bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Literacy and Medication Safety: Spreading the Word
Authors: Brown Timothy 
Published: December 2017

Patient education decreases the incidence of medication errors. However, the barrier to education is the level of comprehension of the patient. Studies show that even those with a college degree function at an eighth grade reading level when provided with medical educational materials. This level almost becomes nonexistent if the patient is considered low literate or a first time reader. This functional illiteracy has been reported to lead to approximately $73 billion in additional health care expenditures annually.1 Methods The Ohio Patient Safety Institute (OPSI), Project: LEARN of Summit County, and the Ohio Society of Health-System Pharmacists (OSHP) collaborated to create and implement a medication safety brochure that could be used by patients at varying reading levels. The partners in this project initiated the development of the brochure after an extensive search for standardized graphics used to relate medical answers to common questions yielded no results. Development of pictures and graphics that were considered universal were keys to the success of the project. The design of the brochure encompassed major problems encountered with medications. Implementation took several routes that led to distribution throughout the state. Results At this point more than 65,000 brochures have been circulated throughout Ohio, as well as mailed to interested parties outside the state. Conclusions By implementing this type of brochure, we are one step closer to ensuring the education of the entire community regarding medications and their dangers, as well as building relationships that maintain the trust in the medical community.
How to Prevent Errors – Safety Issues with Patient-Controlled Analgesia (Part 2); Potential for Confusing Dakin's Solution with Sterile Water
Authors: Cohen Michael R. 
Published: December 2017

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. 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.
Azacitidine; Erlotinib
Authors: Solimando Dominic A. , Russell Martin A. , Waddell J. Aubrey 
Published: December 2017

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Department of the Army or the Department of Defense.
Tadalafil: Pulmonary Hypertension (Adults)
Authors: Generali Joyce , Cada Dennis J. 
Published: December 2017

Off-Label Drug Uses This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. 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 the 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 on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Information Technologies Relevant to Pharmacy Practice in Hospitals: Results of a Statewide Survey
Authors: Warner April , Menachemi Nir , Brooks Robert G. 
Published: December 2017

Purpose To evaluate the extent that Florida hospitals are utilizing a variety of pharmacy-related information technology (IT) applications and contrast these results with nationwide studies regarding IT. Methods Chief Information Officers of Florida acute care hospitals were surveyed from May through October 2003. Facilities were questioned on the utilization of clinical and other IT applications, priorities, and barriers. The results of the questionnaire along with differences between small and large hospitals were examined. Results Overall, few hospitals have adopted computerized physician order entry (CPOE) and bar coded medication management (15.8% and 12.6% respectively), and only slightly more than half (50.5%) have adopted a computer-based patient record (CPR) system. Although utilization of these did not differ between small and large hospitals, larger hospitals were more likely to have a pharmacy information system (100% vs 69.6%, P = 0.004) and an automated pharmacy dispensing system (82.6% vs 30.4%, P < 0.001). Larger hospitals were also more likely to utilize most medical information retrieval services. Implementing technology to reduce medical errors and promote patient safety was cited by facilities as their number one IT priority, and lack of adequate financial support was cited as the single most important barrier to implementing IT. These results were comparable with other nationwide studies. Conclusions Florida hospitals, similar to previous hospitals studied nationwide, were found to have a slow rate of adoption of pharmacy-related IT. As a result, pharmacists are encouraged to play a more active role in collaborating with hospital leaders in order to implement these technologies at their facilities in an effort to reduce medication errors and improve the quality of care delivered to patients.
The Open Abdomen: Enteral Access Results in Cost Savings
Authors: Tsuei Betty J. , Clifford Timothy M. , Magnuson Barbara L. , Kearney Paul A. 
Published: December 2017

Purpose To evaluate the cost savings of using enteral access for drug and nutrition delivery in patients requiring open peritoneal cavity management (laparosotomy). Methods A review of 14 patients who required laparostomy and received at least 4 consecutive days of enteral nutrition treated at our tertiary care facility between January 1999 and May 2001. Data collected included age, sex, reason for laparostomy, enteral formulation, medications, and side effects (diarrhea and gastric reflux). Cost savings were calculated as the difference between the cost of intravenous (IV) and enteral nutritional formulation and drug dosage costs. Results Patients were fed via nasojejunal feeding tube. Average duration of enteral nutrition (EN) was 19.1 ± 12.3 days. Gastric reflux and diarrhea occurred in five (36%) and six (42%) patients, respectively. These were easily treated and did not require conversion to IV nutrition or medications. Drug and electrolyte levels were therapeutic at appropriate enteral doses. A total of 267 days of EN were utilized in these 14 patients. The cost difference between the parenteral nutrition that would have been used during that time and the actual enteral formula utilized was $25,373. The use of enteral rather than IV medications also resulted in a cost savings of $7,058. Thus, the combined cost savings of enteral medication and nutrition therapy for the 14 patients was $32,431. Conclusion EN and drug therapy can be utilized in patients requiring open peritoneal cavity management. The resultant cost savings can be substantial, and these methods of cost reduction can also be applied to other patients.
A Case of Hyperammonemic Encephalopathy Secondary to a Combination of Valproic Acid and Topiramate
Authors: Wargo Kurt A. , Wavra M. Georgia 
Published: December 2017

Purpose To report a case of hyperammonemic encephalopathy induced by a combination of valproic acid and topiramate. Case Summary A 30-year-old male was admitted to our institution after experiencing headaches, decreasing mental capacity and increasing somnolence over the previous 3 days. Past medical history was significant for generalized tonic-clonic seizure disorder and mild mental retardation for which he had been regularly taking valproic acid, topiramate, and lorazepam. The patient was seizure free for the past 9 months prior to his seizure 2 weeks prior to admission. Upon presentation, an electroencephalogram revealed excessive slowing in the left more than right, with a differential consistent with a metabolic encephalopathy, head injury, or postictal state. Laboratory workup revealed a valproic acid level that was slightly elevated, but still within normal limits, at 92.5 mcg/mL (normal = 50 to 100 mcg/mL). Furthermore, the patient's ammonia level was found to be elevated at 72 mcg/dL (normal = 14.7 to 55.3 mcg/dL). On hospital day 3, after discovering these findings, valproic acid was discontinued and lactulose 20 g three times daily was started. Five days after admission, the patient's mental status changes were resolved, and he was discharged with an ammonia level of 57 mcg/dL. Conclusion Hyperammonemic encephalopathy is rare, but a serious and sometimes fatal disorder can occur in patients receiving valproic acid therapy. The incidence of hyperammonemia may be increased in patients receiving concomitant valproic acid and topiramate therapy. In patients on valproic acid and topiramate who present with altered mental status, an ammonia level in addition to a serum valproate level should be ascertained to rule out this potentially serious adverse drug reaction.
Tamsulosin: Ureteral Stones
Authors: Generali Joyce , Cada Dennis J. 
Published: December 2017

Off-Label Drug Uses This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. 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 the 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 on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Natalizumab
Authors: Cada Dennis J. , Levien Terri , Baker Danial E. 
Published: December 2017

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are 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 April 2005 omega-3-acid ethyl esters capsules, iloprost inhalation solution, clofarabine, pegaptanib, and meningococcal conjugate vaccine. The DUE is on omega-3-acid ethyl esters capsules.
Topiramate: Alcohol Dependence
Authors: Generali Joyce , Cada Dennis J. 
Published: December 2017

Off-Label Drug Uses This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. 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 the 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 on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Safety Issues: Anticoagulation and Neuraxial Blockade
Authors: Dalton Mazie F. , Schoenekase Steve 
Published: December 2017

Neuraxial blockade includes techniques of spinal or epidural anesthesia and continuous epidural analgesia. A rare but potentially catastrophic complication of neuraxial blockade is spinal hematoma and subsequent paraplegia. The risk of this complication is increased with patient specific risk factors, and with the concomitant use of antithrombotic drugs.1 The American Society of Regional Anesthesia and Pain Medicine have provided guidelines on the management of patients receiving neuraxial anesthesia and anticoagulation. While the anesthesia staff may be familiar with these guidelines, other practitioners may not be aware of them. In a retrospective review, we found that only eight of 69 (12%) patients with an indwelling epidural catheter over a 12-month period received no concomitant medications that may affect the coagulation system. Two patients received medications, which the guidelines recommend against. Patients receiving neuraxial anesthesia are at high risk to be prescribed medications that may affect coagulation. The pharmacy needs to assume vigilance and responsibility to notify anesthesiology or develop some fail-safe method for these orders to be screened and evaluated. Pharmacy software vendors could assist in this challenge by developing the software to effectively contend with this therapeutic issue.
Clonidine: Postanesthesia Shivering
Authors: Generali Joyce , Cada Dennis J. 
Published: December 2017

Off-Label Drug Uses This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. 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 the 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 on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Retrospective Cohort Study of Granisetron Administration for PONV Prophylaxis and Treatment
Authors: Shillington Alicia , Farley P. Anne , Varkey Jerry A. , Dempsey Cindy , Coop Andrew , Harshaw Qing , Murdakes Christopher 
Published: December 2017

Postoperative nausea and vomiting (PONV) frequently complicates surgical recovery and is considered to be one of the least desirable surgical side effects. Granisetron (Kytril) 1 mg intravenously (IV) was approved by the FDA for the prevention and treatment of PONV in August 2002. Objective This cohort study evaluated outcomes and utilization associated with granisetron use for PONV prevention and treatment. Methods This was a retrospective cohort study of 400 patient records from 10 US hospitals. Patients included were those greater than or equal to 18 years of age having elective surgery under general anesthesia with granisetron administered IV for prevention or treatment of PONV. Excluded were those with concurrent radiation or chemotherapy, or those observed less than 2 hours in the post anesthesia care unit. Results Mean age was 50 y ± 17 with 272 females (68%). The majority was at moderate-high (n = 230; 58%) or mild-moderate risk of PONV (n = 155; 39%). Granisetron was administered predominantly perioperatively and at 0.1 mg dose (n = 382; 96%) from prefilled syringes extemporaneously prepared from 4 mg/4 mL vials. Total control (absence of nausea and vomiting) was experienced in 330 patients (83%), with 16 (4%) having a vomiting episode. In 167 patients at lower risk of PONV, symptoms were prevented in 148 (less than 90%). Regression analysis indicates that, in addition to absence of key risk factors, combination antiemetic prophylaxis was highly associated with optimal outcome. Granisetron dose did not impact outcome. Conclusion The majority of granisetron use for PONV was prophylactic, administered perioperatively at a 0.1 mg dose. Most patients experienced excellent control, even in the highest risk groups, particularly when granisetron was administered in combination with dexamethasone or metoclopramide.
Pramlintide Acetate
Authors: Cada Dennis J. , Levien Terri , Baker Danial E. 
Published: December 2017

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are 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 July 2005 monograph topics are exenatide injection, inhaled insulin, fluocinolone acetonide intravitreal implant, tigecycline, and medroxyprogesterone acetate injectable suspension. The DUE is on exenatide injection.
Tiagabine: Bipolar Disorders
Authors: Generali Joyce , Cada Dennis J. 
Published: December 2017

Off-Label Drug Uses This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. 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 the 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 on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Assessment of Prescriber Compliance with Established Heart Failure Guidelines at a Major Medical Center
Authors: Weant Kyle A , Smith Kelly M. , Lewis Daniel A. 
Published: December 2017

Purpose Treatment guidelines for systolic heart failure (HF), therapy for which largely relies on the combination of renin-angiotensin-aldosterone system (RAAS) agents and beta-blockers, focus on decreasing morbidity and mortality, and increasing quality of life. The objective of this study is to assess prescriber compliance with these guidelines in designing patient medication regimens prior to hospital admission, at discharge, and at readmission if within 30 days at a 473-bed tertiary university hospital. Methods Of 162 patients with a primary diagnosis of HF, 62 were selected for a retrospective data collection utilizing a random number table. Ten with an ejection fraction greater than or equal to 50% were excluded. Regimens were classified as suboptimal (absence of RAAS agent or beta-blocker), optimal, or optimal at target doses. Results Prior to admission (N = 52), 81% were prescribed diuretics, 54% were prescribed beta-blockers (8% target dose), and 50% were prescribed RAAS agents (11% target dose). Overall, 36% were optimal regimens; 2% were optimal and at optimal doses. Upon discharge, these values were 58% and 2%, respectively. Discharge medications included diuretics (92%), beta-blockers (79%; 10% target dose), and RAAS agents (75%; 11% target dose). Of the nine (17%) readmitted within 30 days, 67% were receiving suboptimal therapy; none were at target doses. Conclusions Optimal HF regimens were less common upon admission (36%) and improved upon discharge (58%). Most patients readmitted within 30 days of discharge were receiving suboptimal therapy. Clinical pharmacists are in a position to provide continuing prescriber education regarding proven HF therapies and target titration end points, both in ambulatory and acute care arenas.