Design and Implementation of Student Pharmacist-Driven Assessment of Heart Failure Regimen Appropriateness in Skilled Nursing Facility Residents with Heart Failure: A Quality Assurance Project
by Judy Zheng, 2024 PharmD Candidate, Natalie McCourt, 2024 PharmD Candidate, Mara Kieser, MS, RPh, BCGP
Objective: To provide a framework and evaluate the impact of student pharmacists in optimizing heart failure (HF) regimens in hospitalized patients discharged to skilled nursing facilities (SNF) through targeted disease state patient profile reviews.
Methods: Two student pharmacists performed patient profile reviews of residents with HF to assess for guideline-directed medical therapy (GDMT) at the recommended doses and identify medications that may worsen HF. Findings and recommendations were presented to a pharmacist, using evidence-based guidelines, who later presented them to the SNF providers during weekly huddles.
Results: Thirty patient profiles with a confirmed HF diagnosis (21 HFpEF, 6 HFrEF, 3 unclassified) were reviewed, and 21 were identified to be on GDMT with 3 patients at target doses. Of the 30 patients, 10 (33%) warranted no changes while 20 (67%) tallied 23 total recommendations. These included 6 suggestions to discontinue medications, 4 to decrease dose, 4 to increase dose, 8 to change regimen, and 1 to initiate a new GDMT medication. The most common medications that may worsen HF (5 or more occurrences) included albuterol (11), furosemide (11), ondansetron (8), pantoprazole (6), sertraline (5), and trazodone (5). Other less common medications were amiodarone, metformin, tamsulosin, and citalopram.
Conclusion: Student pharmacists completed patient chart reviews to optimize HF regimens. These assessments demonstrated a positive outcome of incorporating student pharmacists as pharmacy extenders and preventing HF readmission and hospitalization rates. Additionally, this quality assurance project adds to the growing body of evidence for student-led targeted disease state interventions and provides a framework for future work, particularly in SNFs.
Keywords: Pharmacists, Heart Failure, Patient Discharge, Furosemide, Sertraline, Trazodone, Citalopram, Ondansetron, Tamsulosin, Pantoprazole, Patient Readmission, Amiodarone, Albuterol, Metformin, Stroke Volume, Students, Pharmacy
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2023 July/August Table of Contents
Objective: To provide a framework and evaluate the impact of student pharmacists in optimizing heart failure (HF) regimens in hospitalized patients discharged to skilled nursing facilities (SNF) through targeted disease state patient profile reviews.
Methods: Two student pharmacists performed patient profile reviews of residents with HF to assess for guideline-directed medical therapy (GDMT) at the recommended doses and identify medications that may worsen HF. Findings and recommendations were presented to a pharmacist, using evidence-based guidelines, who later presented them to the SNF providers during weekly huddles.
Results: Thirty patient profiles with a confirmed HF diagnosis (21 HFpEF, 6 HFrEF, 3 unclassified) were reviewed, and 21 were identified to be on GDMT with 3 patients at target doses. Of the 30 patients, 10 (33%) warranted no changes while 20 (67%) tallied 23 total recommendations. These included 6 suggestions to discontinue medications, 4 to decrease dose, 4 to increase dose, 8 to change regimen, and 1 to initiate a new GDMT medication. The most common medications that may worsen HF (5 or more occurrences) included albuterol (11), furosemide (11), ondansetron (8), pantoprazole (6), sertraline (5), and trazodone (5). Other less common medications were amiodarone, metformin, tamsulosin, and citalopram.
Conclusion: Student pharmacists completed patient chart reviews to optimize HF regimens. These assessments demonstrated a positive outcome of incorporating student pharmacists as pharmacy extenders and preventing HF readmission and hospitalization rates. Additionally, this quality assurance project adds to the growing body of evidence for student-led targeted disease state interventions and provides a framework for future work, particularly in SNFs.
Keywords: Pharmacists, Heart Failure, Patient Discharge, Furosemide, Sertraline, Trazodone, Citalopram, Ondansetron, Tamsulosin, Pantoprazole, Patient Readmission, Amiodarone, Albuterol, Metformin, Stroke Volume, Students, Pharmacy
Download PDF
2023 July/August Table of Contents