POTENTIALLY INAPPROPRIATE MEDICATION USE AMONG PATIENT WITH HEART FAILURE PRESERVED VERSUS REDUCED EJECTION FRACTION AT AN ACADEMIC MEDICAL CENTER IN RIYADH, SAUDI ARABIA

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe a pharmacist-led reconciliation process for automated dispensing cabinet (ADC) medication override setting maintenance at an academic medical center. Summary ADC override management requires alignment of people, processes, and technology. This evaluation describes system-wide improvements to enhance institutional medication override policy compliance by establishing a formalized evaluation and defined roles to streamline ADC dispense setting management. A pharmacist-led quality improvement initiative revised the institutional medication override list to improve medication dispensing practices across an academic medical center campus with a pediatric hospital and 2 adult hospitals. This initiative included removal of patient care unit designations from the medication override list, revision of institutional override policy, creation of an online submission form, and selection of ADC override metrics for surveillance. A conceptual framework guided decisions for unique dosage forms and interdisciplinary engagement. Employing this framework revised workflows for stakeholders in the medication-use process through clinical pharmacist evaluation, existing shared governance structure communication, and pharmacy automation support. The revised policy increased the number of medications available for override from 80 to 106 (33% increase) and unique dosage forms from 166 to 191 (15% increase). The total number of medication dispense settings was reduced from 5,600 to 541 (90% decrease). The proportion of override dispenses compliant with policy increased from 59% to 98% (P < 0.001). Median monthly ADC overrides remained unchanged following policy revision (P = 0.995). ADC override rate reduction was observed across the institution, with the rate decreasing from 1.4% to 1.2% (P < 0.001). Similar ADC override rate reductions were observed for adult, pediatric, and emergency department ADCs. Conclusion This initiative highlights pharmacists’ role in leading institutional policy changes that influence the medication-use process through ADC dispensing practices. A pharmacist-led reconciliation process that removed practice area designations from our medication override policy streamlined ADC setting maintenance, increased the compliance rate of ADC override transactions, and provided a formalized process for future evaluation of medication overrides.

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Heart Failure Optimize Clinic: Improving Quality of Care In Heart Failure Patients In An Academic Medical Center

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2020.09.381 ◽

2020 ◽

Vol 26 (10) ◽

pp. S131-S132

Author(s):

Theresa Diederich ◽

Scott Lundgren ◽

Bunny Pozehl ◽

Kelly Ferguson ◽

Kyana Holder ◽

...

Keyword(s):

Heart Failure ◽

Quality Of Care ◽

Medical Center ◽

Academic Medical Center ◽

Heart Failure Patients ◽

Academic Medical

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Abstract P164: Urban-rural Disparities Amongst Heart Failure Patients With Reduced Ejection Fraction

Circulation ◽

10.1161/circ.141.suppl_1.p164 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Sherrie Khadanga ◽

Daniel N Silverman ◽

Timothy B Plante ◽

Charles Cubberly ◽

Johannes Steiner

Keyword(s):

Heart Failure ◽

Relative Risk ◽

Ejection Fraction ◽

New England ◽

Urban Areas ◽

Care Delivery ◽

Smoking Status ◽

Medical Center ◽

Reduced Ejection Fraction ◽

Urban Rural

Intro: Differences in health care delivery between urban and rural populations have been described, but the extent to which this impacts treatment and outcomes in patients with heart failure with reduced ejection fraction (HFrEF) within a large, rural HF referral network has not been evaluated to date. Objective: To describe differences in guideline directed medical therapy (GDMT) usage and cardiovascular (CV) mortality in urban vs rural dwelling individuals with HFrEF in Vermont. Methods: A retrospective analysis was performed on adult HFrEF patients residing in Vermont referred to University of Vermont Medical Center between January 1, 2015-2017. The study included all patients with a documented EF < 35% on echo. Demographics, risk factors, use of GDMT, and all-cause CV mortality were obtained. Urban and rural designations were based on the ZIP code version of the Rural-Urban Commuting Area (RUCA) classification system. Poisson regression analysis was used to compare the relative risk for mortality and use of GDMT by rurality. Results: 838 patients were identified (mean age 71.4 + 12.9 years old; 66.5% male) and divided into 3 RUCA groups (urban, rural, isolated). Adjusting for age, sex, hypertension, diabetes mellitus, atrial fibrillation and smoking status, no difference was seen in GDMT (table 1) between urban and rural patients (relative risk [RR], 1.03; 95% CI, 0.64-1.67). Urban patients were less likely than isolated patients to use GDT (RR, 0.75; 95% CI 0.52-1.08). There was a CV mortality benefit for those in rural (RR, 0.50; 95% CI 0.34-0.73) or isolated areas (RR, 0.74; 95% CI 0.62-0.89) compared to those in urban areas. Conclusion: While GDMT reduces morbidity and mortality in HFrEF patients, it was underutilized throughout Vermont. Findings from this state-wide cohort of decreased CV mortality in rural and isolated areas are contrary to prior studies. This finding highlights the unique socioeconomic environment of Northern New England and has important implications for CHF management and resource allocation.

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Determining Inappropriate Medication Alerts from “Inaccurate Warning” Overrides in the Intensive Care Unit

Applied Clinical Informatics ◽

10.1055/s-0038-1642608 ◽

2018 ◽

Vol 09 (02) ◽

pp. 268-274 ◽

Cited By ~ 4

Author(s):

Christine Rehr ◽

Adrian Wong ◽

Diane Seger ◽

David Bates

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Drug Allergy ◽

Medical Center ◽

Inappropriate Medication ◽

Academic Medical Center ◽

Patient Characteristics ◽

Valuable Resource ◽

Provider Behavior ◽

Academic Medical

Objective This article aims to understand provider behavior around the use of the override reason “Inaccurate warning,” specifically whether it is an effective way of identifying unhelpful medication alerts. Materials and Methods We analyzed alert overrides that occurred in the intensive care units (ICUs) of a major academic medical center between June and November 2016, focused on the following high-significance alert types: dose, drug-allergy alerts, and drug–drug interactions (DDI). Override appropriateness was analyzed by two independent reviewers using predetermined criteria. Results A total of 268 of 26,501 ICU overrides (1.0%) used the reason “Inaccurate warning,” with 93 of these overrides associated with our included alert types. Sixty-one of these overrides (66%) were identified to be appropriate. Twenty-one of 30 (70%) dose alert overrides were appropriate. Forty of 48 drug-allergy alert overrides (83%) were appropriate, for reasons ranging from prior tolerance (n = 30) to inaccurate ingredient matches (n = 5). None of the 15 DDI overrides were appropriate. Conclusion The “Inaccurate warning” reason was selectively used by a small proportion of providers and overrides using this reason identified important opportunities to reduce excess alerts. Potential opportunities include improved evaluation of dosing mechanisms based on patient characteristics, inclusion of institutional dosing protocols to alert logic, and evaluation of a patient's prior tolerance to a medication that they have a documented allergy for. This resource is not yet routinely used for alert tailoring at our institution but may prove to be a valuable resource to evaluate available alerts.

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