American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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The practice of blood conservation is aimed at improving patient outcomes by avoiding allogeneic transfusions via a coordinated multidisciplinary, multipronged approach. The numerous blood conservation techniques and transfusion alternatives now available are described. ⋯ Initiating a blood management program requires planning and support from those who are concerned about blood usage reduction and outcomes improvement. Launching a vigorous and ongoing educational program to raise awareness about the risks and hazards associated with blood transfusion is an important step in helping to reshape the medical staffs' attitudes about transfusion and the most cost-effective way to achieve clinical goals.
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Anemia of critical illness is common among intensive care unit patients. A blood management pilot program was initiated to study the pharmacodynamic response of epoetin alfa in critically ill patients and assess the impact of the use of a standardized order set of pharmaceuticals, including epoetin alfa and intravenous iron sucrose, on the quantity of red blood cell units transfused in the adult intensive care unit. ⋯ Use of erythropoiesis stimulating agents (ESAs) in the critically ill is controversial. Implementing a standardized approach in the pharmaceutical management of anemia in the critically ill patient is possible. Limitations with the order set and standardized protocol included errors in selection of dose/weight, incomplete laboratory/monitoring, and inconsistent prospective/concurrent review to guide therapy. The determination of the cost-effectiveness of epoetin alfa therapy in anemia of critical illness was not the purpose of this project, but will be the focus of future studies.
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Am J Health Syst Pharm · Aug 2007
Pharmacist-conducted medication reconciliation in an emergency department.
The effect of pharmacist conducted medication reconciliation on compliance with a hospital's medication reconciliation policy was studied. ⋯ Pharmacist-conducted medication reconciliation in the ED increased compliance to the institution's medication reconciliation policy for admitted patients. Pharmacist-acquired medication histories had significantly fewer errors in documentation and had more documentation of patient allergies.
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Am J Health Syst Pharm · Aug 2007
ReviewTrends in the prescription drug plans delivering the Medicare Part D prescription drug benefit.
The potential impact of the Democrat-proposed Medicare drug program reform plan; possible Congressional actions in 2007; the standard Medicare prescription drug benefit; the use of low-income subsidies (LIS); and trends in 2006 and 2007 Medicare prescription drug plan (PDP) offerings, coverage, deductibles, premiums, cost-sharing practices, and utilization management strategies are described. ⋯ The PDPs delivering the Medicare Part D prescription drug benefit have been and continue to be subject to change. High Medicare prices and a lack of gap coverage for enrollees remain concerns that may be addressed by Congressional action in 2007.
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Am J Health Syst Pharm · Aug 2007
Prescribing patterns and purchasing costs of long-acting opioids over nine years at an academic oncology hospital.
The prescribing patterns and purchasing costs of long-acting opioids over nine years at an academic oncology hospital were studied. ⋯ Long-acting opioid use increased and cost per MEDD decreased at an academic oncology hospital between 1996 and 2004. The decreased cost of purchasing opioids was attributed to the increased proportional use of methadone.