ASHP InterSections ASHP InterSections

May 28, 2014

Student Workshops Honing Future Pharmacy Leaders

Filed under: Current Issue,Feature Stories,Innovation,Students,Uncategorized — Tags: , , — Kathy Biesecker @ 3:26 pm
ASHP's Student Leadership Development Workshops have benefited thousands of students since they debuted in 2008.

ASHP’s Student Leadership Development Workshops have benefited thousands of students since debuting in 2008.

WHEN ARPIT MEHTA, PHARM.D., attended ASHP’s Student Leadership Development Workshop (SLDW) at the 2010 Summer Meeting in Tampa, he couldn’t have known how much impact the three-hour program would have on his future.

“The workshop influenced me to choose a pharmacy administration track for my residency,” said Methta, who was a second-year pharmacy student at the time of the workshop. Now he’s finishing the second year of his pharmacy administration residency at West Penn Allegheny Health System in Pittsburgh.

“The workshop showed me that I would enjoy a leadership role, and it made me think about things that pharmacy students usually don’t consider.”

Developed through the work of the Section of Pharmacy Practice Managers’ Advisory Group on Leadership Development, the first SLDW was first held at the 2008 Pharmacy Society of Wisconsin’s annual meeting. It was part of ASHP’s response to warnings of an imminent leadership gap in hospital and health-system pharmacy—particularly a 2005 watershed paper by pharmacy leader and former ASHP President Sara White, M.S., FASHP[1].

Among White’s recommendations was the need to “identify and encourage students, residents, and practitioners who are interested in and have the ability to be leaders and change agents.”

Leadership Gap on the Horizon?

Diana L. Dabdub, director of ASHP’s Pharmacy Student Forum, concurred that the profession is facing a lack of new leaders and succession planning in coming years.

Diana L. Dabdub

Diana L. Dabdub

“Because many pharmacy leaders will be retiring, ASHP needed a way to interest more students in taking on both formal and informal leadership roles,” she noted, adding that when the workshop was first developed, few pharmacy school curricula include a focus on leadership development skills.

A major goal of the workshop is to spark student interest in leadership opportunities in pharmacy. Other objectives are learning to distinguish between leadership and management; understanding the relationship among administrative, clinical, and other general and specialty leadership roles; understand the need for strong leaders in the future; and learning how to build personal leadership qualities.

The first part of a typical SLDW covers leadership philosophies and concepts. During the second part, participants break into groups to explore contemporary leadership topics in depth and prepare and deliver a presentation to persuade the rest of the group (a role that is often played by C-suite level professionals in hospitals and health systems) to take a particular action, such as funding a new clinical pharmacy service.

The workshop leader—often a well-known figure in the profession—is assisted by several facilitators who are typically pharmacy residents or new practitioners. At least one of those facilitators has gone on to lead the workshops himself, according to Dabdub.

Since the SLDW debuted at the 2008 Pharmacy Society of Wisconsin’s annual meeting, it has been held at more than 20 other ASHP state affiliate meetings and several ASHP Summer meetings.

Not Just for Future Pharmacy Directors

According to David Chen, R.Ph., MBA, senior director of ASHP’s Section of Pharmacy Practice Managers, more than 2,000 pharmacy students have completed the workshop. Its popularity continues to rise.

“Leadership is an energizing topic that’s universal and timeless,” Chen said, adding that the workshop creates opportunities not only for the students to learn a great deal, but also to mingle with like-minded peers from other schools.

Philip Brummond, Pharm.D., M.S.

Philip Brummond, Pharm.D., M.S.

“The workshop is not just for people who want to become pharmacy directors or hold formal management positions, but for anyone who wants to understand and develop leadership skills, even if it’s in the context of clinical practice,” added Philip Brummond, Pharm.D., M.S., director of pharmacy at Froedtert & the Medical College of Wisconsin Froedtert Hospital in Milwaukee, who has led several workshops and was a member of original SPPM advisory group that developed the SLDW.

Students, he continued, come away with techniques they can use to “sell” themselves and their ideas, allowing them to accomplish what is needed for the patients they will serve over their career.  “It teaches fundamentals in a fun, energetic, safe setting that promotes active participation and draws on real-world scenarios.”

Brummond recalls interviewing a pharmacist who was a workshop alumnus for a clinical pharmacist position when he managed pharmacy services at the University of Michigan Hospitals and Health Centers.

“During the interview, he talked about how much the workshop had meant in shaping his approach to practice,” said Brummond. “I hired him, and now he is an up and coming leader in his field.”

SLDW participants focus on contemporary leadership philosophies and concepts.

SLDW participants focus on contemporary leadership philosophies and concepts.

According to SLDW leader Meghan D. Swarthout, Pharm.D., MBA, BCPS, “the workshop brings to life challenges that students can expect to face in practice.” Swarthout, who is division director, ambulatory and care transitions, Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, also believes the workshops are eye-opening for many students.

“It raises awareness that leadership isn’t directly tied to a title—that it happens at every level of a career and that it’s just as important for a frontline clinical pharmacist taking care of patients every day as it is for pharmacy directors and executive administrators,” she said.

Swarthout added that leaders and facilitators can gain as much as students do.

“Every time I conduct an SLDW, I’ve left more energized and full of new ideas. I’ve seen many students come up with ideas, and I said to myself, ‘I never thought of it that way, that could definitely apply to our health system.’ Because students see things in a fresh, different way, their questions and proposed solutions challenge me and help me develop my own leadership skills.”

Conducting Your Own SLDW

Because of the SLDW’s popularity, ASHP now has standardized workshop materials available on the ASHP website for members who are interested in putting on their own workshops. Resources include a slideshow, case studies, self-assessment questions, and a brief podcast with suggestions for how to conduct the program, make the best use of workshop resources, and promote the workshop to pharmacy schools and students.

Kate Farthing, Pharm.D, BCPS, FASHP,

Kate Farthing, Pharm.D.,
BCPS, FASHP

“Everything has been vetted during many successful workshops, and now it’s pre-packaged and ready to use,” said Kate Farthing, Pharm.D., BCPS, FASHP, clinical coordinator with the Legacy Health System in Portland, Oregon, who led the SLDW in the spring of 2012.

“It’s plug-and-play, easy to personalize for your own purposes and for any given audience, and it instills the idea of becoming a leader,” she said, adding that the three-hour program can easily be shortened.

Additionally, the ASHP Foundation provides up to four grants annually to members who work with their ASHP state affiliated.

Molly Juhlin, Pharm.D., served as a facilitator at Farthing’s workshop when she was a third-year pharmacy student at Oregon State University. Juhlin, who is about to finish a residency at Legacy Health, said she benefitted as much as the students did.

“The workshop gives you an opportunity to learn from pioneers in the field who helped sculpt what pharmacy is now,” she said. “How can you pass up an opportunity like that? These people share a lot of advice on how to be successful practitioners and good leaders so that we can guide the field forward when the time comes.”

For more information on attending an ASHP SLDW, click here. If you are interested in conducting a workshop, click here.

–By Steve Frandzel

             



[1] Am J Health-System Pharm. 2005;62:845-855; http://www.ajhp.org/content/62/8/845.short?rss=1&ssource=mfc)

 

May 23, 2014

Privileging Expands Pharmacists’ Role

Pharmacist privileging at Veterans Administration hospitals can extend past traditional pharmacist duties.

Pharmacist privileging at VA hospitals can extend past traditional medication management duties.

HOSPITALS THAT HAVE A STRONG CLINICAL PHARMACY PRESENCE are turning to their institutional privileging programs to expand the high-level patient care services that pharmacists can provide.

At The Johns Hopkins Hospital in Baltimore, a recently approved program will allow certain ward-based pharmacists to prescribe medications to inpatients.

“It’s about empowering some of our folks to practice at the top of their license and the top of what their knowledge base allows them to do,” said John J. Lewin III, division director of critical care and surgery pharmacy at Johns Hopkins. “That’s going to be good for patients in terms of efficiency, and accuracy, and care, and medication safety and its related outcomes.”

Lewin expects the pilot program to begin this summer in the hospital’s surgical ICU, where clinical pharmacists are fully integrated into the multiprofessional team and work there daily.

Writing Medication Orders

Under Maryland law, pharmacists can manage medication therapy by protocol, under the terms of a drug therapy management agreement between pharmacists and physicians.

“Our pharmacists do make the interventions now, but they’re not allowed to write medication orders,” Lewin said. Under the current system, any changes to the medication regimen must be performed by a resident, attending physician, or other prescriber.

John J. Lewin III

John J. Lewin III

“What we really heard from our physicians was, basically, ‘Why can’t you write the orders for this? You guys are the medication experts, and it would be good for patient care,” Lewin said.

He said allowing pharmacists to enter medication orders into the computer system will decrease the administrative burden on physicians and allow them to make better use of their time.

Ultimately, he said, about 20–30 unit-based pharmacists are expected to be granted prescribing authority. He said the expanded scope of practice will be available to clinical pharmacy specialists who have a Pharm.D. degree and postgraduate year 2 (PGY2) residency training or equivalent experience.

Lewin said hospital decision-makers concluded that modifying drug therapy is akin to prescribing, and that the hospital’s governing board should be responsible for assigning privileges to clinical pharmacists to encompass this work. The same process is used to permit physicians, nurse practitioners, and other qualified health care providers to order medications.

Lewin expects the pilot program to focus on renal dosage-adjustment protocols.

He said the protocols are designed to comply with state law and will allow pharmacists to use their professional judgment to make clinical decisions about drug therapy. He noted that different units will use different protocols that take into account the individual needs of the entire health care team and its patients.

Mirroring Physician Privileging

A similar privileging process is used at Fort Belvoir Community Hospital in Virginia, said U.S. Army Lieutenant Colonel Eric Maroyka, director of pharmacy for the joint services military treatment facility.

U.S. Army Lt. Col. Eric Maroyka

U.S. Army Lt. Col. Eric Maroyka

Maroyka said all hospital pharmacists are “core privileged” to perform routine tasks at the hospital. But about a dozen clinical pharmacy specialists with advanced training have been granted additional privileges that include the ability to prescribe medications in specific settings.

“We’re really mirroring what physicians and other midlevel practitioner providers do for their privileging,” Maroyka said.

For example, he said, one pharmacist in a patient-centered medical home setting specializes in diabetes care and is able to prescribe medications, monitor patients, and educate them about their drug therapy.

“She handles newly diagnosed diabetics and type 2 diabetics without complications,” Maroyka said. “If it’s more complex, like they need to be set up on [an insulin] pump or some other advanced regimen, then they would see the endocrinologist.”

Maroyka said credentials for supplemental privileges may include PGY2 residency training or the completion of a fellowship or other recognized educational activity.

For one pharmacist, he said, completion of the ASHP Research and Education Foundation’s three-part traineeship program in pain management and palliative care supported the attainment of advanced privileges to treat patients in need of such services.

The Council on Credentialing in Pharmacy, a coalition consisting of ASHP and nine other national pharmacy organizations, recognizes several groups that may credential or certify pharmacists in advanced practice areas. These include the Board of Pharmacy Specialties, the National Asthma Educator Certification Board, the American Heart Association, the National Certification Board for Diabetes Educators, the Commission for Certification in Geriatric Pharmacy, the American Academy of HIV Medicine, and the American Board of Applied Toxicology.

Click here to find resources that describe credentialing opportunities and related documentation.

Flexibility to Perform Advanced Functions

William Greene, chief pharmaceutical officer at St. Jude Children’s Research Hospital in Memphis, Tennessee, said 11 clinical pharmacists have been granted advanced privileges by the St. Jude governing board.

“These individuals have the authority to order and monitor laboratory tests and other items related to medication therapy and to adjust medication therapy [for] a broad number of medications,” Greene said.

He said most pharmacists practicing at this level have completed a PGY2 residency program and are board certified in oncology pharmacy. But he said the system includes enough flexibility to allow some highly qualified, experienced pharmacists who lack those credentials to perform advanced functions.

William Greene

William Greene

Greene said the decision to privilege pharmacists through the medical staffing process grew out of his concern that an auditor could potentially decide that clinical pharmacists were providing medication therapy services without a valid medication order.

The problem, he said, is that although Tennessee’s pharmacy practice act allows pharmacists and physicians to establish patient care relationships, the act doesn’t define collaborative drug therapy management.

Greene said that the hospital’s medical executive committee determined that clinical pharmacists are functioning as “midlevel practitioners” and should be credentialed and privileged as such. He noted that the determination coincided with the Centers for Medicare and Medicaid Services 2012 revision of its conditions of participation that allowed pharmacists to be considered part of a hospital’s medical staff.

“It was perfect timing,” Greene said.

ASHP’s Council on Education and Workforce Development recently recommended that the Society support the use of postlicensure credentialing, privileging, and competency assessment to establish qualifications for providing direct care to patients. The council agreed that credentialing programs should meet guiding principles established by the Council on Credentialing in Pharmacy.

ASHP’s House of Delegates, when it meets June 1 and 3 in Las Vegas, will consider these positions for adoption as an official ASHP policy.

–By Kate Traynor, reprinted with permission from AJHP
(volume 71, pages 686-687).

May 20, 2014

Ambulatory Care Pharmacy Practice: The Future is Now

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

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

As I reflect on the historic ASHP-ASHP Foundation Ambulatory Care Summit that took place in Dallas in early March, I am excited by how far ambulatory care pharmacy practice has advanced in our clinics, just in the past decade. Of course, we have had visionary practitioners in this setting dating back to the early 1970’s, but the numbers of pharmacists providing care in our Nation’s clinics has been rapidly increasing. As the rollout of the Affordable Care Act continues, and our healthcare system places an increased focus on chronic disease management and health and wellness, new incentives to emphasize the role of the pharmacist in and across all sites of care will be needed more than ever.

Pharmacists are incredibly well-positioned as members of interprofessional teams to serve patients in the ambulatory setting and through care transitions.  It’s no surprise that the fastest growing member segment of ASHP is ambulatory care pharmacists, especially those who are seeing patients in clinics, physician office practices, accountable care organizations, medical homes, and ambulatory pharmacies in health systems.

It pleases me even more to see all of the great resources that ASHP has to offer in the area of ambulatory care, and the work that the ASHP Section of Ambulatory Care Practitioners is doing to create contemporary tools and resources to support its large and rapidly growing Section membership. I hope that it is apparent to you that ASHP has placed an increased emphasis on ambulatory care so that we now have a very comprehensive and growing set of resources to help ambulatory pharmacists care for their patients and chart a path to the future.

If you have not already done so, I would like to invite pharmacists caring for patients in ambulatory settings to check out all of these resources. A great place to start is the Ambulatory Care Resource Center on the ASHP website. Also consider reviewing the recommendations from the recent Ambulatory Care Summit. If you are thinking about getting certified or are currently certified by the Board of Pharmacy Specialties in ambulatory care, see ASHP’s review and recertification courses and preparation materials.

Our work to pass legislation that will recognize pharmacists as providers under Medicare Part B is another area that ASHP has as a top priority, which will benefit all pharmacists, including those in ambulatory settings—especially the patients they serve. And last, but certainly not least, if you are a pharmacist who practices in an ambulatory setting, then the ASHP Section of Ambulatory Practitioners is your home. The Section provides you with the resources you need to be the best patient care provider you can be and many opportunities to participate, including through the Section executive committee, Section Advisory Groups, and many more.

I hope you share my passion for the future growth of pharmacy in our clinics, pharmacies, and other ambulatory care sites. After having been a pharmacist for over 35 years, I can say with confidence that there is no better time than now to practice pharmacy. The rapid changes in health care that are taking place today, coupled with patients need for comprehensive pharmacy care, further demand that pharmacists are part of every health care team.

Thank you for being a member of ASHP and for your tireless efforts to care for your patients. What you do makes a significant and profound difference!

May 9, 2014

Pharmacist Speaks Out as Patient on Compounding Legislation

Filed under: Ambulatory Care,Clinical,Current Issue,Feature Stories,Quality — jmilford @ 4:25 pm
IMG_6888

Rep. Cathy McMorris Rodgers (R-Wash.) speaks with Michael Brandt about his experiences with an NECC-compounded medication.

WHEN MICHAEL L. BRANDT, PHARM.D., FASHP, heard reports last fall of contaminated injectable steroids prepared by the now defunct New England Compounding Center (NECC) in Framingham, Mass., he resolved not to panic.

He had been receiving injections of compounded methylprednisolone acetate (MPA) for nearly 18 months for pain from an unstable vertebra in his back, and he knew there was a chance that at least one of his injections came from lots linked to an outbreak of meningitis, so the first thing he did was investigate the origin of the shots he had received.

An Uncertain Risk Outlook

Initially, he met with good news:  His shots did not come from the lots authorities declared contaminated. But as the story of NECC unfolded, it soon became apparent to Brandt that lot numbers were nearly irrelevant.

“This wasn’t just a speck of dirt on a picture frame. The conditions were so deplorable, it was painfully obvious that they had existed for a long time,” said Brandt, clinical pharmacy supervisor at Kootenai Health, Coeur d’Alene, Idaho. “That raises the possibility that the lot I received was contaminated.” Indeed, when authorities inspected the facility, they found rust, mold, and filthy ventilation, all of which resulted in contaminating injections that have thus far killed 64 people and sickened another 686 more, many of them senior citizens.

The Centers for Disease Control have been tracking the number of patients who have fungal infections linked to the NECC steroid injections.

The Centers for Disease Control has been tracking the number of patients who contracted fungal infections from NECC steroid injections.

According to the U.S. Centers for Disease Control and Prevention (CDC), after the recall of NECC steroid medications last September, state and local health departments  identified approximately 14,000 people in 23 states who were potentially exposed to contaminated MPA, of which 11,000 received spinal or paraspinal injections.

Across the nation, patients who received MPA injections prepared by NECC in that timeframe are still being diagnosed with fungal infections. Thus far, the CDC has been unable to determine whether the infections take several months to incubate or whether patients are not diagnosed until the infections are several months along. For now, those who have received potentially contaminated injections have been informed of their risk.

Brandt says that he will relay the information to his care providers whenever necessary. “It will always be at the back of my mind. If I get headaches or other symptoms, [having received these shots] is something to put into the differential diagnosis.”

Keep Calm and Advocate

There are no tests to determine whether a fungus has taken up residence in the spinal fluid, but Brandt is determined not to let the uncertainty ruin his life.

“When I found out, I thought, ‘Okay, I’m not sick and I’m not immunocompromised, so my risk is probably lower than other people’s,’ ” he said. “But I know there’s a possibility that the fungus may be there and may one day make me sick or kill me. I just don’t want to waste a lot of personal energy worrying about something that may or may not happen.”

Instead, Brandt is channeling his energies into holding both the profession and the government to the highest of standards. “I’m disappointed in those [NECC] professionals who call themselves pharmacists who worked in and allowed those conditions. I would never sign off on that. I would quit first.”

I know there’s a possibility that the fungus may be there and may one day make me sick or kill me.

Although he acknowledges that most compounding pharmacies do a good job, Brandt points to NECC as evidence that a lack of government oversight leaves too much room for potentially lethal short-cuts.

“Why would [NECC] think that this is okay? Obviously, it’s greed. Doing the right thing is not cheap,” he said, noting the expense of the steps, materials, and labor required to maintain clean rooms and a sterile environment.

A Regulatory Gray Area

Brandt believes that the NECC case exemplifies how compounding pharmacies operate in a regulatory gray area with respect to how they prepare, market, and sell their products.

From left, Rachelle Albay, a Pharm.D. student at Washington State University College of Pharmacy at the time of this picture, and Michael Brandt pose in front of the Capitol Building.

“When going through pharmacy school, I learned that there was a big difference between manufacturing and compounding. Compounding was something specific to one individual. Manufacturing means making a large batch of sterile products that you sell to providers,” he said, questioning how NECC could have such a large operation that it could produce and sell so many injections in such a short period of time.

In September, Brandt flew to Washington, D.C., to talk to his senators and representative in favor of Senate Bill 959, the Pharmacy Quality Security and Accountability Act. This legislation was designed to create a new category of producer called “compounding manufacturer” that must register with and be inspected by the Food and Drug Administration.  He considers such cross-country endeavors to be a key part of the way he delivers care and advocates for patients, and it’s something he would have done even if he had not had to grapple with the NECC debacle on a personal level.

“We in the medical community need to do the right thing for the patient,” Brandt said. “Sometimes, factors such as regulation and lack of resources get in the way. Sometimes, the focus becomes a bit jumbled, but patient care should always be the top priority. I have a very strong moral guidance that way.”

A Step in the Right Direction

In October 2013, S. 959 was replaced with a less stringent bill in the House of Representatives, HR 3204, The Drug Quality and Security Act, which President Obama signed into law in November. The new law clarifies the Food and Drug Administration’s authority over compounded medications, establishes a new class of compounding manufacturer known as an “outsourcing” facility, and creates a national set of standards for tracking pharmaceuticals through the supply chain.

The new legislation, while not providing for tight oversight the way S. 959 would have, is a step in the right direction, said Brandt.

“It’s not exactly what we wanted, but it’s something. We got what we needed, and through ASHP and legislative activities, we raised awareness of the issue. I’d like to believe that even this may not have passed had we not gone through the efforts of lobbying,” he said.

Some sectors have criticized the new law, saying it fosters government encroachment on business, but Brandt dismisses such criticism out of hand. “Everyone else—health systems, hospitals, manufacturers—is regulated, so this fits into what government should be doing. We have a case where the compounding industry has not self-regulated and has not done due diligence, so now it’s necessary for the government to step in. The government didn’t ask for this. The industry failed.”

Government oversight is a matter of public safety, Brandt said. “It’s outbreaks like this one that we want to prevent. There are so many compounding pharmacies, and so many people who depend on their medications to be sterile and not dangerous. If these problems can be avoided by oversight, why would you risk them? It’s a no-brainer.”

 

—By Terri D’Arrigo

ASHP’s Medication Safety Collaborative

Filed under: Clinical,From the CEO,Quality — jmilford @ 2:34 pm
Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

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

ASHP is dedicated to building relationships within the health care community that strengthen medication and patient safety through interprofessional care.

We are excited to have the Society of Hospital Medicine’s (SHM) participation this year in our Medication Safety Collaborative. As health care practitioners, our number one goal is to deliver quality care to patients throughout the entire health care continuum. ASHP’s Medication Safety Collaborative helps to achieve this goal.

The collaboration between hospitalists and pharmacists is very important. As medication therapy experts, pharmacists—when working collaboratively with physicians, nurses and other health care practitioners—help to foster optimal models for team-based, patient-centered care. The Collaborative promotes this by offering a unique interprofessional, educational opportunity to bring together practitioners to build and exchange ideas on improving quality and patient care.

The feedback we received about last year’s Collaborative was phenomenal. Participants noted the great sense of community they felt after attending the Collaborative and the valuable resources and networking provided. Participants not only walked away from the Collaborative with continuing education credits in their field, but also with tangible solutions to integrate best practices and deploy new tools to optimize safety and quality outcomes. Our hope is to continue this momentum.

This year we have made the Collaborative an integral part of ASHP’s annual Summer Meetings—as one of three boutique conferences. I cordially invite you to attend and to be a part of this collective experience. As a registrant of the Collaborative, you will also have full access to all of the sessions and events occurring at our two other simultaneous conferences, the Informatics Institute and the Pharmacy Practice and Policy conference. We hope this access will allow you to customize your Summer Meetings’ experience, as you can stay in the Collaborative or attend any individual session of your interest.

The Collaborative’s interactive sessions and networking events, led by a faculty of distinguished patient safety experts, are thought-provoking and engaging. These unifying events bring together an invaluable assortment of knowledge and health care perspectives, like yours, which include: physicians, patient safety officers, nurses, pharmacists, medication safety officers, quality professionals, risk managers, and administrators.

Again, we invite you to attend ASHP’s Medication Safety Collaborative, and look forward to the insight and experience SHM’s members will bring to further enrich its discussions.

Click here for more information on the Medication Safety Collaborative and to register.

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