Hospital Pharmacy

The cost of cancer care is increasing, and tools are needed to understand the economic impact of new drugs on the hospital pharmacy budget.

To develop an interactive budget impact model (BIM) through a collaborative effort of industry, academia, and modeling experts to evaluate the use of a new agent in non-small cell lung cancer (NSCLC); this BIM included an institutional module specific to the needs of practices that purchase medications for use in institutional settings.

Treatment regimens, doses, duration of therapy, toxicity, and cost data are from published sources. All input data may be modified to match the local population. Outputs include cost of care, reimbursement, and margin overall and by treatment regimen.

The base case assumes 20 NSCLC patients progressing after initial therapy (3 receiving ramucirumab+docetaxel, 2 bevacizumab+erlotinib, 3 docetaxel, 6 erlotinib, and 6 pemetrexed), wholesale acquisition cost (WAC) purchase price, and reimbursement at WAC+4.3%. The model estimated the total cost and reimbursement for the institutional oncology pharmacy to be $699,413 and $729,487, respectively, resulting in a margin of $30,075 (difference due to rounding) for the year for regimens utilized in the treatment of NSCLC in the post-progression setting. Results will vary depending on the input data.

There is an increasing need for institutional pharmacies to plan ahead and anticipate the impact of new drugs on their oncology budgets. This interactive Excel-based institutional BIM may provide evidence-based support for pharmacy decision making.

To evaluate the efficacy and safety of clevidipine (CLV) versus sodium nitroprusside (SNP) for the treatment of hypertension (HTN) in postoperative cardiac surgery patients at a community hospital.

This single-center, retrospective, cohort study included cardiac surgery patients treated with CLV or SNP for postoperative systolic blood pressure (SBP) control. The primary efficacy outcome was defined as the mean number of times the SBP rose above 140 mm Hg. Secondary outcomes included a comparative cost analysis and a safety analysis.

Forty patients were included in each arm. Patients who received CLV had a higher incidence of SBP readings greater than 140 mm Hg (p < .05). There were no differences in safety outcomes, number of patients who received as-needed (PRN) antihypertensives, or mean number of PRN antihypertensives required. There were differences in infusion duration (22.4 hours CLV vs 15.6 hours SNP; p = .035), number of infusions dispensed (2.8 CLV vs 1.3 SNP; p = .001), and length of hospital stay (12.33 days CLV vs 7.65 days SNP; p = .013). However, CLV was less expensive based on the AWP cost at the time of review.

Although a difference in blood pressure control was seen between CLV and SNP, the safety profiles were similar between the 2 drugs. In addition, CLV remained less expensive than SNP for postoperative BP control.

Hospital readmission has been identified as a key quality indicator and a target for reducing health care spending.

To evaluate the impact of a pharmacy-facilitated medication reconciliation and patient education model with post discharge follow-up on 30-day readmissions.

This prospective, historical control study included all patients admitted during a 6-month period to a general medicine unit with the highest 30-day readmission rate at Yale-New Haven Hospital. Patients were excluded if they expired prior to discharge, transferred, left against medical advice, were discharged to hospice, or were previously enrolled in the study. Upon admission, pharmacy technicians compiled the medication reconciliation information. Interventions were made by the pharmacist communicating with the patient's primary team. Medication and disease state counseling and final medication reconciliation were performed by the pharmacist before discharge. The primary outcome measure was 30-day readmission rates during the intervention period compared to the preceding 6 months and the same time period the previous year. Secondary outcomes included the total number of pharmacist-identified medication reconciliation interventions, total pharmacy resource utilization, and identification of patients at high risk for readmission.

Study outcomes showed a 27% reduction in readmission during the intervention period. The pharmacist made a total of 546 medication interventions. The average pharmacist and pharmacy technician time per patient were 28.9 and 23.7 minutes, respectively.

Pharmacy-facilitated medication reconciliation and patient education of medicine patients decreased 30-day readmission rates.

Hospitals have attempted to reduce adverse drug events (ADEs) by investing in new technologies, but data regarding their efficacy are lacking.

This study evaluates the effects of the implementation of barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on the profile of ADEs in a hospital setting.

We conducted a before-and-after study examining the effects of the implementation of BCMA and eMAR technology on the profile of ADEs at a 400-bed academic medical center by using incident reports. We compared reported ADEs in pre- and post-implementation periods of 5 months to determine whether there was a reduction in the rate of ADEs within medication use phases. We further examined the severity of errors and described changes in the distribution of types of errors.

A total of 775 electronic error-reporting system reports were included in this study: 397 (51%) in the pre-implementation period and 378 (49%) in the post-implementation period. The rate of ADEs significantly decreased from 0.26% to 0.20% after implementation of the technology (relative risk [RR], 0.78; 95% CI, 0.67–0.89). The rate of transcription errors decreased from 0.089% to 0.036% (RR, 0.40; 95% CI, 0.30–0.54), which was largely attributed to reduction of “wrong time” errors. The rate of administration errors was identical in both groups at 0.017% (RR, 0.98; 95% CI 0.58–1.66). The mean severity level of administration errors significantly decreased from 4.44 to 3.23 (p = .005).

The implementation of eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors. These technologies also reduced the harmful impact to patients caused by administration errors.