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Introduction: Venous thromboembolism (VTE) remains a leading cause of preventable harm among hospitalized patients. Pharmacologic VTE prophylaxis reduces the rate of in-hospital VTE by 60%, but medication administration is often missed for various reasons. Electronic medical record (EMR) prompts may be a useful tool to decrease withholding of critical VTE chemoprophylaxis medications. Methods: In August 2021, an EMR prompt was implemented at a tertiary referral academic medical center mandating nursing staff to contact a provider for approval before withholding VTE chemoprophylaxis. A pre-intervention group from August 2020 to August 2021 was compared to a post-intervention group from August 2021 to August 2022. Rates of VTE chemoprophylaxis withholding were compared between the groups with a P <.01 considered significant. Results: A total of 16,395 patients prescribed VTE chemoprophylaxis were reviewed, with 13,395 (81.7%) receiving low molecular weight heparin. Of the 16,395 patients included, 10,701 (65.3%) were medical and 5694 (34.7%) were surgical. Patients in the pre-intervention cohort (n = 8803) and post-intervention cohort (n = 7592) were similar in hospital length of stay and duration of DVT prophylaxis. In the post-intervention group, the frequency of surgical patients with at least one missed dose had increased by 4.2% (P =.002), with the trauma and acute care surgery (TACS) show an increase of 6.6% (P <.001). However, the frequency of medical patients and non-TACS patients with missed doses decreased by 3.1% (P =.002) and 1.0% (<.001), respectively. Conclusions: EMR prompts appear to be a low-cost intervention that increases the rate of VTE prophylaxis administration among medical and elective surgery patients. [ABSTRACT FROM AUTHOR]

Palanisamy Amirthalingam,1 Abdulrahman Sulaiman Alruwaili,2 Omar Ahmed Albalawi,2 Fayez Mohammed Alatawi,2 Saleh F Alqifari,1 Ahmed D Alatawi,3 Ahmed Aljabri4 1Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 2Pharm.D Program, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia; 4Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Palanisamy Amirthalingam, Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, P.O. Box 741, Tabuk, 71491, Saudi Arabia, Email pchettiar@ut.edu.saIntroduction: The adoption of automated drug dispensing systems (ADDS) in hospital pharmacies is a global trend, driven by its potential to reduce dispensing errors, minimize prescription filling time, and ultimately, improve patient care services. However, a significant research gap exists in the field, as a comprehensive assessment of patient satisfaction with ADDS is currently lacking. This study, with its comprehensive approach, aims to fill this gap by comparing patient satisfaction between hospital pharmacies implementing ADDS and traditional drug dispensing systems (TDDS).Patients and Methods: The cross-sectional study was conducted in hospitals adopting ADDS and TDDS. All the outpatients aged 18 or above who visited the pharmacy were included, and severely ill patients were excluded from the study. A 17-item, 5-point Likert scale questionnaire assessed the participant’s satisfaction. The questionnaire has four domains: pharmacy administration, dispensing practice, patient education, and dispensing system.Results: The demographics of the study participants were normally distributed between ADDS and TDDS according to chi-square analysis. The mean participant satisfaction was significantly (P< 0.05) higher in ADDS than in TDDS regarding all the items of dispensing practice and dispensing system domains. Three items related to the pharmacy administration domain showed significant participant satisfaction with ADDS. However, the participants’ satisfaction showed no significant difference (p=0.176) between ADDS and TDDS in terms of the cleanliness of the pharmacy. Also, the participant’s satisfaction between ADDS and TDDS was not statistically significant regarding the pharmacist’s explanation of the side effects (p=0.850) and provision of all necessary information to the patient (p=0.061) in the patient education domain.Conclusion: Patient satisfaction was higher in the ADDS participants than in TDDS regarding pharmacy administration, patient education, dispensing practice, and systems. However, pharmacists in ADDS need to be motivated to transfer the advantages of ADDS to patient care, including comprehensive patient education, particularly on side effects.Keywords: automated drug dispensing system, dispensing practice, dispensing system, patient satisfaction, pharmacy administration, traditional drug dispensing system

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) dapagliflozin and empagliflozin are indicated for heart failure with reduced ejection fraction (HFrEF) for cardiovascular death and heart failure hospitalization risk reduction. Due to the recent nature of these data, prescribing of SGLT2is may be suboptimal. Objective: This study sought to assess the prevalence of SGLT2i prescriptions at hospital discharge for HFrEF. Methods: A retrospective chart review was conducted on HFrEF patients discharged from April 1st to December 31st, 2021 from one academic medical center in the United States. The primary objective was to determine the percentage of eligible patients prescribed SGLT2i at discharge and the secondary objective was to characterize covariates impacting prescription. Results: Overall, 115 patients were included. The mean age was 72 ± 14.25 years. The majority were male (73.9%) and Caucasian (74.8%). At discharge, 15.7% of patients were prescribed an SGLT2i, although 94.8% were eligible. Baseline characteristics and concomitant medications did not differ significantly, although the mean number of discharge medications differed significantly between those prescribed an SGLT2i (15.78 ± 6.77) and those not (12.05 ± 5.28) (P = 0.023). Conclusions: SGLT2is are under-prescribed at discharge for HFrEF patients, despite many being eligible. Further studies should be done to elucidate factors that influence the under-prescription of SGLT2is. [ABSTRACT FROM AUTHOR]

In the United States, the scope of practice of pharmacists is determined primarily at the state level. Not all state laws expressly permit or prohibit pharmacists from providing certain services; in between is a grey area of legal silence. Does legal silence permit pharmacists to perform a service that is not specifically permitted, but not expressly prohibited? Point-of-care testing provides a useful case study in legal silence: there are 1536 pharmacies currently holding a CLIA-waiver to administer tests in states reporting that pharmacists are not expressly permitted to administer tests. Legal silence may even provide a better framework for pharmacy based testing as it is naturally inclusive of any point-of-care test and no laws need updated when a new test comes to the market. Other health professions navigate this legal silence by governing according to a "standard of care." Rather than specifying a list of services a health professional can or cannot provide in law, it provides a flexible framework for the health professional to provide any service that other similarly situated health professionals would provide in the same or similar situation. A standard of care regulatory framework should thus be the target of the pharmacy profession in order to advance patient care. [ABSTRACT FROM AUTHOR]

The author offers insights on operations centers, also known as control rooms, and their incorporation into hospital pharmacy design. Topics discussed include the functions of operations centers, the design of operations centers, and examples of display data to be found in clinical pharmacist workstations.

Introduction: Hematology/oncology pharmacists work in various roles in healthcare systems and represent a highly skilled and valuable resource. There remains a significant challenge in the recruitment and retention of these well‐trained pharmacists. We sought to identify key factors and propose solutions to impact the ability to recruit, promote, and retain pharmacists. Methods: An initial survey in 2021 assessed the status of the oncology pharmacist workforce with regard to job satisfaction and attrition risk. Based on the top 5 factors identified in the Initial Survey, a Follow‐Up Survey was conducted in 2022 to further understand top dissatisfiers in the workplace. To address these factors, an in‐person collaborative workshop was conducted in 2023 with a focus on creating action plans around the practice model, professional development, well‐being, and metrics. Results: A total of 392 individuals participated in the Follow‐Up Survey. Most were 31–40 years of age (56%), female (70%), Caucasian (78%), and from academic medical centers (68%). Of the 367 individuals who responded to factors contributing to dissatisfaction at work, 51 of the respondents selected all five factors. The most common factor was the practice model (77%), followed by burnout/well‐being (74%), leadership (62%), professional development (56%), and metrics (32%). At the workshop, teams worked collaboratively to review detailed data, evaluate root causes, define a goal future state, and build recommendations for incremental steps to pursue progress in each of these areas. Discussion: Utilizing key information learned from both the Initial and Follow‐Up Survey, the Oncology Pharmacy Workforce Collaborative demonstrated that the key themes are interconnected and institutional support is essential in modernizing practice models, revamping professional development, creating better measures of direct and indirect patient care activities, and ensuring effective support for well‐being. [ABSTRACT FROM AUTHOR]

The authors explore the lessons learned from a pharmacy technician apprentice program by the Cleveland Clinic School of Pharmacy Technology in collaboration with the Cleveland Clinic department of pharmacy. Topics discussed include the beginning of the apprentice program as a pilot program in 2019, barriers to the program's growth, and the challenges faced by the apprentices.

Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient's medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital's outpatient CPEP within 30-days (P =.012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P =.024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings. [ABSTRACT FROM AUTHOR]

The digital transformation movement persuaded many pharma companies towards greater adoption of digital marketing and e-commerce. This was accelerated even more by the COVID-19 crisis. Therefore, this study aims to explore the general perception and attitude of consumers in Malaysia regarding the use of online shopping and digital marketing tactics for OTC drugs. Thirteen in-depth interviews were conducted between September and November 2020. A thematic content analysis approach was used to analyse the qualitative data. Key themes emerging from the interviews included: (1) general perception of OTC drug consumers regarding digital marketing; (2) attitude of consumers towards the purchase of OTC drugs; (3) factors affecting OTC drug consumer behaviour; and (4) perception of consumers towards online advertisements for OTC drugs. The majority of the study participants believe that digital marketing has a direct or indirect impact on their purchasing decisions as OTC consumers. Although most rely mainly on offline purchases for OTC products, they have shown a willingness to increase their adoption of online purchasing methods, particularly in the aftermath of the COVID-19 outbreak. These findings can be useful to public and private healthcare managers on a practical level. [ABSTRACT FROM AUTHOR]

Purpose Pharmacy administrators play a critical role in the success of health systems, yet pathways to pharmacy administration are incompletely understood. The purpose of this study was to explore and describe pathways to becoming a health-system pharmacy administrator, including challenges experienced and resources needed. Methods Participants (N = 21) individually completed one or more journey maps detailing the pathway(s) to pharmacy administration and then engaged in small group discussion to identify common themes. A large group debrief was used to share and identify findings across small groups. Thematic analysis was utilized to identify common ideas shared. Results There was variation across the maps, illustrating many steps one might follow to become a pharmacy administrator. In the 23 maps completed, pathways most frequently began with pharmacy school (n = 9, 39.1%), high school (n = 6, 26.1%), or undergraduate training (n = 4, 17.4%). Most included residency training or dual master's of science in health-system pharmacy administration/residency training (n = 16, 69.6%). Common challenges included distractions, time constraints, grades/performance, financial constraints, and stress. Common resources needed included exposure to diverse career paths, pipeline and outreach support, mentoring, and leadership. Themes included debate about the definition of a pharmacy administrator, questions regarding the core competencies of the pharmacy administrator, discussion regarding ways to enter pharmacy administration, and reflection on the role of serendipity and networking. Conclusion Understanding the pathways to pharmacy administration is critical to fostering a sustainable and competent workforce. Work must be done to identify strategies and develop processes for identifying, equipping, and retaining talented health-system pharmacy administrators and leaders. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the quality of effective discharge communication to primary practice from a hospital that uses ieMR (integrated electronic Medical Record), a complete electronic prescribing/medical record platform. Methods: A retrospective quantitative analysis of 232 discharge encounters from a major tertiary hospital assessed the discharge summary quality; timeliness, completeness and medication information. Results: Median time to discharge summary was 1 day. 22.0% of discharge summaries were incomplete at 30 days post discharge and 44.5% of discharge summaries were incomplete at 30 days post discharge if discharged on a weekend compared to weekday (P -value = 0.001). Rates of medication reconciliation were completed at approximately 35% at each point of the patient stay and 56.9% of patients had a GP discharge summary listing discharge medications. However, if certain progressive steps were completed (i.e. Home Medications recorded in ieMR, Discharge Reconciliation in ieMR, and Patient Discharge Medication Record in eLMs (Enterprise-wide Liaison Medication System)), then, the 'Medications on Discharge' was significantly more likely to be present in the discharge summary, at rates of 70.1%, 85.9%, and 98.6% respectively (P -value = 0.007, <0.001, <0.001). Conversely not doing these steps dropped rates of having medications listed in the discharge summary to 50.0%, 40.3% and 34.1% respectively. Conclusions: This study assessed current discharge summary quality since the introduction of electronic medical records. It demonstrated the significant value of correct use of electronic programs, including performing all crucial steps of reconciliation. Targeted interventions in future studies that rectify the shortfalls in discharge communication are warranted. Significant digital advances to hospital communication practices have occurred over the last 15 years, including technology-based methods to generate discharge summaries. An audit of discharge communication from a major tertiary hospital utilising a complete electronic prescribing/records platform showed there are large deficits in the quality and timing of information going to primary care after discharge. Incorrect use of electronic platforms can have major negative effects on the quality of discharge communication. Workflow processes must put a higher regard to correctly working in-line with the way these programs are designed. [ABSTRACT FROM AUTHOR]

Purpose: To determine the impact of a business intelligence dashboard tool to optimize automated dispensing cabinets (ADCs). Methods: A pre-post implementation design was used to evaluate key performance indicators (KPI) before and after the implementation of a dashboard tool to optimize ADCs. Eleven ADCs were optimized in 2 phases according to dashboard recommendations: (1) removal of unused medications over 90 days, (2) adjusting periodic automatic replenishment (PAR) levels, and (3) addition of commonly dispensed medications. The KPI measures that were assessed included inventory cost, no. of stocked medications, stockout percentage, vend to refill ratio, and missing dose messages from nursing. An interrupted-time-series regression was used to quantify the impact of ADCs on the means of measured KPIs. Results: Differences in mean distribution of all KPIs, except missing dose, between the pre- and post-ADC periods during the Phase 1 period were statistically significant: inventory cost (54.2 vs 56), stockout percentage (1.55 vs 1.12), vend to refill ratio (6.83 vs 6.14), and missing dose messages (221 vs 229). Only the mean ADC utilization (57.3 vs 64) and missing dose (228 vs 179) were statistically different between the pre- and post-ADC periods in Phase 2. The interrupted-time-series analysis showed that Phase 1 optimization significantly reduced the cost of inventory (β = −$1.238.00, P <.01), no. Stocked medications (β = −8.2, P <.01), percent stockout (β = −.49%, P <.01), vend-to-refill ratio (β = −1.29%, P<.01) and ADC utilization (β = −.2, P <.01). Conclusion: Automated dispensing cabinets optimization, through the use of a dashboard tool, had a positive impact on almost all measured KPIs. [ABSTRACT FROM AUTHOR]

Introduction: Hyperinsulinemia-euglycemia therapy [HIE] is a first line therapy recommended in symptomatic calcium channel blocker overdose patients. HIE, particularly if administered in concentrations typically used for glycemic control, would result in a substantial amount of hypotonic fluid administration, which places patients at risk of volume overload. Therefore, it may be beneficial to utilize a concentrated insulin as a strategy to mitigate fluid overload risks. We report the case of a 73 years old, 69.9 kg female, who presented to the emergency department after an accidental ingestion of 70 mg amlodipine and was treated with HIE utilizing a uniquely concentrated insulin infusion. Case Presentation: HIE at 10 units/kg/hr. was used for approximately 17 hours. Insulin was changed from a 1 unit/mL concentration to 16 unit/mL. Dextrose 10% infusion was initiated up to a max of 650 mL/hr. and norepinephrine infusion up to a max of 10 mcg/min. Discussion: Approximate fluid requirements from the 16 unit/mL concentration of insulin totaled 1 L as compared to a 1 unit/mL concentration which would have required 17 L, a total savings of 16 L. This savings potentially decreased the risk of cerebral or pulmonary edema associated with fluid overload. Conclusion: Use of a concentrated insulin in the setting of a calcium channel blocker or beta blocker overdose provides a unique strategy to mitigate the effects associated with fluid overload. [ABSTRACT FROM AUTHOR]

The article presents a call to action to advance health equity among LGBTQIA+. Topics discussed include effects of the lack of representation within pharmacists for the diverse populations that pharmacists serve, how a pharmacist can be transformed from an ally to an accomplice, and the need to expose trainees to diverse identities.

The job of a critical care pharmacy specialist has evolved to include quality improvement and administrative tasks. As such, the American Society of Health‐System Pharmacists (ASHP) highlights specific goals and objectives to ensure post‐graduate year two (PGY2) critical care residents are sufficiently trained to perform these tasks. The PGY2 critical care pharmacy residency leadership at the University of Kentucky sought to develop a 4‐week learning experience entitled, "Critical Care Administration/Medication Use Quality & Outcomes," as a unique rotation to capture these requirements and activities. The focus of this commentary is to serve as a guide for other residency programs to develop such a rotation, highlight resulting resident contributions to the department, describe perceived benefits of this rotation for residents, and highlight how this rotation impacted graduated residents' early years as practitioners. This learning experience is pivotal to providing a more balanced view of the entire medication use process and the healthcare ecosystem during a specialty residency. PGY2 critical care residents can gain valuable experiences away from the bedside that better prepare them for future tasks in addition to patient care that will be expected of them as clinical pharmacists. [ABSTRACT FROM AUTHOR]

Purpose This project describes and quantifies the perceived degree of digital visibility to medication inventory throughout 6 large health systems. Methods In this project, 6 large health systems evaluated their physical medication inventory for digital visibility, or the degree to which physical medication inventory information is viewable in electronic systems, during a 2-year period (2019-2020). Inventory reports included medication items with either a National Drug Code (NDC) or a unique institutional identifier. Physical inventory reports contained the medication item name and a corresponding NDC or identifier, the quantity on hand, and the physical locations and the storage environments of the inventory items at the time of the audit. Investigators independently reviewed physical inventory reports and categorized medication line items by degree of digital visibility: (1) no digital visibility, (2) partial digital visibility without accurate quantities, (3) partial digital visibility with accurate quantities, or (4) full digital visibility. Data were anonymized, aggregated, and analyzed to characterize the degree of digital visibility across the health systems and to identify locations and storage environments where the greatest improvement is needed. Results Overall, less than 1% of medication inventory was judged to have full digital visibility. The majority of the evaluated inventory items were categorized as having partial digital visibility, with or without accurate quantities. Analysis by both units of inventory and inventory valuation indicated that only 30% to 35% of inventory had full digital visibility or partial digital visibility with accurate quantities. Conclusion Most of the medication inventory within 6 large academic centers is either not digitally visible or partially digitally visible but without accurate quantities. Full digital visibility of inventory is rare. Better digital visibility can minimize disruption from recalls and decrease waste. Technology vendors and health systems must collaborate to develop improved automation and systems to make medications on hand more digitally visible. [ABSTRACT FROM AUTHOR]

Objective To summarize the project and fund of Pharmacy Administration from the NSFC during 2010 to 2021 and to provide references for the funding application. Methods The data and relevant documents which related to the projects status of Pharmacy Administration on the website of NSFC were collected and analyzed by Excel. Results There were more paths which were suitable to the Pharmacy Administration in NSFC. The direction and measure were expanded. There were more interdisciplinary researchers involved in Pharmacy Administration projects, while the funded organizations and regional distribution were concentrated. Conclusion The funding situation, research hotspots and basic information of applicants in recent years were summarized through statistical data of NSFC from 2010 to 2021, which suggest that the advantage, regional characteristics, cross-discipline and the policies should be concerned by the applicants . [ABSTRACT FROM AUTHOR]

Introduction: This quality improvement initiative aimed to implement a strategy to increase access to care with clinical pharmacy specialists (CPSs), optimize CPS direct patient care activities, and promote clinical pharmacy services. The primary objective was to assess the impact of patient marketing on expanding access to care and clinic utilization in a CPS clinic. Methods: A marketing technique was applied by a mental health (MH) CPS to expand clinical pharmacy services. Direct-to-patient brochures advertising MH CPS comprehensive medication management services were placed at the check-in window of an interdisciplinary outpatient MH clinic. Brochure content included a description of an MH team, the role of MH CPSs, and benefits of being managed by MH CPSs. Patients could contact the MH CPS or speak to their primary provider for referral. The preintervention and postintervention evaluation periods were 4-month time frames. Clinic utilization for the MH CPS clinic was compared before and after dissemination of marketing brochures. Additional outcomes evaluated were number of encounters, number of patients seen, and number of clinical interventions completed by the MH CPS. Results: There was a significant increase in clinic utilization postintervention. The total number of encounters, patients, and clinical interventions were numerically increased postintervention. Discussion: The observed improvements in clinic utilization suggest the benefit of marketing in optimization of access to care in CPS clinics and justification of clinical pharmacy services.

Purpose An increasing focus on driving margin has pushed health-system pharmacy departments to find new ways of generating new or protecting existing revenue. At UNC Health, a dedicated pharmacy revenue integrity (PRI) team has been operating since 2017. This team has been able to significantly reduce revenue loss from denials, increase billing compliance, and improve revenue capture. This article provides a framework for establishing a PRI program and reports results generated from it. Summary The activities of a PRI program can be grouped into 3 main pillars: minimizing revenue loss, optimizing revenue capture, and ensuring billing compliance. Minimizing revenue loss is accomplished primarily through management of pharmacy charge denials and can be an ideal first step in establishing a PRI program due to the tangible value generated. Optimizing revenue capture involves a combination of clinical expertise and understanding of billing operations to ensure medications are being billed and reimbursed appropriately. Finally, ensuring billing compliance, including ownership of the pharmacy charge description master and maintenance of electronic health record medication lists, is vital in preventing charge and reimbursement errors. Conclusion Successfully bringing traditional revenue cycle functions into the department of pharmacy can be a daunting task but provides significant opportunities to create value for a health system. Key factors to the success of a PRI program include robust data access, hiring individuals with financial and pharmacy expertise into PRI positions, strong relationships with the existing revenue cycle teams, and a progressive model that allows for incremental expansion of services. [ABSTRACT FROM AUTHOR]

Purpose This article highlights one academic medical center's effort to implement a complete credentialing and privileging (C&P) process for both inpatient and ambulatory clinical pharmacists. Summary The C&P process offers a recognized method to advance pharmacy practice. Credentialing is defined as a process whereby an individual is deemed qualified in a specific subject matter area. Privileging is the process whereby an institution grants authority to an individual to perform services based on credentials. Federal guidelines permit pharmacists to obtain the same level of privileges as professional medical staff, such as physicians, if relevant state laws allow for the corresponding pharmacist scope of practice. States establish laws and regulations that specify the scope of practice for various types of licensed healthcare professionals, including pharmacists. Many health systems have attempted pharmacist C&P practices in both the inpatient and ambulatory care setting with varying degrees of success and reach. Privileged pharmacists provide established benefits and value to other members of the healthcare team. Oregon Health & Science University (OHSU) pursued C&P for both inpatient and ambulatory clinical pharmacists. Initiation and implementation processes were complex and accompanied by a variety of challenges. Conclusion OHSU operates with advanced pharmacy practice integrated into the interdisciplinary patient care team. Pharmacist C&P allows pharmacists to demonstrate significant clinical benefits and quality improvement in patient care delivery in both inpatient and ambulatory settings. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this project was to develop and optimize a dashboard and registry to manage the distribution, utilization, and monitoring of coronavirus disease 2019 (COVID-19) emergency use–authorized medications (CEUAMs). Summary CEUAMs have specific requirements that must be met for prescribing, monitoring, and compliance. When remdesivir, the first COVID-19 medication with emergency use authorization (EUA), was approved, it immediately became necessary for the Veterans Health Administration, a national integrated health system, to describe the requirements for EUA, to distribute the medication in a fair and equitable manner, and to ensure compliance with all EUA requirements. A dashboard was developed and iteratively updated as additional CEUAMs were approved. The dashboard tracked CEUAM distribution and monitoring at the national, regional, facility, and patient level. Par stock levels were initially determined at the national level. Facilities were also able to request an additional allotment of medication based on demand and allocated supplies from the Department of Health and Human Services. Providers completed a questionnaire for the CEUAM for each patient to ensure all requirements for the medication were met. If there were data integrity concerns, the entry was flagged for review at the facility level and, upon evaluation, corrections were made. Conclusion Development of the dashboard was resource intensive but provided an excellent mechanism to share information among facilities and national offices. Other healthcare systems can develop similar dashboards to ensure appropriate use of CEUAMs for their patients while meeting all CEUAM requirements. [ABSTRACT FROM AUTHOR]

Purpose: Outpatient antimicrobial stewardship programs (ASPs) are becoming increasingly prevalent in healthcare. Many programs have demonstrated the effectiveness of pharmacist-driven outpatient consultations or follow-up programs to ensure appropriate antimicrobial prescribing. However, there is a paucity of literature describing multidisciplinary approaches in large healthcare systems for patients discharged from the emergency department (ED). The objective of this study was to describe the feasibility and impact of a combined effort between ASP pharmacotherapy specialists and nurse practitioners (NPs) in managing an ED follow-up center. Methods: A retrospective analysis was conducted for patients discharged from the ED between January 2018 and June 2019. Patients were identified for inclusion based on documentation by ASP pharmacotherapy specialists in the electronic health record for patient-specific inquiries from ED follow-up center NPs. The primary outcome of this study was to describe the number and types of interventions made by ASP pharmacotherapy specialists. Results: A total of 1088 patients were included in the study, for 1114 documented ASP calls. The urinary tract was the most common source of positive culture (79%), and third-generation cephalosporins were the most frequent antibiotic associated with calls (20%). Out of total calls, 60% lead to ASP interventions. Among total calls, the most frequent interventions were to correct drug-bug mismatches (20%), initiate new therapy (10%), and discontinue therapy (7%). Conclusion: This report describes a novel initiative that combines the efforts of ED NPs and ASP pharmacotherapy specialists in managing an ED follow-up center at a large healthcare system. [ABSTRACT FROM AUTHOR]

Introduction: Numerous barriers exist to providing high‐yield pharmacy resident research programming, especially at community health systems where research expertise and resources may be limited. Objectives: To describe a feasible educational program structure that other community health system pharmacy residency programs could implement to improve resident research and scholarship skills, and to explore the impact of the programming on indicators of resident preparedness in research activities and system‐wide pharmacist scholarship. Methods: We pursued a retrospective quality improvement study of a single community health system's experience with implementing and refining a longitudinal pharmacy resident research educational program. The program began at a single site in 2017 and expanded to a system‐wide curriculum that now serves 22 residents annually across five hospitals. Structured as quarterly, system‐level, single‐day workshops, the educational program is designed to supplement and support site‐level rotations through hands‐on learning of high‐yield skillsets. Assessed indicators of program success included resident survey evaluations of perceived program value and resident preparedness, pharmacist performance in the annual enterprise‐wide research competition, and rate of system pharmacist‐authored publications. Results: A refined pharmacy resident research program is described, including challenges and worked solutions to success. Residents consistently rate the value of the learning experience highly and endorse favorable readiness for future research endeavors after residency (modes of 4‐5 on 5‐point Likert scale). The percentage of pharmacist winners of the annual research competition increased from 9% in 2014 to 100% in 2022. The annual rate of pharmacist‐authored publications increased from 0 to 1 per year before 2014 to 17 in the calendar year 2021. Conclusion: Community health‐system pharmacy residency programs can provide high‐yield educational programming to equip residents with desired research and scholarship skills through creative and collaborative solutions to identified barriers. Health systems may also realize broader scholarly outputs from pharmacists and preceptors by supporting and lateralizing pharmacy resident research programming. [ABSTRACT FROM AUTHOR]

Purpose Healthcare systems are challenged with implementing high-cost, high-impact medication therapies with increasing frequency. Pharmacy & therapeutics (P&T) committees may struggle to integrate requests for these medications into their existing formulary review process. This article describes one large academic medical center's experience with creating a new P&T subcommittee that addresses the clinical, operational, and financial challenges these medications present. Summary The High-Impact Medication Therapy Subcommittee was established to optimize the institution's process for reviewing formulary requests for medications that are defined as "high impact"—nononcology medications that are extremely expensive and/or have complex operational or clinical challenges. The multidisciplinary subcommittee has 3 chairs—a physician, a nurse, and a pharmacist—and includes representation from all areas of pharmacy practice (clinical pharmacy, operations, supply chain, finance, and informatics), as well as medical and nursing leadership, hospital finance, and patient access services. Additional relevant stakeholders are invited as needed. The first medication to be reviewed at this subcommittee was afamelanotide, a melanocortin receptor agonist indicated for treatment of erythropoietic protoporphyria. The subcommittee addressed cost-efficacy concerns and operational challenges, and the final recommendation was for formulary addition, with clearly defined restriction criteria and the creation of a new workflow to meet the unique operational considerations with this drug. Conclusion As medication costs continue to rise at unprecedented rates and reimbursement requirements continue to increase in complexity, the High-Impact Medication Therapy Subcommittee provides a necessary venue for reviewing high-cost medications with complex clinical or operational considerations and proactively addressing implementation challenges. [ABSTRACT FROM AUTHOR]

Purpose: To provide pharmacy leaders and clinicians with the basic principles of a training method called job instruction (JI) and its application within pharmacy as a strategy to teach routine pharmacy work. Summary: Job instruction is a reliable way to teach a person to quickly learn how to perform a work standard correctly, safely, and efficiently. Job instruction is a proven and successful technique for improving time to train, productivity, employee turnover and quality of work. In healthcare, JI training is not well-known or widely utilized. Job Instruction was the strategy of choice to stabilize the variable training practices within The University of Kansas Health System pharmacy enterprise, and a prospective, single center, multi-cohort study was conducted to study its impact. Conclusion: The preliminary results of this study provide initial insight into the applicability of job instruction in pharmacy. The study indicated the benefits of JI training within different teams to standardize training practices, decrease error and safety event rates, and increase satisfaction of team members with on-the-job training. The results of this study will be used to further analyze and optimize training practices in The University of Kansas Health System pharmacy enterprise. [ABSTRACT FROM AUTHOR]

Introduction: Hospital departments of pharmacy are experiencing significant challenges in the recruitment and retention of trained hematology‐oncology pharmacists. The reasons for these challenges are varied, but one consistent challenge is the growing attrition of clinically‐trained pharmacists from the patient care environment. Methods: An electronic 21‐item survey was distributed to oncology pharmacists across the United States. The survey assessed work environment, board certification, clinical commitment, and other factors. How those factors might be associated with reported job satisfaction and risk for attrition was examined. Results: A total of 607 individuals responded to at least one of the survey questions, with the majority representing those actively in clinical practice. The results demonstrate that the oncology pharmacy workforce is a highly trained and capable one, with a high level of satisfaction with their work. That said, over 60% of those who responded indicated that they were either actively seeking or open to alternate employment outside of the patient care environment. The largest contributing factors to attrition risk include untenable work burdens, burnout, lack of work‐life integration, and ineffective leadership, while commitments to clinical work were associated with improved job satisfaction and decreased attrition risk. Conclusion: These results bring to light the current state of satisfaction and attrition risk for the oncology pharmacy workforce nationwide. A significant opportunity exists to improve the experience of these pharmacists, particularly in the patient care environment. Based on these findings, departmental, organizational, and national leadership must pursue more tenable work burdens, better value and recognition measures, and more accurate and meaningful metrics for clinical pharmacists in order to retain this important workforce. [ABSTRACT FROM AUTHOR]

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time., Purpose: To develop administrative and leadership skills in pharmacy technicians through the implementation of a 6-month advanced technician leadership program., Summary: Health-system pharmacy administrative and leadership (HSPAL) residency programs have been established to develop administrative and leadership skills in pharmacists for more than 60 years. Similar opportunities for pharmacy technicians do not exist despite technicians being placed in leadership positions. Our pharmacy department developed a 6-month advanced pharmacy technician leadership program utilizing the pharmacist HSPAL residency framework and adapting it to focus on pharmacy technicians. Rotations span inpatient and ambulatory leadership, with both pharmacist and technician leaders serving as preceptors. The training program has been established for over 3 years and has produced a total of 6 graduates, of whom 5 have assumed technician leadership roles within our department. The training program has built a pipeline of highly trained technician leaders and decreased the time required to fill technician supervisor openings by 80%. Program graduates have reported the most improvement in management skills, functional skills and knowledge, and communication skills., Conclusion: Creation of an advanced, pharmacy technician-specific leadership program focusing on development of leadership and administrative skills provides short- and long-term benefits to health-system pharmacy departments., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: To determine the physical compatibility of 10% calcium chloride and 10% calcium gluconate in combination with injectable solutions, administered in the paediatric and adult intensive care unit setting during toxicological resuscitation involving calcium channel blockers and beta-blockers., Methods: Forty-eight combinations were prepared at room temperature, including the following products: calcium chloride, calcium gluconate, insulin, epinephrine, norepinephrine, highly concentrated dextrose solution, sodium chloride, Plasma-Lyte A and Ringer's lactate. A visual evaluation at times 0, 1, 4, 24, 48 and 72 hours and a particle count test with the LS-20 particle counter at times 0, 4, 24 and 72 hours were performed. The admixtures were considered incompatible if there was a precipitate, a colour change, turbidity, viscosity or a gas formation. The stability of calcium salts was also tested in empty IV bags and syringes by the particle count test., Results: All drug mixtures were found to be compatible by visual evaluation and using the particle counter based on United States Pharmacopoeia chapter 788 (USP<788>) specifications. Calcium salts were compatible with insulin and vasopressors in the tested combinations. The stability of 10% calcium salts in empty IV bags and polypropylene syringes was demonstrated for up to 48 hours at room temperature., Conclusion: All the combinations tested were physically compatible for up to 72 hours at room temperature. Clinical use of calcium salt infusions, at an undiluted concentration, in combination with these injectable solutions in a toxicological resuscitation context is considered clinically acceptable., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Prefilled syringes (PFS) may offer clinical and economic advantages over conventional parenteral medication delivery methods (vials and ampoules). The benefits of converting from vials and ampoules to PFS have been explained in previous drug-specific economic models; however, these models have limited generalisability to different drugs, healthcare settings and other countries. Our study aims to (1) present a comprehensive economic model to assess the impact of switching from vials to PFS delivery; and (2) illustrate through two case studies the model's utility by highlighting important features of shifting from vials to PFS., Methods: The economic model estimates the potential benefit of switching to PFS associated with four key outcomes: preventable adverse drug events (pADE), preparation time, unused drugs, and cost of supplies. Model reference values were derived from existing peer-reviewed literature sources. The user inputs specific information related to the department, drug, and dose of interest and can change reference values. Two hypothetical case studies are presented to showcase model utility. The first concerns a cardiac intensive care unit in the United Kingdom administering 30 doses of 1 mg/10 mL atropine/day. The second concerns a coronavirus (COVID-19) intensive care unit in France that administers 30 doses of 10 mg/25 mL ephedrine/day., Results: Total cost savings per hospital per year, associated with reductions in pADEs, unused drugs, drug cost and cost of supplies were £34 829 for the atropine example and €104 570 for the ephedrine example. Annual preparation time decreased by 371 and 234 hours in the atropine and ephedrine examples, respectively., Conclusions: The model provides a generalisable framework with customisable inputs, giving hospitals a comprehensive view of the clinical and economic value of adopting PFS. Despite increased costs per dose with PFS, the hypothetical case studies showed notable reductions in medication preparation time and a net budget savings owing to fewer pADEs and reduced drug wastage., Competing Interests: Competing interests: MW, HG, AT, and TE were employees of BD at the time this study was developed and conducted. MP received consultancy fees from BD for providing analytical support. Alkemi LLC (BJL and KAC) received consultancy fees from BD for providing analytical medical writing support. Alkemi LLC did not receive budget for publication writing. JFHE does not have any conflicts of interest to declare., (© European Association of Hospital Pharmacists 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)

Purpose: The purpose of this study is to assess the impact of a clinic embedded Medication Assistance Program (MAP) specialist on the prescription benefit prior authorization (PA) process and provider satisfaction in an adult pulmonary clinic. Methods: In this mixed methods study, a retrospective cohort analysis was done to determine the turnaround time for the PA process from initial referral to approval or final denial in an adult pulmonary clinic. Additionally, a pre- and post-implementation survey to providers was conducted to assess provider satisfaction and perceptions around the prescription benefit PA process. The first study aim assessed PA efficiency by summarizing PA approval rate and PA turnaround time using descriptive statistics. Any prescriptions written by a clinic provider requiring a PA during the timeframe of June 2018 through August 2018 were included. The second study aim assessed change in provider satisfaction, analyzed via the Mann-Whitney U test. Results: The MAP specialist completed 110 PAs over 3 months for 110 unique patients. Median turnaround time was 3 hours, with 76% of PAs approved in less than 24 hours. Initial approval rate was 82.7%, and overall approval rate following the appeals process was 87.3%. A significant difference between the pre- and post-survey responses were identified in 2 of the 17 questions. Conclusion: Implementation of a clinic embedded MAP specialist to complete PAs demonstrated an efficient process while also improving provider satisfaction. [ABSTRACT FROM AUTHOR]

BACKGROUND: The burden of prescription drug prices affects patients and health system, creating a need for pharmacists to use their medication expertise to recommend the most cost-effective treatment for patients. OBJECTIVE: The study aimed to analyze the cost avoidance for medication conversions related to GERD from an integrated medication therapy management call center. METHODS: A quasi-experimental study was conducted at a call center during a 12-month intervention. Adult patients aged ≥18 years who received highercost PPIs were included. The pharmacists provided MTM services to patients telephonically to review all aspects of the patients' medication regimen as well as conversion recommendation to lower-cost PPIs. The cost avoidance analysis and sensitivity analysis were conducted. RESULTS: Of 40 eligible patients, 9 patients accepted the medication conversion, resulting in a 22.5% acceptance rate. The total cost avoidance from medication conversions was $19,937.1 per year, which equated to $2,215.2 per patient. The adjusted cost avoidance of medication conversion was estimated by assuming the patients who accepted the conversion continued taking the medication for 365 days and resulted in a total savings of $40,370.7 per year, which equated to $4,485.6 per patient. There were no significant association between the acceptance of medication conversions and patient's age(P = 0.15), gender(P = 0.73), and insurance status(P = 0.96). CONCLUSION: The study results showed that the call-center MTM with medicationconversion interventions successfully demonstrated an economically advantageous impact from a budgetary perspective. Further studies should explore methods to increase acceptance of MTM services and promote awareness of the profound effect on public health and well-being. [ABSTRACT FROM AUTHOR]

Background: Fluticasone propionate/salmeterol multidose, dry powder inhaler (MDPI) was the first and only authorized generic inhaled corticosteroid/long-acting beta agonist (ICS/LABA) combination inhaler at the time of this study. This offers the potential for significant prescription cost-savings for both patients and accountable care organizations. The objective of the study was to demonstrate patients' clinical response to generic fluticasone propionate/salmeterol MDPI when switched from one of its brand name competitors. Methods: The study was approved by the Institutional Review Board at MCPHS University. This was a prospective chart review of a large, multi-center ambulatory care organization in the Greater Boston area. Patients 12 years of age or older who were switched from a brand-name ICS/LABA inhaler to the generic fluticasone/salmeterol MDPI were included in the study. The primary endpoint was worsened asthma control requiring a change in therapy, oral corticosteroid therapy, or hospitalization at or before 12 weeks after the inhaler was switched. Results: In total, 203 patients met inclusion criteria. Of those 203 patients, 35 had a change in therapy due to worsened asthma control (17.2% of patients, 95% CI 12.0% to 22.4%) within 12 weeks. Total projected yearly prescription cost-savings for patients who were switched and remained on the generic inhaler was $581,628. Conclusion: Eighty-three percent of patients maintained appropriate asthma control after switching from a brand ICS/LABA inhaler to the generic fluticasone/salmeterol MDPI for 12 weeks. Switching to the generic inhaler resulted in significant prescription cost-savings for the accountable care organization. [ABSTRACT FROM AUTHOR]

Background: Pharmacy Value Added Services (VAS) were introduced in Malaysian public health facilities to facilitate the process of medicine collection. Examples include Drive-through pharmacy, Medicine by Post, SMS Take&Go, Appointment Card and medicine locker, commonly referred to as Medibox. Objectives: To assess the perception of VAS among pharmacy staff, and to compare the time and cost needed to prepare medications for VAS and conventional counter service. Methods: A cross-sectional study was conducted in 17 public health facilities across Kuala Lumpur and Putrajaya from May until September 2020. There were two parts of this study: 1) a survey on the perception of VAS among pharmacy staff, which assessed respondents' experience of handling VAS and their perception towards the services; and 2) a cost analysis to compare the direct cost of preparing refill medications for VAS and conventional counter service, estimated from average salary and direct non-medical cost. Results: 290 respondents answered the survey. Most respondents had a positive opinion about VAS. Lack of storage and insufficient manpower were the top two barriers in VAS utilisation and implementation as perceived by pharmacy staff. The average time (in minutes) needed to prepare one prescription was highest for Medicine by Post service (10.31), followed by Medibox (10.25), Appointment Systems (6.24) and conventional counter service (3.99). Medibox had the highest average cost per prescription (RM5.49), followed by Medicine by Post (RM5.05), Appointment Systems (RM2.89) and conventional counter service (RM1.75). Conclusions: The majority of the respondents involved in this study acknowledged the benefits of VAS to patients, but there were aspects of the services that could be improved. Preparation of patient medication for VAS requires significantly more time and cost than conventional counter service, indicating the need to review and streamline implementation of the services.

Purpose Pharmacy technician training and education vary depending on practice site and state law. Although technician certification provides a national standard for credentialing, not all states require it, making certification a voluntary process for technicians or the organizations employing them. As the role of the pharmacist has evolved, the need for highly trained pharmacy technicians has grown. The pharmacy technician's expanded role in specialized areas of pharmacy practice has created new opportunities that require advanced training. Summary Research is lacking on return on investment for workforce development programs, making it difficult to advocate for pharmacy technician training programs. Therefore, it is important to create internal metrics that link one's program to business performance. This begins with conducting a job market analysis for the geographic area. It is imperative to identify the current occupational outlook for pharmacy technicians, identifying areas with potential for growth as well as where there are shortages or high turnover. Successful development of an American Society of Health-System Pharmacists (ASHP) and Accreditation Council for Pharmacy Education (ACPE)–accredited pharmacy technician program requires a long-term strategy to address key market issues as well as social and economic barriers and financial data to secure funding. Conclusion This case study details Yale New Haven Hospital's journey from proof of concept to implementation of an ASHP-ACPE–accredited pharmacy technician training program. [ABSTRACT FROM AUTHOR]

Introduction: The national opioid epidemic has garnered the attention of various health agencies. A leading strategy in mitigating risk from the opioid public health crisis, including opioid use disorder (OUD), is via increased promotion and access to the lifesaving opioid antagonist, naloxone. Pharmacists have been recognized as integral in addressing this emergency; however, literature evaluating outcomes from multifaceted clinical pharmacy specialist (CPS) interventions and involvement is lacking. The purpose of this quality improvement initiative was to evaluate the impact of a CPS initiative to increase naloxone prescribing proportions (number of patients with OUD with an active prescription for naloxone within the past year divided by the number of patients with OUD), patient access to care, and clinical interventions. Methods: Pain management CPSs, mental health CPSs, and clinical pharmacy leadership within a Veterans Health System spearheaded a variety of interventions to increase naloxone prescribing in patients with OUD including focused education with prescribers, naloxone informational letters, review of population management tools identifying patients with OUD indicated to receive naloxone, CPS naloxone prescribing, and automated naloxone drug orders integrated into electronic health record progress note templates. The preintervention and postintervention evaluation periods were three‐month time frames. Naloxone prescribing proportions were compared before and after implementation of these interventions. Additional outcomes evaluated were number of encounters, number of patients seen/reviewed, and number of clinical interventions completed by the CPSs. Results: There was a significant increase observed in naloxone prescribing proportions from 34.1% to 57.5% postintervention (P <.01). The total number of encounters, patients, and clinical interventions had an absolute increase of 58.0%, 88.4%, and 49.9%, respectively, postintervention. Conclusion: The observed improvement in naloxone prescribing proportions suggests the value of CPS involvement in initiatives for increasing naloxone prescribing to optimize patient safety and justify clinical pharmacy services. [ABSTRACT FROM AUTHOR]

Dustin J Uhlenhopp,1 Oscar Aguilar,2 Dong Dai,3 Arka Ghosh,4 Michael Shaw,1 Chandan Mitra1 1Department of Internal Medicine, MercyOne Des Moines Medical Center, Des Moines, IA 50314, USA; 2Department of Business Administration, Grand View University, Des Moines, IA 50316, USA; 3Department of Mathematics, Iowa State University, Ames, IA 50011, USA; 4Department of Statistics, Iowa State University, Ames, IA 50011, USACorrespondence: Dustin J UhlenhoppMercyOne Des Moines Medical Center, 1111 6 th Avenue, Des Moines, IA 50314, USATel +1 515 643-2261Fax +1 (515) 643-5802Email dustin.j.uhlenhopp@gmail.comBackground: Medication reconciliation (MR) on admission has potential to reduce negative patient outcomes. The objectives of this prospective observational study were to 1) measure the impact a hospital-wide MR program has on home medication error identification at hospital admission, 2) demonstrate cost-effectiveness of this program, and 3) identify risk factors placing individual patients at higher risk for medication discrepancies.Methods: Technicians obtained medication histories on adult patients admitted to the hospital that managed their own medications. Frequency and type of medication errors were recorded. Cost avoidance estimations were determined based on expected adverse drug event rates. Logistic regression analysis was used to test for associations between medication errors and patient characteristics. Results were considered significant when p-value was less than 0.05.Results: The study included 817 patients. Technicians recorded a mean of 6.1 medication discrepancies per patient (SD ± 0.4) and took 28.5 minutes (SD ± 1.2 minutes) to complete a medication history. Omission, commission, and dosing/frequency errors occurred in 82%, 59%, and 50% of medication histories, respectively. We estimated cost avoidance of $210.33 per patient with this program. Female gender, age, and high alert/risk medication use were linked to an increase in the likelihood of occurrence of a medication discrepancy.Conclusion: This study validated the ability of a pharmacy technician to identify errors, demonstrated economic cost-effectiveness, provided new data on time to obtain a BPMH, and further identified factors that contribute to the occurrence of medication discrepancies. Potentially harmful medication discrepancies were identified frequently on admission. With further research, it may be possible to identify those at highest risk for home medication discrepancies upon admission.Keywords: medication safety, pharmacoeconomics, pharmacy administration, transitions of care, MARQUIS, drug information

Background: Improving good governance in the pharmaceutical sector is a valuable priority for improving access to essential medicines. Transparency as a means for good governance was the focus of this study. The objective was to evaluate different sectors of the pharmaceutical regulatory sector of Iran from the aspect of transparency. Awareness of the current situation may assist policymakers in making the right decisions. Methods: The aim of this methodology was to present only quantitative measurement but to gather qualitative information as well. The study was carried from November 2016 to July 2017. The questionnaires of the assessment instrument, which the World Health Organization (WHO) produced for measuring transparency in the public pharmaceutical sector, was used. The interviewees were among managers and staff at different levels of the Food and Drug Administration (IFDA) of Iran and its clients. Results: Medicines registration and distribution of medicines’ scores in the 10-point rating system means that they are minimally vulnerable to corruption. Besides, medicine promotion control and procurement of medical products got an acceptable score, which means that they are marginally vulnerable to corruption. On the other hand, qualitative findings and observation of the evidence presented by key informants proved the sufficient legal capacity for transparency in almost all sections. The controversial issue was the ‘conflict of interests,’ which was not anticipated in some cases. Conclusion: It is valuable to know if Iran’s medicine regulatory sector is transparent In order to improve good governance, transparency should be maximized in all sectors, and this is possible by implementing mechanized actions and online tools.

Objectives: In intensive care units, the mixing of injectable drugs via Y-site administration is often necessary. However, some mixtures can lead to physical incompatibility or chemical instability. To assist healthcare professionals, several databases such as Stabilis compile compatibility and stability data. The objectives of this study were to update the online database Stabilis by adding physical compatibility data to the website and to characterise the incompatibility data already present in the database by specifying the phenomenon at the origin of the incompatibility and its time of occurrence., Methods: Bibliographic sources referenced in Stabilis were evaluated using several criteria. After the evaluation, studies were rejected or the data they contain were added to the database. Data entries contained the following information: name of the two injectable drugs involved in the mixture and their concentration if available, the dilution solvent and the phenomenon at the origin of the incompatibility and its time of occurrence for incompatibility data. Three functions of the website were modified, including the 'Y-site compatibility table' function, which allows creation of customised compatibility tables., Results: A total of 1184 bibliographic sources were evaluated, 77.3% (n=915) of which were scientific articles, 20.5% (n=243) were Summaries of Product Characteristics and 2.2% (n=26) were communications in a pharmaceutical congress. After evaluation, 28.9% (n=342) of the sources were rejected. From the 71.1% (n=842) sources selected, 8073 (70.2%) compatibility data entries and 3433 incompatibility data entries (29.8%) were made. With the addition of these data, the database contained compatibility and incompatibility data for 431 injectable drugs., Conclusions: Since the update, the 'Y-site compatibility table' function has seen its traffic increased by about 66% (∼1500 tables per month compared with ∼2500 tables per month). Stabilis is now more complete to offer significant help to healthcare professionals with their problems of drug stability and compatibility., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Interleukin-17 (IL-17) contributes to the pathogenesis of psoriasis. Secukinumab, ixekizumab, and brodalumab are monoclonal antibodies anti-IL-17 antibodies, approved for the treatment of moderate/severe plaque psoriasis.The aim of the study was to describe the effectiveness and safety of anti-IL-17 agents in moderate/severe plaque psoriasis in clinical practice. We also analysed anti-IL-17 therapies' survival, dose adjustment, and clinical patients' factors associated with their effectiveness and safety., Methods: A retrospective, longitudinal study was conducted at a tertiary hospital. We included patients with moderate/severe psoriasis treated with anti-IL-17 agents. The effectiveness was evaluated with Psoriasis Area and Severity Index (PASI) score and safety through the adverse drug reactions (ADRs) collected., Results: 38 patients were studied (median age=47.4 years, 71.0% male). The mean number of biological therapies that patients received was 2.6, and anti-IL-17 therapy was the first biological therapy for 36.8% of patients. The median years in treatment were 2.5 (95% CI 1.95 to 2.98) for secukinumab, 1.2 (95% CI 0.36 to 1.47) for ixekizumab, and 0.7 (IQR 0.71) for brodalumab. The median PASI score after 6 months of treatment was 0 (IQR 0) and 85.3% of patients achieved a PASI of 90 (84.0% with secukinumab, 87.5% with ixekizumab, and 100% with brodalumab). Dose adjustment was associated with the line of treatment (p=0.034 for naïve patients), age (p=0.044 for younger patients), and concomitant pathologies (p=0.015 without more diseases).24 patients suffered from ADRs, mainly infections of the upper respiratory tract, and there were no statistically significant differences between the three therapies., Conclusions: Anti-IL-17 agents constitute an effective treatment for patients with moderate/severe plaque psoriasis and for longer. Dose reductions were associated with fewer lines of treatment, younger patients and absence of concomitant pathologies. ADR were minor and similar among the anti-IL-17., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time., Purpose: Optimization of automated dispensing cabinets (ADCs) has traditionally focused on modifying the inventory within these devices and ignored the replenishment process itself. Rounding replenishment quantities to the nearest package size, termed package size-conscious replenishment (PSCR), was investigated as a way to optimize labor needs for ADC replenishment., Methods: A simulation of PSCR for a subset of medications stocked in ADCs at the University of North Carolina Medical Center was conducted. The simulation utilized real-world vend data and rounding factors to model the impact of PSCR on key ADC metrics. The final simulation utilized 2 months of ADC transactions across 410 medications in 149 ADCs. Four replenishment methodologies were simulated: standard replenishment and 3 PSCR strategies, including rounding down, rounding any direction, and rounding up., Results: All 3 PSCR methodologies had significantly lower stockout frequencies than standard replenishment at 0.722% (P = 0.026) for rounding down, 0.698% (P = 0.024) for rounding any direction, and 0.680% (P = 0.024) for rounding up vs 0.773% for standard replenishment. PSCR methods were associated with significant time savings for both technician and pharmacist activities (P < 0.001 for all 3 strategies), with a savings of up to 0.27 technician and 0.52 pharmacist full-time equivalents estimated for the rounding-up methodology. Maximum carrying cost was higher for all 3 PSCR methodologies., Conclusion: PSCR was modeled to significantly decrease both pharmacist and technician time needed to replenish ADCs while also decreasing stockout frequency. Modest increases in maximum carrying cost were also shown. The simulation created for this evaluation could also be utilized to model other components of the ADC replenishment process., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The objective of regulatory authorities is to ensure a favorable risk-benefit balance for medicines in their licensed indication, without seeking to establish their place in the therapeutic armamentarium beyond that. The licensed indication covers heterogeneous subpopulations and often does not sufficiently specify the characteristics of the patients who may benefit. The regulatory information does not always show the benefit over the standard treatments; moreover, it only reacts to the conditions specified in the developer's application, and lacks an assessment of the clinical relevance of the benefit and its uncertainties. Many cases highlight the need to establish a more specific therapeutic benefit scenario than the licensed indication. For example, abemaciclib was approved in the adjuvant setting for high-risk patients with early breast cancer, but the appropriate level of risk and how to assess it needs to be specified. Also, pembrolizumab is approved for neoadjuvant plus adjuvant treatment in lung cancer; but it remains to be analyzed whether it is superior to nivolumab in neoadjuvant treatment alone, which involves less treatment and economic burden. As therapeutic positioning is always a necessary decision, whether made at a national, regional, local or individual level, it must be made in the most appropriate way. The absence of a multidisciplinary discussion and consensus, relying only on individual decisions to determine positioning from the outset, underestimates information gaps, inter-individual variability and the influence of drug promotion. It can be harmful and costly. To properly manage the introduction of new medicines, it is essential to establish their benefit scenario in a multidisciplinary way. This, together with consideration of the clinical benefit provided versus the appropriate alternatives and the uncertainties of the benefit, constitutes the objective of the clinical assessment and the basis for designing a well-focused economic analysis. This allows policy makers to make the most appropriate decisions on pricing and funding new treatments. In an ideal situation, the benefit scenario considered for the new medicine would coincide with the one established for funding, but costs that are difficult to bear may lead to restrictions and affect the final positioning after the economic and budgetary impact assessment., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Background: In recent years, an increasing number of patient-reported outcome assessment tools (PROs) have been developed specifically to ascertain patients' perceptions of different drug treatments. Among them, the injection process has been analysed, especially in patients chronically treated with chronic biological therapies. One of the main advantages of most current biological therapies is the possibility to self-administer medication at home through the use of a variety of devices, including prefilled syringes (PFS) and prefilled pens (PFP)., Objectives: The aim of this study was to conduct qualitative research to assess the degree of preference between the different pharmaceutical forms PFS and PFP., Methods: We performed a cross-sectional observational study in patients on biological drug therapy through the compilation of a web-based questionnaire at the time of routine delivery of biological therapy. Questions regarding primary diagnosis, adherence to therapy, the preferred pharmaceutical form and the main reason for preference among five possibilities already reported in the scientific literature were included., Results: During the study period, data were collected from 111 patients and 68 (58%) indicated PFP as their preference. From the analysis of reasons that led a patient to choose one device over another, PFSs are chosen mainly out of habit (n=13 (28.3%) PFS vs n=2 (3.1%) PFP) while PFPs are chosen to avoid needle vision (n=15 (23.1%) PFP vs n=1 (2.2%) PFS). Both differences were found to be statistically significant (p<0.001)., Conclusion: As biological subcutaneous drugs are increasingly prescribed for a wide variety of long-term therapies, further research focused on identifying patient factors which may enhance adherence to treatment will become even more valuable., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: When methicillin-resistant Staphylococcus aureus (MRSA) is the causative pathogen in pneumonia, in-hospital mortality rate is approximately 31.2%. However, the occurrence of MRSA pneumonia is uncommon, with a reported incidence of approximately 4.2%. Vancomycin is often empirically used for MRSA pneumonia coverage, but can lead to serious harm. The purpose of this study was to measure the impact of a pharmacy-driven MRSA nares testing protocol on vancomycin and linezolid prescribing patterns and clinical outcomes in patients diagnosed with pneumonia after removal of immediate educational intervention., Methods: This single-centre, quasi-experimental study evaluated the use of a MRSA nasal swab on patients diagnosed with community-acquired pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia. This study consisted of three phases, the preimplementation phase, the active/educational phase and the postimplementation phase. The primary outcome was intravenous anti-MRSA antibiotic duration of therapy. Secondary outcomes included the occurrence of acute kidney injury, duration of hospital stay, number of vancomycin levels obtained, the number of MRSA nares swabs ordered and time points in the MRSA nares collection process., Results: The preimplementation phase (n=39), the active phase (n=45) and the postimplementation phase (n=26) demonstrated similar baseline characteristics. The primary outcome for duration of anti-MRSA therapy 0-72 hours was 61.5% vs 77.8% vs 76.9% (p=0.19). Acute kidney injury was decreased throughout the study at 25.6%, 24.4% and 16.7% (p=0.32). The number of MRSA nares swabs ordered were 23.1%, 60% and 30.8% in each of the phases, respectively (p=0.49)., Discussion: Our novel approach to measuring the impact of pharmacist education and ordering of MRSA nasal swabs has demonstrated benefits that were sustained for a short period after the intervention was removed. Additional study is required to determine the long-term impact., Conclusion: The implementation of a hospital-wide anti-MRSA protocol in patients with confirmed or suspected pneumonia indicated sustained changes for at least 3 months after direct intervention., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To establish a clinical application monitoring system for proton pump inhibitors (PPI-MS) and to enhance the detection and intervention of inappropriate PPI use in adult hospitalised patients., Methods: Natural language processing technology was applied to indication recognition of therapeutic PPI applications and the assessment of admission record recognition for preventive PPI applications. Symptom judgement was based on the tense-negation model and regular expressions. Evidence-based rules for clinical PPI application were embedded for the construction of PPI-MS. A total of 9421 patient records using PPI from July 2022 to July 2023 were analysed to validate the performance of the system and to identify common issues related to inappropriate clinical PPI use., Results: Out of 9421 hospitalised patients detected using PPI, 4736 (50.27%) were used for prophylaxis and the rest for therapeutic use. Among the prophylactic medications, 2274 patients (48.02%) were identified as receiving inappropriate prophylactic PPI. The main reasons were inappropriate prophylaxis without indication. Additionally, 258 cases of inappropriate therapeutic PPI use were identified, mainly involving the use of esomeprazole for peptic ulcers and Zollinger-Ellison syndrome. The efficiency of the PPI rational medication monitoring system, when coupled with human involvement, was 32 times that of manual monitoring. Among cases of inappropriate prophylactic PPI use, 45.29% were due to lack of indications, 28.34% involved inappropriate administration routes, 15.74% were related to inappropriate dosing frequencies and 10.62% were attributed to inappropriate drug selection. There were 933 cases related to the use of antiplatelet and anticoagulant drugs and 708 cases related to the use of non-steroidal anti-inflammatory drugs. The overall accuracy of the PPI-MS system was 88.69%, with a recall rate of 99.33%, and the F1 score was 93.71%., Conclusions: Establishing a PPI medication monitoring system through natural language processing technology, while ensuring accuracy and recall rates, improves evaluation efficiency and homogeneity. This provides a new solution for timely detection of issues relating to clinical PPI usage., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Medication dispensing errors cause wastage of medicines and increase healthcare costs, with serious consequences for patients. However, few studies have systematically and completely reviewed dispensing errors, with inadequate attention to the objective regularity and risk factors for dispensing errors., Objectives: To explore the potential causes and risk factors influencing the prevalence of medication dispensing errors., Methods: We collected patient-reported medication dispensing errors from a large tertiary care hospital in South China over 11 years. We assessed the characteristics of dispensing errors, labelled the causes, compared them with more than 25 million prescriptions from 2012 to 2022, identified the susceptibility factors for the occurrence of dispensing errors, and analysed the characteristics and patterns of the errors., Results: A total of 376 patient-reported dispensing errors were recorded. It took an average of 5.2 days for a patient to find an error. Only 37.5% of errors were reviewed by the patient within 24 hours. These errors directly contributed to a medication loss of US$188 406. Of the 160 recorded pharmacists, 112 (70%) committed dispensing errors. Dispensing errors were affected by the pharmacists' use of the machine, workload and the length of monthly vacation. Of the dispensing errors, 47.9% (n=180) were caused by medication packaging or names that were similar. Antibiotics (n=32, 8.5%) were the most common types of drugs dispensed incorrectly, and traditional Chinese medicines (n=31, 8.2%) and immunosuppressants (n=21, 5.6%) were the most likely to be dispensed in inaccurate quantities., Conclusions: Organising adequate staff and using machines to prepare medicines may be necessary to reduce dispensing errors. When pharmacists have been away from work for more than 72 hours they should find their rhythm in other positions before dispensing medicines. It is more important to prioritise the differentiation of medicines with similar packaging over those with similar names when arranging drug shelving., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: To utilize lean six sigma (LSS) and failure model and effect analysis (FMEA) to prevent dispensing errors in a Chinese teaching hospital. Methods: Medication errors (MEs) reported to the China Core Group of the international network for the rational use of drugs (INRUD) by pharmacists at the hospital were collected. Following LSS methodology, the data analysis was structured according to define, measure, analyse, improve, and control (DMAIC) phases, and typical LSS tools (Pareto diagrams, brainstorming sessions) were used to determine the risk factors leading to dispensing errors. FMEA was applied to generate the risk priority numbers (RPNs) of MEs events, and key medications targeted for error prevention strategies were identified through quantitative analysis of the impacts of failure. Finally, corrective measures to prevent MEs were implemented and monitored for efficacy. Results: Before the implementation of this programme, a total of 603 cases of dispensing errors were reported from the Year 1 to Year 6, reaching an average rate of incidence of 0.33 cases per 10 000 medication orders delivered, and no difference was found between these years (P =.9424). There was also no difference as location, error type, contributing factors, cause classification were considered. We then determined the real cause behind dispensing errors, and a total of 67 medications were targeted for specific error prevention strategies. One year after intervention, progress had been achieved in the following aspects: the incidence rate of dispensing errors was significantly decreased compared with the previous years (0.19, P =.007). Simultaneously, the incidence rate of dispensing errors occurred in outpatient pharmacy (0.04, P =.0008), with junior pharmacists (0.15, P =.0258), with LASA medications (0.06, P =.0319), as well as with memory‐based errors were significantly decreased (0.03, P =.0191). Conclusion: The combination of LSS and the FMEA tool can be an efficient approach for helping reduce MEs in pharmacy dispensing. [ABSTRACT FROM AUTHOR]

The article discusses the health-system specialty pharmacy (HSSP) model that can help specialty pharmacies align to an outcomes-focused mission. Topics covered include a nimble and thought-leadership approach required by the model, the challenges facing HSSP that are entering a highly fragmented and competitive environment, ways of translating differentiated HSSP capabilities into value, and best practices and outcomes measures of HSSP program implementations.

The article describes the use of principles of emergency preparedness and disaster management that have guided pharmacy departments through the COVID-19 pandemic. Topics covered include Hospital Emergency Response Training for Mass Casualty Events, the four primary phases of emergency management, and the role of a department-specific incident command.

Introduction: In response to the coronavirus disease 2019 (COVID‐19) pandemic, health care institutions have faced challenges necessitating operational agility to facilitate provision of optimal patient care. This research was performed to elucidate how pharmacy departments adapted their staffing models, and the impact on frontline staff satisfaction. Methods: Critical care pharmacists in the American College of Clinical Pharmacy (ACCP) and the American Society of Health‐System Pharmacists list‐serves were electronically invited to participate in a 28‐question survey between April and May 2020. Likert‐like questions used a 1 to 5 (strongly agree to strongly disagree) scale, and responses were compared based on the degree of satisfaction with implemented pharmacy leadership strategies. Practice model changes were compared before and during the COVID‐19 pandemic. Multivariate logistic regression was used to assess the effects of independent variables on the primary outcome ‐ satisfaction with pharmacy leadership response. Results: Respondents (N = 168) representing 40 states in the United States participated. Forty percent of respondents experienced a surge, 68% experienced a staffing model change, and 65% were satisfied overall with their pharmacy leadership's response to the COVID‐19 pandemic. Both specialists (50% vs 21%, P =.013) and unit‐based generalists (65% vs 35%, P <.001) rounded less frequently in response to the COVID‐19 pandemic. Disagreement with "Satisfied with leadership efforts to protect staff (limiting in‐person meetings, changing code response)" decreased the odds of satisfaction by 96% (odds ratio [OR] 0.043 [95% confidence interval (CI) 0.005‐0.336], P =.003). Disagreement with "Satisfied with voice of front‐line staff" was associated with an 84% reduction in satisfaction (OR 0.165 [95% CI 0.049‐0.549], P =.003). Eliminating in‐person rounds was associated with a 95% decrease in satisfaction with pharmacy leadership (OR 0.053 [95% CI 0.007‐0.392], P =.004). Disagreement with "I believe I am at increased risk for COVID‐19 due to departmental staffing decisions" increased satisfaction (OR 3.8, 95% CI [1.06‐13.91], P =.041). Conclusion: Frontline staff perceptions can inform practice model changes to improve employee satisfaction while providing safe, reliable, and responsible patient care. [ABSTRACT FROM AUTHOR]