Measures to improve detection and reporting of adverse drug reactions by all health care professionals should be undertaken, to enhance our understanding of the nature and impact of these reactions in children.
Kinetic studies were carried out in 15 very low birth weight (VLBW) infants during three courses of gentamicin (G) therapy for suspected sepsis. All received two courses but only 6 required a third course. G dosage was 2.0 ± 0.2 mg/kg/24 h for the first and second course and 2.5 mg/kg/12 h for the third course. G dosage was adjusted to maintain serum peak G concentration of 4-8 μg/ml and trough concentration of 0.5-2 μg/ml. On the third day of therapy, a 24-hour collection of urine for creatinine (C) and G concentrations was performed in 28 of 36 cases. G clearance and G elimination rate constant were calculated based on chronological age (CA) of ≤ 7 (I), 8-30 (II) and ≥ 31 (III) days. The mean BW and GA were 1,002 ± 206 g and 28.4 ± 1.5 weeks, respectively. Mean CA for the starting of therapy for each course was the first day, 19 ± 9 and 68 ± 26 days of life, respectively. Mean serum G peak and trough concentrations were 5.9 ± 1.1 and 1.6 ± 0.6 μg/ml for the first; 5.7 ± 1.2 and 1.3 ± 0.6 μg/ml for the second; 5.1 ± 0.8 and 1.1 ±0.6 μg/ml for the third course of therapy. Mean apparent volume of distribution of G were 0.53 ± 0.10 liter/kg for the first and 0.50 ± 0.11 liter/kg for the second and third courses. Mean clearances for the three CA groups were 6.4 ± 1.9; 7.6 ± 3.2; 24.1 ± 8.0 ml/min/1.73 m^2 for G and 6.4 ± 2.2; 7.7 ± 3.1; 23.3 ± 8.8 for C with serum C of 1.3 ± 0.4, 1.2 ± 0.6 and 0.6 ± 0.4 mg%, respectively. There were no statistically significant differences for serum C, G and C clearance between CA 1 and II but significant differences were found for the above between CA III vs. CA I and II (p < 0.005). G clearance closely correlated with C clearance (r = 0.99, p < 0.001). The elimination rate constant was significantly higher after 30 days of life when CA III is compared to CA I and II or combined (p < 0.001). This study shows that during the first month of life, VLBW sick infants still have decreased renal function and poor G clearance, therefore, G should be given every 24 h and the dose be adjusted based on individual patient serum G levels.
Background:Innovative approaches, including LEAN systems and dashboards, to enhance pharmacy production continue to evolve in a cost and safety conscious health care environment. Furthermore, implementing and evaluating the effectiveness of these novel methods continues to be challenging for pharmacies. Objective: To describe a comprehensive, real-time pharmacy dashboard that incorporated LEAN methodologies and evaluate its utilization in an inpatient Central Intravenous Additives Services (CIVAS) pharmacy. Methods: Long Beach Memorial Hospital (462 adult beds) and Miller Children's and Women's Hospital of Long Beach (combined 324 beds) are tertiary not-for-profit, community-based hospitals that are served by one CIVAS pharmacy. Metrics to evaluate the effectiveness of CIVAS were developed and implemented on a dashboard in real-time from March 2013 to March 2014. Results: The metrics that were designed and implemented to evaluate the effectiveness of CIVAS were quality and value, financial resilience, and the department's people and culture. Using a dashboard that integrated these metrics, the accuracy of manufacturing defect-free products was ≥99.9%, indicating excellent quality and value of CIVAS. The metric for financial resilience demonstrated a cost savings of $78,000 annually within pharmacy by eliminating the outsourcing of products. People and value metrics on the dashboard focused on standard work, with an overall 94.6% compliance to the workflow. Conclusion: A unique dashboard that incorporated metrics to monitor 3 important areas was successfully implemented to improve the effectiveness of CIVAS pharmacy. These metrics helped pharmacy to monitor progress in real-time, allowing attainment of production goals and fostering continuous quality improvement through LEAN work.
Objective: The enactment of the Affordable Care Act (ACA) in 2010 imposes payment penalty on hospitals with high hospital readmission rates. In an effort to reduce readmissions, a pharmacist discharge counseling program was implemented to facilitate transition of care to the outpatient setting. Our study objective was to evaluate the impact of the program on hospital readmissions and visits to the emergency department (ED).Methods: This was a single-center, retrospective cohort study conducted at a not-for-profit, teaching community hospital with 462 total beds. Pharmacists provided counseling to patients discharged from the medicine floor between November 2013 and January 2014, and included those considered to be high-risk (e.g., taking 5 scheduled medications and had diseases such as congestive heart failure and diabetes mellitus). Descriptive analysis was performed and outcomes were compared between patients who did and did not receive pharmacist counseling.Results: Of a total of 889 discharged patients, 488 (55%) received counseling from a pharmacist. For the entire cohort, mean age was 55 ± 20 years; Charlson Comorbidity Index (CCI) score was 2.74 ± 2.95; and length of hospitalization was 4 ± 4 days. These parameters were not statistically different between the two groups. Within 30-days after hospital discharge, significantly fewer subjects who received counseling, compared with those who did not, were readmitted to the hospital (11.3% vs. 15%, p = .009) or visited the ED (10.6% vs. 15%, p = .005).Conclusions: Discharge counseling provided by pharmacists during transitions of care at a community hospital significantly reduced 30-day readmission and ED visit rates.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.