Objective. To design and implement an advanced cardiac life support (ACLS) workshop featuring a human patient simulator (HPS) for third-year pharmacy students. Design. The ACLS workshop consisted of a pre-session lecture, a calculation exercise, and a 40-minute ACLS session using an HPS. Twenty-four 5-member teams of students were assigned roles on a code team and participated in a ventricular fibrillation/pulseless ventricular tachycardia case. Assessment. Students completed an anonymous postactivity survey instrument and knowledge quiz. Most students who completed the ACLS workshop agreed they would like to participate in additional simulation activities and that the HPS experience enhanced their understanding of ACLS and the pharmacist responsibilities during an ACLS event (99.2% and 98.3%, respectively). However, the median score on the knowledge-based questions was 25%. Conclusion. Pharmacy students agreed HPS enhanced their learning experience; however, their retention of the knowledge learned was not consistent with the perceived benefits of HPS to education.Keywords: advanced cardiac life support, simulation, pharmacotherapy, ventricular fibrillation INTRODUCTIONAdvanced cardiovascular life support (ACLS) is a complex, team-based set of treatment strategies essential for the survival of patients experiencing a life-threatening cardiac event. As members of the ACLS team, pharmacists prepare medications at the bedside, provide pharmacotherapy consultations, and document medication administration.1 Pharmacist participation on a resuscitation team in United States hospitals is a core clinical pharmacy service, as their participation decreases adverse drug reactions and hospital mortality.2,3 From an educational standpoint, ACLS represents an ideal integration of patient assessment skills, drug preparation skills, and pharmacotherapeutic knowledge into a process that requires immediacy and accuracy. The Accreditation Council for Pharmacy Education (ACPE) recommends the integration of ACLS into the doctor of pharmacy (PharmD) curriculum. 4 However, the best methods for incorporating ACLS knowledge and skill competencies into the curriculum have not been established.Patient care simulators have been used with increasing acceptance by schools of medicine, nursing, and pharmacy to train students for a variety of clinical scenarios. 5One example is high-fidelity simulation, a unique way to introduce students to ACLS while creating an activity that allows students to apply ACLS pharmacotherapeutic knowledge and skill sets. Simulations are typically case studies of a physical reality in which participants assume a role and address problems that arise during the simulation. 6 The fidelity of the simulations refers to the degree to which the simulation reflects reality and can be further characterized by environmental, equipment, psychological, and factual accuracy.7 Human patient simulators (HPSs) are a type of high-fidelity simulator that uses a mannequin integrated with a computer to produce dynamic physiologic out...

Intracerebroventricular drug administration is a method that bypasses the blood-brain barrier and other mechanisms that limit drug distribution into the brain, allowing high drug concentrations to enter the central compartment. Instillation of drugs directly into the ventricles of the brain must be done carefully and with full consideration of factors affecting the efficacy and safety of this route of administration. These factors include the osmolarity, pH, volume, and presence of preservatives and diluents of the drug solution being administered. Very few studies have formally investigated intraventricular therapies, and dosing recommendations may vary widely depending on the agent and the patient. Many antimicrobials have been given intraventricularly, although very few prospective studies have evaluated this strategy. There are wide variations among the reports regarding dosage regimens and the pharmacokinetics of the antimicrobials used. Guidance on appropriate formulations and their use is lacking. Clinicians should be aware of their patients' ongoing disease processes and neurologic status, as well as pertinent physiochemical properties of drugs when formulating them for intracerebroventricular administration; a high index of suspicion should be maintained when monitoring patients for adverse drug events after instillation.

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Vasopressin was noninferior to norepinephrine for the achievement of a MAP goal in the first 6 hours from onset of septic shock. Further prospective analysis is warranted; however, the results are useful for consideration of alternative vasopressors in the setting of drug shortages.

The results of a survey of academic medical centers assessing the presence and description of opioid stewardship activities. Methods: Academic medical centers within the Vizient University Health System Consortium Pharmacy Network were asked to complete a survey related to opioid stewardship activities. The survey consisted of 30 questions aimed at identifying current opioid stewardship practices among hospitals and health systems. Results: There were 27 respondents to the survey. Only 42.3% of respondents have opioid stewardship activities in place. Opioid stewardship practices are primarily linked to either formal consult services or the role of a clinical pharmacy specialist. Very few institutions have opioid stewardship embedded into the daily practice of clinical pharmacists. Just over half of respondents have pharmacists as part of a pain consult team. Principle roles of pharmacists on consult teams include provider education, patient education, and optimization of therapy outside of a collaborative practice or prescribing role. Over half of the respondents participating in stewardship maintain a pharmacist's role in monitoring surgery and postoperative opioid prescribing. The majority of respondents have opioid medication policies in place to address range orders, smart pump programming of opioids, limits on meperidine use, and cumulative limits on acetaminophen dosing. Conclusion: There are limited examples of pharmacy services related to opioid stewardship. The authors believe this is a pharmacy practice model that will evolve with the national attention to the opioid epidemic and new Joint Commission Standards.