• A Comparison of Pharmacy Student Intern and Nurse Impact on Home Medication List Completeness During Medication Reconciliation

      Calkins, Linda M.; Salek, Ferena; Michael Ivey; Calkins, Linda M.; Salek, Ferena; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: The purpose of this quality improvement project was to compare the completeness of home medication lists generated upon hospital admission between pharmacy student interns and nurses. Methods: This project was a retrospective review of completed home medication lists obtained by pharmacy student interns or nurses in a Southern Arizona community hospital. During August and September 2013, medication lists from the previous day’s admissions were collected and de-identified. Medication lists were included in the evaluation if the patient was admitted directly to the hospital or through the emergency department, stayed for at least 24 hours and had at least one home medication upon admission. The primary outcome was the number of omissions left on home medication lists completed by pharmacy student interns or nurses. An omission was defined as any missing information in the medication list categories of drug name, dose, unit, route or frequency. Main Results: Fifty medication lists that included 519 medications were collected in the pharmacy student intern group and forty-four lists that included 376 medications were collected in the nurse group. Of the total medications, nurses left significantly more omissions in the categories of dose (19% vs. 1.9%), units (20.2% vs. 2.3%), and frequency (11% vs. 0.7%), where the P-value was < 0.05 for each. Lastly, the total number of omissions left by nurses compared to pharmacy student interns was significantly different (201 vs. 35 omissions, P < 0.05). Conclusion: Compared to nurses, these results suggest pharmacy student interns left fewer omissions and created a more complete home medication list for patients being admitted to the hospital.
    • Impact of Inpatient Metastatic Thyroid Cancer on the United States Healthcare System

      Skrepnek, Grant; Dong, Alex; Skrepnek, Grant; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: To assess associations between clinical and economic outcomes of metastatic thyroid cancer within inpatient settings in the United States from 2001-2010. To determine the direct inpatient burden of and describe the characteristics of patients and hospitals associated with metastatic thyroid cancer. Methods: A multivariate retrospective cohort study was performed on the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database, for the years 2001-2010, focusing on three main outcomes: inpatient mortality, inpatient charges, and inpatient length of stay. Regression analyses controlled for patient demographics, hospital characteristics, payer, clinical comorbidities, and site of metastases. Inclusion criteria included: age ≥ 18 years, any listed diagnosis of thyroid cancer, and any listed secondary malignancy. Main Results: Overall, 84,191 inpatient cases were observed for metastatic thyroid cancer with 3,032 resulting in mortality (3.6%). The total charges were $3.1 billion (USD 2012) for overall inpatient hospitalizations with average inpatient charges at $38,292 (SD±56,135) for each overall case and $80,948 (SD±117,645) for each mortality-only case. Higher inpatient mortality, charges, and length of stay were significantly associated with central nervous system and lung metastatic cancer sites (p < 0.01) and deficiency anemias, coagulopathy, fluid and electrolyte disorders, pulmonary circulation disorders, and weight loss comorbidities (p < 0.01). Conclusion: There is a considerable national inpatient burden of metastatic thyroid cancer. The analyses in this study quantify the associations and outcomes, and as such can be used to assist in the prediction of those outcomes and clinical decision-making.