Pharmacist involvement in trauma resuscitation across the United States: A 10-year follow-up survey.

PURPOSE: A national survey performed in 2007 found that only 23% of American College of Surgeons (ACS) trauma centers involved pharmacists in trauma resuscitation. This study describes interval change in use, perceptions, and responsibilities from 2007 to 2017. METHODS: Of the 419 trauma centers identified from the ACS website, contact information was available for 335. In March 2017, a survey assessing hospital demographics, pharmacist coverage and services, and perception of pharmacist value and use was emailed to the identified trauma representatives. Data were analyzed using descriptive statistics and chi-square analysis, as appropriate. RESULTS: The response rate was 33% (110/335). Pharmacist involvement with trauma resuscitation increased significantly from 23% in 2007 to 70% (p < 0.001) and in 71% of trauma centers was provided by pharmacists practicing within the emergency department. Pharmacist involvement was greatest in the Midwest (p < 0.01), but with similar distribution with regards to ACS designation, institution type, and patient volume. Common bedside responsibilities include calculating dosages (96%), preparing medications (89%), and providing medication information (79%), while trauma program/administrative responsibilities (45%) include trauma team education, pharmacy operations, medication safety, quality improvement data collection, research, review of quality assurance cases, ACS accreditation preparation, and others. The primary reason for not considering pharmacist involvement was unfamiliarity with these roles/benefits. CONCLUSION: Pharmacists are an increasingly important component of the trauma team, as evidenced by growth over the last decade. In addition to clinical benefit at the bedside, pharmacists can support the regular activities of a trauma program in many meaningful ways.

Nurses' Knowledge, Perception, and Self-Confidence Regarding Evidence-Based Antibiotic Use in the Long-Term Care Setting.

OBJECTIVE: Describe knowledge, perceptions, and self-confidence of nurses in the long-term care setting before and after online antibiotic stewardship education, and assess effectiveness and satisfaction with the education. DESIGN: Pre-/postsurvey. SETTING: Three long-term care facilities, Topeka, Kansas. PARTICIPANTS: Convenience sample of 140 licensed practical and registered nurses. INTERVENTIONS: Nurses viewed a 12-minute online module developed by long-term care consultant pharmacists. The module discussed risks of antibiotic use and the Loeb minimum criteria for initiation of antibiotics in long-term care residents for urinary and respiratory tract infections and explored other conditions contributing to suspicion of these infections. MAIN OUTCOME MEASURES: Knowledge, perceptions, and self-confidence were measured using a 5-point Likert-scale survey modified from the Minnesota Department of Health taken before and after the module. RESULTS: Response rate was 45% (63/140) pre-education and 41% (57/140) post-education. Nurses had high baseline self-confidence (mean 4.2 to 4.5/5.0) and pre/post scores did not change significantly. Statistically significant improvements in knowledge and perceptions were seen in 15 of the 33 indices related to assumptions regarding antibiotic use, risks, and indicators of urinary and respiratory bacterial infections. Nurses rated the education as high quality (95%), applicable to practice (95%), and felt very likely to change practice (91%). CONCLUSIONS: Although baseline self-confidence was high, key misperceptions were identified, indicating that nurses may not be aware of their knowledge deficits or misperceptions. This low-cost, 12-minute, online education was highly valued and effectively improved nurses' knowledge and perceptions.

Immersive Interprofessional Education Using an Evidence-Based Practice Course.

Beyond medical knowledge and clinical skills, physician assistant curricula must include instruction in collaborative, interprofessional, patient-centered, evidence-based practice (EBP). Development and implementation of interprofessional education (IPE) are challenging. This article describes a replicable model for an interprofessional graduate-level course that incorporates both exposure and immersion, allowing students to develop and demonstrate the Interprofessional Education Collaborative's 38 core competencies for interprofessional, collaborative decision making and problem solving while also acquiring functional skills in EBP. Pre- and postcourse surveys demonstrated both improved student self-confidence with EBP skills and appreciation for an interprofessional approach to patient care. Barriers to, and facilitators of, development and implementation of IPE courses, as well as effective IPE strategies and tools, are discussed.

Considering Point-of-Care Electronic Medical Resources in Lieu of Traditional Textbooks for Medical Education.

Selecting resources to support didactic courses is a critical decision, and the advantages and disadvantages must be carefully considered. During clinical rotations, students not only need to possess strong background knowledge but also are expected to be proficient with the same evidence-based POC resources used by clinicians. Students place high value on "real world" learning and therefore may place more value on POC resources that they know practicing clinicians use as compared with medical textbooks. The condensed nature of PA education requires students to develop background knowledge and information literacy skills over a short period. One way to build that knowledge and those skills simultaneously is to use POC resources in lieu of traditional medical textbooks during didactic training. Electronic POC resources offer several advantages over traditional textbooks and should be considered as viable options in PA education.

Correlations between PANCE performance, physician assistant program grade point average, and selection criteria.

PURPOSE: The purpose of this study was to examine correlations between first-time Physician Assistant National Certifying Exam (PANCE) scores and pass/fail status, physician assistant (PA) program didactic grade point average (GPA), and specific selection criteria. METHODS: This retrospective study evaluated graduating classes from 2007, 2008, and 2009 at a single program (N = 119). RESULTS: There was no correlation between PANCE performance and undergraduate grade point average (GPA), science prerequisite GPA, or health care experience. There was a moderate correlation between PANCE pass/fail and where students took science prerequisites (r = 0.27, P = .003) but not with the PANCE score. PANCE scores were correlated with overall PA program GPA (r = 0.67), PA pharmacology grade (r = 0.68), and PA anatomy grade (r = 0.41) but not with PANCE pass/fail. CONCLUSIONS: Correlations between selection criteria and PANCE performance were limited, but further research regarding the influence of prerequisite institution type may be warranted and may improve admission decisions. PANCE scores and PA program GPA correlations may guide academic advising and remediation decisions for current students.

Evaluation of process variations in noncompliance in the implementation of evidence-based sepsis care.

INTRODUCTION: Sepsis is recognized as an often-lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis-focused RT and standard care. METHODS: This retrospective chart review categorized septic patients based on treatment by a sepsis response team (SRT) versus standard care (non-SRT). Guideline compliance was based upon the Surviving Sepsis evaluation and treatment guidelines. RESULTS: Patient records for 123 identified septic patients post first-year implementation were evaluated. Overall, compliance rates were low and there were variations in compliance between the treatment providers. The SRT was more compliant than the non-SRT. SRT noncompliance was more often due to failure to achieve therapeutic goals within the recommended time. Mortality benefit was not statistically significant between groups; however mortality was higher in the non-SRT group. CONCLUSION: Noncompliance is more complex than simple failure to initiate, especially in time-dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis-focused therapies over standard care.

Fall risk associated with inpatient medications.

PURPOSE: The association between fall risk and inpatient medications was evaluated. METHODS: A retrospective, case-control study was performed to compare the medication use of patients sustaining at least one fall during hospitalization (case group) with a control group of patients who did not fall. Data were collected from medical records and generated reports. A fall was defined by the hospital as an event in which the patient comes to rest on the floor from a lying, standing, or sitting position. Adult patients (≥18 years of age) admitted between January 1 and December 31, 2006, experiencing a fall at least 48 hours after hospital admission were included in the case group. Each case was matched with one control by age (within five years), sex, admission date (within 30 days), patient care unit, and length of stay. Medications administered within 48 hours before the fall for the case group or designated fall date and time for the control group were documented. RESULTS: Of the 414 documented fall events, 209 patients met the inclusion criteria. Of those patients, 96 matched control patients on all criteria. Significantly more case patients received a greater number of central nervous system (CNS) agents compared with matched control patients (p = 0.017). There was no statistically significant difference in the number of medications from all other drug classes or the total number of medications received by the groups. CONCLUSION: In a sample of hospitalized patients, CNS agents were significantly associated with falls.

Physician assistant student exposure to the long-term care setting by working with a consultant pharmacist.

PURPOSE: Physician assistant (PA) students need exposure to a wide range of clinical settings including long-term care (LTC); however, finding consistent educational LTC opportunities is difficult. This article describes a unique, replicable, educational opportunity for PA students to get exposure to the LTC setting by working with a consultant pharmacist. METHODS: Pairs of students spent 4 hours with the pharmacist, reviewing and copresenting two to three patient charts. Students completed a questionnaire that asked them to describe what they had learned. RESULTS: Students indicated they had an increased appreciation of having strong knowledge of medication prescribing and monitoring and avoiding polypharmacy, as well as disease prevention, the importance of interprofessional care, and preventing medication errors. CONCLUSION: Although LTC settings vary, consultant pharmacists may provide a reliable gateway to the LTC setting for PA students. Gains in skills were not directly measured; however, students reported an increased appreciation for aspects of geriatric care related to all six of the competencies outlined in Competencies for the Physician Assistant Profession.

Falling less in kansas: development of a fall risk reduction toolkit.

Falls are a serious health risk for older adults. But for those living in rural and frontier areas of the USA, the risks are higher because of limited access to health care providers and resources. This study employed a community-based participatory research approach to develop a fall prevention toolkit to be used by residents of rural and frontier areas without the assistance of health care providers. Qualitative data were gathered from both key informant interviews and focus groups with a broad range of participants. Data analysis revealed that to be effective and accepted, the toolkit should be not only evidence based but also practical, low-cost, self-explanatory, and usable without the assistance of a health care provider. Materials must be engaging, visually interesting, empowering, sensitive to reading level, and appropriate for low-vision users. These findings should be useful to other researchers developing education and awareness materials for older adults in rural areas.

Pharmacotherapy and children with autism spectrum disorder: a tutorial for speech-language pathologists.

PURPOSE: The purpose of this tutorial is to provide speech-language pathologists (SLPs) with general information regarding the most commonly prescribed medications for children with autism spectrum disorder (ASD; e.g., central nervous system stimulants, noradrenergic reuptake inhibitors, alpha-2 adrenergic agonists, antipsychotics, anticonvulsants, selective serotonin reuptake inhibitors, benzodiazepines) in regard to their mechanism of action, behaviors treated, and potential side effects. METHOD: This clinical resource was compiled to support SLPs who need to understand the functions and effects of medications that have been prescribed to a child with ASD to whom they have or will be providing assessment and intervention services. CONCLUSIONS: SLPs play an important role in the education, assessment, and treatment of children with ASD. Although there is no definitive cure for ASD, up to 70% of children with ASD are prescribed psychoactive medications to ameliorate disruptive behaviors associated with ASD such as hyperactivity, inattention, impulsivity, aggression, irritability, self-injury, obsessive compulsiveness, anxiety, and mood disorders. The entire health care team, including SLPs, should be involved in monitoring children with ASD for efficacy, tolerability, and potential side effects when medications are prescribed.

Online vs classroom instruction: student satisfaction and learning outcomes in an undergraduate Allied Health pharmacology course.

UNLABELLED: Online instruction is frequently utilized in allied health education yet only a small number of controlled comparative studies specifically in healthcare education have been published. PURPOSE: The purpose of this study was to compare student satisfaction and objective learning outcomes of an undergraduate allied health online pharmacology course using streaming media lectures to traditional classroom instruction. METHODS: The online (n=47) and classroom (n=177) courses for fall 2005 and spring 2006 used the same instructor, notes, text, learning objectives, and exams. Student characteristics, learning style preferences, and aptitude for distance learning were measured. A statistically reliable, valid survey measured student satisfaction with elements of the course, instructor, and self-perceived knowledge gains. Learning outcomes were evaluated using withdrawal rates and exam scores. RESULTS: Mean satisfaction scores for both courses were high, generally >4.0/5.0. Mean scores from the classroom students were significantly higher than online students regarding students' ability to share ideas, instructor's ability to establish rapport, self-perceived knowledge gains, fundamental principles and application of material, and overall excellence of course. There were no significant differences in objective exam scores or withdrawal rates. CONCLUSION: The online and classroom pharmacology courses had similar withdrawal rates and exam scores, indicating similar learning gains. Overall, both courses had high student satisfaction ratings in all 43 criteria measured. However, students in the online course were less satisfied with 8 criteria related to student satisfaction with instructor rapport, course excellence, peer interaction, and self-perceived knowledge gains.

Implementation of an electronic system for medication reconciliation.

PURPOSE: The feasibility of implementing an electronic system for targeted pharmacist- and nurse-conducted admission and discharge medication reconciliation and its effects on patient safety, cost, and satisfaction among providers and nurses were studied. METHODS: This study was conducted in two phases: a preimplementation phase and a postimplementation phase. In the preimplementation phase, admission medication histories and discharge medication counseling followed standard care processes. During postimplementation, pharmacists and nurses collaborated to electronically complete admission and discharge medication reconciliation documentation. Four reports were developed for medication reconciliation documentation: (1) home medication profile report, (2) home medication reconciliation report, (3) discharge medication reconciliation report, and (4) patient discharge medication report. Patients were contacted after discharge to measure their satisfaction with the medication counseling and medication instructions received. Health care providers completed a survey indicating their satisfaction with the electronic medication reconciliation processes. RESULTS: A total of 283 patients were included in the study. Patients in the postimplementation group took significantly more prescription and nonprescription medications, and their total number of medications significantly exceeded the number taken by the preimplementation group. Pharmacists completed significantly more dosage changes in the postimplementation phase than in the preimplementation phase. In the preimplementation phase, nurses identified more incomplete medication orders, dosage changes, and allergies than they did in the postimplementation phase. Patients in the postimplementation group reported a higher level of agreement on all survey items regarding adequate discharge medication instructions. CONCLUSION: Patients who had their medications electronically reconciled reported a greater understanding of the medications they were to take after discharge from the hospital, including medication administration instructions and potential adverse effects.