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  1. Article ; Online: Operationalizing a Medication Safety Gap Assessment for a Large Health System.

    Warren, Carley / Kramer, Joan / Burgess, L Hayley

    HCA healthcare journal of medicine

    2023  Volume 4, Issue 2, Page(s) 167–180

    Abstract: Background: Medication errors continue to be a leading cause of medical errors. In the United States alone, 7000 to 9000 people die annually due to a medication error, and many more are harmed. Since 2014, the Institute for Safe Medication Practices ( ... ...

    Abstract Background: Medication errors continue to be a leading cause of medical errors. In the United States alone, 7000 to 9000 people die annually due to a medication error, and many more are harmed. Since 2014, the Institute for Safe Medication Practices (ISMP) has advocated for several best practices in acute care facilities derived from reports of patient harm.
    Methods: The medication safety best practices chosen for this assessment were based on the 2020 ISMP Targeted Medication Safety Best Practices (TMSBP) and health system-identified opportunities. Each month, for 9 months, select best practices were covered with associated tools to assess the current state, document the gap, and close identified gaps.
    Results: Overall, 121 acute care facilities participated in most safety best practice assessments. Of the best practices assessed, there were 8 practices that more than 20 hospitals documented as not implemented and 9 practices where more than 80 hospitals had fully implemented them.
    Conclusion: Full implementation of medication safety best practices is a resource-intensive process that requires strong change management leadership at a local level. As noted by the redundancy in published ISMP TMSBP, there is an opportunity to continue improving safety in acute care facilities across the United States.
    Language English
    Publishing date 2023-04-28
    Publishing country United States
    Document type Journal Article
    ISSN 2689-0216
    ISSN (online) 2689-0216
    DOI 10.36518/2689-0216.1566
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Elevating Exposure of Pharmacy Services and Medication Management.

    Burgess, L Hayley / Kramer, Joan / Olp, Jocasta G

    HCA healthcare journal of medicine

    2023  Volume 4, Issue 2, Page(s) 73–75

    Abstract: Description Medications are the mainstay of treatment for many disorders and diseases. Our guest editorial board is proud to highlight the complexity of medication management and the talented pharmacists dedicated to safety and effectiveness. This ... ...

    Abstract Description Medications are the mainstay of treatment for many disorders and diseases. Our guest editorial board is proud to highlight the complexity of medication management and the talented pharmacists dedicated to safety and effectiveness. This special issue of the
    Language English
    Publishing date 2023-04-28
    Publishing country United States
    Document type Editorial
    ISSN 2689-0216
    ISSN (online) 2689-0216
    DOI 10.36518/2689-0216.1621
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Reducing Unnecessary Acid Suppression Use in Hospitalized Patients: A Description of Targeted Strategies Implemented Across a Large Health System.

    Wiggins, Elizabeth H / Burgess, L Hayley / Kramer, Joan

    HCA healthcare journal of medicine

    2023  Volume 4, Issue 2, Page(s) 125–137

    Abstract: Background: Ensuring the appropriate use of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) is an important hospital patient safety and quality initiative because therapy may be inappropriately continued during ... ...

    Abstract Background: Ensuring the appropriate use of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) is an important hospital patient safety and quality initiative because therapy may be inappropriately continued during transitions of care. In this article, we aim to describe the impact of targeted quality improvement strategies to reduce unnecessary acid suppression use in hospitalized patients across a large health system.
    Methods: Beginning January 1, 2018, focused quality improvement strategies to prevent unnecessary initiation and continuation of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) were implemented throughout a large health system. Targeted strategies were initially tested as part of the PPI deprescribing Institute for Healthcare Improvement (IHI) International Innovators Network initiative and were expanded to include H2RAs for hospitalized patients. Strategies to decrease PPIs and H2RAs during hospitalization included standardization of stress ulcer prophylaxis care pathways, evidence-based order set modifications, technology-driven support, and clinical pharmacy metric performance to goal. PPI/H2RA days of therapy (DOT) per 1000 patient days were measured from the first quarter (1Q) of 2017 to the fourth quarter (4Q) of 2021 to determine if implemented strategies resulted in improvement.
    Results: After quality improvement strategies were implemented, the number of PPI/H2RA DOT was reduced by 7.9 days per 1000 patient days each quarter over 4 years. The average PPI/H2RA DOT per 1000 patient days decreased from 592 (1Q 2017) to 439 (4Q 2021). In the fourth quarter of 2018, 45 hospitals (28%) achieved a 10% reduction in combined PPI/H2RA DOT per 1000 patient days, and 121 hospitals (97%) attained the goal of greater than 25% of eligible patients deprescribed PPI/H2RA for ICU patients in the fourth quarter of 2019. In the fourth quarter of 2020, 97 hospitals (87%) met the metric of 40% or more of eligible patients deprescribed from PPI/H2RA in or after an ICU stay, and 85 hospitals (87%) reached 50% or more of eligible patients deprescribed PPI/H2RA in or after an ICU stay in 4Q2021.
    Conclusion: Targeted quality improvement strategies decreased unnecessary PPI and H2RA use for a large health system over 4 years. Continually evaluating measured results along with establishing a new clinical pharmacy metric goal each year to encourage further improvement contributed to deprescribing success.
    Language English
    Publishing date 2023-04-28
    Publishing country United States
    Document type Journal Article
    ISSN 2689-0216
    ISSN (online) 2689-0216
    DOI 10.36518/2689-0216.1471
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Implementation of Clinical Pharmacy Surveillance Technology and a Pharmacy Practice Model Re-Design Across a Multi-State Health System.

    Wiggins, Elizabeth H / Kramer, Joan / Burgess, L Hayley / Warren, Carley

    HCA healthcare journal of medicine

    2023  Volume 4, Issue 2, Page(s) 111–117

    Abstract: Background: Outcomes-directed pharmacy models are necessary to further comprehensive, patient-centric clinical care. This report describes the implementation of clinical surveillance technology and the development of clinical pharmacy metrics to measure ...

    Abstract Background: Outcomes-directed pharmacy models are necessary to further comprehensive, patient-centric clinical care. This report describes the implementation of clinical surveillance technology and the development of clinical pharmacy metrics to measure outcomes that support return on investment. The overall goal of clinical surveillance technology implementation in this quality improvement project was to extend the pharmacists' reach and to improve patient safety and clinical outcomes with greater operational efficiencies.
    Methods: In 2013, a clinical pharmacy surveillance tool was piloted and expanded over the next 2 years to 154 hospitals across the health system. Over the next 6 years, the number of hospitals utilizing the technology, the number of drug therapy modifications, the time to pharmacist intervention, clinical pharmacy metric results, and return on investment were tracked.
    Results: From 2015 to 2021, the number of hospitals with clinical surveillance technology implemented grew to 177 hospitals. During this same time, the number of frontline clinical pharmacist drug therapy modifications more than doubled, and the time for pharmacists to respond to alerts decreased from 13.9 to 2.6 hours. Since 2015, the percentage of patients on vancomycin de-escalated by 3 days of therapy has increased by 12% and the percentage of patients with a UTI treated with fluoroquinolone decreased by 25%. Hard and soft dollar savings resulted in an annual return on investment of 1:12.9.
    Conclusion: After implementing the redesigned pharmacy services model, pharmacists were more efficient and patient outcomes improved.
    Language English
    Publishing date 2023-04-28
    Publishing country United States
    Document type Journal Article
    ISSN 2689-0216
    ISSN (online) 2689-0216
    DOI 10.36518/2689-0216.1391
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Impact of Clinical Pharmacy Surveillance on Pharmacy Services: A Quality Improvement Project.

    Kramer, Joan S / Borum, Cynthia / Claxon, Evan L / Wines, Kahari J / Fraker, Sarah / Burgess, L Hayley

    Journal of healthcare management / American College of Healthcare Executives

    2023  Volume 68, Issue 5, Page(s) 312–324

    Abstract: Goal: The purpose of this quality improvement project was to retrospectively evaluate pharmacist time to clinical surveillance alert intervention before and after implementing a pharmacy-directed alert priority category across a large for-profit United ... ...

    Abstract Goal: The purpose of this quality improvement project was to retrospectively evaluate pharmacist time to clinical surveillance alert intervention before and after implementing a pharmacy-directed alert priority category across a large for-profit United States health system with well-established clinical pharmacy surveillance software integrated into the clinical pharmacy workflow. The findings contributed to a financial evaluation of pharmacist productivity compared with drug spend for pharmacy-directed interventions that included intravenous (IV)-to-oral-conversion and renal dosing opportunities.
    Methods: A retrospective quality improvement pre-/postanalysis of deidentified, prepopulated clinical surveillance alert data for the preimplementation period of January 1, 2021, through September 30, 2021, was compared with that for the postimplementation period of November 1, 2021, to January 31, 2022, for 169 hospitals. Clinical pharmacist workflow was mapped pre- and postimplementation. The average time to alert intervention was calculated using the mean time in minutes between the alert firing within the software and when the pharmacist reviewed the alert, grouped by hospital, alert status, and priority category. Medications converted from IV to oral were assessed using the clinical surveillance software IV-to-oral calculator. Postimplementation renal dose cost savings were modeled using pharmacist-completed alerts by rule name that indicated a possible dose decrease based on the patient's renal function and current medication.
    Principal findings: Time to alert intervention for all completed pharmacist interventions was reduced for high-priority alerts by 32.6 min (p < .001) and routine-priority alerts by 65.1 min (p = .147). Alerts that moved to the pharmacy-directed alert priority category resulted in a reduced time to alert intervention of 38.7 min (p = .003). Normalized average wholesale price (AWP) cost savings from IV-to-oral conversion within 3 days of conversion eligibility were $1,693,600 in the preimplementation period and $1,867,400 in the postimplementation period, a $173,700 increase in cost savings. A total of 7,972 completed postimplementation renal dose adjustments resulted in a modeled AWP normalized cost savings of $1,076,700.
    Practical applications: Results indicated that optimizing clinical surveillance software alerts was effective and increased pharmacist productivity. Specifically, creating a pharmacy-directed alert category that pharmacists were able to complete by hospital policy or protocol improved workflow efficiency and increased IV-to-oral medication conversion cost savings. Further study is needed to validate the renal dose-modeled cost savings and address the financial benefits of quality measures to prevent acute kidney injury.
    MeSH term(s) Humans ; United States ; Retrospective Studies ; Quality Improvement ; Pharmacy Service, Hospital ; Pharmacists ; Pharmacy
    Language English
    Publishing date 2023-09-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1418083-2
    ISSN 1944-7396 ; 1096-9012
    ISSN (online) 1944-7396
    ISSN 1096-9012
    DOI 10.1097/JHM-D-22-00176
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Navigating regulatory statutes during the COVID-19 pandemic.

    Murray, Kara L / Burgess, L Hayley / Miller, Karla M

    American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

    2020  Volume 77, Issue 16, Page(s) 1275–1276

    MeSH term(s) COVID-19 ; Coronavirus Infections ; Legislation, Medical/trends ; Legislation, Pharmacy/trends ; Pandemics ; Pharmacy/trends ; Pharmacy Service, Hospital ; Pneumonia, Viral ; Specialty Boards ; United States
    Keywords covid19
    Language English
    Publishing date 2020-05-14
    Publishing country England
    Document type Editorial
    ZDB-ID 1224627-x
    ISSN 1535-2900 ; 1079-2082
    ISSN (online) 1535-2900
    ISSN 1079-2082
    DOI 10.1093/ajhp/zxaa147
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Value of Systematic Approach to Assess Health-System Pharmacy Services.

    Zambrano, Sonnia / Patel, Radha / Burgess, L Hayley / Heath, Kimberly

    HCA healthcare journal of medicine

    2021  Volume 2, Issue 4, Page(s) 239–242

    Abstract: Description Health-system pharmacy leaders are tasked with determining key staffing decisions based on evolving patient care needs and present-day staffing capacity. A systematic approach to evaluate patient care needs, current model and potential gaps ... ...

    Abstract Description Health-system pharmacy leaders are tasked with determining key staffing decisions based on evolving patient care needs and present-day staffing capacity. A systematic approach to evaluate patient care needs, current model and potential gaps enables leaders to allocate resources in patient care need expansions or sudden fluctuations of patient volumes. Resource management, preparedness and ongoing maintenance form principles used by pharmacy leaders to create an optimal operational environment and elevate clinical pharmacy services. Use of this approach for multiple sites of care across a large network of health systems resulted in identification and improvement in pharmacist coverage and retention of clinical pharmacy services in a critical time of economic uncertainty. Hospitals working toward expanding to 24/7 pharmacist coverage may also consider this systematic approach to elucidate their needs.
    Language English
    Publishing date 2021-08-29
    Publishing country United States
    Document type Editorial
    ISSN 2689-0216
    ISSN (online) 2689-0216
    DOI 10.36518/2689-0216.1237
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: COVID-19: The Vaccine Race Continues.

    Burgess, L Hayley / Castelein, Carley / Rubio, Andrew / Cooper, Mandelin K

    HCA healthcare journal of medicine

    2021  Volume 2, Issue 2, Page(s) 81–91

    Abstract: Description Over a year has passed since the discovery of SARS-CoV-2 and the subsequent COVID-19 pandemic. As mitigation efforts continue, COVID-19 has claimed over half a million lives in the United States and 3.1 million lives globally. The development ...

    Abstract Description Over a year has passed since the discovery of SARS-CoV-2 and the subsequent COVID-19 pandemic. As mitigation efforts continue, COVID-19 has claimed over half a million lives in the United States and 3.1 million lives globally. The development and availability of vaccines delivering immunity to prevent COVID-19 offers hope to end the pandemic. Emergency use authorizations from the Food and Drug Administration have been issued in the United States for three vaccines, one each from Pfizer-BioNTech, Moderna and Janssen/J&J. Pfizer-BioNTech and Moderna are both mRNA vaccines with efficacy of 95% and 94.1% respectively, while the vector-based vaccine from Janssen/J&J has an overall efficacy of 66.1%. The Janssen/J&J vaccine, having received the most recent authorization, is an attractive option due to high efficacy with a single dose. With a high immunity rate of 70-80% needed to prevent the continued spread of the virus and mutations, the majority of the population will require vaccination. The rise of mutations from selective pressure has further increased the urgency. Recent discoveries of variants have led to uncertainties regarding the impact of immunity and effectiveness of vaccines. In order to end the global pandemic, it is essential that the Centers for Disease Control and World Health Organization monitor the variant potential and educate the public appropriately to encourage appropriate vaccination and allocation of product. Achieving high vaccination rates in the U.S. has been challenged by supply, storage requirements and public hesitancy. In a recent Gallup poll, a random sample of 4,098 adults demonstrated that 71% of survey respondents were willing to receive a vaccine, which remains on the lower end of the 70-80% vaccination range required to end this pandemic. Despite these challenges, the United States has managed to surpass 225 million vaccinations.
    Language English
    Publishing date 2021-04-28
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2689-0216
    ISSN (online) 2689-0216
    DOI 10.36518/2689-0216.1269
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Assessment of Oral Anticoagulant Adverse Drug Events Before and After Implementation of a Real-Time Clinical Surveillance Tool.

    Daniel, Joel W / Kramer, Joan / Burgess, L Hayley

    Journal of patient safety

    2019  Volume 17, Issue 4, Page(s) e350–e354

    Abstract: Objective: The aim of the study was to determine the effect on occurrence of oral anticoagulant adverse drug events (ADEs) after implementation of a real-time clinical surveillance tool in a large health system.: Methods: Records of patients ... ...

    Abstract Objective: The aim of the study was to determine the effect on occurrence of oral anticoagulant adverse drug events (ADEs) after implementation of a real-time clinical surveillance tool in a large health system.
    Methods: Records of patients receiving an oral anticoagulant during a 6-month period before and after implementation of a real-time clinical surveillance tool were reviewed for 31 hospitals within a nationwide health system. The real-time clinical surveillance tool analyzed clinical data from the electronic medical record and alerted the pharmacist of potential opportunities for patient clinical intervention. Oral anticoagulant administration data, International Classification of Diseases, Ninth Edition code documentation of ADEs caused by oral anticoagulants, and alert notification data from the real-time clinical surveillance tool were evaluated.
    Results: A total of 56,761 patients were included in the study. The oral anticoagulant ADE ratio decreased from 0.69% during the period before implementation of the real-time clinical surveillance tool to 0.41% during the period after implementation (P < 0.001). Most alert notifications and greatest impact on ADE ratio occurred in patients administered a single oral anticoagulant during hospitalization.
    Conclusions: Implementation of a real-time clinical surveillance tool prompting pharmacist intervention reduced the oral anticoagulant ADE ratio for the health system.
    MeSH term(s) Anticoagulants/adverse effects ; Documentation ; Drug-Related Side Effects and Adverse Reactions ; Electronic Health Records ; Humans ; Pharmacists
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2019-04-25
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2394324-5
    ISSN 1549-8425 ; 1549-8417
    ISSN (online) 1549-8425
    ISSN 1549-8417
    DOI 10.1097/PTS.0000000000000607
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Characteristics Contributing to a Pharmacy Services Excellence Model in a Large Health System.

    Burgess, L Hayley / Fletcher, Sara / Cooper, Mandelin K / Wiggins, Elizabeth / Horton, Susan S / Kramer, Joan S

    HCA healthcare journal of medicine

    2021  Volume 2, Issue 5, Page(s) 367–378

    Abstract: Objective: To identify characteristics that contribute to and promote a pharmacy services center of excellence model in a large health system.: Methods: In 2019, a survey was conducted of 161 acute care pharmacy departments of health system- ... ...

    Abstract Objective: To identify characteristics that contribute to and promote a pharmacy services center of excellence model in a large health system.
    Methods: In 2019, a survey was conducted of 161 acute care pharmacy departments of health system-affiliated hospitals. Information captured included pharmacy practice models, pharmacist resource allocation, training of pharmacy residents, postgraduate training and pharmacist certifications. Results were combined with clinical pharmacy metric performance and centralized electronic data to identify features of top performing pharmacy departments.
    Results: Survey results were received from 141 of 161 affiliated hospitals (88%). Hospitals with 100 to 299 beds comprised 54% (n = 16 of 30) of the hospitals "at goal" and 66% (n = 26 of 40) of hospitals with "opportunity". Hospitals with top performing pharmacy services had greater participation in interdisciplinary rounds, reporting "always" participating in Adult Critical Care (67% versus 43%) and Medical/Surgical (30% vs. 8%) rounds. Hospitals that trained pharmacy residents had a greater number of clinical pharmacy metrics at goal (5.89 ± 1.59 versus 4.16 ± 1.86, p < 0.001), employed more board-certified pharmacists (2.32 ± 1.49 versus 1.57 ± 1.62, p = 0.019), more postgraduate year 1 (PGY1) trained pharmacists (2.06 ± 1.33 versus 1.19 ± 1.19, p < 0.001) and more PGY2 trained pharmacists (0.58 ± 0.64 versus 0.19 ± 0.44, p = 0.002). When including several key hospital characteristics into a single model, hospitals that trained pharmacy residents were significantly associated with achieving "at goal" status (p = 0.011).
    Conclusion: Defining characteristics of a pharmacy services center of excellence model included "at goal" clinical pharmacy metrics performance, clinical pharmacist time dedicated to patient care activities, accredited pharmacy residency training programs, presence of pharmacists with advanced training or board certification and optimal operations and scheduling.
    Language English
    Publishing date 2021-10-29
    Publishing country United States
    Document type Journal Article
    ISSN 2689-0216
    ISSN (online) 2689-0216
    DOI 10.36518/2689-0216.1238
    Database MEDical Literature Analysis and Retrieval System OnLINE

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