Class of 2015 Abstract / Objectives: To determine whether comprehensive medication reviews (CMRs) or non-CMR interventions following targeted medication reviews (TMRs) resulted in more positive medication changes. A CMR is a structured medication management session that includes a full review of an individual’s medical and medication records. Non-CMR interventions are more targeted problem-based interventions that include shorter medication management sessions, written patient outreach, and direct to provider interventions. Methods: This cross-sectional quality improvement project compared the number of individuals with positive medication changes who received a CMR to those with positive medication changes who did not receive a CMR (non-CMR). Individuals were included in this project if they qualified for the Medication Management Center’s (MMC) pharmacist-driven medication therapy management (MTM) program and received their medication review(s) in 2012 or 2013. The addition of an appropriate medication or the removal of an inappropriate medication was considered a positive medication change within 120 days of intervention. Odds ratios were calculated using Wilcoxon Rank Sum. Results: A total of 418,649 participants in 2012 and 370,107 in 2013 had their medications reviewed as part of the MTM program. The non-CMR group accounted for the majority of the interventions (375,159 for non-CMR versus 43,490 for CMR in 2012 and 332,006 versus 38,101 for 2013). Significantly more positive medication changes were achieved in the non-CMR group (n=88,467 for 2012 and n=54,971 for 2013) following the medication review compared to the CMR group (n=9,796 for 2012 and n=7,034 for 2013). CMR recipients were more likely to receive a recommendation (odds ratio 0.70, 95% confidence interval 0.69-0.72 for 2012 and odds ratio 0.62, 95% confidence interval 0.60-0.63 for 2013). Non-CMR recipients were more likely to have a recommendation result in a medication change (odds ratio 1.24, 95% confidence interval 1.21-1.28 for 2012 and 1.26, 95% confidence interval 1.22-1.30 for 2013). Conclusions: While the percentage of participants who received a recommendation in the non-CMR group was lower, a greater percentage of these participants received a medication change. This indicates that non-CMR interventions following TMRs may be more effective in producing a positive medication change compared to CMRs.

Class of 2013 Abstract / Specific Aims: To compare the Comprehensive Medication Review (CMR) rate for Workflow Model #1 (used in 2010) to the CMR rate for Workflow Model #2 (used in 2011) at the Medication Management Center (MMC). Methods: A retrospective database analysis was completed in which Comprehensive Medication Review (CMR) completion rates for 2010 and 2011 were assessed. Comparison included only Center for Medicare and Medicaid Services (CMS) contracts that the Medication Management Center (MMC) provided Medication Therapy Management (MTM) services for both in 2010 and 2011. Data was used to determine the effect a process change had on CMR participation rate at the MMC and best practices for improving the rate of Medication Therapy Management Program (MTMP) beneficiaries participating in a CMR. Main Results: In 2010, patient participation and response to a CMR offer letter was low (0.2%). The changes in process yielded an increase in the CMR completion rate (6.93%); this in turn yielded higher performance measurements for prescription drug plans. Conclusion: Workflow modifications, including a pro-active secondary CMR offer, led to a marked increase in member participation and CMR rates. Patients are more apt to consent to a CMR if they are called for a specific medication related problem. It is recommended to continue to convert TMR calls to CMRs whenever possible, monitor CMR rates at least quarterly, and make cold calls where needed to increase CMR percentages.

Medication administration errors (MAEs) may lead to adverse drug events, patient morbidity, prolonged hospital stays, and increased readmission rates, and may contribute to major financial losses for the health system. MAEs are the most common type of error occurring within the health care setting leading to an estimated 7,000 patient deaths every year. Interventions have been designed to prevent MAEs including education for nurses who administer medications; however, little effort has been made to design systematic educational programs that are based on local needs and contexts. The purpose of this project was to identify internal and external factors related to MAEs at the practice site, develop an education program tailored to the factors contributing to MAEs, and implement the program using a pretest posttest design. The Iowa model was used to guide the project. The 26 nurse participants who responded to an initial survey indicated that nurses felt distractions and interruptions during medication administration, and hesitancy to ask for help or to report medication errors increased MAE risks. After the education program, the pretest and posttest results were analyzed and revealed improvement in knowledge and confidence of medication administration (M = 3.2 pre, M = 3.7 post, p < .05). Open-ended question responses suggested a need for dedicated time for preparation and administration of medications without interruptions. Positive social change is possible as nurses become knowledgeable and confident about medication administration safety and as patients are protected from injury secondary to MAEs.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 190-197). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Medication errors are the second most frequent cause of injury among all types of medical errors (Leape, et al., 1991). Of concern to nursing practice, medication administration errors (MAE) are second only to ordering errors (Bates, Cullen, et al., 1995). The introduction of information technology designed to promote safe medication practice, such as the Bar Code Medication Administration (BCMA) system, offers new opportunities for reducing MAE. BCMA was developed to improve patient safety, improve documentation of medication administration, decrease medication errors, and capture medication accountability data. The overall goal of this study was to evaluate the impact of BCMA on medication administration errors: wrong patient, medication, dose, time, and route. Rogers' (1995) theory, organizational diffusion of innovations, provided the study's framework.A descriptive comparative design examined incidence of MAEs before (Time 1) and after implementation (Time 2) of BCMA on eight units in one medical center. MAE incidence was calculated using MAE and patient-days data. Nurse adherence to BCMA usage procedure was assessed with a questionnaire created for the study.Findings indicated that total MAEs increased from Time 1 to Time 2, however, wrong patient and wrong dose errors decreased. There was a statistically significant (p &lt; 0.05) increase in wrong route errors at Time 2. Comparing these findings with previous research demonstrated a diversity of methods, limiting conclusions. Nurse adherence findings indicated high overall adherence. However, completion of certain steps was hindered by software, equipment, or the work environment.Study findings were significant to nursing, informatics and patient safety research. Findings demonstrated the early state of BCMA research, added to knowledge about MAE detection methods, and brought a nursing perspective to information technology research on a process primarily within nursing purview. Implications for future research include improvement in MAE definitions and detection methods to support reliable data collection for research and quality improvement analysis. Also, sociotechnical theory recognizes health care as an interwoven, heterogeneous environment with complex roles and work practices, and may provide a more appropriate framework for evaluation of medication safety technology innovations than the linear model used in this study.

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Background: Improving adherence to medication is a persistent challenge within the health system. Adherence is influenced by many factors at the patient, provider, treatment and health system levels. Adherence may also be affected by continuity of care; defined as the consistent professional relationship between a health provider or source of care and a patient. Objective: To estimate the strength of association between continuity of community pharmacy care and adherence to statin medication among persons initiating statin therapy in Nova Scotia between 1998 and 2008.  Methods: This was a retrospective cohort study using administrative data from the Nova Scotia Seniors’ Pharmacare program. Subjects were included if they were dispensed at least one prescription for a statin medication between 1998 and 2008. Continuity of care was calculated via two methods: the Usual Provider of Care (UPC) index and the Continuity of Care Index (COCI), which measure the density and dispersion of relational continuity of care, respectively. Adherence was calculated using the medication possession ratio. The strength of association between continuity of care and adherence was analyzed using hierarchical regression. Results: During the study period, 31 592 individual subjects received a first statin dispensation. Adjusted hierarchical regression showed that for each 0.10 increase in continuity of care, the odds of adherence increase by 3% (95% CI: 1.01-1.05). Continuity of care measured by the UPC is highly correlated with continuity of care measured by the COCI (r=0.98). Conclusions: Continuity of community pharmacy care is positively associated with adherence to statins among Nova Scotian seniors who initiated statin therapy between 1998 and 2008.

Class of 2010 Abstract / OBJECTIVES: The purpose of the study was to determine the knowledge of third year pharmacy students about the safety of certain medications during pregnancy and to assess their awareness of an important resource available on medication safety. METHODS: The study used an analytical cross-­‐sectional design. A pre-­‐test was administered to determine baseline knowledge. Dee Quinn provided a presentation on teratogens. The same test was then administered as a post-­‐test to assess the amount of knowledge gained from the presentation. The pre and post-­‐tests were matched for data analysis. A mean and standard deviation were developed for pre and post-­‐test data and the results were compared to each other using a t-­‐test for dependent groups. RESULTS: Students showed a significant increase in knowledge after the presentation (p<0.0001). 78% of students had improved scores after the presentation. 100% of students felt that pharmacists could help make a difference in preventing malformations due to teratogen exposure. There was no significant difference between men and women or students with children and without children. Work experience did not affect knowledge scores. 64% of students felt more comfortable counseling pregnant patients after the presentation. Awareness of the Teratology Information Service improved after the presentation. CONCLUSIONS: After the presentation, students rated themselves as more comfortable speaking with pregnant patients and showed improved knowledge of teratogens. Gender, being a parent and work experience had no relevance on knowledge scores. The investigators recommend that this presentation be given to all students at the College of Pharmacy to improve knowledge in this area.

Class of 2017 Abstract / Objectives: To assess the perceived confidence level of community pharmacists in utilizing weight-based dosing, dispensing prescriptions, counseling, and recommending over-the-counter medications for the pediatric population in rural and non-rural settings. Methods: A 33-item questionnaire generated through REDCap was distributed to 11,280 pharmacists registered with the Arizona State Board of Pharmacy via email from March 14 to April 4 of 2017. The survey collected information on the participants’ experiences in managing pediatric prescriptions and demographics. Results: Of the 11,280 surveys distributed, a total of 857 responses were submitted by the end of the survey period (7.6%) and 482 responses were included in the analysis; 49 (10.2%) were practicing in rural areas and 433 (89.8%) were practicing in non-rural areas (including urban and suburban) in Arizona. There was no significant difference in the rural group compared to the non-rural group regarding experiences with dispensing pediatric medications. In regards to the confidence level, there was a significant difference between the two groups in calculating and recommending weight-based dosing for prescription and OTC pediatric medications (p = 0.022 and 0.031, respectively) and identifying a dosing error in pediatric prescriptions (p = 0.016). Conclusions: Community pharmacists practicing in rural and non-rural settings in Arizona had similar experiences with dispensing pediatric medications and confidence levels in managing medications for pediatric patients.