Hospital Pharmacy

To describe an innovative strategy for incorporating leadership training and development across multiple postgraduate year 2 (PGY2) pharmacy residency programs at a single institution.

Tampa General Hospital has 7 pharmacy residency positions: 4 postgraduate year 1 (PGY1) residents and a single resident for each of the 3 PGY2 programs (critical care, emergency medicine, and solid organ transplant). Administrative topics are incorporated across the PGY1 and PGY2 residency programs, with each PGY2 program having additional administrative topics specific to their specialty area.

What began as an elective administrative topic discussion for the PGY2 emergency medicine resident has evolved over time into a longitudinal leadership book club. The leadership book club is utilized to meet the residency goals and objectives related to leadership development for all 3 PGY2 programs. Each year a single book is identified through the American Society of Health-System Pharmacists (ASHP) Leadership Academy book list or by participant suggestion. The book is then divided into 4 sections with corresponding hour-long discussions that occur quarterly throughout the residency year. The residency program directors (RPDs) and co-RPDs lead the initial discussion, and each PGY2 resident leads 1 of the subsequent 3 discussions. Based on resident feedback, the leadership book club is an innovative and effective strategy to incorporate leadership training and development into residency training.

It is imperative to foster the development of leadership skills in pharmacy residency programs to prevent a future leadership gap in health system pharmacy. Leadership book club is a unique strategy to incorporate leadership training longitudinally across multiple PGY2 residency programs at a single institution.

Pain is a major health problem affecting more than 15% of adults in the United States. In a multidisciplinary pain management team, pharmacists can optimize pharmacotherapy quality by ensuring safe and appropriate medication use.

Assess the impact of a pharmacy pain medication management service on pain-related outcomes in an adult inpatient population.

This retrospective study evaluated patients who were admitted from November 2009 through November 2011 and received a pharmacy pain consult. Patients were excluded if they left against medical advice, their care was assumed by palliative care, or they had no complaint of pain when seen by the pharmacist. The primary outcome was the difference between each patient's average pain score from pre-consult to post-consult. Secondary outcomes were difference between each patient's average pain score from pre-consult to pre-discharge, overall functional improvement, pharmacist interventions, and 14-day and 30-day readmissions.

One hundred patients were included in the final analysis. Eight hundred twenty-one interventions were made by the clinical pharmacists. Patients displayed a significant reduction in their pre- and post-consult pain intensity scores on a 0 to 10 numerical rating scale (6.15 vs 3.25; p < .001). Likewise, a significant reduction in pain intensity scores was seen from pre-consult to pre-discharge (6.15 vs 3.6; p < .001). Overall functional improvement, specifically sleep, mobility, and appetite, was seen in 86.6% of patients.

Pain management is an area that provides opportunities for pharmacotherapy interventions. Pharmacists' involvement in pain management on an inpatient consult service had a positive impact on pain scores and improvement in functionality.

The impact of providing nursing staff access to data collected through a medication dose tracking technology (MDTT) web portal was investigated.

A quasi-experimental, nonrandomized, pre-post intervention study was conducted in the Cardiothoracic Intensive Care Unit (CTICU) at Duke University Hospital. The change in the number of medication requests per dispense routed to the pharmacy electronic health record (EHR) in-basket was analyzed pre and post web portal access. Other endpoints included the number of MDTT web portal queries per day by nursing staff, change in nursing satisfaction survey scores, and technician time associated with processing medication requests pre and post web portal access. The pre web portal access phase of the study occurred from June 1, 2014 to August 31, 2014. The post web portal access phase occurred from October 1, 2014 to December 31, 2014.

An 11.4% decrease in the number of medication requests per dispense was exhibited between the pre and post web portal access phases of the study (0.0579 vs 0.0513, respectively; p < .001). Pre and post surveys showed a significant improvement in nurses' satisfaction regarding access to information on the location of medications (p = .009). Additionally, CTICU nursing staff utilized the MDTT web portal for 3.21 queries per day from October 1, 2014 to December 31, 2014.

Providing nurses access to data collected via an MDTT decreased the number of communications between nursing and pharmacy staff regarding medication availability and led to statistically significant improvements in nursing satisfaction for certain aspects of the medication distribution process.

For patients on continuous IV unfractionated heparin (UFH), failing to achieve a therapeutic aPTT by 24 hours can be associated with increased morbidity. A pharmacy clinical surveillance system (PCSS) subtherapeutic aPTT alert was implemented at our institution to improve achievement of therapeutic aPTT goals by 24 hours.

The primary objective was the time to achieve the minimum goal aPTT before and after the alert implementation. The secondary objectives were to examine the percentage of patients who achieved the minimum goal aPTT by 24 hours and the number of dose changes to achieve the minimum goal aPTT

A single-center retrospective study was conducted to include all adult inpatients receiving a continuous UFH infusion during a 3-month period prior to the implementation of a subtherapeutic aPTT alert and a 3-month period after implementation.

317 patients were included in the analysis. The average time to achieve the minimum goal aPTT was 21.8 hours prior to alert implementation and 15.4 hours after implementation (p = .002). The percent of patients who achieved the minimum goal aPTT by 24 hours was 65.7% prior to alert implementation and 82.4% after implementation (p = .035). The average number of dose changes necessary to achieve aPTT value to the minimum goal aPTT prior to alert implementation was 1.67 and 1. 98 after implementation (p = .68).

This analysis showed that implementation of a PCSS subtherapeutic aPTT alert for patients on continuous UFH infusions may ensure patients reach goal aPTT faster and facilitate a higher percent of patients who achieve the minimum goal aPTT by 24 hours.