Best Practices for Safe Use of Pulmonary Hypertension Pharmacotherapies

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The initial best practice recommendations developed focused on the prevention of medication errors, transitions of care, medication access, and the pharmacist's role.

Pulmonary hypertension (PH) experts have developed best practice recommendations (BPRs) for the safe use of pharmacotherapies and a description of the pharmacist’s role in the care of patients with PH, which was recently published in the American Journal of Health-System Pharmacy.

Using the Delphi method, 11 experts developed consensus recommendations to identify best practices on the safe use of PH pharmacotherapies at facilities caring for patients with PH. The experts, representing a diverse group of pharmacists with varying years of clinical practice, reviewed guidelines and statements from the American Society of Health-System Pharmacists, American College of Clinical Pharmacy, Pulmonary Hypertension Association (PHA), and the Institute for Safe Medication Practices and conducted a literature search using PubMed with the combined headings and keywords of “pulmonary hypertension” and “medication safety,” “medication errors,” or “medication policy.”

The initial BPRs they developed focused on the prevention of medication errors, transitions of care, medication access, and the pharmacist’s role. They reached consensus and voted on proposed BPR over 4 independent rounds.

The panel of PH experts reached consensus on 26 BPRs and accepted 25 of these with a strong level of recommendation. Categorized into 5 separate practice domains, the BPRs encompass inpatient practice, inpatient formulary management, ambulatory care practice, diagnostic and procedural areas, and PHA accreditation process. The BPRs identify situations for which delineated procedures should exist to optimize PH medication safety and access but allow for individual sites to develop their own processes given differences in resources and personnel that exist at PHA-accredited centers of comprehensive care, regional clinical programs, and nonaccredited centers.

This study was limited by shortcomings inherent in the Delphi method, including lack of criteria for selecting the expert panel, determining optimal panel size, participation bias, and persuasion of panel members by strongly opinionated participants. The inclusion of 13 experts in this panel is considered adequate to reach consensus.

The BPRs developed in this study expand on previous recommendations and address the importance of managing these therapies in the ambulatory care setting as well as pursuing accreditation by the PHA. They can also “serve as a template for safe practices at institutions that currently do not maintain these therapies on formulary but are considering adding them.”

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Disclosures:  James C. Coons, PharmD, FCCP, BCCP, reports research grant support from United Therapeutics.


Smith ZR, Rangarajan K, Barrow J, et al. Development of best practice recommendations for the safe use of pulmonary hypertension pharmacotherapies using a modified Delphi methodAm J Health Syst Pharm. 2019;76(3):153-165.