ASHP InterSections ASHP InterSections

March 1, 2008

The Importance of Communicating Clearly with Our Patients

            I have been thinking a lot lately about the effect of poor health literacy on our patients’ ability to understand and correctly use their medi­cations. Only 12 percent of adults have proficient health literacy, according to the National Assessment of Adult Literacy. In other words, nearly nine out of 10 adults may lack the skills needed to successfully manage their health and prevent disease.

            Other studies back that up, finding, for example, that patients suffering from high blood pressure, diabetes, asthma, or HIV/AIDS know less about their illness and how to man­age it properly if they have poor health literacy.

            ASHP cares deeply about this public health issue and is doing a number of things to address it. As you’ll see in the 2007 Annual Report that accompanies this magazine, we recently collaborated with the ASHP Research and Education Foundation to create My Medicine List™.

            Designed to help patients document the kind of medica­tion information that is essential to share with pharmacists and other healthcare providers, the tool is an outcome of the Continuity of Care in Medication Use Summit that ASHP and the Foundation sponsored last year. The list, which was specially designed to meet health literacy require­ments, can be found on www.SafeMedication.com and www.ashpfoundation.org.

            I encourage you to begin thinking about how you can help improve the ways in which you communicate with patients about their medications. Don’t take anything for granted. If health literacy isn’t on your administration’s radar screen, begin to talk about it. Share some facts and figures with your phar­macy team about the impact of literacy on compliance, patient health, and the cost of healthcare.

            The data is readily available on many federal, state and private healthcare Web sites, including www.health.gov, www.nih.gov, and www.hrsa.gov.  Many of the most relevant studies are captured on ASHP’s Web site; simply go to www.ashp.org and search on the term “health literacy.”

           And be sure to share My Medicine List with your patients, colleagues, family, and friends. A key part of our mission as pharmacists is to ensure that our patients understand how to use their medications safely and effectively. Beginning to break down health literacy barriers can go a long way toward that goal.

Career Transitions Offer Excitement, Challenges

Lisa Gersema, Pharm.D., BCPS, was in flux, moving into a new role as phar­macy director at United Hospital in St. Paul, Minn. After nearly two decades working as a clinical pharmacy manager, she was ready for a change.

Gersema, 46, was comfortable with the familiarity of being a clinical pharmacy manager, a position she held at both United and Saint Luke’s Hospital in Kansas City, Mo. She knew that feeling would disappear once she began the director position. The thought of accountability for an entire department was daunting. And she would need to build rela­tionships with new peers. Nonetheless, when the director position opened, she went for it.

Although Gersema hasn’t been a rookie for a long time, she was surprised at how challenging the transition has been.

“It was like putting on a different set of glasses and seeing things I hadn’t seen before. I will tell you I probably have had more sleepless nights and worries since I’ve been director, but I do enjoy the challenge,” she said.

Tumultuous Career Changes

Experts say it’s common to struggle and feel isolated in a new job, and pharmacists are not immune from those feelings. Age, experience, and expertise in your field can buffer the difficulty of moving into an unfa­miliar position, but those attributes don’t fully protect you. And whether fresh out of school, mid-career, or on the verge of retire­ment, ASHP members say career changes can be tumultuous even with solid skills and knowledge gleaned from previous positions.

Job transitions are different for each pharmacist. Mid-career pharmacists may not have fully mapped their futures but are looking for promotions that fit. Others are approached for positions they didn’t necessarily expect but are glad to accept. And young pharmacists often live in the moment and opt for the right positions as they emerge.

With a multitude of different oppor­tunities, today’s retirement-age pharmacists seem to be in flux. Some aren’t sure when they’ll stop working, while others work every day toward a set retirement date. Oth­ers leave the profession only to return in a different capacity.%%sidebar%%

Take 52-year-old Alicia Miller, M.S. She may retire at age 65, but “Who knows?” she said. In a U-turn back to work this year, Miller returned as a con­sultant after retiring as associate director of pharmacy at the Ohio State University Medical Center, Columbus, and assistant professor at the university’s College of Pharmacy.

Miller pursued the consulting posi­tion because she wanted to use her skills in pharmacy for something new. The stress is now less, but the change has meant that she has had to adjust both to more travel and the fact that she is called on now to make recommendations. In her previous position, she made decisions.

“You are not there to be a decision-maker, which was one of my primary roles in my previous life,” Miller said.

Living in the Moment

Transition came easy to Jillian Foster, Pharm.D., who has experienced job changes every year since she received her pharmacy degree from the University of Mississippi in Oxford in 2004.

“You’d think that it would be tiring to change, but it’s not. It’s rejuvenating. It’s motivating, and it doesn’t get old,” Foster said. “The transitions have been a whirlwind, but every experience has built on the previ­ous one.”

Foster, 28, currently works as a phar­macy benefits manager at North Mississippi Health Services’ Acclaim, Inc., a third-party administrator in Tupelo, Miss. Her profes­sional philosophy is to not worry about reaching specific career milestones, but to stay open to possibilities.

“I just like to knock on the door. I’m up for anything,” she said. “I have to remind myself not to get caught up with the future. What is my advice to new practitioners? Live in the moment, and nothing that you learn will be wasted.”

Changing careers can mean excitement, but it can also mean a welcome change in stress levels, according to Jordan Cohen, Ph.D., 65.

“I felt the intensity go away,” he said.

Before retiring last year as dean of the University of Iowa College of Pharmacy, Iowa City, for eight years, Cohen said his busy working schedule stretched into many nights and weekends.

Now a faculty member at the college, Cohen will eventually teach part time and spend his free time working as a consultant and writing about pharmacy-related topics.

“It really is time for me to pursue some other things with a little less pressure,” he said.

A Great Sense of Accomplishment

Pharmacists in transition sometimes call upon their mentors for support and assurance that their mentees are making the right decisions.

Before Sheila Mitchell, Pharm.D., FASHP, left her position as director of pharmacy services at Methodist LeBonheur Healthcare-Germantown Hospital in Memphis last year to become the found­ing dean of the Union University School of Pharmacy in Jackson, Tenn., the mid-career pharmacist consulted Grover C. Bowles, a close friend, former ASHP president, and Whitney Award winner.

Bowles, who retired as director of pharmacy at Baptist Memo­rial Hospital in Memphis in 1984, told Mitchell that the position at Union would be a new challenge filled with hard work. But he predicted that it would also rejuvenate Mitchell, offering her the greatest sense of accomplishment she would ever know.

“He was right,” said Mitchell, who serves on the ASHP Board of Directors. “I chose the opportunity and find every day to be a brand new day full of excitement and exhilaration.”

The shift to the academic world likely was the most difficult decision Mitchell has made. “It wasn’t something I had on my career plan,” she said. But “everything is falling into place beautifully. I have never regretted a single day. It has been a joy.”

Mitchell is thankful for the variety of career and leadership posi­tions she has held, saying that they readied her for her new position.

“I would strongly encourage anyone who is considering a career change to view it as an opportunity to build upon past experiences,” she said, adding that redefining one’s career path actually helps to redefine the profession of pharmacy in new and innovative ways.

Kenn Horowitz, Pharm.D., 66, has also had a pleasant career transition. Last year, Horowitz capped a 41-year pharmacy career when he retired as a pharmacist at Hemophilia Health Services (HHS), a division of Accredo Health Group in Los Angeles. Horowitz will continue working for HHS several days a week, a move he describes as “keeping my finger in the pie,” while also working as a staff pharmacist at Cedars-Sinai Medical Center, where he also was previously employed.

Horowitz’s retirement has meant more time to travel the world to visit camps and conven­tions for one of his favorite pas­times: Lindy Hop dancing.

“That’s one of my primary plans for retirement,” he said of the type of swing dance born in New York.

Career transitions are noth­ing new for Horowitz, who has worked for many different kinds of employers, including government health agencies and health sys­tems in New York, Montana and California.

“I’ve enjoyed the many hats I’ve worn in pharmacy. Every­thing has given me experience and knowledge. I wouldn’t trade my career for any other,” he said, adding that over the years, he’s coped with change by “pouring myself into it and doing the best I can.”

Charting a Specific Career Path

Some pharmacists have fine-tuned career maps. Take Rafael Saenz, M.S., Pharm.D., 32, operations manager for the pharmacy department at the University of Pittsburgh Medical Center, where he oversees the outpatient pharmacy. Saenz has diligently planned each step he will need to take to become a corporate or systems director.

In the meantime, Saenz is trying to learn about the many functions of the pharmacy where he works as he works toward becoming a pharmacy director one day.

“If you don’t plan out certain steps in your career, then you’re going to get tunnel vision and only see the department from one angle,” he said. “Hopefully, when the time is right, I’ll see an oppor­tunity to become director and I’ll move into that.”

Saenz admits that he struggled with his introduction to health-system work after spending so much time in pharmacy school and as a pharmacy resident, where many experiences are synthesized and mentoring is always available.

“Real-life situations come up ad hoc, and you have to respond to them as you go,” he said, crediting his success to thorough train­ing and a mindset of curiosity and openness to the perspectives of fellow healthcare professionals.

New Computer Tablets Allow Pharmacists to Stay on Rounds

During the course of a pharmacist’s typical work day, spar­ing a few minutes here and there can mean more time for consulting with fellow healthcare professionals on the care of patients, ensuring proper medication choices and dosages, and educating patients about their medications. It even can mean more time for medical interventions that can potentially save lives. 

At Children’s Hospital in Omaha, Neb., staff pharmacists no longer have to leave a patient’s bedside or step away from patient rounds to enter a medication order, examine laboratory results, or check a dosage reference. Large drug reference books and reams of paper detailing a patient’s medical record are now a thing of the past. 

Tablets Feature ASHP Drug Information 

The advent of new handheld computer tablets has lightened the load for pharmacists and is increasing their ability to share their medication expertise during rounds. The tablets are small but feature ASHP’s powerful drug databases, AHFS Drug Information and AHFS DI Essentials, now offered via Lexi-Comp® ONLINE™. 

In late 2006, Motion Computing approached Children’s about using its new C5 medical tablets in various departments of the hospital. In early 2007, ASHP member and Pharmacy Director Lisa Kwapniowski, Pharm.D., and other hospital officials, worked to adapt the devices for use in the hospital. 

The hospital piloted the new tablets with pharmacists in the pediatric intensive care unit first, and then rolled them out to pharmacists in neonatal intensive care. The emergency department and medical surgical units are scheduled to receive the tablets later this year. 

The pharmacy staff members welcomed the machines with enthusiasm and have come to depend on them. The mobile technology ended the use of computers on wheels and the heavy laptops pharmacists once toted around the facility—a welcome change, according to Kwapniowski. 

“My staff would probably hunt me down if I took the tablets away now,” she said, laughing. 

The three-pound devices feature 10-inch screens. The tablets are pre-loaded with ASHP’s drug information, other medical soft­ware, and patient information. Pharmacists can use the tablets to accomplish a number of critical tasks, including entering and verify­ing medication orders, reviewing medication profiles and laboratory results, and accessing electronic drug information databases. 

Children’s Hospital bills itself as the first in its region and one of the first hospitals in the U.S. to bring the devices onboard. Hospital officials point to immediate positive impacts, such as the fact that pharmacists can now stay on rounds to make medication recommendations and immediately answer any drug-related ques­tions the medical staff may have. 

Evidence Points to Importance of Pharmacists Rounding  

Kwapniowski pointed to studies that show pharmacists’ par­ticipation in hospital rounds with other healthcare team members decreases adverse events in patients. For instance, a 2002 study in ASHP’s American Journal of Health-System Pharmacy[1] showed that including a clinical pharmacist on daily patient rounds reduced medication errors by 51 percent. Another 2003 study published in the Archives of Internal Medicine[2]  revealed a 78 percent drop in preventable adverse drug events when pharmacists participated in weekday medical rounds in a hospital’s general medicine unit. 

Children’s estimates that use of bedside tablet technology has increased the time that pharmacists spend rounding in the pediat­ric intensive care unit from 82 to 98 percent. 

“Pharmacists can now be in rounds up to 99 percent of the time,” Kwapniowski said. “Before they had to break away and miss portions of the rounds, potentially missing medication interventions.” 

Robin Stec, Pharm.D., clinical coordinator at Children’s, said the new technology has improved patient care. “We have more opportunities to find adverse drug events because we can be present on rounds and have the information right there,” Stec said. “I think they are great tools for pharmacists to participate in rounds. We have all the resources we need at our fingertips.” 

Although the tablets are handy for verifying medication orders, they are more challenging to use for order entry because more data entry—and keystrokes—are involved, she said. 

The tablets meet the hospital’s strict infection-control guide­lines and feature bar-code scanners to read medication labels at patients’ bedsides, allowing nurses to verify a patient’s name, medi­cation, time, route, and dosage. 


 

[1] Pharmacists’ participation in medical rounds reduces medication errors. Am J Health-Syst Pharm. 2002; 59: 2089-92. 

[2] Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med. 2003; 163: 2014-2018.

Pharmacists Learn Ins & Outs of Creating New ED Position

            Tanya Claiborne, Pharm.D., had just been hired as the first emergency department (ED) pharmacist at Sentara Healthcare System in Tidewater, Va., when she discovered a new ASHP program to help her navigate the challenges of her new position.
            The six-month certificate patient-care impact program—“Introducing an Emergency Pharmacist into Your Institution”—brought together 20 pharmacists under the mentorship of three pharmacists and one physician in emergency medicine.
            “It was a wonderful coincidence,” Claiborne said, of the inau­gural program that launched at ASHP’s 2007 Summer Meeting in San Francisco and concluded at the Midyear Clinical Meeting in Las Vegas. “This is a new position, so it was great to have a program where you can learn what does work and what doesn’t.”

Monitoring Performance and Quality
            Participants focused on safe medication use in the intense, pressure-filled environment of the ED, including how to moni­tor pharmacists’ performance and conduct quality assurance. They learned how to develop a pharmacist position in emergency medicine, from devising a job description to obtaining support from hospital leaders. While some of the participants hadn’t worked in EDs prior to starting the program, all of them were working in EDs upon completing it.
            Participants, who hailed from as far away as Dublin, Ireland, completed projects detailing how they would successfully implement pharmacy services in the EDs within their own organizations. They also described the duties of the pharmacist in emergency medicine, which included verifying medication orders, assisting with trauma victims, providing drug information to other health profes­sionals, and performing medica­tion reconciliation. After months of emailing their mentors and meeting in groups via teleconference, the participants displayed their projects on posters viewed by thousands of Midyear attendees.
            Participants said their projects have measurable, positive impacts on patient care, including timely administration of pain medication. They also said they have provided valuable medication education to the nursing staff and decreased the opportunities for adverse drug events.
            One of the program mentors, Daniel P. Hays, Pharm.D., BCPS, clinical pharmacy specialist at the University of Rochester Medical Center Department of Pharmacy and Emergency Medi­cine, Rochester, N.Y., said the program is important because there aren’t many emergency medicine pharmacists, let alone training programs for them.
            “We need to increase our numbers in these roles,” he said. “There are so few post-graduate training opportunities in emer­gency departments. We get these people excited about becoming emergency pharmacists and then jumpstart their abilities.”

Interventions and the ED Pharmacist
            Rebecca Drake, Pharm.D., BCPS, emergency medicine clinical pharmacist at Union Memorial Hospital in Baltimore, joined the program with one goal: to convince the pharmacy’s administration that her presence as a full-time ED pharmacist would increase medical interventions that potentially save lives—and money. At the time, Drake was working in the ED for only one-fifth of her workweek.
            “I really wanted to put myself in the ED full time so that people there would know who I am and could ask me questions,” Drake said.
            For her project, Drake calculated the cost savings associated with the interventions she performed in the ED for a three-month period. She recorded a savings of $8,836 for 136 interventions, which included educating patients and obtaining their medication histories.
            Drake presented her findings to the pharmacy’s administra­tion, which subsequently approved her full-time position in the ED.
            Meanwhile, Claiborne successfully integrated herself in the ED at Sentara and is working to improve the quality and safety of medication use in the institution.
            “Slowly I’m getting things accomplished,” Claiborne said. “But there’s a lot of work to do.”
            ASHP believes every hospital pharmacy department should provide pharmacy services to EDs for safe and effective patient care. But only 3.5 percent of hospitals surveyed had a pharmacist assigned to the ED for any period of time, according to the 2005 ASHP National Survey. In June, ASHP’s House of Delegates will consider approving the new Statement on Pharmacy Ser­vices to the Emergency Department, which calls on pharmacists to collaborate with other healthcare professionals to develop medication-use systems in EDs to promote safe and effective medication use.
             The ASHP Research and Education Foundation; University of Rochester; Johns Hopkins University, Baltimore; Cedars-Sinai Medical Center, Los Angeles; and the Agency for Healthcare Research and Quality collaborated with ASHP on the program.

Leadership Center Kicks Off Inaugural Year, Enrolls First Class

Eighty- five pharmacists have enrolled in the inaugural academic program of ASHP’s new Center for Health-System Pharmacy Leadership. The Center, a collaborative effort between ASHP and the ASHP Research and Education Foundation, will help pharmacy leaders address the increasingly complex challenges of institution-wide medication-use policies and procedures.

The Internet-based Pharmacy Leadership Academy is designed for pharmacists in new leadership positions, such as directors, and those aspiring to similar posts in the future.

Center Director Richard S. Walling, M.H.A., said the Academy’s work has come at a critical time for the pharmacy profession. “The academy arose out of ASHP members’ concern that pharmacists don’t have opportunities to build their leader­ship competencies,” he said, adding that the Academy offers students direct access to exceptional faculty members who are “leaders of pharmacy enterprises. Each of them has greatly impacted the profession, and their collective experiences will provide participants with a fantastic learning laboratory.”

The Academy features nine modules—one for each month of the academic year—that cover topics such as patient safety, quality management, information systems, and human resources management. Students will learn how to lead people for results, work collaboratively with executive health-system leadership, and develop themselves professionally to achieve excellence.

Jennifer Austin, Pharm.D., a pharmacy manager at St. Joseph’s Hospital in Tampa, Fla., and student in the inaugural class, said she applied because she was excited by the prospect of working with experienced faculty.

After transitioning from clinical practice to her position as a pharmacy manager, Austin took local college courses, employer-provided training sessions, and continuing education program­ming to receive leadership training. But “I have always wanted a more structured and in-depth pharmacy-focused program,” Austin said, adding that she hopes to broaden her knowledge of pharmacy practice management and prepare herself for addi­tional responsibilities.

While the Academy is geared toward new leaders, the Center’s Pharmacy Leadership Institute will focus on seasoned and experienced health-system pharmacy directors and will be operated by the Boston University School of Business.

For more information on the Center for Health-System Pharmacy Leadership and its Pharmacy Leadership Academy and Pharmacy Leadership Institute, check out www.ashpfoundation.org.

ASHP Again Endorses Intermediate Drug Category

ASHP reiterated its sup­port for the creation of a “behind-the-counter” class of medications during testi­mony at a Food and Drug Admin­istration (FDA) public meeting in November. William A. Zellmer, MPH, ASHP deputy executive vice president (pictured at right), told administration officials that patients would benefit both from the increased availability of medica­tions in an intermediate category and accompanying access to phar­macists as medication experts.

The classification “would give the public greater access to medications that have potential for yielding immense gains in health status,” Zellmer said. “And it would tap the expertise of pharmacists…health profession­als who are well-prepared to help people make the best use of medicines in this category.”

Although pharmacy organizations strongly supported the “behind-the-counter” class for medications at the meeting, other speakers at the meeting voiced a broad range of other opinions on the classification change.

Recommending an Evidence-Based Approach

Longstanding ASHP policy, which calls for establishing an intermediate class of drugs, recommends that regulators use an evidence-based approach to select appropriate products. Under this system, pharmacists would assess diseases or conditions and recommend appropriate medications. Medications in this class should have a high margin of safety and a history of being on the market and used safely and appropriately by patients.

Although ASHP opposed the reclassification of statin as a nonprescription drug, it would be a good candidate for inclu­sion in an intermediate category, according to Zellmer.

In December, two FDA advisory committees recom­mended that the administration not approve over-the-counter (OTC) status for lovastatin 20 mg (Mevacor). Merck & Co., Inc., applied for the status change.

During the joint meeting of the FDA’s advisory com­mittees on nonprescription drugs and endocrinologic and metabolic drugs, ASHP again voiced its opposition to OTC status for statin. Cynthia Reilly, B.S., Pharm., ASHP director of clinical standards and quality, testified that the proposed formu­lation and product use wasn’t consistent with treatment guidelines for hyperlipidemia.

Opening the Door for Adverse Drug Events

ASHP believes assigning an OTC status to statin would force patients to self-assess for this complex therapy, which could open the door to more adverse drug events, she said.

“The wider use encouraged by OTC status will include statin use by individuals with multiple disease states and those taking potentially interacting medications,” Reilly told the committees.

Zellmer said that the fact that the FDA held a public meeting on this topic “signals a milestone in the administration’s interest in the idea of an intermediate category and a maturation of the concept.”

In the end, the FDA followed the recommendation of its two advisory committees and rejected Merck’s application.

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