A medication therapy management residency rotation adjusts to coronavirus disease 2019 constraints.

The purpose of this commentary is to describe the Johns Hopkins Home Care Group's (JHHCG) Community-based Pharmacy Residency Medication Therapy Management (MTM) rotation, summarize adjustments made to the rotation after the onset of the coronavirus disease 2019 (COVID-19) pandemic, describe key learnings from the adjustments, and provide a call to action for other residency programs seeking to improve their rotations amidst pandemic restrictions. MTM clinical pharmacists at JHHCG collaborate with patients to identify barriers to adherence, review medications, and develop plans for improvement. Through improved medication adherence, the goals for this program are to reduce adverse effects, patient cost, and medical visits or hospital admissions. Central to this practice is the belief that strong patient relationships are necessary to uncover the root cause of medication nonadherence. In Postgraduate Year-1 (PGY-1) community-based pharmacy residency training, new pharmacists learn the value of building relationships with patients and working through complex problems during this clinical experience. By assisting patients with complex medical conditions and social situations, new pharmacists gain skills in patient care, pharmacy operations, and medication access challenges. As the COVID-19 pandemic forced the discontinuation of face-to-face interactions in this setting, rotation experiences for residents were adapted with the goal of continuing high-impact patient interactions and keeping everyone involved safe. Although considerable changes were made to the MTM rotation because of the COVID-19 pandemic, residents were still able to provide meaningful clinical care telephonically and continued to learn valuable patient care skills. Most importantly, high quality care was still delivered to the patients despite considerable challenges. The major challenge for the residents' clinical experiences as a result of the adjustments has been finding an impactful volume of complex patients to enhance their skills. Other residency programs are encouraged to consider three recommendations to improve their rotations moving forward.

Effect of Drug Disposal Kits and Fact Sheets on Elimination of Leftover Prescription Opioids: The DISPOSE Multi-Arm Randomized Controlled Trial.

OBJECTIVE: To determine how passively providing informational handouts and/or drug disposal kits affects rates of leftover prescription opioid disposal. DESIGN: A multi-arm parallel-group randomized controlled trial with masked outcome assessment and computer-guided randomization. SETTING: Johns Hopkins Health System outpatient pharmacies. SUBJECTS: Individuals who filled ≥1 short-term prescription for an immediate-release opioid for themselves or a family member. METHODS: In June 2019, 499 individuals were randomized to receive an informational handout detailing U.S. Food and Drug Administration-recommended ways to properly dispose of leftover opioids (n = 188), the informational handout and a drug disposal kit with instructions on its use (n = 170), or no intervention (n = 141) at prescription pickup. Subjects were subsequently contacted by telephone, and outcomes were assessed by a standardized survey. The primary outcome was the use of a safe opioid disposal method. RESULTS: By 6 weeks after prescription pickup, 227 eligible individuals reported they had stopped taking prescription opioids to treat pain and had leftover medication. No difference in safe disposal was observed between the non-intervention group (10% [6/63]) and the group that received disposal kits (14% [10/73]) (risk ratio = 1.44; 95% confidence interval: 0.55 to 3.74) or the group that received a fact sheet (11% [10/91]) (risk ratio = 1.15; 95% confidence interval: 0.44 to 3.01). CONCLUSIONS: These findings suggest that passive provision of a drug disposal kit at prescription pickup did not increase rates of leftover opioid disposal when compared with provision of a fact sheet alone or no intervention. Active interventions may deserve further investigation.

Implementation of a student pharmacist-driven medication history service for ambulatory oncology patients in a large academic medical center.

OBJECTIVE: Patients who have an up-to-date and accurate medication list are less susceptible to medication errors and allow care teams to make more informed treatment decisions. Through utilizing student pharmacists to provide medication history services, we anticipate improved patient safety and overall quality of patient care. The purpose of this project was to implement a medication history service for ambulatory oncology patients of the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital. METHODS: A phased approach was utilized to implement a standardized operating procedure for completing medication histories in ambulatory oncology patients. Data collection included number of total medication discrepancies, percentage of patients with high-risk medications, and high-risk medication classes involved in discrepancies. Additionally, time data were collected, including time spent calling the patient, completing patient work up, and preceptor oversight. RESULTS: Students completed medication histories for 60 patients; 83% of patients had at least one discrepancy with 21% of those discrepancies involving a high-risk medication. High-risk medications involved in discrepancies included oral chemotherapeutic agents, anticoagulants, insulin, and opioids. CONCLUSION: The majority of patients seen had at least one medication discrepancy that was identified and corrected through the medication history service. By correcting the discrepancy, the likelihood of medication errors occurring was decreased. Continuous workflow changes are being made to identify the number and type of resources to expand the service to all appropriate ambulatory oncology patients at the Sidney Kimmel Comprehensive Cancer Center.

Implementation of transitions-of-care services through acute care and outpatient pharmacy collaboration.

PURPOSE: The implementation of a practice model designed to reduce hospital readmissions through optimal deployment of pharmacy staff on multidisciplinary care collaboration teams is described. SUMMARY: In response to Affordable Care Act provisions aimed at reducing preventable hospital readmissions, the pharmacy department at The Johns Hopkins Hospital (JHH) led the implementation of a new pharmacy services model spanning both inpatient and outpatient settings. Key components of the model include (1) increased pharmacist participation in multidisciplinary rounds, (2) targeted medication reconciliation and patient education, (3) postdischarge phone monitoring of selected patients, and (4) bedside discharge medication delivery performed by a "transitions pharmacist extender." Incorporation of care coordination activities into the daily workflow has increased the rate of patient education on high-risk medications and allowed for affordable and effective medication regimens to be designed and prescriptions to be filled prior to patient discharge. The ultimate goal is enhanced multidisciplinary collaboration to decrease hospital readmissions by increasing medication adherence and patients' understanding of medications. CONCLUSION: The inpatient and outpatient pharmacy teams at JHH collaborated to improve their understanding of patients' medication use prior to admission through targeted medication reconciliation, education of patients on high-risk medications initiated during admission, and development of affordable and practical medication regimens that patients would receive in hand on discharge. A pharmacy team model was developed to ensure that these services are adequately provided and enhance patient understanding of the importance of medications for acute and chronic disease state management.