Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy.

The current recommendations for monitoring digoxin, a narrow therapeutic index drug, are limited to confirming medication use or investigating suspicion of toxicity and fail our oath to do no harm. Numerous meta-analyses evaluating digoxin use consistently recommend frequent monitoring to maintain the level of 0.5 to ≤1.0 ng/ml because higher levels lead to increased morbidity and mortality without benefit. Data from the United States National Poison Control Center (2012-2020) show annual deaths due to digoxin of 18-36 compared to lithium's 1-7, and warfarin's 0-2 respectively. The latter drugs also have narrow therapeutic indexes like digoxin yet are more carefully monitored. Recognition of digoxin toxicity is impaired as levels are not being routinely checked after medications are added to a patient's regimen. In addition, providers may be using ranges to guide treatment that are no longer appropriate. It is imperative that monitoring guidelines and laboratory therapeutic levels are revised to reduce morbidity and mortality due to digoxin. In this review, we provide a comprehensive literature review of digoxin monitoring guidelines, digoxin toxicity, and evidence to support revising the ranges for serum digoxin monitoring.

Pharmacy technicians, supporting our past, shaping our future: Implementing an ASHP-ACPE-accredited pharmacy technician training program in an academic medical center.

PURPOSE: Pharmacy technician training and education vary depending on practice site and state law. Although technician certification provides a national standard for credentialing, not all states require it, making certification a voluntary process for technicians or the organizations employing them. As the role of the pharmacist has evolved, the need for highly trained pharmacy technicians has grown. The pharmacy technician's expanded role in specialized areas of pharmacy practice has created new opportunities that require advanced training. SUMMARY: Research is lacking on return on investment for workforce development programs, making it difficult to advocate for pharmacy technician training programs. Therefore, it is important to create internal metrics that link one's program to business performance. This begins with conducting a job market analysis for the geographic area. It is imperative to identify the current occupational outlook for pharmacy technicians, identifying areas with potential for growth as well as where there are shortages or high turnover. Successful development of an American Society of Health-System Pharmacists (ASHP) and Accreditation Council for Pharmacy Education (ACPE)-accredited pharmacy technician program requires a long-term strategy to address key market issues as well as social and economic barriers and financial data to secure funding. CONCLUSION: This case study details Yale New Haven Hospital's journey from proof of concept to implementation of an ASHP-ACPE-accredited pharmacy technician training program.

Prospective cluster controlled crossover trial to compare the impact of an improved hydrogen peroxide disinfectant and a quaternary ammonium-based disinfectant on surface contamination and health care outcomes.

BACKGROUND: Quaternary ammonium-based (Quat) disinfectants are widely used, but they have disadvantages. METHODS: This was a 12-month prospective cluster controlled crossover trial. On 4 wards, housekeepers performed daily cleaning using a disinfectant containing either 0.5% improved hydrogen peroxide (IHP) or Quat. Each month, 5-8 high-touch surfaces in several patient rooms on each ward were tagged with a fluorescent marker and cultured before and after cleaning. Hand hygiene compliance rates and antimicrobial usage on study wards were obtained from hospital records. Outcomes included aerobic colony counts (ACCs), percent of wiped surfaces yielding no growth after cleaning, and a composite outcome of incidence densities of nosocomial acquisition and infection caused by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and Clostridium difficile infection. Statistical analysis was performed using χ2 test, Fisher exact test, Welch test, and logistic regression methods. RESULTS: Mean ACCs per surface after cleaning were significantly lower with IHP (14.0) than with Quat (22.2) (P = .003). The proportion of surfaces yielding no growth after cleaning was significantly greater with IHP (240/500; 48%) than with Quat (182/517; 35.2%) (P < .0001). Composite incidence density of nosocomial colonization or infection with IHP (8.0) was lower than with Quat (10.3) (incidence rate ratio, 0.77; P = .068; 95% confidence interval, 0.579-1.029). CONCLUSIONS: Compared with a Quat disinfectant, the IHP disinfectant significantly reduced surface contamination and reduced a composite colonization or infection outcome.