Mariann D. Churchwell

Background: Pharmacy education and workforce development are undergoing significant disruption. While national forecasts outline key directions, they lack granularity and stakeholder validation. This study aimed to develop a stakeholder‐informed, data‐driven forecast of pharmacy strategic priorities through 2035. Objectives were: (1) identify key themes shaping pharmacy's future, (2) align these themes with national priorities, and (3) forecast their trajectory and readiness to inform strategic planning. Methods: A mixed‐methods design integrated qualitative analysis of 27 stakeholder focus groups and eight interviews with trend modeling and policy triangulation. Participants ( n = 148) represented students, faculty, preceptors, administrators, professional organizations, payors, interprofessional educators, and transformation leaders. Transcripts were coded using grounded theory and analyzed for themes. Identified themes were aligned with the 2024 American Association of Colleges of Pharmacy and 2024 American Society of Health‐System Pharmacy Forecast reports. Historical emphasis scores (2015–2024) were modeled using linear regression to project thematic growth through 2035. Each theme was rated for system readiness based on stakeholder insight and national preparedness indicators. Results: Ten core themes emerged: Workforce Shortages/Accessibility, Digital Health/Technology, Competency‐Based Education (CBE), Public Health/Prevention, Medication Safety/Optimization, Interprofessional Collaboration, Patient‐Centered Care, Leadership/Advocacy, Professional Identity/Perception, and Business/Financial Acumen. Convergent themes like Workforce Shortages, Public Health, and Medication Safety were validated by national forecasts and reflected high stakeholder urgency. Digital Health and CBE showed the steepest forecasted growth slopes but were marked by low readiness. A strategic prioritization matrix was developed to guide policy and curricular responses based on urgency, growth, and readiness. Conclusions: This study offers a novel, future‐facing framework to guide the transformation of pharmacy education and workforce strategy. High‐priority, low‐readiness themes require urgent investment. Strategic scaffolds such as leadership, identity, and business acumen, though underemphasized, are critical to sustaining innovation. Pharmacy must reimagine itself as a lifelong, adaptable profession, equipped not only to respond to change but to lead it.

Background: The need to determine physical compatibility of intravenous admixtures is directly related to patient safety and patient outcomes. While the provision of multi-modal analgesic strategies has increased over the past decade, a paucity of data exists regarding physical compatibility of select medications. Objectives: To evaluate the physical compatibility of methocarbamol in Lactated Ringer’s (LR), 0.45% normal saline (0.45% NaCl), and Plasma-Lyte A (PLA) at concentrations of 4, 10, and 20 mg/mL. Methods: Admixtures were prepared and evaluated using previously validated methods under a laminar flow hood using aseptic technique. Samples were prepared in a triplicate manner, 3 mL aliquots were placed into polymethyl methacrylate cuvettes for evaluation at time points 0, 1, 5, 8, and 24 hours. Visual inspection of samples included assignment of a number: 0—no precipitation, 1—trace evidence of precipitation, 2—slight haze, 3—medium haze, and 4—heavy precipitation. Any evidence of precipitation was considered significant. A variable wavelength spectrophotometer set at 547 nanometers was used to measure absorbance. A change in absorbance of ±0.010 was considered significant. A change in pH of ±0.1 was considered significant. Results: No significant changes occurred relating to visual inspection or absorbance across all concentrations and time points for LR; however, there was a significant change in pH across all concentrations at hour 5. In 0.45% NaCl and PLA, no remarkable changes occurred across all concentrations and time points regarding visual observation, spectrophotometric absorbance, and pH analysis. Conclusions: Methocarbamol at concentrations of 4, 10, and 20 mg/mL is physically compatible for up to 1 hour in LR. Methocarbamol is physically compatible in 0.45% NaCl and PLA for up to 24 hours. Chemical stability tests are warranted to confirm these findings.

Background: Gabapentin and pregabalin are well-tolerated medications primarily cleared by the kidney. Patients receiving higher gabapentinoid doses with decreased kidney function may be at an increased risk of adverse effects (AEs), but limited evidence exists evaluating gabapentinoid dosing and AEs in this population. Objective: To determine whether patients with decreased creatinine clearance (CrCl) experienced increased frequency of AEs related to gabapentinoid dose at hospital admission. Methods: Single-center retrospective cohort study in adults with a gabapentinoid prescription and serum creatinine measurement documented on hospital admission. The primary outcome was the appropriateness of gabapentinoid prescription based on CrCl (stratified by CrCl ≥60 mL/min, <60 mL/min, 15-29 mL/min, and <15 mL/min) at admission. Secondary outcomes included the incidence of AEs related to gabapentinoids and concomitant opioid and psychiatric prescriptions. Results: A total of 286 patients were included in this study (gabapentin n = 234, pregabalin n = 52). Patients with a CrCl <60 mL/min and doses above the manufacturer’s recommendation were prescribed gabapentin (34%) and pregabalin (22.7%). For patients with a CrCl of 15 to 29 mL/min and <15 mL/min groups, inappropriately high doses were prescribed for gabapentin (48.8%) and pregabalin (45%). A significant increase in recorded falls ( P = 0.029) was identified in patients with a CrCl <60 mL/min. Concomitant opioid and psychiatric medications contributed to a higher prevalence of AEs regardless of CrCl. Conclusions: Patients with a CrCl <60 mL/min were frequently prescribed inappropriately high doses of gabapentinoids. The relationship between gabapentinoid dosing, kidney function, and the incidence of gabapentinoid-related AEs at hospital admission requires larger, multicentre studies.

Continuous infusions of heparin and furosemide are often required for hospitalized patients to treat cardiac-related disease states. Concomitant infusion of heparin and furosemide through the same intravenous line minimizes the need for multiple intravenous sites. For concomitant infusions to be administered, knowledge of the physical compatibility for intravenous medications is imperative for patient safety and administering medications to maximize their effectiveness. Currently, heparin and furosemide are listed as Y-site compatible, but precipitation was reported at a large academic medical center, which questions this compatibility. This study investigated the in vitro physical compatibility of heparin sodium premix 25,000 units/250 mL in dextrose 5% water from two different manufacturers with furosemide 40 mg/4 mL at concentrations of 4:1 for heparin sodium and furosemide. The admixtures were prepared in triplicate using aseptic technique, stored at 19°C to 24°C and examined for visual precipitation, turbidity, and pH change at baseline, 1, 5, 8, 24, and 48 hours. Heparin sodium, B. Braun Medical Inc. or Hospira, Inc. solutions, and furosemide admixtures revealed changes over 48 hours. Changes in visual appearance, absorbance, and pH were observed at hour 5 compared to baseline for the B. Braun Medical Inc. admixture. The Hospira, Inc. admixture revealed visual changes by hour 48, but demonstrative changes in absorbance and pH did not occur. Our observations found demonstrative changes in physical compatibility in the admixtures of heparin sodium and furosemide at a ratio of 4:1. The findings suggest that a combination of the solutions in this study be avoided until further research is completed.

Background: Catheters provide vascular access for patients requiring intravenous treatments, but frequently are a source of infection and/or thrombosis. Instilling a solution of an antimicrobial agent with an anticoagulant into the catheter lumen may salvage-infected catheters. Objective: The aim is to evaluate the physical compatibility, antibacterial activity, and stability of varying combinations of cefazolin (10 mg/mL), 40% ethanol, 4% sodium citrate with or without gentamicin (1 mg/mL) as a catheter lock solution over 48 h. Methods: Admixtures were prepared using aseptic technique and stored under four conditions with or without light at 25°C or 37°C. Prepared admixtures were assessed for physical compatibility, antimicrobial susceptibility, and chemical stability in triplicate at 0, 24 and 48 h. Admixture physical compatibility was determined by visual clarity, pH, and ultraviolet (UV) spectroscopy. Antibacterial activity was determined using the Kirby-Bauer disk diffusion method. The chemical stability of cefazolin and gentamicin were assessed using high performance liquid chromatography and UV spectroscopy, respectively. Results: All admixtures maintained clarity for 48 h. All admixtures stored at 25°C and the admixture containing 10 mg/mL cefazolin-4% sodium citrate stored at 37°C sustained antimicrobial activity and were chemically stable. A significant change in pH, antimicrobial activity, cefazolin concentration (<95% of baseline), were observed in admixtures containing ethanol stored at 37°C after 24 h. Gentamicin concentrations remained stable throughout the study. Conclusion: The admixture of 10 mg/mL cefazolin-4% sodium citrate sustained antimicrobial activity over 48 h and was chemically stable. However, admixtures containing ethanol stored at 37°C showed incompatibility with decreased antibacterial activity and cefazolin degradation after 24 h.

Background: Indwelling catheters deliver lifesaving medical treatments for many chronically ill patients but are frequently a source of infection. Treatment may include an antimicrobial agent(s) and anticoagulant solution dwelling within the catheter. In vitro determinations of solution compatibility and stability are necessary prior to use in patients. Objective: The aim of this study was to determine the physical compatibility, chemical stability, and antimicrobial activity of vancomycin (5 or 10 mg/mL) with gentamicin (1 mg/mL) or 40% ethanol in 4% sodium citrate lock solution over 72 hours. Methods: All solutions were prepared per manufacturer’s instructions. Samples were studied under 4 conditions: (1) 25°C with light, (2) 25°C without light, (3) 37°C with light, and (4) 37°C without light. Physical compatibility and chemical stability were assessed at 0, 24, 48, and 72 hours. Antimicrobial susceptibility testing was conducted at 0 and 72 hours. All studies were carried out in triplicate. Results: All solution combinations under each condition remained patent from baseline to 48 hours. One solution combination of vancomycin (5 mg/mL) and ethanol (40% v/v) in 4% sodium citrate revealed a slight turbidity at 72 hours. Clarity and pH remained stable in all other solutions during the entire study period. Chemical compatibility and antibiotic activity ranged from 95% to 105% and 95% to 106% of initial baseline values, respectively, for all solutions under 4 storage conditions. Conclusions: All antibiotic-anticoagulant lock solutions were found to be physically, chemically, and microbiologically stable during the 72-hour study period except vancomycin (5 mg/mL) and ethanol (40% v/v) in 4% sodium citrate solution which showed slight turbidity at 72 hours.

The use of in vitro modeling to predict in vivo drug and solute clearance during renal replacement therapy has evolved to reflect the different dialytic therapies available in clinical practice. This area of renal replacement therapy research is representative of translational research that demonstrates a correlation from bench to bedside where results generated in the laboratory can assist with clinical decisions in the absence of in vivo studies. This review describes in vitro renal replacement therapy models and compares the findings of several in vitro and in vivo studies.