Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Miranda Hester

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Articles

Your weekly roundup of the latest news from Drug Topics®.

News Roundup: June 20 to June 24

Following a review of randomized studies and real-world data from many influenza seasons, the CDC’s Advisory Committee on Immunization Practices (ACIP) will include the Seqirus FluadQuadrivalent vaccine as a preferentially recommended season influenza vaccine for individuals aged 65 years and old. This recommendation is built on the clinical benefits compared to the standard egg-based influenza vaccines. If a preferentially recommended vaccine is not available at the time of administration, any age-appropriate vaccine should be used.

To address the immunosenescence that may lead to a reduction in immune response to vaccines, the Fluad Quadrivalent vaccine uses the MF59 adjuvant to strengthen the immune response. More than 225 million doses have been administered since its approval in 1997, illustrating the safety and efficacy of the vaccine.

Gregg Sylvester, MD, Chief Health Officer at Seqirus said in a news release, "It is critical that we do everything we can to protect vulnerable populations like older adults against influenza. Today's recommendation is evidence of the ACIP's commitment to providing clear, evidence-backed guidance to protect public health. We are proud to offer one of the enhanced flu vaccines that was preferentially recommended by the ACIP for adults 65 years and above in the United States."

CDC advisory committee includes Fluad® Quadrivalent as a preferentially recommended influenza vaccine for adults 65 and older. News Release. Seqirus.June 22, 2022. Accessed June 23, 2022. 

https://www.prnewswire.com/news-releases/cdc-advisory-committee-includes-fluad-quadrivalent-as-a-preferentially-recommended-influenza-vaccine-for-adults-65-and-older-301573521.html

The preferential recommendation is built on research and real-world data 

ACIP Includes Fluad Quadrivalent as a Preferentially Recommended Influenza Vaccine for Adults Over 65 

For much of the pandemic, monoclonal antibody therapy has been an important tool to prevent severe COVID-19 in patients with mildtomoderate disease who were at high risk of severe illness or hospitalization. A poster presented by Jennifer L. Rafferty, PharmD, at St. John Fisher College Wegmans School of Pharmacy/Rochester Regional Health in Rochester, New York at the American Society of Health-SystemPharmacists 2022 Summer Meeting and Exhibition, heldin Phoenix, Arizona, sought to catalog the barriers to monoclonal antibody therapy to discover areas for further educational need.

A single-center, retrospective chart review examined the real-world utilization of monoclonal antibody therapy. A patient was included if he or she had a positive COVID-19 test within 10 days of symptom onset, met the criteria set by the FDA emergency use authorization for monoclonal antibody therapy, and had been referred to a clinical pharmacist. Those who had been given oxygen therapy or had been hospitalized for COVID-19 before referral were excluded.

Patients were split into a non-monoclonal group, which included all eligible patients who had not received treatment within the 10-day window, and the monoclonal group that included patients who had documentation of administration within 10 days of symptom onset. Primary outcomes included the ratio of patients who did not receive therapy and the reasons for not receiving it.

There were 231 potential candidates for monoclonal antibody therapy were referred to clinical pharmacists, 197 of whom met the inclusion criteria. Just 33 patients were given treatment. Among the 164 who qualified but did not receive monoclonal antibody treatment, 55 declined therapy due to mild illness or improving symptoms. Twenty-two patients did not receive the therapy because the patient’s primary care provider did not order monoclonal antibody treatment. In this subset, 11 were not given treatment by the provider because of mild symptoms; the reason for denial was unknown for 7 patients, and 1 patient died within 30 days from complications of COVID-19.

Investigators concluded that despite of authorization for treating mildtomoderate illness in patients with a high risk of more severe outcomes, many did not use monoclonal antibodies because of the mild nature of their illness.

“As COVID-19 treatments are rapidly changing, this study has identified a need for education targeting patients at high risk for severe illness,” the author concluded.

Rafferty JL. Real-world utilization and outcomes of monoclonal antibody therapy in COVID-19: identifying barriers to care. Presented at American Society of Health-SystemPharmacists 2022 Summer Meeting and Exhibition; June 11-15, 2022; Phoenix, AZ. Poster 8-T.

Monoclonal antibodies have been helpful in preventing severe illness in patients at increased risk, but barriers to receiving this therapy exist. 

Identifying Patient Barriers to Monoclonal Antibody Therapy for COVID-19 

Clinical markers of chronic disease may be improved by ambulatory care pharmacists engaging in comprehensive medication management. Little is known about the explicit financial value that such care can produces. A poster presented by Anna Pham, PharmD, of Intermountain Healthcare in Salt Lake City, Utah, at the American Society of Health System Pharmacists 2022 Summer Meeting and Exhibition in Phoenix, Arizona, examined the impact of value of such services in an integrated health system.

Investigators matched study participants 1:2 into an experimental cohort comprised of patients taking medication for chronic diseases who worked with an ambulatory care pharmacists and a control cohort of patients who did not. Intervention patients were eligible for inclusion if they had at least 2 comprehensive medication management appointments at least 3 months apart with an ambulatory care pharmacist from January 2020 to December 2020;control patients were eligible if they had 2 primary care visits at least 3 months apart in the same time period.

The primary outcome was the utilization of the emergency department and hospital from January 2020 to December 2020. Secondary outcomes included the cost savings analysis of emergency department and hospital use data as well as a comparison of disease markers before and after the interventions.

The cohort included 300 patients: 100 in the intervention group and 200 in the control group. A look at health system utilization found an average of 7.1 emergency department visits per 1000 patients in the intervention cohort vs11.4 in the control (P=.018). Furthermore, the control group had an average of 5.0 inpatient per 1000 patientsvs3.1 in the intervention group (P<.01).

Using estimated admission costs, the differences in admission represent a reduction of $46,574 for the emergency department and $306,912 for inpatient visits with the aid of pharmacist intervention. No statistical differences were seen between the 2 groups for blood pressure and lipid panels, but the intervention group did see an average reduction in HbA1c from 8.97% before comprehensive medication management to 7.95% (P<.01) after a year, whereas the control group saw an average increase from 8.85% to 9.37% (P<.43) in the same time span.

“[Comprehensive medication management] provided by ambulatory care pharmacists were shown to reduce ED and inpatient visits…which may lead to monetary savings to the health system,” the author concluded.

PhamA. Impact and value of ambulatory care pharmacists’ clinical interventions within primary care clinics. Presented at American Society of Health-SystemPharmacists 2022 Summer Meeting and Exhibition; June 11-15, 2022; Phoenix, AZ. Poster 7-T.

Comprehensive medication management has been shown to improve disease markers, and new research indicates it could also reduce costs. 

Comprehensive Medication Management Could Be Key to Reducing Cost, Improving Chronic Disease Markers

In emergency situations, a medication override can give an automated dispensing station user the opportunity to bypass order review by a pharmacist to require necessary medications to manage the situation. The Medication Management Standard set by the Joint Commission requires hospitals to assess the effectiveness of their system by reviewing the appropriateness of overrides. A poster presented by Nowshin Islam, PharmD, BCPS, Yale New Haven Hospital in Connecticut at the American Society of Health-SystemPharmacists 2022 Summer Meeting and Exhibition in Phoenix, Arizona examined the dashboard that had been developed for a health system.

The override dashboard was made using business intelligence software and shows the total number of medications that have been made on override for each delivery network in the 5-hospital health system. Overrides that were linked to a medication order were separated from those that were not. Medications that receiving override orders can be examined at multiple levels, including system, delivery network, or patient care unit.

Toolkit components included background information (reasons for the development of the toolkit), the goals of the health system, delineation of team member responsibilities, guidance for linking overrides to orders, a user guide for patient service managers, and a checklist for nurses to complete at the end of shift.

The overall override rate in the health system for the first quarter of fiscal year 2022 was 0.78%, with a linking rate of 32.5%, 30.9% for controlled substances. The plan for the toolkit is for nursing and medical staff to use the dashboard to review override and linking activity, with oversight by the pharmacy. Using the baseline metrics, goals have been set for the remainder of the 2022 fiscal year, which includes sustaining an overall override rate below 1%. The targets for increasing the linking rate are 40% by the end of the third quarter, 50% by the end of the fourth quarter, and achieving and retaining a rate of 75% in fiscal year 2023 and beyond.

The dashboard provides interested parties with an efficient and easy way to monitor automated dispensing station overrides as well as linking those transactions to associated orders.

“Future plans include analysis of dashboard utilization with targeted follow-up and further work to limit overrides to urgent/emergent situations,” the author concluded.

Islam N. Development and implementation of an automated dispensing station (ADS) overrides dashboard and toolkit in a five-hospital health system. Presented at American Society of Health-SystemPharmacists 2022 Summer Meeting and Exhibition; June 11-15, 2022; Phoenix, AZ. Poster 33-T.

A toolkit provides insight into the use of automated dispensing station overrides for emergency situations. 

Toolkit to Evaluates Automated Dispensing Station Overrides   

Automated dispensing cabinets offer quick access to medication and can help reduce harm caused by delays in medication delivery in emergency situations. The Institute for Safe Medication Practices (ISMP) and the American Society of Health-System Pharmacists (ASHP) both recommend stocking these cabinets with reversal agents, rescue agents, and antidotes after an assessment for override status has been performed. A poster presented by Sara F. Wiser, PharmD, of University of North Carolina (UNC) Health Medical Center in Mebane, North Carolina, at the ASHP 2022 Summer Meetings & Exhibition held in Phoenix, Arizona, looked at emergency events to find the medications that should be considered standard stock.

A single-center, retrospective case series included both adult and pediatric patients that were involved in a rapid response” or “code blue” event between June 2020 and May 2021. Investigators collected demographic data as well as unit/type of floor, event type, event start/end times, pharmacy shift during time of event, event outcome event survival, medication(s) administered during event (drug name, dose, route, frequency, order status [STAT, Routine]), and location from which the drug was obtained.

Patients who did not receive medication during the event as well as those admitted to perioperative areas, not currently admitted to the hospital, and those who had the event outside of patient care areas were excluded from the analysis.

During the study period, there were 3634 adult and 374 pediatric events classified as “rapid response” (85.7% for adults; 69.8% for pediatrics) and “code blue” (14.3% for adults; 30.2% for pediatrics). Adults received an average of 3.6 unique medications whereas pediatric patients received 4.1 unique medications. Common medications included sedatives, concentrated electrolyte solutions, antiarrhythmic agents, and vasoactive agents.

When medication could not be taken from a code tray or the floor supply was exhausted, they medication was taken from the automated dispensing cabinets(80.3% for adults; 84.3% for pediatrics) or from the central inpatient pharmacy (19.7% for adults; 11.6% for pediatrics) or pediatric satellite pharmacy (1.9% for pediatrics).

“STAT” priority was designated for medications in 24.7% of adult orders and 33.7% of pediatric orders. Mortality rate for “rapid response” events was 0.3% in adults and 0% in pediatrics. Furthermore, it was 13.8% in adults and 7.1% in pediatrics for “code blue” events. The most commonly ordered medications that came from locations off the patient unit were:

magnesium sulfate 4 mEq/mL injection, and

Investigators concluded that universally stocking medications in automated dispensing cabinets allowed for quick access to medications that reduced potential delays and helped reduce mortality. Medications that helped with survival included:

vasoactive agents (atropine, dopamine, epinephrine, norepinephrine, phenylephrine, dobutamine, vasopressin),

sedatives (etomidate, fentanyl, ketamine, midazolam, propofol, succinylcholine),

concentrated electrolyte solutions (calcium chloride, magnesium sulfate, sodium bicarbonate),

antiarrhythmic agents (amiodarone, adenosine, lidocaine, metoprolol)

Wiser SF. Recommendations for stocking emergency medications in automated dispending cabinets – perspective from a tertiary medical center. Presented at:American Society of Health-System Pharmacists 2022 Summer Meetings & Exhibition; June 11-15, 2022; Phoenix, AZ. Poster 39-T.

In an emergency, automated dispensing cabinets can prevent unnecessary delays. Knowing the agents most needed in the cabinets is an important step to aid in this reduction. 