American Society Of Health-System Pharmacists Research Articles

Assessment of Postgraduate Year 1 Residency Program Director Preferences and Priorities in Evaluation of Pharmacy Residency Candidates.

Limited and conflicting evidence exists evaluating how components of pharmacy residency applications are prioritized by residency program directors (RPDs). This study aims to identify what pharmacy residency programs prioritize when selecting candidates to interview given the incorporation of new American Society of Health-System Pharmacists (ASHP) Pharmacy Residency Standards. A Qualtrics survey was distributed to postgraduate year 1 (PGY1) RPDs across the United States. Programs were identified using the American College of Clinical Pharmacy and ASHP residency directory. Data was collected from October 23, 2023, to December 4, 2023, and priorities were captured using percentage weighting and rank order lists. Of the 1389 survey links disseminated, a total of 254 programs submitted responses for a total response rate of 18.2%. According to RPDs the highest weighted section of a residency application was the curriculum vitae (CV) with an average weight of 51.7% followed by letters of recommendation, letter of intent, and supplemental application (if applicable) in descending order, respectively. Within the CV, programs valued work, leadership, and rotation experiences most. Ability to organize and manage time was reported to be the most important characteristic within letters of recommendation. Based on the results of this study, when reviewing pharmacy residency applications, PGY1 RPDs prioritize the CV, followed by letters of recommendation and letter of intent. These findings could be used by RPDs when assessing current scoring rubrics and may help to inform the efforts of students and letter of recommendation writers when preparing individual components of an application.

Development and implementation of autoverification standardization in the adult and pediatric emergency department.

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. This project utilized the guidance of the American Society of Health-System Pharmacists (ASHP) autoverification toolkit to refine our health system's approach to autoverification and contribute to the literature regarding appropriate use of autoverification technology in a pediatric and adult emergency department (ED). This single-center quality improvement study was conducted in an academic medical center ED that has 33 pediatric beds and 77 adult beds. A team consisting of clinical pharmacy specialists in emergency medicine, medication safety and informatics personnel, operational managers, and pharmacy leadership was identified to develop and implement autoverification best practices in the ED utilizing practices outlined within the ASHP autoverification toolkit. Before implementation of best practices, defined as the "preoptimization" state, autoverification took place for most medications available in the automated dispensing cabinets (ADCs). By anchoring the autoverification rule on ADC inventory, it was challenging to optimize both inventory practices and autoverification best practices. This project focused on redesigning the autoverification rules in the electronic health record, defined as the "postoptimization" state. In the postoptimization state, autoverification in the ED was updated to better align with regulatory standards. Autoverification metrics and the percentage of orders that autoverified vs required pharmacist verification were analyzed in the preoptimization and postoptimization states. This project utilized the guidance from ASHP's autoverification toolkit to refine our health system's approach to autoverification. High-alert medications (eg, insulin, extended-release opioids, digoxin) were taken off autoverification following implementation. Optimization of autoverification rules allows more orders for high-alert medications to be reviewed by a pharmacist.

Antibiotic prophylaxis practice in gastrointestinal surgery in five hospitals in southern Benin

BackgroundBenin’s healthcare system is characterized by a lack of local guidelines for surgical antibiotic prophylaxis (SAP), which is essential to prevent surgical site infection. AimTo audit compliance for SAP practices in gastrointestinal surgery. MethodsData were prospectively collected from gastrointestinal surgery departments in five hospitals. Over a four month period, SAP was assessed using five conventional criteria (indication, choice of antibiotic, dosage, timing, and duration of administration) among patients admitted for Altemeier class 1 or 2 procedures. Three guidelines were used as reference: World Health Organization (WHO), American Society of Health-System Pharmacists (ASHP)and French Society of Anaesthesia and Intensive Care Medicine (SFAR). FindingsOf 68 surgical interventions, overall compliance with WHO, ASHP, and SFAR was observed in zero (0.0%), one case (1.5%) and two cases (2.9%), respectively. Compliance with indication varied according to the guidelines: 65 (95.6%) were compliant with WHO and ASHP and 47 cases (69.11%) with SFAR. Among compliant cases, the antibiotics administered were rarely selected according to guidelines: WHO, 2 (2.9%) and ASHP, 2 (2.9%), and SFAR, 3 (4.4%). Drug dosage compliance varied from 20 (29.4%) (SFAR) to 49 (72.0%) (ASHP). Timings were respected in 47 (69.1%; WHO), 45 (66.2%; ASHP) and 9 cases (13.2%; SFAR). The number of cases compliant with antibiotic prophylaxis duration were 13 (19.1%; WHO), 17 (25.0%; ASHP) and 16 (23.5%; SFAR). ConclusionThe SAP compliance rate in gastrointestinal surgery based on the five conventional criteria was very low. SAP guidelines must be implemented appropriately for local bacteriological epidemiology.

Nationwide Survey to Characterize and Compare the Research Experiences of American Society of Health-System Pharmacists-Accredited Postgraduate Year One Pharmacy Residency Programs.

Background: Many Postgraduate Year One (PGY1) Pharmacy residencies provide research training however, details of this training are not well described. Publication rates have been utilized to assess residency research learning experiences. Higher publication rates have been reported by programs that have implemented a structured research learning experience. Objective: The primary objective was to identify differences in the research learning experiences for American Society of Health-System Pharmacists (ASHP) accredited PGY1 Pharmacy residencies with reported resident publication rates of ≥20% vs <20%. Methods: This survey was distributed to PGY1 Pharmacy residency program directors (RPDs). Seven sections were analyzed to identify research learning experience differences between programs with reported publication rates of ≥20% vs <20%: (1) program characteristics/research outcomes; (2) involved individuals; (3) requirements; (4) learning experience structure; (5) educational methods; (6) formal education; (7) barriers/RPD perceptions. Variables with P < 0.05 on logistic regression were considered statistically significant. Results: The survey response rate was 31.3% (308/984). Significant positive predictors for reported publication rates of ≥20% were: involved individuals: research director/coordinator, individuals trained in statistics, non-pharmacy medical staff; requirements: Collaborative Institutional Training Initiative training, research seminars/training courses, research manuscript; learning experience structure: research committee; educational methods: didactic residency-led lectures/courses, formal workshops, self-taught online modules; and formal education: manuscript preparation. Conclusion: This study suggests there are differences in the research learning experiences at PGY1 Pharmacy residencies with reported resident publications rates of ≥20% vs <20%. We encourage PGY1 Pharmacy residency programs to consider implementing elements associated with reported resident publication rates of ≥20%.

Cross-sectional description of hospital pharmacy services in Puerto Rico in 2022 using the Practice Advancement Initiative 2030 Self-Assessment Tool.

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. The American Society of Health-System Pharmacists (ASHP) developed the Practice Advancement Initiative 2030 (PAI 2030) to support the continuous improvement of hospital pharmacy services in the United States. Puerto Rico (PR) hospitals' level of compliance with PAI 2030 recommendations is not currently known. The primary objective of this study was to describe the hospital pharmacy scenario in PR in the 5 areas addressed in PAI 2030 recommendations. Through a collaboration between the state affiliate, a school of pharmacy, and ASHP, completion of the PAI 2030 Self-Assessment Tool was promoted among hospital pharmacy directors between August 2022 and March 2023. A total of 18 out of 66 hospitals completed the survey. The results were compared with national data provided by ASHP from 163 US hospitals. Areas where PR hospitals rated high were in PAI 2030 domain A (Pharmacy Technician Role, Education, and Training) and domain E (Pharmacist Leadership in Medication Use and Safety). PR hospitals rate their performance lower in domain A (Patient-Centered Care) and domain B (Pharmacist Role, Education, and Training). Specific focus areas for improvement by PR hospitals include pharmacist participation in medication reconciliation, 24/7 access to advanced clinical pharmacy services, expansion of the pharmacist's scope of practice, and training through the Board of Pharmacy Specialties and residency programs. This study illustrates how the PAI 2030 Self-Assessment Tool can be used to benchmark pharmacy services at the state level. We suggest that changes are needed to close the gap between hospital pharmacies working towards optimizing the role of pharmacists in healthcare systems and those still struggling with dedicating staff to well-recognized pharmacist roles and responsibilities.

Executive Summary-Society of Critical Care Medicine Guideline and American Society of Health-System Pharmacists for the Prevention of Stress-Related Gastrointestinal Bleeding in Critically Ill Adults.

Executive Summary-Society of Critical Care Medicine Guideline and American Society of Health-System Pharmacists for the Prevention of Stress-Related Gastrointestinal Bleeding in Critically Ill Adults.

Evaluation of General Surgery Physicians' Approaches to Surgical Antimicrobial Prophylaxis by Questionnaire Method

Introduction: Surgical site infections (SSIs) are infections of the incision site, organ or cavity that occur after surgery, causing a significant burden in terms of morbidity, mortality and healthcare costs. SSIs are the most common healthcare-associated infections in low- and middle-income countries and may affect one-third of surgical patients. This study aimed to conduct a face-to-face survey to evaluate general surgeons' approaches and knowledge levels before and after the training seminar on the use of surgical antimicrobial prophylaxis (SAP). Material and Method: An information-oriented questionnaire consisting of 10 questions was administered to a total of 18 surgeons working a General Surgery Department before and after the education meeting to evaluate their knowledge and attitudes towards the use of SAP. Data were presented as number, percentage, mean (standard deviation) and Fisher exact test was used to compare categorical data. Results: All participants answered the question regarding the time of prophylactic antibiotic administration correctly in both surveys. According to the current American Society of Health-System Pharmacists (ASHP) guideline for cefazolin, 42.2% of the patients had the correct time of antibiotic administration. The proportion of patients whose cefazolin selection, dose and time of administration were appropriate was 14.6%. The number of physicians who thought that postoperative antibiotic prophylaxis was not significantly increased from 16 (88.8%) before the meeting to 18 (100%) after the meeting (p&gt;0.05). In our study, the number of patients who continued to be given antibiotics unnecessarily postoperatively was 66 (16.4%). Conclusion: In order to increase the rate of optimal application of the theoretical knowledge to patients in practice, it is important to organize routine trainings based on current literature and service data for surgeons with a high workload and to follow the reflection of these trainings to the clinic in order to improve SAP compliance rates.

Optimization of appropriate antimicrobial prophylaxis in general surgery: a prospective cohort study

BackgroundSurgical site infections (SSI) are characterized by infections occurring in the surgical incision site, organ or cavity in the postoperative period. Adherence to surgical antimicrobial prophylaxis (SAP) is paramount in mitigating the occurrence of SSIs. In this study, we aimed to evaluate the appropriateness of SAP use in patients undergoing surgical procedures in the field of general surgery according to the American Society of Health-System Pharmacists (ASHP) guideline and to determine the difference between the pre-training period (pre-TP) and the post-training period (post-TP) organized according to this guideline.MethodsIt is a single-center prospective study conducted in general surgery wards between January 2022 and May 2023, with 404 patients pre-TP and 406 patients post-TP.ResultsCefazolin emerged as the predominant agent for SAP, favored in 86.8% (703/810) of cases. Appropriate cefazolin dosage increased significantly from 41% (129 patients) in pre-TP to 92.6% (276 patients) in post-TP (p < 0.001), along with a rise in adherence to recommended timing of administration from 42.2% (133 patients) to 62.8% (187 patients) (p < 0.001). The proportion of patients receiving antibiotics during hospitalization in the ward postoperatively decreased post-TP (21–14.3%; p = 0.012), as did antibiotic prescription at discharge (16.8–10.3%; p = 0.008). The incidence of SSI showed a slight increase from 9.9% in pre-TP to 13.3% in post-TP (p = 0.131).ConclusionsRoutine training sessions for surgeons emerged as crucial strategies to optimize patient care and enhance SAP compliance rates, particularly given the burden of clinical responsibilities faced by surgical teams.

Evaluation of the appropriateness of vancomycin therapeutic drug monitoring in the intensive care unit with a clinical pharmacy approach, a cross-sectional study

ObjectivesVancomycin, a glycopeptide antibiotic has antibacterial activity against Gram-positive bacteria and is frequently used in the intensive care unit (ICU). Inappropriate therapeutic drug monitoring (TDM) of vancomycin is a common...

Success of an expedited health system-based pharmacy technician training program to address the workforce needs of an institution.

The formation, implementation, outcomes, and impact on retention of a health system-based pharmacy technician training program are described. The program seeks to produce graduates who are well equipped for employment within the health system and eligible for certification by the Pharmacy Technician Certification Board, thereby developing a consistent source of well-trained technicians to meet the needs of the health system. The program's ideal candidate is one who is seeking to begin or transition to a career in health-system pharmacy. The affordable accredited program provides candidates with the skills needed to become a certified pharmacy technician. A distinguishing feature of the program design is the pace of the curriculum, designed to be completed in 11 weeks. The program is accredited by the American Society of Health-System Pharmacists and the Accreditation Council for Pharmacy Education at the entry-level accreditation standard. The program is structured to enroll 3 cohorts annually, beginning in April, August, and January. This provides a consistent and dependable bolus of graduates for hiring managers across the health system's pharmacy department. The program supports enrollment by internal and external candidates. In addition to didactic content, the simulation component of the program combines remote and onsite simulations. Following completion of the didactic and simulation content, students receive 2 blocks of acute and ambulatory care shadowing for 111 hours over 2.5 weeks of experiential content. The program realized benefits by partnering with an external digital content provider. First, the platform enabled the team to accelerate the time to program launch. A second benefit of the platform is the ability to conduct the program and update content. In April 2018, the institution launched the program to meet pharmacy technician needs within the organization. As of April 2022, 11 cohorts have successfully completed the program, with a total of 41 graduates. At the time of writing, the retention rate in the health system for those beginning the training program in April 2018 was an impressive 90%. In comparison, the overall retention rate for the pharmacy department during this same period was 31%. The program has a graduation rate of 93% and a job placement rate as a pharmacy technician of 90%. The institution believes that this program has helped provide a consistent supply of well-trained technicians to meet the needs of the health system and that the program provides a superior level of clinical training to technician students at an affordable price. The program represents a novel strategy to efficiently and effectively train pharmacy technicians and has been demonstrated to result in improvements to the health system. Establishing a pharmacy technician training program provides a mechanism to ensure continuity and uniformity as healthcare continues to evolve. By providing a source of well-trained pharmacy technicians, the program allows the profession to continue to achieve its overarching aims.

When Antimicrobial Treatment and Surgical Prophylaxis Collide: A Stewardship Opportunity.

Background: In 2002, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Centers for Disease Control and Prevention (CDC) established the Surgical Infection Prevention (SIP) project for the purposes of developing and standardizing quality improvement measures known to reduce the rates of post-operative surgical site infections (SSIs). Four years later the Surgical Care Improvement Project (SCIP), an expansion of SIP, was published in governmental Specifications Manual for National Inpatient Quality Measures and provided several additional initiatives applicable to the perioperative period. Central to both projects are the assurance of the timeliness, selection, and duration of peri-operative surgical prophylactic antibiotics. In support of this objective, various medical associations, such as the American Society of Health-System Pharmacists (ASHP) and the Infectious Diseases Society of America (IDSA), have developed the Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. To ensure compliance with quality measures, hospitals are required to report data to the Physicians Quality Reporting System, which is then reviewed by CMS for reimbursement purposes and to measure hospital performance. To maintain optimal standards of care and satisfy all core measures, it is expected that patients undergoing most categories of surgical procedures receive prophylactic antibiotics. We recognized that patients already being administered antimicrobial therapy as treatment for the condition requiring the surgery not uncommonly also were prescribed unwarranted and redundant pre-operative antibiotics. Our study was meant to quantify such antibiotic redundancy, which only risks the development of antimicrobial resistance and adverse events, to bolster our and other hospitals antimicrobial stewardship programs. Methods: A retrospective analysis of computerized hospital records over a one-month period of time (November 2022) was conducted focusing on hospital admissions that involved surgical operative procedures. Only those patients who had received a pre-operative surgical prophylactic antibiotic were included in the analysis. Results: Of the 92 surgeries that fulfilled the inclusion criteria, 38 (41.3%) were performed on patients who were already receiving therapeutic antibiotics for more than 24 hours targeted to treat the infection for which they were undergoing surgery. These included laparoscopic cholecystectomy (24), appendectomy (12), wound debridement (12), and soft tissue incision and drainage procedures (9), comprising nearly 50% of each type of these operations performed during the study time period. Conclusion: These findings demonstrate a clear opportunity to strengthen both our, and presumably other, hospitals antimicrobial stewardship programs. Together with physician education, granting the pharmacy the ability to cancel unnecessary and redundant surgical prophylactic antibiotics would conceivably be of great benefit.

Assessment of the appropriateness of stress ulcer prophylaxis use and its determinants among admitted surgical patients at Debre Berhan University Hakim Gizaw Hospital, Ethiopia. A hospital-based cross-sectional study.

Pharmacological stress ulcer prophylaxis (SUP) has been recommended for many years to reduce the risk of clinically significant upper gastrointestinal (GI) bleeding caused by stress ulcers (SUs). Stress-related ulcer bleeding in surgical patients significantly increases morbidity and mortality. Therefore, preventing stress-induced hemorrhage is the most appropriate measure for patients who are at increased risk. However, the inappropriate use of SUP has increased in recent years, and its use in Ethiopian surgical patients has not been well studied. The aim of this study was to assess the appropriateness of SUP use and its determinants among admitted surgical patients at Debre Berhan University Hakim Gizaw Hospital (DBUHGH), Ethiopia. We randomly selected 230 patients from the whole cross-sectional group of all surgical patients at DBUHGH from 1 February to 30 June 2023. The risk of stress ulcer (SU) development was assessed using the modified American Society of Health-System Pharmacists (ASHP) guidelines. For data analysis, we used SPSS version 25. The mean age of study participants was 47.2 years (SD ± 20.4), and out of the total of 230, 130 (56.5%) were women. Approximately 66% of study participants took inappropriate SUP based on ASHP guidelines criteria. The most commonly used drug class for SUP was histamine-2 receptor blockers 115 (50%). Study participants who have a Charlson Comorbidity Index Score of moderate and GI bleeding have been significantly associated with the inappropriate use of SUP. In our study, inappropriate SUP use was common in the surgical ward of DBUHGH. This may be an area that requires further and more focused working together among clinical pharmacists and medical professionals in an institution-specific SUP protocol that aids clinicians in identifying appropriate candidates for SUP medication.

Appropriateness and Cost of Prophylaxis Stress Ulcer for Inpatient in the Internal Medicine Department in a Government Hospital: A Cross-Sectional Study

Guidelines from the American Society of Health-System Pharmacists (ASHP) 1999 prohibit acid-suppressing therapy for stress ulcer prophylaxis (SUP) in patients who are not critically ill. Stress ulcer prophylaxis is not recommended in non-ICU patients with &lt;2 risk factors. Inappropriate use of SUP can increase costs for patients. This study aims to evaluate the use and the cost of SUP. This research was a non-experimental observational study with a cross-sectional approach. Data was collected retrospectively using the consecutive sampling method with a random sampling technique on the medical records of inpatients in the internal medicine ward of Sleman Regional Public Hospital from January to December 2020, totaling 340 samples. The results showed that proton pump inhibitors were the most widely used acid-suppressing drugs, with 45.8%. Furthermore, the histamine-2 receptor antagonist was 42.6%, the sucralfate group was 7.4%, and the antacid group was 4.2%. Of 340 patients, 57 (16.8%) were in the proper indication based on the guidelines, and 283 (83.2%) were under the wrong indication for SUP. They were using SUP with the proper indication so that the therapy could save treatment costs by Rp. 19,933,582. There was a high prevalence of inappropriate SUP prescriptions among inpatients in the internal medicine department; if these drugs were given with the appropriate indications, they could save more on the prophylaxis cost. Clinician pharmacists should develop an effective intervention strategy to reduce inappropriate SUP drugs.

Solid organ transplant residency research publication rates and characteristics associated with successful publication

AbstractIntroductionPublication rates, characterization, and assessment for predictors of publication in post‐graduate year 2 (PGY2) solid organ transplant (SOT) are lacking.ObjectivesThis study was conducted to determine the publication rate of PGY2 SOT pharmacy resident projects, understand practices surrounding resident research, and assess characteristics of published manuscripts.MethodsAn electronic survey of PGY2 SOT residency programs was distributed. Invitation for participation was sent by email to residency program directors (RPDs), and information related to the PGY2 SOT program, RPDs, research mentors/preceptors, residents, and each research project was gathered for residents graduating between 2016 and 2019. Characteristics influencing publication success were assessed with multivariate logistic regression modeling.ResultsThirty‐eight RPD responses were analyzed (67.8% response rate). All PGY2 SOT programs were American Society of Health‐System Pharmacists (ASHP) accredited, 92% were at academic medical centers, and more than 80% were active over 6 years with a median of 10 (interquartile range [IQR] 5–13) graduated residents. In total, 35/97 (36.1%) of SOT PGY2 research projects were published, 22.7% intend to submit or have a manuscript under revision, and 39.2% will not pursue publication. Of published projects, 81% were in medical journals. Median impact factor was 2.9 (IQR 1.5–2.9). Programs active more than 10 years (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.41–11.17, p = 0.009) and utilization of additional resources (OR 4.2, 95% CI 1.23–14.37, p = 0.022), including availability of a biostatistician/epidemiologist or pharmacy student, were independently predictive of publication. Fifty percent of RPDs rated their programs as either “effective” or “extremely effective” in enabling publication. Perceived barriers to publication, most often continuity of PGY2 SOT involvement after residency, were identified.ConclusionOverall, 36.1% of PGY2 SOT pharmacy resident research projects achieved publication over a 4‐year period at the time of the survey. Years of PGY2 SOT program activity and having additional resources were independently associated with publication.

Pharmacy practice in hospital settings in GCC countries: Pharmacists’ medication therapy monitoring activities

PurposeOur study aims to provide an overview of medication therapy monitoring practices carried out by pharmacists in hospitals across the Gulf Cooperation Council (GCC) countries. MethodsThis is a cross-sectional questionnaire-based study of hospitals located in the GCC. Questions were adopted from the American Society of Health-System Pharmacists (ASHP) national survey. Frequency analyses were used to examine the number and percentages of specific responses to the survey questions. ResultsA total of 64 hospitals participated in this survey, reflecting an overall response rate of 52.0%. Almost half of participating hospitals (48.4%) were from Saudi Arabia. Among the 64 participating hospitals, 54.7% monitored their patients daily, 40.6% assigned pharmacists to patient care units for at least eight hours per day, and 42.2% held pharmacists accountable for medication-related outcomes. Moreover, the criteria used to identify patients requiring monitoring, 35.9% relied on the list of high-risk medications, 26.5% relied on specific medical services, 21.9% relied on directions from the hospital committee, and 17.2% relied on lab abnormalities. The most frequently utilized method for monitoring adverse drug events (ADEs) was through notifications from nurses or physicians, observed in 60.9% of participating hospitals. ConclusionThe survey emphasizes the need for hospitals in the GCC to promote increased pharmacist accountability for medication-related outcomes, explore technological solutions to enhance monitoring efficiency and extend the presence of pharmacists in patient care units beyond the current level.

Exposing Pharmacy Residents to Implementation Science.

The American Society of Health-System Pharmacists (ASHP) aims to improve patient care by innovating pharmacy practices. ASHP-accredited pharmacy residencies require projects that enhance pharmacy practice, focusing on effective project management and quality improvement. However, only a few of these innovations smoothly become part of routine clinical practice. One solution worth exploring involves teaching Implementation Science in residencies. Exposing residents and mentors to Implementation Science offers two main benefits. First, it helps learn from failed interventions by considering alternative thoughts and grasping environmental influences, leading to smarter decisions in future implementations. Second, applying implementation science improves patient care by turning evidence-based practices into practical actions, ensuring better care, consistency across healthcare setups, fewer errors, and tailoring innovative services to specific institutional needs. Exposing pharmacy residents to implementation science pushes forward pharmacy practice by actively applying evidence-based innovations in broader pharmacy or clinical practice.

Prevention of iatrogenic fluid overload with naloxone infusions: A patient safety initiative

A higher number of patients admitted to hospital systems are requiring a naloxone infusion for treatment of opioid toxicity. Although naloxone is a safe antidote for the treatment of opioid toxicity, this is not without the risk of iatrogenic harm. During standard pharmacy medication safety review process, it was identified that our standard naloxone concentration protocol would deliver 4 times the standard maintenance fluid rate to our pediatric patient population. After this risk was identified, a multidisciplinary review process of our naloxone infusion protocol was performed to help mitigate the potential risk of fluid overload. Our updated naloxone infusion protocol will result in close to a 10-fold reduction in fluids required for our naloxone infusion protocol to better align with the American Society of Health-System Pharmacists’ Standardize 4 Safety Initiative and reduce the potential for iatrogenic harm.

ANTIMICROBIAL PROPHYLAXIS IN SURGERY: A CROSS-SECTIONAL STUDY IN THE SURGICAL WARD OF A TERTIARY CARE CENTRE IN CENTRAL NEPAL

Background: Surgical Antimicrobial Prophylaxis is administration of a short course of antimicrobial agent prior to surgery. It has long been recommended for routine use in preventing occurrence of surgical site infections. The choice of drug, dosage, route, duration and timing of antimicrobial prophylaxis has been specified in the clinical practice guideline issued by American Society of Health-System Pharmacists. In the present study, we aim to seek the practice of antibiotic prophylaxis at a tertiary care centre in central Nepal and report the adherence to American and National Antimicrobial Treatment Guideline where applicable. Methods: This hospital-based cross-sectional study was conducted between January to June 2023 among 232 patients undergoing surgery at Chitwan Medical College Teaching Hospital. Data collection tool prepared with slight modification from previous studies recorded the demographic details, surgical data, surgical antimicrobial prophylaxis usage data and assessment of Prophylaxis data. Data analysis was done using SPSS-20. Results: We observed compliance to selection of drug, route of administration, dosage of antimicrobial prophylaxis with American guideline. All (100%) prophylaxis was administered parenterally for more than 72 hours in over 40% cases. Choice of drug was appropriate in over 84% of cases and dosage adequacy was observed in over 61% cases. Surgical antimicrobial prophylaxis was administered most frequently 30 minutes before surgery (52.59%). Conclusions: All the surgical patients were found to receive surgical antimicrobial prophylaxis. Ceftriaxone was the most commonly administered drug followed by combination of piperacillin and tazobactam. The duration of treatment post-surgery was found to be unnecessarily broader than recommended guideline.

Navigating obstacles: Perspectives of US pharmacy residency directors on non‐US candidates for PGY‐1 residencies: A survey‐based research

AbstractIntroductionPharmacy education and postgraduate training in the United States (US) are esteemed, drawing international students to American Council for Pharmacy Education (ACPE)‐accredited schools and pursuing residency training after graduation. Despite this, limited literature addresses the obstacles international students face in pursuing American Society of Health‐System Pharmacists (ASHP) accredited residency programs.ObjectivesTo summarize potential eligibility barriers for international graduates of ACPE programs during the residency application process from residency program directors' (RPDs) perspectives.MethodsA 16‐question electronic survey was developed and distributed to all RPDs of US‐based ASHP‐accredited postgraduate year‐1 (PGY‐1) programs in July 2021. Questions addressed whether non‐US citizens were eligible to apply, barriers to recruiting non‐US citizen candidates, and barriers to offer visa sponsorships. Descriptive statistics were used to summarize the data.ResultsA total of 196 programs responded to the survey (response rate, 13.5%). Eighty‐nine (45.4%) programs reported that candidates with F‐1/optional practical training (OPT) status were eligible to apply for their program, while 86 programs (43.9%) reported candidates were not eligible. Barriers for recruiting candidates with F‐1/OPT status included lack of resources to support application process (n = 42), citizenship requirements (n = 41), institution policy (n = 33), department preference (n = 12), and unfamiliar with procedures in selecting these candidates (n = 18). Over 70% (n = 146) would not offer visa sponsorship for pharmacy resident positions. Barriers to offering sponsorship were lack of support resources (n = 62), cost (n = 60), time preparing applications (n = 46), citizenship requirements (n = 45), and department preference (n = 23).ConclusionThis study investigates the obstacles encountered by non‐US citizens in the residency application process, as perceived by program directors. The primary obstacle in recruiting candidates with F‐1/OPT status and providing visa sponsorships revolves around the inadequate support and resources available for the application process.

Improving Treatment Adherence in Patients with Sickle Cell Disease

BACKGROUND: Crizanlizumab is approved for treatment of sickle cell disease (SCD) patients with frequent pain crises and hospital admissions. Here, we address systemic factors that have led to sub-optimal adherence to monthly crizanlizumab infusions at our institution. Due to 340B status limitation, the drug was originally offered at a site affiliated to our hospital with little SCD team presence. In 2020, UW hospital (primary site of SCD care) acquired 340B status, but transferring crizanlizumab infusions to UW hospital was not prioritized. In 2022, our institution's crizanlizumab adherence was 22% 1. Patients receiving crizanlizumab were interviewed to identify adherence barriers. Top barriers included location (44%), scheduling (44%), and low knowledge about the medication (67%). A detailed analysis with SCD team input revealed barriers such as restriction on opioids for day treatment, scheduling delays after hospital admissions, onerous paper orders process, different EMRs, and poor communication/coordination between sites (Fig 1). METHODS: The hospital leadership was appraised of these barriers in a series of meetings by the SCD team and approval to administer crizanlizumab at UW hospital infusion center was granted. UW health pharmacy and infusion staff planned a transition phase with 5 patients transitioned each month between March-April 2023. Crizanlizumab orders were updated in the EMR, and infusion nursing staff received training about the drug. Smart phrases were created for patient education in after visit summaries (AVS). Day treatment with IV fluids and pain management was offered with infusions. SCD care coordinator and social worker helped with scheduling, transport, and childcare. Providers aimed to discuss treatment goals and pros/cons during visits. Goal was set to assess adherence at months 3 and 12 after implementation. Average rate of adherence was defined as percent of prescribed treatments taken by the patient over a specified time period. In case of hospitalization, adherence was defined as rescheduling and receiving the treatment. We aimed to improve adherence to 50% at 3 months and 75% at 12 months if crizanlizumab FDA approval is maintained. RESULTS: By mid-July 2023, 11 patients were transitioned to UW Hospital for crizanlizumab infusions. 10/11 patients received the drug during this period (1 patient taken off due to pregnancy). The average adherence rate increased from 22% to 71% at 3 months, exceeding the original goal. 5/10 patients had an adherence rate of 75% or more. Additionally, 70% received at least one visit from the SCD social worker (SW) during treatment and 70% saw their provider concurrently with at least one visit. All patients received day treatment with supportive IVFs and/or pain medications during the infusion visit (Fig. 2). Only 2/10 patients had 25% or less adherence which occurred due to scheduling errors that will be addressed moving forward. DISCUSSION: Our study aims to address both intentional and unintentional barriers to crizanlizumab adherence that included infusion location, scheduling, and patient education. Our team advocated for the transition of infusions to the main hospital where they receive all other SCD care. This provided patients with direct access to their SCD team during infusions. Care coordinator and social work involvement helped consolidate treatment-related orders to one EMR, standardize nursing and patient education, organize scheduling, and address social barriers. The adherence rate increased from 22% to 71% at 3 months after implementation. Although the current approval of crizanlizumab is under review, we believe the barriers addressed in this project can be extended to current SCD treatments and upcoming novel therapies. Splitting care sites due to insurance and logistical reasons can create barriers for this vulnerable population due to complex care coordination and psychosocial needs. The rapid improvement in crizanlizumab adherence displayed here is a testament to the impact of having a dedicated SCD team at one leading site to advocate for and address the unique barriers to healthcare experienced by people with SCD. Sources 1. Nixon G, Fallon M, Fulcer K, Curran W, Nazeef M, Pradhan R. How can infusion therapy adherence by improved in Sickle Cell Disease. American Society of Health-System Pharmacists; Dec. 2022. Las Vegas, NV.