Gulseth MP, Dinunno C, Smith MD
… +1 more, Smythe MA
Am J Health Syst Pharm
· 2026 Jul · PMID 42400408
·
Publisher ↗
PURPOSE: Hospitalized patients taking direct factor Xa inhibitors (DFXaIs), such as apixaban and rivaroxaban, often need to be transitioned to unfractionated heparin (UFH). This transition is complicated by residual DFXa...PURPOSE: Hospitalized patients taking direct factor Xa inhibitors (DFXaIs), such as apixaban and rivaroxaban, often need to be transitioned to unfractionated heparin (UFH). This transition is complicated by residual DFXaI activity, which can lead to anticoagulant stacking and possible increased bleeding risk. The guidance on this transition from the manufacturers does not account for interpatient variability in drug clearance and may not be appropriate for all hospitalized patients. SUMMARY: Residual DFXaI anticoagulation at the time of UFH initiation can result in a period of dual anticoagulation or anticoagulant stacking. This issue is identified most often when heparin is monitored using the anti-factor Xa assay as this assay is highly sensitive to the DFXaI. Several retrospective descriptive studies have reported supratherapeutic heparin levels (above 0.7 units/mL), which can last for days depending on the presence of patient-specific factors that reduce DFXaI clearance. The period of anticoagulant stacking has been associated with bleeding events. With the UFH anti-factor Xa assay detecting both anticoagulants, alternative methods are needed for heparin monitoring when transitioning from a DFXaI to UFH. Limited data describe alternative approaches that can be categorized as approaches that ignore residual DFXaI anticoagulation and ones that account for residual DFXaI anticoagulation. Observational data suggest that approaches that measure baseline residual DFXaI anticoagulation allow for a delay in UFH initiation and can reduce bleeding risk. The authors provide recommendations for hospitals or health systems to consider for optimizing management of the transition from DFXaI to UFH therapy. CONCLUSION: Each hospital or health system should develop a structured approach for managing DFXaI to UFH transitions. Ideally, the transition should be managed by pharmacists and involve measurement of residual DFXaI anticoagulation to inform the timing of UFH initiation. Prospective studies are needed to better define best practices.
Vanini D, Reid S, Pero E
… +2 more, Rappaport S, Groth CM
Am J Health Syst Pharm
· 2026 Jul · PMID 42400262
·
Publisher ↗
PURPOSE: Data describing the impact of pharmacists on early sepsis management performed by multidisciplinary sepsis response teams are limited to the emergency department and lack contemporaneous comparator groups. Objec...PURPOSE: Data describing the impact of pharmacists on early sepsis management performed by multidisciplinary sepsis response teams are limited to the emergency department and lack contemporaneous comparator groups. Objectives of the study reported here included determining if pharmacist presence on a sepsis response team improves sepsis bundle compliance and outcomes of hospitalized patients. METHODS: This was a single-center, retrospective cohort study of hospitalized adult patients diagnosed with severe sepsis or septic shock seen by a sepsis response team between July 2019 and July 2022. Patients were divided into 2 groups based on the presence (pharmacist present [PhP]) or absence (no pharmacist present [NPh]) of a pharmacist as a member of the sepsis response team. The primary endpoint was 1-hour bundle compliance, as defined by the Surviving Sepsis Campaign, with time zero defined as the time an alert was paged to the responding team. Secondary endpoints included rates of compliance with the Centers for Medicare and Medicaid Services 3- and 6-hour severe sepsis and septic shock (SEP-1) bundles, time to individual bundle component completion, hospital length of stay (LOS), and in-hospital mortality. RESULTS: In total, 167 responses were included (91 in the PhP group and 76 in the NPh group). A pharmacist's presence resulted in improved 1-hour bundle compliance (60.4% vs 44.7%, P = 0.045), an increased rate of antibiotic administration within 1 hour of an sepsis alert page (84.6% vs 59.2%, P < 0.001), and a lower median time to antibiotic administration (51 minutes vs 108 minutes, P < 0.01). Rates of 3- and 6-hour bundle compliance, hospital LOS, and mortality were similar between the PhP and NPh groups. CONCLUSION: Pharmacist involvement in a sepsis response team is associated with improved completion of the 1-hour bundle, specifically the early administration of broad-spectrum antibiotics. Early identification of sepsis and alerting a multidisciplinary team remain barriers to optimizing treatment.
McCarthy TJ, Margolis A, Cooley G
… +3 more, Albright T, Mott DA, Chewning B
Am J Health Syst Pharm
· 2026 Jul · PMID 42397966
·
Publisher ↗
PURPOSE: Centralized health-system specialty pharmacy (cHSSP) clinics are an emerging model in which pharmacists operate independently from individual specialty clinics and manage the use of specialty medications. As mor...PURPOSE: Centralized health-system specialty pharmacy (cHSSP) clinics are an emerging model in which pharmacists operate independently from individual specialty clinics and manage the use of specialty medications. As more health systems adopt cHSSP models, there is a need to understand the foundational components that support their effectiveness. This scoping review aimed to identify and synthesize reported structures, processes, and outcomes of cHSSP clinics using the Donabedian model as a guiding framework. METHODS: A literature search of PubMed was conducted for primary, peer-reviewed articles published between January 2014 and July 2024. Articles were included if they described US-based cHSSP clinics that operated independently from interprofessional specialty teams and provided clinical services related to specialty medication management. RESULTS: A total of 24 articles met the inclusion criteria. Structural elements included staffing with ambulatory care-trained pharmacists, use of scheduling assistants and pharmacy technicians, electronic health record access, and varied scopes of pharmacist prescribing authority. Key processes involved benefits coordination, prior authorization, disease state monitoring, adherence counseling, and care coordination. Reported outcomes included improved medication adherence and persistence, patient satisfaction, disease state control, cost containment, and medical provider satisfaction. CONCLUSION: This review highlights the variability, adaptability, and promising outcomes associated with cHSSP clinics and provides a foundation for future implementation and evaluation of these models in health systems.
Am J Health Syst Pharm
· 2026 Jul · PMID 42394522
·
Publisher ↗
PURPOSE: To review the efficacy and safety of zoliflodacin for the treatment of uncomplicated urogenital gonorrhea (uUGG). SUMMARY: A literature search was performed using PubMed and Google Scholar with the search terms...PURPOSE: To review the efficacy and safety of zoliflodacin for the treatment of uncomplicated urogenital gonorrhea (uUGG). SUMMARY: A literature search was performed using PubMed and Google Scholar with the search terms "zoliflodacin," "AZD0914," and "ETX0914." All relevant English-language articles of studies assessing the efficacy and safety of zoliflodacin for the treatment of uUGG were included. Other resources included abstracts presented at recent conferences, the manufacturer's website, and prescribing information. Zoliflodacin is a first-in-class spiropyrimidinetrione antibiotic with a novel mechanism of action and has been shown to be highly active against Neisseria gonorrhoeae, including strains resistant to other antibiotics such as ceftriaxone and azithromycin. It is FDA approved for the treatment of uUGG in adult and pediatric patients aged 12 or older and weighing at least 35 kg and is administered as a one-time oral dose of 3,000 mg. In a large phase 3 trial, zoliflodacin was noninferior to ceftriaxone plus azithromycin for the treatment of uUGG in both men and women and demonstrated a favorable safety and tolerability profile. CONCLUSION: Zoliflodacin is a newly approved antibiotic with a novel mechanism of action that is highly effective for the treatment of uUGG. It is given as a single dose that can be administered orally at the time of diagnosis, thereby avoiding the intramuscular injection necessary with ceftriaxone. It is also effective against gonorrhea strains resistant to other antibiotics.
Am J Health Syst Pharm
· 2026 Jul · PMID 42384968
·
Publisher ↗
PURPOSE: The purpose of this project was to develop and implement a pharmacy technician training program at Saint Luke's Health System to reduce technician turnover. SUMMARY: As the role of pharmacy technicians has expan...PURPOSE: The purpose of this project was to develop and implement a pharmacy technician training program at Saint Luke's Health System to reduce technician turnover. SUMMARY: As the role of pharmacy technicians has expanded, so has the demand for experienced technicians. There is a national shortage of experienced pharmacy technicians. This shortage has led to increased turnover rates and strain on other staff members. The emergence of advanced pharmacy technician roles provides career advancement opportunities for experienced pharmacy technicians. However, as seasoned technicians move into advanced roles, a health system is left with entry-level technician positions to fill. Other health systems have developed pharmacy technician training programs to provide their staff complete training over the course of several weeks and align with ASHP recommendations. The training program at Saint Luke's Health System is a 12-week paid apprenticeship-model program. There were several barriers faced in implementing the training program including space, recruitment, and role placement after program graduation. CONCLUSION: Formal structured training for pharmacy technicians is pertinent to ensuring patient safety and leveraging pharmacists to further patient care.
Trimech H, Ben Romdhane H, Mahjoub M
… +3 more, Chadli Z, Ben Fredj N, Aouam K
Am J Health Syst Pharm
· 2026 Jul · PMID 42381551
·
Publisher ↗
PURPOSE: Acute generalized exanthematous pustulosis (AGEP) is a rare but severe skin eruption rarely induced by iodinated contrast media (ICMs). We report a clinical observation of AGEP induced by iodixanol with cross-re...PURPOSE: Acute generalized exanthematous pustulosis (AGEP) is a rare but severe skin eruption rarely induced by iodinated contrast media (ICMs). We report a clinical observation of AGEP induced by iodixanol with cross-reactivity with other ICMs, confirmed by positive intradermal tests (IDTs). SUMMARY: A 72-year-old female patient with no history of atopy, skin disease, or adverse drug reaction or allergy to iodine was diagnosed with acute coronary syndrome and underwent a rescue angioplasty using iodixanol as ICM. Four days later, the patient developed a morbilliform maculopapular rash with small nonfollicular pustules overspreading the entire body, accompanied by fever of 39.5 °C and vomiting. Laboratory investigations showed marked leukocytosis with neutrophilia and eosinophilia, and a high creatinine level. Clopidogrel was initially considered as the causative drug, and the patient was switched to ticagrelor, with a partial regression of the skin manifestations. However, 11 days after the angiography, the patient underwent a computed tomography scan using iodixanol, leading to a reactivation of the exanthema, accentuation of pustules, a high body temperature of 38.5 °C, and the reappearance of leukocytosis, neutrophilia, and eosinophilia. The diagnosis of AGEP was confirmed by a EuroSCAR score of 9, and iodixanol was highly suspected to be the culprit agent. Six weeks after the patient's complete recovery, an intradermal test with iodixanol was conducted according to the European Network of Drug Allergy (ENDA) recommendations, with the patient's informed consent, yielding a positive result at the 48-hour reading. To assess for cross-reactivity with other ICMs, IDTs with iopromide, iohexol, and iopamidol, were performed. All IDTs were positive at the 48-hour reading. CONCLUSION: We report a rare case of AGEP induced by iodixanol and point out the potential cross-reactivity between iodixanol, iopamidol, iopromide, and iohexol. IDTs for a wide range of ICMs should be conducted to identify safe alternatives for patients.
Stutzman DL, Ariefdjohan M, Lemons A
… +2 more, Hamner J, Bindseil I
Am J Health Syst Pharm
· 2026 Jun · PMID 42370838
·
Publisher ↗
PURPOSE: The creation of the Inpatient Psychiatric Pharmacy Intern Shift (INSPY) program at an urban, tertiary care children's hospital is described. SUMMARY: In 2021, the INPSY was created at the Pediatric Mental Health...PURPOSE: The creation of the Inpatient Psychiatric Pharmacy Intern Shift (INSPY) program at an urban, tertiary care children's hospital is described. SUMMARY: In 2021, the INPSY was created at the Pediatric Mental Health Institute (PMHI) at Children's Hospital Colorado (CHCO) with the goal of delivering psychotropic medication information to pediatric patients on an inpatient psychiatry unit, optimizing psychotropic medication outcomes for adolescents, and exposing pharmacy interns to child and adolescent psychiatry early in their pharmacy school training. The CHCO pharmacy intern program includes an average of 20 first- through fourth-year pharmacy interns on staff each academic year. The overarching goal of the pharmacy intern program is to provide high-performing pharmacy interns with opportunities to practice at the top of their scope while functioning as clinical extenders for clinical pharmacists. Two lead pharmacy interns support INPSY shift coordination, maintenance, and academic projects (eg, poster presentations) with mentorship from 3 psychiatric pharmacists and the pharmacy intern program director. After program participation, pharmacy interns report greater confidence designing medication education materials, facilitating medication education groups, identifying patients' psychotropic medication-related problems, applying motivational interviewing techniques, and responding to patient questions or concerns related to their mental illness and/or psychotropic medications. CONCLUSION: The INPSY program was demonstrated to have feasibility and acceptability as a training strategy that aligns with national pediatric psychiatric workforce needs by building practical competence, strengthening perceived professional impact, and increasing exposure to high-level psychiatric pharmacy activities.
Afaq H, Colunga S, Hu L
… +11 more, Zhang X, Munson S, Norton J, Townley P, Meyer J, Carpenter L, Hoh T, Perampaladas K, Schuler B, Silberhorn R, Alam A
Am J Health Syst Pharm
· 2026 Jun · PMID 42364102
·
Publisher ↗
PURPOSE: This quality improvement initiative aimed to assess the impact of smart infusion pump-electronic medical record (EMR) interoperability on patient safety events, user programming compliance, and hospital staff pr...PURPOSE: This quality improvement initiative aimed to assess the impact of smart infusion pump-electronic medical record (EMR) interoperability on patient safety events, user programming compliance, and hospital staff productivity at a large academic health system. METHODS: Retrospective, deidentified Spectrum IQ smart infusion pump data (collected from January 2021 to August 2024) from 6 University of Texas Medical Branch hospitals that included integrated drug groups spanning the period before and after EMR integration in quarter 4 of 2022 were analyzed. Infusions for medications in the critical care and acute care area drug groups were included if they had a positive dose. Infusions were excluded if they were associated with multiple care areas or had a duration of more than 24 hours. Data were collected on safety events (hard and soft limit alerts, single-step rate change [SSRC] alerts, good catches, pullbacks, overrides), productivity metrics (number of programming steps, median time to initiate infusions, mean time to resolve alerts), and compliance with programming approaches. Outcomes were analyzed descriptively and compared across various subgroups using (2 tests, t tests, or Wilcoxon rank-sum tests. RESULTS: Smart pump-EMR integration significantly reduced the occurrence of medication safety alerts: the rate of hard limit, soft limit, and SSRC alerts decreased by 50.3%, 30.4%, and 38.1%, respectively (all P < 0.001). These reductions were consistent across high-alert medications (HAMs)/Risk Evaluation and Mitigation Strategies (REMS) medications and the top 20 medications by alert frequency. The rate of good catches also decreased after integration. Autoprogramming had fewer programming steps (1.6 vs 3.3 steps) and shorter alert resolution times (46.3% shorter for soft limit alerts and 55.0% shorter for SSRC alerts) than manual programming (both P < 0.001). Dose error reduction system compliance increased to 96.1% after integration, while autoprogramming compliance was 53.4% overall and 68.3% for HAMs/REMS medications. CONCLUSION: Smart pump-EMR integration and autoprogramming were associated with significantly fewer safety alerts, fewer steps to initiate infusions, and shorter times to resolve alerts. These benefits underscore the importance of effective integration and ongoing optimization of drug libraries and staff training for enhanced patient safety and workflow.
Am J Health Syst Pharm
· 2026 Jun · PMID 42335159
·
Publisher ↗
PURPOSE: To evaluate recent studies assessing the safety of cefazolin for surgical site infection (SSI) prophylaxis in patients with reported β-lactam allergies and to review interventions aimed at optimizing its use in...PURPOSE: To evaluate recent studies assessing the safety of cefazolin for surgical site infection (SSI) prophylaxis in patients with reported β-lactam allergies and to review interventions aimed at optimizing its use in this population. SUMMARY: Decades of clinical practice have been shaped by misleading assumptions regarding the degree of cross-reactivity between penicillins and cephalosporins. Contemporary evidence demonstrates that cefazolin, a first-generation cephalosporin with a unique R1 side chain, is not cross-reactive with penicillins and is well tolerated in patients with histories of immediate and severe delayed hypersensitivity reactions. Retrospective and prospective studies consistently report low rates of cefazolin-associated hypersensitivity reactions, including in cohorts with high-risk allergy histories. In contrast, alternative agents such as clindamycin and vancomycin are associated with higher rates of SSI and adverse effects. Institutional interventions, including educational initiatives, protocol-based antibiotic selection, and R1 side chain-based algorithms, have successfully increased cefazolin utilization without increasing the incidence of hypersensitivity events. CONCLUSION: Cefazolin is a safe and effective agent for SSI prophylaxis and should be used in patients with β-lactam allergies. Overcoming persistent misconceptions and adopting evidence-based prescribing strategies can reduce unnecessary avoidance of cefazolin, decrease postoperative infection rates, and improve patient outcomes.
Jantarathaneewat K, Rukskul P, Yodwisithsak P
… +3 more, Kaewwichai W, Camins B, Apisarnthanarak A
Am J Health Syst Pharm
· 2026 Jun · PMID 42333477
·
Publisher ↗
PURPOSE: To evaluate the impact of a multidisciplinary antimicrobial stewardship program (mASP) on adherence to recommended antimicrobial therapy in neurosurgical units. METHODS: A quasi-experimental study was conducted...PURPOSE: To evaluate the impact of a multidisciplinary antimicrobial stewardship program (mASP) on adherence to recommended antimicrobial therapy in neurosurgical units. METHODS: A quasi-experimental study was conducted in Thammasat University Hospital between May 2020 and June 2022. Our primary outcome was adherence to recommended antimicrobial therapy, and secondary outcomes included clinical improvement, 30-day infectious disease-related mortality, antimicrobial use, and incidence of infection with multidrug-resistant (MDR) pathogens. RESULTS: Overall, 688 antimicrobial orders were reviewed during the study. The most prescribed antimicrobial for empiric therapy was piperacillin/tazobactam (266/688, 39.9%), and the most common source of infection was the respiratory tract (321/688, 46.7%). The overall adherence rate to recommended antimicrobial therapy was higher in the mASP period (70.3% vs 62.5%; P = 0.029). The overall acceptance rate of mASP recommendations was 83.1%. Furthermore, the mean volumes of carbapenem (P = 0.005) and vancomycin (P = 0.045) use declined, while the trend of cefazolin use increased (coefficient, 26.88; 95% confidence interval, 13.53 to 40.24; P < 0.001) during the study period. The incidence of infections caused by MDR pathogens significantly declined (P = 0.012), especially for infections caused by carbapenem-resistant Acinetobacter baumannii (P = 0.043). There were no differences in the secondary outcomes, inclusive of the proportion of patients with clinical improvement and 30-day infectious disease-related mortality. CONCLUSION: Implementation of an mASP in neurosurgical units was associated with improved adherence to recommended antimicrobial therapy, reduced use of broad-spectrum antibiotics, and a decline in the incidence of infections with MDR pathogens.
Van Tuyl JS, Di Palo KE, Huynh T
… +3 more, Joy JP, Kemp L, Judge DP
Am J Health Syst Pharm
· 2026 Jun · PMID 42329158
·
Publisher ↗
PURPOSE: To provide an overview of the manifestation and diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) and the treatment option acoramidis, including its pharmacology and clinical trial data. SUMMARY: ATTR-...PURPOSE: To provide an overview of the manifestation and diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) and the treatment option acoramidis, including its pharmacology and clinical trial data. SUMMARY: ATTR-CM is a progressive, life-threatening cause of heart failure, resulting from destabilization of transthyretin (TTR), a tetrameric transport protein. TTR destabilization leads to monomers that misfold, aggregate, and deposit as amyloid fibrils in cardiac and other tissues. ATTR-CM is underdiagnosed, and the common cardiovascular manifestations associated with it are frequently misattributed to other types of heart disease, delaying diagnosis. ATTR-CM management has historically been largely supportive, but disease-modifying therapies, including TTR stabilizers and gene silencers, have become available in the past decade. Acoramidis, a next-generation oral TTR stabilizer, was approved in 2024 for the treatment of adults with wild-type or variant ATTR-CM based on the results of the phase 3 ATTRibute-CM trial. Acoramidis has been shown to achieve near-complete (≥90%) TTR stabilization, increase levels of serum TTR, reduce rates of cardiovascular-related mortality and hospitalization, and improve patient quality of life. Clinical pharmacists play a central role in the timely diagnosis and treatment of ATTR-CM, including facilitating access to therapies, monitoring safety concerns, and providing patient counseling. CONCLUSION: It is important for pharmacists to become familiar with the clinical manifestations of ATTR-CM and available treatment options. This review provides comprehensive information on ATTR-CM and the treatment landscape, focusing on the treatment option acoramidis.
Rungkitwattanakul D, Rebold N, Belrhiti S
… +3 more, Mere C, Nwaogwugwu U, Kane-Gill SL
Am J Health Syst Pharm
· 2026 Jun · PMID 42325161
·
Publisher ↗
PURPOSE: To describe implementation strategies for a nephrotoxin stewardship service at Howard University Hospital aimed at reducing drug-associated acute kidney disease (D-AKD) in high-risk inpatients, as guided by the...PURPOSE: To describe implementation strategies for a nephrotoxin stewardship service at Howard University Hospital aimed at reducing drug-associated acute kidney disease (D-AKD) in high-risk inpatients, as guided by the Consolidated Framework for Implementation Research (CFIR) and the Capability, Opportunity, Motivation - Behavior (COM-B) behavior change model. SUMMARY: D-AKD remains a prevalent and potentially preventable complication, particularly in patients exposed to multiple nephrotoxic drugs. Although clinical guidelines and evidence-based strategies for reducing D-AKD exist, implementation remains inconsistent in practice. We developed a nephrotoxin stewardship service using the CFIR and COM-B as guiding frameworks to address barriers and promote behavior change amongst clinicians. The program leveraged clinical decision support tools, pharmacist-led interventions, and multidisciplinary engagement to optimize medication safety. To assess impact and feasibility, we applied the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Lessons learned include the importance of leadership support, ongoing physician education, and iterative refinement of alerting systems. Future directions include outcome tracking to assess the incidence of acute kidney injury (AKI) post service initiation. CONCLUSION: Our experience highlights how implementation science frameworks can facilitate the systematic development and integration of a nephrotoxin stewardship program within a complex hospital environment. As hospitals prioritize medication safety, our approach provides a scalable model for preventing AKI in high-risk populations. Ongoing evaluation and refinement will be key in ensuring sustained clinical benefit and broader dissemination.
Hong H, Hanigan Lewis S, Triller DM
… +7 more, Dane KE, Jones M, Whyte C, Lanham MSM, Allen AL, Kaatz S, Barnes GD
Am J Health Syst Pharm
· 2026 Jun · PMID 42320525
·
Publisher ↗
PURPOSE: Direct oral anticoagulants (DOACs) are highly effective in the treatment and prevention of thrombosis. Nevertheless, the prevalence of inappropriate DOAC dosing (ie, dosing not in alignment with Food and Drug Ad...PURPOSE: Direct oral anticoagulants (DOACs) are highly effective in the treatment and prevention of thrombosis. Nevertheless, the prevalence of inappropriate DOAC dosing (ie, dosing not in alignment with Food and Drug Administration package labeling) remains high and is associated with suboptimal patient outcomes. Development and utilization of a digital dashboard to support DOAC management in the acute care setting has not yet been described. SUMMARY: An acute care digital dashboard for population management of DOACs was developed and implemented at 4 acute care facilities, and implementation success was evaluated using qualitative and quantitative surveys completed by lead project clinicians.Based on responses from all participating facilities related to 7 previously described domains of implementation success, including acceptability, adoption, appropriateness, feasibility, fidelity, penetration, and sustainability, the dashboard implementation was considered a complete success. In 21 monthly dashboard snapshot surveys across all sites, the dashboard identified 1,059 acute care patients receiving DOACs. Of these patients, 96 (9.1%) had a known critical alert, 209 (19.7%) had a possible critical alert, and 77 (7.3%) had a "for your information" alert across all sites. CONCLUSION: This case study demonstrated successful implementation of an acute care DOAC dashboard at 4 unique practice sites. Clinicians felt that the dashboard appropriately addressed clinical issues in patients receiving DOACs and was readily incorporated into their daily workflow. Overall, dashboard users were satisfied with the tool and found it palatable.