Inpatient pharmacists' patient referrals to a transitions-of-care pharmacist: Evaluation of an automated referral process.

Objectives: To evaluate the impact of a pharmacist screening and automated referral process that identifies patients at risk for readmission due to medication-related problems (MRPs).

Setting: University of Wisconsin (UW) Hospital is 505-bed flagship hospital that is part of UW Health, an academic health system.

Practice Description: The integrated pharmacy practice model at UW Health has inpatient pharmacists who perform discharge medication reconciliation.

Vancomycin Prophylaxis for Prevention of Clostridium difficile Infection Recurrence in Renal Transplant Patients.

Background: Incidence of primary and recurrent Clostridium difficile infection (CDI) is higher in solid-organ transplant recipients than in the average hospitalized patient. Strategies for preventing recurrent CDI are limited. Prophylaxis with oral vancomycin (VPPx) for preventing recurrent CDI may be beneficial, but there is limited evidence supporting its use.

Fosfomycin tromethamine for the Treatment of Cystitis in Abdominal Solid Organ Transplant Recipients With Renal Dysfunction.

Background: Urinary tract infection (UTI) after abdominal solid organ transplantation (SOT) is associated with significant morbidity and mortality. Fosfomycin tromethamine (FOS), a uroselective antibiotic, is FDA approved for uncomplicated UTIs in women and is used off-label for complicated UTIs and prostatitis in men. Literature supporting the use of FOS in the SOT population is limited, and efficacy is questioned in the setting of renal dysfunction.

Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework.

Introduction: Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff.

Fosfomycin for the Treatment of Cystitis in the Abdominal Solid Organ Transplant Population.

Study Objectives: To evaluate the use of fosfomycin (FOS) at the single-dose regimen approved by the U.S. Food and Drug Administration as well as off-label multidose regimens for the treatment of cystitis after abdominal solid organ transplant (aSOT).

Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention.

OBJECTIVE To characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization. DESIGN Retrospective cohort study. PATIENTS Top 1% of the antimicrobial budget from July 1 through December 31, 2014.