Defining key pharmacist and technician roles in response to a hospital downtime or cyberattack.

The occurrence of ransomware, or "cyberattacks," on hospital institutions has steadily increased in recent years. Pharmacy departments that rely on automation and software applications are greatly affected when those systems are offline. Pharmacy workflow without automation can be manually intensive and unsafe for patients. More challenges may be present if the hospital pharmacy is not prepared for a cyberattack or does not have standardized downtime procedures for such an event. This article describes a specific event that took place at a 350-bed acute care hospital located in the United States during the summer of 2021. The hospital lost access to the electronic health record, admitting and registration system, financial systems, pharmacy information systems, barcode medication administration systems, server for the automated dispensing cabinets or inventory management applications, diversion software, compliance applications, and all clinical decision support tools. The goal is to describe a standardized downtime procedure for medication management by identifying specific pharmacist and technician roles when automated processes are offline.

Before It Is Too Late: Implementation Strategies of an Efficient Opioid and Pain Stewardship Program.

Hospital pharmacies may not have the necessary resources, tools, or policies in place to implement a valuable opioid stewardship program. Meanwhile, the number of opioid prescriptions and medication use has increased nationwide. The overuse of opioids is due to the challenging nature of pain management, drug diversion prevention, and opioid abuse, as well as difficulty in recognizing and implementing best practices regarding opioid stewardship. The purpose of this review is to describe the components and executional strategy of an effective opioid and pain stewardship program. Opioid and pain stewardship programs can help identify opportunities for better adherence to best practice recommendations such as standardization of opioid dosing strategies, prescription of multimodal and opioid-sparing regimens, identification of substance misuse, review of patient history information, recognition of pain as a disease state, and increased dispensing of opioid reversal medications.

Survey of health-system pharmacy administration and leadership residencies.

PURPOSE: To perform an inquiry with response measurement from health-system pharmacy administration and leadership (HSPAL) residency program directors and residents to distinguish variances between the programs and identify enhancement opportunities for key stakeholders. METHODS: Members from the Pharmacy Administration Resident Collaboration Research Committee developed separate 20-question survey instruments to assess the strengths and areas of opportunity for HSPAL residency programs from the perspective of residency program directors and residents. The survey instruments were designed to evaluate the level of pharmacy service integration across HSPAL programs nationwide. RESULTS: Nearly half of the residency program directors within the listserv (40.74%, 33/81) participated in the survey. The recognized areas of opportunity by residency program directors include community pharmacy leadership, professional organization involvement, sterile compounding, and supply chain management. About a third (32.54%, 41/126) of the residents participated in the survey. Residents reported the least exposure to community pharmacy leadership, human resource management, informatics, professional organizations, and ambulatory care/specialty rotations. The overall recommendations for HSPAL residency programs are to incorporate C-suite-level experiences, improve alumni engagement, develop longitudinal human resource/financial experiences, and encourage resident credential obtainment. CONCLUSION: In order to foster professional and leadership growth for HSPAL residents, residency programs should consider incorporating C-suite-level experiences, longitudinal human resource/finance experiences, alumni engagement opportunities, rotation variety, professional organization involvement, and support in credential obtainment.

Early Vancomycin Concentrations and the Applications of a Pharmacokinetic Extrapolation Method to Recognize Sub-Therapeutic Outcomes.

Vancomycin trough concentrations should be measured within 30 min of the next dose, but studies have shown that troughs are often measured too early, producing erroneous results that could lead to dosing errors. The purpose of this study was to identify the frequency of early trough measurements and to evaluate whether pharmacokinetically extrapolating mistimed concentrations may locate sub-therapeutic concentrations. Vancomycin troughs were retrospectively reviewed. For troughs ≥10 mg/L and measured >0.5 h early, the true trough was estimated using pharmacokinetic extrapolation methods to identify sub-therapeutic outcomes. Differences ≥2 mg/L between the measured and estimated true trough level was considered to have potential clinical significance. Of 143 troughs evaluated, 62 (43%) were measured too early and 48 of those troughs were ≥10 mg/L. 25% of those 48 troughs were sub-therapeutic. The potential for a difference ≥2 mg/L between the measured and estimated true trough was found to be greatest when the measured trough was ≥10 mg/L, the patient's creatinine clearance (CrCl) was ≥60 mL/min, and the timing error was ≥2 h. To increase the therapeutic utility of early vancomycin trough concentrations, estimated true troughs can be determined by extrapolating measured values based on the time difference and CrCl.