Pharmacy — Open Access Journal

Medication errors (MEs) often prelude guilt and fear in health care professionals (HCPs), thereby resulting in under-reporting and further compromising patient safety. To improve patient safety, we conducted a study on the implementation of a voluntary medication error-reporting and monitoring programme. The ME reporting system was established using the principles based on prospective, voluntary, open, anonymous, and stand-alone surveillance in a tertiary care teaching hospital located in South India. A prospective observational study was carried out for three years and a voluntary Medication Error-reporting Form was developed to report medication errors MEs that had occurred in patients of either sex were included in the study, and the reporters were given the choice to remain anonymous. The analysis was carried out and discussed with HCPs to minimise the recurrence. A total of 1310 medication errors were reported among 20,256 hospitalised patients and the incidence was 6.4%. Common aetiologies were administration errors [501 (38.2%)], followed by prescribing and transcribing errors [363 (28%)]. Root-cause of these MEs were distractions, workload, and communications. Analgesics/antipyretics (19.4%) and antibiotics (15.7%) were the most commonly implicated classes of medications. A clinical pharmacist initiated non-punitive anonymous ME reporting system could improve patient safety. Full article

Objectives: To determine UK pharmacists’ experiences of their current communication skills and undergraduate training and to identify communication skills training and teaching at UK schools of pharmacy. Methods: Two surveys were developed. The first survey was sent to UK practicing pharmacists examining their current communication skills and interest in behavioural counselling techniques such as Motivational Interviewing (MI). A second survey was sent to all UK Schools of Pharmacy investigating communication skills training and teaching. Results: In the first survey pharmacists reported low satisfaction with their undergraduate communication skills training. A convenience sample of 109 UK pharmacists responded to the first survey. Forty-four per cent (n = 48) of the respondents stated that they continued their professional development in communication skills after an undergraduate degree. Seventy (65.4%) were not familiar with behavioural counselling techniques such as MI. The most common patient consultation delivered by pharmacists was around adherence to medicine 22.4% (n = 50). Pharmacists expressed a need for further training in clinical areas such as mental health 25.7% (n = 80). Results from the second survey to pharmacy schools showed that Schools of Pharmacy response rate was 60% (18/30). All 18 schools stated that they teach health behaviour change consultation skills and this is mostly delivered by a clinical pharmacist. Teaching communication skills was mostly delivered as role play with peers (n = 17). Conclusion: This first national survey of communication skills training in Schools of Pharmacy shows that newer graduates have received more communication training compared to older graduates, however pharmacists’ respondents still felt that they were under prepared for behaviour change patient consultations. MI training would be welcomed by those. Practice Implications: Structured courses in communication skills, including behavioural change techniques, are needed for practicing UK pharmacists. Full article

Background: Not much is currently known about United States (US) physicians’ opinions about healthcare financing, specifically subsequent to the creation and implementation of the Affordable Care Act (ACA). Objectives: A four state survey of practicing US based physicians’ opinions about healthcare financing following ACA passage and implementation. Methods: Physician leaders practicing in the state of New York, Texas, Colorado and Mississippi were surveyed. Two factor analyses (FA) were conducted to understand the underlying constructs. Results: We determined the final response rate to be 26.7% after adjusting it for a variety of factors. Most physicians favored either a single payer system (43.8%) or individualized insurance coverage using health savings accounts (33.2%). For the single-payer system, FA revealed two underlying constructs: System orientation (how the physicians perceived the impact on the healthcare system or patients) and individual orientation (how the physicians perceived the impact on individual physicians). Subsequently, we found that physicians who were perceived neutral in their attitudes towards physician-patient relationship and patient conflict were also neutral in reference to system orientation and individual orientation. Physicians who were perceived as stronger on the physician-patient relationship were more supportive of a single-payer system. Conclusion: This study brings attention to the paradox of social responsibility (to provide quality healthcare) and professional autonomy (the potential impact of a healthcare financing structure to negatively affect income and workload). Efforts to further reform healthcare financing and delivery in the US may encounter resistance from healthcare providers (physicians, mid-level prescribers, pharmacists, or nurses) if the proposed reform interferes with their professional autonomy. Full article

In today’s world, digitalization and automation are ubiquitous and different countries have different strategies for implementing information technology in health care. In Belgium, these plans include the dematerialization of prescriptions, following the implementation of a system of electronic prescribing. In the light of these changes, we studied the attitudes of patients toward a paperless prescription. We collected the opinions of 273 patients by survey. Older people, or people with more complex medical needs, expressed a clear desire to keep receiving a paper version of the prescription. Younger people foresaw practical advantages, and expressed a willingness to buy prescription-only medicines online. Knowledge about the planned changes was, however, limited. Privacy and autonomy issues were expressed by a large fraction of people. The problem of what happens when a third person wants to pick up medicines for a patient, a frequent occurrence, was often mentioned. We conclude that, at present, patients have inadequate knowledge and understanding about the planned changes. In light of these considerations and the recent technical problems encountered by the system, we feel that an updated risk/benefit analysis of the planned policy is urgently needed. Full article

Despite the high incidence of diabetic ketoacidosis (DKA) there is no consensus on the most appropriate way to manage insulin therapy. This study was conducted to evaluate the effect of an insulin bolus on the resolution of DKA. A retrospective chart review of patients admitted between 1 September 2014 and 30 June 2016 with a diagnosis of DKA was conducted. Patients were assigned to the bolus or no bolus group based on provider preference. All patients were initiated on a 0.1 unit/kilogram (kg)/hour (h) intravenous (IV) regular insulin infusion, and patients in the bolus group were treated with a 0.1 unit/kg IV regular insulin bolus. Of the 145 admissions evaluated, 58 received a bolus and 87 did not. There was no difference in baseline demographics, except baseline blood glucose was higher in the bolus group (653 vs. 591 milligrams (mg)/deciliter (dL), p = 0.04). The time to resolution of DKA from emergency department admission did not differ between the bolus and no bolus group (15 vs. 15.9 h; p = 0.24). There was no difference in total insulin received (1.3 vs. 1.1 units/kg, p = 0.18), incidence of hypoglycemia (2 vs. 7%, p = 0.64), hypokalemia (16 vs. 29%, p = 0.65), or length of hospital stay (3.2 vs. 2.7 days, p = 0.27). The insulin bolus administration was not associated with reduced time to resolution of DKA. Full article

Despite federal prohibition of medical marijuana possession, sale, and use, marijuana use continues to escalate as state legalization persists and expands. The purpose of this discussion is to provide a brief summary of the evidence regarding both potential benefits and risks of medical marijuana use. Full article

This review is a narrative description of a collaboration between a travel clinic and a community pharmacy centre within a university primary care and public health centre (Lausanne/Switzerland). Pharmacists and pharmacy technicians participate in this collaboration to provide (1). counselling and clinical activities with travellers (e.g., pre-travel consultations and advice to travellers), (2). clinical pharmacy expertise and medicine information services (e.g., selection of an appropriate antimalarial medication for a traveller to manage of drug-drug interactions), (3). technical and logistical activities related to medicines and vaccines (e.g., management of vaccine shortages and specially imported medicines and vaccines from foreign countries) and (4). educational activities (e.g., undergraduate pharmacy teaching and continuous education to community pharmacists). Such a multidisciplinary collaboration should be encouraged as it enables us to address the evolution and challenges of travel medicine related to medication, such as growing vaccine shortages and an increasing number of chronic patients who travel. This review may be used as a model for the dissemination of such collaborative practices, to develop future advanced teaching and training activities, to provide a framework for research related to travel and medicines and to participate in the evaluation of vaccination practices by community pharmacists. Full article

This review presents the Swiss strategy initiated over the last several years to implement vaccination by community pharmacists. National health authorities aimed to integrate community pharmacists in the National Vaccination Strategy (NVS) in order to increase the vaccination rate in the Swiss population. To support this aim, universities and the Swiss Association of Pharmacists developed pre- and post-graduate education programmes on vaccination for pharmacists. Finally, each Swiss canton (sovereign for health-related aspects) set proper regulations to authorize pharmacists to vaccinate and to determine which vaccines could be administered. As of September 2018, 19 cantons (out of 26) had authorized influenza vaccinations under the sole responsibility of an accredited community pharmacist. Additional vaccinations were available in 13 cantons (e.g., tick-borne encephalitis or hepatitis A, B, or A and B). Such implementation in other countries should follow a similar top-down (following a national strategy to improve vaccination coverage) and stepwise (starting with influenza to demonstrate the competencies of community pharmacists) strategy, supported by the development of research, education and accreditation. The development of health advice related to travels in community pharmacies should follow the same development in Switzerland. Currently, it offers the opportunity for strengthening travellers’ safety, beyond vaccination issues. Full article

Doucette and Schommer recently surveyed U.S. community pharmacy technicians on their willingness to perform tasks including the administration of vaccines. They found that 47.1% of technicians reported they were “unwilling” to administer a vaccine, although this finding must be placed into proper context. The first nationwide survey of U.S. pharmacist perceptions on immunizations in 1998 revealed only 2.2% of pharmacist respondents had administered adult vaccines and only 0.9% had administered childhood vaccines. They also found pharmacists to be “slightly negative on administering immunizations” with many perceived barriers. Nonetheless, pharmacist-provided immunizations have been an unqualified public health success. The theory of planned behavior (TPB) predicts intention from attitude and perceived behavioral control, among other factors. Given low involvement, exposure, and perceived behavioral control to administer vaccinations, technicians’ attitudes or willingness to participate from the Doucette and Shommer study can be regarded as quite positive. Given the results of a successful pilot project in Idaho and that subjective norms and perceived behavioral control will likely shift upward, one can only expect technicians’ willingness to participate in vaccinations to become more favorable and ultimately become a success. Full article

Electronic health record (EHR) technology use in the educational setting to advance pharmacy practice skills with patient simulation has not been described previously in the literature. Therefore, the purpose of this study was to evaluate the impact of a virtual EHR on learning efficiency, perceptions of clinical skills, communication, and satisfaction. This was a prospective study conducted in a cardiovascular therapeutics course in the Doctor of Pharmacy curriculum. Students were randomized to use of a virtual EHR with patient simulation or to patient simulation alone (control). The efficiency of learning was assessed by the time to optimal recommendation for each scenario. Surveys (n = 12 questions) were administered electronically to evaluate perceptions of clinical skills, communication, and learning satisfaction. Data were analyzed with the Mann–Whitney U or Wilcoxon signed-rank test as appropriate. Use of the virtual EHR decreased the amount of time needed to provide the optimal treatment recommendations by 25% compared to control. The virtual EHR also significantly improved students’ perceptions of their clinical skills, communication, and satisfaction compared to control. The virtual EHR demonstrated value in learning efficiency while providing students with an engaging means of practicing essential pharmacist functions in a simulated setting. Full article

Guidelines recommend encouraging young people with attention deficit hyperactivity disorder (ADHD) who are taking medication long-term, to discuss their preferences for stopping or changing their treatment, including a discussion about ‘drug holidays’, with their doctor. Yet, to date, no written information has been available to empower children and adolescents with ADHD and their parents to make informed decisions about drug holidays. The aim of this study was to design and develop a suite of decision aids to help families decide if they want to take a drug holiday from methylphenidate. The material was designed with reference to the literature and in consultation with a secondary-care specialist, and validated with two panels composed of specialists and parents using content validity questionnaires and interviews; before being finished and branded by a design service. Three decision aids were produced, with parental and adolescent versions composed of a booklet and a pull-out form for self-completion, and the child version being a booklet for reading and self-completion. Existing research calls for suitable written materials to feasibly increase the uptake of practitioner-initiated planned drug holidays from methylphenidate. We envisage these materials will open up the space to discuss drug holidays in ADHD during annual reviews, in line with UK government guidelines. Full article

Asthma control can be achieved with effective and safe medication use; however, many patients are not controlled. Patients’ perceptions of asthma, asthma treatment, and pharmacist roles can impact patient outcomes. The purpose of this study was to explore patients’ experiences and patient–pharmacist relationships in asthma care. Qualitative Interpretive Description method guided the study. Semi-structured individual interviews were conducted with 11 patients recruited from personal contacts, pharmacies, and asthma clinics. Categories and themes were identified using inductive constant comparison. Themes indicated patients had a personalized common sense approach to asthma management, “go-to” health care provider, and prioritized patient–pharmacist relationships. Patients described their illness experiences and asthma control based on personal markers similar to the common sense model of self-regulation. Patients chose a family physician, asthma specialist, respiratory therapist, or pharmacist as an expert resource for asthma management. Patient perceived pharmacists’ roles as information provider, adviser, or care provider. Pharmacists who develop a collaborative relationship with their asthma patients are better positioned to provide tailored education and self-management support. Inviting patients to share their perspective could increase patient engagement and uptake of personalised asthma action plans to achieve asthma control. Full article

Medication error reporting (MER) is an effective way used to identify the causes of Medication Errors (MEs) and to prevent repeating them in future. The underreporting of MEs is a challenge generally in all MER systems. The current research aimed to explore nurses’ knowledge on MER by determining their attitudes towards reporting and studying the implicated barriers and facilitators. A total of 23 nurses were interviewed using a semi-structured interview guide. The saturation point was attained after 21 interviews. All the interviews were tape-recorded and transcribed verbatim, and analysed using inductive thematic analysis. Four major themes and 17 sub-themes were identified. Almost all the interviewees were aware about the existence of the MER system. They showed a positive attitude towards MER. The main barriers for MER were the impacts of time and workload, fear of investigation, impacts on the job, and negative reactions from the person in charge. The nurses were knowledgeable about MER but there was uncertainty towards reporting harmless MEs, thus indicating the need for an educational program to highlight the benefits of near-miss reporting. To improve participation strategies, a blameless reporting culture, reporting anonymously, and a simplified MER process should be considered. Full article

Despite providing a consistent and comprehensible format for over-the-counter (OTC) drug communication, research suggests important limitations in the communication effectiveness of the Drug Facts Label required on OTC drugs in the United States. This literature is reviewed and some of these critical limitations of the Drug Facts Label (DFL) highlighted. These include difficulty communicating complex information that requires integration of multiple pieces of label information and limited adaptability to serve the unique needs of individual populations (e.g., low literacy or older consumers). Potential ways to improve the DFL’s communication effectiveness are identified along with complementary opportunities to improve OTC drug communication by leveraging the role of pharmacists and use of adjunctive technologies. Full article

(1) Background: Community pharmacy personnel help mitigate risks of self-care by consumers who seek over-the-counter (OTC) medicines or treatment of symptoms and/or conditions. Exchange of information facilitates the OTC consultation, but pharmacy personnel often report difficulties in engaging consumers in a dialogue. The aim of this study was to describe the development of a behaviour change intervention to enhance information exchange between pharmacy personnel and consumers during OTC consultations in community pharmacies. (2) Methods: The Behaviour Change Wheel methodological framework was used to link factors that influence consumer engagement with information exchange during OTC consultations with intervention functions to change behaviour. Options generated were rationalized and the final intervention strategy was derived. (3) Results: Education, persuasion, environmental restructuring, and modelling were determined to be potential intervention functions. The intervention incorporated placing situational cues in the form of posters in the community pharmacy modelling information exchange behaviour, persuading through highlighting the benefits of exchanging information and educating about its importance. (4) Conclusions: A systematic, theoretically underpinned approach was applied to develop candidate interventions to promote information exchange in OTC consultations. The feasibility and efficacy of the intervention strategy has since been tested and will be reported elsewhere. Full article

Background: The irrational use, “over the counter supply”, and unregulated supply chains of antimicrobials are contributing toward antimicrobial resistance. Antimicrobial stewardship programs regulate antimicrobials usage to prevent resistance and reduce health care burden. Objective: To assess the knowledge and practice of pharmacists’ working in various healthcare settings toward antimicrobial stewardship in Pakistan. Method: A cross-sectional study was conducted among pharmacists working in different sectors between March to June 2017. Results: A total of 181 pharmacists participated, of whom (n = 145, 80.1%) were males. The majority of participants were in the 20–30 age group (n = 147, 81.2%) and hold Doctor of Pharmacy degrees. More than 80% of pharmacists agreed that “antimicrobial stewardship is essential to improve patient care”; while (n = 159, 87.8%) pharmacists agreed that “pharmacist should be trained on the use of antimicrobial”. Close to 90% of pharmacists agreed that “adequate training should be provided to pharmacists on antimicrobial use”. Regarding the practice of antimicrobial stewardship, (n = 72, 39.8%) pharmacists often/always “make efforts to prevent or reduce the transmission of infections within the community”; (n = 58, 32%) pharmacists never “dispense antimicrobials without a prescription”; and (n = 60, 32%) pharmacist often/always “communicate with prescribers if unsure about the appropriateness of an antibiotic prescription”. Conclusions: Increased antimicrobial stewardship efforts can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. Pharmacists in Pakistan have good knowledge and adopt positive practices toward antimicrobial stewardship. Pharmacist and other health care professionals should collaborate within multi-disciplinary teams to reduce the problem of antimicrobial resistance and improve the quality of life of patients. Full article

Pharmacogenomics provides a personalized approach to pharmacotherapy by using genetic information to guide drug dosing and selection. However, partly due to lack of education, pharmacogenomic testing has not been fully implemented in clinical practice. With pharmacotherapy training and patient accessibility, pharmacists are ideally suited to apply pharmacogenomics to patient care. Student pharmacists (n = 222) participated in an educational intervention that included voluntary personal genotyping using 23andMe. Of these, 31% of students completed both pre- and post-educational interventions to evaluate their attitudes and confidence towards the use of pharmacogenomics data in clinical decision making, and 55% of this paired subset obtained personal genotyping. McNemar’s test and the Wilcoxon signed-rank test were used to analyze responses. Following the educational intervention, students regardless of genotyping were more likely to recommend personal genotyping (36% post-educational intervention versus 19% pre-educational intervention, p = 0.0032), more confident in using pharmacogenomics in the management of drug therapy (51% post-educational intervention versus 29% pre-educational intervention, p = 0.0045), and more likely to believe that personalized genomics would have an important role in their future pharmacy career (90% post-educational intervention versus 51% pre-educational intervention, p = 0.0072) compared to before receiving the educational intervention. This educational intervention positively influenced students’ attitudes and confidence regarding pharmacogenomics in the clinical setting. Future studies will examine the use of next-generation sequencing assays that selectively examine pharmacogenes in the education of student pharmacists. Full article