Pharmacist documentation of gaps in care identified during diabetes coaching.

OBJECTIVES: 1) To identify the number of gaps, type of gaps, and contributing factors to gaps in diabetes care reported by pharmacists in the Diabetes Gaps in Care Portal (Gaps Portal). 2) To understand how pharmacists used the Gaps Portal and the implications for quality diabetes care. DESIGN: The Alliance for Patient Medication Safety developed an online Gaps Portal as a tool for pharmacists to identify and document gaps in care when managing patients with diabetes. SETTING: Pharmacists from across the United States in community pharmacy and ambulatory care settings who were engaged in diabetes coaching activities participated. MAIN OUTCOME MEASURES: Pharmacists entered gaps in diabetes care into the Gaps Portal from April 2016 to June 2017. Descriptive statistics were used to determine the type and number of gaps and contributing factors. A qualitative analysis of pharmacist interviews was conducted to identify themes related to pharmacist perceptions of the portal. RESULTS: Ten pharmacists entered 528 gaps in diabetes care (n = 469; 565 encounters). The most common category of gaps in diabetes care was drug therapy (n = 420/528; 79.6%). Of the drug therapy gaps reported, the most common gap occurred in patients with or at risk for atherosclerotic cardiovascular disease and not on a high-intensity statin (122/420), followed by those not on a moderate statin (106/420). Themes focused on during interviews included integration of diabetes coaching and documentation, impact of Gaps Portal on workflow, and prioritization of gaps. CONCLUSION: Pharmacists most commonly identified drug therapy gaps, predominantly pertaining to statin use, which coincides with a change in the guidelines for statin use in diabetics. Telephone interviews indicated that the Gaps Portal template served as a useful checklist to identify gaps in care during diabetes coaching activities and that the Gaps Portal was useful for reporting and monitoring purposes.

Pharmacists' scope of practice in travel health: cregulations.

OBJECTIVES: The primary objective of this study was to assess pharmacists' authority to provide travel health services in each state and Washington, DC. Secondary objectives were to determine the need for collaborative practice agreements (CPAs), protocols, or prescriptions for this type of pharmacy practice and to identify jurisdictions where pharmacists are able to practice as travel health providers independent of CPAs or individual physician protocols. METHODS: An online survey was developed to assess pharmacists' authority to administer travel immunizations, furnish travel-related medications, and order travel-related laboratory tests. Open-ended items on scope of practice, training requirements, and pending legislation or regulations were also included. The survey was distributed to state pharmacy association executives. A member of the research team searched pharmacy laws to clarify missing or inconsistent responses. Data were analyzed using descriptive statistics. RESULTS: The survey response rate was 76.5% (n = 39). Missing (n = 12) or conflicting (n = 6) response issues were resolved. Thus, data were available for 100% of jurisdictions. In most jurisdictions, pharmacists were able to provide one or more components of this service. In 44 jurisdictions (86.3%), pharmacists were allowed to administer travel immunizations. Twenty-seven jurisdictions (52.9%) allowed pharmacists to furnish travel medications. Pharmacists in 23 jurisdictions (43.1%) could order travel health-related laboratory tests. Pharmacists can practice independently in 1 state, but CPAs or individual physician protocols are required elsewhere. CONCLUSIONS: To the authors' knowledge, this study represents the first national pharmacists' travel health scope-of-practice analysis. While pharmacists in many jurisdictions can provide some components of travel health services, only one, New Mexico, currently allows pharmacists to practice all aspects independently. Thus, pharmacists continue to have an opportunity to expand scope of practice in travel health. Additional research may help to drive increased access to and use of travel health care.

Evaluation of a guided continuous quality improvement program in community pharmacies.

BACKGROUND: The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use. This study aims to assess changes in attitudes toward patient safety culture and frequency of quality-related event (QRE) reporting after guided implementation of a continuous quality improvement (CQI) program in a panel of community pharmacies in the United States (U.S.). METHODS: Twenty-one community pharmacies volunteered to participate in the project and were randomly assigned to intervention or control groups. Pharmacy staff in the intervention group received guided training to ensure full implementation of a CQI program while those in the control group partially implemented the program. Pharmacy staff in both groups completed retrospective pre-post safety culture questionnaires and reported medication errors and near misses that occurred in their practices. Rasch analysis was applied to assess questionnaire validity and reliability and to confirm if the ordinal level data approximated interval level measures. Paired t-tests and repeated measure analysis of covariance tests were subsequently used to compare observed changes in the attitudes of subjects and frequency of QREs reporting in intervention and control groups. RESULTS: Sixty-nine employees completed the questionnaire, a 43.9% response rate. Improvement in attitudes toward patient safety was statistically significant in the intervention group in six domains: staff, training, and skill (p = 0.017); patient counseling (p = 0.043); communication about mistakes (p < 0.001); response to mistakes (p < 0.001); organizational learning - continuous improvement (p < 0.001); and overall patient safety perceptions (p = 0.033). No significant differences were observed in QRE reporting rates between intervention and control groups. However, differences were observed in the types of QREs reported (e.g., incorrect safety cap) and the point in the prescription processing workflow where a QRE was detected (e.g., partner check station, and drug utilization review station) in the intervention group (p < 0.001). CONCLUSION: Guided CQI program implementation increased the self-reported patient safety culture attitudes among staff.

Electronic prescribing problems reported to the Pharmacy and Provider ePrescribing Experience Reporting (PEER) portal.

BACKGROUND: Electronic prescribing (e-prescribing) may prevent medication errors caused by prescription illegibility; however, information technologies also may introduce different kinds of medication errors. OBJECTIVE: To identify and quantify e-prescribing problems reported through an electronic prescribing incident reporting tool in the United States. METHODS: Voluntary and anonymous reports to a web-based, e-prescribing incident reporting tool were collected during 18 months using convenience sampling. Questions in the reporting tool were designed to elicit information on pharmacists' experiences with e-prescribing. Data were analyzed to characterize the different types of e-prescribing concerns. RESULTS: A total of 484 reports were collected through the incident reporting tool. Out of 484 reports, 75% corresponded to electronic prescriptions received directly into pharmacies' computers and 23% were computer-generated prescriptions faxed to pharmacies. Most of reports corresponded to comments, complaints or identified unsafe conditions regarding electronic prescriptions (49%), followed by incidents that did not reach the patient (44%) and those that reached patients (6%). The majority of problems reported involved directions (24%) and quantity selection (12%). CONCLUSION: The use of an incident reporting tool revealed a variety of issues regarding e-prescribing. The majority of the issues reported in this study were related to directions and quantity selection. The findings in this study indicate that software system changes and appropriate prescriber training are required to decrease or eliminate some of these issues.