CSHP Professional Practice Conference 2011: Poster Abstracts / Conférence sur la pratique professionnelle 2011 de la SCHP : Résumés des affiches

doi:10.4212/cjhp.v64i1.978

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pTA according to highest MIC (mcg/mL) against which regimen is successful:

	Healthy Subjects		Critically Ill
Regimen	MIC (mcg/mL)	pTA (%)	MIC (mcg/mL)	pTA (%)
500 mg Q6H SI	2	97.7	4	93.8
500 mg Q6H PI	4	99.6	4	93.7
1000 mg Q8H SI	2	93.2	4	98.6
1000 mg Q8H PI	4	100	4	99.4
1000 mg Q6H SI	4	97.7	8	93.9
1000 mg Q6H PI	8	99.6	8	93.7
2000 mg Q8H SI	4	93.2	8	98.6
2000 mg Q8H PI	8	100	8	99.4
2000 mg Q8H PI	16	89.9	16	89.6

Conclusions:

PTPs are common in older people with cognitive impairment or dementia, can be readily identified and managed by a clinical pharmacist. These interventions are key in optimising the care of these vulnerable patients.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):68.

Development and Evaluation of an Instrument for the Critical Appraisal of Randomized Controlled Trials of Natural Products

Tannis M Jurgens ¹, Anne Marie Whelan ¹

Abstract

Rationale:

The efficacy of natural products (NPs) is being evaluated using randomized controlled trials (RCTs) with increasing frequency, yet a search of the literature did not identify a widely accepted critical appraisal instrument developed specifically for use with NPs. Such an instrument would aid pharmacists and other health care providers in evaluating the evidence from trials of NPs to determine the quality of the evidence and applicability of results to their patients.

Objectives:

The objective of this project was to develop and evaluate a critical appraisal instrument sufficiently rigorous to be used in evaluating RCTs of conventional medicines with a section specific for use with single entity NPs, including herbs and natural sourced chemicals.

Methods:

Three phases of the project included: 1) a Delphi process to determine items essential in describing the identity of an NP; 2) compiling a list of non-NP items important for evaluating the quality of an RCT using systematic review methodology; and 3) conducting a field test to compare the new instrument to a published instrument for usefulness in evaluating the quality of 3 RCTs of a NP and in applying results to practice.

Results:

Two Delphi rounds resulted in a list of 15 items essential in describing NPs. Seventeen non-NP item categories were identified from the systematic review. The new assessment instrument was assembled based on content of the two lists and the addition of a Review’s Conclusion section. The field test of the new instrument showed good criterion validity. Participants found it useful in translating evidence from RCTs to practice.

Conclusions:

A new instrument for the critical appraisal of RCTs of NPs was developed and tested that is distinct from other available assessment instruments in its systematic development and validation. The instrument is being used by pharmacists as well as academics teaching students critical appraisal skills.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):68–69.

Pharmacists Adapting to Change: The Who’s Who of the Pilot Cohort of an E-Learning Primary Health Care Program

Barbara Farrell ^1,², Natalie Ward ^1,³, Lisa Dolovich ⁴, Derek Jorgenson ⁵, Natalie Kennie ⁶, Ashley Gubbels ^1,⁷, Brad Jennings ⁸, Pia Marks ⁸, Nancy Waite ⁷

Abstract

Rationale:

The ADapting pharmacists’ skills and Approaches to maximize Patient’s drug Therapy effectiveness (ADAPT) blended e-learning and experiential program (being piloted across Canada) aims to help pharmacists integrate professional skills required for collaborative patient care into everyday practice. Understanding the pilot participants helps with understanding other results of the program evaluation.

Objectives:

To describe the demographics of the ADAPT pilot cohort, their preparedness and motivation levels and reasons for participating. Study Design and Methods: The ADAPT evaluation is a multi-component, mixed-methods assessment. This component captured demographic information, preparedness and motivation levels (analyzed with descriptive statistics). Qualitative analysis of introductory posts included deductive and inductive methods to identify themes. The research team held iterative discussions.

Results:

Eighty-six pharmacists began the program (72% female, average age 40, age range 21–62). Practice sites include community pharmacy only (46.5%), family practice only (5.8%), hospital pharmacist only (11.6%), ambulatory care clinic only (7%) combinations of practice settings (26.7%) and other (2.3%). Participants regularly engage in ongoing education, many possessing additional certifications. Preparedness was high as nearly all participants (99%) stated having 4+ hours/week for the program and 77% having 2+ hours/week for patient interaction. Most participants had a private or semi-private space for patient interaction (69%). Ninety-six percent of participants were highly motivated to improve their skills. Qualitative date revealed participants wanted to improve their skills to provide better patient care and to prepare them for changes in the profession, including working within an interprofessional team. Participants described varied experience participating in on-line learning.

Conclusion:

The pilot cohort of ADAPT participants represents both new and experienced practitioners with varied backgrounds. They recognize the need for change and are motivated to engage in ongoing education to seek skills to adapt to change and improve patient care.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):69.

Medication Error Reporting: A Qualitative Analysis of Incentives, Barriers, and Facilitators as Perceived by Health Care Professionals in Nova Scotia

Nicole R Hartnell ¹, Neil J MacKinnon ¹, Ingrid Sketris ¹, Steven M Smith ², Mark Fleming ²

Abstract

Rationale:

Opportunities to improve patient safety are hindered by wide-spread under-reporting of medication errors. Data from these reports can be used to improve processes, identify areas for progress, and prevent similar errors from occurring in other settings.

Objectives:

(1) to identify incentives, barriers and facilitators to medication error reporting, as perceived by front-line health care professionals, and (2) to understand why certain factors serve as barriers and to explore what some hospitals have done to successfully break down barriers.

Study Design and Methods:

A comparative case study analysis of medication error reporting practices and beliefs at four community hospitals in Nova Scotia was completed using focus groups (with physicians, pharmacists, and nurses) and in-depth interviews (with risk managers). Focus groups and interviews were audio taped, transcribed verbatim, and analyzed for thematic content using the template style of analysis. Safety Culture Theory was used to develop and analyze this study.

Results:

Careful analysis of the textual data identified themes related to incentives for, barriers to, and positive facilitators of medication error reporting. Incentives were thematized into three categories: patient protection, provider protection, and professional compliance. Barriers were thematized into five categories: reporter burden, professional identity, information gap, organizational factors, and fear. Positive facilitators were thematized into three categories: reducing reporter burden, closing the communication gap, and educating for success. Participants indicated they would report medication errors more frequently if reporting were made easier and if educated about the reporting process and timely feedback.

Conclusion:

These results could be used by hospitals to encourage reporting of medication errors and ultimately make organizational changes leading to a reduction in the incidence of medication errors and an improvement in patient safety. Future research efforts should focus on evaluating the effectiveness of implementing various strategies suggested for improving medication error reporting.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):69.

Medication Incidents Involving Psychotropic Drugs: An Aggregate Analysis

Roger Cheng ¹, Calvin Poon ¹, Sanaz Riahi ¹, Sylvia Hyland ¹

Abstract

Rationale:

Mental health disorders pose a significant burden to the Canadian health care system, both from an epidemiological and financial perspective. Given the prevalence and financial burden of treating mental disorders, it is imperative that there is a strong emphasis on safe medication practices when managing psychotropic medications. By analyzing the incidents involving psychotropic medications, systems based contributing factors could be identified which can inform quality improvement initiatives.

Description and Steps Taken:

Medication incidents from the ISMP Canada database were collected from October 7, 2000 to July 29, 2009. Incidents with an outcome of harm or death involving antipsychotics, antidepressants, antimaniac agents, sedatives and hypnotics were included. A quantitative analysis was conducted to provide an overview of various trends such as the severity of outcome. A qualitative analysis was conducted to identify recurrent themes and contributing factors.

Evaluation:

A total of 88 incidents were included in the analysis; 82 had an outcome of harm, and 6 had an outcome of death. These incidents occur at different patient care settings including the hospital, community pharmacy and long term care. A number of themes have been identified and were classified under the patient care setting where the incident occurred. For example, in the hospital setting, the themes identified included “multiple medications”, “incorrect dose”, “incorrect patient”, “incorrect medication”, “change in order”, “transitions of care” and “dose omission”. Incidents classified under these themes were further analyzed to identify potential contributing factors. Examples of contributing factors identified included complicated instructions in orders, pre-pouring of medications and the lack of a systematic medication reconciliation process.

Importance:

The results of this analysis can provide insights into areas for system improvements for the use of psychotropic medications. The potential contributing factors identified provide a solid foundation for the development of solutions to minimize the recurrence of similar incidents.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):70.

Failure Mode Effects Analysis (FMEA) for Morphine Prescribing Practices

Elaine Wong ¹, Christina Vadeboncoeur ¹, Gina Neto ¹, Hilary Writer ¹, Rosemary Horlin ¹, Elena Pascuet ¹, Régis Vaillancourt ¹

Abstract

Rationale:

At the Children’s Hospital of Eastern Ontario, medication related events represent the highest percentage of patient safety incidents (28%). Of these, there have been 38 morphine related events (5.7% of medication incidents). Due to the voluntary nature of the Safety Reporting System, the recorded number of 38 reported events is likely an underestimation. Although not the sole contributing factor, prescribing practices contributed to a number of these incidents.

Description of Concept:

To identify and prioritize potential failures in morphine prescribing, so that these parts of the morphine prescribing process in greatest need of change are acted upon.

Steps Taken:

A failure mode effects analysis (FMEA) was used by the multidisciplinary team to diagram the process of prescribing morphine and to brainstorm potential failure modes and predict their effects should the failures occur in real-time. Following this, the team identified causes of failure modes and prioritized these using severity, detectability and frequency.

Evaluation:

70 failure modes were identified and prioritized these using severity, detectability and frequency as scores. Single point weaknesses are steps so critical that their failure would result in a system failure or adverse event. These were found to be distributed across the entire process (n = 23). Secondly those scored with severity 5, meaning a severe or catastrophic effect should a failure of the step occur (n = 12). Finally, risk priority number (RPN) which is calculated based on frequency, detectability and severity (n = 5).

Importance to Current and Future Practice:

By identifying the potential failures in morphine prescribing, developing strategies and recommendations that include the following: 1) development of corporate dosing guidelines; 2) development of a verbal order policy; 3) promotion of pre printed orders hospital wide; and 4) support for computerized physician order entry with forcing functions.

Footnotes

Encore Presentation

Can J Hosp Pharm. 2011 Jan-Feb;64(1):70.

Can a Pharmacy Student-Pharmacist Model Be Used to Overcome Challenges and Sustain Admission Reconciliation?

Yin Hui ¹, Kimberley Stefaniuk ¹, Jolene Ng ¹, Jack Seki ¹, Geetha Mahalingam ¹, Julia Streminsky ¹, Michelle Baker ¹, Rosalyn Fleites ¹, Ryan Petryschuk ¹, Hannah Vo ¹, Sara Ingram ¹, Jason Volling ¹, Olavo Fernandes ¹

To correct electrolyte abnormalities, an electrolyte replacement protocol is utilized in the Medical Surgical Intensive Care Unit (MSICU) and Trauma and Neurosurgery Intensive Care Unit (TNICU) at St. Michael’s Hospital, Toronto, Ontario. The objectives of this study were to measure the effectiveness and safety of the protocol, and to identify areas for improvement.

Methods:

The charts of 120 patients who received at least one protocol-directed replacement dose of potassium, calcium, magnesium or phosphorus, and who did not have additional physician orders related to electrolyte replacement were reviewed retrospectively. For effectiveness, data were collected to assess the time, total dose, and number of doses required to return a low serum electrolyte concentration to target range. The occurrence of critically low or high concentrations resulting from protocol-directed replacement was measured as an indicator of safety. Staff compliance to the protocol was also explored.

Results:

The average electrolyte concentration requiring replacement was 3.5±0.2mmol/L for potassium, 1.92±0.07mmol/L for corrected calcium, 0.63±0.06mmol/L for magnesium, and 0.54±0.07mmol/L for phosphorus. The median time to return to target range was 9.9 hours to 18.1 hours, depending on the electrolyte. Overall, 77.5% of patients achieved target concentration after one replacement dose. The lowest rate of normalization after one dose was observed for potassium (56.7%). A higher dose was necessary for the replacement of lower serum concentrations of potassium, magnesium, and phosphorus. The use of the protocol did not result in critical electrolyte concentrations. The overall staff compliance rate was 77.9%, with the lowest compliance observed for timing of follow-up electrolyte concentration measurement.

Conclusion:

The electrolyte replacement protocol was safe, and effective for correcting mild to moderate electrolyte deficiencies. Areas for development were identified, including the need for concentration-dependent dosing and reconsideration of follow-up instructions to limit blood collection for only clinically appropriate situations.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):73.

Antimicrobial Use in a Critical Care Unit: A Prospective Observational Study

Christina Candeloro ¹, Lynne Kelly ¹, Anne Marie Bombassaro ¹, Elke Bohdanowicz ¹, Claudio Martin ^1,²

Abstract

Rationale:

Antimicrobial use, pathogens, and infections are unique among individual intensive cure unit (ICU) settings. Unit specific data guides therapy and stewardship efforts.

Objectives:

The study purpose was to describe antimicrobial utilization, modifications, infections and resistance in a medical-surgical-trauma ICU of a tertiary care teaching hospital. The results will guide future stewardship initiatives.

Methods:

This was a prospective observational study of adults admitted to the ICU over 30 consecutive days. Exclusion criteria were ICU stay <24 hours and no antimicrobials prescribed. Patients were followed until 30 days post-ICU admission, discontinuation of antimicrobials, transfer from ICU or death. Primary endpoints included percent use of antimicrobials, consumption measured as days of therapy per 1000 patient days (DOT/1000PD), indications for use and prescribing service. Secondary endpoints included reasons for and timing of therapy modifications and microbial resistance. Data analysis was descriptive.

Results:

Eighty-three patients were screened and 61 enrolled, receiving 133 courses of antimicrobial therapy mainly prescribed by ICU staff. The most frequently prescribed agents were piperacillin-tazobactam (27%), cefazolin (22%) and vancomycin (17%). The indications for therapy were empiric (50%), directed (27%) and prophylactic (23%). Overall consumption was 1368 DOT/1000PD with empiric, directed and prophylactic therapy accounting for 734, 454 and 180 respectively. Consumption exceeded frequency of use only for the carbapenem class of antibiotics (14% versus 8%). There were 86 therapy modifications involving indication (36), efficacy (25), safety (18) and route (7). Suboptimal dosing of piperacillin-tazobactam and vancomycin was the major contributor to efficacy modifications. Median time from a culture report to therapy modification was 2.77h (range 0.23 to 72.2h). Notable micro-organism resistance included methicillin resistant S. aureus, vancomycin resistant enterococcus, P. aeruginosa and S. pneumoniae.

Conclusions:

Piperacillin-tazobactam was the most frequently prescribed antimicrobial. Targets for stewardship initiatives include empiric therapy, prolonged carbapenem courses and optimization of piperacillin-tazobactam and vancomycin doses.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):73.

Mood Elevation and Pain Control with Duloxetine Monotherapy in Multiple Sclerosis

Sarah Burgess ¹, Joel Lamoure ^1,², Jessica Stovel ^1,²

Once daily gentamicin in combination with piperacillin is the empirical treatment used for pediatric neutropenic fevers at our institution. However, literature evaluating the efficacy and toxicity of this therapeutic combination remains scarce.

Objective:

To assess efficacy and toxicity of once daily dosing of gentamicin as a component of the empirical antibiotic treatment for febrile neutropenia.

Study Design and Methods:

Retrospective review of pediatric oncology patients with admitting diagnosis of febrile neutropenia between January 1^st, 2005 and December 31, 2008. Clinical efficacy assessed by success of treatment in achieving symptomatic recovery without any modification to the initial therapy. Theoretical efficacy determined by classifying febrile episodes into groups: 1) clinically documented infection (CDI); 2) microbiologically documented infection (MDI); or 3) fever of unknown origin (FUO). Responses to treatment identified as follows: complete and early response (<3 days) to the initial treatment, later response to the initial treatment with or without the addition of antifungals or antivirals, and failure of the initial therapy defined as a change of antibiotic therapy. Renal toxicity and ototoxicity also assessed.

Results:

168 patient charts reviewed, which included 280 episodes of febrile neutropenia. In terms of clinical efficacy, 16.1% of attempted treatments failed and led to a modification of the antibiotic therapy. In terms of theoretical efficacy, 63.2% of episodes responded completely and rapidly to the gentamicin-piperacillin regimen, 17.1% had a partial and delayed response, and 19.7% failed therapy. Nephrotoxicity observed in 3.9% of episodes (n = 11). In 54.5% of these cases of nephrotoxicity, patients had also received vancomycin. Audiology tests were available for 9 patients, of which 44.4% (n = 4) had abnormal results.

Conclusion:

Empirical treatment with once daily gentamicin in combination with piperacillin in neutropenic fevers is effective and safe. Gentamicin was not responsible for deterioration of renal function when regular monitoring completed.

Footnotes

Encore Presentation

Can J Hosp Pharm. 2011 Jan-Feb;64(1):75–76.

Optimization of Medication Reconciliation on Admission for Pediatric Inpatients

Elaine Wong ¹, Régis Vaillancourt ¹, Pierre Katz ¹

Abstract

Rationale:

Medication reconciliation (MR) is a process designed to provide the most complete and accurate list possible of all medications during transfer of care. The pharmacy department is reviewing the existing MR process completed by a team of Pharmacy Assistants (PA’s) to optimize patient care and capture all inpatient admissions.

Description of Concept:

At its conception, MR was performed by a single PA. However, the process is now supported by a team of 4 PA’s 7 days a week. In an effort to harmonize the MR process, the process is being reviewed to establish best practice and improve the ability to capture all inpatient admissions. Specific objectives include: 1) prioritizing patients requiring MR based on unit /diagnosis; and 2) creating a decision tree to identify the need for pharmacist involvement.

Steps Taken to Implement New Program:

Observe current practice of MR as performed by each PA.
Diagram current process and propose changes for quality improvement.
Audit successes and barriers to revised MR process.
Re-assess for additional training or educational needs.

Results:

We included 195 medical records in the analysis, accounting for 197 prescriptions. The previous study in 2006 included 192 prescriptions. Wait-and-see approach (WASP) was used for only 5.6 % of the children in 2008, compared with 10.4% in 2006. When an antibiotic treatment was prescribed, amoxicillin was the agent chosen for 78.5% of children, compared with 61.0% in 2006. Among prescriptions of amoxicillin or amoxicillin-clavulanic acid, high-dose (80–90 mg/kg/day) was regularly prescribed (137/174; 78.7%) as was the case in 2006 (86/118; 72.9%). The conformity with guidelines for antibacterial agent choice, dose, dosing interval and duration of therapy improved compared to 2006 (16.6%, 16.6%, 8.8%, and 15.4% improvement, respectively; p<0.007). However, treatment duration remained generally longer than recommended (76.1% conformity rate). In children > 2 years old, a 10-day treatment was still frequently prescribed (37.3%), instead of the recommended 5 to 7-day treatment (41.3%).

Conclusions:

WASP remains scarcely used. Global conformity of AOM prescriptions improved, possibly as a result of presentation of the 2006 study findings and better ED physician knowledge of provincial guidelines.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):79.

Point Prevalence Survey of Antimicrobial Utilization in the Cardiac and Paediatric Critical Care Unit

Ekaterina Blinova ^1,⁸, Winnie Seto ^1,^2,⁸, Elaine Lau ^1,⁸, Ari Bitnun ³, Peter Cox ⁴, Steven Schwartz ⁵, Eshetu Atenafu ², Yvonne Yau ⁶, Laurie Streitenberger ⁷, John Marshall ⁹, Christopher S Parshuram ⁴

Abstract

Rationale:

Definitive diagnosis of infection in critically ill children is difficult and antimicrobials are often prescribed empirically. This creates challenges for appropriate antimicrobial use.

Objectives:

To determine the rate of documented infections and prevalence of antimicrobial use among patients admitted to the Cardiac and Medical-Surgical Critical Care Units (CCCU - PICU) at SickKids®. To assess the appropriateness of antimicrobial prescribing according to clinical and microbiological findings, Infectious Diseases consult recommendations, and formulary guidelines.

Study Design and Methods:

A prospective point-prevalence study was conducted in the CCCU-PICU of a tertiary care teaching hospital in Toronto. All patients admitted to the CCCU-PICU during the week of October 27, 2008 (Period A) and February 9, 2009 (Period B) were followed until completion of their antimicrobial course(s). Data was collected on infections treated and antimicrobials prescribed. Appropriateness of antimicrobial prescribing was assessed according to pre-defined criteria by 4 blinded assessors.

Results:

Forty-two of 60 patients (70%) received antimicrobials in Period A and 42 of 53 patients (79%) received antimicrobials in Period B. Of patients receiving antimicrobials, 45% in Period A and 52% in Period B had a definitive diagnosis of infection. The most common infections were pneumonia and sepsis (Period A) and pneumonia and other respiratory tract infections (Period B). Antimicrobials were most commonly prescribed for documented infection (38%) during Period A and empiric therapy (47%) during Period B. Cefazolin, cefuroxime, vancomycin and gentamicin were most commonly prescribed during both periods. Inappropriate antimicrobial use ranged from 16.7% to 61.9%, depending on the assessor and surveillance period. The most common reasons for inappropriate use were wrong dosage, overly-broad spectrum, and unwarranted overlap of spectrum.

Conclusions:

There was a high prevalence of antimicrobial use in CCCU-PICU patients. A significant proportion of antimicrobial use was deemed inappropriate, thus interventions are required to optimize antimicrobial use in critically ill children.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):79.

St-Michael’s Pharmacist Academy of Learning Pilot Program: An Educational Model for Training and Assessment of New Pharmacists and Interns

Christinne Duclos ¹, Elaine Tom ¹

In January 2005, the hemodialysis (HD) unit at Toronto East General Hospital switched all patients from IV epoetin alfa (EPO) to IV darbepoetin alfa (DPO).The purpose of this research was to quantify erythropoiesis stimulating agent (ESA) utilization, cost implications and medication administration errors (MAE) before and after the EPO to DPO switch, as well as quantify 5 year cost implications.

Methods:

The study design was a 15 month retrospective observational study. During this time period, ESA doses were titrated to target hemoglobin and iron indices in accordance with the 2001 NKF-K/DOQI guidelines. ESA weekly doses and MAEs were collected for 6 months pre-conversion and 9 months post-conversion (3 month titration and 6 month post-conversion period). A follow-up sub-group analysis was performed on patients in the HD program 5 years after conversion for 6 months.

Results:

Thirty-seven patients underwent conversion to DPO and the sub-group analysis consisted of 16 patients. During the study, hemoglobin and iron indices were maintained within target range while median DPO dose decreased from 50 to 20mcg (P=0.026, Wilcoxon signed-rank test). Further dose reductions in DPO dose was seen after 5 years (30mcg in 2005 versus 20mcg in 2010, P=0.0006 using Wilcoxon singed-rank test) with an estimated annual cost savings of $3100 per patient. Thirty MAEs were observed after DPO conversion compared to 106 during EPO pre-conversion (P<0.0001, Fisher exact test). Thirty-four patients had at least one or more MAE while on EPO compared to 17 patients after DPO conversion. The absolute risk of a medication discrepancy was reduced by 8% after conversion to DPO.

Conclusion:

This real world dosing evaluation study showed continued cost savings after 5 years and fewer medication administration errors when HD patients were switched from EPO to DPO, while maintaining clinical targets.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):80–81.

Revising Automated Dispensing Cabinet Inventory to Improve Efficiency

Sara Kynicos ¹, Paul Lee ², Jin-Hyeun Huh ³, Esther Fung ³

Abstract

Rationale:

Many hospitals are increasingly dependent on Automated Dispensing Cabinets (ADCs), to provide a safer, medication delivery system. However supporting this system is labour intensive and unfortunately not all medications may be in ADC’s due to capacity restrictions (patient specific medications).

Objectives:

The objective was to revise the entire contents of eight ADCs (across three In-Patient units) to determine if this impacts the frequency, quantities of ADC medication refills and accommodate all patient-specific medications without resorting to non-ADC storage (e.g. cassettes)

Methods:

An annual drug usage report was generated for each inpatient unit to create a top 300 list. A minimum of 72 hour supply in each ADC of the highest use medications was the target quantity. The ADC current and the proposed inventory lists were compared and reviewed with the unit’s pharmacist to ensure that appropriate medications were not inadvertently removed. Each drawer lay-out of the ADC was planned and configurations adjusted to allow sufficient quantities of each drug to be stocked. Where possible a drawer was kept empty for flexible non-standard stock to allow for patient specific drugs to be loaded.

Results:

Prior to the ADC revision, baseline refill records were collected to determine the drugs and quantities that were filled to the ADCs and a 1 day snapshot of cart-fill medications for the specified floors. This refill review repeated 2 months after the ADC revision showed a 57% reduction in the number of drug lines and a 19% reduction in number of doses refilled into the ADC. A 63% reduction in number of patient-specific cart-fill doses dispensed to non-ADC storage was captured following ADC revision.

Conclusion:

This systematic approach demonstrates that revision of an ADC’s inventory can reduce pharmacy workload and maximise capacity of the machines to ensure all medications are stored within ADC.

Can J Hosp Pharm. 2011 Jan-Feb;64(1):81.

Early Impact of a Decentralized Automated Dispensing System in a Small Regional Hospital

Lenard Walser ¹, Jill Skinner ¹, Anne Chisholm ¹

Abstract

Rationale:

Automated drug distribution systems can enhance patient safety, provide cost savings and improve staff satisfaction.

Description:

Colchester East Hants Health Authority is a 120 bed community hospital that transformed a centralized drug distribution system to an automated, decentralised unit-dose system in the Spring of 2010. The transition included pharmacy, in-patient, ambulatory, emergency and surgical services. The system included Automated Dispensing Cabinets (ADC), narcotic vault system, electronic order scanning system, medication carousel and unit-dose packager. Barcode scanning is utilized throughout the distribution system and all ADCs are profiled via the Pharmacy Information System except surgical services.

Implementation:

Following completion of interface testing, the automation transition occurred over four months.

Evaluation:

Three months post implementation, medication-related reportable occurrences decreased by 37% and medication departmental costs decreased by 24 % compared to the same period one year earlier. A staff satisfaction survey was completed by 77 respondents, where 1 = strongly disagreed, 3 = no difference and 5 = strongly agreed. Pharmacists valued reduced distribution responsibilities (AVE = 4, SD = 1.0) and increased time for clinical services (AVE = 4, SD = 0.7). Technicians reported enhancements in narcotic security (AVE = 4.1, SD = 0.79), and improved accuracy with barcode selection (AVE = 3.9, SD = 0.99). Nursing valued reduced narcotic counting and ordering of medications (AVE = 4.3, SD = 1.0), increased patient safety (AVE = 3.5, SD = 0.96) and less time searching for medications (AVE = 3.5, SD = 1.02). Nursing did report an increase in medication administration time (AVE = 3.3, SD = 1.07). Overall, when asked if the distribution system was a significant improvement over the previous system, the responses were as follows: pharmacists (AVE = 4. 8, SD = 0.45), technicians (AVE= 4.2, SD = 0.72) and nurses (AVE = 3.3, SD = 1.02).

PERMALINK

CSHP Professional Practice Conference 2011: Poster Abstracts / Conférence sur la pratique professionnelle 2011 de la SCHP : Résumés des affiches

Sunday, January 30, 2011 • Dimanche 30 janvier 2011

Infectious Disease

Drug Use/Primary Care

Medication Safety

Cardiology/Critical Care/Transplant

Monday, January 31, 2011 • Lundi 31 janvier 2011

Tuesday, February 1, 2011 • Mardi 1er février 2011

Wednesday, February 2, 2011 • Mercredi 2 février 2011

Evaluation of Clinical and Economic Outcomes of Alternative Meropenem Dosing Compared to Traditional Dosing

Shazia Syed

Annie Brooks

Melani Sung

Abstract

Objective:

Methods:

Results:

Conclusion:

A Quality Audit of the Surgical Antibiotic Prophylaxis at a Tertiary Care Hospital

Monique M Pitre

Gary G Wong

James Murdoch

Sophia Cao

Baseer Yasseen

Abstract

Background:

Method:

Results:

Conclusion:

A Reliable Method of Obtaining Blood Samples from Implantable Central Venous Catheters for Determination of Plasma Gentamicin Concentrations

Jennifer Chen

Sabrina Boodhan

Sara Rosaline Lavoratore

L Lee Dupuis

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Single versus Double Gram Negative Coverage Empiric Antibiotic Therapy of Febrile Neutropenia in Pediatric Patients

Shane Pawluk

Roberta Esau

Claire Aston

Rod Rassekh

Roxane Carr

Abstract

Rationale:

Objectives:

Methods:

Results:

Conclusion:

Development of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Pre-Dose Levels at Two Major Canadian Teaching Hospitals

Rosanne Thalakada

Tim T Y Lau

Michael Legal

Joshua Batterink

Mary H H Ensom

Abstract

Rationale:

Objectives:

Methods:

Results:

Conclusion:

Evaluation of Dosing Strategies with Meropenem Using Monte Carlo Simulation to Determine the Probability of Attaining Pharmacokinetic-Pharmacodynamic Targets in a Model of Critically Ill Patients with Pseudomonas aeruginosa Bacteremia

Miranda So

Scott E Walker

Sandra A N Walker

Abstract

Rationale:

Objective:

Results:

Conclusion:

Drugs Use among Seniors on Public Drug Programs in Canada, 2002 to 2008

M Gaucher

J Hunt

Abstract

Rationale:

Objective:

Tuesday, February 1, 2011 • Mardi 1^er février 2011