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Objective: To examine the impact that participation in 2019 coronavirus disease (COVID19) vaccination clinics had on students' self-assessed ability to vaccinate and secondarily, to examine the impact these experiences had on student perspectives of pharmacist engagement in public health. Methods: Student pharmacists who volunteered in COVID-19 vaccination clinics were invited to complete an anonymous, electronic survey consisting of items pertaining to their self-assessed ability to vaccinate and attitudes towards pharmacist engagement in public health in a retrospective pre/post-experience. Results: Students indicated that the experiences were valuable, participation increased their comfort level with vaccination, and they were better prepared to engage in vaccination following engagement. Additionally, student attitudes toward pharmacist engagement in public health improved after engagement. Conclusion: Participation in COVID-19 vaccination clinics had a positive effect on students' self-efficacy toward vaccination and their attitudes toward pharmacist engagement in public health. Similar opportunities should be promoted to student-pharmacists to facilitate their professional development.
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Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point-of-care viscoelastic tests of whole blood that provide real-time analyses of coagulation. TEG and ROTEM are often used to guide blood product administration in the trauma and surgical settings. These tests are increasingly being explored for their use in other disease states encountered in critically ill patients and in the management of antithrombotic medications. As the medication experts, pharmacists should be familiar with how to interpret and apply viscoelastic tests to disease state and medication management. The purpose of this narrative review is to provide a primer for pharmacists on viscoelastic tests and their interpretation and to explore non-trauma indications for viscoelastic testing in critical care. Literature evaluating the use of TEG and ROTEM for patients with acute and chronic liver disease, ischemic and hemorrhagic stroke, myocardial infarction, cardiac arrest, coronavirus disease 2019, and extracorporeal membrane oxygenation are described. Current applications of viscoelastic tests by pharmacists and potential future roles of critical care pharmacists in expanding the use of viscoelastic tests are summarized.Copyright © 2023 The Authors. JACCP: Journal of the American College of Clinical Pharmacy published by Wiley Periodicals LLC on behalf of Pharmacotherapy Publications, Inc.
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Coronavirus disease 2019 (COVID-19) has been admitted by WHO as a global pandemic. The successes-ness in controlling COVID-19 is extremely affected by the knowledge and perception of society. Apothecary students must be competent in carrying out the health promotion effort;one of them is through education. Discovering the impact of education from apothecary students in improving knowledge and perception of the society in controlling COVID-19. One group Quasi-experimental design without a control group (n=102). The data was conducted in March-April 2020 using a validated questionnaire containing the respondents' demographic, knowledge, and perception of COVID-19. This research is 18 years old, does not work as a health worker/medical personnel, domiciled in Yogyakarta, and fills up the pre-test and post-test questionnaire. The data were analyzed descriptively and used the Wilcoxon test (p<0.05) as the statistic test. Most respondents are 52.9% women, 34.31% aged 36-45, with 52.94% having a high school education level. The survey result shows that 71.57% of respondents admit that they know about COVID-19 from television and 2.43% from social media. The answer distribution of questioner on knowledge and perception shows improvements in the pre-test and post-test scores. The Wilcoxon test result, the influence of education on respondents' knowledge and perception, shows the significance of p value=0.000 with the outcome of pre-test and post-test scores with the good category are 67.65% and 5.29%. The presentation of education from apothecary students significantly influences society's knowledge and perception of controlling COVID-19.
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Objective: The aim of this study is to measure the knowledge level of pharmacists working in Turkey about COVID-19 Material(s) and Method(s): The online questionnaire consisting of 16 questions in the form of true-false, developed by the authors after a comprehensive review of the literature, was delivered to pharmacists via social media and professional platforms (such as WhatsApp, Gmail, Instagram, LinkedIn) using the Google form. 364 pharmacists from all over Turkey who filled out the questionnaire were included in the study. Result and Discussion: In this study carried out in Turkey, it was determined that 99.5% of the pharmacists had good knowledge. When the factors affecting the level of knowledge of COVID-19 were examined, in our study, no relationship was found with the independent variables since the level of knowledge was homogeneously high. In the literature, it is reported that age, years of professional experience, having a master's and doctorate education are associated with better knowledge, while the length of experience is associated with the level of knowledge, while in some studies it is stated that no feature is related. However, the fact that it is a cross-sectional study creates a limitation in explaining the cause-effect relationship. Although the number of participants met the sample, it would have been desirable to have more.Copyright © 2022 University of Ankara. All rights reserved.
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BackgroundJanus kinase inhibitors drugs (JAKi) are novel small molecule medications known to cause abnormalities such as elevations in hepatic transaminases, decreases in neutrophil and lymphocyte counts and elevations in cholesterol and creatinine kinase. Blood monitoring is recommended and dose adjustments are advised if abnormalities arise. Recent warnings by the EMA and MHRA have highlighted the importance of monitoring these medications.Timely review and management of patients on JAKi drugs is difficult to maintain with increasing workload amongst the rheumatology team. A baseline audit (2020) demonstrated that hospital blood monitoring guidelines for JAKi drugs were not being followed. The rheumatology multidisciplinary team met and utilised Quality Improvement methodology including fish and driver diagrams to address this. This led to the creation of a pharmacist-led JAKi blood monitoring clinic.ObjectivesTo establish a pharmacist-led rheumatology blood monitoring clinic for the JAKi drug class in order to: increase patient safety with increased compliance to blood monitoring, save consultant/nurse time, improve communication with primary care on the frequency of blood testing required, increase patient understanding of the importance of blood monitoring with JAKi drugs, reinforce counselling advice such as risk of infections, shingles and thrombosis and promote medication adherence.MethodsThe clinic was established in March 2021. Patients commencing JAKi drugs are referred to the pharmacist-led clinic by the medical team. The pharmacist contacts the patient by phone following delivery of their medication. The patient is counselled on their new medication and dates for blood checks are agreed. A letter is sent to the patient and their GP providing this information. The patient is booked into virtual telephone appointments and bloods are monitored every month for the first 3 months and every 3 months thereafter. Any change or abnormality in blood results are flagged early in the patient's treatment and if necessary, discussed with the consultant. Adjustments are made to the patient's dose if appropriate.ResultsIn order to evaluate the benefit of the pharmacist clinic a re-audit of compliance with blood monitoring (March 2021- September 2022) was carried out alongside a patient satisfaction postal survey (August 2022).A total of 58 patients were sampled in the re-audit. The re-audit found an increase in compliance in blood monitoring since the introduction of the pharmacist clinic. 98% of patients had their full blood count performed at 3 months compared to 56% in audit 1 and 95% of patients had their lipid profile completed at 3 months compared to 15% in audit 1 (Table 1).A patient satisfaction survey (N=62, response rate 48%) found that 28 (93%) patients either agreed or strongly agreed that they were more aware of the importance of attending for regular blood monitoring when prescribed JAKi therapy as a result of the clinic.The pharmacy team made several significant interventions (self-graded Eadon grade 4 and 5). For example by improving medication adherence, detecting haematological abnormalities that required JAKi dose reduction, identifying patients suffering from infection requiring intervention including shingles and Covid-19.Table 1.Comparison of audit results pre (Audit 1) and post (Audit 2) clinic establishmentAudit 1 (N=48)Audit 2 (N=58)Number of patients with full blood count completed at weeks 4, 8 & 1227 (56%)57 (98%)Number of patients with lipid profile completed at week 127 (15%)55 (95%)Number of patients LFTs completed at weeks 4, 8 & 1226 (54%)54 (93%)ConclusionIntroduction of the pharmacist-led clinic has increased patient safety by ensuring compliance with blood monitoring as per hospital guidelines. The clinic has paved the way for improved communication with primary care teams and has provided patients with extra support during their first months on treatment with their JAKi. It has also expanded the role of the rheumatology pharmacy team and saved nursing and medical time.Acknowled ementsI wish to thank the SHSCT Rheumatology team for all their help, support and guidance with this project.Disclosure of InterestsNone Declared.
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Several medicines were approved as first treatments, including Gilead Sciences' Veklury (remdesivir) for patients with COVID-19 who require hospitalization (4);Amivas' artesunate for injection for severe malaria (5);Horizon Therapeutics Ireland DAC's Tepezza (teprotumumab-trbw), an antibody drug conjugate (ADC) for treating thyroid eye disease (6);and Ultragenyx Pharmaceutical's Dojolvi (triheptanoin) and Alnylam Pharmaceuticals' Oxlumo (lumasiran), both first treatments for metabolic disorders-Dojolvi for treating paediatric and adult patients with molecularly confirmed long-chain fatty acid oxidation disorders (7) and Oxlumo (lumasiran) for treating the rare genetic disorder, primary hyperoxaluria type 1 (8). Blueprint Medicines Corporation) for treating unresectable or metastatic gastrointestinal stromal tumours harboring a platelet-derived growth factor receptor alpha exon 18 mutation (9);Koselugo (selumetinib, AstraZeneca Pharmaceuticals), for neurofibromatosis type 1 (10);Pemazyre (pemigatinib, Incyte Corporation), for certain types of previously treated, advanced bile duct cancer (cholangiocarcinoma) (11);Tabrecta (capmatinib, Novartis) for non-small cell lung cancer that has spread to other parts of the body and whose tumours have mutations that lead to MET exon 14 skipping (12);and Retevmo (selpercatinib, Loxo Oncology, a subsidiary of Eli Lilly and Company) for treating three types of tumours with alterations of the "rearranged during transfection" gene (13). Gilead, "U.S. FDA Approves Kite's Tecartus, the First and Only CAR T Treatment for Relapsed or Refractory Mantle Cell Lymphoma," Press Release, 24 July 2020.
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BackgroundThe first coronavirus infection was confirmed in Wuhan City, People's Republic of China, in December 2019. On January 30, 2020, the World Health Organization declared the novel coronavirus disease a public health emergency of international concern. On March 11, 2020, World Health Organization announced that the new coronavirus infection can be regarded as a pandemic because of the global spread of the infection. The world's first authorization for a coronavirus disease 2019 vaccine (CV) in the UK was in December 2020. The first authorization for a CV in Japan was in February 2021. A maximum of five times of vaccination had been performed in Japanese people until January 2023. Patients with rheumatoid arthritis (RA) are generally immunocompromised because of the drugs used for RA treatment. Patients with RA are recommended to receive a CV in the 2021 update of the EULAR recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2 [1]. However, some patients with RA rejected CV for various reasons or reports of adverse reactions (ARs) in clinical practice. Real-world clinical information on CV is necessary for better relationships between patients with RA and their physicians.ObjectivesThis retrospective study aimed to determine the vaccination rate, ARs, and reasons for nonvaccination of CV in patients with RA in clinical practice.MethodsThe vaccination rate, ARs, and reasons for nonvaccination of CV in patients with RA on clinical records of our institute were investigated up to the third vaccination. Patients were divided into three age groups: 0–64 years old (YG), 65–74 years old (OG), and >75 years old (VOG). The association between age groups and vaccination rates was also investigated. The Cochran–Armitage test was used for statistical analysis.ResultsRegarding patient background (n = 610), the mean age was 67.8 years (YG, n = 207;OG, n = 196;VOG, n = 207;female, 75.1%;mean RA duration, 14.1 years). The vaccination rate among all patients was 8.4% for nonvaccination;91.6% for the first dose;91.3%, second dose;and 86.6%, third dose. A significant decrease over time was observed (p < 0.01). Nonvaccination was observed in 13.0%, 9.2%, and 2.9% of those in YG, OG, and VOG, respectively. A higher rate of nonvaccination was observed in the YG (p < 0.01). The results of the analysis by age group were 87.0%/90.8%/97.1% (first dose), 87.0%/90.3%/96.6% (second dose), and 77.8%/86.7%/95.2% (third dose) among the YG/OG/VOG, respectively (Figure 1). No statistically significant decrease in the vaccination rate was found over time in OG (p = 0.19) and VOG (p = 0.30) but not in VOG (p = 0.01). ARs occurred in 8.2%, 14.5%, and 16.1% of the patients receiving the first, second, and third doses, respectively. Among the reasons for nonvaccination, 35 (68.6%) patients were concerned about ARs to CV and 6 (11.8%) thought that CV was unnecessary.ConclusionCV rate in our cohort was higher than that of whole nation in Japan (81.4% for the first dose, 80.4% for the second dose, 67.8% for the third dose). CV rate has been declining steadily in patients with RA, with a stronger trend in younger age groups. Fear of ARs was the most frequent reason for nonvaccination.Reference[1]Landewé RBM et al. Ann Rheum Dis 2022.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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To name but a few: they have rapidly mobilized scientific and operating teams;entered into an unprecedented number and variety of co-development arrangements;scaled-up manufacturing capabilities;and leveraged technology solutions and advanced analytics to access and analyze data from animal and early human studies and from commercially available therapies treating other diseases. Clinical trial durations and scope metrics were obtained from summaries of drug approvals available on the FDA website, from medical reviews, and from the ClinicalTrials.Gov website. [...]Phase III clinical trial durations have increased by more than 6% between the two time periods, from an average of 26.8 months in the 2008-2013 period to an average of 28.5 months per individual trial in the 2014-2018 timeframe. Very high variation was observed around the mean number of participants per clinical trial and this variation has increased over time. Mean clinical duration for non-orphan drug approvals increased substantially (16.2 months) in the 2014-2018 period, whereas mean regulatory review duration for non-orphan drugs decreased by one month.
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Background: Phase III trials, corroborated by early post-marketing data globally show that COVID-19 vaccination reduces the risk of severe disease, hospitalisation and death. Despite this, vaccine hesitancy persists amongst some healthcare workers. This study aimed to assess the acceptability of the COVID-19 vaccine amongst South African pharmacists and highlight vaccine-related concerns and predictors of vaccination hesitancy.Methods: Nested within an online survey (14 April 2021 to 18 May 2021) assessing the mental health of South African pharmacists during the COVID-19 pandemic, vaccine acceptability and vaccine-related concerns were studied. A multivariate logistic regression analysis identified factors associated with vaccine hesitancy.Results: From 2 454 registered South African pharmacists sampled, 755 responded to the vaccine acceptability survey (response rate: 30.8%). Vaccine acceptability was 71.9%, while 72.4% and 53.3% were concerned about serious COVID-19 vaccine-related side effects and the lack of vaccine safety data, respectively. Pharmacists aged 20-30 years were more likely to be vaccine-hesitant compared to those aged > 60 years (aOR 3.2, 95% CI 1.1-9.6). Compared to their Caucasian colleagues, Black/African pharmacists were twice as likely to be vaccine-hesitant (aOR2.2, 95% CI 1.2-4.0).Conclusion: COVID-19 vaccine hesitancy among South African pharmacists exists amongst a small but significant proportion. Targeted interventions to address concerns are necessary.
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In a report summarising the feedback it had received,2 the charity noted a litany of "horrendous” safety concerns, as workers were concerned about a lack of personal protective equipment and about their mental health. NICE: assess covid patients for kidney injury Patients with suspected or confirmed covid-19 should be assessed for acute kidney injury (AKI) on hospital admission or transfer, said the National Institute for Health and Care Excellence (NICE). In a new guideline aimed at healthcare professionals who are not kidney specialists, the institute said that patients with suspected or confirmed covid-19 should be monitored for AKI throughout their stay in hospital and managed appropriately if it develops.
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Background: Addressing religious and spiritual needs are important components of holistic healthcare. Little is known about the general public's perspectives about pharmacists providing spiritual care (SC). Objectives: To explore how community members perceive, experience, and desire pharmacist-provided SC. Method: IRB approval was obtained for this observational, cross-sectional study. Adults receiving COVID-19 vaccinations at an immunization clinic completed an investigator-designed 33-item online survey. The survey measured respondents' perspectives about and experiences with pharmacist-provided SC, as well as demographic characteristics. Results: Of the respondents (n = 261), 57% were female and 46% were Hispanic/Latino. Most (59%) agreed that their religion/spirituality would be important to them if they were ill; 64% also agreed that it would be helpful for a pharmacist to know about patients' religious/spiritual beliefs pertaining to their healthcare, and 60% agreed that pharmacists should provide SC to patients who request it. While 96% indicated that they had never talked to a pharmacist about a spiritual or religious matter related to their health or medication, 96% also indicated that no pharmacist had asked to pray with them. These results are contextualized perhaps by the finding that 76% reported having no professional relationship with a pharmacist. Conclusion: Respondents often reported an openness to receiving SC from pharmacists. Most respondents, however, had not received SC from a pharmacist. Future studies should be conducted to better understand patient preferences for pharmacist-provided SC.
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(1) Background: Corticosteroids are commonly used for a variety of conditions, but their use might come with significant side effects. Self-medication practices increased during the COVID-19 pandemic, potentially favoring corticosteroid misuse. Studies on this topic are lacking, thus we aim to characterize the misuse of corticosteroids in Italy through pharmacists' perspectives and sales reports. (2) Methods: We sent to territorial pharmacists a survey that aimed to investigate corticosteroid misuse before and during the pandemic. In parallel, sales reports of the major oral corticosteroids were obtained from IQVIA. (3) Results: We found that 34.8% of clients demanded systemic corticosteroids without a valid prescription, with a rise to 43.9% during the pandemic (p < 0.001). Adults and patients suffering from upper airway diseases or obstructive airway diseases most frequently asked for corticosteroids without an appropriate prescription. The greatest increase after the beginning of the pandemic was seen for lung diseases. Although sales of the major oral corticosteroids decreased during the pandemic, sales of those used for COVID-19 increased. (4) Conclusions: Self-medication with corticosteroids is common and might lead to avoidable toxicities. This tendency increased during the pandemic probably because of incorrect beliefs about the inappropriate use of corticosteroids for treating COVID-19 itself. The development of shared strategies between doctors and pharmacists is essential in defining protocols guiding appropriate patient referral in order to minimize corticosteroid misuse.
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Individuals living in primary care health professional shortage areas (HPSAs) experience health inequities. Community pharmacists are healthcare professionals with an opportunity to provide care to underserved populations. The objective of this study was to compare non-dispensing services provided by Ohio community pharmacists in HPSAs and non-HPSAs. METHODS: An electronic, IRB-approved 19-item survey was sent to all Ohio community pharmacists practicing in full-county HPSAs and a random sample practicing in other counties (n=324). Questions assessed current provision of non-dispensing services as well as interest and barriers regarding such services. RESULTS: Seventy-four usable responses were received (23% response rate). Respondents in non-HPSAs were more likely to recognize their county's HPSA status than those in an HPSA (p=0.008). Pharmacies in non-HPSAs were significantly more likely to offer 11 or more non-dispensing services than those in HPSAs (p=0.002). Nearly 60% of respondents in non-HPSAs reported starting a new non-dispensing service during the COVID-19 pandemic compared to 27% of respondents in full HPSA counties (p=0.009). Most commonly reported barriers to providing non-dispensing services in both county types included lack of reimbursement (83%), workflow (82%), and space (70%). Respondents expressed interest in learning more information about public health and collaborative practice agreements. CONCLUSION: While the need for non-dispensing services is great in HPSAs, community pharmacies in full-county HPSAs in Ohio were less likely to provide these services or begin novel services. Barriers must be addressed so that community pharmacists can provide more non-dispensing services in HPSAs to increase access to care and promote health equity.
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Since early December 2019, the coronavirus disease 2019 (COVID-19) has been relentlessly spread worldwide and has hit the healthcare systems with terrible force. Pharmacists play a vital role in the healthcare system in providing medicines, therapeutics, vaccines, clinical services, and other pharmaceutical care services to patients. Therefore, to ensure all these services continued at King Abdulaziz Medical City - Jeddah during the COVID-19 pandemic, the Department of Pharmaceutical Care initiated a departmental crisis preparedness plan, as a part of general hospital preparedness plan. It started with adjusting medication dosing time, instituting a daily medication refill process, working remotely, expanding the use of automation, and modifying employee schedules. Other actions included the following: handling drug shortages, placing restrictions on some medications, using personal protective equipment, changing routine practices of pharmacy aides, revising the medication delivery process, starting a contingency training program, and restricting pneumatic tube operation. We took guidance from the Ministry of Health, our own institute's experience, World Health Organization recommendations, updated scientific research, and the American Society of Health-System Pharmacists regulatory updates. This article aims to describe how health services, policies, and systems were applied and adapted to address a specific problem while maintaining all pharmacy employees' safety. This article reviews the inpatient pharmacy's particular needs and responses to these needs to meet the COVID-19 pandemic challenges.
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Public health orders were introduced in many countries, including Australia, during the COVID-19 pandemic to reduce the spread of the virus. However, for many people this led to an exacerbation of mental health symptoms, particularly those living with severe or persistent mental illness (SPMI). Additionally, the conduct of clinical research was severely impacted during the pandemic, with many difficulties encountered in the conduct of clinical trials. This paper describes the COVID-related impacts experienced during the implementation of a randomised controlled trial (RCT) testing the effectiveness of a community pharmacist-led support service for people living with SPMI in Australia (the PharMIbridge RCT), and the strategies used to successfully implement the RCT. Australian public health orders led to interstate border closures, stay-at-home orders and work-from-home requirements, resulting in necessary changes to allow for the continuation of the RCT including; changes to trial regions, transferring some training materials online while delaying face-to-face (F2F) training components, delays in pharmacy and consumer recruitment, encouraging telehealth service delivery and extensions to timelines with existing funding. Having a solution-focussed and flexible approach, while still ensuring critical trial protocol elements were adhered to, such as providing opportunities for F2F skills-based training for pharmacists, as well as F2F site visits from researchers and mentors to support trial implementation, resulted in high pharmacy and consumer participant retention through to trial conclusion. Future planning for RCTs should consider possible pandemic-related risks and rapid responses from approval bodies to ensure researchers can be agile and adapt to ensure successful trial completion.
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Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.
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IntroductionRecently, pharmacists in Germany were allowed to administer influenza and COVID-19 vaccines for people aged 12 years and older in order to increase vaccination coverage rates. To adapt pharmacy curriculum for clinical practice, an innovative, high level vaccination training course comprising clinical skills, techniques required for level of competence was developed with participants interacting either with a high-fidelity simulator or low-fidelity injection pad. Clinical scenarios to manage adverse events were also implemented.MethodsA randomized controlled trial using a pre-post-design with pharmacy undergraduates alongside with a theoretical part was performed. The intervention group interacted with a high-fidelity simulator, while the control group was trained with low-fidelity injection pads. Before and after the respective training each participant went through an objective structured clinical examination (OSCE) and each participant completed a self-assessment questionnaire and knowledge quiz.ResultsOSCE Score were raised through an analytical checklist examining skills in anamnesis, patient information, vaccination process, and handling emergency case. Both training methods showed a significant (p<0,01) increase of skills but a significant (p<0,01) greater increase in the intervention group compared to the control group, particularly in vaccination process (p=0,007). Both Groups showed a similar increase of self-assessment score raised through a 6-point-Likert scale, and no significant differences were observed in the quizzes.ConclusionsHigh fidelity simulation proves to be an appropriate tool to train pharmacy students for vaccine administration, as a new pharmaceutical service and enable the students to recognize and manage adverse events.
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BACKGROUND: When prescriptions are being processed in pharmacies, 'rework' is a phenomenon where an activity occurs that requires the return to a prior procedural step in the process for correction. To date, little is known regarding rework prevalence in community pharmacies or how this might be minimised. AIM: To evaluate the cause and frequency of prescription rework in community pharmacies. METHOD: A list of reworks was designed for community pharmacists to self-record prescription rework instances and causes in their workplace across a two-week period. Community pharmacists in Ireland were recruited via convenience sampling and snowballing. Descriptive statistics were used to assess rework frequency according to the various causes, as well as the pharmacist and pharmacy characteristics. RESULTS: Eight pharmacists participated, recording 325 reworks across 92.9% of the 65 study days (mean 5 reworks/day). The pharmacists' mean ranged from 1.82 to 15 reworks/day. Pharmacists and pharmacy technicians alone or together were involved in 72.3% of reworks. The three most common rework categories were involving labelling errors (22.8%), prepared prescriptions which necessitated opening and repackaging (15.1%), and medication owings to patients (13.9%). CONCLUSION: This study reveals that prescription rework occurs frequently in community pharmacies and has provided an indication of some of the main causes. These findings demonstrate areas where pharmacy staff can address rework and should aid the development of approaches to minimise rework in future - thus decreasing workload and facilitating more time for community pharmacy staff to focus on providing patient care.
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There have been increases in prescriptions of high strength opioids for chronic non-cancer pain (CNCP), but CNCP patients perceive themselves as being at low risk of opioid overdose and generally have limited overdose awareness. This study examined how an overdose prevention intervention (opioid safety education, naloxone training, and take-home naloxone (THN)) delivered by community pharmacists for patients prescribed high-strength opioids for CNCP would work in practice in Scotland. Twelve patients received the intervention. CNCP patients and Community Pharmacists were interviewed about their experiences of the intervention and perceptions of its acceptability and feasibility. CNCP patients did not initially perceive themselves as being at risk of overdose but, through the intervention, developed insight into opioid-related risk and the value of naloxone. Pharmacists also identified patients' low risk perceptions and low overdose awareness. While pharmacists had positive attitudes towards the intervention, they outlined challenges in delivering it under time and resource pressures and during the COVID-19 pandemic. Overdose prevention interventions are required in the CNCP population as this group has elevated risk factors for overdose but are commonly overlooked. Customised overdose prevention interventions for CNCP patients attend to gaps in overdose awareness and risk perceptions in this population.
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Background and ImportancePaxlovid® is indicated for the treatment of COVID-19 in adults who do not require supplemental oxygen and who are at increased risk for progressing to severe COVID-19. The Spanish Drug Agency published prioritisation criteria for it access. Paxlovid® has significant drug interactions, mainly due to ritonavir. Hospital pharmacists must validate the prescription, carrying out a thorough review of the patient‘s medical history to check its suitability, as well as the concomitant medication to avoid interactions.Aim and ObjectivesAnalyse the use of Paxlovid® in Huesca and Sector-1 of Zaragoza (Aragon, Spain) in early months post-authorisation.Material and MethodsAll Paxlovid's prescriptions from April to September 2022 were reviewed. The following variables were collected: gender, age, vaccination schedule, prioritised high-risk criteria and renal function. All concomitant medication was reviewed for drug interactions using a protocol created by Coordination Unit for the Rational Drug Use of Aragon. The observations made to the prescribing physician by the hospital pharmacist were recorded.Results40 requests were received. 5 were prescription errors. 29 (82.9%) were accepted and 6 (17.1%) rejected. Median age (years, interquartile-range q1-q3) was 52.2 (45.6–65.3), 57.1% were male. Vaccination status was complete primary vaccination with booster-dose (62.8%) followed by complete vaccination (25.7%) and incomplete vaccination (11.5%). As high-risk criteria prioritised, 91.4% belonged to group composed by immunocompromised persons. 91.4% had renal function >60ml/min. Only in 3 cases (8.6%) the prescribing physician indicated the patient had potential drug interactions.All patients had concomitant medication, median of 8 drugs (4–10). 60% had any potential interaction, with serious drug interactions in 42.9% of them. Drugs with potential serious interactions were statins (5/11);benzodiazepines (2/11) and antithrombotic agents (2/11).44.8% prescriptions were accepted with recommendations to modify or temporary stop some of the patient‘s usual treatment. 80% of the rejected cases were due to serious drug interactions.Conclusion and RelevanceIn the use of Paxlovid®, the role of hospital pharmacists was crucial, as drug interactions were detected in 60% of patients and were serious in 42.9% of them, leading to recommendations for adjustments in patients‘ drug therapy in almost half of the cases, with potentially serious drug interactions being the main reason to not dispense Paxlovid®.References and/or AcknowledgementsConflict of InterestNo conflict of interest