PURPOSE:Many patients treated for Helicobacter pylori (HP) do not complete guideline-recommended post-treatment eradication testing. Patients diagnosed via esophagogastroduodenoscopy (EGD) face unique barriers due to fragmented handoffs between providers. We describe the development and early outcomes of a Clinical Pharmacist Practitioner (CPP)-led clinic designed to improve HP management for EGD-diagnosed patients. SUMMARY:We developed a centralized CPP-led clinic to assume responsibility for HP regimen selection, eradication test ordering, and follow-up. The option for referral to this clinic was integrated into an existing EGD results notification workflow for patients with newly diagnosed HP. Comparing a pre-intervention period (October 2022-March 2024, n=105) to a post-intervention period (May 2024-October 2025, n=111), guideline-concordant prescribing increased from 32.4% to 90.8% (p<0.001), testing completion within 6 months increased from 37.1% to 61.3% (adjusted odds ratio 2.88, p<0.001), and eradication among tested patients improved from 82.1% to 92.6%. With extended follow-up, testing completion increased from 62.9% pre-intervention to 84.7% post-intervention (p<0.001), and eventual eradication among those tested increased from 87.9% to 98.9% (p=0.003). CONCLUSION:A centralized CPP-led clinic significantly improved guideline-concordant prescribing, eradication testing completion, and confirmed eradication for EGD-diagnosed HP patients. This scalable model addresses care fragmentation by centralizing the complete care pathway for HP management.
PURPOSE:The primary objective of the study was to determine how clinically accurate and useful are ChatGPT-4o-generated outputs when identical prompts are entered simultaneously in three independent ChatGPT sessions utilizing the same user-facing model. The secondary objective was to identify if differences in outputs affect clinical outcomes (i.e., impact variability). METHODS:Five clinical prompts were developed focusing on diabetes management and counseling. Each clinical prompt was simultaneously inputted into three separate devices using ChatGPT-4o to generate outputs. A modified Delphi technique was then utilized involving five diabetes management clinical pharmacists. Each clinical pharmacy faculty independently rated each ChatGPT-generated output based on accuracy (i.e., poor, borderline, good) usefulness (i.e., not useful, somewhat useful, very useful) and impact variability (i.e, low, moderate, high). After initial assessment, responses were collated and anonymously shared among the pharmacy faculty. The faculty members were invited to revise their evaluations based on collective feedback. Pharmacy faculty then convened in a virtual panel with moderators to discuss evaluations and work towards consensus. RESULTS:Consensus was achieved for all ChatGPT outputs. Accuracy ratings ranged from borderline to good. Two of the clinical prompts yielded outputs receiving different accuracy ratings which may have impacted variability. Usefulness ratings ranged from somewhat useful to very useful, with one clinical prompt yielding outputs that received different usefulness ratings. CONCLUSION:While outputs were generally accurate and useful, limitations and inconsistencies were noted. Users should be aware simultaneously generated outputs across multiple devices using ChatGPT can vary in their accuracy and usefulness in diabetes management.
PURPOSE:Osteoporosis is an often underdiagnosed and undertreated disease despite its serious consequences. To bridge this gap, fracture liaison services (FLSs) have been implemented in institutions for patients with fractures. Our institutional FLS provides centralized outreach for patients with new fractures and is supported by embedded clinical pharmacists. It has been demonstrated to improve process outcomes, but there is still room for growth. This qualitative evaluation sought to capture healthcare professionals' perspectives on FLS processes, successes, and barriers, to determine how the service could be further improved. METHODS:We conducted 22 semistructured interviews with those who delivered the service and primary care providers (PCPs) who utilized the service. We used thematic analysis and a rapid qualitative approach to identify emerging themes. RESULTS:We identified 6 overarching themes. Successes included helping to identify patients whose new osteoporosis diagnosis might have been overlooked or gone untreated despite the presence of a new fracture, streamlining the process to make it easier for PCPs to address osteoporosis, and providing education for patients and PCPs. Challenges included programmatic issues such as workflow inconsistencies, systemic delays in obtaining laboratory results and dual-energy X-ray absorptiometry scans, and the inappropriateness of the service for some medically complex patients. CONCLUSION:PCPs recognize the value of the FLS program; however, challenges can hinder optimal execution of service components. Opportunities for improvement include more timely communication between the delivery team and PCPs, clearer documentation processes, and further disease state education for both PCPs and patients.
PURPOSE:Manual application of auxiliary labels to compounded sterile preparations (CSPs) can introduce variability, workflow inefficiencies, and risk for omitted safety information. This article describes the design, implementation, and evaluation of electronic health record (EHR)-integrated color auxiliary labels to improve labeling accuracy, consistency, and operational efficiency in a pediatric institution. METHODS:Automated color auxiliary labels were embedded within EHR post-verification labels for CSPs across 3 pharmacy settings. The intervention included printer and label stock selection, standardized label design with prioritization logic, EHR rule development, medication record validation, and phased hardware deployment. Pre- and postimplementation surveys assessed perceptions of labeling accuracy and workflow impact. Operational metrics included estimated technician time savings, supply utilization, and cost analysis. RESULTS:Automation eliminated a manual labeling step, averaging an estimated 12.5 seconds per dispense, corresponding to approximately 38 technician hours per month (0.22 full-time equivalents). Staff confidence in accurate auxiliary label application improved, with the frequency of low-confidence responses declining from 20% before implementation to 6.1% after implementation. The automated label logic standardized placement and reduced variability associated with manual processes. Implementation required capital investment for color printers and increased the annual label cost by approximately 29%. Postimplementation monitoring demonstrated stable supply utilization, which was below initial projections. CONCLUSION:Integration of automated color auxiliary labels within the EHR improved workflow efficiency, enhanced labeling consistency, and increased staff confidence with minimal cost implications. This offers a practical framework for health systems seeking to standardize labeling without major EHR infrastructure changes.
PURPOSE:Ambulatory clinics manage high-cost medications with little visibility into quantity or movement, leaving unrealized opportunities for inventory optimization. Automated dispensing cabinets, common in inpatient settings, address this issue but require significant capital investment, forcing clinics into complex workflows to balance demand for high-cost medications with minimizing waste. This study evaluated a passive bin-based inventory model that tracked clinic transactions in real time using light sensors to log product removal and replacement. The model uses artificial intelligence and various algorithms to recommend inventory optimizations based on transaction data and notably requires no electronic health record integration. METHODS:This 10-week study included select medications at 2 ambulatory locations and assessed whether the utilization of a passive bin-based inventory model allowed a decrease in inventory on-hand valuation. Inventory valuation was assessed before implementation and following implementation of system recommendations at the conclusion of the pilot. The primary outcome was the change in inventory on-hand valuation. The accuracy of the system was validated via twice-weekly manual cycle count. RESULTS:The assessed model recorded 3,454 dispenses during the study period. The average days on hand varied widely, and the total inventory valuation decreased by $34,000 of average wholesale price, although this cannot be extrapolated due to volume. The results of the modified MAS-NAS nursing satisfaction survey were mixed and not generalizable. CONCLUSION:In this prospective pre- vs postimplementation study, the utilization of a passive bin-based perpetual inventory model reduced inventory valuation but the difference was not statistically significant. While the model enhanced visibility in a challenging setting, further studies are necessary.
PURPOSE:Health-system pharmacists play a crucial role in monitoring the pharmaceutical pipeline to manage formularies, allocate resources, and optimize clinical programs for new therapies. This article aims to support pharmacists by sharing new and anticipated novel drug approvals. SUMMARY:Selected drug approvals anticipated in the 12-month period covering the third quarter of 2026 through the second quarter of 2027 are reviewed. The analysis emphasizes drugs expected to have significant clinical and financial impact in hospitals and clinics selected from 66 novel drugs awaiting US Food and Drug Administration (FDA) approval. This year's pipeline features novel therapies for various disease states including rare and inherited genetic disorders, immunology and inflammatory diseases, and continued advancements in both targeted oncology therapies and gene therapies. CONCLUSION:Novel therapies continue to strengthen the current drug pipeline.
PURPOSE:To describe a methicillin-susceptible Staphylococcus aureus (MSSA) thigh abscess following alternate-site placement of a continuous glucose monitor (CGM) sensor and to highlight safety considerations associated with off-label device use in patients with poorly controlled diabetes. SUMMARY:A 49-year-old man with uncontrolled type 2 diabetes (glycated hemoglobin, 11.3%) was referred to an ambulatory care pharmacist for diabetes management. The patient placed the sensor on his upper thigh due to prior dislodgement from the upper arm. Three days later, the patient presented with a painful, erythematous, fluctuant 4.5 x 5 cm abscess at the sensor insertion site. Initial incision and drainage (I&D) was performed and oral sulfamethoxazole/trimethoprim was prescribed. Four days later, he returned with worsening pain and impaired ambulation requiring repeat I&D. Wound cultures grew MSSA. Management additionally included wound packing, topical mupirocin, and continuation of sulfamethoxazole/trimethoprim, with clinical improvement noted after the second I&D procedure. Cutaneous complications with CGM use are typically mild, infrequent, and most often involve contact or irritant dermatitis rather than infection. Reports of CGM-associated skin infections are rare, and none have been reported following sensor placement at unapproved insertion sites. CONCLUSION:This case underscores the potential for a skin and soft tissue infection following off-label CGM placement, especially in patients with uncontrolled hyperglycemia. Pharmacists play a critical role in reinforcing appropriate device use, identifying early signs of infection, and coordinating interdisciplinary care to mitigate device-related complications.
PURPOSE:This study was conducted to compare the completion rate of ancillary tasks associated with sterile compounding and the timeliness of documentation before and after implementation of a technology-assisted workflow (TAWF) and electronic documentation software solution. METHODS:This mixed methods, pre-post study was conducted at 3 related facilities (sites A, B, and C). Sterile and nonsterile compounding records were evaluated using both electronic data and ethnographic observations over two 90-day periods. The workflow before and after implementation was assessed for percentage of ancillary tasks completed, timeliness of completion, percentage of storage area inspections completed, and time required to document compliance activities. RESULTS:Analysis indicated that while sites B and C saw significant improvement in on-time completion of ancillary activities, site A did not. Site B increased its on-time completion from 42.3% of all activities to 79.1%, while site C increased the completion rate from 72.1% to 98.1% (P < 0.0001 for both comparisons). Similarly, sites B and C increased the percentage of completed medication storage area inspections both overall and across the majority of evaluated subcategories. Timely completion of inspections remained relatively consistent at all 3 sites; site A saw a slight increase. Finally, the total time that staff used to document ancillary compounding activities declined by 6 to 92 seconds at each of the 3 sites during the postimplementation period. CONCLUSION:Implementation of mobile technology with a new TAWF system can meaningfully increase timeliness and visibility of documentation of ancillary compounding tasks, leading to improvements in standardization, documentation, and operational efficiency.
PURPOSE:Development and implementation of an emergency department protocol for use of subcutaneous (SQ) insulin in patients with mild to moderate diabetic ketoacidosis (DKA) is described. SUMMARY:Diabetes is on the rise worldwide in what has been described as a coming tsunami, with proportional increases in DKA, outstripping the availability of intensive care unit (ICU) and intermediate care unit beds. Historically, the complexity of care for DKA and safety concerns restricting use of intravenous insulin infusion on medical floors have required admission to an ICU. A potential solution to these concerns is in use of subcutaneous insulin for treating DKA, which avoids an insulin infusion and the intensity of monitoring that requires nursing staff ratios only available in the ICU. Recently our multidisciplinary team implemented a protocol for use of subcutaneous (SQ) insulin in patients with mild- to moderate-severity DKA presenting to the emergency department (ED) called the SQuID (Subcutaneous Insulin in Diabetic Ketoacidosis) protocol. This was followed with a second study expanding the locations to which these patients can be admitted. We are currently expanding this protocol in some of our community affiliate hospitals. Now in its fourth year, this protocol has been highly successful, with over 75% of patients with mild to moderate DKA (nearly all who are eligible) being treated on SQuID and resulting in a more than 33% reduction in ICU utilization for this population. CONCLUSION:Implementation of the SQuiD protocol along with comprehensive education, ongoing monitoring, and targeted modifications to reduce hypoglycemia risk has advanced our institution's efforts to provide a safe alternative to conventional DKA management.
PURPOSE:Published data have shown that meds-to-beds programs may improve patient satisfaction and generate revenue, but the results for readmissions have been mixed. The purpose of this study was to assess the impact of a meds-to-beds program on readmissions. METHODS:This single-center, retrospective cohort study, including adult patients discharged between January 1 and July 30, 2022, compared patients in a meds-to-beds program to patients who did not receive medications through the program. Patients who had data missing, were discharged from an intensive care unit, were not admitted to an inpatient unit, had a nonmedication discharge prescription, or were pregnant were excluded. Patients in the non-meds-to-beds group who filled their prescriptions at the institution's outpatient pharmacy were also excluded. For the primary outcome, the rate of readmission to the emergency department (ED) or hospital within 30 days was modeled using logistic regression. Secondary outcomes included the rates of readmission within 7 days and 60 days, along with economic measures. RESULTS:A total of 768 patients were included in the study, with 384 patients in each group. A lower proportion of patients in the meds-to-beds group had a readmission within 30 days than those in the non-meds-to-beds group (13.3% vs 27.1%, respectively; P < 0.001). Patients in the meds-to-beds group also had a lower readmission rate at 7 days (P < 0.001) and 60 days (P = 0.001). The total marginal profit from the meds-to-beds program was $30,253 over a 7-month period. CONCLUSION:The meds-to-beds program was associated with fewer readmissions to the ED or hospital within 7 days, 30 days, and 60 days and generated revenue for the institution's outpatient pharmacy.
PURPOSE:The creation and implementation of a system-wide frontline pharmacist antimicrobial stewardship (AS) competency curriculum are explained. SUMMARY:Pharmacists are present throughout hospital environments and frequently play a pivotal role in optimizing infection management. However, frontline clinical pharmacists working across inpatient settings vary greatly in terms of training, expertise, years of experience, and background as they relate to infectious diseases (ID) and AS. Establishing a uniform level of ID and AS competency among pharmacists across all hospital departments and shifts is essential to optimizing the effectiveness of antimicrobial stewardship programs. Across a diverse 11-hospital health system, an innovative curriculum, "The Antimicrobial Resistance Fighter Curriculum," was implemented to help standardize care for patients with infections. Core modules incorporated gamified elements, case-based activities, knowledge checks, and visual learning aids. Tactics included system-wide automatic assignment, targeted onboarding for new hires, and strategic use of reminders to ensure completion. Annual feedback cycles and postimplementation surveys guided iterative improvements and module updates, focusing on engagement, efficiency, and practical application. CONCLUSION:An innovative, interactive curriculum successfully standardized AS competency across a diverse health system. Key implementation strategies including system leadership buy-in, modular design, interactive learning, and responsive updates enabled efficient dissemination, high engagement, and improvement of pharmacist competence in applying knowledge of AS topics to patient care.
PURPOSE:This article identifies, summarizes, and prioritizes published literature on the Ambulatory Care Medication-Use Process (ACMUP) from 2025 that can describe ambulatory pharmacy practice. The MUP is the foundational system that provides the framework for safe medication utilization within the health care environment. The ACMUP is defined in this article as having the following components: transitions of care, prescribing, access, dispensing, adherence, and evaluating. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement. SUMMARY:A PubMed search was conducted in January 2026 for the publication year 2025 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 5,758 articles. A thorough review identified 32 potentially practice-enhancing articles: 6 for transitions of care, 8 for prescribing, 2 for access, 1 for dispensing, 7 for adherence, and 8 articles for evaluating. Trends from the impact articles are described and discussed compared to trends identified in articles in this series published from the 2020-2024 publication years. CONCLUSION:It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article continues a series of articles defining and evaluating the currently published literature around the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.
PURPOSE:Sequential nephron blockade is commonly used to augment diuresis in patients with volume overload receiving loop diuretics. While metolazone is frequently used, acetazolamide has emerged as an alternative adjunctive agent. Real-world data comparing these strategies remain limited. This study evaluated the effectiveness and safety of acetazolamide vs metolazone as adjunctive therapy. METHODS:This single-center, retrospective cohort study included adult patients receiving adjunctive acetazolamide or metolazone with loop diuretics for volume overload. The primary outcome was cumulative urine output within 48 hours. Secondary outcomes included high diuretic response (urine output above the cohort median), hypotension, acute kidney injury, hypokalemia, and metabolic acidosis. Multivariable regression and propensity score-matched analyses were performed. RESULTS:A total of 120 patients were included (metolazone, n = 70; acetazolamide, n = 50). Patients receiving metolazone were older and had higher baseline serum creatinine levels. Mean (SD) cumulative urine output was greater with acetazolamide (10,637 [13,847] vs 5,752 [10,231] mL; P = 0.028). After adjustment, acetazolamide remained associated with greater urine output (β = 4,735 mL; 95% confidence interval [CI], 39-9,430 mL; P = 0.048). High diuretic response occurred more frequently with acetazolamide (64% vs 40%), with higher adjusted odds (odds ratio, 3.18; 95% CI, 1.40-7.47; P = 0.0065). Findings were consistent in propensity score-matched analyses. Adverse event rates were similar between the groups. CONCLUSION:Adjunctive acetazolamide was associated with greater urine output and a higher likelihood of achieving a robust diuretic response compared with metolazone. Given the retrospective study design, these findings are hypothesis generating and warrant confirmation in prospective comparative studies.
PURPOSE:This study evaluated whether implementing perpetual inventory automation in decentralized pharmacies at an academic medical center reduces inventory value and optimizes supply chain functions. SUMMARY:This quality improvement project was conducted at an 881-bed academic medical center. The financial and operational impact of an automated perpetual inventory management system was assessed in 2 locations: an ambulatory infusion-based cancer center pharmacy and a perioperative satellite pharmacy. The primary outcome was the change in total inventory value before versus after implementation. Secondary outcomes included staff efficiency and nonfinancial medication inventory metrics. Data was collected from June 2024 to January 2025 and analyzed using descriptive statistics. Postimplementation data showed a cumulative reduction in medication inventory value for both pharmacies. The infusion-based pharmacy's total inventory value decreased by $926,291 (22.15%), and the inventory turnover ratio increased from 1.23 to 1.69 (a 37.01% increase). The perioperative satellite pharmacy's total inventory value decreased by $8,271 (12.88%), and the inventory turnover ratio decreased from 1.14 to 0.78 (31.66%) due to a concurrent decrease in medication spend. Overall, the total inventory was reduced from $4,245,693 to $3,311,131 (22.01%). CONCLUSION:Implementation of an automated perpetual inventory management system resulted in benefits in the reduction of inventory value reduction and increased operational efficiency. Real-time tracking improved inventory oversight, suggesting automated perpetual inventory management can enhance inventory management in academic medical centers from both financial and workflow perspectives.
