Enoxaparin Dosing and AntiXa Monitoring in Specialty Populations: A Case Series of Renal-Impaired, Extremes of Body Weight, Pregnant, and Pediatric Patients.

The use of enoxaparin in specialty populations-including those with renal dysfunction, extremeness of body weight, pregnant patients, and pediatric patients-has not been studied in clinical trials. Monitoring anti-factor Xa activity (antiXa) as a surrogate to measure the activity of enoxaparin may be of interest. A case series of patients admitted to New York University Langone Health between December 2012 and July 2014 who received at least three consecutive doses of enoxaparin for the treatment of VTE and had a peak antiXa level drawn at steady state were evaluated. Patients were included if they were ≤ 18 years of age or if they were > 18 years of age and met one of the following criteria: pregnant, creatinine clearance (CrCl) ≤ 50 ml/min at the time of initiation of enoxaparin, or had a body weight ≤ 50 kg or ≥ 120 kg. A total of 31 patients were included in the analysis. The percentage of patients who achieved a therapeutic antiXa level (0.5-1.2 IU/mL for twice daily enoxaparin or 1-2 IU/mL for once daily enoxaparin) at the time of the first antiXa level drawn was greatest for the adult patients; however, the patients with renal impairment and low body weight were more likely to be sub-therapeutic at first antiXa level check. In addition, neonates and young children required increased enoxaparin doses to achieve therapeutic antiXa. Optimal dosing of enoxaparin in specialty populations has not been established. Furthermore, higher initial doses of enoxaparin may be needed in pediatric patients to attain therapeutic antiXa levels.

Implementing an Inpatient Pediatric Prospective Audit and Feedback Antimicrobial Stewardship Program Within a Larger Medical Center.

BACKGROUND: Pediatric antimicrobial stewardship programs (ASPs) within larger institutions have unique opportunities to develop programs specialized to the needs of the pediatric program. In January 2013, our institution established a formalized pediatric ASP utilizing the prospective audit and feedback process. In an effort to standardize therapy and improve quality of care, members of the ASP developed evidence-based guidelines for management of common inpatient pediatric infections. ASP members met periodically with faculty and house staff to discuss guidelines and ways to improve prescribing. METHODS: Provider adherence with clinical inpatient practice guidelines, frequency of interventions suggested by ASP, and acceptance of interventions by providers were elements used to measure process change. We measured outcome data by analyzing antimicrobial utilization (defined as days of therapy) and length of therapy. RESULTS: Over a period of 2 years, institutional ASP guidelines were applicable to nearly half (44%) of all antimicrobial orders. Interventions were performed on 30% of all antimicrobial orders, of which 89% were accepted. Total antimicrobial days of therapy and length of therapy decreased significantly when comparing pre- and post-ASP. Overall, the susceptibility profiles of common bacterial pathogens to antibiotics remained stable. CONCLUSIONS: Pediatric ASPs within larger institutions have opportunities to create programs specific to the needs of the population they serve. We observed high rates of adherence by providers and a subsequent reduction in antibiotic utilization when implementing an audit feedback-based process.

Residency application screening tools: A survey of academic medical centers.

PURPOSE: The current use and content of screening tools utilized by ASHP-accredited pharmacy residency programs were assessed. METHODS: A survey consisting of 19 questions assessing residency programs and the screening of pharmacy residency program applicants was e-mailed to residency directors of 362 pharmacy residency programs at 105 University HealthSystem Consortium (UHC)-member institutions. Questions gathered general program demographic information, data related to applicant growth from residency years 2010-11 to 2011-12, and information about the residency screening processes currently used. RESULTS: Responses were received from 73 residency program sites (69.5%) of the 105 UHC-member institutions to whom the e-mail was sent. Many sites used screening tools to calculate applicants' scores and then determined which candidates to invite for an onsite interview based on applicants' scores and group discussion. Seventy-eight percent (n = 57) of the 73 responding institutions reported the use of a screening tool or rubric to select applicants to invite for onsite interviews. The most common method of evaluation was individual applicant review before meeting as a group to discuss candidate selection. The most important factor for determining which residency candidate to interview was the overall impression based on the candidate's curriculum vitae (CV) and letters of recommendation. CONCLUSION: Most residency programs in UHC-member hospitals used a screening tool to determine which applicants to invite for an onsite interview. The most important factor for determining which residency candidate to interview was the overall impression based on the candidate's CV and letters of recommendation.