A Cross-Sectional Survey Study of Student Pharmacists' Career Interests.

Background: Career planning is important to student pharmacists and pharmacy schools due to slower job growth for pharmacists over the last decade. Understanding students' career interests can help colleges and schools of pharmacy develop targeted career planning, as well as meaningful curricular and co-curricular activities. Objectives: This study aims to describe the career path interests of two doctor of pharmacy cohorts in each professional year (P1 through P4) during the 2019-2020 and 2020-2021 academic years. Methods: This was a retrospective cross-sectional survey study conducted at an Accreditation Council for Pharmacy Education accredited college of pharmacy in the United States. Students were surveyed regarding their career interests in a mentorship program. Using frequencies and proportions we reported the pattern of students' career interests. Results: The top careers most frequently selected by students in the 2019-2020 cohort as their first choice were hospital (21.4% of P1s, 17.4% of P3s) and community (24.6% of P2s, 24.3% of P4s). Those career paths for the 2020-2021 cohort were hospital (21.4% of P1s), clinical specialty (19.2% of P2s, 21.9% of P4s), and community (22.9% of P3s). In both cohorts and all professional program years, students selected a broad range of first choice career interests and even broader range when indicating top 3 careers of interest. Conclusion: Overall, the most frequently selected career path interests were hospital, community, clinical specialty, and ambulatory care. However, there was broad variability in the career interests, accounting for a third to half of the students with interests different than the majority.

A Survey of Arizona Pharmacists to Identify Opportunities to Enhance Pharmacists' Competitiveness in a Tightening Labor Market.

BACKGROUND: The pharmacy profession has experienced dramatic shifts in scopes of practice, services offered, and employment opportunities over the last couple decades. At the same time, the number of students graduating from pharmacy school each year has steadily increased. The combined effect of these factors is a tightening labor market. Identification of potential knowledge and skill deficits in the applicant pool will create opportunity for pharmacists to tailor their personal development and educators to design content to address contemporary needs. OBJECTIVE: To determine if the current pharmacist pool meets employment needs in Arizona with respect to specific skills and knowledge. METHODS: In a cross-sectional survey design, Arizona licensed pharmacists were asked to provide their perspective of the knowledge and skills of candidates for pharmacist positions within 8 skill & knowledge domains. Descriptive statistics were used for respondents' characteristics. A multivariate logistic regression was used for association between respondent characteristics and responses. Free responses were assessed using a qualitative thematic analysis. RESULTS: Among 685 respondents, 88% were employed, 48% had precepting experience, and 44% were involved with hiring. The majority were from chain community pharmacies (33%) and inpatient settings (22%). Management and conflict resolution skills were reported as lacking by 35% and 28% of respondents respectively; 24% reported insufficient compounding knowledge. CONCLUSION: Our findings suggest knowledge deficits in management, conflict resolution, and compounding. This information can be used for career planning and for educational program development or curricular enhancements. Similar studies in other regions will provide data on national needs.

A Multi-hospital Before-After Observational Study Using a Point-Prevalence Approach with an Infusion Safety Intervention Bundle to Reduce Intravenous Medication Administration Errors.

INTRODUCTION: We previously found a high rate of errors in the administration of intravenous medications using smart infusion pumps. OBJECTIVES/DESIGN: An infusion safety intervention bundle was developed in response to the high rate of identified errors. A before-after observational study with a prospective point-prevalence approach was conducted in nine hospitals to measure the preliminary effects of the intervention. MAIN OUTCOME MEASURES: Primary outcome measures were overall errors and medication errors, with the secondary outcome defined as potentially harmful error rates. RESULTS: We assessed a total of 418 patients with 972 medication administrations in the pre-intervention period and 422 patients with 1059 medication administrations in the post-intervention period. The overall error rate fell from 146 to 123 per 100 medication administrations (p < 0.0001), and the medication error rate also decreased from 39 to 29 per 100 medication administrations (p = 0.001). However, there was no significant change in the potentially harmful error rate (from 0.5 to 0.8 per 100 medication administrations, p = 0.37). An intervention component aiming to reduce labeling-not-completed errors was effective in reducing targeted error rates, but other components of the intervention bundle did not show significant improvement in the targeted errors. CONCLUSION: Development and implementation of the intervention bundle was successful at reducing overall and medication error rates, but some errors remained and the potentially harmful error rate did not change. The error-rate reductions were not always correlated with the specific individual interventions. Further investigation is needed to identify the best strategies to reduce the remaining errors. CLINICAL TRIALS REGISTRATION: Registered at ClinicalTrials.gov, identifier: NCT02359734.

The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study.

INTRODUCTION: Intravenous medication errors persist despite the use of smart pumps. This suggests the need for a standardised methodology for measuring errors and highlights the importance of identifying issues around smart pump medication administration in order to improve patient safety. OBJECTIVES: We conducted a multisite study to investigate the types and frequency of intravenous medication errors associated with smart pumps in the USA. METHODS: 10 hospitals of various sizes using smart pumps from a range of vendors participated. Data were collected using a prospective point prevalence approach to capture errors associated with medications administered via smart pumps and evaluate their potential for harm. RESULTS: A total of 478 patients and 1164 medication administrations were assessed. Of the observed infusions, 699 (60%) had one or more errors associated with their administration. Identified errors such as labelling errors and bypassing the smart pump and the drug library were predominantly associated with violations of hospital policy. These types of errors can result in medication errors. Errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). 1 error of category E (0.1%), 4 of category D (0.3%) and 492 of category C (excluding deviations of hospital policy) (42%) were identified. Of these, unauthorised medication, bypassing the smart pump and wrong rate were the most frequent errors. CONCLUSION: We identified a high rate of error in the administration of intravenous medications despite the use of smart pumps. However, relatively few errors were potentially harmful. The results of this study will be useful in developing interventions to eliminate errors in the intravenous medication administration process.

Enhanced susceptibility to predation in corals of compromised condition.

The marine gastropod, Coralliophila abbreviata, is an obligate corallivore that causes substantial mortality in Caribbean Acropora spp. Considering the imperiled status of Acropora cervicornis and A. palmata, a better understanding of ecological interactions resulting in tissue loss may enable more effective conservation strategies. We examined differences in susceptibility of A. cervicornis to C. abbreviata predation based on coral tissue condition. Coral tissue condition was a strong determinant of snail prey choice, with snails preferring A. cervicornis fragments that were diseased or mechanically damaged over healthy fragments. In addition, snails always chose fragments undergoing active predation by another snail, while showing no preference for a non-feeding snail when compared with an undisturbed prey fragment. These results indicate that the condition of A. cervicornis prey influenced foraging behavior of C. abbreviata, creating a potential feedback that may exacerbate damage from predation in coral populations compromised by other types of disturbance.

Disease dynamics and potential mitigation among restored and wild staghorn coral, Acropora cervicornis.

The threatened status (both ecologically and legally) of Caribbean staghorn coral, Acropora cervicornis, has prompted rapidly expanding efforts in culture and restocking, although tissue loss diseases continue to affect populations. In this study, disease surveillance and histopathological characterization were used to compare disease dynamics and conditions in both restored and extant wild populations. Disease had devastating effects on both wild and restored populations, but dynamics were highly variable and appeared to be site-specific with no significant differences in disease prevalence between wild versus restored sites. A subset of 20 haphazardly selected colonies at each site observed over a four-month period revealed widely varying disease incidence, although not between restored and wild sites, and a case fatality rate of 8%. A tropical storm was the only discernable environmental trigger associated with a consistent spike in incidence across all sites. Lastly, two field mitigation techniques, (1) excision of apparently healthy branch tips from a diseased colony, and (2) placement of a band of epoxy fully enclosing the diseased margin, gave equivocal results with no significant benefit detected for either treatment compared to controls. Tissue condition of associated samples was fair to very poor; unsuccessful mitigation treatment samples had severe degeneration of mesenterial filament cnidoglandular bands. Polyp mucocytes in all samples were infected with suspect rickettsia-like organisms; however, no bacterial aggregates were found. No histological differences were found between disease lesions with gross signs fitting literature descriptions of white-band disease (WBD) and rapid tissue loss (RTL). Overall, our results do not support differing disease quality, quantity, dynamics, nor health management strategies between restored and wild colonies of A. cervicornis in the Florida Keys.

Removal of corallivorous snails as a proactive tool for the conservation of acroporid corals.

Corallivorous snail feeding is a common source of tissue loss for the threatened coral, Acropora palmata, accounting for roughly one-quarter of tissue loss in monitored study plots over seven years. In contrast with larger threats such as bleaching, disease, or storms, corallivory by Coralliophila abbreviata is one of the few direct sources of partial mortality that may be locally managed. We conducted a field experiment to explore the effectiveness and feasibility of snail removal. Long-term monitoring plots on six reefs in the upper Florida Keys were assigned to one of three removal treatments: (1) removal from A. palmata only, (2) removal from all host coral species, or (3) no-removal controls. During the initial removal in June 2011, 436 snails were removed from twelve 150 m(2) plots. Snails were removed three additional times during a seven month "removal phase", then counted at five surveys over the next 19 months to track recolonization. At the conclusion, snails were collected, measured and sexed. Before-After-Control-Impact analysis revealed that both snail abundance and feeding scar prevalence were reduced in removal treatments compared to the control, but there was no difference between removal treatments. Recolonization by snails to baseline abundance is estimated to be 3.7 years and did not differ between removal treatments. Recolonization rate was significantly correlated with baseline snail abundance. Maximum snail size decreased from 47.0 mm to 34.6 mm in the removal treatments. The effort required to remove snails from A. palmata was 30 diver minutes per 150 m(2) plot, compared with 51 min to remove snails from all host corals. Since there was no additional benefit observed with removing snails from all host species, removals can be more efficiently focused on only A. palmata colonies and in areas where C. abbreviata abundance is high, to effectively conserve A. palmata in targeted areas.