Continuous quality improvement regulations for community pharmacy practice in the United States.

OBJECTIVES: In the United States, medication errors are considered to be the cause of 7000 deaths annually. Continuous quality improvement (CQI) is a management process that focuses on continually and systematically evaluating the organization's work process. In community pharmacy, CQI leads to enhanced patient safety through a reduction in medication errors and quality-related events (QREs). There is limited information about the variations in CQI regulations required by State Boards of Pharmacy (SBPs) for community pharmacy across the country. The objective of this study is to comprehensively describe CQI regulations required by SBPs for community pharmacy practice in the United States. METHODS: This was a cross-sectional study. Information regarding SBPs community pharmacy CQI regulations was collected electronically by surveying a representative of each SBP. In addition, a review of State Pharmacy Laws published online complemented the survey data. The percentage of states with CQI regulations for community pharmacy was estimated. RESULTS: Of the 50 Boards, 16 require pharmacies to maintain CQI programs to monitor and prevent QREs in community pharmacy. The most common elements of CQI programs include the management of known, alleged, and suspected medication errors that reach the patient (73%) and regular reviews of the pharmacy's aggregate data of medication errors or incidents (73%). The North Dakota SBP regulation is the most comprehensive, followed by that of Iowa, Maryland, Massachusetts, and Montana. CONCLUSION: There is wide variation among SBP CQI regulations for community pharmacy practice. Standardization of CQI programs across Boards, including a national database for reporting medication errors and QREs would enhance patient safety.

Point-of-care coagulation monitoring: first clinical experience using a paper-based lateral flow diagnostic device.

Vitamin K antagonists such as warfarin are the most widely used class of oral anticoagulants. Due to a narrow therapeutic window, patients on warfarin require regular monitoring. Self-testing using point-of-care (POC) diagnostic devices is available, but cost makes this monitoring method beyond reach for many. The main objective of this research was to assess the clinical utility of a low-cost, paper-based lateral flow POC diagnostic device developed for anticoagulation monitoring without the need for a separate electronic reader. Custom-fabricated lateral flow assay (LFA) test strips comprised of a glass fiber sample pad, a nitrocellulose analytical membrane, a cellulose wicking pad, and a plastic backing card were assembled in a plastic cassette. Healthy volunteers and patients on warfarin therapy were recruited for this prospective study. For each participant, a whole blood sample was collected via fingerstick to determine: (1) international normalized ratio (INR) using the CoaguChek® XS coagulometer, (2) hematocrit by centrifugation, and (3) red blood cell (RBC) travel distance on the experimental LFA device after 240 s using digital image analysis. RBC travel distance measured on the LFA device using blood samples obtained from warfarin patients positively correlated with increasing INR value and the LFA device had the capability to statistically distinguish between healthy volunteer INR values and those for patients groups with INR ≥ 2.6. From these data, it is predicted that this low-cost, paper-based LFA device can have clinical utility for identifying anticoagulated patients taking vitamin K antagonists who are outside of the desired therapeutic efficacy window.

Academia's Support of Community Pharmacy in This Time of Transformation.

Community pharmacy is currently experiencing significant changes that will likely transform practice in unpredictable ways. With student interest in pursuing community pharmacy practice postgraduation on the decline, the Academy needs to ensure that a sufficient number of students passionate in community practice enter the workforce to guide this transformation in a positive manner for the profession and patients. This commentary reviews the ways that pharmacy faculty may promote community pharmacy during the students' academic experiences. These include being mindful of the messages we send our students, promotion of community pharmacy postgraduate training, optimization of community-focused adjunct faculty relationships, and reviewing curricula to ensure contemporary community aspects.

Design and evaluation of an application-based pharmaceutical calculations review module.

BACKGROUND AND PURPOSE: To describe the design of an application-based calculations review module, determine retention of skills learned in a calculations course, determine student ability to identify information necessary to solve calculations, and evaluate student perceptions. EDUCATIONAL ACTIVITY AND SETTING: Three student cohorts completed the calculations application-based review module. All students passed a required pharmaceutical calculations course previously (17 months prior for Cohort 1 and nine months prior for Cohorts 2 and 3). The activity included seven themed stations each with three questions. Each question was categorized by calculation type. Students utilized stock bottles and patient chart information to solve problems. For select stations, necessary information was missing, and students had to request it. Each student completed an activity evaluation form. FINDINGS: Two hundred ninety students completed the module (90, 102, and 98 in Cohorts 1, 2, and 3, respectively). Two hundred eighty students (97%) completed the activity assessment form. The overall average score was 85.1%, which did not differ significantly among the cohorts. Cohort 1 performed significantly lower on dosage, unit conversion, ratio, and milliosmole calculations. Almost all (96.4%) students agreed the activity reinforced lecture material, and 90% agreed the activity improved their ability to perform in future pharmacy practice. Participating students scored significantly higher on a pre-graduation math skills assessment. SUMMARY: Some calculation types, such as dosage, unit conversion, ratio, and milliosmoles may warrant more closely spaced reinforcement activities in the curriculum. Inclusion of the review module was associated with increased knowledge retention.

Challenges and Facilitators of Implementing a Physician-approved Naloxone Protocol: A Mixed-methods Study.

OBJECTIVES: In 2015, the State of Ohio passed legislation to allow pharmacists to dispense naloxone under a physician-approved protocol. The legislation allows all individuals authorized under a physician-approved protocol to personally furnish naloxone without requiring clients to be seen by a licensed prescriber, thus expanding the capacity of Ohio's community distribution programs. We aimed to evaluate the implementation of legislation allowing for a physician-approved protocol in pharmacies and other naloxone distribution sites in Ohio, and to compare barriers and facilitators of implementing the law changes among sites that implemented a physician-approved protocol versus sites that did not. METHODS: The study used a convergent parallel mixed-method design. Random samples from all pharmacies registered with the State of Ohio Board of Pharmacy and community naloxone distribution sites were selected. Quantitative data were collected via survey (n = 168) and qualitative data were collected via semi-structured interviews (n = 17). RESULTS: Most survey respondents agreed that the policy has expanded access to naloxone at their site for individuals who want or need the medication. Both pharmacies and other naloxone distribution sites identified that leadership and organizational support facilitated protocol implementation and cost, stigma, and lack of naloxone demand challenged protocol implementation. CONCLUSIONS: The study identified barriers and facilitators to the implementation of a physician-approved protocol within Ohio. The majority of respondents stated they could implement a protocol. However, barriers of cost, lack of public awareness of naloxone availability, and stigma remain for pharmacies and other naloxone distribution sites.

Motivational interviewing education: Creation and assessment of a learning module implemented among advanced pharmacy practice students.

BACKGROUND AND PURPOSE: The purpose of this prospective nonrandomized study (quasi-experimental), pre-/post-intervention design was to implement and assess a formal orientation training program for Advanced Pharmacy Practice Experience (APPE) students focusing on skills related to motivational interviewing (MI). EDUCATIONAL ACTIVITY AND SETTING: Students were assessed on their knowledge, perceived ability, and perceived need to incorporate MI in practice using a pre-/posttest. Ability was assessed via student-conducted patient interviews, and performance was compared to published standards. Satisfaction with the training program was reviewed using a Likert scale questionnaire. Fourteen APPE students from three colleges of pharmacy were enrolled based on pre-assigned community experience placement. Students participated in a didactic training phase consisting of on-line knowledge acquisition and assessments. A modeling phase was implemented with role-play experiences and simulated video assessments. A shadowing phase was incorporated consisting of students observing a preceptor prior to independently conducting patient interviews. Interactions were audio recorded and reviewed by a preceptor with verbal and written feedback provided twice monthly using a standardized rubric. FINDINGS: Data revealed statistically significant improvements in all categories of the pre-/posttest. MI ability results showed statistically significant improvements as well. Performance scores were higher than goal values in video simulated assessments. Overall student satisfaction with the training program was 4.3 out of 5. DISCUSSION AND CONCLUSIONS: Data suggests the training program increased students understanding and ability to perform MI in patient interviews. High quality of student performance is also suggested due to trained students' post scores being higher than goal values published by scoring manual.

Impact of a required pharmaceutical calculations course on mathematics ability and knowledge retention.

OBJECTIVE: To assess doctor of pharmacy (PharmD) students' mathematics ability by content area before and after completing a required pharmaceutical calculations course and to analyze changes in scores. METHODS: A mathematics skills assessment was administered to 2 cohorts of pharmacy students (class of 2013 and 2014) before and after completing a pharmaceutical calculations course. The posttest was administered to the second cohort 6 months after completing the course to assess knowledge retention. RESULTS: Both cohorts performed significantly better on the posttest (cohort 1, 13% higher scores; cohort 2, 15.9% higher scores). Significant improvement on posttest scores was observed in 6 of the 10 content areas for cohorts 1 and 2. Both cohorts scored lower in percentage calculations on the posttest than on the pretest. CONCLUSIONS: A required, 1-credit-hour pharmaceutical calculations course improved PharmD students' overall ability to perform fundamental and application-based calculations.