Stuart T. Haines

Best practices for safe use of insulin pen devices in hospitals: Recommendations from an expert panel Delphi consensus process

PURPOSE A Delphi consensus development process was used to identify best practices for the safe use of insulin pen devices in hospitals. METHODS A panel of healthcare professionals with experience in patient safety activities and development of insulin-use guidelines was selected. In round 1 of a 4-round Delphi process, panelists were asked to identify key concepts and practices relating to safe use of insulin pen devices in hospitals. In round 2, panelists indicated their level of agreement with draft practice statements reflecting input received in round 1; statements with strong support were refined based on panelist suggestions. In round 3, the modified draft statements were rated for potential impact on patient safety. In round 4, panelists selected a final list of statements to recommend as best practices. RESULTS A 12-member interprofessional panel consisting of nurses, pharmacists, and physicians participated in the Delphi process. In round 1, panelists submitted more than 450 statements describing safe practices for insulin pen use. Based on that input, 125 draft practice statements were developed; among 98 statements receiving panelist support in round 2, 76 were judged in round 3 to be critical to patient safety or likely to have a positive impact on patient safety. In round 4, panelists unanimously affirmed a final list of 35 best-practice statements for the safe use of insulin pens in hospitals. CONCLUSION A Delphi consensus development process yielded a list of recommended best practices to help ensure the safe use of insulin pen devices in hospitals and health systems.

Improving peer review: What reviewers can do

As an author, there is no better feeling than to receive correspondence from a journal editor that your paper has been accepted for publication. However, that sense of elation can quickly turn to dread if the author has to respond to dozens, even hundreds, of comments from peer reviewers. We have

Implementation Science to Advance Care Delivery: A Primer for Pharmacists and Other Health Professionals

Health care is experiencing increasing pressure to implement evidence‐based interventions that improve quality, control costs, and maximize value. Unfortunately, many clinical services and interventions to optimize medication use do not consistently produce the intended humanistic, clinical, and economic outcomes. The lack of conclusive results is believed to stem from the widely recognized research‐to‐practice gap. The field of implementation science seeks to discover and apply strategies designed to accelerate successful integration of interventions into routine practice. This primer provides an overview of implementation science principles for pharmacists and other health care providers interested in accelerating practice transformation to improve health care delivery and, ultimately, patient care.

Improving peer review: What authors can do

Publishing manuscripts in the peer-reviewed literature is essential for the advancement of both science and healthcare.[1][1] For those who work in academic environments, including residency or fellowship training programs, disseminating one’s work in peer-reviewed journals and other forums is

Improving peer review: What journals can do

Peer review is a shared responsibility intended to enhance the quality of manuscripts published in biomedical journals. Under ideal circumstances, everyone—authors, reviewers, and editors—understands their role and responsibilities, approaching the process with deliberate thoughtfulness. In our

Impact of a national antimicrobial stewardship mentoring program: Insights and lessons learned

PURPOSE The impact of an interprofessional mentoring program to advance antimicrobial stewardship programs (ASPs) in selected U.S. hospitals and lessons learned are described. SUMMARY A seven-step mentoring process with self-assessment, telephone calls, continuing education, a one-day onsite visit, action plan, and outcome data collection and analysis was provided to ASP teams at nine hospitals. Six hospitals completed the program. A significant improvement in the timeliness and appropriateness of i.v. antibiotic therapy (defined as a hang time within one hour after prescriber order entry and broad-spectrum coverage for gram-negative pathogens administered first when combination therapy was used) was observed in patients with sepsis over the 12-month period after implementation of the mentoring program. As a result of requiring hospital administrations participation in the mentoring program, increased funding became available at three hospitals for the microbiology laboratory to provide new rapid diagnostic tests and for pharmacist and physician time to devote to ASP activities. The collaboration and engagement of ASP team members, inclusion of hospital administrators and pharmacy directors in the onsite mentoring visits, and an experienced mentor team with an infectious diseases (ID) physician and ID pharmacist contributed to ASP success. Challenges included insufficient time to collect outcome metrics due to competing hospital priorities and loss of momentum over time. CONCLUSION A mentoring program for antimicrobial stewardship provided the perspective that comes from experience. Engagement of hospital administration was a key factor for both developing and sustaining a stewardship program.

Recommendations for Evaluating Practice-Related Activities of Pharmacy Faculty A Delphi Consensus

Objective: To develop definitions of who pharmacy practice faculty and partners are, identify indicators to measure practice-related activities, and provide guidance for evaluating pharmacy practice faculty. Methods: A 4-round, online Delphi was conducted. Panelists with experience evaluating pharmacy practice faculty were invited. Consensus was achieved when there was agreement by at least 70% of panelists. Round 1: Panelists were asked to identify the essential distinguishing characteristics of pharmacy practice faculty and practice partners as well as metrics that could be used to measure practice productivity and quality. Responses were grouped into common themes. Round 2: Panelists were asked to agree, agree with changes, or disagree with themes and metrics identified. Round 3: Panelists were asked to agree, agree with changes, or disagree with definitions of pharmacy practice faculty and practice partners. Panelists were asked about procedural elements of evaluation processes that colleges/schools should adopt. Round 4: panelists were asked about areas of uncertainty that had not yet achieved consensus. Results: A total of 17 experts participated. Consensus definitions for pharmacy practice faculty and practice partners were achieved . From 291 submitted indicators, 14 productivity and 10 quality indicators reached consensus along with recommended frequencies for collection and review. Peer review was identified as an important quality indicator. Recommendations regarding who should participate in the evaluation process and how the data should be used also achieved consensus. Conclusion: Formal mechanisms for evaluating the practice-related activities of pharmacy faculty are critical to ensure this area of responsibility is fairly recognized and considered.

It’s Time to Dismantle CE and Build a CPI System

While well intentioned, most continuing education (CE) programs do not have much impact on patient care.[1,2][1] The one-and-done variety – isolated CE lectures where experts talk at people for an hour or two that are not part of a curriculum and have no systematic follow-up – are particularly

Validation of the entrustable professional activities for new pharmacy graduates

Purpose. The face validity of the core entrustable professional activities (EPAs) for new pharmacy graduates published by the American Association of Colleges of Pharmacy (AACP) in 2017 was evaluated. Methods. A 28‐item questionnaire was sent to experienced pharmacy practitioners affiliated with 4 schools of pharmacy. In addition to demographic information about education, training, credentials, and practice setting, participants were asked whether each EPA statement was pertinent to pharmacy practice and an expected activity that all pharmacists should be able to perform. Questions regarding the secondary attributes of the EPA statements examined whether each activity is observable, is measurable, is transferable to multiple practice settings, and integrates multiple competencies. Results. The questionnaire was distributed to 137 eligible participants, and 71 usable survey responses were received. Participants consistently agreed (≥75% agreement) that the 15 EPA statements for new pharmacy graduates describe activities that are pertinent to pharmacy practice and that pharmacists are expected to perform. A consistent level of agreement was observed regardless of the preceptors employment with a college or school, board certification status, or completion of postgraduate training, and no statistical differences in level of agreement were found based on these attributes. There was consistent agreement (≥60%) across geographic regions. No statistical differences in agreement were found between acute care practitioners and ambulatory care practitioners. Conclusion. A survey suggested that the core EPAs developed and vetted by AACP have face validity and are believed by experienced pharmacy preceptor‐practitioners to be pertinent to pharmacy practice and to describe activities that all pharmacists should be able to competently perform.

Best practices in ensuring the safe use of insulin pens in the hospital: Introduction

Hyperglycemia is common in hospitalized patients, and insulin is the preferred antihyperglycemic treatment in the inpatient setting.[1][1],[2][2] Insulin is a high-alert medication associated with a significant risk for patient harm when used incorrectly or inappropriately.[3][3] Numerous reports