Pharmacy Leaders Research Articles

Virtual Symposium Designed as an Innovative Approach to Disseminate Leadership Development Content.

The American Association of Colleges of Pharmacy (AACP) Leadership Development Special Interest Group (LD SIG) embarked upon a one-week virtual symposium (VS) across three years. The purpose of the VS was to disseminate leadership content, case studies, and various topics of interest utilizing technology. This electronic format provided a new communication approach to facilitate content and discussion of leadership materials amongst faculty colleagues nationally. The VS allowed participants to gain knowledge and skills to address leadership development in a timely, flexible manner that can be challenging during in-person professional meetings and conferences due to conflicting programming and travel limitations. Evaluators across each of the VS (100%) indicated that they either agreed or strongly agreed with the scaled evaluative statements that the video presentations met their educational needs.

Pharmacy Leadership Amid the Pandemic: Maintaining Patient Safety During Uncertain Times.

The relentless surges of global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections that caused the Covid-19 disease had pressured researchers and regulators to develop effective treatments quickly. While studying these therapies amid the pandemic, threats to patient care were reported, including (1) maintaining adequate safeguards as clinical effectiveness and safety data evolves, (2) risks from online counterfeit medications, and (3) disruption of the global pharmaceutical supply chain. This article discusses these patient safety threats and suggests strategies that promote patient safety, foster medication intelligence, and mitigate drug shortages. As the world continues to develop safe and effective treatments for Covid-19, patient safety is paramount. In response to the World Health Organization (WHO) Global Safety Challenge: Medication Without Harm, leaders must establish effective approaches to improve medication safety during the pandemic. Successfully integrating these leadership strategies with current practices allows pharmacy leaders to implement robust systems to reduce errors, prevent harm, and advocate for patient safety.

Constructive debate: A task for all pharmacy leaders

While the future is always uncertain, today’s pharmacy leaders are faced with a particularly wide range of challenges. Therefore, if hospital pharmacy departments are to create well-informed strategic plans, forecasting future events is as important an exercise as ever. To this end, the Society of Hospital Pharmacists of Australia (SHPA) has recently published the inaugural Pharmacy Forecast Australia 2021.1 The impetus for developing this document arose from the success of the American Society of Hospital Pharmacists’ (ASHP) Pharmacy Forecast which, over the past decade, has grown to become a key feature of the Society’s educational landscape.2 It has become a much-anticipated annual publication used by multiple pharmacy practice sectors as a tool to anticipate and plan for future demand, service provision and leadership. Pharmacy Forecast Australia 2021 is a new strategic thought leadership piece on emerging trends and phenomena forecasted to impact pharmacy practice and the health of Australian patients to 2026 developed by SHPA utilising ‘wisdom of crowds’ methodology. It is anticipated that Pharmacy Forecast Australia 2021 will help equip hospital pharmacy departments to proactively position themselves and their teams for potential future events and trends with contextualised recommendations by the report’s authors. The Forecast, then, is a stimulant to prompt discussion that assists health system leaders in their strategic planning efforts, in their mission to provide optimal care for patients and advancing the profession of pharmacy. As a process and an output, the Forecast sits adjacent to SHPA’s advocacy activities and membership frameworks. This important distinction befits the unique methodology with the themes’ questions, analysis and recommendations distilled directly from leading hospital pharmacists and their colleagues based on their experiences in a range of roles, covering all Australian jurisdictions and unrestrained by organisational limitations. It is anticipated the value of the report will be found through its use by pharmacy practitioners and pharmacy leaders to inform strategic planning. The unique methodology is by no means intended to either qualitatively or quantitatively predict future events. Rather, the report should be used as a prompt to stimulate discussion, informed by the themed analysis provided by Australian subject matter experts and including associated recommendations. Pharmacy Forecast Australia 2021 presents current and future challenges to hospital pharmacy care provision, identified by a broad cross-section of the Australian landscape. The report is divided into six themes: ‘Workforce of the future’, ‘Workforce resourcing’, ‘Reliability of supply’, ‘Medication complexity and access’, ‘Medication safety’ and ‘Electronic revolution’. While many of the identified themes will not be surprising to the reader, it is anticipated the recommendations will provide sound advice and guidance on how to approach issues common to many, such as: addressing barriers to new clinical initiatives; investing and developing the pharmacy technical workforce; unifying efforts to fortify procurement; centralising medication safety in workforce planning; and maximising the benefits offered through electronic systems and telehealth. It may be that not all will agree with the opinions and recommendations of the Forecast Panellists and theme authors. This is to be expected and, indeed, hoped for, as it will generate constructive debate, one of the objectives in creating the report. The author has no conflicts of interest to declare.

ASHP Foundation's forecast report feels more relevant than ever this year

ASHP Foundation's forecast report feels more relevant than ever this year

Leadership lessons from administrators, faculty, and students during the COVID-19 pandemic

IntroductionDue to the largescale scope of the COVID-19 pandemic, strain on the higher education system in the United States has been extraordinary. Yet, with any crisis, there is the opportunity to learn, grow, and develop new knowledge and strategies to benefit educational programs moving forward. The purpose of this study is to describe the leadership lessons learned by academic pharmacy during the COVID-19 pandemic from the perspective of administrators, faculty, and students. MethodsA retrospective analysis was performed of qualitative data provided by three focus groups. Each focus group was composed of one of three distinct college of pharmacy constituencies: (1) members of the college’s executive team, (2) faculty members who currently or in the recent past served in college leadership positions, and (3) students in an elective pharmacy leadership course. Focus groups were semi-structured, and discussion concerned leadership lessons learned from the COVID-19 pandemic. A modified form of inductive content analysis and abstraction was used to assess qualitative data collected during the focus groups. ResultsFive main themes emerged across all three focus groups, which include open and ongoing communication, staying connected, turning crisis into opportunity, being adaptable/flexible, and finding ways to stay productive. Themes unique to each focus group were also identified. ConclusionsCore leadership lessons in emergent situations like the COVID-19 pandemic, including adaptability to the changing environment and communicating accurately and with appropriate frequency, illustrate the need for flexibility during times of crisis and highlight areas of focus for future planning.

Pharmacy Distribution, Clinical, and Management Services: A Survey of Small Hospitals in Canada Supported by Telepharmacy Services.

The Canadian Society of Hospital Pharmacists' Hospital Pharmacy in Canada Report presents data from pharmacy departments that service hospitals with at least 50 acute care beds. This report provides valuable data on pharmacy distribution, clinical, and management services in relation to hospital size, type, and geographic region. Pharmacy and hospital leadership use these extensive data in identifying baseline, benchmarking current, and planning enhanced pharmacy services. However, for most of Canada's small hospitals, such data remain unknown, and leadership remains uninformed. To gather and analyze data about current pharmacy distribution, clinical, and management services in hospitals with fewer than 50 acute care beds receiving third-party remote pharmacy (telepharmacy) services. In April 2019, pharmacy administrators of hospitals in Ontario, Quebec, and Saskatchewan that had fewer than 50 acute care beds and were using third-party telepharmacy services were invited to complete a comprehensive survey addressing concepts similar to those in the Hospital Pharmacy in Canada Survey. The following data on clinical pharmacy practice were collected: models of care, assignments to patient care programs, pharmacists' activities, performance indicators, and professional evaluation. The description of pharmacy distribution services comprised type of system, technology, location, hours of operation, method of medication order entry and verification, and medication administration records. Details on facilities' parenteral admixture infrastructure, policy for and provision of sterile compounding, and pharmacy department human resources, including composition and staffing ratios, were also collected. Of the 27 hospitals in Ontario, Quebec, and Saskatchewan that were invited to participate, 24 (89%) completed the survey. The median facility size was 19 acute care beds. Previously unavailable in Canada, these quantitative data from small hospitals supported by telepharmacy services provide facts about pharmacy distribution, clinical, and management services to inform hospital and pharmacy leaders. Creation of a survey unique to small hospitals, whether or not they use telepharmacy services, could provide a valuable resource to assist in the benchmarking, planning, and enhancement of pharmacy services in remote and rural communities.

Pharmacy leaders discuss the future of telehealth at virtual PELA® conference.

Pharmacy leaders discuss the future of telehealth at virtual PELA® conference.

Gap analysis of emergency department pharmacy services within a multistate, multihospital integrated health system

The purpose of this project was to identify current emergency medicine pharmacist (EMP) practices at each site and create a plan to integrate, align, and optimize pharmacy services across the health system with established American Society of Health-System Pharmacists (ASHP) best practices for EMPs. Initially, a review was performed of the literature and guidelines from professional organizations relating to EMPs. A survey was distributed across the health system to assess EMP services at each site, and survey results were used to conduct a gap analysis, comparing current practices to established ASHP best practices. The survey identified unique components of each site, including the patient population served and EMP coverage and responsibilities. To prioritize, design, and execute the gap closure plan, a systemwide EMP workgroup was created. The workgroup formulated a toolkit to provide pharmacy leaders, pharmacy informatics, and EMPs resources to facilitate alignment on the prioritized areas. This project successfully identified gaps in EMP services and alignment with best practices across the health system. Through prioritization of essential EMP responsibilities, workflow standardization, and EHR optimization, a gap closure plan was formulated to align with ASHP best practices.

Pharmacy leadership, expertise imperative for successful COVID-19 vaccine rollout.

Pharmacy leadership, expertise imperative for successful COVID-19 vaccine rollout.

National Inpatient Immunization Patterns: Variation in Practice and Policy Between Vaccine Types.

Many hospitalized children are underimmunized, yet little is known about current systems supporting inpatient vaccination. We aim to describe national pediatric inpatient immunization practices and determine if variation exists among adolescent, childhood, and influenza vaccines. An electronic survey regarding hospital vaccination practices was sent to physician, nurse, and pharmacy leaders via the Pediatric Research in Inpatient Settings Network in spring 2019. Hospitals reported the presence of various practices to support inpatient vaccination stratified by vaccine type: tetanus, diphtheria, and acellular pertussis, meningococcal, human papillomavirus, childhood series, and influenza. One-way analysis of variance testing compared differences in numbers of practices and χ2 tests compared proportions of sites reporting each practice between vaccine types. Qualitative responses were evaluated via content analysis. Fifty-one of 103 eligible hospitals completed the survey (50%). Standardized policies existed in 92% of hospitals for influenza, 41% for childhood, and 29% for adolescent vaccines. Hospitals identified an average of 5.1 practices to deliver influenza vaccines, compared with 1.5 for childhood; 0.9 for tetanus, diphtheria, and acellular pertussis; 0.7 for meningococcal; and 0.6 for human papillomavirus vaccines (P < .001). Standardized screening tools, visual prompts, standing orders, nurse- or pharmacy-driven screening or ordering, staff education, and quality improvement projects were reported more often for influenza vaccines than other vaccine types (P < .01 for all comparisons). Common barriers to delivery included communication difficulties, lack of systems optimization, and parent and provider discomfort with inpatient immunization. Existing hospital infrastructure supports influenza vaccine delivery over other vaccine types, potentially creating missed inpatient vaccination opportunities.

Effectiveness of a clinical decision-support tool on adherence to prescribing and practice guidelines of high-risk antidepressant medications in geriatric patients

IntroductionTCAs and paroxetine, a SSRI, are associated with safety risks in geriatric patients because of anticholinergic properties. The purpose of this project was to evaluate the impact of a clinical decision-support tool (CDST) on adherence with medication prescribing and practice guidance to enhance patient safety.MethodsMental health clinical pharmacy specialists and clinical pharmacy leadership led a multidisciplinary creation and integration of a CDST within a Veterans Health Administration EHR. The CDST focused on the following elements when prescribing TCAs and paroxetine in geriatric patients: clinical justification for initiation of the medication, provision of patient/caregiver education specific to the medication prescribed, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation. Following activation of the CDST in the EHR, measures were evaluated before intervention and after intervention.ResultsAfter intervention, an increase was observed in the primary outcome of the proportion of patients having documentation of all of the following: clinical justification for medication initiation, provision of patient/caregiver education, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation (P = .01). Individual proportions of patients with documented medication reconciliation and follow-up completed within 30 days significantly increased. All other secondary outcomes numerically increased but did not reach statistical significance.DiscussionImprovement was seen in adherence with prescribing and practice guidance following the implementation of the CDST. This suggests the beneficial role of CDSTs within the EHR to optimize patient safety.

Creation of a regional hazardous drug handling task force.

A regional task force of health-system pharmacy leaders was created to assist with successful adoption of United States Pharmacopeia (USP) general chapter <800>. A group of pharmacy leaders in the Kansas City region identified potential benefits to healthcare personnel and patients if hazardous drug handling procedures were standardized. A task force was created, a preimplementation survey was distributed, and meetings were held monthly to discuss sections of USP <800> identified as the most challenging to implement. The task force focused on an assessment of risk tool, hot topics, cleanroom design, and a detailed analysis of controversial medications. After the first year of meetings, a postimplementation survey was distributed, and the results were analyzed. The task force created significant value for the participants and achieved the goal of facilitating efficient USP <800> implementation resulting in greater compliance and consistency across the multiple health systems represented. Over 5,100 beds and 200 clinic sites were affected by this task force's efforts. Nearly three-fourths (73%) of respondents reported that the task force was "extremely helpful," and the majority (64%) of respondents adopted most or all (81%-100%) of the task force's assessment of risk choices. Prioritization of tasks, information sharing, and decision-making were areas where the individual leaders were most supported. Creating a structure to eliminate barriers and facilitate collaboration among regional pharmacy leaders provided a framework for successful implementation of USP <800> requirements. This interdependent leadership model produced innovative and standardized solutions and should be considered when addressing complicated initiatives that impact the profession.

Stepwise Development and Yearlong Assessment of a Pharmacist-Driven Molecular Rapid Diagnostic Test Result Service for Bloodstream Infections.

Provide a stepwise approach to the design and implementation of a service that integrates all staff pharmacists into the communication and interpretation of molecular rapid diagnostic tests (mRDT) for bloodstream infections and summarize outcomes from a 12-month post-implementation assessment. Physician and pharmacist impressions of the service are also described. mRDT have proven clinical benefit in the treatment of bacteremia. Pharmacy leadership can collaborate with other health system leaders to develop policies and a workflow that route result calls to pharmacists to maximize the impact of this technology. Pharmacist education, development of clinical resources and documentation templates allow all pharmacists to perform this antimicrobial stewardship service consistently and confidently. Physicians overwhelmingly recognize the value of this service and often accept the pharmacist's recommendations. Antibiotic de-escalation was the most frequent outcome when changes to the antibiotic regimen were made. Pharmacists are well positioned to utilize results from mRDT to improve antibiotic selection. Through the use of competencies and internally-derived resources, all pharmacists, rather than just infectious diseases pharmacy specialists, can perform this important antibiotic stewardship activity and positively influence patient outcomes.

Implementation of Pharmacy Executive Quality and Safety Walkrounds at a Tertiary Academic Medical Center.

Background: Executive Quality and Safety WalkRounds (EWRs) is a tool that engages department leadership in discussion with the front-line employees to solicit feedback to improve quality and safety. The purpose of this study was to evaluate the impact of the implementation of pharmacy department specific EWRs on quality and safety at a tertiary academic medical center. Method: This was a single-center, retrospective analysis conducted at Brigham and Women's Hospital between November 2016 and November 2019. This study aimed to analyze the implementation of EWRs conducted every other month throughout various service areas and satellites of the pharmacy department. Data evaluated included the number of EWRs conducted, the specific areas visited, the total number of action items recommended by the staff, along with the total number of action items that were completed or remained in process. Results: During the study period, 17 visits were completed in 12 different BWH pharmacy sub-departments. A total of 98 operational, technological, and environmental action items were recommended by staff to improve quality and safety. Of the 98 action items documented, 95 (96.9%) were completed by time of our analysis. Conclusion: Pharmacy department EWRs are an important and systematic process of communication between the pharmacy leadership and frontline staff. Pharmacy department EWRs have resulted in safety and quality improvements at different levels in the pharmacy department. The EWRs program at the pharmacy department was effective in identifying and completing safety initiatives to improve the safety culture of the department.

Reducing medication‐related harm through the adoption of technology

Reducing medication‐related harm through the adoption of technology

Career advancement in health-system pharmacy: Clinical pharmacists as future leaders.

In 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.

A framework for graduate and postgraduate specialty pharmacy training.

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.PurposeThere is a growing need for specialty pharmacy leaders within integrated delivery networks (IDNs). Traditional training for students and residents has not met the demand for pharmacy leaders in this space. This article describes the partnership between UW Health (UWH) and the University of Wisconsin School of Pharmacy (UWSOP) in developing a specialty pharmacy elective course at UWSOP and in creating a postgraduate residency training program at UWH. Future directions for the partnership are discussed.SummaryMembers of the leaderships of UWH and UWSOP met to discuss expanding coursework related to specialty pharmacy business fundamentals at UWSOP. This meeting led to the development of a 2-credit elective course beginning in spring 2017. The course focused on marketplace economics, channel strategies, and specialty pharmacy practice development. Additionally, UWH identified the need to provide postgraduate training to meet the increasing demand across IDNs for specialty pharmacy leaders. The residency program was initiated in 2013 and received accreditation in 2016. The residency provides experience in specialty pharmacy leadership, managed care, finance, the revenue cycle, accreditation, and the supply chain. Future partnership opportunities include creation of a longitudinal student pharmacist track and joint project coordination between UWSOP students and UWH residents.ConclusionThis partnership has provided a pathway for students to gain expertise in specialty pharmacy business fundamentals as well as postgraduate training opportunities for future specialty pharmacy leaders. IDN and school of pharmacy partnerships can expand educational opportunities for future specialty pharmacy leaders and help fulfill the market gap in specialty pharmacy leaders.

Cleveland Clinic International IV Robotics Summit.

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.PurposeThe proceedings of an international summit on the current and desired future state of use of robotic systems to compound intravenous (IV) solutions are summarized.SummaryThe International IV Robotics Summit was held at the Cleveland Clinic main campus in Cleveland, OH, on April 29 and 30, 2019. The purpose of the summit was 2-fold: (1) to define the current state of robotic IV compounding and (2) to develop a guide for automation companies, pharmacy departments, and drug manufacturers to improve the technology and expand the use of IV robotics in health systems in the future. The first day of the summit included 45-minute presentations by each of the speakers. Each lecturer recounted a different hospital’s experience implementing and using IV robotics. On day 2 of the summit, an expert panel dedicated to mapping the future of IV robotics was convened to determine barriers to widespread adoption of IV robotics in health systems and offer potential solutions to remove these barriers. The expert panel targeted 3 specific audiences: robot manufacturers, drug manufacturers, and fellow pharmacy leaders.ConclusionIt is the hope of the international faculty that the information that emerged from the summit can be used by others to successfully implement IV compounding robotics in their sterile products areas to maximize patient safety. The summit also served as a call to action for pharmacy leaders, drug manufacturers, and robotic companies to develop a safer, more efficient future for patients by working together to optimize the development and operation of IV robotics.

Operationalizing Pandemic Vaccinations at a Regional Supermarket Chain Pharmacy

Community pharmacies were underutilized as vaccination locations during the 2009 H1N1 pandemic. Since that time, community pharmacies are a common location for seasonal influenza vaccinations with approximately one-third of adults now getting vaccinated at a pharmacy. Leveraging community pharmacies to vaccinate during a pandemic such as pandemic influenza or the current coronavirus disease (COVID-19) pandemic will result in a more timely and comprehensive public health response. The purpose of this article is to summarize the results of a strategic planning meeting held in 2017 that focused on operationalizing pandemic influenza vaccinations at a regional supermarket chain pharmacy. Participating in the planning session from the supermarket chain were organizational experts in pharmacy clinical programs, managed care, operations leadership, supply chain, information technology, loss prevention, marketing, and compliance. Additionally, experts from the county and state departments of health and university faculty collaborated in the planning session. Topics addressed included (1) establishing a memorandum of understanding with the state, (2) developing an internal emergency response plan, (3) scaling the pandemic response, (4) considerations for pharmacy locations, (5) staffing for pandemic response, (6) pandemic vaccine-specific training, (7) pharmacy workflow, (8) billing considerations, (9) documentation, (10) supplies and equipment, (11) vaccine supply chain, (12) communications, and (13) security and crowd control. Information from this planning session may be valuable to community pharmacies across the nation that seek to participate in COVID-19 pandemic vaccinations.

Integrating health-system pharmacy leadership into the school of pharmacy curriculum: A professional imperative.

Integrating health-system pharmacy leadership into the school of pharmacy curriculum: A professional imperative.