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Orodispersible thin film (ODF) is an innovative dosage form that allows for adjustable dosing and improved patient compliance. It is administered by mouth, where it dissolves, making it suitable for children. Objectives: The aim of the study was to develop and characterize an optimal ODF formulation containing equivalent hydrocortisone at 0.5 mg/cm2 using the solvent-casting method. A stability-indicating assay for the simultaneous quantification of hydrocortisone and hydrocortisone 21-hemissucinate (HMS) was developed. ODFs were characterized by organoleptic properties and by testing for uniformity of mass, content, stability, thickness, and dissolution. Results: When optimized, ODF is thin, flexible, and transparent, making it suitable for production in hospital pharmacies using standard equipment. In contrast to the water-insoluble hydrocortisone, the HMS-loaded cast gel successfully satisfied the tests, including content uniformity. Disintegration appeared acceptable as compared to the commercial grade ondansetron ODF (Setofilm®). The physicochemical stability of the active ingredients (i.e., HMS, hydrocortisone) contained in the ODF at 0.5 mg/cm2 is demonstrated for at least 84 days at 23 °C. Conclusion: The ODF formulated with the water-soluble hydrocortisone prodrug HMS allows accurate drug level to be achieved, thus opening up new opportunities for use in pediatric patients. [ABSTRACT FROM AUTHOR]

Purpose Central line–associated bloodstream infections (CLABSIs) are hospital-acquired, serious complications that greatly affect many vulnerable neonates throughout their hospital stay. This article describes the implementation of a unique practice in which pharmacy primes continuous infusions through medication tubing for neonatal central lines in a cleanroom at Children's Hospital Colorado – Colorado Springs (CHCO-CSH). Summary This institution is a freestanding children's hospital with a level III neonatal intensive care unit (NICU) that opened in April 2019. Since then, the pharmacy department has been priming central line tubing for continuous infusions for all patients in the NICU. Neonates are at increased risk for developing CLABSIs due to their immature immune systems and frequent need for central line placement. With that in mind, the pharmacy department decided to focus efforts on this population. Pharmacists and pharmacy technicians received training on how to properly prime tubing, document when a patient received a new central line, document if a central line was removed, and record when new tubing was due based on a department policy. Conclusion This novel, pharmacy-led priming procedure resulted in a low CLABSI incidence, offering a promising strategy to reduce CLABSIs in a NICU. [ABSTRACT FROM AUTHOR]

Medicine shortages are an increasing issue, with broad public health implications for patients, health professionals and institutions. Despite national notification mechanisms involving sponsors and national regulators (e.g. Australian Therapeutic Goods Administration), shortages continue to be a significant workload in hospitals, particularly for pharmacy staff. In this article, we describe the implications of medicine shortages and a team approach to their management in an Australian public hospital. The medicine shortages team comprises senior pharmacists, a pharmacy technician, and a purchasing officer, in consultation with medical staff. A 10 week audit recorded 34 medicine shortages and/or discontinuations, comprising 49 usually stocked products. Shortages were more quickly identified by the purchasing officer using established relationships with suppliers, rather than relying on sponsor or government communication. Having a team systematically dealing with these shortages enables expertise in supply chains, finances, therapeutics, and medicine safety to be shared, to identify optimal interventions to mitigate patient risk. [ABSTRACT FROM AUTHOR]

Background: Although significant advancements have been made in the acute management of acute coronary syndrome (ACS) in Thailand, there is a need for improvement in the longitudinal care post cardiac stenting. Objective: The study aimed to describe the successful establishment of the first post‐percutaneous coronary intervention (PCI) clinic in Thailand and its preliminary impact compared with historical controls. Method: A multidisciplinary outpatient clinic entitled the "post‐PCI clinic," consisting of cardiologists, nurses, clinical pharmacists, a physical therapist, and a dietitian, was established in 2016 to provide longitudinal care for patients who underwent cardiac stenting at a tertiary care hospital. A standard care pathway, along with the clinic's standard operating protocols, was designed and implemented. A pre‐post intervention, quasi‐experimental study, was conducted to compare the usage rate of secondary prevention medications between patients enrolled in the post‐PCI clinic (January–April 2016) and historical controls (January–June 2015) at month 6 after hospital discharge. Results: During January–April 2016, 91 patients were enrolled in the post‐PCI clinic, with a mean age of 59.2 ± 11.9 years and 65.9% being male. Of these patients, 94.5% presented with ST‐segment elevation myocardial infarction. Regarding the PCI procedure, 90.1% underwent primary PCI, and 9.9% underwent elective PCI. Almost all patients (98.9%) received drug‐eluting stent placement, except for one. Compared with the historical control group, the usage rates of Angiotensin‐converting enzyme (ACE) inhibitors/Angiotensin Receptor Blockers (ACEIs/ARBs) (94.5% vs. 76.5%; p < 0.001), beta‐blockers (93.4% vs. 81.4%; p = 0.013), and high‐intensity statins (90.1% vs. 33.3%; p < 0.001) were higher in the post‐PCI clinic group 6 months after discharge. The three most common interventions by clinical pharmacists were recommendations to initiate new therapy (52.4%), suggestions to adjust dosage regimen (36.7%) and suggestions to change therapy (10.9%). Conclusion: The post‐PCI clinic led to a higher usage rate of secondary prevention medications compared with historical controls. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to assess the real-world experiences of cleanroom managers and specialists who have designed, installed, and maintained stick-built and/or modular cleanrooms, delineate the advantages and disadvantages of each type of cleanroom, and gather sterile compounding cleanroom design and installation advice and lessons learned. Methods This study was conducted via surveys and semistructured interviews of individuals with cleanroom experience in the previous 5 years. Qualitative analyses were conducted on participants' survey and interview responses to assess their satisfaction with each type of cleanroom and to determine what they perceive to be the pros and cons of each type based on their own experiences. Key lessons learned and advice from these individuals were also extracted from their survey and interview responses. Results Fourteen individuals from 13 US states completed the survey; 12 participated in follow-up interviews. Fifty percent of the participants (n = 7) had installed 5 or more cleanrooms in the previous 5 years and over half (n = 8; 57%) had 7 or more years of cleanroom experience. The average satisfaction scores for each type of cleanroom, on a 1 to 10 scale, was 5.3 for stick-built (n = 11) and 9.3 for modular (n = 4). The pros of stick-built cleanrooms included greater design and material flexibility and lower up-front costs. The pros of modular cleanrooms included the cleanroom experience and expertise of modular vendors, quick and easy installations, guaranteed certification, and high-quality and durable design features and materials. Additionally, modular cleanrooms had fewer long-term maintenance issues, greater long-term flexibility, and lower indirect and long-term costs than stick-built cleanrooms. Key pieces of advice from the participants included the following: do your homework before beginning a cleanroom project; make sure heating, ventilation, and air conditioning system(s) and air handlers are adequate for your needs; and remember that the ultimate purpose of a quality cleanroom is patient safety. Participants also advocated for industry-wide cleanroom standards that go beyond USP regulations. Conclusion The findings of this study confirm many of the purported pros and cons of each type of cleanroom, with further insight gained into the relative quality and costs of each type. Modular cleanrooms were considered by most participants to be a better long-term option, based on quality and lifetime costs, if feasible to install. Study participants also emphasized that designing and installing pharmacy cleanrooms is a complex and time-intensive process that often comes with a steep learning curve. While there are federal and state cleanroom standards available and consultants for hire, a comprehensive resource or manual that could provide guidance, insight, and collective lessons learned on cleanroom design and installation is needed. [ABSTRACT FROM AUTHOR]

Background: This article reviews the current state of pharmaceutical care in community pharmacies in Poland and proposes a collaborative framework for its advancement. While pharmaceutical care has evolved significantly worldwide, with Europe leading the way, Poland has lagged in its development. Although Polish pharmacists are well-qualified and community pharmacies are numerous, pharmaceutical care remains underdeveloped. Methods: We conducted a literature review and analyzed case studies from European countries with advanced pharmaceutical services. Based on these findings, we collaborated with policy makers, commissioners, and academics to develop a framework for enhancing pharmaceutical care in Poland. The plan emphasizes integrating seven key services into Polish community pharmacies. Results: Our proposed framework outlines seven essential pharmaceutical services: medicine use reviews, new medicine services, minor ailment services, repeat prescription services, integrated prevention programs, cardiovascular disease prevention programs, and vaccination programs. Evidence from other European countries suggests that implementing these services could significantly improve health outcomes and patient quality of life. This is particularly important in light of Poland's ageing population, the rising prevalence of chronic diseases, and the healthcare system's increasing burden due to polypharmacy. Conclusions: The proposed framework presents a practical and collaborative approach to advancing pharmaceutical care in Poland. By adopting these key services, community pharmacies could play a more integral role in improving patient care quality and alleviating pressure on the broader healthcare system. [ABSTRACT FROM AUTHOR]

Since June 2021 in France, patients with haemophilia A with anti-factor VIII inhibitors and patients with severe haemophilia A without anti-factor VIII inhibitors have the choice between the community and the hospital pharmacy for dispensing emicizumab (Hemlibra®). This study aims to investigate patient-centred access to treatment by evaluating and comparing the dimensions of the Penchansky and Thomas model, between community and hospital pharmacies. The evaluation of access to treatment was based on the dimensions of the Penchansky and Thomas model: accessibility, availability, acceptability, accommodation and affordability. These were assessed using appropriate and specific indicators in the study context and calculated for patients choosing community pharmacy or hospital pharmacy for emicizumab dispensing. Geographical data collected as part of the national 'PASO DOBLE DEMI' study were used for this analysis. The findings reveal that dispensing emicizumab in community pharmacies improves accessibility by significantly reducing travel time. The availability of healthcare services is also improved due to the territorial coverage of community pharmacies. The extended opening hours and low waiting time also contribute to better access to emicizumab in community pharmacies. The dimension of acceptability must be improved, and further investigations are needed to address the affordability dimension. Several months after emicizumab became available in French community pharmacies, access to treatment has significantly improved, reducing the burden of this rare chronic disease for patients and their careers. These results suggest that this innovative model could be extended to other medicines and even other therapeutic areas. [ABSTRACT FROM AUTHOR]

Purpose An investigational drug services (IDS) pharmacy plays a vital role in supporting clinical trial research by ensuring the safe and efficient management of investigational products. This article describes the implementation of an electronic project management software to improve an IDS pharmacy's study protocol work. The article describes the implementation of the software and how this approach addressed specific challenges, including project oversight, process standardization, documentation, reporting, accountability, and intrateam communication. Summary We describe an electronic project management software system used to streamline and standardize the work associated with study protocols. This software provides an organized and customizable workspace to manage tasks associated with each study protocol. The software automates task creation, tracks progress, and ensures comprehensive record keeping. Additionally, the software fosters effective communication within the team and offers real-time reporting to assess team productivity and progress. We have observed improved consistency, enhanced revenue, including approximately $18,000 in additional fee capture, and increased collaboration among pharmacy team members. Conclusion Implementing an electronic project management software has proven highly beneficial in the IDS pharmacy. The software has significantly improved workflow efficiency by addressing challenges in study protocol management. While initial setup and training required time and resources, the long-term benefits in project oversight, collaboration, and revenue capture justify the investment. An electronic project management software is a valuable tool in managing the complexity of study protocol activities and supports the pharmacy's crucial role in advancing clinical research. [ABSTRACT FROM AUTHOR]

Community pharmacies have unparalleled potential to increase access to pre-exposure prophylaxis medications (PrEP) for HIV prevention; however, only 17 out of 50 states in the United States have statewide authority for pharmacists to provide PrEP at community pharmacies. Few studies have reported on how pharmacists overcome the legislative barrier and provide PrEP services in restrictive pharmacy prescription states. The objective of this article is to identify the existing primary literature describing pharmacist PrEP services in the community in states with restrictive prescription authority. Methods: A systemic literature review was conducted to identify the primary literature that involved community pharmacy service and PrEP conducted in states that do not have expanded pharmacist prescriptive authority between 2000 to 2024. Results: Ten publications were identified, describing nine studies, including four interview and survey studies, three intervention reports, and two ongoing clinical trials. None of these studies have a control group. Most pharmacists provide PrEP services in the community through a collaborative practice agreement with a primary care provider. Conclusions: Future clinical studies with randomized controlled designs are required to test novel strategies in the education and implementation of pharmacy-led PrEP services in a community pharmacy setting to increase PrEP access. [ABSTRACT FROM AUTHOR]

Purpose Hospital at home (HaH) program development, spurred by hospital congestion during the COVID-19 pandemic, is moving from a novel idea to a standard of inpatient practice. Understanding pharmacy's clinical role in the HaH patient care team is exceedingly important as programs across the country continue to develop, implement, and expand. The purpose of this study is to describe how clinical pharmacy services are currently provided for home hospital patients and to explain the vital role of pharmacists within the HaH care team. Description A descriptive study was designed to evaluate pharmacy services provided for home hospital patients from January 1, 2023, to February 28, 2023. Prior to the study period, a focused group of pharmacists routinely active in HaH patient care met to define a standard process for documenting pharmacy services using an electronic documentation system (i-Vent) within the EHR. During the study period, a total of 221 patients were admitted to home hospital at either site representing 3,258 inpatient medication orders with 2,997 medication administrations. Pharmacists signed 903 progress notes and documented 561 interventions across all types. The top 3 pharmacy intervention types were drug administration change (37%), medication reconciliation (29%), and antimicrobial stewardship (15%). Each of the top 3 types were further evaluated by subtype. Conclusion Documented pharmacy services encompassed a variety of intervention types. The overwhelming majority of patients admitted to the program received pharmacy consultative services, demonstrating how pivotal pharmacists are to the operational success of these programs and clinical care of HaH patients. More research is needed to expose pharmacy potential and facilitate growth for pharmacists practicing in HaH programs. [ABSTRACT FROM AUTHOR]

Patient prioritization is a effective strategy to identify high risk patients for targeted Clinical Pharmacy Service (CPS) in hospital pharmacy. However, there is a paucity of patient prioritization tool to use in clinical practice. Describe the development, content validation and standardization of an adult patient prioritization tool for hospital CPS named, PrioFarClinH. The tool was developed using a stepwise design multi: Scoping Review to identify prioritization criteria/sub-criteria; Delphi technique to obtain consensus under the identified criteria/sub-criteria; Survey with pharmacists evaluating applicability of the criteria/sub-criteria obtained from Delphi; Definition of criteria/sub-criteria to be included in PrioFarClinH attribution of scores. Content validation was performed by a panel of experts evaluating relevance, feasibility, clarity and adequacy of the score. Content Validity Index (CVI) was calculated. Standardization occurred through a retrospective observational study carried out at 24 and 72 h and median of the patient's hospital stay. An intragroup norm was performed, determining percentile ranks of the instrument's total scores. Patients with a P90 score were classified with a high level of prioritization for CPS. PrioFarClinH is divided into three sections, with prioritization criteria for health issues; therapeutic classes; laboratory parameters. It comprises 51 criteria with specific scores with simple total calculation. None of the criteria presented CVI <0.78, maintaining the items from the initial version of PrioFarClinH. The scores were adjusted per suggestions from the panel of judges. Data were collected from 393 patients. The P90 percentile in the three hospitalization stages (24 h, 72 h, and median) was found, respectively, in the following scores: 18.0, 20.0, and 22.6. PrioFarClinH is a comprehensive tool to target and to prioritize adults patients most likely to benefit from CPS. Evidence for adequate content validity was provided. However, further validation of this tool is necessary to establish tool performance. [ABSTRACT FROM AUTHOR]

Purpose This project compared the time to complete investigational prescription drug order verification by investigational drug service (IDS) pharmacists in an onsite vs offsite (hybrid) staffing model, evaluating the impact of remote work on verification time. Methods Parenteral IDS drug orders from August 2019 through June 2022 were analyzed. Electronic medical records were timestamped for each order, first verification, second verification, and medication administration. The project was divided into four 6-month time periods to allow for 2 independent comparisons of onsite vs hybrid staffing models. A survey was given retrospectively to IDS pharmacists for the last hybrid timeframe to assess work satisfaction and burnout. Results A total of 4,398 orders were evaluated. The time from order entry to first verification was 14 minutes (n = 1,248) during the first onsite time period compared to 13 minutes (n = 1,042) during the first hybrid period (P = 0.003). The time for order verification was similar between the second onsite and hybrid periods (12 minutes [n = 1,041] vs 10 minutes [n = 1,067], respectively; P < 0.0001). The staff satisfaction survey for the hybrid model showed high levels of job satisfaction and no self-reported burnout. Conclusion The remote hybrid staffing model did not result in a meaningful change in the time from order placement to medication administration within the IDS pharmacy. Hybrid staffing also resulted in greater job satisfaction among IDS pharmacists. This study highlights the benefits of implementing remote work practices in the pharmacy practice setting. [ABSTRACT FROM AUTHOR]

BackgroundThe development of community-based health insurance (CBHI) was driven by the need to provide economic protection for the poor against unexpected healthcare expenses. This can lead to increased patient satisfaction with their overall care. Maintaining high levels of client satisfaction with pharmacy services is crucial for effectively treating patients with psychiatric disorders. Therefore, the purpose of this study was to assess the impact of pharmacy services on psychiatry patient satisfaction among users of CBHI in the psychiatric setting.MethodsA multicenter cross-sectional study was conducted at the psychiatric clinics with a systematic random sampling technique between December 2023 and May 2024. A structured interview questionnaire was used to gather data. Both bivariate and multivariate analysis were employed. In multivariate analysis, variables having a p-value of < 0.05 were deemed statistically significant.ResultA total of 420 participants were enrolled with a response rate of 99.5%. Overall, 261 (62.1%) of the patients reported being satisfied with the pharmacy service. However, a significant number of patients expressed dissatisfaction with certain aspects of the service, such as pharmacist counseling on medication side effects (43.1%), medication interactions (36.9%), and labeling and dispensing of medicines (42.4%). According to the study, living in an urban area [AOR = 2.0; 95% CI (1.25, 3.2); P = 0.04], being between the ages of 18–35 and 36–44 [AOR = 2.7, 95% CI (1.38, 5.3), p = 0.04] and [AOR = 3.3, 95% CI (1.6, 5.7), p = 0.001] respectively. First and second visits to the institution [AOR = 2.2; 95% CI (1.15, 4.4); P = 0.01] and [AOR = 1.9; 95% CI (1.13, 3.3); P = 0.01] respectively. Having two psychiatric disorders [AOR = 1.8, 95% CI (1.07, 3.07), p = 0.02] and all drug availability [AOR = 1.5, 95% CI (1.3, 3.43), p = 0.02], were positively associated with psychiatry patient pharmacy service satisfaction.ConclusionIn this study, the users of CBHI psychiatric patients were generally satisfied with the pharmacy service. Additionally, being urban residency age (18–44 years), first and second visits to the institution, having two psychiatric disorders and all drug availability were found to have a significant impact on psychiatric patient pharmacy services satisfaction.

Introduction: Asthma is a chronic disease with a high global prevalence, resulting in substantial economic and social impacts for patients and their families. These impacts include spending on health services, medicines and lost productivity. Objective: to describe the profile of household expenses, including direct and indirect expenses and loss of income of individuals with asthma and their families in a limited population. Methods: a cross-sectional study was carried out with the application of the Family Costs of Asthma Questionnaire in a public community pharmacy in southern Brazil. Expenses were described by mean and standard deviation, presented in reais (BRL) and dollars by purchasing power parity ($). Results: A total of 57 individuals with asthma were interviewed, of which 43 (75.4%) reported having private expenses related to asthma treatment, with an average expenditure of $287.74 (R$495.19), which corresponded to 38% of current minimum wage. Furthermore, it was found that 5 people (8.7%) lost their income, referring to 2021. Loss of income occurred due to employment loss, while expenses were related to the purchase of medicines, examinations, consultations, transportation, and food, among others. Conclusion: The most of interviewees had private asthma expenses, which had a direct impact on their income. In addition to private spending, Covid-19 resulted in income loss. As a result, asthma had a significant impact on family costs during a period the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

OBJECTIVE The purpose of this study was to evaluate the feasibility of a pharmacist-driven discharge medication reconciliation (DMR) service at our children’s hospital by completing a 2-week pilot on a general pediatrics unit. METHODS This was a prospective study and included patients discharged during pilot hours whose DMR was completed by the pharmacist. The primary outcome was evaluation of time required for a pharmacist to complete the DMR. Secondary outcomes included classification of pharmacist interventions made and their associated cost-avoidance, medication-related problems reported within 14 days of discharge, hospital readmission due to medication problems within 30 days of discharge, and medical resident satisfaction assessed via prepilot and postpilot surveys. RESULTS A total of 67 patients had their DMR completed by a pharmacist during the pilot. The pharmacist spent an average of 30 minutes completing each DMR, although this was variable, as evidenced by an SD of 36.4 minutes. Pharmacists documented 89 total interventions during the study period. The most common intervention types were therapeutic optimization (32.6%) and modification of directions (29.2%). Total estimated cost-avoidance during the study pilot was $84,048.01. For the pilot population, 1 medication-related problem was identified within 14 days of discharge. There were no medication-related readmissions identified. Medical residents reported increased confidence that the DMR was completed accurately and satisfaction with the DMR process during the pilot compared with before the pilot. CONCLUSIONS Implementing a pharmacist discharge medication service requires consideration of pharmacist time and salary, which may be offset by cost-avoidance. [ABSTRACT FROM AUTHOR]

Introduction: Our cancer program adopted a method for carboplatin desensitization (4-step 2-bag method) that administers the same intensity of drug exposure with a simplified approach to product management in comparison to a published protocol (4-step 4-bag method). Methods: The intensity of carboplatin administration for 1:1,000, 1:100, 1:10, and 1:1 dilutions and concomitant fluid administration were compared for the 4-step 2-bag (bags A, B) and 4-step 4-bag (bags 1, 2, 3, 4) methods. Pharmacy preparation of bags A and B is described. A succinct overview of the desensitization procedure is provided. Important considerations germane to pharmacy practice are presented. Chart review of patients who underwent carboplatin desensitization with the 4-step 2-bag method between 7/13/2021 and 11/22/2023 was performed to demonstrate institutional use. Results: The 4-step 2-bag method delivers similar rates of drug intensity from start of desensitization to completion of the planned dose as the previously published 4-step 4-bag method. Accuracy of regimen-based dose administration is assured by infusion of bag B contents irrespective of infusion interruptions or rate changes necessitated by patient tolerance. Bag A provides the 1:1000 dilution in a pharmaceutically elegant manner using administration rates and volumes compatible with clinical practice. Conclusion: The 4-step 2-bag method for carboplatin desensitization administers controlled drug titration corresponding to 1:1000, 1:100, 1:10, and 1:1 dilutions for dose administration using two compounded admixture bags. Inaugural clinical use of the 4-step 2-bag method for carboplatin desensitization at our healthcare facility has proceeded with expected patient tolerance. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is a multifactorial condition often induced by drugs commonly used in hospitals. Identifying and staging AKI necessitates frequent monitoring of renal function. Aim: To assess the impact of real-world hospital practices regarding serum creatinine (SCr) testing on the identification and staging of AKI, and its implications for adjusting drug doses. Method: A historical cohort study utilizing hospital records from all adult patients admitted between 01/06/2018 and 31/12/2020 was conducted. Patients with no SCr assessment during their stay or those with an SCr at admission ≥ 2 mg/dL were excluded. AKI was determined using two criteria, namely AKIN and KDIGO, considering the time intervals between two SCr tests as outlined in the criteria. Additionally, patients with SCr increases exceeding AKI limits, regardless the time interval, were also identified. The estimated glomerular filtration rate (eGFR) and kinetic eGFR (KeGFR) were calculated. Results: During the study period, 17,269 hospitalizations and 62,255 SCr tests were recorded. Among the 17,032 hospitalizations with a length of stay > 48 h, 46.8% experienced periods with no SCr tests performed for more than 48 h. Any stage of AKI was identified in 7.0% of patients and in 9.1% using AKI and KDIGO criteria, respectively. Ignoring time limits in both criteria revealed potential AKI in 1942 patients (11.2%), indicating a potential underdiagnosis of AKI by 37.5% or 19.1%, depending on the criteria used. A total of 76 drugs requiring dose adjustment in patients with eGFR ≤ 50 ml/min were prescribed in 78.5% admissions. These drugs were prescribed in 87.9% of patients potentially underdiagnosed with AKIN and in 88.9% with KDIGO. Conclusion: There is a need for changes in the established hospital procedures to ensure more frequent testing of SCr levels. Implementing an advanced scope of practice for clinical pharmacists could support these changes. [ABSTRACT FROM AUTHOR]

Purpose Pharmacist-driven transitions of care interventions have been shown to improve patient clinical outcomes. However, the evidence in the literature on the impact of pharmacy transitions of care services on hospitalization and emergency department visit rates is inconclusive. The purpose of this study is to determine the impact of a pharmacist-driven transitions of care program on hospitalization and emergency department visit rates at an academic medical center. Methods This retrospective observational cohort study was conducted via pre- and postintervention analyses. The data collection period included 30 days before the date of pharmacist intervention and 30 days after the date of intervention. The study evaluated patients who were enrolled in the Transitional Inpatient Rounding Experience (TIRE) program at Wake Forest Baptist Health between August 2017 and September 2020. Patients excluded were less than 18 years old, in hospice care, discharged to long-term care, or did not have a hospitalization within 90 days of intervention. The Wilcoxon signed rank test was utilized to analyze continuous data. Standard descriptive statistics were used for categorical data. Results One hundred patients met the inclusion criteria for this study. For the primary outcome, the TIRE intervention resulted in a reduction of 31 hospitalizations, or 50% (62 prior hospitalizations in the 30 days before the intervention vs 31 admissions in the 30 days after the intervention; P < 0.001). There were significant reductions in the secondary outcomes of 90-day hospitalizations (24% fewer with intervention; P = 0.028) and 30-day emergency department visits (65% fewer with intervention; P =0.006). For the outcome of 90-day emergency department visits, there was a 36% reduction (P = 0.240). Conclusion The results of the study demonstrate that a pharmacy transitions of care program may lead to a reduction in hospitalization and emergency department visit rates. The study also found potential cost savings associated with a pharmacy transitions of care program. [ABSTRACT FROM AUTHOR]

Purpose Studies have shown the positive impact pharmacist-managed services have on patient care. However, little information is available on services for pregnant patients. This study contributes to the current literature by providing data on the impact of a pharmacist-managed service on outcomes in pregnant patients with iron-deficiency anemia. Methods This was a retrospective, data-only, multicenter study comparing pregnant patients with iron-deficiency anemia managed by a pharmacist (n = 100) to those who received standard care (n = 100). During the study period, patients were 16 years of age or older and pregnant with concurrent iron-deficiency anemia. The percentage of patients with a hemoglobin level above goal (>11.0 g/dL) at delivery, the mean hemoglobin level at delivery, and the type of iron supplementation were compared between the groups. Results The percentage of patients with a hemoglobin level of greater than 11.0 g/dL at delivery was 87% for the pharmacist-managed group compared to 71% for the group receiving standard care (P < 0.01). The mean hemoglobin level at delivery was significantly higher in the pharmacist-managed group than in the group receiving standard care, at 12.1 g/dL vs 11.6 g/dL, respectively (P < 0.1). There was no difference between the groups in the percentage of patients receiving blood transfusions (4% vs 3%; P = 0.56). The percentage of patients who received intravenous iron was significantly lower in the pharmacist-managed group than in the group receiving standard care (8% vs 21%; P < 0.01). Most patients in the pharmacist-managed group received oral ferrous sulfate (81%). Conclusion This study showed that including pharmacists in the management of pregnant patients with iron-deficiency anemia significantly improved patient hemoglobin levels at delivery. [ABSTRACT FROM AUTHOR]

Good hand hygiene techniques (HHTs), like those of the World Health Organization (WHO), prevent microbial contamination of aseptic preparations. The objective of this study was to assess the efficacy of a game-based training (GBT) tool (the Handtastic Box) to improve the compliance of hospital pharmacy operators (HPOs) with handwashing guidelines. A camera recorded handwashing by HPOs for 1 month before the training day, for 1 month after the training day (M1), and between month 1 and month 3 (M2&3). Movements were scored as fully executed, partially executed or not executed. Compliance rates of each HPO with HHTs were compared between observation periods. During 1-h training sessions, pairs of HPO trainees watched handwashing videos and noted which of five guideline steps was missing. They examined wooden hands with areas stained with fluorescein under ultraviolet light to find the hand showing the matching contamination. The mean compliance score for nine HPOs increased from 44.6% (before training, N =32 videos) to 86.7% (M1, N =40) to 82.5% (M2&3, N =45). Compliance with every step improved from before training to M1 and generally stabilized in M2&3, except for the fingertip washing step which dropped significantly in M2&3. To the authors' knowledge, this is the first study to assess the efficacy of a GBT tool to improve HPO compliance with the WHO HHTs. The tool improved handwashing scores significantly, and maintained them at the same level for 3 months after training. The separate results for each step highlight the need to train every movement. This GBT tool successfully improved compliance with the WHO HHTs for 3 months. This training could be used for other healthcare professionals. [ABSTRACT FROM AUTHOR]

Community pharmacies have unparalleled potential to increase access to pre-exposure prophylaxis medications (PrEP) for HIV prevention; however, only 17 out of 50 states in the United States have statewide authority for pharmacists to provide PrEP at community pharmacies. Few studies have reported on how pharmacists overcome the legislative barrier and provide PrEP services in restrictive pharmacy prescription states. The objective of this article is to identify the existing primary literature describing pharmacist PrEP services in the community in states with restrictive prescription authority. Methods: A systemic literature review was conducted to identify the primary literature that involved community pharmacy service and PrEP conducted in states that do not have expanded pharmacist prescriptive authority between 2000 to 2024. Results: Ten publications were identified, describing nine studies, including four interview and survey studies, three intervention reports, and two ongoing clinical trials. None of these studies have a control group. Most pharmacists provide PrEP services in the community through a collaborative practice agreement with a primary care provider. Conclusions: Future clinical studies with randomized controlled designs are required to test novel strategies in the education and implementation of pharmacy-led PrEP services in a community pharmacy setting to increase PrEP access.

Introduction: The complexity of treatment and extended therapy duration associated with bone marrow transplantation directly affect the psychological well-being of the patients, create anxiety, and reduce their quality of life. The aim of our study was to evaluate the quality of life of patients admitted to the bone marrow transplantation unit. Methods: This prospective and descriptive study was conducted between January and June 2021 in an adult BMT unit in Turkey. The sociodemographic characteristics of the patients were recorded. The patient's quality of life was measured twice using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) scale at the beginning of the study and 30 days later. SPSS 15 was used for the analysis. Results: A total of 40 patients were included in the study. The mean age was 46 years. Most of the patients were diagnosed with multiple myeloma and 58% had at least one comorbid disease. Most of the patients (78%) were receiving myeloablative therapy. High dose melphalan regimen was the most commonly applied regimen (25%). Thrombocytopenia was the most common side effect (14%). Although there was no change in the quality of life, it was found that the social/family well-being scores increased (p < 0.05). Conclusions: In our study, it was observed that the number of comorbid diseases was higher in patients with bone marrow transplantation. The incidence of side effects may be high in these patients. We believe that clinical pharmacists have an important role in monitoring adverse effects and improving the quality of life in bone marrow transplantation units. [ABSTRACT FROM AUTHOR]

The Discharge Medicines Review (DMR) is a community pharmacy service in Wales that aims to reduce medicines-related harm after care transitions, including hospital discharge. To undertake a DMR, the Community Pharmacist must receive a patient's discharge medicines information, either electronically, by fax or presented by the patient. Although the DMR has evidenced benefits for improving patient safety, its evaluation showed inconsistent uptake, which Community Pharmacists partially attributed to hospitals not providing the necessary information. Aiming to develop recommendations to improve hospital engagement to DMR referrals, this study explores hospital pharmacy professionals' views of the service. Qualitative focus groups, using hermeneutic phenomenology, were conducted in 16 hospitals across Wales, using a quota sampling method to include 61 Pharmacists and 31 Pharmacy Technicians. To understand the suboptimal engagement to DMR referrals, framework analysis was undertaken using the Consolidated Framework for Implementation Research (CFIR). The data were mapped onto all five CFIR domains, each containing barriers and facilitators to engagement with DMR referrals and suggestions for improvement. Only one hospital had successfully implemented DMR referrals, with many participants lacking any knowledge of the service or how to refer to it. Specific barriers included a clear absence of processes to implement referrals and engage hospital pharmacy professionals. A considerable barrier was many participants' perceptions that Community Pharmacist roles were less clinically orientated and patient-centred than their own, viewing them almost as a different profession. Participants believed that local champions for DMR referrals could promote engagement and integrate them into the workflow of hospital pharmacy professionals. Further recommendations to improve engagement was staff training for DMRs and regular feedback of its value. Policymakers may use the findings and recommendations from this study to promote hospital pharmacy staff engagement to similar community pharmacy services like the Discharge Medicines Service in England. [ABSTRACT FROM AUTHOR]

Background: Pharmacogenetic (PGx) testing and counselling (short: PGx service) in the community pharmacy is not routinely practiced. We propose a comprehensive pharmacist-led service where PGx information is integrated into medication reviews. Aim: To evaluate the pharmacist-led service comprising PGx testing and counselling (PGx service) from the perspective of patients. Method: For this mixed-methods study, we conducted two follow-up interviews F1 and F2 with patients recruited for the PGx service in a community pharmacy after 1st of January 2020. The semi-structured interviews were held by phone call and covered understanding of PGx, the implementation of recommendations, handling of PGx documents (list of concerned substances and PGx recommendation), gain in medication knowledge, and willingness to pay for the PGx service. Results: We interviewed 25 patients in F1 and 42 patients in F2. Patients were generally able to understand and use results of the PGx service. At least one PGx recommendation was implemented for 69% of the patients. Handling of PGx documents ranged from patients having forgotten about the PGx results to patients consulting the list for every medication-related decision; the latter often expecting negative effects. Finally, 62% of the patients were willing to pay for the PGx service. Conclusion: For future PGx testing and counselling, HCPs should consider the patients' health literacy in a standardized way and use adequate communication skills to enhance the patient's understanding in PGx and to attenuate potential negative expectations. [ABSTRACT FROM AUTHOR]

Background: Economic evaluation is crucial for healthcare decision-makers to select effective interventions. An updated systematic review of the economic evaluation of pharmacy services is required in the current healthcare environment. Aim: To conduct a systematic review of literature on economic evaluation of pharmacy services. Method: Literature (2016–2020) was searched on PubMed, Web of Sciences, Scopus, ScienceDirect, and SpringerLink. An additional search was conducted in five health economic-related journals. The studies performed an economic analysis describing pharmacy services and settings. The reviewing checklist for economic evaluation was used for quality assessment. The incremental cost-effectiveness ratio and willingness-to-pay threshold were the main measures for cost-effective analysis (CEA) and cost-utility analysis (CUA), while cost-saving, cost–benefit-ratio (CBR), and net benefit were used for cost-minimization analysis (CMA) and cost–benefit analysis (CBA). Results: Forty-three articles were reviewed. The major practice settings were in the USA (n = 6), the UK (n = 6), Canada (n = 6), and the Netherlands (n = 6). Twelve studies had good quality according to the reviewing checklist. CUA was used most frequently (n = 15), followed by CBA (n = 12). Some inconsistent findings (n = 14) existed among the included studies. Most agreed (n = 29) that pharmacy services economically impact the healthcare system: hospital-based (n = 13), community pharmacy (n = 13), and primary care (n = 3). Pharmacy services were found to be cost-effectiveness or cost-saving among both developed (n = 32) and in developing countries (n = 11). Conclusion: The increased use of economic evaluation of pharmacy services confirms the worth of pharmacy services in improving patients' health outcomes in all settings. Therefore, economic evaluation should be incorporated into developing innovative pharmacy services. [ABSTRACT FROM AUTHOR]

Patients with asthma and chronic obstructive pulmonary disease rely on inhaler therapy to reduce disease progression and exacerbation risk. Patients admitted to the hospital are at an increased risk for exacerbations and readmission if their inhaler therapy upon discharge is not aligned with current guidelines and/or affordable. The objective of this study was to assess the appropriateness of the chronic inhaler regimen for patients admitted to the hospital based on clinical practice guidelines and insurance coverage. A sub‐study was designed to analyze a cohort of a single‐center, pragmatic, prospective randomized controlled trial at a large academic medical center. Patients admitted to a medicine service with a pharmacist and prescribed a long‐acting inhaler were included. Participants randomized to a pharmacist‐led intervention were assessed for inhaler appropriateness based on clinical guidelines and patient insurance. The objective of this sub‐study is to assess the number of inhalers identified as inappropriate based on the pharmacist's review. A patient was considered to have an inappropriate inhaler regimen if any of their inhalers were inconsistent with guideline recommendations or not covered by insurance. Descriptive statistics were used to characterize appropriate inhaler use. The study pharmacist reviewed 552 unique inhalers for 348 patients. Overall, 42% of inhalers were inappropriate, affecting 50.3% of participants; 20% of inhalers were inappropriate based on insurance, 26% were inappropriate based on guidelines, and 7% were inappropriate based on both criteria. Recommendations were placed via a pharmacy consult for 198 patients (57%), most recommending an inhaler initiation (55%), followed by inhaler discontinuation (38%). A pharmacist‐led review of chronic inhaler therapy for patients admitted to the hospital identified the need for a change in therapy based on financial or clinical guidelines in over half of the patients reviewed. Interventions to increase the appropriateness of prescribed inhalers are needed to reduce disease progression and disease exacerbation. [ABSTRACT FROM AUTHOR]

Purpose Research pharmacy effort required to safely and compliantly manage investigational products (IP) varies between studies. No validated tool exists in the United States to evaluate these differences in effort. The Vizient Pharmacy Research Committee Investigational Drug Services (IDS) Subcommittee previously developed a systematic complexity scoring tool (CST) through expert consensus to assign a complexity score for pharmacy effort. This project seeks to develop and validate complexity categories based on CST scores. Methods Vizient member institutions in IDS assigned a CST complexity score and a perceived complexity category (low, medium, or high) for study initiation and maintenance. Receiver operating characteristic (ROC) curve analysis defined the best CST score cutoff points for each complexity category. Comparing the CST-assigned to the user-perceived complexity category determined whether the CST-assigned complexity category aligned with practitioner assignment. Results A total of 322 responses were used to determine complexity score categories. The AUC values for study initiation and maintenance were 0.79 (P < 0.001) for the low/medium boundary and 0.80 (P < 0.001) for the medium/high boundary, suggesting the performance of the CST is good. The agreement between CST-assigned and user-perceived complexity categories was 60% for study initiation and 58% for maintenance. The Kendall rank correlation coefficient between the raters and ROC categories was strong, with a value of 0.48 for study initiation and 0.47 for maintenance. Conclusion Development of the CST allows IDS pharmacies to objectively measure the complexity of clinical trials, which is a significant step towards assessing workload and guiding resource allocation. [ABSTRACT FROM AUTHOR]

Background: The number and complexity of patients being admitted to hospitals is rising and some patients may not receive a full clinical pharmacy review or be reviewed as regularly as needed during their inpatient stay. This is a risk factor for medication errors. Clinical prioritisation identifies patients who are high-risk and most in need of a pharmacist review, targeting finite pharmacy resources to patients who will benefit the most. Objectives: Assess and enhance clinical prioritisation within a hospital pharmacy department. Methods: The study was conducted in a large urban academic teaching hospital. A cross-sectional survey of clinical pharmacists in the hospital was conducted to establish the patient clinical criteria they prioritise in their work. A clinical prioritisation tool was developed based on survey findings and was integrated into an existing electronic pharmacy care interface. A pre- and post-intervention study was conducted, consisting of data collection for five days pre- and five days post-implementation of the tool. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were analysed by thematic analysis. Results: Of 39 eligible pharmacists, 37 (95%) responded to the survey. The top-rated prioritisation criteria, including medicines reconciliation tasks and high-risk medicines, helped to inform the content of the clinical prioritisation tool. Post-intervention, there were more Level 1 complex patients reviewed by pharmacists and fewer Level 3 stable patients compared to pre-intervention. Tool sensitivity ranged from 51 to 88%, depending on the experience of the pharmacist using the tool. High levels of satisfaction with clinical prioritisation were reported by those using the tool. Conclusion: This newly developed clinical prioritisation tool has the potential to support pharmacists in identifying and reviewing patients in a more targeted manner than practice prior to tool development. Continued development and validation of the tool is essential, with a focus on developing a fully automated tool.

Background: The COVID-19 pandemic strained healthcare systems immensely as of 2020. Switzerland's hospital pharmacies' responses during the first wave were surveyed with a view to improving the quality of pharmaceutical management in future health crises. Methods: An online survey was sent to the heads of all of Switzerland's hospital pharmacies. The questionnaire was organised into eleven sections of questions covering many topics regarding the management of COVID-19's first wave. Data collection occurred from May to June 2020. Results: Analyses were performed using the 43 questionnaires (66%), with at least one answer per questionnaire, out of 65 distributed. Seventeen of 41 pharmacies responding (41%) had existing standard operating procedures or pandemic plans and 95% of these (39/41) set up crisis management steering committees. Twenty-nine of 43 pharmacies responding (67%) created new activities to respond to the pandemic's specific needs. Twenty-six of 39 pharmacies responding (67%) created new drug lists for: COVID-19-specific treatments (85%; 22/26), sedatives (81%; 21/26), anaesthetics (77%; 20/26) and antibiotics (73%; 19/26). Drug availability in designated COVID-19 wards was managed by increasing existing stocks (54%; 22/41 pharmacies) and creating extra storage space (51%; 21/41). Two drugs generated the greatest concern about shortages: propofol (49%; 19/39 pharmacies) and midazolam (44%; 17/39). Remdesivir stocks ran out in 26% of pharmacies (10/39). Twelve of 43 pharmacies (28%) drafted specific new documents to respond to medical needs regarding drug administration, 12 (28%) did so for drug preparation and 10 (23%) did so for treatment choices. Conclusions: Switzerland's hospital pharmacies encountered many challenges related to the COVID-19 crisis and had to find solutions quickly, effectively and safely. The survey highlighted the key role that hospital pharmacies played in many aspects of the pandemic by providing logistical and clinical support to medical and nursing care teams. The lessons and experiences outlined could be used to improve the quality of hospital pharmacies' readiness for similar future events. Key points: The COVID-19 pandemic generated unprecedented global demand for specific drugs, hand sanitiser solution and other therapeutic products, particularly in critical care settings, highlighting the essential role of hospital pharmacists in such crises. Key COVID-19 responses at the hospital pharmacy level included staff flexibility regarding changes in roles and procedures, communication, teamwork and solidarity, and the need to prepare business continuity plans and management dashboards. Managing and coping with a complex pandemic reveals the importance of involving hospital pharmacists in pandemic response steering committees at many levels. Pharmacists' lived experiences during the pandemic should be described and evaluated by hospital pharmacies worldwide, both to raise awareness and to guide appropriate policy responses when the next crisis occurs. [ABSTRACT FROM AUTHOR]

Purpose: The impact of several pharmaceutical interventions to reduce the use of potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) has been recently studied. We aimed to determine whether clinical medication review (CMR) (i.e. a systematic and patient-centred clinical assessment of all medicines currently taken by a patient) performed by a geriatrician and a pharmacist added to standard pharmaceutical care (SPC) (i.e. medication reconciliation and regular prescription review by the pharmacist) resulted in more appropriate prescribing compared to SPC among older inpatients. Methods: A retrospective observational single-centre study was conducted in a French geriatric ward. Six criteria for appropriate prescribing were chosen: the number of PIMs and POMs as defined by the STOPP/STARTv2 list, the total number of drugs prescribed, the number of administrations per day and the number of psychotropic and anticholinergic drugs. These criteria were compared between CMR and SPC group using linear and logistic regression models weighted on propensity scores. Results: There were 137 patients included, 66 in the CMR group and 71 in the SPC group. The mean age was 87 years, the sex ratio was 0.65, the mean number of drugs prescribed was 9, the mean MMSE was 21 and at admission 242 POMs, and 363 PIMs were prescribed. Clinical medication review did not reduce the number of PIMs at discharge compared to SPC (beta = − 0.13 [− 0.84; 0.57], p = 0.71) nor did it reduce the number of drugs prescribed (p = 0.10), the number of psychotropic drugs (p = 0.17) or the anticholinergic load (p = 0.87). Clinical medication review resulted in more POMs being prescribed than in standard pharmaceutical care (beta = − 0.39 [− 0.72; − 0.06], p = 0.02). Cardiology POMs were more implemented in the medication review group (p = 0.03). Conclusion: Clinical medication review did not reduce the number of PIMs but helped clinicians introduce underused drugs, especially cardiovascular drugs, which are known to be associated with morbidity and mortality risk reduction. [ABSTRACT FROM AUTHOR]

Coronavirus disease (Covid-19) was first discovered in 2019 in Wuhan City, China. The massive spread of the virus has led the World Health Organisation (WHO) to declare the COVID-19 outbreak a pandemic. This brings changes in social life due to the obligation to keep a distance, including getting pharmaceutical services. Online pharmacy services can be a solution to social restrictions imposed during a pandemic. The aim of this study is to find out how to communicate with the public about obtaining pharmaceutical services during a pandemic by implementing physical distancing, knowing the pharmaceutical services that are felt during the implementation of physical distancing, and providing education in order to increase the understanding of the people of East Java regarding online pharmacy services. This research is descriptive with a quantitative approach. Data obtained through a survey using a random sampling technique This research involved 223 respondents who were East Javanese, with the majority being 21 years old. The results showed that respondents had good knowledge regarding physical distancing (98.2%), but lacked awareness to implement it. In pharmaceutical services, respondents felt changes due to the implementation of social restrictions during a pandemic. Most respondents (82.96%) have an interest in using online pharmacy services if they are available. As many as 29.15% of the total respondents had used online pharmacy services. In general, services are obtained through health applications (54.95%) and WhatsApp (35.16%), with a low frequency of use (1-2 times in the last 6 months). Respondents who have used online pharmacy services have the intention of using them again in the future. However, not all pharmacies provide this service. So education on pharmaceutical services is important to support the implementation of physical distancing during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The purpose of this narrative review is to identify studies that describe the use of the FASTHUG-MAIDENS mnemonic and-or adaptations in clinical practice. A literature search was performed in four databases and manual search for other sources, using the terms "fasthug-maidens", "pharmacist", and "pharmacy", for studies published between January 1st, 2011 and October 9th, 2022. Studies that reported the use of the FASTHUG-MAIDENS mnemonic and-or adaptations by clinical pharmacists in any hospital unit were included. One-hundred and twelve records were identified, of which 8 meet the eligibility criteria. The majority of the studies were conducted in Brazil between the years of 2021 and 2022 for critically ill patients exclusively. Four studies used this mnemonic as a tool to support the medicines optimisation. Overall, the studies showed that the mnemonic assisted the pharmacist to identify more drug-related problems and purpose more interventions for the multidisciplinary team. Moreover, four studies used the FASTHUG-MAIDENS as basis for development of new tools according to the profile of patients or context service, ensuring more efficiency in the role of the pharmacists. Researchers and pharmacists must be encouraged to publish their findings using this tool. [ABSTRACT FROM AUTHOR]

Purpose Ambulatory care and specialty pharmacy practices are rapidly growing in tandem with the accelerated development of advanced therapies for complex disease states. A coordinated and standardized interprofessional team–based approach is critical to providing high-quality care to specialty patients on complex, expensive, and high-risk therapies. Yale New Haven Health System dedicated resources to the creation of a medication management clinic under a unique care model that integrates ambulatory care pharmacists within specialty clinics who coordinate with centralized specialty pharmacists. The new care model workflow encompasses ambulatory care pharmacists, specialty pharmacists, ambulatory care pharmacy technicians, specialty pharmacy liaisons, clinicians, and clinic support staff. The strategies employed to design, implement, and optimize this workflow to meet the increasing demand for pharmacy support in specialty care is discussed. Summary The workflow incorporated key activities from highly diverse existing specialty pharmacy, ambulatory care pharmacy, and specialty clinic practices. Standard processes were developed for patient identification, referral placement, visit scheduling, encounter documentation, medication fulfillment, and clinical follow-up. Resources were created or optimized to support successful implementation, including an electronic pharmacy referral, specialty collaborative practice agreements to facilitate pharmacist-led comprehensive medication management, and a standardized note template. Communication strategies were developed to facilitate feedback and process updates. Enhancements focused on eliminating documentation redundancies and delegating nonclinical tasks to a dedicated ambulatory care pharmacy technician. The workflow was implemented in 5 ambulatory rheumatology, digestive health, and infectious diseases clinics. Pharmacists utilized this workflow to complete 1,237 patient visits, serving 550 individual patients over 11 months. Conclusion This initiative created a standard workflow to support an interdisciplinary standard of specialty patient care that is robust to accommodate planned expansion. This workflow implementation approach can serve as a road map for other healthcare systems with integrated specialty and ambulatory pharmacy departments undertaking similar models for specialty patient management. [ABSTRACT FROM AUTHOR]

Introduction: Data regarding drug‐related problems (DRPs) and pharmacist's role in the cardiovascular intensive care units (CICU) from low‐ to middle‐income countries (LMIC) are limited. Objective: The study aimed to characterize the DRP and interventions provided by clinical pharmacists in the CICU settings. Method: A retrospective, cross‐sectional study was conducted in patients admitted to CICU of a tertiary‐care hospital in Thailand during January 2021 to March 2022 was performed. Data were collected from patient's medical records and pharmacy service records. DRPs were categorized according to the Pharmaceutical Care Network Europe classification. Two board‐certified pharmacotherapy specialists, pharmacy residents, and trained clinical pharmacists staffed the units 5 days a week. The pharmacist team conducted a medication review and provided interventions to the cardiology team either verbally during the ward round or in writing, as appropriate. Pharmacist interventions were categorized into two groups including retrospective intervention (interventions made to resolve DRPs after an order was made) and prospective interventions (interventions made prior to ordering process). Outcome measures were (1) number of DRPs identified; (2) category of DRPs; (3) number interventions; and (4) acceptance rate of interventions by the medical team. Results: Among 576 patients admitted to the CICU, 345 DRPs were identified in 203 patients. The pharmacist team provided a total of 790 interventions including 345 retrospective interventions to resolve DRPs and 445 prospective interventions to guide medication use prior to the ordering process. The most frequent intervention was related to dosage adjustment, drug administration, adding drugs for existing conditions, and suggesting laboratory monitoring. The acceptance rate of the pharmacist intervention was 97.4%, most of which led to changes in drug therapy. Conclusion: DRPs in CICU settings are common. Trained clinical pharmacists can effectively resolve DRPs and provide recommendations to improve quality of care through both clinical and distribution functions. [ABSTRACT FROM AUTHOR]

Introduction: Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interferes with desired health outcomes. Objectives: To assess community pharmacists’ knowledge and practice regarding DRP-reduction services, as well as the barriers and factors associated with decreased provision of these services. Methods: This cross-sectional study utilized a validated questionnaire to assess pharmacists’ knowledge, practice, and barriers to the provision of DRP-reduction services in the community pharmacy setting. Binary regression model was used to assess the variables associated with the practice of DRP-reduction services. Results: A total of 412 pharmacists participated in the study. The pharmacists demonstrated strong knowledge but inadequate practice of DRP-reduction services. The most reported DRPs were inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements (52.4%), patients’ inability to understand instructions properly (46.1%), inappropriate drug according to guidelines (43.7%), and too high dose (40.3%). The most common barriers to these services were increased workload (60.5%), limited time (53.2%), and lack of good communication skills (49.8%). The presence of a counselling area in the pharmacy increased the practice of DRP-reduction services (OR: 3.532, 95%Cl: 2.010–5.590, P

Abstract The pharmacist is an important link between doctor and patient. To optimise patient care, it is essential that expectations of doctors and patients regarding pharmacy services are met. Hence the objective of this study was to assess the satisfaction levels of doctors and patients on pharmacy services currently provided, and their expectations from pharmacy services. This cross sectional study was conducted in selected clinics of a university based teaching hospital. Questionnaires developed in-house by referring previously published resources, content validated by a group of experts, and face validated through a pilot study were used. Doctors and patients of chronic disease clinics were selected for the study. All doctors involved in prescribing for more than six months, and patients or their regular care givers attending clinics for more than one year were included. Mentally incapacitated patients were excluded. An interviewee administered questionnaire was distributed to doctors and an interviewer administered questionnaire was used for patients. Exploratory factor analysis (EFA) (principal component analysis with Varimax rotation) was conducted to divide variables of the questionnaires into reliable components. Response rate of doctors was 82.3%. Among them 59.6% (50/84) doctors said that they have a good relationship with pharmacists, and 89.3% (75/84) expected communication with pharmacists more often. EFA for doctors’ perceptions resulted in four components. A statistically significant difference was observed between doctors’ expectation (95.9% - 81/84) and current practice (22.6% - 19/84) on communicating medication issues (p

Abstract This work analyzed the pharmacotherapeutic problems identified by the clinical pharmacist in an intensive care unit (ICU) and the acceptance of pharmaceutical interventions in solving these problems. This is a descriptive cross-sectional retrospective study, carried out in the adult ICU of a public hospital. All patients hospitalized during the study period had their pharmacotherapy monitored and those whose stay at the ICU lasted less than 24 hours were excluded. The pharmacotherapeutic problems were classified according to type, cause, acceptability/implementation, mode of intervention, outcome and related pharmacotherapeutic group. 302 patients were followed up and 350 pharmacotherapeutic problems were identified. Most of them were classified as unnecessary drug-treatment (n=186; 53.1%). The most frequent causes were excessive drug administration (n=181; 97.3%), and antimicrobials was the main group of drugs associated to that type of problem. 350 pharmaceutical interventions were performed, highlighting “prescriber informed only” (n=178; 50.9%), with an average acceptability of 90.7%, with those carried out on site being more effective (93.4%). The number of pharmacotherapeutic problems that were totally solved was 282 (80.6%). Clinical pharmacy activities in the ICU identified, prevented and corrected pharmacotherapeutic problems, contributing to the optimization of pharmacotherapy in aspects related to the need, efficacy and safety of treatments.

The process of drug dispensing in hospital pharmacies (HPs) is one of the essential steps in health care, but presents high complexity due to the diversity of professionals and clinical conditions of patients. Therefore, the use of quality management tools may be an important strategy to improve patient safety and to achieve institutional goals, including user satisfaction and reduction of costs. This scoping review sought to describe quality management tools applied to drug dispensing in HPs; quality indicators used and results obtained. This scoping review was developed according to the Cochrane methodology and reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA), being registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/KP3AJ). The searches were performed in electronic databases Medline, Cochrane Library, Embase, CINAHL and Lilacs, with no limit of date or language. Studies on quality management tools applied to drug dispensing in HPs were assessed for eligibility, extracted and compiled in a narrative form. From the 1318 studies identified, 11 were eligible for this review. The quality management tools more frequently reported were those related to the definition of root cause (n = 4; 36%), e.g. DMAIC (Define, Measure, Analyze, Improve and Control) and the cause and effect diagram; tools for risk management, such as FMEA (Failure Mode and Effect Analysis) and its variations (n = 4; 36%); and tools related to the LSS (LEAN Six Sigma) principles (n = 3; 27%). The quality indicators used to monitor the results were, mainly, work team satisfaction, time spent performing activities and reduction of errors and costs. The use of quality management tools showed a tendency to improve the indicators of the drug dispensing process in HPs, such as increase in work team satisfaction, reduction of time spent performing activities, errors and costs, improving the quality of services. [ABSTRACT FROM AUTHOR]

Measuring patient satisfaction and trust across various dimensions poses a challenge in the economic dynamics and service business development. Therefore, this study aims to analyze determinant factors of patient satisfaction and their impact on pharmacy trust. The investigation was carried out using a cross-sectional survey method with purposive sampling, and the questionnaire was designed based on a scientific literature review. The valid data obtained from 301 respondents were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results showed that the greatest antecedent to patient satisfaction was drug efficacy, followed by drug education, personnel quality, and financial-health coverage (all significant at p < 0.05). Patient satisfaction positively influenced trust in the pharmacy (p < 0.05). However, the physical aspect, procedures-service promptness, medication supply, and social responsibility did not affect patient satisfaction. These results suggest that the process and outcome elements of pharmacy service are critical factors in relationships between patients and pharmacies. [ABSTRACT FROM AUTHOR]

Background: In France, hospital pharmacists perform medication order reviews during patients' hospital stays. This activity can be centralized in the pharmacy or carried out directly in the ward, in collaboration with the healthcare team. During this review, pharmacists can make recommendations to optimize therapeutics. Since 2006, they can document their interventions, via the national Act-IP© observatory. Aim: To determine the characteristics of pharmacists' interventions and their acceptance by physicians in French hospitals. Method: A 6-year observational study of pharmacists' interventions documented on the Act-IP© French observatory between 2009 and 2014 was performed. Multiple logistic regression was undertaken to determine the predictors of physicians' acceptance of interventions. Results: A total of 194,684 pharmacists' interventions were documented and concerned mainly "dosage adjustment" (25.6%). These interventions were mostly related to drugs from the central nervous system (23.7%). Seventy percent of pharmacists' interventions were accepted by physicians. Acceptance rate was higher when conducted by a pharmacist regularly practicing in the ward (ORa = 1.60, CI 95 [1.57–1.64]). Physicians' acceptance was significantly associated with (1) ward specialty: emergency (ORa = 1.24, CI 95 [1.14–1.35]); (2) type of intervention: "drug discontinuation", "drug switch" (ORa = 1.15, CI 95 [1.12–1.19]) and "addition of a new drug" (ORa = 1.15, CI 95 [1.12–1.19]); (3) drug group: antineoplastic and immunomodulators (ORa = 3.67, CI 95 [3.44–3.92]). Conclusion: This 6-year longitudinal study highlights the role of clinical pharmacists, and particularly the impact of those integrated into wards. This was found to improve intervention acceptance, potentially through collaboration with physicians in pursuit of patient care and drug safety. [ABSTRACT FROM AUTHOR]

Pharmacies in several countries are encountering a fierce competition from both local and international rivals, resulting in significant challenges in maintaining competitiveness and market share. Pharmacies are important locations for those seeking non-prescription medicines and are equipped to manage a wide variety of ailments. However, despite the large number of previous qualitative studies on the service quality of community pharmacies, very few studies have explored the service quality dimensions, specifically for non-prescription medications. In this study, we aimed to explore pharmacists' and patients' perception of potential pharmacy service quality for dispensing non-prescription medicines. Purposive and snowball sampling techniques were used to recruit and select qualified pharmacists and patients in the major cities of Thailand. Multiple face-to-face and telephone interviews were recorded, transcribed, and analysed systematically using the interpretive method of content analysis. The participants reported several service attributes for dispensing of non-prescription medicines by community pharmacies. An analysis of the interviews revealed competence, communication, rapport, patient-centredness, and physical environment as the main themes related to service quality dimensions. Specifically, physical environment was categorized into two sub-themes, namely, hygiene and ambience. Service quality dimensions of community pharmacies for non-prescription medications were supported by dyadic perspectives – pharmacist and patient perspectives. The findings of the study contribute to community pharmacy research by focusing on the potential dimensions of service quality, especially for non-prescription medicines. [ABSTRACT FROM AUTHOR]

Background: No Arabic translation exists for the medication management patient satisfaction survey (MMPSS), a 10-item psychometrically valid patient satisfaction survey tool developed to assess patient satisfaction for comprehensive medication management. The objective of this study is to translate the medication management patient satisfaction survey into Lebanese Arabic while culturally adapting and assessing the psychometric properties of the translated survey in the outpatient setting. Methods: Guidelines for translation, adaptation, and validation of instruments for cross-cultural healthcare research were followed. The process included forward translation, expert panel review, back-translation, pretesting, and cognitive interviewing. Participants were approached after picking up their medications from the pharmacy at a primary care facility. The medication management patient satisfaction survey was administered verbally by two trained data collectors. Instrument psychometric analyses included testing both for reliability using Cronbach's alpha (a) and McDonald's omega (ω) and for construct validity using exploratory factor analysis (EFA). Pearson correlations between items were calculated. Results: During the translation process, the term "clinical pharmacist" was changed to "pharmacist today" for improved understanding. Four items were adapted through minor linguistic modifications. Data were collected from 143 patients. The mean age of participants was 72 years. Participants were mostly females (69%) and had an average of four comorbidities and eight daily medications. Findings from Cronbach's a and McDonald's ω indicated that the internal consistency among items from one to nine was very strong (α = 0.90; ω = 0.90). Exploratory factor analysis indicated that all items are strongly influenced by one factor, except for item six, "My clinical pharmacist is working as a team member with my other healthcare providers" which was the least influenced (loading = 0.44) with the highest uniqueness (0.81). The latent factor captured over 50% of the variance originally observed between variables. Items four and five "My clinical pharmacist helped me find easier ways to take my medicines" and "My clinical pharmacist helped me understand the best ways to take my medicines", had the strongest correlation (0.77), while the weakest correlation was seen between item six "My clinical pharmacist is working as a team member with my other healthcare providers" and other items. Conclusion: The Lebanese Arabic version of the medication management patient satisfaction survey was produced as a brief tool to serve as a valid and reliable instrument for measuring patient satisfaction with comprehensive medication management services. [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]

Abstract Purpose Assess whether full-scale simulation exercises improved hospital pharmacies’ disaster preparedness. Methods Swiss hospital pharmacies performed successive full-scale simulation exercises at least four months apart. An interprofessional team created two scenarios, each representing credible regional-scale disasters involving approximately fifty casualties (a major road accident and a terrorist attack). Four exercise assessors used appraisal forms to evaluate participants’ actions and responses during the simulation (rating them using five-point Likert scales). Results Four hospital pharmacies performed two full-scale simulation exercises each. Differences between exercises one and two were observed. On average, the four hospitals accomplished 69% ± 6% of the actions expected of them during exercise one. The mean rate of expected actions accomplished increased to 84% ± 7% (p

Background: No Arabic translation exists for the medication management patient satisfaction survey (MMPSS), a 10-item psychometrically valid patient satisfaction survey tool developed to assess patient satisfaction for comprehensive medication management. The objective of this study is to translate the medication management patient satisfaction survey into Lebanese Arabic while culturally adapting and assessing the psychometric properties of the translated survey in the outpatient setting.Methods: Guidelines for translation, adaptation, and validation of instruments for cross-cultural healthcare research were followed. The process included forward translation, expert panel review, back-translation, pretesting, and cognitive interviewing. Participants were approached after picking up their medications from the pharmacy at a primary care facility. The medication management patient satisfaction survey was administered verbally by two trained data collectors. Instrument psychometric analyses included testing both for reliability using Cronbach’s alpha (α) and McDonald’s omega (ω) and for construct validity using exploratory factor analysis (EFA). Pearson correlations between items were calculated.Results: During the translation process, the term “clinical pharmacist” was changed to “pharmacist today” for improved understanding. Four items were adapted through minor linguistic modifications. Data were collected from 143 patients. The mean age of participants was 72 years. Participants were mostly females (69%) and had an average of four comorbidities and eight daily medications. Findings from Cronbach’s α and McDonald’s ω indicated that the internal consistency among items from one to nine was very strong (α = 0.90; ω = 0.90). Exploratory factor analysis indicated that all items are strongly influenced by one factor, except for item six, “My clinical pharmacist is working as a team member with my other healthcare providers” which was the least influenced (loading = 0.44) with the highest uniqueness (0.81). The latent factor captured over 50% of the variance originally observed between variables. Items four and five “My clinical pharmacist helped me find easier ways to take my medicines” and “My clinical pharmacist helped me understand the best ways to take my medicines”, had the strongest correlation (0.77), while the weakest correlation was seen between item six “My clinical pharmacist is working as a team member with my other healthcare providers” and other items.Conclusion: The Lebanese Arabic version of the medication management patient satisfaction survey was produced as a brief tool to serve as a valid and reliable instrument for measuring patient satisfaction with comprehensive medication management services.