Hospital Pharmacy - June 2018 - 174
174
Hospital Pharmacy 53(3)
Table 2. Baseline Characteristics.
Preimplementation (n = 203)
Male, % (n)
Age
Height (cm)
Weight (kg)
Duration of therapy (d)
Postimplementation (n = 173)
58 (118)
54.8 ± 15.4
172.2 ± 10.3
80.8 ± 20.9
4.4 ± 1.2
53 (92)
57.4 ± 14.1
170.4 ± 10.3
81.8 ± 20.1
4.5 ± 1.2
P
.35
.09
.09
.63
.42
Note. Data presented as mean ± SD.
Table 3. Indication for Epidural Therapy.
Preimplementation (n = 203)
Postimplementation (n = 173)
P
4 (8)
4 (8)
25 (50)
1 (1)
4 (9)
38 (78)
21 (42)
3 (7)
1 (2)
0 (0)
36 (63)
2 (3)
3 (6)
31 (54)
25 (44)
1 (2)
.08
.003
.02
.24
.62
.13
.29
.13
Burn
Cardiovascular surgery
GI or GU surgery
Oncology surgery
Orthopedic surgery
Thoracic surgery
Trauma
Other
Note. Data presented as % (n). GI = gastrointestinal; GU = genitourinary.
Table 4. Primary and Secondary End Points.
Improper medication administered
Enoxaparin
Promethazine
Respiratory depression
Hypotensive events
Naloxone administered
Rapid responses
Preimplementation (n = 203)
Postimplementation (n = 173)
P
13.3 (27)
3.9 (8)
9.4 (19)
3.9 (8)
23.6 (48)
2.5 (5)
3.9 (8)
6.3 (11)
0 (0)
6.3 (11)
4.0 (7)
20.7 (36)
1.2 (2)
1.2 (2)
.054
.002
.27
.97
.49
.34
.08
Note. Data presented as % (n). Medications not listed did not have any instances of inappropriate administration.
observed when examining the primary end point by medication.
This difference was of particular clinical importance because
there were no instances of improper anticoagulant administration in the postimplementation group, while inappropriate
enoxaparin use represented about 30% of total inappropriate
medication administrations in the preimplementation group.
Although the total number of inappropriate medication
administrations was small, risk of complications with anticoagulants and epidural use can be particularly significant.
This study was completed prior to the approval of many of
the direct oral anticoagulants (apixaban, edoxaban, and rivaroxaban), and therefore these medications were not addressed
with the epidural module. There is opportunity for addition
of these medications to the module as prescribers may not be
familiar with these medication names and their mechanisms
as anticoagulants.
When implementing clinical decision support, whether
electronic or manual, it is essential that the intervention first
be evaluated for feasibility of use and that the timing of the
intervention is well understood. For a tool to be effective, it
must be appropriately utilized and there must be acceptance
from prescribers. In the case of our clinical decision support
tool, a few hypotheses have been formulated for why the
module demonstrated a trend toward improved outcomes,
yet our results did not show a significantly decreased risk of
inappropriate medication administration and decreased
complications. When epidural therapy is initiated at our
institution, it most often occurs in the operating room prior to
an order for epidural therapy being placed to the pharmacy.
This results in catheter insertion prior to the provider being
exposed to the ordering module and could result in patients
being on inappropriate high-risk medications without the
provider's knowledge. As the epidural ordering module
gains acceptance among providers performing epidurals,
they will presumably utilize it prior to catheter insertion. In
addition, the ordering module was originally designed as an
Table of Contents for the Digital Edition of Hospital Pharmacy - June 2018
Ed Board
TOC
USP <800>
Oct-Dec 2017 Boxed Warning Highlights approved by the FDA
Zoster Vaccine Recombinant, Adjuvanted
Multifactorial Causes of Tacrolimus Errors: Confusion With Strength/Formulation, Look-Alike Names, Preparation Errors, and More
New Medications in the Treatment of Nonalcoholic Steatohepatitis
One Chance for Your Best First Impression: Tips for New Pharmacists
Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock
Intravenous Push Administration of Antibiotics: Literature and Considerations
The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy
Health Care Professionals Toward Adverse Drug Reaction Reporting in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross-sectional Study
Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients
Detection of HBV, HCV, and Incidence of Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma–Treated Patients
Hospital Pharmacy - June 2018 - Cover1
Hospital Pharmacy - June 2018 - Cover2
Hospital Pharmacy - June 2018 - Ed Board
Hospital Pharmacy - June 2018 - TOC
Hospital Pharmacy - June 2018 - 131
Hospital Pharmacy - June 2018 - USP <800>
Hospital Pharmacy - June 2018 - 133
Hospital Pharmacy - June 2018 - Oct-Dec 2017 Boxed Warning Highlights approved by the FDA
Hospital Pharmacy - June 2018 - 135
Hospital Pharmacy - June 2018 - Zoster Vaccine Recombinant, Adjuvanted
Hospital Pharmacy - June 2018 - 137
Hospital Pharmacy - June 2018 - 138
Hospital Pharmacy - June 2018 - 139
Hospital Pharmacy - June 2018 - 140
Hospital Pharmacy - June 2018 - 141
Hospital Pharmacy - June 2018 - Multifactorial Causes of Tacrolimus Errors: Confusion With Strength/Formulation, Look-Alike Names, Preparation Errors, and More
Hospital Pharmacy - June 2018 - 143
Hospital Pharmacy - June 2018 - 144
Hospital Pharmacy - June 2018 - 145
Hospital Pharmacy - June 2018 - New Medications in the Treatment of Nonalcoholic Steatohepatitis
Hospital Pharmacy - June 2018 - 147
Hospital Pharmacy - June 2018 - One Chance for Your Best First Impression: Tips for New Pharmacists
Hospital Pharmacy - June 2018 - 149
Hospital Pharmacy - June 2018 - 150
Hospital Pharmacy - June 2018 - 151
Hospital Pharmacy - June 2018 - Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock
Hospital Pharmacy - June 2018 - 153
Hospital Pharmacy - June 2018 - 154
Hospital Pharmacy - June 2018 - 155
Hospital Pharmacy - June 2018 - 156
Hospital Pharmacy - June 2018 - Intravenous Push Administration of Antibiotics: Literature and Considerations
Hospital Pharmacy - June 2018 - 158
Hospital Pharmacy - June 2018 - 159
Hospital Pharmacy - June 2018 - 160
Hospital Pharmacy - June 2018 - 161
Hospital Pharmacy - June 2018 - 162
Hospital Pharmacy - June 2018 - 163
Hospital Pharmacy - June 2018 - 164
Hospital Pharmacy - June 2018 - 165
Hospital Pharmacy - June 2018 - 166
Hospital Pharmacy - June 2018 - 167
Hospital Pharmacy - June 2018 - 168
Hospital Pharmacy - June 2018 - 169
Hospital Pharmacy - June 2018 - The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy
Hospital Pharmacy - June 2018 - 171
Hospital Pharmacy - June 2018 - 172
Hospital Pharmacy - June 2018 - 173
Hospital Pharmacy - June 2018 - 174
Hospital Pharmacy - June 2018 - 175
Hospital Pharmacy - June 2018 - 176
Hospital Pharmacy - June 2018 - Health Care Professionals Toward Adverse Drug Reaction Reporting in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross-sectional Study
Hospital Pharmacy - June 2018 - 178
Hospital Pharmacy - June 2018 - 179
Hospital Pharmacy - June 2018 - 180
Hospital Pharmacy - June 2018 - 181
Hospital Pharmacy - June 2018 - 182
Hospital Pharmacy - June 2018 - 183
Hospital Pharmacy - June 2018 - 184
Hospital Pharmacy - June 2018 - 185
Hospital Pharmacy - June 2018 - 186
Hospital Pharmacy - June 2018 - 187
Hospital Pharmacy - June 2018 - Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients
Hospital Pharmacy - June 2018 - 189
Hospital Pharmacy - June 2018 - 190
Hospital Pharmacy - June 2018 - 191
Hospital Pharmacy - June 2018 - 192
Hospital Pharmacy - June 2018 - 193
Hospital Pharmacy - June 2018 - Detection of HBV, HCV, and Incidence of Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma–Treated Patients
Hospital Pharmacy - June 2018 - 195
Hospital Pharmacy - June 2018 - 196
Hospital Pharmacy - June 2018 - 197
Hospital Pharmacy - June 2018 - 198
Hospital Pharmacy - June 2018 - 199
Hospital Pharmacy - June 2018 - 200
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