Decision support at the point of prescribing to increase formulary adherence.

Purpose: Study results demonstrating the effectiveness of order-entry clinical decision support (CDS) alerts as a tool for enforcing therapeutic interchange are presented.

Methods: A retrospective observational study was conducted at an academic medical center to evaluate formulary nonadherence before and after implementation of a fully electronic medical record with computerized prescriber order-entry (CPOE) technology configured to display therapeutic interchange alerts immediately on entry of orders for nonformulary agents. Formulary nonadherence (defined as the proportion of pharmacist-verified nonformulary orders to total verified orders) within eight medication classes was assessed during a six-month baseline period and two consecutive six-month periods after implementation.

Drug-drug interaction checking assisted by clinical decision support: a return on investment analysis.

Background: Drug-drug interactions (DDIs) are very prevalent in hospitalized patients.

Objectives: To determine the number of DDI alerts, time saved, and time invested after suppressing clinically irrelevant alerts and adding clinical-decision support to relevant alerts.

Materials And Methods: The most frequently occurring DDIs were evaluated for clinical relevance by a multidisciplinary expert panel.

Formulary compliance and pharmacy labor costs associated with systematic formulary management strategy.

Purpose: The impact of a comprehensive hospital formulary management system on formulary compliance and pharmacy labor costs was evaluated.

Methods: The formulary management system consisted of monitoring nonformulary medication use, reviewing formulary medication use annually, and providing periodic feedback. Workflow scenarios for nonformulary medication requests were identified.

Effects of a direct refill program for automated dispensing cabinets on medication-refill errors.

Purpose: The effects of a direct refill program for automated dispensing cabinets (ADCs) on medication-refill errors were studied.

Methods: This study was conducted in designated acute care areas of a 386-bed academic medical center. A wholesaler-to-ADC direct refill program, consisting of prepackaged delivery of medications and bar-code-assisted ADC refilling, was implemented in the inpatient pharmacy of the medical center in September 2009.

Plerixafor as first- and second-line strategies for autologous stem cell mobilization in patients with non-Hodgkin's lymphoma or multiple myeloma.

Study Objective: To describe the institutional experience of plerixafor plus filgrastim as the initial peripheral blood stem cell (PBSC) mobilization (first-line strategy) and as rescue therapy after failure with filgrastim plus cyclophosphamide (second-line strategy).

Design: Retrospective medical record review.

Setting: Academic medical center.

High rates of venous thromboembolism prophylaxis did not increase the incidence of heparin-induced thrombocytopenia.

Background: Venous thromboembolism (VTE) prophlaxis is recommended for most hospitalized patients. At a 505-bed urban academic medical center, the rate of VTE prophylaxis recently increased from 50%-55% to > 95% of eligible patients. Heparin-induced thrombocytopenia (HIT) is a potentially devastating, but rare, reaction to medications commonly used for VTE prophylaxis.

Effect of bar-code-assisted medication administration on medication administration errors and accuracy in multiple patient care areas.

Purpose: The effect of a commercially available bar-code-assisted medication administration (BCMA) technology on six indicators of medication administration accuracy and nine types of medication administration errors in distinct patient care areas were studied.

Methods: This prospective, before-and-after, observational study was conducted in two medical-surgical units, one medical intensive care unit (ICU), and one surgical ICU of a 386-bed academic teaching hospital. Nursing staff were observed administering medications one month before and three months after implementation of BCMA technology.