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Background: Opioids are commonly prescribed for patients with acute pain. Guidelines recommend multimodal regimens to synergistically treat pain and provide enhanced recovery. Objective: The objective of this study was to assess changes in oral morphine milligram equivalents (MMEs) prescribed by internal medicine (IM) medical residents for acute pain after a series of pharmacist-led in-services on prescribing multimodal pain regimens. Methods: Two hundred patients were assessed for changes in oral MMEs prescribed prior to and after a 3-part in-service series on multimodal pain management. Inclusion criteria included those who were admitted with acute pain managed by an IM resident, were prescribed analgesic(s), and were 18 years and older. Patients excluded were those admitted into the intensive care unit, receiving chronic pain management, obstetric patients, cancer patients, patients with previous opioid exposure, and patients using patient-controlled analgesia. The study outcomes were change in oral MMEs prescribed by medical residents for acute pain after the in-services, multimodal regimen use, appropriate analgesics prescribed, prescribing a bowel regimen if the patient was prescribed an opioid, and prescribers' survey results. Results: A total of 6358.6 oral MMEs were prescribed before and 5297 oral MMEs were prescribed after the in-services. Fifty-eight patients before and 70 patients after the in-services were prescribed a multimodal regimen. Ten patients before and 18 patients after the in-services were given a bowel regimen. Eighty percent of the patients before and 85% after the in-services had an appropriate pain scale for their prescriptions. IM medical resident and student survey scores improved after each in-service. Conclusion: An educational series on multimodal regimens for acute pain management decreased opioid prescription and increased the use of multimodal regimens for acute pain. [ABSTRACT FROM AUTHOR]

Purpose: Sepsis and septic shock are significant health issues in the United States. Novel treatment options focusing on mitigating the dysregulated host response while reducing the need for vasopressor support are needed. This review discusses ascorbic acid, thiamine, and steroids as monotherapy and in combination for the treatment of sepsis and septic shock. Summary: The results of clinical studies using ascorbic acid, thiamine, and steroids as monotherapy or in combination are reviewed. High doses of IV ascorbic acid improved organ failure evidenced by changes in SOFA scores, declining CRP and PCT levels, and reduced vasopressor use. Thiamine initiation improved lactate levels in thiamine deficient patients in one study and demonstrated quicker lactate clearance and lower 28-day mortality in another study. Steroid studies demonstrated greatest benefit when initiating hydrocortisone and fludrocortisone early in septic shock. Combination therapy with ascorbic acid, thiamine and steroids reduced hospital mortality and vasopressor use in sepsis and septic shock in a small single-center study. Conclusion: Initial studies in patients with sepsis and septic shock demonstrated beneficial effects of ascorbic acid, thiamine, and steroids as monotherapy or in combination without safety concerns. However, the efficacy and safety of these therapies warrant further validation in larger clinical studies. [ABSTRACT FROM AUTHOR]

Objective: To discuss common causes of medication errors occurring upon transitions of care and review key interventions that should be implemented to ensure effective communication and accurate completion of medication reconciliation. Data sources: MEDLINE (1946 to November 2014) using MeSH terms medication errors, medication reconciliation, and nursing homes in addition to conventional text words, including transitions of care and medication safety; Agency for Healthcare Research and Quality Patient Safety Network using search terms transitions of care, medication errors, and medication reconciliation; and relevant websites of national organizations pertaining to transitions of care and medication reconciliation. Study selection: Limited to English-language journals with no limitation set on the year of publication for clinical trials, meta-analyses, and reviews. Data extraction: At the authors’ discretion, preference was given to references focusing on pharmacists’ role in transitions of care and medication reconciliation. Results: Most medication errors stem from a lack of effective communication between health care providers during transitions of care. Part of successful communication and correct patient hand-off is completing accurate medication reconciliation. A patient case highlights a life-threatening medication error that occurred during a transition of care due to ineffective communication between a pharmacist and nurse while transferring medication information. Conclusion: To provide patients with accurate medication information, pharmacists should perform medication reconciliation upon transitions of care using The Joint Commission’s five-step process. Pharmacists can conduct numerous interventions to prevent medication errors during transitions of care and ensure patient safety. Pharmacists are integral to evaluating the appropriateness of medication use, ensuring information is updated in the health record, and verbally communicating accurate information to other health professionals. [ABSTRACT FROM AUTHOR]