Implementation of a pharmacist skill development "work-with" program.

PURPOSE: Pharmacists' clinical competency is necessary to ensure patient safety and medication optimization. There are many barriers to the implementation of competency assessments and scant literature on their implementation. We aimed to determine if a competency assessment program for hospital pharmacists is feasible, acceptable, and effective. METHODS: Clinical competency assessments of hospital pharmacists were conducted. During the assessments, pharmacists presented a patient case or completed patient care activities while a leadership team member evaluated them using a competency rubric and provided feedback. A postevaluation electronic survey adapted from validated tools regarding perceptions of program feasibility and acceptability was emailed to the pharmacists following each competency assessment and to evaluators at study conclusion. Feasibility was also measured through reviewing rubrics for completion within the 1.5- to 2-hour assessment timeframe. Effectiveness was captured by comparing results to expected competency levels based on experience. RESULTS: In total, 20 assessments were completed. Fifty percent of assessments required longer than the allotted timeframe. Most participants surveyed found the competency assessments implementable, possible, doable, and easy to use. The majority also approved of the implemented assessments and found them appealing, likable, and welcomed and commented that they aided in professional development. For 50% of the competencies assessed, most participants aligned with competency expectations based on years of experience. CONCLUSION: The implementation of these competency assessments was found to be feasible and acceptable to hospital pharmacists. The rubric used was found to be moderately effective. Major implementation barriers were related to time constraints and criteria for success. Future work will be done to enhance the program's effectiveness.

Evaluation of ß-cyclodextrin-modified gemini surfactant-based delivery systems in melanoma models.

Novel drug delivery systems are developed to improve the biological behavior of poorly soluble drugs and to improve therapeutic outcomes. In melanoma therapy, the goal is efficient drug delivery and mitigation of drug resistance. Melphalan (Mel), a currently used therapeutic agent for melanoma, requires solvent system for solubilization, leading to poor chemical stability. Moreover, drug resistance often renders the drug inefficient in clinical setting. A novel ß-cyclodextrin-modified gemini surfactant (CDgemini) delivery system was developed to incorporate Mel in order to improve its physicochemical and biological behavior. Melphalan nanoparticles (Mel-NP) showed optimal particle size in the 200-250 nm range for endocytosis and induced significantly higher cell death compared with Mel (50% of inhibitory concentration [IC50] of 36 µM for the complexes vs 82 µM for Mel). The CDgemini delivery system did not alter the pathway of the cellular death triggered by Mel and caused no intrinsic toxicity to the cells. The Mel-NP complexes induced significant cell death in melanoma cells that were rendered resistant to Mel. These findings demonstrate in principle the applicability of the CDgemini delivery system as safe and efficient alternative to the current melanoma therapy, especially in chemoresistant cases.

High-Dose, Extended-Interval Gentamicin and Tobramycin for Pediatric Inpatients: A Survey of Canadian Hospital Pharmacists.

BACKGROUND: The use of high-dose, extended-interval aminoglycosides, a common practice in adult populations, is less well established for pediatric patients. In younger populations, these drugs are often administered according to a multiple daily dosing method. OBJECTIVE: To characterize prescribing practices for aminoglycosides in pediatric inpatients across Canada, with a focus on high-dose, extended-interval regimens. METHODS: This study was based on an electronic survey of pharmacists representing Canadian health care delivery organizations that provided pediatric inpatient services, which was distributed in March 2015. Questions focused on demographic characteristics; indications for high-dose, extended-interval tobramycin or gentamicin; use of these regimens in patients with particular comorbidities; empiric dosing; monitoring parameters; and the extent of pharmacists' authority to independently prescribe doses and order monitoring parameters for aminoglycosides at their respective institutions. RESULTS: Forty-five (48%) of the 94 prospective participants responded to the survey. Of these 45 respondents, 35 (78%) indicated that their respective health regions used high-dose, extended-interval tobramycin or gentamicin in pediatric inpatients. The patient characteristics for use of such regimens were varied. The median reported doses were 10 mg/kg for pulmonary exacerbation in cystic fibrosis, 7 mg/kg for urinary tract infection, and 8 mg/kg for febrile neutropenia. Thirty-one (89%) of the 35 respondents using these regimens reported that they monitored serum levels, and 27 (77%) reported monitoring for nephrotoxicity. With regard to prescriptive authority, 7 (16%) of the 45 respondents indicated that pharmacists were authorized to independently adjust dosing at their institutions, and pharmacists at 14 (31%) of 45 sites were authorized to order monitoring parameters. CONCLUSIONS: High-dose, extended-interval aminoglycoside therapy was frequently used for pediatric patients across Canada, although the dosages and monitoring practices varied greatly. The information from this study can be used for cross-comparison of practice by other centres across Canada.

L'utilisation de doses élevées d'aminosides administrées à intervalle prolongé est une pratique répandue chez l'adulte, mais moins bien établie chez l'enfant. Dans les populations plus jeunes, ces médicaments sont souvent donnés selon une méthode d'administration multiquotidienne.