Research Abstracts 2002

Assessing The Guidelines For Potassium Replacement In Pediatric Oncology Patients Receiving Amphotericin B

Smith J, B.Sc.(Pharm), Don Hamilton, B.Sc.(Pharm), Roxane Carr, B.Sc.(Pharm) Pharm.D.

Department of Pharmacy, Children’s and Women’s Hospital of British Columbia, Vancouver, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.


Objectives

To examine the practice of potassium chloride (KCl) replacement in pediatric oncology patients receiving amphotericin B (amp-B); including a review of adherence to the KCl replacement guidelines in our institution as well as a review of the literature and other pediatric institutions’ KCl replacement protocols.

Setting

A Canadian teaching institution.

Design

A retrospective chart review was conducted of patients who received amp-B on the oncology ward between August 27, 2000 and May 17, 2001. A literature search was conducted. A survey of pediatric oncology pharmacists at other pediatric institutions was done to assess KCl infusion guidelines in other institutions across North America.

Results

A total of 20 hypokalemic episodes were identified within 22 patient admissions. Of these episodes, 55% used KCl replacement at rates exceeding our institution’s current guidelines. Physicians were adherent to providing proper documentation of each episode requiring an interim policy for a rate exceeding our hospital guidelines. A consensus on the maximum rate of KCl that can be safely infused in a non-critical care ward could not be found in the literature. Other pediatric institutions varied with respect to the maximum rates and concentration of KCl permitted on non-intensive care wards..

Conclusions

Based on the data from this review, the intravenous KCl administration guidelines for our hospital were changed. We now allow a maximum peripheral line concentration of 60 mmol/L (as per current protocol), a maximum central line concentration of 120 mmol/L (increased from 80 mmol/L), and a maximum KCl infusion rate of 0.4 mmol/kg/hr (increased from 0.3 mmol/kg/hr) without the requirement of a heart monitor. TPN is now restricted to maximum concentration of 80 mmol/L and fluid restricted patients are restricted to a maximum concentration of 150 mmol/L. As the methodology of this study provided only an estimation of the KCl requirement in a select population, it is important that the effects from the changes of the new guidelines are frequently monitored. It is also important that physician, nursing, and pharmacy staffs are well educated on the new guidelines and continuously monitor for efficacy and toxicity of IV KCl therapy.

Perceptions of Professional Services of a Pharmaceutical Sciences Clinical Service Unit: A Comparison of Stakeholder Groups

Katie Lacaria BSc (Pharm), Robert M. Balen BSc (Pharm), PharmD, Luciana Frighetto BSc (Pharm), MBA, FCSHP, Tim T.Y. Lau BSc (Pharm), PharmD, Terryn L. Naumann BSc (Pharm), PharmD, Peter J. Jewesson PhD, FCSHP

Pharmaceutical Sciences Clinical Service Unit, Vancouver General Hospital , Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.


Objectives

To determine perceptions of patients, nurses, physicians, and pharmacists regarding the awareness, quality, and priority of professional services offered by the Pharmaceutical Sciences Clinical Services Unit (CSU) at Vancouver General Hospital in the areas of patient care, education and research.

Setting

A major Canadian tertiary adult acute care teaching hospital.

Design

A survey was designed to elicit opinions regarding the awareness, quality, and priority of the drug distribution, clinical, education and research services provided by the CSU. Surveys were distributed over a 90-day period directly to patients and to the mailboxes of nurses, physicians and pharmacists who were affiliated with the hospital. Respondent demographics and responses were analyzed using descriptive statistical analysis.

Results

A total of 2,568 surveys were distributed to all stakeholder groups. Of the 460 surveys analyzed, there were 38 (32%) patient, 276 (16%) nurse, 102 (16%) physician, and 44 (50%) pharmacist respondents. Patient respondents tended to have been in hospital for about two weeks at the time of survey completion and were located in several practice areas. The duration of employment for nurse, physician and pharmacist respondents was widespread ranging from 1 to 24 years. For nurses and physicians, there was a relatively balanced representation from the medical and surgical practice areas. Most pharmacist respondents practiced in non-surgical areas. Patients were the least aware of the professional services provided by the CSU. The quality of the majority of services was rated as excellent or good across all groups. Respondents ranked the review of prescriptions for appropriateness, the dispensing of oral, intravenous and total parenteral nutrition preparations, the resolution of patient-specific drug distribution issues, group medication sessions, continuing education programs, and the Clinical Drug Research program as the most important professional services.

Conclusions

The study provided information regarding patient, nurse, physician, and pharmacist perceptions regarding awareness, quality, and priority of patient care, education and research services currently offered by the Pharmaceutical Sciences CSU at Vancouver General Hospital and identified areas that require improvement.

Characterizing Patient Discharge Counseling Activities Performed By Hospital Pharmacists

Rebekah Curran, B.Sc. (Pharm.), Anar Dossa, B.Sc. (Pharm.), Kerry Wilbur, B.Sc.(Pharm), Pharm.D.

Pharmaceutical Sciences Clinical Service Unit, Vancouver General Hospital , Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.


Objectives

To determine how hospital pharmacists identify patients who require discharge counseling and to identify barriers to providing this service.

Setting

A major Canadian tertiary adult acute care teaching hospital.

Design

A survey was distributed to clinical pharmacists at an acute care hospital. They were asked to rank how they identify patients requiring discharge counseling and specific barriers to performing this service. Additional data was collected on discharge activities, such as frequency of documenting patient interviews and liaising with community pharmacists. Opinions regarding the importance of patient discharge counseling were also solicited. Perceptions regarding professional duties and responsibilities of hospital pharmacists were assessed.

Results

The majority ranked prescription of “target drugs” as either the first (50.0%) or second (28.6%) way to identify patients requiring discharge counseling. Almost half surveyed use medication teaching sheets as the primary patient counseling tool. The greatest barriers to providing patient discharge counseling identified were time and workload, followed by patient language. When asked to consider the last 10 patients they had counseled at discharge, two-thirds of pharmacists were able to document 9-10 of the interviews in the chart; however, most were unable to liaise with the community pharmacist. The majority of pharmacists (71%) very strongly agreed that the pharmacist is the health care professional most qualified to provide medication counseling to hospitalized patients.

Conclusions

This study has gathered data on current opinions and perceptions surrounding patient discharge counseling activities of hospital pharmacists.

Venous Thromboembolism Prevention in Medical Patients with Congestive Heart Failure or Chronic Obstructive Pulmonary Disease

Rumi Pattar, B.Sc. (Pharm), Zahra Kanji, B.Sc.(Pharm), Pharm.D., Mark Collins, B.Sc.(Pharm), M.Sc.(Pharmacol)

Department of Pharmacy , Lion’s Gate Hospital, North Vancouver, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.


Objectives

To measure the impact of educational interventions on the utilization of thromboprophylaxis as per current guidelines amongst, patients admitted with an exacerbation of congestive heart disease (CHF) or chronic obstructive pulmonary disease (COPD).

Setting

A Canadian community hospital.

Design

Educational interventions in the form of presentations and memos were undertaken in conjunction with 2 physicians to disseminate the findings of venous thromboembolism (VTE) prophylaxis utilization amongst CHF and COPD patients admitted to Lions Gate Hospital and to educate physicians, pharmacists and nurses regarding current practice guidelines for VTE prophylaxis in medical patients. A retrospective analysis of patients admitted with CHF or COPD during a five-month period was conducted following the educational intervention. Furthermore, all physicians were surveyed regarding perceived barriers to VTE prophylaxis amongst CHF and COPD patients.

Results

Following the educational intervention, 46% (n=28) of patients with CHF and 30% (n=33) of patients with COPD received VTE prophylaxis. The survey results revealed that physicians mainly attributed the low rates of prophylaxis to oversight and unawareness of current guidelines.

Conclusions

There are poor rates of VTE prophylaxis amongst patients with CHF and COPD exacerbations at our institution and educational interventions alone were insufficient to ensure the routine use of prophylaxis in clinical practice.

Evaluation of Cardiac Risk Factors in Renal Transplant Recipients

Trana Hussaini B.Sc. (Pharm), Nilufar Partovi, B.Sc. (Pharm), Pharm.D., FCSHP, RJ Shapiro, MD, FRCP

Pharmaceutical Sciences Clinical Service Unit, Vancouver General Hospital , Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.


Objectives

Cardiovascular disease (CVD) is the cause of death in almost half of renal transplant recipients with functioning grafts. Cardiac risk factors in general population, such as dyslipidemia are also predictive in transplant patients.  The primary objectives of this study were to characterize and stratify cardiac risk factors in renal transplant patients at our outpatient clinic and to develop and implement a dyslipidemia-management protocol in this population.

Setting

A major Canadian tertiary adult acute care teaching hospital.

Design

Medical charts for a total of 98 patients transplanted between Jan 1998 to Oct 2001 were reviewed and cardiac risk factors using Framingham scoring system were determined. A dyslipidemia management protocol was developed based on NCEP Guidelines and a copy of this protocol was inserted in medical records of 42 patients, stating their calculated 10-year cardiac risk percentage and a dyslipidemia treatment option based on NCEP Guidelines.

Results

A significant number of transplant recipients were at intermediate to high risk for developing CVD. Majority of patients had elevated lipids and only a small fraction were receiving antilipid therapy. Our protocol was not effectively utilized as indicated by the small number of patients receiving antilipid therapy.

Conclusions

Considering high prevalence of CVD in transplant patients, aggressive intervention with lipid lowering therapy seems warranted.

Switching from Abciximab to Eptifibatide for Percutaneous Coronary Interventions: A Local Analysis (SWAP Study)

Vivian W.Y. Leung, B.Sc.(Pharm), Rubina Sunderji, Pharm.D., FCSHP, Peter J. Zed, Pharm.D., Ken Gin, M.D., FRCPC

Pharmaceutical Sciences Clinical Service Unit, Vancouver General Hospital , Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.


Objectives

Glycoprotein IIb/IIIa inhibitors (GPI) are recommended as adjunctive therapy with percutaneous coronary interventions (PCI). Only abciximab (AB) was available at our institution until October 2000. Thereafter, eptifibatide (EP) was added to formulary and became the preferred agent due to lower cost. Our objective was to describe the impact of switching from AB to EP on prescribing patterns and clinical outcomes following PCI.

Setting

A major Canadian tertiary adult acute care teaching hospital.

Design

Charts of patients who received a GPI with PCI for various indications were reviewed retrospectively. The AB group spanned the 6 months preceding formulary addition of EP in October 2000. A matching number of consecutive patients following this date were included in the EP group.

Results

A total of 160 patients were included (80 per group). Adjunctive GPI usage increased from 11% to 25% of PCI within three months of adding EP to formulary (p<0.001). Compared to AB, EP was associated with more in-hospital ischemic complications (12.5% vs. 2.5%, p<0.025) and minor bleeding (p=ns). Premature GPI discontinuation was more common in the EP group (46.3% vs. 7.5%, p<0.001). Eptifibatide patients had a longer length of hospital stay post-PCI (mean 44.4h vs. 25.1h, p<0.0001).

Conclusions

Adjunctive GPI usage more than doubled following introduction of EP to the formulary. Eptifibatide may be associated with inferior clinical outcomes compared to AB for PCI.

Multidisciplinary Approach to EPO Resistance in a HD Unit

Anne Sawoniak, B.Sc.(Pharm), Karen Shalansky, Pharm. D., FCSHP, J. Jastrzebski, MD, FRCP

Pharmaceutical Sciences Clinical Service Unit and the Department of Nephrology, Vancouver General Hospital , Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.


Objectives

Erythropoietin (EPO) is given for long-term management of serum hemoglobin (Hgb) in hemodialysis (HD) patients at a typical dose of 50-300U/kg/week. Our objectives were to assess risk factors for HD patients receiving EPO doses greater than 300U/kg/week (EPO-resistant) and to determine the effect of downward EPO dosage adjustments on Hgb.

Setting

A major Canadian tertiary adult acute care teaching hospital.

Design

This was an 8-month prospective, open-label study of 19 EPO-resistant patients drawn from a 160-bed HD unit. Hgb, iron studies, intact parathyroid hormone, folate, B12, aluminum, reticulocyte counts and HD flow adequacy were determined at baseline. The former three parameters were followed every 6, 12, and 26 weeks, respectively. Target Hgb was 120-135g/L. Factors contributing to EPO resistance were assessed and treated every 6 weeks, if possible. Downward EPO dosage adjustments of 12.5-25% to the closest 1000U were considered if underlying causes of EPO resistance could not be identified or reversed, or if Hgb rose beyond the target.

Results

Dysfunctional vascular access and iron deficiency were the predominant treatable factors associated with EPO resistance. By study end, mean EPO dosage decreased significantly from 469U/kg/week to 319U/kg/week and mean Hgb increased significantly from 106g/L to 116g/L. The percent of EPO-resistant patients with a Hgb in the target range rose from 16% at baseline to 63%. Annual cost savings approximated $157,000.00.

Conclusions

A structured multidisciplinary approach to the management of EPO-resistant patients was successful in significantly lowering EPO dosage with improvement in serum Hgb at a substantial cost savings.

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