Scientific Poster Session III - Clinical Pharmacy Forum

Abstract

Justification/Documentation: Yale-New Haven Hospital transitioned from alteplase to tenecteplase as the formulary thrombolytic agent in December 2022. Historically, if patients required thrombolytics for any indication, a call was made to central pharmacy, the medication was prepared in the IV room, and delivered to the unit for administration. In July 2023, a pilot was started to decentralize the preparation of tenecteplase for high-risk PE and cardiac arrest secondary to suspected PE to reduce time from order placement to drug administration and limit drug waste. Pre-pilot (01/2023-06/2023) time-to-administration with tenecteplase was 29.5 mins (N=2), whereas during the pilot (07/2023-12/2023), all doses were administered prior to order entry (N=3). Waste was compared between a historic period using alteplase (07/2022-07/2023) in which six doses were requested and not administered, as compared to one dose during the tenecteplase decentralized pilot period (07/2023-12/2023).

Adaptability: Pharmacists attending AMEs can expedite time-to-administration for thrombolytics in critical patient care situations. In addition to this, pharmacists also are able to provide stewardship of institutional resources by reducing medication-related waste.

Significance: This service decentralizes thrombolytics within the inpatient setting while expanding pharmacist clinical services. The reduction in time-to-administration overcomes a major barrier in patients receiving critical medication. Due to inability to return unused doses, reduction in waste is necessary with tenecteplase. The decentralization of tenecteplase led to a reduction in waste representing a potential annualized cost savings of $91,195.30 (average wholesale cost of tenecteplase).

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