Naloxone Prescribing and Education in Outpatient Pain Management and Palliative Care.

Over the past two decades, opioid use and overdose have increased substantially. Naloxone, an opioid overdose reversal agent, has been one of many risk mitigation strategies for preventing mortality due to overdose. Most literature describing naloxone utilization has been about populations of illicit drug users and patients in hospitals, primary care, and pharmacies. There is limited information regarding naloxone prescribing and training for opioid users in specialty pain management clinics. Furthermore, there are no known publications concerning patients receiving palliative care services and overdose prevention. Pain and palliative care patients are commonly at risk of opioid overdose. In an interdisciplinary outpatient pain and palliative care clinic, pharmacists implemented naloxone prescribing and education. Eleven patients at increased risk for overdose were prescribed naloxone and educated on overdose risk factors, recognition, and management. Seven patients reported picking up their naloxone prescription from the pharmacy, and none reported using it within two weeks of the initial education. This intervention was deemed successful within the clinic, but small sample size and the pharmacist role may not be replicable within other pain and palliative care settings. It encourages further research of overdose risk and prevention in pain management and palliative care.

Reflective metacognition and objective structured clinical examination performance in introductory pharmacy practice experiences.

BACKGROUND AND PURPOSE: Objective structured clinical examinations (OSCEs) allow for holistic evaluation of clinical competence, but integration of reflective practices on OSCE performance has not been well-studied. EDUCATIONAL ACTIVITY AND SETTING: To develop metacognitive skills, second-year pharmacy students completed a self-reflection assignment on a mock medication therapy management OSCE in an introductory pharmacy practice experience course. Students who completed the course during the prior year (no self-reflection assignment) served as the control. The study assessed the correlation of students' reflections of their OCSE abilities to OSCE performance and evaluated if student demographics influenced the correlation. FINDINGS: There were 107 students in the control group and 95 students in the intervention group. A higher proportion of students passed the overall OSCE in the control group (67.4%) compared to the intervention group (58.9%), but this was not statistically significant. Neither gender, age, nor Pharmacy College Admissions Test score had an effect on OSCE pass rates. Grade point average did have a significant effect on OSCE pass rates (P = .019). Overall, no statistically significant association was seen in summative OSCE performance between students who used structured, guided questions to reflect on their formative OSCE performance and those who did not (P > .05). SUMMARY: Despite this study's results, faculty continue to embrace the concept of reflective practice. Further research is needed to assess the value and role of reflective practice in pharmacy education.