient Safety.

Proper Titration Orders Are Essential for Patient Safety.

Antibiotic superheroes: Improving asymptomatic bacteriuria management through academic detailing and provider comparison in the ambulatory care setting

BackgroundThe presence of bacteria in the urine, without coinciding symptoms of infection, is classified as asymptomatic bacteriuria (ASB). Although ASB is common, the Infectious Disease Society of America guidelines discourage its treatment because most patients have no adverse health effects and derive no benefit from antibiotic drugs. Despite these guidelines, patients with ASB frequently receive antibiotic drugs, establishing the need for antimicrobial stewardship interventions. ObjectiveThis study aimed to describe implementation of an antibiotic stewardship campaign targeting proper identification and management of ASB within the ambulatory care setting. Practice descriptionAn antibiotic stewardship campaign was implemented to facilitate prescribing behavior change. An academic detailer performed education outreach to primary care providers (PCPs). Robust conversation was used to deliver key messages focusing on PCP specific improvements. At the completion of the encounter, each PCP was provided with a unique “superhero” name and asked to commit to fight against treating ASB. Subsequently, the superhero name was used for blinded comparison of antibiotic prescribing trends among peers. Practice innovationThe importance of antibiotic stewardship in the ambulatory care setting is increasingly recognized. We depict a stewardship initiative specific to ambulatory care, implemented at a health care system level, that meets the Joint Commission Standards first required in 2020. Evaluation methodsPositive urine cultures from November 1, 2018, to October 31, 2019, served as the preimplementation group, and cultures from November 1, 2020, to October 31, 2021, served as the postimplementation group. A retrospective chart review and logistic regression model were used to compare the antibiotic prescribing rate in ASB before and after the intervention. ResultsThe campaign was associated with a 92% reduction in the odds of antibiotic prescribing (odds ratio 0.08 [95% CI 0.04–0.17]) compared with the preimplementation period controlling for baseline covariates. ConclusionThe utilization of academic detailing, bundled with audit and feedback, decreased the treatment of ASB and improved the quality of care received.

97. Pharmacist Driven Antimicrobial Stewardship Interventions on the Management of Urinary Tract Infections in the Emergency Department at a Tertiary Military Treatment Facility

BackgroundWith the Joint Commission standards targeting ambulatory settings serving as a catalyst, we designed a quality improvement (QI) project was designed to evaluate the existing management and prescribing patterns for urinary tract infections (UTI) in the Walter Reed National Military Medical Center (WRNMMC) Emergency Department (ED) in order to identify targets for ASP intervention. MethodsThis was a Pharmacist-driven, prospective, QI project conducted over a 3-month period. The clinical presentations and microbiological data of uncomplicated cystitis and pyelonephritis cases managed in the ED were reviewed. Within 24-72 hours of ED discharge, recommendations were relayed to both patients and ED staff. Diagnostic criteria and management concordant with established clinical guidelines were assessed. Inclusion criteria included age ≥ 18, admission status, urine culture and antibiotics for UTI or pyelonephritis.ResultsA daily urinalysis (UA) report identified 1781 ED encounters of which 117 cases met inclusion criteria. Nitrofurantoin was most prescribed empirically at 39.3% followed by a cephalosporin (23.1%) or a fluoroquinolone (19.7%), accounting for 32% of inappropriate empiric antibiotic selection. Cases were identified with inappropriate duration of therapy (22.2%), dosage (9.4%), and drug-bug mismatch (9.4%). Nearly 38% of cases required intervention to discontinue (32.5%) or initiate new antibiotics (3.4%). Diagnostic concordance was defined as having positive urinary symptoms, clinically significant UA and positive urine culture. This was only observed in 37.6% of all cases, of which only 43.2% were treated with a guideline concordant empiric regimen, dosage and duration of therapy. Although not included in the final analysis, it was noted 916 urine culture results were ordered where 70% were not associated with genitourinary complaints or sepsis.ConclusionDespite guidelines for UTI management, considerable practice discordance was found in the ED. Multiple Pharmacist targeted interventions were identified. Prioritized areas for ED provider education include first-line therapy, treatment duration, and diagnostic stewardship. This QI project has potential for optimizing prescribing practices in Military Health System ambulatory settings. Disclosures All Authors: No reported disclosures

Characteristics of Opioid Prescribing in Non-surgical Medicine Patients with Acute Pain at Hospital Discharge.

The opioid epidemic and new Joint Commission standards around opioid stewardship have made the appropriate prescribing of opioids a priority. A knowledge gap exists pertaining to the short-term prescription of opioids at hospital discharge for acute pain in non-surgical patients. To characterize the quantity, type, and indication of opioids prescribed for non-surgical patients on hospital discharge and subsequent patient utilization. This multicenter, single-health system retrospective cohort study was conducted for quality improvement purposes from December 2019 to May 2020 with patient follow-up 15 to 29 days after hospital discharge. Patients discharged from a medicine service with new opioid prescriptions, defined as no opioid prescription documented within the past 90 days, were identified as eligible through the electronic health record. Surveys were attempted until a total of 200 were completed, with 374 surveys attempted and a 53% response rate. Patients were contacted via phone and surveyed post-discharge. Surveys consisted of 28 questions and assessed opioid consumption, duration of use, refills, patient satisfaction, and opioid disposal. Prescribing indications and morphine milligram equivalents (MME) quantities were collected for patients at discharge. Subsequently, the quantity of prescribed opioids utilized, remaining, and disposed of post-discharge were collected via patient self-reported survey responses. Indications for opioid prescribing for 200 surveyed patients were grouped into eight broad prescribing categories. A median of 112.5 total MME was prescribed to patients at hospital discharge. Median MME consumed for surveyed patients was 45. The median total MME remaining at time of survey was 35 MME. Only 5.9% of patients who had leftover opioids reported disposal of the medication. Given the observed variation in opioid prescribing and utilization data, standardized indication-based opioid prescribing guidance in the non-surgical medical population would help curb the amount of opioids that remain unused post-discharge.

Impact of Education and Data Feedback on Guideline-Concordant Prescribing for Urinary Tract Infections in the Outpatient Setting.

BackgroundUrinary tract infections (UTIs) are the most common outpatient indication for antibiotics and an important target for antimicrobial stewardship (AS) activities. With The Joint Commission standards now requiring outpatient AS, data supporting effective strategies are needed.MethodsWe conducted a 2-phase, prospective, quasi-experimental study to estimate the effect of an outpatient AS intervention on guideline-concordant antibiotic prescribing in a primary care (PC) clinic and an urgent care (UC) clinic between August 2017 and July 2019. Phase 1 of the intervention included the development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines, presented during educational sessions with clinic providers. Phase 2, consisting of routine clinic- and provider-specific feedback, began ~12 months after the initial education. The primary outcome was percentage of encounters with first- or second-line antibiotics prescribed according to clinic-specific guidelines and was assessed using an interrupted time series approach.ResultsData were collected on 4724 distinct patients seen during 6318 UTI encounters. The percentage of guideline-concordant prescribing increased by 22% (95% CI, 12% to 32%) after Phase 1 education, but decreased by 0.5% every 2 weeks afterwards (95% CI, –0.9% to 0%). Following routine data feedback in Phase 2, guideline concordance stabilized, and significant further decline was not seen (–0.6%; 95% CI, –1.6% to 0.4%). This shift in prescribing patterns resulted in a 52% decrease in fluoroquinolone use.ConclusionsClinicians increased guideline-concordant prescribing, reduced UTI diagnoses, and limited use of high-collateral damage agents following this outpatient AS intervention. Routine data feedback was effective to maintain the response to the initial education.

A Quality Improvement Pilot of Pharmacist-Led Identification of an Inpatient Population for Opioid Stewardship and Pain Management

The Joint Commission standards now include identification and monitoring patients at high-risk for adverse outcomes of opioid use. Our institution does not have a method to identify at-risk patients. This pilot aimed to assess feasibility of pharmacist-led identification of a population for pain management and opioid stewardship. All patients admitted to the hospital were screened; electronic health record reports identified all opioid, antidepressant, and benzodiazepine administrations within the previous 24 hours, and pertinent family and social history risk factors for Opioid Use Disorder (OUD) and opioid-induced respiratory depression (OIRD). Data were exported to spreadsheets and calculated risk scores for OUD and OIRD, and opioid utilization and morphine milligram equivalents (MME) were tabulated. Chart reviews were completed on patients identified as high risk for OUD or OIRD, if MME was 90 or greater, or those receiving four or more “as needed” opioid doses in the previous 24 hours. Potential regimen adjustments based on the primary investigator’s judgment were categorized. Mean number of patients identified per day to receive stewardship was 13, and 18.6 potential interventions per day were identified. Based on results of this pilot, pharmacist-led identification of inpatients warranting pain and opioid stewardship is feasible at our institution.

Abstract P858: The Impact of a Dedicated Stroke Program Quality Coordinator Registered Nurse on the Volume of Performance Improvement Projects

Background: Performance Improvement (PI) enhances processes, services, and outcomes. The Joint Commission (TJC) standards require a comprehensive approach to PI. This can be challenging due to variability of staffing within a stroke program. The stroke coordinator is often left to manage PI projects, which can be arduous due to the multiple demands of their role. A dedicated Stroke Quality Coordinator RN (SQCRN) manages quality improvement activities solely for the stroke program. It is a unique position that requires clinical knowledge of stroke, neuro-interventional and neurosurgical procedures, as well as, comprehension of regulatory requirements, PI and data analysis. Purpose: To determine if having an SQCRN dedicated to a stroke program results in an increased number of PI Projects implemented. Methods: The SQCRN initiative was implemented in 2020 with the objective of determining the impact of having a dedicated SQCRN on the number of projects completed. A survey was created consisting of 5 questions and sent to 328 individuals via email utilizing an anonymous Microsoft Forms Link. The survey was emailed to the Los Angeles Stroke Coordinator Network and National Stroke Coordinator group. Fifty-eight (17.6%) responded. Survey results were compared for stroke programs with a Dedicated SQCRN to those without. Data were analyzed using T-Test. Results: In stroke programs with a dedicated SQCRN, there were more respondents who reported 6 or greater PI projects than stroke programs who did not have a dedicated SQCRN. This was statistically significant when compared to both 2 or less (p=0.001) or 4 or less projects p=0.035. Conclusion: A dedicated SQCRN improves the number of PI projects that a stroke program can implement. PI initiatives help to improve the safety, treatments, services and quality of care in order to improve patient outcomes.

161. Assessing Antimicrobial Stewardship Engagement among Frontline Oncology Nurses and Chartering a Path Forward

BackgroundDeveloping robust, multidisciplinary antimicrobial stewardship programs to combat drug resistance is a priority of healthcare institutions, in accordance with Joint Commission standards and national legislature. However, the involvement of nurses in stewardship programs has trailed behind that of physicians and pharmacists, despite their unique position as frontline providers. In particular, oncology nursing staff can play a key role in extending stewardship to their high acuity patients, who frequently require antimicrobials. We sought to conduct a survey study of oncology nursing providers on their understanding, perceptions, and attitudes about antimicrobial stewardship.MethodsA voluntary and anonymous survey was emailed to oncology nursing staff on adult and pediatric oncology wards and clinics throughout our hospital system. We used an adapted 28-item Likert scale-based survey to assess understanding of antimicrobial stewardship attitudes and perceived barriers to greater involvement in stewardship programs. A survey reminder was emailed weekly for 8 weeks and completion was encouraged by nursing leadership in unit staff meetings.ResultsThe survey was emailed to 281 nurses, of whom 39% (n=109) responded. 54.1% of nurses believed that an antibiotic stewardship program was very important in their healthcare setting. However, 56% of respondents were unfamiliar with the meaning of antibiotic stewardship, and 83.5% were not aware of how to contact the antimicrobial stewardship team with questions. More than 75% felt that nurses could help with antibiotic use, though 76% indicated wanting to know more about which antibiotics treat different infections and 74% wanted to know more about appropriate durations of antibiotics.ConclusionOncology nurses have the potential to play a valuable role in antimicrobial stewardship. Barriers to nursing involvement include knowledge gaps on antibiotics and unfamiliarity with existing stewardship programs and their functions within hospital systems. Nursing education and orientation to available resources are key steps to involving nursing staff in antimicrobial stewardship programs, maximizing benefits for both patients and hospitals.Disclosures All Authors: No reported disclosures

127. A Retrospective Review of Antibiotic Appropriateness for Urinary Tract Infections in Ambulatory Patients

BackgroundThe Centers for Disease Control and Prevention and the Joint Commission recommend establishing antibiotic stewardship in outpatient settings. Previous studies estimate over half of all antibiotic prescriptions in the outpatient setting for any indication are inappropriate. Urinary tract infections present a key stewardship opportunity, as most fluoroquinolones prescribed for acute uncomplicated cystitis are potentially inappropriate and many safety concerns exist for this drug class. This study evaluates the outpatient antimicrobial prescribing practices for cystitis and other urinary tract infections at ambulatory clinics within a health system.MethodsThis retrospective cohort study includes adults treated for cystitis or urinary tract infection at 60 primary care and 21 specialty clinics within a large academic health system over a three-year period. Diagnosis codes and individual chart review were used to collect data. The primary outcome is the proportion of patients prescribed antibiotics for urinary tract infection who received a fluoroquinolone.ResultsOf 22,099 encounters which included one of the diagnosis codes indicative of cystitis, an antibiotic was prescribed in 19,101 (86%). Among the encounters in which an antibiotic was prescribed, 29.1% included a fluoroquinolone prescription. A subset of 100 patients from this population were reviewed and assessed for appropriateness based on symptoms, comorbidities, allergies, and previous urinary isolates. The prescribed drug class was determined appropriate in 40% of the fluoroquinolone cases and in 80% of the nitrofurantoin or sulfamethoxazole/trimethoprim cases.ConclusionPotential strategies that may reduce the inappropriate prescribing of fluoroquinolones in our large academic health system include an EHR alert, regular dissemination of prescriber reports, and additional provider education to facilitate shared decision-making. These results provide a baseline to inform future interventions to reduce inappropriate antibiotic prescribing and to ensure compliance with Joint Commission standards.Disclosures All Authors: No reported disclosures

Antibiotic stewardship: Improving patient-centered right care in urgent care using a shared decision aid and 5 Ds tool.

Overuse of antibiotics leads to antibiotic resistance, costing $35 billion and causing approximately 23,000 deaths in the United States annually. Antibiotic stewardship is important in urgent care centers to prevent antibiotic resistance. Providers prescribed antibiotics to 80% of patients with viral conditions at this urgent care center. The aim of this quality improvement (QI) project was to improve right care for patients of 65 years and younger with upper respiratory infections and/or head, ears, nose, or throat viral illnesses presenting to urgent care from 36.2% to 80% within 90 days. Four rapid Plan-Do-Study-Act cycles were performed every two weeks. Four concurrent focus areas were used for team and patient engagement, antibiotic prescribing, and tracking right care. There were four core interventions. These included biweekly team meetings, a shared decision aid (SDA), an antibiotic prescribing 5 Ds tool, and a case management log. Use of the SDA improved patient engagement from 33% to 93%. The 5 Ds tool improved proper prescribing from 20% to 95%. Pediatric acute otitis media had the greatest improvement, with the proper diagnosis and the use of watchful waiting, delaying the filling of an antibiotic prescription. Antibiotic stewardship and standardization of prescribing were improved in urgent care with the use of the 5 Ds tool. This QI project can be replicated for use in urgent care centers for compliance with the Joint Commission standards required.

National Survey of Clinical Pharmacy Practice in Saudi Arabia-2017-2018: Education and Training

PTB Reports,2020,6,3,91-95.DOI:10.5530/PTB.2020.6.17Published:March 2020Type:Research ArticleAuthors:Yousef Ahmed Alomi, Fatimah Al-Doughan, Sultan Mohammed Al-Jarallah, Yasir Ahmed Ibrahim, Adel Mehmas Alragas, and Norah Omar Bin Haidarah Author(s) affiliations:Yousef Ahmed Alomi*, BSc. Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE, Critical Care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor and Data Analyst, Riyadh, Saudi Arabia. Fatimah Al-Doughan, PharmD, Lecturer College of Pharmacy, Pharmacy Practice Department King Faisal University, Alahssa, Saudi Arabia. Sultan Mohammed Al-Jarallah, Head, Ambulatory Care Pharmacy, Oncology and Hematology Clinical Pharmacist, Pharmaceutical Care Department, Security Forces Hospital, Riyadh, Saudi Araia. Yasir Ahmed Ibrahim, PharmD, Head of Pharmacy Practice Department Pharmacy Practice Department College of Clinical Pharmacy, King Faisal University P.O.BOX 400, Alahssa, Saudi Arabia. Adel Mehmas Alragas, Bsc. Pharm Staff Pharmacist Pharmacy Department Medical City King Saud University, Riyadh, Saudi Arabia. Norah Omar Bin Haidarah, PharmD, Pharmacy Staff Outpatient pharmacy Dr Sulaiman Al-habib Hopsital, Riyadh, Saudi Arabia. Abstract:Objectives: To explore the national survey of clinical pharmacy practice in Saudi Arabia during 2017- 2018 with emphasis on the education and training available to the pharmacy staff. Methods: This is a 4-month cross-sectional national survey on clinical pharmacy practice in Saudi Arabia. The study consisted of two parts: The first part collects demographic information and the second part comprises of 51 questions divided into four domains. The domains are derived from the American Society of Health- System Pharmacists (ASHP), Saudi Pharmaceutical Society (SPS) survey, the international standard of Joint Commission of Hospital Accreditation and from the local standards of Saudi Center of Healthcare Accreditation. The four domains were the clinical pharmacy administration and management, performances and activities, education and training and workload documentation. We used a 5-point Likert response scale system with close- and open-ended questions to obtain responses. The questionnaire was distributed in an electronic format to the 31 directors of pharmacies at hospitals. In this study, we analyzed the national survey of clinical pharmacy practice at hospitals in Saudi Arabia with an emphasis on education and training. All data were obtained through the Survey Monkey system. Results: The survey questionnaire distributed to 31 hospitals. The most qualified educational course available for the clinical pharmacy staff was on cardiopulmonary resuscitation (CPR) (74.19%) and on advance cardiac life support (ACLS) (36.67%) and the least available educational course was advance trauma life support (ATLS) (10.71%). Almost all educational courses were provided to the general clinical pharmacist (89) and clinical pharmacist supervisor (22). The majority of the educational courses provided to the healthcare professionals was on short educational course of 1–5 days (85 (47.22%)) followed by basic medication safety (60 (45.45%)) and clinical pharmacy orientation 50 (41.67%), whereas clinical pharmacists provided educational and training courses to healthcare providers mainly for general nurses (108) followed by resident physicians (66) and specialist physicians (53) periodically. Conclusion: The clinical pharmacy staff missed some primary educational and training courses. Less than half of the hospitals provided educational courses to healthcare care professionals. We highly recommend bilingual educational and training facilities for clinical pharmacy staff and healthcare professionals in the KSA. Keywords:Clinical, Education, Pharmacy, Practice, Saudi Arabia, TrainingView:PDF (206.53 KB) PDF PDF Images The type of education and training available delivered to healthcare professional by for pharmacy staff

Is P&T Ready to Add Rapid Cycle Analytics to Formulary?

Purpose: The intent of this article is to evaluate a novel approach, using rapid cycle analytics and real world evidence, to optimize and improve the medication evaluation process to help the formulary decision making process, while reducing time for clinicians. Summary: The Pharmacy and Therapeutics (P&T) Committee within each health system is responsible for evaluating medication requests for formulary addition. Members of the pharmacy staff prepare the drug monograph or a medication use evaluation (MUE) and allocate precious clinical resources to review patient charts to assess efficacy and value. We explored a novel approach to evaluate the value of our intravenous acetaminophen (IV APAP) formulary admittance. This new methodology, called rapid cycle analytics, can assist hospitals in meeting and/or exceeding the minimum criteria of formulary maintenance as defined by the Joint Commission Standards. In this particular study, we assessed the effectiveness of IV APAP in total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures. We assessed the correlation to same-stay opioid utilization, average length of inpatient stay and post anesthesia care unit (PACU) time. Conclusion: We were able to explore and improve our organization's approach in evaluating medications by partnering with an external analytics expert to help organize and normalize our data in a more robust, yet time efficient manner. Additionally, we were able to use a significantly larger external data set as a point of reference. Being able to perform this detailed analytical exercise for thousands of encounters internally and using a data warehouse of over 130 million patients as a point of reference in a short time has improved the depth of our assessment, as well as reducing valuable clinical resources allocated to MUEs to allow for more direct patient care. This clinically real-world and data-rich analytics model is the necessary foundation for using Artificial or Augmented Intelligence (AI) to make real-time formulary and drug selection decisions.

Current state of opioid stewardship.

The opioid epidemic continues to result in significant morbidity and mortality even within hospitals where opioids are the second most common cause of adverse events. Opioid stewardship represents one model for hospitals to promote safe and rational prescribing of opioids to mitigate preventable adverse events in alliance with new Joint Commission standards. The purpose of this study was to identify the prevalence of current hospital practices to improve opioid use. A cross-sectional survey of hospital best practices for opioid use was electronically distributed via electronic listservs in March 2018 to examine the presence of an opioid stewardship program and related practices, including formulary restrictions, specialist involvement for high-risk patients, types of risk factors screened, and educational activities. Among 133 included hospitals, 23% reported a stewardship program and 14% reported a prospective screening process to identify patients at high risk of opioid-related adverse events (ORAEs). Among those with a prospective screening process, there was variability in ORAE risk factor screening. Formulary restrictions were dependent on specific opioids and formulations. Patient-controlled analgesia was restricted at 45% of hospitals. Most hospitals reported having a pain management service (90%) and a palliative care service providing pain management (67%). The absence of opioid stewardship and prospectively screening ORAEs represents a gap in current practice at surveyed hospitals. Hospitals have an opportunity to implement and refine best practices such as access to pain management specialists, use of formulary restrictions, and retrospective and prospective monitoring of adverse events to improve opioid use.

A Guide to Performance Evaluation for the Intensivist: Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation in the ICU.

In 2008, The Joint Commission implemented a new standard mandating a detailed evaluation of a provider's performance. The Ongoing Professional Practice Evaluation was designed to provide ongoing performance evaluation as opposed to periodic evaluation. The Focused Professional Practice Evaluation was designed to evaluate the performance of providers new to the medical staff or providers who are requesting new privileges. To date, we are unable to find critical care specific literature on the implementation of Ongoing Professional Practice Evaluation/Focused Professional Practice Evaluation. The purpose of this concise definitive review is to familiarize the reader with The Joint Commission standards and their application to Ongoing Professional Practice Evaluation/Focused Professional Practice Evaluation design and implementation, literature review in the noncritical care setting, and future process optimization and automation. Studies were identified through MEDLINE search using a variety of search phrases related to Ongoing Professional Practice Evaluation, Focused Professional Practice Evaluation, critical care medicine, healthcare quality, and The Joint Commission. Additional articles were identified through a review of the reference lists of identified articles. Original articles, review articles, and systematic reviews were considered. Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. There is limited data for the process of Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation implementation in critical care medicine. Key recommendations exist from The Joint Commission but leave it up to healthcare institutions to realize these. The process and metrics can be tailored to specific institutions and departments. Currently, there is no standard process to develop Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation processes in critical care medicine. Departments and institutions can tailor metrics and processes but it might be useful to standardize some metrics to assure the overall quality of care. In the future utilization of newer technologies like applications might make this process less time-intensive.