Residency application screening tools: A survey of academic medical centers.

Purpose: The current use and content of screening tools utilized by ASHP-accredited pharmacy residency programs were assessed.

Methods: A survey consisting of 19 questions assessing residency programs and the screening of pharmacy residency program applicants was e-mailed to residency directors of 362 pharmacy residency programs at 105 University HealthSystem Consortium (UHC)-member institutions. Questions gathered general program demographic information, data related to applicant growth from residency years 2010-11 to 2011-12, and information about the residency screening processes currently used.

Subacute combined degeneration of the spinal cord in a patient abusing nitrous oxide and self-medicating with cyanocobalamin.

Purpose: A case of subacute combined degeneration (SCD) of the spinal cord manifesting as severe ataxia and urinary retention in a patient with a history of heavy nitrous oxide abuse and self-supplementation with cyanocobalamin is reported.

Summary: A 27-year-old woman was treated in the emergency department for complaints of abdominal pain and inability to urinate for about 12 hours. The patient also complained of worsening lower-extremity weakness for 10 days and a "pins and needles" sensation in the lower extremities for approximately 1 year.

Assessing pharmacologic and nonpharmacologic risks in candidates for kidney transplantation.

Purpose: Pharmacotherapy concerns and other factors with a bearing on patient selection for kidney transplantation are discussed.

Summary: The process of selecting appropriate candidates for kidney transplantation involves multidisciplinary assessment to evaluate a patient's mental, social, physical, financial, and medical readiness for successful surgery and good posttransplantation outcomes. Transplantation pharmacists can play important roles in the recognition and stratification of pharmacologic and nonpharmacologic risks in prospective kidney transplant recipients and the identification of issues that require a mitigation strategy.

Implementation of transitions-of-care services through acute care and outpatient pharmacy collaboration.

Purpose: The implementation of a practice model designed to reduce hospital readmissions through optimal deployment of pharmacy staff on multidisciplinary care collaboration teams is described.

Summary: In response to Affordable Care Act provisions aimed at reducing preventable hospital readmissions, the pharmacy department at The Johns Hopkins Hospital (JHH) led the implementation of a new pharmacy services model spanning both inpatient and outpatient settings. Key components of the model include (1) increased pharmacist participation in multidisciplinary rounds, (2) targeted medication reconciliation and patient education, (3) postdischarge phone monitoring of selected patients, and (4) bedside discharge medication delivery performed by a "transitions pharmacist extender.

Development of recommendations for dosing of commonly prescribed medications in critically ill obese children.

Purpose: The development and use of a decision support tool to help formulate recommendations for dosing of commonly prescribed medications in critically ill obese children are described.

Methods: Medications prescribed in 2010 to critically ill infants and children (younger than 18 years) were identified from the Pediatric Health Information System. The most commonly prescribed and therapeutically monitored medications were extracted.

Probable boceprevir-induced hyponatremia in a patient with chronic hepatitis C.

Purpose: A probable case of severe drug-induced hyponatremia associated with boceprevir use is reported.

Summary: A 55-year-old woman was started on boceprevir (800 mg orally thrice daily) during week 5 of triple therapy for chronic hepatitis C. Her serum sodium concentration the morning before starting boceprevir use was 140 mmol/L.

Bosutinib for the treatment of chronic myeloid leukemia.

Purpose: The pharmacology, pharmacokinetics, efficacy, and safety of the tyrosine kinase inhibitor (TKI) bosutinib in the management of chronic myeloid leukemia (CML) are reviewed.

Summary: Although clinical outcomes are favorable in patients wth Philadelphia chromosome (Ph)-positive CML who receive first-line TKI therapy with imatinib, dasatinib, and nilotinib, disease progression or relapse may occur. Thus, effective second-line agents are crucial.

Alternative schedules of levothyroxine administration.

Purpose: Published evidence on bedtime versus prebreakfast administration of levothyroxine is reviewed.

Summary: Because levothyroxine absorption has been shown to increase when the drug is administered to patients in a fasted state, the standard recommendation is that levothyroxine be taken one half to one hour prior to breakfast and at least four hours before or after potentially interacting drugs. However, compliance with this recommendation may be problematic for patients with unpredictable or variable schedules.

Impact of a clinical pharmacy research team on pharmacy resident research.

Purpose: A successful initiative by Kaiser Permanente Colorado (KPCO) to support pharmacy resident research projects and the publication of project results in peer-reviewed journals is described.

Methods: An observational study was conducted to evaluate the publication rates for resident research projects before and after the KPCO pharmacy department established a Clinical Pharmacy Research Team (CPRT) to encourage and enable resident research. All projects presented by KPCO residents at the annual Western States Conference (WSC) for Pharmacy Residents, Fellows, and Preceptors in the 10 years before the CPRT was established (1994-2004, the pre-CPRT group) and the 7 years after CPRT implementation (2005-11, the CPRT group) were included in the analysis.

Major publications in the critical care pharmacotherapy literature: January-December 2013.

Purpose: Ten recently published articles with important implications for critical care pharmacotherapy are summarized.

Summary: The Critical Care Pharmacotherapy Literature Update (CCPLU) group is a national assembly of experienced intensive care unit (ICU) pharmacists across the United States. Group members monitor 25 peer-reviewed journals on an ongoing basis to identify literature relevant to pharmacy practice in the critical care setting.

Use of low-dose prothrombin complex concentrate before lumbar puncture.

Purpose: The use of an off-label dose of four-factor prothrombin complex concentrate (PCC) for International Normalized Ratio (INR) reversal in a patient before a diagnostic lumbar puncture is reported.

Summary: A 57-year-old, 122-kg man arrived at the hospital with a possible diagnosis of meningitis and had an INR of >3 while on warfarin therapy. The patient initiated warfarin therapy in 2009 due to recurrent deep vein thrombosis.

Antiinfective therapy for pregnant or lactating patients in the emergency department.

Purpose: Special considerations in pharmacotherapy for infectious diseases in pregnant and lactating women in the emergency department (ED) setting are reviewed.

Summary: With many women turning to the ED as a source of primary care, it is essential for pharmacists involved in providing ED services to guide the selection of appropriate antiinfective agents during pregnancy and lactation; this area of practice is complicated by the very limited body of published data on the safety and efficacy of maternal antimicrobial use and potential fetal or neonatal adverse effects. Infectious diseases commonly encountered in the ED include sexually transmitted diseases, bacterial vaginosis and other vaginal infections, respiratory and urinary tract infections, and pneumonia.

Effect of computerized prescriber order entry on pharmacy: experience of one health system.

Purpose: Pharmacists' satisfaction with a computerized prescriber order-entry (CPOE) system and the impact of CPOE on pharmacy workflows and order verification were investigated.

Summary: A mixed-method study was conducted to evaluate the implementation of a CPOE system in three hospitals of a large Michigan-based health system and early user experience with the system. Surveys of pharmacists before (n = 54) and after (n = 42) CPOE implementation indicated that they held generally positive expectations about CPOE prior to and during system implementation and continued to hold positive views about CPOE after several months of system use.

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.

Comparison of free fraction serum valproic acid concentrations between inpatients and outpatients.

Purpose: The differences in free fraction serum valproic acid concentrations between inpatients and outpatients were compared, and factors associated with therapeutic discordance were evaluated.

Methods: This retrospective, single-center, cross-sectional study included patients with both a free and a total valproic acid concentration drawn within 30 minutes of each other between January 7, 2003, and June 1, 2011. Serum valproic acid concentrations were stratified by admission status (inpatient versus outpatient).

Safe and effective use of eculizumab in the treatment of severe Shiga toxin Escherichia coli-associated hemolytic uremic syndrome.

Purpose: A severe case of Shiga toxin Escherichia coli (STEC)-associated hemolytic uremic syndrome (HUS) successfully treated with eculizumab is reported.

Summary: An 18-year-old man was admitted to the intensive care unit with HUS due to laboratory-confirmed STEC O121. He was initially treated with plasmapheresis and required hemodialysis for anuric acute kidney injury.

Use of a pharmacy technician to facilitate postfracture care provided by clinical pharmacy specialists.

Purpose: The ability of a pharmacy technician to support the patient screening and documentation-related functions of a pharmacist-driven osteoporosis management service was evaluated.

Methods: A two-phase prospective study was conducted within a large integrated health system to assess a pharmacy technician's performance in supporting a multisite team of clinical pharmacy specialists providing postfracture care. In phase I of the study, a specially trained pharmacy technician provided support to pharmacists at five participating medical offices, helping to identify patients requiring pharmacist intervention and, when applicable, collecting patient-specific clinical information from the electronic health record.

Significant publications on infectious diseases pharmacotherapy in 2013.

Purpose: The most important articles on infectious diseases (ID) pharmacotherapy published in the peer-reviewed literature in 2013, as nominated and selected by panels of pharmacists and others with ID expertise, are summarized.

Summary: Members of the Houston Infectious Diseases Network were asked to nominate articles published last year in prominent biomedical journals that had a major impact in the field of ID pharmacotherapy. A list of 27 nominated articles on ID-related topics in general and 26 articles specifically focused on human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) was compiled.

Survey to assess the role of pharmacy technicians and nonpharmacist staff in the operation of research pharmacies.

Purpose: Results of a survey assessing trends and innovations in the use of pharmacy technicians and other nonpharmacist staff in the research pharmacy setting are reported.

Methods: A Web-based survey was distributed to Internet communities of members of the American Society of Health-System Pharmacists and the University Health-System Consortium involved in investigational drug research and related practice areas. The survey collected data on the characteristics of institutions with pharmacy department staff dedicated to such research activities and the participation of pharmacists, technicians, and other staff in key areas of research pharmacy operations.

Impact of a phenytoin loading dose program in the emergency department.

Purpose: The use of a combined physician-and pharmacist-directed phenytoin loading dose program in an emergency department (ED) was evaluated.

Methods: This single-center, observational, preimplementation-postimplementation study evaluated adult patients who received a phenytoin loading dose in the ED. The primary outcome compared the proportion of optimal phenytoin loading doses in the preimplementation and postimplementation groups.

Moving the Pharmacy Practice Model Initiative forward within a state affiliate.

Purpose: Efforts to advance the ASHP Pharmacy Practice Model Initiative (PPMI) in the Michigan Society of Health-System Pharmacists (MSHP) are described.

Summary: After the Pharmacy Practice Model Summit in November 2010, the board of directors of MSHP began to strategize ways to help health-system pharmacists in Michigan achieve the vision and concepts envisioned by the PPMI. The ultimate goal was to develop a process for acting on recommendations developed by the PPMI to advance the practice of health-system pharmacy in Michigan.

Development and implementation of a postdischarge home-based medication management service.

Purpose: The development and implementation of a postdischarge home-based, pharmacist-provided medication management service are described.

Summary: A work group composed of pharmacy administrators, clinical specialists, physicians, and nursing leadership developed the structure and training requirements to implement the service. Eligible patients were identified during their hospital admission by acute care pharmacists and consented for study participation.

Defining and advancing ambulatory care pharmacy practice: it is time to lengthen our stride.

Purpose: This paper reviews the basic tenets of ambulatory care pharmacy practice, including (1) the historical development of patient-centered care provided by pharmacists, (2) the need for and value of comprehensive medication management, (3) the education, training, and qualifications of pharmacists, and (4) demonstrated improvement in health and healthcare outcomes from pharmacists' services.

Summary: When ambulatory care pharmacists engage in patient care to their full capacity, physician time is saved, access to care is improved, and clinical and economic outcomes are enhanced. There is a need for ambulatory care pharmacists to work toward optimizing safe medication use and optimizing medication therapy for patients with diabetes, asthma, cardiovascular disease, and renal disease.