bluuebunny/crossref_metadata_2025 huggingface dataset:
Advanced Practice Programs in Hospital Pharmacy: Pharmacy-Based Immunization
Authors: Hall Deanne L. , Weber Robert J.
Published: May 2010

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is to address many of the key challenges that pharmacy directors currently face, while providing information to foster growth in pharmacy leadership and patient safety. This month's article describes providing immunizations in a hospital-based retail pharmacy. As the pharmacists' role in immunization evolves to one of procurement, advocacy, and immunizer, hospitals can provide a valuable public health service to patients using hospital-based retail pharmacies. Developing this program may also further develop more advanced-practice programs in patient medication education and medication therapy management.
Baboon Syndrome Induced by Cetuximab Ventricular Arrhythmia during Sodium Bicarbonate Infusion Ezetimibe-Associated Thrombocytopenia Severe Dermatitis with Gefitinib Therapy Adenosine-Induced Respiratory Arrest in an Asthmatic Patient Acanthosis Nigricans Caused by Insulin Interferon-Ribavirin-Associated Ischemic Colitis
Authors: Shuster Joel
Published: May 2010

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 Food and Drug Administration's (FDA) MEDWATCH program (800-FDA-1088). If you have reported an interesting preventable ADR to MEDWATCH, please consider sharing the account with our readers. Write to Dr. Shuster at ISMP, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006 (phone: 215-947-7797; fax: 215-914-1492; e-mail: joel.shuster@temple.edu ). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices in cooperation with the FDA's MEDWATCH Program and Temple University School of Pharmacy. ISMP is an FDA MEDWATCH partner.
Vincristine, Doxorubicin, and Cyclophosphamide Alternating with Ifosfamide and Etoposide Regimen for Ewing's Sarcoma and Primitive Neuroectodermal Tumor (PNET) of Bone
Authors: Rutledge Matthew R. , Waddell J. Aubrey , Solimando Dominic A.
Published: May 2010

The increasing complexity of cancer chemotherapy now requires that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy, and review various agents, both commercially available and investigational, used to treat malignant diseases.
Paricalcitol versus Calcitriol in the Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients
Authors: Rabinovich Marina , Walton Ted
Published: May 2010

Purpose

A mainstay treatment of secondary hyperparathyroidism has been the administration of vitamin D analogs. Paricalcitol is a vitamin D analog thought to reduce parathyroid hormone (PTH) levels with fewer effects on calcium (Ca) and phosphorous (P) levels than intravenous calcitriol. However, there are limited data directly comparing the 2 agents. The primary objective was to compare the efficacy of paricalcitol to calcitriol in hemodialysis patients. Secondary objectives evaluated the safety and direct costs associated with these agents.

Methods

This was a retrospective study of hemodialysis patients who received at least 8 weeks of both therapies from 2002 to 2004. Primary outcomes included the percentage of patients achieving greater than or equal to 50% reduction in baseline PTH levels; the change in PTH levels from baseline to the end of therapy; and time to achieve greater than or equal to 50% reduction in baseline PTH concentrations. Secondary outcomes included the percentage of patients experiencing hypercalcemia, hyperphosphatemia, or elevated Ca and P product; and the percentage of patients hospitalized secondary to these side effects.

Results

Calcitriol-treated patients showed a median reduction in PTH concentrations from baseline to the end of treatment phase of 8.3% versus paricalcitol reduction of 1.5%. This result was not statistically significant ( P = 0.08); however, it should be examined in a study powered to detect this difference. A similar number of patients in both treatment groups were able to achieve a greater than or equal to 50% reduction in baseline PTH concentrations but calcitriol-treated patients were more likely to achieve this primary end point faster than the paricalcitol-treated group (166 days vs 207 days, respectively, P = 0.18). The incidence of side effects between the agents was similar. There was a substantial difference in the annual drug cost between paricalcitol and calcitriol.

Conclusion

Paricalcitol did not seem to result in clear efficacy and safety benefit over calcitriol in this study. However, due to the study's retrospective design and potential for a type 2 error, as well as limited published data comparing this agent to calcitriol, additional research is required before paricalcitol becomes the standard of care in patients with chronic kidney disease and secondary hyperparathyroidism.
The Impact of a Long-Acting Erythropoiesis Stimulating Protein on Patient Throughput in a Hospital-Based Ambulatory Oncology Clinic
Authors: Griffith Niesha , Allen Colleen , Pultz Andrew , Penza Sam
Published: May 2010

Objectives

To quantify labor and time expended, resources used, and the net impact on patient throughput and staff time (from the institution's perspective) associated with short-acting (epoetin alfa) and long-acting (darbepoetin alfa) erythropoietin stimulating proteins (ESPs).

Design

Prospective time/motion assessment and retrospective chart review of patient visits and resources used.

Setting

Single hospital-based ambulatory oncology clinic.

Methods

Time and motion measurements related to patient treatment and drug preparation were collected for (1) patient check-in; (2) phlebotomy; (3) laboratory processing; (4) pharmacist assessment/counseling; and (5) ESP preparation, administration, and documentation. ESP use for 266 chemotherapy cycles administered between August 1, 2003 and March 31, 2004 was grouped as epoetin alfa only and darbepoetin alfa only.

Results

For 313 observed events, the mean total time calculated for the 5 prespecified activities associated with a visit for ESP administration was 55.4 minutes, of which pharmacy assessment/counseling was responsible for the majority of time expended (22.6 min). A significant (23%) reduction in the number of mean visits per cycle was recorded for the darbepoetin alfa group ( P < 0.001, resulting in 1 less visit per average chemotherapy cycle). This difference remained statistically different (42% reduction; P < 0.001) when the mean number of visits specifically for ESP administration was compared between the darbepoetin alfa and epoetin alfa groups. Darbepoetin alfa recipients also received significantly fewer doses of ESP per cycle compared with those given epoetin alfa (P < 0.001). The use of darbepoetin alfa saved the clinic 125 hours of staff/patient time per cycle with a potential of 120 hours/cycle additional savings if the epoetin alfa patients had received this long-acting ESP. During calendar year 2004, 610 patients received a red-cell growth factor following chemotherapy for a solid tumor. These patients represent an average of 3,660 cycles of chemotherapy per year. The reduction in visits (1/cycle) with long-acting ESP, at 55.4 minutes of staff time per visit, will potentially result in avoidance of 3,379.4 hours of staff time or 1.62 full-time equivalents per year.

Conclusions

Patient office visits for ESP administration are associated with significant time for clinic staff. A long-acting ESP, such as darbepoetin alfa, may enable significant time savings for clinic staff and providers by reducing the number of necessary visits for ESP administration. The time saved also provides an opportunity to reallocate staff to perform additional supportive care activities.
Pharmacist Involvement in Order Set and Protocol Development
Authors: Cohen Tammy , Sanborn Michael
Published: May 2010

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is to address many of the key challenges that pharmacy directors face today while providing information to foster growth in pharmacy leadership and patient safety. This Director's Forum will highlight opportunities for the pharmacist to participate in standardized order set and protocol development.
Cross Contamination with Insulin Pens; Look-Alike Vials; Kids and Medication Patches; New Look-Alike Name Pair; Preventing Dosing Errors with Methotrexate Injection
Authors: Cohen Michael R.
Published: May 2010

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 in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP tollfree, 24 hours a day, at 800-233-7767 (800-23-ERROR).

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 through the ISMP ( www.ismp.org ) or United States Pharmacopeia (USP) ( www.usp.org ) Web sites or communicated directly to ISMP 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.
Fluorouracil, Epirubicin, and Cyclophosphamide (FEC) for Breast Cancer
Authors: Mbue John E. , Solimando Dominic A. , Waddell J. Aubrey
Published: May 2010

The increasing complexity of cancer chemotherapy now requires that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy, and review various agents, both commercially available and investigational, used to treat malignant diseases.
Management of Chemotherapy-Induced Neutropenia: Opportunities for Pharmacist Involvement
Authors: Iacovelli Lew M. , Persson Brandy L.
Published: May 2010

Purpose

This article highlights the clinical impact of chemotherapy-induced neutropenia (CIN) and reviews the clinical evidence supporting the updated guideline recommendations from leading scientific organizations that focus on cancer care regarding the use of myeloid growth factors to reduce the incidence of febrile neutropenia (FN) from chemotherapy. The aim is to provide insight for practicing pharmacists regarding how they can be more proactive in developing best-practice strategies for the management of CIN as well as the prevention of FN.

CIN, the primary dose-limiting toxicity of chemotherapy, is common in many tumor types that are treated with myelosuppressive chemotherapy and occurs with the greatest frequency in the first cycle of treatment. Treatment with myeloid growth factors, or colony-stimulating factors (CSFs), has shown to be effective in reducing the risk, severity, and duration of FN from chemotherapy. Despite recent revisions to various clinical guidelines that have resulted in alignment on the recommendation for prophylactic CSF use in patients with a greater than or equal to 20% risk of developing FN, a gap remains between actual clinical usage and best practice. Pharmacists are key members of multidisciplinary health care teams and are uniquely positioned to evaluate current practice and develop strategies that ensure appropriate CSF use. This paper summarizes the recent changes to CSF guidelines, reviews clinical data that support those changes, and discusses strategies for pharmacist involvement in the management of CIN and FN prevention using real-world examples of improvement initiatives.

Conclusion

Neutropenia is a dose-limiting toxicity of chemotherapy that has significant implications for effective cancer treatment and patient health outcomes. Pharmacists are uniquely positioned to perform various interventions, which help ensure appropriate CSF use and improve the management of CIN.
Etravirine
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: May 2010

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 your Pharmacy & Therapeutics Committee. Subscribers also receive monthly 1-page summary monographs on the agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and are also available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The June 2008 monograph topics are on sumatriptan succinate and naproxen sodium, diclofenac epolamine topical patch, bendamustine hydrochloride, rotavirus vaccine, and live, oral, levoleucovorin for injection. The DUE is on sumatriptan succinate and naproxen sodium.
Pharmacist PDA Document Management Considerations
Authors: Felkey Bill G. , Fox Brent I.
Published: May 2010

Pharmacists continue to realize the value of using their PDAs for real-time wireless access to Internet and intranet-based information. However, this level of connectivity is not always available and some pharmacists are yet to incorporate wireless connectivity in their practice. Accordingly, we continue to see pharmacists storing documents to support clinical activities on their devices. The column addresses key considerations for document management as a method to support patient care.
Preformatted, Tamper Evident Prescriptions to Minimize Omissions and Meet Regulatory Requirements
Authors: Knapp Judy Ann
Published: May 2010

Patient safety is a complex issue that is constantly evolving. Communication via standardized drug ordering is recognized as one of the key elements to providing a safer hospital stay as well as a stronger patient outcome. This feature will publish bimonthly and will provide examples of standardized drug prescribing and a forum for discussion.

If you have a template that you believe other hospital pharmacies can benefit from, please submit it along with answers to the questions (seen below in the text) to Joyce Generali, Director of Drug Information at Kansas University Medical Center, 3901 Rainbow Boulevard, Mail Stop 4040, Kansas City, KS 66160 or e-mail at jgeneral@kumc.edu .
Behavioral Changes of Paranoia Associated with Atorvastatin; Hemolytic-Uremic Syndrome Associated with Gemcitabine; Daptomycin-Induced Acute Renal Failure and Hepatic Toxicity; Drug-Induced Liver Disease Related to Citalopram; Unexpected Acute Hepatic Injury in Patients Treated Repeatedly with Ketoconazole; Acute Hepatotoxicity Seen with Lamotrigine; Anticholinergic Adverse Effects in Elderly Patients
Authors: Shuster Joel
Published: May 2010

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 Food and Drug Administration's (FDA) MedWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to MedWatch, please consider sharing the account with our readers. Write to Dr. Shuster at ISMP, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006 (phone: 215-947-7797; fax: 215-914-1492; e-mail: joel.shuster@temple.edu ). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices (ISMP) in cooperation with the FDA's MedWatch Program and Temple University School of Pharmacy. ISMP is an FDA MedWatch partner.
Bortezomib (Intrapleural): Myelomatous Pleural Effusion
Authors: Generali Joyce , Cada Dennis J.
Published: May 2010

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of these data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@wolterskluwer.com .
Protection against the Extravasation of Anticancer Drugs by Standardization of the Management System
Authors: Watanabe Hiroyuki , Ikesue Hiroaki , Yoshida Minoru , Yamamoto Naoko , Sakamoto Setsuko , Koga Tomoichiro , Sueyasu Masanori , Egashira Nobuaki , Inoshima Ichiro , Nakanishi Yoichi , Oishi Ryozo
Published: May 2010

The extravasation of anticancer drugs is a serious complication. On the basis of data regarding extravasation prevention and treatment obtained primarily by pharmacists, the management system for extravasation of anticancer drugs was standardized at an outpatient chemotherapy center. A kit was prepared so that physicians could promptly and safely perform venipuncture; the kit included a classification list of anticancer drugs. Prior to administration of vesicant or irritant drugs, pharmacists and nurses educated the patients.

When anticancer drugs were administered via peripheral vein without using an implanted venous access device, extravasation occurred in 10 out of 7,059 courses (0.14%) during the 2-year study period postintroduction of the present management system. This incidence is remarkably low as compared with those previously reported. The extravasated drugs were epirubicin (n = 3), paclitaxel (n = 3), vinorelbine (n = 1), 5–fluorouracil (n = 1), carboplatin (n = 1), and cyclophosphamide (n = 1). Cold packs were applied around the injection site except in the cases involving vinorelbine, in which warm packs were used. In all cases of extravasation of vesicant drugs, glucocorticoid was injected locally. There were no cases involving continuous pain or skin ulcers.

The standardization of the management system for extravasation of anticancer drugs was very effective in decreasing the occurrence, as well as decreasing skin damage if it occurred.
Now that you Own One: PDA and Smartphone Accessories
Authors: Fox Brent I. , Felkey Bill G.
Published: May 2010

Your personal digital assistant (PDA)/smartphone device is likely the central location for maintaining your list of contacts, both personal and professional, as well as your calendar. You may also keep a running to-do or task list on your device at all times. These personal information management uses are arguably the primary contributors to the growth of the PDA market that we observed in the late 1990s. Much has changed since then, both internally in the PDA market and externally in how we use these devices in our personal and professional lives. If you are new to these devices, you are probably discovering new features, uses, applications, and accessories each week. Readers who adopted portable technology years ago have likely integrated these devices into their lives and rely on them to support many aspects of their daily routine. We fall into the latter category and are devoting this installment to a discussion of features, applications, and accessories that we believe are indispensable to supporting both professional and personal portable computing.
Succession Planning: The Forgotten Art
Authors: Mark Scott M.
Published: May 2010

The Director's Forum series is edited by Michael Sanborn and Robert Weber and is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is to address many of the key challenges that pharmacy directors face today while providing information that will foster growth in pharmacy leadership and patient safety. This month's Forum focuses on succession planning. As part of a long-term strategy, succession planning can provide a pipeline of leadership talent that will support the future of a department, organization, and, ultimately, the profession of pharmacy.
Improving Afghanistan Pharmacy Practices and Services
Authors: Blaine Philip J.
Published: May 2010

The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, the Department of Defense, nor the US Government.

I am a military service member. This work was prepared as part of my official duties. Title 17, USC, 105 provides that “copyright protection under this title is not available for any work of the United States Government.” Title 17, USC, 101 defines a US Government as part of that person's official duties.
Spontaneous Ejaculations Caused by SSRI; Three Concurrent Adverse Drug Reactions Associated with Rifampin; Hallucinations Caused by Modafinil; Bilateral Eardrum Perforation Seen with One Epidermal Growth Factor Receptor Inhibitor and Tumor Lysis Syndrome with Another; Mefloquine-Induced Psychotic Mania in a Patient with Bipolar Disorder; Antipsychotic Therapy and Short-Term Serious Events in Older Adults with Dementia
Authors: Shuster Joel
Published: May 2010

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.
Bendamustine; Levoleucovorin
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: May 2010

The complexity of cancer chemotherapy requires that 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.
Olmesartan: Migraine Prevention
Authors: Generali Joyce A. , Cada Dennis J.
Published: May 2010

Off-Label Drug Uses — This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration (FDA). This new guide to the literature will enable 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. A summary of the most relevant data is provided, including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations. 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 hospitalpharmacy@wolterskluwer.com .
Implementing Consultant Recommendations in Percutaneous Coronary Interventions: Look before you Leap
Authors: Girardeau Caroline Johnson , Montague Deborah
Published: May 2010

Purpose

To determine if hospital consultant recommendations were clinically applicable to the cardiac catheterization laboratory and to compare medication usage in percutaneous coronary intervention (PCI) to those goals.

Methods

The medical records of 96 adults on whom PCI had been performed over a 6-month period were reviewed retrospectively. Only PCIs that included intracoronary stent placement were considered. The primary end point was to determine if abciximab usage was 15% or less in all PCI cases. Secondary end points evaluated the use of abciximab, eptifibatide, and bivalirudin based on the acuity of the clinical syndrome.

Results

Abciximab, eptifibatide, and bivalirudin monotherapy were used in 16.7%, 40.6%, and 42.7% of all cases, respectively. The total consumption of abciximab exceeded the primary end point by 1.7%. Eptifibatide usage was 71% of all glycoprotein (GP) IIb/IIIa inhibitors, less than the 85% target proposed by the hospital consultants. Bivalirudin monotherapy surpassed eptifibatide as the antithrombotic of choice across all PCI cases. The use of provisional GP IIb/IIIa inhibitors in conjunction with bivalirudin was 8.3%, more than the 5% target specified by the consultants. Emergent PCIs comprised 41% of all cases sampled.

Conclusion

This 6-month retrospective survey demonstrated that the use of abciximab exceeded the percentage recommended by consultants. However, given the large percentage of emergent PCIs during the time period and the literature supporting the use of abciximab in emergent PCIs, a change in GP IIb/IIIa inhibitor usage patterns was not considered necessary.
Impact of a Pharmacist on Medication Reconciliation on Patient Admission to a Veterans Affairs Medical Center
Authors: Strunk Lisa B. , Matson Adrienne W. , Steinke Douglas
Published: May 2010

Purpose

Medication errors are a leading cause of injury to hospitalized patients, and studies reveal that these errors occur most often at transitions of care. The objective of this study was to evaluate a pharmacist's impact on medication errors at the Veterans Affairs Medical Center (VAMC) through involvement in medication reconciliation on patient admission.

Methods

A retrospective, observational, single-center study was conducted to evaluate pharmacist-initiated medication reconciliation. Preprogram and postprogram data were compared. In both phases medical records were evaluated for discrepancies by comparing outpatient medications with inpatient medication orders. Inclusion criteria comprised patients with outpatient medications who were admitted to the VAMC for at least 72 hours. The primary outcome measure was the percentage of unreconciled medications. Secondary outcomes included cost savings to the VAMC and avoidance of potential adverse events.

Results

A total of 206 patients were included in the study. Patients in the postprogram group had a significantly lower percentage of unreconciled medications ( P < 0.001). The most common type of discrepancy was omission of medications at admission, and the most common drug class for discrepancies was psychiatric medications. In the postprogram group, 21 medications were discontinued as a result of a pharmacist intervention, with a median cost savings of $36.58 (range, $1.10 to $2,311). An increase in the number of medications per patient was associated with an increase in unreconciled medications (coefficient of linear regression [ R 2 ] = 0.31; P < 0.001). No adverse drug events (ADEs) were noted.

Conclusion

Pharmacists' involvement in medication reconciliation significantly reduces the number of unreconciled medications. In addition, this involvement may greatly improve patient safety and reduce the costs of medication errors and the occurrence of ADEs.
Recent Publications on Medications and Pharmacy
Authors: Sterling Jacyntha A.
Published: May 2010

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly. Suggestions or comments may be addressed to Jacyntha Sterling, Drug Information Specialist at Saint Francis Hospital, 6161 S. Yale Ave, Tulsa, OK 74136
Identify Home Medications Restricted Character Space and Truncated Drug Listings are a Set-Up for Medication Errors “can't Tell a Book by its Cover” Rings True for Medications Child Dies from Misuse of Fentanyl Patch
Authors: Cohen Michael R.
Published: May 2010

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 in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the United States Pharmacopeia (USP) Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

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 through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP 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.
Does Intensive Glycemic Control Reduce Cardiovascular Complications in Type 2 Diabetes?
Authors: Howard Patricia A.
Published: May 2010

This continuing feature updates readers on recent developments in cardiovascular pharmacotherapy. Cardiovascular disease remains the number 1 killer in the United States, and more clinical outcome trials have been conducted in cardiology than in any other field of medicine. Given this rapidly expanding knowledge base, if pharmacists stay current with developments in drug therapy, they can have a significant impact on prevention and treatment.
Driving Standardized Pharmacy Practice through Central Training
Authors: Madsen Janet Jean , Phelps Pamela , Beacher Robert , Stevens Vicki L.
Published: May 2010

Purpose

Fairview Pharmacy Services needed to “systemize” clinical service provision, drug policy, and drug use in its hospitals. Lack of standardized and quality training contributed to dissatisfaction and disengagement early in the employee experience. A shortage in available pharmacists necessitated attracting and retaining new staff. A standardized training system also promised financial and safety incentives. Because financial improvement, medication safety, and employee engagement were all strategic initiatives within the health system, an innovative, uniform training process that would address deficiencies in technology and clinical training was made a key part of the tactical plan to gain and retain new staff.

The central pharmacist training program includes introduction to computer resources, the e-mail system, the intranet, system-wide policies and procedures, the Health Insurance Portability and Accountability Act (HIPAA), and medication safety. Order entry is a primary focus of training because the hospitals share a common pharmacy computer system. Creating consistent training without consistent practice was an initial obstacle, and the program continues to undergo enhancement, which includes more systemization of policy and practice. Trainers involved in the program see opportunities for systemizing that individuals dealing with only their hospitals may overlook. Verbal and written survey feedback regarding the program has been positive; and financial benefit, improved training, enhanced employee engagement, and improved patient safety have resulted.

Conclusion

Taking the pharmacists away from their work locations for initial training has been beneficial. Without the day-to-day interruptions that are typical in a pharmacy, the trainees are able to engage in a more intensive training experience. Patient cases used in order entry have been developed to ensure maximum exposure of the trainees to problems and situations that employ the guidelines and policies they are learning. The implementation of a central hospital pharmacist training program has lowered overall costs of training, enhanced employee satisfaction, and served as a catapult to standardization of policies and practice.
New Drugs Approved by the FDA New Dosage Forms and Indications Approved by the FDA Agents Pending FDA Approval New Drug Applications Filed by Manufacturer Significant Labeling Changes or “Dear Health Care Professional” Letters Related to Safety
Authors: Baker Danial E.
Published: May 2010

This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let us know at hospitalpharmacy@drugfacts.com .
Wireless-Friendly Web Sites that Support Daily Activities
Authors: Fox Brent I. , Felkey Bill G.
Published: May 2010

This column has traditionally focused on portable technology in pharmacy practice. As you are intimately aware, many other health information technologies affect pharmacists and other health care professionals on a daily basis. Accordingly, beginning with our next column, we will address other technologies influencing pharmacy. We will see you here next month for our new, broader focus and for our new title.
Cisplatin and Pemetrexed for Lung Cancer and Pleural Mesothelioma
Authors: Solimando Dominic A. , Patel Kajal , Waddell J. Aubrey
Published: May 2010

The complexity of cancer chemotherapy requires that 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.
Topiramate: Smoking Cessation
Authors: Generali Joyce A. , Cada Dennis J.
Published: May 2010

Off-Label Drug Uses — This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration (FDA). This new guide to the literature will enable 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. A summary of the most relevant data is provided, including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations. 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 hospitalpharmacy@drugfacts.com .
Alvimopan
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: May 2010

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 inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and are also available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The FIX., call The Formulary at 800-322-4349. The October 2008 monograph topics are on clevidipine butyrate injectable emulsion, tetrabenazine, tenofovir disoproxil fumarate tablets, ferumoxytol, and saxagliptin. The DUE is on clevidipine butyrate injectable emulsion.
Controlled Drug Symbol C-IV Mistaken as IV; Fatal Medication Errors in the Home; Ambulatory E-Prescribing Requires Patient's Check; EPINEPHrine-ePHEDrine Mix-Ups
Authors: Smetzer Judy L. , Cohen Michael R.
Published: May 2010

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 United States Pharmacopeia (USP) Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

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 through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP 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.
Ifosfamide, Carboplatin, and Etoposide (ICE) for Metastatic Soft Tissue Sarcoma
Authors: Moussavian Parvaneh A. , Solimando Dominic A. , Waddell J. Aubrey
Published: May 2010

The complexity of cancer chemotherapy requires that 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.

The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government.
Amantadine: Postpoliomyelitis Syndrome—Related Fatigue
Authors: Generali Joyce A. , Cada Dennis J.
Published: May 2010

Off-Label Drug Uses — This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a quarterly 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 (FDA). This new guide to the literature will enable 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. A summary of the most relevant data is provided, including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations. 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 hospitalpharmacy@drugfacts.com .
Innovative Roles for Pharmacy Technicians: Developing and Implementing a Unit-Based Clinical Support Pharmacy Technician Model
Authors: Mark Scott M. , Saenz Rafael , Yourich Bryan E. , Weber Robert J.
Published: May 2010

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed for guiding pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is addressing many of the key challenges that pharmacy directors currently face while providing information that will foster growth in pharmacy leadership and patient safety. Developing innovative roles for pharmacy technicians promotes job growth, as well as staff satisfaction and retention. This Director's Forum article describes how patient-centered roles for technicians can be developed and implemented.
Implementing a Bar-Code Medication Administration System
Authors: Weber Robert J.
Published: May 2010

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed for guiding pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is addressing many of the key challenges that pharmacy directors currently face while providing information that will foster growth in pharmacy leadership and patient safety. Bar-code medication administration (BCMA) is an important medication safety program for hospitals, and the involvement of the pharmacy director in its implementation and evaluation is critical. This installment of the Director's Forum describes the necessary steps for implementing and evaluating a BCMA program.
Misprogramming Patient-Controlled Analgesia Concentration Leads to Dosing Errors; Communicate Alteplase Dose and Indication; Do Not Use Empty Prelabeled Syringes/Bowls
Authors: Cohen Michael R.
Published: May 2010

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 United States Pharmacopeia (USP) Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

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 through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP 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.
Irinotecan and Cisplatin (IP) Regimen
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: May 2010

The complexity of cancer chemotherapy requires that pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensation, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases.
Product Selection and Pharmaceutical Comparison of Two Anti-D Immune Globulins
Authors: Siegel Jerry , Hildebrand April , Richards Jessica
Published: May 2010

Purpose

Two anti-D immunoglobulin (anti-D) products, Rhophylac and WinRho, have been approved by the US Food and Drug Administration for the treatment of chronic immune thrombocytopenic purpura. There is a significant difference in acquisition cost—and perhaps in preparation cost—of the products. This time-and-motion study was designed to evaluate the difference in time and relevant costs required for preparation of a single dose of anti-D immunoglobulin using these 2 products.

Methods

To evaluate the difference in time required for preparation of a single dose (3,600 mcg) of the 2 anti-D immunoglobulins for a patient weighing 72 kg, each product was prepared 9 times and the time for each preparation was recorded. The cost analysis was limited to comparison of the acquisition costs of both anti-D products and the incremental labor costs associated with their preparation.

Results

The results showed that the average total time for 9 preparations of WinRho was 1 minute 30.1 seconds, with the assembly time comprising 46.7 seconds. The average total time for the 9 preparations with Rhophylac was 5 minutes 7.1 seconds, with an average assembly time of 2 minutes 59.2 seconds. The difference in total average time between the 2 products was 3.62 minutes.

Conclusion

The cost comparison showed that the acquisition cost for as single dose of WinRho for a patient weighing 72 kg was $2,647 and that the cost for the same dose of Rhophylac was $946. Even with a personnel cost of $20 per hour, the increased labor cost is only $1.20 per preparation of Rhophylac. This is a minor cost compared to the $1,850 savings in product acquisition per average dose of Rhophylac.
Reactions of bridging C3 ligands in diiron complexes: Unconventional routes to new functionalized organic frames
Authors: Zanotti Valerio
Published: May 2010

Diiron complexes containing C3 ligands, such as vinyliminium and vinylalkylidene bridging units, display unusual reaction patterns, not observed when the same organic fragments are bound to a single metal center, or not coordinated. Bridging vinyliminium complexes [Fe2{μ-η1:η3-C(NMe2)CH=CR}(μ-CO)(CO)(Cp)2][SO3CF3] undergo nucleophilic addition at the iminium C or at α-C position, which is uncommon since non-coordinated vinyliminium species generally undergo conjugated (Michael type) nucleophilic attack. Likewise, bridging vinyliminium ligands undergo new and unusual transformations consisting of the deprotonation and replacement of the α-CH by a variety of functional groups. These reactions, resulting in the formation of C–C and C–heteroatom single and double bonds, produce new bridging ligands of the type [μ-C(NMe2)C(X)CR) (X = S, O, Se, SPh, CNMe, NNCHCO2Me]. Removal of the vinylalkylidene ligands from the bridging coordination is achieved by a [3 + 2] cycloaddition with alkynes. The reaction leads to the formation of ferrocenes containing one polysubstituted Cp ring, which results from the cycloaddition of the bridging C3 ligand with alkynes. This result suggests a new possible route for the synthesis of polyfunctionalized ferrocenes.
New pathways in the gold-catalyzed cycloisomerization of furanynes
Authors: Hashmi A. Stephen K.
Published: May 2010

The most familiar gold-catalyzed cyclization pathway for furanyne substrates leads to synthesis of phenols, but new reaction pathways have recently been discovered. The mechanistic background and the synthetic possibilities of these alternative pathways leading to new heterocyclic products are discussed.