Buprenorphine induction can be challenging for patients with chronic pain or patients who are unable to cease opioids for sufficient time to prevent precipitated opioid withdrawal. In the outpatient setting, low-dose buprenorphine induction strategies have been described to avoid these barriers; however, these strategies are not generalizable to the hospital setting where specific medication regulations may apply. We report a novel strategy for hospital-based low-dose buprenorphine initiation that facilitates transition from full opioid agonists to buprenorphine.

Pharmacist-conducted education of nurses and interventions to ensure completion of influenza vaccine assessments and documentation led to an improved IMM-2 IPFQR compliance rate at the study site.

Objective: To describe the implementation and efficacy of a pharmacist-driven clozapine myocarditis monitoring protocol including 2 cases of clozapine-induced myocarditis identified using this protocol. Methods: In February 2015, the health system formulary committee approved changes to an existing pharmacist-driven protocol to allow for myocarditis monitoring in patients initiated on clozapine therapy based on an algorithm published by Ronaldson et al in 2011. The monitoring includes the measurement of C-reactive protein (CRP; via high-sensitivity CRP [hsCRP] serum test) and troponin at baseline and then weekly for 4 weeks. Patients initiated on clozapine therapy between March 2015 and February 2017 and monitored according to the aforementioned protocol are described in this article. Results: A total of 38 patients were initiated on clozapine therapy during the specified data collection period. Of these 38 patients, 4 screened positive for early signs of myocarditis according to the monitoring protocol, and 2 of those 4 patients were confirmed by cardiology consultation to have clozapine-induced myocarditis. Both of these patients experienced a full cardiac recovery upon discontinuation of clozapine. Conclusion: A pharmacist-driven myocarditis monitoring protocol for clozapine-naïve patients may help to identify early signs of clozapine-induced myocarditis and therefore mitigate potentially life-threatening complications by prompting early discontinuation of the inciting drug.

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