Effectiveness and Safety of Albuterol Solutions With and Without Benzalkonium Chloride.

INTRODUCTION: Continuous aerosolized ß2 agonist, namely albuterol, is the most commonly used therapy for critical asthma. Benzalkonium chloride is a preservative present in some formulations of aerosolized albuterol solutions that can induce bronchospasm. Recent studies have shown that inhalation of albuterol containing benzalkonium chloride might induce unintended bronchoconstriction and poor outcomes. This study aimed to investigate whether using albuterol solutions containing benzalkonium chloride results in prolonged hospital length of stay (LOS). METHODS: This was a retrospective cohort study of pediatric subjects admitted to the pediatric ICU (PICU) and treated with continuous albuterol. Data were collected and compared before and after a change to benzalkonium chloride-containing solutions. Subjects who were treated with preservative-free solutions were used as control. The primary outcome was PICU and hospital LOS; secondary outcomes included the duration of continuous albuterol and use of adjunctive therapies. RESULTS: A total of 266 admissions were included in the study. One hundred forty subjects (52.6%) were exposed to benzalkonium chloride. Median age and severity of illness scoring were similar between groups. The initial dose of continuous albuterol was significantly higher in the benzalkonium chloride group (median 15 interquartile range [IQR] 10-20 mg/h) compared to the preservative-free group (median 10 IQR 10-20 mg/h) (P < .001). PICU LOS was longer for the preservative-free group, 2.5 (IQR 1.4-4.6) d vs 1.8 (IQR 1.1-2.9) d for benzalkonium chloride group (P = .002). There was no significant difference in duration of continuous albuterol therapy (P = .16) or need for adjunctive respiratory support (heliox [P = .32], noninvasive ventilation [P = .81], and invasive mechanical ventilation [P = .57]). CONCLUSIONS: In contrast to published literature showing that benzalkonium chloride may be associated with a longer duration of continuous albuterol nebulization and hospital LOS, our study demonstrated that benzalkonium chloride-containing albuterol is safe for continuous nebulization in critically ill children and not associated with worse outcomes.

Implementation of telehealth for first-dose device teaching within a health-system specialty pharmacy.

PURPOSE: To demonstrate how the integration of a pharmacist-led, telehealth-based first-dose device teaching (FDDT) workflow helped to improve the efficiency of the work system, expand access, and maintain the high quality of care. SUMMARY: The telehealth program was designed utilizing existing specialty pharmacy infrastructure and a partnership with a dermatology clinic. The program includes patients receiving a self-injectable specialty medication (SISM) who require an FDDT and fill with our health system's specialty pharmacy. Patients complete a virtual FDDT with a specialty pharmacist following an initial pharmacist consult and medication shipment. Patient experience and program feedback were captured via a standardized 5-point Likert telephone survey. A total of 30 patients completed the FDDT program. Surveys following the FDDT visit completed by 19 patients showed that patients had high satisfaction with the quality and convenience of the telehealth visit (4.53 and 4.79, respectively). Overall care and education received from the pharmacist was also rated highly (5.00). Notable feedback captured in free responses emphasized the helpfulness of the pharmacist and the convenience of the visit. Areas to improve focused on technology difficulties. CONCLUSION: As SISMs continue to grow in utilization, telehealth services should be considered as part of the clinic workflow. Specialty pharmacists delivered high-quality and convenient care to patients through this patient education program. Expansion of this program into additional clinics may help improve specialty care access and increase the availability of nursing staff for additional clinical needs.

A framework for graduate and postgraduate specialty pharmacy training.

PURPOSE: There is a growing need for specialty pharmacy leaders within integrated delivery networks (IDNs). Traditional training for students and residents has not met the demand for pharmacy leaders in this space. This article describes the partnership between UW Health (UWH) and the University of Wisconsin School of Pharmacy (UWSOP) in developing a specialty pharmacy elective course at UWSOP and in creating a postgraduate residency training program at UWH. Future directions for the partnership are discussed. SUMMARY: Members of the leaderships of UWH and UWSOP met to discuss expanding coursework related to specialty pharmacy business fundamentals at UWSOP. This meeting led to the development of a 2-credit elective course beginning in spring 2017. The course focused on marketplace economics, channel strategies, and specialty pharmacy practice development. Additionally, UWH identified the need to provide postgraduate training to meet the increasing demand across IDNs for specialty pharmacy leaders. The residency program was initiated in 2013 and received accreditation in 2016. The residency provides experience in specialty pharmacy leadership, managed care, finance, the revenue cycle, accreditation, and the supply chain. Future partnership opportunities include creation of a longitudinal student pharmacist track and joint project coordination between UWSOP students and UWH residents. CONCLUSION: This partnership has provided a pathway for students to gain expertise in specialty pharmacy business fundamentals as well as postgraduate training opportunities for future specialty pharmacy leaders. IDN and school of pharmacy partnerships can expand educational opportunities for future specialty pharmacy leaders and help fulfill the market gap in specialty pharmacy leaders.