ASHP InterSections ASHP InterSections

January 23, 2014

“Let’s Talk” Initiative Builds Patient Awareness of Pharmacists’ Role

“This is my third hospitalization in the last two years, and I’ve never seen a pharmacist. It’s very hard to believe that pharmacists are taking part in patient care. I know they do, but they’re always in the background.”

Philip King’s efforts resulted in an increase in patient awareness about pharmacists’ role on the health care team.

THIS RESPONSE TO A SURVEY about patient expectations of  hospital pharmacy services was no surprise to Philip K. King, Pharm.D.

King first noticed this common perception among patients as a pharmacy student while on a five-month rotation at the Cleveland Clinic.

“Patients were always surprised to see a pharmacist in their room,” said King, who is now a first-year resident at the 319-bed University of Toledo Medical Center (UTMC), Toledo, Ohio.

“Many were shocked to learn that pharmacists were involved in patient care. They just didn’t understand that idea,” he said.

“I don’t want them to be surprised. I want them to know we are an important and accessible presence who can have a major impact on their care.”

Increasing Pharmacists’ Visibility

Judging by the results of a pilot study that he conducted, King seems to have found a simple and effective way to ensure that patients know what pharmacists can do for them.

King put into motion a plan he had drafted as a pharmacy student and polished up with the help of his residency research advisor. The goal? Increase awareness of pharmacy services among hospital patients.

King contacted ASHP to see if the Society had any programs or resources available that could help him increase the visibility of pharmacists and raise patient satisfaction with medication-use services.

“It was a timely call because we had just launched the ‘Let’s Talk Medications!’ program, which is designed for both hospitals and other health care sites, such as ambulatory settings,” said Ellen Wilcox, director of ASHP’s Public Relations Division.

“We were very excited that Dr. King reached out to us just as we were initiating the program. His hospital became the first in the nation to roll it out.”

Steven J. Martin, Pharm.D., BCPS, FCCP, FCCM

Steven J. Martin, Pharm.D., BCPS, FCCP, FCCM, professor and chairman of the Department of Pharmacy Practice at UTMC and King’s residency advisor, believes there is great value to a program like “Let’s Talk.”

Once patients recognize that pharmacists are available on a consulting basis, they “naturally understand that we are drug experts. And when they want expert medication advice, patients want to talk to a pharmacist,” he said.

Martin noted that patients are simply unaware that there are pharmacists throughout the health care system involved in their care.

“We tend to fade into the woodwork, and we need to step up our practice so that patients know we’re there and available to help them,” he said.

King went to work using materials supplied by the “Let’s Talk” initiative, which included brochures and posters that describe pharmacist services in the hospital. During the month-long campaign that began October 1, 2013 (coinciding with American Pharmacists Month and National Hospital and Health-System Pharmacy Week), pharmacy students, residents, and staff pharmacists delivered brochures to as many admitted patients as possible and told them that pharmacists were available around the clock to answer questions.

The brochure included the direct phone extension to the inpatient pharmacy. Posters were displayed near elevators and in the nearby outpatient pharmacy. All program material was customized so that it included hospital-specific information.

“We wanted to target more than just patients, which is why we put posters up at main entrances and elevators,” said King. “Patients aren’t likely to see the posters placed in those areas, but family members and other health care providers are, so they’ll know that we have a presence in the hospital, too.”

ASHP's new "Let's Talk Medications!" initiative is designed to build awareness of pharmacists' roles in all settings, including ambulatory care.

ASHP’s new “Let’s Talk Medications!” initiative is designed to build awareness of pharmacists’ roles in all settings, including ambulatory care.

Striking Survey Results

The study included two cohorts: patients who were exposed to the campaign and a control group consisting of patients who were admitted during the month prior to the campaign.

Patients from both groups who met the study inclusion criteria were asked to complete a 12-question survey. Participants also were free to add comments, such as the one at the top of this story which was written before the patient was exposed to the campaign.

Of the 147 control patients who returned their surveys, only seven (4.8 percent) contacted a pharmacist for help. Of the 140 patients exposed to the campaign who returned their surveys, 63 (46 percent) requested information from a pharmacist.

Just as striking were the preliminary survey results. For example, 57 percent of respondents in the control group “agreed” or “strongly agreed” with the statement, “Pharmacists are available for me in the hospital,” compared with 92 percent of patients who had been exposed to the campaign. King is currently working on a full statistical analysis of the results as well as an assessment of how the program might influence HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) patient satisfaction scores.

“The results so far have been very encouraging, but it’s clear that we need to do much more as pharmacists to educate patients and other health care providers about our role in patient care,” said King, adding that he hopes to conduct a long-term campaign in the future. “This campaign can begin that conversation, but it needs to be done on a much larger scale and for a much longer time to have the impact we want.”

To learn more about the Let’s Talk Medications! campaign, click here.

–By Steve Frandzel

 

January 10, 2014

When Ripples Become Waves: Pharmacy as a Caring Profession

Elva Angelique Van Devender, Ph.D., Pharm.D., BCPS

Elva Angelique Van Devender, Ph.D., Pharm.D., BCPS

PEOPLE OFTEN ASK ME about my most memorable intervention as a pharmacist. As an emergency department (ED) pharmacist, I am uniquely positioned on the front lines of patient care to make important life-saving pharmaceutical interventions for patients.

I have been fortunate to have had many meaningful interactions with patients as both an ICU and ED pharmacist. I have caught some serious drug interactions, put patients on life-saving medications, recommended cost-saving therapies to save patients money, and educated my patients about wellness and proper medication use. However, the experiences that stand out in my memory are not the pharmacologic interventions but the personal ones, such as holding a patient’s hand during a difficult diagnosis or hugging an elderly patient in terrible pain.

A Memorable Intervention

These interactions transform me as a practitioner as much as they do the lives of the patients for whom I care. My most memorable intervention happened during the first week of my first rotation as a fourth-year pharmacy student. Aside from igniting my lifelong interest in critical care and emergency medicine and cementing my desire to practice in this intense and challenging setting, this critical care rotation gave me the opportunity to assist in code situations.

At the end of my first week in the ICU, we had a code blue during rounds. The patient was 19 years old, and her mother was in the room when it happened. I was a student at the time, so what was I expected to do? I wasn’t able to administer medications… my preceptor was doing that. I felt useless in that room with so many expertly moving parts, and my preceptor didn’t need any help, so I looked at the patient’s mother.

Everyone was so focused on saving the patient that they didn’t notice that the girl’s mother was standing at the periphery of all of the action, crying. She was shaking, so I brought in a chair and wrapped some warm blankets around her.  Then I crouched down beside her and began explaining what the team was doing and what the telemetry meant, so she would not be so frantic about what was happening to her daughter. When it got to the point when I didn’t know what else to say or do, I just put my arm around her and prayed with her.

We couldn’t save her daughter. But the mother came up to me after the code and threw her arms around me, thanking me for my kindness. I just held her while she cried, not knowing what else I could say or do. We stood in the hallway for a long time like that, until the chaplain came.

The Ripple Effect of Small Actions

As a student with little experience and no real ability to intervene medically to save the patient, I had thought my contribution was trivial compared to the actions of the skilled doctors, nurses, and my preceptor who labored in the room that day.

What I didn’t realize was that my small actions had a ripple effect on those around me. In the weeks following that code, several people stopped me in the ICU to tell me that they remembered me from that code and what I had done for the patient’s mother. One of the nurses told me that I made her remember why she went into health care in the first place.

What I didn’t realize was that my small actions had a ripple effect on those around me.

That code became an important catalyst for my journey as a clinical practitioner because it taught me something very valuable: Every action has a ripple effect. Even when we feel invisible—and pharmacy can sometimes feel like an invisible hand guiding medication usage—actions matter. People matter.

Regardless of whether we are students or seasoned practitioners, I learned that we can never underestimate the power that our actions have on others. Waves can arise from the smallest of ripples. The tides we will experience tomorrow begin, in some small way, from the ripples we make today.

–By Elva Angelique Van Devender, Ph.D., Pharm.D., BCPS, Clinical Pharmacist, Legacy Good Samaritan Medical Center, Portland, Oregon

 

January 3, 2014

Growing Trend Toward Specialization, Board Certification

 

Credentialing in a particular specialty can help enhance relationships among the health care team, as fellow professionals respect the base of knowledge that accompanies a pharmacy specialty certification.

Credentialing in a particular specialty can help enhance relationships among the health care team, as fellow professionals respect the base of knowledge that accompanies a pharmacy specialty certification.

IN THE LAST 11 YEARS, the number of pharmacists who have become board certified in a pharmacy specialty by the Board of Pharmacy Specialties (BPS) has doubled every five years, from roughly 3,600 in 2002 to more than 18,000 in 2013, with many pharmacists attaining dual credentials.

As care shifts toward a team-based approach and health care reform mandates accountability and affordability, board certification stands poised to expand in tandem with the profession as a whole.

“Pharmacists will have a bigger role in direct patient care in primary care settings, and organizations will be looking for pharmacists who have the knowledge, skills, and abilities to take care of their particular populations,” said David Witmer, Pharm.D., ASHP senior vice president and chief operating officer.

“Credentialing in general (board certification being one method) will become more important as pharmacists become increasingly differentiated in terms of the patients we take care of and the increasingly complex medication regimens our patients require.”

 

William Ellis, R.Ph., M.S.

William Ellis, R.Ph., M.S.

Fastest-Growing Specialties

Currently, the largest pharmacy specialty for which the BPS offers certification is pharmacotherapy, with more than 10,000 pharmacists holding that credential, followed by oncology and ambulatory care.

 

“Pharmacotherapy is a broad-based credential that demonstrates a deep knowledge of medications and allows pharmacists to practice in a variety of settings,” said William Ellis, R.Ph., M.S., executive director of BPS.

Ellis noted that ambulatory care is the fastest-growing specialty and will most likely overtake oncology by 2015 as the second largest. “This is because care is shifting from inpatient settings to outpatient settings. A large number of individuals are ambulatory care patients with chronic diseases, and they need medication management.”

Certification Grows with Provider Status

In October, pharmacists won provider status in California, joining their colleagues in North Carolina, New Mexico, Montana, and Washington State. Pharmacists wishing to attain the designation of “Advanced Practice Pharmacist” in California must meet two of three criteria: completion of a pharmacy residency where at least 50 percent of the experience includes providing direction patient care, one year of providing clinical services to patients under a collaborative practice agreement or protocol, or certification in an area of clinical practice.

As provider status in California takes effect this month, there will most likely be an uptick in pharmacists seeking board certification, said Witmer. “In California and other states that may pursue similar approaches, certification will enable pharmacists to obtain recognition and make maximum use their training and education.

 

Daniel B. Truelove, Pharm.D., BCPS (AQ-ID), BCACP, AAHIVP

Daniel B. Truelove, Pharm.D., BCPS (AQ-ID), BCACP, AAHIVP

Daniel B. Truelove, Pharm.D., BCPS (AQ-ID), BCACP, AAHIVP, clinical pharmacy specialist in ambulatory care/HIV and PGY2 residency coordinator at the University of Louisville Hospital in Kentucky, believes that provider status may lead specifically to increased numbers of pharmacists seeking board certification in general and ambulatory care  certification, in particular.

“Recent health care reform is increasing the demand for primary care providers and providers in specialized areas of care,” said Truelove. “In the next five to 10 years, this will lead to expanded scopes of practice for pharmacists and provider status the same way that physician assistants and nurse practitioners have gained.”

Truelove added that in the ambulatory care setting, “there will be a need for providers to handle chronic disease states. Pharmacists can play an integral role as medication experts.”

Advancing Careers

For Abimbola Farinde, Pharm.D., M.S., BCPP, pharmacist at Clear Lake Regional Medical Center in Webster, Tex., and online faculty for Columbia Southern University, Orange Beach, Ala., becoming board certified was a natural step after her residency. She feels it is a way of communicating to other clinicians that she has a particular base of knowledge.

“When credentials are presented to medical and nursing staff, they can relate to it. The testing is similar to what they have, and it lends support to your recommendations and the contributions you can make to the team,” she said.

Farinde added that board certification puts patients at ease, as well.

“Patients often want to talk to someone who knows about the medications they’ll be taking and how they will work. There is a level of reassurance in knowing that the pharmacist is well-trained and has a deep understanding of what they are being treated for.”

 

Earlier this year, BPS approved certifications in pediatric pharmacy and critical care pharmacy. Up next? Specialty certifications in pain and palliative care, cardiology, and infectious diseases.

Earlier this year, BPS approved certifications in pediatric pharmacy and critical care pharmacy. Up next? Pain and palliative care, cardiology, and infectious diseases specialty certifications.

A Good Way to Differentiate Yourself

Witmer notes that in a growing number of health systems, certain positions require board certification as a condition of employment. “As the shortage of pharmacists wanes, board certification in a specialty is a strong way of distinguishing yourself in the job market.”

Truelove can speak to that. “Where I work now, it’s pretty much an unwritten rule that you get board certified after your residency.”

Earlier this year, BPS approved certifications in pediatric pharmacy and critical care pharmacy. According to Ellis, BPS is also working on certifications for specialization in pain and palliative care, cardiology, and infectious diseases. He feels that pharmacy students should keep the changing nature of pharmacy specialization in mind.

“Evolving clinical roles for pharmacists will most likely require board certification,” Ellis said. “The number of specialties from which to choose should help pharmacy students and future practitioners in a job market that will become increasingly competitive.”

–By Terri D’Arrigo

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Stay Tuned for More Stories on Specialty Certification…

ASHP offers specialty review courses and recertification programs to help new pharmacists and veteran pharmacists alike prepare for BPS certification examinations in the pharmacotherapy, ambulatory care, and oncology specialties. A fourth offering, core therapeutic modules, is a collection of on-demand, web-based activities that can help practitioners prepare for BPS exams. The modules can also serve as part of a staff development program.

Stay tuned for the second part of this InterSections series on the value of specialty certification that will explore how ASHP’s programs were designed and the advantages they offer, and share the experiences of those who have used them. 

 

 

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