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Background: Agitation and delirium are common in mechanically ventilated adult intensive care unit (ICU) patients and may contribute to delayed extubation times. Difficult-to-wean ICU patients have been associated with an increased risk of longer ICU length of stays and mortality. The purpose of this systematic review and meta-analysis is to evaluate the evidence of dexmedetomidine facilitating successful mechanical ventilation extubation in difficult-to-wean ICU patients and clinical outcomes. Methods: A literature search was conducted using MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Global Health, Cochrane Central Register of Controlled Trials, Clinical Trial Registries, and the Health Technology Assessment Database from inception to December 5, 2019. Randomized controlled trials evaluating dexmedetomidine with the intended purpose to facilitate mechanical ventilation liberation in adult ICU patients (≥18 years) experiencing extubation failure were included. The primary outcome of time to extubation was evaluated using the weighted mean difference (WMD), with a random effects model. Secondary analyses included hospital and ICU length of stay, in-hospital mortality, hypotension, and bradycardia. Results: A total of 6 trials (n = 306 patients) were included. Dexmedetomidine significantly reduced the time to extubation (WMD: -11.61 hours, 95% CI: -16.5 to -6.7, P = .005) and ICU length of stay (WMD: -3.04 days; 95% CI: -4.66 to -1.43). Hypotension risk was increased with dexmedetomidine (risk ratio [RR]: 1.62, 95% CI: 1.05-2.51), but there was no difference in bradycardia risk (RR: 3.98, 95% CI: 0.70-22.78). No differences were observed in mortality rates (RR: 1.30, 95% CI: 0.45-3.75) or hospital length of stay (WMD: -2.67 days; 95% CI: -7.73 to 2.39). Conclusions: Dexmedetomidine was associated with a significant reduction in the time to extubation and shorter ICU stay in difficult-to-wean ICU patients. Although hypotension risk was increased with dexmedetomidine, no differences in other clinical outcomes were observed. [ABSTRACT FROM AUTHOR]

Introduction: Due to suspension of onsite clinical instruction due to the coronavirus disease 2019 (COVID‐19) pandemic, a remote acute care rotation was created to provide students with an Advanced Pharmacy Practice Experience (APPE) and post graduate year one (PGY‐1) pharmacy residents with an opportunity to gain experience in precepting roles. Objective: The objectives of this study were to evaluate student knowledge, clinical skills, communication, student satisfaction, and PGY‐1 pharmacy resident acceptance of this remote rotation and fulfillment of residency precepting objectives. Methods: A five‐week remote acute care APPE rotation was created with pharmacy residents serving as co‐preceptors. A written evaluation and intermittent clinical examination (ICE) were deployed at baseline and conclusion to assess student knowledge, clinical skills, and communication. Student surveys assessed perceived skill improvement, satisfaction, and assessment of rotation and resident preceptors. Surveys were also utilized to evaluate resident perceived attainment of precepting objectives and residency program fulfillment of precepting requirements. Results: Thirty‐four students and 10 residents participated in the rotation. Student knowledge and clinical skills increased from baseline (41 out of 60 [31‐52] vs 50 [43‐55]; P <.001) and the ICE (36 out of 70 [18‐55] vs 59.5 [43‐70]; P <.001). There was a statistically significant increase at rotation conclusion in resident rating of extreme competence or extreme comfort in 45% of domains assessed. Conclusion: A remote APPE rotation is an effective approach to deliver an APPE rotation and can be successfully used to further student knowledge and provide PGY‐1 pharmacy residents a precepting opportunity to advance their precepting skills when onsite experiences are limited. [ABSTRACT FROM AUTHOR]

Objective: Do pharmacy personnel- (ie, pharmacist or pharmacy technician) driven interventions at transitions of care into or out of the intensive care unit (ICU) improve medication safety measures compared to interventions made by other health-care team members or no intervention? Data Sources: A literature search of MEDLINE and Embase limited to English language and humans was performed (from 1969 until January 2019). Bibliographies of included investigations were reviewed for additional citations. Methods: Investigations were selected if they described a pharmacy-driven intervention at any point of transfer into or out of an ICU setting. Ten investigations were included. Five described interventions relevant to the entire ICU population, and 5 described interventions targeted to specific medications or disease. Results: A variety of interventions were utilized in the 10 included investigations. A significant improvement was demonstrated with pharmacy-driven intervention in all 4 studies that evaluated the entire ICU patient population. Interventions specific to certain medication and disease improved medication safety measures but were not always statistically significant. Medication error rates are high in patients transferred into and out of the ICU, and limited data exist to address this concern. This review compares and evaluates the current literature to guide future interventions and research in this area. Conclusions: Although pharmacy-driven interventions demonstrated some benefit in various medication safety measures in the majority of studies, additional randomized and prospective trials with patient-centered outcomes that assess morbidity and mortality are needed. [ABSTRACT FROM AUTHOR]