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October 29, 2020

VA Clinical Pharmacy Practice Office and Pharmacy Residency Program Office Win ASHP Board of Directors’ Award of Excellence

Anthony Morreale, Pharm.D., M.B.A., BCPS, FASHP

WHEN ANTHONY MORREALE, PHARM.D., M.B.A., BCPS, FASHP, started working for the Veterans Health Administration (VA) in 1985, only a few pharmacists had advanced practice prescriptive authority in the ambulatory care setting, and the majority of their clinical practices were in hospital-based acute care. As the VA evolved into more of an ambulatory care-based system, the role of clinical pharmacists continued to expand.

Prescriptive Privileges

Now, a decade after the VA and Dr. Morreale launched a dedicated Clinical Pharmacy Practice Office (CPPO), the health system has a highly interactive, supportive infrastructure to engage pharmacy leadership, share best practices, and promote the role of clinical pharmacy specialists (CPSs) system-wide. Over 4,500 CPSs, about half of all pharmacists in the VA. have prescriptive privileges as part of their advanced practice roles managing patients in primary care, pain management, mental health, acute care, and antimicrobial stewardship.

It’s a primary reason why the VA Pharmacy Benefits Management CPPO and Pharmacy Residency Program Office (PRPO) were among two recipients of the 2020 ASHP Board of Directors’ Award of Excellence.

“The VA CPPO and PRPO developed and implemented comprehensive strategies to expand advanced clinical practice excellence and post-graduate pharmacy residency training,” ASHP said in a formal announcement. “These innovative efforts resulted in greater patient access to care, improved patient safety, identification and treatment of substance use disorders, and enhanced care coordination.”

According to Dr. Morreale, the CPPO work started in primary care with the VA’s system-wide adoption of the team-based care medical home model, which embraced pharmacists with prescriptive privileges playing key roles in those teams.

“That just happened to be a natural marriage that really helped expand the role of clinical pharmacy specialists in ambulatory care,” he said. “Having pharmacists embedded in all of those teams really launched a number of initiatives.”

Boot Camps for Pharmacists

The pharmacists initially helped manage patients with core diseases like diabetes and hypertension, said Dr. Morreale. Then the CPPO created clinical boot camps in different geographic regions to train primary care pharmacists on additional conditions they would encounter in ambulatory care, including osteoporosis and pain management, utilizing a train-the-trainer model where they would go back and teach their colleagues. In 2015-2016, with the approval of better drugs for hepatitis C, CPPO held national boot camps to train hundreds of pharmacists, who eventually managed over 30% of all hepatitis C patients, resulting in nearly 100% of those patients having a clinical cure from the disease.

More recently, CPPO, in conjunction with the Office of Rural Health, has held boot camps focused on expanded primary care, mental health, and pain management efforts to fill an identified gap in comprehensive medication management in the veteran population. In this project, over 180 CPSs were hired across 63 VA medical facilities focused on improving veterans’ access to comprehensive medication management in rural settings.

“The physicians really appreciate the comprehensive medication management support, because many of those disease states have either complex pharmacotherapy or require a lot of hand-holding of the patients, and they may not have the time or bandwidth to do it,” Dr. Morreale said.

Additionally, CPPO holds leadership trainings for pharmacy champions, conducts site visits with VA center leadership to promote the role of clinical pharmacists, and operates a coaching and mentoring program through which new clinicians and pharmacy leaders are paired with seasoned pharmacists. It’s been a multi-pronged approach to expanding roles for CPSs that was built one step at a time, said Dr. Morreale.

“We obviously don’t do all of this work to win an award—we’re doing it to do the right thing and take care of the Veterans,” he said. “But it’s always nice, after 10 years of hard work with some major successes, to have the recognition of ASHP and national attention to the program. Maybe as a result, there will be more programs that will start to implement the same type of strategies.”

Innovation in Residency Training

Lori Golterman, Pharm.D.

The VA also was recognized for its work in post-graduate pharmacy residency training. The VA operates the largest pharmacy residency program in the country, said Lori Golterman, Pharm.D., National Director of Residency Programs and Education for the PRPO, with some 272 residency program directors, and 628 residents and fellows. About 60% of residents are recruited into full-time positions with the VA when they complete training.

“We’re extremely innovative with our programs,” Dr. Golterman said. Residents have trained in a variety of areas including mental health, rural health, pain, neurology, and oncology. “We are the leaders in psychiatric training, with approximately 77 residents trained annually, as well as pain, neurology and other specialties such as ambulatory care. We were recognized with this award for our latest expansion of pain residencies. We are training 15 residents a year, and it continues to grow as former residents are eligible to become residency program directors.”

Besides monthly calls with residency program directors and residents, PRPO supports teaching and preparing for accreditation visits, responses to surveys, preceptor development, resilience, and much more, Dr. Golterman said. “PRPO supports its trainees throughout the year, with a variety of learning opportunities. The residency year starts with a project design and statistics course, a learning program for presenting articles and evaluating literature, quarterly leadership presentations, monthly conference calls, resilience training, and periodic surveys to check on well -being,” she explained.

The Federal Resident’s Council —a group of 25 residents that include VA and Indian Health Service residents (next year it will include the Department of Defense)—provides information to residents nationally through several committees such as a professional development committee; research committee; networking committee; and an IT committee. The Council works with the Residency Advisory Board to support issues like virtual interviewing and mentoring.

Promoting Resilience

The program also dedicates a lot of time to resilience. “We were among the first to identify stress, anxiety, and depression among

Virginia Torrise, Pharm.D.

residents and report it to ASHP,” Dr. Golterman said. PRPO brought in a psychologist to help with these issues and promoted using mental health resources offered through the VA’s employee assistance program. And, with the start of the COVID-19 pandemic, the residency program quickly adopted virtual training methods for situations where residents could not be on-site.

Dr. Golterman noted that receiving the ASHP Board of Directors’ Award of Excellence is a reflection on the entire team. Her residency advisory board has a combined 240 years’ experience in pharmacy. “They are the heartbeat of the program, and they spend a lot of their own time to support the residency program directors and preceptors and strive toward excellence,” she said.

Virginia Torrise, Pharm.D., deputy chief consultant of Pharmacy Benefits Management professional practice for the VA, added, “Drs. Morreale and Golterman have ensured that the VA has highly qualified, advanced pharmacist-practitioners serving our veteran patients on interdisciplinary teams to meet VA priority needs in primary care, mental health, and pain specialty.  Their work has ensured VA expanded clinical pharmacy telemedicine services to our Veterans who reside in rural health settings and addressed difficulties commuting to a VA clinic. I couldn’t be prouder of their leadership, foresight, and dedication to advancing residency training and clinical pharmacy practice in the VA.”

By Karen Blum

 

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March 12, 2020

ASHP Update on Activities During and in Response to the COVID-19 Pandemic

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

THE COVID-19 PANDEMIC is taking a major toll on people in the United States and around the world. The pandemic is taxing our entire healthcare system and public health apparatus and has or will affect all of our daily lives. ASHP wants you to know that we are here for you as you work on the front lines of patient care to help ensure your healthcare organizations are ready and that your patients get the best care possible. We understand that you and your loved ones may be at risk and the difficulty that this presents as you work to serve your communities and care for your patients during this crisis. We also know that the risks of drug shortages present major challenges in the care of your patients. ASHP and our colleagues at the University of Utah will continue to work to keep the ASHP Drug Shortages Resource Center updated, and we will continue to advocate on your behalf through continued outreach to policymakers as you stand ready to fight this public health emergency.

Last week, we developed two white papers detailing recommendations for federal and state policymakers to address the outbreak. Today, we also sent a letter to Vice President Mike Pence urging the Administration to take immediate steps to maximize pharmacist engagement in COVID-19 preparedness and response efforts. We also asked that decisive action by the Centers for Medicare & Medicaid Services be taken to remove barriers to pharmacists’ patient care services.

ASHP also developed a COVID-19 Resource Center, and we are continually updating it with new resources from various sources, including ASHP.

Due to the current COVID-19 developments, the “Safe, Effective, and Accessible High-Quality Medicines as a Matter of National Security” summit, originally planned for next week, will be postponed. We will be working with the other co-conveners, including the American Hospital Association, American Medical Association, and United States Pharmacopeia, to reschedule this important event in the coming months to continue to drive solution-focused recommendations that address global pharmaceutical manufacturing as a national security priority.

In addition, I would like you to know what we are doing to protect our staff, members and volunteers, and everyone we interact with at ASHP headquarters in Bethesda, Maryland. This includes preparing the organization for a scenario that could include closing our offices. However, we also recognize the need to be able to continue to serve our members even if our physical offices must be closed. We are prepared to run the organization remotely so that we can continue to work on your behalf and provide the tools and resources you need to care for your patients and yourselves.

Furthermore, I would like you to know that ASHP is also assessing all of our upcoming member events on a daily basis. The ASHP Regional Delegates Conferences that are taking place at the end of April in cities around the country are being planned to be held virtually if necessary.

In regard to the ASHP Summer Meetings that are scheduled to take place in Seattle in early June, it is too early to make a final decision. However, we will be fully prepared to make that difficult decision if there is any risk whatsoever to our participants. Safety comes first, no exceptions.

During this crisis, ASHP will remain focused on how we can best assist you, our members, and work at the local, state, and federal levels to be a partner in bringing this unfortunate public health crisis to an end. If you need our assistance, please don’t hesitate to contact ASHP. Please also continue to look to ASHP for up-to-date information and resources on the COVID-19 crisis. We will get through this difficult time together, and be stronger as a profession, citizens, and as a country and global community. In the meantime, ASHP will do everything we can to support you and the patients you serve.

Thank you for everything you do, and please know that we are here for you during this very difficult time.

Sincerely,

Paul

 

July 11, 2019

ASHP, Well-Being, and You

Dear colleagues,

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

There is a great deal of national attention on the issue of healthcare provider burnout, which is affecting our pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians at unprecedented rates.

As many of you know, burnout is a syndrome characterized by emotional exhaustion, depersonalization, and low personal accomplishment. Moreover, there is a significant correlation between poor well-being of healthcare professionals and worsening patient safety. In May 2019, the World Health Organization clarified that burnout is an occupational phenomenon caused by chronic workplace stress that needs to be monitored and better understood. It’s also an expensive problem. Research conducted at the Mayo Clinic estimates that burnout costs the U.S. healthcare system $4.6 billion every year.

A healthy and thriving clinician workforce is essential to ensure optimal patient health outcomes and safety. That’s why ASHP has been a leader in well-being and resilience (WBR) for nearly 40 years. We first addressed this as a critical practice issue in a 1982 AJHP article that explores recognizing, reversing, and preventing hospital pharmacist burnout.

In 2017, ASHP became the pharmacy sponsoring organization of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience. This four-year initiative is raising the visibility of clinician burnout, improving baseline understanding of challenges to clinician well-being, and advancing evidence-based solutions to improve patient care by caring for the caregiver. ASHP is a member of the NAM Action Collaborative Conceptual Model Working Group which is charged with identifying factors that affect clinician well-being and resilience. The goal is to create urgency and understanding of the issue while being careful not to oversimplify the complexity of it. In addition, we recently participated in a NAM meeting in Chicago, focused on redesigning the clinical learning environment to enhance well-being. ASHP member Kofi Andoh, a rising third-year student at Notre Dame of Maryland University School of Pharmacy in Baltimore, was one of five participants selected to share his perspective on the stressful demands placed on students.

To further assess the issue of workplace burnout, ASHP recently conducted a national survey of nearly 2,000 people with help from The Harris Poll. The results show that almost three-quarters (74%) of respondents are concerned about burnout among healthcare professionals. Furthermore, one in four Americans surveyed believes hospital pharmacists (26%) and retail pharmacists (25%) are experiencing burnout. These data show that pharmacy workforce stress is visible to our patients, which is why ASHP has made addressing pharmacy workforce well-being a top priority.

In June 2018, the ASHP House of Delegates approved a new professional policy on clinician well-being and resilience. At our Summer Meetings last month, the House of Delegates reinforced our commitment to WBR by approving a new policy on suicide awareness and prevention, the most tragic and extreme consequence of burnout. The policy recognizes the vital role of the pharmacy workforce in suicide prevention, and the importance of maintaining the health and well-being of both our patients and our colleagues.

June was National Employee Well-Being Month, and in honor of Global Wellness Day on June 8, we launched an online portal – Wellbeing & You – as a resource for pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians. This website is also a place for colleagues to share their experiences with burnout and to pledge their commitment to strengthening personal and workplace resilience. I encourage you to visit the site to learn about burnout, view ASHP’s webinars on WBR, check out the ASHP State Affiliate Toolkit, and contribute to the ASHP Connect Community on Clinician Well-Being and Resilience.

Join ASHP’s movement to combat burnout by sharing your stories and taking the pledge. Keep your eye out for #WellbeingWednesday on social media, where we’ll offer even more WBR tips, member stories, and resources.

Please know that ASHP is here to support you in your career in every way we can and that we will continue to provide you with valuable WBR resources. Thank you for being a member of ASHP, and for everything you do for your patients.

Sincerely,
Paul

May 14, 2019

Mindfulness and Improv Help Pharmacy Students Cope with Burnout

Anne Graff LaDisa, Pharm.D., BCPS, uses improv to teach student pharmacists about effective communication skills.

IN A QUIET LOW-LIT CLASSROOM, students sit comfortably with their eyes closed and their spines straight. They bring attention to their breathing and imagine that they have a balloon in their stomachs. Every time they breathe in, the balloon inflates. Every time they breathe out, the balloon deflates. With every exhale, the students imagine their daily stresses and frustrations floating away. This isn’t a mindfulness retreat at some hideaway resort or the calming conclusion of a power yoga class. It’s a pharmacy course at the Concordia University-Wisconsin School of Pharmacy, where two professors are teaching students to use mindfulness to cope with burnout both during school and throughout their future careers.

According to Christina Martin, Pharm.D., M.S., Director of Membership Forums for ASHP, pharmacist burnout is a serious concern. A 2018 study published in AJHP reported that more than half of health-system pharmacists surveyed felt a high degree of burnout. In addition, a recent salary survey found that two-thirds of pharmacists experienced increased job stress over the previous year, and that 72 percent said workloads increased from the year before.

“When healthcare providers feel stressed, it can also have an impact on their patients,” said Dr. Martin. Burnout is associated with more medical errors and poorer patient safety outcomes, according to the Agency for Healthcare Research and Quality. “We really have to care for the caregiver and ensure that we’re providing resources and support to those who are caring for patients in very chaotic healthcare times,” she added.

Mindfulness in the Classroom

Elizabeth Buckley, Pharm.D., CDE

Elizabeth Buckley, Pharm.D., CDE, Associate Professor of Pharmacy at Concordia University-Wisconsin School of Pharmacy, often includes the balloon-in-the-stomach exercise in her classes. She first introduced it while teaching a diabetes elective for third-year pharmacy students in the spring of 2017 — and she saw immediate changes. It made a huge difference “on attitude, on calmness, on collegiality,” she said.

It worked so well that in the fall of 2018, she added it to her weekly lectures in the Applied Patient Care I course, which is for first-year pharmacy students. “The tone of the class changed in a significant way. Everyone settled down and the discussion was more robust,” she said. “The mindfulness exercise centered me, and it centered the class.”

Dr. Buckley hopes that teaching pharmacy students mindfulness now will help them avoid burnout in the future. “If you’re going to be in a career where you care for other people, you have to figure out self-care in order to be good at being a clinician,” she said.

Improv Shakes Things Up

Anne Graff LaDisa, Pharm.D., BCPS, Associate Professor of Pharmacy at Concordia University-Wisconsin School of Pharmacy, began teaching an improvisational class to first-year students to help bolster communication and teamwork skills. Improv is a theatrical technique where the characters and dialog in scene or story are made up on the spot. Communication skills learned through improv can help a student become a good pharmacist, she noted. Although she didn’t introduce improv classes for pharmacy students with combating burnout in mind, she explained that improv exercises allow students to be creative and break up a school routine.

Anne Graff LaDisa, Pharm.D., BCPS

Dr. LaDisa began taking improv classes herself in 2003. When she discovered that medical schools were using improv to teach and improve medical students’ communications skills, she became intrigued — even more so when she learned that the University of Arizona has been using improv in its pharmacy school since 2004.

She introduced improv to an existing course in 2015, then taught her first stand-alone elective course for first-, second-, and third-year students in 2017. At the beginning of every class, she reviews the rules of improv, which include always saying “yes, and …” to what your partner is trying to communicate, emphasizing the here and now, being specific, and focusing on characters and relationships.

In Dr. LaDisa’s class, a two-person scene requires the students to follow the rules of improv and may involve a scenario unrelated to healthcare. After the students complete the improv exercise, she asks them questions about how they felt about the activity – what things they found challenging and what skills they felt they had to use to be successful. Finally, the students talk about how to apply those skills to clinical pharmacy practice.

Role-playing in a healthcare or social setting can help pharmacy students improve collaboration and teamwork skills. “Improv training gives students an advantage when it comes to communication, which is a critical skill for all pharmacists,” she said.

By Jen A. Miller

 

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March 25, 2019

IHI National Steering Committee for Patient Safety

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

I REPRESENT ASHP ON THE Institute for Healthcare Improvement (IHI) National Steering Committee for Patient Safety and, in that regard, bring pharmacy’s perspectives to this very important initiative. I would like to give you an update on our progress.

The IHI National Steering Committee has representatives from the American Hospital Association, American College of Healthcare Executives, The Joint Commission, American College of Physicians, American Nurses Association, National Quality Forum, CMS, CDC, AHRQ, ISMP, FDA, AARP, and several other prominent organizations involved in patient safety. The committee is charged with creating a National Action Plan to guide patient safety efforts across the country in a cohesive and coordinated fashion. The National Action Plan will focus on the following core areas related to patient safety issues: culture, leadership and governance, learning systems, patient and family engagement, and workforce safety.

To facilitate the work around these core areas, the National Steering Committee members have been divided into subcommittees. I am serving on the Culture, Leadership, and Governance Subcommittee. In addition, ASHP Past President Lisa Gersema and Immediate Past President Paul Bush have been appointed to serve on the Patient and Family Engagement and Workforce Safety subcommittees, respectively.

The work of the subcommittees is well underway and includes assessment of available evidence and best practices, development of key recommendations to influence change at the national level, and practical tactics for implementation and measurement. The subcommittees’ work will continue throughout 2019. A release of the National Action Plan is expected by early 2020.

ASHP is proud to represent the collective efforts of our nearly 50,000 members in the creation of a national strategy for reducing harm in the delivery of healthcare. Though priorities often shift based on the evolving healthcare landscape, ASHP remains committed to its vision that medication use will be optimal, safe, and effective for all people all of the time. Active engagement of pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians in the creation and implementation of this national patient safety strategy will ensure that pharmacy is positioned to help people achieve optimal health outcomes.

Since the release of the landmark To Err Is Human report in 1999, patients and family caregivers, healthcare providers, professional organizations, accrediting bodies, policymakers, and many other stakeholders have made significant progress in advancing patient safety. While this work has resulted in important improvements in the safety of our healthcare system, there is still a need for greater coordination of our efforts. Working in silos can lead to suboptimal patient outcomes, duplication of efforts, lack of accountability, barriers to collective learning, and missed opportunities for strategic approaches — thus the impetus for the work of the IHI National Steering Committee for Patient Safety.

As you continue your professional journeys to zero patient harm, ASHP will continue to play a critical role as your organizational partner and collective professional voice.

Thank you for all that you do to support and sustain a strong culture of safety on behalf of your patients and for being members of ASHP.

Sincerely,

Paul

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February 15, 2018

AJHP’s Top 25 Articles Address Critical Practice Issues

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

WITH A CIRCULATION OF 45,000, ASHP’s peer-reviewed scientific journal, AJHP, is the most widely recognized and respected pharmacy journal in the world. As part of our year-end review in late 2017, the editors of AJHP assembled a list of the Top 25 most frequently accessed articles on www.ajhp.org. What they found was compelling: The articles read most by you and your colleagues address some of the most critical issues facing the profession and healthcare at large. This connection is no accident. From its early days as The Bulletin to its current iteration, AJHP has sought to provide pharmacists with the latest, most relevant practice information available.

AJHP has undergone a comprehensive transformation in recent years in both design and content, including a new approach to cutting-edge clinical topics and an enhanced digital experience. These changes represent a continuation of the journal’s vital role in equipping pharmacists to guide medication-use and healthcare delivery at the patient, population, and policy levels.

A look at the most-accessed content clearly illustrates this principle. The Top 25 list includes articles that predict future directions for practice, offer guidance for strategic planning, and examine the challenges faced by women seeking greater leadership opportunities. Also featured are discussions about the training needs of pharmacy technicians, guidelines on preventing diversion of controlled substances, and approaches for caring for diverse patient populations. The Top 25 list also contains several articles that address important clinical practice issues related to the care of the critically ill as well as patients with cancer, diabetes, infectious diseases, pulmonary hypertension, and thrombotic disorders. This collection of most frequently accessed AJHP content addresses pressing issues for our patients, for our profession, and for our times.

AJHP’s mission to advance science, pharmacy practice, and health outcomes can be realized only when pharmacists take what they’ve learned and apply those findings in their practices. The Top 25 articles, and all of AJHP’s content, can be used to:

  1. Advance ASHP members’ approaches to patient care.
  2. Support pharmacists’ and pharmacy technicians’ professional development activities and approaches to delivering patient care.
  3. Inform proposals for educational offerings at ASHP’s meetings as well as state affiliate-based educational programs.
  4. Supplement educational initiatives with students and residents in the classroom, at the bedside, and through journal clubs and seminars.
  5. Prepare for policy discussions with legislators and other policymakers at the local, state, and federal levels.

I encourage you to take some time to read or revisit the findings in these valuable articles and consider how you can use AJHP to impact patient care at your organization. The full list of the Top 25 most-accessed articles is available as a collection on www.ajhp.org.

Thank you for all that you do on behalf of your patients, and for being a member of ASHP.

Paul

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