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PURPOSE: To describe the implementation of a pharmacy residency resiliency program (PRRP) for postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residents, including program structure, strengths and weaknesses/limitations, resident perceptions as captured by a postprogram survey, generalizability to other institutions, and opportunities for future directions. SUMMARY: Pharmacy residents face significant pressure, workload, and stressors that put them at risk for burnout and depression. While resiliency has been a major area of focus to help combat these risks for healthcare professionals, little has been published regarding formal, structured resiliency training in pharmacy, especially in pharmacy residency programs. American Society of Health-System Pharmacists (ASHP) residency standards recommend that programs consider education related to burnout prevention and that mitigation strategies be provided to residents and other pharmacy personnel, but no formal pharmacy-specific programs or strategies have been established. We implemented a 12-month PRRP for PGY1 and PGY2 pharmacy residents and conducted a postprogram survey to assess resident perceptions and to identify areas for growth. CONCLUSION: Implementation of a PRRP was feasible and could be replicated at other institutions. Residents in our program reported a high level of satisfaction, skills gained, and positive attributes of the addition of the PRRP. Some notable factors contributing to success included the program's longitudinal nature, use of a nonpharmacy facilitator, and impactful content from an established resiliency skills curriculum.

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The median number of medications taken by adults aged 65 and older is four, but may be higher in older adults with cancer. A high number of prescribed medications increases risk for adverse drug reactions (ADRs), drug-drug interactions, drug-disease interactions, and overall healthcare utilization, emphasizing the need for frequent review of medications. There are many tools available to help the health care team assess medication appropriateness; however, none of the currently available tools have been validated in the geriatric oncology population. Older adults with cancer are at increased risk for ADRs and potentially inappropriate medications (PIMs) given the common need for multiple medications to manage cancer and cancer-related symptoms. Frequently used PIM identification tools, such as the American Geriatrics Society's (AGS) Beers criteria, often identify medications as "potentially inappropriate", although many of these medications are considered necessary to provide adequate supportive care in older patients with cancer. There are currently no specific guidelines to help direct application of available tools. This review summarizes literature available on the use of PIM identification tools in geriatric oncology and highlights a theoretical case and proposed medication management strategy, which combines the use of objective review with Beer's criteria and clinical judgement with the Medication Appropriateness Index (MAI). This two-pronged approach can serve to identify PIMs while recognizing factors unique to the geriatric oncology population.

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The problem of opioid diversion and its contribution to the opioid epidemic are well known nationally, existing even within hospice care. Proper disposal of opioids may be a critical factor in reducing diversion. In 2014, Ohio implemented legislation requiring a hospice employee to destroy or witness disposal of all unused opioids within a patient's plan of care. The purpose of this study was to determine the impact of Ohio Revised Code 3712.062 on hospice programs' policies and procedures to prevent opioid diversion in the home. Directors of Ohio-licensed hospices were surveyed to assess the percentage of programs with a written policy in place for disposal of opioids and to calculate a compliance score based on responses to survey questions assessing compliance with legislation components. Fifty-two surveys were completed (39.4%). All survey respondents reported having a written policy in place. A 95.5% average compliance score was calculated, with the largest disparity occurring with timing of opioid disposal. While Ohio Revised Code 3712.062 requires opioid disposal at the time of patient's death or when no longer needed by the patient, only 84% of respondents report disposing opioids upon discontinuation. Overall, a high compliance rate was seen among hospice programs indicating such regulation is manageable to meet.

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