Johnson ST, Cook K, Dallmeier J
… +2 more, Heuett N, Barker K
Am J Health Syst Pharm
· 2026 Jan · PMID 41572721
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PURPOSE: This primer reviews the economic implications of hospital price transparency (HPT), delineates federal requirements, and describes how HPT may curb US healthcare spending, with an emphasis on drug costs. SUMMARY...PURPOSE: This primer reviews the economic implications of hospital price transparency (HPT), delineates federal requirements, and describes how HPT may curb US healthcare spending, with an emphasis on drug costs. SUMMARY: National health expenditures are projected to reach nearly $6 trillion (19.4% of gross domestic product) by 2027. Transparent pricing reduces cost variation in straightforward markets, although its potential impact in the more complex healthcare environment is less predictable. The provisions of the federal HPT rule (which took effect in January 2021) require hospitals to publish machine-readable charge data and consumer-friendly prices for at least 300 shoppable services. However, compliance has been inconsistent, and heterogeneous data formats hamper use of the data. Nonetheless, visible prices can inform patient choices, strengthen payer negotiations, and foster competition, underscoring the urgency of robust HPT. CONCLUSION: Low compliance with the HPT rule limits the ability of the Centers for Medicare & Medicaid Services to gauge market effects. While HPT alone cannot resolve structural cost drivers, it establishes a foundation for value-based purchasing, competitive pricing, and future payment reform.
Am J Health Syst Pharm
· 2026 Jun · PMID 41570120
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PURPOSE: This article provides a concise evaluation of the monoclonal antibodies that have received regulatory approval for prevention of respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) in certai...PURPOSE: This article provides a concise evaluation of the monoclonal antibodies that have received regulatory approval for prevention of respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) in certain pediatric groups, with an emphasis on key considerations for pharmacists to aid in clinical decision-making, medication access, and patient education. SUMMARY: RSV monoclonal antibodies have emerged as a critical preventative strategy, particularly in infants and young children. For over 25 years, palivizumab was administered in select pediatric populations; however, it is no longer preferred due to the improved efficacy, duration of protection, and convenience of administration of newer agents. The recently FDA-labeled monoclonal antibodies nirsevimab and clesrovimab demonstrate strong efficacy in preventing RSV LRTD and have favorable safety profiles. Regulatory approval and guidance from national health authorities continue to shape the appropriate use of these therapies across different patient groups. CONCLUSION: The utility of RSV monoclonal antibodies continues to evolve, with these antibodies offering promising targeted, durable protection against a virus that remains a major cause of morbidity in infants and young children. Ongoing surveillance, real-world evidence, and continued innovation will further refine the role of these agents in clinical practice. Pharmacists play a pivotal role in evaluating appropriate candidates for therapy, navigating payor and formulary requirements, and educating caregivers and healthcare teams on administration, storage, and monitoring.
Canedo JE, Andrews E, Mabry WA
… +4 more, Allen DC, Robertson J, Hoffman JM, Aguero D
Am J Health Syst Pharm
· 2026 Jan · PMID 41570085
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PURPOSE: Drug shortages pose a serious threat to the quality of healthcare provided to patients, particularly in a pediatric care setting. The Delphi method was used to develop acuity scores for medication supply chain r...PURPOSE: Drug shortages pose a serious threat to the quality of healthcare provided to patients, particularly in a pediatric care setting. The Delphi method was used to develop acuity scores for medication supply chain redundancy planning. We prioritized redundancy measures for medications for which a shortage would result in the greatest disruption to patient care. SUMMARY: The acuity scoring system developed at St. Jude Children's Research Hospital included 4 primary criteria: historical supply disruption, medication unit cost, operational impact, and clinical impact. A list of medications was developed based on disruptive supply distributor patterns and carrying cost classification for inventory valuation. To rank the medications of highest priority, the Delphi method facilitated consensus over 2 rounds of scoring to assess operational and clinical impact. Medications with less than 75% agreement were addressed in the first round, and 80% consensus was achieved in the second round. After weighting operational and clinical impact scores based on cutoff standard deviations, the scores for all 4 primary criteria were combined, with the final aggregated shortage list containing 95 medications and formulation combinations. The top 10 medications of highest priority (acuity) had similar operational and clinical impact scores. CONCLUSION: This approach and the proposed scoring algorithm can be used by other institutions to implement shortage mitigation and resilience measures. Future research could assess the reliability of this scoring algorithm for use at other institutions.
Am J Health Syst Pharm
· 2026 Jan · PMID 41569796
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PURPOSE: This article reviews adjunctive medications utilized to increase the quantity of viable organs available for procurement and optimize donor graft function. SUMMARY: In response to the growing demand for transpla...PURPOSE: This article reviews adjunctive medications utilized to increase the quantity of viable organs available for procurement and optimize donor graft function. SUMMARY: In response to the growing demand for transplantable organs, various procurement methods and adjunctive medications are being explored to improve outcomes. Research in transplantation often involves small patient populations and limited randomized trials, resulting in a paucity of strong evidence for many interventions. The most robust data support fluid, hemodynamic, and hormone therapy management. However, the last comprehensive review of pharmacotherapy commonly utilized for this indication was in 2016. Newer adjuncts-such as naloxone, heparin, and alteplase-are increasingly being incorporated into local protocols. As pharmacists are responsible for verifying appropriate dosing and timing of these medications, it is essential that they remain up to date with the latest literature. Their familiarity with this evolving evidence base enables them to support the medical team and local organ procurement organizations in improving transplantation outcomes. CONCLUSION: The literature surrounding strategies to optimize organ donation is continuously evolving. Pharmacotherapy plays a critical role in ensuring positive outcomes, and emerging therapies aim to further expand the available donor pool and improve recipient outcomes. While hemodynamic optimization remains central, newer agents such as naloxone, alteplase, and heparin are gaining relevance in clinical practice.
Am J Health Syst Pharm
· 2026 May · PMID 41549325
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PURPOSE: The purpose of this study was to assess demographic and clinical characteristics and potential risk factors for linezolid-associated serotonin toxicity in patients receiving linezolid and concomitant serotonergi...PURPOSE: The purpose of this study was to assess demographic and clinical characteristics and potential risk factors for linezolid-associated serotonin toxicity in patients receiving linezolid and concomitant serotonergic agents. METHODS: This was a single-center, retrospective, single-cohort study. Adults at least 18 years of age who were ordered linezolid from January 1, 2014, through October 31, 2023, were screened for inclusion. Patients were included if they received at least one dose of linezolid and a concomitant serotonergic agent. Patients were excluded if the medications were administered more than 24 hours apart or if the patient was pregnant or lactating. All concomitant serotonergic agents were assessed and assigned a dose category based on typical dosing ranges for FDA-approved indications. Serotonin toxicity was assessed utilizing data from the electronic medical record and was defined according to the Sternbach or Hunter criteria. RESULTS: Of the 615 patients screened, 227 adults met the inclusion criteria with administration of linezolid and a concomitant serotonergic agent. The mean age was 62.4 years, and the mean duration of linezolid treatment was 5.5 days. Most patients were administered only one concomitant medication (59.9%), and most were classified as receiving a low dose (69.1%). Only 2 patients (0.9%) were identified with possible serotonin toxicity as defined by the Sternbach or Hunter criteria, with one case possibly associated with linezolid. CONCLUSION: The incidence of serotonin toxicity in hospitalized patients receiving linezolid with concomitant serotonergic agents was low in our study. Linezolid is likely safe in patients receiving select concomitant agents.
Am J Health Syst Pharm
· 2026 Jan · PMID 41525346
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PURPOSE: The Institute for Safe Medication Practices (ISMP) collected data about vaccine-related errors, resulting in a new targeted medication safety best practice for vaccine error prevention strategies. ISMP best prac...PURPOSE: The Institute for Safe Medication Practices (ISMP) collected data about vaccine-related errors, resulting in a new targeted medication safety best practice for vaccine error prevention strategies. ISMP best practice 22 includes 10 interventions that should be implemented to safeguard against vaccine-related errors in the inpatient and outpatient settings. The goal of this publication is to outline operational and electronic health record (EHR)-based interventions that have been successfully implemented to mitigate vaccine errors. SUMMARY: The goal of the Cleveland Clinic Health System vaccine governance committee is to maintain a vaccine formulary that maximizes adherence to published adult and childhood immunization schedules while minimizing the risk of error. EHR-based interventions to address ISMP best practice 22 were implemented and include standardization of vaccine nomenclature and EHR alerts prior to vaccine administration to prevent errors related to wrong interval, wrong dose, or wrong age. Additionally, ordering decision support was implemented to display vaccine orders to providers through groupings of orders. Administration-specific questions were also added to improve vaccination practices and reduce the risk of error at the time of vaccine administration. CONCLUSION: Overall, a variety of EHR-based mechanisms have been used to ensure the safety and effectiveness of the vaccine-use process. Guidance from external governing bodies, namely ISMP, has been evaluated in relation to current tools and practices and promoted using EHR tools. While there are gaps that have been identified, the effort to ensure patient safety for vaccinations and adherence to guidance is clear.
Meftah M, Chelly F, Ben Hammamia R
… +5 more, Denguir N, Enneb Z, Hajjem A, Ayed A, Felfel H
Am J Health Syst Pharm
· 2026 Jun · PMID 41512106
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PURPOSE: This study highlights the role of a Tunisian hospital pharmacy department in the management of rabies. METHODS: This prospective and descriptive study was conducted over a 6-month period, from July through Decem...PURPOSE: This study highlights the role of a Tunisian hospital pharmacy department in the management of rabies. METHODS: This prospective and descriptive study was conducted over a 6-month period, from July through December 2024, in the pharmacy department of Mongi Slim hospital. It evaluated both hospital and clinical pharmacy activities related to rabies management. Hospital pharmacy activities included human resource management, procuring rabies immunobiologicals, controlling stock, and monitoring the cold chain. Clinical activities involved reviewing post-exposure prophylaxis (PEP) prescriptions, distributing standardized protocols, and running awareness campaigns. RESULTS: Pharmacy staff worked within a structured system to ensure accurate PEP dispensing. A dedicated pharmacist coordinated with the regional health directorate to maintain an uninterrupted supply of antirabies treatments. Pharmacy interns and technicians performed daily double checks of stock, while refrigerator tag monitoring and manual temperature checks ensured the integrity of the cold chain. Clinical pharmacists reviewed prescriptions, identified errors, and worked with physicians to correct them. Standardized PEP protocols were distributed to healthcare providers to improve adherence and patient safety. Awareness campaigns led by pharmacists, interns, and residents promoted community engagement in rabies prevention. CONCLUSION: The hospital pharmacy department played a critical role in ensuring continued access to and proper administration of PEP, thereby supporting national rabies control efforts.
Am J Health Syst Pharm
· 2026 Jun · PMID 41507036
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PURPOSE: A case of severe coagulopathy induced by treatment with cefazolin and rifampin is described. SUMMARY: A 72-year-old male presented for generalized weakness accompanied by chills and fevers. Infectious workup rev...PURPOSE: A case of severe coagulopathy induced by treatment with cefazolin and rifampin is described. SUMMARY: A 72-year-old male presented for generalized weakness accompanied by chills and fevers. Infectious workup revealed methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and mechanical aortic valve endocarditis with perivalvular abscess. The patient was initially treated with intravenous cefazolin and gentamicin until surgical valve replacement. His postoperative course was complicated by acute kidney injury, and antimicrobial therapy was transitioned to cefazolin and rifampin. On postoperative day 10, the patient acutely developed hypotension requiring vasopressor support and respiratory failure secondary to volume overload requiring initiation of continuous renal replacement therapy. Significant oozing was observed from puncture sites and large-volume hemoptysis. Coagulation studies revealed an undetectable international normalized ratio (INR) and prothrombin time (PT) and a prolonged activated partial thromboplastin time (aPTT). In the absence of alternative causes, rifampin-induced coagulopathy was implicated as the probable cause. Prescribing information for rifampin provides a warning for concomitant therapy with cefazolin and rifampin due to a risk of prolonged PT and severe vitamin K-dependent coagulation disorders. CONCLUSION: Current guidelines recommend treatment of MSSA prosthetic valve endocarditis with combination therapy consisting of cefazolin or an antistaphylococcal penicillin and rifampin, with the addition of gentamicin for the first 2 weeks of therapy. Rifampin-induced coagulopathy and cefazolin-induced coagulopathy due to hypoprothrombinemia have been rarely reported. Concomitant therapy with rifampin and cefazolin may exacerbate coagulopathy, particularly in the setting of renal dysfunction, thus coagulation studies should be closely monitored if combination therapy is indicated.
Mueller HJ, Barner JC, Odonkor GN
… +2 more, Brown CM, Stewart MP
Am J Health Syst Pharm
· 2026 Jan · PMID 41505450
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PURPOSE: To describe ambulatory care pharmacists' beliefs and confidence in managing diabetes in perinatal women through guided interviews based on the Theory of Planned Behavior (TPB). METHODS: This qualitative study co...PURPOSE: To describe ambulatory care pharmacists' beliefs and confidence in managing diabetes in perinatal women through guided interviews based on the Theory of Planned Behavior (TPB). METHODS: This qualitative study consisted of a web-based presurvey and semistructured virtual interviews with ambulatory care pharmacists practicing at a federally qualified health center (FQHC) system to elicit salient beliefs about managing diabetes in perinatal women using the following TPB constructs: behavioral beliefs (BB), normative beliefs (NB), and control beliefs (CB). Descriptive statistics were conducted for quantitative data. Interviews were transcribed and analyzed by 2 independent researchers. RESULTS: The pharmacist participants (N = 8) were all female and predominantly white (62.5%) and 35 to 44 years of age (87.5%). The majority (87.5%) were board certified in ambulatory care pharmacy, with 6 or more years of experience (75%). When the pharmacists were asked to rate the frequency of their involvement in managing diabetes in perinatal women in current or previous practice settings on a 5-point Likert scale (1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always), the mean (SD) score was 2.9 (1.1). When the pharmacists were asked to rate their confidence in their ability to manage diabetes in perinatal populations on a different Likert scale, the mean (SD) score of 3.8 (1.0) indicated a moderate level of confidence. Thirteen salient beliefs emerged (BB, n = 5; NB, n = 4; CB, n = 4), and pharmacists had positive BB, positive NB, and negative CB toward managing diabetes in perinatal women. "Improved patient outcomes" was the most prevalent BB. For NB, all participants expressed that patients would be in support of pharmacists managing their diabetes in pregnancy. For CB, restrictive collaborative practice agreements emerged as the most salient barrier. CONCLUSION: Pharmacists who participated in this study were not routinely involved in perinatal diabetes management despite being moderately confident in their ability to provide such services, having positive BB, and believing their patients would be supportive. Pharmacists had negative CB, and future interventions can focus on addressing these barriers.
Makhija H, Davidson JE, Barnes A
… +4 more, Zisook S, Choflet A, Nguyen N, Lee KC
Am J Health Syst Pharm
· 2026 Jan · PMID 41502143
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PURPOSE: Pharmacists and pharmacy technicians are essential healthcare professionals with limited data on their risk for suicide. METHODS: Using the National Violent Death Reporting System, pharmacist, pharmacy technicia...PURPOSE: Pharmacists and pharmacy technicians are essential healthcare professionals with limited data on their risk for suicide. METHODS: Using the National Violent Death Reporting System, pharmacist, pharmacy technician, and general population suicides (for individuals 25 years of age or older) were identified. Suicide incidence was estimated from 2011 to 2022 due to data limitations, while suicide characteristics (preceding circumstances, method, and toxicology) were analyzed in adjusted Firth logistic regression models from 2005 to 2022. RESULTS: A total of 369 pharmacist (87 [24%] female), 243 pharmacy technician (149 [61%] female), and 245,114 general population (52,890 [22%] female) suicides were found for the period from 2011 to 2022. When data were standardized by sex, pharmacists had a higher risk of suicide (incidence rate ratio [IRR], 1.21; 95% confidence interval [CI], 1.09-1.34) while pharmacy technicians had a lower risk (IRR, 0.86; 95% CI, 0.74-0.99) than individuals in the general population during the 2011-2022 study period. Male pharmacists had a higher risk of suicide than other males (IRR, 1.25; 95% CI, 1.11-1.41) while female technicians had a higher risk than other females (IRR, 1.22; 95% CI, 1.04-1.44) during the 2011-2022 study period. In terms of the features associated with suicide, compared to the general population, pharmacists had higher odds of preceding job problems, while pharmacy technicians had higher odds of mental health problems. Pharmacists also had higher odds of using poisoning as a method. CONCLUSION: Our findings suggest that pharmacists and female pharmacy technicians are at higher risk of suicide than their counterparts from the general population, possibly indicating that increased awareness and prevention are warranted.
Choquette R, Côté-Sergerie C, Roy H
… +1 more, Tanguay C
Am J Health Syst Pharm
· 2026 May · PMID 41502018
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PURPOSE: Investigational drug services (IDS) rely on trial documentation to manage investigational products (IPs). Trial start-up can be delayed when essential information is missing. The objective of this study was to a...PURPOSE: Investigational drug services (IDS) rely on trial documentation to manage investigational products (IPs). Trial start-up can be delayed when essential information is missing. The objective of this study was to assess the completeness of information provided in protocols and pharmacy manuals for IDS. METHODS: This retrospective descriptive study was conducted in the IDS of a 500-bed mother-child university health center. Clinical trials open for recruitment as of April 14, 2023, were included. The latest versions of protocols and pharmacy manuals were evaluated for information on prohibited medications, dosage, storage, concentration, packaging, and preparation. The frequency of pharmacy manual availability was compared by sponsor type using a bilateral χ2 test. RESULTS: Sixty trials and 83 IPs were included in the study. Most trials were phase 3 trials (33/60, 55%) and targeted pediatric populations (56/60, 93%). Trials with a commercial sponsor (33/36, 92%) were significantly more likely to supply a pharmacy manual than those with institutional sponsors (13/24, 54%) (P < 0.001). Important elements that were not always present included a list of specific prohibited medications (26/76 IPs, 34%), the maximum dose (14/19, 74%), storage requirements (60/83, 72%), the concentration (69/83, 83%), and the beyond-use date after preparation (26/38, 38%). Documents seldom included elements such as rounding rules (3/23, 13%) and packaging dimensions (4/83, 5%). CONCLUSION: This study highlighted a lack in clinical trial documentation of some elements required by IDS. Comprehensive documents may expedite pharmacy start-up of clinical trials. Thorough information is needed to support participant safety and data integrity. These documentation gaps underscore the need for improved collaboration between industry sponsors and IDS.
Xu O, Graven P, Downs S
… +7 more, Orwoll B, Chintalapani A, Hudkins M, Hubel K, Chen ZJ, Eriksson C, Merkel M
Am J Health Syst Pharm
· 2026 Jun · PMID 41499452
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PURPOSE: In September 2024, Hurricane Helene disrupted a key North Carolina facility producing 60% of medical-grade fluids in the United States, causing a nationwide intravenous fluid (IVF) shortage and prompting urgent...PURPOSE: In September 2024, Hurricane Helene disrupted a key North Carolina facility producing 60% of medical-grade fluids in the United States, causing a nationwide intravenous fluid (IVF) shortage and prompting urgent conservation in hospitals. The impact of these efforts on patient outcomes remains poorly understood. The purpose of this study is to examine the effect of a hospital-wide fluid conservation strategy on the incidence of acute kidney injury (AKI). METHODS: A single-site retrospective study was conducted between January 1, 2024, and December 4, 2024, at an academic hospital. The hospital was exposed to a multifaceted fluid conservation intervention, including education, a tiered conservation approach, perioperative protocol change, digital interventions to support clinical decision-making, and performance monitoring and feedback. Baseline data was collected for 10 months, and intervention period data was collected for 8 weeks. RESULTS: In total, 21,017 hospitalizations before and 3,494 hospitalizations after the intervention were reviewed. The rate of AKI did not change significantly (17.9% vs 18.4%; P = 0.37) despite a 34% per patient-day reduction in IVF utilization (590 mL vs 388 mL). There was no statistically significant impact on the incidence of critical care admissions from a ward (23.4% vs 23.9%; P = 1.00) or mean hospital length of stay (6.8 days vs 7.2 days; P = 0.07). Mortality, the rate of dialysis, vasopressor utilization, and rapid response activations for hypotension were evaluated; however, statistical significance was not reached due to low frequency. CONCLUSION: In this study, a multifaceted fluid conservation approach significantly reduced IVF utilization without a concomitant increase in patient adverse outcomes.
Hellwig T, Jansma Vant Hul B, Schaar M
… +2 more, Shehzad D, Ahmed M
Am J Health Syst Pharm
· 2026 Jun · PMID 41498215
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PURPOSE: A case is reported in which the anti-factor Xa activity of enoxaparin was measured during therapeutic plasma exchange (TPE). SUMMARY: A 52-year-old male underwent TPE for antineutrophil cytoplasmic antibody-asso...PURPOSE: A case is reported in which the anti-factor Xa activity of enoxaparin was measured during therapeutic plasma exchange (TPE). SUMMARY: A 52-year-old male underwent TPE for antineutrophil cytoplasmic antibody-associated vasculitis while receiving therapeutic enoxaparin. Enoxaparin anti-factor Xa levels were measured before and immediately after TPE sessions as well as outside TPE sessions. The calculated enoxaparin half-life during TPE was 0.897 hours, whereas the calculated half-life outside TPE was 5.26 hours, demonstrating that the half-life of enoxaparin is dramatically shortened during TPE. CONCLUSION: Enoxaparin's anti-factor Xa activity should be monitored and dosing schedules should be adjusted to ensure therapeutic enoxaparin levels in all patients receiving TPE.
Karas BL, Golf M, Shepard E
… +3 more, Cherry M, Levitsky AM, Rim MH
Am J Health Syst Pharm
· 2026 Mar · PMID 41473968
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PURPOSE: Health-system pharmacists play a crucial role in monitoring the pharmaceutical pipeline to manage formularies, allocate resources, and optimize clinical programs for new therapies. This article aims to support p...PURPOSE: Health-system pharmacists play a crucial role in monitoring the pharmaceutical pipeline to manage formularies, allocate resources, and optimize clinical programs for new therapies. This article aims to support pharmacists by providing updates on new and anticipated novel drug approvals. SUMMARY: Selected drug approvals anticipated in the 12-month period covering the fourth quarter of 2025 through the third quarter of 2026 are reviewed. The analysis emphasizes drugs expected to have significant clinical and financial impact in hospitals and clinics, as selected from 41 novel drugs awaiting US Food and Drug Administration approval. This year's pipeline features novel therapies for various disease states, including rare diseases, Wiskott-Aldrich syndrome, and mucopolysaccharidosis type II, as well as targeted cancer treatments and cell and gene therapies. CONCLUSION: Novel therapies continue to strengthen the current drug pipeline.