Fostering cultural sensitivity amongst students of pharmacy through an interprofessional book club activity.

BACKGROUND AND PURPOSE: To describe a large-scale, cultural sensitivity-focused interprofessional book club activity that is required in the first-professional year of an accelerated pharmacy curriculum. EDUCATIONAL ACTIVITY AND SETTING: An interprofessional book club activity, focusing on the need for cultural sensitivity in health care, is conducted annually for students in the acupuncture, pharmacy, physical therapy, physician assistant, and sonography programs. Each year over 400 students are required to attend and are assigned to interprofessional groups to discuss guided questions pertaining to the book written by Anne Fadiman, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Pharmacy students complete multiple assignments before and after the activity. Students are administered a post-survey to collect student feedback and self-assessment data. The book club has been run in both synchronous and asynchronous formats. FINDINGS: Student survey responses have consistently revealed that the majority of students agreed or strongly agreed that they were better prepared for culturally-diverse patient interactions, the activity allowed for interprofessional learning, and the activity should continue for future students. SUMMARY: A book club activity is an effective strategy for delivering content related to cultural sensitivity in an interprofessional format. This activity model can be used to support interactions with multiple professions in different schools within the same university or with multiple professions located at different universities/institutions.

Enhancing High Alert Medication Knowledge Among Pharmacy, Nursing, and Medical Staff.

OBJECTIVES: Limited data exist regarding staff's knowledge and perceptions of high alert medications (HAMs) and associated procedures. Objectives of this study were to conduct an initial assessment of institution-specific HAM knowledge among pharmacy, nursing, and medical staff; implement interventions to enhance staff knowledge of HAMs; and conduct a similar assessment 1 year later to determine if interventions successfully enhanced HAM knowledge. METHODS: A 6-question electronic survey was distributed to 1006 pharmacy staff, nurses, and physicians in June 2009. In response to results achieved, HAM-related interventions were implemented over a 6-month period. A similar electronic survey was distributed to hospital staff 1 year later to determine any change in HAM knowledge. RESULTS: A total of 203 staff completed the presurvey (20% response rate), whereas 170 completed the postsurvey (17% response rate). Before the HAM interventions, 42.9% of respondents expressed confidence in their knowledge of HAMs and the procedures defined by the institution. This increased to 73.5% after the interventions (P < 0.001). More respondents correctly identified HAMs and safety procedures on postsurveys: insulin IV bolus (83.3% vs. 92.4%; P < 0.01), neonatal medications (79.3% vs. 88.2%; P < 0.05), total parenteral nutrition (57.1% vs. 73.5%; P = 0.001), and "documentation of 2 independent registered nurse checks for HAM IV infusion rate changes" (76.4% vs. 92.9%; P < 0.001). CONCLUSIONS: An assessment of staff HAM knowledge and handling procedures allows for customized interventions for institution-specific HAM improvements. Hospital staff knowledge of HAMs increased 1 year after implementing interventions.

In the Eye of the Storm: The Role of the Pharmacist in Medication Safety during the COVID-19 Pandemic at an Urban Teaching Hospital.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease (COVID-19) pandemic, has challenged practitioners with complex clinical scenarios as well as conflicting and scarce data to support treatment strategies. The pandemic has also placed strains on institutions due to drug shortages, alterations in medication use processes, economic losses, and staff exposure to the virus. This article provides pharmacist-led suggestions and strategies to various case questions, describing some of the challenges faced by practitioners at an urban teaching hospital during the COVID-19 pandemic. The strategies suggested can be explored at other institutions.

Physical therapy and pharmacy interprofessional education in the context of a university pro bono physical therapy setting.

Interprofessional care is the standard for quality in healthcare. Interprofessional education (IPE) is an accreditation requirement in many health-care fields. This qualitative study evaluated the benefits of an interprofessional education program for Doctor of Physical Therapy (DPT) and Doctor of Pharmacy (PharmD) students in the context of a pro bono physical therapy setting focused on reducing fall risk among older adults. For each pro bono participant, PharmD and DPT students worked together to analyze fall risk of the participating older adults. PharmD students completed a medication review while the DPT students completed balance assessments. Each profession recommended adjustments to care and presented their findings to peers, faculty, and participants. Following completion of the IPE program, students completed a voluntary evaluation with seven questions requiring semi-structured written reflection regarding their IPE experience. Student reflective responses from 2014-2016 were coded by IPE faculty using a coding guide collaboratively developed by the study team. Descriptive analysis included a summary of code frequency by year, discipline and Interprofessional Education Collaborative core competency: Values and Ethics, Communication, Teams and Teamwork, and Roles and Responsibilities. Values and Ethics were the most frequently coded core competency. Students consistently noted the importance of valuing the other profession, understanding each other's roles, having good interprofessional communication, and working within a health-care team. Additional codes emerged during the analysis process. Written reflective findings suggest that hands-on collaboration, focused on a real-world problem (fall risk) relevant to both PharmD and DPT students, enabled interprofessional care that benefited students through real-world practice of skills learned during coursework, and benefited clinical participants through increased awareness of physical function and medication factors that could affect fall risk. Findings indicate that a pro bono physical therapy setting can provide hands-on learning that meets IPE accreditation requirements and student learning needs while addressing a public health concern.

A Bitter Pill to Swallow: Why Medication Safety Is Critical in Hepatitis C Treatment.

PURPOSE: To provide medication safety tips to optimize the management of patients receiving treatment for chronic hepatitis C virus (HCV) infection. SUMMARY: Ensuring safe medication use in patients who receive treatment for HCV infection is a crucial component in providing optimal patient care. Because of the complexity of available treatment options, numerous challenges exist in preventing medication errors with HCV therapies. This article will focus on the selection of appropriate treatment options along with proper dosing and duration, awareness of concomitant disease states and drug interactions, identifying adverse drug reactions (ADRs) and patient counseling points, the provision of adherence counseling and prevention of treatment interruptions, improving communication with patients and between pharmacies, and recognizing the importance of a multidisciplinary approach. CONCLUSION: Maintaining awareness of medication safety strategies geared toward HCV pharmacotherapy is critical for providing optimal care for patients while minimizing the opportunity for errors.

Vaxchora: A Single-Dose Oral Cholera Vaccine.

OBJECTIVE: To review trials evaluating the efficacy and safety of Vaxchora, a reformulated, single-dose, oral, lyophilized Vibrio cholerae CVD 103-HgR vaccine for the prevention of travel-related cholera caused by V cholerae serogroup O1. DATA SOURCES: A literature search was conducted using MEDLINE (1946 to January week 3, 2017) and EMBASE (1996 to 2017 week 3). Keywords included oral cholera vaccine, single-dose, Vaxchora, and CVD 103-HgR. Limits included human, clinical trials published in English since 2010. ClinicalTrials.gov was used as a source for unpublished data. Additional data sources were obtained through bibliographic review of selected articles. STUDY SELECTION AND DATA EXTRACTION: Studies that addressed the safety and efficacy of Vaxchora, the reformulated, single-dose oral CVD 103-HgR cholera vaccine, were selected for analysis. DATA SYNTHESIS: Approval of Vaxchora, was based on efficacy of the vaccine in human trials demonstrating 90.3% protection among those challenged with V cholerae 10 days after vaccination and in immunogenicity studies with 90% systemic vibriocidal antibody conversion at 6 months after a single-dose of vaccine. Tolerability was acceptable, with the most common adverse effects reported to be fatigue, headache, and abdominal pain. CONCLUSION: Vaxchora is the only FDA-approved, single-dose oral vaccine for the prevention of cholera caused by V cholerae serogroup O1 in adult travelers from the United States going to cholera-affected areas. Safety and efficacy has not been established in children, immunocompromised persons, and pregnant or breastfeeding women or those living in cholera-endemic areas.

Fidaxomicin: a macrocyclic antibiotic for the management of Clostridium difficile infection.

OBJECTIVE: To evaluate the efficacy and safety of fidaxomicin for the treatment of Clostridium difficile infection. DATA SOURCES: Literature retrieval was accessed through MEDLINE (1966-January 2010) and International Pharmaceutical Abstracts (1970-January 2010) using the terms OPT-80, difimicin, PAR-101, fidaxomicin, tiacumicin, lipiarmycin, and Clostridium difficile. In addition, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles published in English that were identified from the data sources were evaluated and pertinent information was included. DATA SYNTHESIS: Fidaxomicin is an 18-membered macrocyclic antibiotic with activity against gram-positive aerobes and anaerobes, including C. difficile. Microbiologic studies comparing in vitro activity of fidaxomicin with that of metronidazole and vancomycin have shown good activity against all strains of C. difficile tested; however, minimum inhibitory concentrations were consistently lower for fidaxomicin. Studies showed that fidaxomicin lacks activity against gram-negative pathogens, thereby preserving normal gastrointestinal flora. Small pharmacokinetic trials have shown that fidaxomicin administration leads to low concentrations in plasma, high concentrations in stool, and a postantibiotic effect of greater than 24 hours, all of which are potentially advantageous characteristics for treating C. difficile infection. Data from 2 Phase 2A trials and 1 Phase 3 (multicenter, randomized, double-blind) trial suggest that fidaxomicin is effective for the treatment of mild-to-moderate C. difficile infection at a dose of 200 mg orally every 12 hours. Limited early results from the Phase 3 trial showed favorable outcomes for fidaxomicin when compared to oral vancomycin. Overall, fidaxomicin has been well tolerated to date. CONCLUSIONS: The activity of fidaxomicin and limited clinical data suggest that it may have a future role in the treatment of mild-to-moderate C. difficile infection. The complete pharmacokinetic/pharmacodynamic profile, safety, and place in therapy have yet to be determined as trials comparing this agent to vancomycin are forthcoming.

Educational campaign for proper medication disposal.

OBJECTIVE: To assess the effect of an educational intervention on pharmacists' attitudes and knowledge about medication disposal. METHODS: In September 2005, a survey was mailed to 488 registered pharmacists serving as experiential education preceptors to Massachusetts College of Pharmacy and Health Sciences students in 27 states throughout the country. Mailing of this presurvey occurred 2 months before an educational intervention. An identical postsurvey was mailed to the 223 respondents to the presurvey 3 months after the intervention. The main outcome measure was change in pharmacist attitudes and knowledge about medication disposal after educational intervention. RESULTS: 158 pharmacists (32% response rate) completed the pre- and postsurveys. Before the intervention, 47% of pharmacists perceived inappropriate medication disposal to be an environmental problem compared with 57% after the intervention (P = 0.03). Similarly, when asked about medication disposal, 10% correctly indicated that patients could arrange for hazardous waste pick up compared with 20% postintervention (P < 0.01). Conversely, 19% incorrectly indicated that patients should wash medications down the sink compared with 5.6% postintervention (P < 0.01). CONCLUSION: A brief educational intervention is effective at changing pharmacists' attitudes and knowledge of inappropriate and environmentally unsafe medication disposal practices. Pharmacists receiving the educational intervention were more likely to report that they would recommend appropriate methods of medication disposal. Further educational efforts are necessary for improving pharmacists' knowledge regarding safe medication disposal practices.

Adverse-drug-reaction reporting by pharmacy students in a teaching hospital.

PURPOSE: Adverse-drug-reaction (ADR) reporting by pharmacy students in a teaching hospital is described. SUMMARY: Faculty and pharmacy staff collaborated to modify the existing data collection form for suspected ADRs. During the orientation session for each new rotation, pharmacy students received an overview of ADRs, ADR trigger medications, and the hospital's ADR reporting program. Pharmacy students collected ADR data by prospectively and retrospectively reviewing inpatient charts for suspected ADRs that were identified through various means. The students were responsible for completely and accurately documenting all aspects of the suspected ADRs. At least once a week, patient charts were requested to aid students in their investigation of suspected ADRs. Data from patient cases involving allergy-related ADRs were confirmed and updated in the hospital's computer system. All documented ADRs were entered into a spreadsheet for the purpose of generating quarterly reports. Report data were analyzed by faculty and students to identify hospitalwide trends in an effort to develop new ADR prevention strategies. Pharmacy student involvement with the ADR process began in January 2006. A total of 310 ADRs were documented for 2006, compared with 42 for 2005, when pharmacy students were not involved in data collection. ADR reports also led to allergy updates for 42 patients. With students collecting and analyzing ADR data, the hospital was able to recognize those medications that commonly caused ADRs and track hospitalwide trends in an effort to target new initiatives to prevent their occurrence. CONCLUSION: Pharmacy student participation in the ADR reporting program led to a significant increase in the number of ADRs documented.