Impact of the COVID-19 pandemic on pharmacists practicing in community pharmacies in the state of Nebraska.

BACKGROUND: The rapid increase in COVID-19 combined with uncertainty surrounding transmission and treatment protocols resulted in unprecedented burnout amongst health care workers. As other health care workers scrambled to support patients, community pharmacists quickly responded to the pandemic by extending their services. This constantly changing environment amongst other factors created a high degree of psychological burden associated with COVID-19 for pharmacists. Although studies have examined the psychological impact of the pandemic on frontline health care workers, pharmacists are rarely included in these studies. OBJECTIVE: To examine the impact of COVID-19 on work and personal well-being from the perspective of pharmacists practicing in community pharmacies in Nebraska. METHODS: A cross-sectional online survey collected data from pharmacists with an active Nebraska Pharmacist license (N=2763) from November 2022 to January 2023. The survey was a hybrid of researcher-developed items and the validated abbreviated Maslach Burnout Inventory (aMBI). The aMBI is a 9-item Likert-scale scored instrument, which captures three domains of burnout: Personal Accomplishment; Emotional Exhaustion; and Depersonalization. Data was analyzed using IBM SPSS Statistics version 27. RESULTS: The response rate to the survey was 12.3% (n=339). Mean age of the respondents was 44.8 years with an average of 18.7 years in practice. Most respondents (n = 113, 50.7%) practiced in a community pharmacy followed by hospital (n = 72, 32.3%). 55.8% of community pharmacists reported that they considered leaving their current employer. Chi-square analysis confirmed that community pharmacists are more burned out than noncommunity pharmacists. CONCLUSIONS: Pharmacists realized they had not been recognized for their contributions as frontline health care workers, which motivated them to consider leaving their employer and even the profession of pharmacy. This study found community pharmacists are burned out more than non-community pharmacists. Within community pharmacies, it was found that pharmacists practicing at corporate-owned community pharmacies had increased burnout compared to those practicing in independent community pharmacies.

Integrating Patient Safety Discussions with First-Year Doctor of Pharmacy Students in a Skills Lab Course.

The patient safety problem has been well established for over 20 years in the United States (U.S.), and there is a recognized focus on ensuring that health professions' trainees receive explicit education in various patient safety principles and practices. While the literature provides examples of different approaches towards patient safety education for pharmacy students, there are few that focus on first-year pharmacy students. This educational observational study describes the implementation and evaluation of two 20 min patient safety learning activities integrated into a required pharmacy skills lab course. The first learning activity utilized a mock prescription and patient safety checklist that had students identify patient safety problems on the prescription, followed by a group discussion of implications for the patient. The second learning activity used images of common safety problems with a facilitated group discussion to have students identify systems-based solutions to those problems. Our study's findings revealed that students were able to identify basic patient safety problems and safety solutions, although some additional foundational information may be needed, particularly for students who may not have pharmacy work experience. Additional research is needed to continue building a literature base on patient safety education approaches, particularly for first-year pharmacy students.

Enhancing application and long-term retention of clinical knowledge using an extracurricular non-credit course.

BACKGROUND AND PURPOSE: Curricular overload in doctor of pharmacy (PharmD) programs is necessitating innovative approaches to support student learning. The purpose of this study was to describe the design, delivery, and assessment of a non-credit extracurricular course that reinforced foundational concepts through the application of learning in case-based activities. EDUCATIONAL ACTIVITY AND SETTING: A 14-week extracurricular course, designed using principles of spaced repetition and interleaving in the context of case-based exercises, was offered to third-year PharmD students. Content focused on Top 300 and over-the-counter medications, brown bag sessions/drug utilization review, and medication therapy management. Short-term course effectiveness was assessed through post-course focus groups. Longitudinal effectiveness was assessed nine months post-course using an online survey. Qualitative data were analyzed using a content analysis process with overarching themes identified. Clinical interventions identified in the post-course survey were analyzed descriptively. FINDINGS: Twenty-four students completed the course and all assessments. Focus group themes were: (1) making connections to prior learning; (2) moving beyond memorizing facts; and (3) benefit from a low-stakes course. Students identified 162 course-linked clinical interventions during advanced pharmacy practice experiences (APPEs) in 16 different settings. SUMMARY: Student learning can be enhanced through integration of evidence-based teaching strategies both within and across the curriculum. This can be accomplished not only through introduction of an extracurricular course but through modification of existing courses. Providing additional opportunities for reinforcing core clinical knowledge and applying clinical decision-making in a low-stakes environment was well-received by students and helped them make clinical interventions during APPEs.

Effect of a Financial Education and Coaching Program for Low-Income, Single Mother Households on Child Health Outcomes.

The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017-2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes.

Effect of behavioural sampling methods on local and global social network metrics: a case-study of three macaque species.

Social network analysis (SNA) is a powerful, quantitative tool to measure animals' direct and indirect social connectedness in the context of social groups. However, the extent to which behavioural sampling methods influence SNA metrics remains unclear. To fill this gap, here we compare network indices of grooming, huddling, and aggression calculated from data collected from three macaque species through two sampling methods: focal animal sampling (FAS) and all-occurrences behaviour sampling (ABS). We found that measures of direct connectedness (degree centrality, and network density) were correlated between FAS and ABS for all social behaviours. Eigenvector and betweenness centralities were correlated for grooming and aggression networks across all species. By contrast, for huddling, we found a correlation only for betweenness centrality while eigenvector centralities were correlated only for the tolerant bonnet macaque but not so for the despotic rhesus macaque. Grooming and huddling network modularity and centralization were correlated between FAS and ABS for all but three of the eight groups. By contrast, for aggression network, we found a correlation for network centralization but not modularity between the sampling methodologies. We discuss how our findings provide researchers with new guidelines regarding choosing the appropriate sampling method to estimate social network metrics.

A Cross-Sectional Survey Study Examining the Provision of Continuous Glucose Monitoring Education in U.S. Doctor of Pharmacy Programs.

Continuous glucose monitoring (CGM) is used to help patients with diabetes and their healthcare providers more effectively manage care. CGM use is expanding to all healthcare settings where pharmacists practice and new pharmacy graduates may increasingly be asked to assist patients utilizing CGM devices and assess diabetes management through the interpretation of CGM data. The purpose of this study was to describe CGM education across Doctor of Pharmacy (Pharm.D.) programs in the United States. An online survey was administered to 139 accredited Pharm.D. programs. Information was solicited about CGM education, including curricular placement, course type, hands-on experience, and credential(s) of faculty providing the education. Fifty-seven programs responded with 51 (89.5%) providing CGM education for a median of 1.0 h. Of programs providing detailed responses, content was delivered in required (60.4%) or elective (45.8%) lectures as well as experiential settings (41.7%). Education occurred most frequently in the third year (58.3%), followed by the second (43.8%) and fourth (37.5%) years. Thirty-one (66.0%) programs were taught by a faculty member with an advanced diabetes credential. The results from this study confirm that there is an ongoing need to examine optimal amount, timing, and methods for providing CGM education.

Student Perceptions of an Interprofessional Short Course Designed to Increase Awareness of Human Trafficking.

Human trafficking is a global problem with significant impacts on victims' physical and emotional health. Many health care professionals lack human trafficking knowledge, leading to missed opportunities for intervention. This cross-sectional study used evaluation data from a short course on human trafficking to evaluate the course's perceived impact on students. Closed-ended questions were analyzed descriptively while open-ended questions were analyzed using qualitative content analysis. A total of 241 students across eight professions/disciplines completed the evaluation. The vast majority indicated course content was valuable, applicable to their future practice, and recognized interprofessional teamwork is needed to address human trafficking. Despite course effectiveness, there remains a need to continue expanding interprofessional engagement and examining the longitudinal impact of this educational effort.

Independent community pharmacies' provision of enhanced services: A mixed methods approach.

BACKGROUND: The pharmacy profession continues to broaden toward a patient-centered care practice. Pharmacy members of formal enhanced services networks are embracing this practice. However, descriptions of how pharmacies adopt a patient-centered care practice by providing enhanced services are not widely known. OBJECTIVES: To explore the pharmacy services of Nebraska independent community pharmacists within the context of the pharmacy profession's transition toward patient-centered care and determine if pharmacy participation in a formal enhanced pharmacy services network is associated with the provision of enhanced services. METHODS: A mixed methods approach was used by first conducting a cross-sectional quantitative survey, followed by a small qualitative study to further explain the survey findings. The survey of 193 Nebraska independent community pharmacies included members and nonmembers of the Nebraska Enhanced Services Pharmacies (NESP) network. Data were collected on the enhanced services offered. Survey analyses used descriptive and inferential statistics. Qualitative data on reasons for offering enhanced services and their profitability were subsequently collected using a focus group of 3 independent community pharmacy owners. The interview transcript analysis used coding to generate major themes. RESULTS: The survey response rate was 59%. Across all respondents, the average number of enhanced services offered was 17.3 out of 47 services studied. NESP members provided more enhanced services (x¯ = 20) than non-NESP members (x¯ = 16), P = 0.003. NESP membership was associated with the opinion that offering enhanced services increases profits, P = 0.016. The major themes were "NESP members have always been taking care of people" and "Profitability from enhanced services is key for sustainability of independent community pharmacies." CONCLUSION: Independent community pharmacies provide a range of enhanced services. NESP members provided more enhanced services than non-NESP members and focused on taking care of people by providing enhanced services. NESP membership may provide opportunities for pharmacies to offer more enhanced services to patients with the intent to improve patient-centered care.

Clinical impact of a pharmacist + health coach chronic disease management program in a rural free clinic.

OBJECTIVES: Recent data have demonstrated benefits of pharmacist-led protocols for chronic disease state management in the primary care setting. Health coaching has also been shown to improve patient outcomes and reduce health care costs. A program was initiated in August 2017 at a rural, free clinic to provide team-based, patient-centered care management through the use of pharmacist-provider collaborative practice and health coaching for patients with chronic diseases such as diabetes, hypertension, and hyperlipidemia. METHODS: After an initial patient examination, physicians could refer patients for management by the pharmacist + health coach team. Patients continued to see their primary care provider at least yearly and as needed. The pharmacist + health coach team provided a protocol-based approach to chronic disease management, as well as health education pertaining to diet and lifestyle recommendations. In-depth medication and disease state education were provided at each visit. Motivational interviewing was also conducted at each visit. Clinical metrics were collected at baseline and analyzed routinely after program initiation, including glycosylated hemoglobin (A1c), blood pressure, and lipids. Primary objectives were to evaluate the program's impact on A1c, blood pressure, and cholesterol outcomes. RESULTS: A total of 95 patients were included in the analysis (A1c n = 37; systolic and diastolic blood pressure n = 47; total cholesterol n = 40; low-density lipoprotein [LDL] cholesterol n = 38; high-density lipoprotein cholesterol n = 40; and triglycerides n = 40). From baseline to 1 year, statistically significant improvements were observed for A1c (mean ± standard deviation, 8.55 ± 2.58 to 7.04 ± 1.12, P < 0.001), systolic blood pressure (136.79 ± 20.04 to 123.15 ± 16.81, P < 0.001), diastolic blood pressure (87.94 ± 12.28 to 78.64 ± 10.98, P < 0.001), total cholesterol (198.25 ± 52.47 to 183.55 ± 47.22, P = 0.014), and LDL cholesterol (115.74 ± 43.56 to 105.92 ± 39.27, P = 0.040). CONCLUSION: A protocol-driven collaborative practice approach to chronic disease management by a clinical pharmacist in conjunction with health coaching by a registered nurse in a low-income, rural, primary care setting improved A1c, blood pressure, total cholesterol, and LDL cholesterol.

A Descriptive Study Examining Trends in Pharmacist-Authored Original Research Publications in the Journal of the American Medical Association Network from 2000 to 2019.

Pharmacists are expected to participate in the conduction of research to advance the profession and health care broadly. Additional opportunities for pharmacist research engagement have emerged with the increased integration of clinically trained pharmacists into interprofessional care teams. Research conducted over the past four decades has demonstrated an increasing trend of pharmacist-authored publications in medical journals. The purpose of this study was to build upon this work and investigate trends in pharmacist-authored original research publications within the JAMA Network over the past 20 years. A descriptive study design was used to retrospectively evaluate trends in the numbers of pharmacist-authored publications and authorship within those publications in nine JAMA Network journals. Data were aggregated into ten-year time periods (2000-2009 and 2010-2019) and compared using chi-square and Fisher's exact tests. Overall, pharmacist-authored publications significantly increased over the ten-year period (2.0% to 3.0%, p < 0.001), including in five specific journals: JAMA, JAMA Dermatology, JAMA Neurology, JAMA Ophthalmology, and JAMA Surgery. There was no change in first-and senior-authored publications. While the overall pharmacist publication trend was positive, room for significant growth remains. A deeper understanding of the barriers and facilitators to pharmacist engagement in research is needed, along with strategies to enhance pharmacist research training.

A MIXED-METHODS EVALUATION OF STANDALONE PERSONAL HEALTH RECORD USE BY PATIENTS WITH TYPE 2 DIABETES.

Background: Self-management of diabetes is key for achieving positive clinical outcomes, with personal health records (PHRs) proposed as a patient-centered technology for facilitating self-care. However, few studies have described patient engagement with a PHR, including facilitators and barriers to use from the perspective of actual users. Objectives: To compare use of a standalone PHR by patients with Type 2 diabetes to usual care through assessment of self-care behaviors, and short-term impact on social cognitive outcomes and hemoglobin A1c (HbA1c). Methods: A mixed-methods design combining a comparative effectiveness pilot with qualitative interviews was used. Qualitative interviews explored the primary outcome of changes in self-care behaviors, while quantitative data obtained from health records and a survey focused on social cognitive and clinical outcomes. Results: A total of 117 participants completed the study (intervention group = 56, control group = 61). Only 23 individuals used the PHR at least once after baseline. Five themes emerged from the qualitative analysis describing participants' experiences with the PHR and identifying reasons for lack of engagement. Quantitative findings supported qualitative results with no significant changes in HbA1c and only a significant increase in diabetes knowledge in the intervention group. Conclusions: Study findings revealed low PHR uptake and minimal impact on study outcomes, including lack of communication and information-sharing between patients and providers. Future research should explore the fit of PHRs within the context of other self-management tools, integration with provider workflow, and the need for enhanced functionalities beyond an information repository to optimally support patient self-care.

Prescribing and Safety of Direct-Acting Oral Anticoagulants Compared to Warfarin in Patients with Atrial Fibrillation on Chronic Hemodialysis.

ESRD patients receiving hemodialysis (HD) were excluded from landmark trials evaluating direct-acting oral anticoagulants (DOACs) in atrial fibrillation (AF). The objective was to evaluate prescribing and bleeding with DOACs compared to warfarin in AF patients with chronic HD. A retrospective, observational study of patients receiving warfarin or DOAC from April 2010-April 2016 from area health system hospitals and Dialysis Clinics, Inc. records. Data was analyzed using descriptive statistics, ANOVA, and chi-square. Ninety-one patients were included with warfarin as the initial OAC in most patients (n = 76) at average dose of 29 mg/week. Fifteen patients were initially prescribed apixaban (n = 12) or dabigatran (n = 3). Most switches in OAC therapy were to apixaban. When the initial OAC was a DOAC, it was not dosed appropriately in five with one bleed, two dosed appropriately had bleeds. When initial warfarin was switched to a DOAC, it was not dosed appropriately in seven with five bleeds. More bleeds occurred with warfarin alone (n = 18) vs. those on warfarin switched to DOAC (n = 5) vs. DOAC alone (n = 3), p = 0.022. All but four patients that bled had HAS-BLED scores three or higher. Warfarin was most often prescribed and associated with a higher incidence of bleeding compared to DOACs in this population of patients at high risk for bleeding. Larger studies should be conducted to analyze the impact of DOAC dose appropriateness on safety and clinical outcomes.

National survey of diabetes self-management program coordinators views about pharmacists' roles in diabetes education.

OBJECTIVES: To examine the viewpoints of diabetes self-management training (DSMT) program coordinators about the roles and engagement of pharmacists who participate in DSMT programs, and the engagement between community pharmacies and DSMT programs by developing and administering a nationwide survey. DESIGN: A mixed-methods exploratory sequential design; initial qualitative phase followed by a quantitative phase. Six in-depth interviews of DSMT program coordinators and intensive literature review informed the development of a 20-item survey instrument. Survey responses were descriptively analyzed, and themes were generated from context analysis of open-ended questions to generate the overall findings. SETTING AND PARTICIPANTS: The survey was distributed in 2017 to 742 active American Association of Diabetes Educators DSMT program coordinators in the United States. OUTCOME MEASURES: Proportion of DSMT programs engaging pharmacists and description of pharmacist's roles. Content areas pharmacists teach in DSMT programs. Challenges faced by pharmacists in completing 1000 direct patient hours as a prerequisite for attaining Certified Diabetes Educator certification and strategies used to overcome them. Perceived benefits of pharmacist involvement by coordinators and patients. RESULTS: One-third of DSMT programs have pharmacists involved with most using pharmacists as educators. Coordinators believe that pharmacist care is highly beneficial to patients and recognize that community pharmacist's care is an added benefit to patients. However, collaborative practices are not well established between community pharmacists and DSMT programs. Program coordinators identified challenges they face when trying to involve community pharmacists in program delivery. CONCLUSION: Coordinators of DSMT programs and their patients see pharmacists' care as highly beneficial within DSMT programs. Increasing participation and scope of community pharmacists' involvement is desired by both DSMT coordinators and the patients they serve. There is substantial growth potential for both greater involvement of pharmacists in DSMT programs and enhancing links to community pharmacists' care.

Error types with use of medication-related technology: A mixed methods research study.

BACKGROUND: Health information technology has been integrated throughout the medication use process to enhance safety, quality, and care efficiency. However, technologies have the potential to eliminate or reduce, but also create some new types of errors. OBJECTIVE: Assess specific error types before and after the incorporation of two different health information technologies (HITs), e-prescribing and automated dispensing cabinets (ADCs), into pharmacists' daily work. METHODS: A mixed methods design guided use of a pre-existing database of pharmacist survey responses describing patient safety HIT-related issues in the form of errors prevented and errors observed. In vivo descriptive text responses were converted into error types. Descriptive analysis was performed to characterize the error types associated with each HIT. RESULTS: Four error types were eliminated with the use of e-prescribing, three new error types emerged, and three error types persisted. With ADC use, four error types were eliminated, three new error types emerged, and three error types persisted. CONCLUSION: Each technology has its own error types, and some persist regardless of HIT use. There is a need to determine optimal risk reduction approaches for each unique HIT introduced, and design safety practice improvement for error types unaffected by the introduction of HIT use.

Health Information Technology Use and Patient Safety: Study of Pharmacists in Nebraska.

This study aimed to describe the impact of 13 different health information technologies (HITs) on patient safety across pharmacy practice settings from the viewpoint of the working pharmacist. A cross-sectional mixed methods survey of all licensed practicing pharmacists in 2008 in Nebraska (n = 2195) was developed, pilot-tested and IRB approved. One-fourth responded (24.4%). A database of pharmacists' responses to closed-ended quantitative questions and in vivo qualitative responses to open-ended questions was built. Qualitative data was coded and thematically analyzed, transformed to quantitative data and descriptive and relational statistics performed. One-third were involved in an error of any kind in the six months preceding the survey, and half observed an error or "near miss". Most errors or near misses were attributed to workload. When asked specifically about the 13 HITs, these participants reported 3252 observations about the types of errors that were associated with each. These were reports about either error types reduced or eliminated by integration of HIT (n = 1908) or occurring in association with a specific technology's use (n = 1344). Integration of HIT into pharmacy practice also introduced new error types such as excessive alert programming in the pharmacy computer systems clinical information support causing pharmacists to experience alert fatigue and ignore warnings or bar code scanners mismatching NDC codes of products resulting in wrong drug product identification. Continued vigilance is essential to identifying patient safety issues and implementing safety strategies specific to each HIT.

Report of the 2018-2019 Research and Graduate Affairs Committee.

The 2018-2019 Research and Graduate Affairs Committee (RGAC) was charged with critically evaluating the leadership development support necessary for pharmacy researchers, including postdoctoral trainees, to develop the skills needed to build and sustain successful research programs and analyzing how well those needs are being met by existing programs both within AACP and at other organizations. The RGAC identified a set of skills that could reasonably be expected to provide the necessary foundation to successfully lead a research team and mapped these skills to the six domains of graduate education in the pharmaceutical sciences established by the 2016-2017 RGAC (Table 1). In addition, the RGAC identified competency in team science and the bench-to-bedside-to-beyond translational spectrum as being critical elements of research leadership. The universality of these skills and their value prompted the RGAC to make two related recommendations to AACP: [Table: see text] Recommendation 1: AACP should promote the development and use of strategies to ensure intentional and ongoing professional development, such as Individual Development Plans. Recommendation 2: AACP should explore collaborative research leadership development opportunities between faculty at research-intensive institutions and faculty at non-research-intensive institutions. The RGAC also examined programs available at AACP and other national organizations that could help pharmacy faculty develop foundational skills for research leadership (Table 2). The RGAC administered two surveys, one to administrators responsible for research at colleges and schools of pharmacy and one to faculty members at pharmacy schools, to gather information about training needs, programming and support available for research leadership development. Administrators and faculty agreed that research is important for career advancement for faculty, and almost all administrators reported their schools provide funds, release time and mentoring for participation in research career development. However, a lack of faculty awareness regarding programs and available support may be a barrier to participation. The RGAC therefore makes two recommendations and one suggestion related to AACP programming: [Table: see text] Recommendation 3: AACP should expand research leadership development opportunities building from existing programs such as ALFP and AACP Catalyst, with consideration placed on developing programs that promote collaborative research. Recommendation 4: AACP should collaborate with other professional organizations to expand research leadership development opportunities across the academy. Suggestion 1: Colleges and schools of pharmacy should take a proactive role in promoting and facilitating research leadership development for faculty. The RGAC separately examined the research leadership development needs of postdoctoral trainees, recognizing the distinct needs of trainees along the PhD or PhD/PharmD, PharmD/fellowship, and PharmD/residency paths. A review of organizational resources and opportunities for post-doctoral trainees available from national organizations, including AACP, was undertaken (Table 5). The RGAC sees an opportunity for AACP to foster research development of those trainees whose career track will likely be in clinical practice and makes one recommendation and one suggestion related to postdoctoral trainees: Recommendation 5: AACP should support and/or develop programs and activities for pharmacy residents seeking to transition into faculty positions to acquire the skills necessary to develop and lead research programs. Suggestion 2: Colleges and schools of pharmacy should include postdoctoral trainees with academic interests in research leadership development opportunities available to junior faculty. In addition, the RGAC proposed one policy statement that was adopted July 2019 by the AACP House of Delegates: Policy Statement: AACP recognizes the positive role that research leadership development can play in the success of early and mid-career faculty.

A Pharmacist's Role in a Dental Clinic: Establishing a Collaborative and Interprofessional Education Site.

BACKGROUND: Dental patients often have comorbidities and take multiple medications, some of which could impact their dental health and treatment. A pharmacist in a dental clinic can assist with the gathering, documentation and evaluation of a dental patient's medication history as it pertains to their dental visit and overall health. PURPOSE: To develop and implement a collaborative and interprofessional education program with a pharmacist providing services in a dental school clinic. SUMMARY: Creighton University School of Dentistry, a student-operated dental clinic located in Omaha, Nebraska, provides dental care by student dentists, faculty and staff to the surrounding community in a learning-focused environment. A pharmacist was incorporated into the dental clinic to create and establish an interprofessional relationship with both dental students and faculty beginning August 2014. Pharmacy students on an ambulatory care advanced pharmacy practice experience rotation were eventually added to the team. The pharmacy team provided medication therapy management services including disease state and medication counseling, medication reconciliation, identifying drug-related problems and dental implications of medications, and recommendations for prescribed medications. CONCLUSION: The pharmacy team's presence was largely accepted by dental faculty, staff, dental students, and patients. Pharmacists can play an important role in a dental clinic by performing thorough health and medication histories and communicating with dental and medical providers involved in a patient's care.

An online health informatics elective course for doctor of pharmacy students.

OBJECTIVE: To describe the development and assessment of an online elective health informatics course and determine its potential for universal integration into doctor of pharmacy (PharmD) curricula. DESIGN: A 2-credit hour online elective course was developed and offered to all PharmD students; voiced-over Powerpoint lectures were used to deliver content. ASSESSMENT: Assessment of student performance was measured using quantitative metrics via discussion questions, quizzes, written papers, and examinations. Qualitative findings were measured through discussion questions, a goal-setting classroom assessment technique, and an end-of-course reflection. Students report finding value in the course and recognizing how the knowledge gained could impact their future practice as pharmacists. CONCLUSION: An online course in health informatics can be an effective way to deliver content and provide a blueprint for continued integration of the content into curricula.

A Qualitative Case Study Exploring Nurse Engagement With Electronic Health Records and E-Prescribing.

There is a national focus on the adoption and use of electronic health records (EHRs) with electronic prescribing (e-Rx) for the goal of providing safe and quality care. Although there is a large body of literature on the benefits of adoption, there is also increasing evidence of the unintentional consequences resulting from use. As little is known about how use of EHR with e-Rx systems affects the roles and responsibilities of nurses, the purpose of this qualitative case study was to describe how nurses adapt to using an EHR with e-Rx system in a rural ambulatory care practice. Six themes emerged from the data. Findings revealed that nurses adjust their routine in response to providers' preferential behavior about EHR with e-Rx systems yet retained focus on the patient and care coordination. Although perceived as more efficient, EHR with e-Rx adoption increased workload and introduced safety risks.