PROBLEMMultiple inpatient sterile compounded doses are prepared in "batches" in the majority of hospitals across the United States and the world.1 This is a process in which doses that are due at a given administration timeframe are prepared upfront in central or satellite institutional pharmacies to maximize operational and workflow efficiencies. The preparation of patient-specific sterile compounds is a time-consuming process that requires a great deal of attention to avoid any errors being introduced. The "batching" method is a prospective approach, where a hospital pharmacy produces several batches of medications that are tailored to the patients receiving them. There is normally a gap of several hours (or more) between the time of preparation and that of administration. During this gap, several variables can alter the intended use of dispensed medications. For example, doses might be discontinued or modified, patients might be transferred or discharged, or doses might be misplaced in the health care system requiring reproduction. These variables contribute to compounded sterile products (CSPs) being unused and eventually wasted, which costs the health care system unretrievable expenses.2 In many cases, the unused medications cannot be repurposed to other patients due to very specific dosing criteria (eg, weight-based doses) or beyond-use dating (BUD) issues. To minimize waste, an optimal balance between timely sterile compounded preparation (frequency) and personnel workload is necessary. Many studies were conducted of alternatives that might reduce the waste of sterile compounded products and doses.2-5 A review of the current literature 3,[6][7][8][9][10] suggests that the well-established practice of lean intravenous (IV) methodology had a positive effect on pharmacy efficiency as ABSTRACT Purpose: To measure the impact of increasing sterile compounding batch frequency on pharmaceutical waste as it relates to cost and quantity. Methods: Pharmaceutical IV waste at a tertiary care hospital was observed and recorded for 7 days. The batching frequency of compounded sterile products (CSPs) was then increased from twice daily to 4 times daily. After a washout period, pharmaceutical IV waste was then recorded for another 7 days. The quantity of units wasted and the cost were compared between both phases to determine the impact that batching frequency has on IV waste, specifically among high-and low-cost drugs. Results: Patient days increased from 2,459 during phase 1 to 2,617 during phase 2. The total number of CSPs wasted decreased from 3.6 to 2.7 doses per 100 patient days.

Purpose: Assess the impact of electronic health record interventions on patient access to post-hospital discharge prescriptions. Methods: Five interventions were implemented in the electronic health record to improve patient access to prescriptions after discharge from hospital: electronic prior authorization, alternative medication suggestions, order sets, mail order pharmacy alerts, and medication interchange instructions. This was a retrospective cohort study of patient responses from discharges during 6 months before the first intervention implementation and 6 months after the last intervention implementation documented in the electronic health record and a transition-in-care platform. Primary endpoint was the proportion of discharges with patient-reported issues that would have been prevented by the studied interventions out of number of discharges with at least one prescription, analyzed using Chi-squared test (level of significance .05). Results: Discharges with patient-reported issues that would have been prevented by the studied interventions decreased from 1.68 to 1.07 out of 1000 discharges with prescriptions ( P < .001). Conclusion: Interventions in the electronic health record reduced barriers faced by patients to picking up prescriptions post-discharge from hospital, potentially leading to improved patient satisfaction and improved health outcomes. Important factors to consider for electronic health record intervention implementation are workflow development and intrusiveness of clinical decision support. Multiple targeted electronic health record interventions can improve patients’ access to prescriptions after discharge from hospital.

Presence of hyperlipidemia directly correlates with the risk of developing coronary heart disease (CHD) and future cardiovascular (CV) events. Less than half of adults with elevated low density lipoprotein cholesterol (LDL-C) levels receive treatment or are adequately treated and as a result, high-risk patients continue to remain at risk for new CV events. Modest reductions in CHD rates by decreases in saturated fat are possible if saturated fat is replaced by a combination of poly-and mono unsaturated fat, and the benefits of polyunsaturated fat appear strongest. However, little or no benefit is likely if saturated fat is replaced by carbohydrate, but this will in part depend on the form of carbohydrate. Because both N-6 and N-3 polyunsaturated fatty acids are essential and reduce risk of heart disease, the ratio of N-6 to N-3 is not useful and can be misleading. In practice, reducing red meat and dairy products in a food supply and increasing intakes of nuts, fish, soy products and nonhydrogenated vegetable oils will improve the mix of fatty acids and have a markedly beneficial effect on rates of CHD. This study was conducted to see hypolipidemic potential of two medicinal herbs. The research work was single blind placebo-controlled, conducted at Jinnah Hospital, Lahore It was conducted from January 2018 to June 2018. Seventy five already diagnosed primary and secondary hyperlipidemic patients were selected with age range from 17 to 65 years. Diabetes mellitus, cigarette smoking/alcohol addictive patients, peptic ulcer disease, hypothyroidism, kidney dysfunction, any heart disease and liver disease. All patients were divided in three groups (group-I, group-II, group-III), 25 in each group. All participant's baseline lipid profile data were taken and filed in specifically designed Performa, at start of taking medicine. Twenty five patients of group-I were advised to take 10 grams of Flaxseeds in three divided doses after meal. Twenty five patients of group-II were advised to take Ajwain seeds 10 grams in three divided doses after each meal for two months. Twenty five patients of group-III were provided placebo capsules, (containing grinded rice), taking one capsule after each meal. All participants were advised to take these medicines for eight weeks. Followup period: All participants were called fortnightly for their query and follow up. Their LDL-cholesterol, and HDLcholesterol was determined at the hospital laboratory. In two months therapy by Flaxseeds decreased LDL-cholesterol from 195.11±2.11 mg/dl to 190.22±3.11 mg/dl, which is significant statistically. HDL was increased from 34.53±1.65 mg/dl to 38.97±2.29 mg/d, which is also significant change. In two months therapy by AJWAIN, LDL-c reduced from 201.51±2.62 mg/dl to 197.11±2.66 mg/dl, which is significant statistically. HDL-cholesterol increased by Ajwain from 36.97±3.32 mg/dl to 37.45±1.87 mg/dl, which is insignificant statistically.It was concluded from this study that Flaxseeds have more effect on HDL-c but Ajwain has lowest effect on this parameter.

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