Objective Wrong drug product errors occurring in community pharmacies often originate at the transcription stage. Electronic prescribing and automated product selection are strategies to reduce product selection errors. However, it is unclear how often automated product selection succeeds in outpatient pharmacy platforms. Materials and Methods The intake of over 800 e-prescriptions was observed at baseline and after intervention to assess the rate of automated product selection success. A dispensing accuracy audit was performed at baseline and postintervention to determine whether enhanced automated product selection would result in greater accuracy; data for both analyses were compared by 2x2 Chi square tests. In addition, an anonymous survey was sent to a convenience sample of 60 area community pharmacy managers. Results At baseline, 79.8% of 888 e-prescriptions achieved automated product selection. After the intervention period, 84.5% of 903 e-prescriptions achieved automated product selection (P = .008). Analysis of dispensing accuracy audits detected a slight but not statistically significant improvement in accuracy rate (99.3% versus 98.9%, P = .359). Fourteen surveys were returned, revealing that other community pharmacies experience similar automated product selection failure rates. Discussion Our results suggest that manual product selection by pharmacy personnel is required for a higher than anticipated proportion of e-prescriptions received and filled by community pharmacies, which may pose risks to both medication safety and efficiency. Conclusion The question of how to increase automated product selection rates and enhance interoperability between prescriber and community pharmacy platforms warrants further investigation.

Introduction Case studies and retrospective chart reviews of health system data have demonstrated an increased risk of nephrotoxicity in patients receiving immune checkpoint inhibitors compared to clinical trials. This study investigated the frequency, causes, and risk factors for acute kidney injury in a real-world, rural setting. Methods This was a retrospective cohort study of patients who received at least one dose of a checkpoint inhibitor at a rural health system from May 2013 to February 2020 and who received at least one dose of a checkpoint inhibitor. Electronic and manual chart review helped to determine the incidence of, risk factors for, and renal outcomes and management strategies of checkpoint inhibitor-related acute kidney injury. Multivariable Fine and Gray subdistribution hazard models were used to assess the impact of patient characteristics on the incidence of sustained acute kidney injury and checkpoint inhibitor-induced acute kidney injury. Results After exclusion criteria, 906 patients who received at least one dose of a checkpoint inhibitor at Marshfield Clinic Health System during the study period were included. The incidence of acute kidney injury of any duration and due to any cause was 36.1%, while sustained acute kidney injury occurred in 28.7% of patients. Checkpoint inhibitor-related acute kidney injury was thought to have occurred in 2.7% of patients. Baseline estimated glomerular filtration rate < 60 was the sole predictor of checkpoint inhibitors-related acute kidney injury. Most patients with suspected checkpoint inhibitor-related acute kidney injury were managed with corticosteroids, and 62.5% experienced complete renal recovery. Conclusions Ours is the first retrospective cohort study to test whether baseline Eastern Cooperative Oncology Group score and checkpoint inhibitor place in therapy were associated with checkpoint inhibitor-related acute kidney injury, and neither of these data points were found to be predictive. Even after expanding the parameters and methodologies of our study as compared to other retrospective cohort studies, we found only three baseline characteristics to be predictive of sustained acute kidney injury: Baseline eGFR, loop diuretic, and spironolactone use. For checkpoint inhibitor-related baseline, eGFR alone was predictive.

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Introduction: Although both the 2016 Centers for Disease Control and Prevention (CDC) guidelines and the 2020 Food and Drug Administration (FDA) safety announcement recommend naloxone co-prescribing to patients receiving long-term opioid therapy (LTOT) for non-cancer pain, the rate of naloxone co-prescription in this population remains low.Objectives: The primary objective of this project was to determine whether a pharmacist intervention would lead to increased rates of naloxone co-prescribing among providers.Methods: This was a before-and-after interventional study to evaluate changes in naloxone co-prescribing rates in response to clinical pharmacist recommendation of naloxone for LTOT patients to providers. The primary end point was rate of naloxone co-prescription after pharmacist intervention. Providers of LTOT patients were emailed patient-specific recommendations. Additional end points included calculation of the naloxone possession rate among patients and identification of patient-specific predictors for not having naloxone co-prescribed at baseline. Results: A total of 152 patients met inclusion criteria throughout the intervention period. Out of the 152 patients who were eligible for naloxone, 90 (59.2%) were prescribed naloxone before the intervention and 131 (86.2%) were prescribed naloxone after the pharmacist provided interventions. This increase in naloxone prescription (27%) was statistically significant (P < .001). Our results also showed that LTOT patients who were prescribed opioids by adult primary care providers were at risk for lack of naloxone co-prescribing at baseline (adjusted odds ratio [aOR] 3.66, P = .013) as compared with patients taking opioids prescribed by a pain management provider.The overall possession rate among patients with naloxone co-prescribed by the end of the intervention period was 56.4% (74/131 patients). Conclusion:A pharmacist-led intervention was found to increase the naloxone co-prescribing rate for LTOT patients. However, co-prescribing naloxone does not guarantee patient possession; only 56.4% of patients with a naloxone prescription appeared to have naloxone at home. Future studies should explore ways to increase naloxone possession rates.