Exploring the Value of Medical Affairs Learning Experiences for Pharmacy Students and Residents.

The objective of this article is 3-fold: to strengthen the understanding of medical affairs (MA) among pharmacy professionals; to provide greater visibility into the value experienced by educators, learners, and the practice of pharmacy across the health care ecosystem when MA learning opportunities are available; and to provide a framework for organizations who seek to establish an MA experiential rotation. The authors collated information from published literature, anecdotal experience, and interviews with experiential education leaders from several colleges of pharmacy. As a result, the article summarizes the current perceptions of MA practice among educators and students and highlights how MA experiences may support pharmacy learners in the future.

Implementation of Debriefing Services for Pharmacy Residents in a 24-Hour, In-House Clinical Pharmacy On-Call Program: A Pilot Study.

Background: This clinical pharmacy on-call program (CPOP) is a 24-hour, in-house service provided by pharmacy residents. During shifts, challenging situations may arise, which may correlate with depression, anxiety, and stress. Objective: This pilot study aims to describe the implementation of a debriefing program and characterize mental health patterns of residents in the CPOP. Methods: A structured debriefing process was developed to provide support to residents in the CPOP. Over a 1-year period, twelve outgoing pharmacy residents and ten incoming pharmacy residents completed a modified Depression Anxiety Stress Scale (mDASS-21) questionnaire and received a stress perception score (SPS) during debriefing. Data from first and final on-call shifts were compared via a paired Wilcoxon signed-rank test. Residents were referred to an Employee Assistance Program (EAP) based on mDASS-21 and SPS results. Scores from final on-call shifts were compared between residency classes via a Wilcoxon rank sum test. Results: Following successful implementation, 106 debriefing sessions were completed. Pharmacy residents responded to a median number of 38 events per shift. Significant reductions in anxiety and stress scores were observed from the first and final on-call shifts. Six residents were referred to EAP. A lower incidence of depression, anxiety, and stress was observed in pharmacy residents who received debriefing compared to previous residents. Conclusion: The debriefing program provided emotional support to pharmacy residents participating in the CPOP. Implementation of debriefing demonstrated a reduction of anxiety and stress from the beginning to the end of the academic year and in comparison to the previous year.

Initiation of a discharge pharmacy within a busy urban emergency department: The first year.

PURPOSE: Discharge prescriptions represent an important aspect of care for patients seen in the emergency department (ED) setting and are used by providers to continue therapy for acute illness once patients leave the ED or to prevent future exacerbations of chronic conditions. The success of an ED discharge and the medications prescribed rely on patient compliance. Compliance depends on patients' ability to obtain prescriptions, which can be hindered by limited access to pharmacies and cost. SUMMARY: In order to address issues traditionally associated with medication noncompliance, a discharge pharmacy was implemented within a busy urban ED. The pharmacy began processing prescriptions on December 18, 2019, using a formulary aimed towards providing commonly prescribed and high-risk medications. The pharmacy accepts insurance plans in addition to utilizing 340B Drug Pricing Program pricing to offer affordable medications to patients. During the first year of operation 10,230 prescriptions were filled for 5,703 patients, representing 13% of all patients discharged during that time. Of the prescriptions filled, 35.4% were for products considered high-risk medications, including epinephrine auto-injectors, insulin, and antibiotics. Over 50% of these high-risk medications were provided to patients through reduced cash pricing. Pharmacist interventions were made on 4.3% of prescriptions to address incorrect dosing, avoid use of inappropriate antibiotics, and recommend alternative therapies. CONCLUSION: The implementation of a discharge pharmacy within the ED allowed over 5,700 patients to be discharged with medications and represents a potential solution to issues surrounding medication noncompliance. Similar initiatives have the opportunity to improve medication access for a larger ED population.

Impact of a Nurse-Driven Diabetic Ketoacidosis Insulin Infusion Calculator on the Rate of Hypoglycemia.

OBJECTIVE: The aim of the study was to evaluate the impact of an insulin infusion calculator incorporated into electronic health record system in reducing the rate of hypoglycemia in diabetic ketoacidosis (DKA) management. METHODS: Retrospective chart review of patients with primary admission diagnosis of DKA was conducted in a university-affiliated academic medical center. End points including the rate of hypoglycemia, time to DKA resolution, rate of hypokalemia, time on insulin drip, and length of stay were measure before and after implementation of DKA calculator. RESULTS: Of 181 adult patients admitted for primary diagnosis of DKA, 103 were managed using the calculator. After implementation of the calculator, incidence of hypoglycemia and severe hypoglycemia were significantly reduced by 70% and 87%, respectively (P < 0.01). No difference was observed for time to DKA resolution, time on insulin drip, and length of stay. CONCLUSIONS: Implementation of DKA insulin infusion calculator significantly reduced the rate of hypoglycemia. Future improvements should focus on reducing time to DKA resolution and length of stay.

Effect of IV Push Antibiotic Administration on Antibiotic Therapy Delays in Sepsis.

OBJECTIVES: Timeliness of antibiotic administration is recognized as an important factor in reducing mortality associated with sepsis. According to guidelines, antibiotics should be administered within 1 hour of sepsis presentation and the Centers for Medicare & Medicaid Services mandates administration within 3 hours. This study evaluates the difference in time from sepsis diagnosis to first-dose completion of ß-lactam antibiotics between IV push and IV piggyback administration. DESIGN: Single-center, retrospective analysis. SETTING: Urban, tertiary-care emergency department. PATIENTS: Inclusion criteria were as follows: 1) adult patients (n = 274) diagnosed with severe sepsis or septic shock per Sepsis-2 criteria from September to November 2016 and from September to November 2017 and 2) received ß-lactam antibiotic. INTERVENTIONS: Initial ß-lactam agent administered as either IV push or IV piggyback. MEASUREMENTS AND MAIN RESULTS: Median time (interquartile range) from sepsis diagnosis to administration of a ß-lactam antibiotic was 48 minutes (19-96 min) versus 72 minutes (8-180 min) and to administration of the complete broad-spectrum regimen was 108 minutes (66-144 min) versus 114 minutes (42-282 min) in the IV push (n = 143) versus IV piggyback (n = 131) groups, respectively. When controlling for time to sepsis diagnosis and other factors, IV push was associated with approximately 32-minute time savings to ß-lactam (ß = -0.60; 95% CI, -0.91 to -0.29) and approximately 32-minute time savings to broad-spectrum (ß = -0.32; 95% CI, -0.62 to -0.02) antibiotic administrations. The IV push group was less likely to fail the goal of ß-lactam antibiotics within 1 hour (44.6% vs 57.3%; odds ratio, 2.27; 95% CI, 1.34-3.86) and 3 hours (7.6% vs 24.5%; odds ratio, 4.31; 95% CI, 2.01-10.28) of sepsis diagnosis compared with IV piggyback. The IV push strategy did not affect mortality, need for ICU admission, or ICU length of stay. No adverse events, including infusion reactions, were found in either arm. CONCLUSIONS: Use of an IV push strategy may safely facilitate more rapid administration of ß-lactam antibiotics and may allow for better compliance with sepsis management guidelines.

A Cross-Sectional Survey of Medical Trainee Experiences During Medication Shortages.

BACKGROUND: Medication shortages prevent patients from receiving optimal care. Despite the frequency with which medical trainees care for inpatients, no assessment of their experiences in medication shortage management has been performed. OBJECTIVE: We evaluated trainees' experiences managing medication shortages. METHODS: We performed a cross-sectional survey of trainees postgraduate year 2 (PGY-2) and above in medicine, anesthesiology, and emergency medicine departments at 2 academic centers in 2018-2019. Categorical and ordinal assessments evaluated shortage awareness, substitution availability, pharmacy and therapeutics committee-based restrictions, communication, and education. Regressions were performed to determine effect of PGY, department, and institution on responses. RESULTS: A total of 168 of 273 subjects completed the survey (62% response rate). Most (95%, 159 of 168) reported managing medication shortages during training; 51% (86 of 168) described managing clinically relevant shortages daily or weekly. Seventy-seven percent (129 of 168) noted equivalent alternatives were unavailable at least one-quarter of the time, and 43% (72 of 168) reported clinically necessary medications were restricted at least weekly. Fifty-four percent (89 of 168) and 64% (106 of 167) of respondents discussed clinically relevant shortages with supervising physicians or patients "some of the time" or less, respectively. Most respondents (90%, 151 of 168) reported they would benefit from shortage management training, but few (13%, 21 of 168) reported prior training. CONCLUSIONS: Although trainees reported frequent involvement in clinically impactful shortage management, medication shortage communication between trainees and supervising physicians or patients appears sporadic. Medication shortage management training is uncommon but perceived as beneficial.

Impact of a Pharmacy-Led Medication Reconciliation Program.

OBJECTIVE: To determine the impact of a pharmacy-led medication reconciliation program at a large community hospital. The magnitude of the benefit of pharmacy-led medication reconciliation was evaluated based on the number of medication-related discrepancies between nursing triage notes and medication histories performed by pharmacy technicians or students. Discrepancies identified by pharmacy personnel medication histories that required pharmacist intervention on physician admission orders were further classified based on expected clinical impact if the error were to be propagated throughout hospitalization. METHODS: A retrospective chart review was performed on 200 patients who met the following inclusion criteria: adults admitted from the emergency department from October 1, 2015, to November 17, 2015, with a medication history collected by medication reconciliation personnel (MRP) containing at least three home medications or one high-risk home medication that was reviewed and reconciled by one of the investigators. The primary endpoint was the number of discrepancies between nursing triage notes and pharmacy personnel medication histories. The secondary endpoint was the percentage of pharmacy interventions categorized as "significant," "serious," or "life threatening" on a medication error severity scale. Additional data points included: number and type of clinical interventions; percent of interventions involving high-risk medications; amount of time spent obtaining medication histories and comparing them to admission orders; number and type of sources used; number of home medications; and percent of admitted patients interviewed by the MRP within 24 hours of admission. RESULTS: In a population of 200 patients, 1,762 medication history discrepancies were identified. MRP-collected histories identified issues involving 46 patients that required pharmacist intervention for a total of 235 interventions, of which 68% were related to errors categorized as significant, serious, or life threatening. CONCLUSION: Utilization of a pharmacy-led medication reconciliation program decreased the number of significant, serious, and life-threatening medication reconciliation errors upon hospital admission.