Pharmacists as Interprofessional Collaborators and Leaders through Clinical Pathways

Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs). We present a tertiary care facility experience of pharmacists vis-a-vis interprofessional collaboration for designing and implementing CPs. We participated in the development of CPs as leading members of a collaborative team of healthcare professionals. We reviewed literature, aligning it with hospital formulary and institutional standards, and participated in weekly team meetings for six months. Several tools and services were adapted to guide prescribing and standardization of care through time-bound order sets. Fifteen CPs leading to admissions in medical wards were developed and integrated into Computerized Prescriber Order Entry (CPOE) sets. Tools and services included (1) reporting of creatinine clearance to guide optimum dosing; (2) advisory flags for dosing and infusion rates; (3) piloting of medication reconciliation and counseling services before discharge were initiated; (4) Arabic drug leaflets were designed to educate patients; and (5) five CPs were included in pragmatic randomized control trials with a clinical pharmacist as co-investigator. Clinical pharmacists conducted continuous orientation to various healthcare professionals throughout the process. CPs provide unique opportunities for establishing and evaluating patient-centered pharmaceutical services and allow clinical pharmacists to demonstrate interprofessional leadership in collaboration with multidisciplinary teams

Evaluation of bleeding risk in patients with renal impairment treated with Fondaparinux (Arixtra)

Background: Fondaparinux (Arixtra) a synthetic pentasaccharide that causes an antithrombin III-mediated selective inhibition of factor Xa. The clearance of fondaparinux reduces in patients with renal impairment, and there are no dosage adjustments provided in the manufacturer’s labeling. In patients with creatinine clearance rate (CrCl) >50 ml/min, total clearance is reduced by 25% while in case of CrCl 30–50 ml/min, the total clearance could be 40% lower when compared to patients with normal renal function. Aim of the Study: To evaluate the risk of bleeding in patients with renal impairment treated with fondaparinux. Materials and Methods: We performed a retrospective chart review study of patients 18 years of age and older who received fondaparinux between 11/10/2003 and 30/12/2009 during their hospital stays, and who had a CrCl of ≤80 ml/min. The patients were classified according to their degree of renal dysfunction as either stage A (CrCl: 80–50 ml/min; mild dysfunction) or stage B (CrCl: <50 ml/min; moderate or severe dysfunction). The HAS-BLED scoring system (HAS-BLED mnemonic stands for: hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalized ratios, elderly, drugs or alcohol) was used to categorize the bleeding risk as mild, moderate, or high. Additionally, the bleeding severity was categorized as either major bleeding or minor bleeding. Results: A total of 165 patients were included in the study; of which 87 were men. In that 52.7% of the total were classified as stage A and the remainder as stage B. The patients classified as stage B were more frequently classified at high risk of bleeding than stage A patients (48.7%, n = 38 of stage B patients vs. 23.0%, n = 20 of stage A patients). Twenty-three percent (n = 38) of the patients experienced bleeding, and most of which were stage B patients (55.3%, n = 21). The majority of the patients who bled experienced major bleeding (71.0%, n = 27). Ten percent (n = 16) of the total number of patients, whose fondaparinux doses were adjusted as per the drug monograph, were documented to have had a bleeding event during their hospital stay. By contrast, 13% of the total number of patients (n = 22) who required dose adjustments and received fondaparinux without adjustments had bleeding events. Conclusion: Fondaparinux increases the risk of bleeding in patients with mild-to-moderate renal impairment even with appropriate dose adjustments. The risk of bleeding and the incidence of major bleeding are increased in patients with moderate and severe renal dysfunction

Adoption of a personal health record in the digital age: Cross-sectional study

Background: As health care organizations strive to improve health care access, quality, and costs, they have implemented patient-facing eHealth technologies such as personal health records to better engage patients in the management of their health. In the Kingdom of Saudi Arabia, eHealth is also growing in accordance with Vision 2030 and its National Transformation Program framework, creating a roadmap for increased quality and efficiency of the health care system and supporting the goal of patient-centered care. Objective: The aim of this study was to investigate the adoption of the personal health record of the Ministry of National Guard Health Affairs (MNGHA Care). Methods: A cross-sectional survey was conducted in adults visiting outpatient clinics in hospitals at the Ministry of National Guard Health Affairs hospitals in Riyadh, Jeddah, Dammam, Madinah, and Al Ahsa, and primary health care clinics in Riyadh and Qassim. The main outcome measure was self-reported use of MNGHA Care. Results: In the sample of 546 adult patients, 383 (70.1%) reported being users of MNGHA Care. MNGHA Care users were more likely to be younger (P<.001), high school or university educated (P<.001), employed (P<.001), have a chronic condition (P=.046), use the internet to search for health-related information (P<.001), and use health apps on their mobile phones (P<.001). Conclusions: The results of this study show that there is substantial interest for the use of MNGHA Care personal health record with 70% of participants self-reporting use. To confirm these findings, objective data from the portal usage logs are needed. Maximizing the potential of MNGHA Care supports patient engagement and is aligned with the national eHealth initiative to encourage the use of technology for high-quality, accessible patient-centered care. Future research should include health care provider perspectives, incorporate objective data, employ a mixed-methods approach, and use a theoretical framework