Expanded pharmacy technician roles: Accepting verbal prescriptions and communicating prescription transfers

As the role of the clinical pharmacist continues to develop and advance, it is critical to ensure pharmacists can operate in a practice environment and workflow that supports the full deployment of their clinical skills. When pharmacy technician roles are optimized, patient safety can be enhanced and pharmacists may dedicate more time to advanced clinical services. Currently, 17 states allow technicians to accept verbal prescriptions called in by a prescriber or prescriber's agent, or transfer a prescription order from one pharmacy to another. States that allow these activities generally put few legal limitations on them, and instead defer to the professional judgment of the supervising pharmacist whether to delegate these tasks or not. These activities were more likely to be seen in states that require technicians to be registered and certified, and in states that have accountability mechanisms (e.g., discipline authority) in place for technicians. There is little evidence to suggest these tasks cannot be performed safely and accurately by appropriately trained technicians, and the track record of success with these tasks spans four decades in some states. Pharmacists can adopt strong practice policies and procedures to mitigate the risk of harm from verbal orders, such as instituting read-back/spell-back techniques, or requiring the indication for each phoned-in medication, among other strategies. Pharmacists may also exercise discretion in deciding to whom to delegate these tasks. As the legal environment becomes more permissive, we foresee investment in more robust education and training of technicians to cover these activities. Thus, with the adoption of robust practice policies and procedures, delegation of verbal orders and prescription transfers can be safe and effective, remove undue stress on pharmacists, and potentially free up pharmacist time for higher-order clinical care.

Pharmacist Prescriptive Authority for Epinephrine Auto-Injectors in Idaho

Objective: To describe recent legislation in Idaho that granted pharmacists autonomous prescriptive authority for epinephrine auto-injectors. Practice Innovation: States have taken action to increase access to epinephrine auto-injectors by allowing them to be stocked and prepositioned at locations where individuals may encounter allergens. All 50 states have allowed schools to maintain stock supplies of epinephrine auto-injectors and 26 states have allowed other entities, such as summer camps, daycare centers, gymnasiums, and restaurants to begin stocking product as well. In 2016, legislation in Idaho pursued entity stocking while simultaneously granting pharmacists autonomous prescriptive authority for epinephrine auto-injectors. Results: Idaho legislation granted prescriptive authority for pharmacists for epinephrine auto-injectors not just for individual patients, but also for authorized entities. No collaborative practice agreement is necessary. To receive an epinephrine auto-injector, an agent or employee of an authorized entity must present proof that they have completed an appropriate training program. Pharmacists are provided liability protections when prescribing in good faith to an authorized entity. Conclusion: Idaho’s legislation provides a potential model for pharmacist prescriptive authority for epinephrine auto-injectors that other states may consider pursuing in the years ahead.   Type: Commentary

An Analysis of Community Pharmacy Shared Faculty Members' Contributions to Teaching, Service, and Scholarship

Objective. To identify community pharmacy shared faculty members across the United States and to describe their roles and responsibilities in terms of teaching, service, and scholarship. Methods. This study was a mixed-methods analysis using surveys and key informant interviews. Results. Twenty-two faculty members completed the survey; nine were interviewed. Their major roles and responsibilities included teaching in community-based and experiential learning courses, precepting students and/or residents, being actively involved in professional organizations, providing patient care while leading innovation, and disseminating findings through scholarship. Conclusion. Community pharmacy shared faculty members contribute to their academic institutions and community pharmacy organizations by educating learners, providing direct patient care, and advancing community practice through innovation and service to the profession. Findings of this study can be used as a guide for academic institutions and community pharmacy organizations interested in partnering to develop a community pharmacy shared faculty position.

The Continuum of Pharmacist Prescriptive Authority

Recently momentum has been building behind pharmacist prescriptive authority for certain products such as oral contraceptives or naloxone. To some, prescriptive authority by pharmacists represents a departure from the traditional role of pharmacists in dispensing medications. Nearly all states, however, currently enable pharmacist prescriptive authority in some form or fashion. The variety of different state approaches makes it difficult for pharmacists to ascertain the pros and cons of different models. We leverage data available from the National Alliance of State Pharmacy Associations (NASPA), a trade association that tracks pharmacy legislation and regulations across all states, to characterize models of pharmacist prescriptive authority along a continuum from most restrictive to least restrictive. We identify 2 primary categories of current pharmacist prescriptive authority: (1) collaborative prescribing and (2) autonomous prescribing. Collaborative prescribing models provide a broad framework for the treatment of acute or chronic disease. Current autonomous prescribing models have focused on a limited range of medications for which a specific diagnosis is not needed. Approaches to pharmacist prescriptive authority are not mutually exclusive. We anticipate that more states will pursue the less-restrictive approaches in the years ahead.

Defining and Measuring Primary Medication Nonadherence: Development of a Quality Measure

Poor medication adherence has been increasingly recognized as a major public health issue and a priority for health care reform. Primary medication nonadherence (PMN) is a subset of this broader subject and occurs when a new medication is prescribed for a patient, but the patient does not obtain the medication, or an appropriate alternative, within an acceptable period of time after it was prescribed. It is increasingly evident that the public health problem of PMN is widespread. However, the lack of standardized definitions and measures inhibits the ability to establish the true incidence of this problem or to track changes in PMN rates over time. Given the limitations of current measures, the Pharmacy Quality Alliance (PQA) convened an expert working group to set parameters for a new industry measure. That new measure, which links electronic prescribing and pharmacy dispensing databases and was developed and approved by the PQA, is described here. PMN literature from 1990 to June 2015 is also reviewed, and existing PMN measures are summarized.

DISCLOSURES

No funding was received for this article, and the authors declare no conflicts of interest. The views expressed in this article are those of the authors alone and do not necessarily reflect those of their respective employers. Adams has received grant support from Pfizer for adherence research. Adams and Stolpe were equally involved in all aspects of study design, data collection and interpretation, and manuscript preparation.

Use of CLIA-waived point-of-care tests for infectious diseases in community pharmacies in the United States

Review of point-of-care (POC) testing in community pharmacies, availability and specifications of CLIA-waived infectious disease POC tests, and provide recommendations for future community pharmacy POC models in an effort to improve patient outcomes while reducing antibiotic resistance. PubMed and Medscape were searched for the following keywords: infectious disease, community pharmacy, rapid diagnostic tests, rapid assay, and POC tests. All studies utilizing POC tests in community pharmacies for infectious disease were included. Studies, articles, recommendations, and posters were reviewed and information categorized into general implementation of POC testing in community pharmacies, CLIA-waived tests available, Influenza, Group A Streptococcus pharyngitis, Helicobacter pylori, HIV and Hepatitis C. POC testing provides a unique opportunity for community pharmacists to implement collaborative disease management programmes for infectious diseases and reduce over-prescribing of antibiotics and improve patient outcomes through early detection, treatment and/or referral to a specialist.

U.S. community pharmacies as CLIA-waived facilities: Prevalence, dispersion, and impact on patient access to testing

BACKGROUND

The Clinical Laboratory Improvement Amendments of 1988 (CLIA) enabled greater access to low-risk tests by allowing their use in facilities with a Certificate of Waiver in the U.S. Community pharmacies are among the most accessible health professionals, and they are increasingly offering CLIA-waived tests. This manuscript aims to determine: 1) the current number of pharmacies in the United States with CLIA-waivers; 2) the uptake of CLIA-waivers by different pharmacy store types; and 3) the state-by-state differences in the percentage of pharmacies with a CLIA-waiver.

METHODS

Data were collected from the U.S. Centers for Disease Control and Prevention CLIA Laboratory Search website on May 3rd, 2015. The website allows for exportation of demographic data on all CLIA-waived facilities by state.

RESULTS

Pharmacies are currently the fourth highest-ranking facility of CLIA-waived laboratories with 10,838 locations. Supermarkets had the highest percentage of pharmacies with a CLIA-waiver (43.16%). States demonstrated considerable variability in the percentage of pharmacies with a CLIA-waiver, with a median percentage of 19.56% (0%-60.00% range).

CONCLUSIONS

Community pharmacies are currently a leading facility for CLIA-waived laboratories. Substantial state-level variation is observed in the percentage of pharmacies with CLIA-waivers, and these differences may be driven by restrictions in state law or regulations.

Coaching for Success: A Residency Search Primer and Update for Preceptors and Faculty

Pharmacy residency programs have become increasingly competitive in recent years, and changes to the residency search and application process have altered the process for matching with a residency. In this article, major residency topics, from the benefits of residency training to searching for and ranking programs, are summarized. A discussion of tips and tricks for applying for residencies and interviewing for positions is included along with specific suggestions developed with data following the implementation of the Pharmacy Online Residency Centralized Application Service (PhORCAS). The article is organized in a question and answer format to help facilitate understanding of key concepts and common questions that may arise from applicants. Many changes have taken place in the residency search and application process in recent years, and the process of obtaining a residency is complex. Residency applicants and those advising applicants may find value in the answers to commonly asked residency application questions to help ensure the greatest chance of a successful residency match.

A Novel Education and Training Program to Enhance Student Advocacy

Objective. To develop and implement a unique student advocacy program to train student pharmacists to be effective advocates for the profession of pharmacy and the patients it serves. Design. The Academy is a 2-day program hosted annually in Washington, DC, that combines didactic presentations on the legislative process, communication with policymakers, current legislation, and active-learning exercises such as mock congressional visits. The Academy culminates with visits to Capitol Hill where students meet with legislators and their staff to discuss pending legislation. Assessment. Nearly 350 students from 43 schools and colleges of pharmacy completed the program in its 4 years. Students are assessed following the active-learning exercises and meetings with legislators. Conclusion. Advocacy has been listed as a competency that requires more attention in pharmacy education. The Academy provides a model that schools may replicate to enhance their advocacy offerings.

Mentoring Residency Candidates: Avoiding Misinformation and Employing Best Practices

Type: Commentary

PCMHs, ACOs, and medication management: lessons learned from early research partnerships

The Patient Protection and Affordable Care Act has greatly accelerated the formation of team-based models of care delivery, primarily accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).  Many have written about the need to incorporate medication management services into these systems in order to improve care and reduce total health care costs. Two primary ways of doing so have emerged: (1) an embedded model, whereby pharmacists are employed directly by a physician practice, or (2) a "virtual care team" model, whereby a PCMH or ACO develops an arrangement with external pharmacists in community settings to provide coordinated services.

Student pharmacists' perceptions of community pharmacy residency programs

OBJECTIVES

To compare penultimate-year (next-to-last) and final-year student pharmacists' perceptions of the educational value of community pharmacy residency programs (CPRPs) and to compare student pharmacists' perceptions of the educational value of CPRPs and health-system residency programs (HSRPs).

METHODS

A self-administered online survey was sent to administrators at 119 Accreditation Council for Pharmacy Education-accredited schools of pharmacy for ultimate distribution to penultimate- and final-year student pharmacists. The survey included demographic measures and a 20-item residency program "perceived value of skill development" scale developed for this study.

RESULTS

1,722 completed surveys were received and analyzed. Penultimate-year students attributed greater value to CPRPs more frequently than final-year students. Students more often attributed higher value to CPRPs for skills related to business management, practice management, and medication therapy management, while they attributed higher value to HSRPs for skills related to teaching, research, and clinical knowledge.

CONCLUSION

The results of this study suggest students' perceived value of CPRPs may be related to their year of pharmacy school and the pharmacy practice skill in question.

Historical development and emerging trends of community pharmacy residencies

Clinical pharmacy services necessitate appropriately trained pharmacists. Postgraduate year one (PGY1) community pharmacy residency programs (CPRPs) provide advanced training for pharmacists to provide multiple patient care services in the community setting. These programs provide an avenue to translate innovative ideas and services into clinical practice. In this paper, we describe the history and current status of PGY1 community pharmacy residency programs, including an analysis of the typical settings and services offered. Specific information on the trends of community programs compared with other PGY1 pharmacy residencies is also discussed. The information presented in this paper is intended to encourage discussion regarding the need for increasing the capacity of PGY1 community pharmacy residency programs.

The Mandatory Residency Dilemma: Parallels to Historical Transitions in Pharmacy Education

Objective:

To review recent literature regarding mandatory residencies in the perspective of the historical entry-level degree debate.

Data Sources:

Articles were identified through searches of MEDLINE/PubMed, national pharmacy association Web sites, and a review of the references of related literature.

Study Selection and Data Extraction:

Several studies, commentaries, and reviews are examined to discuss viewpoints from both the entry-level degree and mandatory residency debates. Similarities were observed between the 2 debates in regard to objectives and rationale for change, educational issues, pharmaceutical care issues, and economic issues.

Data Synthesis:

Fewer than 10 years ago, after many years of debate, colleges of pharmacy made the transition to offering the PharmD degree as the sole entry-level degree for licensure as a pharmacist. Similar debates have taken place over the past several years and continue to take place regarding the necessity for residency training. One key 2006 document by the American College of Clinical Pharmacy calls for mandatory residency training for entry into pharmacy practice by 2020.

Conclusions:

In parallel with the entry-level degree debate, consensus has yet to be reached among pharmacists and pharmacy organizations, but several have shown support for mandatory residency training for all pharmacists involved in direct patient care. Many questions have yet to be answered regarding the timeline, economics, and feasibility of such a mandate.

Design of a light stimulator for fetal and neonatal magnetoencephalography

The design, safety analysis and performance of a fetal visual stimulation system suitable for fetal and neonatal magnetoencephalography studies are presented. The issue of fetal, neonatal and maternal safety is considered and the maximum permissible exposure is computed for the maternal skin and the adult eye. The risk for neonatal eye exposure is examined. It is demonstrated that the fetus, neonate and mother are not at risk.