Patrick D. Fuller

Antibiotic dosing during sustained low-efficiency dialysis: special considerations in adult critically ill patients.

Objective:To address issues of antibiotic dosing during sustained low-efficiency dialysis by using available pharmacokinetic data, intermittent and continuous renal replacement therapy dialysis guidelines, and our experience with sustained low-efficiency dialysis. Data Resources:Published clinical trials, case reports, and reviews of antibiotic dosing in humans during sustained low-efficiency dialysis. Data Extraction:A search of electronic databases (MEDLINE, PubMed, and Ovid) was conducted by using key words of extended daily dialysis, sustained low-efficiency dialysis, antibiotics, antimicrobial agents, and pharmacokinetics. MEDLINE identified 32 sustained low-efficiency dialysis articles, and PubMed identified 33 articles. All papers describing antibiotic clearance prospectively in patients were considered for this article. Data Synthesis:We identified nine original research articles and case reports that determined the impact of sustained low-efficiency dialysis on antibiotic clearance in patients. The blood and dialysate flow rates, duration of dialysis, type of filter, and the pharmacokinetic parameters were extracted from each article. If multiple articles on the same drug were published, they were compared for consistency with the aforementioned dialysis parameters and then compared with forms of continuous renal replacement therapy. Antibiotic clearance by sustained low-efficiency dialysis was determined to be similar or higher than continuous renal replacement therapy therapies. The estimated creatinine clearance during sustained low-efficiency dialysis was approximately 60 mL/min to 100 mL/min depending on the blood and dialysate flow rates and the type of filter used. Conclusions:The potential for significant drug removal during an 8-hr-or-longer sustained low-efficiency dialysis session is evident by the limited number of studies available. Because significant amounts of drug may be removed by sustained low-efficiency dialysis combined with altered pharmacokinetic variables in critically ill patients, the risk for suboptimal drug concentrations and pharmacodynamics must be considered. Appropriate dose and calculation of dosing intervals is essential to provide adequate antibiotic therapy in these patients. It is recommended that institutions who utilize sustained low-efficiency dialysis establish dosing guidelines for all pharmacists and physicians to follow to provide consistent delivery of antibiotics at adequate concentrations.

Program for developing leadership in pharmacy residents

PURPOSE An innovative, structured approach to incorporating leadership development activities into pharmacy residency training is described. SUMMARY The American Society of Health-System Pharmacists (ASHP) has called for increased efforts to make leadership development an integral component of the training of pharmacy students and new practitioners. In 2007, The Nebraska Medical Center (TNMC) took action to systematize leadership training in its pharmacy residency programs by launching a new Leadership Development Series. Throughout the residency year, trainees at TNMC participate in a variety of activities: (1) focused group discussions of selected articles on leadership concepts written by noted leaders of the past and present, (2) a two-day offsite retreat featuring trust-building exercises and physical challenges, (3) a self-assessment designed to help residents identify and use their untapped personal strengths, (4) training on the effective application of different styles of communication and conflict resolution, and (5) education on the history and evolution of health-system pharmacy, including a review and discussion of lectures by recipients of ASHPs Harvey A. K. Whitney Award. Feedback from residents who have completed the series has been positive, with many residents indicating that it has stimulated their professional growth and helped prepared them for leadership roles. CONCLUSION A structured Leadership Development Series exposes pharmacy residents to various leadership philosophies and principles and, through the study of Harvey A. K. Whitney Award lectures, to the thoughts of past and present pharmacy leaders. Residents develop an increased self-awareness through a resident fall retreat, a StrengthsFinder assessment, and communication and conflict-mode assessment tools.

Coping with the residency scramble: The need for national guidelines

For pharmacy students and others seeking postgraduate pharmacy residency training, March has become the most stressful month of the year. While 2011 brought the highest fill rate for residency positions since the ASHP Resident Matching Program was launched in 1979, the demand for postgraduate

State of Privileging in Pharmacy: A Survey of Vizient-Affiliated Institutions

Purpose: The process of privileging pharmacists is an important step in developing optimal pharmacy practice models. Currently, little published literature exists detailing the status of pharmacist privileging efforts. The objective of this study is to assess and characterize a snapshot of the current and future state of privileging practices in pharmacy at Vizient academic medical centers (AMCs) and their affiliate institutions. Methods: An electronic survey questionnaire was sent to Vizient pharmacy directors and their affiliates to assess institutional privileging practices and identify perceived or actual barriers. The survey was divided into 2 pathways based on the current status of privileging at the institution. Results: In total, 46 directors of pharmacy completed the survey. Only 33% (15/46) of pharmacy directors indicated they had a current privileging process in place. About 70% (21/30) of institutions without an established privileging process indicated they were considering establishing a process. For institutions without an established privileging process, most pharmacy directors identified a lack of organizational support and resources as barriers to implementation. Conclusion: Although credentialing and privileging is considered a national priority to aid in expanding and enhancing pharmacists’ scope of practice, our survey demonstrated that few respondents currently have a privileging process in place. The results from this study may highlight important barriers and keys to success to be considered when implementing a privileging process.

StrengthsFinder ® signature themes of talent in pharmacy residents at four midwestern pharmacy schools

BACKGROUND AND PURPOSE StrengthsFinder® is a widely-used assessment that can be used to help student pharmacists discover their talents (i.e., signature themes [STs]) and develop their leadership skills. The assessment has also been used in pharmacy residents, but the prevalence of various STs in that group has not been compared to those in student pharmacists. EDUCATIONAL ACTIVITY AND SETTING Residents from four midwestern pharmacy institutions completed StrengthsFinder® 2.0 and received their top five STs. STs were organized and examined by domains (executing, influencing, relationship building, and strategic thinking). StrengthsFinder® data on student pharmacists were obtained from a previously published study. The distribution of the themes and domains was compared between residents and student pharmacists. FINDINGS Responses from 31 residency program cohorts, including 290 pharmacy residents from a pool of 304 (95.4%) possible respondents, were included in the study. The learner ST was more frequently reported in the top five in pharmacy residents versus student pharmacists (42.8% versus 35.5%, p = 0.022). The woo and communication STs were also more frequently reported in the top five, while the consistency ST was reported less frequently in the top five in pharmacy residents versus student pharmacists (p < 0.05). The executing and relationship building domains had the highest average number of STs (1.58 and 1.56, respectively). DISCUSSION AND SUMMARY The ST profile of pharmacy residents at residency programs affiliated with four midwestern schools of pharmacy is generally similar to that of pharmacy graduates. However, several STs were more or less prevalent in pharmacy residents. Recognition of these differences may assist residency program directors in marketing and design of programs and ranking of candidates.

Managing multiple residents with incongruent personalities: A case-based scenario for the new preceptor

The transition from residency to practice is ripe with challenges, such as learning a new medication distribution system, establishing relationships with other health care providers, becoming familiar with insurance plans and reimbursement, learning to navigate drug shortages, and moving to another

Conflict resolution strategies between preceptor and resident—A case-based scenario

Preceptors play a critical role in the education of pharmacy students and residents in the practice setting. Preceptor development programs are necessary to facilitate continued advancement of preceptors’ teaching skills and ensure the quality of instruction provided. The American Society of