Prescriber and employee utilization of a health sciences center campus outpatient pharmacy: A qualitative analysis.

PURPOSE: The college of pharmacy has operated pharmacies on campus for over 26 years. Employees and patients are users of the pharmacies; however, utilization across the campus has been limited. This paper describes a process, as well as results, that was used to gather input from employees on a large university health sciences center campus on pharmacy needs and related behaviors on campus pharmacy utilization. METHODS: Two focus groups of staff and 4 focus groups of prescribers were conducted over 1 month. Participants were selected through purposive sampling via email within an academic health sciences center campus over a 1-month period. The sessions were moderated by one investigator using a preconstructed discussion guide and lasted 1 hour. Two additional investigators observed sessions for nonverbal communication; all sessions were audio recorded for subsequent transcription. An open-coding process was performed on verbatim transcripts using NVivo12. The investigator team then developed, refined, and grouped themes during subsequent group discussions. RESULTS: A total of 44 participants took part in 6 focus groups. Participants included prescribers (physicians, nurses, physician assistants) and staff (nonprescribers). Two major themes identified were (1) factors related to on-campus pharmacies and (2) qualities valued in a pharmacy. There was an equal split (8% for each group) on awareness of the on-campus pharmacies. Almost 11% of participants commented on the accessibility of a pharmacy being a quality valued in a pharmacy. CONCLUSION: Focus groups provided insights for the administration team regarding additional value-added services that would be helpful for the campus community, as well as various approaches to increase utilization of the on-campus pharmacies. Focus group methodology is an effective approach to engage employees of a large university campus to garner new ideas to enhance existing policies or services, as well as to gather thoughts on preliminary strategic plans before implementation.

Creation and implementation of a pharmacy-led meds-to-beds program at a large teaching hospital.

BACKGROUND: "Meds-to-beds" programs are a quality improvement intervention that is gaining wider implementation throughout the United States. The University of Oklahoma hospital system did not have this program and sought to implement one. There are sufficient data on the benefits of meds-to-beds programs, but there is a lack of literature on describing the development and implementation process. OBJECTIVES: The objective of this article is to describe the planning process, implementation, and barriers encountered during the organization of a pharmacy-led meds-to-beds program operating within 2 large teaching hospitals. PRACTICE DESCRIPTION: The University of Oklahoma Health Sciences Center campus has 7 colleges, multiple primary care and specialty clinics, and 2 hospitals. In addition, there are 3 on-campus outpatient pharmacies operated by the University of Oklahoma College of Pharmacy (OUCOP). PRACTICE INNOVATION: The college implemented a meds-to-beds program primarily serving 2 on-campus hospitals, The Oklahoma Children's Hospital and University of Oklahoma College of Pharmacy Medical Center. The program operated out of The Children's Pharmacy, an outpatient pharmacy located within the Children's Hospital. EVALUATION METHODS: A Plan-Do-Study-Act model was used, which allowed for adaptation in response to barriers encountered throughout the process. Frequent meetings among stakeholders were held to continuously evaluate progress (e.g., awareness and utilization of the program and prescription counts) and make necessary changes. RESULTS: Implementation of the program required changes in workflow both within the pharmacy and within the registration and discharge processes of medical teams. In addition, after the initiation of the meds-to-beds program, the daily prescription count more than doubled. The program averages 40 deliveries per day and 3 prescriptions per delivery and continues to grow, providing evidence of a successful meds-to-beds implementation. CONCLUSION: The Plan-Do-Study-Act model allowed for many adjustments to be made throughout the process, including the conversion from an opt-in to an opt-out model to increase program utilization.

Mechanism of Cobalt-Catalyzed Heterodimerization of Acrylates and 1,3-Dienes. A Potential Role of Cationic Cobalt(I) Intermediates.

Coupling reactions of feedstock alkenes are promising, but few of these reactions are practiced industrially. Even though recent advances in the synthetic methodology have led to excellent regio- and enantioselectivies in the dimerization reactions between 1,3-dienes and acrylates, the efficiency as measured by the turnover numbers (TON) in the catalyst has remained modest. Through a combination of reaction progress kinetic analysis (RPKA) of a prototypical dimerization reaction, characterization of isolated low-valent cobalt catalyst precursors involved, several important details of the mechanism of this reaction have emerged. (i) The prototypical reaction has an induction period that requires at least two hours of stir time to generate the competent catalyst. (ii) Reduction of a Co(II) complex to a Co(I) complex, and subsequent generation of a cationic [Co(I)]+ species are responsible for this delay. (iii) Through RPKA using in situ IR spectroscopy, same excess experiments reveal inhibition by the product towards the end of the reaction and no catalyst deactivation is observed as long as diene is present in the medium. The low TON observed is most likely the result of the inherent instability of the putative cationic Co(I)-species that catalyzes the reaction. (iv) Different excess experiments suggest that the reaction is first order in the diene and zero order in the acrylate. (v) Catalyst loading experiments show that the catalyst is first order. The orders in the various regents were further confirmed by Variable Time Normalization Analysis (VTNA). (vi) A mechanism based on oxidative dimerization [via Co(I)/Co(III)-cycle] is proposed. Based on the results of this study, it is possible to increase the TON by a factor of 10 by conducting the reaction at an increased concentration of the starting materials, especially, the diene, which seems to stabilize the catalytic species.