Staff Pharmacists Research Articles

Determining user implementation needs for pharmacist-prescribed contraception using concept mapping: A participatory, multiple stakeholder approach

BackgroundAs of October 2024, 29 states and the District of Columbia allow community pharmacists to prescribe hormonal contraceptives. Pharmacists have reported many challenges and barriers to service implementation. MethodsConcept mapping was used to gather insights from diverse stakeholders to identify resources to facilitate implementation of pharmacist-prescribed contraceptive services. Stakeholders included end-users (pharmacy managers, staff pharmacists) and decision-makers (pharmacy owners/executives). Participants' ideas for resources were collected via multi-stakeholder focus groups. Participants then rated each idea (i.e. statement) in terms of importance and feasibility (1 = not at all important/feasible, 4 = extremely important/feasible) and sorted ideas into groups based on similarity via an online survey. Sorting data were analyzed using multidimensional scaling and hierarchical cluster analysis to develop a cluster map. Descriptive statistics were used to analyze rating data to develop a go-zone map, where statements rated above average in terms of both importance and feasibility are plotted in the “go-zone” and are considered the most actionable ideas. ResultsParticipants (focus groups n = 19, survey n = 48) generated 46 unique statements which created four clusters via multidimensional scaling: 1) implementation guidance for practice setup, 2) marketing resources, 3) billing and payment resources, and 4) appointment management. The majority of the statements (13 of 15) considered the most actionable were from the implementation guidance and appointment management clusters. ConclusionsStakeholders seek guidance on implementation, marketing, billing and payment, and appointment management. To increase the ability of community pharmacies to meet the contraceptive needs of patients, resources should be dedicated to creating tools and solutions to address these identified needs.

Pharmacies and use of antibiotics: a cross sectional study in 19 Arab countries

BackgroundThe rise of antimicrobial resistance, which is partially attributed to the overuse and/or misuse of antibiotics in health care, is one of the world’s largest public health challenges. The distribution of antibiotics in absence of a prescription in pharmacies is a significant contributor to the growing global public health crisis of antibiotic resistance. A pharmacist’s clinical and lawful knowledge of antibiotic provide has an impact on the proper way to dispense medication. There are few novel studies assessing pharmacists comprehension and experience in prescribing antibiotics in low- and middle-income countries, including those in the Arabian region.Objectives(I) assess pharmacy team members Knowledge about antibiotics as reported by individuals themselves and their behavior in dispensing antimicrobial without a prescription and (ii) find potential influences on this behavior.SettingPharmacists were chosen from various regions in Algeria, Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen, based on their convenience and ease of access.MethodsA descriptive cross-sectional assessment among a random sample (n = 2833) of community pharmacists was conducted Utilizing a structured, validated, and questionnaire that underwent pilot testing, a comprehensive survey with four distinct sections covering biography, knowledge, practice, and attitude domains was employed.The main outcomeMeasures were knowledge, attitude, and practice toward dispensing antibiotics without prescription.ResultsOf the 3100 pharmacists reached, 2833 completed and return the questionnaires (response rate 91.3%). Most of the respondents were male (57.4%). Aged between 19 and 31 years old (76.2%). Most of them held a B.Sc. Degree (78.5%). Worked as staff pharmacists (73.2%). During the survey, it was discovered that there were gaps in their knowledge regarding antibiotic usage. A total of 45.7% of the respondents were unaware that antibiotics can be used as prophylaxis, while 33.3% did not recognize the consequences of making incorrect antibiotic choices. Regarding their practice patterns, 53.8% of the pharmacists admitted that they did not consistently adhere to guidelines when dispensing antibiotics. In terms of attitudes toward antibiotic usage, 36.8% disagreed with the guidelines of not supply antibiotics without a prescription, suggesting some variation in opinions among pharmacists on this matter. Additionally, a significant percentage (75%) believed that community pharmacists had qualifications to prescribe antibiotics for infections.ConclusionThe recent survey has shed light on the differences among pharmacists in regard to dispensing antibiotics without prescriptions and their understanding of resistance. The findings are concerning, indicating a deficient in of knowledge as regards the use of antibiotics. It is crucial to implement regulations and enhance education efforts to tackle the growing problem of resistance. Collaboration between healthcare professionals and awareness campaigns is essential in addressing this issue.

Prevalence and Factors Associated with Burnout among Community Pharmacists in Saudi Arabia: Findings and Implications.

Burnout has negative consequences for the well-being of healthcare professionals and for the safety of patients. The prevalence of burnout varies among health professions and practice settings and across studies. Consequently, this cross-sectional study aimed to determine the prevalence and factors associated with burnout among community pharmacists in the Qassim region, Saudi Arabia. The study used the Copenhagen Burnout Inventory (CBI) to assess the burnout. The CBI consists of three scales, including personal burnout, work-related burnout, and client-related burnout. A total of 226 community pharmacists participated in the study. Of these, 63.72% were male, and 44.25% had experience of 1-5 years as community pharmacists. The prevalence of personal burnout was 83.63%, while the prevalence of work-related burnout was 83.19%, and the prevalence of client-related burnout was 76.11%. The prevalence of burnout was higher among younger age, early-career pharmacists; staff pharmacists; pharmacists working ≥6 days per week; and those working in pharmacies with fewer pharmacy teams. Multivariable logistic regression showed that compared to five workdays, working six and seven days per week was an independent risk factor for developing personal burnout [(adjusted odds ratio (aOR) = 3.60: CI = (1.29-10.05), p = 0.014) and (aOR = 4.72: CI = (1.17-19.08), p = 0.030), respectively]. Similarly, pharmacists working in pharmacies with one or two pharmacists were at higher odds of developing personal burnout compared to others working in a larger team (aOR = 3.41: CI = (1.09-10.66), p = 0.035). For work-related burnout, working six and seven days per week was also an independent risk factor [(aOR = 5.78: CI = (1.96-17.06), p = 0.001), and (aOR = 8.38: CI = (1.99-35.27), p = 0.004, respectively)]. For client-related burnout, staff pharmacists were at higher odds of developing client-related burnout compared to pharmacy managers [(aOR = 2.28: CI = (1.01-5.14), p = 0.046)]. Overall, the prevalence of burnout is alarmingly high among community pharmacists in Saudi Arabia. Consequently, it is crucial to urgently address it through robust initiatives, strategies, and interventions that support the well-being, quality of life, and resilience of community pharmacists.

Survey of community pharmacists' opinions on drug scheduling in Ontario and Québec.

Over the past decade, Canada has witnessed a shift of several drugs from prescription-only to behind-the-counter (BTC) and over-the-counter (OTC) status. This work examined community pharmacists' agreement with the current scheduling of agents used in the management of allergic rhinitis, heartburn, and vulvovaginitis. From September to October 2022, an online survey was administered to pharmacists practicing in in Ontario and Québec. The survey aimed to gather insights into their preferred scheduling for 15 medicines commonly used to manage the three selected conditions. Pharmacists were asked whether they agreed with the current scheduling status of each and, if not, how they feel it should be scheduled. 715 pharmacists completed the survey, 462 from Ontario and 253 from Québec. Most were staff pharmacists working 30 or more hours per week, having been a pharmacist for 1-10 years. Ontario pharmacists expressed a preference for scheduling change for five drugs (four prescription [terconazole for intravaginal use, famotidine, rupatadine, mometasone nasal spray] and one unscheduled [ranitidine 75 mg]), while Québec pharmacists expressed preference for scheduling change for three prescription drugs (terconazole for intravaginal use, famotidine, rupatadine). As pharmacy practice continues to evolve, pharmacists' comfort with initiating previously prescription-only therapy independently or assisting patients with self-selection may similarly evolve. Of the five drugs identified as having a discrepancy between current status and pharmacist preference, four are prescription and may be candidates to consider for prescription to OTC switch. Pharmacists in Ontario and Québec have expressed preference for most products used in the treatment of allergic rhinitis, heartburn, and vulvovaginitis to be categorised as Schedule II (BTC) or Schedule III (OTC) available only in pharmacies.

Evaluation of Mental Health and Well-Being Among Kansas Pharmacists Post-COVID-19 Pandemic.

Background COVID-19 has profoundly affected pharmacists, causing burnout from heavier workloads, personal stressors, and disrupted healthcare delivery. Research on pharmacists' mental health during the pandemic, especially in rural areas like Kansas, remains limited. Objectives This study aimed to understand perceptions, experiences, and impacts on the mental, emotional, and psychological well-being of active Kansas pharmacists during the COVID-19 pandemic, includingevaluatingworkplace modifications on mental health. Methods Kansas licensed pharmacists were recruited via email distributions through five Kansas pharmacy organizations and informal referrals among colleagues. After consenting, respondents completed a 15-minute, 28-question survey via Qualtrics. The survey included 11 questions concerning demographics and employment characteristics, along with 17 questions designed to assess the impact of COVID-19 on mental health, structured according to existing literature. Participation was uncompensated, and incomplete surveys were omitted from the analysis. Results One hundred and seven respondents (83.59% completion) represented 3.25% of Kansas's 3,290 pharmacists. They were aged 26-66 (M=38.7), the majority female (72.57%) and white (84.84%), with 14.24 years average practice duration (SD=10.94). Data covered 12 rural and 11 urban counties, with 50.91% staff pharmacists and 22.73% pharmacy managers. Many worked over 40 hours weekly in 13 settings. Findings showed increased workload (24.68%), medication shortages (24.03%), and burnout (24.32%) affecting job considerations. Workplace changes impacted personal mental health, with the main stressors being work-related factors (19.21%), social distancing (18.95%), and health concerns (12.63%). Conclusion This study underscores the pandemic's profound toll on Kansas pharmacists' mental, emotional, and physical health, leading to burnout, job dissatisfaction, and decreased effectiveness. It emphasizes the urgency of organizational interventions.

THE OPTIMIZATION OF ACCREDITATION DOCUMENTS FOR THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE AT SUGIO MUHAMMADIYAH CLINIC, LAMONGAN

Background: In 2023, Sugio Muhammadiyah Clinic embarked on an accreditation program, encountering challenges pertaining to the preparation of strategic plan documents, Standard Operating Procedures (SOPs), and quality assessment documents. Objective: To optimize the accreditation documents of Sugio Muhammadiyah Clinic to foster good corporate governance. Method: The study encompassed three primary stages-preparation, implementation, and evaluation-spanning from July to September 2023. A workshop on September 11, 2023, then group discussions on September 12, 2023. A cohort of 24 medical staff members, comprising nurses, doctors, pharmacists, and medical records officers from Sugio Muhammadiyah Clinic, actively participated in these endeavors. Results: Evaluation of the community service was conducted through pre-test and post-test assessments, revealing a noteworthy 35% increase in participants’ knowledge of accreditation document preparation. The pre-test mean score was 66.67, with the highest score recorded at 76, while the post-test mean score increased to 90, with the highest score reaching 100. These findings underscore the effectiveness of the community service in enhancing participants’ understanding of accreditation document preparation. Conclusion: The community service was successfully carried out to improve participants’ knowledge of preparing accreditation documents. It is anticipated that well-crafted accreditation documents will underpin good corporate governance at Sugio Muhammadiyah Clinic, thereby enhancing patient care services.

Yemeni Physicians' Attitudes and Perceived Barriers Toward Ward-Based Clinical Pharmacist in Hospital Settings.

Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians' attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards. A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study's questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics. Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were "attending medical rounds", followed by "order review". About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by "clinical pharmacist responsibilities were not clearly defined" and "clinical pharmacist recommendations are not properly documented". Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.

SHORTAGE OF ESSENTIAL MEDICINES DURING THE COVID-19 PANDEMIC: CROSS SECTIONAL STUDY FROM COMMUNITY PHARMACIES

Background: The drug shortage is a very serious issue regarding the quality of Health System of any country. The problem is increased in the pandemic causing serious issues to the health system. Objectives: The objective of current study was to evaluate the factors responsible for the drug shortages in Pakistan and way forward to avoid these problems in the future. Methodology: A cross-sectional observational study was carried out in different cities of Pakistan. An online form was designed after thorough literature review. The study population included Staff pharmacists, Pharmacy managers and pharmacists self-owning pharmacies. Data was then collected, analyzed using SPSS-26. Results: The majority of pharmacists agreed that Global restrictions on trade activities added to drug shortage during COVID-19. The knowledge was relatively higher in pharmacists of Punjab as compared to pharmacists of other provinces. Majority of pharmacist (52%) from Punjab province of Pakistan strongly believed that Provincial drug regulatory department should play its role effectively during the emergency crisis to prevent drug shortages during the pandemic. Conclusion: In order to prevent the problem of drug shortages, efforts should be made to control the factors responsible for the drug shortages and local production should be enhanced along with proper control by regulatory authorities.

Priority-setting for hospital funding of high-cost innovative drugs and therapeutics: A qualitative institutional case study.

Rising costs of innovative drugs and therapeutics (D&Ts) have led to resource allocation challenges for healthcare institutions. There is limited evidence to guide priority-setting for institutional funding of high-cost D&Ts. This study sought to identify and elaborate on the substantive principles and procedures that should inform institutional funding decisions for high-cost off-formulary D&Ts through a case study of a quaternary care paediatric hospital. Semi-structured, qualitative interviews, both virtual and in-person, were conducted with institutional stakeholders (i.e. staff clinicians, senior leadership, and pharmacists) (n = 23) and two focus groups at The Hospital for Sick Children in Toronto, Canada. Participants involved in, and impacted by, high-cost off-formulary drug funding decisions were recruited through stratified, purposive sampling. Participants were approached for study involvement between July 27, 2020 and June 7, 2022. Data was analysed through reflexive thematic analysis. Institutional resource allocation for high-cost D&Ts was identified as ethically challenging but critical to sustainable access to novel therapies. Important substantive principles included: 1) clinical evidence of safety and efficacy, 2) economic considerations (direct costs, opportunity costs, value for money), 3) ethical principles (social justice, professional/organizational responsibility), and 4) disease-specific considerations. Multidisciplinary deliberation was identified as an essential procedural component of decision-making. Participants identified tension between innovation and the need for evidence-based decision-making; clinician and institutional responsibilities; and value for money and social justice. Participants emphasized the role of health system-level funding allocation in alleviating the financial and moral burden of decision-making by institutions. This study identifies values and processes to aid in the development and implementation of institutional resource allocation frameworks for high-cost innovative D&Ts.

Non-prescription antibiotics dispensing by community pharmacies: implications for antimicrobial resistance

Introduction: The non-prescription antibiotics dispensing (NPAD) from pharmacies is on the rise in low- and middle-income countries, which contributes to the emergence of antimicrobial resistance (AMR). This study was conducted with the objective to determine the community pharmacy personnel’s perspectives on NPAD and its implications for AMR. Methods: A questionnaire-based cross-sectional survey was conducted in Pakistan among 336 pharmacies. The data were analyzed using SPSS v21 and MedCalc for Windows v12.3.0. Modified Bloom’s cut-off point was utilized to categorize the participants’ overall knowledge, attitude, and practice. For univariable logistic regression analyses, odds ratio (OR) was calculated at 95% confidence interval (CI). For multivariable logistic regression analyses, adjusted OR was calculated at 95% CI. Spearman’s rank correlation coefficient test was used to assess the relationships among knowledge, attitude, and/or practice scores. Results: The majority of the respondents were staff pharmacists (45.5%). About four-fifths (78.9%) and half (50.9%) of the participants demonstrated moderate to good knowledge and practice, respectively. However, about only one-third (33.1%) had a moderate to good attitude. Staff pharmacists had higher odds of moderate to good knowledge (OR: 2.4, 95% CI: 1.2–4.7) and practice (OR: 2.3, 95% CI: 1.4–3.8). Total knowledge and practice (Spearman’s ρ: 0.280; P <0.001) and total attitude and practice (Spearman’s ρ: 0.299; P <0.001) scores were significantly correlated. Conclusion: The qualified pharmacists had satisfactory knowledge, attitude, and practices toward antibiotics. However, non-pharmacist staff lacked knowledge and had probable NPAD practice, which has a negative impact on public health. Regular refresher training, seminars, and strict enforcement of rules and regulations are essential.

1189. The Impact of Clinical Staff Pharmacist Driven Weekend Antimicrobial Stewardship Coverage in a Quaternary Hospital in UAE

Abstract Background Pharmacy antimicrobial stewardship services were extended to cover the weekends, incorporating a clinical staff pharmacist with infectious disease (ID) training to cover antimicrobial stewardship program (ASP) activities on weekends is an opportunity. The aim of this study is to assess the impact of integration ASP clinical staff pharmacist into an ASP on weekends by collecting and analyzing the documented pharmacists’ ASP interventions before and after implantation of the service. Methods A single center, pre-post quasi-experimental study. Data were collected retrospectively from the electronic medical record (EMR). The study included at 2 sets of data: pre-implementation (2020) and post-implementation (2021) of an ASP weekend pharmacist, The primary outcome is to evaluate pharmacist ASP Interventions through prospective audit and feedback review analysis. Secondary outcomes include antibiotics days of therapy (DOT), length of hospital stay (LOS), healthcare associated Clostridioides difficile infection (CDI) and infection-related readmission.Table 1:Characteristics of the pre-and post-intervention group Results During the study, an increase in the number of documented interventions was observed with 452 interventions were documented on 362 patients during the post-implementation period compared to 114 interventions were documented on 108 patients during the pre-implementation period (p = 0.04). A reduction in the LOS was observed with a median (IQR) of 16 days (8-34) during the post-implementation period compared to 27.5 days (10-56) during the pre-implementation period (p = 0.001), while the median (IQR) total DOT was increased during the post-implementation period 8 (6-11) versus 7 (4-11) during the pre-implementation period (p = < 0.001). No differences were observed in healthcare associated Clostridioides difficile infection (CDI) and infection-related readmission.Table 2:Pharmacist interventions on the pre-and post-intervention groupTable 3:Outcome of pharmacists driven weekend antimicrobial stewardship on the pre-and post-intervention group Conclusion The pharmacists driven weekend antimicrobial stewardship is an opportunity for the pharmacists to intervene and optimize patients’ treatment plan and contributed towards a significant shortened length of hospital stay. Therefore, healthcare facilities should prioritize the involvement of pharmacists in weekend ASPs to ensure consistent, high-quality care throughout the week. Disclosures All Authors: No reported disclosures

1211. Impact of Gram-Negative Rod Bacteremia Rapid Diagnostic Testing and Real-Time Clinical Staff Pharmacist Review

Abstract Background Although Rapid Diagnostic Testing (RDT) enables optimization of antimicrobial therapy, there is no consensus on how to integrate utilization into clinical practice. At our institution, the BIOFIRE® Blood Culture Identification 2 (BCID2) RDT was implemented in September 2021 in conjunction with real-time clinical staff pharmacist result notification and review. The objective of this study was to determine the impact of RDT plus real-time clinical staff pharmacist review on the management of gram-negative rod (GNR) bacteremia. Methods This retrospective, matched cohort study included patients with a positive blood culture for a GNR on the BCID2 panel from September 2020 to August 2021 (historical) and October 2021 to September 2022 (interventional). Exclusion criteria were polymicrobial bacteremia, discrepant RDT results from traditional culture, 24-hour mortality, and comfort care or not admitted at the time of RDT result. Patients were randomly screened to include 120 patients in each group and matched based on age, pathogen, and resistance mechanism. The primary endpoint was time from Gram stain to appropriate antibiotic therapy. Secondary endpoints included time to first pathogen-directed change in therapy, days of anti-pseudomonal therapy, length of stay (LOS), and inpatient mortality. Results The study population was predominantly female (61%) and the majority were over 70 years old (55%). Escherichia coli was isolated in 71% of patients with extended-spectrum beta-lactamase-producing organisms isolated in 8%. The median time to appropriate therapy was 0 hours for both groups, indicating patients were on appropriate therapy at the time of Gram stain result (p=0.28). There was a statistically significant decrease in time to first pathogen-directed change in therapy (40 vs. 11 hours; p< 0.01). There was no difference in days of anti-pseudomonal therapy, LOS, or inpatient mortality between groups. Conclusion Implementation of RDT plus real-time clinical staff pharmacist intervention did not impact time to appropriate therapy in patients with GNR bacteremia but did significantly reduce time to pathogen-directed antibiotic changes. RDT plus real-time clinical staff pharmacist intervention is a practical method of utilizing technology to improve patient care. Disclosures All Authors: No reported disclosures

Implementing services for pediatric cystic fibrosis treatment in a community hospital.

Our community hospital was recently charged with providing care for pediatric people with cystic fibrosis (PwCF). Pediatric PwCF generally need a higher level of care than is required by other pediatric patients cared for at our institution. This project aimed to prepare the pharmacy department to care for this specialized population safely and efficiently. The implementation process was divided into 3 phases to accomplish the larger purpose. These phases were as follows: (1) creating order sets and protocols; (2) providing staff and clinical pharmacists with training and resources; and (3) creating and managing clinical decision support. The central aspect of preparing inpatient pharmacy staff to care for PwCF was the development of antibiotic dosing protocols and order sets comprised of intravenous and oral antibiotics as well as aminoglycoside and vancomycin pharmacokinetic guides. A pharmacokinetic calculator was created to assist with aminoglycoside dosing and monitoring. During phase 2, pharmacist education modules were created to provide guidance on cystic fibrosis and medications commonly used to treat it. As the newly designed protocols were enacted, education was provided on how to use them. Phase 3 occurred concurrently, as clinical decision support was vital to completing phases 1 and 2. The phased approach was imperative to the project's success and kept individual components on track. All parts were completed in just over one year.

Study on awareness, knowledge, and practices towards antibiotic use among the educated and uneducated people of Khyber Pakhtunkhwa Province, Pakistan

Introduction: Antimicrobial resistance developed through the inadequate use of antibiotics; is an overriding task for global public health. Objective: To explore awareness, knowledge, and practices, and compare the elements associated with antibiotic misuse in different University students and uneducated people of Khyber Pakhtunkhwa Province, Pakistan. Methods: Cross-sectional study was conducted from July to December 2020 using a validated questionnaire. Data were collected from eleven different university students and uneducated people of Khyber Pakhtunkhwa, Pakistan. Results: 3,600 questionnaires were completed, consisting of 56.9% Male and 43.0% Female. 1,999 (55.5%) of the antibiotic users reported through the survey used non-prescription antibiotics within a one-month study period. Out of the participants, 230 (6.3%) were uneducated or their education level was below matric rest were university students. 1999 (55.5%) reported buying Antibiotics with Medical Prescription. Most self-medicated participants (56.9%) stop taking antibiotics when they feel better. More than 90% of the respondents answered that doctors and pharmacist staff do not guide them well that how to use antibiotics. 2,171 (60.03%) respondents mistakenly believed that antibiotics improve restoration from coughs and colds. Only 720 (20%) respondents knew that antibiotics also disturb normal flora and 547 participants (15.9%) agree that unnecessary use of antibiotics causes bacterial resistance. Conclusion: Finding from this study may have important implications for public health policy in Khyber Pakhtunkhwa, Pakistan given the growing global resistance to antibiotics and the reported health issues related to their improper use.

Interprofessional collaboration between prescribers, managers, nursing staff and on-site pharmacists within residential aged care facilities: a mixed-methods study.

A new on-site pharmacist (OSP) intervention within residential aged care facilities (RACFs) is being investigated to help improve medication management. Interprofessional collaboration amongst prescribers, nursing staff and pharmacists is critical to improving RACF medication management. To explore the extent of interprofessional collaboration and the nature of the working relationships between OSPs and prescribers, managers and nursing staff. A mixed-methods study was undertaken within the context of a 12-month cluster randomised controlled trial. Semi-structured interviews were conducted with data analysed using framework analysis, and a survey based upon the Physician-Pharmacist Collaboration Index (PPCI) was distributed at two time points (T1 at 3months and T2 at 9months after OSP commencement) across seven intervention RACFs. The qualitative data (n =33 interviews) findings related to the processes supportive of these relationships e.g. on-site proximity, OSP personality and perceived (or beneficial) benefits of OSPs working with health care team members (such as OSPs being trusted and providing reassurance to RACF health care team members). The PPCI survey mean scores at T1 (n =33) and T2 (n =19) suggested that OSPs were able to establish positive working relationships at 3months and that positive relationships also existed at 9months. The integrated findings suggested that the working relationships between OSPs and health care team members were generally positive. This study is the first to explore interprofessional collaboration between OSPs and health-care team members in RACFs. The findings suggest that OSPs can positively contribute to interprofessional collaborative care within RACFs.

“No one went into pharmacy … to sell a lot of Coca-Cola. It's just sort of a necessary evil” – Community pharmacists' perceptions of front-of-store sales and ethical tensions in the retail environment

BackgroundCommunity pharmacists are expected to uphold ethical duties to patients and society while maintaining independent businesses or fulfilling expectations of corporate owners. Canadian pharmacy colleges provide only indirect guidance on the retail setting of the profession. Little is known about whether pharmacists identify ethical issues in retail pharmacy or around the sales of non-drug products. ObjectiveThis study sought to examine pharmacists' perceptions of their roles in health promotion, the factors that influence the selection of front-of-store products, and ethical issues relating to their dual roles as health care providers and retailers. MethodsIn 2020, 25 Canadian pharmacists participated in semi-structured phone interviews. Interviews were audio-recorded, anonymized, transcribed verbatim, and thematically analyzed using qualitative methods. ResultsAlmost all participants described their role primarily as a health care provider, though some described themselves as 50–50 health care providers and retailers. Most staff pharmacists reported little control over front-of-store product selection. Where participants reported some control, external factors such as business viability and profitability impacted their choices, though some reported selecting products based on the needs of their patient community or their personal beliefs. The dominant tensions described stemmed from participants' dual roles as health care providers and retailers, though specific issues and situations were varied, ranging corporate targets, to service provision, to the sales of unproven or unhealthy products. Participants suggested solutions to the issues they described, ranging from a complete overhaul of the licensing structure of community pharmacies, down to one-on-one conversations with patients. ConclusionOur findings suggest that the retail setting of community pharmacy produces unique ethical tensions: the imposition of retail sales standards and targets are commonplace, and business viability is a primary driving force in front-of-store product selection. Clear guidance from Canadian pharmacy colleges and legislators to address these tensions and issues may be necessary.

Characterization of tele‐pharmacy interventions performed via an expanded tele‐critical care pharmacist protocol

AbstractBackgroundTo enhance patient care during the COVID‐19 pandemic, tele‐critical care (TCC) pharmacists within Atrium Health (AH) managed therapy in multiple domains under a Critical Care Pharmacist Emergency Protocol Agreement (CCPEPA).MethodsThis was a multicenter, retrospective quality improvement (QI) study conducted at AH's North Carolina facilities to compare TCC pharmacist interventions between shifts (timeframes 1 and 2), identify and categorize medication management interventions (timeframe 3), and to assess how the CCPEPA was utilized during these different timeframes.ResultsAfter removing duplicate patients and interventions that were recorded in overlapping timeframes, 5681 interventions were performed on 1665 unique patients. Timeframe 1 documented 2150 interventions on 861 patients with an average of 37.2 interventions/shift on first shift and 14.3 interventions/shift on second shift. Medication management (46.5%) was the most common activity on first shift whereas glucose management activities (42.8%) were most common on second shift. During timeframe 2, the full time TCC pharmacists documented 710 interventions on 395 patients with an average of 15.8 interventions/shift on first shift and 11.3 interventions/shift on second shift. Activity results were similar to timeframe 1. During timeframe 3, 2331 medication management interventions were performed on 700 patients, averaging 18.4 interventions/day, including medication discontinuation (39.2%), medication addition (15.7%), and order clarification (11.8%). The most common medication class was sedation and analgesia (26.3%).ConclusionsThe CCPEPA provided TCC pharmacists various opportunities to enhance patient care and practice at the top of their license. First shift hours with proactive patient review for both faculty and full‐time TCC pharmacists resulted in more interventions per shift and increased medication management interventions. These QI initiatives demonstrate the benefit of having TCC pharmacists as part of the healthcare team. Within AH, the success of the CCPEPA protocol has supported advocating for Clinical Pharmacist Practitioner status and increases in TCC pharmacist staff.

Pharmacist and pharmacy staff knowledge, attitude and practice of wound care in the community setting: A cross-sectional survey

Pharmacist and pharmacy staff knowledge, attitude and practice of wound care in the community setting: A cross-sectional survey

Understanding medication safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor study

ObjectiveTo understand the sociotechnical factors affecting medication safety when intensive care patients are transferred to a hospital ward. Consideration of these medication safety factors would provide a theoretical basis, on...

486 Safety Culture in Irish Community Pharmacies: a cross-sectional study using the Community Pharmacy Survey on Patient Safety Culture

Abstract Introduction Safety culture is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation’s health and safety management.(1) Community pharmacists play a vital role in ensuring optimum medication safety however the study of patient safety culture in this setting is less developed than in secondary care. Aim The study aim was to measure patient safety culture in Irish community pharmacies using the validated Community Pharmacy Survey on Patient Safety Culture (PSOPSC).(2) Methods The survey consisted of 39 questions based on a 5-point Likert scale, within 11 dimensions. Demographic questions were asked including the pharmacist’s role within the pharmacy. A free-text box allowed respondents to give comments on the survey topic. The online questionnaire, hosted on Microsoft Forms, was emailed to all 3943 community pharmacists registered with the Pharmaceutical Society of Ireland in November 2021. A reminder email was sent 14 days later. Data were analysed in Microsoft Excel. Categorical data were presented as frequencies (%). The positive rate response (PRR) of each survey question and dimension was calculated.(2) The PRR is the mean percentage of positive Likert scale responses to each item and each dimension of the survey. A PRR >75% indicated a strong safety culture, while a PRR <50% indicated a dimension that may be improved upon. Free-text responses were explored by thematic analysis. Results The survey was completed by 173 pharmacists, response rate 4.5%. Of these, 33 (19.1%) were superintendent pharmacist, 65 (37.6%) supervising pharmacist, 53 (30.6%) staff pharmacist and 22 (12.7%) locum pharmacist. The mean %PRR across the 11 survey dimensions was 72.3%. Individual statements with highest PRR were “Our pharmacists tell patients important information about their new prescriptions” (PRR=91.3%) and “Staff are treated fairly when they make mistakes” (PRR=87.3%). Individual statements with lowest PRR were “Interruptions/distractions in this pharmacy (from phone calls, faxes, customers, etc.) make it difficult for staff to work accurately” (PRR=6.4%) and “We feel rushed when processing prescriptions” (PRR=8.1%). The dimension of “Organizational Learning-Continuous Improvement” demonstrated the highest PRR (81.6%), followed by “Response to Mistakes” (PRR=81.2%). The dimension of “Staffing, work pressure and pace” demonstrated the lowest PRR (35.6%). Respondents rated overall patient safety in their pharmacy as excellent/very good/good (88.4%). Differences in perception of patient safety emerged between pharmacists with different levels of responsibility. Patient safety rating was described as fair/poor by 0.0% of superintendent pharmacists, 6.3% of supervising pharmacists, 17.0% of staff pharmacists and 31.8% of locum pharmacists. Fifty-one (29.0%) respondents provided free-text comments. Emergent themes were impact on safety culture of staffing issues; staff training; dispensary workload; and dispensary work pressures. Conclusion The study was limited by low response rate. This may reflect its timing during the COVID-19 pandemic and pharmacists’ prioritisation of clinical roles at that time. Respondents reported a broadly positive patient safety culture in the pharmacy in which they work. Differences in perception of safety culture were observed between those with differing levels of responsibility in community pharmacy practice.