METHODS Approval was obtained from the University of British Columbia Clinical Research Ethics Board before initiation of the study. This project was conducted in partial fulfillment of the requirements for completion of a hospital pharmacy residency year by the first author (O.S.).
Continue reading " Appropriateness of Adrenocorticotropic Hormone Stimulation Test: METHODS "
INTRODUCTION The adrenal gland is responsible for the production and secretion of many hormones in the body, including glucocorticoids, specifically cortisol. During sepsis or septic shock, patients may not produce enough cortisol relative to the demand created by the stress imposed on the body; this may cause a transient state of relative adrenal insufficiency contributing [...]
Continue reading " Appropriateness of Adrenocorticotropic Hormone Stimulation Test "
As with any reactive program, the work of the Royal Victoria Hospital pharmacy department during the CDAD outbreak left room for improvement. Future revisions to the clinical decision support tools must incorporate new evidence as it becomes available. The decision to approach antibiotic selection on the basis of CDAD risk levels was supported by the [...]
Continue reading " A Small Group of Pharmacists Makes a Big Impact: FUTURE DIRECTIONS "
The clinical decision support tools were designed and implemented within the first 2 weeks of the hospital declaring the C. difficile outbreak. Although there is no way to measure the direct impact of the pharmacy department’s program on the rate of CDAD, the rate of identification of new nosocomial cases dropped by mid-March 2007 (Figure [...]
Continue reading " A Small Group of Pharmacists Makes a Big Impact: PROGRAM RESULTS "
To specifically address the C. difficile crisis, the pharmacy department developed an algorithm for antibiotic surveillance by pharmacists (Figure 1). The pharmacists used this algorithm in the central dispensary when assessing antibiotic orders for both patient-related and drug-related CDAD risk factors. Based on extrapolations from the published literature and consultation with the University Health Network [...]
Part of the outbreak action plan included review of antimicrobial therapy and a review of antibiotic use within the hospital. To achieve these objectives and to reduce the rate of CDAD within the hospital, the hospital looked to the pharmacy department for clinical direction and leadership. The pharmacy department approached this challenge with the goal [...]
Continue reading " A Small Group of Pharmacists Makes a Big Impact: PROGRAM DESCRIPTION "
Clostridium difficile is a gram-positive, spore-forming anaerobic bacillus that has been an identified cause of nosocomial diarrhea for at least 30 years. Up to 25% of patients experiencing diarrhea associated with antibiotics and 95% of patients with a diagnosis of pseudomembranous colitis test positive for C. difficile toxin. CDAD ranges from mild diarrhea to sepsis [...]
Continue reading " A Small Group of Pharmacists Makes a Big Impact: BACKGROUND "
