Utilizing an optional cumulative examination in a skills-based lab course series to assess student performance and knowledge retention.

INTRODUCTION: In the doctor of pharmacy curriculum, students are subjected to scenarios where success is contingent upon accurate retention of information learned during class. To provide incentive to students and simultaneously gauge student retention of course material, an optional honors examination was created for a skills laboratory course. The objectives of this research were to determine student pharmacist performance on the examination and to assess student pharmacist interest and motivation for taking (or not taking) the optional examination. METHODS: An optional comprehensive honors examination was implemented simultaneously within a laboratory course series. Student performance was analyzed across cohorts and students were given a web-based survey prior to the examination to gauge initial interest and engagement. A second survey was conducted after the examination to identify motivation for taking the optional examination. Surveys were analyzed using quantitative and qualitative methods. RESULTS: There were 238 responses to the initial survey (47%) and 183 (96%) responses to the post-examination survey. Common topics of motivation for taking the examination included enhancing transcripts, gauging their own retention, and assessing readiness for experiential activities. One hundred sixty-one students participated in the optional examination, and 65 achieved a score of 90% and the honors designation. The majority (96%) of students who chose to take the examination thought the activity was valuable to their education. CONCLUSIONS: An optional comprehensive honors examination is one method of evaluating student retention of course material and provides an opportunity for students to set themselves apart from colleagues with an honors designation.

Patient Fall Risk Caused by Unintended Diphenhydramine Use.

A 62-year-old patient living in a rural community was referred to participate in a pharmacist-led home visit program because of concerns with the patient's increasing falls and medication complexity. The patient reported experiencing an increasing number of falls over the past few months, resulting in a recent hospitalization and mild head trauma. The patient's past medical history included diabetes mellitus type 2, hypertension, hyperlipidemia, gastroesophageal reflux disease, paroxysmal atrial fibrillation, unspecified back pain, and benign prostatic hyperplasia. During the comprehensive medication review, pharmacists determined the patient had inadvertently purchased an acetaminophen/ diphenhydramine combination medication, rather than his usual acetaminophen. According to the 2019 Beers criteria, use of acetaminophen/diphenhydramine for back pain without insomnia is not the best option and may contribute to falls. With an estimated four to eight tablets per day, the patient was taking 200-400 mg of diphenhydramine daily. Pharmacist recommendations included contacting the prescribing physician to obtain a prescription for acetaminophen. By asking the local pharmacy to dispense acetaminophen as a prescription, the risk of the patient inadvertently purchasing an inappropriate product is reduced. After removing the diphenhydramine from the patient's regimen, the falls ceased. This case demonstrates the effects of inappropriate diphenhydramine use in an especially vulnerable population. It also highlights the critical role that rural community pharmacists can play in improving their patients' health care.

Medication Management; Hypertensive Crisis During a Home Visit.

This report describes a case of hypertensive crisis identified by two pharmacists conducting a patient home visit. A 72-year-old woman living in a rural town in Eastern Washington state was referred for a pharmacist home visit by her care coordinator, who had concerns of possible medication-related issues. The patient had a history of type 2 diabetes mellitus, hypertension, ischemic stroke, heart failure with preserved ejection fraction, hypothyroidism, and unspecified back pain. This patient also experienced additional challenges resulting from living in a rural and medically underserved community. During the home visit, the patient's chief complaint was recurrent, painful migraine headaches that she self-treated with nonsteroidal anti-inflammatory medication. Upon examination, the pharmacists found the patient's blood pressure to be 223/132 mm Hg and her self-monitoring log consistently showed blood pressure readings greater than 180/110 mm Hg with a pulse between 75 bpm to 80 bpm. The patient was referred to the emergency department after determining her blood pressure met criteria for hypertensive crisis despite her adherence to her current antihypertensive regimen. She was hospitalized for three days. After her hospitalization, she was referred to her primary care providers and her pharmacist for follow up. The pharmacist reconciled her current medication regimen and made guideline-directed adjustments to her antihypertensive medications. Six months after her hospitalization her blood pressure was within goal and associated headaches had resolved.

Rural patient perceptions of pharmacist-provided chronic condition management in a state with provider status.

OBJECTIVE: To understand rural patient opinions regarding their willingness to participate in pharmacist-provided chronic condition management. DESIGN: Qualitative semi-structured key informant interview using The Concept of Access as a theoretical framework. SETTING: Three community pharmacies serving patients in rural Washington State from November 2016 to November 2017. PARTICIPANTS: Current patients from 3 rural independent community pharmacies. MAIN OUTCOME MEASURES: Qualitative analysis of patient attitudes, acceptance, perceptions, and preferences regarding pharmacist-provided chronic condition management services in a community pharmacy. RESULTS: Eighteen key informant interviews were conducted between November 2016 and November 2017. Five themes were identified: trust between the pharmacist, patient, and physician is key; patients already value pharmacists' knowledge about chronic condition medications; participants identified the pharmacist as the first point of contact with regard to understanding appropriate use of medications to treat medical conditions; implementing clinical services in the community pharmacy setting may reduce the need for doctors' visits and improve timely patient care; and creating designated clinical space, appointment options, and efficient service may increase patient accommodation. CONCLUSION: Management of chronic conditions continues to be one of the largest health care expenditures in the United States. One promising method of addressing this public health concern is through sustainable clinical pharmacy services. The themes identified in this study provide insight into factors that community pharmacists might consider as medical provider status continues to gain momentum and the use of clinical pharmacy services becomes more prominent.

Training pharmacy technicians to administer immunizations.

OBJECTIVES: To evaluate the effectiveness of an immunization training program for pharmacy technicians on technicians' self-reported confidence, knowledge, and number of vaccines administered. METHODS: A one-group pre- and posttest study was conducted with certified pharmacy technicians from Albertsons and Safeway community pharmacies in Idaho. Thirty pharmacy technicians were recruited to participate in an immunization administration training program comprising a 2-hour home study and a 2-hour live training. Pharmacy technician scores on a 10-question knowledge assessment, responses on a pre- and posttraining survey, and number of immunizations administered in the 6-month period following the training were collected. RESULTS: Twenty-five pharmacy technicians completed the home study and live portions of the immunization training program. All 29 pharmacy technicians who took the home study assessment passed with greater than 70% competency on the first attempt. Technicians self-reported increased confidence with immunization skills between the pretraining survey and the posttraining survey. From December 2016 to May 2017, the technicians administered 953 immunizations with 0 adverse events reported. CONCLUSION: For the first time, pharmacy technicians have legally administered immunizations in the United States. Trained pharmacy technicians demonstrated knowledge of vaccination procedures and self-reported improved confidence in immunization skills and administered immunizations after participating in a 4-hour training program.