A Data-Driven Approach to Evaluate Barcode-Assisted Medication Preparation Alerts at a Large Academic Medical Center.

BACKGROUND: The purpose of this study was to develop a data-driven process to analyze barcode-assisted medication preparation alert data with a goal of minimizing inaccurate alerts. METHODS: Medication preparation data for the prior three-month period was obtained from an electronic health record system. A dashboard was developed to identify recurrent, high-volume alerts and associated medication records. A randomization tool was used to obtain a prespecified proportion of the alerts to review for appropriateness. Alert root causes were identified by chart review. Depending on the alert's cause(s), targeted informatics build changes, workflow and purchasing changes, and/or staff education were implemented. The rate of alerts was measured postintervention for select drugs. RESULTS: The institution averaged 31,000 medication preparation alerts per month. The "barcode not recognized" alert (13,000) was the highest volume over the study period. Eighty-five medication records were identified as contributing to a high volume of alerts (5,200/31,000), representing 49 unique drugs. Of the 85 medication records triggering alerts, 36 required staff education, 22 required informatics build changes, and 8 required workflow changes. Targeted interventions for 2 medications, resulted in reducing the rate of the "barcode not recognized" alert from 26.6% to 1.3% for polyethylene glycol and from 48.7% to 0% for cyproheptadine. CONCLUSION: This quality improvement project highlighted opportunities to improve medication purchasing, storage, and preparation through development of a standard process to evaluate barcode-assisted medication preparation alert data. A data-driven approach can help identify and minimize inaccurate alerts ("noise") and promote medication safety.

Accommodating Pharmacy Students With Physical Disabilities During the Experiential Learning Curricula.

Accommodating pharmacy students with physical disabilities during the experiential learning portion of the Doctor of Pharmacy (PharmD) curriculum can present unique challenges for pharmacy schools. The available literature regarding accommodations for pharmacy students in the experiential learning environment is sparse, leaving programs with little guidance. This commentary from the Big Ten Academic Alliance calls on the Academy to create a community of shared resources and best practice examples and offers practical suggestions for accommodating pharmacy students with mobility, vision, and auditory disabilities during introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs).

Use of failure modes and effects analysis to mitigate potential risks prior to implementation of an intravenous compounding technology.

PURPOSE: The purpose of this study was to identify potential failure points in a new chemotherapy preparation technology and to implement changes that prevent or minimize the consequences of those failures before they occur using the failure modes and effects analysis (FMEA) approach. METHODS: An FMEA was conducted by a team of medication safety pharmacists, oncology pharmacists and technicians, leadership from informatics, investigational drug, and medication safety services, and representatives from the technology vendor. Failure modes were scored using both Risk Priority Number (RPN) and Risk Hazard Index (RHI) scores. RESULTS: The chemotherapy preparation workflow was defined in a 41-step process with 16 failure modes. The RPN and RHI scores were identical for each failure mode because all failure modes were considered detectable. Five failure modes, all attributable to user error, were deemed to pose the highest risk. Mitigation strategies and system changes were identified for 2 failure modes, with subsequent system modifications resulting in reduced risk. CONCLUSION: The FMEA was a useful tool for risk mitigation and workflow optimization prior to implementation of an intravenous compounding technology. The process of conducting this study served as a collaborative and proactive approach to reducing the potential for medication errors upon adoption of new technology into the chemotherapy preparation process.

Implementation of systematic progression of community pharmacy-based prescription verification into the skills-based laboratory curriculum.

BACKGROUND AND PURPOSE: To describe the design, implementation, and evaluation of systematic progressive community pharmacy-based prescription verification activities across a skills-based laboratory course series. EDUCATIONAL ACTIVITY AND SETTING: Community pharmacy-based prescription verification activities were implemented into three laboratory courses, Abilities Lab (ABL) 1, 2, and 4. During each activity, students practiced prescription verification using a handout with two components. First, a checklist outlining an eight-step verification process serves as a student resource. In the second handout component, students are required to identify which step contains a prescription error(s), the appropriate pharmacist action, and the recommendation needed in order to correct the error(s). After verifying and completing the handout, the students participate in a facilitator-led discussion on the recommendations necessary to dispense the prescription. As students progressed through ABL 1, 2, and 4, both the error type and scope of the verification process expanded. Class verification exercises culminated in a final practical assessment at the end of each semester. FINDINGS: In ABL 1 students scored an average of 99.5% (n = 161, standard deviation (SD) = 1.92) on the final practical assessment. In ABL 2, students scored an average of 97.6% (n = 166, SD = 3.07). In ABL 4, students scored an average of 90.3% (n = 159, SD = 11.2). SUMMARY: This manuscript adds value to the current literature by describing the implementation of progressive community pharmacy-based prescription verification activities across a skills-based laboratory course series.

Effect of Advanced Pharmacy Practice Experience Grading Scheme on Residency Match Rates.

Objective. To examine the effect of advanced pharmacy practice experience (APPE) grading schemes on residency match rates. Methods. A cross-sectional survey was administered to U.S. pharmacy schools and colleges to determine an APPE grading scheme. Post-graduate year 1 residency match data for the years 2013-2015 was obtained from the American Society of Health-System Pharmacists. Additional variables thought to affect residency match rates were collected from publicly available sources and prior research. Unadjusted and adjusted multivariate logistic regression analysis was performed to compare 2013-2015 residency match rates between institutions using letter grading and those using pass/fail grading schemes. Potential confounders for incorporation into the adjusted model were identified by Chi-square or Fisher's exact test as appropriate. Results. There were 110 of 126 schools that responded to the survey. Of these, 100 schools reported using either letter grading or pass/fail grading schemes in APPE courses and were included in the study. Unadjusted analysis revealed no difference in match rates between letter grading and pass/fail grading schemes over the aggregated time frame or in individual years. After adjusting for potential confounders, pass/fail grading was associated with higher match rates in the aggregate analysis and in 2013. However, no association was observed in 2014 or 2015. Conclusion. This study demonstrates that there is limited difference in residency match rates between schools using pass/fail or letter grading schemes in APPEs.

Characteristics of schools of pharmacy associated with a successful PGY1 residency match.

INTRODUCTION: The literature is limited related to school of pharmacy (SOP) characteristics that may impact a student's residency match success. Given the paucity of information, the aim of our study was to examine the association between multiple school specific characteristics and Post-Graduate Year 1 (PGY1) residency match rate. METHODS: PGY1 residency match data and SOP specific characteristics were obtained. The median aggregate match rate was used to categorize programs as high or low match rate. Univariate and multivariate analyses were conducted to assess the impact of SOP characteristics on match rate. RESULTS: Median match rates were 64% (2013), 63.25% (2014), and 64.25% (2015). Schools with >95% North American Pharmacist Licensure Examination® (NAPLEX®) pass rate and >15 funded faculty were more likely to have a high match rate. Private schools were less likely to have a high match rate when compared to public programs. CONCLUSION: SOP characteristics associated with a high likelihood of a successful PGY1 residency match were greater than 95% of NAPLEX® pass rate, more than 15 funded faculty members, and public school status.

Implementation and assessment of a naloxone-training program for first-year student pharmacists.

BACKGROUND AND PURPOSE: Develop a naloxone training activity and assess the activity's impact on increasing student pharmacist knowledge and confidence to counsel about management of opioid overdose and naloxone administration. EDUCATIONAL ACTIVITY AND SETTING: First-year student pharmacists participated in a naloxone training activity in an abilities laboratory course. The students completed pre-lab questions, received a brief lecture about responding to an opioid overdose, and then practiced counseling and administering intranasal and intramuscular naloxone using training kits. An Objective Structured Clinical Examination (OSCE) was conducted to assess students' ability to counsel on intranasal naloxone use in response to opioid overdose. Students completed self-assessments about their confidence in counseling patients about management of opioid overdose and naloxone administration following the OSCE and at course end. FINDINGS: 158 students participated and the average OSCE score was 82%. In the post-encounter self-assessment, 93% of students agreed or completely agreed that the OSCE improved their confidence in counseling about management of an opioid overdose and intranasal naloxone administration. Fifty-nine students completed the end-of-course survey and >90% of respondents reported they were somewhat or very confident in their ability to administer intranasal or intramuscular naloxone, recognize the opioid overdose symptoms, and counsel about intranasal naloxone use. Confidence in counseling about use of intramuscular naloxone was slightly lower. SUMMARY: Further study of training programs to increase future healthcare professionals' ability to respond to opioid overdoses is warranted. Incorporation of a short training activity can increase student pharmacists' knowledge and confidence in counseling patients about opioid overdose and naloxone administration.

Composing Effective and Efficient E-mails: A Primer for Pharmacy Practitioners.

This primer describes the purpose and importance of e-mail as a key communication medium in the workplace. It emphasizes clarity as a primary modality to enhance efficiency and effectiveness. Finally, the primer reviews elements of grammar, punctuation, and style that contribute to each e-mail's ability to meet language standards, enhance the writer's image, and successfully transmit information.

To-Go medications for decreasing ED return visits.

OBJECTIVES: The primary objective was to determine if providing patients with a complete course of antibiotics for select conditions would decrease the rate of return to the emergency department (ED) within 7 days of the initial visit. METHODS: In an urban, academic medical center, we compared patients who received medications at discharge (To-Go medications) with patients who received standard care (a prescription at discharge). Emergency department patients were included if they were older than 18 years; had a discharge diagnosis International Classification of Diseases, Ninth Revision, code for urinary tract infection, pyelonephritis, cellulitis, or dental infection; and presented initially between January and December 2010. Candidates had limited health insurance or were discharged when nearby pharmacies were closed. Return visits were included if the condition was related to the initial diagnosis. Wound checks and scheduled revisits were excluded. Medications dispensed were penicillin, clindamycin, sulfamethoxazole-trimethoprim, and nitrofurantoin. RESULTS: A total of 4257 individuals were seen in initial ED visits for the included conditions. Comparing the 243 individuals given medications with the 4014 who were not given medications, the To-Go medications group was less likely to return than the comparison group (2.5% vs 5.9%; P = .026). The cellulitis subgroup also showed a significant reduction in return visits (1.6% vs 6.9%; P = .024). Three hundred eighteen courses of medication were given to the 243 individuals for a total cost of $1123. CONCLUSIONS: For a 1-year expense of $1123, we demonstrated a 50% reduction in ED return visits for patients who were given a free, complete course of antibiotics at discharge for select conditions.