Implementation of a North Dakota Opioid Misuse and Overdose Prevention Program in West Virginia.

BACKGROUND: Pharmacy has an important role in combating the opioid epidemic. However, there is a need for more consistency of programs and evidence-based practices across the country. OBJECTIVES: To describe how an evidence-based opioid misuse and overdose prevention program that originated in North Dakota was implemented in West Virginia and to compare program results between the two states including pharmacist interventions and patient screening for opioid misuse and overdose. PRACTICE DESCRIPTION: This advancement in practice took place in participating North Dakota and West Virginia community pharmacies. PRACTICE INNOVATION: An evidence-based program that originated in North Dakota was implemented in West Virginia. The details of this collaboration are outlined in this manuscript. EVALUATION METHODS: Program screening and pharmacist intervention data were collected using DocStation, an online pharmacy patient management platform. RESULTS: Thirty-four pharmacies in West Virginia implemented the program. Between April 2022 and September 2023, a total of 34 West Virginia pharmacies conducted 449 documented screenings compared to 12,105 screenings by 81 pharmacies in North Dakota over the same time. There were differences between the states with regard to the proportion of individuals screened as high-risk for OUD and individuals at risk of accidental opioid overdose likely attributable to different demographics. CONCLUSION: An opioid misuse and prevention program was successfully implemented in two states, which can serve as a model to implement similar programs in other pharmacies across the United States.

Nurse delivered medication safety screening program for home care visits.

Home care clients have safety barriers related to medication storage, disposal, and safe use of opioids. Limited research is available regarding medication safety initiatives in the home care setting. This study evaluates a medication safety initiative, linked with opioid misuse and overdose prevention screening, for home care clients with different levels of service. Training and screening tools designed for community pharmacies by the Opioid & Naloxone Education (ONE) Program were modified for use by home health nurses. All new admits to the home health services were screened for medication storage, medication disposal, and use of pain medications. Patients taking opioids were screened for opioid-specific risks. Interventions based on screening results included education, provision of medication lock boxes, drug disposal packets, and/or naloxone. Most home care clients (85%) are properly storing their medication and 38% were not properly disposing unused medications. Higher levels of care had greater pain medication needs, including the provision of naloxone. This study demonstrates the opportunity to incorporate medication safety screening into nursing home health visits.

Hello Operator? A Pharmacy Practice Simulation to Increase Student Confidence in Telephone Communication Skills.

Background: Communicating interprofessionally using the telephone is an essential skill within pharmacy practice. Student pharmacists' ability to perform this task effectively and efficiently may be hindered by generational changes, social anxiety, and very few opportunities to practice these skills. Objective: The purpose of this study was to develop and implement a simulation allowing students to practice interprofessional communication and assess the simulation's impact on students' confidence in providing pharmacy-related interventions to another health care professional via telephone. Methods: Faculty developed a simulation focused on interprofessional telephone communication. Baseline student information was collected to quantify pharmacy work experience in terms of practice setting, duration of employment, and skills. Presimulation and postsimulation surveys evaluated self-assessed telephone-related skills, attitudes, and confidence. Quantitative data were analyzed with descriptive statistics. Qualitative data were evaluated through a thematic analysis of students' reflective responses to 2 open-ended questions. Results: Of the 53 pharmacy students that participated in the simulation, 44 (83%) and 43 (81%) completed the anonymous presimulation and postsimulation surveys. Students significantly improved as reflected in the following response: "I have confidence in my ability to provide pharmacy-related interventions to another health care professional in a logical and concise manner via telephone call." Significant improvement also occurred in the ability to work independently, communicate an order change to another health care professional, justify recommendations, answer a drug information question, and discuss recommendations in a logical and concise manner. Conclusion: The simulation discussed in this article provided students an opportunity to practice interprofessional telephone communication in a low-risk environment and resulted in significant growth in confidence and skills.

Teaching Independent Decision-Making Through a Computer-Based Drug Utilization Review Simulation.

Background: Drug utilization review (DUR) skills are important for pharmacists across all settings. Computer-based DUR simulations to teach student pharmacists are currently scarce. This article describes a computer-based DUR simulation that required limited faculty and financial resources and was implemented in collaboration among 3 institutions. Objective: To describe the innovation of a computer-based DUR simulation and its impact on pharmacy students' knowledge and confidence of DUR skills. Methods: This pre-post educational study assessed a computer-based DUR simulation that replicated the DUR process in dispensing systems. First- and third-year pharmacy students at 3 institutions were guided through simulated patient cases with various medication-related problems. The self-paced activity provided students with immediate, formative feedback and rationale for each option after an attempt was made in lieu of faculty intervention. Students completed pre-and post-assessments to evaluate changes in knowledge and confidence. Knowledge was assessed by comparing results of multiple choice and matching questions on the pre- and post-assessments. Confidence was assessed by the change in self-reported confidence scale measurements. Results: Students at all institutions (N = 405) had nonsignificant changes in knowledge scores from the pre-assessment to the post-assessment, with the exception of 1 question. All confidence survey questions significantly improved from pre- to post-assessment. Conclusion: The DUR educational innovation had a nonsignificant overall impact on students' knowledge but significantly improved confidence in their abilities. Skills-based instruction provides additional practice to increase student confidence.

A Longitudinal Comparison of Pharmacy Documentation Platforms Using the Technology Acceptance Model: Experiences With Opioid Risk Screening.

Background: Pharmacy practice continues to expand in scope, and technology platforms to assist with meeting the standards for documentation of billable services are needed. The ONE Program (Opioid and Naloxone Education) is an initiative centered on the community pharmacy focused on opioid risk screening for patients receiving opioid prescriptions. Objective: Opioid risk screening results and pharmacist interventions were documented using first REDCap and later the DocStation platforms. This study compared pharmacy staff experience with these 2 platforms. Methods: A survey using the Technology Acceptance Model (TAM) was designed to compare usability, ease of use, social influence, and facilitating conditions. Results: Analyses using descriptive statistics and open-ended responses showed similar results for each platform; however, pharmacy staff indicated that REDCap required less time when entering information, whereas the DocStation platform offered elevated pharmacy practice service opportunities, management support, and available informational technology support services. Conclusion: Health care technology continues to advance in meeting the needs of expanded service provision through pharmacy. This longitudinal study shows the value of the TAM framework in identifying efficiencies and deficiencies of health care technology systems.

Evaluation of a Program to Screen Patients in Community Pharmacies for Opioid Misuse and Accidental Overdose.

INTRODUCTION: Community pharmacies nationwide have adopted new strategies to combat the opioid epidemic. One strategy to prevent opioid misuse and accidental overdose is patient screening to identify those at risk. The purpose of our study was to determine whether such screening in community pharmacies led pharmacy personnel to intervene with patients at risk and to describe the proportion of patients they identified as at risk. METHODS: We implemented the Opioid and Naloxone Education (ONE) program in North Dakota to give community pharmacies and pharmacists training and tools to provide preventive screening for opioid misuse and accidental overdose before dispensing a prescribed opioid. Data were collected and analyzed from September 15, 2018, through May 15, 2021, to evaluate overall patient risk characteristics for opioid misuse and accidental overdose. RESULTS: Of 8,217 patients screened, 3.9% were identified as at high risk for opioid misuse, and 18.3% at risk for accidental overdose. Nearly 1 of 3 screenings (31.7%) indicated opioid medication use in the past 60 days. Pharmacists delivered 1 or more risk-factor-dependent interventions to 41.1% of patients in the study. Following screening, naloxone dispensing in pharmacies increased to 6 times the national average. CONCLUSION: Pharmacy-based patient screening for risk of opioid misuse and accidental overdose led to risk-dependent interventions targeted to individual patients. The tools and risk-dependent interventions applied in the ONE program increased patient awareness of opioid risks and ways to reduce risk. Future studies should examine long-term outcomes, including reduction in overdose, treatment of opioid use disorder, and reduced opioid-related acute care.

Longitudinal evaluation of pharmacists' social distance preference and attitudes toward patients with opioid misuse following an educational training program.

Background: Pharmacist stigma via examination of social distance preference and negative attitudes toward persons who misuse opioids is prevalent and may lower the quality of care provided to patients. Few studies have previously extended beyond the immediate post-intervention period to examine stigma change. Methods: This longitudinal cohort study utilized a pre-survey administered before the training program, a post-survey immediately upon completion of the training program, and a delayed post-survey, administered 12 months after the training program. Co-primary outcomes were changes in social distance scale (SDS) total score from baseline to post-survey and from baseline to 12 months. Secondary outcomes included change in SDS question scores and change in negative attitudes. One hundred eighty-seven of the 1211 eligible pharmacists in the state completed the training. Matched responses of forty-four pharmacists who completed all three surveys were examined. Results: The mean total SDS score was significantly lower in the immediate post-training survey than the pre-training mean (14.75 vs. 16.57, p = .000). The 12 months mean total SDS score was also significantly lower than the pre-training mean (15.32 vs. 16.57, p = .017). Significant changes in negative attitudes from baseline to post-survey and from baseline to 12 months were seen. Conclusion: Stigma reduction components integrated into opioid training decreased pharmacist social distance preference and negative attitudes toward patients who misuse opioids immediately after the training and, most notably, were sustained for 12 months.

Opioid risk screening: Program evaluation from the community pharmacists' perspective.

BACKGROUND: Pharmacist-implemented screening programs can be improved through continuous program evaluation. Pharmacists are in a position to determine whether interventions are realistic and efficacious when used in practice. OBJECTIVE: The purpose of this study is to evaluate how community pharmacists perceive the use of an opioid risk screening for patients receiving opioid prescriptions and the associated implications for improved patient-centered care. METHODS: North Dakota community pharmacists received training on the use of an opioid risk tool for all patients filling an opioid prescription to evaluate for opioid misuse and overdose risk potential. Pharmacists then implemented the screening in their community pharmacy to screen all patients prescribed an opioid. Six months after implementation, pharmacists across the state were surveyed regarding their perception of the value of screening patients for the risk of opioid misuse and overdose. The survey questions used the Joint Committee on Standards for Educational Evaluation focusing on utility, propriety, feasibility, and accuracy. RESULTS: All pharmacists (n = 35) indicated the opioid risk screening improved patient communication and patient-centered interventions. A total of 97% of pharmacists agreed the opioid screening tool provided an objective measure in providing care to patients and improved the potential for patient safety during prescription opioid use. Although 66% of pharmacists disagreed that the screening process was time consuming, 14% of respondents agreed with this statement indicating they may require additional assistance to optimize their workflow. CONCLUSION: The results of this study support that opioid risk screening ensures utility for opioid risk stratification, feasibility to incorporate into existing workflow, and propriety for patient safety and well-being.

Patient acceptance of naloxone resulting from targeted intervention from community pharmacists to prevent opioid misuse and accidental overdose.

Background: Community pharmacists are in a unique position to prevent opioid-related deaths through the provision of naloxone. However, for those identified as candidates for take-home naloxone, the acceptance rate remains low. Value would be gained from knowing what patient demographics and pharmacist actions are associated with increased patient acceptance of naloxone. Methods: Through a state-wide program, community pharmacists screened all patients receiving an opioid prescription for risk of opioid misuse and/or accidental overdose. Pharmacists prescribed and/or dispensed take-home naloxone to patients at elevated risk. Naloxone acceptance rates were stratified based on risk factors for misuse and overdose to determine which patients are most likely to accept naloxone. Patient acceptance of naloxone and risks were captured electronically. Results: Pharmacist-initiated naloxone recommendations based on risk screening resulted in a 5.81% take-home naloxone acceptance rate. Individuals that were taking multiple opioid medications were most likely to accept the naloxone (20.45%). Concurrent disease states or medications (COPD, concurrent anxiety/depression medication, concurrent sleep aid) were associated with a statistically significant increase in the rate of naloxone acceptance. Acceptance of take-home naloxone increased as a patient risk for opioid misuse and/or accidental overdose increased. Conclusion: Patient acceptance of naloxone at the community pharmacy level was notably higher compared to national naloxone dispensing rates when pharmacists implemented a patient screening and systematic risk-based approach to identify candidates in need of take-home naloxone.

Pharmacists' stigma toward patients engaged in opioid misuse: When "social distance" does not mean disease prevention.

Background: Health professionals may stigmatize and prefer social distance from patients with opioid misuse, leading to poorer quality of care provided. The degree to which pharmacists prefer social distance from patients with opioid misuse and opioid use disorder (OUD) is not known. Methods: Pharmacists (n = 187) completed a survey comprised of demographics, attitudinal, and Social Distance Scale (SDS) questions based on a vignette patient who displayed opioid misuse. SDS question responses and total scores (maximum of 30; higher scores representing great preference for social distance) were tallied and associations with attitudes and demographics were examined. Results: Mean SDS total score was 16.32 (range 9-23). More than 59% of respondents had an SDS score >15, indicating overall lack of willingness to interact with the vignette patient. Females had a higher mean SDS score vs male pharmacists (16.58 vs. 15.36, respectively; p = 0.023). Pharmacists were more likely to prefer social distance from the vignette patient in personal situations (i.e. renting a room) than work-related interactions (i.e. providing patient education). Pharmacists with >10 years of experience, those without personal experience with a substance use disorder, those who strongly agreed that patients with OUD require excessive time and effort, and those who agreed that some people lack self-discipline to use prescription pain medication without becoming addicted had significantly higher SDS scores than pharmacists without these characteristics. Conclusions: Pharmacists expressed significant preference for social distance indicating stigmatization of patients with opioid misuse. Pharmacists were comfortable performing pharmacy tasks with patients with opioid misuse, but were less comfortable forming therapeutic relationships, an important tenet of patient-centered care. Efforts are needed to examine contributions to social distance preferences and implement measures to reduce them. Targeting of pharmacists with >10 years' experience and without personal experience with OUD may also be most beneficial.

Community Pharmacists' Contributions to Disease Management During the COVID-19 Pandemic.

Community pharmacists assist patients to manage disease and prevent complications. Despite the enormous challenge the coronavirus disease 2019 (COVID-19) pandemic has dealt to the health care system, community pharmacists have maintained the delivery of critical health services to communities, including those most at risk for COVID-19. Community pharmacists are in a key position to deliver priority pandemic responses including point-of-care testing for chronic disease management, vaccinations, and COVID-19 testing.

Implementation of a statewide program within community pharmacies to prevent opioid misuse and accidental overdose.

OBJECTIVE: To describe the implementation of a statewide pharmacy program called ONE Rx (Opioid and Naloxone Education) within community pharmacies. SETTING: Thirty community pharmacies. PRACTICE DESCRIPTION: Community pharmacies throughout the state of North Dakota were invited to participate. Pharmacists in North Dakota can legally prescribe and dispense naloxone. PRACTICE INNOVATION: ONE Rx is a statewide program that provides pharmacists with the education and tools to screen every patient who was prescribed an opioid medication for the risk of opioid misuse and accidental overdose. The goal of ONE Rx is to prevent opioid misuse and accidental overdose through patient screening and individualized education and intervention within the community pharmacy. EVALUATION: Outcomes to measure the implementation of ONE Rx included the number of pharmacists and technicians who participated in the training, the number of pharmacies who chose to implement ONE Rx, and the number of patients screened for the risk of opioid misuse and accidental overdose. RESULTS: The ONE Rx training was completed by 240 pharmacists and 41 registered pharmacy technicians. Thirty community pharmacies implemented the program between October 2018 and May 2019, and more than 1700 patients were screened for the risk of opioid misuse and accidental overdose. CONCLUSION: A statewide program to screen for opioid misuse and accidental overdose was successfully implemented.

Performance and Perceptions: Evaluation of Pharmacy Students' Consultation via Telepharmacy.

Background: Pharmacy education standards highlight the importance of effective communication skills and the use of technology to provide patient care. As technology evolves, pharmacists have opportunities to communicate in different and broader ways. Objective: The objectives of this study were 3-fold: to evaluate student ability to counsel via telepharmacy, to determine if there is a difference in students' abilities to counsel face-to-face or via telepharmacy, and to determine students' perceptions regarding patient consultation via telepharmacy. Methods: Professional pharmacy students completed a pharmaceutical care laboratory activity focused on communication via telepharmacy. Comparisons were made between students' ability to provide patient consultation via telepharmacy and face-to-face utilizing a faculty-developed rubric. Students also completed a questionnaire on their perception of utilizing telepharmacy technology to provide patient consultation. Results: Eighty-two second-year professional pharmacy students participated in the study. Results showed students are able to successfully provide patient consultation via telepharmacy without prior practice; however, there was a statistically significant difference between students' ability to counsel face-to-face and via telepharmacy (P < .001). Overall, students were more successful at providing face-to-face consultation than via telepharmacy, and students who were first assessed on their ability to counsel face-to-face perceived a greater difference between telepharmacy and face-to-face consultation (P < .05). Conclusion: Student-perceived differences between the 2 means of consultation and demonstrated a difference in their ability to counsel via telepharmacy and face-to-face. It appears that, when evaluating the need to teach professional pharmacy students how to provide patient consultation via telepharmacy, additional exposure to telepharmacy technology could be beneficial by enhancing student comfort and proficiency.

A comparison of in-person vs. asynchronous learning with self-care patient cases.

BACKGROUND AND PURPOSE: To evaluate the effectiveness of a live laboratory setting compared to an asynchronous session in a crossover teaching design on knowledge and confidence in self-care review topics. EDUCATIONAL ACTIVITY AND SETTING: Pharmacy students (n = 88) participated in a crossover designed laboratory session where they either attended a live, active-learning laboratory session on self-care review topics, followed by a virtual, asynchronous self-care simulation or vice versa. Sessions were held one week apart. Pre- and post-assessments were administered that contained knowledge and confidence questions as well as student perceptions on the teaching modalities. FINDINGS: Of the 88 students who participated in the study, 67 (76.1%) were included in the study findings. Post-assessment knowledge and confidence significantly increased after both the live, active-learning session and the asynchronous simulation. The majority of students (85%) indicated that they preferred the in-person activity. SUMMARY: Students preferred the live, active-learning laboratory for reviewing self-care concepts. However, knowledge and confidence improved using either teaching modality, therefore, in institutions where resources are limited, the virtual, asynchronous activity may be useful especially if facilitators and/or budget are limited.

Virtual self-care simulations for third-year pharmacy skills laboratory courses in three institutions.

BACKGROUND AND PURPOSE: This study was designed to determine whether a virtual, self-care activity improved knowledge and confidence in third-year student pharmacists. EDUCATIONAL ACTIVITY AND SETTING: Third-year student pharmacists (n = 386) from three institutions participated in the virtual self-care simulation during their respective practice laboratory course. A pre- and post-assessment collected 10 knowledge and five confidence questions, self-reported on 0-100 scale, mapped to learning outcomes and pharmacy standards. Responses for participants who provided consent and had linked assessments were analyzed. Additionally, students participated in a perception assessment following the simulation with the post-assessment. Each knowledge question was scored as binary (correct/incorrect), presented as percentage, and significance identified with a McNemar's test. Total knowledge score and confidence changes were presented as means with standard deviations and significance with a paired t-test. Student perceptions were presented as frequencies and percentages. FINDINGS: Total knowledge assessment demonstrated a significant improvement (p < 0.001) for the entire cohort of 198 study participants. Upon additional analysis, a single institution led the cohort to significant increase, with variable improvement and significance for each individual question. Confidence improved for the entire cohort of students and at each institution individually. The students perceived the virtual self-care activity favorably. SUMMARY: The third-year student virtual self-care activity improved knowledge and confidence with varying significance between institutions. Future studies will focus on the impact of continued reinforcement of self-care activities on student growth in knowledge and confidence.

Implementation of a Pharmacy Follow-Up Program for Dispensed Opioid Medications.

BACKGROUND: There have been multiple reported pharmacy initiatives to reduce opioid misuse and accidental overdose to address our nation's public health crisis. To date, there has not been a description in the literature of a community pharmacy follow-up initiative for dispensed opioids. METHODS: A follow-up program was designed and implemented in community pharmacies as part of a previously developed opioid overdose and misuse prevention program (ONE Program). Five to twelve days after the dispensing of an opioid, pharmacy technicians called the patient to follow up on opioid safety topics. Pharmacy technicians used a questionnaire to inquire about medication disposal plans, if the patient was taking the medication more than prescribed, medication side effects, and if the patient needed a pharmacist consultation. The results from that questionnaire were documented. RESULTS: During the first 18 months of the follow-up program, 1789 phone calls were completed. Of those contacted, 40% were still using their opioid medication, and over 10% were experiencing side effects which triggered a pharmacist consult. Patients were reminded of proper medication disposal methods, and most patients (78%) desired to dispose of unused medication at the pharmacy medication disposal box. CONCLUSIONS: Follow-up phone calls post-opioid medication dispensing were shown to add value to a previously established opioid misuse and accidental overdose prevention program and allowed for the fulfillment of the Pharmacist Patient Care Process.

The Safety Showdown: Perceptions and Practice Change of Inpatient Caregivers After a Patient Safety Escape Room.

Educational escape rooms actively engage learners and foster teamwork. It is unclear if they result in nursing practice change. Three hundred ninety-eight nursing and ancillary caregivers participated in an escape room involving patient safety and fall prevention concepts. An average rating of 4.3 out of 5 on the escape room perception scale was obtained via a postsurvey, showing positive perceptions of the event. In a delayed postsurvey, participants discussed resultant patient safety practice changes.

Design and Implementation of Tech-Check-Tech Programs in North Dakota Pharmacies.

Background: Tech-check-tech (TCT) programs in pharmacies are beneficial in facilitating a transition from fee for service dispensing tasks to advanced patient care, but they are underutilized. Objective: To describe the design, implementation, and evaluation of a transferable TCT program in several North Dakota pharmacies, with the goal of facilitating future efforts in other states. Methods: We developed a universal TCT implementation toolkit, recruited 6 pharmacies to implement it, developed an educational program for the pharmacies, and worked with the pharmacies over a year to assess success of the program. Pre- and post-implementation surveys assessed pharmacist and technician responses in regards to program effectiveness. Four outcomes were measured, and included pharmacist's time savings, descriptive comments on changes in workflow, incidence of errors and near misses, and barriers to implementation. Results: The implementation of TCT was unanimously perceived as successful and increasing efficiency in the post-site surveys completed by pharmacists. All 13 technicians who participated in the post-survey indicated the methods and materials used for training were sufficient and appropriate. The most commonly cited barrier to implementation of TCT stated by technicians was incorporating TCT into their current workflow. No dispensing errors which resulted in patient impact occurred throughout the duration of this study. Conclusions: A TCT implementation template provided a successful framework for TCT in various pharmacy settings and can serve as a model for other pharmacy settings, states, or regions.

An Introductory Over-the-Counter Simulation for First-Year Pharmacy Students Using a Virtual Pharmacy.

Objective. First-year pharmacy students at two institutions were required to complete a virtual over-the-counter (OTC) simulation during their community pharmacy practice skills laboratory course. The simulation was designed to introduce first-year pharmacy students to OTC product selection and consultation prior to didactic coursework and community introductory pharmacy practice experiences. The objective of this study was to assess the impact of the OTC simulation on students' knowledge and confidence of OTC medications and overall perceptions of the activity.Methods. Patient simulation cases in the virtual community pharmacy setting were developed and delivered to students using the MyDispense platform. Students concurrently completed a Google Form that provided directions for the virtual activity, including a combination of didactic and active learning strategies within the online platform. Student surveys assessed knowledge and confidence before and after the activity, with perceptions added to the postsurvey.Results. Total knowledge scores for the 142 students from two institutions who completed both the pre- and postsurvey significantly improved and, when assessed individually, improved for seven out of 10 individual knowledge questions. All five confidence statements significantly increased after students completed the OTC simulation. Student perceptions were overall very positive.Conclusion. Introduction of OTC counseling processes to first-year pharmacy students through a virtual pharmacy simulation resulted in increased student knowledge and confidence in providing OTC recommendations. Students perceived the activity favorably.