Am J Health Syst Pharm
· 2026 Jun · PMID 42261098
·
Publisher ↗
PURPOSE: To describe a case of severe acute hepatitis in an adolescent in whom fosfomycin was identified as the highly probable cause of drug-induced liver injury (DILI) and to highlight the potential hepatotoxicity of f...PURPOSE: To describe a case of severe acute hepatitis in an adolescent in whom fosfomycin was identified as the highly probable cause of drug-induced liver injury (DILI) and to highlight the potential hepatotoxicity of fosfomycin. SUMMARY: A previously healthy 17-year-old male presented with nausea, vomiting, fever, and progressive epigastric pain over 3 days, accompanied by fatigue and malaise. Laboratory testing revealed marked hepatocellular injury, coagulopathy, metabolic acidosis, mild pre-renal acute kidney injury, and elevated inflammatory markers. Imaging demonstrated hepatomegaly with ascites, without biliary obstruction or vascular abnormalities. Extensive evaluation excluded viral hepatitis, autoimmune liver disease, Wilson's disease, ischemic hepatitis, zoonotic infections, and other potential hepatotoxic exposures. Within the 15 days before symptom onset, the patient had completed a 7-day course of oral fosfomycin 500 mg every 8 hours for renal colic-associated dysuria, with no other medications linked to liver injury. Clinical deterioration with hypotension and oliguria required admission to the intensive care unit, where the patient improved with supportive management during a 4-day stay. Using the Roussel-Uclaf Causality Assessment Method (RUCAM), the score was 9, indicating a highly probable association between fosfomycin and the liver injury. Levels of liver enzymes gradually normalized, and the patient was discharged with full recovery. CONCLUSION: Although fosfomycin is widely used and generally well tolerated, clinicians should remain vigilant for this rare but potentially serious adverse effect. Early recognition and prompt discontinuation of the suspected agent are essential. Reporting uncommon adverse reactions helps strengthen pharmacovigilance and supports safer therapeutic decision-making.
Aguero B, Ham Y, Diaz A
… +2 more, Spinar M, Narayanaswami P
Am J Health Syst Pharm
· 2026 Jun · PMID 42258670
·
Publisher ↗
PURPOSE: To describe development and implementation of a "clear bagging" workflow to improve coordination of vaccinations after hematopoietic stem cell transplantation (HSCT) while maintaining clinic-based administration...PURPOSE: To describe development and implementation of a "clear bagging" workflow to improve coordination of vaccinations after hematopoietic stem cell transplantation (HSCT) while maintaining clinic-based administration and reimbursement. SUMMARY: Vaccines administered during clinic visits are often billed through medical insurance using a buy-and-bill model, which can result in patient claim denials and subsequent institutional write-offs, particularly for Medicare beneficiaries. To address this, health systems have adopted alternative distribution models such as clear bagging, whereby an internal pharmacy dispenses medication for on-site administration, supporting care coordination and reimbursement retention. At Oregon Health & Science University (OHSU), patients receiving HSCT complete a 24-month posttransplant vaccination protocol at an ambulatory oncology clinic. To address challenges associated with medical billing for these vaccines, a clear bagging workflow for post-HSCT vaccinations was implemented to route vaccine dispensing through an internal outpatient pharmacy while maintaining clinic-based administration. The implementation leveraged an existing post-HSCT vaccination protocol within the electronic health record (EHR) by incorporating electronic prescriptions that are routed by default to an OHSU outpatient pharmacy. A dedicated outpatient pharmacy work queue captured vaccine prescriptions originating from the EHR protocol, ensuring efficient identification and prioritization for dispensing. Implementation established a standardized workflow for vaccine distribution, documentation, and billing. Over the first 10 weeks after workflow implementation, 173 vaccine prescriptions were processed through the clear bagging workflow. Projected increased reimbursement was $1,655 per Medicare patient completing the 24-month post-HSCT vaccination protocol. CONCLUSION: This report demonstrates that clear bagging can be an effective model for vaccine delivery in oncology populations, reducing administrative burden while supporting both patient care and institutional protocols.
Am J Health Syst Pharm
· 2026 Jun · PMID 42258622
·
Publisher ↗
PURPOSE: Mechanically ventilated emergency department (ED) patients require appropriate postintubation sedation and analgesia. Many investigators have published reports of their interventions to improve ED postintubation...PURPOSE: Mechanically ventilated emergency department (ED) patients require appropriate postintubation sedation and analgesia. Many investigators have published reports of their interventions to improve ED postintubation sedation and analgesia, but this work has not been systematically or critically evaluated. METHODS: We performed a systematic review of studies reporting original clinical research on interventions to improve ED postintubation sedation and analgesia. We identified studies for inclusion via a secondary analysis of a recent scoping review on ED postintubation sedation and analgesia. Two investigators independently abstracted data and graded study quality; a third investigator adjudicated any disagreements. RESULTS: We identified 22 studies meeting our inclusion criteria, of which 11 were conference abstracts. Meta-analysis was not pursued due to substantial heterogeneity, primarily in outcome definitions. Methods described included educational interventions (n = 18) and protocols, guidelines, order sets, and checklists (n = 16). Ten studies reported improvement in a prespecified primary outcome directly related to ED postintubation sedation. Outcome definitions were heterogeneous. Most interventions were not described in adequate detail to permit replication, and implementation science techniques and frameworks were identified in only 3 studies. CONCLUSION: There is a small- to moderate-sized body of evidence to guide interventions to improve ED postintubation sedation and analgesia that is limited by heterogeneous outcome definitions and poor reporting of methods. Future work should include consistent, patient-centered outcome selection and rigorous reporting in adherence to guidelines on education and implementation research.
Tulio C, Neidecker MV, Hudson-DiSalle S
… +3 more, Polley S, Pilz J, Kennerly-Shah JM
Am J Health Syst Pharm
· 2026 Jun · PMID 42257403
·
Publisher ↗
PURPOSE: To reduce administrative burden and support timely access to payor-preferred therapies, The Ohio State University Wexner Medical Center (OSUWMC) initiated an electronic health record (EHR)-based program in 2021...PURPOSE: To reduce administrative burden and support timely access to payor-preferred therapies, The Ohio State University Wexner Medical Center (OSUWMC) initiated an electronic health record (EHR)-based program in 2021 to automate product selection for biologics and biosimilars, which was later expanded to intravenous (IV) iron in 2024. SUMMARY: The program was designed by pharmacy informaticists in collaboration with managed care, finance, and clinical stakeholders. Advanced order groups were utilized in the treatment plan workflows, with payor and formulary logic embedded to enable automatic product selection at order entry. Postimplementation surveys of pharmacists (n = 17) and prior authorization (PA) team members (n = 5) demonstrated satisfaction: 94% of pharmacists and 60% of PA team members reported being very or somewhat satisfied. Pharmacists estimated a time savings of 3.2 minutes per treatment plan modification, while PA team members estimated a time savings of 8.8 minutes per authorization, totaling approximately 460 staff hours saved over 2 years. Turnaround time (TAT) was defined as the interval from PA submission to payor approval using EHR timestamps, and the data were cleaned to exclude duplicate referrals, reauthorizations, manufacturer assistance program cases, and TATs of more than 60 days. In the 3 months before implementation, the median total TAT was 1.77 days (interquartile range [IQR], 0.11-7.95 days; n = 153) vs 1.81 days (IQR, 0.53-7.80 days, n = 226) in the 3 months after implementation, a 0.04-day increase (P = 0.29). The average TAT improved from 5.75 days to 5.22 days, a 0.53-day (9%) reduction. Staff reported fewer manual substitutions, fewer delays in therapy initiation, improved accuracy of product selection, and reduced billing risk. CONCLUSION: The OSUWMC autoselection program improved operational efficiency, reduced administrative workload, and supported timely patient care. Its adaptability and interdisciplinary design offer a scalable model for other health systems pursuing EHR-based strategies to align with payor requirements.
Booth J, Brimmer J, Thirwani A
… +3 more, Nelson M, Lopez B, Forshay C
Am J Health Syst Pharm
· 2026 Jun · PMID 42252932
·
Publisher ↗
PURPOSE: This project aimed to develop, implement, and evaluate an automatic scheduled dispensing workflow for titratable and nontitratable continuous infusions leveraging infusion pump integration within the electronic...PURPOSE: This project aimed to develop, implement, and evaluate an automatic scheduled dispensing workflow for titratable and nontitratable continuous infusions leveraging infusion pump integration within the electronic health record. SUMMARY: Infusion pump integration allows the development of a scheduled dispensing workflow, in which the electronic health record automatically schedules the next dispense for a continuous infusion based on the administered rate and volume of the medication. This functionality streamlines pharmacy and nursing workflows by eliminating the need for manual re-dispensing pursuant to manual tracking or nursing-to-pharmacy electronic requests. An automatic scheduled dispensing workflow was developed and piloted at a select pharmacy, with subsequent expansion throughout the health system. A retrospective, descriptive analysis was performed comparing the following data points before and after implementation: total dispenses, bags returned, and in-basket messages for continuous infusion dispenses. At the pilot site and the expansion sites, after implementation the number of in-basket messages per continuous infusion dispense decreased by 49% and 65%, respectively. An increase in the number of medication returns and the number of wasted bags per continuous infusion dispense was observed for both the pilot site and the expansion sites. CONCLUSION: A continuous infusion scheduled dispensing workflow was successfully implemented within a health system. This workflow resulted in a reduction in nursing-to-pharmacy in-basket message communication per dispense, with an increase in returns and waste.
Olson AW, Pradhan A, Whary P
… +6 more, Dombrowski SK, Dobbins D, Ward T, Obert K, Siegrist CN, Wright EA
Am J Health Syst Pharm
· 2026 Jun · PMID 42252749
·
Publisher ↗
PURPOSE: Ambient documentation tools (ADTs) are an emerging technology designed to help clinicians complete documentation more effectively with less time and effort. This study aimed to understand the impact of ADT on th...PURPOSE: Ambient documentation tools (ADTs) are an emerging technology designed to help clinicians complete documentation more effectively with less time and effort. This study aimed to understand the impact of ADT on the pharmacist care experience. METHODS: Data from Epic Signal, surveys, and interviews were collected between February 2024 and October 2025 for 41 medication therapy disease management (MTDM) pharmacists given ADT licenses across 33 primary care and subspecialty clinics at a large integrated health system. Study variables included the pharmacist ADT utilization rate and changes from before to after ADT implementation in the time spent in notes per encounter, as well as pharmacists' perceptions of documentation burden, patient access, undivided attention for patients, afterhours documentation, and burnout. Quantitative data were analyzed using descriptive statistics, regression models, and comparative tests of pre- vs postimplementation statistical significance and effect size. Qualitative data were mined for exemplary excerpts to deepen understanding. RESULTS: Thirty pharmacists from 28 clinics utilized ADT and provided usable responses. ADT was utilized for 65% of eligible encounters, and the average time in notes per encounter fell by 86 seconds after ADT implementation (P < 0.001). Pharmacist perceptions of documentation burden (P < 0.0001), undivided attention ability (P < 0.0001), and afterhours documentation (P = 0.003) improved after ADT implementation. Interview responses were largely positive for most variables and revealed multiple explanatory mechanisms. CONCLUSION: ADT meaningfully improved several care experience aspects for MTDM pharmacists over a short period of time (in 2 to 7 months). Future research with larger samples and longer time horizons across multiple health systems is needed to investigate the full and sustained impact of ADT on the care experience.
Am J Health Syst Pharm
· 2026 Jun · PMID 42252739
·
Publisher ↗
PURPOSE: Gonadotropin-releasing hormone (GnRH) analogs are widely used in the treatment of hormone-dependent conditions such as prostate cancer, breast cancer, and central precocious puberty. These agents suppress sex ho...PURPOSE: Gonadotropin-releasing hormone (GnRH) analogs are widely used in the treatment of hormone-dependent conditions such as prostate cancer, breast cancer, and central precocious puberty. These agents suppress sex hormone secretion by persistently downregulating the hypothalamic-pituitary-gonadal axis. To improve convenience and adherence, various long-acting injectable formulations, administered monthly, quarterly, or every 6 months, have been developed. However, there is ongoing debate regarding the relative advantages and optimal choice among these formulations. SUMMARY: Evidence from clinical trials and real-world studies suggests that the efficacy and safety of multimonthly formulations are equivalent to or noninferior to those of monthly variants and produce similar clinical outcomes in hormone suppression and disease control. In addition, multimonthly injections are associated with fewer hospital visits, improved adherence to treatment, lower indirect costs, and improved quality of life for patients. CONCLUSION: Although differences in pharmacokinetics and initial hormonal responses have been observed, they do not translate into meaningful differences in clinical outcomes. Long-acting GnRH analogs are equally effective and offer a more efficient, patient-centered approach to managing hormone-dependent diseases.
Am J Health Syst Pharm
· 2026 Jun · PMID 42252737
·
Publisher ↗
PURPOSE: Personal health records (PHRs) enhance patient engagement by allowing individuals to manage their health data, including medications, laboratory results, and treatment plans. Despite increasing PHR adoption, the...PURPOSE: Personal health records (PHRs) enhance patient engagement by allowing individuals to manage their health data, including medications, laboratory results, and treatment plans. Despite increasing PHR adoption, the role of pharmacists in PHR-based interventions remains underexplored. This scoping review aimed to characterize how PHRs have been used in pharmacy practice and the roles pharmacists have played in PHR-facilitated patient care. SUMMARY: Ten studies met the inclusion criteria, 9 conducted in the United States and 1 in China. Since 2020, application-based PHR platforms have become more prominent, particularly among patients with chronic conditions. The predominant PHR type was a hospital-integrated patient portal incorporating reminders and secure messaging. Across studies, pharmacists contributed to clinical reviews, therapeutic drug monitoring, adverse drug reaction (ADR) management, medication reconciliation, and patient education. Recent research highlighted increasing use of patient-reported outcomes, with a focus on adverse drug events, adherence, and pharmacist-patient communication. CONCLUSION: This review found that PHRs have been used in pharmacy practice to support medication safety, optimize therapeutic outcomes, and promote patient-centered care. Standardizing pharmacist-led interventions and addressing barriers such as interoperability, patient engagement, and digital literacy are critical next steps for integrating PHRs into clinical pharmacy practice.
Pashaeimofrad A, Schriever C, Rosella T
… +1 more, Carmichael A
Am J Health Syst Pharm
· 2026 May · PMID 42207568
·
Publisher ↗
PURPOSE: To describe the implementation and outcomes of a pharmacist-led initiative designed to improve access to continuous glucose monitoring (CGM) technology for adults with uncontrolled type 2 diabetes at a Federally...PURPOSE: To describe the implementation and outcomes of a pharmacist-led initiative designed to improve access to continuous glucose monitoring (CGM) technology for adults with uncontrolled type 2 diabetes at a Federally Qualified Health Center (FQHC). SUMMARY: Uncontrolled diabetes remains highly prevalent among underserved populations and contributes to major health disparities. CGM can enhance glycemic control and patient engagement, yet in resource-limited communities access remains a major issue. Pharmacists are positioned to address these disparities by facilitating education, device access, and insurance navigation. CONCLUSION: Pharmacist-led interventions at an FQHC substantially improved access to CGM devices for patients with uncontrolled diabetes. Through direct education, payor navigation, and device coordination, pharmacists mitigated common financial and logistical barriers to care. This model offers a potential scalable strategy to advance health equity in access to diabetes technology.
Kiskaddon AL, Johnson PN, Dallas L
… +11 more, Stang C, Beckman E, Gattis S, Smith C, Pingle J, Butchin J, Ordons KJ, Amankwah EK, Witt DM, Rech MA, Goldenberg NA
Am J Health Syst Pharm
· 2026 May · PMID 42148541
·
Publisher ↗
PURPOSE: Pharmacists play a crucial role in managing antithrombotic therapy in critically ill adults; however, data on this topic in critically ill children are limited. Therefore, we sought to characterize the types of...PURPOSE: Pharmacists play a crucial role in managing antithrombotic therapy in critically ill adults; however, data on this topic in critically ill children are limited. Therefore, we sought to characterize the types of antithrombotic therapy interventions provided by pediatric pharmacists. SUMMARY: Via a multicenter, prospective, observational study at 9 children's hospitals in the United States, pediatric pharmacists in the pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), mixed intensive care unit (ICU), and pediatric cardiac intensive care unit (PCICU) at participating centers recorded recommendations made during clinical activities during at least 20 shifts. Interventions were documented in a central REDCap database. Descriptive statistics were used to summarize the data. From July 2023 to November 2024, a total of 41 pediatric pharmacists from 9 participating institutions completed data collection on interventions during 697 shifts. A total of 12,632 accepted interventions for 2,264 patients were recorded. Among the 12,632 interventions, 1,130 (9%) were antithrombotic-related interventions, involving 693/2,264 (26.4%) patients. Most antithrombotic medication interventions occurred in the PCICU (844/1,130, 74.7%). Approximately half of the antithrombotic interventions were related to antithrombotic initiation/management (n = 607/1,130, 53.7%), with the majority involving an anticoagulant medication(s) (549/607, 90.4%). CONCLUSION: The majority of antithrombotic interventions in critically ill children were in the PCICU and involved anticoagulation for thromboembolism treatment and prevention. Further research is warranted to evaluate pediatric pharmacist-driven clinical services and the impact on antithrombotic outcomes in critically ill children, particularly those with cardiac disease.
Patel AN, Curtin CR, Ortiz K
… +4 more, Valencia D, Martin R, Runge M, Wicks J
Am J Health Syst Pharm
· 2026 May · PMID 42120928
·
Publisher ↗
PURPOSE: To assess the comprehensive workflow and time and motion activities associated with hospital pharmacy and nursing staff for a cephalosporin antibiotic in 3 different marketed formulations: (1) a formulation prep...PURPOSE: To assess the comprehensive workflow and time and motion activities associated with hospital pharmacy and nursing staff for a cephalosporin antibiotic in 3 different marketed formulations: (1) a formulation prepared by traditional compounding, (2) a dual-chamber IV bag stored with prefilled diluent in the upper chamber and powdered drug in the lower chamber, and (3) a standard diluent container with an integrated drug vial adaptor that allows for drug admixture after connection to a single-dose powdered drug vial. METHODS: The study was conducted at 3 hospital locations from a single hospital network located in Arkansas. Study procedures were assessed by direct observations of pharmacists, pharmacy technicians, and nurses. Sequences and durations of tasks were observed to identify and document the actual time for each task. RESULTS: Approximately 402 observational hours of data collection occurred, with more than 100 formulated doses observed per formulation, with 98.6% overall study confidence. Use of the dual-chamber IV bag formulation resulted in a 63% decrease in labor time compared to traditional compounding. When comparing the dual-chamber IV bag formulation to the standard diluent formulation, there was about a 22% decrease in labor time. Based on the number of process steps, use of the dual-chamber formulation resulted in approximately 54% fewer opportunities for error versus traditional compounding and 35% fewer opportunities for error than use of the standard diluent formulation. CONCLUSION: Independent descriptive statistical analysis verified that the dual-chamber IV bag cephalosporin antibiotic formulation is a faster, simpler-to-use drug administration platform and associated with less chance of formulation and dosing errors.