Abstract:Objective. To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider.Interventions. Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider. Pharmacists in the VTE clinic work independently under a collaborative practice agreement. An evaluation of thirty-four patients, seventeen in each treatment arm, was conducted to compare the differences in treatment-related outcomes of rivaroxaban when managed by a pharmacist versus a primary care provider.Results. The primary endpoint was a six month composite of anticoagulation treatmentrelated complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication Accepted ArticleThis article is protected by copyright. All rights reserved.adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p=1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in 8 patients in the pharmacist group versus 0 patients in the control group. No differences were seen amongst other secondary endpoints.Conclusions. The pharmacist-managed clinic is a novel expansion of clinical pharmacy services that treats patients with low-risk VTEs with rivaroxaban in the outpatient setting.The evaluation of outcomes provides support that pharmacist-managed care utilizing standardized protocols under a collaborative practice agreement may be as safe as care by a primary care provider. Introduction:

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Background: Pharmacy preceptors may encounter challenges like timeline restraints, knowledge gaps, or project complexity when assigning projects to the appropriate level of learner (ie, resident vs student). There is a lack of validated assessment tools for preceptors to evaluate which projects are most appropriate for specific levels of learners.Objective: The objective of this study was to assess content validity and ease of use of the Standardized Project and Learner Alignment Tool (SPLAT) as a tool for validating the appropriateness of pharmacy learner level to promote successful project completion. Methods:The SPLAT was created in 2018 and evaluated retrospectively between April and June 2022. Projects completed by pharmacy learners (residents and students) between July 2020 and June 2022 were included for evaluation with completion of the SPLAT for each project by both the learner and preceptor. The primary end point was the content validity of the rubric assessed by a scale content validity index (S-CVI). Secondary end points included agreement in scores between preceptors and learners (a surrogate marker of interrater reliability) and ease of use.Results: A total of 52 matched pair completed forms were returned for analysis.Content validity of the SPLAT was found to have an overall S-CVI of 0.86, indicating it is valid in determining the appropriate level of pharmacy learner to complete a project. There were no statistically significant differences in the agreement of paired scores between groups (preceptors vs learners) for any level of learner on the rubric.The tool takes about 5 min to complete for both groups. In total, 100% of end users indicated the tool was helpful, 91% of both groups found the tool easy-to-use, and 94% would use it again in the future. Conclusion:The SPLAT provides an easy-to-use and validated rubric to evaluate the appropriate level of pharmacy learner for various types of projects.

Introduction Burn patients are at an increased risk of hyperglycemia due to metabolic, anabolic, and treatment-related factors. Studies in burn patients have targeted goal blood glucose (BG) values ranging from 80–140 mg/dL. Our study aimed to evaluate current management of hyperglycemia in burn patients and to develop a treatment protocol in this population. Methods A retrospective study of patients admitted between 10/2016 - 8/2019 was conducted. Eligible patients were at least 18 years old, admitted within 48 hours following injury, and admitted for either thermal, chemical, or electrical burn, frostbite, or inhalation injury. The primary outcome was glycemic control, defined as percent of time spent within our predefined BG goal range of 90–130 mg/dL using a time-weighted BG (TWBG) level. Insulin regimens were compared to determine the most effective modality for achieving this goal. Additional secondary outcomes included consequences of hypoglycemia, complications of poor glycemic control, length of stay, and in-hospital mortality. Results A total of 68 patients were evaluated, and 48 met inclusion criteria. Majority of patients were male (73%), with a mean (SD) age 60 (16) years, median (IQR) TBSA 10% (4,19), and median (IQR) baseline HbA1c 6.6% (5.6,8.2). Twenty-four (50%) patients did not have a history of diabetes. Patients spent a median (IQR) 38% (20,61) of days in goal range. Twelve patients (25%) had a TWBG level between 90–130 mg/dL. Overall, the median (IQR) TWBG level for all 48 patients was 140 mg/dL (132,160). Majority of patients were either on an insulin infusion (60%) or basal + sliding scale insulin (SSI) (51%). Patients that were on insulin infusions were controlled for a median (IQR) 75% (50,83) of days compared to patients treated using basal + SSI 20% (0,40) of days (p< 0.01). Other regimens are included in the table below. No patients were hypoglycemic (BG less than 70 mg/dL) based on TWBG. Conclusions The majority of patients in this study were not within goal BG range during their hospitalization. Patients were primarily managed by an insulin infusion or basal + SSI. However, the most appropriate regimen appears to be an insulin infusion or basal + bolus + SSI.