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October 15, 2019

Health Systems Launch Technician Training Programs

Matt Kelm, Pharm.D., M.H.A.

AN INCREASING NUMBER OF HEALTH SYSTEMS are realizing the benefits of creating their own pharmacy technician training programs. With 10 health-system-based tech training programs in the United States either accredited or in the process of getting accredited, institutions are taking control of the training process. This helps ensure the quality of new hires, enhances the skill set of existing employees, and improves retention within their organizations.

Duke University
“Health system pharmacy departments have a lot of experience training pharmacy residents and students, so it’s a logical extension to include pharmacy technicians in that educational effort,” said Matt Kelm, Pharm.D., M.H.A., Associate Chief Pharmacy Officer at Duke University Hospital in Durham, North Carolina. He helped launch the tech training program, officially called the Duke University Health System Pharmacy Technology Training Program, in April 2018.

Like other programs that meet the recent Accreditation Council for Pharmacy Education (ACPE) and ASHP accreditation standards, the Duke program involves didactic, simulation-based, and experiential learning. The didactic component and some of the simulation training is offered online, which allows students to balance home and work life with training.

“There is plenty of on-site time,” said Dr. Kelm. “The experiential training, in particular, allows students to work alongside technicians in the ambulatory and inpatient environments. [It] offers us a chance to get to know candidates before offering them a position. I often describe the program to the students as a 10- to 15-week job interview.”

Many graduates of the Duke program, which runs three cohorts a year, enter traditional medication distribution and preparation positions. The program also provides opportunities for existing technicians at Duke to learn how to perform more advanced functions.

An 85% technician retention rate within the health system attests to trainee satisfaction with the program, and more broadly, with the opportunities Duke provides, Dr. Kelm noted.

Aubrey Dy-Cok, C.Ph.T.

For their part, technicians like Aubrey Dy-Cok, C.Ph.T., who graduated from the Duke program in 2019, have a variety of reasons for enrolling in health system-based technician training programs.

“I was a pharmacist in the Philippines before moving to the United States, but I can’t practice here yet,” explained Dy-Cok. “I eventually want to become a pharmacist here, but things work quite different than in the Philippines. Studying to be a pharmacy technician was one way to get to know how health systems operate here.” Today, Dy-Cok works at one of Duke’s compounding facilities.

Yale-New Haven
At Connecticut’s Yale-New Haven Hospital, students enrolled in the pharmacy technician training program learn the hard skills required to perform in a hospital or health system setting.

Students learn about sterile compounding and complete a professionalism boot camp during the first week of the program. “We talk about leadership, and how to handle sticky situations and adapt to change,” said Janet Kozakiewicz, Pharm.D., M.S., FASHP, Director of Pharmacy Services at the hospital. “Starting a professional career is a big transition for some students, whether they’re coming out of high school, a college-type program, or if they have been out of school for a long time.”

There is also a “how to dress for success” section and a segment that discusses “what it takes to be part of a large organization like Yale-New Haven,” said Dr. Kozakiewicz. “If you become an employee here, your hand isn’t held. There are expectations when you graduate from the program.” She hopes that the lessons in professionalism and leadership also translate to other parts of a student’s life.

Up to eight students are enrolled every 10 weeks into Yale-New Haven’s ACPE/ASHP-accredited 20-week training program. Although Connecticut only requires a registration for technicians to work and does not require licensure or certification, there is a demand for graduates of Yale’s program, Dr. Kozakiewicz noted.

She believes part of the reason for the program’s high enrollment is that most students have their tuition paid for, either by the Department of Labor or by the health system, in exchange for a work commitment. “Because we’re trying to push for national requirements that health systems only hire technicians who have completed an accredited training program, training through a program like ours is part of a sustainable employment model for technicians for the future,” said Dr. Kozakiewicz.

Working at a large organization like Yale-New Haven following successful completion of the program and licensure is another reason students are drawn to the program, she explained. “Being a 1,500-bed academic medical center, we always have opportunities, and because we have 17 infusion centers across the state, employees can often work at a cancer center close to their home,” said Dr. Kozakiewicz.

With Yale-New Haven hiring 85% of the program’s graduates, none of whom have left to work elsewhere, the health system has benefited by having a steady stream of qualified candidates. “The program has also offered employed pharmacy technicians at Yale-New Haven the chance to serve as preceptors in the program, helping them advance through the career ladder and offering a means for career development,” she added.

Beaumont Health
According to ASHP President, Kathy Pawlicki, M.S., B.S., FASHP, Vice President and Chief Pharmacist at Beaumont Health in Detroit, skilled and dedicated pharmacy technicians are what many health systems are interested in, which is why we are in the process of creating our own training program.

Kathy Pawlicki, M.S., B.S., FASHP

Like many organizations, Beaumont Health has been experiencing a pharmacy technician shortage for a while now. “With variability in the quality of training programs within the community, we believe that creating our own program is the best way to make sure we have quality trained and educated pharmacy technicians to supply our workforce,”  Pawlicki said.

Beaumont’s first cohort is slated to enter the classroom this month, and so far, the process of developing and rolling out a training program has gone smoothly. “Knock on wood, we haven’t had any serious difficulties,” said Pawlicki. “We completed a five-year pro forma on the program, and it showed a very favorable return on investment, so the senior leadership was extremely supportive.”

The variety of pharmacy settings Beaumont offers students to rotate through makes it an attractive program, she noted. Trainees have the option to gain experience at one of eight acute care pharmacies, 12 outpatient retail pharmacies, and a home infusion pharmacy. “Beaumont has a very well-recognized reputation within the community, and the potential to be employed here is really attractive, as is the fact that we support students financially by offsetting all of the costs of the program in exchange for a two-year work commitment at Beaumont,” Pawlick added.

Ultimately, Pawlicki believes the growing number of ACPE/ASHP-accredited health system technician training programs is part of a movement to professionalize the field. Standardizing technician education and training creates a baseline of entry-level skills that technicians bring to their job, she said. “I’m excited for our program, and others like it across the country,” explained Pawlicki. “I think they have a very positive impact on our technician workforce.”

 

By David Wild

August 31, 2018

Pharmacy Technician Untangles Knots in the Supply Chain

This article is part of a series featuring ASHP’s pharmacy technician members and their valuable contributions to the profession. Check out ASHP’s Pharmacy Technician Forum for more information about efforts to advance the pharmacy technician workforce, as well as ways for pharmacy technicians to become more involved in ASHP.

 

AS A PHARMACY TECHNICIAN WHO WORKS AS A  SUPPLY CHAIN CONSULTANT for McKesson Pharmacy Optimization, Cindy Jeter, CPh.T., solves problems. She uses 20 years of pharmacy expertise, her Lean Six Sigma training, and specialized interviewing techniques to help hospital pharmacies across the country optimize workflow, reduce drug expense, and maintain optimal medication inventory levels.

 

Cindy Jeter, CPh.T.

Super Sleuth

On one assignment, Jeter was asked to use her supply chain knowledge to solve a mystery at a large teaching hospital in Texas. More than half of the IV bags prepared in the hospital’s pharmacy were being sent back to the pharmacy at the end of the day. “This meant that roughly 400 bags of IV solution were unused, resulting in thousands of dollars’ worth of medication being thrown in the trash every day,” explained Jeter. “In addition, pharmacy technicians spent four to five hours every day updating the computer system to make sure patients weren’t being charged for unused IV medication.”

After conducting an in-depth analysis, she identified one major cause, observing that when patients were moved to a different area of the hospital, their IV medications weren’t moving with them. The medication was being reordered once the patient was on the new floor and the IV medications on the old floor were then returned to the pharmacy. With more than 250 intensive care unit beds, the number of transfers among floors each day was substantial.

Once Jeter identified the problem and the causes, pharmacy leadership revised their processes and reduced IV bag returns to the pharmacy by 91%. “Consequently, they saved a lot of money, and staff morale increased because technicians didn’t have to spend so much time at the computer updating patient charges,” said Jeter. The pharmacy staff appreciated that I did the investigative work and removed the problem from their plates so they could concentrate on patient care.”

 

Why Pharmacy?

The satisfaction that comes with solving problems is one of the reasons why Jeter went into pharmacy. Jeter, who resides in Springdale, Ark., has a bachelor’s degree in general science from West Texas A&M University. She landed a job as a pharmacy technician at a community hospital pharmacy in 1998. “I didn’t know anything about pharmacy,” she recalled “But they were willing to teach me and invest time in my development for a six-month trial period.” She passed the National Pharmacy Technician Certification exam and, with her aptitude for business, she found her niche in supply chain pharmacy.

Reflecting upon her career accomplishments, Jeter is most proud of winning an innovation award for a McKesson competition in October 2017. The award will fund an online training course for pharmacy buyers, inventory coordinators and supply chain. It is comprised of courses in key areas that are pertinent to pharmacy purchasing such as inventory management, drug shortages, purchasing analytics, emergency preparedness, and pharmacy regulations. “There is a lack of formal training for this vital staff position,” she said. “The world of pharmacy purchasing has increased in complexity over the last decade and requires more skills than before to navigate the challenges associated with pharmacy purchasing.”

 

Inventory Control

In addition to solving supply chain mysteries, Jeter finds fulfillment in helping pharmacy purchasers with inventory management. “In a hospital pharmacy, it’s imperative that you have needed medications in stock,” she said. “You also need to be prepared to treat many patients at the same time. This differs from retail pharmacies, which don’t have to be equipped with products for emergency situations such as a mass shooting or traffic accidents.”

By helping hospital pharmacies control inventory costs, Jeter believes she saves pharmacy jobs. She explained that there are generally three expenses in a hospital pharmacy: medications, staff compensation, and automation expenses. When hospitals are struggling financially, they either have to cut drug costs or employees. “It’s rewarding to help customers more efficiently manage inventory so they can maintain a full staff,” she said.

Jeter is also passionate about being an advocate for pharmacy purchasers. She noted that purchasers have a difficult job trying to manage drug shortages and provide for patient needs. “It takes a lot of dedicated time and effort to keep the hospital pharmacy supplied with the right drugs at the right time,” Jeter said. “Pharmacy purchasers do not always receive training or professional development opportunities.”

She added that being a purchaser is a complex, complicated, and demanding job. Purchasers have tremendous responsibility in providing for patients and do not have the option of simply being out of a medication or a product. Bringing awareness to the position is critical.

 

Advanced Opportunities

With pharmacists taking on more direct patient care roles, there are more advanced opportunities for pharmacy technicians than ever before. Examples include being a supply chain consultant like Jeter, a pharmacy purchaser, a data analyst, a business manager, or a quality assurance specialist.

According to the Bureau of Labor and Statistics, there will be a 12% job growth rate for pharmacy technicians between now and 2026. “It’s an exciting time for pharmacy technicians to find their niche,” Jeter said. Her best advice for technicians is to be an advocate for yourself, make a plan to reach your goals, and let your manager know what you’d like to achieve.

 

ASHP Endeavors

Jeter, an ASHP member since 2003, finds the organization’s education and networking opportunities invaluable. “Being able to present to my peers about projects I have worked on has helped me increase my leadership skills,” she said.

From 2010 to 2014, Jeter served on the Section Advisory Group on Pharmacy Support Services. As chairwoman of the group from 2011 to 2012, she advocated for the development of new opportunities for pharmacy technicians. She is excited about ASHP’s Pharmacy Technician Forum, which developed from these discussions, and the future of pharmacy technicians as integral members of ASHP.

More recently, Jeter served from 2015 to 2017 on the Pharmacy Technician Certification Board Task Force for Advanced Technician Certification, which is working to advance opportunities for technicians to become certified in expanded roles.

“There has never been a more exciting time to be a pharmacy technician and involved in ASHP,” Jeter concluded. “There are practically endless ways technicians can help patients and provide important care.”

By Karen Appold

 

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July 1, 2013

Moving Closer to Achieving Our Vision

Abramowitz-PREFERRED-Featured

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

In the last 20 years, the ASHP House of Delegates has debated and passed important proposals like support for the entry-level Pharm.D., universal health insurance, mandatory reporting of medication errors and “just culture,” collaborative practice, and the implementation of health information technology.

In recent years, the ASHP House of Delegates has approved policies that set future goals for residency training for all practitioners in direct patient care roles; defined the role of pharmacist prescribing in interprofessional patient care; called on federal officials to take action on compounding, drug shortages, REMS, and meaningful use standards; and pushed for standardized education, certification, registration, and licensure requirements for pharmacy technicians.

These policies touch every facet of pharmacy practice and have a profound impact on medication use in this country. ASHP’s professional policies offer a vision for the future of the profession in which pharmacists are essential members of every health care team and where medication use is optimal, safe and effective for all people, all of the time.

Last month, the ASHP House of Delegates approved more than 20 new professional policies during its session at the 2013 Summer Meeting in Minneapolis. Along with passing measures that support training in team-based patient care for student pharmacists and residents and the reclassification of hydrocodone combination products under the Controlled Substances Act, delegates also took strong positions on compounding safely and achieving provider status for pharmacists.

These actions are emblematic of the leadership that ASHP has taken on key medication-use issues throughout its history. ASHP’s professional policies provide a solid foundation for the Society to pursue transformative solutions to the issues that affect our ability to care for our patients.

In particular, the newly approved policies on compounding by health care professionals and pharmacist recognition as health care providers highlight this principle.

Compounding

ASHP is actively engaged in federal efforts to close gaps in the regulatory oversight of pharmaceutical compounding activities. We’ve worked closely with members of Congress and congressional staff on legislation that we expect the Senate to vote on this month; namely, the Pharmaceutical Quality, Security, and Accountability Act. While this legislation addresses federal authority, our new policy focuses on the laws and regulations that govern traditional compounding that occurs in hospitals, clinics, and other areas within health systems. It advocates for the adoption of applicable standards of the United States Pharmacopeia by state legislatures and boards of pharmacy.

The laws and regulations governing compounding vary from state to state. It is essential for the safety of all patients that all pharmacies that compound medications, regardless of the setting, adhere to the very highest standards. A uniform standard will help to ensure that the medications our patients receive are safe and that they are not harmed by agents that are intended to help them.

Pharmacist Recognition as a Health Care Provider

Pharmacists are health care providers. You demonstrate that each day. But we have some work to do to fix antiquated federal and state laws that place unnecessary limits on patients having access to the care we provide.

Our new policy on pharmacist recognition as a health care provider makes a strong case for changing the status quo. It points to the pharmacist’s role as a medication expert who provides safe, accessible, high-quality, cost-effective care. The policy also highlights that, as health care providers, pharmacists improve access to patient care and bridge existing gaps in care.

Achieving recognition as providers for pharmacists is ASHP’s top advocacy priority. We are devoting substantial time and energy with our partner pharmacy organizations to push for changes in the Social Security Act that will recognize the valuable role we play in the health care system.

Please take a look at the summaries of these policies below, and review the other professional policies that were recently finalized by the ASHP House of Delegates:

Pharmacist Recognition as a Health Care Provider

To advocate for changes in federal (e.g., Social Security Act), state, and third-party payment programs to define pharmacists as health care providers; further, to affirm that pharmacists, as medication-use experts, provide safe, accessible, high-quality care that is cost effective, resulting in improved patient outcomes; further, to recognize that pharmacists, as health care providers, improve access to patient care and bridge existing gaps in health care; further, to collaborate with key stakeholders to describe the covered direct patient-care services provided by pharmacists; further, to pursue a standard mechanism for compensating pharmacists who provide these services.

Compounding by Health Professionals

To advocate that state laws and regulations that govern compounding by health professionals adopt the applicable standards of the United States Pharmacopeia.

___________________________

I also encourage you to spend some time thinking about what you envision for the future of practice and what is needed to bring us closer to that goal. Share your thoughts with me in the comments section of this column or by sending an email to ceo@ashp.org. Members serve as the catalyst for our policy initiatives. Your input can help bring us even closer to achieving the vision we have for patient care.

June 4, 2013

Courage

Gerald E. Meyer, Pharm.D., MBA, FASHP

Editor’s Note: The following inaugural address was given by new ASHP President Gerald E. Meyer, Pharm.D., MBA, FASHP, at the Opening Session of ASHP’s Summer Meeting in Minneapolis, Minn.,  June 4, 2013. Dr. Meyer is director of experiential education, Jefferson School of Pharmacy, Philadelphia. His full address will appear in the August 15 issue of the American Journal of Health-System Pharmacy. To watch the speech in its entirety, click here.

GOOD MORNING, AND THANK YOU for that warm welcome!

I would like to begin by acknowledging you—our members. I want to personally thank all of the members who have participated in ASHP’s state societies.

ASHP could not fulfill its mission without the support and inspired leadership of our affiliates. Yes, being president of ASHP involves a lot of time and travel. But, it also comes with a large support staff.

Local volunteer leaders, on the other hand, do it all. You are the membership committee, the program committee, the finance committee, and the professional advocacy committee. So, to all of you, a great big thanks!

A Rich Pharmacy History

Many of you may know that I am from Philadelphia. And I am proud of it.

Philadelphia has a very rich pharmacy history. We have the first hospital in the United States—Pennsylvania Hospital, founded by Benjamin Franklin in 1751. We have the first college of pharmacy in the United States—the Philadelphia College of Pharmacy, which opened in 1821. And we had the first hospital pharmacist in the United States—no, not me. His name was Jonathan Roberts.

We also lay claim to the first Hospital Pharmacy Residency Program to be surveyed for ASHP accreditation and the first accredited Pharmacy Technician Training Program–both at Thomas Jefferson University Hospital.

We have four past-presidents of ASHP currently working in Philadelphia and a fifth in retirement nearby. I won’t tell you who they are—that’s a quiz.

I have been truly fortunate to have had access to so many health-system pharmacy leaders. They, together with many other professional colleagues, have been invaluable as I charted a course through my career. And, of course, I have the most wonderful personal support from my wife, Cheryl, and my family.

I want to extend my personal thanks to all of them for their encouragement and support.

Top Priorities

In writing this speech, I definitely had a lot of people to call upon. Yet, as much as I value their wisdom, I did not ask a single one of them for guidance on what I should talk about today.

Rather, I asked you, the members. ASHP is a membership organization. It is owned by you, its members. So I felt it was appropriate to focus our discussion today on those issues that are of greatest importance to you.

We sent out a survey to a random sample of ASHP members and asked: “What question would you like to ask Gerry Meyer?” Well, you did not disappoint. We received 130 questions, many of which spoke to the concept of courage. So, settle back and relax. This may take awhile. (OK, for the sake of time, we did narrow it down a bit.)

For our first question, Fred Bender, Pharm.D., FASHP, director of pharmacy services at Greenville Health System in Greenville, S.C., asked, “What will be your top priorities as incoming president of ASHP?”

Fred, I have a list of priorities to share with you. But my priorities are of little value unless they become our priorities. My top priority, therefore, is to be the best leader I can possibly be. And you can’t lead without a vision. So, let’s start there.

What makes a good leader?

  • The ability to articulate a vision,
  • The ability to motivate others toward that vision, and
  • The ability to remove obstacles to promote achievement of the vision.

Now, who among you can recite ASHP’s vision? ASHP’s vision is that medication use will be optimal, safe and effective for all people, all of the time. There’s no mention of “hospitals” or “health systems.” There’s not even mention of “patients.” It says “all people, all of the time.”

So, Fred, here is my list of priorities for the year. I would suggest that we view most of the individual items on this list as obstacles confronting us in our efforts to accomplish ASHP’s vision:

  • Build coalitions,
  • Implement the recommendations of the Pharmacy Practice Model Initiative,
  • Pursue provider status,
  • Promote interprofessional education and practice,
  • Expand training and certification for pharmacists and pharmacy technicians,
  • Position ASHP to be as nimble as possible in a rapidly changing environment, and…
  • World peace!

I’m somewhat serious about that last item on the list. Creating an environment in which medication use will be optimal, safe and effective for all people, all of the time is a bold and expansive vision. And just because it is hard to conceptualize, we cannot be deterred from putting our energies towards its achievement. (So, in that respect, our vision is a bit like world peace.)

Becoming Strong Advocates for Patients, Profession

Kevin Aloysius, who just graduated with his Pharm.D. last month from Texas Tech University Health Sciences Center, in Lubbock, (congratulations to all new graduates, by the way!), asked the next question: “How do we prevent doctors’ comments such as, ‘Well, if you wanted to give me recommendations on how to treat a patient, why didn’t you go to medical school?’ “

Kevin, there is a serious answer to your question, but if I wanted to be flippant, I’d say to the physician in question: “If you wanted to be a medication-use expert, why didn’t you go to pharmacy school?” That is an accurate, patient-centric response, isn’t it? A pharmacist’s unique education focuses on the optimal, safe and effective use of medication for all people, all of the time.

Having said that, let’s remember that physicians build their reputations on high-quality outcomes. Why, then, don’t physicians seek the counsel of pharmacists in all matters of medication use? After all, the rate of medication misadventures in the current system is well-documented and not acceptable.

I believe their hesitancy relates to the element of trust. Physicians trust pharmacists to prepare and dispense medications accurately. They trust pharmacists to offer advice on proper administration. They expect pharmacists to offer suggestions on medication compatibility and dosage adjustments.

But, some may not trust pharmacists to create optimal, safe and effective medication-use plans for all people, all of the time. How, then, do we build this trust?

We must aggressively pursue all avenues to modify the perceptions of physicians. And not just physicians, but also health care policy makers, decision makers, and providers, as well as  the general public about the unique education and training possessed by pharmacists. We must have the courage to be strong advocates for our patients and for our profession. Historically, we have been far too passive in promoting our value.

Antagonism vs. Synergism

Our next question comes from Jamie Ridley Klucken, Pharm.D., MBA, BCPS, an assistant professor of pharmacy practice at Shenandoah University, Ashburn, Va., who asked, “We see a push to work collaboratively with other health care providers but seem to have a difficult time putting this into practice. Are there ways to accelerate this interprofessional practice? Perhaps through pharmacy education and post-graduate residency programs?”

Jamie, by definition, interprofessional activities cannot be accomplished by one profession. Each profession must be willing to participate.

The good news is that in May 2011, a group called the Interprofessional Education Collaborative—consisting of educators representing pharmacy, medicine, nursing, dentistry, and public health—released a report that summarized the core competencies needed for interprofessional collaborative practice. Those core competencies fell within four domains:

  • Values and ethics,
  • Roles and responsibilities,
  • Interprofessional communication, and
  • Teams and teamwork.

What this report says is that to build an efficient and effective health care system, health care providers need to:

  • Have a common understanding of health care ethics and values,
  • Understand one another’s roles and responsibilities,
  • Learn how to communicate with one another, and
  • Learn how to be part of effective teams and how to play well together in the sandbox.

For two years, we have had this guidance document that delineates the curricular components that should be taught to health care students, interprofessionally. Jamie, I agree with you. Our profession needs to take a leadership position in incorporating interprofessional competencies into our formal education and training standards. These changes cannot occur fast enough.

Furthermore, to develop this set of skills and knowledge within practicing pharmacists, ASHP must incorporate this critical content within our continuing professional development offerings.

It’s important to consider what this report does not say. Nowhere does it say that interprofessional education should encompass getting health care students into the same classroom to teach them pathophysiology, pharmacology, diagnosis, or treatment. So, if those are not our commonalities, then those must be our differences. Exactly.

Let’s look at this in pharmacologic terms. Sometimes, we administer two very effective drugs that may compete for the same receptor, and the result is that they become less effective. We call that phenomenon “antagonism.” On the other hand, sometimes we prescribe two drugs and the positive effect is greater than the anticipated sum of their individual effects. We call that “synergism.”

Let’s move past interprofessional antagonism. Let’s have the courage to promote an efficient and effective health care system comprised of interdependent, synergistic health care providers.

Practicing at the Top of Our Education, Training

The next question comes from Cassie Heffern, Pharm.D., a PGY2 ambulatory care resident with CoxHealth, in Springfield, Mo., who asked: “In some more rural hospitals, change is almost feared. Despite [the fact] that no one will lose a position by  including more PPMI, the subject is still feared. How would you suggest to keep moving forward with PPMI?”

As you may know, ASHP’s Pharmacy Practice Model Initiative—or PPMI—envisions a future in which pharmacists practice at the top of their education and training. The model identifies the roles that pharmacists must assume and then describes the need to maximize the incorporation of enablers—notably, technicians and technology—to help achieve those roles.

Earlier, I stated that leadership encompasses stating a vision, engaging others to embrace the vision, and removing obstacles toward accomplishing the vision.

For 71 years, ASHP has been a leadership organization. This professional leadership continues. Through the PPMI, ASHP members created a bold vision, and ASHP is committing significant resources to help our members achieve their vision.

Cassie, your question alluded to challenges faced by rural health care providers. We recognize that many of our members are not able to leave their workplace to attend live educational offerings. We have begun, and will continue to accelerate, the delivery of educational programming in formats that offer accessibility to all of our members.

The PPMI envisions advancing pharmacy practice beyond pharmacists offering recommendations for others to implement. It envisions pharmacists as interdependent prescribers who accept accountability for the patient-care plans that they personally initiate.

The willingness to expand our scope of accountability to improve our patients’ health is the essence of our envisioned pharmacy practice model. Are we prepared to expand our scope of practice? Are we prepared to accept accountability for prescribing decisions?

Doing so requires courage. It requires the courage to challenge the status quo. It requires the courage to practice at the top of our education and training, not just at the top of our licenses. It requires the courage to practice beyond the borders of established practice.

The Future of Residency Training

Among the questions I received, more related to residencies than to any other topic. Two members, Kent Montierth, Pharm.D., director of pharmacy for Banner Estrella Medical Center, in Phoenix, Ariz., and Erica Maceira, Pharm.D., BCPS, CACP, clinical pharmacy specialist and student and resident coordinator at Albany Medical Center Hospital in Albany, N.Y., asked: “How does ASHP plan to help grow the number of residency programs and the number of available positions? And, how can the accreditation process be simplified?”

Although it sometimes may feel like we are making little progress in this area, the numbers tell a different story. From 1995 to 2006 (a 12-year period), the number of available accredited residency programs and the number of available positions in those programs doubled. From 2006 to 2012 (a subsequent six-year period), the number of accredited residency programs and number of positions doubled again.

Part of the reason for this rapid growth is that the value proposition for residencies is easily developed for residents,  employers, patients, and the profession. The ASHP website contains a number of documents that can assist practitioners in justifying, designing, and conducting residency training programs.

However, one of the greatest barriers to increasing the number of residency training programs cannot be overcome with guidance documents  alone. A good training program requires a solid infrastructure.

Pharmacy services must meet contemporary standards of practice. Preceptors must have the ability to impart knowledge and develop critical reasoning skills. Residency program directors must be able to mentor and  inspire those entering the profession. And an organization’s culture must be supportive of the training mission.

We cannot, and we should not, compromise on these foundational pillars.

There are now more than 1,000 residency programs in the United States that have a solid infrastructure. I call on those programs to consider expanding. For those institutions without a sufficient infrastructure currently in place, consider collaborating with an existing residency program.

In the 1970s, and then again in the 1990s, my institution offered joint residency positions with neighboring institutions. Those joint programs continued until our partners had developed sufficient infrastructure to conduct their residencies independently.

Kent and Erica, you also asked about simplifying the accreditation process. I agree that we must critically evaluate the current standards to ensure that each requirement contributes to the quality of the training process.

Both the PGY1 and PGY2 standards for accreditation are currently under revision, which presents us with just such an opportunity. As drafts of proposed revisions to those standards are circulated, I encourage all residency program directors to provide your feedback.

Many of the questions I received about residency training referred to ASHP’s member-developed policy that, by 2020, all pharmacists involved in direct patient care must complete a residency.

Let me be clear. Residency training is a critical element in enhancing patient care by expanding pharmacists’ responsibilities. Residencies instill the confidence in young practitioners to have the courage to drive the profession past its current borders.

Please remember that ASHP’s residency policy is aspirational in nature. The decision about whether to pursue a residency is  a career decision. You do not need a residency to obtain a pharmacist license. But you do need a residency to pursue and advance along certain career paths, and the number of those career paths continues to grow every year.

There are four stages to the education and continued training of a pharmacist: pre-pharmacy undergraduate education, professional doctorate education, formalized training, and continuing professional development.

Coordinating the outcomes of each of these four stages is a professional imperative. While the requirements for the pre-pharmacy and pharmacy curricula will evolve, we must recognize that there is only so much that we can accomplish in the classroom because (1) contact time is limited, and (2) students do not have pharmacist licenses.

At some point in time, the profession will need to address the question: Should residency training be required for pharmacists to meet their obligation to  their patients? At some point, that answer will be “yes.” Whether this happens by 2020 or not, it is far better for the profession to prepare for that future than to be unprepared when that future arrives.

Gaining Provider Status

Zina Gugkaeva, Pharm.D., a PGY1 resident at the University of Iowa Hospitals and Clinics, in Iowa City, asked our sixth and final question: “When are pharmacists finally going to be recognized as providers, and what will it change?”

Many of you may have attended the Provider Status Town Hall at this Summer Meeting where this very issue was discussed. Much of what we heard, we already knew:

  • The health care environment is changing.
  • Emerging practice models are focused on integrated health care delivery systems.
  • Policymakers are seeking ways to make health care more affordable for more people.
  • Payment will be focused on quality, not quantity, of care.
  • Consumers will demand transparency in the cost of their care.

So, what will happen when pharmacists are recognized as health care providers?

  • Pharmacists’ patient care services will improve access.
  • Pharmacists’ patient care services will improve quality.
  • Pharmacists’ patient care services will help control costs.

Access—quality—cost. There is substantial documentation to support the positive impact of pharmacists on access, quality and cost of care. We know it. Now we have to sell it. We must have the courage of our convictions.

The first step is to ensure that the profession moves forward with this common message by solidifying these basic principles within the existing coalition of pharmacy organizations. Then, we need to expand the coalition to include other critical stakeholders, including health care provider groups, payers, and patient advocates. We need to draft legislation and seek support by educating legislators, both on a state and national level.

ASHP will serve as your collective voice in formulating the message. ASHP will develop the materials needed to deliver that message. ASHP will tailor those materials for different audiences. And ASHP will train you.

But, we need you to deliver the message to your legislators, to your C-suite, to your health-system’s lobbyists, to your health care colleagues, to your complacent pharmacist colleagues, to your local media, and to your patients.

Access—quality—cost. The message is clear. The message is focused. The message meets society’s needs.

Gaining provider status will ensure that pharmacy is at the table when regulators and other policymakers invite health care providers to help construct new delivery models. And that is why ASHP, the American Pharmacists Association (APhA), the American College of Clinical Pharmacy (ACCP), and other health care organizations have committed significant resources to achieving provider status for pharmacists.

Zina, while no one can predict when we will finally succeed, I am confident that we will succeed if we have the courage to stand strong and united on this issue and if our members get personally involved.

I call upon all pharmacists who believe they are health care providers, on all student pharmacists who believe they are training to become health care providers, on all people who want their medication use to be optimal, safe and effective all of the time. I call on everyone to send the message: “Pharmacists are medication-use experts. Pharmacists improve access, improve quality, and control the cost of health care. Pharmacists are health care providers.”

In closing, I want to thank everyone who took the time to submit questions. I invite you to continue to send me your comments and suggestions over the next year. Finally, I want to thank you for the courage you show every day toward advancing ASHP’s vision: that medication use will be optimal, safe and effective for all people, all of the time.

Thank you.

June 3, 2013

New CE Service for Techs Features Webinars

Filed under: Current Issue,Feature Stories — Tags: , , — Kathy Biesecker @ 3:44 pm

ASHP’S NEW ONLINE LEARNING PORTAL for pharmacy technicians, PharmacyTechCE.org, is hosting a number of webinars as part of a monthly series. The subscription service, which is available to individual pharmacy technicians, pharmacies, and pharmacy departments, will offer over 20 hours of continuing pharmacy education (CPE) annually.

photo by Matthew LesterEducational categories on the site include automation, sterile compounding, medication and patient safety, pharmacy operations, pharmacy law, professional practice, and quality improvement.

“ASHP is making this investment in quality education and professional development for pharmacy technicians because we believe that well-trained pharmacy technicians can help us advance pharmacy practice and improve quality for all patients in all health care settings,” said ASHP CEO Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP.

Subscriptions to PharmacyTechCE.org are available both to employers investing in these critical members of the pharmacy team and to individual pharmacy technicians looking for technician-designated education. Most topics are available in podcast, CE monograph, and on-demand formats, providing the flexibility for different learning preferences.

April 22, 2013

Boston Bombing Puts Hospital Pharmacies into Emergency Mode

Filed under: Current Issue,Feature Stories — Tags: , , , , , , — Kathy Biesecker @ 11:54 am

Ambulances line Columbus Avenue after two explosions went off near the finish line of the Boston Marathon April 15. Photo by David L. Ryan/Boston Globe via Getty Images

THE PEOPLE WHO ARRIVED in the emergency department on April 15, 2013, had injuries unlike any Nancy Balch had seen in her 12 years as an emergency department pharmacist at Massachusetts General Hospital in Boston. Their injuries were severe. At least one person had had a limb blown off.

“I’ve seen a lot, unfortunately,” she said of her decade-plus in emergency care at the level 1 trauma center, “but nothing like this.”

High Volume, Extensive Injuries

By the end of Balch’s regularly scheduled shift on Monday, the hospital had treated 29 people injured by the bombs that exploded near the finish line of the Boston Marathon.

People came to the emergency department the next day, too, Balch said. Some sought care because their hearing had not returned to normal. Others did not realize until Tuesday that they had a piece of metal stuck in them.

Shannon Manzi, at Boston Children’s Hospital, has spent almost as much time in an emergency department as Balch has.

“I have not seen these types of injuries since I was in Haiti,” said Manzi, who went there in 2010 immediately after the 7.0-magnitude earthquake.

But in Haiti, the patients had crush injuries, she said. On Monday, the patients at Boston Children’s had blast injuries. Both types of injuries can sever limbs.

The children hit by the blasts, however, had injuries more extensive than what Manzi had seen after the earthquake.

On Monday, Boston Children’s, a level 1 pediatric trauma center, received 10 patients from the blasts, the hospital has reported. Manzi said she had just torn down the medical tent at mile 15 in the marathon when her pager alerted her to a “mass casualty” at the hospital. The first two patients were in the emergency department when she arrived.

Good Decisions, Well-Made Plans

The bombs exploded about the same time as the overlap in day and evening shifts for emergency department pharmacists and pharmacy technicians, Manzi said.

On arrival, she assumed the role of managing pharmacist. Pharmacists with emergency department training who had been working upstairs in the hospital came downstairs to bring the total to six.

Shannon Manzi

Manzi said emergency care personnel organized into four teams, each with two physicians, two nurses, one clinical assistant, one respiratory therapist, and one pharmacist. She remained available to manage resources, ensure everyone had what they needed, communicate with the main pharmacy, and step in when a pharmacist needed relief. The sixth pharmacist worked with the patients who were in the emergency department for reasons other than the bomb explosions.

Brigham and Women’s Hospital, a level 1 trauma center next to Boston Children’s, received 31 patients from the explosions, an emergency department physician told CNN on Monday night. Nine of those patients underwent major surgery that day, he said.

Pharmacy services executive director William Churchill said his department’s immediate goal was to ensure that the physicians and nurses in the emergency department would not have to leave a bedside to obtain a medication. The pharmacy accomplished that goal by shifting resources to have six pharmacists in the emergency department in the initial hours after the explosions, he said.

One pharmacist was already in the emergency department for the evening shift. The day-shift emergency department pharmacist, Churchill said, stayed on, as did nearly all the staff.

And, “as luck would have it,” he said, several members of the “emergency department pharmacy team” were already on duty in other areas of the hospital. The pharmacy deployed two to each of the main areas of the emergency department. In each twosome, one spoke with the nurses and physicians to determine what they needed and answer questions and the other pharmacist expedited medication delivery.

“We drill a lot with preparing for disasters and mass casualties,” Churchill said.

In those types of emergencies, patients may need a medication before they have a medical record number or their name is known. Lacking that information, he said, personnel other than the pharmacists can have trouble obtaining a medication from an automated dispensing machine. So the pharmacy on Monday deployed pharmacists who could obtain medications quickly from automated technology, he said. Those pharmacists also facilitated the preparation and delivery of preoperative i.v. drug doses for the patients heading for surgery.

“One of the pharmacists said to me that it was her perception that . . . the nurses seemed to be relieved that the pharmacists were there as part of the team helping them,” Churchill said. All of this transpired while he was offsite.

John Fanikos, one of the pharmacy’s senior directors, assumed the role of the pharmacy unit leader and went to the hospital’s command center, Churchill said. “We’ve actually drilled and practiced that with all of my senior directors.”

With Fanikos in the hospital’s command center, Churchill said, two of the mid-level managers took roles in operating the pharmacy command center.

Contingencies

Erasmo “Ray” Mitrano

At Massachusetts General, interim chief pharmacy officer Erasmo “Ray” Mitrano made sure Balch had support in the emergency department—another pharmacist who could lend a hand and provide care to pediatric patients if any arrived.

Mitrano sent Lois Parker to the emergency department from the pediatric intensive care unit. He also had pharmacists elsewhere in the hospital remotely handle the workload that would have been Balch’s on a normal day. This, he said, freed up Balch and Parker to focus on the patients injured by the bombs.

Parker said she stayed in the pediatric emergency department to be out of the way until her assistance was needed. But no pediatric patients had arrived by 5:30 p.m., she said, when the hospital’s incident command center sent a broadcast e-mail stating that staff coverage was adequate enough for the day shift to leave. She checked with Balch, who concurred that Parker could leave.

Parker said she felt “pretty prepared” for the situation in the emergency department. The hospital has conducted disaster drills on a regular basis, and she participated in a tabletop disaster drill that was specifically geared toward pediatrics.

Emotional Support

The day after the bombs exploded, Manzi said, Boston Children’s held a debriefing for emergency department personnel. She said the hospital commonly holds a debriefing after a bad outcome. But the recent debriefing was held for another reason. The injuries on Monday were not the type seen every day, she said.

“When it’s in your background and it’s terrorism,” Manzi said, “it’s a different thing than when it was a very, very sad case of a motor vehicle accident or a shaken baby.”

Churchill estimated that 50-some pharmacists were at “The Brigham” when the bombs exploded. “People rolled up their sleeves and volunteered to stay and did whatever was necessary to get it done,” he said. “I couldn’t be more proud of that situation or my department.”

When interviewed two days after the bombing, Churchill said he continues to check on how his staff members are doing. “Hopefully, everybody’s going to do real well,” he said.

Parker, who said she was not directly involved in caring for any of the injured, said the bombing hit particularly “close to home” because coworkers could have been among the injured. “The Mass General has a fairly sizable team of people who run in the marathon, and they raise money for various programs at the hospital, including the pediatric oncology clinic,” she said.

Word of the bombing reached Parker soon after she and others had determined through the marathon organizer’s athlete tracking system that some of their colleagues were near the finish line. Balch said she sees “awful accidents” all the time, yet what she saw April 15 was different.

“The thing that most struck me,” she said, “is it was something that somebody did to people. . . . That’s what makes it most horrific for me.”

Three hours after the bombing, the Boston Police Department reported that three people had died. Local hospitals had received 176 people by 7 a.m. Tuesday, the department later stated.

–By Cheryl Thompson; reprinted with permission from ASHP News.

 

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