Pharmacy Technicians Research Articles

Comparing visual inspection methods for parenteral products in hospital pharmacy: between reliability, cost, and operator formation considerations

IntroductionThe COVID-19 pandemic has led to unforeseen and novel manifestations, as illustrated by the management of drug shortages through the development of hospital production of sterile pharmaceutical preparations (P2S). Visual...

Impact of a pharmacist-led oral chemotherapy monitoring clinic at the South Texas Veterans Health Care System.

As cancer treatments shift from traditional intravenous chemotherapy to inclusion of oral oncolytics, there is a critical need for structured oral chemotherapy monitoring and follow-up programs. To provide continuous care and minimize clinical gaps to Veterans receiving oral chemotherapy, the hematology/oncology clinical pharmacy practitioners designed and initiated a pilot, pharmacist-driven, Oral Chemotherapy Monitoring Clinic at the South Texas Veterans Health Care System supported by an oral chemotherapy certified pharmacy technician. A retrospective evaluation of patients receiving oral chemotherapy at the South Texas Veterans Health Care System was performed before (Phase I) and after (Phase II) pilot implementation to assess the impact of an Oral Chemotherapy Monitoring Clinic on compliance with drug-specific lab and symptom monitoring. Complete monitoring was defined as 100% of recommended labs and symptoms assessed per cycle, partial monitoring was <100%, but >0%, and incomplete monitoring was defined as 0%. The primary outcome assessed the proportion of patients receiving complete monitoring in Phase II compared to Phase I. Most patients were male (94%), with a median age of 72 years. The most common oncolytic was abiraterone acetate. Overall, drug-specific baseline and follow-up laboratory and symptom monitoring was complete at a statistically significantly higher rate in Phase II compared with Phase I (p-value < 0.01). A significantly higher portion of patients in the Phase II cohort had a clinical pharmacy practitioner intervention (44% vs. 90%; p < 0.01). Monitoring for Veterans receiving oral chemotherapy was optimized with clinical pharmacy practitioner and certified pharmacy technician involvement while simultaneously alleviating Oncologist and nurse oral chemotherapy workload.

Optimisation of medication reconciliation using queueing theory: a computer experiment.

Medication reconciliation (MedRec) in hospitals is an important tool to enhance the continuity of care, but completing MedRec is challenging. The aim of this study was to investigate whether queueing theory could be used to compare various interventions to optimise the MedRec process to ultimately reduce the number of patients discharged prior to MedRec being completed. Queueing theory, the mathematical study of waiting lines or queues, has not been previously applied in hospital pharmacies but enables comparisons without interfering with the baseline workflow. Possible interventions to enhance the MedRec process (replacing in-person conversations with telephone conversations, reallocating pharmacy technicians (PTs) or adjusting their working schedule) were compared in a computer experiment. The primary outcome was the percentage of patients with an incomplete discharge MedRec. Due to the COVID-19 pandemic, it was possible to add a real-life post hoc intervention (PTs starting their shift later) to the theoretical interventions. Descriptive analysis was performed. The queueing model showed that the number of patients with an incomplete discharge MedRec decreased from 37.2% in the original scenario to approximately 16% when the PTs started their shift 2h earlier and 1 PT was reassigned to prepare the discharge MedRec. The number increased with the real-life post hoc intervention (PTs starting later), which matches a decrease in the computer experiment when started earlier. Using queueing theory in a computer experiment could identify the most promising theoretical intervention to decrease the percentage of patients discharged prior to MedRec being completed.

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

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

Tiered Licensure for Pharmacy Technicians: Is the Advanced Pharmacy Technician (APhT) License the Model for State Regulators?

Two states-Connecticut and New Hampshire-have created or attempted to create advanced pharmacy technician (APhT) licenses. Both licenses, proposed and actual, have high barriers to entry, such as requiring 1 to 3 years of prior technician experience and passage of various assessments or trainings, such as a state-specific jurisprudence exam. Those obtaining APhT licensure are granted additional authority, such as performing final product verification (e.g., tech-check-tech) and vaccine administration. Compared with practices in other states, the APhT role in CT and NH provides minimal scope gains relative to the requirements imposed; as a result, there has been limited uptake (<1%) among current technicians. As such, it appears unlikely that tiered licensure for technicians will be the preferred mechanism for states to expand the role of pharmacy technicians in the future.

Techs as Teachers: A Decade’s Experience Utilizing Pharmacy Technicians in a Doctor of Pharmacy Program

Pharmacy technician responsibilities, certifications, and duties across pharmacy settings have evolved in recent years, allowing them to potentially become a valuable resource for skills-based pharmacy education. Our institution has employed pharmacy technicians since 2014. This brief commentary addresses the training and roles of pharmacy technician staff in our skills-based education curriculum.

A survey on the implementation of clinical medication reviews in community pharmacies within a multidisciplinary setting

BackgroundPolypharmacy is common in chronic medication users, which increases the risk of drug related problems. A suitable intervention is the clinical medication review (CMR) that was introduced in the Netherlands in 2012, but the effectiveness might be hindered by limited implementation in community pharmacies. Therefore our aim was to describe the current implementation of CMRs in Dutch community pharmacies and to identify barriers to the implementation.MethodsAn online questionnaire was developed based on the Consolidated Framework for Implementation Research (CFIR) and consisted of 58 questions with open ended, multiple choice or Likert-scale answering options. It was sent out to all Dutch community pharmacies (n = 1,953) in January 2021. Descriptive statistics were used.ResultsA total of 289 (14.8%) community pharmacies filled out the questionnaire. Most of the pharmacists agreed that a CMR has a positive effect on the quality of pharmacotherapy (91.3%) and on medication adherence (64.3%). Pharmacists structured CMRs according to available selection criteria or guidelines (92%). Pharmacists (90%) believed that jointly conducting a CMR with a general practitioner (GP) improved their mutual relationship, whereas 21% believed it improved the relationship with a medical specialist. Lack of time was reported by 43% of pharmacists and 80% (fully) agreed conducting CMRs with a medical specialist was complicated. Most pharmacists indicated that pharmacy technicians can assist in performing CMRs, but they rarely do in practice.ConclusionsLack of time and suboptimal collaboration with medical specialists are the most important barriers to the implementation of CMRs.

Evaluation of factors affecting pharmacists and pharmacy technicians' satisfaction towards practicing CE activities in Saudi Arabia

BackgroundContinuing education (CE) is an essential requirement for pharmacy professionals to stay abreast with the evolving knowledge and skills of the practice and meet the regulatory mandate. The purpose of this research is to assess factors affecting the satisfaction of pharmacists and pharmacy technicians towards CE practices in Saudi Arabia. Material and methodsA self-administered survey instrument was developed following an extensive literature search. The questionnaire consisted of three sections: participants’ demographics, data on CE activities over the past year and overall satisfaction, and statements of barriers (14 items) and facilitators (12 items) for participation in CE activities (scored on a 5-point Likert scale (5 = always, 1 = never)). The survey was piloted and then distributed as a link through the Saudi Commission for Health Specialties and Saudi Pharmaceutical Society (SPS) between Jan 2018 and Feb 2019. ResultsData was available on 398 pharmacists and 40 pharmacy technicians (completion rate was 55 %). The majority were practitioners, male, working in a hospital setting and had more than five years of practice experience. Half of the participants were from the Central Region and about one-third were non-Saudi. Only a quarter of the participants were satisfied/very satisfied with the current CE practices in Saudi Arabia. Job constraints (62.7 %), cost (55.9 %), schedule of CE activities (55.4 %), lack of information on CE opportunities (53 %) and professional burnout (49.7 %) were the top barriers. There was a significant level of dissatisfaction among pharmacy technicians when compared to pharmacists (p = 0.003), as well as among Saudi pharmacists when compared to non-Saudi pharmacists (p = 0.002). Lack of relevant CE activities (p = 0.05), lack of quality activities (p = 0.002), lack of recognition (p = 0.013) and lack of internet access (p = 0.006) were significantly more barriers for pharmacy technicians compared to pharmacists. The most identified facilitators to engage in CE activities were a personal desire to learn (78.4 %), the requirement to maintain a professional license (73.8 %) and relaxation provided by learning (58.5 %) and networking opportunities (53.4 %). The majority of the participants preferred conferences or interactive workshops, short CE over half a day or less, and the topic of disease management/drug therapy. ConclusionThe findings of the study highlight the need for a partnership strategy that includes various stakeholders to improve CE program quality and accessibility that supports and promotes the professional development of pharmacists and pharmacy technicians in Saudi Arabia. It also underscores the importance of meeting the preferences of pharmacy practitioners when designing CE programs and aligning such activities with their practices.

Semi-automated versus manual compounding of chemotherapy: a pilot study of dosing accuracy and pharmacy technician perceptions at a university teaching hospital

Abstract Introduction The semi-automated compounding of intravenous chemotherapy is an evolving technology with previously identified benefits to patients and operator safety.[1] The introduction of a Gri-fill® 4 semi-automated unit to University Hospital Limerick (UHL) in 2022 marked the first use of semi-automated chemotherapy compounding in Ireland. To date, limited research exists regarding implementation of semi-automated units within Irish hospitals. Aim To compare dosing accuracy and preparation time of manually versus semi-automated compounded chemotherapy. To understand perceptions of pharmacy technicians regarding manual versus semi-automated compounding of chemotherapy. Methods Dose accuracy, defined as absolute percentage dose error versus the prescribed dose, was obtained gravimetrically for a total of 90 chemotherapy preparations. Preparations of carboplatin (22 manual, 22 semi-automated) and paclitaxel (23 manual, 23 semi-automated) were included. Dose accuracy via both procedures for each drug was compared statistically using the Mann-Whitney U-test, whereby p&amp;lt;0.05 denotes statistical significance. A dose accuracy cut-off, signalling need for repreparation, was &amp;gt;5%. Time in seconds for compounding via each procedure was recorded. An anonymous online survey consisting of both Likert-scale and free-text questions was disseminated to all ten pharmacy technicians who work in the UHL aseptic compounding unit (ACU). Likert-scale responses were analysed using descriptive statistics, while qualitative statements were analysed thematically. Results A statistically significant difference in dose accuracy distribution between manual (mean rank = 28.20) versus semi-automated (mean rank = 16.80) groups was found for the carboplatin preparations (p&amp;lt;0.05, U=367.5). Absolute percentage dose error tended to be higher using the manual procedure. No significant difference in dose accuracy distribution was observed between procedures for paclitaxel (p&amp;gt;0.05, U=285.0) (manual mean rank = 22.61, semi-automated mean rank = 24.39). Overall, zero semi-automated and 2 manual preparations exceeded the &amp;gt;5% dose accuracy limit. For both drugs, median preparation times were longer for the semi-automated (200.5, 199 seconds) versus the manual (116.5, 141 seconds) procedure. Nine out of ten pharmacy technicians responded to the survey. Over half (55%) found working with the semi-automated unit demanding. A higher percentage felt preparations compounded manually were safer than preparations from the semi-automated unit (100% versus 66%). Practical issues with the semi-automated unit, including lack of space within the isolator, staff resource allocation and reliance on machine calibration were highlighted. However, its capacity to produce large multiples of one preparation type was recognised. Conclusion This pilot study highlighted comparative (paclitaxel) or significantly improved (carboplatin) dosing accuracy of a semi-automated compounding unit versus a manual procedure. While the number of preparations analysed was limited and necessity for larger confirmatory studies across numerous ACUs is acknowledged, this data highlights capacity for semi-automated units to accurately prepare chemotherapy. The observed decreased repreparation requirements of the semi-automated procedure highlight potential for such units to aid sustainable chemotherapy production. However, to optimise implementation, future research should investigate solutions to concerns identified by pharmacy technicians and verify the accuracy results obtained. Only then can the benefits of such semi-automated units to both patients and staff be achieved. Reference 1. Seger AC, Churchill WW, Keohane CA, Belisle CD, Wong ST, Sylvester KW, Chesnick MA, Burdick E, Wien MF, Cotugno MC, Bates DW. Impact of robotic antineoplastic preparation on safety, workflow, and costs. Journal of Oncology Practice. 2012;8(6):344–9.

Planning the implementation of a new oncology compounding information system in an aseptic compounding unit: a mixed methods study

Abstract Introduction Systemic anti-cancer therapy (SACT) compounding is a high-risk process. Traditional mixed method systems for workflow management in aseptic compounding units (ACUs) are inherently prone to risk. Workflow management systems (WFMSs) are recognised internationally to improve safety, reduce costs, and increase ACU capacity.[1] Planning of the implementation of a WFMS has not been characterised before. In our ACU, Clinichemo® will be replaced with BD-CATO®. BD-CATO® is a WFMS and is the vendor for the National Cancer Information System (NCIS), implemented by the National Cancer Control Programme (NCCP).[2] Aim The aim of this study was to demonstrate how the implementation of a new WFMS can be safely planned, managed, and assessed. This aim was achieved using the following objectives: 1. Describe and risk assess the current workflows for SACT compounding. 2. Investigate agreed and published standards for SACT compounding. 3. Define the change management process. 4. Describe and evaluate the benefits, challenges and risks associated with the introduction of a new SACT compounding system. 5. Interview adopters of NCIS/BD-CATO® to assess their experience of the barriers encountered, how challenges were overcome, risks identified, mitigated, and eliminated through the change management process and ongoing. Methods The current workflow and future workflow for SACT compounding were characterised and current process risk assessed. Semi-structured interviews were carried out to evaluate pharmacist and pharmacy technicians’ attitudes and opinions towards the implementation of BD-CATO® in their organisations and the system itself. Participants were recruited by means of purposive and snowball sampling from ACUs across the country that had implemented/were in the process of implementing BD-CATO®/NCIS. Themes identified in interviews were compared to those found in the literature and guidelines. Interviews, a review of guidelines, published standards and the literature were used to guide and risk assess future process development. The change management plan was also defined. Results Nine participants (8 pharmacists and 1 pharmacy technician) were interviewed in June-August 2023. The interviews were conducted across 7 ACUs in Ireland. Thematic analysis of interview data yielded four key themes: 1. Participants discussed the importance of planning activities, such as communication with key stakeholders, discussions around phased implementation, and development of training material. 2. Having a designated individual tasked with change implementation improved outcomes of the implementation project. 3. Participants also discussed benefits and risks associated with BD-CATO®. 4. Participants discussed their reasons for perceived complexity of the system. A combination of interview data, review of guidelines, published standards and the literature were used to devise future process workflow and the change management plan. The future process workflow was also risk assessed using bowtie analysis. Conclusion The introduction of WFMSs has been interpreted both in the literature and within the Irish healthcare setting to increase efficiencies, reduce error rates, and improve the accuracy of SACT compounding. A formal change management strategy devised with resourcing, training, and obtaining stakeholder engagement is key to successful implementation.

Evaluation of a hybrid medication synchronization training module for pharmacy technicians

BackgroundMedication synchronization involves coordinating a patient’s medications to a single date each month. Medication synchronization programs close gaps in care and improve adherence compared with automatic refill-processing programs. Patients are 2-6 times more adherent to medications when enrolled in a medication synchronization program. Medication synchronization has historically been driven by pharmacists; however, pharmacy technicians are in a unique position to logistically run this service. ObjectiveThis study aimed to develop a training program for pharmacy technicians regarding medication synchronization and assess changes in knowledge and confidence before and after implementing a training program. Practice descriptionAn independent community pharmacy in North Carolina. Pharmacists provide medication therapy management, reimbursed clinical services, medication synchronization, and immunizations. Practice innovationThe training program included medication synchronization basics, patient enrollment process, processing a synced patient, and a hands-on practice session. Evaluation methodsTechnicians took a pre-training survey assessing knowledge and confidence before immediately completing a one-on-one pharmacist-led training session with a hands-on component regarding medication synchronization. Technicians took the same post-training survey 2 weeks after completing the training session and using medication synchronization in daily workflow. Pre- and post-training scores were assessed using a paired samples t test. ResultsTen technicians completed the training program; 40% of the technicians were certified and 30% were enrolled in a PharmD program. The mean pre-training knowledge score was 78% (7.1 of 9 points), the mean post-training knowledge score was 92% (8.3 of 9 points), and the mean difference between the pre- and post-training knowledge scores was 13.4% (1.2 points), with a statistically significant difference (P = 0.0026). Confidence with conducting a medication synchronization call increased from 7.2 to 9.6 on a 10-point Likert scale, and confidence scores increased regarding incorporating medication synchronization into workflow from 6.9 to 8.7. ConclusionThe standardized technician training program increased knowledge and confidence in technicians regarding managing a medication synchronization program.

Evaluation of pharmacy-supplied half and quarter tablets at an academic medical center.

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. Manipulation of tablet medications to produce a customized dose is common practice, and splitting tablets may reduce the acquisition cost of the medication. However, cost savings may be diminished by the cost of the increased labor and repackaging materials needed when splitting tablets. Splitting tablets may also result in safety concerns if the final products are under (eg, reduced benefit) or over (eg, toxicity) the desired dosage. The purpose of this quality improvement project was to evaluate and recommend changes for all half- and quarter-tablet medications prepared and distributed from the inpatient pharmacy at University of Utah Health (U of U Health). The evaluation included all half- and quarter-tablet medications prepared by pharmacy technicians for administration to patients admitted to U of U Health hospitals. A final list of 173 half- and quarter-tablet dosages was evaluated for opportunities to decrease the total number. On the basis of the developed criteria, 93 half- and quarter-tablet dosages (54%) were recommended to be removed from routine stock in the inpatient pharmacy. Systems remain in place to create customized half and quarter tablets if required for patient care. Reducing the number of medications for which half and quarter tablets are used may allow pharmacy technicians to prioritize other patient care tasks and potentially decrease waste.

Growth of a pharmacy technician apprenticeship: Lessons learned on the path to success.

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.

Intelligent supervision of PIVAS drug dispensing based on image recognition technology.

Pharmacy Intravenous Admixture Services (PIVAS) are places dedicated to the centralized dispensing of intravenous drugs, usually managed and operated by professional pharmacists and pharmacy technicians, and are an integral part of modern healthcare. However, the workflow of PIVAS has some problems, such as low efficiency and error-prone. This study aims to improve the efficiency of drug dispensing, reduce the rate of manual misjudgment, and minimize drug errors by conducting an in-depth study of the entire workflow of PIVAS and applying image recognition technology to the drug checking and dispensing process. Firstly, through experimental comparison, a target detection model suitable for drug category recognition is selected in the drug-checking process of PIVAS, and it is improved to improve the recognition accuracy and speed of intravenous drug categories. Secondly, a corner detection model for drug dosage recognition was studied in the drug dispensing stage to further increase drug dispensing accuracy. Then the PIVAS drug category recognition system and PIVAS drug dosage recognition system were designed and implemented.

Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey.

There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres. To describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs. We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK ECMO centre. We collated information on workforce, service provision, and pharmaceutical care activities provided by pharmacy teams in adult CCUs with an ECMO service. The survey response rate was 90.9%: representatives of 10/11 tertiary hospitals providing ECMO services responded. Median critical care pharmacist to critical care bed was 1:12.1 (IQR: 1:9.4-1:14.9). Most centres (90.0%) did not meet national standards for pharmacy professionals to critical care bed staffing ratios for weekday services. Total critical care beds covered by the critical care pharmacy team varied across the UK: median (IQR) - 45 (37-80) beds. Two centres funded pharmacist time for ECMO activity, and one centre funded a pharmacy technician post. Median peak ECMO activity was 4 ECMO patients in a single day (IQR: 3-5). Most respondents reported reduced pharmacy service at weekends compared to weekday, with limited on-site support. Most responding ECMO centres in the UK reported pharmacy staffing ratios below nationally agreed critical care standards. There was high variability in clinical pharmacy services to ECMO patients over 7days.

Closing the Tobacco Treatment Gap: A Qualitative Study of Tobacco Cessation Service Implementation in Community Pharmacies.

Tobacco use remains a leading preventable cause of morbidity and mortality, with pharmacotherapy and counseling recognized as effective cessation aids. Yet, the potential role of pharmacists and pharmacy technicians in tobacco cessation services is underutilized. This study explores the integration of such services in community pharmacies, identifying facilitators and barriers to their implementation. A qualitative study was conducted across seven community pharmacies in California that were affiliated with the Community Pharmacy Enhanced Services Network. Participants included 22 pharmacists and 26 pharmacy technicians/clerks who completed tobacco cessation training. Data were collected through semi-structured interviews, focusing on experiences with implementing cessation services. The analysis was guided by Rogers' Diffusion of Innovations Theory. MAXQDA software was used for data management and thematic analysis. Sixteen pharmacy personnel participated in the study, highlighting key themes around the integration of cessation services. Compatibility with existing workflows, the importance of staff buy-in, and the crucial role of pharmacy technicians emerged as significant facilitators. Challenges included the complexity of billing for services, software limitations for documenting tobacco use and cessation interventions, and gaps in training for handling complex patient cases. Despite these barriers, pharmacies successfully initiated cessation services, with variations in service delivery and follow-up practices. Community pharmacies represent viable settings for delivering tobacco cessation services, with pharmacists and technicians playing pivotal roles. However, systemic changes are needed to address challenges related to billing, documentation, and training. Enhancing the integration of cessation services in community pharmacies could significantly impact public health by increasing access to effective cessation support.

Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People With HIV Who Are Virally Unsuppressed.

Early evidence suggests long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) may be beneficial for people with HIV (PWH) who are unable to attain viral suppression (VS) on oral therapy. Limited guidance exists on implementation strategies for this population. Ward 86, a clinic serving publicly insured PWH in San Francisco. We describe multilevel determinants of and strategies for LA-CAB/RPV implementation for PWH without VS, using the Consolidated Framework for Implementation Research. To assess patient and provider-level determinants, we drew on pre-implementation qualitative data. To assess inner and outer context determinants, we undertook a structured mapping process. Key patient-level determinants included perceived ability to adhere to injections despite oral adherence difficulties and care engagement challenges posed by unmet subsistence needs; strategies to address these determinants included a direct-to-inject approach, small financial incentives, and designated drop-in days. Provider-level determinants included lack of time to obtain LA-CAB/RPV, assess injection response, and follow-up late injections; strategies included centralizing eligibility review with the clinic pharmacist, a pharmacy technician to handle procurement and monitoring, regular multidisciplinary review of patients, and development of a clinic protocol. Ward 86 did not experience many outer context barriers because of rapid and unconstrained inclusion of LA-CAB/RPV on local formularies and ability of its affiliated hospital pharmacy to stock the medication. Multilevel strategies to support LA-CAB/RPV implementation for PWH without VS are required, which may necessitate additional resources in some settings to implement safely and effectively. Advocacy to eliminate outer-context barriers, including prior authorizations and specialty pharmacy restrictions, is needed.

Implementation of a pharmacy technician career ladder and pharmacy technician training program.

To describe the implementation of a pharmacy technician career ladder and internal technician training program at UF Health Shands Hospital in Gainesville, FL. As the systems for providing care and receiving reimbursement become more complex, the ability to deliver comprehensive care in the most efficient and effective manner is critical. In order to maximize impact, pharmacists must practice at the top of their license. Recruitment and retention practices that support an optimized pharmacy technician workforce and continued expansion of technician roles are vital to advancement of pharmacy practice. This report describes the efforts to improve technician recruitment, professional development, and retention through the implementation of a technician career ladder and internal training program. The programs contributed to a reduction in technician rolling 12-month turnover rates from 26.72% in July 2015 to 13.1% in March 2023 (a reduction of 51%). Overtime hours as a percentage of total hours worked were reduced from 11.02% in July 2015 to 4.54% in March 2023 (a reduction of 59%). Improvements were noted in pharmacy technician job satisfaction, as evidenced by key employee engagement indicators including responses to the posed statement "Overall, I am a satisfied employee," with a mean score of 3.32 (on a scale of 1-5) in 2015 as compared to 4.2 in 2019 (a 21% increase). Implementation of a pharmacy technician career ladder and technician training program creates a sustainable and effective recruitment and retention pathway that may favorably impact technician job satisfaction, turnover, and career development opportunities.

Medication discrepancies across care transitions and the role of pharmacy technicians: A retrospective chart review

BackgroundAfter hospitalization, older adults are increasingly discharged to postacute care facilities such as skilled nursing facilities (SNFs). Medication reconciliation and obtaining the best possible medication history (BPMH) are key components of medication management for care transitions and essential for preventing medication errors and adverse drug events. ObjectiveThis study aimed to assess medication discrepancies across care transitions after a Certified Pharmacy Technician (CPhT) obtains the BPMH on hospital admission. MethodsSingle-center, retrospective chart review and included adults ≥ 18 years admitted to the medicine service and discharged to a SNF between November 2016 and June 2017. Medication lists were evaluated for discrepancies across 3 transitions: hospital admission to hospital discharge (Time I), hospital discharge to SNF admission (Time II), and SNF admission to SNF discharge (Time III). Discrepancies were categorized by medication class, type of discrepancy, and whether it was potentially intentional or unintentional. ResultsIn 127 patients, the average age was 83.3 (SD 9.16), 61% (n = 77) were female, and 67% (n = 85) were white. Median hospital length of stay (LOS) was 6 days (interquartile range [IQR] 4-10) and SNF LOS 21 days (IQR 15-30). Across 381 transitions, 6322 medications were reviewed, and 2602 discrepancies identified. The total number of medication discrepancies was 1034 (Time I), 687 (Time II), and 881 (Time III), respectively. All patients had at least one medication discrepancy. The average number of potentially unintentional discrepancies per patient at each transition was 0.14, 0.2, and 0.16, respectively. The most common discrepancy type was omissions (39%), and the highest number of discrepancies in the potentially intentional and unintentional discrepancy groups was gastrointestinal (21%) and cardiovascular medications (24%), respectively. ConclusionMedication discrepancies are common across all care transitions. Future studies are needed to evaluate the role of CPhT in obtaining the BPMH on hospital admission for reducing medication discrepancies across the continuum of care.

Impact of pharmacist-driven referral to increase specialty pharmacy prescription capture.

To assess the impact of a clinical pharmacy specialist (CPS) embedded within a rheumatology clinic at a large academic medical center on the prescription capture rate at the health-system specialty pharmacy. Initially low prescription capture rates for the health-system specialty pharmacy led to the integration of a CPS in the main campus rheumatology clinic. Benchmarking was completed by assessing the prior prescription capture rate using electronic medical record analytics and Loopback Analytics (a database of prescription capture for the health-system specialty pharmacy). The existing workflows for both the rheumatology clinic and specialty pharmacy were observed with regard to biologic medication ordering and processing. Strategies for an updated workflow for biologic ordering with the incorporation of an embedded CPS in the rheumatology clinic were designed. This new workflow was established with key stakeholders, including the CPS, rheumatology providers, clinic staff, and pharmacy technicians. Once the workflow was established, all parties were educated and updated, including rheumatology providers, nursing staff, and specialty pharmacy staff. Prescription capture rate was monitored on a monthly basis. Prescription capture increased from 13.16% before pharmacist implementation (October to December 2021) to 35.42% after pharmacist implementation (October to December 2022) (P = 0.019). During the same periods, the revenue generated increased from $43,222.89 to $135,198.70 (P = 0.224) and the proportion of prescriptions initially sent to the health-system specialty pharmacy compared to other specialty pharmacies increased from 37% to 79% (P < 0.001) with CPS implementation. Expansion and implementation of pharmacy services by integrating a CPS in a rheumatology ambulatory clinic increased prescription capture and pharmacy revenue while optimizing patient care. We hope to expand similar CPS services to other clinics within the health system.