Includes bibliographical references.

Updated List of Light-Sensitive Oral Medications -- Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature Search -- Significant Published Articles for Pharmacy Nutrition Support Practice in 2019 -- Effect of Therapeutic Interchange on Medication Changes Between Admission and Discharge -- Evaluating Six Commercially Available Closed-System Drug-Transfer Devices Against NIOSH’s 2015 Draft Vapor Protocol -- Adjusted vs Total Body Weight–Based Dosing of Sedation and Analgesia Used in the Intensive Care Unit -- Medication Safety at Home: A Qualitative Study on Caregivers of Chronically Ill Children in Malaysia.

[Article Title: Updated List of Light-Sensitive Oral Medications / Scott Perkins, Adam Evans and Allison King, p. 349-365]

Abstract: The Campbell University Drug Information Center supports health professionals by providing responses to drug-related inquiries. An inquiry was received by the Drug Information Center for a comprehensive list of oral solutions which should be protected from light. In investigating this request for information, a list of light-sensitive oral prescription drug products published in Hospital Pharmacy in 2009 was identified. This discovery highlighted the need for both an updated list and one which distinguished oral solid products and oral liquid products. The purpose of this project was to update the previously published list and to distinguish between oral solid and liquid dosage forms. The process of updating this list entailed several professional resources. A list of all oral products was obtained and then sorted to clearly identify which products were available in oral solid dosage form only, oral liquid dosage form only, and both dosage forms. Once delineated, the product labels for each medication were scoured for language indicating the product is light sensitive.

https://doi.org/10.1177/0018578719844699

[Article Title: Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature Search / Van N. Tran, Ilya Varfolomeev, and Geoff Hill, p. 366-372]

Abstract:

Objective: The objective of the study was to review the current literature for prophylactic enoxaparin dosing in obese orthopedic patients.

Method: A literature search was undertaken using OVID Medline, OVID Embase, and Cochrane Central databases, accessed through hospital library websites. Key search terms (in UK and US spelling) included orthopaedics, low-molecular-weight heparin, enoxaparin, venous thromboembolism prophylaxis, weight, obese, morbid obesity. Possible related subheadings, such as bone, fractures, anticoagulants, overweight, body mass index, deep vein thrombosis, pulmonary embolism, were also included in the database search to optimize the search strategies. The search was restricted to human subjects and limited to articles published from 1998 to the present.

Results: The search identified 429 potentially relevant articles. Once duplicates were removed, 345 were screened for inclusion in this review. Only 3 articles (a case-control study, an observational prospective study, and a case report) met both the inclusion and exclusion criteria. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias.

Conclusion: The results of a multiple database search draw one to the conclusion that there is very limited evidence in the literature with regard to prophylactic enoxaparin dosing in obese orthopedic-specific patients. Orthopedic patients are among the highest risk of all surgical specialties for venous thromboembolism. There is strong evidence to support an increased prophylactic low-molecular-weight heparin doses in obese patients; thus, the authors recommend higher prophylactic enoxaparin dosing in obese orthopedic patients.

https://doi.org/10.1177/0018578719848732

[Article TItle: Significant Published Articles for Pharmacy Nutrition Support Practice in 2019 / Roland N. Dickerson, Angela L. Bingham, Todd W., Lingtak N. Chan, M. Petrea Cober, Sarah V. Cogle, Anne M. Tucker and Vanessa J. Kumpf, p. 373-381]

Abstract:

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature.

Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2019 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included.

Results: A total of 111 articles were identified; 6 from the primary literature were voted by the group to be of high importance. An additional 9 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided.

Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.

https://doi.org/10.1177/0018578720928264

[Article Title: Effect of Therapeutic Interchange on Medication Changes Between Admission and Discharge / Ryan A. Popp, Kathleen A. Lusk, Shelley S. Glaess, Donna Burkett and Rebecca L. Attridge, p. 382-390]

Abstract:

Background: Therapeutic interchange (TI) is the dispensing of an alternative medication within the same class as the original medication. TI often occurs in hospitals; however, failure to return patients to their original medications may increase the risk of adverse effects following hospital discharge.

Objective: The purpose of this study was to evaluate the relationship between TI and discharge medication changes, hospital readmission rates, and emergency department visit rates following hospital discharge.

Methods: Patient demographic and medication data were collected retrospectively for patients admitted to a nonprofit, acute care hospital. The primary outcome was the relationship between TI and the rate of discharge medication changes. Secondary outcomes included types of discharge medication changes and the relationship between TI and both hospital readmissions and emergency department visits following hospital discharge.

Results: A total of 497 patients accounting for 1072 medications were included; 21.2% of home medications were interchanged following admission, and 21.8% of home medications were changed at discharge. TI increased the incidence of discharge medication changes by 70% (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.22-2.37, P = .0021). Cardiovascular agents were most likely to be changed at discharge (26%), and gastrointestinal agents were most likely to be interchanged (65%). Psychotropic agents were least likely to be changed at discharge (12%) or interchanged (7%). Neither TI nor discharge medication changes were predictive of 30-, 60-, or 90-day hospital readmission or emergency department visits following discharge.

Conclusion and Relevance: This study was the first to examine the effects of TI on post-discharge outcomes. Despite being associated with an increased rate of discharge medication changes, the presence of TI did not correlate with hospital readmission or emergency department visit rates. This study supports the safety of TI.

https://doi.org/10.1177/0018578719848733

[Article Title: Evaluating Six Commercially Available Closed-System Drug-Transfer Devices Against NIOSH’s 2015 Draft Vapor Protocol / Shiraz Halloush, Ivan A. Reveles and Jim Koeller, p. 391-399]

Abstract:

Purpose: In 2015, the National Institute for Occupational Safety and Health (NIOSH) published a draft vapor containment protocol to quantitatively evaluate combined liquid, aerosol, and vapor containment performance of commercially available closed-system drug-transfer devices (CSTDs) that claim to be effective for gas/vapor containment within a controlled test environment. Until the release of this proposed protocol, no standard method for evaluating airtightness of CSTDs existed. The aim of this study was to evaluate six commercially available CSTDs utilizing NIOSH draft protocol methodology to evaluate vapor containment under a robust vapor challenge.

Methods: In this study, six commercially available CSTDs were tested utilizing draft NIOSH vapor containment protocol methodology to simulate drug compounding and administration using 70% isopropyl alcohol (IPA) as the challenge agent. All device manipulations were carried out in an enclosed test chamber. A Miran sapphIRe gas analyzer was used to detect IPA vapor levels that escaped the device. Study test included the two tasks designated by the NIOSH protocol, with additional steps added to the evaluation. Tasks were repeated 10 times for each device.

Results: Only three of the six tested CSTDs (Equashield®, HALO®, and PhaSealTM) had an average IPA vapor release below the quantifiable performance threshold (1.0 ppm) for all tasks performed. This value was selected by NIOSH to represent the performance threshold for successful containment. The remaining three CSTDs had vapor release above 1 ppm at various times during the IPA manipulation process.

Conclusion: Equashield®, HALO®, and PhaSealTM devices tested met the 2015 NIOSH protocol quantifiable performance threshold, functioning as a truly closed system. Quantifiable effective data may be useful in product selection.

https://doi.org/10.1177/0018578719848730

[Article Title: Adjusted vs Total Body Weight–Based Dosing of Sedation and Analgesia Used in the Intensive Care Unit / Julianne Yeary, Alexandra Greco, Richard McKnight, Karen Petros, Gregory Schaefer and Jeffrey Garavaglia, p. 400-404]

Abstract:

Background: The purpose of this study was to evaluate if dosing fentanyl, dexmedetomidine, and propofol based on ideal or adjusted vs actual weight in patients would decrease overall opioid and sedative use.

Methods: This was a retrospective chart review comparing adjusted vs actual weight-based dosing protocol of mechanically ventilated (MV) intensive care unit (ICU) adult patients who required fentanyl and either propofol or dexmedetomidine.

Results: A total of 261 patients were included in which 101 patients were in the actual weight group and 160 patients were in the adjusted weight group. Total doses per MV day of fentanyl was 1042 ± 1060 µg in the actual weight group vs 901 ± 1025 µg in the adjusted weight group (P = .13). Total doses per MV day of midazolam was 20 ± 19 mg in the actual group vs 15 ± 19 mg adjusted group (P = .02). Average MV days was 8.2 vs 7.1 days, ICU length of stay was 10.6 vs 9.4 days, and self-extubation rates were 17.8% vs 4.4% in the actual group and adjusted group, respectively.

Conclusion: Total midazolam doses per MV day were lower in the adjusted group. No significant change was seen in MV days, ICU length of stay, or self-extubation rates.

https://doi.org/10.1177/0018578719851452

[Article Title: Medication Safety at Home: A Qualitative Study on Caregivers of Chronically Ill Children in Malaysia / Chii-Chii Chew, Amar-Singh HSS, Huan-Keat Chan and Mohamed Azmi Hassali, p. 405-411]

Abstract:

Introduction: Medication errors are more likely to occur in chronically ill children, who are highly dependent on caregivers for medication administration. This study aimed to explore the issues related to medication safety among pediatric outpatients in Malaysia from the caregivers’ perspective.

Methods: This was a qualitative study conducted between May and June 2018 at a pediatric clinic of a regional referral hospital. Caregivers of children who (1) were under 6 years of age and (2) had hypothyroidism, epilepsy, thalassemia, asthma, or other chronic diseases were recruited via purposive sampling. Each selected disease was represented by at least 3 caregivers, who were identified from the medical records of their children. Face-to-face interviews were conducted with each of them, facilitated by a semi-structured interview guide. All the interviews were audio-recorded, transcribed verbatim, and analyzed using the thematic analysis approach.

Results: A total of 15 mothers with a median age of 34 years were interviewed. Three themes emerged from the interviews: (I) actual experiences with medication errors, (II) underlying risk factors for medication errors, and (III) recommendations to improve medication safety. Several cases of administration errors, including missed doses and self-decided dose adjustment, were detected. Furthermore, the caregivers were found to have inadequate understanding of the medications in general.

Conclusions: While children were shown to be consistently exposed to medication errors at home in Malaysia, the recommendations of the caregivers, including the use of written instructions and a diary, could be effective strategies to improve the out-of-hospital medication safety in children.

https://doi.org/10.1177/0018578719851719