Barriers and motivational factors for engaging in novel opioid and medication disposal-related services in community pharmacies.

OBJECTIVE: This study aimed to explore and identify motivational factors and barriers for pharmacy personnel participation in specific opioid mitigation programs, using the Theory of Planned Behavior (TPB) as an investigational framework. METHODS: A naturalistic inquiry method was employed involving semi-structured interviews with pharmacy personnel to assess their intentions, attitudes, normative beliefs, and behaviors towards participating in naloxone dispensing and provision of at-home drug disposal solutions. Purposive sampling was utilized to recruit participants, with saturation achieved after 12 interviews. Interviews were transcribed and coded to identify recurring themes. RESULTS: Four primary themes emerged: 1) the value and benefits of helping others, emphasizing societal, patient, and environmental benefits; 2) limits and barriers to participation, including financial concerns, management support, and time constraints; 3) pharmacists' intrinsic motivators, highlighting personal motivations and differentiation between programs for specific patient types; and 4) program implementation challenges and strategies. CONCLUSION: The findings underscore the applicability of the TPB in understanding pharmacy engagement in opioid abatement programs. Despite facing barriers such as financial considerations and time constraints, the overall positive attitudes towards the programs indicate a strong motivation to contribute to public health efforts. Addressing identified barriers and leveraging motivators could enhance participation, potentially mitigating the opioid crisis. Future research should incorporate patient perspectives to fully understand the impact and effectiveness of pharmacy-led interventions, such as naloxone dispensing and disposal solutions, in opioid misuse prevention.

Cultures of support and resilience are associated with certified pharmacy technicians embracing new roles.

BACKGROUND: Various technological, economic, and regulatory factors are creating opportunities for pharmacy technicians to take on additional responsibilities. Technicians in the broader sense have indicated a preference for expanded scope of duties; however, it is not known what drives technicians' greater inclinations to accept these new roles. OBJECTIVE: The purpose of this study was to determine the association of various work-related factors, such as co-worker support, pharmacist-leadership style, future uncertainty, their own organizational commitment, and personal characteristics of technicians, including their resilience, on pharmacy technicians' willingness to take on emerging responsibilities in pharmacy. METHODS: A self-administered questionnaire survey was disseminated through email to a national, randomized sample of 3000 technicians certified through the National Healthcareer Association (NHA). The questionnaire solicited data on willingness to participate in either of 13 emerging responsibilities as well as resilience, perceived transformative leadership behaviors of supervising pharmacists, future uncertainty, coworker support, organizational commitment, and various personal and practice-related variables. Following the use of principal component analyses for item purification and summation of various scale responses, inferential analyses were conducted via independent sample t-tests, one way analyses of variance, and Pearson's product moment correlation, as appropriate. RESULTS: From 2906 surveys delivered, 878 were returned, with 745 of them providing completed responses on willingness to participate in emerging responsibilities. Willingness on most items/responsibilities was highly rated, with many means being at least 4 on a 5-point scale, though some were lower and perhaps a reflection of less exposure to these by way of their personal experience orpractice setting. Technicians' resilience, their coworker support, organizational commitment, and perceived transformative behaviors undertaken by their supervising pharmacists were all highly associated with willingness to engage. CONCLUSIONS: Pharmacists, pharmacy technician peers, and organizations can contribute to a culture that is supportive for pharmacy technicians and may serve to encourage commitment, resilience, and willingness to embrace new, or emerging responsibilities.

Correlations to and potential implications of resilience among certified pharmacy technicians.

OBJECTIVES: To assess resilience among a sample of certified pharmacy technicians in the United States and evaluate associations between resilience and various personal and work-related characteristics and conditions, including coworker support and pharmacist leadership behaviors, and to assess the relationship between technicians' resilience and support from coworkers and commitment to their organization. METHODS: This study employed the use of a self-administered questionnaire survey electronically in a cross-sectional design. The questionnaire was delivered with a response portal open for approximately 6 weeks during the spring of 2022 to a sample of 3000 technicians certified through the National Healthcareer Association. The questionnaire consisted of items comprising the Brief Resilience Scale, an adapted version of the Multifactorial Leadership Questionnaire (A-MLQ), and items measuring aspects of coworker support, future uncertainty, commitment, and turnover, in addition to demographic and practice site-related questions. RESULTS: Usable responses were acquired from 822 respondents, who reported relatively high levels of resilience. Resilience was observed to be positively correlated with pharmacy transformative leadership behaviors measured on the A-MLQ and with coworker support and negatively correlated with future uncertainty. Respondents indicating the highest level of profession commitment reported a statistically higher level of resilience than did others. There were very few relationships observed between resilience and technicians' personal characteristics. CONCLUSIONS: Immutable characteristics (e.g., race/ethnicity, sex, and age) played a very small role in describing resilience among pharmacy technicians. Instead, organizational characteristics of the workplace were shown to be highly associative with resilience of technicians, adding further evidence that organizations and the profession can help facilitate resilience among these important pharmacy support personnel.

Clinical Characteristics of Youth with Autism or Developmental Disability during Inpatient Psychiatric Admission.

Children with autism spectrum disorder and developmental disabilities (ASD/DD) often experience severe co-occurring psychological and behavioral challenges, which can warrant inpatient psychiatric care. However, very little is known about the characteristics and clinical care of children with ASD/DD within the context of inpatient psychiatric settings. In this paper, we describe factors unique to inpatients with ASD or DD, by drawing on electronic health records from over 2300 children and adolescents ages 4-17 years admitted to a pediatric psychiatric inpatient unit over a 3-year period. Patients with ASD/DD accounted for approximately 16% of inpatients and 21% of admissions, were younger, more likely to be readmitted, more likely to be male, and more likely to have Medicaid insurance, as compared to patients without ASD/DD. Clinically, those with ASD/DD more frequently had externalizing concerns documented in their records, in contrast to more frequent internalizing concerns among other patients. Within the ASD/DD group, we identified effects of patient age, sex, and race/ethnicity on multiple dimensions of clinical care, including length of stay, use of physical restraint, and patterns of medication use. Results suggest the need for psychiatric screening tools that are appropriate for ASD/DD populations, and intentional integration of anti-racist practices into inpatient care, particularly with regard to use of physical restraint among youth.

Technicians' perception of pharmacist leadership behaviors on their own commitment and turnover intention.

PURPOSE: To evaluate technicians' perceptions of how they are supported and supervised by pharmacists through assessment of various components of pharmacists' leadership behaviors in developing the technician workforce. Additional objectives included evaluating levels of pharmacy technician uncertainty about their future, job commitment, and turnover intention in relation to perceived pharmacist leadership behaviors. METHODS: This study employed a cross-sectional design involving administration of an online questionnaire survey. The target population was technicians certified through the National Healthcareer Association. The questionnaire was disseminated to a random, nationwide sample of 3,000 technicians. It solicited responses to an adapted version of the Multifactorial Leadership Questionnaire (MLQ), a 29-item instrument for measuring the frequency of observed pharmacist supervisory behaviors, which are categorized as transactional, transformative, or both. The questionnaire also inquired as to respondents' levels of future uncertainty, profession commitment, organization commitment, and turnover intentions. RESULTS: Responses were acquired from 882 certified pharmacy technicians, who reported their observance of pharmacy supervisory behaviors, as measured by the adapted MLQ, with moderate frequency. Higher technician-reported levels of transformative leadership behavior by pharmacists were associated with lower levels of future uncertainty, greater profession and organization commitment, and diminished turnover intentions. CONCLUSION: Pharmacists' supervisory behaviors, namely transformative leadership behaviors, may be impactful to pharmacy technicians' attitudes and work-related outcomes. The pharmacy profession's leaders and educators might consider these results in educating current and future pharmacists so as to improve the workplace and, potentially, organizational and profession-wide outcomes in the delivery of care.

The effects of a hands-free communication device system in a surgical suite.

This case report describes a qualitative investigation into how a Hands-free Communication Device (HCD) system impacted communication among anesthesia staff in a pediatric surgical suite. The authors recruited a purposive sample that included anesthesiologists, certified registered nurse anesthetists, circulating nurses, a charge nurse, and a postanesthesia care unit nurse. Data were collected using semistructured interviews and observations, then analyzed using a constant comparison approach. The results corroborate and enrich themes that were discovered in a previous qualitative study of HCD systems: (1) communication access, (2) control, (3) training, (4) environment and infrastructure. The results also generated new subthemes and themes: (1) technical control, (2) choosing communication channels, and (3) reliability. The authors conclude that HCD systems profoundly impacted communication in a largely positive way, although reliability of the technology remained an issue. The authors' findings contribute a valuable insight into the growing body of knowledge about implementation and use of HCD systems.

Overweight/obesity and gastric fluid characteristics in pediatric day surgery: implications for fasting guidelines and pulmonary aspiration risk.

BACKGROUND: The safety of 2-h preoperative clear liquid fasts has not been established for overweight/obese pediatric day surgical patients. Healthy children and obese adults who fasted 2 h have small residual gastric fluid volumes (GFVs), which are thought to reflect low pulmonary aspiration risk. We sought to measure the prevalence of overweight/obesity in our day surgery population. We hypothesized that neither body mass index (BMI) percentile nor fasting duration would significantly affect GFV or gastric fluid pH. In children who were allowed clear liquids up until 2 h before surgery, we hypothesized that overweight/obese subjects would not have increased GFV over lean/normal subjects and that emesis/pulmonary aspiration events would be rare. METHODS: Demographics, medical history, height, and weight were recorded for 1000 consecutive day surgery patients aged 2-12 yr. In addition, 1000 day surgery patients (age 2-12 yr) undergoing general endotracheal anesthesia were enrolled. After tracheal intubation, a 14-18F orogastric tube was inserted and gastric contents evacuated. Medications, fasting interval, GFV, pH, and emetic episodes were documented. Age- and gender-specific Center for Disease Control and Prevention growth charts (2000) were used to determine ideal body weight (IBW = 50th percentile) and to classify patients as lean/normal (BMI 25th-75th percentile), overweight (BMI > or = 85th to <95th percentile), or obese (BMI > or = 95th percentile). RESULTS: Of all day surgery patients, 14.0% were overweight and 13.3% were obese. Obese children had lower GFV per total body weight (P < 0.001). When corrected for IBW, however, volumes GFV(IBW) were identical across all BMI categories (mean 0.96 mL/kg, sd 0.71; median 0.86 mL/kg, IQR 0.96). Preoperative acetaminophen and midazolam contributed to increased GFV(IBW) (P = 0.025 and P = 0.001). Lower GFV(IBW) was associated with ASA physical status III (P = 0.024), male gender (P = 0.012), gastroesophageal reflux disease (P = 0.049), and proton pump inhibitor administration (P = 0.018). GFV(IBW) did not correlate with fasting duration or age. Decreased gastric fluid acidity was associated with younger age (P = 0.005), increased BMI percentile (P = 0.036), and African American race (P = 0.033). Emesis on induction occurred in eight patients (50% of whom were obese, P = 0.052, and 75% of whom had obstructive sleep apnea, P = 0.061). Emesis was associated with increased ASA physical status (P = 0.006) but not with fasting duration. There were no pulmonary aspiration events. CONCLUSIONS: Twenty-seven percent of pediatric day surgery patients are overweight/obese. These children may be allowed clear liquids 2 h before surgery as GFV(IBW) averages 1 mL/kg regardless of BMI and fasting interval. Rare emetic episodes were not associated with shortened fasting intervals in this population.