Roy Guharoy

Every Error a Treasure: Improving Medication Use with a Nonpunitive Reporting System

BACKGROUND The fear of reprisal, combined with the additional time required for reporting, are significant disincentives to reporting of medical events. Such considerations provided an incentive for the Upstate Medical University Hospital (Syracuse, New York) to develop monitoring systems to decrease the potential for drug harm. IMPLEMENTING A NONPUNITIVE REPORTING SYSTEM: Previously, a convenient, point-based score card system for punishment and remediation led to underreporting and hindered the identification of safety improvement opportunities in medication use processes. Nursing buy-in was accomplished through careful initial negotiations that emphasized that patients were best served by learning from errors in the medication use process. The revised medication event reporting policy, as established in October 2000 for all staff, severed the link between reporting errors and performance evaluations. RESULTS Data collected 18 months before the policy change was compared with data collected after the policy change was enacted in October 2000. The number of reports received each month increased from an average of 19 to 102 (p < .001). DISCUSSION Substantive quality improvements in medication have been achieved by using a systematic approach to the analysis of the markedly increased number of reported medication events following the introduction of a nonpunitive reporting system.

Antibiogram compliance in University HealthSystem Consortium participating hospitals with Clinical and Laboratory Standards Institute guidelines.

PURPOSE The degree of compliance with antibiogram guidance among University HealthSystem Consortium (UHC) hospitals was analyzed. METHODS The UHC Pharmacy Council Pharmacy Practice Advancement Committee conducted a survey to evaluate hospital policies regarding the generation, reporting, and utilization of antibiograms among UHC hospitals. The survey was distributed via a UHC online survey tool to pharmacy directors at 237 UHC hospitals. Responses were collected from April 13 to May 14, 2010. RESULTS Of the 237 hospitals to which surveys were sent, 49 hospitals (21%) from 28 states submitted survey responses. Forty-eight hospitals reported that they routinely generated antibiograms, and 36 reported that they adopted all or most of the standards recommended by the 2009 guidelines on antibiograms published by the Clinical and Laboratory Standards Institute (CLSI). The compliance rates to the four key CLSI recommendations were as follows: 98% reported data at least annually, 89% eliminated duplicate isolates, 83% did not include surveillance isolates, and 64% required at least 30 isolates for each reported species. Thirty-eight hospitals had an antimicrobial stewardship program; 35 of them formally reviewed antibiograms and 19 implemented new programs based on the antibiogram data. In 16 hospitals, formulary changes were made as a consequence of antibiogram results. In 30 hospitals, pharmacists had significant involvement in compiling, reviewing, and reporting antibiograms. CONCLUSION Among respondents from 47 UHC hospitals, the compliance rates to four key CLSI recommendations for antibiograms ranged from 64% to 98%. Respondents from 30 hospitals reported significant involvement of pharmacists in compiling, reviewing, and reporting antibiograms.

Bupivacaine Liposomal Versus Bupivacaine: Comparative Review

Bupivacaine liposomal injection was recently approved by the US Food and Drug Administration (FDA) as a local anesthetic for use in management of postsurgical pain in adults. When compared to placebo, bupivacaine liposomal decreases postoperative pain and opioid use. This review examines the efficacy of bupivacaine liposomal when compared to conventional bupivacaine ± epinephrine using published and unpublished data provided to the FDA by the manufacturer.

Pharmacy practice model for academic medical centers.

The pharmacist’s role in health systems continues to evolve from a product-focused to a patient-centered care model that ensures the safe and effective use of medications in all practice settings. The best way to deploy pharmacists, technicians, and technology in support of the transition has been

Clinical use of anti-infective agents :

clinical use of anti-infective agents , clinical use of anti-infective agents , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

Clinical Approach to Treatment of Fungal Infections

In the last 20 years, we have begun to see some progress in the treatment of viruses. The treatment of viral infections other than HIV-1 has not reached the level of sophistication that treatment of bacterial infection has. Therefore, we have devoted less time to this subject than to the treatment of bacteria. The treatment of HIV-1 is a subject for a separate textbook, so in this book we are only presenting basic principles of treatment. The actual drug used changes dramatically from 1 year to the next based on availability of new agents as well as the development of resistance to some old drugs.

Basic Principles of Drug Delivery and Dosing

Anti-bacterial drugs work by exploiting differences between mammalian and microbial physiologic processes. Since bacteria, unlike mammals, have cell walls, many anti-bacterial agents work by binding to components of the cell wall or inhibiting the synthesis of the cell wall. These agents include the beta-lactam and glycopeptide antibiotics. Other anti-bacterial agents function by exploiting differences in DNA replication (the quinolones inhibit DNA gyrases that are used in bacterial replication) or transcription (rifampicin). Still other agents exploit differences in the translational process, as bacteria use ribosomes that are different from mammalian ribosomes. The macrolides, tetracyclines, and aminoglycoside antibiotics exert their anti-bacterial effects by binding to different components of the bacterial ribosome (see Fig. 2.1). Still other anti-microbial agents such as the sulfonamides function by exploiting differences in the metabolic pathways between mammals and bacteria. Since bacteria are unable to use folic acid but must synthesize it from para-aminobenzoic acid, drugs that inhibit this pathway will selectively inhibit bacterial growth without toxicity to mammalian cells.

Polypharmacy: America’s other drug problem

The opioid epidemic has become a national crisis. The number of overdose deaths involving opioids has quadrupled since 1999.[1][1] Indeed, the United States, with 5% of the global population, consumes 80% of the global opioid supply.[2][2] This epidemic has rightly entered the national consciousness

189Hospital onset Clostridium difficile infection not a predictor of increased antibiotic use in small hospitals: an evaluation of 54 hospitals

189. Hospital onset Clostridium difficile infection not a predictor of increased antibiotic use in small hospitals: an evaluation of 54 hospitals Roy Guharoy, PharmD, MBA; Mohamad G. Fakih, MD, MPH; Jeffrey Seggerman, MBA; Angelo Bufalino, PhD; Michelle Heavens, BSN, MHA; Ann Hendrich, RN, PhD; Clinical Excellence, University of Massachusetts Health Care, St. Louis, MO; Infection Prevention and Control, St. John Hospital and Medical Center, Grosse Pointe Woods, MI; Ascension Health, St Louis, MO; Ascension Health, St. Louis, MO; Clinical Excellence, Ascension Health, St Louis, MO

183Evaluating Multidrug Resistance Prevalence and Antimicrobial Stewardship Preparedness in the Largest Not-For-Profit Healthcare System in the United States: Taking the First Step to Optimize Antimicrobial Use

183. Evaluating Multidrug Resistance Prevalence and Antimicrobial Stewardship Preparedness in the Largest Not-For-Profit Healthcare System in the United States: Taking the First Step to Optimize Antimicrobial Use Roy Guharoy, PharmD, MBAS; Mohamad G. Fakih, MD, MPH; Gail Fraine, RN; Michelle Heavens, BSN, MHA; Ann Hendrich, RN, PhD; Medicine, University of Massachusetts Medical School, Worcester, MA; Clinical Excellence, Ascension Health, St. Louis, MO; Infection Prevention and Control, St. John Hospital and Medical Center, Grosse Pointe Woods, MI; St. Thomas Midtown, Nashville, TN; Clinical Excellence, Ascension Health, St Louis, MO