Impact of Implementing Screening and Interventions to Target Prevention of Opioid Misuse and Accidental Overdose in the Inpatient Setting.

Introduction: There are limited publications supporting the use of screening tools to implement upstream prevention of opioid-related problems. Opioid and Naloxone Education (ONE) is utilized in outpatient pharmacies to screen and identify patients at risk of opioid-related problems and make interventions. Objectives: To implement ONE in the inpatient setting to promote prevention of opioid-related problems and overdose risk mitigation. Methods: For this pilot, ONE screening tool was completed via chart review and patient interview for inpatients prescribed an opioid. Risk scores were calculated and recommendations were provided. Outcomes evaluated included morphine milligram equivalents (MME) prior to hospitalization, inpatient screening pre-, post-, and at discharge; naloxone orders at discharge; and comparison of overdose risk from different sources. Results: The control group (n = 44) had a mean MME decrease of 1.5, and following implementation of pharmacist interventions, the experimental group (n = 45) observed a mean MME decrease of 28.6 (P = .0001). For the threshold of 50 MME, 8.6% of patients in the control group had a change from >50 MME to <50 MME at 24 hour follow up. This change occurred in 29% of patients in the experimental group (P = .03). For non-opioid analgesics, 6.8% of patients in the control group had non-opioid analgesic orders added or increased compared to 26.6% in the experimental group (P = .01). Conclusion: Screening for opioid misuse and accidental overdose risk appears impactful in the inpatient setting. Screening and appropriate risk-based intervention was associated with decreases in total daily MME and increased non-opioid analgesics.

Addressing the Conflict Between Promoting Wellness, Perpetuating Mental Illness Stigma and Making Psychiatric Pharmacy Education Less Intense.

One in five Americans has a diagnosable mental illness, and pharmacists encounter these patients daily. This commentary addresses the conflict between the profession's wellness movement and its ongoing contribution to mental illness stigma. The need for improved pharmacist wellness is based on the profession's risk for burnout and development of related mental illness. The presence of stigma towards patients with mental illness among pharmacists is multi-factorial and complex. Risk of those within the profession perpetuating mental illness stigma could be diminished by developing pharmacy curricula that provide greater opportunities for students to learn more completely about mental illness, how to effectively engage persons with mental illness, and how to take care of themselves, express vulnerability, and talk about mental illness. While reducing mental illness stigma through curricular revision is best achieved through in-person learning experiences, elective coursework and cocurricular activities may also help achieve this goal. Examples of evidence-based best practices are provided.

Using Photovoice to explore patients' experiences with mental health medication: A pilot study.

INTRODUCTION: The objective of this research is to explore and share the medication experience of those with a mental illness in order to gain understanding of the patient's medication perceptions as well as the impact of medication upon patients' lives. METHODS: Patients with a mental disorder were given cameras and asked to capture the experience of "living with my medication." Using Photovoice methodology, participants reflected on their photos individually and in focus groups. Conceptual themes were drawn from the data. RESULTS: Five participants captured an average of 14 photos each. Self-efficacy with mental illness, mental and physical health connections, and education were the 3 most prominent themes. Aspects of medications were interwoven within these themes but were not the primary focus of the participants. DISCUSSION: Medication experiences of patients with mental illness may encompass much more than the medications themselves.

A medical mission to Guatemala as an advanced pharmacy practice experience.

OBJECTIVE: To describe the development and outcomes of an advanced pharmacy practice experience (APPE) for a medical mission trip to Guatemala. DESIGN: Pre-mission preparation and post-mission reflection activities were combined with in-country activities to create a 5-week APPE. During the 10-day medical mission trip, pharmacy students dispensed medications, counseled patients, conducted quality improvement assessments, and presented their findings and experiences as part of an interdisciplinary health care team. ASSESSMENT: The students who completed the mission trip met the objectives of the APPE and reported substantial learning in the areas of interdisciplinary teamwork and cultural competency. All students' scores on the Inventory for Assessing the Process of Cultural Competence-Student Version (IAPCC-SV) increased. The majority (81%) of student-generated quality improvement recommendations were implemented by the mission team. CONCLUSIONS: The medical mission APPE provided a rich learning environment for pharmacy students and resulted in modifications to the medical mission operation. This type of APPE could be implemented in other colleges of pharmacy via formation of partnerships with established medical mission teams as this one was.

Poster project to emphasize public health in the pharmacy curriculum.

OBJECTIVE: To implement and assess a required public health poster project in a doctor of pharmacy (PharmD) program. DESIGN: Third-year PharmD students collaborated in pairs to research a public health topic relating to pharmacy practice. Each student group prepared an informational poster, while receiving feedback from a faculty mentor at each stage of the project. The students presented their completed posters at a statewide pharmacy conference. ASSESSMENT: Faculty members evaluated the posters with a grading rubric, and students completed a survey instrument that assessed the overall experience. In general, faculty members rated the class highly across all domains of the grading rubric. The class generally agreed that the poster project increased their awareness of public health issues related to pharmacy practice, overall knowledge of public health, and presentation skills. CONCLUSION: The implementation of a poster project was well received by students and faculty members as an effective method for enhancing public health instruction in the PharmD program at North Dakota State University.

Current events project in a pharmacotherapy course.

OBJECTIVE: To implement and assess a current events project added to the curriculum of a pharmacotherapy course in a doctor of pharmacy (PharmD) program. DESIGN: Third-year PharmD students researched a current event topic related to infectious diseases and prepared a written and verbal summary that was presented to their classmates. ASSESSMENT: Scores on course examinations and quizzes to assess students' knowledge of current events material were equal to or better than non-current events material. Based upon a student self-assessment survey, this active-learning activity increased students' awareness of current events related to pharmacy practice, and their understanding of the process to prepare and present information to a group in a statistically significant manner. There was a positive but not significant improvement in students' desire to prepare and present information to a group; ability to evaluate, organize, and present information in a written report; and ability to verbally present material to a group. CONCLUSION: The addition of a current events presentation as an active-learning activity significantly increased students' awareness of current events related to pharmacy practice and their understanding of the process to prepare and present information to a group.