Pharmacist Full-time Equivalents Research Articles

État des lieux de la prise en charge sanitaire des détenus et de l’organisation du circuit médicamenteux en milieu carcéral en France

Since the healthcare system reform in prisons by the law of 18January 1994, health care for prisoners has depended on the public hospital service. Since the application of this law, hospital pharmacists have been responsible for the health product circuit in the prison. In order to reassess the overall health care of detainees in prison in 2022, a study is being carried out. This study also aims to carry out an inventory of the organization of the drug circuit in prisons in France. In June 2022, a questionnaire was sent by email to pharmacists in charge of supplying health products to one or more prison health units in France. The response rate to the questionnaire is 34%. The average number of full-time equivalent (FTE) somatic doctors is 1.25. The average FTE pharmacist and pharmacy technician are respectively 0.4and 0.96. Prescriptions are computerized in 84% of cases. Therapeutic education and pharmaceutical interviews are carried out in 24% and 20% respectively. This study showed an overall improvement in the care of prisoners and the organization of the medication circuit in France compared to the last study. Pharmacists are more present in prisons. However, clinical pharmacy and health promotion actions are insufficiently deployed.

Clinical and economic impact of oncology-trained pharmacist integration in an ambulatory cancer clinic.

Outpatient oncology practice is a growing area of opportunity for pharmacists to provide clinical services and evidence-based care. This single-center, retrospective chart review analyzed the clinical and economic benefits of a board-certified oncology pharmacist after integration into the ambulatory oncology clinic setting. Primary outcomes were total cost avoidance for pharmacist interventions and impact on Centers for Medicare and Medicaid Services (CMS) OP-35 measures. Pharmacist interventions were characterized into distinct types which were then assigned a cost avoidance value. Cost avoidance was calculated per hour and then extrapolated to a yearly estimate based on a 40-h work week for one year for one full-time equivalent pharmacist. Data collection for the primary clinical outcome was performed by compiling provider-specific emergency department (ED) and inpatient admission rates for diagnoses specified in CMS OP-35 measures within 30 days after receiving outpatient chemotherapy. The rates for the data collection period were compared to the rates six months prior to pharmacist integration to assess pharmacist impact. In six months, 516 total interventions were made by the oncology pharmacist. The incidence of ED visits was 3.34% and 1.72% during the pre- and post-pharmacist intervention periods, respectively. The incidence of inpatient admissions was 2.43% and 0.34% pre- and post-pharmacist intervention, respectively. Total cost avoidance was estimated to be US$375,795 and when accounted for the median pharmacist salary at our institution, total cost savings was US$204,437. The presence of an oncology pharmacist specialist in the ambulatory cancer clinic provided clinical and economic benefits to the cancer clinic.

Organizational Readiness to Implement Community Pharmacy-Based Opioid Counseling and Naloxone Services: A Scoping Review of Current Practice Models and Opportunities

The purpose of this study was to explore existing practice models and opportunities surrounding community pharmacist-delivered opioid counseling and naloxone (OCN) services in the U.S., with the goal of enhancing organizational readiness and improving patient access. A scoping literature review was conducted. English-language articles published in peer-reviewed journals from January 2012–July 2022 were sought via PubMed, CINAHL, IPA, and Google Scholar using permutations of terms such as “pharmacist/pharmacy”, “opioid/opiate”, “naloxone”, “counseling”, and “implement/implementation”. Original articles reporting the resources/inputs (personnel; pharmacist full-time equivalents; facilities and expenses; in-house versus outsourced personnel), implementation processes (legal source of pharmacist authority; patient identification strategies; intervention procedures; workflow strategies; business operations), and programmatic outcomes (uptake and delivery; interventions made; economic impact; patient or provider satisfaction) of pharmacist-delivered OCN services in community (retail) settings were retained. Twelve articles describing ten unique studies were included. The studies primarily used quasi-experimental designs and were published from 2017 to 2021. The articles described seven broad program elements/themes: interprofessional collaboration (n = 2); patient education format including one-on-one patient education (n = 12) and group education sessions (n = 1); non-pharmacist provider education (n = 2); pharmacy staff education (n = 8); opioid misuse screening tools (n = 7); naloxone recommendation/dispensing (n = 12); and opioid therapy and pain management (n = 1). Pharmacists screened/counseled 11–2716 patients and provided 11–430 doses of naloxone. Limited implementation costs, patient/provider satisfaction, or economic impact measures were reported. This review may serve as a guide for community pharmacists in implementing OCN services in their own practices. Future studies should clarify OCN program implementation costs, patient/provider satisfaction, and the economic impact.

Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study

Background General practices have had difficulty recruiting and retaining enough general practitioners to keep up with increasing demand for primary health care in recent years. Proposals to increase workforce capacity include a policy-driven strategy to employ additional numbers and a wider range of health professionals. Objectives Our objective was to conduct a comprehensive study of the scale, scope and impact of changing patterns of practitioner employment in general practice in England. This included an analysis of employment trends, motivations behind employment decisions, staff and patient experiences, and how skill mix changes are associated with outcome measures and costs. Design NHS Digital workforce data (2015–19) were used to analyse employment changes and to look at their association with outcomes data, such as the General Practitioner Patient Survey, General Practitioner Worklife Survey, prescribing data, Hospital Episode Statistics, Quality and Outcomes Framework and NHS payments to practices. A practice manager survey (August–December 2019) explored factors motivating general practices’ employment decisions. An in-depth case study of five general practices in England (August–December 2019) examined how a broader range of practitioners is experienced by practice staff and patients. Results We found a 2.84% increase in reported full-time equivalent per 1000 patients across all practitioners during the study period. The full-time equivalent of general practitioner partners decreased, while the full-time equivalent of salaried general practitioners, advanced nurse practitioners, clinical pharmacists, physiotherapists, physician associates and paramedics increased. General practitioners and practice managers reported different motivating factors regarding skill mix employment. General practitioners saw skill mix employment as a strategy to cope with a general practitioner shortage, whereas managers prioritised potential cost-efficiencies. Case studies demonstrated the importance of matching patients’ problems with practitioners’ competencies and ensuring flexibility for practitioners to obtain advice when perfect matching was not achieved. Senior clinicians provided additional support and had supervisory and other responsibilities, and analysis of the General Practitioner Worklife Survey data suggested that general practitioners’ job satisfaction may not increase with skill mix changes. Patients lacked information about newer practitioners, but felt reassured by the accessibility of expert advice. However, General Practitioner Patient Survey data indicated that higher patient satisfaction was associated with a higher general practitioner full-time equivalent. Quality and Outcomes Framework achievement was higher when more practitioners were employed (i.e. full-time equivalent per 1000 patients). Higher clinical pharmacist full-time equivalents per 1000 patients were associated with higher quality and lower cost prescribing. Associations between skill mix and hospital activity were mixed. Our analysis of payments to practices and prescribing costs suggested that NHS expenditure may not decrease with increasing skill mix employment. Limitations These findings may reflect turbulence during a period of rapid skill mix change in general practice. The current policy of employing staff through primary care networks is likely to accelerate workforce change and generate additional challenges. Conclusions Skill mix implementation is challenging because of the inherent complexity of general practice caseloads; it is associated with a mix of positive and negative outcome measures. Future work Findings from this study will inform future funding applications for projects that seek to examine the nature and impact of evolving multiprofessional teams in primary care. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.

The Impact of a Hematopoietic Cellular Therapy Pharmacist on Clinical and Humanistic Outcomes: A RE-AIM Framework Analysis

The hematopoietic cellular therapy (HCT) pharmacist is an essential member of the multidisciplinary care team. Yet, standardized incorporation of a pharmacist at transplantation centers remains challenging. Implementation science uses theory-driven and systematic approaches to integrate interventions into clinical practice. We describe our experience implementing an HCT pharmacist at our center and conducted a program evaluation using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. We implemented 1 full-time equivalent pharmacist to provide medication management services through a collaborative practice agreement (CPA) to the allogeneic transplantation population at a medium-sized center in rural Pennsylvania over a 2-year period. The HCT pharmacist documented all in-person and telephonic care encounters in the electronic medical record. A pharmacist intervention tool was developed to document identified medication-related problems with corresponding interventions and magnitude of intervention. Summary statistics including frequency and percentages were presented for categorical variables in RE-AIM domain. Over the 2-year period, the HCT pharmacist monitored 40 allogeneic patients at our institution accounting for 1531 patient encounters. The average duration of follow-up was 299 days. The HCT pharmacist medication therapy services were able to reach all allogeneic transplants at our institute. The HCT pharmacist managed 388 medications and identified 2156 medication related problems for which the pharmacist provided 2959 interventions. Time in therapeutic range of immunosuppression was 73.9% when managed by the HCT pharmacist through a CPA. Of the 24 patients and 9 caregivers who completed the patient satisfaction survey, 25 (76%) were strongly satisfied with their care. Pharmacy services were gradually adopted and expanded to incorporate additional populations, including 121 autologous transplant and 272 hematology patient encounters. The role of the HCT pharmacist was justified with hospital administration and sustained as a designated pharmacist role at our center. The implementation of an HCT pharmacist service can positively impact patient care. The RE-AIM framework provides a methodological approach for programmatic evaluation and generalizability. © 2022 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

The Pharmacist Is In: The Availability and Distribution of French-Speaking Pharmacists in Ontario

Francophones are an official language minority in Ontario with limited access to linguistically concordant healthcare services. Although communication is an important skill in the field of pharmacy, little is known about the availability of French-speaking pharmacists. This secondary data analysis of the Ontario College of Pharmacists registry converted weekly hours worked into full-time equivalents (FTEs) and calculated ratios of pharmacist FTEs per 1,000 population. French-speaking pharmacists tended to offer fewer FTEs in communities with a larger concentration of Francophones, particularly in northern and rural areas, a trend that was not observed among English-speaking pharmacists. This maldistribution of French-speaking pharmacists may limit the ability of official language minority patients to receive pharmacy services in their language of choice.

Workforce planning and safe workload in sterile compounding hospital pharmacy services.

DisclaimerIn an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these 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.PurposeA prospective observational study was conducted to assess sterile compounding time and workforce requirements in a hospital pharmacy, resulting in development of staff benchmarking metrics.MethodsThe study was conducted in the IV room of a quaternary hospital over a total of 7 weeks. Compounding was directly observed and timing data collected for each compounded sterile preparation (CSP). The primary objective was to assess CSP workload, compounding time requirements, and workforce requirements to enable development of a data-driven staffing benchmark.ResultsA total of 320 sterile product preparations were directly observed during the study. Overall, the average time to compound 1 CSP (including small- and large-volume parenteral solutions, chemotherapy CSPs, batched CSPs, and syringes) was 3.25 minutes. Chemotherapy CSPs had the longest average preparation time (17.74 minutes); batched CSPs had the shortest preparation time, at 1.90 minutes per unit. A safe workload analysis indicated that in an 8-hour shift, 1 pharmacy technician can safely prepare 253 batched CSPs; 148 preparations of SVP solutions, LVP solutions, and syringes combined; 31 parenteral nutrition solutions prepared using an automated device; or 29 chemotherapy preparations. Through extrapolation of these results, it was calculated that a hospital with a capacity of 100 beds would require 1.4 pharmacist full-time equivalents (FTEs) and 2.7 technician FTEs to meet its sterile compounding needs, with proportionate increases in those estimates for a 300-bed hospital.ConclusionOrganizations wishing to use external benchmarking information need to understand data characterization, pharmacy services offered, automation, workflows, and workload before utilizing that information for workforce planning.

Characterizing the reach of comprehensive medication management in a population health primary care model.

As care teams adopt team-based models of care, it is important to examine the reach of interdisciplinary services, such as pharmacists providing comprehensive medication management (CMM). This study examined the reach of pharmacist-delivered CMM in the first 10 months of a population health-focused primary care transformation (PCT). Using electronic health record data, descriptive statistics (counts and percentages, as well as means and standard deviations) were quantified to summarize the patients who received CMM in two PCT pilot clinics pre- and post-PCT. Patients who had at least one CMM visit increased from 554 during the pre-PCT window to 880 during the post-PCT window. However, when adjusted for the increased pharmacist full-time equivalents (FTE) included as part of the PCT, 462 and 330 patients/FTE were seen in the pre- vs post-PCT periods, respectively. When calculating the percentage of patients who received CMM, this increased from 2.3% of all primary care patients seen in the two pilot clinics before the PCT began to 4.4% after the PCT was implemented. Most patient demographics remained largely the same between the pre- and post-PCT periods. However, CMM patients seen in the post-PCT period had more medication therapy problems across all medication therapy problem categories compared to patients in the pre-PCT period. Additionally, patients receiving CMM had significantly more conditions and medications and higher hospitalizations and emergency department use compared to the general clinic population. Reach is an important implementation outcome to determine the representativeness of individuals participating in a given service. This study illustrates that pharmacists providing CMM see complex patients with a high propensity for medication therapy problems. However, opportunities exist to improve the reach of CMM and, in turn, enhance team-based care.

Resources Assessment for Penicillin Allergy Testing Performed by Pharmacists at the Patient's Bedside.

Background:False penicillin allergies lead to increased antimicrobial resistance, adverse effects, and health care costs by promoting the use of broad-spectrum antibiotics. The Infectious Diseases Society of America recommends the implementation of allergy testing.Objectives:The primary objective of this research was to estimate the number of pharmacist full-time equivalents (FTEs) required for an intervention aimed at determining penicillin allergy in hospitalized patients. Acceptance of pharmacists’ suggestions on antibiotic therapy are described.Methods:A quasi-experimental study was conducted in a 712-bed university hospital involving hospitalized patients with a suspected penicillin allergy and an infection treatable with penicillin. The time required for the intervention, which included a questionnaire, penicillin allergy testing (skin-prick test, intradermal injection, and oral provocation test), and recommendations on antibiotic therapy were measured to calculate the number of pharmacist FTEs.Results:A total of 55 patients were included. Scarification allergy testing was performed on 37, intradermal allergy test on 33, and oral provocation test on 26 patients. The intervention ruled out penicillin allergy in 26 patients, with no serious adverse effects. The intervention was associated with a median weekly pharmacist FTE of 0.15 (interquartile range = 0.12-0.25). The acceptance of pharmacists’ suggestions was high and led to 9 patients being switched to an antibiotic with a narrower spectrum of activity.Conclusions and Relevance:This study describes penicillin allergy testing and the number of median weekly hospital pharmacist FTEs required, which was approximately 0.15. These data may aid in the implementation of this safe intervention that promotes narrower-spectrum antibiotherapy.

Analyzing the costs of developing and operating an integrated health-system specialty pharmacy: The case of a centralized insurance navigation process for specialty clinic patients.

Direct and indirect costs related to the growth of specialty pharmacy services and the insurance navigation process for specialty clinic patients are discussed, and development and implementation of a pharmacy-driven and system-wide prior authorization (PA) processing center within a health system are described. Expensive specialty drugs require PA. Due to the concentration of specialists, health systems with multiple specialties experience higher PA burden and resulting care delays. Although clinic staff typically handle PA requests, health-system specialty pharmacies are well positioned to support patients, clinic staff, and physicians by assuming responsibility for the PA process entirely. University of Utah Health established its Pharmacy Ambulatory Clinical Care Center (PAC3) to centralize PA processing for selected specialty and primary care clinics within the health system. In fiscal year 2019, the PAC3 team (10 pharmacy technician and 1.5 pharmacist full-time equivalents) completed over 13,000 PAs. The pharmacy labor cost increase was significant; however, the benefits gained from increased services, quality, and financial strength surpassed all costs associated with the implementation and maintenance of the pharmacy operation. Other tangible benefits included decreased delays in therapy initiation, increased patient satisfaction, increased clinic visits, and increased staff and provider satisfaction and engagement. Increased PA requests associated with specialty drugs have placed considerable stress and staff burden on specialty clinics within health systems. However, development and implementation of an efficient PA processing infrastructure within a health-system specialty pharmacy may reduce the burden, increase financial strength, and improve the patient experience.

Nearly one in five pharmacist roles vacant in parts of England, report finds

Nearly one in ten full-time equivalent (FTE) pharmacist positions in England were vacant as of July 2020, a survey by the Community Pharmacy Workforce Development Group (CPWDG) has found. The survey, which collected workforce information from 40% of community pharmacies, found a 9% FTE pharmacist vacancy rate across the country, rising to 15% and 18% […]

Transforming data into insight: Establishment of a pharmacy analytics and outcomes team.

The importance of a data management strategy is increasingly necessary for demonstrating value and driving performance within pharmacy departments. Data analytics capabilities often do not match the pace of data accumulation. At our organization, the establishment of an embedded pharmacy analytics and outcomes (PAO) team has been instrumental to pharmacy services in generating and demonstrating value and proactively supporting a business intelligence strategy grounded in a data-driven culture. The PAO team was established to support the operational and strategic needs of clinical, financial, and operational pharmacy services. The team is charged with implementing the vision of extending medication-use influence and data insight to drive value-based patient care outcomes while decreasing waste, optimizing therapeutic decisions, and achieving medication management standardization across the continuum of healthcare. The PAO team is composed of 3 pharmacist full-time equivalents (FTEs), 5 business analyst FTEs, 1 biostatistician FTE, 0.2 pharmacy intern FTE, and 1 pharmacy manager FTE. Pharmacy services leaders believe it is necessary to have a mix of both clinical and analytical skill sets, given the clinical nature of the data managed by team and complexities of the medication-use process. Pharmacy reporting and analytics should require the same depth of scrutiny and overview as any other step in the medication-use process where pharmacists are held accountable. For our organization, it was critical to establish pharmacist-level oversight into every portion of the analytics process where medication data are involved. This structure has led to measurable improvements in patient outcomes, operational efficiency, and financial performance.

Pharmacist Prescribing in Pediatric and Neonatal Acute Care: An Observational Study.

The intent of this project was to objectively describe the frequency of pharmacist prescribing in acute care pediatrics and neonatology and to determine the medications most often prescribed by pharmacists practicing in a jurisdiction that permits pharmacists' prescribing. This was a subgroup analysis of a retrospective observational study using prescribing data from an electronic medical record system used in 5 acute care hospitals (1 pediatric, 4 primarily adult but with pediatric and neonatal units) within Calgary, Alberta, Canada. Considering orders for pediatric or neonatal patients only, there was a mean (SD) of 126 (226) prescriptions per pharmacist per year, with a wide range (1-1101 per year). Considering only the 9 clinical pharmacist full-time equivalents (FTEs) assigned to pediatrics and/or neonatology (i.e., not including dispensary pharmacist FTE), this represents 572 prescriptions per clinical pharmacist FTE per year (726 in pediatrics and 380 in neonatology). The most common medication classes on pediatric units included anti-infective agents, central nervous system agents, and gastrointestinal agents. In NICUs, blood formation, coagulation and thrombosis agents (mainly iron), electrolytes, caloric and water balance agents (primarily sodium supplements), and vitamins were also commonly prescribed by pharmacists. As the scope of pharmacy practice expands to include prescribing, health team leadership can use these data to support incorporation of this role into practice. Prescribing pharmacists can ensure appropriate use of many medications used in acutely ill infants and children, potentially improving efficiency and quality of care.

Challenges for Expansion of Thoracic Transplant Clinical Pharmacy in Brazil: Comparison with U.S. Accredited Centers and Call for Action

Clinical pharmacists' involvement in the care of transplant recipients has become a requirement in the accreditation process of transplant centers. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programs nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centers in Brazil and compared them with accredited U. S. programs. An electronic questionnaire was distributed to all heart and lung transplant centers registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. The survey consisted of 16 questions on presence, full-time equivalents (FTEs), practice-setting and training of clinical pharmacists at each center. Survey findings were compared to available published data from accredited U.S. centers. From 39 centers invited, 22 (16 heart and 6 lung) responded, representing 88.6% (n=420) of thoracic transplants performed nationally in 2018. Ten centers (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translates into 144 (35.2%) transplant recipients without any direct pharmaceutical care. In centers with pharmacists (n=12), none had a full-time professional dedicated to their programs. When compared to U.S. centers, there was a significantly lower expression of several aspects of transplant clinical pharmacist activities among Brazilian centers (Figure 1). Importantly, pharmacist FTE in Brazil was less than half of that observed in the U.S. Marked differences exist in Brazilian centers in comparison to the U.S. Our findings point to an unmet need related to clinical pharmacist activity within thoracic transplant programs, especially in developing countries, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.

P099 Implementation of an Inflammatory Bowel Disease Clinical Pharmacy Service

BACKGROUND: Inflammatory bowel disease (IBD) is a group of chronic inflammatory illnesses with a relapsing and remitting course often complicated by flares requiring hospital visits and/or surgeries. Numerous studies have outlined the role of a clinical pharmacists within IBD. The primary role of the clinical pharmacists in the published literature includes ensuring safe and effective use of biologics and immunomodulators through patient education and close monitoring of recommended laboratory tests. Further, the studies demonstrate the effectiveness of a clinical pharmacist in increasing adherence to medication therapy and in reducing the number of clinic visits. However, there has yet to be a study that ties such interventions to clinical or economic outcomes that demonstrate the potential long-term impact of a clinical pharmacist in IBD management. At Kaiser Permanente San Diego Medical Center, a pilot clinic was started in September 2018 where a clinical pharmacist was integrated within the IBD clinic. The primary role of the clinical pharmacist included patient education, baseline laboratory testing and vaccinations prior to initiating patients on biologics and immunomodulators, therapeutic drug monitoring, and routine laboratory testing prior to refilling medications. METHODS: The study is a descriptive, retrospective study conducted from October 1, 2018 to February 1, 2019. The study methods consisted of establishment of a Pharmacy & Therapeutics (P&T) approved protocol, which will define an approved workflow for the clinical pharmacist within the Gastroenterology clinic. Baseline and post-clinic implementation data were collected for analysis. The purpose is to determine the role of a pharmacist in IBD management & can they make an impact on quality and cost of care. One full-time equivalent pharmacist’s interventions were classified and quantified during this time frame. RESULTS: The pharmacist’s workflow begins with the IBD pharmacist receiving the referral from the gastroenterologist. IBD Pharmacist conducts full patient work up, including medication reconciliation to make interventions and contacts patients. IBD Pharmacist collaborates with gastroenterologist as needed to discuss complex treatment cases. Of 1,243 patient encounter reviews, 1,090 interventions were classified. Lab monitoring was the leading intervention accounting for 32% of all interventions followed by Medication adherence 26%, therapeutic drug monitoring 10%, and new start education 9%. CONCLUSION(S): Overall, pharmacists can potentially improve quality outcomes by increasing lab and medication adherence. Pharmacist-managed IBD service may result in more cost-effective use of medications. The IBD pilot clinic was well-received by our gastroenterologists and they have unanimously advocated for continuation of the service. Future studies using a control center to compare with our center with a clinical pharmacist within the workflow may provide more direct insight on impact of quality and cost of care.

Determining specialty pharmacy FTEs (full-time equivalents) needed in a clinical practice

Background: The Hospital of the University of Pennsylvania (HUP) created the Penn Specialty Pharmacy Program in 2014 to establish a pharmacy presence in clinics, with a patient focus on specialty medication access and adherence. The program utilizes both pharmacists and technicians to assist the clinics with medication counseling, prior authorizations, and copay assistance. As the program expands to more clinics throughout Penn, there is a growing need to employ more pharmacists and technicians, without a method in place to determine exactly how many FTEs are needed in clinic. Aims: To determine the number of clinical pharmacist and technician FTEs required in a clinical practice for maximum efficacy and patient care. Methods: Calculations were obtained by recording duties handled by the pharmacist (including those for which time does not allow), and determining if the task requires handling by a pharmacist, or if it could be delegated to a tech. This pilot program was first tested in the Dermatology Clinic at HUP, with the intent of launching throughout Penn, if successful. Once assignments were determined as either pharmacist or tech-appropriate, the recommended number of FTEs needed in the practice was calculated based on data obtained during an average 8-h work day: Duration of all tasks (in hours) × 5 days = ___ RPh/Tech Hours, and RPh/Tech Hours/40 = ___ RPh/Tech FTE. Results: The Dermatology pharmacist was observed over the course of 4 h as they completed several tasks, such as sending electronic rxs, patient calls, filling out paperwork for drug manufacturer programs, and responding to patient and provider cost-related concerns. Using the formula, and including roughly 7 h of assistance a pharmacist cannot currently provide (clinic/photopheresis rounds, appeals, etc.), this study was able to determine that the clinic would require ∼1.5 Pharmacist FTE and 0.39 Tech FTE. Conclusions: Many of the duties categorized as tech-specific were clerical or cost-related issues that did not require clinical intervention from a pharmacist. Addition of the 0.39 Tech FTEs would provide the RPh with additional resources to delegate duties to a tech, maximizing focus on patient care. This would also give the clinic an opportunity to include the pharmacist in other areas of the practice. More data may be needed to make a final decision on the needs of the clinic; however, this will be a helpful tool in validating departmental needs in other clinical settings for broad use in FTE determinations.

Evaluating Pharmacist Impact on Guideline-Directed Medical Therapy in Patients With Reduced Ejection Fraction Heart Failure

Background: Limited literature exists evaluating the ability of a pharmacist to quickly and effectively initiate and manage dose titrations of guideline-directed medication therapy (GDMT) in an outpatient setting. Methods: This pilot study aimed to investigate the impact of pharmacist-managed, outpatient heart failure management on patients’ heart failure outcomes, and health-care–related costs. Retrospective chart review performed on patients referred to pharmacist practicing under collaborative practice agreement. End points included time to achieve individualized target doses of GDMT; beta-blocker dose tolerance; and the clinic’s impact on left ventricular ejection fraction (LVEF), hospital admission, and emergency department encounter rates. Descriptive statistics were used to report nominal data. Wilcoxon signed-rank test was used to evaluate continuous variables. Results: Thirty-six patients completed full titration utilizing an average of 4.9 visits over 12.7 weeks. Seventy-eight percent (n = 28) achieved full beta-blocker titration. Seventy-six percent of patients had LVEF >35% after titration versus 43% at baseline. A significant reduction in all-cause hospital admissions was seen during both 13-week and 12-month comparison periods (P < .05). We estimated >US$50 000 annual revenue generation from 0.2 full-time equivalent pharmacist. Conclusions: Although hypothesis generating, our results support the idea that pharmacist-managed medication titration clinics are effective at completing titration, improving LVEF, and generating revenue.

Development and application of an objective staffing calculator for antimicrobial stewardship programs in the Veterans Health Administration.

The development and validation of a staffing calculator and its use in creating staffing guidance for antimicrobial stewardship programs (ASPs) in Veterans Health Administration (VHA) facilities are described. The Tools and Resources Work Group of the Antimicrobial Stewardship Task Force and PBM Clinical Pharmacy Practice Office of the Department of Veterans Affairs developed, tested, and validated a staffing calculator to track patient care and ASP management activities needed to maintain a comprehensive ASP. Time spent on activities was based on time-in-motion tracking studies and input from experienced antimicrobial stewards. The staffing calculator was validated across VHA facilities of varying sizes and complexities to determine the number of needed clinical pharmacist full-time equivalents (FTEs) to implement and maintain ASPs per 100 occupied beds. A total of 12 facilities completed the staffing calculator for 1 calendar week. The median number of occupied beds was 226. Most facilities had at least 100 occupied beds, and 6 of the 12 were considered high complexity facilities. The median calculated FTE personnel requirement was 2.62, or 1.01 per 100 occupied beds. The majority of FTE time (70%) was spent on patient care activities and 30% on program management activities, including infectious diseases or ASP rounds. The final recommendations indicated that in order to implement and manage a robust ASP, a pharmacist FTE investment of 1.0 per 100 occupied beds would be needed. A staffing calculator to account for the time needed to implement ASP activities and provide staffing guidance across a large health-care system was validated.

Development of a pharmacy resident rotation to expand decentralized clinical pharmacy services.

The development of a pharmacy resident rotation to expand decentralized clinical pharmacy services is described. In an effort to align with the initiatives proposed within the ASHP Practice Advancement Initiative, the department of pharmacy at Cleveland Clinic, a 1,400-bed academic, tertiary acute care medical center in Cleveland, Ohio, established a goal to provide decentralized clinical pharmacy services for 100% of patient care units within the hospital. Patient care units that previously had no decentralized pharmacy services were evaluated to identify opportunities for expansion. Metrics analyzed included number of medication orders verified per hour, number of pharmacy dosing consultations, and number of patient discharge counseling sessions. A pilot study was conducted to assess the feasibility of this service and potential resident learning opportunities. A learning experience description was drafted, and feedback was solicited regarding the development of educational components utilized throughout the rotation. Pharmacists who were providing services to similar patient populations were identified to serve as preceptors. Staff pharmacists were deployed to previously uncovered patient care units, with pharmacy residents providing decentralized services on previously covered areas. A rotating preceptor schedule was developed based on geographic proximity and clinical expertise. An initial postimplementation assessment of this resident-driven service revealed that pharmacy residents provided a comparable level of pharmacy services to that of staff pharmacists. Feedback collected from nurses, physicians, and pharmacy staff also supported residents' ability to operate sufficiently in this role to optimize patient care. A learning experience developed for pharmacy residents in a large medical center enabled the expansion of decentralized clinical services without requiring additional pharmacist full-time equivalents.

Cross-Sectional Survey of Perceived Barriers Among Community Pharmacists Who Do Not Immunize, in Wayne County, Michigan.

IntroductionThe goal of the study was to identify perceived barriers to implementation of vaccination services encountered by independent and small-chain community pharmacies in an urban setting.MethodsPharmacists in independent and small-chain pharmacies located in 29 Michigan ZIP codes were visited and asked to complete a 5- to 10-min semi-structured interview.ResultsA total of 93 independent and 12 small-chain pharmacies participated (n = 105; 61%). The pharmacies filled an average of 700 prescriptions each week with 1.1 pharmacist full-time equivalents and 57 h of technician time. The most common services that participating pharmacies provided were dispensing outpatient medication (99%), medication therapy management (MTM, 65.7%), disease management or coaching (54.3%), point-of-care testing (34.3%), and dispensing medications to inpatient facilities (16.2%). Only seven pharmacies (6.7%) administered vaccinations. When pharmacists were asked to identify what it would take to start to administer vaccines, the most common responses were increased demand from patients (37.1%), adequate time (19%), appropriate space (17.1%), appropriate amount of staff (14.3%), change in attitudes or beliefs of the owner or pharmacists at that pharmacy (13.3%), increased profit related to vaccines (11.4%), and increased awareness among patients about the importance of vaccines (11.4%). The majority of pharmacies (65.3%) reported that only one factor would need to change to start to administer vaccines.ConclusionIndependent and small-chain community pharmacies in an urban, primarily low-income area identified several barriers that have prevented implementation of vaccination services. However, the majority of pharmacies reported that only one factor would need to change in order to begin to administer vaccines. Interventional efforts necessary to address commonly cited barriers may include providing education to pharmacists about the need for community pharmacy-based immunization programs in addition to services provided by physician offices, as well as the importance of proactively providing immunization-related recommendations to patients.