Pharmacy Leaders Research Articles

Commission proposes UK-wide federation to lead professional development of pharmacy

A report on professional leadership — commissioned by the four UK chief pharmaceutical officers — has called on all pharmacy leadership bodies to form an “inclusive federation” to work on setting post-registration standards for pharmacists and pharmacy technicians. It proposes that the new federation, the ‘Pharmacy Leadership Council’, will be formed of representatives from the […]

920. Leveling Up: Evaluation of IV vs. PO Linezolid Utilization and Cost after an Antimicrobial Stewardship Program Revision of IV to PO Conversion Criteria within a Healthcare System

Abstract Background Intravenous (IV) to oral (PO) conversion is specifically listed as a pharmacy-based intervention in the CDC’s Core Elements of an Antimicrobial Stewardship Program (ASP). Due to linezolid’s high PO availability and high IV cost, it is used as a marker for pharmacist-driven IV to PO conversion within our healthcare system, which remained low despite the existence of a pharmacist-driven IV to PO protocol. The system ASP implemented an intervention aimed at improving rates of IV to PO conversion of antimicrobials. Methods This retrospective, observational cohort was conducted within a healthcare system composed of 5 adult acute care facilities. The system ASP reviewed and revised the conversion eligibility criteria November 30, 2021 (Table 1). Education was conducted, and a compulsory computerized training module was assigned to every pharmacist in the system. Two follow-up emails reporting results were also sent to the system ASP pharmacy leaders during the post-intervention period, and leaders were encouraged to share results with their departments. The primary objective of this study was to determine if there was a difference in PO linezolid utilization reported as days of therapy per 1000 patient days (DOT/1000 PD) between the pre- and post-intervention periods. Secondary objectives included IV linezolid utilization and cost savings. Results The average DOT/1000 PD for PO linezolid in the pre-intervention period (February-November 2021) was 38.9 compared to 58.8 for the post-intervention period (December 2021-March 2022), p< 0.01 (Figure 1). This reflected an increase in the average percentage of PO use from 42.9 to 62.4% for the pre- and post-intervention periods, respectively (p< 0.01, Figure 2). Inversely, the average DOT/1000 PD for IV linezolid fell from 52.1 to 35.4 in the pre- and post-intervention periods, respectively (p< 0.01). A cost savings analysis revealed a monthly post-intervention savings of $7,091.34 with a projected total annual cost savings of $85,096.09 for the system. Conclusion An ASP intervention that revised criteria for IV to PO conversion, educated pharmacists, and tracked and reported results led to significantly more PO linezolid use and reduced overall cost in a large healthcare system. Disclosures Kerry O. Cleveland, MD, AbbVIe: Honoraria|Merck: Honoraria.

Pharmacy leaders find common ground on population health.

Participants in ASHP’s August 24 Pharmacy Executive Leadership Alliance (PELA®) and the Section of Pharmacy Practice Leaders forum say that the profession’s path forward on population health management runs through strategic initiatives focusing on quality metrics for public and private payers. What’s still unclear is exactly where to direct the profession’s efforts to meet payers’ quality expectations. “Do we prioritize putting pharmacists in internal medicine practices versus family medicine, [because] internal medicine patients tend to be more complicated?” asked presenter Fern Paul-Aviles, assistant vice president for population health strategy, 340B, community clinic pharmacy services, behavioral health, and long-term care for Charlotte, NC–based Atrium Health. “Do you put more pharmacist resources in the practices that have more value-based contracts? Or do you look at where the worst quality scores are and allocate pharmacists where the worst quality scores are in the hope of improving the quality scores in those practices?” Fern-Aviles said her health system has shared-savings contracts with 4 Medicare Advantage plans. To secure the full financial incentives and attain the highest Medicare star rating, the healthcare team must meet medication adherence targets for beneficiaries taking statins, antihypertensive drugs, and diabetes medications.

Interprofessional virtual simulation to promote leadership and patient advocacy skills in pharmacy and nursing students

This curricular resource describes an educational opportunity to develop leadership and patient advocacy skills between pharmacy and nursing students through a virtual interprofessional simulation. This format selected was a virtual simulation as it is an increasingly popular teaching tool during the current health climate and can be applied to teach the interprofessional skills of leadership, patient advocacy, understanding the role of other professions, and interprofessional communication. The activity's objective was to increase student self-perception in confidence of leadership ability, patient advocacy skills, understanding the role of other professions, and interprofessional communication skills through an interprofessional leadership and patient advocacy focused simulation activity. To measure these four items, students self-rated their confidence level in these items in a pre- and post-survey. Thirty-six second-year pharmacy students and thirty-seven senior nursing students participated in the experience and completed both the pre and post surveys. Student self-rating increased in all four items. Additionally, all post survey respondents remarked that they would recommend this experience to future students. Participation in an interprofessional virtual simulation between pharmacy and nursing students focused on leadership development and patient advocacy demonstrated a statistically significant increase in students' confidence in their ability of leadership, patient advocacy skills, understanding the other profession's role, and interprofessional communication. The experience provides an engaging and effective method to teach students these vital skills within an interprofessional team.

Improving Safety by Evaluating the Impact of the Supply Chain and Drug Shortages on Health-Systems.

Background: The COVID-19 pandemic has shown how fragile our healthcare supply chain is with product delays, drug shortages, and labor shortages being exacerbated in recent years. Objective: This article reviews current threats to the healthcare supply chain that impact patient safety and highlights potential solutions for the future. Method: A review of the literature was conducted, and important up-to-date resources associated with drug shortages and supply chain were analyzed to build foundational knowledge. Potential supply chain threats and solutions were then explored through further literature analyses. Conclusions: The information provided in this article helps to brief pharmacy leaders on current supply chain issues and solutions that can be integrated throughout the healthcare supply chain in the future.

EpiPen STAT: A quality improvement project for anaphylaxis management.

319 Background: The medical oncology infusion unit at Beth Israel Deaconess Medical Center (BIDMC) experienced six anaphylactic reactions to chemotherapy between June 2000 and April 2021. EpiPen was delayed in all cases. In one instance, a patient experienced an emergency where she could not breathe, and her blood pressure continued to decrease. The covering nurse hesitated before administering an EpiPen. In follow-up, nurses reported a lack of confidence in administering an EpiPen. No licensed independent provider (LIP) was stationed in the infusion unit to guide nurses. The project's goal was to facilitate timely EpiPen administration, guided by the Translating Evidence into Practice (TRIP) framework. Methods: The project lead and the medical director revised the hospital’s chemotherapy reaction guidelines to highlight anaphylaxis management. They established an interdisciplinary project team with medical, nursing, pharmacy, and informatics representatives. Interventions, which started in November 2021, included a reaction management algorithm and PRN-reaction orders allowing nurses to initiate interventions while waiting for a LIP arrival. The unit educator provided EpiPen training, and the pharmacy leaders created an adverse drug reactions (ADR) kit—a locked box with necessary medications that followed BIDMC’s institutional algorithm to manage infusion reactions. Results: The project team collected post-intervention data between December 2021 and April 2022. Nurses reported twenty mild-to-severe chemotherapy reactions, including four anaphylactic episodes. Nineteen patients were discharged home on the day of reactions, and one patient required hospital admission for persistent symptoms. The management algorithm was followed in ten reactions (50%). Deviations from the algorithm were noted in eight cases, with the most frequent reason being smaller doses of antihistamine or corticosteroid. The algorithm was not applicable in two cases with atypical patient symptoms. In seventeen of the twenty reactions (85%), PRN-reaction orders were available in the electronic ordering system. The ADR kit was used in all reactions. In two of the four anaphylactic reactions, EpiPen was administered immediately following hypotension or hypoxia. In the remaining two cases, it was administered for persistent symptoms. Conclusions: The project facilitated EpiPen administration. The critical steps were systemic analysis of barriers, problem-solving with the TRIP framework, and engagement of frontline nurses. In our next step, we will consider narrowing the scope to managing acute hypotension or hypoxia. The narrower scope will enable targeted education about emergency management, potentially at the hospital’s simulation center. To ensure every patient has an order, the department could consider a standing EpiPen order for hemodynamically unstable patients.

Advances in Pharmacy Practice: A Look towards the Future.

This review looks at the factors that may influence practice in the future. Transformation could occur at 3 levels. Firstly, the traditional profession of the pharmacist as a dispenser of medicines is expanding. Secondly, the pharmacist’s activities are progressing into new healthcare fields. Thirdly, other changes are stimulated by global developments. This review may be helpful for pharmacy and healthcare leaders looking at the future configuration and aims of their pharmacy services.

Women in pharmacy leadership: The journey continues.

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.

Walmart hikes technician wages in a bid to hire 5,000 this year

Walmart hikes technician wages in a bid to hire 5,000 this year

Evaluation of Pharmacy Residency Recruitment and Interview Processes during the COVID-19 Pandemic (2020-2021 Application Cycle).

IntroductionDue to the COVID‐19 pandemic, most pharmacy residency programs changed to an all‐virtual format for recruitment and interviews for the 2020 to 2021 application cycle. There are no data evaluating the experiences and perceptions of these changes from the perspective of pharmacy residency programs and applicants.MethodsAn electronic cross‐sectional survey was distributed via email to postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residency programs and applicants across the Southeastern United States. Results have been reported according to the Checklist for Reporting of Survey Studies (CROSS) guidelines (Enhancing the QUAlity and Transparency Of health Research [EQUATOR] Network).ResultsExactly, 142 residency applicants and 104 residency programs responded to the survey. Most respondents participated in virtual recruitment and interviews. In 2020 to 2021, less residency programs participated in local/regional showcases and personal placement services, but social media engagement increased. Of the applicants who responded, over half felt the need to apply to more programs during this application cycle, and a corresponding increase in applications were seen by residency programs. Residency interviews appeared shorter than previous years, and less programs offered an informal time to get to know the applicants. Overall, applicants and residency programs preferred on‐site interviews, but both parties reported feeling confident creating rank lists after virtual interviews.ConclusionThese results highlight the impact of COVID‐19 on residency recruitment and the interview process. Residency programs should implement feedback for improving the virtual experience, as able. The ongoing pandemic may affect the 2022 to 2023 application cycle, and pharmacy leadership organizations should consider developing guidance for applicants and residency programs on navigating another year of virtual events.

Leadership aspiration: An intersectional analysis of racial and gender equity in pharmacy

BackgroundThe glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, underrepresented groups face various barriers and limitations to their successes. ObjectivesThe purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership. MethodsThe 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson’s r and chi-square test statistics. ResultsBlack, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. “The ability to make an impact” was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (± $73,701) for Other men to $112,384 (± $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r = 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 ± $88,898). ConclusionInterest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepresented pharmacists into leadership positions.

2022 ASHP Conference for Pharmacy Leaders

2022 ASHP Conference for Pharmacy Leaders

Assessment of burnout and pandemic fatigue among pharmacy leadership in the Veterans Health Administration healthcare system.

PurposeFactors associated with burnout in Veterans Health Administration (VHA) pharmacy leadership positions were examined during the coronavirus disease 2019 (COVID-19) pandemic.MethodsA questionnaire was distributed to all pharmacy executives of the VHA healthcare system. It collected demographic and employment characteristics, career satisfaction and work-related variables, indicators of burnout using validated single-item measures adapted from the Maslach Burnout Inventory, and the impact of the COVID-19 pandemic on psychosocial and work-related variables. A χ 2 test with Bonferroni correction was used to evaluate the data. Burnout was defined as a score of 4 or greater on either of the 2 single-item validated statements adapted from the Maslach Burnout Inventory to assess emotional exhaustion and depersonalization.ResultsIn total, 407 (of 1,027; 39.6%) VHA pharmacy leaders representing Veterans Integrated Service Network pharmacy executives, chiefs of pharmacy, associate chiefs of pharmacy, and inpatient and outpatient supervisors completed the survey. The overall prevalence of burnout was 68.6% using the aggregate measure of emotional exhaustion or depersonalization. Pharmacy leaders who worked more than 60 hours a week reported significantly greater rates of burnout than those who worked 40 to 60 hours a week (86.7% vs 66.9%, χ2 = 7.34, degrees of freedom = 1, P < 0.05). Those experiencing increased workload related to COVID-19 also reported high burnout rates (72.1%, χ2 = 16.40, degrees of freedom = 1, P < 0.001). Burnout scores were similar across groups when respondents were stratified by leadership position, gender, age, or years in position.ConclusionAs of March 2021, two-thirds of pharmacy leaders were experiencing burnout. It is important for healthcare system leadership to identify patterns of burnout among their pharmacy leaders to ensure a productive and sustainable workforce.

The Impact of Job Instruction Training Within Pharmacy.

Purpose: To provide pharmacy leaders and clinicians with the basic principles of a training method called job instruction (JI) and its application within pharmacy as a strategy to teach routine pharmacy work. Summary: Job instruction is a reliable way to teach a person to quickly learn how to perform a work standard correctly, safely, and efficiently. Job instruction is a proven and successful technique for improving time to train, productivity, employee turnover and quality of work. In healthcare, JI training is not well-known or widely utilized. Job Instruction was the strategy of choice to stabilize the variable training practices within The University of Kansas Health System pharmacy enterprise, and a prospective, single center, multi-cohort study was conducted to study its impact. Conclusion: The preliminary results of this study provide initial insight into the applicability of job instruction in pharmacy. The study indicated the benefits of JI training within different teams to standardize training practices, decrease error and safety event rates, and increase satisfaction of team members with on-the-job training. The results of this study will be used to further analyze and optimize training practices in The University of Kansas Health System pharmacy enterprise.

Implementation of a unique mass casualty and emergency preparedness longitudinal learning experience for postgraduate year 2 pharmacy residents

Background and purposeThe American Society of Health-System Pharmacists (ASHP) postgraduate year 2 (PGY2) critical care pharmacy residency program offers an elective competency area, E3: Mass Casualty. Similar elective competencies are also available for PGY2 emergency medicine and postgraduate year 1/2 pharmacotherapy programs. Because of the COVID-19 pandemic, pharmacist proficiency in the management of disasters is even more urgent. However, few residency programs require or include a specific learning experience to achieve this competency. This article provides examples of opportunities that residency programs can implement to offer an Emergency Preparedness/Mass Casualty (EP/MC) learning experience. Educational activity and settingA longitudinal EP/MC learning experience was integrated into a PGY2 critical care program. FindingsA longitudinal EP/MC learning experience within the PGY2 critical care, emergency medicine, and pharmacotherapy residency program curricula is achievable and promotes resident development. Learning experience components included topic discussions, participation on local and state-level emergency preparedness (EP) committees, completion of certification programs, projects, and participation on statewide emergency response teams. SummaryImplementation of a longitudinal EP/MC learning experience formalizes topics and activities that support achievement of the ASHP elective competency area of Mass Casualty for PGY2 residency programs. EP/MC goals and objectives should be a requirement for critical care, emergency medicine, pharmacotherapy, and health-system pharmacy administration and leadership PGY2 programs. By formalizing training, pharmacists can be better prepared for EP and more integrated into multidisciplinary disaster response teams.

Development and implementation of pharmacy department and pharmacy resident well-being programs.

Burnout in healthcare can have serious consequences, as it decreases patient care quality. Recent studies have found pharmacy employees have high rates of burnout, but formalized pharmacy well-being programs are not reported in the literature. We developed a departmental pharmacy well-being program and focused residency well-being program in October and July 2020, respectively. The program committees sent anonymous surveys to all pharmacy employees to identify opportunities to improve well-being. The feasibility and impact of ideas were assessed by committee members and presented to pharmacy leadership who endorsed and supported all proposed initiatives prior to implementation. Pharmacist distress scores were measured using the Well-Being Index (WBI). The WBI was completed by 49% of invited pharmacists (137 of 278) in November 2020 and 41% (116 of 283) in June 2021. There was a numerical improvement in mean (SD) WBI scores from 2.06 (2.47) in November 2020 to 1.52 (2.49) in June 2021 (P = 0.09). Pharmacy residents had significantly higher distress scores than nonresident pharmacists (P = 0.01). However, pharmacy resident scores improved by almost 50% between the 2 time points, from 4.43 (2.13) to 2.40 (2.42); P = 0.03. The development of a system-wide pharmacy well-being program creates a structure to collect ideas from employees, implement well-being initiatives, measure burnout using a validated tool such as the WBI, and continue to build, evaluate, and adapt new interventions. Importantly, the program went beyond addressing individual needs and addressed institutional opportunities that impact well-being. This can serve as a model for other pharmacy departments looking to implement similar programs.

Medication Management of Early Pregnancy Loss: The Impact of the U.S. Food and Drug Administration Risk Evaluation and Mitigation Strategy [A289

INTRODUCTION: Early pregnancy loss (EPL) occurs in 1 million U.S. patients annually. Mifepristone pretreatment for medication management increases efficacy but requires compliance with the U.S. Food and Drug Administration Risk Evaluation and Mitigation Strategy (REMS) program. This study examined how REMS influences mifepristone use for EPL among obstetrician–gynecologists (ob-gyns) in Massachusetts. METHODS: This mixed methods study included in-depth qualitative interviews focused on EPL management analyzed under a thematic analysis framework using multiple coders and a consensus method. Qualitative data informed development of a survey fielded among all ob-gyns in Massachusetts identified through the American Medical Association Physician Masterfile. The Partners IRB deemed this study exempt. RESULTS: Nearly all interviewees (17 of 19, 89%) listed the REMS as a barrier to mifepristone use. Barriers included belief that the REMS indicated mifepristone was not available to general ob-gyns, lack of pharmacy dispensing, and concerns about signing the required prescriber agreement. The REMS sometimes gave hospital or pharmacy leadership the impression that mifepristone is dangerous, prolonging protocol development and implementation. A total of 197 physicians responded to a subsequent survey. Of those, 37% did not offer mifepristone for EPL, and 40% were not or only somewhat familiar with mifepristone's REMS program. Among those who reported on barriers to mifepristone use (n=57), the most common was uncertainty with how to comply with the REMS (53%); 73% reported that removing these regulations would help them use mifepristone for EPL. CONCLUSION: The FDA REMS program for mifepristone impedes evidence-based medication management of EPL. Removing the REMS would improve access to this best practice.

Scaling opioid overdose prevention and naloxone dispensation among rural and small metro area pharmacists: findings from a qualitative study

ABSTRACT Background Community pharmacies offer a population-wide approach to scale opioid overdose prevention programs (OOPP). This qualitative study identified factors influencing implementation of New York State’s OOPP to inform the uptake of naloxone dispensation in rural and small metro area pharmacies. Methods In-person interviews were conducted among licensed retail, independent, or supermarket pharmacists (n = 60) in the mid-Hudson valley area of New York in high- and medium-overdose regions. The semi-structured 29-item survey captured attitudes and experiences related to pharmacy participation in naloxone dispensation. Results Data revealed pharmacist support for naloxone dispensation. Barriers to OOPP success included: (1) Insufficient retail pharmacy leadership support for administrative and clinical tasks for OOPP tasks; (2) excessive opioid analgesic prescribing by physicians; (3) limited uptake of naloxone by prescribers and patients; (4) out-of-pocket costs for patients to obtain naloxone; (5) lack of time, staffing, and space to provide opioid overdose prevention counseling; (6) concern for increased overdose fatalities and injection drug use in the pharmacy premises if pharmacists dispensed sterile syringes, naloxone, and/or Buprenorphine-naloxone; and (7) stigmatizing attitudes toward persons who use opioids. Conclusion Multi-level intervention efforts that include pharmacist-prescriber communication and training, and stigma-reducing efforts in rural and small metro area regions are needed.

Addressing the pharmacy leadership crisis in Canada: A call to action for a unified approach.

Addressing the pharmacy leadership crisis in Canada: A call to action for a unified approach.

Factors influencing primary care organization commitment to technical assistance for pharmacist clinical services integration

BackgroundWhile technical assistance (TA) has been utilized by primary care organizations (PCOs) for electronic health record installation and medical home recognition, little is known about PCOs’ use of TA to optimize pharmacist clinical services and integration in team-based care or population health programs. In 2019, the Connecticut Office of Health Strategy’s State Innovation Model Program funded a no-cost TA initiative for 9 PCOs to initiate and/or advance pharmacist clinical services. ObjectiveTo assess organizational, operational, and pharmacist factors that influenced PCO commitment to the TA program. MethodsDuring the TA program, data were collected from multiple sources including PCO demographic data; discussions and meetings with PCO medical, pharmacy, and administrative leaders; on-site workflow observations; and pharmacist coaching sessions.Configurational comparative methods were applied using the data collected during the TA program. Candidate factors were identified and calibrated on the basis of the researchers’ knowledge of the TA program, organizational readiness for change models, implementation science frameworks, and published literature. Each candidate factor was iteratively assessed until 13 factors were selected and calibrated by independently assigning each factor a dichotomous value across PCOs. Calibration differences between the researchers were discussed until consensus was reached. Solutions were modeled using the Coincidence Analysis (cna) package in R and RStudio (RStudio, PBC). ResultsOf the 9 PCOs, 4 committed to participating in the TA program. Only 1 factor, the presence of a hired pharmacist, consistently distinguished PCOs that committed from those that did not, with 100% coverage and 80% consistency. ConclusionPCO commitment to participate in the TA program was best explained by the factor of already having hired a pharmacist. These results can inform future efforts to engage PCOs in TA, primary care policy initiatives, and future research to understand factors influencing PCO success with pharmacist clinical services integration.