INNOVATIONS in pharmacy (Iip - E-Journal)
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Improving Vaccine Safety by Using an Algorithmic Model as a Replacement for a Physical Thermal Buffer
Get PDFConventional practice in vaccine storage is to insert a temperature probe into a bottle of glycol, or another equivalent thermal buffer medium, to simulate the temperature experience of the stored vaccine, rather than just the air temperature. Such a thermal buffer is intended to reduce false alarms so that the drug manager will know with higher confidence that a temperature alert is an event requiring action. While necessary and appropriate to correctly monitor the storage conditions, it is a practice that is messy, inconvenient, and costly, and can result in reports that diverge from the actual experience of the stored inventory. This paper explores the use of a mathematical algorithm to reproduce the behavior of a physical thermal buffer medium. The paper describes the algorithm and reports the degree to which it accurately simulates the experience of a 20-ml glycol container. The algorithm is shown to be highly predictive of the temperatures measured inside a container containing glycol
Evaluation of a Longitudinal Institutional Advanced Pharmacy Practice Model
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Objective: To evaluate a longitudinal experiential training model for advanced pharmacy practice experiences (APPEs).
Innovation: A six-month longitudinal pilot program named the Focused Institutional Longitudinal Experience (FILE) program was developed at two academic medical centers to maximize active participation of the student and minimize the time spent orienting and onboarding students to each APPE experience. A unique component of the FILE program is the longitudinal service project, which involved a medication use evaluation, including a review of published literature and drug policy recommendations to medical center quality committees.
Analysis: Student ratings regarding the quality and value of the FILE student experience was compared to the traditional APPE model. Nine quality measures were compared (e.g. amount of opportunity for direct patient care experience, learning, integration into healthcare team, and accountability for patient outcomes) between students from the FILE program to peers completing similar APPEs outside the FILE program. FILE students and APPE preceptors also completed surveys regarding the value of several program aspects.
Key Findings: There was no difference between FILE and non-FILE student self-rated measures of APPE quality, and thus the decision to participate in a longitudinal APPE program should be based on the personal preference of the student. Students in the FILE program agreed or strongly agreed (mean score 4.3) that they felt prepared for post-graduate training at the completion of the program. The potential value that students in a longitudinal program might bring to the site is reinforced by the general agreement by preceptors in the end of year survey that FILE students take less of their time to orient to their service and the trend toward perception that FILE students are more likely to independently participate in patient care activities.
Next Steps: To address feedback on preceptor-mentor role and the desire for more interaction with pharmacy residents, students are now paired with a pharmacy resident, and the student and resident work together on the service project with a clinical pharmacist as an advisor. Updated standards of practice clearly delineate the roles and responsibilities of students, residents, and the clinical pharmacist preceptor. Annual surveys of FILE students and preceptors provide necessary feedback to continuously improve the quality of the program.
Article Type: Not
Engaging with Patients In-need through Public Health Partnerships
No full textA public health partnership was established between a state Medicare Regional Care Collaborative Organization (RCCO), the state health department, a pharmacy school and three community pharmacies located in rural Colorado to optimize the utilization of a free public health service provided through each pharmacy. Fourth-year pharmacy students were allocated year-round by the University of Colorado to support disease management and medication therapy management (MTM) services offered to patients in three rural towns served by the RCCO. Faculty from the school of pharmacy reviewed data provided by the RCCO to identify patients who could benefit from MTM or disease state management (DSM) services. These patients were contacted and encouraged to take advantage of these free pharmacy-based services. Additionally, a number of targeted interventions were performed within these populations to optimize their health. Concerted efforts were made to improve information flow and communication between these pharmacy sites and partnering medical offices. Additionally, pharmacy students were successfully integrated in to medical offices to work alongside medical providers in these communities. This manuscript describes the implementation and coordination of this project as well as the impact these pharmacies had on the communities they served.
Topic: Original Research
 
Development and Implementation of Tennessee Nonresidential Buprenorphine Treatment Guidelines
Get PDFObjective: To describe the recent legislation in Tennessee and subsequent development and implementation of state-wide buprenorphine treatment guidelines.
Practice Innovation: In 2016, Tennessee began licensing office-based opioid treatment (OBOT) clinics. Due to initial licensing criteria, not all providers were required to be licensed with the Department of Mental Health and Substance Abuse Services (TDMHSAS). The gap in licensing made it difficult to ensure an appropriate standard of care was being met by all addiction treatment providers. Therefore, the state developed legislation that allowed for the creation of best practice guidelines to encompass all providers of buprenorphine in the state of Tennessee, not just the licensed OBOT clinics. The guidelines define what the standard of care should entail while treating this vulnerable addiction population.
Results: Tennessee legislation granted the formation of a committee to create the Tennessee Nonresidential Buprenorphine Treatment Guidelines. The committee was comprised of physicians, pharmacists, lawyers, law enforcement, and state officials. The finalized guidelines were published and effective January 1, 2018, and adopted as policy by the boards of medical examiners, osteopathic examination, and pharmacy shortly thereafter. The guidelines are now enforceable by the boards and give them the ability to discipline physicians who practice outside the standard of care.
Conclusion: Tennessee legislation provides a model for other states to take action in combating this opioid crisis by not only increasing access to addiction treatment, but increasing access to quality care.
Article Type: Commentary
 
A Systematic Review of the Effectiveness of Text Message Reminders on Asthma Medication Adherence
Get PDFObjective: Cell phone text messaging reminders offers the promise of an efficient technology for the management of chronic diseases, such as asthma. This review aims to evaluate the effectiveness of text message reminders in improving medication adherence for asthma compared to usual care.
Methods: Randomized controlled trials assessing the effect of text message reminders on adherence to asthma medication were identified from PubMed, Medline, Web of Knowledge EBSCOhost, OvidSP, PsycINFO, and Cochrane Central Register of Controlled Trials and Cochran Health Technology Assessment databases. Literature searches were restricted to the English language, and no restrictions were imposed on the year and country of publication.
Results: Five studies that were deemed relevant to the systematic review were identified from the literature search. Findings on whether text message reminders improve medication adherence were mixed. However, the review indicates that text-messaging interventions were effective as a means of addressing forgetfulness by reminding patients to take their medications.
Conclusion: This review adds to the body of literature reviewing the effectiveness of emerging technologies in the management of diseases. Despite the fact there is limited evidence across the population of studies to support the effectiveness of text message reminders, such technology represents an important tool to achieve optimal medication adherence among asthmatics.
Article Type: Student Projec
Implementation and Development of Emergency Department Pharmacist-Driven Patient-Care Transitional Model: A Discussion of Our Experiences and Processes
Get PDFFrequent preventable emergency department (ED) visits is an area of great concern among healthcare administrators. Although pharmacist interventions have been shown to reduce re-hospitalizations, studies demonstrating reduction in ED utilizations among the elderly are limited. Additionally, factors influencing readmissions in the ED are multifactorial. Hence, some healthcare systems struggle to reduce readmissions using pharmacy services. This has been a major issue facing care provided to the elderly in the ED. As healthcare care systems develops and implement a collaborative pharmacist and physician/mid-level provider comprehensive transitional model of care in the ED, the quality of care provided to the elderly will be enhanced which will ultimately translate to reduced inappropriate ED visit and re-hospitalization with corresponding reduction in financial burden placed on both the patient, caregiver and the society. Therefore, the objective of this article is to discuss our process with implementing pharmacist-providers transitional model in the ED. The intent is to elucidate some pharmacist-intervention principles and a pharmacist-driven, patient-care transitional model that would provide direction for other healthcare systems to improve ED visits within their locality.
Type: Idea Paper
 
A New Paradigm of Pharmaceutical Drug Delivery Systems (DDS) : Challenges for Space, Time, and Shapes
Get PDFUsing 3D food printing with the Internet of Things (IoT) technology, patients can receive diagnoses and prescriptions from their doctors while in the comfort of their homes. The patient-specific prescription has been innovated by converging 3D food printing technology with drug delivery systems (DDSs). Quantitative drug dosages can be incorporated into the composition of food and produced in any shape within a short time. Automating food and DDSs makes promising implications for healing patients remotely, as well. Each of these aspects, along with IoT technology, have contributed to increased health care for patients, no matter their location. The quantitative discharge of vitamin C melted in water, mayonnaise, ketchup, and peanut butter has been verified using the Piston Typed Extrusion (PTE) method. Designs with different curves and shapes were repeatedly printed with a head speed of 1.6×10-2 m/s, and it was confirmed that effective control while printing the shapes was possible. The Hagen-Poiseuille (HP) formula was utilized to simulate the overall printing time. This simulation affirmed that increasing the head speed from 1.6×10-2 m/s to 4.0×10-2 m/s had reduced the printing time consistently, but the time was not reduced continuously after 4.0×10-2 m/s, depending on the materials’ viscosities and how much curvature exists in the designs. The precision of printing was adjusted within 5% of the theoretical value during printing, and the IoT technology allowed printing of the materials within five minutes, regardless of the patient’s location.
Article Type: Original Researc
Implementation of a Pharmacist-Administered Influenza Vaccination Program in the Oupatient Setting at the Military Treatment Facility
Get PDFThe goal of the Army’s influenza prevention program is to protect all Soldiers, healthcare professionals, and beneficiaries from influenza and its complications to maximize force readiness. Commanders have the daunting and challenging task of ensuring 100% of Soldiers and Military Treatment Facility (MTF) assigned employees are vaccinated against influenza by a specified timeframe. Outpatient Pharmacy Services at the MTF are in the perfect position to provide enhanced accessibility to the influenza vaccination to assist in meeting this requirement. Irwin Army Community Hospital at Fort Riley, Kansas, became the first MTF to offer a pharmacist-administered influenza vaccination program in the outpatient setting, as a walk-in service to all Soldiers, MTF employees, and beneficiaries, in 2016. Since then over 1,500 flu shots have been administered with no documented adverse events, and a potential cost-savings between 61,880. Here we describe the planning and implementation of such a program, which can easily be reproduced at any MTF outpatient pharmacy with minimal efforts and resources, enabling outpatient pharmacists to provide a convenient and accessible alternative for seasonal flu vaccination, with the ultimate goal of maximizing force readiness.
Article Type: Idea Pape
Structured Multi-Stakeholder Workshops to Advance a Global Transformative Roadmap for Pharmaceutical Workforce
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In November 2016, the International Pharmaceutical Federation (FIP) endeavored to create an environment to foster a shared vision to lead a transformative pharmaceutical workforce roadmap. Three milestone documents were developed and presented at the Global Conference on Pharmacy and Pharmaceutical Education. Workshops with the key themes and connecting Pharmaceutical Workforce Development Goals (PWDG) were conducted and analyzed. This Note serves to summarize the key aspects of these workshops, reporting on the innovative approaches used to generate guidance for stakeholders regarding implementation.
Innovation: Seven workshops with a uniform structure were developed. These were designed to improve communication, harmonise outcome-generation, and allow for aggregate analysis. A team of seven conducted each workshop, each team consisted of: a Chair, a facilitator, one rapporteur, and four speakers purposively selected from FIP member organisations and other key stakeholders with expertise for sharing a variety of perspectives. Guidelines and templates were developed for all roles and each team was briefed in advance.
Key findings: Approximately 200 personnel participated in the seven workshops, with around 20 country representatives per workshop, covering all six World Health Organisation regions. Three key aspects of workforce transformation, using the PWDGs, were explored in each workshop: drivers for implementation; challenges to implementation; and ways of encouraging implementation. Drivers for implementation mentioned were enhancing collaboration and engagement. Challenges to implementation were identified as variance in terminology. Several ways of encouraging implementation were acknowledged, such as communication strategies, advocating for workforce development and sharing best practices to foster partnerships.
Next steps: The unique format of the workshops, the innovative approach to include stakeholders across an array of settings and the parallel structure in all the seven workshops, aided in creating reliable findings. The achievability of the PWDGs depends on several factors. Engagement with stakeholders and engagement from and between professional associations are important factors to achieving workforce development goals.
Article Type: Not
Evaluating Student Performance and Perception of a Workshop Integrating Pharmacy Practice and a Pharmaceutics Lab
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Objective: Evaluating Student Performance and Perception of a Workshop Integrating Pharmacy Practice and a Pharmaceutics Lab
Innovation: Common methods for curricular integration are often time and faculty-intensive. An innovative approach to integration was developed and utilized in an introductory compounding workshop. Faculty members collaborated with a compounding pharmacist to design and facilitate a pharmaceutics workshop for first-year pharmacy students. The workshop was composed of four major sections, an introduction to pharmaceutical compounding and the regulations surrounding manufacturing and sterility, a case discussion involving a pediatric patient and the need to develop an appropriate drug delivery system, a short review of pharmaceutical calculations and labeling requirements, and then an introduction to logistics and active learning in a lab setting.
Critical Analysis: After taking part in the workshop, students indicated a significantly higher comfort level going into the pharmaceutics lab (3.48±0.83 to 4.04±0.70) and in the compounding process (3.06±0.83 to 3.71±0.80). Their views of the clinical application of the lab and the need to use knowledge gained from other courses in the lab were also significantly improved (4.36±0.68 to 4.61±0.49 and 3.71±0.77 to 4.26±0.74, respectively). In addition, their perceptions of how they will utilize the skills developed as a practicing pharmacist, and their feelings towards the safety procedures involved in compounding, were also positively affected (3.96±0.87 to 4.45±0.59 and 3.28±0.92 to 3.91±0.72, respectively). Finally, students’ average quiz score in Spring 2016, when the workshop was instituted, significantly increased from Spring 2015 (90.154±4.98 versus 85.89±10.87, respectively).
Article Type: Not