RESULTS
buy‐in’, overdose, ’
ABUSE
Twelve meetings occurred over the course of 8 months, during which there were nine meetings with an average of nine pharmacy stakeholders, two separate meetings with a veteran stakeholder (VREB) panel, and one separate meeting with two suicide prevention experts. Each meeting lasted roughly 1 h and was facilitated by the study post‐doctoral research assistant over Zoom. Using the written notes from the panel meetings, changes to website content were adopted iteratively and reviewed by the stakeholders over the course of the 8‐month meeting period.The overall structure of the website was divided into four main sections (or modules): (1) ‘Why me?’, (2) ‘What can I do?’ (Pharm‐SAVES), (3) ‘How does it work?’ and (4) Resources. Stakeholders wanted content that modeled realistic pharmacy interactions to increase the pharmacy staff member's confidence to engage in suicide prevention gatekeeping behaviors. Stakeholders wanted to know how they could integrate SAVES into their pharmacy workflow with minimal disruption to prescription filling, counseling, and other pharmacy services. The four modules were decided upon after the pharmacy stakeholder panel was provided with a summary of the formative data,One issue consistently raised by the pharmacy stakeholders was the importance of developing content that maximizes pharmacy staff ‘buy‐in’ and ‘relatability’. Therefore, the module starts with a section on ‘why me?’. Pharmacy stakeholders thought this section would help pharmacy staff (i.e., pharmacists and pharmacy technicians) understand the critical role they have in suicide prevention (Figure Pharm‐SAVES Module 1: Why Me?Module 2 presents the acronym ‘SAVES’, which stands for: (1) Recognize the warning Pharm‐SAVES Module 2: What Can I Do?Under the first ‘S’ tab (“The ‘E’ tab reinforces two key points: (1) Patients with warning signs of suicide should not be left alone, and (2) In addition to local resources, the NSPL is open 24/7, 365 days and is free and confidential. Finally, the second ‘S’, or ‘Video examples ground the ‘how does it work?’ section, modeling drive‐through, telephone, and in‐person cases. Each scenario models a ~3‐min initial interaction and a 30‐s follow‐up (set a reminder to follow‐up) interaction. The drive‐through interaction was deemed particularly important to model given the increased use of the drive‐through during the COVID‐19 pandemic.Summary of video scenarios.The pharmacy stakeholder panel felt it was important to keep users engaged and give opportunities to practice SAVES, which is why we developed the two interactive cases. The interactive cases allowed participants to practice SAVES in a controlled environment that provided feedback on their responses. One case depicts a white, middle‐aged male patient ‘Mr. Jones’ who is having difficulty sleeping. This demographic has a relatively high risk of suicide and is representative of the veteran population. A second case depicts an upbeat, female patient ‘Ms. Smith’ who asks about how much it would take to overdose on her medication. In each case, the trainee watches the video and types of responses to several questions, which are interspersed throughout the video. Example questions include: ‘Does Mr. Jones show any signs of suicide?’ or ‘How confident are you that you can ask Ms. Smith about suicide?’. Questions are a combination of free text response and multiple choice, where the participant is provided feedback after their response is submitted.In addition to the NSPL, the pharmacy stakeholder panel also wanted a resource referral tool that provided a list of local behavioral health, substance use, and other resources. Using online searchable databases, including the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator and the Veterans Administration (VA) treatment locator, a list of mental health and substance use treatment facilities, providers, and other resources were compiled by zip code and county. Resources were classified based on services provided, current location, and contact information. This tool provides a consolidated list of local resources that can be sorted by county or zip code to provide pharmacy staff with suicide prevention or crisis resources (Figure Pharm‐SAVES Resources and Referral Tool.