Objective. To examine the effect of advanced pharmacy practice experience (APPE) grading schemes on residency match rates Methods. A cross-sectional survey was administered to United States schools of pharmacy to determine APPE grading scheme. Post-graduate year 1 residency match data for the years 2013-2015 was obtained from the American Society of Health-System Pharmacists. Additional variables thought to affect residency match rates were collected from publically available sources and prior research. Unadjusted and adjusted multivariate logistic regression analysis was performed to compare 2013-2015 residency match rates between institutions using letter grading and those using pass/fail grading schemes. Potential confounders for incorporation into the adjusted model were identified by chi-square or Fisher's exact test as appropriate.Results. 110 of 126 schools (87.3%) responded to the survey. Of these, 100 schools reported using either letter grading (n=66) or pass/fail grading (n=34) schemes in APPE courses and were included in the study. Unadjusted analysis revealed no difference in match rates between letter grading and pass/fail grading schemes over the aggregated time frame (OR 1.52, 95% CI 0.92-2.47) or in individual years OR 1.83, 95% CI 0.79-4.22, 2014 OR 1.44, 95% CI 0.62-3.30, 2015. Conclusion. This study demonstrates that there is limited difference in residency match rates between schools using pass/fail or letter grading schemes in APPEs.
Purpose
The purpose of this study was to identify potential failure points in a new chemotherapy preparation technology and to implement changes that prevent or minimize the consequences of those failures before they occur using the failure modes and effects analysis (FMEA) approach.
Methods
An FMEA was conducted by a team of medication safety pharmacists, oncology pharmacists and technicians, leadership from informatics, investigational drug, and medication safety services, and representatives from the technology vendor. Failure modes were scored using both Risk Priority Number (RPN) and Risk Hazard Index (RHI) scores.
Results
The chemotherapy preparation workflow was defined in a 41-step process with 16 failure modes. The RPN and RHI scores were identical for each failure mode because all failure modes were considered detectable. Five failure modes, all attributable to user error, were deemed to pose the highest risk. Mitigation strategies and system changes were identified for 2 failure modes, with subsequent system modifications resulting in reduced risk.
Conclusion
The FMEA was a useful tool for risk mitigation and workflow optimization prior to implementation of an intravenous compounding technology. The process of conducting this study served as a collaborative and proactive approach to reducing the potential for medication errors upon adoption of new technology into the chemotherapy preparation process.
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