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

The 2023 Educational Affairs Committee reviewed relevant position statements and publications to update the 2014 ACCP position statement on the educational outcomes (EOs) necessary for pharmacy students to enter postgraduate year 1 (PGY1) residency training. The committee initially aligned entry-level graduate outcomes with current PGY1 residency competencies achieved after postgraduate training. The committee then used these alignments to identify consistencies, insufficiencies, and gaps in preparation. This process revealed that the EOs and entrustable professional activities from curricular outcomes and entrustable professional activities and the North American Pharmacist Licensure Examination blueprint could serve as a partial list of outcomes necessary to enter postgraduate training; however, some of the outcomes necessary to enter residency were not consistently addressed. To improve residency readiness, the committee recommends that both academic programs and the individual learner evaluate and seek opportunities to address any curricular gaps in alignment. The findings also underscore the need for a single set of well-defined and mutually agreed-on educational competencies that evolve over time and embrace the knowledge, skills, and attitudes that demonstrate residency readiness.

Pharmacists play a crucial role in medication safety and quality improvement in healthcare, yet face significant challenges due to limited data access, poor data quality, and insufficient data management skills. National pharmacy organizations emphasize the importance of pharmacists using data effectively to improve patient care. This paper suggests several strategies to overcome data challenges, including more widespread adoption of a Chief Pharmacy Informatics Officer (CPIO) role in healthcare institutions, the development and validation of medication safety metrics and dashboards, and the incorporation of data analysis and application skills into pharmacist education and training. The creation of the CPIO position is proposed to lead efforts in data management and use for medication safety. Additionally, establishing clear medication safety metrics and dashboards is recommended to monitor and improve safety practices. To support these roles and tools, enhancing pharmacist training in data analytics is deemed essential. Implementing these strategies aims to empower pharmacists to engage more effectively in proactive medication safety and quality improvement efforts. This approach is expected to address current gaps in data utilization and management, facilitating a more informed method for pharmacists to make healthcare safe for patients.

Pharmacogenomics (PGx) results can potentially guide the prescribing of dozens of medications; however, use of such results is often limited by the prescriber's awareness of results and knowledge of drug–gene interactions. Integration of PGx results with corresponding clinical decision support (CDS) in the electronic health record (EHR) is critical to facilitate genotype-guided medication prescribing among all clinicians in an integrated health system. We describe our experience with developing an infrastructure to house PGx results and ensure actionable findings can be used at the point of care in real time using CDS. Upon transitioning to a new EHR, PGx-related CDS alerts for more than 50 medications were developed using a systematic and multidisciplinary process where clinical pharmacist input was key. Multiple strategies were required to enable the storage of PGx results as discrete data from any laboratory source to drive CDS. EHR features were leveraged to link results from external laboratories to CDS and a homegrown translational software platform was developed to integrate results from the in-house genomics laboratory directly into the EHR. These processes enabled PGx result integration for 2342 patients. As an example, among 356 patients who were genotyped for CYP2C19 to guide voriconazole dosing as part of a standard protocol in bone marrow transplant, 114 (32%) had CDS alerts for medications other than voriconazole presented to a clinician. For 50 of these patients, alerts were presented to a clinician of a different specialty who likely was not aware the patient had PGx results. Clinical pharmacists at institutions performing PGx testing are encouraged to champion the integration of PGx results and CDS in the EHR to maximize clinician awareness and evidence-based use of PGx results.

A literature review with an evaluation of existing evidence is often the first step in designing a research project. This article provides a systematic framework and guide for clinicians, researchers, and clinician-scientists to appraise the available literature to inform a clinical research project. The three-step approach outlined in this article starts with defining your research question using the Population Intervention Comparator Outcome-Design framework, followed by evaluation of the existing evidence and identification of gaps that could be addressed by a research project, and ends with guidance to refine the research question and start preparing a protocol.