NEW YORK (Reuters Health) – To help limit hospital staff’s exposure to SARS-CoV-2 patients, pharmacists at a university hospital aggregated the number of medication times per day, optimizing dose and therapeutic drug monitoring efforts.
“We leverage the role of pharmacists and our clinical decision support system to help protect our colleagues on the front lines and protect personal protective equipment (PPE), while still maintaining the best care for SARS-CoV-2 patients,” Ashley Jones of Emory Healthcare in Atlanta told Reuters Health by email.
“Pharmacists can easily identify patients infected with SARS-CoV-2 or under investigation and make recommendations to service providers over the phone after reviewing electronic medical records,” she said. death without direct contact with the patient or the service provider”. “This initiative was taken in conjunction with the transition of our pharmacy division to telecommuting.”
As reported in Infection Control and Hospital Epidemiology, pharmacists at all levels performed daily patient histogram reviews to optimize pharmacotherapy, including antibiotics. They also use clinical monitoring software with both real-time alerts and structured workflows for anticoagulation monitoring, renal dose adjustment, therapeutic drug monitoring, and microbiological review.
As positive SARS-CoV-2 PCR results have been incorporated into pharmacists’ daily workflow through monitoring software, pharmacists can identify infected patients and review medication administration records. theirs for optimization. The individuals under investigation were identified during periodic chart reviews.
The initiative provided pharmacists with guidance on strategic approaches to strengthening the drug regulatory profile across three areas:
1) Reasonable time of drug use:
Guidelines were made after considering the safety of early or late dosing during conversion, and potential drug interactions (eg, doxycycline with calcium supplementation).
2) Optimizing pharmacotherapy:
Pharmacists are encouraged to recommend therapy modifications to maintain both safety and efficacy, while reducing exposure to healthcare workers. For example, a patient taking NPH insulin twice daily as an outpatient could be switched to long-acting insulin once daily while inpatient. This approach subsequently led to a reasonable regimen for the management of mild to moderate diabetic ketoacidosis with subcutaneous insulin.
3) Monitoring of therapeutic drugs:
With regard to vancomycin dosing and monitoring, for example, the team encouraged pharmacists to reduce levels unnecessarily (eg, for uncomplicated skin and soft tissue infections or a short tentative course of treatment). to help reduce exposure to healthcare workers. If the pharmacist determines a level is needed, he or she will order a timer for phlebotomy or nursing.
“Phlebotomy staff realized that these efforts improved their team’s efficiency and reduced PPE requirements,” says Jones. One of the lessons learned is that we should learn how to use this approach for infections that are highly contagious in hospitals, such as Clostridioides difficile.”
Deborah Sadowski, Director of Pharmaceutical Services at the Deborah Heart and Lung Center in Browns Mills, New Jersey, commented in an email to Reuters Health, “This approach appears to be quite viable, despite some modifications by procedures may be needed based on bed size and pharmacy staffing patterns in individual hospitals. “
“While many of these interventions are routinely performed as part of good clinical practice, adopting this more active approach to take a broader view of any and all types of medicine/therapy is a real positive.”
“My concerns will double,” she said. “First, the ability of hospitals of different sizes to adapt a similar process, whether or not they are currently using a clinical monitoring software program, and second, ensuring Ensure the process includes both known and suspected positive patients and apply its consistency across all areas of the hospital involved in their care. “
She concludes: “I would also like to emphasize the significant clinical value that positive reviews of this therapy can bring to patients, in addition to the operational and safety value it provides to healthcare professionals. .
Erin Marriott, director of clinical and legal support for Guardian Pharmaceutical Services in Atlanta, also commented via email. “Before these best practices were brought to the fore, consultant pharmacists in skilled nursing facilities and assisted living facilities adopted a variety of strategies,” she told Reuters Health. described in the study”. “Our teams streamline drug transition times and often optimize drug therapy, and we only perform drug monitoring when appropriate and necessary.”
“We find these strategies particularly valuable today, during this pandemic, where minimizing patient touchpoints reduces exposure risk for patients and staff,” she said.
“My main concern is ensuring the necessary compliance when optimizing drug therapy,” she added. “It’s pretty straightforward to streamline dosing time, but when it’s time to change medication type and frequency, it’s important that tracking and tracking aren’t lost with switching.”
Infection Control and Hospital Epidemiology, online June 19, 2020.
Self-translated article, please do not reup!!
https://bit.ly/3isvz2P Infection Control and Hospital Epidemiology, online June 19, 2020.