Success of an expedited health system-based pharmacy technician training program to address the workforce needs of an institution.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The formation, implementation, outcomes, and impact on retention of a health system-based pharmacy technician training program are described. The program seeks to produce graduates who are well equipped for employment within the health system and eligible for certification by the Pharmacy Technician Certification Board, thereby developing a consistent source of well-trained technicians to meet the needs of the health system. SUMMARY: The program's ideal candidate is one who is seeking to begin or transition to a career in health-system pharmacy. The affordable accredited program provides candidates with the skills needed to become a certified pharmacy technician. A distinguishing feature of the program design is the pace of the curriculum, designed to be completed in 11 weeks. The program is accredited by the American Society of Health-System Pharmacists and the Accreditation Council for Pharmacy Education at the entry-level accreditation standard. The program is structured to enroll 3 cohorts annually, beginning in April, August, and January. This provides a consistent and dependable bolus of graduates for hiring managers across the health system's pharmacy department. The program supports enrollment by internal and external candidates. In addition to didactic content, the simulation component of the program combines remote and onsite simulations. Following completion of the didactic and simulation content, students receive 2 blocks of acute and ambulatory care shadowing for 111 hours over 2.5 weeks of experiential content. The program realized benefits by partnering with an external digital content provider. First, the platform enabled the team to accelerate the time to program launch. A second benefit of the platform is the ability to conduct the program and update content. In April 2018, the institution launched the program to meet pharmacy technician needs within the organization. As of April 2022, 11 cohorts have successfully completed the program, with a total of 41 graduates. At the time of writing, the retention rate in the health system for those beginning the training program in April 2018 was an impressive 90%. In comparison, the overall retention rate for the pharmacy department during this same period was 31%. The program has a graduation rate of 93% and a job placement rate as a pharmacy technician of 90%. The institution believes that this program has helped provide a consistent supply of well-trained technicians to meet the needs of the health system and that the program provides a superior level of clinical training to technician students at an affordable price. The program represents a novel strategy to efficiently and effectively train pharmacy technicians and has been demonstrated to result in improvements to the health system. CONCLUSION: Establishing a pharmacy technician training program provides a mechanism to ensure continuity and uniformity as healthcare continues to evolve. By providing a source of well-trained pharmacy technicians, the program allows the profession to continue to achieve its overarching aims.

Characterization of Casirivimab Plus Imdevimab, Sotrovimab, and Bamlanivimab Plus Etesevimab-Derived Interference in Serum Protein Electrophoresis and Immunofixation Electrophoresis.

BACKGROUND: Therapeutic monoclonal antibodies can be a source of assay interference in clinical serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE), producing monoclonal bands that can be misinterpreted as a monoclonal gammopathy related to a B-cell or plasma cell neoplasm. The extent to which new anti-COVID-19 monoclonal antibodies produce this interference is unknown. METHODS: Casirivimab plus imdevimab, sotrovimab, and bamlanivimab plus etesevimab were spiked into patient serum samples to evaluate for SPEP/IFE interference, to characterize the position of therapy-derived bands relative to a reference band (either combined beta band or beta 1 band, depending on instrument platform), and to confirm heavy and light chain utilization of each medication. Serum samples from patients who had recently received casirivimab plus imdevimab or sotrovimab were also evaluated for comparison. RESULTS: When spiked into serum samples, all tested anti-COVID-19 monoclonal antibodies generated interference in SPEP/IFE. Importantly, the patterns of interference differed between spiked serum samples and serum from patients who had recently received casirivimab plus imdevimab or sotrovimab. CONCLUSIONS: Imdevimab can be added to the growing list of therapeutic monoclonal antibodies that produce sustained interference in SPEP/IFE. Although casirivimab and sotrovimab also produce assay interference in vitro, these antibodies are not reliably detected in serum from recently infused patients. The value of relative band position in recognizing bands that may represent therapeutic monoclonal antibodies is also emphasized. Clinicians and laboratorians should consider therapeutic monoclonal antibody interference in diagnostic SPEP/IFE and review a patient's medication list when new or transient monoclonal bands are identified.

Cost evaluation model to compare in house repackaging, repackaging vendors, and sourcing unit dose medications from manufacturers for oral liquids.

Purpose: Unit-dose packaging systems are widely used and accepted practices in many hospitals in the US. When adopting a unit-dose, there are three different avenues in which pharmaceuticals can be obtained. Products can be purchased from a manufacturer-produced source, outsourced to repackaging by a 3rd-party repackaging service or repackaged in-house by investing in the technology and the resources to do so. Prior literature has suggested that manufacturer-based unit-dose purchasing was associated with a 1% cost savings over repackaged unit-dose. In this study, we hope to take a more extensive look at the cost and concerns associated specifically with unit dose liquids when purchased from a manufacturer, outsourced to a third party repackager, or repackaged from bulk bottles with in-house technology and resources. Methods: A cost evaluation model, which factored in cost associated with used and expired product, was utilized to estimate and compare the cost of the three systems. Results: Overall cost between the three systems was largely similar, although manufacturer-based repackaging was determined to be the most cost effective system. Conclusion: The results of this decision model analysis suggests that the cost associated with purchasing unit dose liquids from manufacturers, third party repackagers, and in-house repackaging are similar. Therefore, utilizing a specific system is unlikely to make a significant impact on the overall pharmaceutical budget for a large hospital or health system.

Prevalence and risk factors of burnout in community pharmacists.

OBJECTIVES: This study aimed to identify the prevalence and risk factors for occupational burnout in community pharmacists. METHODS: Community pharmacists were solicited through a professional network e-mail Listserv to complete an anonymous, electronic survey on burnout. The survey included the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and a work-factors-based questionnaire. The MBI-HSS assessed burnout on the basis of feelings of emotional exhaustion, depersonalization, and reduced personal accomplishment. The additional questionnaire was used to evaluate risk factors for burnout by collecting information on pharmacist demographics, position characteristics, and pharmacy store characteristics. Logistic regression was performed to identify the risk factors associated with burnout. RESULTS: A total of 412 community pharmacists responded to the survey (7.4% response rate), of whom 411 were included in the final analysis. Overall, 308 (74.9%) of responding community pharmacists experienced burnout in at least 1 of the 3 subscales of the MBI-HSS. Most of the pharmacists experienced burnout owing to emotional exhaustion (68.9%), followed by depersonalization (50.4%) and reduced personal accomplishment (30.7%). The significant risk factors for burnout included shorter years of experience, practicing primarily in a chain pharmacy, and a lack of resources for burnout or resiliency. CONCLUSION: There is a high degree of burnout in community pharmacists (74.9%). Future research is warranted to examine optimal strategies to prevent burnout and promote resiliency in the profession.

Utility of health system based pharmacy technician training programs.

Establishing a pharmacy technician training program is a direction that an organization can take to support the development of pharmacy technicians. A pharmacy technician training program allows for pharmacy technicians to be skilled to work and understand the ever-increasing complex medication use process. In addition, uniform training programs can help with the retention of skilled pharmacy technicians and expand practice. The pharmacy technician workforce needs standardization in licensure, registration, certification, education requirements, and advanced technician roles. Pharmacy technician training programs can help pave the way for a consistent and uniform pharmacy technician workforce. The Duke University Hospital perspective is one approach that has seen success in pharmacy technician training programs. The continuous transformation of health care demands that health professionals advance to meet the care delivery needs of patients. The pharmacy technician workforce is a key stakeholder in the care delivery that the profession of pharmacy provides. Establishing a pharmacy technician training program and ensuring pharmacy technicians complete this type of program provide a mechanism to ensure continuity and uniformity as health care continues to evolve.

Digital content delivery in a pharmacy technician training program in a health system.

PURPOSE: Development and implementation of a pharmacy technician training program are described. SUMMARY: As key members of the healthcare team, pharmacy technicians are integral to a pharmacy's operation. Training programs allow technicians to assume roles that support pharmacists practicing "at the top of their license," assist in providing optimal patient care, and serve as an important tool for retaining trained pharmacy technicians. Duke University Health System (DUHS) launched its Pharmacy Technology Training Program (DUHS-PTTP) within the department of pharmacy at Duke University Hospital in April 2018 to assist in meeting current and future pharmacy technician demand. Candidates are provided with the tools to become certified pharmacy technicians through the completion of an affordable accredited program incorporating didactic, simulation-based, and experiential education. The program's partnership with a digital content provider enables accelerated start-up, minimizes investment in content creation and maintenance, enables automated record keeping, and provides flexibility for program participants to complete didactic content outside of the traditional classroom setting. Implementation of this program aims to support students both internal and external to the institution. Students are trained to begin a career as a pharmacy technician with the intent of producing graduates well equipped and eligible for certification by the Pharmacy Technician Certification Board. CONCLUSION: Implementation of a pharmacy technician training program is a logical extension of the demonstrated core training competency of health-system pharmacy departments.

Improved Arrangement and Capacity for Medication Transactions: A Pilot Study to Determine the Impact of New Technology on Medication Storage and Accessibility.

Purpose: A new-generation automated dispensing cabinet (ADC) deployment is described. Methods: A single-center retrospective-prospective pilot product performance study was conducted, and prospective nurse satisfaction survey and pharmacy technician product performance feedback survey were performed to determine the impact of new technology on medication storage and accessibility. The study measured efficiency of the 9:00 am medication pull for nursing users, assessment of nursing perceptions of medication administration pre- and postinstallation of the cabinetry, pharmacy technician perceptions of working with the cabinetry, and assessment of the efficiency of the pharmacy technician restock process. Results: In total, 2981 total nursing medication retrieval processes for the 9 am standard medication administration time (SMAT) time were analyzed: 1321 in the preoptimization phase and 1660 in the postoptimization phase. Analysis of the mean time per transaction confirmed a significant improvement from 10.5 to 10.3 seconds per transaction (P = .026) in the postoptimization configuration. The modified assessment of nursing satisfaction survey demonstrated increased satisfaction with many aspects of the new-generation cabinetry. Pharmacy technician survey data highlighted beneficial aspects of the device, while restock data showed an increase in the time spent restocking the cabinet from 11.5 seconds in the preoptimization phase compared with 21.3 seconds in the postoptimization phase (P < .0001). Conclusion: ADC installation and inventory optimization had a statistically significant improvement in the mean time per nursing transaction. Nursing and pharmacy technician surveys demonstrated a trend of enhanced satisfaction with the platform.

Impact of Medication Dose Tracking Technology on Nursing Practice.

Objective: The impact of providing nursing staff access to data collected through a medication dose tracking technology (MDTT) web portal was investigated. Methods: A quasi-experimental, nonrandomized, pre-post intervention study was conducted in the Cardiothoracic Intensive Care Unit (CTICU) at Duke University Hospital. The change in the number of medication requests per dispense routed to the pharmacy electronic health record (EHR) in-basket was analyzed pre and post web portal access. Other endpoints included the number of MDTT web portal queries per day by nursing staff, change in nursing satisfaction survey scores, and technician time associated with processing medication requests pre and post web portal access. The pre web portal access phase of the study occurred from June 1, 2014 to August 31, 2014. The post web portal access phase occurred from October 1, 2014 to December 31, 2014. Results: An 11.4% decrease in the number of medication requests per dispense was exhibited between the pre and post web portal access phases of the study (0.0579 vs 0.0513, respectively; p < .001). Pre and post surveys showed a significant improvement in nurses' satisfaction regarding access to information on the location of medications (p = .009). Additionally, CTICU nursing staff utilized the MDTT web portal for 3.21 queries per day from October 1, 2014 to December 31, 2014. Conclusion: Providing nurses access to data collected via an MDTT decreased the number of communications between nursing and pharmacy staff regarding medication availability and led to statistically significant improvements in nursing satisfaction for certain aspects of the medication distribution process.

Impact of Mobile Dose-Tracking Technology on Medication Distribution at an Academic Medical Center.

BACKGROUND: Medication dose-tracking technologies have the potential to improve efficiency and reduce costs associated with re-dispensing doses reported as missing. Data describing this technology and its impact on the medication use process are limited. OBJECTIVE: The purpose of this study is to assess the impact of dose-tracking technology on pharmacy workload and drug expense at an academic, acute care medical center. METHODS: Dose-tracking technology was implemented in June 2014. Pre-implementation data were collected from February to April 2014. Post-implementation data were collected from July to September 2014. The primary endpoint was the percent of re-dispensed oral syringe and compounded sterile product (CSP) doses within the pre- and post-implementation periods per 1,000 discharges. Secondary endpoints included pharmaceutical expense generated from re-dispensing doses, labor costs, and staff satisfaction with the medication distribution process. RESULTS: We observed an average 6% decrease in re-dispensing of oral syringe and CSP doses from pre- to post-implementation (15,440 vs 14,547 doses; p = .047). However, when values were adjusted per 1,000 discharges, this trend did not reach statistical significance (p = .074). Pharmaceutical expense generated from re-dispensing doses was significantly reduced from pre- to post-implementation ($834,830 vs $746,466 [savings of $88,364]; p = .047). We estimated that $2,563 worth of technician labor was avoided in re-dispensing missing doses. We also saw significant improvement in staff perception of technology assisting in reducing missing doses (p = .0003), as well as improvement in effectiveness of resolving or minimizing missing doses (p = .01). CONCLUSION: The use of mobile dose-tracking technology demonstrated meaningful reductions in both the number of doses re-dispensed and cost of pharmaceuticals dispensed.

Interdisciplinary analysis of chemotherapy preparation at a pediatric hospital.

This report represents the results of an interprofessional investigation of the pharmaceutical procedures for hematology and oncology at a pediatric hospital. Pharmacists and industrial engineers identified areas for improvement, including a reduction in the interruption of regular pharmaceutical operations for the expedited preparation of chemotherapy treatments and the development of more robust drug preparation procedures that would ensure medication safety. The establishment of a satellite hematology/oncology pharmacy was also examined. Procedural changes were proposed in an effort to increase the safety and service levels of chemotherapy treatments for patients with hematological and oncological disorders.