Scholarship of Drug Information and Library Sciences Instruction in North American Pharmacy Education: A Systematic Review of English-Language Research.

OBJECTIVES: This study aimed to characterize the scholarship of teaching and learning specific to drug information and library sciences (DILS) in pharmacy education and provide a comprehensive, evidence-based resource for faculty, detailing published practices for content delivery and scholarly research gaps. FINDINGS: Systematic searches of PubMed, Embase, International Pharmaceutical Abstracts, Educational Resources Information Center, Scopus, Library Literature & Information Science Full Text, and Library, Information Science & Technology Abstracts were conducted from January 1997 through early February 2022. Included studies were published in English, involved DILS content, were specific to pharmacy education, were original research, and were conducted in North America. The review excluded abstract-only records and studies that did not include learners (ie, pharmacy students and residents) as participants. Duplicate records were removed. After screening and review, 166 articles met the eligibility criteria, 60% of which (n = 100/166) were published in the last 10 years. Most studies focused on literature evaluation (45/166, 27%), fundamentals of drug information (43/166, 25%), evidence-based medicine (21/166, 13%), and resource utilization (21/166, 13%). Studied learners were mainly pharmacy students (77%), and 82% of research included authors who were pharmacists, whereas 14% included librarians. Assessment techniques used primarily focused on student perception (61/166, 37%), followed by summative assessment (46/166, 28%), other (25/166, 15%), and formative assessment (18/166, 11%). SUMMARY: This article presents a systematically identified collection of North American literature examining the education in DILS of pharmacy learners. Areas for continued research of DILS content include evaluating underrepresented educational domains (ie, systematic approach, response development and provision, literature searching, study design), using librarians more in scholarship of teaching and learning research, and using formative and summative assessments as outcomes.

Video killed the multiple-choice quiz: capturing pharmacy students' literature searching skills using a screencast video assignment.

BACKGROUND: In a flipped, required first-year drug information course, students were taught the systematic approach to answering drug information questions, commonly utilized resources, and literature searching. As co-coordinator, a librarian taught three weeks of the course focused on mobile applications, development of literature searching skills, and practicing in PubMed. Course assignments were redesigned in 2019 based on assessment best practices and replaced weekly multiple-choice quizzes used in prior iterations of the course. CASE PRESENTATION: Following two weeks of literature searching instruction, students were assigned a drug information question that would serve as the impetus for the search they conducted. Students (n=66) had one week to practice and record a screencast video of their search in PubMed. Students narrated their video with an explanation of the actions being performed and were assessed using a twenty-point rubric created by the course coordinator and librarian. The librarian also created general feedback videos for each question by recording screencasts while performing the literature searches and clarifying troublesome aspects for students. The librarian spent about twenty-four hours grading and six hours writing scripts, recording, and editing feedback videos. CONCLUSION: Most students performed well on the assignment and few experienced technical difficulties. Instructors will use this assignment and feedback method in the future. Screencast videos proved an innovative way to assess student knowledge and to provide feedback on literature searching assignments. This method is transferrable to any medical education setting and could be used across all health professions to improve information literacy skills.

Motivating Students to Engage in Preparation for Flipped Classrooms by Using Embedded Quizzes in Pre-class Videos.

BACKGROUND: The success of flipped classrooms is dependent upon students' preparation prior to class, the lack of which is the most common challenge associated with this teaching methodology. To mitigate this limitation, it is important to develop and assess methods of engaging learners during pre-class activities. OBJECTIVE: To determine if quiz delivery method (embedded throughout versus after pre-class videos) affects students' knowledge retention, grades, and video viewing behavior. METHODS: Participating students were randomized to take quizzes, either during pre-class videos via Panopto™ (EQV) or after pre-class videos in the traditional manner via Moodle™ (TMM). Outcomes assessed included students' knowledge retention, scores on pre- and post-class quizzes, and pre-class video viewing behavior (total views and minutes viewed per student) during a three-week period. Having experienced both quizzing modalities during the semester, the perceptions from students in the EQV group were surveyed. RESULTS: Baseline assessment results of both groups (n = 27 per group) were comparable with a median score of 33% (IQR: 17, 50) in both groups. Performance was also similar on knowledge retention [TMM: 67% (50, 83) vs. EQV: 83% (50, 83)], pre-class quiz scores [TMM: 90% (87, 97) vs. EQV: 93% (90, 95)], and post-class quiz scores [TMM: 93% (80, 100) vs. EQV: 87% (80, 100)], while students in the EQV group had more total views [10 (8, 12)] vs. [5 (2, 11)] and minutes viewed [71 (36, 108) vs. 35 (15, 81)]. Results from the perception survey administered to students in the EQV group (74.1% response rate) indicated a preference for embedded quizzes overall (58%) and for class preparation (75%) when compared with post-video quizzes. CONCLUSION: Students' knowledge retention and performance were similar in both EQV and TMM groups, though students in the EQV group were more engaged with videos and most of them preferred this quiz delivery. Using embedded quizzes for formative rather than summative assessment might be an appropriate mechanism to encourage students' viewing of pre-class videos and their preparation for flipped classes.

Incorporation of a mock drug information telephone call exercise in a health-systems pharmacy laboratory.

BACKGROUND AND PURPOSE: Hospital pharmacists routinely receive and answer drug information questions via telephone while performing order verification. This report describes the development, implementation, and evaluation of a mock learning experience for student performance of these tasks in a health-systems pharmacy laboratory course. EDUCATIONAL ACTIVITY AND SETTING: An active learning skills-based exercise involving students receiving and answering a standardized drug information question via telephone during an order verification activity, referred to as a cold-call exercise, was developed and implemented. Data collected included student grades on a baseline assessment, the cold call exercise, order verification exercises, and student perceptions from a voluntary post-exercise survey. Student performance on the cold-call exercise was further evaluated via individual sections of the cold-call rubric. Data were summarized using descriptive statistics. Thematic analysis of student opinion and an estimate of faculty time were also executed. FINDINGS: Student grades on the cold call and order verification exercises were 86.14% and 88.8%, respectively. Students often failed to ask category-specific questions because they did not categorize the ultimate question appropriately. Students found the activity organized and applicable. Time dedicated to creation was extensive, but execution and grading were reasonable. SUMMARY: Students performed well on the drug information exercise as well as the order verification component. Students and faculty enjoyed the experience, and students found the exercise relevant and challenging. This exercise could be implemented into any pharmacy curriculum in order to prepare students using authentic learning experiences.

Gamification of a Mobile Applications Lecture in a Pharmacy Course.

This report describes a librarian's development of an interactive and competitive trivia game using Poll Everywhere, an audience response system software. The trivia game was implemented during a live lecture session on drug information mobile applications taught to first-year pharmacy students. To add a fun and engaging reference for students, the librarian decided to model the game after HQ, a free trivia gaming app. Development of the session, student response, changes to future iterations, and lessons learned by the librarian are described.

Use of economic predictions to make formulary decisions.

PURPOSE: The accuracy of cost savings and reimbursement predictions for medications added to an academic medical center formulary was assessed. METHODS: Formulary changes over a 5-year period were reviewed by the investigators. Medications were included if the medication was added to formulary and the monograph included cost savings or reimbursement data that indicated a positive net margin. The primary endpoints were percent predicted cost savings and net margin per medication based on medication cost only. Secondary endpoints included the percent of medications with at least 100% predicted cost savings or net margin and evaluation of median percent predicted savings or net margin individually. RESULTS: The pharmacy and therapeutics committee reviewed 558 formulary agenda items, 184 of which were selected for further analysis. In total, 19 medications were identified as having a predicted monetary advantage. The endpoints of percent predicted cost savings and net margin yielded a median of 76.5% (range 72.9-188.71%) (n = 3) and 148.2% (IQR 108.9-543.3%) (n = 16), respectively. For 13 (68%) of 19 medications, the percent predicted cost savings or net margin was at least 100%. CONCLUSION: Economic predictions utilized for formulary management at an academic medical center generated net positive monetary value for medications where predicted cost savings or reimbursement factored into the decision to add a medication to the formulary.

Redevelopment of a journal club assignment at a distance-education college of pharmacy.

BACKGROUND AND PURPOSE: Given the proliferation of distance learning in pharmacy education, the ability to conduct journal club in this setting warrants examination. This paper will describe the development of a journal club assignment at a distance-education (DE) college of pharmacy. EDUCATIONAL ACTIVITY AND SETTING: A group journal club (JC) assignment at a DE college of pharmacy was modified to require recorded presentations in order to decrease the number of evaluators and recover lost classroom teaching time. The process utilized during the modification and opportunities and challenges encountered are described. Mean project grades, course grades, and grades between campuses were collected in the recorded-presentation period. The number of evaluators and hours of available lecture time were documented before and after modification. Starting in 2013, student perception of the JC experience was gathered via two post-class survey questions. FINDINGS: The recording of JCs in the distance-learning environment was initiated in 2010 and continued through 2017. A total of 1463 students completed the course during this time. Project and course grades averaged 89.06% (±1.83) and 86.5% (±2.27), respectively; project grade averages were similar across campuses. Following modification, evaluators decreased from an average of 15 to 1.5 and available lecture time increased by six hours. Students from 2013 through 2017 agreed that the JC project was reflective of course content (90.14%) and valuable (82.66%). SUMMARY: Using recordings to have students complete a JC project in a DE environment increased available lecture time, maintained grading consistency, and provided value to students.

Development and impact of a simplified approach to didactic powerpoint presentations performed in a drug information course.

INTRODUCTION: To describe multimedia presentation development and assess impact of use on student and educator performance in a drug information course. METHODS: Slides were modified from bullet-point format to simplified pictorial format and three-slide handouts became outlined Word documents. Student performance, via exam scores and class average, and educator evaluation scores were compared between 2013 and 2014. RESULTS: Presentation revision resulted in a similar number of slides per presentation and smaller handout packets. Class average and final exam scores decreased (86.65% vs. 85.91%, p = 0.222; 84.88% vs. 84.08%, p = 0.053) while midterm exam scores improved (85.81% vs. 87.80%, p = 0.007). Assessment of teacher effectiveness (scale of 1 = strongly disagree to 5 = strongly agree) rose from a median of 3-4 (p = 0.06). CONCLUSION: Simplifying presentations provided anecdotal value but did not impact student performance nor student perception of educator effectiveness.

Comparison of Linezolid and Vancomycin for Methicillin-Resistant Staphylococcus aureus Pneumonia: Institutional Implications.

OBJECTIVE: Recent studies suggesting clinical superiority of linezolid over vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia led to a change in our institution's clinical pathway/order form for hospital-acquired pneumonia, positioning linezolid as the preferred agent. Our objective was to assess the impact of this change within our institution. DESIGN: Retrospective electronic medical records review. METHODS: The analysis for this observational study included eligible patients admitted to our medical center between May 1, 2011, and August 31, 2014, with ICD-9 codes for MRSA and pneumonia. Included patients were at least 18 years of age and had vancomycin or linezolid initiated at least 2 days after admission and continued for at least 2 consecutive days. The primary end points were extent of antibiotic use before and after order form change and length of stay (LOS) and hospital charges in the two treatment groups. A secondary aim was to detect any gross discrepancies in patient outcomes such as treatment duration, mechanical ventilation duration, all-cause mortality rate, nephrotoxicity, and 30-day readmission between the two treatment groups. MEASUREMENTS AND MAIN RESULTS: Outcomes in 227 patients were assessed. Linezolid use increased 16.2% subsequent to the change in the order form. Although not statistically significant, the median hospital admission charge was $6200 lower in patients treated with linezolid compared with those treated with vancomycin ($25,900 vs $32,100). Hospital LOS was significantly associated with Charlson Comorbidity Index score (p<0.001), type of treatment (p=0.032), duration of treatment (p<0.001), mechanical ventilation (p<0.001), and intensive care unit admission (p<0.001). All-cause mortality favored linezolid treatment, and these patients were more likely to be discharged (shorter LOS). CONCLUSIONS: Although linezolid use increased markedly with this pathway/order form change, no negative institutional consequences or unfavorable patient outcomes were detected, justifying the change in policy from these perspectives.

Evaluation of urinalyses ordered for diagnosis of urinary tract infections at an inpatient psychiatric hospital.

OBJECTIVE: A retrospective study was conducted to assess the diagnosis and treatment of urinary tract infections (UTIs) using urinalyses (UA)s at a psychiatric hospital. METHOD: Patients admitted between July 2010 and June 2011 receiving at least one UA during inpatient psychiatric hospitalization were included. Pregnant patients and those with a UA receiving antibiotic treatment in the emergency department were excluded. The primary objective of the study was to characterize and assess the appropriateness of UAs ordered for the diagnosis of UTIs. Secondary objectives included analyzing frequency of cultures obtained, appropriateness of empiric antibiotics, and de-escalation of therapy if warranted. RESULTS: Thirty-nine percent (n = 891/2292) of patients admitted received a UA at least once during their hospitalization. Of 203 patients further evaluated, 78% were asymptomatic, 11% were older than 65 years of age with altered mental status (AMS) or dementia, and 11% had typical UTI symptoms. Thirty-one patients were given antibiotics for a UTI during their stay, with a majority of those being asymptomatic (n = 19/31). CONCLUSIONS: A significant proportion of UAs ordered at a psychiatric hospital were inappropriate. When patients were treated, empiric antibiotic selection and length of treatment were appropriate in most instances.

Evaluation of discharge medication orders following automatic therapeutic substitution of commonly exchanged drug classes.

OBJECTIVE: Automatic therapeutic substitution (ATS) is a mechanism that, upon patient hospitalization, prompts the pharmacist to exchange an equivalent formulary drug for a nonformulary medication, typically without prescriber contact. In facilities utilizing ATS, there is the possibility that physicians and patients may be unaware of the substitution, potentially leading to drug-drug interactions, therapeutic duplication, and/or increased patient expense following discharge should the original regimen not be resumed. The purpose of this study was to determine the frequency with which hospitalized patients subjected to an ATS protocol were not returned to outpatient drug therapy. METHODS: A retrospective chart review of adult patients admitted to an academic medical center between January 1 and June 30, 2011, was conducted. Patients were included if they were admitted on angiotensin-converting enzyme (ACE) inhibitors, antidepressants, nonsedating antihistamines, histamine (H2) receptor antagonists, or proton pump inhibitors (PPIs), and were then prescribed a different agent via ATS. Admission and discharge medication reconciliation documents, dictated discharge summaries, and patient education documentation reports were reviewed for drug therapies and doses, as well as medication counseling evidence. The primary endpoint was the percentage of patients not returned to original outpatient therapy following ATS. Secondary endpoints included prescribing events in patients not returned to original therapy, the rate and source of drug therapy counseling at discharge, and the number of patients discharged on a potentially cost-prohibitive drug, defined as any drug available only as a branded product during the study period. RESULTS: A total of 317 interventions were identified through review of pharmacy records. Of these, 47 patients (15%) were not returned to original outpatient therapy. Within this subsection, 15 patients (32%) were discharged on the substituted drug, eight patients (17%) resumed initial therapy but received a dosage adjustment from previous outpatient therapy, and three patients (6%) were discharged on a drug that was neither the substituted product nor the previous outpatient therapy. The remaining 21 patients had therapy discontinued (n = 12/47, 26%) or lacked documentation of discharge therapy (9/47, 19%). Nursing staff provided medication counseling to 288 of the 317 patients (91%). Overall, 51 patients (16%) were identified as receiving a cost-prohibitive drug. CONCLUSION: Patients subject to ATS of commonly substituted drug classes were returned to their original outpatient drug therapy more than 85% of the time following inpatient hospitalizations, with similar rates of medication counseling at discharge. The prescribing of cost-prohibitive drugs has been identified as a potential area for pharmacist intervention at discharge.

Collaboration between a drug information center and an academic detailing program.

PURPOSE: The collaboration between a drug information center (DIC) and an academic detailing program is described. METHODS: An agreement was reached between the South Carolina Offering Prescribing Excellence (SCORxE) academic detailing program and the Medical University of South Carolina (MUSC) Drug Information Center (DIC) to provide responses to drug information (DI) questions pharmacists received on academic detailing visits. Questions received were analyzed to determine the impact that the collaboration had on MUSC DIC requests. RESULTS: From May 2009 to October 2012, the MUSC DIC answered 2727 DI questions, 62 (2.3%) of which were generated by SCORxE. Compared with DIC questions received from other sources, academic detailing questions were more likely to be therapeutic consultations, reference searches, or dosage queries and less likely to be about formulation or drug interactions. When comparing the deadline for the 62 academic detailing requests with the deadline for all other requests, the academic detailing requests allowed for a longer median time to deadline per request (21.2 days versus 27.1 hours). The majority of SCORxE questions (68%) were completed by students or residents. Benefits of the collaboration for the DIC included advanced educational opportunities for learners, increased dissemination of provided information, external funding, and scholarship opportunities. SCORxE has benefited from increased access to information and efficiency. CONCLUSION: Collaboration between an academic detailing program and an academic medical center DIC has proven beneficial for both parties. Questions have been communicated by a simple and effective process and have required more research than queries received from other sources.

Strategies for transitioning therapy to aripiprazole from other antipsychotics in schizophrenia.

OBJECTIVE: To determine the optimal approach for transitioning therapy to aripiprazole from other antipsychotics in schizophrenia and to describe these strategies. DATA SOURCES: MEDLINE (January 2000-March 2012) and PubMed (January 2000-March 2012) searches were conducted using the search terms aripiprazole, switch, and switching. Citations from references were reviewed to identify additional primary literature. STUDY SELECTION AND DATA EXTRACTION: Articles identified as primary literature were considered for inclusion. Case series, opinion papers, and review articles were also examined. Literature was required to be in English. For evaluation purposes, included articles were randomized trials specifically comparing different switching strategies from an alternative antipsychotic to aripiprazole. Randomized trials and single-arm studies that evaluated the effect of a change to aripiprazole and reported switching methods were also reviewed but not evaluated. DATA SYNTHESIS: Aripiprazole, an atypical antipsychotic agent with a unique mechanism of action, causes fewer adverse effects when compared with other atypical antipsychotics. Patients unable to tolerate or unresponsive to their current regimens might benefit from a change to aripiprazole, but the best method for switching is unknown. Four randomized trials were identified that compared the efficacy, safety, and tolerability of at least 2 different switching strategies. The 5 strategies used a combination of immediate or titrated initiation of aripiprazole with immediate or tapered discontinuation of the current antipsychotic. A significant worsening of symptoms in the abrupt discontinuation group when compared with the combined tapered discontinuation groups was seen in 1 trial at week 2; however, all other comparisons yielded no significant differences among switching strategies. CONCLUSIONS: Strategies for transitioning therapy to aripiprazole from alternative antipsychotics in schizophrenia have been investigated in randomized trials, but studies have failed to establish a preferred method. Despite the lack of evidence, experts recommend an overlap strategy that includes maintaining the current antipsychotic dosage while titrating to a therapeutic dose of aripiprazole.

Rufinamide: a new antiepileptic medication for the treatment of seizures associated with lennox-gastaut syndrome.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of rufinamide in the treatment of epileptic seizures and describe its potential place in therapy. DATA SOURCES: MEDLINE (1966-January 2010) and PubMed (1966-January 2010) literature searches were conducted to identify primary literature investigating rufinamide. References from selected publications discussing rufinamide, as well as the package insert, were reviewed. STUDY SELECTION AND DATA EXTRACTION: Published controlled trials describing the efficacy and safety of rufinamide were given preference. Available abstracts were also reviewed. Four published trials were identified and included and a retrospective review of the clinical use of rufinamide was also analyzed. The remainder of the information described is from 4 abstracts. DATA SYNTHESIS: Rufinamide is a new antiepileptic agent that differs structurally from other antiepileptic drugs and is approved as adjunctive therapy for Lennox-Gastaut syndrome (LGS). It presumably provides its antiseizure activity by prolonging sodium channel inactivity, stabilizing cell membranes. It is absorbed and metabolized extensively, then excreted renally as an inactive metabolite. Clinical trials show that adjunctive rufinamide is effective at reducing seizure frequency in patients with LGS and refractory partial seizures. Rufinamide showed no effect on cognitive function in patients with refractory partial seizures. Short-term adverse event rates were similar to those of placebo. Safety data from long-term studies show that rufinamide is well tolerated, causing headache, dizziness, and fatigue at rates of >10%. Rufinamide has few clinically relevant drug interactions, although it does increase phenytoin serum concentrations, while valproate increases rufinamide serum concentrations. CONCLUSIONS: Data show that rufinamide is safe and effective as an adjunctive agent for LGS and may be used to treat partial seizures. The benefits of rufinamide include its pharmacokinetics, limited drug interactions, and lack of effect on cognitive function, but its use is limited by the rarity of LGS and the lack of comparative data with other antiepileptic agents.

Documenting drug information questions using software for poison information documentation.

PURPOSE: Current and alternative approaches to documenting drug information (DI) questions at DI centers in the United States and features of a software program used for documenting poison information are described. METHODS: A survey was distributed through an Internet listserver for DI specialists in institutional or academic practices. The survey requested information regarding the use of electronic databases to document DI inquiries and the type of databases used. Documented DI questions during a nine-month period using Visual Dotlab (Visual Dotlab Enterprises, Fresno, CA) at the University of Pittsburgh Medical Center (UPMC) DI center were analyzed to demonstrate the feasibility and efficiency of the software for documenting DI questions. RESULTS: Thirty-three DI centers responded to the survey, and 22 (67%) used electronic databases for question documentation. Of these, 15 (68%) were created with Microsoft Office Access (Microsoft Corporation, Redmond, WA). At the UPMC DI center, 841 DI questions were documented using Visual Dotlab. Questions from pharmacists, nurses, and physicians accounted for 654 (78%) of entries. Drug-drug interactions (12%) and dosage recommendations (12%) were the most common types of questions received. On average, DI specialists spent 46 minutes per response, which required an average of 1.7 follow-up calls per inquiry. Quality assurance was performed on 98% of questions documented. CONCLUSION: Visual Dotlab is not well-known and is currently not used widely by DI centers. However, it includes features that may help DI centers document and retrieve DI questions efficiently and comprehensively.