Hospital Pharmacy

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.

In 2001, the landmark trial of early goal-directed therapy versus standard care for the treatment of severe sepsis and septic shock was published. The marked decrease in mortality with early recognition of sepsis and quantitative resuscitation revolutionized the treatment of patients with these conditions. Specific pieces of the early goal-directed therapy protocol have not been routinely adopted into bedside care; however, early administration of antibiotics, resuscitation with intravenous fluids, and attainment of hemodynamic stability to achieve end-organ perfusion have become the standard of care. To help ensure all patients receive optimal therapy at the first signs of severe sepsis or septic shock, the Surviving Sepsis Campaign has developed a core set of initial process steps and treatment goals grouped into a care bundle. Recognizing the benefit of early quantitative resuscitation on patient care, the National Quality Forum adopted a severe sepsis and septic shock care bundle that is similar to the Surviving Sepsis Campaign bundle. This care bundle has been adopted by the US Centers for Medicare & Medicaid Services, with reimbursement to be influenced beginning in 2017. The purpose of this review is to summarize evidence supporting the sepsis quality measure and care bundle and simplify key components of the care bundle where pharmacists can be impactful in ensuring optimal patient care and bundle compliance.

Until 2010, the vitamin K antagonist warfarin was the only available oral anticoagulant for the prevention of stroke or systemic embolic events (SEE) in patients with nonvalvular atrial fibrillation (NVAF) and the treatment of venous thromboembolism (VTE) in the United States. Despite its proven efficacy, the use of warfarin is limited by numerous disadvantages, including a delayed onset of action and variable efficacy resulting from interactions with genetic and environmental factors. Consequently, optimal anticoagulation with warfarin requires dose adjustments based on frequent monitoring. In contrast to warfarin, direct oral anticoagulants (DOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban have predictable pharmacokinetic profiles, few drug-drug interactions, no known interactions with food, and can be administered at fixed doses without the requirement for routine monitoring. All DOACs have received US Food and Drug Administration (FDA) approval for the prevention of stroke or SEE in patients with NVAF and the treatment of VTE based on phase 3 trials demonstrating that they are at least as efficacious as warfarin. In addition, the incidence of clinically relevant bleeding associated with DOACs is comparable to or lower than with warfarin. In this article, the preclinical and clinical data that led to the FDA approval of once-daily edoxaban in January 2015 are presented. Furthermore, practical considerations for edoxaban use including dosing recommendations, transitions of care, reversal of anticoagulation, precautions, contraindications, and cost-effectiveness are discussed. Edoxaban is an important addition to oral anticoagulation options available for the therapeutic management of patients with NVAF or VTE.

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases.

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.

Job shadowing is an excellent way to learn more about the pharmacy profession. The shadowing individuals gain a greater sense of the role pharmacists play in the health care team and are exposed to the variety of roles that are filled by pharmacists. Job shadowing is also an important way for pharmacists to demonstrate the value of the profession and recruit talented individuals to their institution. However, there are several important considerations to ensure that the shadowing experience is beneficial for the individual, is a positive experience for the sponsor, and is compliant with the host institution's policies and procedures. The goal of this article is to prepare a potential host site for developing and maintaining a successful job shadow experience.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. The January 2016 monograph topics are idarucizumab, patiromer, coagulation factor VIII/antihemophilic factor (recombinant), cariprazine, and trifluridine and tipiracil. The Safety MUE is on idarucizumab.

This monthly feature will help readers keep current on new drug, new indications, dosage forms and safety-related changes in labeling or use. Efforts have been made to assure the accuracy of this information; however, if there are any questions, please let us know at jgeneral@ku.edu

Leaders in health-system pharmacy are challenged to minimize costs, maximize revenue, and maintain or improve quality while simultaneously expanding services. Strong command of productivity and workload measurement is necessary to achieve these goals. This article reviews foundational pharmacy productivity concepts and key terminology, reviews historical pharmacy productivity models and their limitations, and considers new and evolving pharmacist productivity models.

We have mentioned the need for a multidisciplinary app in health care in at least 3 of our previous columns. We have also written about the Internet of Things (IoT) and how this exploding technology change will impact us all. In case you need a refresher, we believe that there are 5 new rights in health care that can be supported by mobile connectivity.