CSHP Professional Practice Conference 2014: Poster Abstracts / Conférence sur la pratique professionnelle 2014 de la SCPH : Résumés des affiches

Pharmacy students in the pre-admission clinic documented medication histories containing fewer discrepancies than staff in the emergency department and are, therefore, a viable hospital resource to help improve patient safety and continuity of patient care.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):60.

Retrospective Analysis of the Implementation Success of an Antimicrobial Stewardship Program in a Community Hospital Without an Infectious Disease Physician

Mark Taylor ¹, Andrea Wist ¹, Gayathri Radhakrishnan ¹, Rebecca Strutchbury ¹, Joel Varsava ¹, Alicia Oesch ¹

Abstract

Rationale:

There is a paucity of data on the impact of the implementation of an Antimicrobial Stewardship Program in community hospitals without an Infectious Disease physician. This report of the Bluewater Health (BWH) Stewardship Program, with emphasis on the pharmacist, serves as a sustainable template for community hospitals to satisfy the Accreditation Standards.

Description:

BWH is a 326 bed community hospital without an Infectious Disease Physician. Our Stewardship program is designed based on the Infectious Disease Society of America (IDSA) guidelines. We used the 2 IDSA proactive models: Prospective audit with intervention and Formulary Restriction.

Implementation Steps:

Our process included the following steps:

Creation of a BWH antimicrobial guideline and antibiogram in 2011.
Implementation of a “restricted” antimicrobial selection process based on cost, adverse events, negative patient outcome risks.
Monitoring of antimicrobials’ Defined Daily Dosing (DDD)
Monitoring of Clostridium Difficile infection rates.

Evaluation:

The Stewardship program was evaluated using qualitative and quantitative parameters. Quantitative parameter(s) include: Number of antimicrobial orders which necessitated Clinical Interventions initiated by pharmacists (Table 1), trends in Defined Daily Dose (DDD) of 2 broad spectrum antimicrobials, trends in Clostridium Difficile rates. Qualitative parameter(s) include: Pharmacists’ self perceived level of comfort and competency regarding antimicrobials. On a Likert Scale of 1 to 4, pharmacists rated their competency and comfort as 1.42 (pre implementation) and 1.89 (post implementation)

Table 1: Summary of Quantitative parameters for Clinical Interventions (for the table that goes with this abstract, please see Abstract Appendix, available online at www.cjhp-online.ca/index.php/cjhp/issue/view/100/showToc)

Relevance to Practice:

By highlighting our strategies, we will be adding to the current paucity of literature that surrounds antimicrobial stewardships in community hospitals without Infectious Disease Physicians.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):60.

Risk Factors of Adverse Drug Reaction–Related Hospitalizations among Seniors, 2006 to 2011

Michele Arthur ¹, Michael Gaucher ¹

Abstract

Rationale:

Adverse drug reactions (ADRs) are defined by the World Health Organization as adverse effects of a drug that was properly administered in the correct dose, for therapeutic or prophylactic use. Seniors are at greater risk for ADRs, as well as other types of drug-related adverse events, due to the number of drugs they take, their higher prevalence of certain chronic conditions and age-related changes in the body.

Objectives:

This analysis examined potential risk factors for ADR hospitalizations and compared seniors’ drug therapy pre-admission and post-discharge to see if ADR-related hospitalizations led to changes in drug therapy.

Study Design and Methods:

This analysis used hospital discharge data from the Discharge Abstract Database and drug claims data from the National Prescription Drug Utilization Information System Database to assess potential risk factors for ADR hospitalizations among seniors on public drug programs in Alberta, Manitoba and P.E.I.

Results:

The number of drugs was the most significant risk factor, with seniors taking 15 or more drugs being 6.4 times more likely than seniors taking fewer than 5 drugs to have been hospitalized for an ADR. Other factors associated with hospitalizations for ADRs were age and hospitalizations in the previous year. The relationship between new drug starts and ADR-related hospitalizations varied by drug class. Of seniors hospitalized for an opioid-related ADR, 33.2% started taking an opioid within 30 days of hospitalization, while only 28.2% of seniors hospitalized for an anticoagulant-related ADR started an anticoagulant within a year of hospitalization.

Conclusion:

Although it is often necessary for seniors to take multiple drugs to manage their chronic conditions, regular medication reviews can help reduce the risk of adverse events including drug interactions. A high proportion of the hospitalizations related to anticoagulant ADRs occurred more than a year after starting therapy, which underscores the importance of ongoing monitoring.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):61.

Chemotherapy-Induced Nausea and Vomiting in Children Receiving High Dose Methotrexate with or without Vincristine: Preliminary Results

Jacqueline Flank ^1,⁴, Sara Lavoratore ¹, Helen Vol ¹, Tracey Taylor ¹, Elyse Zelunka ¹, Paul Nathan ², Anne Marie Maloney ³, L Lee Dupuis ^1,⁴

Abstract

Rationale:

Chemotherapy-induced nausea and vomiting (CINV) negatively influences the quality of life of children receiving chemotherapy. Little is known about the severity of CINV experienced by children receiving IV methotrexate ≥ 1g/m²/dose (HD-MTX).

Objective:

To describe the prevalence of acute and delayed phase CINV in children aged 4–18 years receiving HD-MTX ± vincristine.

Study Design and Methods:

Children about to receive HD-MTX were eligible to participate in this prospective, observational study. Patients received antiemetics as ordered by their primary care team. Nausea severity (assessed using the Pediatric Nausea Assessment Tool; PeNAT), time of emetic episodes, and administration of antiemetics were recorded in a diary beginning immediately prior to HD-MTX administration, for 24 hours after the patient achieved a MTX concentration of < 0.1μM (acute phase), and for up to an additional 7 days (delayed phase). Complete CINV control was defined as: no vomiting, no retching and a maximum PeNAT score of 1 (out of 4).

Results:

Data are available for 23 patients (mean age: 12±3.9 years; 14 boys). Fourteen patients received HD-MTX plus vincristine while 9 received HD-MTX alone. The average MTX dose was 9g/m² (range: 3–12g/m²). Antiemetic prophylaxis consisted of either ondansetron (16) or granisetron (7) with (10) or without (13) dexamethasone. Six patients also received nabilone. Ten patients received breakthrough antiemetics (lorazepam ± dimenhydrinate). Mean duration of the acute and delayed phases were 81.7 and 144.8 hours, respectively. One (4%) and 7 (30%) patients experienced complete CINV control during the acute and delayed phases, respectively. More patients experienced complete vomiting control during the acute (52%) and delayed (61%) phases than experienced complete nausea control (4 and 30%, respectively).

Conclusion:

Acute and delayed phase CINV control, most especially nausea control, following HD-MTX administration is sub-optimal. Subsequent analyses will evaluate the influence of guideline-consistent antiemetic prophylaxis on CINV control.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):61.

Safe Swallowing of Oral Liquid Medications in Patients with Dysphagia: A Patient Quality and Safety Initiative

Aarthi Iyer ¹, Darien Heathcote ¹

Abstract

Rationale:

Patients with oropharyngeal dysphagia are at aspiration risk, making the administration of oral medications challenging. Liquid medications may be too thin and the use of xantham gum based thickeners for liquid medications has not been evaluated.

Objectives:

This project sought to:

classify the viscosity of commonly prescribed liquid medications
standardize thickening of liquid medications
establish an institution specific collaborative process for thickening liquid medications

Study Design and Methods:

Viscosity of commonly prescribed liquid medications was visually determined. Next, serial quantities of water (thinnest consistency) were added to applesauce to determine the threshold at which its puree consistency is altered. Finally, medications prescribed in volumes above 10mls were tested with thickening agent. Viscosity of the prepared product was determined using The Line Spread Test.

Results:

It was determined that up to 2.5 ml of thin liquid added to 16ml of applesauce does not alter the consistency of applesauce. For medications prescribed in volumes greater than 10mls, for which crushable alternatives are not available, recipes with thickener were established. The final consistency attained was pudding thickening (with the exception of Lactulose).

	Dose is More Than 10 ml:
Medication	Usual Dose	Amount of thickener to be added	Special Instructions
CAS-MAG	15 ml	1 packet	Stir
Docusate Sodium	25 ml	2 packets	Stir & let sit for 10 mins.
Hydroxyzine	25 ml	2 packets	Stir
Lactulose^*	30 ml	4 packets	Stir (see ^* below)
Lithium	20 ml	2 packets	Stir & let sit for 30 mins.
Milk of Magnesia	30 ml	1 packet	Stir
Potassium chloride	15 ml	1 packet	Stir & let sit for 10 mins.
Theophylline	26.5 ml	1 packet	Stir

Open in a new tab

^*

Lactulose can only be thickened to honey thick. If the patient is on pudding thick do not give. Consult Pharmacy.

Conclusion:

Administering liquid medications to patients with oropharyngeal dysphagia is a significant challenge. We developed a standardized approach to the safe and effective administration of liquid medications.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):61–62.

Evaluation of a Secondary Stroke Prevention Checklist Implemented on a Stroke-Medicine Unit in a Community Teaching Hospital

Monica Lee ¹, Vickie Chang ¹, Parisa Parnian ¹, Rochelle Liem ¹, Tiffany Kan ¹

In the era of new oral anticoagulants (NOAC) for atrial fibrillation (AF), few studies have identified patterns of NOAC use over warfarin.

Objectives:

To describe oral anticoagulants (OAC) use and to identify patterns associated with the choice of NOAC over warfarin.

Methods:

A cohort of patients on OAC for AF was built from inpatient records of hospitalisations between October 2011 and March 2013. A nested case-control study was conducted to identify predictors of NOAC use among new users of OAC.

Results:

Conclusions:

The use of clinical informatics order set standardization and design principles and the sharing of service level data was successful in improving the rates of VTE prophylaxis assessment/treatment.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):64.

How Do Local, Provincial and National Perspectives on Clinical Pharmacy Key Performance Indicator Critical Activity Areas Compare?

H Bannerman ¹, S Gorman ², K Toombs ³, J Lo ¹, S Shukla ¹, D Doucette ⁴, R Slavik ², B Semchuk ⁵, W Chan ¹, N Benninger ¹, N MacKinnon ⁶, C Bell ⁷, J Slobodan ⁸, C Lyder ⁹, T Pereira ⁸, A Bjelajac-Mejia ¹⁰, S Spina ¹¹, O Fernandes ^1,¹²

Pharmacists are well positioned within the health care team to provide patient care based on pharmacogenomics, an emerging field of clinical relevance for individualized drug therapy. Current curricula of the pharmacy schools and residency programs across Canada lack substantial education in this field.

Description:

The ultimate goal of the rotation is to familiarize the resident with the new field of medicine known as personalized medicine or pharmacogenomics.

Implementation:

To better develop the skills of pharmacists to be able to provide pharmacogenomics-based pharmaceutical care, a mandatory pharmacy residency rotation in personalized medicine was established. Learning objectives for the rotation were defined and specific, validated teaching strategies were deployed by the preceptor.

Evaluation:

The residents were given a survey at the end of the rotation to assess the mandatory personalized medicine rotation and assess the teaching strategies used during the rotation (response rate of 80%). Answers to the survey questions used the following assessment scale: does not apply, strongly disagree, disagree, agree, and strongly agree

Relevance:

Conclusion:

Each model offers unique advantages and disadvantages. While no model was superior to the others, the 2:1 model may facilitate peer learning and increase institutional placement capacity, without substantially increasing preceptor workload. To our knowledge this is the first review of its kind to include pharmacy models.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):68.

Patient Medication Education at Discharge: A Multidisciplinary Team Based Approach (TEACH)

Cheyanne Boehm ¹, Lynette Kosar ¹, Lisa Ruda ¹, Lori Zulyniak ¹

Abstract

Rationale:

Healthcare models lack effective means of communicating patients’ drug therapies upon hospital discharge. Up to 45% of discharge medications are first prescribed in hospital, which increases the risk of patient adverse events if adequate medication education is not received.

Objectives:

The purpose of the study was to propose a feasible and sustainable patient-centered medication discharge education process for atrial fibrillation (AF) patients within the Cardiac Surveillance Unit (CSU) at the Regina General Hospital. The objectives were:

To identify the current medication discharge education process.
To elicit the enablers for the provision of patient medication discharge education.
To elicit the barriers for the provision of patient medication discharge education.
To determine what medication discharge education is essential for patients to receive to promote adherence and safety.
To provide suggestions for further consideration of a multidisciplinary medication discharge education process.

Study Design and Methods:

A single multidisciplinary focus group including pharmacists, nurses, and a social worker, was conducted.

Results:

Thematic coding was used to identify the current process, enablers, barriers, and essential information, and to propose the following suggestions: (1) All CSU providers should be responsible for providing patient education; (2) Use pharmacy technology to identify patients for education; (3) Provide consistent written and verbal information to increase patient understanding; (4) Facilitate patient access to discharge medications; (5) Improve inpatient and outpatient provider communication; (6) Expand use of the Cardiac Teaching Document to all CSU members; (7) Create an AF pathway; (8) Develop additional education tools and house materials online.

Conclusion:

The ideas proposed build upon the current process and integrate aspects of discharge medication education that have been successful for CSU or other teams. Implementation of these suggestions may improve both patient understanding and adherence to AF medications.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):68–69.

How Do National Clinical Pharmacy Key Performance Indicators Align With Top-Ranked Consensus Selection Criteria?

J Lo ¹, S Gorman ², K Toombs ³, H Bannerman ¹, S Shukla ¹, R Slavik ², B Semchuk ⁴, D Doucette ⁵, W Chan ¹, N Benninger ¹, N MacKinnon ⁶, C Bell ⁷, J Slobodan ⁸, C Lyder ⁹, T Pereira ⁸, A Bjelajac-Mejia ¹⁰, S Spina ¹¹, O Fernandes ^1,¹²

This project demonstrates the successes (Pharmacoeconomics and Time) of implementing IV to PO antibiotic stepdown involving a multidisciplinary approach, as part of a stewardship program in line with Accreditation Standards.

Description:

Bluewater Health (BWH) is a 326 bed community hospital without an Infectious Disease Physician. BWH had an automatic IV to PO stepdown policy only for 5 antibiotics since 2007. In this project, all IV antibiotics on formulary were included for review.

Implementation:

All patients initiated on IV antibiotics in Med Telemetry unit (MEDT) were reviewed on Day 3 of antibiotic therapy. Patients were excluded if they transferred in or out of MEDT during their IV antibiotic therapy. The project period covered 4 weeks in May–June 2012. The pharmacist reviewed the patient’s clinical status to determine eligibility for stepdown. If patient met eligibility, the pharmacist notified the clinician of an appropriate PO alternative. Follow up was done the next day to determine if the suggestion was accepted, partially accepted or rejected. IV to PO stepdown data was also captured when there was no pharmacist involvement. The amount of time spent in reviewing patients and follow up was also collected. Upon completion, the cost of total PO antibiotic therapy was subtracted from the cost of the anticipated full duration of IV therapy (if PO conversion was not completed) to calculate cost savings.

Evaluation:

18 patients (who had a total of 20 antibiotic orders) were included.

Relevance to Practice:

This project adds to current literature on IV to PO antibiotic conversions, creating a template on how it can be accomplished without an Infectious Disease Physician.

Table 1:

Summary of IV to PO outcomes

# of orders ineligible for IV → PO (15%)	3
# of orders discontinued (20%)	4
# of orders discontinued with pharmacist and physician involvement	(3)
# of orders discontinued with physician involvement only	(1)
# of orders eligible for IV → PO (50%)	10
# of orders changed to po with pharmacist and physician involvement	(6)
# of orders changed to po with physician involvement only	(3)
# of orders continued as IV	(1)
# of orders lost to follow up (15 %)	3
Antibiotics reviewed: Ceftriaxone, Ceftazidime,	-
Moxifloxacin, Cefazolin, Azithromycin, Ciprofloxacin, Metronidazole.
Average amount of time required to review patients who were eligible for IV to PO:	50 minutes
Cost savings by switching to PO	$ 2128.96

Open in a new tab

Can J Hosp Pharm. 2014 Jan-Feb;67(1):71.

Update of the Canadian Labels for Antipsychotic Drugs Following a Review of the Evidence on the Risk of Venous Thromboembolism Associated with the Use of These Medications

David Duguay ¹, Co Pham ¹, Marc Berthiaume ¹

Abstract

Rationale:

Venous thromboembolism (VTE) has been reported with antipsychotics use in numerous published case reports and in several studies since the introduction of phenothiazines in Canada in the 1950’s.

Objectives:

The purpose of the review conducted by Health Canada was to evaluate the association between the risk of VTE and the utilization of antipsychotics as a class, and to recommend strategies to mitigate risk as needed.

Study Design and Methods:

Health Canada conducted a review of cases of VTE with antipsychotic drugs reported in the Canada Vigilance database between January 1^st, 1965 and May 31, 2011, and a review of published studies and case reports related to VTE and antipsychotics.

Results:

As of May 31, 2011, the CanadaVigilance database contained a total of 140 unique reports of VTE associated with antipsychotic drugs (most cases were reported with clozapine [69%]* and some with olanzapine, risperidone, quetiapine, haloperidol, flupenthixol, and loxapine). A literature search from 1948 to September 9, 2011 identified over 80 published case reports of VTE suggestive of an association with antipsychotic drugs, in addition to 14 pharmacoepidemiology studies on this specific issue. The review demonstrated a consistent trend in studies suggesting an increased risk of VTE with exposure to antipsychotic drugs.

Conclusion:

Can J Hosp Pharm. 2014 Jan-Feb;67(1):72–73. [Article in French]

Médias sociaux, comportements en ligne et pharmaciens : lignes directrices et réflexions

Aurélie Guérin ¹, Denis Lebel ¹, Jean-François Bussières ¹

Abstract

Justification:

Avec l’émergence de nombreux outils de communications, la place des médias sociaux comportent de nombreuses opportunités et défis pour les pharmaciens et ses collaborateurs.

Objectifs :

Recenser et comparer les lignes directrices et normes pouvant contribuer à l’encadrement des comportements en ligne professionnels.

Méthodologie et démarche de l’étude :

Étude descriptive. À partir d’une revue documentaire, nous avons identifié les principales lignes directrices de société savantes médicales et pharmaceutiques publiées sur les médias sociaux. Nous avons ensuite comparé le contenu et la portée des lignes directrices proposées.

Résultats :

Nous avons recensé 11 lignes directrices de 11 sociétés savantes dont quatre canadiennes, trois américaines, deux britanniques et une australienne. Dix sociétés savantes sont médicales et une pharmaceutique. Treize paramètres ont été extraits des lignes directrices. Quatre paramètres font davantage consensus à savoir la protection des renseignements personnels des patients, le respect de la frontière professionnel-patient, l’évitement de la communication des renseignements personnels sur soi et la saisie des enjeux des communications en ligne. Il existe peu de balises en pharmacie et les pharmaciens doivent être sensibilisés aux opportunités et enjeux reliés aux comportements en ligne.

Conclusion:

Conclusion:

Many of the commonly observed ADRs were well known reactions. Although it is not always possible to prevent an ADR from occurring, patient monitoring and education are important to ensure that ADRs can be identified quickly so that harm to the patient, and in turn the likelihood of hospitalization, can be minimized.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):74.

Development of a Process to Ensure Timely Home Medication Access for Patients Awaiting Admission in the Emergency Department

Shelita Dattani ¹

Abstract

Rationale:

In our Emergency Department (ED), patients frequently wait several hours before a final decision is made for admission to hospital. These patients do not consistently receive their home medications during this time as a complete Medication Reconciliation is usually not performed until the point of admission. This has great potential to compromise patient safety and efficiency of care.

Description:

Our multidisciplinary task group developed a consistent and streamlined process in order to:

Ensure timely access to patient’s home medications during longer ED stays
Enhance interdisciplinary communication of home medication initiation prior to admission.

Steps Taken to Implement Change:

In order to minimize duplication of successful processes, our pharmacist-led multidisciplinary team evaluated a modification of our current Best Possible Medication History (BPMH) form.

This tool was designed to:

Trigger completion of a BPMH on patients remaining in the ED greater than four hours.
Provide an opportunity for the ED physician to continue home medications as needed for patients with longer ED stays.

Solutions:

Several broad areas of solutions were identified: health authority-faculty partnership, novel learner-preceptor models, direct faculty support for preceptors and learners, learner preparation, and enhanced experiential office. Formal, mutually beneficial partnerships between the faculty and health authorities will ensure preceptors and sites are equipped to provide optimal experiences for learners, while the faculty will benefit from a reliable supply of placements. The faculty will promote the use of pairs, small tiers and facilitated multi-placements for junior learners. Dedicated clinical faculty or protected teaching time for preceptors will address workload concerns and teaching support needs. A comprehensive preceptor development program that leverages technology and preceptor networks will ensure preceptors have the skills to teach. The addition of an early hospital practice experience and inclusion of acute care content in the curriculum will improve the preparedness of learners. Creation of a user friendly “preceptor portal” on the Faculty’s website will provide an enhanced customer oriented approach.

Implications:

While these solutions will require substantial investment and the commitment of all parties involved, the result will be a modern, collaborative, and adaptable institutional experiential program. These solutions could have broad applicability to other jurisdictions in Canada.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):77.

Successful Medication Reconciliation Implementation in a Multi-site Acute Care Facility

N M Facca ¹, S Ahrari ^1,², S Jansen ¹, C Sellery ¹, D Laman ¹, I Bogorad ¹, P Andress ¹, R Runnels ^1,², G Barbour ¹, P Buschell ¹, K Caldwell ¹, C Channon ¹, L Creasor ¹, M Davies ¹, K Delamere ¹, S Dhaliwal ^1,², M Douglas ¹, M Goldszmidt ^1,³, N Johnson ¹, C Glover ¹, S Lawson ¹, S Lee ^1,², D Lemaire ¹, C Loblaw ¹, M Macpherson ¹, M Martin ¹, L Neumann ¹, J Sumpton ¹, A Vandervecht ¹, J Yoon ¹, R Walker ^1,³

Abstract

Background:

Medication reconciliation is a required organizational practice by Accreditation Canada, and has been shown to reduce both medication errors at interfaces of care and prevent adverse drug events.

Description:

Previous strategies to implement medication reconciliation in one of Canada’s largest acute care teaching hospitals focused on admission and were limited in spread across all inpatient units. The goal of this project was to establish a medication reconciliation process at all interfaces of care.

Action:

A strategy was devised to implement a new process and forms. The medication reconciliation project team engaged with various stakeholders to ensure successful adoption and implementation. Broad stakeholder communication strategies were used to inform and sustain change. The educational process included:

Early general information sessions with frontline staff and leadership;
Creation and distribution of tools and resources including work-flows, web-based training modules, posters, and presentations;
Unit specific planning, workflow reviews, and follow-up sessions led by the project team with clinical and clerical staff; and
Unit specific educational sessions led by clinical educators for all frontline staff and by the project team for prescriber and pharmacy staff.

Evaluation:

The project team and Health Records set up a process to abstract information from the medication reconciliation forms and generate reports that would assess staff and prescriber compliance.

Implication:

Medication reconciliation was successfully implemented at admission, transfer, and discharge across all inpatient units of this institution as of June 2012. The process continues to be successful and sustainable. Institutions that are in the process of fully adopting medication reconciliation would benefit from using similar strategies to be successful in implementing this vital patient safety initiative.

For the table that goes with this abstract, please see Abstract Appendix, available online at www.cjhp-online.ca/index.php/cjhp/issue/view/100/showToc

Can J Hosp Pharm. 2014 Jan-Feb;67(1):77.

Facilitation of Medication Reconciliation by a Clinical Registered Pharmacy Technician in an Orthopedic Unit of a Community Hospital: A Pilot Project

Lindsay Yoo ¹, Jenny Chiu ¹, Jocelyn Jackson ¹, Mary Salgado-Corpuz ¹, Yuen Chan-Lau ¹, Joyce Choy ¹, Edith Rolko ¹

Abstract

Rationale:

A previous study at North York General Hospital identified delays in completion of a Best Possible Medication History (BPMH) to be associated with low rates of admission Medication Reconciliation (MedRec) performed in surgical in-patients. In order to improve the admission MedRec rates, means to enhance the timeliness of BPMH completion were explored.

Description and Steps Taken:

With the expanded scope of registered pharmacy technicians (RPhTs), our goal was to develop a BPMH RPhT role to facilitate the process of conducting a BPMH. We first performed a literature review and reviewed the experience of BPMH RPhTs at other institutions. Then, we examined the current BPMH and admission MedRec workflow in our hospital. Finally, we defined the role of the BPMH RPhT and developed a BPMH training and certification program for RPhTs. One RPhT was certified, and the BPMH RPhT role was piloted in the orthopedic unit for approximately 1 month.

Evaluation:

During the 20 days on the unit, the BPMH RPhT interviewed 78 of 140 (55.7%) patients, who were taking an average of 7 medications. The RPhT verified the availability of patient’s own supply in 31 (67.4%) of the 46 patients who were on non-formulary medications. Based on workload data, it was determined the RPhT saved the pharmacist 80 minutes per day in BPMH interviews and documentation. The RPhT prioritized and referred 67% of patients for further evaluation by the pharmacist (e.g. NF alternatives, need for influenza vaccine, etc). Comparing this period to the same a year ago, an increase from 57.3% to 87.9% in admission MedRec was observed.

Importance:

The BPMH RPhT role helped facilitate admission MedRec and potentially saved pharmacists’ time, thus allowing them to focus on other clinical activities. This initiative should be further evaluated and possibly expanded to other areas.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):77–78.

Impact of a Multidisciplinary Program on Smoking Cessation Medication Use Patterns

Koren Lui ¹, Livia Vodenicar ¹, Janice Ma ¹

Abstract

Background:

In May 2012, a multidisciplinary smoking cessation program was implemented at a Canadian Armed Forces medical clinic. The program aimed to enhance patient access and convenience to multidisciplinary support. Weekly clinics were conducted for self-referred and medically referred patients. A pharmacist educated patients regarding available medication therapies (nicotine replacement therapy (NRT), varenicline, and bupropion) to aid the patients in making informed choices. A health promotions team member followed with an interactive teaching session on behaviour modification. After these group sessions, patients were individually assessed by a physician. The selected medication was dispensed in two-week allocations at the clinic’s pharmacy.

Objective:

To describe a multidisciplinary approach and its impact on smoking cessation medication use patterns.

Methods:

A retrospective analysis was performed comparing dispensing records of patients who expressed interest in smoking cessation to a health care team member from June to December 2011 (pre-program implementation) and June to December 2012 (first 6 months after program implementation). Specifically: the selected therapy, completion of the 12 week therapy, and first to last fill intervals (as estimations of time spent in therapy).

Conclusion:

Can J Hosp Pharm. 2014 Jan-Feb;67(1):80. [Article in French]

Impact des données probantes sur l’implantation des prescripteurs électroniques en milieu hospitalier

Aurélie Guérin ¹, Denis Lebel ¹, Jean-François Bussières ^1,²

Abstract

Justification :

On reconnaît les difficultés inhérentes à l’implantation de nouvelles technologies dans le circuit du médicament en hôpital. Certains auteurs considèrent qu’il faut en moyenne plus de 15 ans au réseau de la santé pour qu’un changement soit implanté à plus de 50% en présence de données probantes.

Objectifs :

Évaluer les délais entre la publication des meilleures preuves disponibles et l’implantation de prescripteurs électroniques au Canada.

Méthodologie et démarche de l’étude :

Étude descriptive et rétrospective. À partir d’une revue documentaire sur Pubmed et Google, les meilleures preuves disponibles ont été identifiées, les revues (méta-analyses, revues systématiques, revues de littérature), les études descriptives issues de ces revues et les recommandations. Le taux d’implantation a été documenté à partir des données des rapports canadiens sur la pharmacie hospitalière de 1985–1986 à 2011-2012.

Résultats :

Nous avons recensé trois méta-analyses (2008–2013), 13 revues systématiques (2003–2013), quatre revues de littérature (2003–2010), 198 études descriptives issues de ces revues (1984–2011) et quatre recommandations (2010–2011). On s’intéresse à l’implantation de prescripteurs électroniques au Canada pour la première fois en 2001–2002. Son implantation demeure limitée, soit 7% (2001–2002), 5% (2003–2004), 6% (2005–2006), 5% (2007–2008), 8% (2009–2010) et 8% (2011–2012). Compte tenu du faible taux d’implantation, on ne peut calculer le délai entre la publication des meilleures preuves disponibles et l’implantation à large échelle de prescripteurs électroniques au Canada.

Conclusion :

Il existe peu de données sur les délais observés entre la publication des meilleures preuves disponibles et l’implantation de technologies. Le délai d’implantation des prescripteurs électroniques n’est peut-être pas étranger aux coûts, à la complexité de l’implantation et aux preuves limitées dans la littérature.

Can J Hosp Pharm. 2014 Jan-Feb;67(1):80. [Article in French]

Impact des données probantes sur l’implantation d’aides à la décision clinique pour les prescripteurs électroniques en milieu hospitalier

Aurélie Guérin ¹, Denis Lebel ¹, Jean-François Bussières ^1,²

Abstract

Justification :

On reconnaît les difficultés inhérentes à l’implantation de nouvelles technologies dans le circuit du médicament en hôpital. Certains auteurs considèrent qu’il faut en moyenne plus de 15 ans au réseau de la santé pour qu’un changement soit implanté à plus de 50% en présence de données probantes.

Objectifs :

Évaluer les délais entre la publication des meilleures preuves disponibles et l’implantation d’aides à la décision clinique pour les prescripteurs électroniques au Canada.

Méthodologie et démarche de l’étude :

Étude descriptive et rétrospective. À partir d’une revue documentaire sur Pubmed et Google, les meilleures preuves disponibles ont été identifiées, les revues (méta-analyses, revues systématiques, revues de littérature), les études descriptives issues de ces revues et les recommandations. Le taux d’implantation a été documenté à partir des données des rapports canadiens sur la pharmacie hospitalière de 1985–1986 à 2011–2012.

Résultats :

Nous avons recensé 3 méta-analyses et revues systématiques (1999–2013), 17 revues systématiques (1998–2013), sept revues de littérature (1994–2012) et deux rapports (2011,2012), 341 études descriptives différentes issues des revues (1957–2012) et une recommandation (2006). On s’intéresse à l’implantation d’aides à la décision clinique pour les prescripteurs électroniques au Canada pour la première fois en 2001–2002. Son implantation évolue progressivement, soit 33% (2001–2002), 14% (2003–2004), 75% (2005–2006), 58% (2009–2010) et 75% (2011–2012). Le délai calculé entre la publication des meilleures preuves et l’implantation à large échelle de prescripteurs électroniques au Canada était de 5 ans, soit entre 2000 et 2005.

Conclusion :

Il existe peu de données sur les délais observés entre la publication des meilleures preuves disponibles et l’implantation de technologies. On reconnaît que le changement est difficile et sa gestion complexe, particulièrement au sein de grandes organisations. Il a fallu 5 années pour implanter à large échelle des aides à la décision clinique pour les prescripteurs électroniques au Canada; le nombre de prescripteurs électroniques implanté demeure toutefois extrêmement limité.

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

CJHP-67-57-s001.pdf^{(91.3KB, pdf)}

PERMALINK

CSHP Professional Practice Conference 2014: Poster Abstracts / Conférence sur la pratique professionnelle 2014 de la SCPH : Résumés des affiches

Sunday, February 2, 2014 • Dimanche 2 février 2014

Education

Clinical 1

Clinical 2

Professional Practice

Monday, February 3, 2014 • Lundi 3 février 2014

Tuesday, February 4, 2014 • Mardi 4 février 2014

CSHP 2015

SCPH 2015

Abstract Appendix for PPC 2014 Poster Abstracts / Document supplémentaire pour les résumés des affiches de la CPP 2014

Do Learning Styles of Pharmacy Practice Residents Change When They Enter Practice?

Peter Loewen

Janice Yeung

Anca Jelescu-Bodos

Torey Lau

Abstract

Rationale:

Objective:

Study Design and Methods:

Results:

Conclusions:

Implementation and Assessment of a Continuous Pharmacy Student Clinical Role in a Hemodialysis Unit

Karen Cameron

Marisa Battistella

Colette Raymond

Abstract

Rationale:

Description:

Implementation:

Evaluation:

Importance:

Institutional Pharmacists’ Perspectives on Precepting: A Comprehensive Province-Wide Study

Michael Legal

Donna Rahmatian

Kyle Collins

Patricia Gerber

Angela Kim-Sing

Peter J Zed

Peter S Loewen

Abstract

Rationale:

Objectives:

Methods:

Results:

Conclusions:

Assessment of the Effect of Behavioral Change Strategies on Knowledge Translation and Interventions from Disease State Education Modules: DSEM-KT Study

Richard Slavik

Sarah Murray

Sean Gorman

Nicole Bruchet

Dawn Dalen

Brett Hamilton

Abstract

Rationale:

Objective:

Methods:

Results:

Conclusions:

Accuracy of Medication Histories Documented by Pharmacy Students versus Health Care Professionals

N M Facca

S Ahrari

J Stovel

J A Seabrook

S Jansen

Abstract

Rationale:

Objective:

Methods:

Results:

Conclusion:

Retrospective Analysis of the Implementation Success of an Antimicrobial Stewardship Program in a Community Hospital Without an Infectious Disease Physician

Mark Taylor

Andrea Wist

Gayathri Radhakrishnan

Rebecca Strutchbury

Joel Varsava

Alicia Oesch

Abstract