Philip J. Trapskin

Pharmacist participation in infection prevention: An innovative approach to monitoring compliance with the Five Moments for Hand Hygiene in a large academic medical center

Using pharmacy residents as covert observers, we evaluated compliance with hand hygiene and contact precautions among 101 unique health care workers on entrance, exit, and inside rooms of patients with known or suspected Clostridium difficile infection. Overall compliance rates with hand hygiene upon entering and exiting patient rooms were 63.4% and 69.3%, respectively. However, there was a lack of hand hygiene inside patient rooms for the observed opportunities.

Writing a personal philosophy of practice.

![Figure][1] A personal philosophy of practice can be described as a written document that serves as a compass to guide one’s practice. The document may include a practice vision, professional values, professional goals, a professional mission statement, and any other elements that may

Herbal medications in the perioperative orthopedic surgery patient.

Herbal medication use should be discussed during the perioperative patient assessment to prevent potential complication.

Leadership and effective succession planning in health-system pharmacy departments

Leadership succession planning is crucial to the continuity of the comprehensive vision of the hospital pharmacy department. Leadership development is arguably the main component of training and preparing pharmacists to assume managerial positions. Succession planning begins with a review of the organizational chart in the context of the institutions strategic plan. Then career ladders are developed and key positions that require succession plans are identified. Employee profiles and talent inventory should be performed for all employees to identify education, talent, and experience, as well as areas that need improvement. Employees should set objective goals that align with the departments strategic plan, and management should work collaboratively with employees on how to achieve their goals within a certain timeframe. The succession planning process is dynamic and evolving, and periodic assessments should be conducted to determine how improvements can be made. Succession planning can serve as a marker for the success of hospital pharmacy departments.

The Implementation of a Personnel Training and Assessment Program for New Standards in the US Pharmacopeia General Chapter Pharmaceutical Compounding of Sterile Preparations

Purpose The US Pharmacopeia (USP) general Chapter <797> sets standards for personnel training and assessment of aseptic manipulation skills. We describe the implementation of a training and assessment program to meet these standards at an academic medical center. Methods Exempt approval by the University of Kentucky Institutional Review Board was granted. All pharmacy personnel responsible for compounding sterile preparations were included. Participants completed three computer-based learning modules (CBLs) related to mathematics skills, aseptic manipulations, and USP <797>. Participants were given an online test, prior to viewing a CBL (pretest) and after completion of a CBL (posttest). Mean pre- and posttest scores were analyzed using a paired Students t-test. A proctored practical examination involved manipulations of sterile fluid culture media (media-fill challenge) to assess aseptic manipulation skills. Culture media were incubated at room temperature for 14 days and monitored for growth. Results A significant increase was found in mean percentage of correct answers for pre- and posttest scores for the aseptic manipulation (85% vs 93%; P < 0.05) and USP <797> (78% vs 90%; P < 0.001) CBLs. The mean percentage of correct answers on the mathematics test was 92%. The results of the media-fill challenge revealed that 4 of the 84 (4.2%) proctored assessments were contaminated. Conclusion This personnel training and assessment program meets the requirements of USP <797>. The use of CBLs was effective in teaching and assessing participants on the theoretical and practical principles of aseptic manipulations. The proctored practical assessment meets USP <797> requirements for medium-risk level media-fill challenge tests.

Improving Warfarin Management Within the Medical Home: A Health-System Approach.

BACKGROUND Anticoagulation clinics have been considered the optimal strategy for warfarin management with demonstrated improved patient outcomes through increased time in therapeutic international normalized ratio (INR) range, decreased critical INR values, and decreased anticoagulation-related adverse events. However, not all health systems are able to support a specialized anticoagulation clinic or may see patient volume exceed available anticoagulation clinic resources. The purpose of this study was to utilize an anticoagulation clinic model to standardize warfarin management in a primary care clinic setting. METHODS A warfarin management program was developed that included standardized patient assessment, protocolized warfarin-dosing algorithm, and electronic documentation and reporting tools. Primary care clinics were targeted for training and implementation of this program. RESULTS The warfarin management program was applied to over 2000 patients and implemented at 39 clinic sites. A total of 160 nurses and 15 pharmacists were trained on the program. Documentation of warfarin dose and date of the next INR increased from 70% to 90% (P <.0001), documentation occurring within 24 hours of the INR result increased from 75% to 87% (P <.0001), and monitoring the INR at least every 4 weeks increased from 71% to 83% (P <.0001) per patient encounter. Time in therapeutic INR range improved from 65% to 75%. CONCLUSION Incorporating a standardized approach to warfarin management in the primary care setting significantly improves warfarin-related documentation and time in therapeutic INR range.

Anti-diarrheal medication use in the treatment of Ebola virus-induced diarrhea

We would like to comment on the use of anti-diarrheal medication in the treatment of Ebola virus-induced diarrhea. Early symptoms of Ebola virus disease (EVD) are nonspecific and may include fever, chills, myalgias, malaise, and anorexia. Approximately five days after symptom onset, 62 percent of patients develop gastrointestinal (GI) illness including abdominal pain, nausea, vomiting, and watery diarrhea [1]. The often voluminous diarrhea may lead to significant hypovolemia, ultimately resulting in shock and/or death. Supportive, symptom-based treatment is recommended; the use of anti-diarrheal medications to reduce GI output may be considered. Patient outcomes attributed to EVD-induced diarrhea treatment choice are not known. In general, non-antibiotic anti-diarrheal medications are not recommended for diarrhea associated with fever or for mucous-containing diarrhea marked by inflammation, ulceration, or bleeding of the GI tract [2]. However, this general recommendation is based largely upon expert opinion or extrapolation from small series limited to a few causes of infectious diarrhea. A key question for an assessment of the role of anti-diarrhea therapy in EVD is: In the pathophysiology of EVD, does diarrhea play a protective role through elimination of the infectious agent? Equating the treatment of EVD-induced diarrhea to that of diarrhea associated with severe bacterial GI infections or self-limiting community-acquired viral gastrointestinal infections is problematic. EVD-induced diarrhea has been described in recent reports as watery and voluminous (5 or more liters per day) [3]. Profuse and watery diarrhea is known to occur as a result of small bowel hypersecretion

Internally-Developed Online Adverse Drug Reaction and Medication Error Reporting Systems

Abstract Online reporting systems for adverse drug reaction (ADR) and medication error (ME) reporting were developed at the University of Kentucky Chandler Medical Center. Collaboration between Pharmacy Services, Information Services, and the Drug Information Center resulted in the creation of two stand-alone systems that input data directly into centrally-stored databases. Web forms were designed using Web-authoring tools, as well as javascript and server-side scripting. Medication error reporting incorporated an E-mail notification process for hospital personnel based upon patient location, medical service, and severity of the error. Adverse drug reaction reporting increased initially following implementation, but leveled out soon thereafter. Conversely, ME reporting greatly increased, and also captured a greater number of type A MEs (eg, situations with a capacity for error). A number of system changes and patient safety initiatives have been implemented in response to data obtained from the reporting systems. Internally developed systems have supported customized forms that meet the institutions reporting needs and support a safer patient care environment.