BACKGROUND In March 2022, Nationwide Children’s Hospital’s primary care clinic-embedded pharmacists became credentialed and privileged, allowing them to refill medications independently. OBJECTIVES The primary aim of this study is to evaluate and compare the time taken to complete medication refill requests between the Primary Care Network (PCN) clinics with and without clinic-embedded pharmacists. Secondary objectives include comparing the time to authorize refill requests pre- and post-pharmacist credentialing and quantifying refill requests addressed by pharmacists. METHODS A retrospective review was conducted utilizing an electronic health record (EHR) data report for refill requests completed within the PCN from January 2020 to December 2024. This network comprises 14 clinics caring for children from birth to 21 years, one of which also cares for adults. Three clinics have a clinic-embedded pharmacist. The data report included patient age, clinic location, medication class, ordering provider credentials, and time to complete refill authorization requests. Requests for controlled medications and patients 21 years and older were excluded. Descriptive statistics and a generalized linear model were conducted for data analysis using SAS 9.4 (Cary, NC; 2016). RESULTS From January 2020 to December 2024, clinics completed 38,057 refill requests. Clinics with a pharmacist completed requests in an average of 2.39 hours, and clinics without a pharmacist averaged 2.72 hours (p<0.0001). The difference in time to complete a request between clinics with and without a pharmacist during pre-credentialing years was 0.04 hours (2.27 vs. 2.31 hours) and 0.52 hours (2.47 vs. 2.99 hours) for post-credentialing years (p<0.0001). During the post-credentialing period, pharmacists fulfilled 2.9% of requests. On average, pharmacists authorized a request in 1.78 hours compared to other prescribers who averaged 2.88 hours (p<0.0001). CONCLUSION Primary care clinics with an embedded credentialed and privileged pharmacist took significantly less time to complete refill requests than clinics without a pharmacist.

BackgroundTransitions of care (TOC) is the coordination and continuity of healthcare as a patient transfers between different settings.1 This can include a wide range of services, such as medication reconciliation, patient counseling, bedside delivery of medications, and others that meet individual patient needs.2 In the pediatric population, patients are at increased risk of potential medication errors and subsequent harm due to reduced patient and/or caregiver health literacy, limited dosage form availability, and errors in medication administration.5 The use of TOC services at the time of hospital discharge in this population has the potential to make a positive impact on patient safety and the treatment of medical conditions.ObjectivesThe primary objective of this study was to determine if patient-perceived understanding of home-going medications was greater in patients and/or caregivers that received medication bedside delivery and education from a pharmacy-led TOC service at a large, pediatric academic medical center. The secondary objective was to determine if the primary practice area of the pharmacist providing medication education led to changes in understanding of home-going medication(s).MethodsUsing institution-wide, patient satisfaction surveys from January 1, 2021, through December 31, 2021, patient and/or caregiver responses were queried for two questions about home-going medications, relating to the understanding of administration and the potential side effects. Patients were divided into two groups depending on TOC services received, as documented in the electronic medical record (EMR). Survey responses for each of the two questions were categorized as top-box percentage by study group. Hypothesis testing between study groups for the primary and secondary outcomes were conducted using chi-squared tests at an alpha of 0.05. Statistical analyses were conducted using SAS version 9.4.ResultsOf the 1,159 patients included in the study, 441 received TOC services, deemed the intervention group, and 718 did not receive TOC services, deemed the control group. When the intervention and control group were asked about understanding of medication administration, 96.37% versus 93.18% (p=0.007) of patients gave the most favorable response of “yes, definitely,” respectively. Further, 78.51% versus 77.44% (p=0.053) of patients gave the most favorable response when asked about understanding potential medication side effects, respectively.ConclusionPatients receiving TOC services by a member of the pharmacy team had a greater score for understanding of both medication administration and side effects. Furthermore, this greater score was consistent among the education provided by the inpatient and outpatient pharmacist.

BACKGROUND:Pharmacists provide increased access to care, vaccinations, and medication management for patients. Credentialing and privileging of pharmacists allows pharmacists to practice at the top of their licenses and elevate pharmacy practice. OBJECTIVE:The primary objective of this study was to assess the perception of healthcare team members of credentialed and privileged pharmacists working in a pediatric primary care network before and after implementation of pharmacist privileges. The secondary objective was to determine team members' perceptions on the amount of time spent refilling medications, resolving medication access issues, and ordering vaccines before and after implementation of pharmacist privileges. METHODS:This was a prospective pre-post study utilizing surveys to capture healthcare team members' perceptions of credentialed and privileged ambulatory care pharmacists. Surveyed participants included attending physicians, advanced practice nurses, registered nurses, licensed practical nurses, medical assistants, and patient care assistants. Summary statistics are reported as frequencies and percentages. Statistical analysis was conducted using SAS version 9.4. RESULTS:Fifty-eight pre-privileging and 56 post-privileging surveys were distributed. The return rate was 79.3% (n=46) for pre-privileging and 80.4% (n=45) for post-privileging surveys. More than 90% of respondents had a favorable perception of credentialed and privileged pharmacists in the clinic. There was a significant difference in the perception of the amount of time spent on medication access issues after pharmacist privileges were implemented (p = 0.0296). CONCLUSION:Credentialed and privileged pharmacists in a pediatric primary care network are viewed favorably by clinic team members and can have a positive impact on clinic workload.

BACKGROUND: Ambulatory clinical pharma-cists are viewed as the medication experts on the health care team and frequently assist with medication access concerns. However, medication access and insurance naviga-tion are difficult because of wide variations in insurance formularies. Accountable care organizations (ACOs) incorporate pharma-cists as members of their population health teams to assist with these efforts. These ACO pharmacists are uniquely positioned to assist pediatric ambulatory care pharmacists with medication access concerns. This collabora-tion has the potential to not only improve patient care but also provide cost savings.OBJECTIVE: To estimate cost savings to an ACO derived from alternative therapy interventions made by pharmacists embed-ded in pediatric ambulatory clinics, using resources created by ACO pharmacists, within a pediatric Medicaid population. The secondary objectives were to quantify the frequency of alternative therapy inter-ventions provided by these pharmacists, evaluate the impact on medication access through the avoidance of prior authorizations (PAs), and assess the frequency and cost sav-ings of alternative therapy interventions per treatment category.METHODS: This was a retrospective review of alternative therapy interventions provid-ed by pediatric ambulatory care pharmacists within a health-system in central Ohio. Interventions were collected within an elec-tronic health record from January 1, 2020, to December 31, 2020. Cost savings were calculated using average wholesale pricing, and PA avoidance was quantified.RESULTS: A total of 278 alternative therapy interventions were made with an estimated cost savings of $133,191.43. Primary care clin-ics (n = 181, 65%) had the most documented interventions. A total of 174 (63%) interven-tions resulted in the avoidance of a PA. The antiallergen (28%) treatment category had the most documented interventions.CONCLUSIONS: Alternative therapy interventions were provided by pediatric ambulatory care pharmacists in collabora-tion with pharmacists working for an ACO. The use of ACO prescribing resources can result in cost savings to an ACO and PA avoidance within a pediatric Medicaid population.

PURPOSE:As health systems continue to expand pharmacy and clinical services, the ability to evaluate potential medication safety risks and mitigate errors remains a high priority. Workload and productivity monitoring tools for the assessment of operational and clinical pharmacy services exist. However, such tools are not currently available to justify medication safety pharmacy services. The purpose of this study is to determine methods used to assess, allocate, and justify medication safety resources in pediatric hospitals.METHODS:A 32-question survey was designed and distributed utilizing the Research Electronic Data Capture (REDCap) tool. The survey was disseminated to 46 pediatric hospitals affiliated with the Children's Hospital Association (CHA). The survey was distributed in October 2018, and the respondents were given 3 weeks to submit responses. Data analysis includes the use of descriptive statistics. Categorical variables were summarized by frequencies and percentages to distinguish the differences between pediatric health systems.RESULTS:Of 26 respondents, 15.4% utilized metrics to justify medication safety resources. Metrics utilized were based on medication dispenses, projects, and error coding. Twenty-three percent of respondents were dissatisfied with current pharmacy-based medication safety resources within the organization. There was variability of medication safety resources within pediatric hospitals, including the number of dedicated full-time equivalents, time spent on tasks, and task prioritization.CONCLUSION:Assessing medication safety resources at various pediatric hospitals highlights several potential barriers and opportunities. This information will serve as the foundation for the creation of a standardized workload assessment tool to assist pharmacy leaders with additional resource justification.

Introduction: The United States is in the midst of an opioid epidemic and the pediatric population is vulnerable to prescription opioid misuse and overdose. There is a mismatch between the amount of opioids needed to treat pediatric acute pain and leftover opioids account for a substantial source available for unintentional overdose by young children and misuse among adolescents. It is imperative that providers seek to decrease the amount of excess opioids prescribed, while still providing adequate pain control. A quality improvement approach was taken at our pediatric institution to decrease excess opioid prescribing. …

Goal: Opioid misuse is a public health concern reaching epidemic levels and the pediatric population is not immune to the problem. Improving education of patients and families is crucial so they are aware of the need for appropriate monitoring, securing, transitioning, and disposal of opioid medications when prescribed for pain. A multidisciplinary Opioid Safety Task Force was developed as part of a quality improvement initiative at our pediatric institution. Nurses and prescribers were initially surveyed regarding their educational practices surrounding opioids and found that less than 25% of healthcare providers were routinely discussing opioid safety and disposal with patients and families. An aim of the Task Force was to Increase the percentage of patients discharged from surgical inpatient units prescribed opioids that received opioid safety education from 0% in 10/1/2016 to 50% by 7/31/2017 and then increase to 100% by 1/31/2018 and sustain for 6 months. Methodology: Educational handouts were created for patients and families on pain management and opioid safety practices in the home with the 4 tenets of Monitor, Secure, Transition and Dispose. Handouts on treating pain after surgery were also created to discuss use of acetaminophen and ibuprofen in conjunction with opioids. In order to meet the health literacy need of our patients and families, an educational video was created on opioid safety in the home which can be viewed through the hospital patient education system or online. Standardized documentation on if opioid education given was added to the electronic medical record (EMR) for data tracking purposes. All nurses on the surgical units were educated on the handouts and documentation. .Data was extracted monthly via a report generated from the EMR and plotted on a p chart. Results: The percentage of patients receiving opioid safety education on inpatient units has increased from the initial baseline of 0% to over 50% by March 2019. Multiple interventions have led to several process stage shifts. Discussion: Providing education on safe monitoring, securing, transitioning, and disposal of opioids is needed so that when opioids are prescribed, the potential for misuse is decreased. Our quality improvement initiative demonstrated the ability to increase education on opioid safety to our patients and families. The home opioid safety video is now assigned to all patients on the surgical units and has a >90% completion rate of reviewing. A new process will be implemented to add opioid safety education to the discharge instructions for all patients at our institution prescribed opioids, not just those discharged from surgical units, in the next month. It is our hope that pediatric organizations across the country can implement these processes at their own institutions to keep their patients, families, and communities safe.

Objective: One strategy to combat opioid misuse is to remove excess opioids from circulation by providing patients with drug disposal products that enable the safe disposal of opioids. We aimed to evaluate opioid use and disposal of unused opioids among children and young adults before and after pharmacy staff at our institution began to provide patients and families filling opioid prescriptions with a drug disposal bag. Methods: We performed a prospective pre-post cohort study of patients who filled an opioid prescription in May-August 2019 at the outpatient pharmacies of a large tertiary children's hospital. Patients and caregivers were enrolled at the time the opioids were dispensed. During the first half of the study period, standard opioid-related education was offered by pharmacy staff. During the second half of the study period, standard education was offered, and a drug disposal bag and instructions on its use were provided when the opioids were dispensed. A follow-up survey to assess opioid use and disposal was completed online or by telephone 4-7 weeks after the opioids were dispensed. Results: A total of 215 participants were enrolled; 117 received a drug disposal bag and 98 did not. Of those, 68% of the participants completed a follow-up survey. In both groups, the median patient age was 11 years, and most patients had been prescribed opioids after a procedure. More than 70% had opioids leftover after they had stopped taking them, and this did not vary by group. However, among families with leftover opioids, the receipt of a drug disposal bag was associated with a higher likelihood of disposal of the unused opioids (71.7% vs. 52.1%, P = 0.04). Conclusion: Providing a drug disposal bag to families of children receiving opioids increases the likelihood of excess opioid disposal. Greater availability of drug disposal products can complement prescribing reduction efforts aimed at decreasing prescription opioid misuse. (C) 2021 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

OBJECTIVES:To describe the implementation of a standardized documentation workflow within an electronic health record (EHR) and to track pharmacists' interventions in pediatric ambulatory care clinics.SETTING:Ambulatory care clinics and a transitions-of-care (TOC) service within a pediatric health care system in central Ohio.PRACTICE DESCRIPTION:Ambulatory clinical pharmacists work as integrated members of the health care team in 7 pediatric ambulatory care clinics and a TOC service to achieve the best medication-related outcomes for patients.PRACTICE INNOVATION:A standardized documentation workflow was established among ambulatory clinical pharmacists to document the interventions made in their practice settings with the use of a tool in the EHR. A weekly report from the EHR was run by a technician to gather intervention data, identify reimbursable opportunities, and document and bill via a separate Internet-based medication therapy management platform.EVALUATION:The success of the new documentation workflow was evaluated, and continuous feedback was gathered from the pharmacists and the billing technician. Updates were provided to the ambulatory clinical pharmacist at monthly staff meetings and workflow changes implemented as needed.RESULTS:A total of 5210 interventions were documented by the pharmacists in various intervention categories. The 3 most common intervention categories included patient and medication education (1765), medication reconciliations (1170), and compliance assessments (795).CONCLUSION:A standardized documentation workflow allowed for consistent tracking of interventions across ambulatory care clinics and a TOC service. Key elements to the successful implementation of this new documentation workflow included proper training and continuous feedback to the ambulatory clinical pharmacists, assistance from a billing technician, and consistent documentation by the ambulatory clinical pharmacists.

Accountable care organizations (ACOs) have emerged as an effective healthcare delivery model for managing quality and cost at a population level. Within ACOs, pharmacists are critical for the delivery of high-value health care, offering patients and health care providers medication-related training, resources, and guidance that can improve quality of care at lower costs. Partners For Kids (PFK), one of the oldest and largest pediatric ACOs in the country, has successfully leveraged pharmacists to provide population health management and medication management to promote health outcomes for individual patients and the overall population it serves. This review explores how the inclusion of pharmacists in the development and execution of various quality improvement initiatives within PFK has positively impacted outcomes for patients while also lowering overall spend. A catalog of interventions is provided to offer various ways that pharmacists can intersect as providers in the triad of patient/family, payor, and provider. By providing enhanced training and education, on-site guidance, medication management, and population-level data analysis, pharmacists are able to identify and improve inefficiencies in care. Moving forward, ongoing engagement of pharmacists in health care operations will be a necessary feature to maximize health care value.

BACKGROUND AND OBJECTIVES There has been slow adoption of electronic prescribing of controlled substances (EPCS) due to cost concerns and cumbersome technological and security specifications required by the DEA. The objective of this study was to assess the effects of an EPCS implementation at a tertiary care pediatric hospital on prescribing patterns and providers’ perceptions of this functionality pre and post implementation. METHODS The prescribing patterns of both the pilot group and the institution as a whole were analyzed before and after implementation. A survey was distributed to …

Objective: To determine pharmacist impact on vaccination errors and missed opportunities in the pediatric primary care setting with the presence of clinical decision support (CDS) by comparing a clinic with a pharmacist and CDS to a clinic with CDS alone.Design: A retrospective chart review of patients' electronic medical records compared vaccination errors and missed opportunities between 2 pediatric primary care clinics. Setting: Two urban, pediatric primary care clinics were selected for the study. Participants: Encounters were included in the analysis for children presenting for any visit over a 3 -month period.Intervention: The intervention clinic had a full-time clinical pharmacist and CDS. The comparison clinic had CDS alone.Main outcome measures: Vaccination errors were defined as follows: doses administered before minimum recommended age, doses administered before minimum recommended dosing interval, unnecessary doses, and invalid doses for a combination of these reasons. Missed opportunities were defined as vaccine doses due at the date of encounter but not administered, without documented reason for vaccination delay or refusal by provider or patient. The likelihood of missing an opportunity was also assessed for patient age, visit type, and provider type.Results: One thousand and twenty patient encounters were randomly selected and reviewed. The vaccination error rate was 0.4% in the comparison group and 0% in the intervention group (P = 0.4995). The number of encounters with a missed opportunity was significantly higher in the comparison group compared with the intervention group (51 vs. 30 encounters with missed opportunities; P = 0.015; adjusted odds ratio, 2.14 [95% CI 13-35]).Conclusion: Although the use of CDS results in a low rate of vaccination errors, technology cannot be solely relied on for vaccination recommendations in the pediatric population because of the rigidity of CDS configuration. Pharmacists continue to play a vital role to ensure that children are appropriately vaccinated in the primary care setting. (C) 2017 American Pharmacists Association. Published by Elsevier Inc. All rights reserved.

PURPOSE:The reduction of immunization errors through the use of age-specific alerts within the electronic medical record (EMR) and mandatory interactive education for prescribers is described.METHODS:A health system-wide initiative was implemented at an academic pediatric hospital to reduce the number of immunization errors. The preimplementation period (January 1-December 31, 2013) involved a baseline review of adverse drug events (ADEs) reported through a voluntary event reporting system to determine the number and types of immunization errors. During the prescribing phase of the medication-use process, 57% (43 of 75) of errors occurred. First, age-based restrictions were implemented within the EMR. This was followed by mandatory immunization education for all prescribers working in the primary care network. Data collection included all reported vaccine errors within the voluntary event reporting system and completion rates of education by physicians, nurse practitioners, and medical residents.RESULTS:During the seven-month postimplementation period (January 1- July 31, 2014), prescribing events decreased from 57% to 25%. Following implementation of age-specific immunization alerts and mandatory prescriber education, the hospital went 175 days without a vaccine ADE.CONCLUSION:The implementation of age-specific alerts within the EMR and mandatory prescriber education decreased the number of immunization errors within a pediatric health system.

OBJECTIVE:To measure the impact of ambulatory clinical pharmacist integration in a pediatric primary care clinic on vaccination error rates and to evaluate missed opportunities.METHODS:A retrospective, quasi-experimental review of electronic medical records of visit encounters during a 3-month period compared vaccine error rates and missed opportunities between two pediatric residency primary care clinics. The intervention clinic has a full-time ambulatory clinical pharmacist integrated into the health care team. Pharmacy services were not provided at the comparison clinic. A vaccine error was defined as follows: doses administered before minimum recommended age, doses administered before minimum recommended spacing from a previous dose, doses administered unnecessarily, live virus vaccination administered too close to a previous live vaccine, and doses invalid for combinations of these reasons.RESULTS:900 encounters were randomly selected and reviewed. The error rate was found to be 0.28% in the intervention clinic and 2.7% in the comparison clinic. The difference in error rates was found to be significant (P = 0.0021). The number of encounters with greater than or equal to one missed opportunity was significantly higher in the comparison clinic compared with the intervention clinic (29.3% vs. 10.2%; P <0.0001).CONCLUSION:The pediatric primary care clinic with a pharmacist had reductions in vaccination errors as well as missed opportunities. Pharmacists play a key role in the pediatric primary care team to improve the appropriate use of vaccines.