Pharmacy Training Research Articles

Development and Implementation of an Integrated Framework for Undergraduate Pharmacy Training in Maternal and Child Health at a South African University.

The South African Pharmacy Council (SAPC) regulates undergraduate pharmacy education and pharmacy practice. The SAPC Good Pharmacy Practice manual describes the role of pharmacists in maternal and child health (MCH) in line with the recommendation of international health regulatory bodies. However, baseline study findings in 2017 supported literature from around the world that indicated a need for curriculum review and integration to address the knowledge and skills gap in pharmacists’ MCH training. This paper describes the development and implementation of an integrated framework for MCH training across the four years of a Bachelor of Pharmacy program. The intervention included didactic lectures, skills practical on infant growth assessment, and an experiential learning component at primary health care clinics and pharmacies. Knowledge and skills assessment on contraception, maternal and antenatal care, and neonatal and child care were carried out pre, eight weeks post, and two years post intervention using the same questionnaire. ANOVA and post hoc analyses showed that participants’ knowledge and skills increased post intervention but decreased significantly two years later except in contraception where students experienced longitudinal integration of the MCH component. Generally, participants performed above the university average except in maternal and antenatal care.

EXPERIENTAL INTERPROFESSIONAL SIMULATION-BASED EDUCATION IMPROVES KNOWLEDGE, PERCIEVED PROFICIENCY AND VALUE IN COLLABORATIVE CRITICAL CARE

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Interprofessional care teams are the pillars of intensive care units (ICUs) where severity of illness is high and care requires unique knowledge, skills and experience. Despite this model, programs rarely integrate different professions in training. ICU rotations present unique challenges, especially the rapid recognition of clinical deterioration. Many trainees are expected to have working knowledge of these without previously setting foot in an ICU. Simulation provides "hands-on" practice in a safe environment and also allows for the integration of teamwork into knowledge and skill training. Our study is important as it assesses the impact of this much needed interprofessional training in a novel but practical ICU simulation. We assessed the impact on knowledge, skills, comfort level with providing ICU care in a collaborative approach following participation in a simulation experience designed to educate and provide opportunities to lead, make decisions, and manage crises in critical patients. METHODS: This pilot study was designed as a mixed method study in a simulated environment where all participants took part in a three-hour immersive interprofessional learning. They completed a pre-survey followed by simulations meant to represent skills critical to the ICU setting in multi-disciplinary groups. Learners rotated through different stations such as the Ventilator knowledge hub where they received an overview of respiratory physiology, and ventilator mechanics. This was followed by a Ventilator simulation and using "VentiSim" software. They were also educated about the different oxygen delivery devices. They then partook in ultrasound-guided central line placement on a mannequin, cardiac rhythm recognition, and simulated Megacode using high fidelity simulators. A post survey was completed for assessment of knowledge, skills, and comfort level of participants. A three-tiered approach to debriefing was implemented for all participants. RESULTS: There were 74 participants of which 48% were medical residents, 19% nursing students, 16% medical students, 10% respiratory therapy students, 5% pharmacy trainees. Paired t-test was used to analyze the knowledge, and skills data which showed significant improvement with P-value < 0.0001(95% CI 1.16 to 2.20). Based on the Post-intervention survey, 99% agreed that it was worth their time to attend the session. 96% believed their ability to deliver patient care improved, 80% felt their anxiety reduced about rotating in ICU. During debriefing an overwhelming majority of learners commented how much they appreciated, “getting to interact with other professions”. There was strong feedback that we needed to conduct more workshops. CONCLUSIONS: Our novel ICU simulation workshop provided a statistically significant improvement in the knowledge base and understanding of common ICU procedures and concepts in a multidisciplinary team of healthcare trainees. It was evident during debriefing that participants appreciated the importance of an interprofessional, collaborative approach to critical care during their training. CLINICAL IMPLICATIONS: We will continue to refine our educational tool to bridge the gap in learning and collaboration. Although implementing such a detailed workshop was challenging, we feel it is essential for learning critical care skills in a safe environment and also to prioritize teamwork and communication in the ICU setting. DISCLOSURES: No relevant relationships by Nalini Kalanadhabhatta, source=Web Response No relevant relationships by Rajesh Kunadharaju, source=Web Response No relevant relationships by Archana Mishra, source=Web Response No relevant relationships by Alexander Pomakov, source=Web Response No relevant relationships by Raj Thapar, source=Web Response

Sustaining safety and delivery of oral chemotherapy utilizing lean methodology.

218 Background: An oral chemotherapy safety event in 2017 prompted analysis of related workflows utilizing lean quality improvement methodology. Three kaizen workshops utilizing lean methodology with primary objectives to 1) develop safety standards for oral chemotherapy as rigorous as those for intravenous chemotherapy; 2) improve efficiency; and 3) design workflows that enable data collection and process control were conducted. Since 2017, our goal has been to sustain developed workflows to ensure oral chemotherapy patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by all care providers. Methods: After multidisciplinary teams participated in three kaizen workshops to develop workflows, education plans were developed and results were incorporated into the lean management system. The lean production method of Training Within Industry (TWI) was used to train physician, nursing, and pharmacy teams to the workflows. Results were communicated to key stakeholders weekly to monitor progress on workflow creation, spread, and process metrics designed to signal defects in the workflow. When processes were deemed ‘out of control,’ clinical team members provided regular and targeted interventions. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 62 consecutive weeks with 99% reduction in oral chemotherapy defects reaching pharmacy. 86 consecutive weeks with 51% error reduction processing oral chemotherapy though a single EMR workflow. 57 consecutive weeks with 62% error reduction processing oral chemotherapy though a single EMR workflow. No serious safety events have occurred since 2017. Conclusions: Comprehensive quality improvement in our oral chemotherapy process has resulted in sustained safety, efficiency, and a data collection to signal when process defects occur. Multidisciplinary teams utilizing established lean methodology were critical to success.

Implementation and Evaluation of a 10-Week Health Equity Curriculum for Pharmacy Students

Objective To describe a health equity curriculum created for pharmacy students and evaluate students' perceptions and structural competency after completion of the curriculum.Methods A health equity curriculum based on transformative learning and structural competency frameworks was implemented as a 10-week mandatory component of the pass-no pass neuropsychiatric theme for second year pharmacy students. Each week, students reviewed materials around a neuropsychiatric-related health equity topic and responded to discussion prompts through asynchronous forums or synchronous online video discussions. The effectiveness of the health equity curriculum was evaluated through assessment of structural competency through a validated instrument, an objective structured clinical examination (OSCE), and a questionnaire.Results All enrolled second year pharmacy students (n=124) participated in the health equity curriculum. Of the 75 students who completed the structural competency instrument, 46 (61%) were able to identify structural determinants of health, explain how structures contribute to health disparities, or design structural interventions. Ninety-six of the 124 students (77%) were able to address their OSCE standardized patient's mistrust in the health care system. Thematic analysis of student comments elucidated three themes: allyship, peer connection, and self-awareness. Students rated asynchronous discussion forums as significantly less effective than online video discussions and patient cases for achieving curricular objectives.Conclusion A mandatory curriculum delivered remotely throughout the didactic pharmacy curriculum using a blended learning approach was an effective way to incorporate health equity content and conversations into existing courses. Implementation of this or similar curriculums could be an important step in training pharmacy students to be advocates for social justice.

Preceptor perceptions of contemporary practice skills among new graduates amid community pharmacy transformation

IntroductionWith community pharmacy transitioning from a fee-for-service model to a value-based care focus, the desired skills of pharmacist graduates is an evolving paradigm. As active stakeholders in community practice, pharmacist preceptors are in a unique position to compare the ever-changing dichotomy between pharmacy practice and training. Examining preceptors' assessments of these essential contemporary practice skills may provide useful insights. MethodsA survey was emailed to all regional, active college of pharmacy community advanced pharmacy practice experiences preceptors. Participating preceptors were given 30 days to complete the online survey. Weekly reminders were provided. ResultsOf the 168 preceptors invited to participate, 42 (25%) completed the survey. Descriptive analysis compared preceptors' perceptions of transformative services vs. their relative implementation in practice. This revealed service areas such as health screenings that were proportionate in their prevalence of offering and perception as contemporary. In contrast, services such as pharmacogenomic testing were more widely perceived as contemporary compared to their low prevalence as an offering. Participants showed broad consensus in the importance of most skills listed in the survey, predominantly indicating these skills were either “very important” or “extremely important.” Only a few specific skills areas were identified that showed less consensus, with a minority of respondents specifying that these skills were of less importance. ConclusionsPreceptor surveys may offer insights on the progression of community practice curricula. Continued monitoring of changes in service parameters over time may reveal trends in practice transformation, identifying service areas being more widely adopted.

Clinical pharmacy definition, required education, training and practice in Saudi Arabia: A position statement by the Saudi society of clinical pharmacy

The Saudi Society of Clinical Pharmacy (SSCP) is a scientific and professional society in the field of clinical pharmacy that operates under the Saudi Commission for Health Specialties governance. The SSCP believes that there is a need to define and describe many aspects related to the clinical pharmacy profession in Saudi Arabia. Moreover, there is an increasing demand for promoting the concept of clinical pharmacy and developing a consensus regarding the scope of practice and clinical pharmacist's required postgraduate education and training in Saudi Arabia. This paper is intended to present several position statements by the SSCP that define the concept of clinical pharmacy, describe the required education and training, and highlight clinical pharmacists' scope of practice in Saudi Arabia. This paper calls for further investigations that examine the impact of clinical pharmacists on individual and population health levels.

Exploring Pharmacy Trainee Experiential Learning in a Full Scope Collaborative Rural Primary Care Practice: A Retrospective Chart Review.

Despite reported benefits of pharmacy trainees (e.g., pharmacy students, pharmacy residents) in hospital settings, limited research on the impact of these trainees has been conducted in rural primary care. To explore the potential benefits and impact of pharmacy trainees practicing in a supervised collaborative rural primary care setting, a retrospective chart review was conducted. Drug therapy problems (DTPs) were classified using the Pharmaceutical Care Network Europe (PCNE V9) system. Valuation was measured using a validated tool developed by Overhage and Lukes (1999). Over 16 weeks on a part-time basis, pharmacy trainees (n = 3) identified 366 DTPs during 153 patient encounters. The most common causes for DTPs were related to patient transfers and the need for education. Drug level interventions carried out directly by trainees under supervision accounted for 13.1% of total interventions. Interventions that required prescriber authorization had an acceptance rate of 83.25%, 25% higher than previous acceptance rates found in urban primary care settings. About half (51%) of the interventions proposed and made by pharmacy trainees were classified as significant or very significant, suggesting these trainees added significant value to the pharmacy service provided to rural community residents. This study suggests that pharmacy trainees can be effective resources and contribute meaningfully to patient care in a collaborative rural primary care team setting.

Exploring transformative learning for trainee pharmacists through interprofessional simulation: a constructivist interview study

BackgroundThe expanding roles of UK pharmacists have prompted substantial changes to the initial pharmacy education and training, including increasing recognition of the value of learning alongside other professional groups in acute settings. Interprofessional immersive simulation training appears to represent a useful educational tool to meet the evolving needs of the profession, but the impact of such training on workplace behaviour and relationships has not been explored. This study aimed to explore how interprofessional simulation training facilitates transformative learning in pre-registration pharmacists.MethodsAcross three different locations in Scotland, pre-registration pharmacists were paired with medical students to participate in immersive simulation scenarios with post-scenario debriefs. Pre-registration pharmacists were individually interviewed shortly after their simulation session, using a semi-structured interview schedule based on the transformative learning framework. Transcripts were analysed using template analysis, with Mezirow’s phases of perspective transformation forming the initial coding template.ResultsFifteen interviews following five simulation sessions at three different sites were undertaken. Phases 1–6 of the transformative learning framework all resonated with the pre-registration pharmacists to varying degrees. Two prominent threads became evident in the data: a change in participants’ perceptions of risk, and deepened understanding of their role within an acute context. These themes were woven throughout phases 2–6 of the transformative learning framework.ConclusionsInterprofessional immersive simulation training involving acute clinical scenarios has been found to be helpful for pre-registration pharmacists and can foster transformative learning. Through this powerful process, they developed new ways to see the world, themselves and their professional relationships. Positive future actions and roles were planned. As the patient-facing roles of pharmacists expand, educational practices that translate into meaningful change to workplace behaviour and relationships become increasingly important. Carefully constructed interprofessional immersive simulation training should be utilised within pharmacy education more widely.

Pharmacy Education In Indonesia

Pharmacy education in Indonesia mainly involves a four-year undergraduate degree, followed by a one-year professional pharmacy programme. The curriculum and learning outcomes of undergraduate and professional pharmacy programmes follow academic standards set by the Association of Indonesian Pharmacy Higher Education, based on the Seven Star Pharmacist concept developed by the World Health Organisation (WHO). Most pharmacy undergraduate programmes are focused on general pharmacy skills and knowledge, which includes pharmaceutical sciences and clinical pharmacy. Professional pharmacy programmes provide more pharmacy practice training and skills; thus, graduates have broader career opportunities than undergraduates because they are prepared for higher responsibilities within pharmacy practice. Although there have been significant improvements in pharmacy education, there remain challenges related to government policies, stakeholder agreements, educational offerings, competencies, and training. This requires considerable collective efforts from the government, educational systems, associations, and other stakeholders to improve the role of pharmacists in Indonesia.

Expansion of a postgraduate year 2 ambulatory care pharmacy residency program utilizing Medicare annual wellness visits within primary care

BackgroundFunding for pharmacy residency programs is traditionally allocated by the Centers for Medicare and Medicaid Services. In 2003, funding for postgraduate year 2 (PGY-2) was retracted. PGY-2 sites must develop additional funding methods to facilitate program expansion. ObjectiveTo describe the impact of expanding a PGY-2 ambulatory care pharmacy residency through an innovative funding model. Practice descriptionSt. Joseph’s/Candler Health System (SJC) employs pharmacists, including ambulatory care pharmacists, supported by revenue from Medicare annual wellness visits (AWVs) and pharmacy residents. Practice innovationThe PGY-2 ambulatory care program at SJC historically offered 1 position supported by SJC. The program expanded in 2020 to further patient outreach with disease state management by increasing the number of pharmacists providing comprehensive patient care. The additional position was primarily supported using funding from AWVs completed by pharmacy residents. To ensure adherence with the American Society of Health-System Pharmacists, residents were evaluated quarterly by preceptor based on feedback provided by clinicians at the practice site. Evaluation methodsIn addition to conducting AWVs, residents worked with physicians within the state-defined scope of practice to optimize medications, support office visits, promote medication adherence and antimicrobial stewardship improvement activities, and implement a blood pressure monitoring program. ResultsFrom July 15, 2020 to March 31, 2021, 407 AWVs were completed by SJC PGY-2 ambulatory care residents, and average AWVs per day increased from 4.5 to 6.9. As compared with the previous year, total AWVs at the primary clinic doubled after pharmacy resident addition, increasing from 251 to 550 (P < 0.001). ConclusionThrough an additional position fiscally supported by reimbursement from AWVs, SJC Ambulatory Care PGY-2 residents increased patient outreach to preventative services as compared with the previous year, expanded pharmacy practice to a new practice site, and generated revenue. This funding method is a viable option to expand postgraduate pharmacy training and ensure optimal patient care in the outpatient setting.

Identification of factors for a successful implementation of medication reviews in community pharmacies: Using Positive Deviance in pharmaceutical care

Background Pharmacists in community pharmacies worldwide successfully conduct an increasing number of medication reviews (MR). Since June 2012 MR are incorporated in the German ordinance on the operation of pharmacies as pharmaceutical service. In November 2014, a German guideline for MR was established. Different teaching programmes for MR were implemented since. Despite these favorable conditions, only few pharmacies conduct MR regularly. Objective: Identification of factors necessary for a successful implementation of MR in community pharmacies. Setting: Community pharmacies located in the area of the Pharmacists’ Chamber Westphalia-Lippe (Part of Northrhine-Westphalia, Germany). Method: Following a Positive-Deviance approach, telephone interviews were conducted in community pharmacies with pharmacy-owners, MR-trained employed pharmacists, and technicians. Data evaluation was performed using qualitative content analysis. Main outcome results: Successful strategies for implementing MR in community pharmacies. Results: Forty-four interviews were conducted and analysed. Thirty-three success factors were identified. Data analysis revealed two groups of success-factors important for implementation of MR; organisational (n = 25) and individual factors (n = 8). Relevant organisational success-factor were involvement of the entire team with active involvement of technicians, documentation of results in the pharmacy software and training in patient-identification and communication. Restructuring of workflows increased time-periods for MR. Important individual success-factors were: motivation and identification with the service, routine in execution to enhance self-esteem, and specialisation in pharmacotherapy of particular diseases. Pharmacy-owners play a pivotal role as motivators. Professional healthcare attitude, exhibited in daily routine, leads to increased acceptance by patients and practitioners and thus increases implementation-rates considerably. Conclusion: We were able to define strategies for successful implementation of MR in community pharmacies.

Work readiness scale for pharmacy interns and graduates: A cross-sectional study

IntroductionAs the number of unemployment among pharmacy graduates increases, the Saudi Ministry of Labor implemented extra measures to facilitate their training and hiring by the private sectors. Nevertheless, there is a paucity of data regarding pharmacy graduates’ work readiness (WR). Hence, we aim to assess their WR and identify predicting factors associated with WR among pharmacy graduates’ in Saudi Arabia. MethodsA 46-item self-reported pre-validated anonymous work readiness scale (WRS) survey with a 5-point Likert scale was administered to pharmacy senior students and graduates using Qualtrics XM® survey tool over the month of May 2020. The main outcome was to assess WRS for pharmacy interns and graduates and identify factors associated with work readiness. ResultsA total of 617 participants have participated in this survey, out of which 46.5% were freshly graduated pharmacists and 19.6% were pharmacy interns. Most participants (82.3%) were PharmD candidates or graduates. Around two-third of participants (63%) have successfully completed all survey items. The maximum points scored was 223 out of 230, and the median overall score was found to be 175. There was no significant association with gender, age, or type of university regarding overall scores. However, a statistically significant odds ratio was observed with PharmD program type and previous pharmaceutical marketing training (OR = 1.778, 95% CI = 1.143–2.765: OR = 0.618, 95% CI = 0.432–0.884, respectively). ConclusionThe overall median score shows a good work readiness level among pharmacy students/graduates in Saudi Arabia; however, PharmD program graduates exposed to advance pharmacy training, including the pharmaceutical marketing experience, have higher work readiness odds than Bpharm graduates. Further studies involving other related perspectives, such as stakeholders, employers, and preceptors, would give a clear image of pharmacy graduates’ job readiness levels.

Students' perceptions of a new transitions of care elective course in the pharmacy curriculum

Background and purposeThe purpose of the new transitions of care (TOC) elective to the pharmacy curriculum is to train pharmacy students to address TOC medication-related problems, assess students' knowledge and perceptions of the TOC pharmacist's role, and explore the impact on interest in post-graduate career planning. Educational activity and settingThird-year pharmacy students were enrolled in the two-credit TOC elective course. The course was designed to include relevant TOC concepts and application of the Pharmacists' Patient Care Process. The pre- and post-assessment surveys were distributed at the beginning and end of the course by a staff administrator to eliminate survey bias. Students were asked to anonymously respond to nine survey questions using a five-point Likert scale (strongly disagree = 1, strongly agree = 5). FindingsNinety-two percent (n = 23) of the pharmacy students responded to the pre- and post-assessment surveys, and results were subsequently analyzed. Statistically significant responses existed to eight of nine questions regarding students' perceptions of increased knowledge of the TOC concepts and pharmacists' role, communication skills, confidence in providing comprehensive patient care, and interest in recommending the TOC elective course to their peers. There was interest in pursuing additional training opportunities, such as post-graduate residency or fellowship training, but the survey item was not statistically significant. SummaryThe TOC elective course provides an opportunity for pharmacy students to learn about the TOC pharmacist's role, improve knowledge on the TOC patient care process, develop practical skills, and engage with clinical pharmacists.

Incidence of a negative hidden curriculum, cynicism, and burnout within pharmacy resident education: A nationwide survey

IntroductionThe term “hidden curriculum” (HC) is a set of ethical, moral, and value-based teachings communicated in a non-explicit manner. Recent literature has described increasing awareness of the prevalence of the HC and potential negative impact on medical learners; however, this information is lacking in pharmacy resident education. Consequently, we conducted a survey study of United States pharmacy residents to learn their perceptions concerning the HC in pharmacy residency training. MethodsA nationwide survey of pharmacy residents was conducted in June 2019. The survey assessed the following: presence of negative HC (score 0 to 80), cynicism (score 0 to 25), burnout via Maslach Burnout Inventory depersonalization (MBI-D) (range 0 to 30), and emotional exhaustion via Maslach Burnout Inventory emotional exhaustion (MBI-EE) (range 0 to 54). Higher scores represent increased occurrences of each domain. ResultsThe mean HC score was 20 (SD 14.7), mean cynicism score was 9 (SD 5.5), MBI-D was 5.5 (SD 4.5), and MBI-EE was 24.2 (SD 12.4). Of those completing an MBI score, 40.4% (82/203) reported burnout in one area, while 15.8% (32/203) reported burnout in both areas. Residents reporting burnout had higher mean HC and cynicism scores. ConclusionsAwareness to develop and grow cultures that minimize the presence of a negative HC is essential to improve postgraduate pharmacy training.

Clinical pharmacists’ services, role and acceptance: a national Swedish survey

AimDescribe, and between regions, compare the services provided, and the pharmacists’ perceptions of their role and its importance.MethodOnline survey involving active clinical pharmacists in Sweden.ResultThe survey was completed by 118...

Pharmacy technicians, supporting our past, shaping our future: Implementing an ASHP-ACPE-accredited pharmacy technician training program in an academic medical center.

Pharmacy technician training and education vary depending on practice site and state law. Although technician certification provides a national standard for credentialing, not all states require it, making certification a voluntary process for technicians or the organizations employing them. As the role of the pharmacist has evolved, the need for highly trained pharmacy technicians has grown. The pharmacy technician's expanded role in specialized areas of pharmacy practice has created new opportunities that require advanced training. Research is lacking on return on investment for workforce development programs, making it difficult to advocate for pharmacy technician training programs. Therefore, it is important to create internal metrics that link one's program to business performance. This begins with conducting a job market analysis for the geographic area. It is imperative to identify the current occupational outlook for pharmacy technicians, identifying areas with potential for growth as well as where there are shortages or high turnover. Successful development of an American Society of Health-System Pharmacists (ASHP) and Accreditation Council for Pharmacy Education (ACPE)-accredited pharmacy technician program requires a long-term strategy to address key market issues as well as social and economic barriers and financial data to secure funding. This case study details Yale New Haven Hospital's journey from proof of concept to implementation of an ASHP-ACPE-accredited pharmacy technician training program.

Experiential training during COVID-19 pandemic: a virtual attachment experience from a college of pharmaceutical sciences in the United Arab Emirates

Description: The COVID-19 pandemic compelled the traditional higher educational institutions to make a quick transition to the virtual instruction model. Considering the COVID-19 restrictions, the Department of Clinical Pharmacy and Pharmacology at Ras Al Khaimah College of Pharmaceutical Sciences, United Arab Emirates restructured their original onsite experiential training for final year Bachelor of Pharmacy students as a virtual online experience to ensure educational continuity. Evaluation: The virtual experiential training was conducted over two weeks and was imparted employing different virtual platforms like Google Classroom, Google Meet, Google Forms, Google Docs, etc. As a part of the community pharmacy training, the students were given different e-activities and tasks like e-case scenario analysis and interpretation, e-prescription screening, virtual patient education and were shown various 3-D animated videos related to community pharmacy. For the hospital training, the students were given different e-cases for developing pharmaceutical care plans, e-case scenario analysis, e-drug information query and were shown different animated videos related to rounds of different hospital departments. Conclusion: The virtual experiential training was successfully conducted achieving the desired learning outcomes and was well received by the students. Based on this experience, it is recommended that efforts should be made to develop an integrated model for experiential training in the future, which can be an amalgamation of online tools and traditional experiential methods.

454-P: Pharmacist-Led Diabetes Self-Management Education and Reduction of Readmission Rates at a County Hospital

Pharmacist-led Diabetes Self-Management Education and Reduction of Readmission Rates at a County Hospital With 10.5% of the US population or 34.2 million people affected by diabetes, education is greatly needed. The American Diabetes Association (ADA) and the Association for Diabetes Care and Education Specialists (ADCES) state that Diabetes Self-Management Education or Training (DSME/T) improves diabetes management, which can avoid hospital admissions and readmissions. Although DSME/T has traditionally been provided by nurses and dieticians, pharmacists can play a part, given their expertise in medication management, non-pharmacological therapies, and monitoring. The ADA and ADCES recommend that people with diabetes receive DSME/T at diagnosis, annually, when factors influence self-management, and at transitions of care. Therefore, a pharmacist-led transitions of care program was developed to reduce readmissions for patients with diabetes at Zuckerberg San Francisco General Hospital and Trauma Center. This hospital serves a diverse, low-income, and unhoused patient population, increasing the challenges of diabetes management. Pharmacists and pharmacy trainees were given a refresher course on DSME/T. Low-health literacy handouts in several languages, as well as demonstration kits, glucometers, insulin and insulin supplies, were all utilized for patient education. The objective of the study was to determine whether using pharmacists as educators, could reduce hospital readmissions. In 2017, provision of DSME/T at this institution was less than 5% and increased to 74% by December 2019, with the implementation of this program. The rate of readmission for patients with diabetes who received DSME/T was 11.7% compared to 19.2% for those who did not; an absolute risk reduction in readmission of 7.5%. Pharmacists and pharmacy trainees should use DMSE/T to help reduce readmissions, improve outcomes, and increase the national levels of patients with diabetes receiving DSME/T. Disclosure L. Mulala: None. T. Lenhoff: None.

Designing and Delivering a New Elective for Pharmacy Students during COVID‐19

Pharmacists are increasingly becoming the health professionals that interact most regularly with patients who have diseases or disorders for which exercise is an effective and recommended treatment or therapy. Despite major curricular changes within pharmacy training programs in recent years to facilitate a more hands‐on role with patients, there has been negligible attention paid to training in exercise physiology and prescription. The goal was to therefore develop a course that would provide student pharmacists with the knowledge and skills to make evidence‐based exercise recommendations to their patients, with a specific focus on chronic diseases and conditions that are commonly seen in community pharmacies. The 2‐credit elective was designed to be taught by distance in order to accommodate students across two campuses and final year students undertaking clinical rotations across Washington. In hindsight, this decision was prescient given that its deployment was delayed until the fall of 2020 when all courses in Doctor of Pharmacy program at Washington State University were being delivered remotely due to the COVID‐19 pandemic. Fifteen self‐contained modules were developed and delivered using the Blackboard learning management system and released to students on a weekly basis. Each module contained 3‐5 learning objectives, an instructor‐prepared video of no more than 15 minutes in duration that introduced and described the relevant material and provided practical examples relative to pharmacy practice, and links to resources that provided additional information on the respective topic. Students were then required to complete a quiz containing five open‐book, multiple choice questions that directly addressed the stated learning objectives. Finally, 2‐3 case studies, questions, tasks or articles that directly related to the weekly topic were posted by the instructor to a shared discussion board and students were required to review and analyze the materials and then share their thoughts and findings with their peers. The instructor held two voluntary one‐hour Zoom meetings each week to allow students to discuss the module topic in a live online conversation with their peers and the instructor. N=33 students were registered in the course and all demonstrated attainment of knowledge and skills relevant to the defined learning outcomes and therefore received a passing grade. Formal feedback from the students was 100% positive in terms of the course structure, pace, assessment requirements and use of technology, in addition to the instructor's ability to stimulate interest, challenge students, respond to questions or problems, and integrate the course to the students’ pharmacy training. Future plans include examining whether the course increased the frequency and improved the effectiveness of evidence‐based exercise recommendations given by pharmacy graduates to their patients.

Parenteral Nutrition Process Management for Newborn and Preterm Infants - A Preliminary Risk Analysis.

BackgroundThere are variable practices in the management of the parenteral nutrition (PN) process in hospitals having a neonatal intensive care unit (NICU). In our hospital, PN is prepared partially on the neonatal ward by nurses but also at the central pharmacy by trained pharmacy technicians. A previous study showed a concentration non-conformity of 34% of on-ward PN preparations potentially resulting in under- or overfeeding of the patients.ObjectiveThe objectives were to perform preliminary risk analyses (PRA) in preparation for our hospital’s transition to universal central pharmacy PN compounding.MethodsA working group including pharmacists, neonatologists, nurses, and pharmacy technicians performed two PRA. The risks of 9 management steps of the PN process were identified, evaluated, and quoted. A comparison of the number of risks and their criticality index (CI) was conducted.ResultsA total of 36 and 39 risks were identified for PN preparation in the NICU and the pharmacy, respectively. For the NICU, ten risks (28%) had an “acceptable” CI, 15 risks (42%) were “under control” and eleven (31%) were defined as “non-acceptable”. For the pharmacy, 14 risks (36%) had an “acceptable” CI, 19 risks (49%) were “under control” and six (15%) were defined as “non-acceptable”. Risks directly related to the preparation process, including the steps preparation hood, PN preparation and analytical quality control, represented a cumulated CI of 145 for eleven NICU-risks vs 108 for twelve pharmacy risks (−26%). The implementation of immediate improvement measures, eg, an electronic prescription form, reduces the total CI by 5.7% and 2.2% for the NICU and the pharmacy, respectively.ConclusionThis PRA highlighted the safety differences between PN preparation in the NICU vs the pharmacy at our institution, and facilitated our moving forward with a process change that should improve the care of our neonatal patients. Nevertheless, long-term improvement measures have to be implemented to further reduce risks related to the PN management process.