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October 19, 2020

ASHP Members Highlight the Value of Board Certification

Katie Hughes, Pharm.D., BCPPS

WHEN SNEHAL BHATT, PHARM.D., BCPS, was going through pharmacy school and residency training, he noticed that the pharmacists and mentors he looked up to most all were board certified. So when he completed his training in 2001, he pursued his board certification in pharmacotherapy to achieve expertise in pharmacy practice and emulate those who inspired him.

Professional benefits

Dr. Bhatt, a clinical pharmacist in cardiology at Beth Israel Deaconess Medical Center in Boston, and an ASHP member since 1999, said this distinction comes in handy on a daily basis.

“Most of my patients have a variety of other disease states and comorbidities that aren’t necessarily cardiology-related, and that’s an area where I have just as important an impact in patient care,” said Dr. Bhatt, who also is a professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences University. “While I certainly help with recommending medications for patients’ primary cardiovascular problems, I often find myself having to help the team with non-cardiovascular medications, too. Being well-rounded as a pharmacist and well-versed in a variety of drug therapy options outside of your specialty is essential to pharmacy practice.”

Being well-versed in your field is just one of the professional benefits pharmacists can reap from becoming board-certified, said Angela Bingham, Pharm.D., BCPS, BCNSP, BCCCP, FASPEN,  an associate professor of clinical pharmacy at the University of the Sciences in Philadelphia. She is also a clinical pharmacist in the medical/surgical intensive care units at Cooper University Hospital, in Camden, N.J.

Angela Bingham, Pharm.D., BCPS, BCNSP, BCCCP, FASPEN

She and other pharmacists enjoy the validation of their clinical knowledge and competency beyond licensing requirements, she says. There also can be financial incentives related to salary, promotions, and new practice opportunities that emerge. With a seed grant from the Board of Pharmacy Specialties (BPS), Dr. Bingham and one of her residents are investigating the prevalence and value of board certification among pharmacy practice faculty at colleges and schools of pharmacy in the United States. A previous survey indicated that one of the most important benefits identified by participants was gaining personal satisfaction by accomplishing professional goals that were important to them.

Advanced practice opportunities

Dr. Bingham is board certified in three areas: pharmacotherapy, nutrition support, and critical care, and now works with ASHP on the critical care review and recertification programs. She first pursued pharmacotherapy board certification as a PGY-2 critical care pharmacy resident, then pursued certification in nutrition support and in critical care as those emerged as areas of passion and specialization for her after she completed a residency.

“It really impressed me that board certification is a gold standard for determining which pharmacists are qualified to contribute to advanced practice roles,” said Dr. Bingham, an ASHP member for 14 years. “I also was impressed by the rigorous processes BPS uses to help ensure that board certified pharmacists are trained to meet the expectations of interprofessional health care teams and saw specialization as an opportunity to improve patient outcomes. I was drawn to the complex, evolving nature of critically ill patients and the team structure of care within the ICU environment, which led me down this path.”

Improving confidence and becoming an expert in pediatric care inspired Katie Hughes, Pharm.D., BCPPS, to pursue board certification in pediatric pharmacy. Dr. Hughes had a long interest in working with children but found that she needed much more information during a pediatrics rotation in pharmacy school.

“It was overwhelming from a clinical and emotional/social perspective,” said Dr. Hughes, who now works with the pediatric ICU at Riley Hospital for Children at Indiana University in Indianapolis, as well as the burn and rehabilitation units. “I realized that a lot of the kids we were seeing then weren’t the textbook kids we looked at in school. They were different sizes, had different volumes of distribution, had different clearance rates, their organs were totally different, and we didn’t have black and white guidelines to tell us what to do.”

Dr. Hughes, an ASHP member since 2012, said she did appreciate helping patients through their illnesses and watching their incredible ability to bounce back and recover. When BPS introduced the pediatrics pharmacy board certification during her PGY-2 year, she jumped on it. She attended ASHP’s board prep meeting as part of her training. Now, Dr. Hughes helps ASHP develop curricula for its board recertification.

“The medical profession has some imposter syndrome, and I don’t think that’s uncommon in pharmacy either,” she said. “You want to make sure you know what you’re doing, and sometimes you’re hesitant because you don’t have that confidence. The board certification helped me with that, and making sure I was taking the best care of patients I could.”

Certification offerings

BPS recognizes 14 pharmacy specialties, of which ASHP has available resources, including review courses, for nine currently: Ambulatory care pharmacy, critical care pharmacy, cardiology pharmacy, compounded sterile preparations pharmacy, geriatric pharmacy, infectious diseases pharmacy, oncology pharmacy, pediatric pharmacy, and pharmacotherapy. Soon, ASHP and the American College of Clinical Pharmacy (ACCP) will offer a review package for the transplant pharmacist exam, including an online review course and practice exam.

ASHP and ACCP also partner to provide resources for the Ambulatory Care, Cardiology, Geriatric, Infectious Diseases, and Oncology specialties.

Whether to pursue board certification always will be a personal decision, Dr. Bhatt said. There are so many specialty areas now board-certified that it allows every practitioner to find their own home.

“For anyone who really has a desire to stay as advanced in their practice, and as broad-based and up-to-date as you can, board certification is one of the best ways to do so because it’s a very structured environment, and you know you’re getting high-quality education from your peers in terms of what matters for pharmacy practice,” he said.

ASHP programs

Dr. Bhatt originally had to make his own study guides from reading textbook chapters, guidelines, and primary literature. But more recently, while pursuing recertification, he has taken advantage of ASHP’s continuing education programs. Many of ASHP’s activities offer dual recertification credit for pharmacists with more than one specialty credential.

“There are several ways I can get board certification credits through ASHP throughout the year,” he said. “It allows us to fit those activities into our schedules in a convenient fashion so we can maintain our board certification without being intrusive to our day-to-day practices or family lives.”

Board certification is “certainly a commitment that can’t be taken lightly,” added Dr. Bingham. “But it can ultimately be very professionally rewarding.”

By Karen Blum

# # #

September 30, 2020

Sense of Community and Social Justice Characterize Pharmacy School Deans

Dean Marie Chisholm-Burns, Pharm.D., M.B.A., M.P.H.

EVERY DAY, AS SHE WALKS THROUGH THE LOBBY of the College of Pharmacy at the University of Tennessee Health Science Center (UTHSC), Dean Marie Chisholm-Burns, Pharm.D., M.B.A., M.P.H., passes a wall covered with the portraits of all eight of the college’s deans to date. While all have made important academic and clinical contributions, there is a distinct contrast between her portrait and the seven pictures that precede hers: all of the deans leading up to her were white males.

Addressing social inequalities

“Funny enough, it wasn’t until my students pointed out how impactful it was to have my picture up on the wall that I noticed how striking the difference between me and the deans before me was,” said Dr. Chisholm-Burns, who has been an ASHP member for over 25 years. “I hope that when people see my picture up there, they dwell on possibilities that they may not have otherwise considered.”

Dr. Chisholm-Burns was recently named a UTHSC Distinguished Professor and the Chair of ASHP’s new Section of Pharmacy Educators Executive Committee. Throughout her career and during her deanship, Dr. Chisholm-Burns has made it a priority to address social inequalities. For example, she has made an effort to ensure equal access to education, which she sees as a civil rights issue by cutting tuition costs. “I came from a humble background, so I know that the cost of college can be prohibitive, and I also know that education can help lead you out of poverty,” she said.

Gender inequality has been another target of Dr. Chisholm-Burns’s energy. Before becoming dean, she was involved in an initiative that taught economically disadvantaged young girls how to play chess to encourage them to pursue their aspirations.

“In chess, if you advance your pawn all the way to the other side of the board, you can change it into any piece – except for the king – but many would say the most powerful piece on the board is a queen,” said Dr. Chisholm-Burns. “The message, which I think is a strong one, is that your future is not necessarily dictated by your past.”

On her own career path, one accomplishment Dr. Chisholm-Burns has been incredibly proud of is establishing the Medication Access Program, which provides access to treatment for solid organ transplant recipients.

“As a clinical pharmacist working with transplant patients, I noticed that the cost of medications sometimes prevented people from being adherent to their medications,” she said. “That bothered me a lot, and I felt an obligation to improve the situation.”

With a long list of achievements to date and a long career still ahead of her, there is every indication that Dr. Chisholm-Burns will continue to help right the wrongs that she sees around her, whether in the clinic, the college, or the community.

“As long as there are social injustices out there, I would like to be a part of efforts to address them,” she said.

A responsive leader

For Natalie Eddington, Ph.D., FAAPS, FCP, Dean of the School of Pharmacy at the University of Maryland, Baltimore, being a good leader has meant serving her faculty and students, and also the residents of her city.

Dean Natalie Eddington, Ph.D., FAAPS, FCP

During her 12 years as dean, she has been involved in several initiatives aimed at improving the lives of those around her. For example, she co-leads the university’s Center of Addiction Research, Education and Service – or CARES – which employs faculty and students to address the impact of addiction on Baltimore’s communities.

“Addiction is one of those things that we might not necessarily want to talk about, but it is really important to treat if we want to improve the lives of those in the community and our school,” Dr. Eddington said.

Dr. Eddington has tried to be a responsive leader on campus, tending to students and readying them to thrive after graduation. She has led the roll-out of innovative pharmacy degrees in regulatory science, pharmaceutical metrics, palliative care, and even the first Master of Science program in the country focusing specifically on medical cannabis.

“The practice of pharmacy today is nothing like it was when I graduated over 20 years ago, and we have to prepare students to meet the demands of this new world,” she said.

An initiative at the college that Dr. Eddington is particularly proud of is the “Pharmapreneurism” program, which teaches students the innovative mindset that enterprising pharmacists need to reach their career aspirations. “Students who want to go out and change the way we practice pharmacy need to have the confidence and knowledge to do things differently,” she said.

Recently, Dr. Eddington has focused on increasing diversity in academic pharmacy, which she has found remains a priority. In her research, she discovered that the number of pharmacy schools almost doubled over a recent 10-year period, but diversity in academic pharmacy hasn’t changed much.

“We need diversity because it widens what we know and what we understand as healthcare professionals treating patients from diverse backgrounds. It makes sure we implement in practice the ways that are most appropriate for our patients,” Dr. Eddington emphasized.

Cheerleader-in-Chief

When long-time ASHP member Toyin Tofade, Pharm.D., M.S., BCPS, CPCC, FFIP, took up the office of Dean at Howard University’s College of Pharmacy in Washington, D.C., in 2016she found an abundance of impressive work being done by faculty and students alike, but discovered that their achievements were “one of the best-kept secrets around.”

Dean Toyin Tofade, Pharm.D., M.S., BCPS, CPCC, FFIP

“I was surprised by how many contributions were going unrecognized, so I decided to adopt the role of cheerleader-in-chief,” said Dr. Tofade, who was recently appointed to ASHP’s Task Force on Racial Diversity, Equity, and Inclusion.

One of the first things she did as cheerleader-in-chief was let her faculty and students know that their work was valued by publishing an annual report and a weekly e-newsletter celebrating their accomplishments.

Like Drs. Chisholm-Burns and Eddington, Dr. Tofade has made it a priority to address inequalities in the college and the wider community. She co-directs a center to help individuals from unrepresented minority backgrounds prepare for undergraduate and professional STEM and healthcare professions. Under her leadership, the college is planning to place clinical pharmacists in independent community pharmacies to implement ambulatory care services.

Having those services in place will help “transform practice in the District” and ensure lower-income community members have access to medication therapy management and basic chronic disease care, she noted. “These are the kinds of things we need here in D.C., where the health of some communities is very low,” said Dr. Tofade.

Further afield, Dr. Tofade has been working with the International Pharmaceutical Federation, which collaborates with the World Health Organization to implement pharmacy care and related policies in developing countries. Serving in multiple roles and paying her success forward, she mentors budding academic pharmacy leaders abroad so that they can make their mark in the field.

“I feel very privileged and honored to be working to help transform pharmacy education and support academic pharmacy leaders around the world,” she said of this experience.

And with trademark humility, Dr. Tofade acknowledged that while her ambitions have been critical to getting to where she is today, the help of others has been as instrumental to her success.

“I am so grateful to God, my mentors, and supervisors who have taken the time over the years to invest in my growth as a leader,” she said.

 

By David Wild

 

# # #

August 20, 2020

Dedicated Leader Brings Early African American Pharmacists to Light

John Clark, Pharm.D., M.S., FASHP, at the Mexican Independence Day Annual Health Fair

AT THE UNIVERSITY OF SOUTH FLORIDA (USF) in Tampa, John Clark, Pharm.D., M.S., FASHP, has made a name for himself as a mentor, an active volunteer for underserved communities, and a researcher unearthing little-known facts about early African Americans in pharmacy. Although he cherishes these roles, if not for a simple twist of fate, he wouldn’t have become a pharmacist at all.

A life-changing conversation

Dr. Clark, director of experiential education and the pharmacy residency program at USF’s College of Pharmacy, was born in a farmhouse his grandfather owned in Conehatta, Miss., in an area considered part of Native American land designated for the Choctaws. He grew up about 20 miles from there in a small town called Forest, where he became interested in chemistry and applied to college as a chemistry major.

But at Texas Southern University in Houston, when he went to register for classes, Dr. Clark was surprised to overhear two young men pharmacy majors in line in front of him talking about enrolling in similar courses. He struck up a conversation with them and became so enthused about pharmacy that he crossed out chemistry on his registration forms and signed up as a pharmacy major.

About halfway through the semester, one of the deans called Dr. Clark and said he would have to switch back to chemistry, but he begged to stay. Before taking action, the dean fell ill, and Dr. Clark went on to graduate with a bachelor’s degree in pharmacy. “I have no regrets,” he says. “I love being a pharmacist.”

Preceptor and mentor

Dr. Clark is a faculty preceptor in ambulatory care for the university’s BRIDGE (Building Relationships and Initiatives Dedicated to Gaining Equality) Clinic. It is a student-run free clinic started by medical students to provide care to the underserved.

John Clark, Pharm.D., M.S., FASHP

One evening a week, Dr. Clark spends time at the clinic, helping train pharmacy students to interview patients, write chart notes, provide vaccines and medication therapy management. He also trains students to offer counseling and education about inhalers, blood glucose monitors, and smoking cessation.

In a peer-to-peer mentoring model, Dr. Clark supervises fourth-year students who watch over those earlier in their schooling. The position isn’t without its challenges in what medications to recommend. He noted that patients attending the clinic are uninsured and have little to no income. Students learn to get creative about finding free or low-cost drug programs.

“There’s a lot of fear, hand-holding, and simulations before they see patients,” said Dr. Clark. “I enjoy it because I see how they start with low confidence, but when I meet with them later, before graduation, I see the change. It so inspires me, and makes me feel clear about my role there.”

Dr. Clark also enjoys bringing student teams with him to a local Mexican Independence Day festival and a Haitian festival. They staff health fair booths screening people for diabetes, high cholesterol, and hypertension, and providing basic education and referrals to local providers for follow-up care.

Early African Americans in pharmacy

One of Dr. Clark’s passion projects over the past five years or so has been researching early African Americans in pharmacy. It started with a phone call he received from a staff member at a New York pharmacy school, looking to gain information about the first African American female pharmacy graduates for a women’s history month program.

Dr. Clark didn’t know the answer but started surfing the internet as they talked, finding a few names that could have been likely. One was Anna Louise James, the first African American female pharmacist in Connecticut, who graduated from the Brooklyn College of Pharmacy in 1908.

But he had a strong feeling there were others. He then found a book on early African American medical schools, which mentioned that some of these now-defunct schools encompassed pharmacy schools. He figured that was where at least some of the women would have gone to school.

First female pharmacy grads

From there, a spark was lit. Dr. Clark called the Library of Congress and National Library of Medicine looking for records from these early schools but came up empty. Librarians knew the schools had existed but had no records. He kept digging and visited Meharry Medical College in Nashville to study years’ worth of catalogs from its former Pharmaceutical College, which opened in 1889. Painstakingly he compiled lists of its curricula, faculty members, number of students enrolled, and number of graduates. He also called historical societies in Tennessee.

At last, he found three women he believes to be the first African American graduates of pharmacy schools, all from the same class at Meharry in 1894: Ella Coleman, Margaret Miller, and Matilda Lloyd.

The business climate likely was not easy for these women, Dr. Clark said. At the time, the few female pharmacists in business got their starts working for pharmacies owned by their fathers or brothers, and still faced some discrimination because of their gender.

African American female pharmacists would have had to get their start by affiliating with early African American physicians, he said, as they generally would not have had family members owning pharmacies.

Among Dr. Clark’s research finds is a photo of the last class of pharmacists to graduate from the former University of West Tennessee in 1923. He was searching for female graduates and found one in that class. But as he and one of his residents looked closer, they saw one of the faculty members was BeeBe Steven Lynk, and the photo said “dean” under her name.

“I believe we found the first female dean of a school, black or white,” Dr. Clark said, noting that Dr. Lynk’s husband Miles, the first black physician to practice in the area, owned the school.

African American women in pharmacy

He has also learned about other prominent early African American women in pharmacy, such as Ella Phillips Stewart. She graduated from the University of Pittsburgh’s School of Pharmacy in 1916 and became among the first licensed African American female pharmacist in Pennsylvania.

Dr. Stewart went on to become president of the National Association of Colored Women’s Club from 1948-1952. The organization, at its height, had some 300,000 members. Julia Pearl Hughes Coleman, part of Howard University’s Class of 1897, became the first African American female pharmacist to run for political office in the New York General Assembly in 1924. Dr. Coleman not only owned her own drug store for a bit, but she also founded a weekly newspaper and launched a chemical company for hair products and a school of hair.

Dr. Clark has compiled information on the seven Historically Black Colleges and Universities’ (HCBUs’) pharmacy schools that he hopes to publish this year, but his research into the women pharmacy graduates continues.

A “project for life”

“It’s a huge, monumental task,” he said. “I feel like I’m not finished because every time I turn around, I discover more information.” Dr. Clark explained that his goal is to bring this information to the pharmacy community.

“I don’t know if these areas have been overlooked, or if people just don’t know that [the information is] there,” he said. “What I’m really writing about is American pharmacy history. I’m not trying to make money off this or gain personal notoriety. It’s a personal interest I have that I believe we need to put into the record books to be part of our total pharmacy history that, for some reason, is left out.

“I told my dean that this is a project for life,” he added. “I’ll probably be working on this for the rest of my life because I can’t see the end of it yet. Hopefully, it’s a legacy I can leave.”

Gregory Bond, Ph.D.

“It’s really important that John is doing this work,” said Gregory Bond, Ph.D., assistant director of the American Institute of the History of Pharmacy at the University of Wisconsin–Madison School of Pharmacy. Dr. Bond also is researching the history of African American pharmacists and pharmacy education, and became friendly with Dr. Clark through their mutual interests. “It’s been a very barren field for a while, and he is great at doing research and ferreting out the interesting stories of some of these early African American pharmacists. He’s very excited and passionate about it, and that comes across when he gives talks and writes papers.”

The HBCU pharmacy schools sprung up at a time when pharmacists needed to pass state licensing exams and needed a pharmacy diploma to be licensed as a pharmacist, Dr. Bond said.

“These schools were filling a niche, especially in the South, where African Americans did not have access to the predominantly white institutions,” he said. “Pharmacists were very important in the provision of health services in the segregated cities or small towns most African Americans lived in.”

Studying the obstacles that these pharmacy students had to overcome can help in understanding the origins of some health disparities that continue in the United States today, Dr. Bond said, and perhaps can encourage the pharmacy profession to help address the ongoing dearth of access to good health services for some populations.

 

By Karen Blum

 

# # #

July 28, 2020

Creative Ways to Support Staff Resilience During the COVID-19 Pandemic

Mayrim Millan-Barea, Pharm.D., M.B.A., discusses strategies to practice mindfulness at work, holding a sign that reads, “Pause, Take One Mindful Breath. Observe, Resume.”

ASHP’S MEMBERS ARE IN VARIOUS STAGES of preparing for, responding to, and recovering from the COVID-19 pandemic. During this challenging time, it is imperative for pharmacists, residents, student pharmacists, and pharmacy technicians to step up well-being for themselves and the healthcare workforce community.

During the 2019 Midyear Clinical Meeting, ASHP held two sessions where pharmacists shared the various ways their hospitals and health systems support workplace joy. With new guidance in place for social distancing and other measures to reduce the transmission of the virus, pharmacists are taking creative approaches to promote staff well-being and resilience.

Share what works for you

“There is greater and greater recognition that burnout is an issue, and many institutions have started putting initiatives in place to prevent it from happening,” said Mayrim Millan-Barea, Pharm.D., M.B.A., who just completed her Health System Pharmacy Administration and Leadership Residency, at the Johns Hopkins Hospital, and is an ASHP member since 2015.

She led two roundtable sessions on well-being, resilience, and burnout at the 2019 ASHP Midyear Clinical Meeting. “More awareness needs to be raised as there is still a stigma associated with this topic,” said Dr. Millan-Barea. She recalled one session participant who shared that a colleague of theirs was afraid to ask others if they were burned out, “because they did not want to accept that they could be burned out as well.”

Although some institutions are in the early stages of addressing burnout, others are moving full steam ahead with solutions to build staff resilience and well-being. For example, pharmacists at Dr. Millan-Barea’s institution share their daily accomplishments and medication error “good catches” during shift changes. These short meetings also offer an opportunity to present a clinical pearl or celebrate a birthday, Dr. Millan-Barea said. “These meetings have worked for us as a good way to engage with staff,” she emphasized. However, due to the COVID-19 pandemic, staff has had to adapt and leverage electronic platforms to celebrate, engage, and care for one another. “During such difficult and unprecedented times, the Department of Pharmacy launched a newly built website that included internal and external well-being and resilience resources. Additionally, we hosted a small virtual contest where staff was encouraged to share a picture of their favorite well-being/wellness resource or activity. The idea is to emphasize that we should all feel empowered to identify the resources that resonate with us,” said Dr. Millan-Barea.

Pharmacy kudos board

Creating opportunities for more staff interaction is one approach to cultivating happiness in the workplace, said Jennifer M. Schultz, Pharm.D., Clinical Pharmacy Supervisor and PGY1 Residency Program Director in the Pharmacy Department at Bozeman Health Deaconess Hospital. She is an ASHP Fellow and member since 1994 and co-led one of the roundtable sessions. “Feeling engaged with others and having a culture that values the role of pharmacists energizes people,” she said.

Some participants at the session Dr. Schultz co-led said they have been creating calm and fun workplace environments in several ways, including having an aromatherapy room where staff can relax if they are feeling overwhelmed or stressed.

Jennifer M. Schultz, Pharm.D.

“At my institution, we have ‘white elephant parties,’ where somebody draws a name and brings that person a little gift,” said Dr. Schultz. Other pharmacists said they recognize and engage staff efforts by giving employees who have worked exceptionally hard a long lunch. Other sites said they encourage peer-to-peer recognition through an e-card function in their institutional intranet, allowing staff to send appreciative notes to their colleagues.

Dr. Schultz’s hospital has what they call a “Kudos Board, which is a whiteboard where colleagues can give each other kudos for a nice gesture or a great job using Velcro stickers and different shapes,” she said. “At the end of the month, we hold a drawing for all of the kudos received, select a coffee card winner, and publicize why that person got kudos,” she said. “It’s a simple way to support and recognize each other.”

The more that staff feel connected with and valued by each other and hospital leaders – whether through a kudos board, by checking in on each other and seeing how their workload is going – the less likely they are to experience burnout, Dr. Schultz said. “We like to think of our pharmacy department as a phamily, with a ‘ph,’” she quipped.

Something Dr. Schultz said session attendees broadly recognized the value of is extracurricular hobbies. Having something to look forward to outside of work helps create a fulfilling work-life balance, she said. “People who are very, very engaged only in their work and don’t do much outside of work seem to be more stressed and burned out,” Dr. Schultz said. “We need to get out and have hobbies – it doesn’t matter what they are, but we all have to do something for ourselves.”

Adding food and fun

Nicole Clark, Pharm.D., MHA, FASHP, Director of Pharmacy Services at Melrose Wakefield Healthcare, always relied on enjoyable non-pharmacy activities to have fun outside of work. Her favorite hobby was going to Boston Celtics games with her friends and husband, who is also a pharmacist. “That’s where we hang out and don’t talk pharmacy!” she said. “It’s an example I share with my students to encourage them to do something for themselves – and not feel guilty about it.”

Nicole Clark, Pharm.D., MHA, FASHP

With the COVID-19 pandemic, fun hobbies like this have been put on hold, so it has been important to find other things to do to remain resilient during these tough times, she noted. For example, Dr. Clark hosts video gatherings with friends, including her “Celtics Family,” the friends she has made through the Celtics. “It allows us to check in with each other and support each other through this challenging time,” she said.

Dr. Clark, who also co-facilitated an ASHP session on well-being, burnout, and resilience, said her organization has a wellness committee that has developed a range of activities focused on the health and well-being of employees. These activities have taken on a new look during the COVID pandemic.

For example, staff can attend a regular meditation call or well-being webinar series, noted Dr. Clark. “Awards and celebrations are continuing, just in different ways from before,” she added. During hospital week, hospital leadership greeted employees coming to work with a DJ and thank you signs. Ice cream treats, care packages, and meals were also given to staff.

“These small gestures meant a lot to staff and made them feel valued during this difficult time,” said Dr. Clark, an ASHP member since 2008. “During the holiday season, our department participates in an adopt-a-family program that? gives to a family in need, which helps us feel the holiday spirit.”

While planned events and well-considered institutional initiatives to address well-being and burnout are critical, Dr. Millan-Barea of the Johns Hopkins Hospital believes building pharmacy staff resilience does not always require much money or time.

“Simply saying ‘good morning’ can be a small but important step towards building community and increasing recognition,” she said. “We live in such a rushed world that we can forget to acknowledge each other.”

 

By David Wild

March 6, 2020

Pharmacist-led Initiative Cuts Post-Operative Opioid Use

Pharmacists at Riverside discuss patient pain control in daily interdisciplinary rounds with providers, nurses, and therapists.

PHARMACISTS AT RIVERSIDE HEALTH SYSTEM in Newport News, Va., are at the helm of an innovative paradigm shift in post-operative pain management. Historically, most joint replacement patients who sought to eliminate post-operative pain presumed opioids would be the cornerstone their pain control strategy. In 2017, Riverside’s pharmacy team rolled out a new  initiative aimed at reducing the amount of opioids prescribed for post-operative pain. The results have been nothing short of remarkable.

Multiple pain interventions

According to Cynthia Williams, Pharm.D., B.S., FASHP, two essential elements make the opioid reduction initiative a success: managing patient expectations regarding post-operative pain and provider use of multimodal analgesia (MMA).

“Unlike opioid-based regimens, MMA relies on non-opioid treatments, such as acetaminophen, non-steroidal anti-inflammatory drugs, neuropathic pain medications, and muscle relaxants, thus reducing the use of opioids,” Dr. Williams said. She is vice president and chief pharmacy officer at Riverside Health System and led the initiative along with a multidisciplinary team.

Cynthia Williams, Pharm.D., B.S., FASHP

Riverside’s “Joint University”

Dr. Williams, an ASHP member for over 20 years, said the efforts to change how Riverside’s total joint replacement patients think about post-operative pain begins well in advance of the procedure during conversations between patients and providers, and through group education sessions known as the “Joint University.”

“Joint University is our structured program that gives joint replacement patients, their caregivers, and families a chance to learn about all of the aspects and steps of total joint replacement surgery, from the pre-operative period to post-discharge home health care,” explained Dr. Williams.

While the Joint University was in place before this opioid reduction initiative was rolled out, Ms. Williams and her colleagues revised the educational materials to emphasize the need to balance post-operative pain control with safety and physical recovery.

The educational materials are reviewed with a nurse, who explains to patients that eliminating post-operative pain is unrealistic, may slow recovery, and place patients at risk of misuse and complications. “Chipping away at the commonly held patient expectation that there should be no pain post-operatively has been challenging, but the educational initiative has been effective,” said Dr. Williams.

Pharmacists take the lead

While addressing patient expectations, the Riverside team has also been encouraging providers to use MMA regimens, explained Katherine Koehl, Pharm.D., system director of clinical pharmacy services at Riverside Health System, and an ASHP member since 2006.

She said pharmacists have played a key role in achieving this shift in practice, through presentations at grand rounds, at provider retreats, and in one-on-one discussions with physicians, she noted. Pharmacists have also helped revise order sets to “make it easier for providers to do the right thing, which is to use fewer opioids,” Dr. Koehl said.

“Physicians can still order opioids, but the revised order sets for total joint replacement now default to include MMA components and require providers to take additional steps to prescribe opioids,” said Dr. Koehl. We’ve driven clinical practice by how we built our order sets, she added, pointing to a 95% adoption rate of MMA for total joint replacement surgeries.

Juanita Baer, Pharm.D.

Morning rounds

Ensuring joint replacement surgery patients are managed with MMA is a priority for Juanita Baer, Pharm.D., who is Riverside Health System’s surgical team lead for pharmacy.

“When I do my morning rounds, if a patient has high levels of pain, I’ll glance down at their chart and make sure that if they are receiving an opioid, they’re also being given multimodal components when appropriate, because pain medications work much better together than individually,” Dr. Baer said.

Indeed, she said having multiple components in place has led to less opioid use and is helping patients progress more rapidly in their physical therapy and through to discharge and rehabilitation. “By combining several different classes of drugs, we can find that individual optimal pain level where the patient is comfortable enough to sleep, while also being able to stand up safely and participate in physical therapy,” she said.

Expanding the program

Since the initial effort on elective total joints, Riverside has moved the focus to Enhanced Recovery After Surgery (ERAS) implementation in several specialty areas, including total colectomy and neurosurgery. One of the components of ERAS is the minimization of opioids, with a focus on multimodal pain management.

In early 2019, Riverside embarked on rapid performance improvement focused on ERAS implementation in colectomy surgery. “During the process, which included provider engagement from anesthesia and surgeons, the focus was placed on opioid-sparing treatment by utilizing multimodal pain management pre-operatively, the use of surgical blocks during the procedure, and the continuation of scheduled non-opioid medications post-operatively,” said Dr. Williams.

Katherine Koehl, Pharm.D.

Based on chart review, patients were successfully managed on limited or no opioid therapy and reported management pain levels. When opioids were needed for break-through pain, the oral route was utilized, which is a component of ERAS pathways, she added.

Leveraging the success of colorectal ERAS implementation, a neurosurgery project was launched in Summer 2019 and is showing early success, noted Dr. Williams.

Optimizing pain management

While there is now near-complete adoption of MMA regimens in Riverside’s total joint replacement, colectomy, and neurosurgery patient populations, Dr. Koehl said there was some initial resistance.

Perhaps the greatest reluctance, which was seen among both providers and patients, was that acetaminophen was thought of as a “low-value pain medication,” despite the evidence showing “it can be very powerful,” said Dr. Koehl. Some nurses were also initially apprehensive about spending more time administering the multiple medications included in an MMA regimen.

However, with education from pharmacists, providers and nurses ultimately placed the welfare of patients and others affected by the opioid epidemic over any hesitation, said Dr. Koehl.

“At the end of the day, we all want to minimize exposure to opioids and prevent large quantities of these drugs from getting into the community, and optimizing post-operative pain management is one way we have achieved this,” she said.

 

By David Wild

 

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February 18, 2020

Active Pharmacists Use Exercise to Boost Health and Well-Being

Abhay Patel, Pharm.D., M.S., R.Ph.

AFTER FOUR MONTHS OF TRAINING for a half marathon, Abhay Patel, Pharm.D., M.S., R.Ph., Pharmacy Manager for Ambulatory Services at Children’s Hospital of Philadelphia, was amazed by not only improvements in his endurance and strength, but also by how his attitude about his work had changed. “Things that used to be a source of stress did not seem as stressful anymore,” he said.

Benefits of Exercise

As Dr. Patel and other pharmacists are finding out, staying fit can yield a multitude of rewards, from bolstering mental resilience to reducing symptoms of depression and anxiety. Staying fit through regular exercise is also one way individuals can address the problem of burnout, which over 50% of pharmacists in acute and ambulatory care settings experience.

The benefits of a fitness regimen became clear to Dr. Patel after he finished a short jog in the park near his home in the summer of 2015, during his PGY-2 residency. “At the end of that day, I looked back and realized I had accomplished even more than I normally did on a day without any deliberate physical activity,” recalled Dr. Patel, an ASHP member since 2011.

Fitness Journey

That realization left him wanting to exercise more. After completing residency and starting his job, he began to integrate short bike rides after work, weightlifting at his local fitness center, and taking advantage of his workplace’s wellness services. “I started by squeezing whatever I could into my day, and that laid the groundwork for establishing a more targeted, consistent routine,” he said.

As it turned out, squeezing in those bits of exercise yielded additional benefits. “My demeanor began to change positively, I had more energy, I was more focused on the tasks I was doing, and I felt better about myself and about the care I was providing, as well as my role as a team leader,” said Dr. Patel.

Exercising is not a panacea, he admitted, and his days include “all of the same highs and lows that I had before,” but his ability to manage these fluctuations has improved. There have been important changes in his perspective on work and life, Dr. Patel added. “It’s clearer to me that professionally and personally, it is not just about the pursuit of the finish line, but about pursuing progress instead,” he said. “It truly is a marathon, not a sprint, and about appreciating the journey.”

Yoga Unites Mind and Body

Jogs and gym visits are two ways to stay fit, but exercise can take other forms, as Christina Martin, Pharm.D., M.S., CAE, ASHP’s Director, New Practitioners Forum, has shown.

Christina Martin, Pharm.D., M.S., CAE

Dr. Martin started practicing yoga roughly seven years ago, an interest she developed when she began her first post-residency pharmacy supervisor position and fell into the trap of working too much. “Things went out of balance,” she said. “Yoga was something that I could commit to beyond work.” Over the years, Dr. Martin has learned to enjoy not only the physical aspects of yoga but also its inward, meditative focus.

“The Sanskrit word for yoga is ‘yuj,’ which means to control or to unite, and that is what my yoga practice has transformed into – controlling the noise from the outside world and uniting my mind, body, and soul,” said Dr. Martin. “One of my teachers regularly reminds us that coming to the yoga mat is an escape to our own private island.”

Yoga has also added another layer of meaning to her life, she said, as she recently completed a hot yoga teacher training program so that she can share her passion for the practice with others. The 200-hour training program included learning about human anatomy, how to address common ailments that yoga practitioners face, as well as studies in yogic breathing, nutrition, and chakra theory. A chakra is a center of spiritual power in Hindu thought.

“Being part of any community – including the yoga community – can be an antidote to the pervasive isolation and loneliness that we see in today’s society,” Dr. Martin said.

CrossFit Champ

A strong sense of community built around the goals of fitness is one reason Robert Weber, Pharm.D., M.S., FASHP, Chief Pharmacy Officer at the Ohio State University Wexner Medical Center in Columbus, Ohio, has fallen in love with CrossFit, a high-intensity form of exercise.

Robert Weber, Pharm.D., M.S., FASHP

As Dr. Weber recalls, his journey toward developing a rigorous CrossFit regimen began after years of struggling with weight gain as well as complications from a colon cancer diagnosis in 2008 and chemotherapy and surgery that eradicated his cancer, but left him with neuropathic pain in his hands and feet.

“I was told that I should not and could not [do any vigorous exercise] because of the neuropathy and that walking with some light yoga was sufficient,” said Dr. Weber, an ASHP Fellow and member since 1980. He assumed his physicians were right, because at the time, “I wasn’t able to balance myself, jump, and do all the things that are part of exercising.”

With the neuropathic pain limiting his ability to exercise, Dr. Weber tried to stay healthy through a proper diet, but eight years of a sedentary lifestyle left him overweight, and in need of cardiovascular medications, he said.

“The turning point for me came when my brother died of cancer in 2017,” Dr. Weber recalled. “I was standing over his grave, and I said to myself, ‘I need to make a change and start exercising again and move the dial in terms of my overall health and wellness.’”

His daughter urged Dr. Weber, who is now 63, to take CrossFit classes. While the exercise leaves him feeling “tired and winded, once I’m done, I feel like a million bucks,” he said. Dr. Weber noted that he overcame the neuropathic pain in his feet by increasing the frequency and intensity of the exercises in “baby steps, and not pushing too hard at first.”

Today, as a result of regular exercise and proper nutrition, Dr. Weber is 42 pounds lighter and has been able to discontinue most of his cardiovascular and neuropathic pain drugs. “I’m now more stable on my feet, more confident, and I make better decisions at work,” he added.

For those in his age group interested in starting an exercise regimen, Dr. Weber cautioned first to get a physician’s approval and also to start at a low intensity. He noted that a personal trainer or coach has the expertise to design a safe exercise program customized to your needs. This is important because performing too many repetitions too early can cause cardiac stress, he said, and lifting too much weight initially can lead to several days of discomfort and possibly serious injury.

“Particularly at my age, it can be frustrating if you start an exercise program and get stiff and sore for a few days,” said Dr. Weber. “I’ve seen many people my age quit after a brief time because they can’t tolerate the soreness that follows exercising.”

With those caveats in mind, Dr. Weber believes that almost anyone of any age can build an exercise regimen that works for them and reap the benefits. “You can do anything you set your mind to do,” he said.

 

By David Wild

 

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