Improving transitions of care for critically ill adult patients on pulmonary arterial hypertension medications

Abstract

Purpose The purpose of this report is to describe the activities of critical care and ambulatory care pharmacists in a multidisciplinary transitions-of-care (TOC) service for critically ill patients with pulmonary arterial hypertension (PAH) receiving PAH medications. Summary Initiation of medications for treatment of PAH involves complex medication access steps. In the ambulatory care setting, multidisciplinary teams often have a process for completing these steps to ensure access to PAH medications. Patients with PAH are frequently admitted to an intensive care unit (ICU), and their home PAH medications are continued and/or new medications are initiated in the ICU setting. Inpatient multidisciplinary teams are often unfamiliar with the medication access steps unique to PAH medications. The coordination and completion of medication access steps in the inpatient setting is critical to ensure access to medications at discharge and prevent delays in care. A PAH-specific TOC bundle for patients prescribed a PAH medication who are admitted to the ICU was developed by a multidisciplinary team at an academic teaching hospital. The service involves a critical care pharmacist completing a PAH medication history, assessing for PAH medication access barriers, and referring patients to an ambulatory care pharmacist for postdischarge telephone follow-up. In collaboration with the PAH multidisciplinary team, a standardized workflow to be initiated by the critical care pharmacist was developed to streamline completion of PAH medication access steps. Within 3 days of hospital discharge, the ambulatory care pharmacist calls referred patients to ensure access to PAH medications, provide disease state and medication education, and request that the patient schedule a follow-up office visit to take place within 14 days of discharge. Conclusion Collaboration by a PAH multidisciplinary team, critical care pharmacist, and ambulatory care pharmacist can improve TOC related to PAH medication access for patients with PAH. The PAH TOC bundle serves as a model that may be transferable to other health centers.

Fluid resuscitation and relation to respiratory support escalation in patients with and without pulmonary hypertension with sepsis

“…for the included study sample to fit within this effect size range for an a priori sample size calculation. [19][20][21][22][23]34 Lastly, previous stud-…”

“…The physiology of these PH groups drastically differs from patients with group 1 PAH, which may lead to different effects with regard to fluid administration and escalation of respiratory support. A formal power calculation was not completed for the present study, but the effect size observed in the literature in the escalation of respiratory support between the general population and PH population with sepsis ranges from 10.2% to 57% allowing for the included study sample to fit within this effect size range for an a priori sample size calculation 19–23,34 . Lastly, previous studies in fluid‐sensitive populations used placement on mechanical ventilation as the definition of escalation of respiratory support 11 .…”

Approach to the hospitalized patient with pulmonary arterial hypertension

“…There is no uniform benefit during the acute episode, but long-term survival might be improved [ the outpatient setting. This mandates a thorough evaluation of the patient's physical, psychological, cognitive, and social ability to handle continuous parenteral infusions in the long-term and extensive and careful coordination of care [31,32].…”

Interprofessional and Intraprofessional Communication about Older People’s Medications across Transitions of Care

“…Recent research examining medication management across transitions of care has focused on medication incidents [3,8], pharmacist-led interventions [9][10][11][12] and patient and family perspectives [13,14]. Research also identifies communication breakdowns contributing to medication incidents across transitions [15,16]; yet, little is known about what influences how health professionals communicate with each other to manage medications and avoid potential breakdowns in communication across transitions.…”