Practice-enhancing publications about the medication-use process in 2021.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2021 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring, and monitoring/medication reconciliation. Articles evaluating at least one step of the MUP were assessed for their usefulness toward practice improvement. SUMMARY: A PubMed search was conducted in January 2022 for articles published in calendar year 2021 using targeted Medical Subject Headings (MeSH) keywords, and searches of the table of contents of selected pharmacy journals were conducted, providing a total of 7,178 articles. A thorough review identified 79 potentially practice-enhancing articles: 15 for prescribing/transcribing, 17 for dispensing, 4 for administration, 21 for monitoring, and 22 for monitoring/medication reconciliation. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of their importance within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing the most impactful publications. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the significant published studies can assist in changing practice at the institutional level.

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

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: 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. SUMMARY: 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. CONCLUSION: 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.

Practice-enhancing publications about the medication-use process in 2022.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2022 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring. Articles evaluating at least one step of the MUP were assessed for their usefulness toward practice improvement. SUMMARY: A PubMed search was conducted in January 2023 for articles published in calendar year 2022 using targeted Medical Subject Headings (MeSH) keywords, and searches of the table of contents of selected pharmacy journals were conducted, providing a total of 6,213 articles. A thorough review identified 69 potentially practice-enhancing articles: 13 for prescribing/transcribing, 13 for dispensing, 5 for administration, and 38 for monitoring. Practice trends discussed in the articles are briefly summarized, with a mention of their importance within health-system pharmacy. The articles are listed and summarized in tables for further review and evaluation. CONCLUSION: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing the most impactful publications. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the significant published studies can assist in changing practice at the institutional level.

Comprehensive workflow evaluation to improve medication distribution to the emergency department in an academic medical center.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The fast-paced environment of the emergency department (ED), with frequent admissions, discharges, and transfers, poses a challenge for pharmacy departments to effectively distribute and store medications. The purpose of this study is to propose a unique workflow of patient-specific medication delivery to the ED from a hospital pharmacy to reduce the number of missing medications resulting in medication messages and redispenses. METHODS: The medication delivery workflow proposed in this study consists of batching the preparation and distribution of patient-specific medications sent from the pharmacy to the ED in the 1 to 2 hours prior to their administration time. Chi-square analysis was completed to compare medication redispenses and "missing medication" messages before and after the intervention, with the significance level set at P < 0.05. RESULTS: The percentage of redispensed medications was effectively decreased following implementation of the workflow change from 21.6% to 9.2% (P < 0.001), with unit doses having the greatest reduction (25.8% vs 6.1%, P < 0.001). Benefits of this workflow change were also illustrated through a reduction in the percentage of missing-medication messages sent by nursing staff from 97.7% to 93.9% (P < 0.001). CONCLUSION: This study showed that implementation of standard, hourly batches of medications dispensed from the pharmacy to the ED resulted in a significant reduction in the total percentage of redispensed medications and missing-medication messages. The overall reduction in redispensed medications as a result of this innovative workflow change not only benefited nursing and pharmacy staff but can reduce medication waste and improve patient care through timely administration of medications.

Evaluation of a pharmacist-led workflow for the FDA Expanded Access Program.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: This project aimed to characterize the resources necessary for pharmacists to support the required steps for obtaining and handling investigational drugs outside of a study protocol in the individual patient and intermediate-size population Expanded Access Program (EAP) processes. The second aim was to characterize the types of EAP requests received. SUMMARY: This retrospective, single-center, observational study was performed by reviewing EAP requests initiated at Duke University Hospital (DUH) between August 1, 2017, and February 11, 2023. The annualized cost of unreimbursed EAP study services was projected to be approximately $196,500 at DUH for 2023. Of the 168 EAP requests submitted after the institutional policy requiring pharmacy and therapeutics (P&T) committee approval was established, 162 (96.4%) were approved by the P&T committee. CONCLUSION: Given the lack of published information on a pharmacist-led workflow related to EAP services, this study sought to share DUH's process for managing EAP requests. As there is no mechanism for reimbursement of EAP services, they can be difficult to manage given the labor resources required. Further work is needed to recoup unreimbursed investigational drug service labor costs to ensure compassionate use programs can be implemented in a manner that is financially sustainable for a health system.

Evaluation and Enhancement of a Comprehensive Controlled Substances Management Process at an Academic Medical Center.

PURPOSE: Controlled substances management is highly regulated, and requires institutions to have processes in place to maintain a closed-loop. This study was conducted to comprehensively evaluate the current state of controlled substances management, propose optimization opportunities, and implement steps to align the medication use process (MUP) to a defined desired state. METHODS: This evaluation was conducted in 2 phases. In phase 1, the current state of controlled substances management was assessed in order to develop a gap analysis tool and failure mode and effects analysis (FMEA). In phase 2, a work group was assembled to address opportunities within the FMEA. The work group prioritized opportunities using the risk priority number (RPN), and formulated action steps to align processes with the defined desired state. RESULTS: Through the literature evaluation, a desired state, consisting of 86 segments, was defined and compared with a gap analysis tool. Direct observation of the MUP allowed for development of 13 process maps depicting current state. Of the 86 segments, it was determined the study institution had a compliance rate of 62%. The remaining 38% correlated with 55 actionable process opportunities that were included in the FMEA. To date, 31 of the 55 (56%) opportunities have been successfully addressed by the work group. CONCLUSION: Use of direct observation to formulate a gap analysis tool and FMEA is an effective modality to evaluate controlled substances processes. These tools allow for pharmacy departments to identify and prioritize opportunities to optimize controlled substances management within an academic medication center.

A new perspective: Practice-enhancing publications about the medication-use process in ambulatory care in 2020.

PURPOSE: This article identifies, prioritizes, and summarizes published literature on the ambulatory care medication-use process (ACMUP) from calendar year 2020 that can impact ambulatory pharmacy practice. SUMMARY: The medication-use process is the foundational system that provides the framework for safe medication utilization within the healthcare environment and was reimagined to focus on new innovations and advancements in ambulatory pharmacy practice. The ACMUP is defined in this article as having the following components: transitions of care, prescribing and collaborative practice, accessing care, adherence, and monitoring and quality. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement. A PubMed search covering calendar year 2020 was conducted in January 2021 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 9,433 articles. A thorough review identified 65 potentially practice-enhancing articles: 14 for transitions of care, 19 for prescribing and collaborative practice, 10 for adherence, 6 for accessing care, and 16 for monitoring and quality. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why each article is important. The other articles are listed for further review and evaluation. CONCLUSION: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article is the first to define and evaluate the currently published literature pertinent to the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

Considerations When Transitioning From Health-System Pharmacy Administration and Leadership Resident to Pharmacy Leader.

A key part to assimilating into an organization in a leadership role is managing transitions. Health-System Pharmacy Administration and Leadership (HSPAL) Residency Programs focus on laying the foundation for continued growth in management and leadership skills. This article focuses on keys for transitioning from HSPAL Pharmacy Resident to Pharmacy Leader. Managing transitions is and will continue to be an important topic for all leaders. As HSPAL Residents transition to new pharmacy leaders, understanding pharmacy practice building relationships, maintaining them, and having a thoughtful strategy through this transition will allow for a more complete understanding of the organization to navigate complexities, develop people, and complete projects and initiatives. While this article is specific to HSPAL residents, these concepts can apply to the transition to pharmacy leaders.

Practice-enhancing publications about the medication-use process in 2020.

PURPOSE: This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2020 that can impact health-system pharmacy daily practice. SUMMARY: The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring. Articles evaluating at least one step of the MUP were assessed for their usefulness in practice improvement. A PubMed search for articles published in calendar year 2020 was conducted in January 2021 using targeted Medical Subject Headings (MeSH) keywords, and the table of contents of selected pharmacy journals was searched, providing a total of 9,433 articles. A thorough review identified 49 potentially practice-enhancing articles: 15 for prescribing/transcribing, 10 for dispensing, 6 for administration, and 18 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing the most impactful recently published literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the moist significant published studies can assist in changing practice at the institutional level.

A state affiliate's utilization of ASHP's Practice Advancement Initiative 2030 to identify current state of practice and a process to prioritize goal achievement.

PURPOSE: The American Society of Health-System Pharmacists (ASHP) has been a long-standing supporter of advancing pharmacy practice, specifically in the area of pharmacy practice models. In 2019, ASHP began the planning to launch PAI (Practice Advancement Initiative) 2030. PAI 2030 describes and details a bold vision for patient care, medication use, and pharmacy practice over the next decade. This work represents an ambitious goal to continue to advance the profession of pharmacy for the betterment of our patients. While much has been accomplished with the PAI, there is little literature on PAI 2030 (the authors are unaware of any published examples). SUMMARY: The purpose of the article is to explain a novel state affiliate's prioritization of ASHP's PAI 2030 recommendations. In the spring of 2020, the North Carolina Association of Pharmacists (NCAP), the North Carolina state affiliate of ASHP, began discussions around PAI 2030. In the fall of 2020, prior to the NCAP Annual Convention, health system pharmacy leaders within NCAP developed a questionnaire to serve as a PAI 2030 self-assessment. This approach allowed a state affiliate to implement an innovative program to act on the recommendations from PAI 2030. After the prioritization, health system pharmacy leaders engaged in discussion to comment on what recommendations have been identified. The goal of this discussion was to provide NCAP a direction to pursue focused efforts to support recommendations of PAI 2030. Ultimately, NCAP seeks that this statewide approach would help advance pharmacy practice, and improve pharmacy practice across the state of North Carolina in collaboration with NCAP. CONCLUSION: This discussion illustrates how a state affiliate has pursued implementing PAI 2030. This approach provides a strategy for state affiliates in addressing the recommendations within PAI 2030. A novel statewide approach can help marshal resources to advance practice when health systems partner with a state affiliate.