Journal of pharmacy practice
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To evaluate whether a pharmacist-initiated electronic handoff tool can reduce the overall, and potentially inappropriate, hospital discharge prescribing rate of atypical antipsychotics (AAP) initiated in AAP-naive critically ill adults. ⋯ A pharmacy-initiated electronic handoff tool may reduce the proportion of AAP-naive ICU survivors with an AAP continued at the time of ICU transfer. The handoff tool was not associated with a significant reduction in the discharge prescribing rates of AAPs for hospital survivors, but a clinically meaningful reduction was possibly achieved due to enhanced communication enabled by this tool.
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This quasi-experimental study compared the aztreonam utilization in patients with self-reported beta-lactam allergies admitted to an inpatient service between two study periods (pre- and post-implementation). Post-implementation followed the initiation of a standardized beta-lactam allergy questionnaire, a student pharmacist-driven performance improvement project for beta-lactam allergy documentation. Interviews clarified the allergy, reaction history, and any previous tolerance of beta-lactams. If receiving aztreonam at the time of the questionnaire, recommendations were made for changes in therapy if deemed appropriate by the pharmacist. ⋯ Utilization of a standardized beta-lactam allergy questionnaire as a pharmacy education tool resulted in a statistically significant decrease in aztreonam utilization, based on doses, days of therapy, and de-escalations.
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The Centers for Disease Control and Prevention (CDC) reports a 200% escalation in the rate of opioid overdose deaths in the United States. Unfortunately, Ohio has been deemed the epicenter of the nation's opioid epidemic. In 2015, Ohio passed a bill that permits a pharmacist to distribute naloxone without a prescription. ⋯ Additional educational programs should be delivered to Ohio pharmacists to inform them of the state law and policies. Continuing education programs that review substance abuse and attempt to reduce social stigma may assist with increasing naloxone distribution to those in need, especially, if directed toward younger pharmacists in Ohio.
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Endocrine emergencies are frequent in critically ill patients and may be the cause of admission or can be secondary to other critical illness. The ability to anticipate endocrine abnormalities such as adrenal excess or , hypothyroidism, can mitigate their duration and severity. ⋯ Electrolyte abnormalities such as hypercalcemia and hypocalcemia may have underlying endocrine causes, and may be treated differently with recognition of those disorders- electrolyte replacement alone may not be adequate for efficient resolution. Sodium disorders are common in the ICU and are generally related to altered water balance however may be related to pituitary abnormalities in selected patients, and recognition may improve treatment effectiveness and safety.
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Critically ill patients commonly experience pain, and the provision of analgesia is an essential component of intensive care unit (ICU) care. Opioids are the mainstay of pain management in the ICU but are limited by their adverse effects, risk of addiction and abuse, and recent drug shortages of injectable formulations. ⋯ Nonopioid analgesics discussed in detail in this article are acetaminophen, α-2 receptor agonists, gabapentinoids, ketamine, lidocaine, and nonsteroidal anti-inflammatory drugs. This literature review describes the clinical pharmacology, supportive ICU and relevant non-ICU data, and practical considerations associated with the administration of nonopioid analgesics in critically ill adult patients.