Joseph P. Nathan

Weight Variability of Pharmacist-Dispensed Split Tablets

OBJECTIVE To determine the level of weight uniformity of fragments from tablets split into halves and dispensed by pharmacists. DESIGN Pre-post comparison. SETTING Laboratory analysis of split tablets returned unused from four long-term care facilities. INTERVENTIONS Twenty-two dispensed prescriptions containing 560 split tablet halves were collected, and fragment weights (FWs) were determined. Theoretical weights (TWs) of split tablets of the same medications were determined mathematically. MAIN OUTCOME MEASURES Comparison of the mean FW with the mean TW of each dispensed prescription and determination of whether fragments met United States Pharmacopeia 24 (USP) criteria for weight variation of whole tablets. RESULTS A significant difference (P < .05) between mean TW and mean FW was found in 2 (9.1%) of the 22 dispensed prescriptions. Overall, 30 (5.4%) of 560 fragments, contained in 10 (45.5%) of the 22 dispensed prescriptions, had weights that deviated by more than 15% from the mean FW. Of the 560 fragments, 32 (5.7%), contained in 10 (45.5%) of 22 dispensed prescriptions, had weights that deviated by more than 15% from mean TW. A total of 15 (68.2%) of the 22 dispensed prescriptions had standard deviations (SDs) that were more than 6% of the mean FW. None of the TWs displayed an SD greater than the USP limit of 6%. Only 7 (31.8%) of the 22 dispensed prescriptions met USP standards, with FWs not exceeding 15% of mean FW and SDs of no greater than 6%. CONCLUSION Tablet splitting resulted in an unacceptably high incidence of weight variation. Standards should be developed to ensure uniformity of split tablets.

Responding to drug information requests

A pharmacist is busy entering a complicated order into the pharmacy computer system when the phone rings. The caller asks, “What is the dose of Lovenox?” The pharmacist places the caller on hold and logs on to a computerized drug information (DI) resource or opens up a book, locates an answer,

Functions performed by paid pharmacy interns in hospitals in New York

PURPOSE The types of clinical and nonclinical activities performed by paid pharmacy interns in the hospitals in New York state were studied. METHODS In November 2008, a list of hospitals in New York was obtained from the website of the New York State Department of Health. A survey was sent to each hospitals pharmacy director requesting information on hospital characteristics and whether the pharmacy department employed nongraduate pharmacy interns. For those hospitals that employed pharmacy interns, questions were asked about the number of nongraduate pharmacy interns employed, the shifts worked by interns, whether there was a minimum work-hour requirement for interns, the functions routinely performed by interns, and the percentage of interns who remained employed at the hospital upon licensure. RESULTS Of the 184 surveys distributed, 96 responses (52.2%) were received. The majority of hospitals had 400 beds or fewer and were teaching institutions, and 45 employed pharmacy interns. The five functions reported most frequently were answering telephone calls (91%), preparing and distributing medications (82%), compounding nonparenteral medications (69%), compounding parenteral medications (62%), and responding to drug information queries (51%). The mean ± S.D. number of clinical activities performed by interns was 2.1 ± 2.1. The most frequently reported clinical activities were responding to drug information queries (51.1%), performing clinical interventions (33.3%), and completing adverse-drug-reaction reports (31.1%). CONCLUSION Hospital pharmacy departments in New York utilized paid pharmacy interns to perform a variety of functions, including clinical activities. While there appears to be recognition that interns can perform clinical activities, the mean number of such activities was relatively low.

Pharmacy in Israel

Israel is a small country located at the juncture of 3 continents (Africa, Asia, and Europe). With a population of just over 8 million and an area of just over 22,000 km2, Israel had a population density of 373 persons/km2 in 2015.[1][1] The state is a democracy with a parliamentary, multiparty

Drug information--the systematic approach: continuing education article.

Proper drug information (DI) skills are essential for being a competent pharmacy practitioner. To effectively manage DI queries and clinical dilemmas, the practitioner should follow a systematic approach that includes identifying the requester, determining the “true” DI need and obtaining background information, categorizing the question, performing the search and analyzing the information, disseminating the information, and following up when appropriate. The practitioner must be mindful to couple the published literature with clinical experience, knowledge, and logic in order to achieve optimal clinical outcomes.

Professional reading habits of pharmacists attending 2 educational seminars in New York City.

Purpose: Data regarding the professional reading habits of pharmacists in the United States are lacking. The purpose of this pilot study was to investigate whether pharmacists read professional publications and assess other aspects of their professional reading habits. Methods: In December 2010, surveys were distributed to pharmacists participating in 2 educational seminars in New York City. The main outcome measures were percentages of pharmacists who read regularly (at least monthly), specific publications read, and the perceived value and impact of reading. Results: A total of 184 pharmacists were surveyed. Of the 122 (66%) respondents, 112 (92%) reported reading professional publications regularly. Of these, 97 (87%) indicated the titles read, with the 4 publications reported most frequently being Drug Topics (n = 73; 75%), Pharmacy Times (n = 67; 69%), US Pharmacist (n = 60; 62%), and Pharmacist’s Letter (n = 48; 49%). All 122 respondents indicated that reading positively impacted their practice, and 121 (99%) reported that reading was important. Conclusions: The value of reading professional publications was recognized by surveyed pharmacists; this likely contributed to the high reading rate reported in this study.

A Survey of Fee-for-Service Activities of Drug Information Centers

A survey was conducted to evaluate the fee-for-service (FFS) activities of drug information centers (DICs). Questionnaires were sent to 103 DICs across the United States. Centers were queried about funding source(s), percentage of funds obtained from fees-for-service, fee schedules and rates, and changes in revenue over the previous 5 years. Hospitals, universities, fees, grants, pharmaceutical companies, and unspecified source(s) were reported as funding source(s). Seventeen (22.4%) of the 76 responding DICs reported obtaining revenue from service fees; these DICs utilized various fee schedules and rates, including annual rates, hourly rates, per request charges, and a “900” toll phone line. Of the DICs that reported FFS revenue, nine centers (52.9%) ranked their sources. An increase, decrease, or no change in FFS revenue over the past 5 years was reported by eight centers (47.1%), two centers (11.8%), and seven centers (41.2%), respectively. It was concluded that the FFS activities of DICs have remained essentially unchanged over the past 2 decades.

Clinical and other specialty services offered by pharmacists in the community: the international arena and Israel

The community pharmacy setting is a venue that is readily accessible to the public. In addition, it is staffed by a pharmacist, who is a healthcare provider, trained and capable of delivering comprehensive pharmaceutical care. As such, community pharmacists have a colossal opportunity to serve as key contributors to patients’ health by ensuring appropriate use of medications, preventing medication misadventures, identifying drug-therapy needs, as well as by being involved in disease management, screening, and prevention programs. This unique position gives the pharmacist the privilege and duty to serve patients in roles other than solely that of the stereotypical drug dispenser.Worldwide, as well as in Israel, pharmacists already offer a variety of pharmaceutical services and tend to patients’ and the healthcare system’s needs. This article provides examples of professional, clinical or other specialty services offered by community pharmacists around the world and in Israel and describes these interventions as well as the evidence for their efficacy. Examples of such activities which were recently introduced to the Israeli pharmacy landscape due to legislative changes which expanded the pharmacist’s scope of practice include emergency supply of medications, pharmacists prescribing, and influenza vaccination. Despite the progress already made, further expansion of these opportunities is warranted but challenging. Independent prescribing, as practiced in the United Kingdom or collaborative drug therapy management programs, as practiced in the United States, expansion of vaccination programs, or wide-spread recognition and reimbursement for medication therapy management (MTM) programs are unrealized opportunities. Obstacles such as time constraints, lack of financial incentives, inadequate facilities and technology, and lack of professional buy-in, and suggested means for overcoming these challenges are also discussed.

Pharmacovigilance in Israel – tools, processes, and actions

BackgroundDue to the limited safety data available at the time that a new medication is first marketed, it is essential to continue the collection and monitoring of safety data about adverse drug reactions (ADRs) during the medication’s life cycle. This activity, known as pharmacovigilance (PV), is performed worldwide by the pharmaceutical industry as well as by regulatory agencies. In 2012, the Israeli Ministry of Health (MOH) established a Pharmacovigilance and Drug Information Department. The Department is tasked with identifying, monitoring, and initiating activities aimed at minimizing risks associated with medication utilization. To enable this, the MOH has devised procedures for PV and promoted extensive legislation in this area that require marketing authorization holders (MAHs) and medical institutions in Israel to report ADRs and new safety information to the MOH. A computerized database was created to support the reporting process. The objective of this article is to characterize the PV tools and activities implemented in Israel.MethodsSince September 2014, The Israeli Pharmacovigilance and Drug Information Department receives ICSRs at a central computerized database developed for this purpose. The data were analyzed by Department personnel and ICSRs were characterized according to their seriousness, source, categories of drugs involved, and the reporting format. Additionally, the Department reviewed signals detected from ADR reports and from other sources and assessed the resulting regulatory actions.ResultsAn analysis of the Individual Case Safety Reports (ICSRs) submitted to the MOH’s ADRs central database reveals that during the review period, a total of 16,409 ICSRs were received by the Department and 850 signals were identified, resulting in the following PV activities: inquiry and enhanced follow-up (430, 50.6%), prescriber’s and patient’s leaflets updates (204, 24%), recall of products/batches (6, 0.7%), alerts for health care professionals (63, 7.4%). Eighty five (10%) of the signals required a comprehensive investigation involving external specialist and 1 (0.1%) resulted in initiation of epidemiologic study. Additionally, in 2015 the Department incorporated comprehensive framework for risk minimization of marketed medicinal products, also known as risk management plans (RMPs).ConclusionsAs practiced by other health authorities, the Israeli MOH effectively implemented various PV tools to ensure the safety of the Israeli health consumer.

Prevalence and characteristics of pharmacies owned and operated by schools of pharmacy in the United States

INTRODUCTION To identify schools/colleges of pharmacy that own and operate a pharmacy and to gather key details about such pharmacies. METHODS Schools of pharmacy (n = 134) in the United States were contacted to determine whether they own and operate a pharmacy. Schools identified as having a pharmacy were subsequently sent an online questionnaire to solicit information about school and pharmacy characteristics. RESULTS Eighteen (13.4%) schools reported owning and operating at least one pharmacy; of these, 14 (77.8%) responded to the questionnaire. The provision of education was a goal for all pharmacies. Pharmacy services were provided to students, faculty/staff, and community members (85.7%, 78.6%, and 50%, respectively). Student pharmacists were regularly involved in the operations of 13 (92.9%) pharmacies, largely as part of their introductory and advanced pharmacy practice experiences and/or as paid employees. CONCLUSION Few schools of pharmacy in the United States own and operate a pharmacy. These pharmacies primarily serve as teaching and learning venues and provide services to the campus community and/or the community at large.