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June 26, 2013

ASHP Celebrates 50 Years of Residency Accreditation

 

Photo courtesy of ASHP Archives.

Photo courtesy of ASHP Archives.

WHEN YOU THINK OF THE 1960s, chances are you think of the civil rights movement, the passage of the Medicare law, the women’s movement, and peace protests… all substantial forces for change. But the ‘60s were also a pivotal time in the evolution of pharmacy training.

In 1962, the Board of Directors of ASHP—then the American Society of Hospital Pharmacists—adopted the ASHP Statement on Accreditation of Hospital Pharmacy Internship Training Programs, which laid out objectives for post-graduate programs that would provide in-depth training.

To distinguish these programs from those geared toward meeting the legal requirements for licensure, that same year ASHP dropped the term “internship” and replaced it with “residency.” In 1963, ASHP began the process of surveying the first 32 hospitals accredited for residency in hospital pharmacy.

Over the last 50 years, the form and function of accredited residency programs have shifted several times. The 1980s saw residencies divided into hospital, clinical and specialty programs. This format gave way to the pharmacy practice and specialty residencies of the 1990s and early 21st century.

ASHP Past-President Paul G. Pierpaoli, M.S., inspects sterile solutions while a resident at the Univ. of Michigan. Photo courtesy of ASHP Archives.

At the same time, ASHP created post-graduate year two (PGY2) residencies, which prepare residents for specialty pharmacy practice in areas such as ambulatory care, infectious diseases, and oncology.

“Residency standards have evolved from focusing on systems and production to focusing on patient care and clinical services,” said Douglas Scheckelhoff, M.S., FASHP, ASHP’s vice president of professional development. “Now students are able to build upon their skills and actually apply them as they go through their residencies.”

More than 32,000 pharmacists have completed ASHP-accredited residency programs since 1963, and the number of accredited programs has grown to 1,577.

It has been a long but necessary journey, one that serves to propel pharmacists into rewarding careers and to advance the profession as a whole.

 

Benefits for Residents

Daniel M. Ashby, M.S., FASHP

“Accredited residency programs ensure competency that is rooted in knowledge, skills and abilities,” Ashby said. “Accreditation is our profession’s Good Housekeeping Seal of Approval, signifying that certain requirements in training have been met.”

Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP, associate dean of academic and student affairs and associate professor, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, and a member of ASHP’s Board of Directors, added that accreditation is testimony to the atmosphere of the program in which the resident has trained.

Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP

Participating in an accredited program also gives residents an edge in seeking employment, said Janet L. Teeters, M.S., ASHP’s director of accreditation services.

“Many jobs require applicants to have had a residency,” she said. “The current market is prompting health systems to ratchet down on costs, and they are scrutinizing who they hire. When they see that someone has been through an accredited residency program, they automatically know what kind of skills and training the person has.”

At the Department of Veterans Affairs (VA), which has 585 accredited residency positions spread across 140 programs, accreditation levels the playing field, said Lori J. Golterman, Pharm.D., national director of pharmacy residency programs and education for the VA.

“Each student has different experience because they all come from different schools, and accredited residency provides an opportunity for consistent training,” she said.

 Benefits for Hospitals and Other Health Care Settings

For organizations seeking accreditation, the benefits start accruing long before their ASHP surveyor visit. Simply completing the preliminary RU Ready Assessment Tool for Pharmacy Residency Programs will be enlightening, said Smith.

“The self-assessment helps organizations review their own compliance with each element or standard. It gives them a good idea of how they are doing and what their strengths and weaknesses are.”

The number of residencies in ambulatory clinics and community pharmacies is growing. Above, Brooke Hudspeth, Pharm.D., a former PGY1 resident at the University of Kentucky College of Pharmacy, measures a patient’s blood pressure at Kroger Pharmacy, Lexington, Ky.

“It comes back to the environment,” she said. “A lot of people want to be involved with the programs and work in systems with that kind of culture and recognition.”

Brian Swift, Pharm.D., vice president and chief pharmacy officer at Thomas Jefferson University Hospital in Philadelphia, the very first site surveyed for accreditation back in 1963, agrees.

“Accreditation adds credibility. It carries an association with a large body of individuals [ASHP members] who have already traveled the path [of training and experience], and includes the organization in a legacy of outstanding practitioners and leaders in the pharmacy world,” he said.

And then there is the reimbursement. “Hospitals that run accredited residencies can get Medicare pass-through funding for allied health postgraduate educational programs,” said Teeters. “If 40 percent of their patients are Medicare patients, having an accredited program will enable them to get 40 percent of the cost of their PGY1 residency program funded.”

Benefits for the Profession

Accredited residency programs advance pharmacy within organizations and among other clinicians in the allied health professions. Indeed, preparing to apply for accreditation prompts pharmacy departments to become more cohesive and visible, said Golterman.

From left, Katie Long, Pharm.D., a University of Kentucky PGY2 oncology resident, consults with Stephanie Sutphin, Pharm.D., Clinical Pharmacy Specialist, Outpatient Hematology/Oncology.

“Everyone needs to be involved in the training to give the residents an optimal experience. If the chief of pharmacy or other professionals don’t want to teach or be involved, residency directors need to communicate the importance of their programs to them and change that.”

Because administrators must provide approval to seek accreditation, the process offers an opportunity to shine the light on the profession, said Swift.

“It helps to illustrate where pharmacy should fit in, and it forces pharmacy departments to push for recognition of their programs throughout the organization.”

Accredited residencies also drive practice innovation, which will help expand pharmacy into additional patient-care areas and promote the inclusion of pharmacists as vital members of the care team. For example, at Jefferson, residents conduct research projects and marry those projects with the needs of the pharmacy department in a way that fosters organizational and practice change, said Swift.

“We turn to residents more as practitioners and welcome creative practice methods. We look to them for their insight and energy in breaking down barriers in areas where traditional pharmacy practice may sometimes be limited.”

—By Terri D’Arrigo

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June 4, 2013

Courage

Gerald E. Meyer, Pharm.D., MBA, FASHP

Editor’s Note: The following inaugural address was given by new ASHP President Gerald E. Meyer, Pharm.D., MBA, FASHP, at the Opening Session of ASHP’s Summer Meeting in Minneapolis, Minn.,  June 4, 2013. Dr. Meyer is director of experiential education, Jefferson School of Pharmacy, Philadelphia. His full address will appear in the August 15 issue of the American Journal of Health-System Pharmacy. To watch the speech in its entirety, click here.

GOOD MORNING, AND THANK YOU for that warm welcome!

I would like to begin by acknowledging you—our members. I want to personally thank all of the members who have participated in ASHP’s state societies.

ASHP could not fulfill its mission without the support and inspired leadership of our affiliates. Yes, being president of ASHP involves a lot of time and travel. But, it also comes with a large support staff.

Local volunteer leaders, on the other hand, do it all. You are the membership committee, the program committee, the finance committee, and the professional advocacy committee. So, to all of you, a great big thanks!

A Rich Pharmacy History

Many of you may know that I am from Philadelphia. And I am proud of it.

Philadelphia has a very rich pharmacy history. We have the first hospital in the United States—Pennsylvania Hospital, founded by Benjamin Franklin in 1751. We have the first college of pharmacy in the United States—the Philadelphia College of Pharmacy, which opened in 1821. And we had the first hospital pharmacist in the United States—no, not me. His name was Jonathan Roberts.

We also lay claim to the first Hospital Pharmacy Residency Program to be surveyed for ASHP accreditation and the first accredited Pharmacy Technician Training Program–both at Thomas Jefferson University Hospital.

We have four past-presidents of ASHP currently working in Philadelphia and a fifth in retirement nearby. I won’t tell you who they are—that’s a quiz.

I have been truly fortunate to have had access to so many health-system pharmacy leaders. They, together with many other professional colleagues, have been invaluable as I charted a course through my career. And, of course, I have the most wonderful personal support from my wife, Cheryl, and my family.

I want to extend my personal thanks to all of them for their encouragement and support.

Top Priorities

In writing this speech, I definitely had a lot of people to call upon. Yet, as much as I value their wisdom, I did not ask a single one of them for guidance on what I should talk about today.

Rather, I asked you, the members. ASHP is a membership organization. It is owned by you, its members. So I felt it was appropriate to focus our discussion today on those issues that are of greatest importance to you.

We sent out a survey to a random sample of ASHP members and asked: “What question would you like to ask Gerry Meyer?” Well, you did not disappoint. We received 130 questions, many of which spoke to the concept of courage. So, settle back and relax. This may take awhile. (OK, for the sake of time, we did narrow it down a bit.)

For our first question, Fred Bender, Pharm.D., FASHP, director of pharmacy services at Greenville Health System in Greenville, S.C., asked, “What will be your top priorities as incoming president of ASHP?”

Fred, I have a list of priorities to share with you. But my priorities are of little value unless they become our priorities. My top priority, therefore, is to be the best leader I can possibly be. And you can’t lead without a vision. So, let’s start there.

What makes a good leader?

  • The ability to articulate a vision,
  • The ability to motivate others toward that vision, and
  • The ability to remove obstacles to promote achievement of the vision.

Now, who among you can recite ASHP’s vision? ASHP’s vision is that medication use will be optimal, safe and effective for all people, all of the time. There’s no mention of “hospitals” or “health systems.” There’s not even mention of “patients.” It says “all people, all of the time.”

So, Fred, here is my list of priorities for the year. I would suggest that we view most of the individual items on this list as obstacles confronting us in our efforts to accomplish ASHP’s vision:

  • Build coalitions,
  • Implement the recommendations of the Pharmacy Practice Model Initiative,
  • Pursue provider status,
  • Promote interprofessional education and practice,
  • Expand training and certification for pharmacists and pharmacy technicians,
  • Position ASHP to be as nimble as possible in a rapidly changing environment, and…
  • World peace!

I’m somewhat serious about that last item on the list. Creating an environment in which medication use will be optimal, safe and effective for all people, all of the time is a bold and expansive vision. And just because it is hard to conceptualize, we cannot be deterred from putting our energies towards its achievement. (So, in that respect, our vision is a bit like world peace.)

Becoming Strong Advocates for Patients, Profession

Kevin Aloysius, who just graduated with his Pharm.D. last month from Texas Tech University Health Sciences Center, in Lubbock, (congratulations to all new graduates, by the way!), asked the next question: “How do we prevent doctors’ comments such as, ‘Well, if you wanted to give me recommendations on how to treat a patient, why didn’t you go to medical school?’ “

Kevin, there is a serious answer to your question, but if I wanted to be flippant, I’d say to the physician in question: “If you wanted to be a medication-use expert, why didn’t you go to pharmacy school?” That is an accurate, patient-centric response, isn’t it? A pharmacist’s unique education focuses on the optimal, safe and effective use of medication for all people, all of the time.

Having said that, let’s remember that physicians build their reputations on high-quality outcomes. Why, then, don’t physicians seek the counsel of pharmacists in all matters of medication use? After all, the rate of medication misadventures in the current system is well-documented and not acceptable.

I believe their hesitancy relates to the element of trust. Physicians trust pharmacists to prepare and dispense medications accurately. They trust pharmacists to offer advice on proper administration. They expect pharmacists to offer suggestions on medication compatibility and dosage adjustments.

But, some may not trust pharmacists to create optimal, safe and effective medication-use plans for all people, all of the time. How, then, do we build this trust?

We must aggressively pursue all avenues to modify the perceptions of physicians. And not just physicians, but also health care policy makers, decision makers, and providers, as well as  the general public about the unique education and training possessed by pharmacists. We must have the courage to be strong advocates for our patients and for our profession. Historically, we have been far too passive in promoting our value.

Antagonism vs. Synergism

Our next question comes from Jamie Ridley Klucken, Pharm.D., MBA, BCPS, an assistant professor of pharmacy practice at Shenandoah University, Ashburn, Va., who asked, “We see a push to work collaboratively with other health care providers but seem to have a difficult time putting this into practice. Are there ways to accelerate this interprofessional practice? Perhaps through pharmacy education and post-graduate residency programs?”

Jamie, by definition, interprofessional activities cannot be accomplished by one profession. Each profession must be willing to participate.

The good news is that in May 2011, a group called the Interprofessional Education Collaborative—consisting of educators representing pharmacy, medicine, nursing, dentistry, and public health—released a report that summarized the core competencies needed for interprofessional collaborative practice. Those core competencies fell within four domains:

  • Values and ethics,
  • Roles and responsibilities,
  • Interprofessional communication, and
  • Teams and teamwork.

What this report says is that to build an efficient and effective health care system, health care providers need to:

  • Have a common understanding of health care ethics and values,
  • Understand one another’s roles and responsibilities,
  • Learn how to communicate with one another, and
  • Learn how to be part of effective teams and how to play well together in the sandbox.

For two years, we have had this guidance document that delineates the curricular components that should be taught to health care students, interprofessionally. Jamie, I agree with you. Our profession needs to take a leadership position in incorporating interprofessional competencies into our formal education and training standards. These changes cannot occur fast enough.

Furthermore, to develop this set of skills and knowledge within practicing pharmacists, ASHP must incorporate this critical content within our continuing professional development offerings.

It’s important to consider what this report does not say. Nowhere does it say that interprofessional education should encompass getting health care students into the same classroom to teach them pathophysiology, pharmacology, diagnosis, or treatment. So, if those are not our commonalities, then those must be our differences. Exactly.

Let’s look at this in pharmacologic terms. Sometimes, we administer two very effective drugs that may compete for the same receptor, and the result is that they become less effective. We call that phenomenon “antagonism.” On the other hand, sometimes we prescribe two drugs and the positive effect is greater than the anticipated sum of their individual effects. We call that “synergism.”

Let’s move past interprofessional antagonism. Let’s have the courage to promote an efficient and effective health care system comprised of interdependent, synergistic health care providers.

Practicing at the Top of Our Education, Training

The next question comes from Cassie Heffern, Pharm.D., a PGY2 ambulatory care resident with CoxHealth, in Springfield, Mo., who asked: “In some more rural hospitals, change is almost feared. Despite [the fact] that no one will lose a position by  including more PPMI, the subject is still feared. How would you suggest to keep moving forward with PPMI?”

As you may know, ASHP’s Pharmacy Practice Model Initiative—or PPMI—envisions a future in which pharmacists practice at the top of their education and training. The model identifies the roles that pharmacists must assume and then describes the need to maximize the incorporation of enablers—notably, technicians and technology—to help achieve those roles.

Earlier, I stated that leadership encompasses stating a vision, engaging others to embrace the vision, and removing obstacles toward accomplishing the vision.

For 71 years, ASHP has been a leadership organization. This professional leadership continues. Through the PPMI, ASHP members created a bold vision, and ASHP is committing significant resources to help our members achieve their vision.

Cassie, your question alluded to challenges faced by rural health care providers. We recognize that many of our members are not able to leave their workplace to attend live educational offerings. We have begun, and will continue to accelerate, the delivery of educational programming in formats that offer accessibility to all of our members.

The PPMI envisions advancing pharmacy practice beyond pharmacists offering recommendations for others to implement. It envisions pharmacists as interdependent prescribers who accept accountability for the patient-care plans that they personally initiate.

The willingness to expand our scope of accountability to improve our patients’ health is the essence of our envisioned pharmacy practice model. Are we prepared to expand our scope of practice? Are we prepared to accept accountability for prescribing decisions?

Doing so requires courage. It requires the courage to challenge the status quo. It requires the courage to practice at the top of our education and training, not just at the top of our licenses. It requires the courage to practice beyond the borders of established practice.

The Future of Residency Training

Among the questions I received, more related to residencies than to any other topic. Two members, Kent Montierth, Pharm.D., director of pharmacy for Banner Estrella Medical Center, in Phoenix, Ariz., and Erica Maceira, Pharm.D., BCPS, CACP, clinical pharmacy specialist and student and resident coordinator at Albany Medical Center Hospital in Albany, N.Y., asked: “How does ASHP plan to help grow the number of residency programs and the number of available positions? And, how can the accreditation process be simplified?”

Although it sometimes may feel like we are making little progress in this area, the numbers tell a different story. From 1995 to 2006 (a 12-year period), the number of available accredited residency programs and the number of available positions in those programs doubled. From 2006 to 2012 (a subsequent six-year period), the number of accredited residency programs and number of positions doubled again.

Part of the reason for this rapid growth is that the value proposition for residencies is easily developed for residents,  employers, patients, and the profession. The ASHP website contains a number of documents that can assist practitioners in justifying, designing, and conducting residency training programs.

However, one of the greatest barriers to increasing the number of residency training programs cannot be overcome with guidance documents  alone. A good training program requires a solid infrastructure.

Pharmacy services must meet contemporary standards of practice. Preceptors must have the ability to impart knowledge and develop critical reasoning skills. Residency program directors must be able to mentor and  inspire those entering the profession. And an organization’s culture must be supportive of the training mission.

We cannot, and we should not, compromise on these foundational pillars.

There are now more than 1,000 residency programs in the United States that have a solid infrastructure. I call on those programs to consider expanding. For those institutions without a sufficient infrastructure currently in place, consider collaborating with an existing residency program.

In the 1970s, and then again in the 1990s, my institution offered joint residency positions with neighboring institutions. Those joint programs continued until our partners had developed sufficient infrastructure to conduct their residencies independently.

Kent and Erica, you also asked about simplifying the accreditation process. I agree that we must critically evaluate the current standards to ensure that each requirement contributes to the quality of the training process.

Both the PGY1 and PGY2 standards for accreditation are currently under revision, which presents us with just such an opportunity. As drafts of proposed revisions to those standards are circulated, I encourage all residency program directors to provide your feedback.

Many of the questions I received about residency training referred to ASHP’s member-developed policy that, by 2020, all pharmacists involved in direct patient care must complete a residency.

Let me be clear. Residency training is a critical element in enhancing patient care by expanding pharmacists’ responsibilities. Residencies instill the confidence in young practitioners to have the courage to drive the profession past its current borders.

Please remember that ASHP’s residency policy is aspirational in nature. The decision about whether to pursue a residency is  a career decision. You do not need a residency to obtain a pharmacist license. But you do need a residency to pursue and advance along certain career paths, and the number of those career paths continues to grow every year.

There are four stages to the education and continued training of a pharmacist: pre-pharmacy undergraduate education, professional doctorate education, formalized training, and continuing professional development.

Coordinating the outcomes of each of these four stages is a professional imperative. While the requirements for the pre-pharmacy and pharmacy curricula will evolve, we must recognize that there is only so much that we can accomplish in the classroom because (1) contact time is limited, and (2) students do not have pharmacist licenses.

At some point in time, the profession will need to address the question: Should residency training be required for pharmacists to meet their obligation to  their patients? At some point, that answer will be “yes.” Whether this happens by 2020 or not, it is far better for the profession to prepare for that future than to be unprepared when that future arrives.

Gaining Provider Status

Zina Gugkaeva, Pharm.D., a PGY1 resident at the University of Iowa Hospitals and Clinics, in Iowa City, asked our sixth and final question: “When are pharmacists finally going to be recognized as providers, and what will it change?”

Many of you may have attended the Provider Status Town Hall at this Summer Meeting where this very issue was discussed. Much of what we heard, we already knew:

  • The health care environment is changing.
  • Emerging practice models are focused on integrated health care delivery systems.
  • Policymakers are seeking ways to make health care more affordable for more people.
  • Payment will be focused on quality, not quantity, of care.
  • Consumers will demand transparency in the cost of their care.

So, what will happen when pharmacists are recognized as health care providers?

  • Pharmacists’ patient care services will improve access.
  • Pharmacists’ patient care services will improve quality.
  • Pharmacists’ patient care services will help control costs.

Access—quality—cost. There is substantial documentation to support the positive impact of pharmacists on access, quality and cost of care. We know it. Now we have to sell it. We must have the courage of our convictions.

The first step is to ensure that the profession moves forward with this common message by solidifying these basic principles within the existing coalition of pharmacy organizations. Then, we need to expand the coalition to include other critical stakeholders, including health care provider groups, payers, and patient advocates. We need to draft legislation and seek support by educating legislators, both on a state and national level.

ASHP will serve as your collective voice in formulating the message. ASHP will develop the materials needed to deliver that message. ASHP will tailor those materials for different audiences. And ASHP will train you.

But, we need you to deliver the message to your legislators, to your C-suite, to your health-system’s lobbyists, to your health care colleagues, to your complacent pharmacist colleagues, to your local media, and to your patients.

Access—quality—cost. The message is clear. The message is focused. The message meets society’s needs.

Gaining provider status will ensure that pharmacy is at the table when regulators and other policymakers invite health care providers to help construct new delivery models. And that is why ASHP, the American Pharmacists Association (APhA), the American College of Clinical Pharmacy (ACCP), and other health care organizations have committed significant resources to achieving provider status for pharmacists.

Zina, while no one can predict when we will finally succeed, I am confident that we will succeed if we have the courage to stand strong and united on this issue and if our members get personally involved.

I call upon all pharmacists who believe they are health care providers, on all student pharmacists who believe they are training to become health care providers, on all people who want their medication use to be optimal, safe and effective all of the time. I call on everyone to send the message: “Pharmacists are medication-use experts. Pharmacists improve access, improve quality, and control the cost of health care. Pharmacists are health care providers.”

In closing, I want to thank everyone who took the time to submit questions. I invite you to continue to send me your comments and suggestions over the next year. Finally, I want to thank you for the courage you show every day toward advancing ASHP’s vision: that medication use will be optimal, safe and effective for all people, all of the time.

Thank you.

June 3, 2013

New CE Service for Techs Features Webinars

Filed under: Current Issue,Feature Stories — Tags: , , — Kathy Biesecker @ 3:44 pm

ASHP’S NEW ONLINE LEARNING PORTAL for pharmacy technicians, PharmacyTechCE.org, is hosting a number of webinars as part of a monthly series. The subscription service, which is available to individual pharmacy technicians, pharmacies, and pharmacy departments, will offer over 20 hours of continuing pharmacy education (CPE) annually.

photo by Matthew LesterEducational categories on the site include automation, sterile compounding, medication and patient safety, pharmacy operations, pharmacy law, professional practice, and quality improvement.

“ASHP is making this investment in quality education and professional development for pharmacy technicians because we believe that well-trained pharmacy technicians can help us advance pharmacy practice and improve quality for all patients in all health care settings,” said ASHP CEO Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP.

Subscriptions to PharmacyTechCE.org are available both to employers investing in these critical members of the pharmacy team and to individual pharmacy technicians looking for technician-designated education. Most topics are available in podcast, CE monograph, and on-demand formats, providing the flexibility for different learning preferences.

June 2, 2013

ASHP Connect Blog Dives into Ambulatory Care Issues

Filed under: Feature Stories,Uncategorized — Tags: — Kathy Biesecker @ 3:10 pm

connect.fwINTERESTED IN AMBULATORY CARE issues? Need some advice on a challenge you are facing from fellow practitioners who may have experienced the same thing? Take a look at the new blog series on ASHP Connect called, “Fridays with Ambulatory Care.” Each post is based on a different chapter from the book, Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists. Topics include creating a sound business plan, incorporating a sound electronic medical records system, new practice models, and more.

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