Implementation of a 24-hour pharmacy service with prospective medication review in the emergency department.

BACKGROUND: It is reported that more than 128 million patients are seen in emergency departments (EDs) annually. Patient overcrowding had been associated with an increased occurrence of medication errors. PURPOSE: Due to increased patient volume and the need for improved patient safety, a 24-hour pharmacy service was established for our institution's ED. The purpose of the study is to quantify and demonstrate the impact of a 24-hour pharmacy service in an urban ED. METHODS: This was a retrospective descriptive study conducted at a regional level 1 trauma center. The study period occurred between December 2012 and July 2013. The following variables were quantified and analyzed: number of medication orders reviewed, number of intravenous medications compounded, and number of clinical interventions that were recommended by the ED pharmacy team (EDPT) and accepted by ED clinicians. RESULTS: A total of 3,779 medication orders were reviewed by the EDPT. Of these orders, 3,482 (92%) were prospectively reviewed. A total of 3,068 (81.2%) and 711 (18.8%) orders were reviewed for the adult and pediatric ED, respectively. During the study period, the EDPT procured 549 intravenous admixtures and conducted 642 clinical interventions. Most of the interventions involved providing drug information for physicians and nurses (45.9%), adjusting drug dosages (21.1%), and recommending antimicrobial therapy (15.1%). CONCLUSION: The implementation of a 24-hour pharmacy service at our institution was an innovative practice that increased the role of pharmacists in the ED. The EDPT conducted prospective medication review, procured intravenous admixtures from a sterile environment, and provided therapeutic recommendations for the ED interdisciplinary team.

Participant-centered education: building a new WIC nutrition education model.

OBJECTIVE: To assess the readiness of the Western Region Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) states to implement participant-centered nutrition education (PCE) and to develop a PCE model for WIC service delivery. DESIGN: Formative research including on-line survey, qualitative in-depth interviews, focus groups, and observational assessments. SETTING: WIC clinics within the Western Region WIC states. PARTICIPANTS: State and local staff and WIC clients within 8 states, 2 tribal organizations, and 2 territories. PHENOMENON OF INTEREST: Readiness indicators of states to implement and expand PCE elements to include in PCE model development. ANALYSIS: On-line surveys were collected and analyzed. On-site assessment forms, interviews, and focus group findings were collected, coded, and summarized by themes. RESULTS: Key themes from state and local findings guided the model development for PCE implementation in the Western Region WIC states. The PCE model must be flexible and systems oriented, contain strong training and mentoring components, and integrate cultural sensitivity to best reach program participants. CONCLUSIONS AND IMPLICATIONS: The PCE model has the potential to improve WIC nutrition services and enable participants to make positive health-related behavior changes that will influence long-term health issues. Further outcome studies are needed to determine the success of PCE implementation in the Western Region WIC states.

Identification of two gene variants associated with risk of advanced fibrosis in patients with chronic hepatitis C.

BACKGROUND & AIMS: Previously identified clinical risk factors such as sex, alcohol consumption, and age at infection do not accurately predict which patients with chronic hepatitis C (CHC) will develop advanced fibrosis (bridging fibrosis and cirrhosis). The aim of this study was to identify genetic polymorphisms that can predict the risk of advanced fibrosis in patients with CHC. METHODS: A total of 916 subjects with CHC was enrolled from 2 centers. A gene-centric disease association study of 24,832 putative functional, single nucleotide polymorphisms (SNPs) was performed. Of the 1609 SNPs that were significantly associated (P