Discharges with patient-reported problems, which the tested interventions could have prevented, decreased by 61 out of 1000 (from 168 to 107) of discharges that involved prescribed medications, showing statistical significance (P< 0.001). Electronic health record interventions, by addressing the obstacles to picking up prescriptions after hospital discharge, may have contributed to increased patient satisfaction and better health outcomes. Careful consideration of workflow design and the degree to which clinical decision support systems might interfere with existing procedures is vital for successful electronic health record intervention implementation. Targeted electronic health record interventions, applied in a multifaceted way, can facilitate patients' access to prescriptions subsequent to their discharge from a hospital.

In the background. For a spectrum of shock conditions in critically ill patients, vasopressin is a frequently selected medication. Intravenous admixture stability, according to the current manufacturer's labeling, is limited to a 24-hour timeframe. This requires immediate preparation, which unfortunately may lead to treatment delays and medication waste. We investigated the persistence of vasopressin's properties in a 0.9% sodium chloride solution, held in polyvinyl chloride bags and polypropylene syringes, for the duration of 90 days. Along with this, we considered the implications of extended stability on the administration time and the monetary savings resulting from less medical waste at a teaching hospital. Methods. check details Using aseptic methods, vasopressin was diluted to achieve concentrations of 0.4 and 1.0 units per milliliter. Bags and syringes were maintained at a temperature of 23°C-25°C (room temperature) or 3°C-5°C (refrigerated). Three samples per preparation and storage environment were examined on days 0, 2, 14, 30, 45, 60, and 90. Physical stability was established through a visual inspection of the object. Evaluation of pH occurred at every point, and the final degradation analysis also involved pH assessment. Sterility testing was not part of the protocol for the samples. Employing liquid chromatography coupled with tandem mass spectrometry, the chemical stability of vasopressin was assessed. Samples were judged stable if their degradation did not exceed 10% at the 30-day time point. The implementation of a batching process led to a decrease in waste of $185,300 and an improvement in the administration time, which was reduced from 26 minutes to 4 minutes. In summation, Vasopressin, diluted to 0.4 units per milliliter with 0.9% sodium chloride injection, retains stability for 90 days, regardless of storage conditions, including room temperature and refrigeration. Diluting to 10 units per milliliter with 0.9% sodium chloride for injection ensures 90 days of stability under refrigeration. Infusion batch preparation using extended stability and sterility testing protocols may result in quicker administration times and reduced medication waste-related costs.

Discharge planning procedures are often affected by medications that require prior approval. To ensure prior authorization completion, this study created and examined a method for identifying and processing such authorizations during the inpatient period, preceding the patients' release. The electronic health record now includes a patient identification tool, signaling the patient care resource manager to inpatient orders for medications requiring prior authorization and potentially delaying discharge. An identification tool and flowsheet documentation-driven workflow process was developed to initiate a prior authorization, if deemed necessary. check details After the hospital's complete transition, a two-month study collecting descriptive data was undertaken. A two-month review of patient encounters by the tool uncovered 1353 medications used by 1096 patients. The analysis revealed that apixaban (281%), enoxaparin (144%), sacubitril/valsartan (64%), and darbepoetin (64%) were the most commonly encountered medications. In the flowsheet records, 91 unique patient encounters had details of 93 different medications documented. Of the 93 documented medications, 30% did not require prior authorization, 29% had the prior authorization process initiated, 10% were for facility-bound patients after discharge, 3% were for in-home medication management, 3% were discontinued during discharge, 1% had their prior authorization requests denied, and 24% exhibited missing data points. From the flowsheet, apixaban appeared 12% of the time, enoxaparin 10%, and rifaximin 20%, representing the most frequent medications documented. From the twenty-eight prior authorizations reviewed, a pair were identified for recommendation to the Medication Assistance Program. By implementing an identification tool and documentation process, the efficiency of PA workflow and the coordination of discharge care can be substantially improved.

The COVID-19 pandemic exposed a weakness in our healthcare supply chain, characterized by amplified difficulties, including delays in product delivery, shortages of essential medications, and a lack of sufficient healthcare workers over recent years. This article assesses current perils to the healthcare supply chain which directly affect patient safety and proposes potential solutions for the future. To establish a foundational knowledge base, Method A entailed a review of the literature, focusing on contemporary sources related to drug shortages and supply chains. Through a further examination of existing literature, potential supply chain threats and their corresponding solutions were explored. This article provides a summary of current supply chain issues and solutions, enabling pharmacy leaders to apply them in the future healthcare supply chain.

Various physical and psychological elements contribute to the increased frequency of newly developed insomnia and other sleep disturbances in hospitalized patients. Effective non-pharmacological treatments for insomnia within inpatient settings, particularly intensive care units (ICUs), have been demonstrated in various studies; however, further investigation into optimal pharmacologic interventions remains necessary to fully address this issue. The study seeks to compare the treatment outcomes of melatonin and trazodone for treating new-onset insomnia in non-ICU hospitalized patients, including their dependence on supplemental sleep medication and the rate of adverse events. A retrospective chart review of adult patients admitted to a non-ICU general medicine or surgical floor at a community teaching hospital was undertaken between July 1, 2020 and June 30, 2021. For the study, patients were admitted to the hospital and included if their treatment for newly developing insomnia consisted of a scheduled regimen of melatonin or trazodone. Exclusion criteria for the study included patients with a history of insomnia, patients receiving two concurrent sleep medications, and patients whose admission medication reconciliation documented pharmacologic treatment for insomnia. check details The clinical data gathered included details on non-pharmacological interventions, the dosage of sleep aids, the number of sleep aid doses administered, and the total number of nights where an extra sleep aid was necessary. The effectiveness of melatonin and trazodone was assessed by the proportion of patients necessitating extra sleep medication during their hospital stay, defined as administering a supplementary hypnotic between 9 PM and 6 AM or use of more than a single sleep aid. This study's secondary outcomes encompassed the incidence of adverse events, including difficulty waking, daytime somnolence, serotonin syndrome, falls, and in-hospital delirium development. From the group of 158 patients, 132 individuals received melatonin treatment, and 26 received trazodone. Sleep aid groups showed comparable rates for male sex (538% [melatonin] vs. 538% [trazodone]; P=1), length of hospital stays (77 vs 77 days; P=.68), and the administration of medications linked to insomnia (341% vs 231%vs; P=.27). During hospitalization, the percentage of patients requiring an additional sleep aid differed slightly between sleep aids (197% vs 346%; P = .09). Similarly, the percentage of patients receiving a sleep aid at discharge did not show a significant difference between the sleep aids (394% vs 462%; P = .52). The sleep aids showed similar patterns in the occurrence of adverse events. A comparative study of the two agents on the primary outcome demonstrated no substantial difference, although a higher percentage of trazodone-treated patients experiencing newly developed insomnia during hospitalization needed an additional sleep aid than melatonin-treated patients. The adverse events experienced displayed no deviation.

In hospitalized settings, enoxaparin is a standard prophylactic treatment for venous thromboembolism (VTE). Existing literature provides guidance on adjusting enoxaparin dosages for patients with higher body weights and renal issues, however, there's a scarcity of information regarding optimal prophylactic dosing strategies for underweight patients. This study examines whether reducing enoxaparin VTE prophylaxis to 30mg subcutaneously once daily, instead of standard dosing, leads to variations in adverse outcomes and effectiveness in underweight medically ill patients. The study methodology was a retrospective chart review of patient records, encompassing 171 patients and 190 individual treatments with enoxaparin. Therapy, administered continuously for at least two days, was provided to patients who were 18 years old and weighed 50 kg. Exclusion criteria included patients on admission anticoagulation, creatinine clearance below 30 mL/min, ICU, trauma, or surgical service admission, and cases of bleeding or thrombosis. The Padua score served to evaluate baseline thrombotic risk, whereas the IMPROVE trial yielded a modified score for evaluating baseline bleeding risk. Bleeding events were analyzed and grouped using the parameters established by the Bleeding Academic Research Consortium. No disparity was found in the baseline risk of either bleeding or thrombosis when the reduced-dosage and standard-dosage cohorts were compared.