Creation of a regional hazardous drug handling task force.

PURPOSE: A regional task force of health-system pharmacy leaders was created to assist with successful adoption of United States Pharmacopeia (USP) general chapter <800>. SUMMARY: A group of pharmacy leaders in the Kansas City region identified potential benefits to healthcare personnel and patients if hazardous drug handling procedures were standardized. A task force was created, a preimplementation survey was distributed, and meetings were held monthly to discuss sections of USP <800> identified as the most challenging to implement. The task force focused on an assessment of risk tool, hot topics, cleanroom design, and a detailed analysis of controversial medications. After the first year of meetings, a postimplementation survey was distributed, and the results were analyzed. The task force created significant value for the participants and achieved the goal of facilitating efficient USP <800> implementation resulting in greater compliance and consistency across the multiple health systems represented. Over 5,100 beds and 200 clinic sites were affected by this task force's efforts. Nearly three-fourths (73%) of respondents reported that the task force was "extremely helpful," and the majority (64%) of respondents adopted most or all (81%-100%) of the task force's assessment of risk choices. Prioritization of tasks, information sharing, and decision-making were areas where the individual leaders were most supported. CONCLUSION: Creating a structure to eliminate barriers and facilitate collaboration among regional pharmacy leaders provided a framework for successful implementation of USP <800> requirements. This interdependent leadership model produced innovative and standardized solutions and should be considered when addressing complicated initiatives that impact the profession.

Functional and Biochemical Characterization of Dib1's Role in Pre-Messenger RNA Splicing.

The spliceosome is a dynamic macromolecular machine that undergoes a series of conformational rearrangements as it transitions between the several states required for accurate splicing. The transition from the B to Bact is a key part of spliceosome assembly and is defined by the departure of several proteins, including essential U5 component Dib1. Recent structural studies suggest that Dib1 has a role in preventing premature spliceosome activation, as it is positioned adjacent to the U6 snRNA ACAGAGA and the U5 loop I, but its mechanism is unknown. Our data indicate that Dib1 is a robust protein that tolerates incorporation of many mutations, even at positions thought to be key for its folding stability. However, we have identified two temperature-sensitive mutants that stall in vitro splicing prior to the first catalytic step and block assembly at the B complex. In addition, Dib1 readily exchanges in splicing extracts despite being a central component of the U5 snRNP, suggesting that the binding site of Dib1 is flexible. Structural analyses show that the overall conformation of Dib1 and the mutants are not affected by temperature, so the temperature sensitive defects most likely result from altered interactions between Dib1 and other spliceosomal components. Together, these data lead to a new understanding of Dib1's role in the B to Bact transition and provide a model for how dynamic protein-RNA interactions contribute to the correct assembly of a complex molecular machine.

A review of American pharmacy: education, training, technology, and practice.

In the United States, pharmacists are responsible for the provision of safe, effective, efficient, and accountable medication related-care for hospital and health-system patients. Leveraging automated technologies, pharmacy technicians, and pharmacist extenders are the means through which efficient, effective, and safe medication use processes are created and maintained. These strategies limit the amount of pharmacist resources needed for nonjudgmental tasks such as medication distribution, allowing more capacity for advanced direct patient care roles. Pharmacists are directly integrated into interprofessional medical teams. Pharmacists optimize patient outcomes through a variety of channels, including: providing recommendations for evidence-based medication selection on patient care rounds; offering drug information to other health care providers and patients; monitoring therapeutic responses; and reconciling medications as patients transition across the continuum of care. Achieving the highest level of pharmacy practice necessitates that United States pharmacists are soundly educated and trained. Pharmacist education, training, and professional practice models closely mirror those of physicians. Many health-systems also pursue credentialing and privileging of pharmacists to ensure competency and facilitate growth and development. Advanced training, along with credentialing, privileging, and collaborative practice agreements have positioned pharmacists to serve as stewards of the medication use system, champions of patient safety, and essential contributors to optimal patient outcomes.

Enactment of mandatory pharmacy technician certification in Kansas.

PURPOSE: The successful enactment of mandatory pharmacy technician certification in Kansas is described. METHODS: In 2004, Kansas began requiring registration of all pharmacy technicians with the state board of pharmacy. Registration identified individuals working as pharmacy technicians but did not require any specific education or certification. In September 2012, the Kansas Board of Pharmacy created a task force of key stakeholders including pharmacists from multiple areas of practice, the University of Kansas School of Pharmacy, organizational leaders from the Kansas Council of Health-System Pharmacists (KCHP) and Kansas Pharmacists Association, and professional lobbyists. The goals of this task force were to research practices of technician certification in other states and to make recommendations to the state board of pharmacy on how Kansas could accomplish mandatory technician certification. RESULTS: The task force outlined the steps needed to achieve legislation that could be supported by the members. These topics included the creation of a technician trainee category, grandfathering certain technicians who had been practicing for a designated period of time, state board-approved exemptions, training requirements, age and education requirements, continuing-education requirements, and pharmacist:technician ratio. The recommendations were finalized at the August 2013 Kansas Pharmacy Summit, and the proposed legislation was introduced and passed during the 2014 legislative session. KCHP members learned many valuable lessons about advocacy and the legislative process with this initiative, including building relationships, working with legislators, and working with other professional organizations. CONCLUSION: The formation of a task force led to the successful passage of a bill granting the Kansas Board of Pharmacy the authority to issue regulations regarding mandatory pharmacy technician certification.

Improving medication safety in a neonatal intensive care unit.

PURPOSE: A revision of the medication-use process intended to reduce errors on a neonatal intensive care unit (NICU) is described. SUMMARY: A multidisciplinary team conducted a systematic review and implemented multifaceted changes to improve the NICU's medication-use process. These changes were made to improve safety and consistency and make the system more user-friendly. A distinct, unit-specific formulary was created for the drug products used on the NICU. Rules were built into the order-entry computer system for these NICU formulary items to identify doses outside the documented range on the basis of body weight. A unit-specific reference was developed detailing all formulary mnemonics, oral drug compounding and i.v. admixture procedures, and guidelines for appropriate product selection. Emergency medication sheets listing the calculated doses by weight for critical or urgent medications were developed; these sheets are provided for every new admission and are updated weekly. End-product-testing procedures for i.v. admixtures and a medication-checking process for the unit's automated dispensing machine were implemented. CONCLUSION: Systematic changes in the medication-use process designed to reduce the opportunity for errors were implemented on an NICU.