Tip of the Week: Effective Changes in Practice Can be Spurred by Small Adjustments

Dispensing naloxone provides an example of how small changes can make a significant difference.

When we think of practice change or implementing new patient care services, what comes to mind are often behemoth projects or things that require momentous changes in workflow, organizational culture, and use of advanced technology. However, pharmacists can draw upon their education and training, along with years of experience to seize an opportunity to make incremental changes that ultimately mean a lot for patients and also promote the profession and the business operation. These changes can be assisted sometimes through very simple adaptations or modified techniques of what we’ve always known and been doing.

Research in the Journal of the American Pharmacists Association examined the results of modified communication training on pharmacists’ dispensing of naloxone. The research was conducted in Illinois, where since 2015, regulators authorized entities such as pharmacies, pharmacists, and opioid overdose education and naloxone distribution programs to obtain and distribute naloxone, mucosal atomizer devices, syringes, and naloxone kits to an individual at risk of suffering an opioid-related overdose. However, even in spite of such autonomy, uptake by pharmacists to act had been slow.

The researchers hypothesized that active learning initiatives could help spur pharmacist knowledge and confidence to distribute naloxone. As such, they designed a Communication Technique Training (CTT) program. Pharmacists were recruited from 1 pharmacy chain (Jewel-Osco) in the Chicago area. The CTT was a simple intervention involving a patient case scenario activity and a pocket card. The pocket card was a quick reference with information on who to consider for naloxone distribution, morphine milligram equivalence, counseling points on side effects of opioids, how to start a conversation with patients on naloxone, and key phrases to use during the naloxone conversation. The case scenarios were designed to reinforce and apply concepts provided on the pocket card.

A total of 21 pharmacists from 6 pharmacies participated in the study. The researchers observed a statistically significant increase in naloxone dispensing rates pre- versus post-intervention, with approximately 6 units versus 24 units per pharmacist, respectively, during each 3-month period. This occurred despite a reduction in opioid dispensing during the same time period. The study saw no significant differences in naloxone dispensing rates between pharmacists varying by gender, years of work experience, or time of day (shift) upon naloxone dispensing.

In this study, an appeal to simplicity was made. In spite of previous training, pharmacists simply needed a bit of a confidence boost, a pocket card, and a few active learning exercises to substantially boost their dispensing of naloxone. Might the same be possible for uptake of other pharmacy interventions, whether it be dispensing of other products, refined methods of counseling, limited prescribing, or others? Evidence dictates that this is probably the case, but we cannot discern that just from this study. What we can discern is that a relatively simple intervention and investment by a pharmacy or group of pharmacies could possibly mean a great deal for the pharmacy staff and the patients they serve. Pharmacy managers can bear this in mind when entertaining new ideas and promoting a culture of innovation.

Additional information about Operations Management and Implementing Value-Added Pharmacy Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

REFERENCE

Gandhi N, Hanes S, Candelario DM, Clough C, Highland J. Impact of a communication technique training on rates of naloxone dispensing. J Am Pharm Assoc. 2020;6(3):S37-S40.

ABOUT THE AUTHOR

Shane P. Desselle, RPh, PhD, FAPhA, is a professor of social and behavioral pharmacy at Touro University California College of Pharmacy.