Integrating patient-centric indications into the prescribing process: Experience at a tertiary academic medical center

2020 ◽  
Vol 77 (Supplement_2) ◽  
pp. S26-S33 ◽  
Author(s):  
Jackie Ho ◽  
Carolyn E Wrzesniewski ◽  
Noelle K Hasson
Keyword(s):  
Focus Group ◽  
Medical Center ◽  
Group Discussion ◽  
Academic Medical Center ◽  
Record System ◽  
Outpatient Prescription ◽  
Stakeholder Groups ◽  
Retrospective Data Analysis ◽  
Academic Medical ◽  
Patient Centric

Abstract Purpose To describe the development of and implementation of a patient-centric clinical indications library (CIL) into the prescribing process and determine the operational and humanistic outcomes (from prescriber, pharmacist, and patient perspectives) of including indications on outpatient prescription labels. Methods A descriptive retrospective data analysis was conducted. Multiple stakeholder groups were engaged to develop and integrate the CIL into the prescription package. After CIL integration, prescribers, pharmacists, and patients were surveyed. A focus group discussion consisting of Veterans and caregivers was held. Results Following implementation of the CIL, the proportion of prescriptions associated with an indication increased from 88% to 96%. Surveyed clinicians responded that indications helped them better understand a patient’s profile (61.1% of prescribers and 100% of pharmacists). Among surveyed pharmacists, 61.5% and 53.8%, respectively, believed that indications helped them catch instances of wrong medications and wrong doses ordered. Veterans surveyed found that indications on their prescription labels helped them know what their medications were for (91.0% of respondents) and why it is important to take their medications (70.7%). In focus group discussions, Veterans and family members and/or caregivers expressed a preference to see indications that describe how a medication works (eg, “to lower blood sugar” vs “for diabetes”) because they felt that type of phrasing is measurable, action oriented (which was appealing due to Veterans’ military background), provides surreptitious education, and tells the users what to expect. Conclusion Engaging multidisciplinary stakeholder groups, optimizing the electronic health record system, and authorizing pharmacists to add known indications to prescriptions increased the number of prescriptions with indications, decreased the perceived time spent on order entry and verification, and enabled better understanding of each medication’s purpose by providers and patients.

scholarly journals Key Elements of Clinical Physician Leadership at an Academic Medical Center

2011 ◽  
Vol 3 (1) ◽  
pp. 31-36 ◽  
Author(s):  
C. Jessica Dine ◽  
Jeremy M Kahn ◽  
Benjamin S Abella ◽  
David A Asch ◽  
Judy A Shea
Keyword(s):  
Focus Group ◽  
Medical Center ◽  
Group Discussion ◽  
Academic Medical Center ◽  
Leadership Education ◽  
Personal Attributes ◽  
Clinical Team ◽  
Physician Leadership ◽  
Academic Medical ◽  
Formal Leadership

Abstract Background A considerable body of literature in the management sciences has defined leadership and how leadership skills can be attained. There is considerably less literature about leadership within medical settings. Physicians-in-training are frequently placed in leadership positions ranging from running a clinical team or overseeing a resuscitation effort. However, physicians-in-training rarely receive such training. The objective of this study was to discover characteristics associated with effective physician leadership at an academic medical center for future development of such training. Methods We conducted focus groups with medical professionals (attending physicians, residents, and nurses) at an academic medical center. The focus group discussion script was designed to elicit participants' perceptions of qualities necessary for physician leadership. The lead question asked participants to imagine a scenario in which they either acted as or observed a physician leader. Two independent reviewers reviewed transcripts to identify key domains of physician leadership. Results Although the context was not specified, the focus group participants discussed leadership in the context of a clinical team. They identified 4 important themes: management of the team, establishing a vision, communication, and personal attributes. Conclusions Physician leadership exists in clinical settings. This study highlights the elements essential to that leadership. Understanding the physician attributes and behaviors that result in effective leadership and teamwork can lay the groundwork for more formal leadership education for physicians-in-training.

scholarly journals Aprepitant and Fosaprepitant Use in Children and Adolescents at an Academic Medical Center

2014 ◽  
Vol 19 (2) ◽  
pp. 127-131 ◽  
Author(s):  
Alexandra Shillingburg ◽  
Lisa Biondo
Keyword(s):  
Children And Adolescents ◽  
Pediatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Prophylaxis ◽  
Emetogenic Chemotherapy ◽  
Record System ◽  
Patients Âgés ◽  
Academic Medical

OBJECTIVE: To describe the use of aprepitant and fosaprepitant, a neurokinin 1 (NK-1) receptor inhibitor, in children and adolescents at a large academic medical center, for the prevention and management of chemotherapy-induced nausea and vomiting (CINV). METHODS: A retrospective chart review was conducted using an electronic medical record system to evaluate the use of aprepitant and fosaprepitant in all pediatric patients that were discharged from a single academic medical center between February 25, 2009 and May 25, 2012. RESULTS: Twenty-six patients were included in this review and received a total of 287 doses over the span of 114 cycles. Mean age was 10.1 years, with a range of 11 months to 17 years old. In 16 of 26 patients, aprepitant was used as the primary prophylaxis. Of those patients who received primary prophylaxis, 6 of 16 received it for highly emetogenic chemotherapy, and 10 of 16 received it for moderately emetogenic chemotherapy. Intravenous fosaprepitant was used in 7 of 26 patients, ages 13 to 17 (median 14) years old. No adverse effects attributable to aprepitant were reported. CONCLUSIONS: Use of aprepitant and fosaprepitant in pediatric patients appeared to be well tolerated. No currently published reports data using aprepitant in a patient younger than 32 months old, whereas we reported its use in patients as young as 11 months old.

scholarly journals The Prescribing and Education of Naloxone in a Large Academic Medical Center

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 31
Author(s):  
Sabrina Miller ◽  
Lauren Williams ◽  
Amy N. Thompson
Keyword(s):  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Reversal Agents ◽  
Outpatient Prescription ◽  
Current State ◽  
Academic Medical ◽  
History Of ◽  
Improvement Measures

The opioid epidemic has led to increased needs for opioid reversal agents which require education and counseling for proper use. The purpose of this study was to evaluate outpatient naloxone prescribing and education practices at an academic medical center to understand the current state and inform quality improvement measures. This retrospective chart review study included 439 patients that were at least 18 years old and received an outpatient prescription for naloxone between 1 July 2017 and 30 June 2018. Descriptive and demographic data were collected. The primary endpoint was whether an indication for naloxone and education on administration were documented when naloxone was initially prescribed to patients. Overall, 39% of naloxone prescriptions did not have an indication for prescribing listed in the medical record. Of those with a documented indication, concomitant benzodiazepines and history of overdose or substance abuse were most common (22% and 14%). The average morphine milligram equivalents were 165. Additionally, 69% of dispenses did not have documentation that the patient or a caregiver received education regarding the use and administration of naloxone. These findings suggest that patients are receiving naloxone for appropriate indications. Documentation of medication education is needed to ensure it is occurring and that patients are informed.

scholarly journals Conditional Support: Focus Group Participants’ Views on Researchers’ Access and Use of Personal Health Information

2020 ◽  
Author(s):  
Jennifer Blair McCormick ◽  
Margaret A Hopkins
Keyword(s):  
Focus Group ◽  
Personal Information ◽  
Medical Center ◽  
Academic Medical Center ◽  
Personal Health Information ◽  
Advisory Council ◽  
Related Data ◽  
Academic Medical ◽  
Important Health ◽  
Health Related

Abstract Background: Researchers are increasingly collecting large amounts of de-identified data about individuals to address important health-related challenges and answer fundamental questions. Current US federal regulations permit researchers to use already collected and stored de-identified health-related data from a variety of sources without seeking consent from patients. While multiple studies have explored patients’ views on the sharing of their health-related data, few have investigated their views on the policies and processes institutions have in place or should have in place for accessing, using, and sharing of data.Methods: We conducted 5 with individuals who live within a 20-mile radius of the local academic medical center. In addition, in order to increase the number of participants younger than 45 years of age, we held a focus group with undergraduates at a local university. Transcripts were analyzed using content analysis. The codebook was revised and refined, codes clarified, and disagreements resolved through discussion.Results: A total of 37 individuals participated, ages 18-76. Most participants were not surprised that researchers accessed and used de-identified personal information for research. For participants, transparency was key. They wanted to know when their data were accessed, for what purpose, and by whom. However, for some participants, just knowing their data had been accessed and used was not enough. Rather they wanted to have some control over the use of their data valuing the chance to opt-out. That said, wanting some control didn’t conflict with participants’ support of the use of their data for research. Most participants trusted their local academic medical institution, but were less trusting of other academic medical institutions and commercial entities. Finally, participants supported establishment of an advisory council or group with responsibility for deciding what data were used, who was accessing those data, and whether data could be shared. Conclusions: The trust people have in their local institutions should be considered fragile, and institutions should not take that trust for granted. How institutions choose to govern patients’ data and what voices they include in decisions about use and access are critical to maintaining the trust of the public.

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
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