• Adapting clinical pharmacy staffing models during the COVID-19 pandemic: Lessons learned and considerations for future disaster planning

      Thompson Bastin, Melissa L.; Berger, Karen; Adams, Christopher D.; Altshuler, Jerry; Dixit, Deepali; Effendi, Muhammad K.; Johnston, Jackie P.; Lemieux, Diana G.; Lemieux, Steven M.; Littlefield, Audrey J.; et al. (Blackwell Publishing, 2020-12-14)
      Introduction: In response to the coronavirus disease 2019 (COVID-19) pandemic, health care institutions have faced challenges necessitating operational agility to facilitate provision of optimal patient care. This research was performed to elucidate how pharmacy departments adapted their staffing models, and the impact on frontline staff satisfaction. Methods: Critical care pharmacists in the American College of Clinical Pharmacy (ACCP) and the American Society of Health-System Pharmacists list-serves were electronically invited to participate in a 28-question survey between April and May 2020. Likert-like questions used a 1 to 5 (strongly agree to strongly disagree) scale, and responses were compared based on the degree of satisfaction with implemented pharmacy leadership strategies. Practice model changes were compared before and during the COVID-19 pandemic. Multivariate logistic regression was used to assess the effects of independent variables on the primary outcome - satisfaction with pharmacy leadership response. Results: Respondents (N = 168) representing 40 states in the United States participated. Forty percent of respondents experienced a surge, 68% experienced a staffing model change, and 65% were satisfied overall with their pharmacy leadership's response to the COVID-19 pandemic. Both specialists (50% vs 21%, P =.013) and unit-based generalists (65% vs 35%, P <.001) rounded less frequently in response to the COVID-19 pandemic. Disagreement with “Satisfied with leadership efforts to protect staff (limiting in-person meetings, changing code response)” decreased the odds of satisfaction by 96% (odds ratio [OR] 0.043 [95% confidence interval (CI) 0.005-0.336], P =.003). Disagreement with “Satisfied with voice of front-line staff” was associated with an 84% reduction in satisfaction (OR 0.165 [95% CI 0.049-0.549], P =.003). Eliminating in-person rounds was associated with a 95% decrease in satisfaction with pharmacy leadership (OR 0.053 [95% CI 0.007-0.392], P =.004). Disagreement with “I believe I am at increased risk for COVID-19 due to departmental staffing decisions” increased satisfaction (OR 3.8, 95% CI [1.06-13.91], P =.041). Conclusion: Frontline staff perceptions can inform practice model changes to improve employee satisfaction while providing safe, reliable, and responsible patient care.
    • Analgesia and Sedation Strategies in Mechanically Ventilated Adults with COVID-19.

      Adams, Christopher D; Altshuler, Jerry; Barlow, Brooke L; Dixit, Deepali; Droege, Christopher A; Effendi, Muhammad K; Heavner, Mojdeh S; Johnston, Jackie P; Kiskaddon, Amy L; Lemieux, Diana G; et al. (Pharmacotherapy Publications Inc., 2020-10-17)
      Evidence-based management of analgesia and sedation in COVID-19-associated acute respiratory distress syndrome remains limited. Non-guideline recommended analgesic and sedative medication regimens and deeper sedation targets have been employed for patients with COVID-19 due to exaggerated analgesia and sedation requirements with extended durations of mechanical ventilation. This, coupled with a desire to minimize nurse entry into COVID-19 patient rooms, marked obesity, altered end-organ function, and evolving medication shortages, presents numerous short- and long-term challenges. Alternative analgesic and sedative agents and regimens may pose safety risks and require judicious bedside management for appropriate use. The purpose of this commentary is to provide considerations and solutions for designing safe and effective analgesia and sedation strategies for adult patients with considerable ventilator dyssynchrony and sedation requirements, such as COVID-19.
    • Corticosteroid use in ARDS and its application to evolving therapeutics for coronavirus disease 2019 (COVID-19): A systematic review

      Landolf, Kaitlin M; Lemieux, Steven M; Rose, Christina; Johnston, Jackie P; Adams, Christopher D; Altshuler, Jerry; Berger, Karen; Dixit, Deepali; Effendi, Muhammad K; Heavner, Mojdeh S; et al. (Pharmacotherapy Publications Inc., 2021-10-18)
      Data regarding the use of corticosteroids for treatment of acute respiratory distress syndrome (ARDS) are conflicting. As the coronavirus disease 2019 (COVID-19) pandemic progresses, more literature supporting the use of corticosteroids for COVID-19 and non-COVID-19 ARDS have emerged. Glucocorticoids are proposed to attenuate the inflammatory response and prevent progression to the fibroproliferative phase of ARDS through their multiple mechanisms and anti-inflammatory properties. The purpose of this systematic review was to comprehensively evaluate the literature surrounding corticosteroid use in ARDS (non-COVID-19 and COVID-19) in addition to a narrative review of clinical considerations of corticosteroid use in these patient populations. OVID Medline and EMBASE were searched. Randomized controlled trials evaluating the use of corticosteroids for COVID-19 and non-COVID-19 ARDS in adult patients on mortality outcomes were included. Risk of bias was assessed with the Risk of Bias 2.0 tool. There were 388 studies identified, 15 of which met the inclusion criteria that included a total of 8877 patients. The studies included in our review reported a mortality benefit in 6/15 (40%) studies with benefit being seen at varying time points of mortality follow-up (ICU survival, hospital, and 28 and 60 days) in the COVID-19 and non-COVID-19 ARDS studies. The two non-COVID19 trials assessing lung injury score improvements found that corticosteroids led to significant improvements with corticosteroid use. The number of mechanical ventilation-free days significantly were found to be increased with the use of corticosteroids in all four studies that assessed this outcome. Corticosteroids are associated with improvements in mortality and ventilator-free days in critically ill patients with both COVID-19 and non-COVID-19 ARDS, and evidence suggests their use should be encouraged in these settings. However, due to substantial differences in the corticosteroid regimens utilized in these trials, questions still remain regarding the optimal corticosteroid agent, dose, and duration in patients with ARDS. © 2021 Pharmacotherapy Publications, Inc.
    • Minimizing pharmacotherapy-related healthcare worker exposure to SARS-CoV-2

      Barlow, Brooke; Barlow, Ashley; Thompson Bastin, Melissa L; Berger, Karen; Dixit, Deepali; Heavner, Mojdeh S (American Society of Health-System Pharmacists, 2020-09-04)