Strategic approach for improving the medication-use process in health systems: The high-performance pharmacy practice framework

Pharmacies' income and its effective factors in Iran: A cross-sectional study

Purpose

Financial assessment of pharmacies and the factors affecting it is an important issue in health system and pharmaceutical industry. The present study aimed to analyze the revenue of pharmacies in Iran and the factors affecting it.

Methods

In the present study revenue data of all active pharmacies in Shiraz in 2018 (n = 298) were gathered using a checklist. Descriptive statistics, mean difference test, correlation, and regression analysis were performed for statistical evaluation. Heteroskedasticity and multicollinearity also were checked. Stata 15 was used for statistical analysis.

Results

Average monthly income of the pharmacies was $82,879 USD (SD = 30,635). The monthly revenue of 24 h pharmacies was about $6560 higher than that of the daily pharmacies. The pharmacies founded by non-pharmacists made about $44,038 more than others, and the pharmacies located on main streets earned over $84,247 more than the ones located on side streets. Besides, the pharmacies inside or near hospitals, clinics, or physician buildings made more money than others. Correlation analysis also showed that the pharmacies' working years, the number of adjacent pharmacies, the number of OTC prescriptions, and the number of staff working at the cosmetics counters had a positive relationship with the pharmacies' income.

Conclusions

Final findings indicated that 24 h pharmacies, pharmacies located on main streets, the ones located in hospitals or private clinics and physician buildings, pharmacies with more OTC prescriptions, and the ones with a larger number of employees in the cosmetics departments had higher monthly revenues.

Expanding nonclinical roles in specialty pharmacy: How to grow a high-performance specialty pharmacy team

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The high-value pharmacy enterprise framework: Advancing pharmacy practice in health systems through a consensus-based, strategic approach

Purpose

The high-value pharmacy enterprise (HVPE) framework and constituent best practice consensus statements are presented, and the methods used to develop the framework’s 8 domains are described.

Summary

A panel of pharmacy leaders used an evidence- and expert opinion–based approach to define core and aspirational elements of practice that should be established within contemporary health-system pharmacy enterprises by calendar year 2025. Eight domains of an HVPE were identified: Patient Care Services; Business Services; Ambulatory and Specialty Pharmacy Services; Inpatient Operations; Safety and Quality; Pharmacy Workforce; Information Technology, Data, and Information Management; and Leadership. Phase 1 of the project consisted of the development of draft practice statements, performance elements, and supporting evidence for each domain by panelists, followed by a phase 2 in-person meeting for review and development of consensus for statements and performance elements in each domain. During phase 3, the project cochairs and panelists finalized the domain drafts and incorporated them into a full technical report and this summary report.

Conclusion

The HVPE framework is a strategic roadmap to advance pharmacy practice by ensuring safe, effective, and patient-centered medication management and business practices throughout the health-system pharmacy enterprise. Grounded in evidence and expert recommendations, the statements and associated performance elements can be used to identify strategic priorities to improve patient outcomes and add value within health systems.

Workarounds in the Workplace: A Second Look

Nursing workarounds have garnered increased attention over the past 15 years, corresponding with an increased focus on patient safety and evidence-based practice and a rise in the use of health information technologies (HITs). Workarounds have typically been viewed as deviations from best practice that put patients at risk for poor outcomes. However, this narrow view fails to take into consideration the multifactorial origins of workarounds. The authors explore the ways in which evidence-based protocols and HIT, designed to improve patient safety and quality, can have an unintended consequence of increasing the likelihood of nurses engaging in workarounds. The article also examines workarounds considering the ethical obligations of both nurses and administrative leaders to optimize patient safety and quality.

Relationship between Student Pharmacist Decision Making Preferences and Experiential Learning

Objective. To determine if student pharmacists' preferences towards experiential and rational thinking are associated with performance on advanced pharmacy practice experiences (APPEs) and whether thinking style preference changes following APPEs. Methods. The Rational Experiential Inventory (REI), a validated survey of thinking style, was administered to student pharmacists before starting APPEs and re-administered after completing APPEs. APPE grades were compared to initial REI scores. Results. Rational Experiential Inventory scores remained consistent before and after APPEs. Overall, APPE grades were independent of REI scores. In a regression model, the REI experiential score was a significant negative predictor of hospital APPE grades. Conclusion. These findings suggest that overall APPE performance is independent of decision-making preference, and decision-making style does not change following immersion into APPEs. Instead of targeting teaching strategies towards a specific decision-making style, preceptors may use pedagogical approaches that promote sound clinical decision-making skills through critical thinking and reflection.

Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice

This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.

An in-depth examination into pharmacy technician worklife through an organizational behavior framework

BACKGROUND

Pharmacy technicians are a vital part of the health care workforce. Little is known about perceptions of their own work environment that would engender more effective recruitment, retention, and management strategies by pharmacists and employers.

OBJECTIVES

The purpose of this study was to gain a greater understanding of certified pharmacy technician worklife. Specific objectives included the identification of themes of worklife phenomena to assist with the development of appropriate responses by other pharmacy stakeholders and to ascertain the contribution of various factors engendering or discouraging career commitment of pharmacy technicians.

METHODS

Semi-structured in-depth interviews were carried out with a convenience sample of pharmacy technicians in one U.S. state, who varied by their work settings and level of experience. The interview guide and corresponding participant responses were framed from around an organizational cultural basis rooted in organizational behavior theory. Notes from the interviews were analyzed thematically using directed content analysis.

RESULTS

Four primary themes emerged, including: career impetus, job responsibilities, quality of work life, and equitable partnership. The data revealed pharmacy technicians' need for self-actualization and recognition of the value they bring to the organization. The participants identified primary responsibilities that contribute to their sense of worth and those that if not managed adequately potentially detract from their well-being and effectiveness. Findings in regard to rate of pay corroborate previous work on wages as both an intrinsic and extrinsic motivator. Pharmacy technicians seek equity among each other (their peers) and in a mutually beneficial relationship with their employing organization.

CONCLUSIONS

This study provides the impetus for interventions and further study that should serve to enhance pharmacy technician effectiveness, quality of work life, and longevity in an emerging profession.

Difference between Pharmacist-Obtained and Physician-Obtained Medication Histories in the Intensive Care Unit

Purpose

To quantify the differences between medication histories obtained by physicians and pharmacists from critically ill patients in the intensive care unit (ICU) and to identify patient types at greatest risk of medication errors.

Methods

Retrospective medical record review of 200 consecutively admitted critically ill patients to the medical/surgical ICU of a university-affiliated hospital. The pharmacist-obtained medication history was compared to the physician-obtained medication history. Variations assessed included the number of drugs identified, drug name, drug formulation, dose, and frequency of administration. Inpatient medication orders were reviewed to obtain the number and accuracy of home medications prescribed in the ICU. Patients were divided into predefined groups: trauma, medical, and nontrauma surgical to assess the risk of medication error by patient type.

Results

Pharmacists and physicians identified a total of 981 and 665 medications, respectively. The mean (± SD) number of home medications per history was 4.2 (±4.9) for physicians and 6.2 (±5.7) for pharmacists ( P < .0001). Physician-obtained medication histories contained 1,628 variances relative to the pharmacist-obtained medication histories. The variances by type included the frequency of administration, 37%; drug dose, 34.6%; missing drugs, 22.3%; extra drugs, 3.6%; and drug formulation, 2.5%. Thirty-nine patients received continuation of their home medications in the ICU totaling 97 orders (9.9% of home medications identified by pharmacists). Thirty of these orders varied from the pharmacy history and 27 were subsequently corrected. Conclusion. Pharmacists identified more home medications than physicians when obtaining a medication history in the ICU. This may improve the accuracy of home medications ordered in the ICU.

Developing a Meaningful Strategic Plan

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed for guiding pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is addressing many of the key challenges that pharmacy directors currently face, while also providing information that will foster growth in pharmacy leadership and patient safety. Previous articles in this series have discussed the many different aspects of pharmacy management and leadership challenges. This feature addresses the importance of developing and effectively executing a pharmacy strategic plan.

Establishing a Plan for Central Pharmacy Automation

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed for guiding pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is addressing many of the key challenges that pharmacy directors currently face, while also providing information that will foster growth in pharmacy leadership and patient safety. Previous Director's Forum articles have discussed various aspects of pharmacy technology implementation and utilization. This feature reviews the steps and strategies for implementing and evaluating automation in a central pharmacy area supporting a decentralized pharmaceutical model.