Investigating inpatient medication administration using the theory of planned behavior.

PURPOSE: Results of a study to determine behavioral factors that help explain why nurses often do not obtain and administer medications from automated dispensing cabinets (ADCs) "one patient at a time" are reported. METHODS: To investigate nurses' frequent failure to adhere to best-practice standards for ADC use, a 12-item questionnaire developed using information obtained from an elicitation study and a focus group session was e-mailed to 755 nurses at an academic medical center. A model based on constructs of the theory of planned behavior (attitude, subjective norm, and perceived behavioral control) was used to evaluate nurses' intent to follow ADC best practices through univariate and multivariate analyses. RESULTS: Of the 755 nurses targeted in the survey, 271 (34%) submitted usable responses. A favorable attitude toward safe ADC dispensing practices and a supportive subjective norm were strongly associated with intent to use ADCs properly; those factors remained highly correlated with intent (p < 0.001 for both) after controlling for demographic and work-related variables such as years in practice and patient workload. Eighty percent of observed variability of intent was explained by the evaluated constructs and variables (p < 0.001), suggesting that direct interventions at the patient care unit level and peer influence would likely be effective in promoting safe ADC use. CONCLUSION: A survey based on the theory of planned behavior demonstrated that attitude and subjective norm were important independent predictors of nurse intent to use ADCs properly.

Pharmacy Practice Model Initiative task force report: Improving participation in a survey on hospital pharmacy practices in Texas.

PURPOSE: Results of an initiative to increase participation in a survey on hospital pharmacy practices are reported. METHODS: In an initiative led by pharmacy residents at the University of Houston College of Pharmacy, a task force was created to boost the rate of response to the Hospital-Assessment Survey (HSA), an online benchmarking tool developed as part of the ASHP-sponsored Pharmacy Practice Model Initiative (PPMI). Under the guidance of leaders from ASHP's Texas affiliate and state health-system pharmacy leaders, an 11-member team of residents targeted Texas hospitals that had not responded to the HSA as of December 2013 and used phone and e-mail methods to encourage survey participation. Data obtained from newly responding institutions were aggregated with previously collected data on Texas facilities and compared with national data. RESULTS: During the 11-week initiative, 66 new HSA responses were received from Texas hospitals, raising the total number of respondents to 89 and boosting the overall participation rate from 4.3% to 16.7% (p <0.001). Analysis of the survey data indicated broad similarities among small and large Texas hospitals with regard to six optimal practice characteristics. Pharmacy practice models and characteristics in Texas overall were largely consistent with national statistics. CONCLUSION: The involvement of the PPMI task force was associated with a substantial increase in the survey response rate. The survey results indicated that, with a few exceptions, practice models and the use of optimal practices were similar at Texas hospitals of various sizes and between Texas hospitals overall and sampled hospitals nationwide.

Monoterpenes as inhibitors of digestive enzymes and counter-adaptations in a specialist avian herbivore.

Many plants produce plant secondary metabolites (PSM) that inhibit digestive enzymes of herbivores, thus limiting nutrient availability. In response, some specialist herbivores have evolved digestive enzymes that are resistant to inhibition. Monoterpenes, a class of PSMs, have not been investigated with respect to the interference of specific digestive enzymes, nor have such interactions been studied in avian herbivores. We investigated this interaction in the Greater Sage-Grouse (Phasianidae: Centrocercus urophasianus), which specializes on monoterpene-rich sagebrush species (Artemisia spp.). We first measured the monoterpene concentrations in gut contents of free-ranging sage-grouse. Next, we compared the ability of seven individual monoterpenes present in sagebrush to inhibit a protein-digesting enzyme, aminopeptidase-N. We also measured the inhibitory effects of PSM extracts from two sagebrush species. Inhibition of aminopeptidase-N in sage-grouse was compared to inhibition in chickens (Gallus gallus). We predicted that sage-grouse enzymes would retain higher activity when incubated with isolated monoterpenes or sagebrush extracts than chicken enzymes. We detected unchanged monoterpenes in the gut contents of free-ranging sage-grouse. We found that three isolated oxygenated monoterpenes (borneol, camphor, and 1,8-cineole) inhibited digestive enzymes of both bird species. Camphor and 1,8-cineole inhibited enzymes from chickens more than from sage-grouse. Extracts from both species of sagebrush had similar inhibition of chicken enzymes, but did not inhibit sage-grouse enzymes. These results suggest that specific monoterpenes may limit the protein digestibility of plant material by avian herbivores. Further, this work presents additional evidence that adaptations of digestive enzymes to plant defensive compounds may be a trait of specialist herbivores.