Hospital Pharmacy - July/August 2017 - 500
500
Hospital Pharmacy 52(7)
Table 1. Baseline Characteristics.
Age, mean, y
Weight, mean, kg
Male (%)
Caucasian (%)
No. of PTA medications, mean
Health literacy score
At risk (%)
Not at risk (%)
Insurance (%)
Uninsured
Government
Private
History of VTE (%)
History of cancer (%)
History of heart failure (%)
History of lung disease (%)
Thrombophilia (%)
Indication (%)
PE only
Distal DVT only
Proximal DVT only
PE + DVT
PESI score, median
Primary etiology (%)
Unprovoked
Recent surgery
Immobilization
Estrogen therapy
Cancer
Other
Hgb, mean, g/dL
Hct, mean (%)
Platelets, mean, ×109/L
SCr, mean, mg/dL
Table 2. Results.
R-PAK
n = 12
Control
n = 13
54
111.3
5 (42)
10 (83)
5.3
61
96.9
8 (62)
12 (92)
5.6
0 (0)
12 (100)
0 (0)
13 (100)
1 (8)
2 (17)
9 (75)
2 (17)
3 (25)
0 (0)
1 (8)
1 (8)
1 (8)
7 (54)
5 (38)
9 (69)
3 (23)
1 (8)
1 (8)
1 (8)
4 (33)
2 (17)
1 (8)
5 (42)
71
9 (69)
1 (8)
0 (0)
3 (23)
82
5 (42)
4 (33)
2 (17)
1 (8)
0 (0)
2 (17)
13
36.3
237.9
0.87
8 (62)
4 (31)
1 (8)
0 (0)
1 (8)
2 (15)
12.3
35.9
285.8
0.93
P value
.20
.18
.32
.49
.84
1.00
.14
.41
.91
.33
.49
.95
.29
.69
.72
.53
.95
.25
.31
Note. R-PAK = Rivaroxaban Patient Assistance Kit; PTA = prior to
admission; VTE = venous thromboembolism; PE = pulmonary embolism;
DVT = deep vein thromboembolism; PESI = PE severity index; Hgb =
hemoglobin; Hct = hematocrit; SCr = serum creatinine.
The study investigators also received a grant to help provide funds to obtain adequate supplies required for the implementation of this project. Without necessary funds and
supplies, it may be hard to implement this project into other
community and teaching hospitals. However, the benefit of
compliance to the recommended treatment regimen likely
outweighs the cost of the supplies required for the implementation of this project.
Another limitation was that patient recall was heavily
relied on when performing the follow-up phone call, after at
least 22 total days of therapy. This type of investigation could
lead to both recall and/or reporting biases. Although the
investigators attempted to reach every individual the day
Primary outcome
Proper transition at day
22 (%)
Secondary Outcome
Understanding of dose/
interval (%)
Total adherence, %
≥90% adherence (%)
Contacted by nurse prior to
follow-up (%)
Self-reported side effects (%)
Self-reported VTE (%)
Minor bleed (%)
Bleed requiring medical
attention (%)
VTE recurrence (%)
Reported death (%)
Early discontinuation (%)
ACTS benefit score, median
ACTS burden score, median
In-hospital doses, median
Cost of hospitalization, mean
(2016 dollars)
R-PAK
n = 12
Control
n = 13
8 (67)
9 (69)
.89
12 (100)
13 (100)
1.00
99.8
12 (100)
1 (8)
97.65
12 (92)
0 (0)
.07
.33
.29
0 (0)
1 (8)
1 (8)
0 (0)
3 (23)
0 (0)
4 (30)
0 (0)
.08
.29
.16
1.00
1 (8)
0 (0)
1 (8)
10
15
4
27,257.99
0 (0)
0 (0)
0 (0)
12
15
2
33,838.48
.29
1.00
.29
.05
.68
.47
.48
P value
Note. R-PAK = Rivaroxaban Patient Assistance Kit; VTE = venous
thromboembolism; ACTS = Anti-clot Treatment Scale.
after transition, most patients could not be contacted on day
22 of therapy. The majority of patients were contacted within
the 30-day time frame. However, the accuracy of data is
more likely to be lost, the farther out the day of contact is
from the day of transition.
A confounding factor presented in the Fall of 2015 when
the investigators realized that many patients were being sent
home with the Xarelto StarterPack™, produced by the manufacturer. The StarterPack™ contains 42 doses of 15 mg tablets, totaling 21 days of twice daily therapy, and 9 doses of 20
mg to help ease the transition between different dosage
strengths and frequencies. Unlike the StarterPack™, the
R-PAK can be customized for each specific patient by factoring in doses taken while hospitalized to individualize each
patient's outpatient treatment regimen at discharge. A total of
6 patients, 2 patients in the R-PAK group and 4 patients in the
control group, were prescribed the Xarelto StarterPack™
while 19 patients were sent home with 2 prescriptions (1 for
15 mg twice daily and 1 for 20 mg once daily) on hospital
discharge. The education in this study was not appropriately
tailored to the patients receiving the StarterPack™, as patients
received an average of 4 days of therapy while hospitalized.
As such, patients were not thoroughly educated to omit tablets
contained within the StarterPack™ based on doses administered in the hospital, but all patients received education on
Table of Contents for the Digital Edition of Hospital Pharmacy - July/August 2017
The Evolution of Drug Information Centers and Specialists
Letter: Sodium Phosphates Injection—Osmolarity Labeling Correction
ISMP Adverse Drug Reactions
Drug Monographs: Avelumab and Ribociclib
Formulary Drug Review: Naldemedine
Chimeric Antigen Receptor T-Cell Therapy for Lymphomas: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
International Mentoring Programs: Leadership Opportunities to Enhance Worldwide Pharmacy Practice
Compounded Apixaban Suspensions for Enteral Feeding Tubes
Impact of Developing Adult Ketamine Order Panels for the Emergency Department
Critical Appraisal of Biomedical Literature With a Succinct Journal Club Template: The ROOTs Format
Effect of a Rivaroxaban Patient Assistance Kit (R-PAK) for Patients Discharged With Rivaroxaban: A Randomized Controlled Trial
Examining the Use of Sodium Nitroprusside in Coronary Artery Bypass Grafting: Is the Benefit Worth the Cost?
Successful Implementation of an Antimicrobial Stewardship Program at an Academic Medical Center
Hospital Pharmacy - July/August 2017 - 445
Hospital Pharmacy - July/August 2017 - 446
Hospital Pharmacy - July/August 2017 - 447
Hospital Pharmacy - July/August 2017 - 448
Hospital Pharmacy - July/August 2017 - 449
Hospital Pharmacy - July/August 2017 - 450
Hospital Pharmacy - July/August 2017 - 451
Hospital Pharmacy - July/August 2017 - The Evolution of Drug Information Centers and Specialists
Hospital Pharmacy - July/August 2017 - 453
Hospital Pharmacy - July/August 2017 - Letter: Sodium Phosphates Injection—Osmolarity Labeling Correction
Hospital Pharmacy - July/August 2017 - ISMP Adverse Drug Reactions
Hospital Pharmacy - July/August 2017 - 456
Hospital Pharmacy - July/August 2017 - 457
Hospital Pharmacy - July/August 2017 - 458
Hospital Pharmacy - July/August 2017 - Drug Monographs: Avelumab and Ribociclib
Hospital Pharmacy - July/August 2017 - 460
Hospital Pharmacy - July/August 2017 - 461
Hospital Pharmacy - July/August 2017 - 462
Hospital Pharmacy - July/August 2017 - 463
Hospital Pharmacy - July/August 2017 - Formulary Drug Review: Naldemedine
Hospital Pharmacy - July/August 2017 - 465
Hospital Pharmacy - July/August 2017 - 466
Hospital Pharmacy - July/August 2017 - 467
Hospital Pharmacy - July/August 2017 - 468
Hospital Pharmacy - July/August 2017 - Chimeric Antigen Receptor T-Cell Therapy for Lymphomas: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Hospital Pharmacy - July/August 2017 - 470
Hospital Pharmacy - July/August 2017 - International Mentoring Programs: Leadership Opportunities to Enhance Worldwide Pharmacy Practice
Hospital Pharmacy - July/August 2017 - 472
Hospital Pharmacy - July/August 2017 - 473
Hospital Pharmacy - July/August 2017 - 474
Hospital Pharmacy - July/August 2017 - 475
Hospital Pharmacy - July/August 2017 - 476
Hospital Pharmacy - July/August 2017 - 477
Hospital Pharmacy - July/August 2017 - Compounded Apixaban Suspensions for Enteral Feeding Tubes
Hospital Pharmacy - July/August 2017 - 479
Hospital Pharmacy - July/August 2017 - 480
Hospital Pharmacy - July/August 2017 - 481
Hospital Pharmacy - July/August 2017 - 482
Hospital Pharmacy - July/August 2017 - Impact of Developing Adult Ketamine Order Panels for the Emergency Department
Hospital Pharmacy - July/August 2017 - 484
Hospital Pharmacy - July/August 2017 - 485
Hospital Pharmacy - July/August 2017 - 486
Hospital Pharmacy - July/August 2017 - 487
Hospital Pharmacy - July/August 2017 - Critical Appraisal of Biomedical Literature With a Succinct Journal Club Template: The ROOTs Format
Hospital Pharmacy - July/August 2017 - 489
Hospital Pharmacy - July/August 2017 - 490
Hospital Pharmacy - July/August 2017 - 491
Hospital Pharmacy - July/August 2017 - 492
Hospital Pharmacy - July/August 2017 - 493
Hospital Pharmacy - July/August 2017 - 494
Hospital Pharmacy - July/August 2017 - 495
Hospital Pharmacy - July/August 2017 - Effect of a Rivaroxaban Patient Assistance Kit (R-PAK) for Patients Discharged With Rivaroxaban: A Randomized Controlled Trial
Hospital Pharmacy - July/August 2017 - 497
Hospital Pharmacy - July/August 2017 - 498
Hospital Pharmacy - July/August 2017 - 499
Hospital Pharmacy - July/August 2017 - 500
Hospital Pharmacy - July/August 2017 - 501
Hospital Pharmacy - July/August 2017 - Examining the Use of Sodium Nitroprusside in Coronary Artery Bypass Grafting: Is the Benefit Worth the Cost?
Hospital Pharmacy - July/August 2017 - 503
Hospital Pharmacy - July/August 2017 - 504
Hospital Pharmacy - July/August 2017 - 505
Hospital Pharmacy - July/August 2017 - 506
Hospital Pharmacy - July/August 2017 - 507
Hospital Pharmacy - July/August 2017 - Successful Implementation of an Antimicrobial Stewardship Program at an Academic Medical Center
Hospital Pharmacy - July/August 2017 - 509
Hospital Pharmacy - July/August 2017 - 510
Hospital Pharmacy - July/August 2017 - 511
Hospital Pharmacy - July/August 2017 - 512
Hospital Pharmacy - July/August 2017 - 513
Hospital Pharmacy - July/August 2017 - 514
Hospital Pharmacy - July/August 2017 - 515
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