Although concomitant use of warfarin and tamoxifen is deemed a contraindication, evidence regarding this potential interaction is limited. Therefore, safety of concomitant use of tamoxifen and warfarin may be similar to that of other drugs that interact with warfarin, requiring consistent and careful monitoring. However, more evidence is needed to warrant the routine use of this combination.

Introduction: Appropriate inhaler technique is important for optimizing treatment of pulmonary conditions, including asthma and chronic obstructive pulmonary disease.Nurses often administer inhaled medications in the acute care setting, providing an opportunity to educate patients on appropriate inhaler technique. To date, no published study has evaluated the impact of pharmacist-led training on skill improvement and retention among acute care pulmonary nursing staff regarding their ability to instruct a patient on inhaler technique.Objective: The primary objective of this study was to evaluate both the immediate and sustained impact of pharmacist-led inhaler technique for acute care pulmonary nurses using hands-on training for instructing on appropriate inhaler use. Methods: This prospective study used a one group pre-test, posttest design for an educational intervention. Pharmacists conducted a brief in-service followed by an individualized simulation where the nurse participant instructed a standardized patient on how to use a placebo metered dose inhaler (MDI) and dry powder inhaler (DPI) before and after receiving individual technique training by a pharmacist. Participant inhaler counseling technique was assessed via standardized checklist. Nurses then received individual coaching from a pharmacist regarding proper inhaler technique. After the pharmacist intervention, the nurse again counseled the standardized patient on how to use the devices. Measures included investigator rating on inhaler technique at baseline, after training, and 2 months later. Results: After the interventions, participant performance significantly improved for MDI and DPI technique. At the 2-month follow-up, there was a statistically significant increase for MDI and DPI technique from baseline. Conclusion: Brief, pharmacist-led inhaler technique education results in sustained improvements in inhaler administration skills among pulmonary nursing staff.