Journal of the American College of Clinical Pharmacy : JACCP最新文献

Clinical cross-coverage in ambulatory care pharmacy practice is currently lacking and can lead to gaps in patient care, lost revenue generation, and pharmacist burnout due to a lack of time and support for indirect patient care and non-clinical activities. To address this need, a cross-coverage model for a team of ambulatory care pharmacists practicing in diverse clinical settings was developed and is primarily supported by a single broadly-trained pharmacist known as an ambulatory care generalist. Cross-coverage from the ambulatory care generalist includes in-person and virtual patient care as well as in-basket management and is available to all clinic-based pharmacists on the specialty and primary care team with a few select clinics involving a designated collaborative practice agreement. The cross-covering pharmacist has been shown to positively impact productivity measures and components of pharmacist burnout. Widespread implementation of this cross-coverage model has the potential to greatly impact pharmacy practice and patient care in the ambulatory care setting and increase sources of revenue.

Community pharmacies are rapidly becoming destinations for health services beyond medication dispensing. Delivery models for community-based services have become increasingly complex, creating expanded opportunities and necessitating collaboration between pharmacists in the community setting and other health care professionals. As a result, it is essential to articulate best practices and recommendations to assist stakeholders in responding to the changing landscape and optimize care for patients. This white paper provides a summary of published examples of interprofessional practice that include community pharmacies in the United States and internationally, and then adapts established guiding principles for interprofessional practice to the community pharmacy setting to outline a framework and specific recommendations for consideration. This framework highlights a need to place patients at the center of collaborative community-based care models, have organizational leaders show a commitment to and establish an infrastructure for interprofessional collaboration that includes community-based pharmacists, foster respect for community pharmacy practice, address communication and technology barriers in the health care system, and finally, embrace interprofessional learning in the community pharmacy setting. Addressing challenges and embracing opportunities is vital to accelerate practice transformation and further position community-based pharmacists as essential members of interprofessional care teams.

Vancomycin dosing guidelines recommend using first-order analytic calculations or Bayesian software along with two drug concentrations at steady state to confirm an area under the serum concentration versus time curve (AUC24), which is safe and efficacious for the treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections. Evidence supporting optimal vancomycin dosing for empiric or nonserious MRSA infections is sparse. A systemwide vancomycin dosing protocol applying the latest guidelines and a novel dosing strategy to estimate AUC was created by a large, multicenter healthcare organization. A dosing calculator was embedded in the electronic medical record, and an analytics tool was created to monitor the incidence and predictors of vancomycin-associated acute kidney injury (VA-AKI). The incidence of VA-AKI was tracked over time and between hospitals to identify opportunities to reduce variation. This article describes the implementation of the vancomycin protocol and the use of informatics to ensure patient safety.

The North American Pharmacist Licensure Examination (NAPLEX) is a major assessment metric for graduates pursuing licensure and the institutions from which they graduated. Before 2014, the mean NAPLEX first-time pass rate was roughly 95% every year. Mean pass rates have fallen dramatically since then to less than 80%, with many schools currently unable to achieve a 70% pass rate. Such a drastic decline in NAPLEX performance constitutes a crisis for many schools. Changes to the exam blueprint, administration, and scoring provide a partial explanation for the decline, but the issue of cause ultimately comes down to one simple question: What has changed over the last 10 years that is making it more difficult for graduates to pass NAPLEX on the first attempt? The effects of excessive academic expansion, beginning in 2000, cannot be overlooked. The newest schools, established after 2009, and accelerated (3-year) programs, many of which are also new, appear to be particularly vulnerable. In 2023, 16 pharmacy schools had first-time pass rates below 65%. Nine (56%) of those schools opened after 2009 and seven (44%) were accelerated programs. Newer schools have had to compete for a limited supply of qualified faculty, administrators, preceptors and experiential training sites, while also striving to meet enrollment targets amid a dwindling applicant pool. The ability to overcome the NAPLEX crisis depends on first establishing a more effective process of assessing NAPLEX results—one that measures the right metrics in the right way—and upholds fair, but rigorous, quality standards. Stakeholders need access to actionable information and the most relevant, useful data available. The purpose of this article is to provide evidence that the Academy is facing a legitimate crisis and offer four recommendations by which assessment and understanding of the crisis can be enhanced.