Systemization of a pharmacy technician career ladder in a multi-hospital system.

Purpose: Hospital consolidation into larger, systemized health systems has enabled system-wide standardization of promotion processes, including pharmacy technician career ladders. However, whether system standardization affects the job satisfaction or outcomes of pharmacy technicians is unknown. The purpose of this project was to assess pharmacy technician perceptions and outcomes after systemization of a pharmacy technician career ladder. Methods: Pharmacy technician satisfaction scores and outcomes (promotion and turnover rates) were assessed in an eight-hospital health system before and after systemization of a pharmacy technician career ladder. Results: Two hundred and forty-nine pharmacy technicians were employed during the pre-intervention (n = 104) and post-intervention (n = 145) time periods. One hundred and twenty-three of 145 (84.83%) pharmacy technicians completed a job satisfaction survey after implementation of the system-wide technician career ladder. Overall satisfaction for the career ladder averaged 3.8 ± 0.61 or between neutral to positive satisfaction. There was no difference in total satisfaction regardless of teaching (3.8 ± 0.59) or community hospital (3.8 ± 0.63) location (p = 0.53) or stratifying by Pharmacy Technician status. A total of 50 pharmacy technicians were hired during the study period, either during the pre-implementation (n = 36) or post-implementation (n = 14) time periods. Time to the first promotion averaged 1.73 ± 1.00 years in the pre-implementation period and 1.36 ± 0.55 years in the post-implementation period (p = 0.20). Technician voluntary turnover was similar between the time periods. Conclusion: In conclusion, the standardization of a systems-level pharmacy technician promotion ladder from a single hospital to a systems-level was associated with positive job satisfaction and similar promotions and turnover rates as the historic, single hospital-based promotion ladder.

Systemic racism: Pharmacists' role and responsibility.

Systemic racism is a public health emergency and disproportionately impacts communities of color, specifically black Americans. Pharmacists took an oath to protect the welfare of humanity and protect our patients. As such, to practice truly patient-centered care, pharmacists must recognize racism as a root cause of social determinants of health and use their privilege to educate themselves and their colleagues around dismantling structural racism.

Second victim syndrome and the pharmacy learner.

This commentary describes the concept of second victim syndrome and its application to pharmacy learners and preceptors. Although there is published literature regarding implementation of second victim syndrome programs at an institutional level, there is limited guidance regarding the second victim syndrome in the context of a pharmacy training environment; however, there are known risk factors such as medication safety events, failure to rescue events, or overall lack of experience of a clinician. With a growing awareness of the mental health concerns of health care providers, this is a potential area for growth and skill development for pharmacists of all levels. As pharmacy leaders and role models, we have a fundamental ethical responsibility to take care of our learners, particularly when it comes to emotionally challenging patient care scenarios. By giving a name to what our learners may be experiencing, the second victim syndrome, we can progress toward improving the well-being of these learners and increase their ability to be effective pharmacists. Involvement with medication safety events or patients with negative outcomes has been shown to have adverse professional outcomes, and this article describes steps that can be taken by preceptors and peers to help facilitate professional growth and recovery. Second victim is an underappreciated phenomenon that can have a profound impact on pharmacists' well-being. Strategies for proactive recognition and intervention are vital.

Systemic Racism: Pharmacists' Role and Responsibility.

Systemic racism is a public health emergency and disproportionately impacts communities of color, specifically Black Americans. Pharmacists took an oath to protect the welfare of humanity and protect our patients. As such, to practice truly patient-centered care, pharmacists must recognize racism as a root cause of social determinants of health and use their privilege to educate themselves and their colleagues around dismantling structural racism.

Frequency of and risk factors for medication errors by pharmacists during order verification in a tertiary care medical center.

PURPOSE: The frequency of and risk factors for medication errors by pharmacists during order verification in a tertiary care medical center were reviewed. METHODS: This retrospective, secondary database study was conducted at a large tertiary care medical center in Houston, Texas. Inpatient and outpatient medication orders and medication errors recorded between July 1, 2011, and June 30, 2012, were reviewed. Independent variables assessed as risk factors for medication errors included workload (mean number of orders verified per pharmacist per shift), work environment (type of day, type of shift, and mean number of pharmacists per shift), and nonmodifiable characteristics of the pharmacist (type of pharmacy degree obtained, age, number of years practicing, and number of years at the institution). RESULTS: A total of 1,887,751 medication orders, 92 medication error events, and 50 pharmacists were included in the study. The overall error rate was 4.87 errors per 100,000 verified orders. An increasing medication error rate was associated with an increased number of orders verified per pharmacist (p = 0.007), the type of shift (p = 0.021), the type of day (p = 0.002), and the mean number of pharmacists per shift (p = 0.001). Pharmacist demographic variables were not associated with risk of error. The number of orders per shift was identified as a significant independent risk factor for medication errors (p = 0.019). CONCLUSION: An increase in the number of orders verified per shift was associated with an increased rate of pharmacist errors during order verification in a tertiary care medical center.

Impact of a pharmacotherapy alerting system on medication errors.

PURPOSE: An evaluation of a rules-based pharmacotherapy alerting system configured to identify improperly verified new medication orders in an inpatient setting is described. METHODS: A retrospective pre-post cohort study was conducted to assess order-verification alerts and pharmacy interventions at a 900-bed hospital before and after implementation of a commercial pharmacotherapy alerting system. In the preintervention phase of the study, the pharmacotherapy alerting system was used on a limited basis, with clinical pharmacists responding to all alerts and the resulting data used to refine the trigger rules; for the intervention phase, the pharmacotherapy alerting system was programmed to alert only on order-verification errors involving four medications (darbepoetin, filgrastim, fondaparinux, and warfarin). In the event of alerts, a pharmacy response team provided nearly real-time feedback to the order-verification pharmacist, mainly via e-mail or paging. RESULTS: From the preintervention period to the intervention period, there was a 36% decrease in the frequency of order-verification alerts (p = 0.035), and the average number of alerts per day declined from 1.0 to 0.6, suggesting that the pharmacotherapy alerting system and associated oversight mechanisms were effective in enabling pharmacy staff to prevent future errors at the order-verification step before such errors could result in patient harm. The review team spent an average of 10.2 minutes carrying out interventions in response to alerts during the intervention phase. CONCLUSION: Incorporation of a real-time pharmacotherapy alerting system with an oversight response process reduced the number of pharmacotherapy alerts and facilitated interception and prevention of adverse drug events.