Evaluation of a Pharmacy-to-Dose Pneumococcal Vaccination Protocol at an Academic Medical Center

Background: In February 2016, a pharmacy-to-dose (PTD) pneumococcal vaccination protocol was implemented to aid in the appropriate selection of pneumococcal vaccines. Objective: The primary objective was to compare the rate of appropriate vaccine ordering with the PTD protocol. Secondary objectives were to assess vaccine administration rate and determine factors preventing patients from receiving the vaccine after appropriate selection. Methods: This was a single-center, retrospective cohort study of adult patients admitted to an inpatient service. Eligible patients were 19 years of age or older and had either a PTD pneumococcal vaccination order placed or an alert triggered indicating that the patient was a candidate for a vaccination. Patients were excluded if they had contraindications to receiving either pneumococcal vaccine. The Fisher exact test was used to evaluate the primary objective, and descriptive statistics were used to evaluate the secondary objectives. Results: A total of 327 patients were included in the analysis: 167 in the preprotocol cohort and 160 in the postprotocol cohort. The correct vaccine ordering rates were found to be 26.9% (45/167) and 83.1% (133/160) in the preprotocol and postprotocol cohorts, respectively ( P < 0.001). In the postprotocol cohort, 17.5% (28/160) of patients did not have a vaccine administered. Reasons for vaccine administration failure were identified as patient refusal, patient expired during admission, vaccine not dispensed by pharmacy, and vaccine dispensed by pharmacy but returned. Conclusions: The PTD pneumococcal vaccination protocol significantly improved correct vaccine ordering rates.

Pharmacy residents' preparedness for the emotional challenges of patient care

PURPOSE

Results of a survey to determine levels of pharmacy resident exposure to and preparedness for emotionally unsettling clinical scenarios are presented.

METHODS

A pretested electronic survey was distributed to 1501 U.S. pharmacy residency program directors (RPDs), who were asked to complete the survey and forward it to residents in their programs. Both respondent groups provided perspectives on pharmacy residents' frequency of exposure to and preparedness for nine scenarios that could potentially be emotionally unsettling to pharmacy residents (e.g., a patient's death, participation in a response to a cardiorespiratory arrest). RPDs and residents were queried regarding training methods used by their programs to prepare trainees to cope with emotionally unsettling events.

RESULTS

A total of 940 responses were received. Overall, resident-reported ex posure to the nine scenarios listed in the survey was infrequent. Majorities of both RPDs and residents (85.2% and 67.1%, respectively) indicated that residents could be better prepared for the emotional challenges of patient care. The most common method of training was a one-on-one discussion between a preceptor and a resident on an as-needed basis. No training was reported by 30% and 40% of RPDs and residents, respectively.

CONCLUSION

The majority of RPD and resident respondents indicated that residents could be better prepared for the emotional challenges of patient care. The most commonly reported method of training for coping with emotional challenges was a one-on-one discussion between a preceptor and a resident on an as-needed basis.

National survey of pharmacy residency on-call programs

PURPOSE

The results of a national survey to evaluate on-call practices and responsibilities of pharmacy residents nationwide, as well as opinions related to duty-hour changes, are reported.

METHODS

A 39-question survey was distributed to 1292 residency program directors (RPDs) listed in the American Society of Health-System Pharmacists (ASHP) online residency directory, which includes programs in all stages of the accreditation process. The survey opened on November 7, 2011, and closed on November 28, 2011. The survey collected demographic information and answers to questions about the residency's on-call component (if applicable) and barriers to the creation of an on-call component. Respondents were also asked to indicate their support of or opposition to the adoption of the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty-hour rules and identify the areas of greatest concern.

RESULTS

Of the 1292 RPDs listed in the ASHP online residency directory to whom the survey was sent, 521 surveys were completed, yielding a response rate of 40%. Of these, 471 identified their residency program as including or excluding an on-call component. Of the 138 programs with on-call services, 102 programs (74%) indicated the inclusion of an overnight experience. Programs that did not utilize an on-call component indicated barriers such as a perceived lack of demand (39%) and duty-hour limitations (21%). Common on-call activities included drug information consults and therapeutic drug monitoring. There was not a clear consensus from RPDs regarding the adoption of the 2011 ACGME duty-hour standards.

CONCLUSION

Among usable responses to a survey of pharmacy residency programs, 29% indicated that their program included an on-call component. On-call programs varied greatly in activities, location, hours, and requirements.