American Journal Of Health-system Pharmacy[JOURNAL]
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200 papers
Improving outpatient antimicrobial stewardship through a urine culture follow-up program utilizing pharmacist-led symptom assessment.
Muron B, Dumkow L, Ellena K … +3 more , Yetsko A, Mitzner T, Draper H
Am J Health Syst Pharm · 2026 Mar · PMID 41818710 · Publisher ↗
PURPOSE: To compare clinical outcomes for patients with a positive urine culture who were prescribed antibiotics vs those who were not prescribed antibiotics, as determined by pharmacist-conducted symptom evaluation via...
PURPOSE: To compare clinical outcomes for patients with a positive urine culture who were prescribed antibiotics vs those who were not prescribed antibiotics, as determined by pharmacist-conducted symptom evaluation via an outpatient culture follow-up program. METHODS: This retrospective cohort study included adult female patients with a positive urine culture collected at an emergency department (ED) or urgent care (UC) visit who were contacted by a pharmacist for follow-up and symptom assessment. Patients with urinary symptoms had antibiotic therapy initiated or changed (standard of care [SOC]); however, patients without symptoms did not receive a new antibiotic prescription (intervention). The primary objective was to compare treatment for symptomatic urinary tract infection within 30 days of follow-up between the groups. Secondary objectives included evaluating pharmacist workload and comparing adverse events and Clostridioides difficile infection within 30 days between the groups. RESULTS: A total of 214 patients were included (97 in the SOC group and 117 in the intervention group). At their initial visit, 83.5% of patients in the SOC group reported urinary symptoms vs 53% of patients in the intervention group (P < 0.001). Empiric antibiotic prescribing was similar between the groups (SOC, 37.1%; intervention, 25.6%; P = 0.392). There was no difference in treatment of symptomatic urinary tract infection within 30 days of follow-up (SOC, 14.4%; intervention, 11.1%; P = 0.466). Follow-up occurred on average 2.5 days after discharge, requiring a median of 1 contact attempt and 15 minutes to conduct the call and documentation. CONCLUSION: Our findings support nonprescribing of antibiotics at follow-up for asymptomatic patients, despite a positive urine culture, as an appropriate stewardship intervention for ED and UC patients to prevent unnecessary antibiotic exposure.
Impact of a pharmacist-led adalimumab biosimilar interchange protocol on order processing time.
Raju J, Ritenour A, Harmon K … +1 more , Newman TR
Am J Health Syst Pharm · 2026 Mar · PMID 41818708 · Publisher ↗
PURPOSE: The transition to biosimilars poses challenges for health systems, due to diverse options and insurance-specific preferences. Implementing a pharmacist-driven adalimumab interchange protocol could improve the ef...
PURPOSE: The transition to biosimilars poses challenges for health systems, due to diverse options and insurance-specific preferences. Implementing a pharmacist-driven adalimumab interchange protocol could improve the efficiency of specialty prescription processing and address a significant gap in health-system specialty clinic workflows. This study evaluated the impact of an adalimumab interchange protocol on order processing times across specialties and payor types. METHODS: This retrospective, multicenter cohort study evaluated the impact of a pharmacist-led adalimumab interchange protocol, implemented on May 20, 2024, by clinic-embedded pharmacists at CHRISTUS Specialty Pharmacy. Eligible patients were those prescribed adalimumab for inflammatory conditions. Data retrieved included baseline characteristics such as the reason for switching, payor type, duration on adalimumab, and biosimilar ordered. The primary outcome was order processing time, measured from the date of notification to switch to the date the order was released to the pharmacy. The study also assessed biosimilar discontinuation rates and reasons. RESULTS: Of the adalimumab orders requiring a switch (n = 178), 28% were handled utilizing the interchange protocol. The mean order processing time with the protocol was 2.08 days compared to 4.60 days without the protocol (P = 0.000106). Medicare orders had the highest mean processing time (8.22 days). Of the discontinued biosimilar orders (n = 18), 67% had loss of efficacy reported as the reason for discontinuation. CONCLUSION: This study indicates that utilization of a pharmacist-led interchange protocol may improve the order processing time for biosimilars. Focused efforts could prioritize comparison of the rates of discontinuation for adalimumab products.
Assessment of pharmacy technician medication history accuracy following clinical competency implementation.
Espeut J, Dittmar E, Wolfel T … +3 more , Panella S, Trimino E, Martinez L
Am J Health Syst Pharm · 2026 Mar · PMID 41810543 · Publisher ↗
PURPOSE: Obtaining the most accurate admission medication history is paramount to ensure patient safety with medication reconciliation across the continuum of care during hospitalization. The purpose of this performance...
PURPOSE: Obtaining the most accurate admission medication history is paramount to ensure patient safety with medication reconciliation across the continuum of care during hospitalization. The purpose of this performance improvement initiative was to assess the accuracy of pharmacy technician home medication history collection at a large community medical center following clinical competency education. METHODS: A retrospective review was conducted using a sample of adult patients who presented to the emergency department (ED) over an 8-month period. Data analysis was grouped into 2 phases. Phase I data represented the 4 months before implementation of clinical competency education (May 2023 through August 2023). Phase II data represented the 4 months after competency program implementation (September2023 through December 2023). Data points collected were patient age and gender, discrepancy type, total number of discrepancies, total number of discrepancies in high-risk medication categories, information sources utilized by the pharmacy technician, and total number of home medications. RESULTS: ED pharmacy technician home medication history collection accuracy increased from 53% to 79%. The increase in home medication history collection accuracy resulted in a decrease in discrepancies. CONCLUSION: Implementation of medication history clinical competency education for pharmacy technicians resulted in fewer discrepancies and improved accuracy prior to pharmacist review. The results of this study may help other institutions improve home medication history collection accuracy by implementing targeted education to increase pharmacy technician clinical knowledge.
Exploring the impact of medication type and infusion duration on IV smart pump alarms.
Armistead LT, Giuliano KK, Degnan D … +1 more , Eckel SF
Am J Health Syst Pharm · 2026 Mar · PMID 41810511 · Publisher ↗
PURPOSE: Alarm fatigue is a serious problem in hospitals, often affecting nurses' concentration and increasing the risk of patient harm. Alarms associated with intravenous smart pumps (IVSPs) contribute to alarm fatigue;...
PURPOSE: Alarm fatigue is a serious problem in hospitals, often affecting nurses' concentration and increasing the risk of patient harm. Alarms associated with intravenous smart pumps (IVSPs) contribute to alarm fatigue; however, little is known about what causes unnecessary IVSP alarms or how to reduce them. The purpose of this study is to explore variables that impact the type and number of IVSP alarms and to demonstrate how alarm data can be used to identify IVSP alarm problem areas to target for improvement. METHODS: A dataset containing IVSP infusion and alarm data for 62 million infusions from 107 US hospitals over a 24-month period was analyzed. Detailed analyses on the types and frequency of IVSP alarms for medication classes and select medications were performed. RESULTS: Over 65 million alarms were analyzed. Infusions of antibacterials generated a higher percentage of "Door Open" and "Bolus Air in Line" alarms than were generated in the all-infusion sample. Central nervous system (CNS) agents had fewer "Patient Side Occlusion" alarms, and opioid agonists generated more patient-controlled analgesia-related alarms. Antineoplastic agents, monoclonal antibodies, and agents for blood formation, coagulation, and thrombosis all had a high ratio of alarms to infusions with alarms. Antineoplastic agents and monoclonal antibodies generated a high percentage of Bolus Air in Line alarms, and agents for blood formation, coagulation, and thrombosis (ie, heparin) had more Patient Side Occlusion alarms. CONCLUSION: This study demonstrates how IVSP alarm data, when evaluated by medication class or individual medication(s), can be used to identify potential areas to target for reducing unnecessary IVSP alarms.
Comment on "Implementing standard practices in the safe handling of gene therapy and biohazardous drugs in a health-system setting".
Satapathy P, Mehta R, Sah R
Am J Health Syst Pharm · 2026 Mar · PMID 41810504 · Publisher ↗
Abstract loading — click title to view on PubMed.
Implementation of optimized epidurals in the anesthesiology pain service at UNC Medical Center: A pilot study.
Ly S, Eckel SF, Donnowitz K … +1 more , Britt F
Am J Health Syst Pharm · 2026 Mar · PMID 41810502 · Publisher ↗
PURPOSE: A previous project was completed to evaluate the opportunity to standardize and optimize epidural use at the UNC Medical Center. VERB (vial, exchange, rate, and bag) analysis was applied to identify preparations...
PURPOSE: A previous project was completed to evaluate the opportunity to standardize and optimize epidural use at the UNC Medical Center. VERB (vial, exchange, rate, and bag) analysis was applied to identify preparations optimized for efficient supply and resource utilization. Converting a hydromorphone/bupivacaine epidural preparation from a total bag volume of 250 mL to 100 mL was proposed for a pilot study. The primary objective of this implementation study was to assess the operational impacts on drug and fluid utilization and waste. METHODS: A quasi-experimental, single-center pilot implementation study was conducted at a large academic medical center. The proposed volume change was piloted in 2 units for a duration of 6 months. Data from various sources were collected, including administration data documented in the electronic health record and epidural infusion pumps and dispense and waste data from automated dispensing cabinets. Outcomes assessed included the total drug volume infused, the total waste accumulated per encounter, the number of nursing bag exchanges per encounter, and nursing and pharmacy staff satisfaction. RESULTS: Implementation of the 100-mL hydromorphone/bupivacaine epidural preparation resulted in a notable decrease in waste during the compounding and administration process. Nursing bag exchanges occurred at a higher rate than hypothesized per 48-hour period. Storing the epidural medication on the units allowed for timely administration and bag exchanges. CONCLUSION: Storing epidurals at the site of care in automated dispensing cabinets increased nursing satisfaction, but the increased rate of bag exchanges remained a concern. Estimated decreases in drug and fluid waste should be noted for future hospital-wide implementation.
Use of weight-based dosing of enoxaparin for venous thromboembolism prophylaxis in an extremely underweight elderly patient.
Lanier C, Lassiter M, Covert K
Am J Health Syst Pharm · 2026 Mar · PMID 41807259 · Publisher ↗
PURPOSE: The purpose of this report is to highlight a case of utilizing weight-based enoxaparin for prophylaxis of venous thromboembolism (VTE) in an elderly, extremely underweight patient. VTE represents a significant c...
PURPOSE: The purpose of this report is to highlight a case of utilizing weight-based enoxaparin for prophylaxis of venous thromboembolism (VTE) in an elderly, extremely underweight patient. VTE represents a significant concern for hospitalized patients. There is a dearth of literature regarding utilization of low-molecular-weight heparins such as enoxaparin or unfractionated heparin in patients who are underweight. SUMMARY: In this case, a 68-year-old female who was extremely underweight (21.8 kg) presented to the emergency department in acute respiratory distress secondary to pneumonia and a chronic obstructive pulmonary disease exacerbation. The patient had a Padua score of 5 and an IMPROVE score of 2 that signified the necessity of pharmacologic VTE prophylaxis. A clinical decision was made to utilize a weight-based enoxaparin dosing strategy for VTE prophylaxis using a pediatric dilution to deliver the dose. Enoxaparin was initiated at 0.5 mg/kg (10 mg) subcutaneously daily and monitored via anti-factor Xa peak levels to verify that the dose provided an adequate prophylactic level. Ultimately, a dose of 0.5 mg/kg resulted in an appropriate anti-factor Xa level of 0.21 units/mL, equating to suitable VTE prophylaxis. CONCLUSION: A review of the literature revealed little evidence for optimal anticoagulation dosing for VTE prophylaxis in adult patients weighing under 40 kg. Various adjustment strategies have been utilized; however, there is no available evidence pertaining to patients at the extreme of low weight represented by the reported case or to attainment of an anti-factor Xa level within the therapeutic range in such patients. This case represents the use of a weight-based enoxaparin strategy for an extremely underweight elderly patient and the attainment of a therapeutic prophylactic anti-factor Xa level.
Virtue ethics for pharmacists: A call to action to develop and exercise.
Erstad BL
Am J Health Syst Pharm · 2026 Mar · PMID 41807251 · Publisher ↗
Abstract loading — click title to view on PubMed.
Response to Satapathy et al.
Ngo Z, Wang A, Yu SJ … +1 more , MacDonald EA
Am J Health Syst Pharm · 2026 Mar · PMID 41807248 · Publisher ↗
Abstract loading — click title to view on PubMed.
Impact of implementing an order panel for insulin and dextrose dosing for management of hyperkalemia in emergency department patients.
Skeeters K, Stjepic M, Webb ML … +1 more , Millay M
Am J Health Syst Pharm · 2026 Mar · PMID 41805940 · Publisher ↗
PURPOSE: The purpose of this study was to compare the incidence of hypoglycemia before and after implementation of an insulin/dextrose order panel for hyperkalemia in emergency department patients. METHODS: This single-c...
PURPOSE: The purpose of this study was to compare the incidence of hypoglycemia before and after implementation of an insulin/dextrose order panel for hyperkalemia in emergency department patients. METHODS: This single-center, retrospective, pre-post cohort study evaluated the impact of an insulin/dextrose order panel for hyperkalemia. The primary endpoint was hypoglycemia incidence before and after panel implementation. Secondary endpoints included the reduction in serum potassium concentration and the incidence of severe hypoglycemia. The panel used real-time creatinine clearance (CrCl) to guide insulin dosing, ordering 5 units of intravenous regular insulin if CrCl was less than 30 mL/min or 10 units if it was 30 mL/min or higher. Dextrose 25 g was added if the blood glucose level was less than 250 mg/dL; otherwise, dextrose was omitted. Hourly point-of-care glucose monitoring occurred for 4 hours following insulin administration beginning 30 minutes after administration. The study period was from November 1, 2021, through April 30, 2023 (preimplementation group) and from June 1 through September 30, 2024 (postimplementation group). RESULTS: A total of 433 patients were included, with 230 in the preimplementation group and 203 in the postimplementation group. Baseline characteristics were similar between the groups, with slightly lower initial potassium levels in the postimplementation group. Hypoglycemia incidence was significantly lower after implementation (23.9% vs 8.9%; P < 0.0001), as was incidence of severe hypoglycemia (10.0% vs 2.5%; P = 0.0015). The median potassium reduction was slightly lower after intervention (1.3 vs 1.1 mEq/L; P = 0.007), but the rate of hyperkalemia resolution was not different between the groups (83.0% vs 88.7%; P = 0.10). CONCLUSION: Implementation of a standardized order panel for insulin and dextrose significantly reduced the incidence of hypoglycemia and severe hypoglycemia in emergency department patients treated for hyperkalemia. These findings support protocol-driven management to improve safety without compromising efficacy.
Assessing the impact of the Inflation Reduction Act on Medicare prescription drug coverage.
Zhang YW, Blyumin MG, Qu C … +2 more , Guo X, Zhang M
Am J Health Syst Pharm · 2026 Mar · PMID 41805901 · Publisher ↗
PURPOSE: The Inflation Reduction Act (IRA) introduced significant reforms to Medicare Part D in 2025, aiming to reduce medication costs for beneficiaries by eliminating the coverage gap ("donut hole") with a $2,000 annua...
PURPOSE: The Inflation Reduction Act (IRA) introduced significant reforms to Medicare Part D in 2025, aiming to reduce medication costs for beneficiaries by eliminating the coverage gap ("donut hole") with a $2,000 annual out-of-pocket cap. However, insurers' responses to these policy reforms-and their potential implications for medication affordability and access-have not been systematically evaluated. METHODS: This was a retrospective comparative analysis of Medicare Part D plans (standalone prescription drug plans [PDPs] and Medicare Advantage prescription drug [MAPD] plans) comparing plan structure, formulary coverage, utilization management, and cost-sharing details from January 2024 to January 2025. Analyses were conducted using publicly available Centers for Medicare & Medicaid Services (CMS) datasets. Primary outcomes included changes in annual deductible amounts, cost-sharing structures (co-payment vs co-insurance), formulary coverage and utilization management practices, and patient out-of-pocket costs for glucagon-like peptide 1 (GLP-1) receptor agonists, including first-fill cost burden. RESULTS: Across PDPs, mean annual deductibles significantly increased from $384.7 (95% CI, $369.2-$400.1) to $454.0 (95% CI, $432.9-$475.1); MAPD plans showed a greater increase from $98.7 (95% CI, $93.6-$103.8) to $249.0 (95% CI, $241.4-$256.6). In MAPD plans, co-insurance-style coverage utilization drastically increased for tier 3 medications (from 6.3% in 2024 to 38.1% in 2025). Specifically for GLP-1 agonists, while overall coverage decreased, coverage expanded for preferred drugs like subcutaneous semaglutide and tirzepatide. However, first-fill out-of-pocket expenses increased substantially due to higher deductibles and increased costs associated with co-insurance-style coverage. The rate of first-fill costs exceeding $600 rose from 40% to 45% (2024) to over 80% (2025) in PDPs and from less than 1% to approximately 13% in MAPD plans. CONCLUSION: Medicare Part D plans in 2025 were strategically designed to increase beneficiaries' financial responsibilities via higher deductibles, increased co-insurance cost sharing, and restricted formulary coverage. While overall annual patient medication cost burdens will decrease, the cost of filling each medication will increase, which may negatively impact medication access and adherence.
Establishing a system-wide assessment of risk process for investigational drugs.
Zinchuk K, Volf H, Li K … +5 more , Bekelian E, Lam J, Manners S, Silverman J, Sanil N
Am J Health Syst Pharm · 2026 Mar · PMID 41802163 · Publisher ↗
PURPOSE: To describe the development and implementation of a standardized, pharmacy-led assessment of risk (AOR) process for investigational products (IPs) in compliance with United States Pharmacopeia (USP) chapter <800...
PURPOSE: To describe the development and implementation of a standardized, pharmacy-led assessment of risk (AOR) process for investigational products (IPs) in compliance with United States Pharmacopeia (USP) chapter <800> across a large academic health network. SUMMARY: USP <800> mandates institutions to maintain a hazardous drug list but offers limited guidance for investigational agents. The US National Institute for Occupational Safety and Health (NIOSH) has a published list of hazardous drugs that institutions should reference. However, the list only includes agents approved through December 2015, leaving a large gap in hazardous drug standardization for marketed products, providing less precedent for those working with investigational agents. In response, a multidisciplinary workgroup led by pharmacy services developed a system-wide IP AOR process. Two distinct tools incorporating toxicological and biosafety criteria were created to assess small-molecule and biopharmaceutical agents. A centralized database and oversight committee were established to ensure consistency, transparency, and regulatory compliance. As of July 2025, 255 IPs were assessed: 8 high-risk hazardous, 126 low-risk hazardous, and 121 nonhazardous agents. The process has enabled appropriate labeling, safe handling, and efficient review workflows across research pharmacies. CONCLUSION: The IP AOR process demonstrates the essential role of pharmacists in operationalizing USP <800> requirements for investigational drugs. This model supports occupational safety, regulatory compliance, and scalable implementation across health systems engaged in clinical research. The process outlined in this manuscript is applicable to both investigational agents and any newly marketed drugs being brought into an institution that haven't been reviewed by NIOSH for inclusion on their list.
Informatics project creates a better way to optimize dispensing cabinet inventory.
Am J Health Syst Pharm · 2026 Mar · PMID 41800878 · Publisher ↗
Abstract loading — click title to view on PubMed.
The impact of early oral anticancer medication monitoring through electronic patient assessments.
Looney B, Bui T, DeClercq J … +3 more , Whelchel K, Choi L, Zuckerman A
Am J Health Syst Pharm · 2026 Mar · PMID 41793760 · Publisher ↗
PURPOSE: This study evaluated the effectiveness of electronic early oral anticancer medication monitoring questionnaires in identifying adverse effects (AEs) requiring pharmacist intervention among patients initiated on...
PURPOSE: This study evaluated the effectiveness of electronic early oral anticancer medication monitoring questionnaires in identifying adverse effects (AEs) requiring pharmacist intervention among patients initiated on oral anticancer therapy. METHODS: A prospective randomized study was conducted within an integrated health system specialty pharmacy. Patients were excluded if they never started treatment, discontinued oral anticancer therapy within 14 days, were not new to therapy, or had a hematologic condition. Stratified randomization by age (≥60 years versus <60 years) and sex was performed to assign patients to intervention or usual care. Intervention patients received an electronic questionnaire 7 to 14 days after initial counseling. Outcomes included time to first AE-related pharmacist intervention and intervention frequency within 45 days and dose modifications, healthcare utilization, and treatment modifications within 90 days. Per-protocol analysis compared outcomes among questionnaire responders and patients assigned to usual care. Cox proportional hazard (time to intervention) and ordinal logistic regression (intervention number) models adjusted for age, sex, race, diagnosis, Charlson comorbidity index score, and medication type. RESULTS: Of the 446 patients randomized, 388 were included in the analysis (183 in the intervention cohort and 205 in the usual care cohort). The questionnaire response rate was 47%. In the intent-to-treat analysis, no significant differences were observed in time to intervention (hazard ratio [HR], 1.2; P = 0.360) or intervention frequency (odds ratio [OR], 1.2; P = 0.409). Per-protocol analysis (n = 291) showed responders had significantly faster time to intervention (HR, 2.4; P < 0.001), more interventions (OR, 2.7; P < 0.001) and lower healthcare utilization (OR, 0.4; 95% CI, 0.2-0.9; P = 0.023). CONCLUSION: Electronic monitoring resulted in earlier and more frequent interventions and less healthcare utilization among questionnaire responders.
Developing an assessment workflow for 505(b)(2) products within the outpatient setting withina large academic medical center.
Matsuda C, Findlay R, Fox E
Am J Health Syst Pharm · 2026 Mar · PMID 41790790 · Publisher ↗
PURPOSE: To describe the development of a proactive workflow to identify medications approved through the 505(b)(2) pathway and anticipate potential challenges they may pose to the medication-use process within a large m...
PURPOSE: To describe the development of a proactive workflow to identify medications approved through the 505(b)(2) pathway and anticipate potential challenges they may pose to the medication-use process within a large multisite health system. SUMMARY: The baseline workflow was based on the health system's response to a potential mix-up with bendamustine products, which resulted in the formation of a 505(b)(2) task force. An Excel tool was created to visualize and track changes to Centers for Medicare and Medicaid Services (CMS) ASP NDC-HCPCS crosswalk files. A 505(b)(2) directory was created to store the changes identified from the Excel tool. A list of 505(b)(2) medications was assessed with a prioritization matrix and gap analysis. The baseline workflow and gap analysis informed the creation of a new proactive workflow. The top-priority medication identified from the prioritization matrix was selected to trial the new workflow. CONCLUSION: A proactive, interdisciplinary approach is essential to effectively manage the evolving challenges associated with 505(b)(2) medications. Implementing structured tools, including a crosswalk comparison tool, directory, and prioritization matrix, provided a systematic method to identify and monitor these products within a complex regulatory environment. Continued refinement will be necessary as CMS and Food and Drug Administration policies evolve, but this model offers a framework that may be adapted to different care settings.
Efficacy and risks of psychedelics in treatment of posttraumatic stress disorder: A systematic review.
Thomas JE, Dellarole A, Caballero J
Am J Health Syst Pharm · 2026 Mar · PMID 41784123 · Publisher ↗
PURPOSE: The purpose of this review is to evaluate which psychedelics have the most efficacy data to support their use in the treatment of posttraumatic stress disorder (PTSD). This review also aims to assess safety data...
PURPOSE: The purpose of this review is to evaluate which psychedelics have the most efficacy data to support their use in the treatment of posttraumatic stress disorder (PTSD). This review also aims to assess safety data and concerns related to psychedelic therapies and identify demographic characteristics that may influence clinical outcomes. SUMMARY: A systematic review of the literature was conducted on PubMed, Web of Science, and Scopus to identify randomized controlled studies evaluating the use of psychedelic therapy in treatment of PTSD. Thirteen studies met our inclusion criteria and were included in the review. Six studies evaluated 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy, while 7 studies evaluated ketamine. Study findings regarding efficacy were mixed. Four of the 6 studies evaluating MDMA-assisted psychotherapy demonstrated statistically significant improvement in PTSD symptoms, while 3 of the 7 studies evaluating intravenous ketamine (ketamine IV) demonstrated statistically significant efficacy (eg, reduced PTSD symptoms, durable effect) in relation to comparators. Both therapies were generally well tolerated. The majority of studies were conducted in primarily civilian populations, with one MDMA study and 2 ketamine IV studies focused on veterans. CONCLUSION: MDMA and ketamine IV currently have the greatest support in the literature for efficacy in PTSD. Studies suggest treatment with these agents under supervision may lead to improvements in PTSD symptoms, with the medications being generally well tolerated. However, caution should be used when interpreting study results due to limitations such as treatment expectancy effect and the potential for inadequate blinding. Randomized controlled studies of other psychedelics (eg, psilocybin, lysergic acid diethylamide) are needed to assess their utility in PTSD.
Implementation of a pharmacy technician medication history service at a pediatric health system.
Schwaller K, Michel N, Crotty M … +2 more , Craynon R, Thomas M
Am J Health Syst Pharm · 2026 Mar · PMID 41782366 · Publisher ↗
PURPOSE: Medication history collection continues to be a growing area of innovation to meet the needs of complex patients. Pediatric patients are no exception to this need and often require health systems to dedicate res...
PURPOSE: Medication history collection continues to be a growing area of innovation to meet the needs of complex patients. Pediatric patients are no exception to this need and often require health systems to dedicate resources to provide appropriate medication history collection and reconciliation for patients. This study reviews the implementation of a pharmacy technician medication history service for patients at a freestanding pediatric health system. SUMMARY: In this study, technicians were able to complete 38.31% (n = 367) of medication histories for 1,000 patients with a pharmacy-completed medication history upon admission from the emergency department. Additionally, the study identified the impact of a medication history complexity scoring tool. The tool directs pharmacy technicians to complete medication histories that may be less complex and pharmacists to complete more complex medication histories and reconciliations. The study also looked at health system-assigned errors associated with medication histories to ensure patient safety with pharmacy technician medication history implementation. CONCLUSION: Medication history training in a didactic setting can help pharmacy technicians successfully complete medication histories, which could be extrapolated to benefit all healthcare professionals completing medication histories.
Survey of pharmacy strategic planning and execution in US health systems.
Clark JS, Vlasimsky TB, Fera T … +1 more , Nussbaum B
Am J Health Syst Pharm · 2026 Mar · PMID 41779162 · Publisher ↗
PURPOSE: Results of a survey on the state of enterprise-wide pharmacy strategic planning and execution in US health systems are presented. METHODS: An online survey instrument was developed based on guidance by an expert...
PURPOSE: Results of a survey on the state of enterprise-wide pharmacy strategic planning and execution in US health systems are presented. METHODS: An online survey instrument was developed based on guidance by an expert advisory committee. The survey covered 5 domains: (1) current state of strategic planning, (2) plan-development process, (3) stakeholder engagement, (4) plan dissemination, and (5) demographics. RESULTS: Of the 1,092 health-system pharmacy practice leaders surveyed, 225 (21%) responded. Among the respondents, 187 (83%) had a current enterprise-wide pharmacy strategic plan (EWPSP) or were slated to develop one in the next 12 months. The 165 respondents actively engaged with an EWPSP responded to questions about their process. Most EWPSPs covered a timeframe of 3 to 5 years and were revisited at least annually. The strategic plans of more than two-thirds of respondents included (1) goals; (2) actions to achieve each goal; (3) mission, vision, and values of the pharmacy enterprise; and (4) the accountable person or team for each goal. Most respondents agreed strongly that their plan helped showcase pharmacy initiatives to external stakeholders and facilitated networking across the pharmacy enterprise. Respondents indicated it would be helpful to have additional resources to identify emerging trends, measure plan performance, and align plans with service line priorities. Based on the survey results and their own experience, the authors offer advice on ways to enhance the effectiveness of enterprise-wide pharmacy strategic planning. CONCLUSION: EWPSPs in US health systems are developed and executed using a variety of resources and methods and are aligned with the overall goals of their organizations. Survey respondents indicated that their strategic plans help (1) expand existing services or develop new services and (2) gain support from internal and external stakeholders.
Adrenal hemorrhage requiring apixaban reversal in the setting of active deep vein thrombosis and heparin-induced thrombocytopenia: A case report.
Lichardi M, Moriarty S, Nicholas H
Am J Health Syst Pharm · 2026 Mar · PMID 41776964 · Publisher ↗
PURPOSE: To describe the management challenges of bilateral adrenal hemorrhage (BAH) in a patient on apixaban with recent heparin-induced thrombocytopenia (HIT) and active deep vein thrombosis (DVT). SUMMARY: A 71-year-o...
PURPOSE: To describe the management challenges of bilateral adrenal hemorrhage (BAH) in a patient on apixaban with recent heparin-induced thrombocytopenia (HIT) and active deep vein thrombosis (DVT). SUMMARY: A 71-year-old woman with a history of orthopedic trauma developed HIT during hospitalization and was transitioned to fondaparinux. She was later discharged on apixaban for treatment of a provoked left common femoral DVT. Within 48 hours, she presented with shock initially attributed to sepsis. Computed tomography revealed BAH, raising concern for adrenal crisis. Reversal of apixaban was urgently considered but complicated by the patient's active thrombosis and history of HIT, which excluded the use of 4-factor prothrombin complex concentrate and posed challenges to the use of andexanet alfa given institutional policy and the limited data in patients with thrombotic events. After shared decision-making with the patient and family, andexanet alfa was administered given the life-threatening nature of the hemorrhage. The patient stabilized with corticosteroid support, required placement of an inferior vena cava filter, and was later restarted on prophylactic-dose fondaparinux. She was discharged to a skilled nursing facility with recovery of hemodynamic stability. CONCLUSION: This case illustrates the intersection of BAH, active thrombosis, and HIT, where guideline-directed reversal strategies are limited. It underscores the challenges of selecting and timing anticoagulation reversal in patients with recent thrombotic events and contraindications to standard agents, highlighting the importance of individualized, interdisciplinary decision-making in managing complex anticoagulation scenarios.
Adherence to antituberculous medication regimens in the United States: Insights from MarketScan databases, 2016-2022.
Gokhale P, Villa Zapata L
Am J Health Syst Pharm · 2026 Mar · PMID 41770628 · Publisher ↗
PURPOSE: Tuberculosis remains a major global public health problem. Adherence to antituberculous treatment is essential to prevent disease transmission and the emergence of multidrug-resistant tuberculosis. This study ai...
PURPOSE: Tuberculosis remains a major global public health problem. Adherence to antituberculous treatment is essential to prevent disease transmission and the emergence of multidrug-resistant tuberculosis. This study aims to evaluate adherence to first-line antituberculous medications in the United States. METHODS: A retrospective cohort study was conducted using data compiled in the Merative MarketScan commercial and Medicaid claims databases from 2016 to 2022. High adherence was defined as a proportion of days covered of ≥80% over a 6-month follow-up period. The study included patients with prescription claims for all 4 first-line antituberculous medications: isoniazid, rifampin, ethambutol, and pyrazinamide. Patients without continuous enrollment for 6 months prior to treatment initiation were excluded. RESULTS: The final cohort included 168 Medicaid patients and 257 commercially insured patients. The lowest adherence was observed for isoniazid (Medicaid, 45.8% [95% CI, 38.1%-53.7%]; commercial plans, 50.2% [95% CI, 43.9%-56.5%]), followed by rifampin (56.6 % [95% CI, 48.7%-64.2% in Medicaid). Higher adherence was observed for ethambutol (Medicaid, 71.4% [95% CI, 63.9%-78.1%]; commercial, 68.9% [95% CI, 62.8%-74.5%]) and pyrazinamide (Medicaid, 67.3% [95% CI, 59.6%-74.3%]; commercial, 71.6% (95% CI, 65.7%-77.0%]). CONCLUSION: Adherence to first-line antituberculous medications remains suboptimal. Higher rates of adherence to ethambutol and pyrazinamide may reflect better adherence during the intensive treatment phase compared to the continuation phase.
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