Implementation of Pharmacy Executive Quality and Safety Walkrounds at a Tertiary Academic Medical Center.

Executive Quality and Safety WalkRounds (EWRs) is a tool that engages department leadership in discussion with the front-line employees to solicit feedback to improve quality and safety. The purpose of this study was to evaluate the impact of the implementation of pharmacy department specific EWRs on quality and safety at a tertiary academic medical center. This was a single-center, retrospective analysis conducted at Brigham and Women's Hospital between November 2016 and November 2019.

Low Efficacy of Medication Shortage Clinical Decision Support Alerts.

Objective: We examined clinical decision support (CDS) alerts designed specifically for medication shortages to characterize and assess provider behavior in response to these short-term clinical situations.

Materials And Methods: We conducted a retrospective analysis of the usage of medication shortage alerts (MSAs) that included at least one alternative medication suggestion and were active for 60 or more days during the 2-year study period, January 1, 2018 to December 31, 2019, in a large health care system. We characterized ordering provider behavior in response to inpatient MSAs.

Non-Sterile to Sterile Compounding: An Unconventional Response During the COVID-19 Pandemic.

The drug supply chain has suffered many interruptions over the past decade. The COVID-19 pandemic exacerbated an already fragile infrastructure for supplying critical medications to hospitals and health-systems. The purpose of this paper is to provide insight to the history, thought-processes, and response to critical medication shortages during the COVID-19 pandemic, with a focus on hydromorphone infusions and the action steps taken to engage in non-sterile to sterile (NSTS) compounding.

Management of a parenteral opioid shortage using ASHP guidelines.

Purpose: Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described.

Summary: In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages.

Single Center Experience with Robot Technologies for Sterile Compounding: A Retrospective Review.

The compounding of sterile medication admixtures is a labor-intensive process and subject to potential human error. The addition of robotic devices and workflow technology may mitigate some of the challenges of compounding sterile product admixtures, especially for those associated with antineoplastic and hazardous medications. This article discusses the single-center experiences from October 2009 through August 2017 with various sterile compounding robotic technologies.

Pharmacy Response to the Boston Marathon Bombings at a Tertiary Academic Medical Center.

Objective: Effective crisis response requires multidisciplinary communication and rapid action. Our goals are to highlight the experience of a pharmacy department's response to the 2013 Boston Marathon bombing, to discuss the role of the pharmacist in a crisis response, and to identify potential learning opportunities for a future mass casualty event.

Case Summary: Our initial response targeted 3 general areas: staffing, supplies, and communication.

Longer hospitalization of patients with positive blood cultures receiving total parenteral nutrition.

Background: Total parenteral nutrition (TPN) via central venous catheters has improved nutrient delivery to patients unable to receive nutrition enterally, but its administration can be complicated by bacteremia and fungemia.

Methods: At a large tertiary-care academic medical center, 245 patients with concurrent positive blood cultures, among 1,716 adult patients who received TPN over a period of three consecutive years, were divided into those in whom parenteral nutrition was continued and those in whom it was stopped after the occurrence of a positive blood culture. To determine whether continuation of TPN after a positive blood culture was associated with a statistically significantly longer hospitalization than with its discontinuation after a positive blood culture, we performed a logistic regression analysis with step-wise selection, with parenteral nutrition status as the dependent variable and type of venous access, type of pathogen responsible for a positive blood culture, recurrence of a positive blood culture, respiratory failure, shock, and length of stay as covariates.

Safety of compounded calcium chloride admixtures for peripheral intravenous administration in the setting of a calcium gluconate shortage.

Calcium gluconate is preferred over calcium chloride for intravenous (IV) repletion of calcium deficiencies in the inpatient setting. In the setting of a national shortage of IV calcium gluconate, our institution implemented a compounded calcium chloride admixture for IV administration. The objective of this analysis is to evaluate the peripheral infusion site safety of compounded IV calcium chloride admixtures in adult inpatients.

Evaluation of the maximum beyond-use-date stability of regular human insulin extemporaneously prepared in 0.9% sodium chloride in a polyvinyl chloride bag.

Background: Regular human insulin 100 units added to a sufficient quantity of 0.9% sodium chloride, to yield a total volume of 100 mL within a polyvinylchloride bag, is accepted to be stable for 24 hours due to physical denaturation and chemical modification. The objective of this study was to evaluate the extended stability of such extemporaneously prepared regular human insulin, stored under refrigeration, to the maximum beyond-use-date allowed by United States Pharmacopeia chapter 797.

Impact of robotic antineoplastic preparation on safety, workflow, and costs.

Purpose: Antineoplastic preparation presents unique safety concerns and consumes significant pharmacy staff time and costs. Robotic antineoplastic and adjuvant medication compounding may provide incremental safety and efficiency advantages compared with standard pharmacy practices.

Methods: We conducted a direct observation trial in an academic medical center pharmacy to compare the effects of usual/manual antineoplastic and adjuvant drug preparation (baseline period) with robotic preparation (intervention period).