Strategies to Bring Transgender and Non-binary Health Care into Pharmacy Education.

Research has shown an increase in the number of people in the United States identifying as transgender and non-binary (TNB) . Many pharmacy schools and colleges do not offer any instruction specific to students interacting with and caring for TNB people, and practicing pharmacists have reported a lack of confidence in managing TNB patients. Regardless of the practice setting they choose, there is an increased likelihood that pharmacy graduates will serve TNB patients. Pharmacy schools that include TNB-specific education in their Doctor of Pharmacy curriculum will equip graduates with the necessary knowledge and skills to support this vulnerable population. The purpose of this commentary is to suggest methods for incorporating TNB-related material into pharmacy curricula and to provide resources for developing content.

Development, Implementation, and Outcomes of a Delirium Protocol in the Surgical Trauma Intensive Care Unit.

BACKGROUND: Delirium in the critically ill is associated with increased mortality, length of stay (LOS), and prolonged cognitive dysfunction. Existing guidelines provide no recommendation for use of combination nonpharmacological and pharmacological prevention protocols or use of antipsychotic medications for the prevention or treatment of delirium. OBJECTIVE: This study evaluated the impact of implementing a delirium treatment protocol on the number of delirium-free days experienced by acutely delirious patients in the surgical trauma intensive care unit (STICU). METHODS: This retrospective, institutional review board-approved, pre-implementation (PRE) versus post-implementation (POST) cohort evaluated delirious patients admitted to the STICU. Patients were evaluated based on the duration of delirium. Secondary end points included ICU LOS, amount of atypical and typical antipsychotic medication used, amount of analgesia and sedation used, and adverse drug events associated with antipsychotics. RESULTS: Of the 593 evaluated, 89 patients were included (38 PRE vs 51 POST). Implementation of a delirium protocol reduced the number of delirious days, 8.2 ± 5.7 days PRE versus 4.5 ± 4.4 days POST; P = 0.001. ICU LOS in surviving patients and use of concomitant medications, intravenous morphine equivalents, and propofol were significantly reduced in the POST group. CONCLUSION: The implementation of a delirium protocol with nonpharmacological and pharmacological interventions had an impact on STICU patients experiencing acute delirium by significantly increasing delirium-free days and reducing the ICU LOS, in addition to decreased administration of concomitant medications.

Pharmacists' role in a hospital's initiative to become a certified primary stroke center.

PURPOSE: Significant pharmacy department contributions to a medical center's efforts to attain certification as a primary stroke center (PSC) are described. SUMMARY: As part of an initiative to improve outcomes in patients with stroke and earn the PSC designation, the pharmacy department of an 855-bed community teaching hospital participated in developing a multifaceted "Code Stroke" program. Pharmacists deployed in the emergency department (ED), intensive care units, and medical units are involved in all aspects of stroke care from admission to discharge. Pharmacists attend ED responses to Code Stroke alerts, assisting in patient evaluation and helping to ensure timely tissue plasminogen activator (t-PA) administration and prompt computed tomography scanning. Throughout the hospital stay of a patient with stroke, pharmacists are involved in verifying that applicable Joint Commission core measures are met. Once a patient with stroke is deemed ready for discharge, a transitions-of-care pharmacist ensures that the patient receives the assistance necessary to obtain newly prescribed medications and counseling to promote postdischarge compliance. Implementation of the Code Stroke program was associated with improvements in stroke care quality measures, including a reduction in the median time from hospital arrival to t-PA administration and improved core measure compliance. CONCLUSION: By participating in the implementation of a number of transformative initiatives, the pharmacy department played an important role in enabling the medical center to provide consistent, excellent care for all patients with stroke as it prepared for certification as a PSC.