Prescriber and pharmacist attitudes toward inclusion of diagnosis or clinical indication on prescription orders.

BACKGROUND: Pharmacy and medication safety organizations have long recommended that diagnosis or clinical indication be required on medication orders to improve the safety and effectiveness of care. OBJECTIVE: To assess attitudes of Arizona prescribers and pharmacists toward the inclusion of the clinical indication or the diagnosis on prescription orders and perceived barriers to its implementation in Arizona. METHODS: Data were obtained by questionnaires from pharmacists and primary care prescribers after a continuing pharmacy education presentation on the value of including a clinical indication or a diagnosis on prescription orders. The survey was distributed to licensed pharmacists who attended the Arizona Pharmacy Association's Southwest Clinical Pharmacy Seminar. The survey was distributed to primary care providers with active Arizona licenses who attended the Arizona Osteopathic Medical Association Annual Convention and to nurse practitioners after an Arizona Nurse Practitioner Council educational webinar. Prescriber and pharmacist responses were compared using the Mann-Whitney U test. An a priori alpha of 0.05 was used, and in the cases of multiple comparisons, a Bonferroni correction was employed. RESULTS: A total of 74 complete questionnaires were submitted by prescribers and 54 by pharmacists. Approximately 71% of the prescribers and 66% of the pharmacists agreed that they would support voluntary inclusion of a diagnosis or a clinical indication on prescription orders (P = 0.81). However, the 2 groups disagreed on whether the inclusion of the diagnosis or clinical indication should be a requirement (44% of prescribers agreed vs. 96% of pharmacists, P < 0.001). Two perceived barriers revealed statistically significant differences, with the prescribers being more concerned about possible insurance rejections than pharmacists (P = 0.005, whereas the pharmacists were more concerned about potential software transmission accuracy than prescribers (P < 0.001). CONCLUSION: Arizona prescribers and pharmacists in our convenience sample supported the voluntary inclusion of a diagnosis or a clinical indication on prescriptions orders but disagreed as to whether it should be required. Prescribers especially indicated they have a variety of concerns that need to be overcome before they could support a statewide mandate.

10 ways to improve medication safety in community pharmacies.

DATA SOURCES: Not applicable. SUMMARY: Since at least the time of Hippocrates, health care providers have recognized their responsibility to protect patients from potential harm resulting from the care they provide. In pharmacy, such harm typically results from a violation of any of the "5 rights" of safe medication use. However, a memorable adage stops short of providing operational guidance to improve medication safety. Specific actionable recommendations are needed to identify changes that, if implemented, would significantly improve the safety of medication delivery and use. CONCLUSION: Most threats to medication safety result from weaknesses or failures in one or more of the key system elements identified by the Institute for Safe Medication Practices. Pharmacists should be advocates for implementing targeted recommendations to strengthen their practice systems and improve medication safety.

Apocalypse Now?

Despite the wishful thinking of those who have long prophesied an imminent surge in demand for clinical pharmacists, the tipping point for healthy supply-demand balance in pharmacy has almost certainly been surpassed. Imprudent overbuilding of pharmacy programs has combined with trends toward increasing automation and consolidation in pharmacy practice to create an existential threat in pharmacy education. Surviving the looming industry shakeout will require schools and colleges of pharmacy to do what our colleagues in practice and the private sector have always done: compete.

Searching for Affective and Cognitive Restoration: Examining the Restorative Effects of Casual Video Game Play.

OBJECTIVE: We investigated the effects of a passive break, relaxation activity, and casual video game on affect, stress, engagement, and cognitive performance. BACKGROUND: Reducing stress and improving cognitive performance is critical across many domains. Previous studies investigated taking a break, relaxation techniques, or playing a game; however, these methods have not been compared within a single experiment. METHOD: Participants completed a baseline affective and cognitive assessment (ACA), which included the Positive and Negative Affect Schedule, shortened version of the Dundee Stress State Questionnaire, and backward digit-span. Next, participants completed a vigilance task, followed by another ACA. Participants were then assigned at random to complete a break or relaxation activity or play a casual video game, followed by a final ACA. RESULTS: Participants who played the casual video game exhibited greater engagement and affective restoration than the relaxation condition. The break condition slightly decreased affect and prevented cognitive restoration. CONCLUSION: Playing a casual video game even briefly can restore individuals' affective abilities, making it a suitable activity to restore mood in response to stress. However, future research is needed to find activities capable of cognitive restoration. APPLICATION: Many activities in life require sustained cognitive demand, which are stressful and decrease performance, especially for workers in performance-critical domains. Our research suggests some leisure activities are better than others for restoring fatigued affective processes.

Intelligent Agent Transparency in Human-Agent Teaming for Multi-UxV Management.

OBJECTIVE: We investigated the effects of level of agent transparency on operator performance, trust, and workload in a context of human-agent teaming for multirobot management. BACKGROUND: Participants played the role of a heterogeneous unmanned vehicle (UxV) operator and were instructed to complete various missions by giving orders to UxVs through a computer interface. An intelligent agent (IA) assisted the participant by recommending two plans-a top recommendation and a secondary recommendation-for every mission. METHOD: A within-subjects design with three levels of agent transparency was employed in the present experiment. There were eight missions in each of three experimental blocks, grouped by level of transparency. During each experimental block, the IA was incorrect three out of eight times due to external information (e.g., commander's intent and intelligence). Operator performance, trust, workload, and usability data were collected. RESULTS: Results indicate that operator performance, trust, and perceived usability increased as a function of transparency level. Subjective and objective workload data indicate that participants' workload did not increase as a function of transparency. Furthermore, response time did not increase as a function of transparency. CONCLUSION: Unlike previous research, which showed that increased transparency resulted in increased performance and trust calibration at the cost of greater workload and longer response time, our results support the benefits of transparency for performance effectiveness without additional costs. APPLICATION: The current results will facilitate the implementation of IAs in military settings and will provide useful data to the design of heterogeneous UxV teams.

Check it out: A practical tool for improving medication safety.

OBJECTIVE: To recommend incorporation of a prospective drug utilization review (DUR) checklist into the routine processing of prescription orders in the community practice setting to improve the quality and safety of pharmaceutical care. PRACTICE INNOVATION: We proposed a checklist that was designed to include all the elements of a prospective DUR required by the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) and most pharmacy practice acts. CONCLUSION: If properly incorporated into workflow and supported by company policies and procedures, a simple DUR checklist like that proposed in this study could significantly improve the quality of pharmacists' prospective DUR activities and the safety of medication therapy provided to patients. We also recommend that future quality metrics be created and implemented to ensure that pharmacists consistently perform this key professional responsibility.

Evaluating input device usability as a function of task difficulty in a tracking task.

Game controllers are emerging as a preferred choice for the manual control of unmanned vehicles, but an understanding of their usability characteristics has yet to emerge. We compared the usability of an Xbox 360 game controller in a dual task situation using MATB II to the traditional joystick and keyboard interface in two experiments. In the first experiment, performance with the game controller was associated with fewer tracking errors. In a second experiment, we trained users on the devices, and found that even after training the game controller was still associated with fewer tracking errors as well as higher usability and lower workload ratings. These results are consistent with the idea that game controllers are highly usable input devices and do not require high mental workload to operate, thus making them suitable for complex control tasks.

Stakeholder views on requiring diagnosis or clinical indication on e-prescriptions.

BACKGROUND: Medication safety organizations have been recommending the inclusion of diagnosis or clinical indication on prescription orders for decades. However, this information is typically not provided by prescribers and shared with pharmacists, despite the availability of data fields in the most commonly used standard for electronic prescriptions. OBJECTIVE: To elucidate the views of selected industry stakeholders relative to perceived barriers to including diagnosis or indication on all electronic prescriptions. METHODS: Semistructured concept elicitation interviews identified key issues. Survey items were refined iteratively by the research team. The final instrument consisted of 34 questions intended to elicit the importance and relative priority of perceived barriers and potential solutions. A link to the Internet survey was emailed to members of the National Council for Prescription Drug Programs in February 2023, with biweekly follow-up reminders. RESULTS: A total of 139 surveys were analyzed for a response rate of 9.6%. On the importance of resolving issues related to the inclusion of diagnosis or indication on e-prescriptions, a majority of respondents indicated "extremely important" or "very important" for all items except one. On level of agreement with statements about how to implement such a requirement, a majority indicated "strongly agree" or "agree" for 10 of 17 items. CONCLUSIONS: Although clearly exploratory, the results of our survey suggest industry stakeholder agreement that uniform inclusion of diagnosis or clinical indication on all e-prescriptions would improve patient safety and health outcomes. A number of important questions and potential barriers must be resolved for implementation to be successful.

A Critical Look at Student Evaluations of Teaching.

Student evaluations of teaching are used at many schools and colleges of pharmacy as the primary, often exclusive, means of assessing the quality of instruction and instructor performance. As such, they can be pivotal in annual performance evaluations and rank and tenure decisions. However, serious concerns have been raised about these ubiquitous surveys and how, or even if, they should be used to measure the quality of instruction or the performance of the instructor. This commentary discusses concerns that have been raised about using student evaluations of teaching scores to assess teaching performance and offers recommendations for how they can be better interpreted and used in schools and colleges of pharmacy.

Analyzing the costs to deliver medication therapy management services.

OBJECTIVES: To provide pharmacy managers and consultant pharmacists with a step-by-step approach for analyzing of the costs of delivering medication therapy management (MTM) services and to describe use of a free online software application for determining costs of delivering MTM. PRACTICE DESCRIPTION: The process described is applicable to community pharmacies and consultant pharmacists who provide MTM services from nonpharmacy settings. PRACTICE INNOVATION: The PharmAccount Service Cost Calculator is an Internet- based software application that uses a guided online interview to collect information needed to conduct a comprehensive cost analysis of any specialized pharmacy service. In addition to direct variable and fixed costs, the software automatically allocates indirect and overhead costs to the service and generates an itemized report that details the components of service delivery costs. RESULTS: The service cost calculator is sufficiently flexible to support the analysis of virtually any specialized pharmacy service, irrespective of whether the service is being delivered from a physical pharmacy. The software application allows users to perform sensitivity analysis to quickly determine the potential impact that alternate scenarios would have on service delivery cost. It is therefore particularly well suited to assist in the design and planning of a new pharmacy service. CONCLUSION: Good management requires that the cost implications of service delivery decisions are known and considered. Analyzing the cost of an MTM service is an important step in developing a sustainable business model.

Indication or diagnosis should be required on prescriptions.

Although prospective drug utilization review and patient counseling have long been recognized as professional and ethical responsibilities of pharmacists, the implementation of the Omnibus Budget Reconciliation Act of 1990 made them legal responsibilities. Ensuring the safety and effectiveness of prescription pharmaceutical care requires that all members of the prescriber-patient-pharmacist triad are equally informed about the therapeutic plan for which the pharmacist is professionally, ethically, and legally responsible for properly implementing. Providing pharmacists with the clinical indication or diagnosis is an important and long overdue first step. DISCLOSURES: No funding was received for the writing of this article. Warholak has received grant funding through the University of Arizona from Sinfonia Rx, Pharmacy Quality Alliance, and the Arizona Department of Health Services, unrelated to this work. The other authors have nothing to disclose.

To Reform Pharmacy Reimbursement Begin with the Basics.

DISCLOSURES: No funding supported the writing of this commentary. The author has nothing to disclose.

Work Group Report: COVID-19: Unmasking Telemedicine.

Telemedicine adoption has rapidly accelerated since the onset of the COVID-19 pandemic. Telemedicine provides increased access to medical care and helps to mitigate risk by conserving personal protective equipment and providing for social/physical distancing to continue to treat patients with a variety of allergic and immunologic conditions. During this time, many allergy and immunology clinicians have needed to adopt telemedicine expeditiously in their practices while studying the complex and variable issues surrounding its regulation and reimbursement. Some concerns have been temporarily alleviated since March 2020 to aid with patient care in the setting of COVID-19. Other changes are ongoing at the time of this publication. Members of the Telemedicine Work Group in the American Academy of Allergy, Asthma & Immunology (AAAAI) completed a telemedicine literature review of online and Pub Med resources through May 9, 2020, to detail Pre-COVID-19 telemedicine knowledge and outline up-to-date telemedicine material. This work group report was developed to provide guidance to allergy/immunology clinicians as they navigate the swiftly evolving telemedicine landscape.

Analysis of community chain pharmacists' interventions on electronic prescriptions.

OBJECTIVE: To measure the incidence and nature of prescribing errors on electronic prescriptions (e-prescriptions) that required active intervention by dispensing pharmacists to correct. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: 122 chain community pharmacies that met a prior minimum dispensing volume of five e-prescriptions per day in five states during July through September 2006. PARTICIPANTS: Pharmacists in participating pharmacies. INTERVENTION: A panel of participating pharmacists reported their medication therapy interventions using a standardized documentation protocol. MAIN OUTCOME MEASURES: Number, type, and reason for pharmacist interventions on e-prescriptions. RESULTS: Data were reported from 68 participating chain pharmacies in five states during 312 work shifts. During the study pharmacists reviewed 2,690 e-prescription orders (new, 83.0%; refill, 17.0%) and took action 102 times for an intervention rate of 3.8%. The rate at which pharmacists identified problems on new e-prescriptions was found to be nearly twice that of refills (4.1% and 2.2%, respectively). The most common reason for pharmacists' interventions on e-prescriptions was to supplement omitted information (31.9%), especially missing directions. Dosing errors were also quite common (17.7%). The most common response by pharmacists to e-prescription problems was to contact the prescriber (64.1%), consult the patient's profile or medication history (12.8%), or interview the patient or the patient's representative (9.4%). In most cases (56%), the e-prescription order was changed and the prescription was ultimately dispensed. In 15% of cases the e-prescription was dispensed as written following clarification by the prescriber. In 10% of cases the prescription was not dispensed. An additional 12% of prescription issues remained unresolved. Pharmacists required an average of 6.07 minutes to conduct their interventions on problematic e-prescription orders, representing an incremental dispensing cost of $4.74. CONCLUSION: Electronic prescribing can improve the safety and effectiveness of patient care. As currently implemented in the community practice setting, this still-emerging technology maintains selected threats to both medication safety and effectiveness, although probably less than handwritten prescriptions. The adoption of selected best practice recommendations by prescribers could improve the safety, effectiveness, and efficiency of e-prescribing.

Assessing the Quality of Pharmacy Care: It's Not About Adherence.

DISCLOSURES: No funding supported the writing of this article. The author has nothing to disclose.

Encouraging Students to Challenge Assumptions.

Sound logical reasoning requires a critical examination of all available evidence and the willingness and ability to challenge key assumptions implicit in the conclusions we reach and the informed decisions we make. Student pharmacists should be encouraged to recognize and challenge assumptions that practicing pharmacists frequently make, which threaten patient safety.

Examining associations between action game play and motor control.

The effects of playing action video games have been investigated across a wide range of attentional and cognitive abilities. However, few studies have examined the association between motor control and action gaming experience. We report data from two discrete pointing tasks, manipulating the index of difficulty (ID) by movement distance and target size, respectively. Participants' gaming experience ranged from non-players to individuals who played several hours a night. Our results indicated greater experience playing action games, but not video games in general, was associated with shorter movement times (MT), higher velocities, and shallower ID-MT slopes when difficulty was manipulated across increasingly further distances and smaller target sizes. Additionally casual players, those who only play action games a couple times a week, were able to achieve a similar level of performance as more experienced players.