CHI Health Lakeside

Antithrombotic optimization with a glycoprotein IIb/IIIa inhibitor has been used for the treatment of suspected pump thrombosis, but available literature with tirofiban is lacking. This study aims to describe the use of tirofiban for suspected pump thrombosis. This was a single-center cohort study of left ventricular assist device patients who received tirofiban for the treatment of suspected pump thrombosis from January 1, 2016 to July 31, 2017. Tirofiban was initiated at 0.1 μg/kg/min in patients with normal renal function and subsequent dose adjustments for altered renal function or history of bleeding were employed. Success was defined as resolution of lactate dehydrogenase back to patients' known baseline. Fourteen patients were included for 16 total instances of tirofiban use during the time period. Tirofiban was continued for a median of 5 days (range: 0.3-35 days). Successful treatment was achieved in 12 of the 16 tirofiban uses (75%). Seven bleeding events occurred while on therapy, two major and five minor. This study showed a majority of patients achieved success with tirofiban for suspected pump thrombosis. For patients who are not current candidates for pump exchange or transplant, tirofiban may be considered a therapeutic medical management option.

Purpose. To determine if implementation of an enhanced clinical pharmacy service (ECPS) at a community hospital could improve patient experience as measured by medication-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Methods. A cohort study of 260 patients at a community hospital was conducted. Patients in the intervention group received additional pharmacy services from the standard of care (SOC) group, including daily medication counseling, pharmacist-driven medication administration, discharge medication reconciliation and education, consistent offers to enroll in a bedside medication delivery program (BMDP), and a telephone call following discharge. The primary outcome of patient experience was assessed through patients’ responses to a care transitions HCAHPS survey question regarding understanding of the purpose of taking medications following discharge. Results. Among patients in the ECPS cohort, 75.8% had a top-box response to the care transitions HCAHPS question, compared to 63.3% of patients in the SOC cohort (OR = 1.81; 95% CI [0.61-5.37]). Top-box responses increased for all assessed HCAHPS questions but were not statistically significant. The HCAHPS survey response rate was 29.3% in the SOC cohort and 29.9% in the ECPS cohort. Conclusion. Following an ECPS intervention, patient experience as determined by HCAHPS scores increased, but the results did not reach statistical significance. Further, larger studies are needed on this topic.