Impact of Clinical Pharmacy Specialists on the Design and Implementation of a Quality Improvement Initiative to Decrease Inappropriate Medications in a Veterans Affairs Emergency Department

Moss, Jason M.; Bryan, William E.; Wilkerson, Loren M.; Jackson, George L.; Owenby, Ryan K.; Houtven, Courtney Harold Van; Stevens, Melissa B.; Powers, James S.; Vaughan, Camille P.; Hung, William; Hwang, Ula; Markland, Alayne D.; McGwin, Gerald; Hastings, S. Nicole

doi:10.18553/jmcp.2016.22.1.74

Cited by 21 publications

(26 citation statements)

References 17 publications

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“…Our study highlights and confirms the findings of previous studies[5] that for the optimal drug therapy in elderly patients it is desirable to enhance and systematize the collaboration between a clinical pharmacist-geriatrician team and the treating physicians in medical units.…”

supporting

confidence: 89%

“Drug use without indication” in elderly hospitalized patients

Haider

Mazhar

Ahmed³

2017

Journal of Postgraduate Medicine

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supporting

confidence: 89%

“Drug use without indication” in elderly hospitalized patients

Haider

Mazhar

Ahmed³

2017

Journal of Postgraduate Medicine

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“…Various publications have demonstrated the importance of adopting approaches to care that will decrease the risk of adverse drug reactions for patients being treated in institutional settings. [24][25][26] One prior study of inpatients receiving treatment with insulin for hyperkalemia found an association between low pretreatment blood glucose and the risk of developing posttreatment hypoglycemia. 13 The current study also found that posttreatment hypoglycemic patients had significantly lower baseline blood glucose levels compared to those with normal posttreatment blood glucose levels; however, there were no significant differences in the dose of insulin each group received.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemia Associated With Insulin Use During Treatment of Hyperkalemia Among Emergency Department Patients

et al. 2018

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Hypoglycemia is a common adverse event associated with insulin during treatment of hyperkalemia in hospitalized patients; however, limited data exist regarding hypoglycemia incidence and appropriate dosing strategies for treatment of patients in the emergency department. The study objective was to determine the incidence of hypoglycemia associated with insulin use during treatment of hyperkalemia among patients seen in the emergency department. Methods: This was an Institutional Review Board (IRB)-approved retrospective, chart-review study. All adult patients who received intravenous regular insulin as a result of an order from the emergency department hyperkalemia order set were eligible for inclusion. The main clinical outcomes were incidence of hypoglycemia (blood glucose <70 mg/dL) and severe hypoglycemia (blood glucose <40 mg/dL). Blood glucose was checked within 24 hours of insulin administration. Results: A total of 172 patients were included. The incidence of hypoglycemia was 19.8% (n = 34) and the incidence of severe hypoglycemia was 5.2% (n = 9). Hypoglycemic patients had a significantly lower median blood glucose at baseline compared to those who did not develop hypoglycemia (83.5 [72.0-112.0] mg/dL vs 123.0 [96.0-167.0] mg/dL, P < .0001); however, no difference was noted between groups in the average insulin dose administered (0.11 ± 0.04 units/kg vs 0.12 ± 0.05 units/kg, P = .6175). Conclusion: There is a concerning risk of hypoglycemia associated with insulin use during treatment of hyperkalemia in the emergency department. Standard insulin doses may not be appropriate in some cases like patients with lower baseline blood glucose. Further research is warranted to develop safer hyperkalemia treatment protocols that mitigate this high risk of hypoglycemia associated with insulin use.

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“…For research that is being conducted within pharmacy, three main types of studies seem to exist with focus on outcomes or processes at the clinical intervention or programmatic level: 1) studies of implementation of interventions within educational, community or clinical practice settings, 3,4 2) studies that apply frameworks into practice, 5,6 and 3) program assessment studies. 7,8 Program assessment studies in particular have the potential to influence health and reimbursement policies in support of practice transformation. The committee was able to identify research studies in both community pharmacy and clinical pharmacy practice settings, with a larger subset of papers dedicated to studies in the community setting.…”

Section: Literature and Funding Landscape Search Resultsmentioning

confidence: 99%

Implementation Science to Advance Practice and Curricular Transformation: Report of the 2019-2020 AACP Research and Graduate Affairs Committee

Chair

Bacci

Chui

et al. 2020

American Journal of Pharmaceutical Education

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Impact of Clinical Pharmacy Specialists on the Design and Implementation of a Quality Improvement Initiative to Decrease Inappropriate Medications in a Veterans Affairs Emergency Department

Abstract: This QI project resulted in a meaningful decrease in PIM prescribing in older ED adults. CPS contributions to QI can extend beyond pharmacotherapy and provider education to also include information technology tools using formulary management expertise.

Cited by 21 publications

References 17 publications

“Drug use without indication” in elderly hospitalized patients

“Drug use without indication” in elderly hospitalized patients

Hypoglycemia Associated With Insulin Use During Treatment of Hyperkalemia Among Emergency Department Patients

Implementation Science to Advance Practice and Curricular Transformation: Report of the 2019-2020 AACP Research and Graduate Affairs Committee

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