Impact of guideline awareness in public pharmacies on counseling of patients with acute or chronic constipation in a survey of pharmacy personnel.

BACKGROUND: Constipation is often self-managed by patients and guidelines are available to aid healthcare professionals in the counseling of patients for self-management. Therefore, we have explored the knowledge and attitude of pharmacy personnel towards guidelines for the management of acute and functional chronic constipation and how they affects their recommendations. METHODS: An online survey was conducted among 201 pharmacists and pharmacy technicians from an existing panel. They were presented with two typical cases, a 62-year old woman with functional chronic constipation and a 42-year old woman with travel plans. For each case, they were asked about their treatment recommendations and the underlying rationale. Thereafter, they were provided with contents from an applicable national guideline and asked again about their recommendations and the underlying rationale. In line with the exploratory nature, data were analyzed in a descriptive manner only. RESULTS: Before exposure to guideline content, the most frequent recommendations for chronic constipation were macrogol, fiber and lactulose and for acute constipation sodium picosulfate, bisacodyl and enemas. Following guideline exposure, the most frequent recommendations for chronic constipation were macrogol, bisacodyl and sodium picosulfate and for acute constipation bisacodyl, sodium picosulfate and macrogol (all three equally recommended by the guideline for the management of acute and chronic constipation). Correspondingly, the rationale behind the recommendations shifted with guideline conformity becoming a leading reason. CONCLUSIONS: Awareness of the content of an applicable guideline on the management of constipation was poor among pharmacy personnel. Accordingly, recommendations in many cases were not in line with the guideline. Greater awareness of guideline content is desirable to enable more evidence-based recommendations in the management of constipation.

Differences in knowledge about epilepsy and antiepileptic drugs among pharmacy-dispensing workers in Cambodia and in Lao PDR.

Epilepsy is the most common neurological disorder encountered in primary care in Southeast Asia. People with epilepsy require long-term therapy management. Nonadherence to antiepileptic drugs (AEDs) has been identified as a major factor in suboptimal control of epilepsy. Pharmacies offer patients a first-line point of contact with the healthcare system. Many pharmacies operate with limited or nonqualified human resources that can lead to insufficient knowledge, inappropriate supply of medicines, and insufficient counseling. OBJECTIVE: The aim of this study was to evaluate the qualification and knowledge concerning epilepsy and AEDs among pharmacy-dispensing workers who sell drugs to people with epilepsy. METHOD: A cross-sectional qualitative study was conducted in public and private pharmacies, in both urban and rural areas of Cambodia and Lao People's Democratic Republic (Lao PDR). The knowledge was collected through a questionnaire. RESULTS: A total of 180 respondents from 123 outlets in the two countries were included in this study. A proportion of 40.8% (31) of respondents in Cambodia and 38.5% (40) in Lao PDR were pharmacists, followed by sellers who did not received any healthcare training with a proportion of 18.4% (14) in Cambodia compared to 20.2% (21) in Lao PDR. Head trauma was cited as the main cause of epilepsy by 72.4% (55) in Cambodia and 27.2% (28) in Lao PDR (p < 0.001). Epilepsy was considered as a contagious disease by 6.6% (5) of respondents in Cambodia compared to 18.4% (19) in Lao PDR (p = 0.03). Eighty-seven percent (66) of respondents in Cambodia knew at least one long-term AED versus 67.3% (70) in Lao PDR (p = 0.003). Phenobarbital was mentioned in more than 90.0% of cases in both countries. In overall, 15.4% (21) thought that if seizures are controlled for some months, people with epilepsy could stop taking their AEDs. Only one respondent from Lao PDR was aware of drug-drug interaction between AEDs and oral contraception. CONCLUSION: An educational intervention should be implemented to improve the knowledge of epilepsy and AEDs for pharmacy-dispensing workers. This could include advice for all pharmacy-dispensing workers in order to improve AED management and follow-up of therapeutic adherence.

Supervising pharmacists' opinions about pharmacy technicians as immunizers.

OBJECTIVES: To determine the opinions of pharmacists who supervise immunizing pharmacy technicians regarding initial trust of immunizing technicians, perceived quality of the training program, need for additional on-the-job training, frequency of technician utilization, and recommendations for other pharmacists who are considering implementation of an immunizing technician. SETTING: Albertsons pharmacies located in the state of Idaho in May 2017. PRACTICE DESCRIPTION AND INNOVATION: Qualitative descriptive study of semistructured key informant interviews with Idaho pharmacists who currently supervise a pharmacy technician trained to administer immunizations. EVALUATION: Informant interviews were recorded, transcribed, and coded to evaluate key themes. RESULTS: Nineteen individual pharmacist interviews were conducted at different Albertsons pharmacy locations in the state of Idaho. Pharmacists in this study felt that their immunizing technicians were properly trained to administer immunizations, capable of giving immunizations, and empowered by their new role within the pharmacy. Participants expressed challenges with initial comfort in allowing a technician to immunize, support of this new advanced technician role, and additional on-the-job training for individual technicians. Findings also included a pharmacist-perceived increase in vaccination rates and recommendation for other technicians to be trained to administer immunizations. CONCLUSION: Community pharmacists who supervise pharmacy technicians trained to administer immunizations were receptive to this new advanced technician role. Pharmacists' opinions revealed that working with newly trained immunizing pharmacy technicians has not only positively affected the morale of their team, but can help to increase the number of vaccinations given by the pharmacy. Understanding pharmacist perceptions about technicians as immunizers may lead to regulation changes and adoption of this advanced technician role.

Evaluation of community pharmacy tech-check-tech as a strategy for practice advancement.

OBJECTIVE: The purpose of this study was to design, pilot, and evaluate a community "tech-check-tech" (TCT) program as a strategy for pharmacy practice advancement. SETTING: Community pharmacy with both mail order and outpatient pharmacy services. PRACTICE DESCRIPTION: The policies, technician training requirements, prescription eligibility requirements, and quality assurance measures necessary for the pilot were developed. The TCT workflows and procedures were integrated into the existing prescription dispensing framework at a pilot site. An analysis of pharmacist and technician checking accuracy was conducted with a 4-week data collection period for each role. To determine TCT technician accuracy, the TCT technician performed the first product verification check after the prescription was filled by a pharmacy staff member. If the TCT technician found an error, they documented the error and returned the prescription to the filling technician for correction. If the prescription was filled correctly, the TCT technician passed the prescription to a pharmacist for final verification. The pharmacist documented any incorrect prescriptions that the TCT technician verified. Pharmacist accuracy was measured through direct pharmacist observation. Direct observation was also used to measure and record pharmacist and technician prescription checking time. The data were then used to evaluate pharmacist time savings as a result of community TCT, while ensuring prescription dispensing accuracy. PRACTICE INNOVATION: TCT was piloted in a community pharmacy. EVALUATION: An analysis of pharmacist and technician checking accuracy was conducted with a 4-week data collection period for each role. To determine TCT technician accuracy, the TCT technician performed the first product verification check after the prescription was filled by pharmacy staff. If the TCT technician found an error, they documented the error and returned the prescription to the filling technician for correction. If filled correctly, the TCT technician passed the prescription to a pharmacist for final verification. The pharmacist documented any incorrect prescriptions that the TCT technician verified. Pharmacist accuracy was measured through direct pharmacist observation. Direct observation was also used to measure and record pharmacist and technician prescription checking time. This data was then used to evaluate pharmacist time savings as a result of community TCT, while ensuring prescription dispensing accuracy. RESULTS: A TCT workflow was piloted successfully in the community pharmacy setting. Technicians were at least as accurate as pharmacists, as validated with statistical analysis (99.95% [95% CI 99.89%-99.99%] versus 99.74% [95% CI 99.61%-99.87%]), and patient safety was maintained. Time studies allowed for the quantification of potential pharmacist time savings (23 days per year) resulting from the implementation of a community TCT program. CONCLUSION: This study demonstrates the feasibility of a TCT program in the community pharmacy setting.

SIMMEON-Prep study: SIMulation of Medication Errors in ONcology: prevention of antineoplastic preparation errors.

WHAT IS KNOWN AND OBJECTIVE: Medication errors (ME) in oncology are known to cause serious iatrogenic complications. However, MEs still occur at each step in the anticancer chemotherapy process, particularly when injections are prepared in the hospital pharmacy. This study assessed whether a ME simulation program would help prevent ME-associated iatrogenic complications. METHODS: The 5-month prospective study, consisting of three phases, was undertaken in the centralized pharmaceutical unit of a university hospital of Lyon, France. During the first simulation phase, 25 instruction sheets each containing one simulated error were inserted among various instruction sheets issued to blinded technicians. The second phase consisted of activity aimed at raising pharmacy technicians' awareness of risk of medication errors associated with antineoplastic drugs. The third phase consisted of re-enacting the error simulation process 3 months after the awareness campaign. The rate and severity of undetected medication errors were measured during the two simulation (first and third) phases. The potential seriousness of the ME was assessed using the NCC MERP(®) index. RESULTS AND DISCUSSION: The rate of undetected medication errors decreased from 12 in the first simulation phase (48%) to five in the second simulation phase (20%, P = 0.04). The number of potential deaths due to administration of a faulty preparation decreased from three to zero. Awareness of iatrogenic risk through error simulation allowed pharmacy technicians to improve their ability to identify errors. WHAT IS NEW AND CONCLUSION: This study is the first demonstration of the successful application of a simulation-based learning tool for reducing errors in the preparation of injectable anticancer drugs. Such a program should form part of the continuous quality improvement of risk management strategies for cancer patients.

Pharmacy technician-to-pharmacist ratios: a state-driven safety and quality decision.

OBJECTIVE: To discuss the policy of pharmacy technician-to-pharmacist ratios by comparing Florida as an example of legislative-led authority versus Tennessee as an example of board of pharmacy-led ruling. SUMMARY: Over the past 2 years, the Florida legislature has debated the issue of pharmacy staffing ratios, initially leaving the Florida Board of Pharmacy with little authority to advocate for and enact safe technician staffing ratios. Anticipating this situation, the Tennessee Board of Pharmacy created rules to meet pharmacy staffing needs while protecting the authority of the pharmacist-in-charge and promoting patient safety. Before enacting rules, members of the board toured the state and talked about proposed rule changes with pharmacists. The final rule sets the pharmacy technician-to-pharmacist ratio at 2:1 but permits a 4:1 ratio based on public safety considerations and availability of at least two Certified Pharmacy Technicians. CONCLUSION: Pharmacists and leaders within the profession should conduct further research on appropriate and safe ratios of pharmacy technicians to pharmacists, with a focus on safety and quality of care.

Migraine management in community pharmacies: practice patterns and knowledge of pharmacy personnel in Thailand.

OBJECTIVES: To describe practice behavior and understanding among pharmacy personnel, both pharmacists and non-pharmacist staff, in the management of mild and moderate migraines. BACKGROUND: Migraine is recognized as a prevalent and chronic neurological disorder. In developing countries, such as Thailand, community pharmacies are a widely used source of health care for various illnesses including migraine. However, the quality of migraine management and knowledge among pharmacy personnel is unclear. METHODS: Cross-sectional study. The sample comprised 142 randomly selected community pharmacies in a city in the south of Thailand. Simulated clients visited the pharmacies twice, at least 1 month apart, to ask for the treatment of mild and moderate migraines. After the encounters, question asking, drug dispensing, and advice giving by pharmacy staff were recorded. Subsequently, the providers in 135 pharmacies participated in the interview to evaluate their knowledge in migraine management. RESULTS: The majority of pharmacy personnel were less likely to ask questions in cases of mild migraine when compared with moderate attack (mean score [full score = 12] 1.8 ± 1.6 vs 2.6 ± 1.5, respectively, P < 0.001). Mean difference of question asking between mild and moderate migraines was -0.8 (95% confidence interval -1.1 to -0.5, P < 0.001). Approximately 33% and 54% of the providers appropriately dispensed non-steroidal anti-inflammatory drugs for mild attack and ergotamine for moderate migraine, respectively, P < 0.001. Prophylactic medications (eg, atenolol, propranolol, flunarizine) were inappropriately recommended, particularly in moderate attack (28.2% vs 17.6% in mild migraine, P = 0.018). Less than 30% of providers advised the patients on the maximum limit of dose or discontinuity of medications when recovered. Compared with non-pharmacists, pharmacists tended to ask more questions, give more advice, and dispense less appropriately; however, there were no significant differences. The results from the interview showed that most pharmacy personnel had inadequate knowledge on migraine management. Pharmacists had better knowledge on question asking (mild migraine 5.1 ± 2.1 vs 3.1 ± 1.3, respectively, P < .001; moderate disorder 6.5 ± 3.1 vs 3.9 ± 2.1, respectively, P < .001) and tended to have more knowledge on advice giving but poorer drug dispensing in moderate migraine according to the guidelines, relative to non-pharmacists (20.5% vs 40.3%, P = .014). CONCLUSIONS: A large number of community pharmacists and non-pharmacist staff had inappropriate practice behavior and understanding. Continuing education and interventions are important to improve the practice and knowledge of pharmacy personnel, particularly the pharmacists.

The role of the pharmacy technician in the skill-mixed district nursing team.

Registered nurses in the district nursing service delegate a broad range of medication administration activities to healthcare assistants. Although healthcare assistants have provided extra capacity, not all activities are suitable for delegation to unregulated practitioners. At the same time, their competency assessment is often patient-specific and demands significant registered nursing input. The purpose of this 6-month pilot programme was to test the premise that the employment of a pharmacy technician in the district nursing service would enhance productivity levels and deliver cost savings. Activities delegated included the administration of oral tablets and subcutaneous insulin and low molecular weight heparin injections. The evaluation found that the introduction of the pharmacy technician was associated with neither enhanced productivity nor more than modest cost savings. However, role redesign is a long-term activity and their role could be built on with further competency analysis.

Implementation of patient education at first and second dispensing of statins in Dutch community pharmacies: the sequel of a cluster randomized trial.

BACKGROUND: As a result of the previous part of this trial, many patients with cardiovascular disease were expected to receive a statin for the first time. In order to provide these patients with comprehensive information on statins, as recommended by professional guidance, education at first and second dispensing of statins had to be implemented. This study was designed to assess the effectiveness of an intensive implementation program targeted at pharmacy project assistants on the frequency of providing education at first dispensing (EAFD) and education at second dispensing (EASD) of statins in community pharmacies. METHODS: The participating community pharmacies were clustered on the basis of local collaboration, were numbered by a research assistant and subsequently an independent statistician performed a block randomization, in which the cluster size (number of pharmacies in each cluster) was balanced. The pharmacies in the control group received a written manual on the implementation of EAFD and EASD; the pharmacies in the intervention group received intensive support for the implementation. The impact of the intensive implementation program on the implementation process and on the primary outcomes was examined in a random coefficient logistic regression model, which took into account that patients were grouped within pharmacy clusters. RESULTS: Of the 37 pharmacies in the intervention group, 17 pharmacies (50%) provided EAFD and 12 pharmacies (35.3%) provided EASD compared to 14 pharmacies (45.2%, P = 0.715) and 12 pharmacies (38.7%, P = 0.899), respectively, of the 34 pharmacies in the control group. In the intervention group a total of 72 of 469 new statin users (15.4%) received education and 49 of 393 patients with a second statin prescription (12.5%) compared to 78 of 402 new users (19.4%, P = 0.944) and 35 of 342 patients with a second prescription (10.2%, P = 0.579) in the control group. CONCLUSION: The intensive implementation program did not increase the frequency of providing EAFD and EASD of statins in community pharmacies. TRIAL REGISTRATION: clinicaltrials.gov NCT00509717.

Do remote community telepharmacies have higher medication error rates than traditional community pharmacies? Evidence from the North Dakota Telepharmacy Project.

OBJECTIVE: To evaluate the differences in medication dispensing errors between remote telepharmacy sites (pharmacist not physically present) and standard community pharmacy sites (pharmacist physically present and no telepharmacy technology; comparison group). DESIGN: Pilot, cross-sectional, comparison study. SETTING: North Dakota from January 2005 to September 2008. PARTICIPANTS: Pharmacy staff at 14 remote telepharmacy sites and 8 comparison community pharmacies. INTERVENTION: The Pharmacy Quality Commitment (PQC) reporting system was incorporated into the North Dakota Telepharmacy Project. A session was conducted to train pharmacists and technicians on use of the PQC system. A quality-related event (QRE) was defined as either a near miss (i.e., mistake caught before reaching patient; pharmacy discovery), or an error (i.e., mistake discovered after patient received medication; patient discovery). MAIN OUTCOME MEASURE: QREs for prescriptions. RESULTS: During a 45-month period, the remote telepharmacy group reported 47,078 prescriptions and 631 QREs compared with 123,346 prescriptions and 1,002 QREs in the standard pharmacy group. Results for near misses (pharmacy discovery) and errors (patient discovery) for the remote and comparison sites were 553 and 887 and 78 and 125, respectively. Percentage of "where the mistake was caught" (i.e., pharmacist check) for the remote and comparison sites were 58% and 69%, respectively. CONCLUSION: This study reported a lower overall rate (1.0%) and a slight difference in medication dispensing error rates between remote telepharmacy sites (1.3%) and comparison sites (0.8%). Both rates are comparable with nationally reported levels (1.7% error rate for 50 pharmacies).

Scope of contemporary pharmacy practice: roles, responsibilities, and functions of pharmacists and pharmacy technicians.

OBJECTIVE: To provide an overview of the current context and scope of pharmacy practice, the range of professional services offered by pharmacists, and the supporting role of pharmacy technicians. DATA SYNTHESIS: A synopsis of the current state of pharmacy practice as it relates to the spectrum of professional roles and responsibilities, the diversity of patient populations served, the complexities of patient services provided, and various aspects of emerging pharmacy practice is provided. The current work focuses on patient care services provided by pharmacists; it does not address all possible activities of pharmacists, such as administration and general management. This is a descriptive analysis. It does not take a position regarding future changes but is intended to serve as a foundation for understanding the relationship and alignment between the profession's various mandatory and voluntary credentials and the scope of practice continuum. The key educational and credentialing standards for pharmacists and pharmacy technicians are summarized and referenced. CONCLUSION: The evolutions in health care and pharmacy practice are presenting many new opportunities for pharmacists to perform functions and provide services not considered as traditional roles. The profession of pharmacy is working to achieve a pervasive model and standard of care determined only by the needs of patients and populations. The Council on Credentialing in Pharmacy hopes that the material presented herein, including the framework for credentialing in pharmacy practice, will allow audiences to gain a better understanding of where pharmacy is today and what future pharmacy practice will look like.

Work Preferences and General Abilities Among US Pharmacy Technicians and Danish Pharmaconomists.

INTRODUCTION: The importance of pharmacy support personnel is increasingly recognized. Studies have evaluated workplace issues and evolving roles; however, needed information from technicians themselves is scarce. The purpose of this study was to examine preferences for work activities and the general abilities of US pharmacy technicians and Danish pharmaconomists. METHODS: Surveys were administered to random samples of US technicians in 8 states and the general population of Danish pharmaconomists. Respondents indicated their preference for involvement in a set of work activities in community or hospital pharmacy on numeric scales. They also self-assessed their level of ability on facets associated with professional practice, in general. Descriptive results were tabulated, and bivariate tests were conducted on total general abilities ratings. RESULTS: The 494 technicians and 313 pharmaconomists provided similar ratings on many activities. In community pharmacy, US technician ratings for performance of activities were generally higher than those of pharmaconomists; however, pharmaconomists rated certain "higher order" communication activities quite highly, such as discussing lifestyle changes with the patient. In hospital practice, Danish pharmaconomists provided low preferences for medication handling but high preferences for communication activities. General ability ratings were given high self-evaluations, but lower on some components, such as keeping up with the profession. Employer commitment was a strong correlate for both. CONCLUSIONS: Evaluation of preferred work activities and general abilities were likely reflected in different scopes of practice between the two and could be insightful for education and work redesign in both countries, particularly the United States, as leaders evaluate shifts in technician professionalization.

Pharmacists ascribing value of technician certification using an organizational behavior framework.

PURPOSE: To gather rich details about the value of technician certification from diverse groups of pharmacists of various practice settings and levels of experience. METHODS: Focus groups of pharmacists were conducted using a semistructured interview guide in 4 states (California, Idaho, Tennessee, and Washington) varying in pharmacy technician scope of practice, regulation, and education and/or training environment. Participant pharmacists came from health-system, clinic, and community pharmacy environments. The focus groups took the unique approach of an organizational behavior perspective to contextualize technician readiness for practice change and employer fit. The sessions were audio-recorded and transcribed verbatim. Rapid-based qualitative analysis was used to code the data, with summary templates completed by 2 of the researchers for each of the 4 sessions. RESULTS: There were a total of 33 focus group participants, including 13 male and 20 female pharmacists ranging in age from 27 to 68 years. The 4 major themes yielded by the data were (1) impact of certification, (2) context of certification, (3) organizational culture considerations, and (4) future credentialing. Certification was deemed to have a greater impact on technician maturation, professional socialization, and career commitment than on actual job skills, even while job knowledge was also deemed to be enhanced. In fact, the certification process was also deemed beneficial in that it meshes with on-the-job training. Participants indicated preferences for technician certification examinations to incorporate more content in "soft skills" and also for development of more specialty and/or differentiated certification products. CONCLUSION: Pharmacists from 4 states saw value in certification but agreed that certification is but one component of readying technicians for future practice. Suggestions for furthering the value of certification were shared.

Development and validation of an instrument to measure the professional's knowledge of dispensing medication (CDM-51) in community pharmacies.

Medication dispensing performed without the necessary information on proper use can result in harmful effects to the individual, and therefore providing this service with quality for the users is necessary to promote the rational use of medication; however, in a developing country this activity is performed largely by unqualified people and in an inappropriate way. This study aims to develop and validate a study instrument that measures the knowledge of medication dispensing for the professionals involved in this practice (pharmacist, pharmacy technician in the pharmacy, and clerk/assistant). The study has methodological design and is characterized by the development and validation of an instrument to measure the knowledge of dispensation. A questionnaire denominated CDM-51 was elaborated and divided in two parts: the first collects the socio-demographic characteristics of the participants, and the second has 51 questions to assess the knowledge construct regarding dispensation. The validity of content was realized through the evaluation by seven experts regarding the relevance and clarity of the items. A pretest and main validation study with 30 and 79 pharmacy professionals respectively, from the city of Ribeirão Preto in the Brazilian state of São Paulo were carried out, and questions presented to the respondents were corrected. The analysis of the internal consistency of the KR-20 (Kuder-Richardson) was 0.837, and validity construct evidence was found (p value: 0.001) that participants with formal education have greater knowledge of medication dispensing. This work contributes to increasing the quality of services provided by dispensing pharmacies and points out the importance of training for formal education to perform this service, thus promoting the rational use of medication.

Development of a sterile compounding training and competency program at a large academic medical center.

PURPOSE: This article is one of the 5 articles describing steps taken to enhance sterile compounding compliance at a large, multisite academic medical center. This article focuses on the development of a comprehensive personnel training and assessment program for sterile compounding. SUMMARY: Increased regulatory oversight and the release of new United States Pharmacopeia chapters motivated the reenvisioning of the medical center's sterile compounding personnel training and assessment program. The main challenges facing any entity undertaking sterile compounding include identification of compounding staff, development of policies and procedures, and baseline and ongoing training including observational competency assessments and record keeping. These challenges are exacerbated by high work volumes and variation in compounding practices encountered within a large multisite institution. Our organization developed a team of specialized pharmacists and pharmacy technicians to implement and enforce changes promoting the safe production and use of compounded sterile products and meet rising regulatory requirements. This team worked within various operational areas to customize purchased policies and procedures and group compounding staff based on training needs. The team performs ongoing personnel monitoring and training of new compounders in a shared training space. Challenges encountered and future considerations for program enhancement are described. CONCLUSION: Implementation of standards and enforcement of staff behaviors in a large academic medical center is perhaps best completed by a team of highly trained experts working in collaboration with supervisors and using a dedicated training and testing space, as evidenced by the success of the described program in overecoming past challenges.

Exploring an extended role for pharmacy assistants on inpatient wards in UK hospitals: using mixed methods to develop the role of medicines assistants.

Objectives: This project explored the deployment of pharmacy assistants to inpatient wards in a new role as 'medicines assistants' (MA). Methods: Ward-based MAs were introduced to six wards across two UK hospitals to support medicines administration. Each 30-bed ward delivered acute inpatient services with MAs supporting typical nursing medication administration rounds to 15 patients. Data were collected using activity diaries, observations, clinical audit and semistructured interviews with pharmacy assistants, pharmacy technicians, clinical pharmacists, nurses, ward managers and pharmacy managers. Thematic analysis, descriptive statistics and the Mann-Whitney U test were used to analyse qualitative and quantitative data, respectively. Results: MAs were able to act as a point of contact between the ward and the pharmacy department and were perceived to save nursing time. A statistically significant reduction in the length of time to complete morning medication administration to 15 patients was observed (mean 74.5 vs 60.8 min per round, p<0.05). On average, 17.4 hours of medicines-related activity per ward per week was carried out by MAs rather than by nursing staff. Participants identified broader training and clarity was needed in relation to the accountability and governance of patient-facing roles. Conclusion: Pharmacy assistants deployed as MAs can contribute to saving nursing time and bridge the gap between nursing and pharmacy professionals.

Relationship between regulatory barriers to entry and pharmacy technician wages.

BACKGROUND: Pharmacy technicians are vital to the operation of pharmacies, and national pharmacy associations have advocated for mandatory education and training requirements. While these requirements may improve patient safety, there is a risk that laws and regulations which impose substantial education and training requirements on technicians could create barriers to entry which restrict the workforce and increase wages. OBJECTIVE: This study has two objectives: 1) Describe changes in barriers to entry and wages over time; and 2) Evaluate the correlation between changing barriers to entry and pharmacy technician wages. METHODS: Data come from Bureau of Labor Statistics Occupational Employment Statistics from 1997 to 2017 and National Association of Boards of Pharmacy Surveys of Pharmacy Law from 1997 to 2014. A barrier to entry was defined as adoption of registration, licensure, or certification. Wage data was adjusted to 2017 dollars using the Consumer Price Index. Ordinary least squares regression evaluated the correlation between the proportion of states which had at least one barrier to entry and wages. An interrupted time series model estimated the impact of adopting a barrier to entry on the trend in technician wages over time. RESULTS: Technician wages increased between 1997 and 2007 but remained flat between 2008 and 2017. A strong correlation was observed between the proportion of states which had at least one barrier to entry and technician wages (R2 = 0.93, p < 0.0001). However, the interrupted time series models did not identify any relationship between adoption of a barrier to entry and the trend in technician wages (p = 0.363). CONCLUSIONS: This research suggests adoption of legal/regulatory barriers to entry did not have a significant influence on the trend in technician wages over time. More research is needed to evaluate the impact of barriers to entry on non-wage practice variables, such as privileges and satisfaction.

The impact of a Calderdale Framework designed advanced pharmacy assistant role on inpatient pharmacy services.

Background Pharmacists in Australian hospitals do not see all inpatients. Effectively utilising pharmacy assistants in non-traditional roles may provide an opportunity to increase the number of patients seen by pharmacists. Objective To implement a Calderdale Framework designed advanced pharmacy assistant role on an inpatient unit and evaluate the impact of the role on the provision of clinical pharmacy services provided by the pharmacist in an Australian University hospital. Setting The study was conducted in a single 24-bed medical IPU at a tertiary hospital in Queensland, Australia. Method A quasi-experimental two-cohort comparison design, completed over three phases from 30/5/2016 to 30/9/2016 was employed. To evaluate the impact of the advanced pharmacy assistant on an inpatient unit an 8-week period of usual care was compared to the same time period on the same unit where the pharmacist provided usual care with the support of an advanced assistant. Pharmacist and assistant satisfaction was also surveyed. A training and lead-in phase was completed to ensure the advanced pharmay assistant was competent in completing the delegated tasks. Main outcome measure The primary outcome was percentage change of medication management plans documented by the pharmacist with an advanced assistant comparative to the pharmacist without. Results The number of documented medication management plans significantly increased by 9.5% (p = 0.019; CI 1.86-17.14). Plans documented within 24 h and time to documentation remained unchanged. Completeness increased in community pharmacy documentation. The percentage of completed discharge medication records rose by 15.6%, (p < 0.001; CI 7.78-23.16). Interventions documented increased by 55 and the percentage of patients with clinical reviews documented increased by 35%. There were fewer missed doses recorded and pharmacists spent more time on clinically based tasks. Pharmacist and assistant satisfaction also improved. Conclusion The use of the Calderdale Framework enabled structured pharmacy assistant role redesign that impacted significantly on the provision of clinical pharmacy services on an inpatient unit.