Purpose
The clinical impact of a critical care pharmacist in reducing medication errors in the intensive care unit (ICU) setting was evaluated.
Methods
The study was divided into two 8-week phases: control phase without a critical care pharmacist and an ICU pharmacist phase with a critical care pharmacist. During both phases, pharmacy staff documented interventions using an electronic documentation system. Interventions that could be classified as medication errors were categorized by type of error and whether they were “averted” (intervention accepted) or “not averted” (intervention not accepted). The type and frequency of medication errors, number of medication errors “averted,” and clinical outcomes associated with the medication errors were compared between the control and ICU pharmacist phases.
Results
There was no significant difference between the groups for gender and mean age. Of the 267 interventions included in the ICU pharmacist phase, 256 were classified as medication errors compared with 54 of 58 interventions for the control phase. The average number of medication errors per day was significantly higher during the ICU pharmacist phase (4.27 ± 5.2) compared with the control phase (0.92 ± 1.29, P < 0.0001). The number of medication errors “averted” was higher in the ICU pharmacist phase compared with the control phase (212 vs 50). The “averted” medication errors during the ICU pharmacist phase were related to a higher percentage of improved or resolved clinical outcomes compared with the control phase (66/194 [34%] vs 7/46 [15.2%], P = 0.013).
Conclusion
A critical care pharmacist improves medication safety by identifying and preventing medication errors and improving outcomes.
Viekira, the first coformulated direct-acting antiviral that targets different stages of the HCV life cycle, is an interferon-free treatment for HCV genotype 1 infection. It is associated with a virological cure rate of ≥90% and treatment durations of 12 and 24 weeks. Viekira is also effective and safe for patients who have undergone liver transplantation, are coinfected with HIV, or have advanced kidney disease.
Previously untreated patients with chronic HCV monoinfection, as well as patients who do not respond adequately to or relapse after standard dual therapy, may benefit from adjunctive boceprevir therapy. Careful selection and close monitoring of patients receiving boceprevir are essential to avoid drug-drug interactions, reduce adverse effects, and optimize treatment outcomes.
Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual’s likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.
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