The association between number of learners and pharmacist and technician levels of burnout.

Purpose: Little is known about the relationship between learner load and pharmacist and pharmacy technician burnout. Therefore, the purpose of this study was to examine the association between burnout and the number of learners (residents, students, and new employees) assigned to pharmacists or pharmacy technicians.

Methods: A validated survey to measure burnout and professional fulfillment was administered to employees of a university health system's pharmacy service in 2019.

Implementation of radio-frequency identification technology to optimize medication inventory management in the intraoperative setting.

Purpose: Manual restocking and tracking of noncontrolled medications in anesthesia workstations (AWSs) is complicated and time intensive, provides several opportunities for error, and lacks perpetual inventory transparency regarding expiration and lot number. This pre-post study assessed the impact of radio-frequency identification (RFID) technology on restocking of noncontrolled medications in AWSs in relation to workflow, improved patient safety due to reduced restocking errors, and restocking accuracy and efficiency, as well as the estimated costs of on-site medication RFID tagging versus purchase of pretagged products.

Summary: Pre- and postimplementation process steps were mapped.

Interventions to reduce waste and improve billing compliance with medications in single-dose vials.

Purpose: The purpose of this process improvement project was to implement features in the electronic health record to help reduce inappropriate drug waste and Medicare billing noncompliance for injectable drugs in single-dose vials in outpatient settings.

Methods: The pharmacy department mapped processes from order entry to dose administration and claims processing. They used the process map to identify gaps that could lead to inappropriate drug waste.

Angiotensin-converting enzyme inhibitors reduce community-acquired pneumonia hospitalization and mortality.

Background: Pneumonia is a global disorder and a common reason for prolonged hospitalization. Angiotensin-converting enzyme inhibitors (ACEi) have pleiotropic effects that support a role in modulating pneumonia, but results have been controversial.

Objectives: The present study was conducted to elucidate an ACEi-induced pneumonia benefit in at-risk neurologically impaired population and to determine whether a mortality benefit exists.

Implementation of implicit bias awareness and action training in a pharmacy residency program.

Purpose: To implement an implicit bias awareness and action seminar program for the University of Utah Health pharmacy residency program and measure knowledge, awareness, and comfort around race-related topics.

Summary: An implicit bias awareness training program was implemented with a pre- and post-training survey to measure knowledge, comfort, and confidence around understanding and addressing biases. Fifty-one residents and preceptors participated in the implicit bias training, and 47 (92.

Burnout, professional fulfillment, sleep impairment, and self-compassion within an academic medical center pharmacy department.

Purpose: To examine the prevalence of burnout, professional fulfillment, sleep impairment, and self-compassion within an academic medical center pharmacy department across varying job titles and practice settings.

Methods: In fall 2019, pharmacy staff completed a REDCap-based survey that consisted of a validated instrument relating to burnout, professional fulfilment, sleep-related impairment, and self-compassion. Burnout was measured by both single-item and extended 10-item questions on the survey.

Evaluating hematology/oncology clinical pharmacist activities via self-reported work sampling.

Purpose: Hematology/oncology clinical pharmacists' work activities have been described in previous literature, but time spent on pharmacist tasks has not been well characterized. Random work sampling (WS) is a form of activity assessment to determine the proportion of time spent in various types of work. Based on results from previous WS evaluations at University of Utah and its Huntsman Cancer Hospital, activities were changed to maximize time dedicated to clinical activities and pharmacists' benefit to providers and patients in both inpatient and ambulatory care settings.

A 2019 evaluation of opioid use disorder treatment resources in rural Utah counties.

Objectives: The opioid crisis significantly affects residents of rural communities who already experience poor health outcomes based on social determinants. Therefore, this project evaluated the reported availability and accessibility of opioid use disorder (OUD) treatment resources in rural Utah county pharmacies through a multistep process intended to estimate the distance (miles) to registered (waivered) OUD care providers and community pharmacies and, thus, the ability to fill prescriptions for OUD treatment medications.

Methods: First, the United States Department of Agriculture Economic Research Service dichotomous classification scheme was used to identify nonmetropolitan counties.

Reduction of phone interruptions post implementation of a central call center in community pharmacies of an academic health system.

Purpose: A pharmacy services call center (PSCC) was implemented to centralize pharmacy phone calls and reduce interruptions of dispensing activities in 7 community pharmacies of an academic health center. An evaluation was conducted to define, quantify, and compare the numbers and types of phone interruptions before and 3 months after PSCC implementation.

Methods: Through structured, direct observation of pharmacy staff, the numbers and types of "breaks in task" (BIT) due to phone interruptions and other distractions were identified.

Cost-Sharing Requirements for the Herpes Zoster Vaccine in Adults Aged 60.

Rates of zoster vaccination in US adults aged 60+ were approximately 30.6% in 2015. Out-of-pocket cost-sharing has been identified as a major barrier to vaccination for patients.

Factors influencing rates of human papillomavirus vaccination.

Purpose: Failure modes and effects analysis (FMEA) was used to identify ways in which community clinic practices related to suboptimal human papillomavirus (HPV) vaccination rates could be improved.

Method: FMEA is a standardized safety method that helps determine where processes fail, the impact of failures, and needed process changes. In a quality improvement initiative conducted at an academic health center-based community clinic, a multidisciplinary team used FMEA to map HPV vaccination processes and identify areas for improvement of vaccination practices.

Assessment of perceived workload in academic health center community pharmacies before and after implementation of a central call center.

Purpose: Results of a study to determine whether reducing pharmacy phone call workload through implementation of a pharmacy services call center (PSCC) led to decreased employee workload, improved efficiency, and increased pharmacist availability for patient care are reported.

Methods: A pre-post study was conducted using the NASA Task Load Index (NASA-TLX) instrument. Pharmacists, pharmacy technicians at 7 academic health center community pharmacies, and PSCC staff provided NASA-TLX data over 5 days during 3 data collection periods before and after PSCC implementation.

Implementation of a centralized mail-order pharmacy service.

Purpose: The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described.

Summary: The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients.

Use of multiple methods to measure impact of a centralized call center on academic health system community pharmacies.

Purpose: The process and methods used in an impact assessment of a centralized pharmacy call center on community pharmacy employee patient safety climate perceptions, telephone distractions/interruptions, and prescription filling efficiency are described.

Summary: A broad-based team designed a multi-faceted, pre-post call center implementation analysis that included multiple change assessment measures. First, yearly administration of the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was used to assess patient safety climate based on employee perceptions of a safe working environment and potential for errors due to interruptions and distractions.

Effect of a central call center on employee perceptions of safety culture within community pharmacies in an academic health system.

Purpose: This study evaluated employee perceptions of safety culture in 9 health-system-owned community pharmacies using a safety culture survey before and after implementation of a Pharmacy Services Call Center (PSCC) designed to reduce distractions through reduction of phone volume related to refills and prescription readiness.

Methods: The Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture (CPSPSC) was used to collect employee safety culture perceptions pre-post PSCC implementation. A percent positive score (PPS) was calculated for each of 11 CPSPSC composite questions and for 1 overall rating of patient safety question based on AHRQ-suggested analytic procedures.

The effect of a prescription order requirement for pharmacist-administered vaccination on herpes zoster vaccination rates.

Objective: To determine the effect of a prescription order requirement for pharmacist-administered zoster vaccination on zoster vaccination in adults aged 60+.

Methods: A 50-state law review of statutes and regulations regarding pharmacists' ability to administer the zoster vaccine with/without a prescription order was performed. States were classified as prescription order required or not required as of January 1, 2014.

Harmonization of technology across an integrated delivery network.

Purpose: A standardized blueprint for use when harmonizing or standardizing pharmacy automation and technology resources across individual institutions or an integrated delivery network (IDN) of institutions is described.

Summary: Whether to strive for standardization (use of the same vendors and equipment) versus harmonization (use of various technologies to meet patient-specific needs and organizational stability requirements) and how to coordinate activities across IDNs consisting of 3-30 or more hospitals are common questions due to consolidations in the healthcare industry. For most IDNs with legacy systems, harmonization may be the better option.

Implementation and quality assessment of a pharmacy services call center for outpatient pharmacies and specialty pharmacy services in an academic health system.

Purpose: The implementation and quality assessment of a pharmacy services call center (PSCC) for outpatient pharmacies and specialty pharmacy services within an academic health system are described.

Summary: Prolonged wait times in outpatient pharmacies or hold times on the phone affect the ability of pharmacies to capture and retain prescriptions. To support outpatient pharmacy operations and improve quality, a PSCC was developed to centralize handling of all outpatient and specialty pharmacy calls.

Predicting poor adherence to antiretroviral therapy among treatment-naïve veterans infected with human immunodeficiency virus.

Previous studies suggested that human immunodeficiency virus (HIV) infected patients at risk of poor adherence were not distinguishable only based on the baseline characteristics. This study is to identify patient characteristics that would be consistently associated with poor adherence across regimens and to understand the associations between initial and long-term adherence. HIV treatment-naïve patients initiated on protease inhibitors, nonnucleoside reverse transcriptase inhibitors, or integrase strand transfer inhibitors were identified from the Veteran Health Administration system.

Adherence and virologic outcomes among treatment-naïve veteran patients with human immunodeficiency virus type 1 infection.

Many studies have estimated the association between the adherence to antiretroviral therapies and human immunodeficiency virus (HIV) patients' virologic/immunologic outcomes. However, evidence is lacking on the causal effect of adherence on the outcomes. The goal of this study is to understand whether near perfect adherence is necessary to achieve optimal virologic outcome and also to investigate the effect of initial adherence to antiretroviral therapies on initial viral suppression by different regimens.

The Chorus of User Voices: Meeting the Challenge of Patient-Reported Outcomes From Medications.

Prescription medication management by both healthcare providers and patients describe struggles not to inflict harm and encourage safe use in the context of culture and social relationships. Risk vs benefit assessments conducted in these contexts are essential for understanding how medication-taking decisions are made. Qualitatively-based Patient Reported Outcomes (PROs) are critical to understanding how medication pathways are navigated by both healthcare providers and patients seeking relief from maladies.

The Paradox of Safety in Medication Management.

The reduction of medication errors is largely dependent upon the structure of the medication management system and the role of the pharmacist in the acute care setting. The significance of this claim became evident in an ethnographic study of nurses' work in which data were generated from extensive observations, formal interviews, and document reviews. Each step of medication management-from ordering to administering-was microanalyzed, and spaces and places for error emerged.