Rotation self-evaluation checklist (REC): A preceptors' perspective.

PURPOSE: Healthcare checklists standardize processes and procedures in medical facilities. In pharmacy experiential education programs, checklists may allow preceptors to standardize some student activities that affect patient care. During my time as a preceptor, I found that a checklist could assist struggling students who overlook critical patient information regularly. DESCRIPTION: In this article, I reflect on the incorporation of a rotation self-evaluation checklist (REC) in the training of 83 pharmacy students. The reflection of this integration was performed with Brookfield's four lenses' model of critical reflection. These interconnecting lenses allowed for self, learner, peer, and literature reflection of a checklist implementation in an experiential rotation. ANALYSIS/INTERPRETATION: The critical reflection analysis incorporated evaluations from students and discussions from learners and peers on the REC implementation. Introspection provided valuable insights into the origin and impact of the REC. CONCLUSION: The REC assisted in the standardization of the medication review process for the pharmacy student, but also provided the learner the opportunity to self-evaluate their process. The reflection allowed me to conclude that the REC provided guidance and assistance to the learner, but also recognized that it was a stressor. IMPLICATIONS: The critical reflection of this educational activity provided me with valuable insight into the perceptions and beliefs of this teaching and learning method and the impact on students. The REC assisted in student learning and a modified REC may have a role in the training of pharmacy students in other rotation settings.

The Gap in Electronic Drug Information Resources: A Systematic Review.

The landscape of drug information is growing, leading to information overload from various avenues, both scientific and public opinion. The completeness of these resources are not well-studied and no standardizations exist for these databases. Thus, it is not uncommon to have missing information across the drug information resources used by healthcare professionals. Such gaps in these resources may lead to fatal and nonfatal incidences if more than one resource is not consulted. To date, there have been numerous medication errors reported in the literature. In an effort to review the data found in drug information resources, we conducted a comprehensive search of the PubMed, Embase, and EBSCO electronic databases from January 2000 to January 2017, using the terms "drug information," "medical information," and "drug information resource." A total of 14 articles were identified and five were included in our review, which evaluated the differences between drug information resources. Two articles evaluated pharmacogenomics information, one was infectious disease-specific, one evaluated usability as well as other factors, and the last evaluated general content. Overall, there was consistency across the articles in that they each reported on disparities in drug information among several drug information resources. Drug information keeps changing, and it is imperative that healthcare professionals have access to multiple resources to ensure the accuracy and completeness of information. We strongly encourage the standardization of drug information content on drug information resources as well as the information made available from pharmaceutical companies, as it may refine the quality of drug information provided to help prevent medication errors and adverse drug events.

Hypersensitivity reaction after inhalation of a lactose-containing dry powder inhaler.

Milk protein allergy-induced reactions from lactose-containing dry powder inhalers (DPIs) have not been widely described in the literature. Lactose is a common inactive ingredient in many pharmaceutical products that is used to enhance the stability of active substances in medicinal products, including asthma medications. Contamination of lactose with milk proteins has been identified in reports of inhaled corticosteroid product lot testing. Serious respiratory sequelae may follow after the inhalation of a DPI corticosteroid in a patient with milk protein allergy because DPIs that contain lactose may be contaminated with milk proteins. Lactose-containing DPIs are contraindicated in patients with milk protein allergy. Although manufacturers identify this contraindication in product package inserts, some drug references may not include this information and health care professionals may lack awareness. Clinicians should consider reviewing multiple medication resources for warnings and contraindications of medications to prevent complications. We describe a refractory asthma exacerbation secondary to a hypersensitivity reaction following administration of a lactose-containing DPI corticosteroid and long-acting ß2 agonist combination in a child with a milk protein allergy.

Impact of a pilot pharmacy health-care professional out-of-school time physical activity and nutrition education program with exercise on fourth and fifth graders in a rural Texas community.

OBJECTIVES: Childhood obesity continues to be a problem. Children in rural populations are more likely to be overweight or obese and a lack of resources in those areas may contribute to this problem. We aimed to assess the impact of a pilot pharmacy health-care professional out-of-school time vigorous physical activity and nutrition education program on fourth and fifth graders in a rural Texas community. METHODS: We conducted a prospective 12-week cohort study from August to November 2012. Thirty-three children, aged 8-11 years, in Bailey County, Texas, were enrolled in the study. Body mass index, body mass index percentile, blood pressure, waist circumference, and a diet preferences and activities knowledge survey were obtained at 0, 4, 8, and 12 weeks. Study participants completed a twice weekly physical activity and nutrition education program with exercise over weeks 1-4 with no intervention during weeks 5-12. RESULTS: Thirty-one (94%) of the 33 children, predominately Hispanic girls, completed the program. Body mass index (-0.30 (95% confidence interval, -0.44 to -0.17); P = <0.0001), body mass index percentile (-2.75 (95% confidence interval, -4.89 to -0.62); P = 0.0026), systolic blood pressure (-1.9 (95% confidence interval, -2.9 to -0.9); P = <0.0001), and waist circumference (-0.47 (95% confidence interval, -0.85 to -0.10); P = <0.0001) mean change decreased between baseline and week 12 with no intervention for 8 weeks. Positive survey results at 3 months indicated a decrease in fried/sweet foods; increase in exercise; decreases in video games and computer use; and a change in knowledge regarding the selection of the most healthy food group servings per day. CONCLUSION: In this pharmacy health-care directed pilot study, participants had a reduction of body mass index, body mass index percentile, systolic blood pressure, waist circumference, and improvement in certain survey results at the end of 12 weeks despite no further intervention after 4 weeks.

Management of bronchiolitis in the emergency department: impact of evidence-based guidelines?

OBJECTIVE: Recent practice guidelines from the American Academy of Pediatrics recommend limiting use of bronchodilators, corticosteroids, antibiotics, and diagnostic testing for patients with bronchiolitis. We sought to determine the association of the evidence-based guidelines with bronchiolitis care in the emergency department (ED). METHODS: We analyzed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits. We compared utilization for patient visits before and after the publication of the guidelines. We used logistic regression to determine the association of the availability of the guidelines with resource utilization. RESULTS: Bronchodilators were used in 53.8% of patient visits with no differences noted after the introduction of the guidelines (53.6% vs 54.2%, P = .91). Systemic steroids were used in 20.4% of patient visits, and antibiotics were given in 33.2% of visits. There were no changes in the frequency of corticosteroid (21.9% vs 17.8%, P = .31) or antibiotic (33.6% vs 29.7%, P = .51) use. There was an associated decrease in use of chest x-rays (65.3% vs 48.6%, P = .005). This association remained significant after adjusting for patient and hospital characteristics with an adjusted odds ratio of 0.41 (95% confidence interval 0.26-0.67). CONCLUSIONS: For patients seen in the ED with bronchiolitis, utilization of diagnostic imaging has decreased with the availability of the American Academy of Pediatrics practice guidelines. However, there has not been an associated decrease in use of nonrecommended therapies. Targeted efforts will likely be required to change practice significantly.

The impact of preceptor and student learning styles on experiential performance measures.

OBJECTIVES: To identify preceptors' and students' learning styles to determine how these impact students' performance on pharmacy practice experience assessments. METHODS: Students and preceptors were asked to complete a validated Pharmacist's Inventory of Learning Styles (PILS) questionnaire to identify dominant and secondary learning styles. The significance of "matched" and "unmatched" learning styles between students and preceptors was evaluated based on performance on both subjective and objective practice experience assessments. RESULTS: Sixty-one percent of 67 preceptors and 57% of 72 students who participated reported "assimilator" as their dominant learning style. No differences were found between student and preceptor performance on evaluations, regardless of learning style match. CONCLUSION: Determination of learning styles may encourage preceptors to use teaching methods to challenge students during pharmacy practice experiences; however, this does not appear to impact student or preceptor performance.

Evaluation of dosage form information provided in pediatric drug trial reports.

This report is the first to replicate the earlier findings of Standing et al and validates the inadequacy of reporting of dosage forms used in pediatric drug trials. Journal authors should provide and journal editors should require adequate dosage form information for published reports of pediatric drug trials. We also recommend that compounding pharmacists provide detailed compounding instructions to assure that extemporaneously compounded formulations can be reliably reproduced, and that quality-control data be provided to support formulation stability. Until the problem of insufficient information is addressed, replication of many pediatric drug trials is impossible, calling into question their reliability and validity.

Effect of 24-hour intravenous tubing set change on the sterility of repackaged fat emulsion in neonates.

BACKGROUND: Duration of intravenous fat emulsion (IVFE) infusions, precise method of administration (manufactured bottle vs repackaged syringe), and interval for administration set change continue to be debated. OBJECTIVE: To determine the contamination rate associated with replacing IVFE administration sets every 24 hours in newborn infants receiving fat emulsion repackaged into unit-of-use syringes. METHODS: This was a prospective, microbiologic study of 90 administration sets used in 19 neonates. IVFE samples were obtained from administration sets at the end of a 19- to 23-hour infusion and prior to daily tubing set change from infants who received repackaged IVFE. Samples of IVFE (1-3 mL) were aseptically removed at the catheter connection site proximal to the patient, transferred into BACTEC PEDSPlus culture media, and continuously monitored for 5 days to detect gram-positive and gram-negative organisms, as well as yeast. RESULTS: Two samples (2.27%) grew coagulase-negative Staphylococcus. Both samples were from the same asymptomatic patient and were obtained on consecutive days. A blood sample obtained through this infant's central catheter grew the same organism and suggested catheter hub colonization as the primary site of microbe origin. CONCLUSIONS: Microbial contamination of IVFE infusion sets changed at 24-hour intervals, using unit-of-use syringes in neonates, was low at 2.2%.