Implementation of a pharmacy technician career ladder and pharmacy technician training program.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To describe the implementation of a pharmacy technician career ladder and internal technician training program at UF Health Shands Hospital in Gainesville, Florida. SUMMARY: As the systems for providing care and receiving reimbursement become more complex, the ability to deliver comprehensive care in the most efficient and effective manner is critical. In order to maximize impact, pharmacists must practice at the top of their license. Recruitment and retention practices that support an optimized pharmacy technician workforce and continued expansion of technician roles are vital to advancement of pharmacy practice. This report describes the efforts to improve technician recruitment, professional development, and retention through the implementation of a technician career ladder and internal training program. The programs contributed to a reduction in technician rolling 12-month turnover rates from 26.72% in July 2015 to 13.1% in March 2023 (a reduction of 51%). Overtime hours as a percentage of total hours worked were reduced from 11.02% in July 2015 to 4.54% in March 2023 (a reduction of 59%). Improvements were noted in pharmacy technician job satisfaction, as evidenced by key employee engagement indicators including responses to the posed statement "Overall, I am a satisfied employee," with a mean score of 3.32 (on a scale of 0-5) in 2015 as compared to 4.2 in 2019 (a 21% increase). CONCLUSION: Implementation of a pharmacy technician career ladder and technician training program creates a sustainable and effective recruitment and retention pathway that may favorably impact technician job satisfaction, turnover, and career development opportunities.

Novel use of a sequential standardized oral board exam to assess PGY1 resident progression.

PURPOSE: A standardized oral board exam was created to longitudinally assess postgraduate year 1 (PGY1) pharmacy residents in key domains. SUMMARY: We provide a descriptive review of a novel oral board exam administered quarterly to our PGY1 pharmacy residents. Preceptors from our core rotations (internal medicine/infectious diseases, adult critical care, oncology, pediatrics, and administration/health policy and outcomes) developed questions based on situations commonly encountered by PGY1 residents to assess residents' communication; the content of their response, assessment, and plan; and coachability. Over the 4-year history of this assessment, scoring has matured to consider whether a resident has or has not met or has exceeded expectations for a PGY1 resident at a given stage in their training. Our comprehensive feedback and action planning approach included residents' self-assessment, feedback from the exam committee, development and implementation of a customized training plan for execution, and dissemination to our preceptors. Systematically assessing our PGY1 residents with this innovative method provided a process for tracking their performance and served as a baseline for those who completed additional training at our institution. CONCLUSION: A standardized quarterly oral board exam was developed to identify residents' strengths and areas for improvement at established periods during the PGY1 residency training program. This standardized assessment, paired with individualized action plans and open communication with key stakeholders, stimulated development in residents' performance, communication, and interpersonal skills. We aim to expand this system's application to identify predictors of success for candidates we interview for our postgraduate training programs.

An outbreak of acute delirium from exposure to the synthetic cannabinoid AB-CHMINACA.

BACKGROUND: Synthetic cannabinoid containing products are a public health threat as reflected by a number of outbreaks of serious adverse health effects over the past 4 years. The designer drug epidemic is characterized by the rapid turnover of synthetic cannabinoid compounds on the market which creates a challenge in identifying the particular etiology of an outbreak, confirming exposure in cases, and providing current information to law enforcement. RESULTS: Between 28 May 2014 and 8 June 2014, 35 patients were evaluated and treated at the University of Florida Health Medical Center in Gainesville following reported exposure to a synthetic cannabinoid containing product obtained from a common source. Patients demonstrated acute delirium (24) and seizures (14), and five required ventilator support and ICU-level care; none died. The presence of N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-(cyclohexylmethyl)-1H-indazole-3-carboxamide (AB-CHMINACA), or one of its predicted metabolites was confirmed in 15 of 21 cases. A rapid public health response and aggressive public messaging prevented further morbidity, identified the source, and led to law enforcement seizure of the implicated product. DISCUSSION: The significance of this outbreak lies as much in the rapid occurrence of unpredictable, life-threatening adverse health effects from a newly identified synthetic cannabinoid compound as it does in the multidisciplinary investigation and novel partnership between local public health, the laboratory, and the chemical industry, resulting in termination of the outbreak. CONCLUSION: A coordinated response and collaboration between law enforcement, the local public health, emergency medical services and Health Center staff, were all key interventions in preventing a more substantial public health outbreak resulting from use of a novel synthetic cannabinoid compound. Real time collaborations between toxicology laboratories, suppliers of analytical standards and the public health system may be useful in the face of future novel chemical exposures.

Comparative effectiveness of 3- versus 4-factor prothrombin complex concentrate for emergent warfarin reversal.

INTRODUCTION: Three- and 4-factor prothrombin complex concentrates (PCC) are routinely administered for emergent reversal of warfarin, but direct comparisons of clinical outcomes are lacking. The purpose of this study was to compare the safety and effectiveness of 3- and 4-PCC in patients requiring emergent warfarin reversal. MATERIALS AND METHODS: This was a single-center retrospective study in adult patients requiring administration of either 3-PCC or 4-PCC for emergent reversal of warfarin. RESULTS: One hundred sixty-five patients were included (3-PCC, n=109; 4-PCC, n=56). The most frequent indications for PCC were intracranial and gastrointestinal bleeding. Baseline median INR was 2.5 (2.0-3.2) and 2.4 (2.0-4.2) in the 3-PCC and 4-PCC groups. Thirty minutes after PCC administration, median INR decreased to 1.3 in both groups (p<0.001), and 87 (80%) versus 47 (84%) of patients had INR values≤1.5 (p=0.52) in the 3-PCC group versus the 4-PCC group. Thromboembolic events occurred in 7 patients (4%) and were similar between the 3-PCC (n=3, 3%) and 4-PCC (n=4, 7%) groups (p=0.23). Thirty-four (31%) patients in the 3-PCC group died compared to 5 patients (9%) in the 4-PCC group (p=0.001). INR>1.5 thirty minutes after PCC was associated with increased mortality (OR 4.3; 95% CI 1.8-10.4, p=0.001), and administration of a 4-PCC was associated with decreased mortality (OR 0.19; 95% CI 0.06-0.54, p=0.002). CONCLUSION: Patients who received 4-PCC, and those with INR≤1.5 regardless of type of PCC received were more likely to survive. Thromboembolic events were low in both groups and similar to previous studies.

National survey of pharmacy residency on-call programs.

PURPOSE: The results of a national survey to evaluate on-call practices and responsibilities of pharmacy residents nationwide, as well as opinions related to duty-hour changes, are reported. METHODS: A 39-question survey was distributed to 1292 residency program directors (RPDs) listed in the American Society of Health-System Pharmacists (ASHP) online residency directory, which includes programs in all stages of the accreditation process. The survey opened on November 7, 2011, and closed on November 28, 2011. The survey collected demographic information and answers to questions about the residency's on-call component (if applicable) and barriers to the creation of an on-call component. Respondents were also asked to indicate their support of or opposition to the adoption of the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty-hour rules and identify the areas of greatest concern. RESULTS: Of the 1292 RPDs listed in the ASHP online residency directory to whom the survey was sent, 521 surveys were completed, yielding a response rate of 40%. Of these, 471 identified their residency program as including or excluding an on-call component. Of the 138 programs with on-call services, 102 programs (74%) indicated the inclusion of an overnight experience. Programs that did not utilize an on-call component indicated barriers such as a perceived lack of demand (39%) and duty-hour limitations (21%). Common on-call activities included drug information consults and therapeutic drug monitoring. There was not a clear consensus from RPDs regarding the adoption of the 2011 ACGME duty-hour standards. CONCLUSION: Among usable responses to a survey of pharmacy residency programs, 29% indicated that their program included an on-call component. On-call programs varied greatly in activities, location, hours, and requirements.

Rabies prophylaxis in the emergency department.

The rabies virus is transmitted through exposure to infected saliva during either a bite or direct contact with mucosal tissues. Infection with this virus results in a progressive encephalitis, ultimately leading to coma, end-organ damage, and death. Because rabies-associated mortality is strikingly high, preventing viral transmission associated with an exposure is paramount. Fortunately, 2 available options exist for this purpose and include the rabies vaccine and the associated immunoglobulin. Patients presenting for consideration of rabies postexposure prophylaxis constitute a frequent complaint seen in the emergency department (ED) in most geographical areas. Management of these patients should be guided by an accurate and thorough discussion of the circumstances surrounding their exposure to attain maximum pharmacological benefit and avoid viral transmission. This article provides an overview of the practice recommendations surrounding rabies virus prophylaxis and their associated pharmacological characteristics in the ED.

Preventing the harm of a closer look: contrast-induced nephropathy in adults.

Contrast media is administered to many patients in hospitals nationwide. Although the use of contrast and dyes is widespread and has a well accepted use among the medical profession, contrast-induced nephropathy can be a common and potentially harmful complication. Identifying patients at risk, attempting to minimize risk, and using preventative strategies should be priorities to decrease the harmful effects that are associated with the administration of contrast media. This article provides a general overview of contrast-induced nephropathy and a brief review of the risk factors and prophylactic treatment.