Stephen F. Eckel

Relationship between Fluoroquinolone Use and Changes in Susceptibility to Fluoroquinolones of Selected Pathogens in 10 United States Teaching Hospitals, 1991-2000

We retrospectively examined the relationship between fluoroquinolone use and the susceptibilities of 11 bacterial pathogens to fluoroquinolones in 10 US teaching hospitals from 1991 through 2000. Statistical significance was determined by 2-way analysis of variance, with the number of isolates tested each year as a weighting factor. The analysis of baseline-to-end point change in the percentage of susceptibility and the slope of the regression line (trend line) for logit percentage of susceptibility showed that the overall percentage of susceptibility to fluoroquinolones decreased significantly during the study period (P<.05) and that change in percentage of susceptibility was significantly related to change in fluoroquinolone use (P<.05). Particularly notable were the decreases in the susceptibilities of Pseudomonas aeruginosa, Proteus mirabilis, and Escherichia coli (decreases of 25.1%, 11.9%, and 6.8%, respectively).

Availability and characteristics of teaching certificates offered by pharmacy residency programs

ASHP’s residency accreditation standards require a teaching component within resident training programs. These teaching experiences can be extremely valuable to residents interested in positions within teaching institutions. The opportunities for teaching vary among programs, and the creation of a

Acute Care Clinical Pharmacy Practice: Unit- versus Service-Based Models

This commentary from the 2010 Task Force on Acute Care Practice Model of the American College of Clinical Pharmacy was developed to compare and contrast the “unit‐based” and “service‐based” orientation of the clinical pharmacist within an acute care pharmacy practice model and to offer an informed opinion concerning which should be preferred. The clinical pharmacy practice model must facilitate patient‐centered care and therefore must position the pharmacist to be an active member of the interprofessional team focused on providing high‐quality pharmaceutical care to the patient. Although both models may have advantages and disadvantages, the most important distinction pertains to the patient care role of the clinical pharmacist. The unit‐based pharmacist is often in a position of reacting to an established order or decision and frequently is focused on task‐oriented clinical services. By definition, the service‐based clinical pharmacist functions as a member of the interprofessional team. As a team member, the pharmacist proactively contributes to the decision‐making process and the development of patient‐centered care plans. The service‐based orientation of the pharmacist is consistent with both the practice vision embraced by ACCP and its definition of clinical pharmacy. The task force strongly recommends that institutions pursue a service‐based pharmacy practice model to optimally deploy their clinical pharmacists. Those who elect to adopt this recommendation will face challenges in overcoming several resource, technologic, regulatory, and accreditation barriers. However, such challenges must be confronted if clinical pharmacists are to contribute fully to achieving optimal patient outcomes.

Economic and Microbiologic Evaluation of Single-Dose Vial Extension for Hazardous Drugs

PURPOSE The update of US Pharmacopeia Chapter <797> in 2008 included guidelines stating that single-dose vials (SDVs) opened and maintained in an International Organization for Standardization Class 5 environment can be used for up to 6 hours after initial puncture. A study was conducted to evaluate the cost of discarding vials after 6 hours and to further test sterility of vials beyond this time point, subsequently defined as the beyond-use date (BUD). METHODS Financial determination of SDV waste included 2 months of retrospective review of all doses prescribed. Additionally, actual waste log data were collected. Active and control vials (prepared using sterilized trypticase soy broth) were recovered, instead of discarded, at the defined 6-hour BUD. RESULTS The institution-specific waste of 19 selected SDV medications discarded at 6 hours was calculated at

Evaluation of a Condensed Training Program to Introduce the Process of Continuing Professional Development

766,000 annually, and tracking waste logs for these same medications was recorded at

Continuing professional development training program among pharmacist preceptors and nonpreceptors

770,000 annually. Microbiologic testing of vial extension beyond 6 hours showed that 11 (1.86%) of 592 samples had one colony-forming unit on one of two plates. Positive plates were negative at subsequent time points, and all positives were single isolates most likely introduced during the plating process. CONCLUSION The cost of discarding vials at 6 hours was significant for hazardous medications in a large academic medical center. On the basis of microbiologic data, vial BUD extension demonstrated a contamination frequency of 1.86%, which likely represented exogenous contamination; vial BUD extension for the tested drugs showed no growth at subsequent time points and could provide an annual cost savings of more than

Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times

600,000.

Assessment of final product dosing accuracy when using volumetric technique in the preparation of chemotherapy

Objectives: Continuing professional development (CPD) is a novel approach to learning and developing as a professional. The purpose of this study is to administer, observe, and evaluate a condensed CPD training program to determine its effectiveness. Study method: The program consists of a 2-hour home study section with reflective components and a 3-hour live portion complete with active learning activities and group exercises. Pre- and post-surveys were administered to participants, with several questions being asked to determine their perception of the CPD process. Results: Of the 21 participants that attended the program, 99% indicated on the post-workshop evaluation that they were able to accomplish the pre-stated program objectives. Of the 19 participants who completed the pre- and post-surveys, 88% responded that the program time was just right for them. After the post-survey, 71% responded that they were very familiar with the concept of CPD as opposed to 11% on the pre-survey. Conclusion: A combined 2-hour self-study and 3-hour live interactive program is efficient and effective in training professionals on CPD.

Evaluating an approach to improving the adoption rate of wireless drug library updates for smart pumps

OBJECTIVES To administer, observe, and evaluate the effectiveness of a condensed continuing professional development (CPD) training program among chain community pharmacy preceptors and nonpreceptors in North Carolina. METHODS 120 community preceptors and nonpreceptors affiliated with a large community chain pharmacy completed a 5-hour CPD program consisting of home study and live portions and were given pre- and postintervention surveys. The main outcome measures were knowledge and familiarity of CPD among community chain pharmacy preceptors and nonpreceptors, effectiveness of the condensed training program, and perceptions on implementing the CPD process after training. RESULTS Before the educational activity, differences between participants were (1) the percent of women pharmacists (40% of preceptors and 65% of nonpreceptors) and (2) that preceptors were more likely to accomplish planned learning activities compared with nonpreceptors. Of 97 nonpreceptors and 23 preceptors trained, more than 90% reported being able to achieve the program objectives and responded positively to the survey questions and 100% indicated that the educational activity enhanced their knowledge and skill levels. At least 85% of participants responded that the program length was satisfactory. The postsurvey revealed that 87% of participants were at least moderately familiar with the concept of CPD. Of respondents, 83% indicated that they will implement CPD at their practice site. CONCLUSION A condensed CPD program is efficient and effective in training community chain pharmacy preceptors and nonpreceptors. The majority of the pharmacists who responded indicated that they will implement CPD at their practice site after going through this program.

Development and evaluation of a novel product to remove surface contamination of hazardous drugs

PURPOSE The workflow and chemotherapy preparation turnaround times at an adult infusion clinic were evaluated to identify opportunities to optimize workflow and efficiency. METHODS A three-phase study using Lean Six Sigma methodology was conducted. In phase 1, chemotherapy turnaround times in the adult infusion clinic were examined one year after the interim goal of a 45-minute turnaround time was established. Phase 2 implemented various experiments including a five-day Kaizen event, using lean principles in an effort to decrease chemotherapy preparation turnaround times in a controlled setting. Phase 3 included the implementation of process-improvement strategies identified during the Kaizen event, coupled with a final refinement of operational processes. RESULTS In phase 1, the mean turnaround time for all chemotherapy preparations decreased from 60 to 44 minutes, and a mean of 52 orders for adult outpatient chemotherapy infusions was received each day. After installing new processes, the mean turnaround time had improved to 37 minutes for each chemotherapy preparation in phase 2. In phase 3, the mean turnaround time decreased from 37 to 26 minutes. The overall mean turnaround time was reduced by 26 minutes, representing a 57% decrease in turnaround times in 19 months through the elimination of waste and the implementation of lean principles. This reduction was accomplished through increased efficiencies in the workplace, with no addition of human resources. CONCLUSION Implementation of Lean Six Sigma principles improved workflow and efficiency at an adult infusion clinic and reduced the overall chemotherapy turnaround times from 60 to 26 minutes.