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April 30, 2013

New Strategic Plan Points the Way Forward

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

A GOOD STRATEGIC PLAN allows us to map our future with a clear course to success. In January of this year, the ASHP Board of Directors approved a new comprehensive Strategic Plan.

This plan is a significant departure from the Leadership Agenda that it replaces because it includes and integrates all ASHP activities and operations. While the previous document focused only on professional priorities, our new Strategic Plan includes three main pillars: Our Patients and Their Care, Our Members and Partners, and Our People and Performance.

This new plan embodies our passion, our energy, and our unwavering commitment to you–our members–and the patients whom you serve.

We began the process of creating this comprehensive Strategic Plan by starting with a new vision statement for ASHP. Working with a great team of Board members, Section and Forum Executive Committee leaders, and ASHP staff at an April 2012 retreat, we strove to develop a new vision that would be bold, far-reaching and important to our members and patients.

In particular, we wanted to create a vision that is universal in focus and covers all patients in all settings across the continuum of care. I am pleased to say that our new vision statement achieves this important goal:

ASHP’s vision is that medication use will be optimal, safe and effective for all people, all of the time.

Working from our new vision statement, we turned to revising our mission. Again, we focused on pharmacists’ role in the full spectrum of individual and public health. We wanted to craft a mission statement that moved beyond medications to emphasize that, in addition to treating disease, pharmacists have an important role in improving and maintaining health. Our new mission statement, below, also sets the stage for our member pharmacists as providers caring for and following patients through their entire healthcare experience, regardless of the site of care:

The mission of pharmacists is to help people achieve optimal health outcomes. ASHP helps its members achieve this mission by advocating and supporting the professional practice of pharmacists in hospitals, health systems, ambulatory clinics, and other settings spanning the full spectrum of medication use. ASHP serves its members as their collective voice on issues related to medication use and public health.

Drawing from the vision and mission, we created ambitious strategies, goals and objectives. As I mentioned above, the Strategic Plan includes three pillars, which are short and simple, yet all-encompassing, high-level strategies:

    1. Our Patients and Their Care
    2. Our Members and Partners
    3. Our People and Performance

The first pillar focuses on the central purpose of pharmacists: improving the health of our patients throughout the entire continuum of care, including both ambulatory and acute care. The goals and objectives within this strategy provide a roadmap for how ASHP helps its members care for their patients now and in the future. They include:

  • Improving patient outcomes from medications;
  • Wellness and preventative care;
  • Advancing pharmacy practice;
  • Helping the pharmacy workforce meet patient needs;
  • Providing professional development;
  • Advocating for laws, regulations, and standards; and
  • Placing an increasing emphasis on expanding our members’ practices in clinics and other ambulatory care settings.

Examples of activities in this realm include efforts related to improving care transitions, using information technology and pharmacy technicians more effectively, advancing efforts related to the Pharmacy Practice Model Initiative, ensuring an adequate supply of well-trained pharmacists, providing contemporary education and professional development, and advocating for changes in laws and regulations that give patients greater and more effective access to pharmacists.

The second pillar of our new Strategic Plan focuses on the central purpose of ASHP: our members. Members are the focus of our work and are the core of ASHP’s inspiration and reason for being. The goals and objectives of this pillar relate to how we serve our members and work with other stakeholders, including:

  • Maintaining a high level of member satisfaction,
  • Growing membership,
  • Supporting our state affiliates,
  • Engaging members through Sections and Forums,
  • Working in collaboration with our various partners in pharmacy and the broader healthcare community, and
  • Publishing timely and innovative resources.

Some examples of activities in this area include enhancing opportunities for members to participate and take leadership roles in ASHP; partnering with ASHP state affiliates on advocacy and other efforts to improve patient care; increasing the number of tools and resources to help our members best care for their patients; and fostering and growing relationships with pharmacy, medicine, nursing, consumer organizations, and others.

The third pillar focuses on a vital element to our success: our staff and organizational performance. ASHP can be proud of its strong staff team. Our staff is a critical success factor and an invaluable asset to the organization as we strive to meet and exceed our ambitious goals. This pillar’s goals include:

  • Fostering staff excellence, teamwork and innovation;
  • Ensuring a financially strong organization;
  • Maintaining effective and energized governance;
  • Effectively managing our organizational infrastructure; and
  • Fostering high-performance staff leadership.

The essence of this pillar and its related goals and objectives is that having the best staff in the business and a financially strong organization is central to the Society’s ability to continue to maintain and enhance the services that we provide to our members.

We are all very excited about the future this plan will help guide us to. We will use the Strategic Plan to direct all ASHP activites, focusing our work on the most important issues and services required by you and the patients you serve.

I encourage you to review the new ASHP Strategic Plan, share it with your colleagues, and use this plan as you engage in your own strategic planning efforts within your practice setting.

April 22, 2013

Boston Bombing Puts Hospital Pharmacies into Emergency Mode

Filed under: Current Issue,Feature Stories — Tags: , , , , , , — Kathy Biesecker @ 11:54 am

Ambulances line Columbus Avenue after two explosions went off near the finish line of the Boston Marathon April 15. Photo by David L. Ryan/Boston Globe via Getty Images

THE PEOPLE WHO ARRIVED in the emergency department on April 15, 2013, had injuries unlike any Nancy Balch had seen in her 12 years as an emergency department pharmacist at Massachusetts General Hospital in Boston. Their injuries were severe. At least one person had had a limb blown off.

“I’ve seen a lot, unfortunately,” she said of her decade-plus in emergency care at the level 1 trauma center, “but nothing like this.”

High Volume, Extensive Injuries

By the end of Balch’s regularly scheduled shift on Monday, the hospital had treated 29 people injured by the bombs that exploded near the finish line of the Boston Marathon.

People came to the emergency department the next day, too, Balch said. Some sought care because their hearing had not returned to normal. Others did not realize until Tuesday that they had a piece of metal stuck in them.

Shannon Manzi, at Boston Children’s Hospital, has spent almost as much time in an emergency department as Balch has.

“I have not seen these types of injuries since I was in Haiti,” said Manzi, who went there in 2010 immediately after the 7.0-magnitude earthquake.

But in Haiti, the patients had crush injuries, she said. On Monday, the patients at Boston Children’s had blast injuries. Both types of injuries can sever limbs.

The children hit by the blasts, however, had injuries more extensive than what Manzi had seen after the earthquake.

On Monday, Boston Children’s, a level 1 pediatric trauma center, received 10 patients from the blasts, the hospital has reported. Manzi said she had just torn down the medical tent at mile 15 in the marathon when her pager alerted her to a “mass casualty” at the hospital. The first two patients were in the emergency department when she arrived.

Good Decisions, Well-Made Plans

The bombs exploded about the same time as the overlap in day and evening shifts for emergency department pharmacists and pharmacy technicians, Manzi said.

On arrival, she assumed the role of managing pharmacist. Pharmacists with emergency department training who had been working upstairs in the hospital came downstairs to bring the total to six.

Shannon Manzi

Manzi said emergency care personnel organized into four teams, each with two physicians, two nurses, one clinical assistant, one respiratory therapist, and one pharmacist. She remained available to manage resources, ensure everyone had what they needed, communicate with the main pharmacy, and step in when a pharmacist needed relief. The sixth pharmacist worked with the patients who were in the emergency department for reasons other than the bomb explosions.

Brigham and Women’s Hospital, a level 1 trauma center next to Boston Children’s, received 31 patients from the explosions, an emergency department physician told CNN on Monday night. Nine of those patients underwent major surgery that day, he said.

Pharmacy services executive director William Churchill said his department’s immediate goal was to ensure that the physicians and nurses in the emergency department would not have to leave a bedside to obtain a medication. The pharmacy accomplished that goal by shifting resources to have six pharmacists in the emergency department in the initial hours after the explosions, he said.

One pharmacist was already in the emergency department for the evening shift. The day-shift emergency department pharmacist, Churchill said, stayed on, as did nearly all the staff.

And, “as luck would have it,” he said, several members of the “emergency department pharmacy team” were already on duty in other areas of the hospital. The pharmacy deployed two to each of the main areas of the emergency department. In each twosome, one spoke with the nurses and physicians to determine what they needed and answer questions and the other pharmacist expedited medication delivery.

“We drill a lot with preparing for disasters and mass casualties,” Churchill said.

In those types of emergencies, patients may need a medication before they have a medical record number or their name is known. Lacking that information, he said, personnel other than the pharmacists can have trouble obtaining a medication from an automated dispensing machine. So the pharmacy on Monday deployed pharmacists who could obtain medications quickly from automated technology, he said. Those pharmacists also facilitated the preparation and delivery of preoperative i.v. drug doses for the patients heading for surgery.

“One of the pharmacists said to me that it was her perception that . . . the nurses seemed to be relieved that the pharmacists were there as part of the team helping them,” Churchill said. All of this transpired while he was offsite.

John Fanikos, one of the pharmacy’s senior directors, assumed the role of the pharmacy unit leader and went to the hospital’s command center, Churchill said. “We’ve actually drilled and practiced that with all of my senior directors.”

With Fanikos in the hospital’s command center, Churchill said, two of the mid-level managers took roles in operating the pharmacy command center.


Erasmo “Ray” Mitrano

At Massachusetts General, interim chief pharmacy officer Erasmo “Ray” Mitrano made sure Balch had support in the emergency department—another pharmacist who could lend a hand and provide care to pediatric patients if any arrived.

Mitrano sent Lois Parker to the emergency department from the pediatric intensive care unit. He also had pharmacists elsewhere in the hospital remotely handle the workload that would have been Balch’s on a normal day. This, he said, freed up Balch and Parker to focus on the patients injured by the bombs.

Parker said she stayed in the pediatric emergency department to be out of the way until her assistance was needed. But no pediatric patients had arrived by 5:30 p.m., she said, when the hospital’s incident command center sent a broadcast e-mail stating that staff coverage was adequate enough for the day shift to leave. She checked with Balch, who concurred that Parker could leave.

Parker said she felt “pretty prepared” for the situation in the emergency department. The hospital has conducted disaster drills on a regular basis, and she participated in a tabletop disaster drill that was specifically geared toward pediatrics.

Emotional Support

The day after the bombs exploded, Manzi said, Boston Children’s held a debriefing for emergency department personnel. She said the hospital commonly holds a debriefing after a bad outcome. But the recent debriefing was held for another reason. The injuries on Monday were not the type seen every day, she said.

“When it’s in your background and it’s terrorism,” Manzi said, “it’s a different thing than when it was a very, very sad case of a motor vehicle accident or a shaken baby.”

Churchill estimated that 50-some pharmacists were at “The Brigham” when the bombs exploded. “People rolled up their sleeves and volunteered to stay and did whatever was necessary to get it done,” he said. “I couldn’t be more proud of that situation or my department.”

When interviewed two days after the bombing, Churchill said he continues to check on how his staff members are doing. “Hopefully, everybody’s going to do real well,” he said.

Parker, who said she was not directly involved in caring for any of the injured, said the bombing hit particularly “close to home” because coworkers could have been among the injured. “The Mass General has a fairly sizable team of people who run in the marathon, and they raise money for various programs at the hospital, including the pediatric oncology clinic,” she said.

Word of the bombing reached Parker soon after she and others had determined through the marathon organizer’s athlete tracking system that some of their colleagues were near the finish line. Balch said she sees “awful accidents” all the time, yet what she saw April 15 was different.

“The thing that most struck me,” she said, “is it was something that somebody did to people. . . . That’s what makes it most horrific for me.”

Three hours after the bombing, the Boston Police Department reported that three people had died. Local hospitals had received 176 people by 7 a.m. Tuesday, the department later stated.

–By Cheryl Thompson; reprinted with permission from ASHP News.


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