Includes bibliographical references.

Prescribing of Pressor Agents in Septic Shock: A Survey of Critical Care Pharmacists -- Strategy to Improve Efficiency of Comprehensive Medication Reviews in a Community Pharmacy -- Comparison of Vancomycin Treatment Failures for Methicillin-Resistant Staphylococcus aureus Bacteremia Stratified by Minimum Inhibitory Concentration -- Qualitative Investigation of Community Pharmacy Immunization Enhancement Program Implementation -- The Unmet Need for Pharmacists as Important Members of the Emergency Department Team in Resource-Limited Settings: A Case of Nepal -- Searching the Literature: A Simple Step-Wise Process for Evidence-Based Medicine -- Rifampin Augmentation in Hardware Infections: A Case Report of Thrombocytopenia.

[Article Title: Prescribing of Pressor Agents in Septic Shock: A Survey of Critical Care Pharmacists / Susan E. Smith, Andrea Sikora Newsome and Randall L. Tackett, p. 187-193]

Abstract:

Background: Pressor agents are recognized as high-alert medications by the Institute for Safe Medication Practices, but little evidence is available to guide their use in septic shock.

Objective: Characterize the use of pressor agents for septic shock in clinical practice.

Methods: A cross-sectional electronic survey assessing demographics, institutional practices, and respondent perceptions related to pressor agents was distributed to the American College of Clinical Pharmacy Critical Care Practice and Research Network. The primary outcome was the use of a weight-based dosing (WBD) strategy versus non-WBD strategy for norepinephrine. Descriptive statistics were used to summarize survey results. Binary logistic regression was performed to determine variables associated with dosing strategies.

Results: The survey was completed by 223 respondents. The typical respondent worked in a medical or mixed intensive care unit at a teaching hospital and had training and/or board certification beyond the Doctor of Pharmacy degree. Nearly all respondents (n = 221, 99%) reported norepinephrine as the first-line vasopressor for septic shock; however, 38% used WBD and 60% used non-WBD. In logistic regression, respondents located in the South and practicing at institutions with larger numbers of intensive care unit beds were more likely to use WBD for norepinephrine infusions. Similar findings were observed with epinephrine and phenylephrine.

Conclusion: Wide variability exists in prescribing patterns of pressor agents and in pharmacist perceptions regarding best practices. The use of WBD varied based on institutional characteristics and resulted in higher maximum allowable infusion rates of pressor agents. Future research should compare dosing strategies to identify associations with patient outcomes.

https://doi.org/10.1177/8755122519846164

[Article Title: Strategy to Improve Efficiency of Comprehensive Medication Reviews in a Community Pharmacy / Diana Ching, Hussein El-Khatib and Anthony J. Pattin, p. 194-202]

Abstract:

Background: Comprehensive medication reviews (CMRs) provide opportunities for pharmacists to perform clinical services to their patients. However, pharmacists are often not able to perform CMRs due to time constraints. Studies have shown that incorporating support staff into the CMR workflow may lead to increases in the completion of CMRs.

Objective: The primary objective was to examine the change in the number of CMRs completed at the pharmacy after a new strategy was implemented to perform and prepare for CMRs. The secondary objective was to examine the changes in the revenue generated from CMRs.

Methods: This study was a pre-post retrospective, observational study performed at an independent pharmacy. Data were collected and analyzed 10 months before and after implementation of a new strategy. The new strategy called for pharmacy interns to use a template for working up patients prior to CMRs. Wilcoxon signed-rank tests were run on IBM SPSS, Version 24.0, to determine the significance of the changes. Results that generated P values <.05 were considered statistically significant.

Results: The total number of CMRs completed increased from 29 before the intervention to 158 after the intervention (P = .009). The revenue generated from CMRs improved statistically (P = .007).

Conclusions: Implementing a strategic workflow that uses pharmacy interns and a patient workup template can significantly increase the number of CMRs completed in a community pharmacy. Appropriate delegation of such tasks may allow more time for pharmacists to deliver more CMRs. Additional benefits include increased compensation from delivering more CMRs.

https://doi.org/10.1177/8755122519849118

[Article Title: Comparison of Vancomycin Treatment Failures for Methicillin-Resistant Staphylococcus aureus Bacteremia Stratified by Minimum Inhibitory Concentration / Mary Joyce B. Wingler, Darrell T. Childress and Ricardo A. Maldonado, p. 203-207]

Abstract:

Background: Optimal treatment of methicillin-resistant Staphylococcus aureus bacteremias (MRSABs) with vancomycin minimum inhibitory concentrations (MICs) high within the susceptible range is of concern due to the high rate of mortality and increased prevalence.

Objective: The purpose of this study is to evaluate vancomycin treatment failures in patients with MRSAB stratified by vancomycin MIC.

Methods: In this retrospective chart review, patients ≥19 years of age with MRSAB between July 2010 and December 2016 were included if they received intravenous vancomycin for ≥72 hours. Vancomycin treatment failures were compared between patients with vancomycin MICs of ≤1 mg/L and 2 mg/L. Vancomycin treatment failure was defined as microbiological failure at 7 days. Inpatient mortality, 30-day readmission, vancomycin-associated nephrotoxicity, and early bacteremia clearance at 48 to 96 hours were assessed as secondary endpoints.

Results: Fifty-eight patients were included in the vancomycin MIC ≤1 mg/L group and 22 patients in the vancomycin MIC 2 mg/L group. No significant difference was found in vancomycin treatment failures at 7 days between groups (88% vs 91%, respectively; P = .850). At 96 hours, there was no significant difference in vancomycin treatment failures between groups (72% vs 90%, respectively; P = .127). No significant difference was found in mortality (P > .99) or 30-day readmission (P > .99).

Conclusions: In this study, vancomycin treatment failures were not more prevalent in patients with vancomycin MIC of 2 mg/L at 7 days. Regardless of MIC, antibiotics should be switched to an alternative agent at 7 days for persistent bacteremia.

https://doi.org/10.1177/8755122519852679

[Article Title: Qualitative Investigation of Community Pharmacy Immunization Enhancement Program Implementation / Sally A. Huston, David R. Ha, Lindsey A. Hohmann, Tessa J. Hastings, Kimberly B. Garza and Salisa C. Westrick, p. 208-218]

Abstract:

Background: Despite widely available nonseasonal immunization services in community pharmacies, actual pharmacist-administered vaccines are not yet optimal. A flexible choice multicomponent intervention, the “We Immunize” program, was implemented in Alabama and California community pharmacies, with the goal to enhance pneumococcal and zoster immunization delivery. Limited research has been done to qualitatively understand factors influencing immunization service expansion.

Objective: Explore pharmacist perceptions of the We Immunize program in terms of its acceptability, impact, and real-world feasibility, and pharmacist-perceived facilitators and barriers influencing success in immunization delivery enhancement.

Methods: This practice-focused qualitative research used semistructured telephone interviews with 14 pharmacists at the completion of the 6-month intervention.

Results: Major program implementation facilitators were technician inclusion, workflow changes, training and feedback, goal setting, and enhanced personal selling and marketing activities. Multiple pharmacies increased the number of delivered pneumococcal and zoster immunizations, and increased revenue. Many pharmacists felt professional image, knowledge, skills, roles, and personal satisfaction were enhanced, as were technician knowledge, skills, and roles. Program flexibility, along with multiple perceived benefits, increases the potential for success.

Conclusions: The We Immunize program appears to have been viewed positively by participating pharmacists and was seen as having a beneficial impact on immunization delivery in the community pharmacies in which it was implemented.

https://doi.org/10.1177/8755122519852584

[Article Title: The Unmet Need for Pharmacists as Important Members of the Emergency Department Team in Resource-Limited Settings: A Case of Nepal / Sunil Shrestha, Krisha Danekhu, Santosh Thapa, Saval Khanal and P. Ravi Shankar, p. 219-224]

Abstract:

Background: The role of pharmacists in many developed countries has evolved from the traditional practice of dispensing medicines to contributing directly or indirectly to improve patient health outcomes. They are providing hospital services and patient care including services in the emergency department (ED). However, there is limited evidence for pharmacist involvement in the ED from resource-limited countries such as Nepal.

Objective: The aim of this study is to discuss the role of pharmacists and highlight the unmet need of pharmacists in ED in Nepal.

Methods: A narrative review of existing literature was conducted. Results: The status of ED services in Nepalese hospitals is not yet at a desirable level, and there is limited information about the role of pharmacists in EDs. Evidence obtained from developed nations on the role of pharmacists in EDs suggests that they help in improving patient outcomes by minimizing medication errors, adverse drug reactions, and enhance patient care.

Conclusion: The study highlights the need for pharmacists in EDs in resource-limited settings. There is limited evidence of pharmacists’ role in EDs from Nepal. Therefore, this study suggests a need for further studies on the possible contribution of pharmacists to ED services in Nepal.

https://doi.org/10.1177/8755122519850118

[Article Title: Searching the Literature: A Simple Step-Wise Process for Evidence-Based Medicine / Kane Larson, Sae Gyul Jung, and Simon Albon, p. 225-229]

Abstract: Sifting and sorting through the literature and research on health care is an important skill for practicing pharmacists. It is vital for staying current and, most important, helping with the critical task of avoiding adverse drug events in the optimal care of patients. Today, searching this literature efficiently and effectively is increasingly difficult at a time when clinical knowledge is growing exponentially. This article aims to provide a systematic process for going through the literature in an evidence-based manner.

https://doi.org/10.1177/8755122519849885

[Article Title: Rifampin Augmentation in Hardware Infections: A Case Report of Thrombocytopenia / Yuliya P. Mozol, Stephen B. Vickery, Brian J. Kaderli and Ryan E. Owens, p. 230-231]

Abstract: While most notably used in the treatment of tuberculosis (TB), rifampin is recommended off-label in combination with pathogen-specific antimicrobial therapy for prosthetic joint infections (PJIs) caused by Staphylococcus aureus.1 Rifampin is utilized in PJIs due to its concentration within biofilms and activity against biofilm-forming pathogens.1,2 Although rifampin toxicities, such as hepatotoxicity and hematologic toxicity, are well known in the management of TB, there is a paucity of data describing toxicities in the setting of hardware infections.3-7

https://doi.org/10.1177/8755122519854855