Lindsey E. Dayer

Background: Although the layered learning practice model (LLPM) was introduced to pharmacy residency practice over a decade ago, uptake has been slower in smaller community hospitals and practice settings, particularly in rural areas, compared to large academic teaching centres. This study investigates preceptor perceptions of the LLPM in a relatively rural state, seeking to assess whether findings replicate and extend prior work assessing various barriers and benefits associated with LLPM implementation. Methods: This was an observational, cross-sectional survey study of Arkansas preceptors. A survey was emailed to Arkansas pharmacy residency programme directors to distribute to their site preceptors between April and June 2023. Results: In a sample of 40 preceptors, findings showed that barriers to implementation were related to issues of resource, time, and learning constraints, and that benefits of implementation were related to issues of improved learning and opportunities for students. Most preceptors noted that implementing the LLPM took time away from other responsibilities and that managing multiple learners was a challenge. Preceptors also noted that greater didactic experiences and collaborative problem solving were benefits. Those who had postgraduate training experiences and/or had some experience implementing an LLPM were more inclined to note fewer barriers and greater benefits. Conclusion: Implementing the LLPM faces similar challenges today in a variety of practice settings compared to larger academic medical centres that reported these challenges previously.

Background and purpose: This manuscript describes two successful student remediation plans for an introductory pharmacy practice experience (IPPE) and an advanced pharmacy practice experience (APPE). Both students were not successful on rotation due to socio‐behavioral and professionalism deficits.Educational activity and setting: An IPPE and an APPE remediation student case will be presented in which a student exhibited socio‐behavioral issues in the experiential curriculum that lead to an individual educational plan (IEP) for each student.Findings: An IPPE student and an APPE student successfully completed an assigned IEP focusing on socio‐behavioral and professionalism remediation and both went on to successfully complete further experiential rotations.Discussion: There is little guidance in the literature regarding experiential education remediation procedures, especially for students who are unsuccessful due to socio‐behavioral issues (e.g., professionalism, communication, lack of self‐awareness). This paper describes benefits and barriers associated with this type of student educational plan.Summary: A targeted, yet individualized remediation plan including a student assessment and reflection of experiential rotation deficits and presentation to experiential faculty has helped students with a metacognitive understanding of performing better on rotation in the future and allowed for successful completion of future experiential rotations.

This study explores the under-researched domain of patient-controlled analgesia (PCA) for cancer pain management in adult outpatients, focusing on the transition from patient-controlled analgesia pumps (PCA pump) to oral medications. While existing literature primarily addresses the use of PCA in inpatient settings, this descriptive study investigates the initiation of outpatient PCA in palliative care patients. The retrospective chart review includes data from all admissions between July 1, 2014, and December 31, 2020. Among the 49 identified patients, 41 were admitted for cancer-related pain, with an indication for PCA such as insufficient pain relief, highly fluctuating pain, or inadequate response to other routes. Of these patients, 13 were successfully transitioned from outpatient PCA to oral opioids. The study underscores the effective use of PCA as a transitional tool following a pain crisis that necessitates inpatient admission. Future research avenues could explore healthcare utilization, length of stay, and required outpatient resources, such as home visits or telehealth, for optimal PCA use in outpatient settings.

Falls pose a significant threat to older adults, resulting in injuries and mortality. Concurrently prescribed opioids and gabapentin for pain management may increase fall risks in older patients. This study aimed to estimate fall risks associated with the concurrent use of gabapentin and opioids, comparing them to opioid monotherapy in older adults. A retrospective case-control study of 1,813 patients aged 65-89 on chronic opioid therapy (2017-2020), excluding those with a fall history, analysis focused on the first fall occurrence. Logistic regression assessed the association between concurrent gabapentin and opioid use and fall events. Out of eligible patients, 122 (6.73%) experienced falls during opioid therapy, with 232 (12.80%) having concurrent gabapentin use. Concurrent use significantly increased fall risk (AOR = 1.73; 95% CI: 1.08-2.78). Being female, aged >= 81, and having more chronic conditions also increased risk. Mitigating fall risk in older adults requires education on prevention, exploring alternative pain management, and careful consideration of prescribing. Further research is crucial to understand adverse events linked to combined opioid and gabapentin use in the geriatric population.