Validation of the specialized competency framework for pharmacists in hospital settings (SCF-PHS): a cross-sectional study.

OBJECTIVES: This study aimed to validate the content of the specialized competency frameworks for pharmacists working in hospital settings (hospital and clinical pharmacists) and pilot the frameworks for practice assessment. METHODS: This online cross-sectional study was carried out between March and October 2022 among a sample of 96 Lebanese pharmacists working in hospital settings. The frameworks were distributed to full-time hospital and clinical pharmacists, who filled them out according to their role in the hospital. RESULTS: Overall, the competencies were distributed over five domains for hospital pharmacists (fundamental skills, safe and rational use of medicines, patient-centered care, professional skills, and preparedness for emergencies), while for clinical pharmacists, competencies were distributed over seven domains (quality improvement, clinical knowledge and skills, soft skills, ability to conduct clinical research, ability to provide effective education, use information technology to make decisions and reduce errors, and emergency preparedness). Moreover, Cronbach alpha values were appropriate, indicating sufficient to high internal consistency. Pharmacists were highly confident in most competencies, with some exceptions related to research in emergency settings (data evaluation, research, and reporting). CONCLUSIONS: This study could validate competency frameworks for clinical and hospital pharmacists, with the competencies and their respective behaviors showing an adequate construct analysis. It also identified the domains that require further development, i.e., soft skills and research in emergency settings. Both these domains are timely and needed to overcome the current practice challenges in Lebanon.

Value of pharmacy services upon admission to an orthopedic surgery unit.

BACKGROUND: In Lebanon, the role of the pharmacist remains underestimated in the medication reconciliation process, especially in surgical departments. This study aims to assess the impact of pharmacist-conducted medication reconciliation performed within 48 h of hospital admission to the orthopedic surgical department. METHODS: This was a prospective single-arm study conducted in a tertiary-care teaching hospital in Lebanon between October 2019 and April 2020. Participants were adult inpatients hospitalized for orthopedic surgeries with ≥ 1 outpatient medications. Properly trained pharmacy resident obtained the Best Possible Medication History (BPMH) and led the reconciliation process. The primary endpoint was the number of reconciliation errors (REs) identified. Descriptive statistics were used to report participants' responses and relevant findings. Linear regression was performed with the number of REs as a continuous dependent variable using backward method. Results were assumed to be significant when p was < 0.05. RESULTS: The study included 100 patients with a mean age of 73.8 years, admitted for elective (54%) or emergency (46%) surgeries. Half of the study population had ≥ 5 home medications. The mean time for taking BPMH was around 8 min. A total of 110 REs were identified in 74 patient cases. The most common discrepancies consisted of medication omission (89.1%) and the most common medications involved were antihyperlipidemic agents. Twenty-four REs were judged as clinically significant, and four as serious. The most common interventions included the addition of a medication (71.9%). Most of the relayed interventions (84.5%) were accepted. The number of home medications was the only variable significantly associated with the number of REs (ß 0.492; p < 0.001). CONCLUSION: Pharmacy-led medication reconciliation upon admission to orthopedic surgery department can reduce reconciliation errors and improve medication safety. TRIAL REGISTRATION: Retrospectively registered in the Lebanon Clinical Trials Registry (LBCTR2020124680).

A population-based study of self-reported adverse drug events among Lebanese outpatients.

There is a limited number of studies assessing the epidemiology of Adverse Drug Events (ADEs) in the outpatient setting, especially those that do not result in healthcare use. The primary objective of this study was to assess the prevalence and determinants of self-reported ADEs among Lebanese outpatients. It was a cross-sectional observational study performed among Lebanese outpatients visiting community pharmacies across Lebanon. A questionnaire was designed to elicit patients' relevant information. The association between categorical variables were evaluated using Pearson χ2 test or Fisher's exact test. Binary logistic regression was performed to identify factors that affect the experience of self-reported ADEs. The study comprised 3148 patients. Around 37% of patients reported experiencing an ADE in the previous year. When ADEs occur, 70.5% of the respondents reported informing their physicians. Increasing number of medications per patient, use of injectable medication, and inquiring about potential drug-drug interactions were associated with higher experience of ADEs (p = 0.049; p = 0.003; and p = 0.009 respectively). Patients who received hospital discharge counseling reported experiencing less ADEs (p = 0.002). Our study showed prevalence of ADEs among Lebanese outpatients especially patients with polypharmacy, and highlighted the need to educate patients about the importance of reporting ADEs to their physicians.

Impact of pharmacist-conducted anticoagulation patient education and telephone follow-up on transitions of care: a randomized controlled trial.

BACKGROUND: There is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates. METHODS: This study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge. RESULTS: Two hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups. CONCLUSIONS: Although pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge. TRIAL REGISTRATION: Lebanon Clinical Trial Registry LBCTR2020033424 . Retrospectively registered. Date of registration: 06/03/2020.

Assessing knowledge, attitude, practice, and preparedness of hospital pharmacists in Lebanon towards COVID-19 pandemic: a cross-sectional study.

BACKGROUND: During the COVID-19 pandemic, the Lebanese government has taken the proactive anticipatory measure to minimize the infection rates. Despite the pivotal role of the pharmacists working in hospital settings, hospital pharmacists have not been engaged in the emergency preparedness for hospitals. The primary objective of this survey is to assess the knowledge, attitude, and practice of hospital pharmacists in Lebanon towards COVID-19 pandemic and explore the level of health emergency preparedness of Lebanese hospitals in response to this outbreak. METHODS: A standardized English-based, anonymous and online questionnaire was diffused via social media platforms to all Lebanese hospital pharmacists. The questionnaire consisted of 78 questions related to sociodemographic characteristics, knowledge-based, attitude-based, practice questions, and pandemic preparedness. Descriptive statistical analysis was used to summarize data. RESULTS: A total of 81 questionnaires were completed; the participants were able to know > 90% of the knowledge-based questions regarding COVID-19. Most of the respondents were concerned about getting infected and their families due to their professional exposure. Similarly, around 67% were following the safety recommendations. Most of the participants agreed that they are facing shortages, rising prices, and delays in supply of masks and sanitizers. In terms of COVID-19 readiness, about 50% of hospitals have taken practical steps. CONCLUSIONS: Our findings revealed an appropriate level of knowledge and good practice towards COVID-19, among the respondents from Lebanese hospitals. National organizations may benefit in utilizing the expertise of the hospital pharmacists to be able to minimize/avoid future waves of COVID-19 if it emerges.

Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals.

BACKGROUND: The Institute for Healthcare Improvement identifies medication reconciliation as the shared responsibility of nurses, pharmacists, and physicians, where each has a defined role. The study aims to assess the clinical impact of pharmacy-led medication reconciliation performed on day one of hospital admission to the internal medicine service. METHODS: This is a pilot prospective study conducted at two tertiary care teaching hospitals in Lebanon. Student pharmacists who were properly trained and closely supervised, collected the medication history, and pharmacists at the corresponding sites performed the reconciliation process. Interventions related to the unintended discrepancies were relayed to the medical team. The main outcome was the number of unintended discrepancies identified. The time needed for medication history, and the information sources used to complete the Best Possible Medication History were also assessed. The unintended discrepancies were classified by medication class and route of medication administration, by potential severity, and by proximal cause leading to the discrepancy. For the bivariate and multivariable analysis, the dependent variable was the incidence of unintended discrepancies. The "total number of unintended discrepancies" was dichotomized into yes (≥ 1 unintended discrepancy) or no (0 unintended discrepancies). Independent variables tested for their association with the dependent variable consisted of the following: gender, age, creatinine clearance, number of home medications, allergies, previous adverse drug reactions, and number of information sources used to obtain the BPMH. Results were assumed to be significant when p was < 0.05. RESULTS: During the study period, 204 patients were included, and 195 unintended discrepancies were identified. The most common discrepancies consisted of medication omission (71.8%), and the most common agents involved were dietary supplements (27.7%). Around 36% of the unintended discrepancies were judged as clinically significant, and only 1% were judged as serious. The most common interventions included the addition of a medication (71.8%) and the adjustment of a dose (12.8%). The number of home medications was significantly associated with the occurrence of unintended discrepancies (ORa = 1.11 (1.03-1.19) p = 0.007). CONCLUSIONS: Pharmacy-led medication reconciliation upon admission, along with student pharmacist involvement and physician communication can reduce unintended discrepancies and improve medication safety and patient outcomes.

Assessment of bleeding in chronic liver disease and coagulopathy using the IMPROVE bleeding criteria.

BACKGROUND: In this study, the authors utilized the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding definition to explore the safety profile of pharmacologic venous thromboembolism (VTE) prophylaxis in patients with chronic liver disease (CLD) and concurrent coagulopathy (INR ≥1.5). METHODS: A retrospective study was conducted on 193 adult patient admissions with a diagnosis of CLD and INR ≥1.5 not due to therapeutic anticoagulation. Patients were stratified based on their receipt of pharmacological thromboprophylaxis or not during hospitalization. The rates of overall bleeding, defined as the composite of major bleeding and clinically relevant non-major bleeding; major bleeding; and clinically relevant non-major bleeding, within 14 days of admission were evaluated. Secondary endpoints included the rates of thrombosis and mortality. RESULTS: The composite of overall bleeding occurred in 17.6% of the admissions. More patients in the group not receiving pharmacological thromboprophylaxis had overall bleeding (18.5% vs 10%), major bleeding (13.3% vs 10%), and clinically relevant non-major bleeding (14.5% vs 5%), with overlapping 95% CI. When stratified per pharmacological thromboprophylaxis status, IMPROVE bleeding risk score (BRS) ≥ 7 was associated with higher rates of overall bleeding, major bleeding, and clinically relevant non-major bleeding as compared to IMPROVE BRS <7, whether patients received or did not receive pharmacological thromboprophylaxis. The overall incidence of in-hospital mortality among our study population was 15.5%. Receiving pharmacological thromboprophylaxis was markedly associated with higher in-hospital mortality (OR = 16.58, 95% CI = 4.47-61.45). CONCLUSION: This study shows that the IMPROVE BRS calculated on admission may serve as a guide for omission of thromboprophylaxis in advanced CLD.

Medication safety knowledge, attitude, and practice among hospital pharmacists in Lebanon.

BACKGROUND: Studies showed that pharmacists have little experience with adverse drug reactions (ADRs) reporting due to insufficient knowledge of the concept of ADR and pharmacovigilance (PV). There is an urge to assess hospital pharmacists' knowledge in medication safety practices. OBJECTIVE: To evaluate the knowledge, attitude, and practice, among hospital pharmacists in Lebanon concerning ADRs and PV concepts. METHODS: A cross-sectional study, conducted between March and July 2016, enrolled 187 hospital pharmacists in all Lebanese districts. RESULTS: Concerning knowledge, 60.8% of the pharmacists said that ADR is an injury caused by appropriate and suboptimal care, while 74.6% of them said it can be preventable and nonpreventable. Moreover, 47.5% of them defined PV as being the study that detects, assesses, understands, and prevents adverse effects. Furthermore, 55.1% believed that PV concerns drug, herbal, medical devices, and vaccine problems. Concerning attitude, 61% of the pharmacists said they do not support direct ADR reporting by the patient. Of them, 78.6% confessed that ADR reporting is a professional obligation to them while 88.2% admitted that it is time-consuming with no outcome. When it comes to practice, 64.2% had been trained to report ADRs. Only 20.8% and 24.2% confessed reporting ADRs more than once a week, respectively. More than half (54.5%) said that they report the ADR to the patient's prescriber. CONCLUSION: Lebanese hospital pharmacists have little knowledge about the concept and process of PV and spontaneous ADRs reporting system. However, these pharmacists have positive attitudes, but very little practice with reporting systems. Educational programs are urgently needed to emphasize the role and responsibility of pharmacists in PV practices and to raise awareness towards ADR reporting process.

Medication safety knowledge, attitudes and practices among community pharmacists in Lebanon.

BACKGROUND: The effectiveness of a national post-marketing surveillance program depends directly on the active participation of all health professionals. There is no current comprehensive and active pharmacovigilance program available in Lebanon. OBJECTIVES: To assess the knowledge, attitudes, and practices (KAP) among community pharmacists in Lebanon with respect to potential pharmacovigilance and adverse-drug-reaction reporting in Lebanon. METHODS: A cross-sectional descriptive study, using a self-administered KAP questionnaire and conducted between March and July 2016, included 1857 pharmacists practicing in community settings. Statistical analysis included χ2 test for dichotomous or multinomial qualitative variables, and Wilcoxon test for quantitative variables with non-homogeneous variances or non-normal distribution. RESULTS: The majority of responders had good knowledge concerning the concept and purpose of pharmacovigilance as well as adverse drug reactions (how to report these/the importance of reporting adverse events/the definition of an adverse event and pharmacovigilance). Concerning community pharmacists' attitudes and practice towards pharmacovigilance, the majority described having a positive attitude towards their role in adverse drug reaction reporting and this activity was even seen as one of their core duties. The questionnaire revealed a lack of practice and training regarding pharmacovigilance. Nonetheless, the pharmacists agreed on the Order of Pharmacists in Lebanon and the Ministry of Health's role in promoting this practice and helping them be more involved in reporting adverse drug reactions (ADRs). The pharmacists thought that they are well positioned regarding patient-safety practice in their pharmacies and the results were not statistically different between pharmacy employers and employees. CONCLUSION: Lebanese pharmacists have the required knowledge and positive attitude to start reporting ADRs, were aware of ADRs occurring with various medicines post-marketing, yet were currently not able to disseminate this information widely or to record it centrally, emphasizing the importance of establishing a national ADR reporting system.

Factors Associated with Functional Disability Among Lebanese Elderly Living in Rural Areas: Role of Polypharmacy, Alcohol Consumption, and Nutrition-based on the Aging and Malnutrition in Elderly Lebanese (AMEL) Study.

The objective is to describe disability risk factors in Lebanese elderly living in rural settings, focusing on the role of polypharmacy, alcohol consumption, and nutrition. The Aging and Malnutrition in Elderly Lebanese study, a cross-sectional population-based one (April 2011-April 2012), included 1200 individuals aged ≥65 years from 24 Lebanese rural districts. The results showed that 288 (24%) were disabled and 287 (23.9%) exposed to polypharmacy. More disabled participants were found among patients exposed to polypharmacy (40.8%) than those who were not (18.8%). Major classes associated with disability were "Parkinson" and "Alzheimer" medications, with "alcohol consumption" being responsible for a major interaction with medications. Chronic diseases, nutrition, and socioeconomic status also had a large effect on disability. Skin ulcer (ORa = 8.569; CI 5.330-14.823), followed by dementia (ORa = 3.667; CI 1.167-8.912), and anti-gout drugs (ORa = 3.962; CI 1.290-7.622) were found to be significantly associated with increased odds of disability the most. Many factors are associated with disability among elderly, including polypharmacy and the association of medications with alcohol. Counseling of the elderly caregivers is warranted.

Misconceptions and Malpractices Toward Antibiotic Use in Childhood Upper Respiratory Tract Infections Among a Cohort of Lebanese Parents.

Antimicrobial resistance is an emerging global health threat. Misuse and abuse of antibiotics are of particular concern in the pediatric population. Since management of childhood illnesses depends considerably on parents' perceptions, the objectives of this study were to report parents' perspectives and assess their practices toward antibiotics used for upper respiratory tract infections (URTIs) in children. Using a cross-sectional design, anonymous structured questionnaires were completed by 1,037 parents in public and private schools across Lebanon's largest governorate. Descriptive statistics were used to report participants' responses. A multivariate analysis was performed to identify factors affecting knowledge and malpractice related to antibiotic use. Significant misconceptions and malpractices were identified among parents. For instance, 33.9% of parents considered that antibiotics are helpful in treating common cold among children and 36.2% believed antibiotics expedite the recovery of their child with common cold infection. Moreover, there was a lack of knowledge concerning antibiotic coverage, since 37.9% of the respondents believed that antibiotics treat viral infections and 21.5% were neutral toward this question. Around 20% of the participants believed they can reduce the dose of antibiotics if the child gets better. Significant factors associated with poor knowledge and misuses were parents' lower educational and socioeconomic levels. Despite extensive evidence on the limited role of antibiotics in URTIs, parents in Lebanon continue to misuse them. More concerted efforts are needed to improve parents' knowledge and practices with regard to the rational use of antibiotics.

Assessment of patients' knowledge and practices regarding their medication use and risks in Lebanon.

Background Patients' knowledge of their medications play a pivotal role in their disease management. Objective Assess the knowledge and practices of Lebanese outpatients regarding their own medication use and risks. Setting Four hundred and sixty community pharmacies across Lebanon. Method It was a cross-sectional study performed from March through May 2016 among Lebanese outpatients, using a self-administered questionnaire. Descriptive statistics were used to calculate all participants' responses. The association between categorical variables were evaluated using Pearson χ2 test or Fisher's exact test. Binary logistic regressions were performed to identify factors associated with medication patients' knowledge and interest. Main outcome measure Ability of the patients to identify own medications' elements: name, strength, dosage regimen, indication, and adverse drug reactions. Results Our study comprised 921 patients, with around 16% taking ≥5 medications/day. Around 56% of our patients showed sub-optimal medication knowledge. Patients' higher educational level, number of chronic diseases, and patient physician interaction were associated with higher medication knowledge. Many patients admitted not discussing their medications each time they visit their physicians (38.7%); not reading the leaflet of each medication they take (61.2%); and not regularly asking their pharmacist about the potential interactions of OTC drugs with prescribed medications (53.9%). Conclusion This study showed suboptimal medication-related knowledge, and suboptimal patient's interactions with primary care givers. Our findings serve as a platform for healthcare providers to understand patients' needs and educate them about medication use and risks.

Patient Perception of Acute Pain Management: Data from Three Tertiary Care Hospitals.

Introduction. The primary objectives of this study were to assess patients' description of their acute pain intensity; patients' attitude towards their pain management during hospitalization; and their overall satisfaction with pain treatment. Methodology. A cross-sectional questionnaire-based study was conducted between October 2014 and March 2015 in three medical centers in Lebanon. All participants' responses were reported using descriptive statistics. The association between categorical variables was evaluated using Pearson χ2 test or Fisher's exact test where the expected cell count was < 5. Results. A total of 119 women on the maternity services and 177 patients on the orthopedic services were surveyed. Around 50% of obstetric and 37% of orthopedic patients reported pain to be severe at its highest intensity. In maternity and orthopedic patients, respectively, unfavorable practices included pain not being assessed prior to pain medication administration (19.3% and 30.5%), having to wait for ≥30 minutes before getting the pain medication (14.2% and 11.3%), and pain score not being documented on medical chart (95% and 93.2%). Surprisingly, 94.1% of the maternity and 89.2% of orthopedic patients were satisfied to strongly satisfied with their pain management. Conclusion. Pre- and postoperative pain remain a prevalent problem that requires a consensus and joint efforts for improvement.

Mapping and assessment of personal and professional development skills in a pharmacy curriculum.

BACKGROUND: Health sciences programs are increasingly expanding their curricula to bridge foundational scientific knowledge with needed skills to practice and patient care. The primary objectives of this study are to 1) assess whether the personal and professional development (PPD) subdomains (self-assessment, leadership, innovation and entrepreneurship, and professionalism) are integrated in a pharmacy curriculum; and 2) identify any gaps related to the subdomains' learning objectives. METHODS: Four different mapping activities were completed to create a comprehensive mapping plan regarding the integration of the PPD subdomains in the curriculum. The first mapping activity entailed matching the school's program educational outcomes (PEOs) to these subdomains (Step 1). Mapping of the enacted curriculum by faculty (Step 2) and learned curriculum by students (Step 3) were also completed in order to evaluate the integration of these subdomains in the curriculum. Finally, Step 4 involved mapping of the assessed curriculum by analyzing the progress of students on PPD-related competencies using standardized scoring rubrics and the correlation between students' and facultys' assessments with regard to matching competencies. The Cochrane's Q test and the Cohen's kappa coefficient were used in the statistical analysis of parametric data. RESULTS: The subdomains were found to be woven across curricular, co-curricular, and extra-curricular activities based on the four different mapping activities. Faculty and students agreed that the PPD competencies are integrated in the curriculum; provided example courses, experiences and activities; and identified areas of further improvements. The completed mapping activities drove the development of action plans for remediation of identified gaps in the curriculum. CONCLUSION: Mapping activities showed the sequential integration of the PPD skills at different depths and breadths in the curriculum. This study provides an example to health sciences schools on the incorporation of the PPD skills in their curricular, co-curricular and extra-curricular activities as current accreditation standards have directed Pharmacy programs to integrate and enforce them in their curricula.

Completion of therapeutic and safety monitoring tests in Lebanese outpatients on chronic medications: a cross-sectional study.

PURPOSE: To evaluate the appropriateness of laboratory-test monitoring recommended for patients on chronic medication therapies in the Lebanese community setting. PATIENTS AND METHODS: In October 2011, all outpatients visiting selected community pharmacies in Lebanon were screened by pharmacists to evaluate their use of one or more chronic medications requiring safety and/or therapeutic laboratory tests. The list of medications was elaborated after an extensive review of laboratory-test monitoring recommendations from pertinent up-to-date clinical guidelines, medications that have been issued black box warnings for monitoring, and the most current information from the US Food and Drug Administration website. Patients receiving these medications were subjected to a questionnaire assessing the appropriateness of their laboratory-test monitoring. The study was approved by the Lebanese American University's Institutional Review Board. RESULTS: A total of 284 outpatients, with almost equal distribution by sex, were identified during the aforementioned period to be on one or more of the specified medications. The majority of the sample (68%) was younger than 65 years of age. Overall, most of the study group (65%) were found to be partially monitored with laboratory tests, while only 27% were fully monitored and 8% were not monitored at all. The study group reported clinic-visit intervals as follows: more than a year (35%), on yearly basis (18%), every 6 months (25%), every 3 months (16%), less than 3 months (6%). CONCLUSION: Seventy-three percent (73%) of the study group were receiving incomplete therapeutic/safety laboratory-test monitoring recommended for patients on chronic medication in the Lebanese community. It is concluded from the results that patients need to better understand the importance of recommended test monitoring for the safe and effective use of their medications. Education by physicians may be required to achieve better understanding.