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Browsing by Author "Triboletti, Mark"
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Item Analyzing the Clinical Outcomes of a Rapid Mass Conversion From Rosuvastatin to Atorvastatin in a VA Medical Center Outpatient Setting(SAGE, 2017-10) Naville-Cook, Chad; Rhea, Leroy; Triboletti, Mark; White, Christina; Pharmacology and Toxicology, School of MedicineBackground: Medication conversions occur frequently within the Veterans Health Administration. This manual process involves several pharmacists over an extended period of time. Macros can automate the process of converting a list of patients from one medication to a therapeutic alternative. Objectives: To develop a macro that would convert active rosuvastatin prescriptions to atorvastatin and to create an electronic dashboard to evaluate clinical outcomes. Methods: A conversion protocol was approved by the Pharmacy & Therapeutics Committee. A macro was developed using Microsoft Visual Basic. Outpatients with active prescriptions for rosuvastatin were reviewed and excluded if they had a documented allergy to atorvastatin or a significant drug-drug interaction. An electronic dashboard was created to compare safety and efficacy endpoints pre- and postconversion. Primary endpoints included low-density lipoprotein (LDL), creatine phosphokinase (CPK), aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase. Secondary endpoints evaluated cardiovascular events, including the incidences of myocardial infarction, stroke, and stent placement. Results: The macro was used to convert 1520 patients from rosuvastatin to atorvastatin over a period of 20 hours saving $5760 in pharmacist labor. There were no significant changes in LDL, AST, ALT, or secondary endpoints (P > .05). There was a significant increase in alkaline phosphatase (P = .0035). Conclusions: A rapid mass medication conversion from rosuvastatin to atorvastatin saved time and money and resulted in no clinically significant changes in safety or efficacy endpoints. Macros and clinical dashboards can be applied to any Veterans Health Administration facility.Item Increased Efficiency: Formulary Drug Conversion Automation Using Visual Basic-Based Macros with Attachmate Reflections in the Pharmacy Setting(2013-11-22) Naville, Chad A.; Jones, Josette F.; Gamache, Roland E.; Triboletti, MarkHealth care automation provides opportunities for health care agencies to save time, save money, and increase patient safety. The Department of Veterans Affairs medical centers use a program, Attachmate Reflections, for pharmacy medication order verification. This program is a command line interface that allows the use of macros, or programmed automated routines, that have the ability to automate repetitive tasks. Through the use of macro programming at the VISN 11 VA medical centers, this author was able to automate converting patients from Combivent MDI inhalers to its successor Combivent Respimat inhalers due to the MDI inhaler being withdrawn from the market. Usage of the macro resulted in a time savings of 649.1 hours, cost savings of $32,748.36, and increased patient safety by providing consistent medication instructions, correct dispense quantities, correct prescription day supply, and correct number of refills remaining on the prescription.