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December 26, 2010

Innovating the Pharmacy Technician’s Role

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Illustrated by Matt Sweitzer ©2010 ASHP

AS PHARMACISTS EXPAND THEIR ROLES and carve out new niches in an era of health care reform, they are counting more and more on highly skilled pharmacy technicians to take on added responsibility.

Pharmacy technicians in practice sites around the country are performing tasks that were once considered solely the domain of pharmacists, such as dispensing medication, taking prescriptions over the phone, and managing error-reduction efforts. The result is tandem evolution: When pharmacy techs handle these duties, it frees pharmacists up to counsel patients and grow as key members of multidisciplinary health teams.

“Highly trained, skilled technicians are critical elements in a high-functioning pharmacy team,” said ASHP President Diane Ginsburg, M.S., R.Ph., FASHP. “If pharmacists are to achieve their highest calling—direct patient care—we must be able to rely on our technician workforce as our support system.”

In order for technicians to shoulder more responsibility, they will need more training and education. The push is on nationwide for standardization and accreditation.

“With the advancing role of pharmacists, we need technicians who are properly trained,” said Lisa S. Lifshin, R.Ph., director of program services and coordinator of technician program development in ASHP’s Accreditation Services Division. “Consumers are more in tune with their own safety, and they want someone who is trained to handle their medications safely.”

Portable, High-Level Skills

Heather Stremick, a student in the North Dakota State College of Science Pharmacy Technician Program in Wahpeton, checks the stock for a medication

The requirements for ASHP-accredited programs are stringent. Students must complete at least 600 hours of training and education that combine didactic components such as lectures and textbook learning, hands-on experience through lab work, and actual experiential rotations in real pharmacy environments.

The result of such an intensive mix of education is a thoroughly prepared pharmacy technician. This new type of worker has skills that are portable not just from environment to environment but also from region to region as more and more states ratchet up their standards and require pharmacy technicians to register with boards of pharmacy.

“We are a mobile society, and when techs train under accredited programs, there is an assurance that they have the same broad knowledge and training,” said Barbara Lacher, assistant program director and associate professor at the North Dakota State College of Science (NDSCS) Pharmacy Technician Program in Wahpeton. “They are not trained just to be a retail technician or a hospital technician. They have across-the-board training, and you know that anyone you hire out of an accredited program has had experience with things that nonaccredited programs might not offer, like vaccines, sterile products, IV preparation, and stress management.”

ASHP is not the only organization advocating for the professionalism of the pharmacy technician workforce. The National Association of Boards of Pharmacy, which has several technician training task forces, is advocating that technicians complete an education and training program that meets minimum standardized guidelines. It also recommends the use of a single accrediting agency
and a program that is developed by an established pharmacy organization.

Innovations in Pharmacy Tech Education

As the demand for highly trained pharmacy technicians grows, educators are using local resources creatively to offer comprehensive instruction to students. In Florida, Orange County Public Schools (OCPS) offers accredited pharmacy technician programs through technical schools such as Westside Tech in Orlando and Winter Park Techin Winter Park, where students range in age from 16 to about 40.

A pharmacy technician at Wishard Health Services, Indianapolis, utilizes the pharmacy’s electronic inventory.

“One of the toughest things [about setting up a program] was finding a way to educate full-time adult students and part-time high school students,” said Lori DeVeau-Diem, CPhT, a pharmacy technician instructor at Westside. “We had to juggle the schedule to ensure that the part-time students would get all of the necessary instruction and the full-time students wouldn’t have stretches of unoccupied time.”

The answer was to craft a modular program in which students can proceed at the pace that works best with their schedules and allows for one-on-one time with instructors as well as interaction with other students.

The heterogeneity of the student population benefits all involved, said John Diem, CPhT, director of pharmacy technician programs for OCPS. “Our students work extremely well together. The high school students challenge the adults academically, and the adults give them an example of professionalism and maturity,” he said. “It prepares them for working in the real world, where they’ll be working alongside people of all ages.”

At Southeastern Technical College, which has three campuses in southeastern Georgia, the pharmacy technician program stresses hands-on experience indifferent environments.

“My students do a lot of community service,” said Karen Davis, CPhT, pharmacy technology instructor at the Vidalia campus and former president of the Pharmacy Technician Educators Council. “They will work in patient assistant programs, do paperwork, conduct inventory, request medications, type labels, and more.”

Students in Southeastern’s program can rotate through different facilities as interns, where they learn how to be part of a multidisciplinary health team. “What students get in the classroom and lab should be reinforced at the work site,” said Davis. “By the time they have to take their tests for certification, they know how to do everything from data entry to IVs to total parenteral nutrition. The ASHP requirements are designed not for us to teach but for students to do.”

Looking Ahead

The future for pharmacy technicians is a bright one. The Bureau of Labor Statistics predicts that employment of pharmacy technicians will increase 31 percent by 2018 compared with 2008 figures, not only because pharmacists are expanding into more clinical roles, but also because prescription drug use will increase overall as the population ages.

%%sidebar%%The projected growth of programs is not just in hospital systems and traditional academia, said ASHP’s Lifshin. “We are getting a lot of calls from community and chain pharmacy representatives about how they can start an accredited program,” she said. “Health care is always a good avenue for schools to explore, and accreditation is their way of becoming more competitive. The voice of accreditation is a lot louder than it was just a few years ago.”

Davis sees pharmacy technician education evolving as the role of pharmacy technicians evolves. “Lick, stick, and pour jobs are all but gone,” said Davis. “Now that techs are working in triage, diabetes clinics, veterans’ programs, and so on, I think that eventually we will need national minimum standards. I can see the technician’s role expanding to the point where it will require an associate’s degree.”

Davis also predicts different levels of practice for pharmacy technicians and eventually specialization. “Pharmacists are asking for it,” she said. “They want technicians to be able to do things like take scrips over the phone. I can see someone calling us to request a technician for job placement and asking for a Level 1 pharmacy technician for one level of care, a Level 2 tech for more involved care, and so on.”

She added that pharmacy technicians and their educators should stay abreast of legislative changes within their states and continue to push for standardization and accreditation.

Pharmacy Job Market Changing

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Richard Montgom­ery, R.Ph., MBA, administrative director of pharmacy at Florida Hospital in Orlando


JUST FIVE YEARS AGO, newly minted pharmacists were assured of placement in their desired residencies and jobs. With a broad job market and options in hospital, health-system, and community retail pharmacy, recent graduates were offered signing bonuses by recruiters and hiring managers eager to fill open slots.

Today’s graduates, however, may need to make a few concessions if they want to be gainfully employed, particularly when it comes to location. According to figures posted by the Pharmacy Manpower Project, which compiles and analyzes data to determine the demand for pharmacists by state and geographic region, there appears to be a dip in demand for pharmacists in New England and the Mid Atlantic. Likewise, competition is heating up for hospital positions in urban areas, particularly in states where there are several pharmacy schools.

Increased Competition

Several factors are affecting the pharmacy job market, according to Richard Montgomery, R.Ph., MBA, administrative director of pharmacy at Florida Hospital in Orlando.

“We used to compete with retail chains [for pharmacists]” said Montgomery, “but now that we have multiple pharmacy schools in state, the pool of applicants has increased even as retail chains have gone to a centralized fill model requiring fewer pharmacists on staff.” Hospital cutbacks due to reduced patient volume are also complicating the picture.

Nicole Metzger, Pharm.D., BCPS, clinical assistant professor of pharmacy practice at Mercer University College of Pharmacy and Health Sciences in Atlanta, has noticed a tightening in the market as well.

“When I graduated in 2006, there was room for salary and benefit negotiation,” Metzger said. “Qualified students who wanted to do a residency easily found programs to fit their needs. In contrast, last year many graduates in the area were struggling to find work and had to relocate to more rural areas to ensure employment.”

Metzger’s words describe a broader trend, one affecting young pharmacists and residents like Jessica B. Winter, Pharm.D., PGY1 pharmacy practice resident at UC Health–University Hospital in Cincinnati.

“I do worry about job placement after my completion of a PGY2 residency next year,” Winter said. “I’m sure I’ll have to be flexible in terms of location and salary. With seven schools of pharmacy in the state, positions in more densely populated areas like Cincinnati are harder to come by.”

Make It Work

%%sidebar%%Although there appears to be a decrease in demand in certain geographic areas, there is still plenty of work for clinical pharmacists. For those willing to go west, there are more jobs than pharmacists in the south-central region of the country (Ark., La., Okla., and Tex.) and the Pacific region (Alaska, Calif., Hawaii, Ore., and Wash.). Rural areas are another option.

Location isn’t everything, however. New practitioners can take a number of steps to appeal to recruiters and pharmacy directors, including being flexible regarding the kinds of jobs one is willing to take, according to Montgomery.

“Take a part-time or per diem job, work that odd shift, and show that you can be part of the team,” he said. “Try to find a niche; many pharmacists have built their careers by seeing an opportunity and running with it. The more creative and entrepreneurial you can be, the better your chances are.”

Taking advantage of leadership opportunities in professional associations such as ASHP is a great way to gain a foothold in a tight hiring market, according to ASHP President Diane Ginsburg, M.S., R.Ph., FASHP. “Getting involved in a large community of successful practitioners allows you to hone your leadership skills,” she said. “Tapping into that network also gives you access to some of the top leaders in health-system pharmacy.”

Finally, Metzger suggests getting involved in research or scholarly activity to work toward becoming a well-rounded professional. “The more skills you have, the more leadership positions you fill, and the more you network, the more it will set you apart,” she said.

Pharmacists Successfully Managing Drug Shortages

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THE BAD NEWS: Chronic drug shortages continue unabated across the country, delaying medical procedures, potentially contributing to medication errors, leading to price-gauging by third-party suppliers, and frustrating hospital personnel who must scramble to substitute therapeutic equivalents. The good news? Pharmacists are successfully stepping into that gap, creating systems and processes for coping with the shortages.

An Escalating Problem

Hospitals are increasingly experiencing shortages of drugs that are critical for patient care, including morphine, succinylcholine, and amikacin. “From a direct patient care viewpoint, it has been very difficult,” said Bernadette S. Belgado, Pharm.D., clinical assistant pro­fessor and manager of therapeutic policy at Shands Jacksonville, an affiliate of the University of Florida Health Science Center Jacksonville.

According to Bona E. Benjamin, B.S. Pharm., director of medication-use quality improvement at ASHP, the number of shortage reports has steadily grown since 2006. “If you were to chart shortages, the line would be straight up,” she said.

To minimize the impact of shortages, hospitals and health systems across the country are proactively developing new processes and strategies.

At Shands Jacksonville, the purchasing, inpatient operations, and therapeutic policy managers meet weekly to review an electronic report that includes a spreadsheet of inventory and utilization and a plan to manage the process. If a nonformulary item is involved, a process is in place to fast-track the formulary addition or therapeutic substitution through the pharmacy and therapeutics (P&T) committee.

From there, communication fans outward, said Joel Parnes, Pharm.D., MHA, manager of central operations in the department of pharmacy. “The shortage may prompt a direct bulletin to physicians and different departments as well as phone calls,” he said. “We make sure it gets down to nurses and those providing care at bedside.”

Contingency plans for shortages at WakeMed Health & Hospitals in Raleigh, N.C., include a step-by-step description of the procedures required to make a substitution.

“We use a checklist of all the pieces that have to be put in place when you make a change,” said Lynn Eschenbacher, Pharm.D., MBA, the pharmacy’s clinical manager. “We look at the data, determine how much drug we need, how much we have on hand, what the therapeutic alternatives are, and what our options are.”

The process is driven by a committee that includes WakeMed’s product buyer, business manager, operations manager, pharmacy director, medication safety officer, and Eschenbacher. “We meet to decide when to take a shortage to our P&T committee to get approval for a formulary change,” she said.

The plan also accounts for technical changes that must be put in place, such as adding new products to the pharmacy order system or rotating items from automated dispensing cabinets on the patient care units back into the pharmacy, Eschenbacher added.

The Problem With Third Parties

Coping with shortages is a time-consuming, labor-intensive task, according to Eschenbacher. “On any given day, I can spend two to four hours working on a shortage,” she said. “You have to figure out what the restrictions are for therapeutic substitution and decide if and when to go to a third party, such as a compounding pharmacy.”

Buying from third parties is an expensive option. For example, during a shortage of prefilled syringes of epinephrine, WakeMed chose to contract with compounding pharmacies even though the system would not be reimbursed for the markup.

“We felt that safety outweighed the cost,” Eschenbacher said. “The alternative would be mixing and pulling up a syringe in a crisis. In a code situation, that takes extra time you may not have.”

The cost of going to third parties rankles Belgado, who noted how the recent amikacin shortage affected Shands Jacksonville. “Working with third parties is part of the cost of business, but when the pricing is 400 or 500 percent more than what we normally pay, it is astounding that that is legal,” she said.

Belgado is equally frustrated by thegray market, which provides alternate sources of drug products outside the normal supply chain.

“We were desperate, calling all over to get amikacin,” Belgado said. “We were even looking at veterinary options. But when you look at the gray market companies and find that they have plenty of product, that can be really hard for us to digest. Why is it that those of us who care directly for patients cannot get it?”

According to Parnes, one reason shortages are so tough to handle is that they often occur with little to no warning. “Often we find out about evolving shortages from product managers or from ASHP,” he said. “We want to be proactive, but a lot of what we do is reactive, which makes it difficult.”

Need for the FDA to Step In?

Parnes feels there is room for the Food and Drug Administration (FDA) to get involved. “When companies pull out of the market, the FDA needs to assess what impact that will have,” he said.

%%sidebar%%That is where it gets tricky, according to ASHP’s Benjamin. “The FDA has fairly limited authority to do much about drug shortages,” she said. “They can’t require manufacturers to tell them of an evolving shortage, and they can’t prevent a manufacturer from discontinuing a product that many people use. They cannot interfere with trade.”

However, change at the federal regulatory level with respect to information management would be immensely helpful, she said. “Information that would allow people to predict a shortage, how long it might last, and its impact on care should be available more transparently so that people can at least plan for the shortage,” she said.

In the meantime, pharmacists can help one another by reporting shortages to ASHP. “We talk almost daily with the FDA,” said Benjamin. “As soon as I hear of a shortage report from a member, I call my contact at the FDA and let her know we need to look into this. Sometimes, that’s the only way the FDA learns of the problem.”

Pharmacists Integral to Creating Medical Home Models

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Stephen M. Setter, Pharm.D., CDE, CGP, FASCP, speaks with an elderly patient.

AS HEALTH CARE REFORM GETS UNDER WAY, hospitals and health systems across the country are looking into the viability of implementing the Primary Care Medical Home (PCMH) model. In PCMHs, provider-led teams of health care professionals provide coordinated, patient-centered care. The provider is often a physician, whose office acts as a kind of care hub, but much of the direct care is delivered by a multidisciplinary team.

Pharmacists’ Roles Changing

With more than 18 states currently participating in PCMH pilots, the model stands to make a deep impact on the way that care is provided and on the pharmacist’s role as an allied health professional.
Stephen M. Setter, Pharm.D., CDE, CGP, FASCP, associate professor of pharmacotherapy at Washington State University, Spokane, sees the PCMH model as a golden opportunity for pharmacists.
“Pharmacists will be able to use their training to the utmost in this model,” he said, adding that the challenge is simply getting a foot in the door with providers. “Pharmacists are often reactive in the way we provide care,” he said. “We find errors or interactions, but that is downstream. In the medical home model, we can be right at the point of care.”

L. David Harlow III, R.Ph.

Pharmacists need to be more proactive in communicating their expertise to providers, according to L. David Harlow III, R.Ph., director of pharmacy operations at the Carilion Clinic’s New River Valley Medical Center, Christiansburg, Va., and Tazewell Community Hospital, Tazewell, Va.

“Physicians are just not familiar with what pharmacists are qualified to do,” said Harlow, “and that’s just as much our fault, because we have not gotten
the word out.”

Evidence and Incentives

The evidence is there to support pharmacist involvement in multidisciplinary models like PCMH. Studies have shown that pharmacist-provided direct patient care improves patient outcomes across several disease states, and that patients cared for by a team that includes a pharmacist have fewer hospital readmissions.1

Troy Trygstad, Pharm.D., MBA, Ph.D.

Troy Trygstad, Pharm.D., MBA, Ph.D.

As the Centers for Medicare and Medicaid Services roll out “accountable care” projects, the financial incentive for including pharmacists in care teams will grow, as well. Accountable care makes providers responsible for ensuring that patients do not return with preventable complications, such as venous thromboembolisms after orthopedic surgery. If a patient returns with a condition noted under accountable care, the provider will not be reimbursed.

“That changes the equation completely,” said Troy Trygstad, Pharm.D., MBA, Ph.D., director of the Network Pharmacist Program at Community Care of North Carolina in Raleigh. “Now you have business reasons for a multidisciplinary team. Physicians need help in providing the deliverable, and they’re asking, ‘Who can you give me?’” Harlow notes how pharmacists are a natural choice for reining in health care costs.

“Twenty percent of the patient population uses 80 percent of the dollars in health care,” he said. “They are the patients with chronic diseases like diabetes and cardiovascular disease—the same things that account for the drug dollars. If you think about that in primary care, those patients take the most time, their medication regimens need the most tweaking, and they are most likely to relapse to the hospital if their medication issues are not corrected.”

Even in smaller medical practices, scheduling patients to come in and see a pharmacist can go a long way toward addressing those issues, he added.

Cushioning the Impact of Health Care Reform

The cost-effectiveness of involving pharmacists in the PCMH model is one reason ASHP worked so hard to obtain appropriate recognition for pharmacists in health care reform legislation, said Joseph M. Hill, ASHP’s director of federal legislative affairs.

Gretchen Tong, Pharm.D., discusses a patient’s medications with a University of North Carolina Family Medicine physician.

“Our initial accomplishment was the inclusion of pharmacists in the Affordable Care Act, which mentions pharmacists as part of the care team,” he said. “The Act sets out to develop and test delivery and payment models in health care, and [the PCMH model] could potentially be the first step.”

The PCMH model may prove to be a boon to patient care by driving health professionals together, even as it gives providers a cushion for absorbing the impact of health
care reform.

“It’s a holistic model,” said Setter of Washington State University. “From my perspective, that’s the way pharmacists should be practicing and the way medicine needs to move forward.”

Trygstad predicts that as physicians begin to lead multidisciplinary teams, they will see the value in such intense collaboration. The signs are already there, he said, reflecting on a conversation he recently had with a physician in a small town. “He was the sole doctor in the town” said Trygstad, adding that the doctor told him, “I’ve been practicing medicine for nearly 30 years, and it has taken me this long to realize how much I could have been learning from other professionals like pharmacists.’”

1. Chisholm-Burns MA, Graff Zivin JS, Lee JK, et al. US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Medical Care. 2010;48:923–933

Mentorship Program Helps Pharmacists Improve VTE Prevention

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The team at Sharp Grossmont Hospital in La Mesa, Calif., has put the suggestions of VTE Initiative faculty member Gregory A. Maynard, M.D., to good use.

DESPITE THE FACT that venous thromboembolism (VTE) is the most preventable cause of death in hospitalized patients, and that evidence-based guidelines for mechanical and pharmacological prophylaxis are widely available, VTE is still a significant cause of morbidity and mortality among patients at risk. Studies have shown that the incidence of VTE is about one in 1,000, with more than 250,000 patients hospitalized annually with the condition.1

Recognizing the great need for VTE interventions, ASHP Advantage recently developed the Institutional Impact VTE Mentored Quality Initiative.2 Through the program, physician-pharmacist faculty teams provide on-site evaluations of health systems’ VTE preventions practices and offer site-specific recommendations to help each system meet its quality-improvement goals.

Mentorship and Support

True to the initiative’s name, faculty members go beyond a consulting role and instead mentor each facility’s staff members, said Stuart T. Haines, Pharm.D., BCPS, BC-ADM, professor and pharmacotherapy specialist, University of Maryland School of Pharmacy, Baltimore, and clinical specialist, West Palm Beach VA Medical Center, West Palm Beach, Fla. “VTE prophylaxis is one of the bread-and-butter things pharmacists do, but this particular project is far more intensive for the selected sites,” he said. “We have regular contact with them, and although we analyze what they are doing and offer suggestions for how it can be better, we also support them as colleagues and help them communicate their efforts to peers.”

Indeed, faculty members for the initiative were chosen because of their collegial efforts and reputations, according to Kristi N. Hofer, Pharm.D., ASHP Advantage’s director of scientific projects. “In choosing mentors, we focused on their expertise,” she said. “These faculty have either been involved in VTE prophylaxis at their own hospitals, have experience with similar programs, or are known for sharing their knowledge.”

Tailored Partnerships

Each participating hospital has different needs, and the recommendations they receive vary as much as the hospitals themselves. At the suggestion of initiative faculty, the focus at Baylor Medical Center in Waxahachie, Tex., is shifting from a “two-bucket” system, in which a patient is considered either low or high risk, to a “three-bucket” system that includes moderate risk, said Donna Drain, Pharm.D., clinical pharmacist.

Initiative faculty also prompted Waxahachie’s staff to revisit its risk- assessment procedures.

“The mentors were intuitive about that,” said Drain. “For years, we concentrated risk assessment within a few hours of admission, but the mentors asked us how we reassess when a patient changes level of care, like from surgery to ICU. It was an ‘aha’ moment.”

A third suggestion was to home in on the quality of VTE prophylaxis, as opposed to the quantity.

“That hit home with me,” Drain said. “As clinical pharmacists, we can get caught up on numbers. We’ll say that we are providing prophylaxis 72, 80, or 90 percent of the time, but we aren’t stepping back and saying, ‘Are we caring for Mr. Green? Are we there for Mrs. Jones?’”

At West Virginia University Hospitals, mentor recommendations swung in the other direction.

“We’d been sharing our VTE efforts with nursing units, but trying to attribute outcomes back to different units was difficult,” said Frank Briggs, Pharm.D., CACP, director, Center for Quality Outcomes. “Now, rather than look at which unit did what, we look instead at the percentage of patients who receive pharmacological prophylaxis.”

The focus changed as a result of mentor review, Briggs added. “We saw that we were overrelying on mechanical prophylaxis,” he said. “[The mentors] really drilled down into that and got us to look at ways of improving pharmacologic prophylaxis. We found that if you want to drive pharmacologic prophylaxis, then you have to report its use.”

VTE Initiative faculty member Gregory A. Maynard, M.D., M.S., FHM, chief, Division of Hospital Medicine, University of California, San Diego

Identifying Communication Gaps

The team at Sharp Grossmont Hospital in La Mesa, Calif., is incorporating suggestions from initiative faculty members Gregory A. Maynard, M.D., M.S., FHM, chief, Division of Hospital Medicine, University of California, San Diego, and Zachary A. Stacy, Pharm.D., BCPS, associate professor of pharmacy practice, St. Louis College of Pharmacy, into efforts to revamp its ordering system.

“After meeting with Dr. Maynard and Dr. Stacy, we found that we may have undermined our efforts at VTE prevention by utilizing a complicated point-based system,” said Electa Stern, Pharm.D., pharmacy clinical supervisor. “We also failed to associate the list of risk factors with the preferred pharmacological options.”

Maynard also shared a real-time measurement tool that utilizes a color-coded dashboard: Patients who have no VTE prophylaxis are in the red zone, those with only mechanical prophylaxis are in the yellow zone, and those who have pharmacological prophylaxis are in the green zone.

%%sidebar%%Stern said that the first priority is to minimize the number of patients in the red zone. A standardized nursing procedure will allow nurses to start mechanical prophylaxis in at-risk patients found to be without any prophylaxis. The new tool consolidates risk into two pools, low versus moderate/high, as well as defines risk factors to help prescribers choose appropriate therapy.

Stern notes the practicality of the advice her team has received. “These are simple ideas” she said, “but that’s why they are so exciting: They should be easy
to implement.”

1. Goldhaber SZ. Pulmonary embolism.N Engl J Med. 1998;339:93–104.
2. An educational grant from Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC., allows hospitals to participate in the program for free.

A Time to “Be Bold And Be Urgent”

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Diane Ginsburg, M.S., FASHP

I WRITE THIS COLUMN having just returned from an incredibly energizing, exciting Pharmacy Practice Model Initiative (PPMI) Summit in Dallas. Pharmacy thought leaders from across the country came together to reach consensus on how we, as hospital and health-system pharmacists, should be practicing our profession in the future.

Summit attendees looked at a number of overarching principles for future pharmacy practice models and came to an agreement on the following principles:

• We, as pharmacists, must move closer to the patient.
• The role of a qualified technician workforce and the use of technology must be greatly expanded.
• Pharmacy departments are accountable for the development and implementation of medication-use policy to ensure safe and effective use of medications.
• Pharmacists are accountable for patient outcomes.

As Billy Woodward urged, we need to “be bold and be urgent” in our work to enact practice change. We need to embrace our common commitment to our patients and be accountable for their positive outcomes.

Stay tuned in the months and years ahead as the Pharmacy Practice Model Initiative gains momentum. As a tangible outcome of the Summit, we envision that every pharmacy department in the country will be engaged in examining how it deploys its resources. It’s a truly exciting time to practice pharmacy!

InterSections is a great place to catch a glimpse of some of the most innovative practice models happening today. Our cover story (page 8), about the enhanced role for educated, trained, and certified pharmacy technicians, shows just how important this segment of the pharmacy workforce is. As pharmacists move into direct patient-care roles, we’ll need to rely more and more on our professional technician partners.

Also in this issue, you’ll find a story on exciting work being done in the prevention of venous thromboembolism (VTE). Pharmacists in five hospitals around the country are being mentored in cutting-edge VTE practices through an ASHP Advantage program called Stop VTE. This interprofessional initiative is designed to increase the rate of thromboprophylaxis in hospitalized patients and promote the safe use of anticoagulants.

As the country continues to struggle under the weight of an economic downturn, pharmacyschool graduates are beginning to feel the pinch. The story on page 12 focuses on the strategic choices that recent graduates and new practitioners are facing regarding how and where to practice pharmacy.

%%sidebar%%Finally, ASHP’s recent Drug Shortages Summit highlighted an unfortunate trend in medicine today. Drug shortages cause significant disruptions in patient care, including canceled or delayed medical treatments and procedures. They also lead to adverse events caused by medications that may have the potential for greater harm than the first-line therapy that is unavailable due to a shortage. In the story on page 14, read about how pharmacists are stepping into this gap, coming up with processes and approaches that minimize risks to the patient.

I hope you’ll be informed and inspired by what you find in this issue of ASHP InterSections!

Diane Ginsburg, M.S., FASHP

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