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Clinical Decision Making
Clinical Decision Making
Prescription drugs are prescribed during clinical encounters. Thorough and effective patient-provider communication about the benefits, risks, costs and alternatives to prescription medicines is a vital part of clinical care. The Center supports research and advocacy to identify and overcome barriers to patient-provider communication to improve safe medication use and to maximize adherence.
Comparative Effectiveness
Comparative Effectiveness
For stakeholders to make informed decisions about prescription drug use, they need timely evidence about the comparative effectiveness of therapies and their alternatives, including their risks and benefits. Incomplete evidence contributes to overuse of some therapies, underuse of others and risky prescribing. The Center supports innovative research into these topics.
Global Medicines
Global Medicines
Ensuring adequate access and affordability of prescription medicines poses major and unique challenges for countries around the world. These challenges are particularly salient in emerging economies that account for an increasing proportion of the world's population and pharmaceutical expenditures. Center investigators focus on how public policy can be optimized to maximize global drug availability and access.
Medication Safety
Medication Safety
Some adverse effects of medicines only come to light after medications have been on the market and widely used. Center investigators are working to develop new methods for identifying risk, to predict the likelihood of high-risk medicines or drug combinations and to protect the public from excessive exposure to these products.
Policy Analyses
Policy Analyses
Complex and dynamic policies govern prescription drug regulation. Policymakers face the challenge of maximizing innovation while protecting public health, and developing payment policies that promote evidence-based usage. Center investigators evaluate regulatory policies to provide policymakers with information to continually optimize pharmaceutical regulation.
Prescription Abuse
Prescription Abuse
Prescription drugs provide therapeutic value to millions of Americans. At the same time, rates of prescription drug abuse and overdose deaths are skyrocketing. The annual number of fatal drug overdoses in the United States now surpasses those of motor vehicle deaths. The Center supports innovative research and public advocacy to help stem this epidemic.

Making a Difference

One of the aims of the Center for Drug Safety and Effectiveness is to support efforts to assure the safest and most effective use of medicines throughout Johns Hopkins Medicine. The opportunities here are as large as Johns Hopkins Medicine itself, which encompasses six academic and community hospitals, four suburban health care and surgery centers, three insurance plans and a nearly 400-person physician group active in more than 30 primary health care outpatient sites.

Many Center faculty are actively involved in clinical care, and its partners, including the Armstrong Institute for Patient Safety and Quality and the Department of Pharmacy within Johns Hopkins Hospital, provide important collaborative opportunities to improve the quality of care. Examples include:

The Pharmacy and Therapeutics Committee

The P&T Committee at Johns Hopkins Hospital is led by Brent Petty, MD, a member of the Center’s core faculty.  This multidisciplinary Committee serves a vital institutional function by formulating and evaluating policies regarding the distribution, storage and safe use of medications within Johns Hopkins Hospital. 

Drug Utilization Reviews 

These Reviews are structured, ongoing reviews of prescribing, dispensing and use of medication. As a quality assurance measure, Drug Utilization Reviews (DURs) allow for corrective action, prescriber feedback and inform future evaluations. The Johns Hopkins Department of Pharmacy continually conducts drug utilization reviews that inform their pharmacy practice. Recent reviews include:

  • Formulary Concordance of Antineoplastic and Oncology Supportive Care Medications
  • Intravenous Allopurinol Use in Pediatric Oncology Inpatients
  • Assessment of Dabigatran Use in Adult Inpatients
  • Evaluation of Citrate-based Continuous Renal Replacement Therapy
  • Prescribing Patterns and Administration of Intravenous Acetaminophen (Ofirmev®) in Adult and Pediatric Patients
  • Evaluation of the Use of Natalizumab in Adult and Pediatric Patients
  • Evaluation of Cytomegalovirus Hyperimmune Globulin Use in Adult and Pediatric Patients
  • Infliximab Use in the Johns Hopkins Outpatient Center

Investigations by Core Faculty

In addition to supporting Drug Utilization Reviews, Core Faculty also lead additional longer-term investigations that may explore the quality and determinants of drug utilization in further detail.  For example, core faculty member Kenneth Shermock, PharmD, PhD and colleagues are undertaking work to identify causes of the underuse of heparin for venous thrombosis prevention among patients hospitalized at Johns Hopkins, and to develop, implement and evaluate interventions to address this underutilization. Their earlier work assessed diagnostic errors with use of point-of-care devices for assessing anticoagulation status, as well as evaluated the impact of an inpatient anticoagulation management service on clinical outcomes.

Drug Use Evaluation Projects

Additional projects which explore drug use are the following: 

  • Characterization of Opioid-related Patient Safety Events at The Johns Hopkins Hospital
  • Albumin Utilization in Adult ICUs at The Johns Hopkins Hospital
  • Evaluation of Nursing Managed Heparin Protocols at The Johns Hopkins Hospital
  • A Case-Control Study Comparing Risk Factors for Oversedation and Respiratory Depression in Naloxone-Administered Patients
  • Dose Rounding in an Inpatient and Outpatient Oncology Pharmacy
  • Analysis of Antineoplastic Waste in the Weinberg Adult Inpatient Pharmacy
  • A Retrospective Review of Patients Not Admitted and Receiving Treatment for Hypertensive Urgency
  • Off-Label Inhaled Tobramycin Use in Hospitalized Pediatric Patients
  • Surgical Site Infection Prophylaxis Dosing in Obese Patients at The Johns Hopkins Hospital
  • An Evaluation of Vancomycin Serum Concentration Ordering Practices at The Johns Hopkins Hospital
  • Aprepitant/Fosaprepitant Use for Prevention of Chemotherapy-Induced Nausea and Vomiting with Moderate Emetic Risk Chemotherapy Agents

 

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