CONCLUSIONS: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
OBJECTIVE: To identify pharmacy technician career pathways across pharmacy practice settings and opportunities to strengthen and expand these pathways.
METHODS: Interviews were conducted with 17 participants from national pharmacy organizations, community pharmacies, health systems, and academia from March to May 2023. Interview questions were designed to elicit participants\' perceptions of factors influencing entry into, recruitment and retention of, and advancement of the pharmacy technician workforce. Interview notes were analyzed using a rapid thematic analysis approach.
RESULTS: Seven themes were identified, including 3 themes related to entry: (1) healthcare interest and prior exposure facilitate pharmacy technician career discovery; (2) variation in and quantity of entry-level requirements can impede entry into pharmacy technician careers; and (3) proactive promotion of pharmacy technician careers needed. Two themes were related to recruitment and retention: (4) pharmacy technician compensation not aligned with job demands and (5) career ladders or lattices create advancement opportunities. Two themes were related to professional advancement: (6) pharmacy technician advancement limited by weak professional identity and (7) scope-of-practice policies can facilitate pharmacy technician advancement.
CONCLUSIONS: This study highlights the challenges pharmacy technicians face in their careers. Key findings stress cultivating a professional identity for pharmacy technicians, establishing career ladders or lattices, and advocating for policies that facilitate pharmacy technician professional advancement. These efforts are vital for sustaining the pharmacy technician workforce and ensuring quality patient care amidst the changing landscape of the pharmacy profession.

CONCLUSIONS: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
OBJECTIVE: The American Society of Health-System Pharmacists (ASHP) developed the Practice Advancement Initiative 2030 (PAI 2030) to support the continuous improvement of hospital pharmacy services in the United States. Puerto Rico (PR) hospitals\' level of compliance with PAI 2030 recommendations is not currently known. The primary objective of this study was to describe the hospital pharmacy scenario in PR in the 5 areas addressed in PAI 2030 recommendations.
CONCLUSIONS: Through a collaboration between the state affiliate, a school of pharmacy, and ASHP, completion of the PAI 2030 Self-Assessment Tool was promoted among hospital pharmacy directors between August 2022 and March 2023. A total of 18 out of 66 hospitals completed the survey. The results were compared with national data provided by ASHP from 163 US hospitals. Areas where PR hospitals rated high were in PAI 2030 domain A (Pharmacy Technician Role, Education, and Training) and domain E (Pharmacist Leadership in Medication Use and Safety). PR hospitals rate their performance lower in domain A (Patient-Centered Care) and domain B (Pharmacist Role, Education, and Training). Specific focus areas for improvement by PR hospitals include pharmacist participation in medication reconciliation, 24/7 access to advanced clinical pharmacy services, expansion of the pharmacist\'s scope of practice, and training through the Board of Pharmacy Specialties and residency programs.
CONCLUSIONS: This study illustrates how the PAI 2030 Self-Assessment Tool can be used to benchmark pharmacy services at the state level. We suggest that changes are needed to close the gap between hospital pharmacies working towards optimizing the role of pharmacists in healthcare systems and those still struggling with dedicating staff to well-recognized pharmacist roles and responsibilities.

CONCLUSIONS: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
OBJECTIVE: Central line-associated bloodstream infections (CLABSIs) are hospital-acquired, serious complications that greatly affect many vulnerable neonates throughout their hospital stay. This article describes the implementation of a unique practice in which pharmacy primes continuous infusions through medication tubing for neonatal central lines in a cleanroom at Children\'s Hospital Colorado - Colorado Springs (CHCO-CSH).
CONCLUSIONS: This institution is a freestanding children\'s hospital with a level III neonatal intensive care unit (NICU) that opened in April 2019. Since then, the pharmacy department has been priming central line tubing for continuous infusions for all patients in the NICU. Neonates are at increased risk for developing CLABSIs due to their immature immune systems and frequent need for central line placement. With that in mind, the pharmacy department decided to focus efforts on this population. Pharmacists and pharmacy technicians received training on how to properly prime tubing, document when a patient received a new central line, document if a central line was removed, and record when new tubing was due based on a department policy.
CONCLUSIONS: This novel, pharmacy-led priming procedure resulted in a low CLABSI incidence, offering a promising strategy to reduce CLABSIs in a NICU.

BACKGROUND: Acne vulgaris (acne) is a common skin condition sometimes needing topical or oral antibiotic treatment. Pharmacists and pharmacy technicians (together known as pharmacy professionals) working in general practice are well placed to ensure their appropriate use.
OBJECTIVE: The objectives of this study are to pilot an evidence-based intervention (\'How to…\' tool) to review treatments in the management of acne and evaluate the capability, opportunity, motivation and behaviour (COM-B) of pharmacy professionals working in general practice before and after the use of this tool.
METHODS: A quantitative electronic survey was developed asking UK-based pharmacy professionals working in general practice to rate their agreement with 21 predefined statements related to the COM-B model.
METHODS: Participants were sent an initial survey, given time to access and use the \'How to…\' acne resources and then sent a follow-up survey 2 weeks later.
METHODS: Primary outcome was change in 5-point Likert scale responses to statements on capability, opportunity and motivation in the management of acne. Secondary outcome was the perceived usefulness of the toolkit.
RESULTS: 141 pharmacy professionals completed the initial survey; 19 completed the follow-up survey. Significant improvement in the 5-point Likert scale means that responses were observed after implementation of the acne \'How to\' resource; capability 3.68 (SD 0.40) versus 4.11 (SD 0.29), t(189) =-5.10, p <0.001; opportunity 3.85 (SD 0.24) versus 4.07 (SD 0.29), t(94)=-2.50, p=0.007 and motivation 4.35 (SD 0.47) versus 4.51 (SD 0.32), t(113)=-2.51, p=0.007. The \'How to\' resources were rated as being useful (4.06, SD 0.12) and supportive (4.08, SD 0.18) to help pharmacy professionals in all areas of managing acne.
CONCLUSIONS: The acne \'How to\' resources are useful to pharmacy professionals in managing acne in general practice and may improve their capability. Further work is needed with greater numbers of participants to demonstrate generalisability of this outcome.

The 2023-2024 Professional Affairs Committee was charged to (1) Create an action plan in response to the clear urgent need for transformation of community pharmacy practice; and (2) Develop \"readiness for change\" instrument that addresses multiple pharmacy stakeholder groups that are based on the ACT \"community pharmacy enhanced services\" definition. Due to the continuous and rapid-paced changes occurring in community pharmacy practice, the committee developed a document that provides the baseline elements that should be considered for community pharmacy practice currently and into the future. This document, Envisioning the Near Future of Community Pharmacy Patient Care Practice: Key Elements of Practice Redesign in Community Pharmacies, contains 8 sections and is recommended to be socialized within the pharmacy profession to ensure that it resonates with current and future community pharmacy practice.

UNASSIGNED: The current study compared preparation time, errors, satisfaction, and preference for a prefilled syringe (PFS) versus two RSV vaccines requiring reconstitution (VRR1 and VRR2) in a randomized, single-blinded time and motion study.
UNASSIGNED: Pharmacists, nurses, and pharmacy technicians were randomized to a preparation sequence of the three vaccines. Participants read instructions, then consecutively prepared the three vaccines with a 3-5-min washout period in between. Preparations were video recorded and reviewed by a trained pharmacist for preparation time and errors using predefined, vaccine-specific checklists. Participant demographics, satisfaction with vaccine preparation, and vaccine preference were recorded. Within-subjects analysis of variance was used to compare preparation time. Mixed-effects Poisson and ordered logistic regression models were used to compare the number of preparation errors and satisfaction scores, respectively.
UNASSIGNED: Sixty-three pharmacists (60%), nurses (35%), and pharmacy technicians (5%) participated at four sites in the United States. The least squares mean preparation time per dose for PFS was 141.8 s (95% CI = 156.8-126.7; p <.0001) faster than for VRR1, 103.6 s (95% CI = 118.7-88.5; p <.0001) faster than for VRR2, and 122.7 s (95% CI = 134.2-111.2; p <.0001) faster than the pooled VRRs. Overall satisfaction (combined \"Very\" and \"Extremely\") was 87.3% for PFS, 28.6% for VRR1, and 47.6% for VRR2. Most participants (81.0%) preferred the PFS vaccine.
UNASSIGNED: The study is limited by the inability to completely blind observers. To minimize the effects of order, we utilized a 3-sequence block design; however, the order in which the vaccines were prepared may have affected outcomes. Participants were assessed once, whereas if repeated preparations were performed there may have been trained efficiencies gained for each vaccine.
UNASSIGNED: PFS vaccines can greatly simplify the vaccine preparation process, allowing administrators to prepare almost four times more doses per hour than with vial and syringe systems.

BACKGROUND: Medication reconciliation (MedRec) in hospitals is an important tool to enhance the continuity of care, but completing MedRec is challenging.
OBJECTIVE: The aim of this study was to investigate whether queueing theory could be used to compare various interventions to optimise the MedRec process to ultimately reduce the number of patients discharged prior to MedRec being completed. Queueing theory, the mathematical study of waiting lines or queues, has not been previously applied in hospital pharmacies but enables comparisons without interfering with the baseline workflow.
METHODS: Possible interventions to enhance the MedRec process (replacing in-person conversations with telephone conversations, reallocating pharmacy technicians (PTs) or adjusting their working schedule) were compared in a computer experiment. The primary outcome was the percentage of patients with an incomplete discharge MedRec. Due to the COVID-19 pandemic, it was possible to add a real-life post hoc intervention (PTs starting their shift later) to the theoretical interventions. Descriptive analysis was performed.
RESULTS: The queueing model showed that the number of patients with an incomplete discharge MedRec decreased from 37.2% in the original scenario to approximately 16% when the PTs started their shift 2 h earlier and 1 PT was reassigned to prepare the discharge MedRec. The number increased with the real-life post hoc intervention (PTs starting later), which matches a decrease in the computer experiment when started earlier.
CONCLUSIONS: Using queueing theory in a computer experiment could identify the most promising theoretical intervention to decrease the percentage of patients discharged prior to MedRec being completed.

Pharmacy technician responsibilities, certifications, and duties across pharmacy settings have evolved in recent years, allowing them to potentially become a valuable resource for skills-based pharmacy education. Our institution has employed pharmacy technicians since 2014. This brief commentary addresses the training and roles of pharmacy technician staff in our skills-based education curriculum.

CONCLUSIONS: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
OBJECTIVE: Manipulation of tablet medications to produce a customized dose is common practice, and splitting tablets may reduce the acquisition cost of the medication. However, cost savings may be diminished by the cost of the increased labor and repackaging materials needed when splitting tablets. Splitting tablets may also result in safety concerns if the final products are under (eg, reduced benefit) or over (eg, toxicity) the desired dosage. The purpose of this quality improvement project was to evaluate and recommend changes for all half- and quarter-tablet medications prepared and distributed from the inpatient pharmacy at University of Utah Health (U of U Health).
CONCLUSIONS: The evaluation included all half- and quarter-tablet medications prepared by pharmacy technicians for administration to patients admitted to U of U Health hospitals. A final list of 173 half- and quarter-tablet dosages was evaluated for opportunities to decrease the total number. On the basis of the developed criteria, 93 half- and quarter-tablet dosages (54%) were recommended to be removed from routine stock in the inpatient pharmacy. Systems remain in place to create customized half and quarter tablets if required for patient care.
CONCLUSIONS: Reducing the number of medications for which half and quarter tablets are used may allow pharmacy technicians to prioritize other patient care tasks and potentially decrease waste.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.