A Randomized, Single Centered, Parallel and Open labelled Interventional Study on Effectiveness of Clinical Pharmacists on Adverse Event Following Immunization (AEFI) in Pediatric Population

Background: Adverse events are a major threat to any immunization programs, which in turn have proven to be a boon for developing nations like India. Hindering factors, such as inadequate knowledge, inappropriate attitude, incorrect practices, etc., of the guardian affect the vaccination rate. Aim: This study aims to assess the effectiveness of clinical pharmacist intervention on an adverse event following immunization in the pediatric population receiving immunization. Materials and Methods: Pediatric subjects <5 yrs of both genders receiving immunization in a tertiary care hospital during the period of 8 months were considered. Subjects were randomized into control and interventional groups. Pharmaceutical intervention was done in interventional group in the form of patient counselling, and a patient information leaflet. Adverse event following immunization was recorded and analysed for both groups along with Knowledge, Attitude, and Practice scores of guardians’ pre and post intervention through customized data collection forms. Microsoft excel and statistical software SPSS IBM version 22 was used to analyse the data. Results: The study was conducted on a total of 88 subjects (n) in which 79 were <2 years, 1 and 8 were between 2-4 years and 4-5 years respectively. Forty-ninesubjects (55.69%) were female, while 39 were male (44.31%) with a response and completion rate of 91.66%. 97.7% subjects received Bacillus Calmette-Guerin vaccination (majority), while 8.88% received pneumococcal special vaccine (minority). Adverse event following immunization was recorded in 31(35.22%) cases. Knowledge, Attitude and Practice scores increased by 42.17%, 52% and 12.67%, respectively in guardians after clinical pharmacist intervention. Conclusion: This studydemonstrates that educational inputs, awareness programs, and proper medical professional intervention can act as a helping factor to fight against AEFI and towards the success of an immunization program.

Pharmacist-Facilitated Interactive E-Learning for Patients Newly Initiated on Warfarin: A Randomised Controlled Study

It is not known whether electronic-learning (e-learning) is effective for educating hospital inpatients about complex medications such as warfarin. This prospective randomised controlled study compared pharmacist-facilitated e-learning with standard pharmacist-delivered face-to-face education on patients’ or their unpaid carers’ knowledge of warfarin and satisfaction with warfarin education as well as the time that was spent by pharmacists in delivering warfarin education. Adult English-speaking patients (or their carers) who had been prescribed warfarin were randomised to receive standard pharmacist face-to-face education (control) or an e-learning module on a tablet device facilitated by a pharmacist (intervention). All of the participants received written warfarin information and were presented with the opportunity to ask any questions that they may have had to a pharmacist. Fifty-four participants completed the study (27 per group). The participants who received e-learning had median correct Oral Anticoagulation Knowledge (OAK) test scores of 85% compared to 80% for standard education (p = 0.14). The participants in both groups were satisfied with the information that they received. There was a trend towards pharmacists spending less time on warfarin education for the e-learning group than in the standard education group (25.5 vs. 33 min, respectively, p = 0.05). Education delivered via pharmacist-facilitated e-learning was non-inferior in terms of patient or carer warfarin knowledge compared to standard pharmacist-delivered education.

Benefits of Pharmacist Intervention in the Critical Care Geriatric Patients with Infectious Diseases: A Propensity Score Matching Retrospective Cohort Study

Background The variabilities of the pharmacotherapeutics’ efficacy and safety in the ICU geriatric patients further highlighted the importance of optimization of antimicrobial therapy. The aim of our study was to assess the impacts of clinical pharmacist intervention on antibiotic use, cost outcomes, and clinical benefits of the geriatric patients with infectious diseases in the critical care unit (ICU). Methods A propensity score matching (PSM) retrospective cohort study was undertaken in ICU patients with infectious diseases from 2017 to 2019. Baseline demographic, pharmacists’ activities and clinical outcomes including the patients’ mortality, antibiotic utilization, length of ICU stay (LOS), and costs of the drugs were compared between these two groups. Univariate analysis and bivariate logistic regression were adopted to illustrate the influencing factors on the mortality outcome. Results Of 1523 patients evaluated during the observed period, a total of 102 geriatric ICU patients with infectious diseases were enrolled in each group after PSM matching. Top 5 recommendations occurred by the pharmacist were medication regimen adjustments by diseases on progression, medication regimen adjustments by microbial results, drug withdrawal by full treatment courses, suggestions for TDM and medication regimen adjustments by de-escalation. The antibiotic use density (AUD) of all antibiotics consumed decreased significantly (p=0.018) from 241.91 DDD/100 bed days in the control group to 176.64 DDD/100 bed days in the pharmacist exposed group. AUD proportion was dropped in carbapenems from 23.07% to 14.43% and tetracyclines from 11.56% to 6.26% after pharmacist interventions. Although the mortality or LOS had no statistical difference between these two groups, the total cost of antibiotics was reduced significantly from $836.3 (IQR 426.88, 1682.09) in the control group to $362.15 (IQR 148.23, 1034.4) (p＜0.001) in the pharmacist intervention group, and cost for all the medications were reduced from $2868.18 ($1268.44, $5059.00) to $1941.5 ($1092.89, $3538.97) (p=0.016). Univariate analyses showed that there was no statistically difference in pharmacist intervention between the groups of survival and death (p=0.288) Conclusions The services provided by the critical care pharmacist could promote the rational use of drugs, which benefit both ICU geriatric patient and hospital care.

Effect of Pharmacist Intervention on 30-Adverse Drug Event after Discharge in Elderly Patients through a Comprehensive Medication Reconciliation: A Randomized Clinical Trial

Polypharmacy can cause drug-related problems, such as potentially inappropriate medication (PIM) use and medication regimen complexity in the elderly. This comprehensive medication reconciliation study was designed as a prospective, open-label, randomized clinical trial with patients aged 65 years or older from July–December 2020. Comprehensive medication reconciliation comprises medication reviews based on the PIM criteria. The discharge of medication was simplified to reduce regimen complexity. Changes in regimen complexity were evaluated using the Korean version of the medication regimen complexity (MRCI-K). Adverse drug events (ADEs) were monitored throughout hospitalization and 30 days after discharge. Of the 32 patients, 34.4% (n = 11) reported ADEs before discharge, and 19.2% (n = 5) ADEs were reported at the 30-day phone call. No ADEs were reported in the intervention group, whereas five events were reported in the control group (p = 0.039) on the 30-day phone call. The intervention group showed a greater score reduction than the control group in terms of the number of medications, MRCI-K, and PIMs. As a result of the pharmacist intervention, we identified the feasibility of pharmacist-led interventions using comprehensive medication reconciliation, including the criteria of the PIMs and the MRCI-K, and the differences in ADEs between the intervention and control groups at the 30-day follow-up after discharge (Clinical trial number: KCT0005994, 03/12/2021).

136. Impact of an OPAT Pharmacist on Guideline Adherence and Clinical Outcomes

Background Outpatient parenteral antibiotic therapy (OPAT) provides select patients a cost-effective alternative to completing intravenous (IV) antibiotic therapy outside the hospital. The Infectious Diseases Society of America (IDSA) OPAT practice guidelines and handbook recommend weekly laboratory monitoring and timely follow-up for OPAT patients. An analysis at VA Palo Alto Healthcare System (VAPAHCS) conducted prior to pharmacist involvement demonstrated that IDSA recommendations were not routinely followed, leading to a clinical cure rate of 62.7%. This led to the implementation of an OPAT pharmacist in 2019. This analysis aims to determine the impact of a pharmacist-managed OPAT program at VAPAHCS. Methods This comparative, retrospective analysis included patients who received OPAT at VAPAHCS between October 1, 2019 and September 30, 2020 and those who received OPAT in a prior analysis. Primary outcomes included rates of adherence to IDSA recommendations on follow-up visits and weekly lab monitoring during OPAT. Secondary outcomes included rates of clinical cure, 90-day readmission, and adverse events or complications. Data was analyzed using Fisher’s exact test and independent t-test. Results This analysis included 74 patients and 76 total OPAT episodes. Bacteremia was the most common diagnosis (n=35, 38.0%), and the most common organism was methicillin-susceptible Staphylococcus aureus (MSSA) (n=23, 29.9%). With respect to guideline adherence pre- and post- pharmacist-managed OPAT, 31.3% versus 93.4% of patients had follow-up within 7 to 14 days of discharge (p&lt; 0.001). Rates of weekly lab monitoring of CBC, BMP, and LFTs pre-pharmacist were 63.2%, 63.3%, and 49.5%, respectively, compared to post-pharmacist rates of 93.0%, 92.1%, and 83.6%, respectively. Clinical cure rates were 62.7% pre-pharmacist and 89.6% post-pharmacist (p&lt; 0.001). More adverse drug reactions were identified in the post-pharmacist period, of which 30% required pharmacist intervention. Figure 1. Weekly Laboratory Monitoring of Antimicrobials (%) Figure 2. Adherence to IDSA Guideline Follow-up Recommendation Figure 3. Rates of Clinical Cure Conclusion Pharmacist involvement in OPAT significantly increased IDSA guideline adherence to lab monitoring and follow-up visits, and clinical cure rates. Identification of adverse drug reactions prompting pharmacist intervention further highlights the importance of follow-up in OPAT patients. Disclosures All Authors: No reported disclosures