A blueprint for success: Using an implementation framework to create a medication history technician pilot program.

BACKGROUND: Medication discrepancies at transitions of care may compromise patient safety. Trained pharmacy technicians can reduce harmful medication discrepancies at transitions of care by collecting medication histories. OBJECTIVE: We describe how to create a program integrating medication history technicians (MHTs) into the hospital discharge process using implementation science. PRACTICE DESCRIPTION: We created our MHT program at a Veterans Affairs (VA) hospital. PRACTICE INNOVATION: We used an evidence-based framework and implementation science to tailor our MHT program to meet local stakeholder needs. EVALUATION METHODS: We completed a literature review and review of current discharge practices. Then, we completed a workflow pilot, a needs assessment, and semistructured interviews with pharmacy technicians and pharmacists. We integrated these findings to identify barriers of MHT program implementation. Finally, we mapped these barriers to implementation strategies to create an MHT program implementation blueprint. RESULTS: The literature review and review of current discharge practices revealed opportunities for our program to reduce medication discrepancies. We applied these findings to our proof-of-concept workflow pilot, which reduced medication discrepancy rates at discharge. When we explored barriers in the needs assessment, we learned that 4 of 6 pharmacy technicians had some training conducting medication histories, but 5 of 6 requested additional training for the new MHT role. We explored these and additional barriers in semistructured interviews. Four themes emerged: elements of pharmacy technician training, challenges to implementation, program logistics and workflow, and pharmacy technician self-efficacy. We mapped barriers to implementation strategies to create an MHT program implementation blueprint, including developing pharmacy technician training materials, modifying our workflow, creating program evaluation materials, and strategizing how to overcome anticipated and current implementation barriers. CONCLUSIONS: We used implementation science to create a tailored MHT program. Others may adapt our implementation blueprint to fit local stakeholder needs.

Curricular and Co-curricular Coverage of Leadership Competencies and the Influence of Extracurricular Engagement on Leadership Development.

Objective. To evaluate coverage of leadership-related competencies in a Doctor of Pharmacy (PharmD) curriculum and the impact of co-curricular and extracurricular experiences on students' leadership perceptions and self-efficacy. Methods. Course syllabi were used to comprehensively map the PharmD curriculum to 11 competencies related to the Leadership CAPE outcome. A survey was developed and administered to all first year through fourth year pharmacy (P1-P4) students to evaluate their leadership experience and engagement, and to assess their attitudes and self-efficacy in 11 leadership competencies. Descriptive statistics were used to evaluate student level of engagement in leadership activities and the Mann-Whitney U test was used to compare students' attitudes and self-efficacy based on the extent of leadership engagement. Results. Curriculum mapping revealed that all competencies were covered in at least one course at the introductory or reinforce levels. There were 362 students (68% of all PharmD students) who completed the survey. When responses from students who reported active engagement in pharmacy student organizations (defined as e-board member or chair of committee, N=142 or 39% of respondents) were compared to the rest of the cohort, statistically significantly better attitudes and self-efficacy were seen in 7 of 11 competencies. Perceptions and self-efficacy of the 72 students (19.9%) who reported active engagement in non-pharmacy organizations did not significantly differ from those not actively involved in any organizations. Conclusion. The leadership competencies curriculum mapping exercise was useful in identifying gaps in coverage and depth of coverage, inconsistencies in course objectives accurately reflecting coverage of leadership topics and competencies, and considerations that should be given to co-curricular leadership development. Active leadership engagement in pharmacy student organizations should be encouraged because of associated improved leadership perceptions and self-efficacy.