Journal of Pharmacy Technology

Hyperkalemia is one of the most common drug-related electrolyte abnormalities resulting in adverse drug events (ADEs) at our institution.

To determine the effect of a computerized pharmacy alert on the number of adverse events related to hyperkalemia in a hospital setting and to study the impact of guidelines and education on pharmacist response to high potassium levels.

An alert was built into the pharmacy computer system, which warned pharmacists about a potassium level greater than 5.1 mEq/L when processing an order that could increase potassium. The alert was linked to a trigger medication list. After the alert was implemented, the number of ADEs due to hyperkalemia was compared for the 3 months pre- and postalert. Due to a lack of consistency in pharmacist interventions after implementation of the alert, hyperkalemia management guidelines were developed by the pharmacy department. The staff pharmacists received training on how to address hyperkalemia when processing prescriptions. After the education component was completed, the types of pharmacist interventions made pre- and posttraining were also compared.

Building an automated pop-up alert resulted in a decreased number of ADEs related to hyperkalemia (p < 0.001) and reduced the utilization of medications needed to treat hyperkalemia (p = 0.019).

Implementation of a computerized pharmacy alert resulted in a statistically significant decrease in adverse drug events related to hyperkalemia in our institution. Educating pharmacists about hyperkalemia and developing guidelines for its management provided consistency among responses to the high potassium computerized alert. Further studies are needed to evaluate the impact of guideline development and pharmacist education on the trend of drug-induced hyperkalemia in an inpatient pharmacy setting.

Inpatient pharmacy automation is becoming an increasingly important component of the medication distribution process across the country. The use of pharmacy automation is perceived as a tool for increasing patient safety and pharmacy department efficiency. Adjusting pharmacy workflow requirements and staffing redefinitions is essential when implementing pharmacy automation.

To evaluate the results of an acute care, community, teaching hospital's experience as the inpatient pharmacy implements a robot, medication carousel, and barcode packager, and shifts its medication distribution model from a cartless to cart fill method.

Data on robot efficiency, changing pharmacy technician roles, and pharmacist time were collected over 2 years. The medication distribution process and pharmacy technician roles had to be adjusted multiple times to increase workflow efficiency. The initial shift to a cart fill distribution model, with first doses dispensed from the robot, resulted in robot efficiency of approximately 71%. When the distribution model was shifted to hybrid cart fill and cartless model, with first doses dispensed from automated dispensing cabinets, the robot efficiency improved to between 85% and 90%.

Pharmacy automation requires proper workflow adjustments to realize the potential increased efficiency of this technology. Additionally, optimizing the medication distribution model to maximize the efficiency of staffing workflow has a significant impact on automation efficiency.

To describe a method for creating an electronic document management (EDM) system at a drug information (DI) center based at an academic medical center to improve efficiency and provide increased availability through remote access.

At DI centers, written materials not available electronically are often stored in file cabinets and retrieved by an individual when required. This process can be time-consuming and inefficient. Various EDM programs were evaluated and compared based on capabilities, cost of implementation and maintenance, and efficiency. Following program selection, documents were scanned onto a dedicated personal computer (PC) and organized according to a predetermined hierarchy of folders. Specialists then performed optical character recognition (OCR) and entered authors, titles, and assigned key words for each new electronic file.

It was determined that Adobe Acrobat software fulfilled all requirements at minimal expense. A specialist is able to scan and electronically file 72 documents (496 pages) per hour, perform OCR on 40 documents per hour, and attach titles, authors, and key words to newly scanned documents at a rate of 10 articles per hour. This EDM system is capable of storing in excess of 70,000 documents on a PC with 250 GB of hard disk space and 4 GB of random access memory, which can be accessed remotely from any computer through a secure virtual private network connection.

Adobe Acrobat software, when combined with a high-resolution scanner, provides an inexpensive method for EDM that allows for immediate document retrieval, expansion of operations, and remote access.

To evaluate the role of ranolazine as an effective and safe first-line treatment option for the management of chronic stable angina (CSA).

A literature search was conducted using MEDLINE (1966-August 2009), International Pharmaceutical Abstracts (1970-August 2009), and Cochrane database (publications archived until August 2009) using the terms chronic stable angina and ranolazine. In addition, reference citations from publications identified were reviewed.

English-language, randomized, controlled trials evaluating ranolazine extended release (ER) for the treatment of CSA in humans were selected for review. Four randomized controlled trials were identified. Findings pertaining to efficacy and safety were extracted.

Three randomized, placebo-controlled CSA studies (N = 191, N = 823, N = 565) and 1 non-ST-segment elevation acute coronary syndrome (ACS) study (N = 6560) were identified that evaluated ranolazine ER. The 3 CSA studies showed that ranolazine ER treatment resulted in statistically significant improvements in exercise tolerance, time to angina onset, and time to 1-mm ST-segment depression. Two of the 3 CSA studies showed statistically significant reductions in angina episodes per week and nitroglycerin use per week compared to placebo. No significant reduction in cardiovascular events was seen in the non-ST-segment elevation ACS study following 1 year of treatment with ranolazine ER. Evidence has demonstrated that monotherapy with ranolazine ER is effective in increasing exercise tolerance in patients with CSA. Ranolazine ER therapy added to traditional antianginal therapy has shown efficacy in increasing exercise tolerance and minimally decreasing angina frequency in clinical trials.

Ranolazine ER should be used judiciously in the management of CSA and should not be used as a first-line agent routinely unless traditional therapy is contraindicated.

To review the pharmacology, pharmacokinetics, dosage, administration, clinical efficacy, safety, and place in therapy of plerixafor, a CXCR4 receptor antagonist used to mobilize stem cells prior to hematopoietic stem cell transplantation.

Articles were identified by searching MEDLINE (1950-August 2009) and the American Society of Hematology abstract database using the key terms plerixafor, AMD3100, hematopoietic stem cell transplant, mobilization, multiple myeloma, and non-Hodgkin's lymphoma. Additional articles were obtained by using the reference sections of articles found during the literature search.

All articles identified from the literature search were reviewed for relevant information. Appropriate information was included in this review. The search was restricted to available English-language articles, including those on both preclinical and clinical trials.

Plerixafor is a CXCR4 receptor antagonist approved by the FDA to assist in the mobilization of hematopoietic stem cells in patients with non-Hodgkin's lymphoma or multiple myeloma undergoing autologous stem cell transplant. Plerixafor is used in combination with granulocyte colony-stimulating factor. Plerixafor has been compared with placebo in both Phase 2 and Phase 3 clinical trials and has been shown to allow for a greater collection of hematopoietic stem cells in fewer apheresis sessions. Plerixafor demonstrated good tolerability in clinical trials.

Plerixafor has demonstrated efficacy and tolerability when used for stem cell mobilization in patients with non-Hodgkin's lymphoma and multiple myeloma. Further studies are warranted to determine the safety and efficacy of plerixafor in patients with malignancies other than non-Hodgkin's lymphoma or multiple myeloma who are undergoing stem cell transplant and to determine its potential use in healthy stem cell donors.