Trending Topics in Health-System Pharmacy
Pharmacy-based transition of care improves patient satisfaction, lowers readmission rates
Patients who received focused care and education from pharmacists while transitioning out of the hospital showed higher satisfaction and lower readmission rates, according to research presented at the American Society of Health-System Pharmacists 54th Midyear Clinical Meeting and Exhibition.
Researchers assessed the effects of a pharmacy-based transition-of-care education protocol on patient satisfaction, safety, and readmission. Through this model, which was implemented without any additional resourcing, pharmacy staff at Methodist University Hospital in Memphis reconciled medications before hospital discharge and educated patients on the ones they were taking. Pharmacists also followed up with patients by phone after discharge to discuss their care.
The study included 1,728 patients, 414 of whom received the full transition-of-care protocol. Those patients expressed higher satisfaction with their care, marked by an increase of 14.7% in the overall average mean score measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey.
Patients who received a follow-up phone call from a pharmacist after hospital discharge also saw a 5% drop (from 17.3% to 12.4%) in hospital 30-day readmission rates.
“Pharmacists play a multitude of vital roles for patients during a hospital stay, including comprehensive medication management and ensuring medication safety,” said Katherine L. March, PharmD, BCPS, clinical pharmacy specialist at Methodist University Hospital, in a statement. “Now, they can feel increasingly confident about their role in helping patients when transitioning from different levels of care. Our findings add to growing literature demonstrating that pharmacist involvement in hospital discharge improves outcomes and safety.”
New report updates opioid prescribing guidelines for acute pain
A new report issued by the National Academies of Sciences, Engineering, and Medicine (NASEM) follows the patient-centered path in recommending that clinicians develop plans for addressing pain in patients based on the individual.
FDA tasked NASEM with developing the report in order for medical groups, health care providers, and others to evaluate current and future opioid prescribing to support a clinical practice guideline and to identify gaps in the evidence where future research is needed. The report is meant to serve as a framework on opioid prescribing guidelines for acute pain.
“One of the ways we believe we can work together with medical professional societies is by developing a framework that can assist them in creating and evaluating evidence-based guidelines on appropriate opioid analgesic prescribing to treat acute pain caused by specific medical conditions and common surgical procedures for which these drugs are prescribed,” said FDA in a statement.
FDA said it will consider recommendations included in the NASEM report, especially as the agency works to implement the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) provision that requires the development of evidence-based opioid prescribing guidelines for acute pain.
According to the NASEM report, specific areas to focus on include developing or modifying prescribing guidelines for C-sections, wisdom tooth removal, low back pain, sickle cell disease, and migraines.
New test detects MRSA bacteria
FDA recently authorized marketing of a new diagnostic test for methicillin-resistant Staphylococcus aureus (MRSA) bacterial colonization, a widespread cause of hospital-acquired infections. The cobas vivoDx MRSA diagnostic test, developed by Roche Molecular Systems, is based on bacterial viability and use of novel technology to detect the bacteria. The new test was designed to enable health professionals to evaluate patients for colonization with MRSA bacteria more quickly than traditional culture-based techniques.
“Diagnostics that are able to provide accurate results more quickly can offer health care providers an advantage when trying to prevent and contain the spread of resistant bacteria,” said Tim Stenzel, MD, PhD, director of the Office of In Vitro Diagnostics and Radiological Health in FDA’s Center for Devices and Radiological Health, in a statement.
CDC estimates that approximately 5% of U.S. hospital patients carry the MRSA bacteria in their nose or on their skin. In 2017, more than 323,000 MRSA cases were identified in U.S. hospitals, and more than 10,000 deaths occurred.
MRSA infections can be very challenging to treat and control, especially in a hospital environment, because MRSA is resistant to many common antibiotics. Active screening to detect MRSA colonization and infection control measures have helped to reduce the rates of MRSA infection.
The cobas vivoDx MRSA test uses a bacteriophage technology based on bioluminescence to detect MRSA from nasal swab samples in about 5 hours compared with 24 to 48 hours for conventional cultures. Performance studies showed that the test correctly identified MRSA in approximately 90% of samples in which MRSA was present and correctly identified no MRSA in 98.6% of samples in which MRSA was not present. The test can be used to identify patients needing enhanced precautions for infection control, such as isolation and additional decolonization efforts.
FDA reviewed the cobas vivoDx MRSA test through the de novo premarket review pathway, a regulatory pathway for low- to moderate-risk devices of a new type. Along with this authorization, FDA is establishing special controls for tests of this type, including requirements relating to labeling and design verification and validation to address certain risks, such as false positives. When met, the special controls, along with general controls, provide a reasonable assurance of safety and effectiveness.
This action also creates a new regulatory classification, which means that subsequent devices of the same type with the same intended use may go through FDA’s 510(k) pathway, whereby devices can obtain clearance by demonstrating substantial equivalence to a predicate device.