ASHP InterSections ASHP InterSections

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

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February 13, 2019

A3 Collaborative Elevates Diabetes Care in Rural Appalachia

Amy Westmoreland, Pharm.D., BCGP, counsels a patient about her medications.

Amy Westmoreland, Pharm.D., BCGP, Pharmacy Manager and Clinical Pharmacist at Carilion Giles Community Hospital, has a frontline view of the challenges of diabetes management. For years she wondered if there was a way for her and the other pharmacists at the hospital to provide services to patients beyond filling lifesaving prescriptions. Many of the patients admitted to the 25-bed facility in rural Appalachia were there due to lack of adherence to a diabetes medication regimen.

“Many of my patients didn’t understand all of the complexities involved in taking care of their diabetes, and that could spell disaster once they were discharged from the hospital,” explained Dr. Westmoreland. She noticed that some patients weren’t entirely sure how to monitor their blood sugar, and others had only a vague idea of what they should and should not eat. Many were resistant to any sort of dietary education, or those interventions proved to be ineffective.

A3 Collaborative
About a year ago, Dr. Westmoreland heard about a unique program known as the A3 Collaborative. The collaborative is made up of three organizations – ASHP, Apexus, and AIMM (Alliance for Integrated Medication Management). Its purpose is to help healthcare providers and organizations step in to and succeed in the new era of value-based payment models. The A3 Collaborative provides funding to hospitals that would like to bolster the role pharmacists play in value-based patient care.

Dr. Westmoreland (right), collaborates with case manager Jody Janney, R.N., medical social worker Drema Gautier, Mariana Gomez De La Espriella, M.D., and hospitalist Stephanie Boggs, Pharm.D.

Through Dr. Westmoreland’s efforts, Carilion became a member of the A3 Collaborative and was the recipient of 12 months of guidance and leadership from ASHP, Apexus, and AIMM. The comprehensive medication management program she and her colleagues created with help from the collaborative is simple, but it’s already delivering significant results. Carilion’s new value-based patient care model allows diabetes patients more access to their pharmacist in the days, weeks, and months after discharge.

“Our patients are really happy that they have someone they can turn to, someone they can call and help them understand their illness better,” said Dr. Westmoreland. There have been times when she met patients who were on 30 different medications and they needed someone who could help them understand their diabetes management plan.

Postdischarge Counseling
Dr. Westmoreland and her colleagues started the program in July 2018, and they are currently following 22 patients after discharge. Before the patient is discharged, Dr. Westmoreland and her colleagues meet with the patient. They review their medication list and determine what information and help they may need after they’re discharged from the hospital and moved to ambulatory care.

Before discharge from the hospital, the attending pharmacist will ask the patient if they’d like a follow up phone call from a pharmacist to answer any lingering questions. The pharmacist also provides their information and phone number so the patient can contact them during business hours.

If a patient opts into the medication management program, then the pharmacist coach will call to follow up at 10 days, 20 days, a month, and two months after discharge. After that, calls are made once a month. During each call, a pharmacist ask a specific list of questions:

  • Are you able to afford your medication?
  • Are you taking your meds as prescribed?
  • How often do you check your blood sugar?
  • What is the range of your blood sugar ratings? Are you keeping a log?
  • Are you having any side effects such as low blood sugar occurrences?

Although the program is still relatively new, Dr. Westmoreland and her colleagues have already identified a number of medication-related problems such as duplication errors. They found, for example, that one patient was unnecessarily taking two different forms of thyroid replacement therapy. She’s observed other concerning trends as well: Many patients don’t understand the difference between long-acting insulin and short-acting insulin. Some patients are unclear how — and when — to test their blood sugar, or why it is important that a patient log this information for their doctor to review at follow-up appointments.

“Taking the time that is required to effectively review a medication list is time-consuming,” said Dr. Westmoreland. “That’s where a pharmacist has the skill set to come in and effectively look at the medications and provide recommendations for eliminating some drugs that may not be necessary, or optimize doses to make things better for the patient.”

Amy Westmoreland, Pharm.D., BCGP

Closing the Care Gap
Dr. Westmoreland said the program also addresses the disconnect that often exists between specialists and a primary care physician, especially when a patient’s doctors are not all contained in one facility — meaning there may be more than one electronic medical system where the patient’s records are kept.

“There’s a huge gap in care, in my opinion, without having the pharmacist on the care team for every patient,” said Dr. Westmoreland. “I think we’re at a crossroads in healthcare with having the pharmacist on the care team. Pharmacists have a unique knowledge of the medications, and they understand what a normal dose would be and what an exorbitant dose would be. They could look at a prescription and realize something is off or not correct, whereas nurses and doctors may not be looking at the medication lists in the way that pharmacists do.”

A3 Adds Value
Melanie Smith, Pharm.D., BCACP, DPLA, Director of ASHP’s Section of Ambulatory Care Practitioners, serves as a staff liaison for the A3 Collaborative. She noted that the collaborative allows ASHP members to test out great ideas that could help keep patients out of the hospital. “Many of our members are being tasked with setting up a clinic or setting up a service in an ambulatory care setting,” said Dr. Smith. “Participating in a program like the A3 Collaborative provides them with essential coaching and mentoring, and helps provide a foundation and the bridge they need to transition the clinical practice from inpatient to outpatient.”

Dr. Westmoreland, for her part, hopes the success of the program will demonstrate the value of adding pharmacists to patient-care teams. “We’re trying to be very proactive before the point of discharge.” It’s important, she said, for patients to have someone they can turn to when their diabetes management becomes overwhelming, or they can’t afford their prescriptions, or their doctor is not readily available to answer questions. “I would like others to see there’s enough value in this program for it to be expanded across the system and across the nation.”

 

By Jessica Firger

 

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November 28, 2018

Clinical Privileging Paves the Way for Expanded Pharmacy Services

This opinion column was authored by ASHP member and InterSections guest columnist Ryan Mills, Pharm.D., M.B.A, M.H.A., BCPS. Dr. Mills is the Pharmacy Manager at Novant Health Kernersville Medical Center and Novant Health Clemmons Medical Center in North Carolina. He is a passionate pharmacy leader who believes that bringing pharmacists to the forefront of patient care will have a significant impact on chronic disease management and population health issues.

 

Ryan Mills, Pharm.D., M.B.A, M.H.A., BCPS

HEALTH SYSTEMS TODAY STRUGGLE WITH RISING COSTS and lower reimbursement coupled with expectations for greater safety and quality of care. Failing to adapt to these changes and position your pharmacy enterprise for the future will result in fates similar to those of  Blockbuster and Kodak. As hospitals and health systems shift toward a value-based reimbursement model, we must promote a progressive pharmacy practice model with pharmacists working together with providers in collaborative practice agreements.

 

Leveraging Pharmacists’ Expertise

My colleague, Matthew Gibson, Pharm.D., M.S., BCPS, is the Clinical Pharmacy Manager for Ambulatory Services at Novant Health. He has many years of experience with implementing collaborative practice agreements, pharmacist credentialing, and expanding pharmacy services. His pharmacy team delivers the highest-quality clinical care to our patients throughout the continuum of care.

It takes more than interprofessional collaboration throughout the patient’s hospital stay to improve patient care. Pharmacists need to be officially recognized for their expertise. North Carolina state medical and pharmacy boards have recognized pharmacists as practitioners since 1998, under the designation of clinical pharmacist practitioners (CPPs). Like other midlevel providers, CPPs enter into collaborative practice agreements with physicians, whereby the physician grants authority to the pharmacist to provide specific patient care services. The North Carolina Board of Pharmacy requires a protocol agreement between the supervising physician and CPP. This agreement details the CPP’s scope regarding disease state, medication therapy, and monitoring privileges.

 

Know Your Medical Staff Bylaws

At Novant Health, Dr. Gibson has partnered with physician leadership to successfully add CPPs to the medical staff bylaws. This means CPPs are now considered advanced practice clinicians, which is the same designation as nurse practitioners and physicians assistants. At a high level, medical staff bylaws describe how the medical staff governs itself. The bylaws explain the rights of the medical staff, the qualifications for medical staff members and advanced practice clinicians, and the necessary steps in the appointment, reappointment, and clinical privileging processes.

Every health system has its own credentialing and privileging process. Our credentialing and privileging process occurs through our central verification and medical staff offices, which determined that our CPPs would complete the same rigor of credentialing, privileging, and oversight process as our medical providers.

North Carolina laws have established a quality assessment schedule for CPPs to meet with their supervising physician on a regular basis to review clinical performance. Since the training of pharmacists has rapidly progressed over the past 10 years resulting in a spectrum of clinical skill sets among pharmacists, we decided to adopt more stringent eligibility requirements than the state, such as Board of Pharmacy Specialties certification and two years’ clinical pharmacy experience.

 

Successful Use of CPPs

Novant Health first used CPPs in the acute care setting to support optimal medication management in the neurology service line and is in the process of expanding into other venues of care, such as medication reconciliation at admission and discharge, emergency department culture review, and high-risk chronic disease state management.

The role of the pharmacist has drastically changed over the years from dispensing and verifying orders to direct patient care in partnership with all other disciplines. Our pharmacists play a crucial role in ensuring that our patients receive the highest-quality care and safest experience possible every time.

One of the most cost-effective investments any health system can make is leveraging its pharmacists in collaborative practice agreements throughout every venue of care to deliver a remarkable experience.

By Ryan Mills, Pharm.D., M.B.A., M.H.A., BCPS

 

October 26, 2018

Pharmacists Spearhead Opioid Stewardship at Virginia Mason

ON A SPRING DAY IN 2016, a female patient walked into the Physical Medicine and Rehabilitation clinic at Virginia Mason Medical Center in Seattle. The patient, who came to Virginia Mason after her previous provider moved out of state, was receiving more than 1,300 morphine milligram equivalents (MMEs) per day for chronic low back pain.

As one of the medical center’s Ambulatory Pharmacy Managers—and one of the first pharmacists at Virginia Mason to join its innovative team-based care model for opioid stewardship — Amanda Locke, Pharm.D., M.B.A., BCACP, is well equipped to care for this patient and others receiving potentially dangerous amounts of opioids for chronic pain.

Opioid Interventions

Amanda Locke, Pharm.D., M.B.A., BCACP

Since 2012, when she helped establish the opioid stewardship program, Dr. Locke and other ambulatory care pharmacists at Virginia Mason have been meeting with patients receiving chronic opioid therapy for persistent pain. The goal is to reduce or eliminate opioid use. Under the new model, patients have an average of four routine clinic visits per year — one with both their opioid-prescribing provider and a clinic pharmacist provider, and three other appointments alternating between the pharmacist and the prescribing provider.

Prior to and during clinic visits, pharmacists review the patient’s medication regimen, assess the risk for opioid-related complications, and conduct and review urine screens. They also provide education on pain management and opioid use, and explain the medical center’s opioid use policy. The pharmacists recommend non-opioid and non-pharmacological treatments, such as physical therapy, mindfulness, and acupuncture, and they prescribe naloxone.

Lowering MMEs, Standardizing Care

According to Dr. Locke, patients partaking in the opioid stewardship program have seen their total MMEs decrease during a 32-month period. In addition, the program helps ensure that each patient receiving chronic opioid therapy is treated according to the same best practices at every visit, whether the patient is seen by a pharmacist or another provider.

“Since the program has been in place, we’ve seen prescribers adhering more closely to safe prescribing guidelines and state regulations, and using risk-assessment tools, urine screens, and patient agreements significantly more often,” Dr. Locke said.

Supporting Patients Through Life Changes

While treating patients receiving opioids for chronic pain, Dr. Locke has learned some important lessons. For example, tapering opioid doses can lead to emotional responses from many patients, and they need to feel supported and listened to within the provider-patient relationship.

“The best and most effective tapering experiences involve working with the patient and supporting them, rather than just telling them how to taper,” she said. “We have lots of discussions with the patient and try to understand their goals and concerns. We also use shared decision-making tools and motivational interviewing to make sure they have the goal of reaching that lower dose.”

Non-pharmaceutical care — such as physical therapy, mindfulness, and acupuncture — during the opioid-tapering process has also been an important component, Dr. Locke said, noting that opioid use and persistent pain can be driven by unmet needs like uncontrolled depression, anxiety, and sleep deprivation. “Our clinic pharmacist providers are trained to address behavioral health concerns and sleep care, and we’re also getting more involved in substance use disorder management,” she said.

Word Is Spreading

The success of the opioid stewardship program has inspired a growing list of departments at Virginia Mason, such as rheumatology and neurology, to include pharmacists in the management of their patients receiving opioids for chronic pain.

Because managing opioid treatment in patients with neurological and movement disorders patients presents unique challenges, Virginia Mason brought Lorifel Nabong, Pharm.D., BCACP, on to its neurology clinic in early 2017. “It can be a challenge to manage medications. Patients may lose their prescriptions or tablets, so coming to the clinic to see a provider once a month or every three months for refills can reduce the likelihood of that happening,” said Dr. Nabong. “Meeting with patients more often also means they can be monitored more closely than they might be, if they were to have access only to their primary care provider.”

Lorifel Nabong, Pharm.D., BCACP, talks to a patient about how opioids affect brain function. Photo credit: Bob Riedlinger, Medical Photography Department at Virginia Mason

In addition to being an invaluable opioid management resource at the neurology clinic, Dr. Nabong has also seized upon other opportunities for medication therapy management. “I’ve been helping the team with a variety of conditions, including managing seizure medications for epilepsy, symptom relief medications for patients with multiple sclerosis, and finding financial assistance for patients with Parkinson’s disease who cannot afford the newer, more expensive medications,” said Dr. Nabong.

Both Dr. Nabong and Dr. Locke feel that greater pharmacist involvement in the opioid and pain management process has been an opportunity for health-system pharmacists to provide the high-level clinical care they are trained for. Moreover, their work has also freed other providers to practice at the top of their licenses.

“For example, two days a week of having a pharmacist see patients in the Physical Medicine and Rehabilitation Clinic has meant physicians can see an additional 1,200 patients annually,” said Dr. Locke. “And taking on some medication-heavy tasks that nurses were frequently called on to do — like creating a drug-tapering schedule — has allowed them to focus on providing the care that best fits their skill set.”

Group Sessions to Meet High Demand

Demand for pharmacist involvement in the care of patients receiving chronic opioid therapy has been so high at Virginia Mason that, at some clinics, offering group meetings has been the most effective way to reach as many patients as possible.

Emily Sullivan, Pharm.D.

Emily Sullivan, Pharm.D., Primary Care Pharmacist at Virginia Mason, meets with groups of six to 12 patients for 20 to 40 minutes, twice a month. “During the sessions, I talk about pain and opioids, and emphasize the effectiveness of complementary and non-opioid pain treatments,” she explained.

Despite the group format, Dr. Sullivan individualizes care by checking each patient’s prescription drug monitoring program record prior to a session and scouring their medical record for potential drug interactions. She also reviews their drug screens and writes naloxone prescriptions for patients receiving high-risk doses of opioids.

Dr. Sullivan said the group format offers patients an opportunity to ask questions, share their experiences, and learn about approaches that have been effective for others with persistent pain. “Something I like about the group format is that patients can see that they’re not alone. Pain can be very isolating, and meeting others who are in similar situations can alleviate some of that isolation,” she said. “Caring for patients using chronic opioids can be challenging, but the experience has been extremely rewarding.”

The results have also been rewarding for patients, including the woman who walked into Dr. Locke’s office receiving 1,300 MMEs per day. “Initially, as we were lowering her opioid dose, she said her pain was increasing, but after a while she also began noticing other things, like not dozing off on the couch as much at the end of the day, sleeping better, and being more active,” recalled Dr. Locke. “Now, two years after the initial visit, we’ve cut her opioid dose to 300 MMEs, and we plan to keep going until we reach 90 MMEs.”

 

By David Wild

 

 

 

October 5, 2018

Pharmacy and the Art of Resilience

PAUL MILLIGAN, PHARM.D., a Medication Safety Pharmacist at BJC HealthCare in St. Louis, has worked in the pharmacy profession for 35 years. His career, while incredibly rewarding, has required him to contend with plenty of daily stress, manage the expectations of doctors and other practitioners at busy healthcare facilities, and regularly face the pressure that comes with saving lives. When the rewards of the job don’t outweigh the struggle, however, Dr. Milligan said it can leave him feeling burned out.

Pharmacy Sculpture

Pharmacists are increasingly suffering from professional burnout, which is why Dr. Milligan was immediately interested when the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience issued a call for submissions for original artwork from healthcare professionals. The organization’s goal was to curate a digital art gallery that shows how clinicians are affected by burnout. By allowing healthcare providers to creatively express their experiences with burnout, Expressions of Well-Being: An Art Exhibition captures critical moments in their journey toward well-being.

Paul Milligan, Pharm.D., used sculpture to capture the moment a clinician holds a patient’s hand to make them feel safe and comfortable.

Dr. Milligan, who serves as Director-at-Large of the ASHP Section of Inpatient Care Practitioners, has created sculptures as a hobby for the last decade and welcomed the opportunity to submit his artwork for a project that is so close to his heart. He sent images of two of his works, and one was accepted for the project. He named the sculpture “Treat the Person, Treat Yourself,” at title that aptly sums up the professional mission that has carried him through his career.

“I wanted to capture that moment when a clinician is holding a patient’s hand and making them feel safe and comfortable,” he said. “It is really a two-way street at that point. These are the moments that I remember most, the ones that keep me going.”

Opioid Imagery

ASHP member Elizabeth Canterbury, Pharm.D., an emergency department resident at SwedishAmerican Hospital in Rockford, Ill., is another contributor to the NAM collaborative’s digital art gallery. She saw the project as a way to comment on current challenges plaguing the healthcare system.

”Don’t Slip“ was created by Elizabeth Canterbury, Pharm.D., who used Photoshop to superimpose a photo of herself on a chair with prescription bottles spilling on the floor.

Dr. Canterbury submitted a powerful image of herself on a chair superimposed with prescription bottles spilling on the floor, an image she created with the magic of Photoshop. The work is a commentary on the opioid epidemic, which in 2016 alone killed more than 42,000 Americans, according to the Centers for Disease Control and Prevention (CDC).

At age 26, Dr. Canterbury is closer to the beginning of her career, but she’s already found ways to stay levelheaded and avoid burnout. In addition to her artwork, she remains involved in activities that allow her to network with colleagues, which provides an outlet to voice her concerns with like-minded people.

“Holding leadership positions and taking advantage of opportunities like attending ASHP’s Midyear Clinical Meeting and doing a resident rotation at ASHP headquarters have helped me stay engaged and feel like I am contributing to the growth of the profession in addition to helping the patients I see on a day-to-day basis,” she explained.

A Portrait of Pharmacy

Evan Slagle, Pharm.D., BCPS, Antimicrobial Stewardship Pharmacist at Penn State Health St. Joseph in Reading, Pa., has also found solace and stress relief in activities outside of his job. Dr. Slagle, an avid runner, lived in South Philadelphia while attending the Jefferson College of Pharmacy. He would frequently go for runs toward the northern end of the city. The route would always take him past the Edgar Allen Poe National Historic Site, a tribute to the beloved 19th-century writer.

Evan Slagle, Pharm.D., BCPS, based “Imp of the Perverse” on a portrait of Edgar Allen Poe.

Dr. Slagle became fixated on a mural of Poe at the site. The writer, Dr. Slagle said, approached the themes of depression and anguish in uniquely expressive ways. One day, Dr. Slagle felt especially inspired after his run. The endorphins were rolling, he said, and so he sat down to recreate the portrait as best he could recall it. It took him four hours to complete, and he then submitted the work to the collaborative’s digital art gallery.

Over time, Dr. Slagle has come to realize that creative expression through art is a way to help him process the stress of his job. In fact, doing so became a necessity early in his career. Dr. Slagle initially dropped out of his PGY1 residency program because of stress, but later completed his PGY1 at a different hospital.

“I experienced burnout before I could define it,” he said. “Detaching yourself a little bit from the work and getting some perspective is the key. You need to totally separate yourself from time and the constant bombardments you get on a daily basis. We all need a reprieve from that.”

 

By Jessica Firger

 

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May 4, 2018

Can Pharmacists Have it All? Balancing a Dream Career with a Busy Family

Editor’s Note: This story is part of a special series examining the growing number of women in pharmacy leadership.

Kelly Epplen, Pharm.D., BCACP, FASHP

JUGGLING YOUR CAREER, KIDS, HOBBIES, AND FRIENDSHIPS can sometimes be a wobbly balancing act, but Kelly Epplen, Pharm.D., BCACP, FASHP, has integrated the elements of work and family into a cohesive and satisfying lifestyle.

“I believe having a rewarding career has made me a better mother, and being a good mom has made me a better practitioner,” said Dr. Epplen, Associate Professor of Clinical Pharmacy Practice and Administrative Sciences at the James L. Winkle College of Pharmacy at the University of Cincinnati. “Being a mother is the most rewarding, most challenging, and most important job I have, but being a pharmacist completes me as a person. And the nurturing elements of motherhood bleed into my role as a healthcare professional.”

A Balancing Act

With four teenagers, coordinating a career and a family is not easy. “I may get up at 3 a.m. to read an article, prepare for a lecture, or write a paper so that I can get my kids up at 6 a.m. and get them out the door for school,” she said. “Or I may leave work at 3 p.m. to get to a baseball game or volleyball match, and then pick work back up at 8 p.m. It is not for everyone, but it works for me!”

Dr. Epplen and her husband have a team approach to raising their children, which gives each of them the time and space to pursue their own professional goals. While this approach has been successful, it has also led to occasional work and family clashes.

For instance, Dr. Epplen was scheduled to deliver a presentation at the 2016 ASHP Summer Meetings that coincided with her daughter’s eighth-grade play. “I was so upset I had to miss her play. Ask any mom who works outside the home — the guilt can be overwhelming at times!” she said. “But I sat her down and explained the situation. It turned out that she was completely OK with it, and I quickly remembered that I am raising strong, independent kids who often are more mature than I give them credit for.”

Ambulatory Care Expertise

That strength and independence are some of the characteristics Dr. Epplen models for her children. Since becoming a board-certified ambulatory care specialist in 2011, she has largely dedicated her career in pharmacy to enhancing clinical roles for pharmacists in the ambulatory setting to improve patient care.

“I have had the opportunity to justify, develop, establish, and maintain several ambulatory care services across multiple health systems in the Greater Cincinnati area,” she noted, pointing to her work in anticoagulation, pharmacotherapy, and family medicine. “My goal right now is to establish the role of ambulatory care pharmacists within the accountable care organization [ACO] at which I practice and to demonstrate how pharmacists can significantly improve quality of care for high-risk populations while creating a positive return on investment.”

For example, she has led projects looking at medication-related performance measures in medication adherence and the management of osteoporosis in women. She found that pharmacists’ interventions helped significantly  improve Star Ratings and contribute to increased incentive payments in this value-based performance environment.

A Real Person

A faculty member at the University of Cincinnati College of Pharmacy since 2009, Dr. Epplen’s primary teaching responsibilities focus on women’s health and topics in health-system pharmacy practice, professional practice development, and pharmacy management.

Dr. Epplen serves as the faculty advisor for Ana Jenjebir, a student pharmacist.

Dr. Epplen said she starts the course on health-system pharmacy practice by painting a full picture of her life, sharing what she finds exciting about pharmacy as well as other activities she participates in outside of clinical practice.

“I think it is important that students understand that I am a real person, including being a mom, a pharmacist, an ambulatory care specialist, a professional, and an advocate for the profession,” she said.

Dr. Epplen typically precepts two Advanced Pharmacy Practice Experience students per month, chairs the Honor Council for the University of Cincinnati College of Pharmacy, serves as a continuing education administrator, and sits on the college’s Reappointment, Promotion, and Tenure committee.

“Inevitably, after class I have a line of female students wanting to know how I balance everything. However, I tell them that, to me, there is no balance. Integration of work and home life is essential to my success,” she said.

ASHP Roles

Dr. Epplen has been an active ASHP member since 1997 and was introduced to service opportunities within ASHP by her own female role model and mentor, ASHP Past President Marianne Ivey, Pharm.D., M.P.H., FASHP. Dr. Epplen became active in ASHP’s Section of Ambulatory Care Practitioners (SACP) 20 years ago through her involvement in the Section Advisory Group on Reimbursement for Cognitive Services (now called the Section Advisory Group on Compensation and Practice Sustainability)

She is a Fellow of ASHP and served as the Chair of the Executive Committee of SACP from 2015 to 2016. “Being elected Chair was one of the proudest moments I have ever had professionally,” Dr. Epplen recalled. “It was a professional validation that I had been elected by my peers to represent one of the fastest-growing sections of our professional community.”

The leadership role offered Dr. Epplen an opportunity to advance ambulatory care pharmacy practice and share her experiences in ambulatory care with initiates to the field. “It was also as an opportunity to learn from advanced practitioners with established ambulatory care services,” she noted.

As gratifying as it was to be elected Chair of a prominent ASHP committee, Dr. Epplen noted that the pinnacle of her career as an ambulatory care pharmacy specialist was speaking at ASHP’s inaugural Ambulatory Care Summit in 2014.

“To be a part of such a gathering of ambulatory care specialists from across the country, as we came together to define ambulatory care pharmacy practice and our roles and responsibilities in patient care, was truly inspiring,” said Dr. Epplen, who authored a briefing paper for the summit, co-authored ASHP’s Minimum Standard for Ambulatory Care Pharmacy Practice, and co-authored a chapter in Building Ambulatory Care Services.

“Ambulatory care pharmacy practice has experienced significant growth over the last decade, and I am proud to say that I have been present for that growth!” she said.

Advice for Young Women Pharmacists

Dr. Epplen often collaborates with members of the ASHP Section of Ambulatory Care Practitioners.

Dr. Epplen has had many opportunities to work alongside strong female ambulatory care leaders. “All of these women exhibited characteristics that I have incorporated into my work life: dedication, determination, confidence, and independence,” she said.

Based on the wisdom she’s gleaned from her mentors and the experience she has gained, Dr. Epplen has some advice for women starting their careers in ambulatory care pharmacy: “Find successful female professionals to emulate, take time to meet with them often, and ask them what they love about their career path and what pitfalls to look out for,” she recommended.

Women pharmacists should also consider identifying their professional and personal goals, giving thought to how these goals complement each other, and figuring out how barriers might prevent them from achieving those goals, Dr. Epplen added.

“Learn how to integrate your personal and professional lives. Figure out how it can work for you and your family,” she suggested. “And realize that your house may not always be perfect. You may not be at every dance recital or sporting event. Your laundry may not always be done. And then realize that it is okay! Give yourself a break!”

 

By David Wild

 

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