Switching Topical Diclofenac from Higher to Lower Strength: Financial and Clinical Evaluation.

Background: In February 2020, the Fraser Health Authority in British Columbia introduced an automatic therapeutic interchange policy, whereby orders for any strength of topical diclofenac would be automatically interchanged to the commercially available diclofenac 2.32% gel for twice-daily administration. The new policy was intended mainly as a cost-saving measure but had the potential for clinical impacts that needed to be considered.

Hiding in Plain Sight: Quantifying Salbutamol and Ipratropium Inhaler Wastage in Hospitals.

Background: Previous studies have found significant inhaler wastage in the inpatient setting, which contributes to unnecessary health care expenditures. Wastage may involve inhalers available in automated dispensing cabinets (ADCs).

Objectives: To evaluate whether salbutamol and ipratropium inhalers were unnecessarily withdrawn from ADCs for hospital inpatients.

Hidden Costs of Multiple-Dose Products: Quantifying Ipratropium Inhaler Wastage in the Hospital Setting.

Background: Previous studies have quantified wastage involving drugs that are available in multiple-dose formats. Ipratropium bromide by metered dose inhaler (MDI) is commonly used in hospitals, and may be contributing to waste of pharmaceutical and financial resources.

Objectives: The primary objective was to quantify the number of patients in the authors' health authority with waste of at least 1 ipratropium MDI.

Management of Acute Agitation and Aggression in Children and Adolescents with Pro Re Nata Oral Immediate Release Antipsychotics in the Pediatric Emergency Department.

Acute agitation in the pediatric emergency department (ED) has the potential to escalate into aggression and result in harm. Rapid and effective management may be warranted. Use of pro re nata (prn) oral immediate-release (IR) quetiapine, haloperidol, loxapine, and chlorpromazine has been observed in the pediatric ED at Surrey Memorial Hospital to manage this condition; however, evidence for oral prn antipsychotic use is limited in the pediatric population.

A cautionary tale of multiple-dose drug products: Fluticasone and salmeterol combination inhaler waste.

Rationale: Some drugs can only be dispensed in multiple-dose containers. Multiple-dose packaging may pose a problem for hospitals in terms of drug wastage and cost. Oral inhalers, such as fluticasone propionate and salmeterol combination inhalers, are only available as multiple-dose formats in Canada.

Acute Kidney Injury With Tobramycin-Impregnated Bone Cement Spacers in Prosthetic Joint Infections.

Background: Antibiotic-impregnated bone cement spacer (ACS) with tobramycin ± vancomycin is commonly used in a 2-stage replacement of infected prosthetic joints. This procedure has been associated with development of acute kidney injury (AKI).

Objective: To determine the incidence and risk factors for AKI after implantation of tobramycin-impregnated ACS.