A Pharmacotherapy Scholars Program to Provide Intensive Training to Enhance Pharmacy Students' Postgraduate Readiness.

To design, integrate the curriculum for, and evaluate an innovative program to facilitate placement of students into postgraduate pharmacy residency training programs involving direct patient care. The Pharmacotherapy Scholars Program (PSP) was designed to prepare fourth-professional year students to become highly proficient in a direct patient care role and to successfully match with postgraduate residency training programs. The following elements were included in the year-long curriculum: integrated synchronous advanced pharmacy practice experiences with personal advising, team-based mentoring, peer-to-peer learning, longitudinal research, and professional development.

Implementation of a new dantrolene formulation across a multifacility health system.

Purpose: An initiative to optimize the treatment of malignant hyperthermia in surgical patients through a dantrolene product conversion program is described.

Summary: A large health system's formulary evaluation of a new dantrolene sodium product indicated that despite a higher cost per treatment course, the product could offer key advantages over older formulations of dantrolene in terms of preparation and administration time, product content, and storage requirements. A work group, consisting of pharmacy personnel, an anesthesiologist, a nurse anesthetist, and a representative of the health system's group purchasing organization, determined that a switch to the new dantrolene product would offer both patient care benefits and process benefits.

Pharmacodynamics and clinical efficacy of fentanyl iontophoretic transdermal system for post-operative pain in hospitalized patients.

Introduction: The fentanyl iontophoretic transdermal system (ITS) is a patient-controlled transdermal system allowing needle-free administration of on-demand doses of Fentanyl of 40 µg over a 10-min period up to 80 doses or over a 24-h period. It is indicated in opioid naïve patients for the treatment of acute postoperative pain in the hospitalized patients for up to 72 h.

Areas Covered: It has been demonstrated to be effective and safe in randomized trials and to provide comparable analgesia versus morphine intravenous (i.

Addressing innovative off-label medication use at an academic medical center.

Purpose: A large hospital's systematic and evidence-based approach to adjudicating, monitoring, and ensuring the safety of off-label medication use is described.

Summary: In 2003 the University of Pittsburgh Medical Center (UPMC)-Presbyterian implemented a policy that created a formal process for the systematic evaluation of formulary requests and drug-utilization patterns indicating or suggesting off-label use. Explicit criteria were developed for differentiating "innovative off-label use" (i.

Building an outpatient cancer center pharmacy program across a tristate region.

Purpose: The transition to a hybrid model of oncology pharmacy services including remote order verification across a regional network of cancer centers is described.

Summary: Five years ago the University of Pittsburgh Medical Center (UPMC) began a major expansion of its cancer care services, gradually integrating 19 community-based physician practice sites into its tristate oncology network as affiliated hospital-based clinics (HBCs). The network expansion was achieved through a stepwise process including (1) development of oncology medication protocols, (2) interdisciplinary efforts to modify oncology care workflows, (3) implementation of a hybrid practice model to optimize the use of clinical pharmacy resources, and (4) focused staff training programs.

Extrapyramidal symptoms following administration of oral perphenazine 4 or 8 mg: an 11-year retrospective analysis.

Background: Perphenazine is a treatment option in postoperative nausea and vomiting (PONV) prophylaxis. Chronic administration and high dose are known to cause extrapyramidal system (EPS) dysfunction at a frequency of 8%, but the incidence of acute EPS after a single 4 or 8 mg dose is unknown.

Objective: A retrospective analysis of patient medication billing data and departmental quality records was performed (January 2001 to 10 July 2012) to identify patients who experienced EPS dysfunction after oral perphenazine.

Quality-improvement analytics for intravenous infusion pumps.

Purpose: The implementation of a smart-pump continuous quality-improvement (CQI) program across a large health system is described, with an emphasis on key metrics for outcomes analyses and program refinement.

Summary: Three years ago, the University of Pittsburgh Medical Center health system launched a CQI initiative to help ensure the safe use of 6000 smart pumps in its 14 inpatient facilities. A centralized team led by pharmacists is responsible for the retrieval and interpretation of smart-pump data, which is continuously transmitted to a main server.

Core competencies for research training in the clinical pharmaceutical sciences.

Objective: To identify and apply core competencies for training students enrolled in the clinical pharmaceutical scientist PhD training program at the University of Pittsburgh School of Pharmacy.

Design: Faculty members reached consensus on the required core competencies for the program and mapped them to curricular and experiential requirements.

Assessment: A rubric was created based on core competencies spanning 8 major categories of proficiency, and competencies of clinical versus traditional PhD training were delineated.

Educational program for pharmacists at a multifacility academic medical center.

Purpose: An educational program for pharmacists in a multifacility health care setting is described.

Summary: The expansion of pharmacy services at a university medical center from a centralized to a decentralized, unit-based model created the need for enhanced education of staff pharmacists. A steering committee with pharmacy department and school of pharmacy representation surveyed educational and professional needs related to the expanded services.

Training and recruiting future pharmacists through a hospital-based student internship program.

Purpose: A hospital-based pharmacy internship program is described.

Summary: The University of Pittsburgh Medical Center (UPMC) is a 19-hospital partnership affiliated with the University of Pittsburgh Schools of the Health Sciences, serving over 4 million patients per year through its community and teaching hospitals, community care programs, and managed care insurance product. UPMC created a structured pharmacy internship program that provides students with the skills to prepare them for future employment in a hospital or institutional pharmacy setting and creates a hiring and benefits infrastructure focused on student retention after graduation.

Coagulation factor VIIa (recombinant) in nonhemophilic patients requiring neurosurgery.

Purpose: The clinical outcomes, safety, and use of resources associated with the administration of factor VIIa (recombinant) to nonhemophilic patients requiring neurosurgery were evaluated.

Methods: An interdisciplinary group created guidelines for the pharmacy and therapeutics committee for the unlabeled use of factor VIIa (recombinant). Nonhemophilic patients were eligible to receive the agent without approval from the hematology-coagulation service if they had an intracranial hemorrhage (ICH), were undergoing an emergency neurosurgical procedure, and had coagulopathy.

Formulary decisions for pre-1938 medications.

Purpose: A process is described for formulary revisions consistent with the Food and Drug Administration (FDA)'s current initiative to ensure that all drugs marketed in the United States have been approved for safety and efficacy.

Summary: A list of pre-1938 drugs (i.e.

Use of lipid emulsion to reverse local anesthetic-induced toxicity.

Objective: To evaluate the use of lipid emulsion for reversal of local anesthetic-induced toxicity.

Data Sources: Literature was accessed through PubMed and OVID (1966-May 2007) using the search terms lipid emulsion and local anesthetic. Reference lists were consulted to identify additional publications.

Routine multimodal antiemesis including low-dose perphenazine in an ambulatory surgery unit of a university hospital: a 10-year history. Supplement to: Eliminating postoperative nausea and vomiting in outpatient surgery with multimodal strategies including low doses of nonsedating, off-patent antiemetics: is "zero tolerance" achievable?

For 10 years, we have used intravenous and oral perphenazine as part of a multimodal antiemetic prophylaxis care plan for at least 10,000 outpatients. We have never encountered an adverse event, to our knowledge, when the intravenous dose was less than or equal to 2 mg, or when the single preoperative oral dose did not exceed 8 mg (with no repeated dosing). As a single-dose component of multimodal antiemetic prophylaxis therapy, we believe that this track record of anecdotal safety in adults who meet certain criteria (age 14-70, no less than 45 kg, no history of extrapyramidal reactions or of Parkinson disease, and no Class III antidysrhythmic coadministered for coexisting disease) constitutes a sufficient patient safety basis for formal prospective study.

Eliminating postoperative nausea and vomiting in outpatient surgery with multimodal strategies including low doses of nonsedating, off-patent antiemetics: is "zero tolerance" achievable?

For ondansetron, dexamethasone, and droperidol (when used for prophylaxis), each is estimated to reduce risk of postoperative nausea and/or vomiting (PONV) by approximately 25%. Current consensus guidelines denote that patients with 0-1 risk factors still have a 10-20% risk of encountering PONV, but do not yet advocate routine prophylaxis for all patients with 10-20% risk. In ambulatory surgery, however, multimodal prophylaxis has gained favor, and our previously published experience with routine prophylaxis has yielded PONV rates below 10%.

A model for supporting and training clinical pharmaceutical scientist PhD students.

Objectives: To enhance the clinical training and financial support of graduate students in a Clinical Pharmaceutical Scientist PhD Program at the University of Pittsburgh School of Pharmacy.

Design: The School of Pharmacy and University of Pittsburgh Medical Center entered into a collaborative agreement to develop the Clinical Scientist Associate (CSA) program, as well as financially support students enrolled in a Pharmaceutical Sciences PhD program. These clinical training experiences are in addition to the didactic and laboratory experiences in the pharmaceutical sciences graduate program.

Role of student pharmacist interns in hospital-based standing orders pneumococcal vaccination program.

Objective: To describe the role of student pharmacist interns in supporting a standing orders program (SOP) for pneumococcal polysaccharide vaccination in hospitalized patients.

Setting: University of Pittsburgh Medical Center (UPMC) Presbyterian, an academic teaching hospital in Pittsburgh.

Practice Description: The hospital-based Drug Use and Disease State Management (DUDSM) program designs, implements, and promotes evidence-based practice guidelines to ensure safe and cost-effective drug therapy.

Designing and implementing a hospital-based vaccine standing orders program.

Purpose: An inpatient pneumococcal polysaccharide vaccine (PPV) vaccination program was designed and implemented to meet federal and state regulatory requirements and national vaccination goals.

Summary: In 2002, the Centers for Medicare and Medicaid Services published a final rule removing the federal requirement for an individual patient physician-signed order for the pneumococcal and influenza vaccines in Medicare- and Medicaid- participating hospitals. This statute authorized implementation of standing orders programs (SOPs) in health care institutions.

Clinical outcomes of intravenous immune globulin in severe clostridium difficile-associated diarrhea.

Objectives: Our objective was to determine if use of intravenous immune globulin (IVIG) decreases the incidence of mortality, colectomies, and length of stay in the hospital in patients presenting with severe Clostridium difficile-associated diarrhea (CDAD).

Methods: A retrospective analysis was undertaken of 79 patients who had a positive C. difficile toxin titer and severe disease admitted to the University of Pittsburgh Medical Center Presbyterian between July 2001 and July 2003.

Evaluation of conflicting literature and application to formulary decisions.

Purpose: Guidelines were developed for grading the quality, quantity, and consistency of drug literature in support of formulary recommendations.

Methods: Four developmental steps were taken to create a comprehensive literature evaluation system. The first step identified the attributes of a body of literature that were most reflective of its applicability to patient care.

Advanced practice internship: experiential learning in a drug use and disease state management program.

Objective: Establish a 3-year hospital internship within a drug use and disease state management program that would provide doctor of pharmacy students with experiential learning while still completing their classroom studies.

Design: As paid interns, students engaged in group and individual activities that assessed clinical practice guidelines. Patient monitoring and clinical intervention techniques were learned through prospective evaluation of drug therapy.