BACKGROUND: Reusable nebulizer-compressor combinations deliver inhaled medications for patients with chronic lung diseases. On hospital discharge, the patient may take home the disposable nebulizer that was packaged and combine it with their home compressor. Though this practice may reduce waste, it can increase variability in medication delivery. Our study compared several reusable and disposable nebulizers packaged with compressor kits used in the US. We included a common disposable hospital nebulizer that may not be supplied with popular home kits but may be brought home after a hospitalization or emergency department visit. We focused on fine droplet mass < 4.7 μm aerodynamic diameter (FDM<4.7 μm), associated with medication delivery to the airways of the lungs.
METHODS: We evaluated the following nebulizer-compressor combinations (n = 5 replicates): 1. OMBRA® Table Top Compressor with MC 300® reusable and Airlife™ MistyMax™ 10® disposable nebulizer, 2. Sami-the-Seal® compressor with SideStream® reusable and disposable nebulizers and Airlife™ MistyMax 10™ disposable nebulizer, 3. VIOS® compressor with LC Sprint® reusable, and VixOne® and Airlife™ MistyMax™ disposable nebulizers, 4. Innospire® Elegance® compressor with SideStream® reusable and disposable nebulizers and Airlife™ MistyMax 10™ disposable nebulizer, 5. Willis-the-Whale® compressor with SideStream® reusable and disposable nebulizers and Airlife™ MistyMax 10™ disposable nebulizer, 6. Pari PRONEB® Max compressor with LC Sprint® reusable and Airlife™ MistyMax 10™ disposable nebulizer. We placed a 3-ml albuterol solution (0.833 mg/ml) in each nebulizer. A bacterial/viral filter was attached to the nebulizer mouthpiece to capture emitted medication, with the filter exit coupled to a simulator of a tidal breathing adult (rate = 10 cycles/min; Vt = 600 ml; I/E ratio = 1:2). The filter was replaced at 1-min intervals until onset of sputter. Droplet size distributions (n = 5 replicates/system) were determined in parallel by laser diffractometry.
RESULTS: Cumulative FDM<4.7 μm varied from 381 ± 33 μg for the best performing combination (Proneb/LC-Sprint) to 150 ± 21 μg for the system with the lowest output (VIOS®/MistyMax 10™).
CONCLUSIONS: Substituting one nebulizer for another can result in large differences in medication delivery to the lungs.

BACKGROUND: Pharmaceutical care plays a crucial role in optimizing medication administration and improving patient health outcomes. However, medication adherence remains a challenge, with a significant percentage of patients discontinuing their medications. Value-added services (VASs), such as medication delivery, have been introduced to enhance pharmacy services and medication adherence.
OBJECTIVE: This study aims to evaluate satisfaction with a new medication delivery service at an Armed Forces Hospital outpatient pharmacy in Saudi Arabia and identify factors impacting utilization.
METHODS: A cross-sectional survey assessed patient satisfaction with a new pharmacy delivery service between January 2023 and March 2023. The target population consisted of adult patients who had used the pharmacy delivery service for at least one month. The survey contained 23 Likert scale questions assessing satisfaction across three domains: delivery process/personnel, medication quality, and pharmacist adherence to best practices.
RESULTS: A total of 110 patients responded to the survey, 383 invited patients; the mean age was 51.2 ± 15.3, and most were male 92 (83.6%), married 97 (88.2%), and living in urban areas 63 (57.3%). The overall satisfaction rate was 97 (88.1%), with 67 (60.9%) reporting satisfaction with the medication delivery service. On the delivery process/personnel items, over half strongly agreed that the delivery person called before arriving 59 (53.6%), medications were received on time 58 (51.8%), and the delivery person was polite 64 (58.2%). Most strongly agreed that the service helped with adherence 70 (63.6%) and saved travel costs 72 (65.5%) for medication-quality items. Most also strongly agreed that medications were properly packaged 65 (59.1%) and labeled 71 (64.5%). Regarding pharmacist practices, approximately 56 (50.9%) strongly agreed that the pharmacist provided education materials, inquired about adherence 49 (44.5%), and was respectful 55 (50%). Bivariate analyses found no significant associations between satisfaction and age, gender, residence, education, marital status, income, or disease (all p > 0.05). Satisfaction remained uniformly high across subgroups.
CONCLUSIONS: The medication delivery service demonstrated excellent patient reception regardless of its characteristics. Overall satisfaction with these services was high. There was no association between sociodemographic characteristics and the level of satisfaction. Continued monitoring and refinement could maximize the quality of pharmaceutical care afforded through innovative models supporting medication adherence.

UNASSIGNED: To determine the drop volume and total number of dispensed drops using the Nanodropper eyedrop bottle adaptor (Nanodropper, Inc.) compared to drops dispensed from stock bottles to potentially limit ocular toxicity of these eyedrops and prolong bottle use.
UNASSIGNED: Six topical ocular hypotensive medications (5 solutions, 1 suspension), one steroid (suspension) and two artificial tears emulsions were selected for this study. An analytical balance was used to determine the mass per 10 drops with and without the volume-reducing adaptor and repeated until the bottles were completely emptied. The density of each product was determined using the calculated density. The average drop volume and number of drops per bottle for the nine medications were compared with and without the adaptor with paired t-testing.
UNASSIGNED: When all medications were assessed, the drops delivered with the adaptor were 62.1% smaller than eyedrops administered from standard bottles. Compared to stock bottle eyedrops, which had a mean volume of 39.8 ± 2.1 μL, the adaptor resulted in drops with a mean volume of 15.1 ± 1.0 μL, p<0.0001. The adaptor delivered 2.6x the number of drops dispensed from a standard 2.5 mL bottle (184.1 ± 15.1 drops with adaptor and 69.8 ± 4.9 drops from stock bottle, p<0.0001).
UNASSIGNED: The Nanodropper eyedrop bottle adaptor can significantly reduce drop volume and increase the overall number of drops dispensed compared with stock eyedrop bottles. Further studies are needed to elucidate the clinical impact of utilizing decreased drop volume with direct comparison to current standards of care.

Delayed management of nonconvulsive status epilepticus (NCSE) can lead to an increased morbidity and mortality. We previously established that inefficient treatment of NCSE at our institution stemmed from delayed initiation of emergent anti-seizure medications (ASM). In the present study, we assessed the trajectories of these time parameters and determined patient outcomes following the specific quality improvement (QI) interventions.
The QI interventions, including the revision of the educational content for trainees and pharmacy workflow optimization were implemented between January 2019 and September 2021 by a dedicated multidisciplinary task force. The times needed to initiate and administer the ASMs for patients with NCSE as well as patient mortality were assessed in comatose and noncomatose patients and compared with the corresponding values prior to the interventions.
There were 79 occurrences of NCSE in 74 patients. The median time from seizure detection on EEG to the order of the first and second ASM for NCSE was reduced by 4 (p = 0.83) and 8 min (p = 0.52), respectively compared to the times prior to the initiation of interventions. The median times from the order to administration of the first and third ASM for all NCSE occurrences were reduced by 8 and 10 min, respectively (p = 0.28 and p = 0.10). In the present cohort of comatose patients, the median time spent to order the first ASM was reduced by 16.5 min and the time to administer it reduced by 35 min compared to that in our previous study. The overall patient mortality was decreased by 11.1%.
More efficient delivery of rescue ASMs in patients with NCSE and improvement in their mortality can be achieved with multidisciplinary team efforts aimed at streamlining the functioning of pharmacy and strengthening the education of trainees and nurses.

OBJECTIVE: Hospital emergency medication kits (HEMKs) are used to provide certain critical medications in emergent situations, despite many technological advancements for patient safety and medication distribution. We sought to evaluate HEMK usage and analyze associated costs to identify and recommend process improvements.
METHODS: Mayo Clinic in Rochester, MN, is a large multisite academic medical center with 2 hospital campuses and many ambulatory clinics. All documentation of the approximately 250 HEMKs in circulation was analyzed from January to November 2017. The primary outcome was HEMK use. Secondary outcomes included individual medication usage and associated costs. These data were then used to recommend process improvements.
RESULTS: Of 880 HEMKs evaluated, 675 (76.7%) were used, resulting in expiration 23.3% of the time. A total of 1,024 emergency medications were used, most commonly for hypoglycemia. Many of these medications are also available in automated dispensing machines for patient care use. Cost analysis revealed an average annual cost of nearly $200,000 associated with HEMKs. The results of our analysis indicated little added benefit of HEMKs in the setting of automated dispensing machine optimization. Steps for HEMK retirement are described.
CONCLUSIONS: HEMKs offered little added benefit considering technological advancements that have been made in patient safety and medication distribution since their inception. Retirement of HEMKs is anticipated to increase pharmacy operational efficiency by using automated dispensing machine technology and appropriate emergency response protocols to ensure optimal patient care.

The objective of this empirical research is to compare nurses\' operational workflow and nurses\' and patients\' satisfactions of two different infusion center designs. One center has a traditional open bay design and the other has semi-private bays. This study also intends to gather baseline data to compare to a future post-occupancy evaluation of a new infusion center where the two existing centers will be combined.
The increasing number of patients with cancer diagnosis who refer to infusion centers highlights the importance of design of these centers.
The mixed-method approach of this study involves shadowing nurses and surveying nurses and patients. Data collection captured nurses\' activities, activity durations, and nurses\' and patients\' satisfaction with the design of clinics.
Comparison of shadowing data indicated that although the infusion centers have different layouts, there are no significant differences in the activities or time spent by nurses in different areas among the centers. Staff, however, have different satisfaction levels with visual and speech privacy, ability to concentrate without distraction, collaboration with other staff, and the process of medication delivery. Patients also had slightly different satisfaction levels with their ability to communicate with staff and design of bays.
This research sheds light on operational workflows and satisfaction of staff and patients in two different infusion center design. Considering the limited studies on these settings, this study serves as baseline data to compare to other studies on cancer infusion centers and addresses issues of benchmarking and staff and patient satisfaction.

UNASSIGNED: To improve efficiency, reduce interruptions and reduce the time taken to complete oral drug rounds.
UNASSIGNED: Lean Six Sigma methods were applied to improve drug round efficiency using a pre- and post-intervention design.
UNASSIGNED: A 20-bed orthopaedic ward in a large teaching hospital in Ireland.
UNASSIGNED: Pharmacy, nursing and quality improvement staff.
UNASSIGNED: A multifaceted intervention was designed which included changes in processes related to drug trolley organization and drug supply planning. A communications campaign aimed at reducing interruptions during nurse-led during rounds was also developed and implemented.
UNASSIGNED: Average number of interruptions, average drug round time and variation in time taken to complete drug round.
UNASSIGNED: At baseline, the oral drug round took an average of 125 min. Following application of Lean Six Sigma methods, the average drug round time decreased by 51 min. The average number of interruptions per drug round reduced from an average of 12 at baseline to 11 following intervention, with a 75% reduction in drug supply interruptions.
UNASSIGNED: Lean Six Sigma methodology was successfully employed to reduce interruptions and to reduce time taken to complete the oral drug round.