American Society Of Health-System Pharmacists Research Articles

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

Abstract 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 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. Summary 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. Conclusion 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 <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.

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.

Landscape of board certification preparation in pharmacy residency programs

AbstractIntroductionBoard certification among pharmacists is increasing in prevalence, accompanying expanded practice opportunities and exam availability to broader specialty areas. Residency training is one common prerequisite for board certification. Although there are documented benefits, board certification preparation (BCP) has yet to be evaluated among the American Society of Health System Pharmacists (ASHP)‐accredited residency programs.ObjectivesThe objectives of this study were to determine the status of BCP among ASHP‐accredited residency programs and corresponding attitudes of residency program directors (RPDs) regarding BCP.MethodsThis study is a mixed methods cross‐sectional survey of RPDs from United States (US) states. Eligible RPDs were identified through the ASHP residency directory. A 33‐item survey was developed in REDCap® and distributed via email. Those with missing or invalid emails were excluded. The survey was open for 6 weeks and responses were anonymous. Descriptive statistics were applied for data evaluation.ResultsOf the 1601 RPDs emailed, 360 survey responses were received, a 23.3% response rate when excluding invalid email addresses. Among the survey respondents, 313 (86.9%) were board certified. Respondents served as RPDs of Postgraduate Year One (PGY1) (175, 48.6%) or Postgraduate Year Two (PGY2) (177, 49.2%) programs. Structured BCP was offered by 33 (9.2%) programs and 49 (13.6%) financially support residents' BCP. Among programs that offer structured preparation, 12 (36.4%) use institution‐specific materials. Among programs that do not currently offer BCP, 142 (57.3%) indicated they were “somewhat” or “very” interested in implementation, identifying the top barriers as cost and time.ConclusionsA small proportion of programs offer structured BCP, although interest appears high among RPDs to consider implementation. The likelihood of implementation would presumably increase if associated barriers were addressed. Further qualitative evaluation may assist interested programs in efficient, cost‐effective implementation of BCP through institution‐specific or commercially available products.

National Hospital and Health-System Controlled Substances Drug Diversion Prevention & Surveillance Program Assessment Survey - 2021.

To present and discuss the results of the National Hospital and Health-System Controlled Substances Drug Diversion Prevention & Surveillance Program Assessment Survey. The survey was emailed to 1,529 chief pharmacy officers utilizing the list of directors of pharmacy from the American Society of Health-System Pharmacists. The survey opened September 15, 2021, and closed October 4, 2021. Forty-nine questions were included in 5 different sections, and participants were also given the option to respond to 39 additional questions. The survey response rate was 12.75%, with the results showing consistencies in practice around drug security and human resource management. Sixty-two percent of sites had a formalized drug diversion committee, half of which had been implemented since 2018. Adoption of electronic controlled substance systems continues to increase, with 50% of sites having implemented such a system in the previous 3 years. At the time of the survey, 18% of organizations did not have an electronic system, but 90% of sites had implemented or intended to implement one by 2023. Over 40% of sites that utilized an electronic system were looking to upgrade to a next-generation system. Most organizations had 0.5 to 1 full-time equivalent dedicated to diversion prevention, and two-thirds of sites had a formalized diversion committee. The majority of sites defined "significant loss" by utilizing professional judgement, based on the scenario, as a percentage of inventory or as a range of units. Community practice consensus is needed around auditing adjustments to controlled substance inventory and for perpetual inventory processes. Respondents reported 1 to 2 (29%), 3 to 5 (26%), and more than 10 (26%) formal drug diversion investigations annually. This first-time survey provided significant insight into the realities of drug diversion prevention practices in hospitals and health systems nationally.

ASHP Survey of Health-System Specialty Pharmacy Practice: Practice Models, Operations, and Workforce - 2022.

The results of the 2022 American Society of Health-System Pharmacists (ASHP) Survey of Health-System Specialty Pharmacy (HSSP) Practice: Practice Models, Operations, and Workforce are presented. A total of 273 leaders in HSSPs were contacted by email to complete a survey hosted using Qualtrics. The survey sample was compiled from ASHP member lists, the presence of a specialty pharmacy indicated in previous ASHP surveys, and outreach to ASHP member organizational leaders. The survey response rate was 35.9%. Most HSSPs dispense 30,000 or fewer specialty prescriptions annually. Most respondents have an annual revenue of $100 million or less, are part of a 340B-covered entity, operate one location, have 1 to 2 specialty pharmacy accreditations, dispense both nonspecialty and specialty medications, and employ an average of 15.5 pharmacists and 17.6 technicians. The majority (66.7%) dispense 50% or less of prescriptions written by internal providers due to payor and manufacturer network restrictions. Over one-third employ nonpharmacist and nontechnician professionals. Specialty pharmacists are involved in treatment decisions and therapy selection before prescription generation (69.8%), and 47.7% of respondents report pharmacists operating under collaborative practice agreements. Most (82.6%) offer experiential or formal education in specialty pharmacy. The top point of pride remains patient satisfaction and level of service. Top challenges include access to payor networks, the ability to hire and retain qualified staff, and shrinking reimbursement from payors. The HSSP is a continually maturing integrated advanced practice model focused on providing patient-centric care to all patients and employees of the health system regardless of network status. HSSPs are raising the standards for quality in specialty pharmacy care.

Implementing and evaluating a diversity, equity, and inclusion resident recruitment strategy.

A recruitment strategy was designed to increase the racial diversity of applicants to the postgraduate year 1 pharmacy program at University of Michigan Health, Michigan Medicine (MM). This article describes MM's diversity, equity, and inclusion (DEI) residency recruitment approach, from conceptualization through implementation, and includes an evaluation of its effectiveness. The report of the American Society of Health-System Pharmacists (ASHP) Task Force on Racial Diversity, Equity, and Inclusion, published in January 2021, provided a foundation for our recruitment approach. The approach consisted of establishing a residency DEI subcommittee, conducting outreach to under-represented students, and reducing bias in the process by amending the application screening rubric. The combination of these efforts resulted in a 5% increase in applicants from pharmacy schools with a high proportion of under-represented minority students. A diverse residency program benefits patients, trainees, and the larger healthcare organization. In addition, incorporating DEI into resident recruitment is required by the new ASHP Accreditation Standard for postgraduate pharmacy residency programs effective July 1, 2023. Evaluation of our recruitment efforts demonstrated targeted recruitment as an effective strategy to increase the diversity of a residency program's applicants. There may be additional barriers not addressed by our interventions to be further explored.

Alternatives to Hydrocortisone for Hemodynamic Support in Septic Shock Management Due to Medication Shortage.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Septic shock is when initial fluid resuscitation fails to increase the mean atrial pressure to greater than or equal to 65 mm Hg. The 2021 Surviving Sepsis Campaign guidelines recommend corticosteroids for vasopressor and fluid-refractory septic shock patients. Medication shortages can arise, and their etiologies include natural disasters, quality control issues, and manufacturing discontinuation. The U.S. Food and Drug Administration and the American Society of Health-System Pharmacists announced a shortage of IV hydrocortisone. Methylprednisolone and dexamethasone are considered therapeutic alternatives to hydrocortisone. This commentary aims to guide clinicians on the alternative to hydrocortisone among septic shock patients due to medication shortage.

We're Out Again?! Drug Scarcity and What We Can Do About It

Committee News| June 2023 We're Out Again?! Drug Scarcity and What We Can Do About It Michael J. Norton, MD, MBA, FASA; Michael J. Norton, MD, MBA, FASA Search for other works by this author on: This Site PubMed Google Scholar Kayla M. Knuf, MD Kayla M. Knuf, MD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2023, Vol. 87, 32. https://doi.org/10.1097/01.ASM.0000938856.48028.ef Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Michael J. Norton, Kayla M. Knuf; We're Out Again?! Drug Scarcity and What We Can Do About It. ASA Monitor 2023; 87:32 doi: https://doi.org/10.1097/01.ASM.0000938856.48028.ef Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: medication shortages, united states food and drug administration, american society of health-system pharmacists, army, government, professors In recent years, people around the world have experienced difficulty obtaining the medications they need to manage their acute and chronic health concerns. Adderall, amoxicillin, and Tamiflu have recently made news for being in short supply, but they're just the latest in a long line of drugs whose availability has been disrupted. Many other drugs have suffered shortages over the years, as we in the anesthesiology community know all too well. Uncertainty over drug availability inevitably leads to questions. How big is the drug shortage problem? Is the problem getting worse or is recency bias simply making it feel that way? What is being done to combat it, and what can anesthesiologists and other physicians do locally and globally to alleviate supply challenges? In our role as clinical pharmacologists and patient safety advocates, anesthesiologists must understand the current problem and the answers to these questions. The American Society of Health-System... You do not currently have access to this content.

Part II: Interactive case: Drug‐induced endocrine disorders

Part <scp>II</scp>: Interactive case: <scp>Drug‐induced</scp> endocrine disorders

Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Care Teaching Hospital in Central India: A Retrospective Analysis.

Surgical antibiotic prophylaxis (SAP) has been a boon in the prevention of surgical site infections (SSIs). This study was conducted to assess and evaluate the selection, timing, and duration of administration of SAP and their compliance withnational and international guidelines in a tertiary care teaching hospital in India. This retrospective study included the data collected from the central records department in a tertiary care teaching hospital on major surgeries conducted between January 1, 2018, and December 31, 2018, from the departments of ENT, general surgery, orthopedic surgery, and obstetrics and gynecology. The data was analyzed for the appropriateness of their indication for SAP administration, choice, timing, and duration of antibiotics, and compliance with the American Society of Health-System Pharmacists (ASHP) and Indian Council of Medical Research (ICMR) guidelines. Results and interpretation Out of the total 394 case records included, only 2.53% (n = 10) of the cases were given an appropriate antibiotic. The duration of SAP was appropriate only in 6.53% (n = 24), and the timing of SAP administration was appropriate only in 50.76% (n = 204). The most commonly used antibiotic was ceftriaxone (pre-operative 58.12% (n = 229) and post-operative 43.14% (n = 170)). Major inappropriateness was observed in the selection of antibiotics which may be attributed to the non-availability of cefazolin in the institute. The inappropriateness of the duration of the SAP may be attributed to the extra precautions taken by the treating physicians to prevent SSIs. The overall compliance of the surgical cases with respect to the ASHP and ICMR guidelines was less than 1%. Conclusion This study identified the lacuna between the guidelines for SAP and the clinical application of the same. It also identified the areas where quality improvement was needed which can be improved by implementing antimicrobial stewardship, especially the choiceand the duration of SAP administration.

The Role of a Pharmacy Administration and Leadership Rotation within Postgraduate Year Two Critical Care Residency Training.

The job of a critical care pharmacy specialist has evolved to include quality improvement and administrative tasks. As such, the American Society of Health-System Pharmacists (ASHP) highlights specific goals and objectives to ensure post-graduate year two (PGY2) critical care residents are sufficiently trained to perform these tasks. The PGY2 critical care pharmacy residency leadership at the University of Kentucky sought to develop a four-week learning experience entitled, "Critical Care Administration / Medication Use Quality & Outcomes," as a unique rotation to capture these requirements and activities. The focus of this commentary is to serve as a guide for other residency programs to develop such a rotation, highlight resulting resident contributions to the department, describe perceived benefits of this rotation for residents, and highlight how this rotation impacted graduated residents' early years as practitioners. This learning experience is pivotal to providing a more balanced view of the entire medication use process and the healthcare ecosystem during a specialty residency. PGY2 critical care residents can gain valuable experiences away from the bedside that better prepare them for future tasks in addition to patient care that will be expected of them as clinical pharmacists.

Evaluating the role of clinical pharmacist in the detection and reduction of medication errors in a specialized burn unit.

This study evaluated the frequency and types of medication errors and the role of clinical pharmacist in the reduction of medication errors in a burn unit. The clinical pharmacist monitored medication use process in all patients admitted to the burn unit in the 4-month interventional study. Direct observation and chart review methods were used to detect medication errors. Medication errors were classified according to the classification of American Society of Health-system Pharmacists. The seriousness of medication errors was categorized based on the National Coordinating Council for Medication Error Reporting and Prevention index. During the study, 1653 drugs were prescribed to 94 patients. Totally, 259 medication errors were identified. The rates of medication errors were 2.75 errors/patient, 0.16 errors/ordered medication, and 0.98 errors/prescription. The most common type of errors was prescribing error (61.8%) followed by dispensing error (14.7%). Regarding the seriousness of medication errors, 1.9%, 21.6%, 45.9%, 30.1%, and 0.4% of errors were in the categories B, C, D, E, and F, respectively. Antibiotics had the highest rate of errors. Of all detected medication errors, 64.5% were intercepted or corrected by the clinical pharmacist interventions. Medication errors were not rare in the burn unit. Providing clinical pharmacy services to burn patients to reduce the incidence of medication errors is highly recommended.