Correlates and Economic and Clinical Outcomes of an Adult IV to PO Antimicrobial Conversion Program at an Academic Medical Center in Midwest United States.

The study objectives were to evaluate the correlates and outcomes of a parenteral (IV) to oral (PO) antimicrobial conversion program at a Midwest US Academic Medical Center with the hypothesis that it will be associated with reduced drug costs. Patient-level data (n = 237; sex, race, admission source, admission status, admission severity, risk of mortality [relative expected, admission], and early death) were extracted from the Clinical Data Base/Resource Manager. Medication-level, drug-encounter data (n = 317; antibiotic/dose/route/frequency/duration, conversion status, 10-day IV/PO switch-eligibility criteria) were extracted from patient's hospital medical records. Univariate analyses using chi-square or Fisher's exact test for categorical variables and Wilcoxon rank-sum test for continuous variables showed patients not converted (n = 149) versus converted (n = 88) at some point from IV to PO were more likely to be of white race and had higher risk of relative expected mortality. By applying the unit drug cost (derived from 2010 Thomson Reuters RED BOOK(TM)) and labor costs for IV/PO administration, both per dose, the overall 1-month drug cost-saving estimates in 2010 in US dollars were US$5242 from converting and US$8805 savings missed from not converting 518 and 1387 switch-eligible antibiotic doses, respectively. Despite sample-size limitations, this study demonstrated correlates and missed opportunities to convert antimicrobials from IV to PO, which warrants providers' attention.

Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients.

BACKGROUND: Data on the risk factors and clinical course of hungry bone syndrome are lacking in dialysis and renal transplant patients who undergo parathyroidectomy. In this study, we aimed to assess the risks and clinical course of hungry bone syndrome and calcium repletion after parathyroidectomy in dialysis and renal transplant patients. METHODS: We performed a retrospective review of parathyroidectomies performed at The Nebraska Medical Center. RESULTS: We identified 41 patients, ie, 30 (73%) dialysis and eleven (27%) renal transplant patients. Dialysis patients had a significantly higher pre-surgery intact parathyroid hormone (iPTH, P<0.001) and a larger iPTH drop after surgery (P<0.001) than transplant recipients. Post-surgery hypocalcemia in dialysis patients was severe and required aggressive and prolonged calcium replacement (11 g) versus a very mild hypocalcemia requiring only brief and minimal replacement (0.5 g) in transplant recipients (P<0.001). Hypophosphatemia was not detected in the dialysis group. Phosphorus did not increase immediately after surgery in transplant recipients. The hospital stay was significantly longer in dialysis patients (8.2 days) compared with transplant recipients (3.2 days, P<0.001). CONCLUSION: The clinical course of hungry bone syndrome is more severe in dialysis patients than in renal transplant recipients. Young age, elevated alkaline phosphatase, elevated pre-surgery iPTH, and a large decrease in post-surgical iPTH are risk factors for severe hungry bone syndrome in dialysis patients.

Formulary evaluation using a class review approach: experience and results from an academic medical center.

Developing and maintaining a drug formulary is an essential process that allows hospitals to meet mandatory standards, such as those defined by The Joint Commission, while ensuring that drugs are being used in a safe, appropriate, and cost-effective manner. In this article, we describe our strategy for an annual formulary review, the first year's results of its implementation, and its ongoing development at an academic medical center. Our strategy for reviewing the formulary was based on two main components-a scheduled class review (CR) process and a continuous safety-review process. After the first year of implementation, the pharmacy and therapeutics (P&T) committee reviewed 17 drug classes. The CR and safety review processes led to three formulary additions, 15 deletions, five new therapeutic interchanges, and six drug-safety issues requiring action. Cost-savings opportunities also resulted from using lower-priced generic medications and alternative product formulations. Institutional strategies to address the annual formulary review requirements can be accomplished via several methods, including the drug CR process. This process should be routinely evaluated and modified with the potential to provide additional institutional drug use evaluation benefits and to incorporate efficiencies as needed.