Implementation of a pharmacist-guided pharmacogenomics dosing service at a rural NCI-designated comprehensive cancer center.

INTRODUCTION: The goal of pharmacogenetic testing is to identify genetic variants with significant implications on drug safety and efficacy. Several professional organizations and institutions have demonstrated the value of pharmacist involvement in the implementation of pharmacogenomic services. Therefore, we aimed to establish a pharmacist-guided model for interpretation of pharmacogenetic results for all oncology patients seen at the Dartmouth Cancer Center (DCC) in Lebanon, NH. METHODS: A pilot of a pharmacist-guided pharmacogenomics dosing service was implemented at the DCC. Pharmacy services included review of results from a next generation sequencing panel for DPYD, TPMT, NUDT15, and UGT1A1 variants. The pharmacist wrote a note in the electronic health record (EHR) detailing actionable drug-gene interactions and drug-dosing guidance, which was then routed to the treating oncologist. Outcomes collected included highlighting actionable mutations and defining pharmacist interventions. In addition, time spent formulating and documenting patient-specific drug-dosing recommendations was collected. RESULTS: From February 2024 through May 2024, a total of 71 patients with pharmacogenetic results, provided by the clinical molecular laboratory at Dartmouth Health, were reviewed by the pharmacist. The majority of patients tested were diagnosed with a malignancy of gastrointestinal origin. Twenty-one patients were found to have actionable variants in at least one of the four genes evaluated, and five of the 21 identified patients had active treatment plans for which dose changes were then implemented. CONCLUSIONS: Implementation of a pharmacist-guided pharmacogenomics based dosing service aided in optimizing drug therapy and has positioned Dartmouth Health for further expansion of pharmacogenomics and personalized patient care.

Practice outcomes for the first decade of Rural Pharmacy Education (RPHARM) Program graduates.

BACKGROUND: The maldistribution of pharmacy services in underserved areas is a national issue. Analysis of data from the 2019 National Pharmacist Workforce Study indicated that 13.9% of pharmacists were working in a rural community. However, the percentage of people living in rural communities in the United States is 20.0%. Currently, there are 20 rural pharmacy programs in the United States, including the Rural Pharmacy Education (RPHARM) Program at University of Illinois Chicago (UIC) College of Pharmacy, which contain both didactic and experiential rural components. This research project examines the practice outcomes of the RPHARM Program graduates. METHODS: Descriptive analysis was used to examine the practice outcome characteristics of RPHARM Program graduates between 2014 and 2023. The characteristics of the RPHARM graduates included the rurality of hometowns, practice locations and populations, and distance of practice locations to hometowns. Rural practice outcomes were described utilizing frequently used rural definitions. The practice locations of 54 of the 61 RPHARM graduates were used in the analysis. RESULTS: Approximately 41% of the practicing RPHARM graduates were from rural hometowns and two-thirds were female. RPHARM graduates mostly work in either a community setting (44.4%) or a hospital setting (37.0%). Approximately 11% worked in a federal government organization and 5.6% worked in a long-term care pharmacy. When examining job location, 42.6% were working in a rural location based on Rural-Urban Commuting Area Version 3.0 and 35.2% of RPHARM graduates had always worked in a rural location. Approximately 57% of practicing RPHARM graduates are working in a location < 50 miles from their hometown, and 13% are working 50 to 100 miles from their hometown. Approximately 74% of RPHARM graduates are practicing in Illinois. CONCLUSIONS: Approximately 40% of RPHARM graduates practice in rural locations. A significant portion (35.2%) of RPHARM graduates have always practiced in rural locations, and many (57.4%) are practicing near their hometowns. Results indicate that the RPHARM Program is making meaningful contributions to increasing the rural pharmacy workforce. Due to the lack of information on rural pharmacy practice outcomes, all programs with rural pharmacy content are encouraged to track graduates' practice locations.

A Snapshot of Introductory Pharmacy Practice Experience Program Characteristics.

OBJECTIVE: To provide schools and colleges of pharmacy a snapshot of Introductory Pharmacy Practice Experience (IPPE) program characteristics to generate and share ideas for IPPE program modifications to improve student learning outcomes and comply with Standards 2025. METHODS: A 41-item electronic survey was distributed to 140 Accreditation Council for Pharmacy Education fully accredited schools and colleges of pharmacy in 2023. IPPE program characteristics such as structure, learning activities, assessments, and requirements were described. RESULTS: Eighty-seven programs participated in the survey (62.1% response rate). Notable findings included 64.4% of programs starting IPPEs during the first professional year, 78.6% did not count simulation hours toward Accreditation Council for Pharmacy Education hour requirements, 24.1% incorporated patient care electives, over 90% incorporated various patient care activities, 40.2% exceeded a 2:1 student-to-preceptor ratio, 15.7% incorporated layered learning, 50.0% incorporated interprofessional education, 57.5% used summative assessment rubrics based on Entrustable Professional Activities, and 77.0% used pass/fail grading. CONCLUSION: Owing to evolving accreditation standards, the study provided valuable information about the current state of IPPEs. The study results included examples and components that programs can use to ensure that they comply with Standards 2025.

Student pharmacist's application of the pharmacists' patient care process during an interprofessional diabetes camp introductory pharmacy practice experience.

BACKGROUND AND PURPOSE: To describe student pharmacist's application of the Pharmacists' Patient Care Process (PPCP) during participation in an interprofessional introductory pharmacy practice experience (IPPE) at a Type 1 Diabetes (T1D) pediatric summer camp. EDUCATIONAL ACTIVITY AND SETTING: Student pharmacists entering professional year two (P2) and three (P3) attended a one-week, overnight T1D summer camp as part of the longitudinal IPPE curriculum between June 2021 and July 2023. They completed two PPCP assignments, a reflective assignment and a self-evaluation following the experience. FINDINGS: Thirty-seven students attended camp. The most common PPCP assignments submitted corresponded to the collaborate core competency (75.6%) and the implement (51.4%) and collect (27.0%) steps. Written reflections revealed students learned about therapeutic monitoring of diabetes, hypoglycemia and hyperglycemia management, insulin dose adjustment, and lifestyle strategies such as carbohydrate counting. Many students expressed feeling increased empathy (59.5%) and inspiration (56.8%) toward individuals with T1D. Students reflected positively on their experience working with an interprofessional team. Self-evaluations indicated perceived competency in all steps and core areas of the PPCP, especially in communication. DISCUSSION: Overall, student feedback indicates inclusion of camp as a non-traditional pharmacy practice site provides ample opportunity to apply the PPCP through participation and interprofessional decision-making opportunities in patient care. Our findings demonstrate camp provided the ability to partake in activities that encompass every step and core component of the PPCP. Immersion in the camp environment allowed early learners to feel competent in their ability to engage in the PPCP and communicate with patients and healthcare professionals. SUMMARY: Participation in a T1D summer camp provided early student pharmacists exposure to direct patient care and opportunity to apply the PPCP in an interprofessional education environment. Students learned clinical diabetes knowledge and skills, in addition to increased empathy and a feeling of inspiration. Students felt highly competent in their ability to communicate with patients, pharmacists, and other healthcare providers.

[Pharmaceutical Interventions in Benzodiazepine users during the COVID-19 Pandemic]. / Intervenciones farmacéuticas en usuarios de benzodiacepinas durante la pandemia COVID-19.

Introduction: Pharmaceutical Intervention aims to optimize and rationalize the use, effectiveness, and safety of dispensed medications resolving drug-related problems (DRPs) and negative medicine outcomes (NMOs). Objectives: To evaluate Pharmaceutical Interventions in Benzodiazepines users during the COVID-19 pandemic from a Community Pharmacy. Method: Prospective observational, descriptive, and cross-sectional study (AEMPS code: DAA-CLO-2020-01) of Pharmaceutical Interventions offered by the community pharmacy between August 2020 and February 2021. Results: A total of 306 Pharmaceutical Interventions were conducted involving 127 patients. Health education and personalized medication information were the most common Pharmaceutical Interventions after detecting a high level of unfamiliarity with the Benzodiazepines among patients. Pharmaceutical Interventions leading to medical referrals accounted for 37.8% of the total, triggered by the detection of DRPs and/or NMOs or after identifying the patient as candidate for deprescription. These referrals included patients with a very high level of depression according to the Euroqol 5D-3L test. Pharmaceutical Interventions resulting in Medication Review with Follow-up Service were performed in 3.1% of patients. The patient acceptance rate of Pharmaceutical Interventions reached 98.4%. Conclusions: The high acceptance rate of Pharmaceutical Interventions reinforces the value of Community Pharmacy in optimizing and rationalizing Benzodiazepines usage, while strengthening the pharmacist-patient relationship. The COVID-19 pandemic posed challenges to pharmacist-physician collaboration despite of the availability of telecommunication protocols among healthcare professionals.

Competency development for pharmacy: adopting and adapting the FIP global advanced development framework.

Background: Pharmacy education shifts toward competency-based training to meet healthcare demands. This study aims to develop and validate the Kuwait Advanced Competency Framework (KACF) for pharmacists. The study adopts the FIP Global Advanced Development Framework (GADF) to develop a country-specific framework, emphasizing the importance of aligning with global standards while adapting to local contexts. The developed framework builds upon the Kuwait Foundation Competency Framework to address the need for advanced pharmacy services. Methods: This is a mixed methods study that employed an "adopt and adapt" approach. The KACF was adopted from the FIP GADF and adapted following four phases. Phase one involved checking and validating the Arabic version of the FIP GADF. Phase two employed a series of focus groups to validate accuracy and relevancy of competency statements. Phase three utilized a workshop with different stakeholders as a final step of validation. Phase four involved a national survey to assess the national pharmacy workforce against the framework competencies. Qualitative feedback from focus groups and workshops informed competencies modifications. Quantitative data were analyzed using descriptive and multiple correspondence analyses (MCA). Results: The translation phase verified a bilingual framework that could be utilized by pharmacists in Kuwait. The initial and final validation phases identified 20 behavioral statements (out of 22 in the original document) that are relevant to pharmacy practice in Kuwait. The national survey, comprising 169 respondents, validated the KACF's applicability, revealing variations in career stage progression across competency clusters. Findings highlighted associations between career stages and practice settings, offering insights for tailored workforce development strategies. Conclusion: The KACF emerges as a pivotal tool for advancing pharmacy services in Kuwait, aligning with global trends toward competency-based education. Findings underscored the necessity for context-specific approaches in advancing pharmacy practice, providing a comprehensive understanding of competency progression and readiness for advanced roles.

Examining Delineated Competencies within Blended Hospital/Health System Pharmacy and General Medicine Advanced Pharmacy Practice Experiences.

In the United States, Doctor of Pharmacy (PharmD) programs are required to provide advanced pharmacy practice experiences (APPEs) in the core inpatient rotation areas of hospital/health system pharmacy and inpatient general medicine patient care. Colleges and Schools of Pharmacy (C/SOPs) nationwide are increasingly utilizing blended or longitudinal APPE models to offer experiential opportunities; however, there is a gap in the literature to support programs with delineating rotation-specific competencies when integrating two or more rotations together. Utilizing a survey instrument, PharmD students at two C/SOPs reported their onsite inpatient rotation sub-competency activities achieved within the four competency areas of Hospital/Health Pharmacy Systems, Medication Safety and Quality, Clinical Applications, and Professional Practice, which are listed in Appendix C of the 2016 Accreditation Council for Pharmacy Education Standards Guidance Document. Unpaired two-sample t-tests were performed to compare proportions of sub-competency activity occurrence in the two rotation settings. In total, 168 students reported inpatient activities related to the four competency areas, with 95-100% reporting their involvement in one or more sub-competency opportunities within each area. Of the 26 sub-competencies compared, 73% significantly facilitated the development of competency to a greater extent for one APPE inpatient rotation type over the other (p < 0.05). The findings can be utilized by C/SOPs to support the delineation of rotation-specific competencies when blending inpatient experiential opportunities.

Student Stress, Coping, and APPE Readiness at Two Public Institutions before and during the Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic significantly impacted pharmacy students' education and well-being. The primary aim of this study was to evaluate the effects of the pandemic on students' perceived stress by comparing third- and fourth-year students from the pre-pandemic Class of 2019 with mid-pandemic Class of 2021 at two public institutions. Secondary aims were to evaluate the pandemic effects on students' academic and professional development skills and practice readiness. The Perceived Stress Scale (PSS) and the Brief Coping Orientation to Problems Experienced (COPE) scale were used to measure student well-being. Students' self-rated problem-solving, time management, and study skills were used to measure their academic and professional development; practice readiness was measured using students' self-rated confidence levels. PSS scores were significantly higher in mid-pandemic than pre-pandemic students, and the Brief COPE avoidant coping subscale differed between pre-pandemic and mid-pandemic students. No differences were found in any academic and professional development skills between the pre- and mid-pandemic students, and there were significant improvements in student confidence levels for practice readiness among the mid-pandemic students. In conclusion, the pandemic appeared to affect students' stress and avoidant coping mechanism but had variable effects on academic and professional development and practice readiness.

Assessment of Patient Care Activities and Readiness for Advanced Pharmacy Practice Experiences in Revised Third-Year Introductory Pharmacy Practice Experiences.

OBJECTIVE: To quantify the impact of a revised third-year (P3) introductory pharmacy practice experience (IPPE) curriculum on student opportunities for direct patient care and to evaluate student and preceptor perceptions of advanced pharmacy practice experience (APPE) readiness. METHODS: An intentional, structured curriculum redesign shifted 50 IPPE hours from each of the first- and second-years into the P3 year. A survey was developed and administered to students in the graduating classes of 2023 (original curriculum) and 2024 (revised curriculum) at the end of their first APPE rotation. The survey quantified the frequency of patient care activities completed during P3 IPPEs and assessed student perceptions of the effectiveness of P3 IPPEs in preparation for APPEs. At the conclusion of the first APPE, preceptors answered a single question assessing student APPE readiness. RESULTS: A total of 213/226 (94%) students responded to the optional survey. A significantly higher proportion of students in the 2024 cohort had the opportunity to complete several direct patient care activities compared to the 2023 cohort in community, institutional, and elective IPPEs. Additionally, the 2024 cohort was provided with greater access to the electronic health record (EHR). Although the 2024 cohort had higher perceived APPE readiness in areas of navigating the EHR and administering vaccines, student- and preceptor-perceived overall APPE readiness was similar between the 2 cohorts. CONCLUSION: Transferring more IPPE hours into the last didactic year can increase student opportunities for direct patient care while promoting APPE readiness. Activity quantification could be used by other pharmacy programs to optimize IPPEs.

Multifaceted Strategy That Improves Students' Achievement of Entrustable Professional Activities Across Advanced Pharmacy Practice Experiences.

OBJECTIVE: To outline an approach to help students achieve Entrustable Professional Activities (EPAs) entrustment during a sequence of Advanced Pharmacy Practice Experiences (APPEs) by implementing longitudinal monitoring and individualized intervention and remediation strategies. METHODS: Using the recommended EPAs within the core APPEs (acute care, ambulatory care, community, institutional), students were expected to achieve entrustment on all EPAs by graduation. A longitudinal monitoring approach, using an "EPA report card," was implemented to continuously identify students at risk of not meeting the EPA requirement of "Level 3" entrustment (perform with reactive supervision). Individualized interventions, including proactive outreach and in-sequence remediation, were incorporated into the APPE core and elective sequence to help ensure all students were entrusted by the end of APPEs without requiring further end-of-year remediation to graduate. RESULTS: For the graduating classes of 2023 and 2024, 12% (8 of 69) and 16% (12 of 75) students, respectively, were identified as at risk of not meeting EPA entrustment. Proactive outreach, in-sequence remediation, or a combination of both strategies, were used to enhance learning and EPA performance. As a result, all students achieved "Level 3" entrustment on the deficient EPA(s) by the end of the APPE sequence. No student required further end-of-year remediation to graduate. CONCLUSION: Utilizing a multifaceted strategy provided timely, real-world practice opportunities to improve the students' achievement of EPAs across the APPE curriculum and decreased the need for end-of-year remediation and potential graduation delays.

Assistive products in pharmacy practice to optimize medications use for visually impaired patients: Focus groups to explore community pharmacists' opinions and expectations.

Background: Visual impairment can significantly affect a person's ability to take medications safely. Therefore, pharmacists need to ensure safe and effective access to medication information, particularly through the use of assistive products, which are devices that compensate for partial or total vision loss. Although assistive products are used by visually impaired patients for activities of daily living, their use in medication management needs to be more widespread. Objective: The study aimed to investigate community pharmacists' opinions and excpectations on the use of assistive products in pharmacy practice to optimize and secure medications use for visually impaired patients. The goal is to transfer these assistive products to pharmacy practice. Methods: Focus groups were conducted with 6 French-speaking community pharmacists via videoconference in Belgium, following the principle of participatory action-research. The participants were recruited voluntarily, and moderator's guides were developed to lead the discussion. The focus groups were recorded, transcribed verbatim, and analyzed in a double-blind fashion using thematic analysis. The data were organized by NVivo software. Results: Four themes were identified: easy-to-use assistive products according to pharmacists, usefulness of assistive products in pharmacy practice, barriers to the use of assistive products, and potential solutions. According to community pharmacists, certain assistive products were deemed easy-to-use and transferable to pharmacy practice. Conclusions: This qualitative study demonstrates the transferability of assistive products to pharmacy practice for visually impaired patients in medications use. The study taken into account the patient's profile and the multidisciplinary approach, which community pharmacists consider essential.

Using quality improvement frameworks to develop, implement, and evaluate a novel ambulatory oncology pharmacy practice model: A descriptive example.

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: To describe the application of the Plan-Do-Study-Act quality improvement framework in the development, implementation, and evaluation of a novel pharmacy practice model in ambulatory oncology. SUMMARY: Four iterations of the Plan-Do-Study-Act framework were completed to develop a patient-facing, pharmacist-led ambulatory oncology clinic program. The clinic provided care to patients with prostate cancer on oral anticancer therapy. Metrics were collected throughout all stages of development to inform target processes for improvement. The pharmacist saw 136 patients between July 2019 and January 2023, resulting in 464 total encounters. The pharmacist provided clinical interventions and counseling to patients newly starting on oral anticancer therapy and those established on therapy using a longitudinal model of care. CONCLUSION: Application of the Plan-Do-Study-Act quality improvement framework to a novel pharmacy practice model supported the development, evaluation, and sustainability of a pharmacist-led ambulatory oncology clinic providing care to patients with prostate cancer on oral anticancer therapy.

Equity, diversity, and inclusion in oncology pharmacy practice: Everyone's business.

INTRODUCTION: Equity, Diversity, and Inclusion (EDI) is gaining increased attention within all industries healthcare being no exception. The terminology Equity, Diversity, and Inclusion and its abbreviation EDI gained popularity in the early 2000's when varied socio-political factors prompted many organisations to examine EDI concepts and how to operationalise them. The growing diversity of our society requires cross-cultural inclusive approaches to increase equity and access to services. METHOD: This unique research is community-led research supported by the British Oncology Pharmacy Association, in which the members of the BOPA community are equal partners to inform action on policies that address EDI. This research was a cross-sectional study involving an online survey of financial BOPA members. RESULTS: Demographic data was extracted, and the quotes were analysed for common themes. The majority of respondents were women, and the largest age group was between 34 and 44. The first cause of microaggressions identified by the respondents was of racial and ethnic origin, followed by marital status and religious nature. Participants described the lack of diversity in senior positions and the microaggressions experienced by those who hold leadership positions. Some participants described how some situations at work made them feel excluded or alienated. The impact of discrimination and bullying/microaggressions extended to patients was also reported. CONCLUSION: Despite strategic directions encompassing this aspect, this research underscores the pressing need for more evidence on the lack of EDI in healthcare institutions. Our findings, located in the pharmacy oncology specialty, have identified the problem and highlighted the potential benefits of addressing it. More needs to be done in training and professional development to address unconscious bias and change behaviours.

Clinical management protocols for community pharmacist-led management of urinary tract infections: a review of the grey literature and quality appraisal.

BACKGROUND: Pharmacist-led management of urinary tract infections has been introduced as a service in the United Kingdom, Canada, United States of America, New Zealand, and Australia. The management of acute uncomplicated urinary tract infections by community pharmacists has gained increasing attention as a potential avenue to alleviate the burden on primary healthcare services. AIM: The objectives of the review were to: (1) identify protocols for community pharmacist management of acute uncomplicated urinary tract infections in women aged 16-65 years; (2) outline their key components; and (3) appraise the quality of protocols. METHOD: A grey literature search was undertaken for protocols intended for use by community pharmacists for the management of acute uncomplicated urinary tract infections in women aged 16-65 years, met the definition of a clinical management protocol and written in English. Their quality was appraised using the Appraisal Guidelines for Research and Evaluation version II instrument. RESULTS: Forty of the 274 records screened were included. Content analysis identified ten key components: common signs/symptoms, differential diagnosis, red flags/referral, choice of empirical antibiotic therapy, nonprescription medications, nonpharmacological/self-care advice, patient eligibility criteria, patient follow-up, dipstick testing recommendations, and recommendations on antimicrobial resistance. The lowest scoring domains in the quality assessment were 'Editorial Independence' and 'Rigour of Development'. Only four protocols were deemed high-quality. CONCLUSION: The review demonstrates that clinical management protocols for pharmacist-led management of urinary tract infections consist of similar recommendations, despite variation in international practice. However, the findings highlight a deficiency in the quality of most clinical management protocols governing pharmacist-led urinary tract infection management.

Improving Self-Perceived Competencies of Second-Year Pharmacy Students Through an Introductory Medication Reconciliation Rotation.

OBJECTIVE: Medication reconciliation (MedRec) is an essential health care function that is particularly relevant to pharmacists' expertise and a learning opportunity for pharmacy students. Our objective was to assess change across clinical competence, confidence, and communication skills after the completion of a MedRec rotation by second-year pharmacy students. METHODS: A retrospective post-then-pre-survey including 29 questions was developed/delivered to students after the completion of required MedRec hours. The primary end point was the change in 3 domains via summed scores from individual questions. Cohen's difference (d) was used to determine group effect size change. The secondary end points included individual question change, perceived patient impact, and subgroup analyses. RESULTS: Of 115 second-year pharmacy students, 81.7% (n = 94) participated in the study. Students self-reported increases on the Likert scale (0-10) of 2.49 ± 1.90 in clinical competency domain, 3.57 ± 2.13 in confidence domain , and 3.12 ± 2.15 in communication skills domain, representing statistically significant and large group effect changes across all 3. A total of 21 of the 22 individual questions had large group effect changes; 1 question (nursing communications) had a moderate group effect change. Student perception of MedRec impact on patient care (Likert scale 0-10) was positive: post-rotation score 7.39 ± 1.57. CONCLUSION: To the best of our knowledge, this is the first larger-scale study that examines student-evaluated outcomes of a MedRec-based rotation. Students self-reported high levels of post-rotation competency across all domains; students from ethnic minorities and with less work/MedRec experience increased their lower pre-rotation scores to statistically similar post-rotation scores, compared with non-minority and more experienced peers. Further study of the model and outcomes is advised.

Rational Redesign of an Introductory Pharmacy Practice Experience Curriculum.

OBJECTIVE: To utilize a process to identify strengths and weaknesses of an introductory pharmacy practice experience (IPPE) curriculum from stakeholder perspectives and undergo IPPE curricular revision. METHODS: An IPPE curriculum redesign taskforce was created, and a 5-step systematic quality improvement process was developed and applied to redesign an IPPE curriculum. The steps were to identify existing curriculum challenges and strengths, determine potential solutions to challenges, redesign IPPE curricular structure, obtain stakeholder input and support, and redesign IPPE content. Throughout these steps, surveys were administered, and feedback was solicited from stakeholder groups through focus groups and meetings. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using inductive content analysis and peer debriefing to identify themes. RESULTS: Student survey and focus group results identified desires to limit student-preceptor negotiations when scheduling hours, decrease conflict between IPPE hours and scheduled classes, and increase direct patient care opportunities. Structural revisions included transition of IPPE hours from the first and second year of the program into the third year, revising course schedule grids to allow third-year students 1 day per week to complete hours, and aligning rotation dates during class-free times. Curricular content was strengthened through curricular mapping, threading, and course coordinator collaborations. CONCLUSION: A 5-step IPPE redesign systematic quality improvement process utilizing solicitation, analysis, and incorporation of stakeholder feedback was used to revise an IPPE curriculum to maintain framework and content strengths and address weaknesses. Other pharmacy programs could utilize this process to redesign their IPPE curriculum.

Cross-sectional description of hospital pharmacy services in Puerto Rico in 2022 using the Practice Advancement Initiative 2030 Self-Assessment Tool.

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 American Society of Health-System Pharmacists (ASHP) developed the Practice Advancement Initiative 2030 (PAI 2030) to support the continuous improvement of hospital pharmacy services in the United States. Puerto Rico (PR) hospitals' level of compliance with PAI 2030 recommendations is not currently known. The primary objective of this study was to describe the hospital pharmacy scenario in PR in the 5 areas addressed in PAI 2030 recommendations. SUMMARY: Through a collaboration between the state affiliate, a school of pharmacy, and ASHP, completion of the PAI 2030 Self-Assessment Tool was promoted among hospital pharmacy directors between August 2022 and March 2023. A total of 18 out of 66 hospitals completed the survey. The results were compared with national data provided by ASHP from 163 US hospitals. Areas where PR hospitals rated high were in PAI 2030 domain A (Pharmacy Technician Role, Education, and Training) and domain E (Pharmacist Leadership in Medication Use and Safety). PR hospitals rate their performance lower in domain A (Patient-Centered Care) and domain B (Pharmacist Role, Education, and Training). Specific focus areas for improvement by PR hospitals include pharmacist participation in medication reconciliation, 24/7 access to advanced clinical pharmacy services, expansion of the pharmacist's scope of practice, and training through the Board of Pharmacy Specialties and residency programs. CONCLUSION: This study illustrates how the PAI 2030 Self-Assessment Tool can be used to benchmark pharmacy services at the state level. We suggest that changes are needed to close the gap between hospital pharmacies working towards optimizing the role of pharmacists in healthcare systems and those still struggling with dedicating staff to well-recognized pharmacist roles and responsibilities.

Focused Preceptor Feedback Assessing Student Pharmacists' Ability to Administer Pediatric Immunizations.

OBJECTIVE: To evaluate experiential pharmacy preceptor perceptions of student pharmacists' ability to administer pediatric immunizations. METHODS: Semi-structured, qualitative key informant interviews using the Outcomes Evaluation Framework were conducted with 10 pharmacist preceptors in outpatient community pharmacies where pediatric immunizations were provided. Interviews were audio-recorded, transcribed, and deidentified prior to analysis by the research team. Qualitative analysis and thematic coding procedures were used to identify relevant themes. RESULTS: Saturation was met after 10 pharmacists participated. All stated that it was beneficial for student pharmacists to administer pediatric vaccines if trained in proper technique. Participants acknowledged that the training students currently receive in immunization administration within the PharmD curriculum is valuable but did identify general confidence and child-comforting techniques during and after vaccination as areas of improvement for students. Just-in-time training, preceptor coaching, and hands-on practice outside of the didactic curriculum were utilized to help build confidence. Barriers to the implementation or expansion of pediatric immunization delivered by students in community pharmacies were identified as competing priorities, time, and reimbursement. CONCLUSION: Student pharmacists can be helpful in easing the challenges of incorporating pediatric immunization services into the community pharmacy setting. Results demonstrate that the integration of student pharmacists into these services is beneficial. Pediatric immunizations are still relatively new to many pharmacists and specific training for pediatric immunization administration may not be integrated into all Doctor of Pharmacy curricula but the experiential education of pediatric immunization training can be beneficial to help prepare student pharmacists for hands-on practice.

Students empowering pharmacist provided contraception services: An APPE student perspective on service development.

PURPOSE: This reflection aims to highlight the ambulatory care setting and its impact on pharmacy student experiential education through student involvement in developing a contraception pharmacy service. Although pharmacist-prescribed contraception has been permitted through collaborative practice agreements (CPA) for some time, the recent enactment of Indiana House Bill 1568 has sparked interest amongst students in promoting this service and enhancing accessibility.1. DESCRIPTION: This manuscript invites readers into the dynamic experience of two Advanced Pharmacy Practice Experience (APPE) students engaged in developing and implementing a pharmacist-prescribed contraception service within an ambulatory care clinic. They address the creation, implementation, and feedback of students participating in developing this service throughout their four-week rotation. ANALYSIS/INTERPRETATION: Their experience contributes valuable insights into the evolving field of ambulatory care and its educational potential for student pharmacists. CONCLUSIONS AND IMPLICATIONS: This reflection is a testament that such initiatives have valuable benefits not only for students but also for health systems, clinics, and the broader community. In the future, the authors hope to see more students collaborating with experienced preceptors to design ambulatory practice protocols and services across various fields of expertise.

Building an effective medicines optimisation model: a health system approach.

This commentary narrates on the building of an effective and innovative medicines optimisation model. It discusses the essential features, emphasizes the need, and considers the strong health and pharmacy system as a prerequisite before such a model could be built. The paper argues that it is important to strengthen the health system before the elements of pharmaceutical care and medicine optimisation can take shape. It discusses the discourse and interplay between medicine use and medicine access research. The other important elements to include are the "selection of medicines by health technology assessment", "economic evaluation of pharmacy services", "pharmacists' remuneration by the government", "Health system strengthening status", "quality use of generic medicines programmes", "rationale prescribing", "access to medicines and medicines pricing", "medicines advertising" and the "state of pharmacy practice and the development of the pharmacist's role". A set of different high-, middle- and low-income countries are used to provide examples of the status of the health system and the subsequent development of pharmacy practice and medicines optimisation. The countries include the UK, Australia, New Zealand, Pakistan, Türkiye, Malaysia, India, and Pakistan.