Includes bibliographical references.

The Future CPOE Workflow: Augmenting Clinical Decision Support With Pharmacist Expertise -- Contributing Factors to Perceptions of Residents’ Statistical Abilities -- Mix-Ups Between Epidural Analgesia and IV Antibiotics in Labor and Delivery Units Continue to Cause Harm -- Acute Hepatotoxicity After High-Dose Cytarabine for the Treatment of Relapsed Acute Myeloid Leukemia: A Case Report -- Baloxavir Marboxil -- Integration of an Academic Medical Center and a Large Health System: Implications for Pharmacy -- The Culture of Carbapenem Overconsumption: Where Does It Begin? Results of a Single-Center Survey -- Clinical Pharmacist Impact on Intensive Care Unit Delirium: Intervention and Monitoring -- A Case Report of Hypertensive Emergency and Intracranial Hemorrhage Due to Intracavernosal Phenylephrine -- Stability of Meropenem After Reconstitution for Administration by Prolonged Infusion -- Hypoglycemia Associated With Insulin Use During Treatment of Hyperkalemia Among Emergency Department Patients -- Impact of Implementing Smart Infusion Pumps in an Intensive Care Unit in Mexico: A Pre-Post Cost Analysis Based on Intravenous Solutions Consumption.

[Article Title: The Future CPOE Workflow: Augmenting Clinical Decision Support With Pharmacist Expertise / John A. Dougherty and Mark Bonfiglio, p. 149-152]

Abstract: he advent of computerized provider order entry (CPOE) brought substantial changes to the medication order processing workflow. Much of the justification for these changes included improvements in medication safety. CPOE for medications has reduced errors contributing to improvements in patient safety. The benefits of CPOE include a reduction in prescribing and transcription errors and the ability to manage medication-related problems in real time through alerts to the user. Benefits to patient care have been noted with many alert types including the following: drug-allergy, drug-drug interaction, drug-dose, drug-duplication, and formulary compliance alerts.

https://doi.org/10.1177/0018578718791556

[Article Title: Contributing Factors to Perceptions of Residents’ Statistical Abilities / Elizabeth Eitzen and Jennie B. Jarrett, p. 153-154]

Abstract: Publication of PGY1 pharmacy residency research manuscripts is challenging. Annual publication rates for PGY1 pharmacy residency research projects are reported to range from 4% to 20%. Low resident publication rates are due to both low submission and low acceptance rates. Utilization of a 50% or greater publication breakpoint as a predictor of RPD confidence may be an overzealous point of reference in this study compared with the national standard. Only 8.9% of the cohort had a publication rate of 50% or greater, representing an elite group of residency programs and not consistent with the national average. Results may be more generalizable if a publication rate breakpoint was closer to the national average, such as 15% to 20%. Furthermore, the nearly unattainable publication rate was included in the multivariate analysis performed to control for confounding effects of all the statistically significant predictors. The use of an excessive breakpoint for publication rate may be masking retained statistical significance of other potential predictors.

https://doi.org/10.1177/0018578718792806

[Article Title: Mix-Ups Between Epidural Analgesia and IV Antibiotics in Labor and Delivery Units Continue to Cause Harm / Michael R. Cohen and Judy L. Smetzer, p. 155-159]

Abstract: Within weeks of each other this past fall, 2 hospitals reported mix-ups between epidural analgesia and intravenous (IV) antibiotics in labor and delivery (L&D) units. These mix-ups mimic previously published events and have similar contributing factors including look-alike infusion bags, overlooked warning labels, and a point-of-care barcode medication administration (BCMA) system that was not fully engaged. However, unlike the prior events, drug shortages also played a role in the most recent errors.

https://doi.org/10.1177/0018578719825730

[Article Title: Acute Hepatotoxicity After High-Dose Cytarabine for the Treatment of Relapsed Acute Myeloid Leukemia: A Case Report / Samuel H. Fu, Alexander H. Flannery, and Melissa L. Thompson Bastin, p. 160-164]

Abstract:
Purpose: Cytarabine is considered the standard of care for induction therapy in patients with acute myeloid leukemia (AML) who are preparing for bone marrow transplant.

Summary: We report a case of a 72-year-old female presenting to the intensive care unit with hepatic failure after high-dose cytarabine (HiDAC) for the treatment of relapsed AML. The patient’s liver function tests (LFTs) were elevated acutely, with a mildly elevated bilirubin and a normal alkaline phosphatase. HiDAC was discontinued but her LFTs remained high for 9 days post discontinuation, and the patient eventually expired due to sepsis and multiple organ failure. We estimated the probability of the hepatotoxicity observed with HiDAC as probable based on a score of 5 on the Naranjo scale.

Conclusion: Clinicians should be aware of the potential hepatotoxicity associated with HiDAC for patients with AML, specifically in the elderly population.

https://doi.org/10.1177/0018578718779763

[Article Title: Baloxavir Marboxil / Danial E. Baker, p. 165-169]

Abstract: Each month, subscribers to The Formulary Monograph Service receive 5 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 available online to subscribers. Monographs can be customized to meet the needs of a facility. 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.

https://doi.org/10.1177/0018578719841044

[Article Title: Integration of an Academic Medical Center and a Large Health System: Implications for Pharmacy / Brian L. Erstad, Tina Aramaki, and Kurt Weibel, p. 170-174]

Abstract:
Objective: To provide lessons learned for colleges of pharmacy and large health systems that are contemplating or in the process of undergoing integration.

Method: This report describes the merger of an academic medical center and large health system with a focus on the implications of the merger for pharmacy from the perspectives of both a college of pharmacy and a health system’s pharmacy services.

Results: Overarching pharmacy issues to consider include having an administrator from the college of pharmacy directly involved in the merger negotiation discussions, having at least one high-level administrator from the college of pharmacy and one high-level pharmacy administrator from the health system involved in ongoing discussions about implications of the merger and changes that are likely to affect teaching, research, and clinical service activities, having focused discussions between college and health system pharmacy administrators on the implications of the merger on experiential and research-related activities, and anticipating concerns by clinical faculty members affected by the merger.

Conclusion: The integration of a college of pharmacy and a large health system during the acquisition of an academic medical center can be challenging for both organizations, but appropriate pre- and post-merger discussions between college and health system pharmacy administrators that include a strategic planning component can assuage concerns and problems that are likely to arise, increasing the likelihood of a mutually beneficial collaboration.

https://doi.org/10.1177/0018578718823735

[Article Title: The Culture of Carbapenem Overconsumption: Where Does It Begin? Results of a Single-Center Survey / Bryan T. Mogle, Robert W. Seabury, Zachary Jones, Christopher D. Miller, and Jeffrey M. Steele, p. 175-179]

Abstract:
Purpose: The United States has seen an increased consumption of carbapenem antibiotics in recent years. The increased utilization of these agents has potential negative consequences, including the increasing incidence of carbapenem-resistant Enterobacteriaceae. Reasons for the rise in carbapenem use among providers in acute care hospitals are not well elucidated in literature. The objectives of this study were to identify factors that influence empiric carbapenem use among providers in a single academic medical center, and to assess therapeutic knowledge pertaining to carbapenem use.

Methods: A cross-sectional, single-center, 9-item electronic research survey was developed independently and validated by an infectious diseases pharmacist and infectious diseases physician. The survey was distributed to email accounts of providers at a single academic medical center. Demographic data, factors affecting carbapenem prescription, and baseline therapeutic knowledge were assessed.

Results: Ninety-five of 416 providers responded to the survey (response rate of 22.8%). Respondents were well distributed across all levels of training with primary roles in internal medicine and surgery. The most important factors influencing empiric carbapenem use were suspected pathogens at the site of infection, drug allergies, history of multidrug resistant organisms, severity of illness, type of infection, and local resistance rates. A recommendation from a pharmacist was selected as the most likely factor for deterring carbapenem use. Misconceptions pertaining to penicillin drug allergy and beta-lactam cross reactivity, knowledge of local resistance rates according to the institutional antibiogram, and comparative efficacy data for carbapenems were apparent across all levels of training.

Conclusions: Provider misconceptions regarding several factors appear to contribute to unnecessary use of carbapenems. An opportunity exists for hospital pharmacists to improve the prescribing patterns of carbapenems by correcting provider misconceptions through education.

https://doi.org/10.1177/0018578718775328

[Article Title: Clinical Pharmacist Impact on Intensive Care Unit Delirium: Intervention and Monitoring / Myaa Lightfoot, Adam Sanders, Christopher Burke, and Jessica Patton, p. 180-185]

Abstract: Delirium is an insidious cognitive dysfunction which can lead to deleterious clinical outcomes such as death and accelerated cognitive decline. This acute cognitive dysfunction has also been associated with an annual health care cost of $4 to $16 billion in the United States alone. Unfortunately, delirium commonly occurs in elderly patients during hospitalization and has been estimated to occur in up to 80% of mechanically ventilated adult intensive care unit (ICU) patients. Delirium is an independent risk factor for increased mortality within 12 months after hospitalization and is associated with increased length of ICU stay, increased hospital acquired infections, and persistent cognitive deficits.

https://doi.org/10.1177/0018578718778226

[Article Title: A Case Report of Hypertensive Emergency and Intracranial Hemorrhage Due to Intracavernosal Phenylephrine / Raga Deepak Reddy Palagiri, Kshitij Chatterjee, Anusha Jillella, and Drayton A. Hammond, P. 186-189]

Abstract: The incidence of priapism has been reported to be between 0.73 and 1.50 per 100 000 men per year. Priapism can be ischemic (veno-occlusive) as seen in patients with sickle cell disease or nonischemic due to penile or perineal trauma. Ischemic priapism is usually treated with intracavernosal injection of a sympathomimetic, the most commonly utilized agent being phenylephrine. Ridyard et al reported that high dose intracavernosal phenylephrine resulted in detumescence in 86% of patients with ischemic priapism. Phenylephrine is a selective α1-adrenergic agonist and used as a vasopressor when systemically administered. Other routes of administration have reduced bioavailability and a low effect on blood pressure (BP). However, topical administration of phenylephrine has infrequently been described to be associated with hypertensive crisis or cardiovascular compromise. We report a case where intracavernosal injection of phenylephrine resulted in hypertensive emergency leading to intracranial hemorrhage.

https://doi.org/10.1177/0018578718778230

[Article Title: Stability of Meropenem After Reconstitution for Administration by Prolonged Infusion / Sarah Fawaz, Stephen Barton, Laura Whitney, Julian Swinden, and Shereen Nabhani-Gebara, p. 190-196]

Abstract: Antibiotic resistance is increasing to dangerously high levels worldwide threatening the effective prevention and treatment of an ever-increasing range of infections. The increasing occurrence of infection caused by multidrug-resistant, gram-negative bacterial pathogens challenges clinicians to adopt new administration strategies with the intent of optimizing bactericidal activity of currently available beta-lactams. Meropenem is a parenteral carbapenem that is structurally related to beta-lactam antibiotics such as penicillin and cephalosporin. It has an excellent bactericidal activity against a wide range of clinically significant gram-negative and gram-positive aerobic and anaerobic bacteria, thus known as a broad spectrum antibiotic. Meropenem is a time-dependant antibiotic; hence, bactericidal effects are closely correlated to the time at which concentrations remain above the MIC.8 Periods at which concentrations are above the MIC (T > MIC) is a major parameter determining efficacy. When concentrations drop lower than the MIC (T < MIC), bacterial growth resumes immediately because meropenem has no significant postantibiotic effect.

https://doi.org/10.1177/0018578718779009

[Article Title: Hypoglycemia Associated With Insulin Use During Treatment of Hyperkalemia Among Emergency Department Patients / Bobby C. Jacob, Samuel K. Peasah, Hannah L. Chan, Dora Niculas, and Angela Shogbon Nwaesei, p. 197-202]

Abstract: Hyperkalemia is a common electrolyte disorder that can cause clinically significant adverse outcomes including cardiac arrhythmia leading to death. A variety of factors including renal insufficiency, aldosterone insufficiency, and medication use have been associated with an increased risk of hyperkalemia. In 2014, approximately 141 million patients visited emergency departments in the United States. Epidemiological studies estimate that 2.6% to 3.5% of emergency department visits and the resulting hospital admissions arise from hyperkalemia; however, these figures may underestimate the problem. Clinicians initiate treatments for hyperkalemia based on varying serum potassium thresholds and certainly when patients display serious signs and symptoms associated with hyperkalemia including abnormal electrocardiographic changes. Treatment options include protection of myocardial tissue with intravenously administered calcium, promotion of intra-cellular shifting of potassium with insulin, albuterol, or sodium bicarbonate in the setting of metabolic acidosis, and removal of potassium from the body with ion-exchange agents, loop diuretics, or hemodialysis.

https://doi.org/10.1177/0018578718779012

[Article Title: Impact of Implementing Smart Infusion Pumps in an Intensive Care Unit in Mexico: A Pre-Post Cost Analysis Based on Intravenous Solutions Consumption / Erika Palacios Rosas, Isaac F. Soria-Cedillo, Fabiola Puértolas-Balint, Rebecca Ibarra-Pérez, Sergio E. Zamora-Gómez, Elizabeth Lozano-Cruz, Marcos A. Amezcua-Gutiérrez, and Lucila I. Castro-Pastrana, p. 203-208]

Abstract: The use of smart infusion pumps has improved precision in the administration of medication to critical patients. These pumps are a useful tool to reduce errors in the administration of intravenous (IV) medication. More specifically, this system contributes to the prevention of over and under dosing through the standardization of doses, as the limits for each medication established in the drug library restrict the volume, concentration, and rate of infusion of the drug that can be administered, preventing waste and potential accidents.

https://doi.org/10.1177/0018578718786943