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November 12, 2013

Children’s National Develops Innovative Peds Residency Program

Filed under: Clinical,Feature Stories,Residents,Uncategorized — Kathy Biesecker @ 3:58 pm

 

The residency program at Children’s National Medical Center has tripled in size in just five years.

FIVE YEARS AGO, the 303-bed Children’s National Medical Center in Washington, D.C., supported only two first-year pharmacy residents. Since then, the program has tripled in size to a total of six residents: three in the PGY1 pharmacy residency and three in the recently formed PGY2 pediatric pharmacy residency.

The dramatic expansion in post-graduate education resulted from the convergence of need, opportunity, and the right people, according to Ursula Tachie-Menson, B.S., Pharm.D., the hospital’s acting chief of the division of pharmacy.

“We recognized that there was a real need for a PGY2 program focused on pediatrics. There aren’t many out there, and competition for them is huge,” she said, adding that she is unaware of any other pediatric-focused PGY2 slots in all of Virginia and across a huge swath of the eastern seaboard between Baltimore and Chapel Hill, N.C.

A Strong and Growing Need for Pediatric Pharmacists

Demand for pharmacists who practice in this specialty area is widespread and growing. According to the Board of Pharmacy Specialties, approximately 70 percent of all pediatric hospital bed days are for chronic illnesses, and the Children’s Hospital Association reported that shortages of pediatric care results in many young patients having to wait weeks and sometimes months to get an appointment.

Katherine Pham, Pharm.D., BCPS

Katherine Pham, Pharm.D., BCPS

PGY1 Residency Program Director Katherine Pham, Pharm.D., BCPS, was impressed with the clinical environment when she joined Children’s National in 2008 as the NICU clinical specialist and residency coordinator. When Dr. Pham surveyed the formidable pharmacy staff at her new employer, it seemed as if the department was “just built to have second-year residencies.”

With a core of then four (now six) clinical pharmacy specialists and a substantial number of decentralized pharmacists who had completed at least one year of residency, “there were just so many clinical pharmacy resources to draw from,” she said. “We have many talented clinical specialists who can provide a high level of residency training.”

In addition, because the hospital is one of the rare freestanding pediatric hospitals on the east coast, any residency program becomes, de facto, one of pediatric specialization. Residencies in general population hospitals are more broadly based by nature.

“We knew there were not enough PGY2 programs for pediatrics on the East Coast,” said Dr. Pham.

Pursuing a PGY2 Seen as a Career Boost

Given the competitive job market faced by clinical pharmacists in some regions of the country, more opportunities for advanced clinical training are clearly needed. When Kelli Covington, Pharm.D., a current PGY2 resident at the hospital, decided to pursue a second post-graduate year (she completed her PGY1 at Children’s National), she knew it would boost her marketability.

Her decision hinged as much on the potential career boost as on her desire to participate in a clinically oriented program focused entirely on pediatrics. “I’m being trained to be an independent pediatric pharmacist,” she said. “Most PGY2 programs don’t provide that opportunity.”

In addition, the residency has opened an avenue into academia—another of her interests. Dr. Covington is currently a preceptor and lecturer at the nearby Howard University College of Pharmacy.

Both Drs. Tachie-Menson and Pham emphasize that the expansion of the residency program owes much to steadfast support from pharmacy leadership and hospital administrators. David Stockwell, M.D., executive director of improvement science in the hospital’s intensive care unit recognizes the rewards of a strong residency program.

“Residents think and act at a high level, so they’re able to operate in very complex situations,” said Dr. Stockwell. “That delivers value to our patients and therefore to our organization. And when our residents move on, they’ll help somebody in a different place, so everyone benefits.”

Residency Experience Transfers Well

Rebecca Deoras, Pharm.D.

Rebecca Deoras, Pharm.D.

Rebecca Deoras, Pharm.D., a pediatric pharmacotherapy clinical specialist at the 464-bed Brooklyn Hospital Center in New York, was among the inaugural PGY2 class of two residents in 2011-2012 at Children’s National. She calls her decision to embark on the PGY2 “hands down one of the best decisions I’ve made.”

After pharmacy school, Dr. Deoras became a staff pharmacist at a pediatric satellite facility in New York. Three years later, her path led to the Children’s National PGY1 because she sought a higher degree of clinical training and, she hoped, a competitive edge in the job market. Her choice to stay on for another post-graduate year paid off.

“I was competitive for every job I applied for,” said Dr. Deoras. “Employers were really looking for that second year of specialty training.”

Now, as the only pediatric pharmacy clinician in a community hospital, Dr. Deoras’s responsibilities run wide—PICU, NICU, general pediatrics, hematology/oncology, outpatient asthma, and the emergency department. Yet she has felt completely prepared for the demands of multiple roles, largely, she says, because of the experience and knowledge gained during the PGY2. Because “Children’s National offered me a first-hand look at what’s involved in building a PGY2 from the ground up,” Dr. Deoras hopes to develop one at her hospital.

Patients, Residents Benefit

Second-year resident Gabriella Blyumin, Pharm.D., also anticipates that a PGY2 will bestow some professional advantage, but takes a cautious view. She’s not so sure the opportunities are as plentiful as generally believed, especially for job seekers who are regionally restricted. “There are a lot of overly saturated areas and not every hospital has a pediatric unit,” she said.

Still, for pharmacists such as herself who want to immerse themselves in pediatrics, the second-year residency at Children’s National offered an attractive opportunity. From the time of her first neonatology rotation in pharmacy school, Dr. Blyumin knew that pediatrics was right for her. But because her PGY1 was at an adult community hospital with a 20-bed pediatric unit and a 44-bed NICU, her exposure to young patients was limited to two rotations.

That changed immeasurably when Dr. Blyumin arrived at Children’s National.

“I wanted something very heavy in clinical pediatrics. Last year, I spoke with residents here, and that affirmed to me that the clinical experience was much more in depth than I would experience at other places and that I would see things here that I wouldn’t see elsewhere,” she said. “They made a place for me on the unit, and they don’t hold my hand. I feel like I have a lot of impact on patient care here at Children’s.”

The bottom line, said Dr. Tachie-Menson, is that the pharmacy leaders believed they had the ability, clinical skills, and motivation to create a robust and dynamic residency program that serves patients and residents.

“I think we’ve succeeded in doing that,” she said. “We’ve also been successful in preparing our residents to leave here and find the jobs they really want.”

–By Steve Frandzel

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August 8, 2013

Leadership: Central to Pharmacy Practice Advancement

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

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

EFFECTIVE, FOCUSED LEADERSHIP AND EXECUTIVE PRESENCE are essential to driving pharmacy practice advancement, thus optimizing patient care. ASHP and the ASHP Foundation are committed to supporting pharmacists in their professional and leadership development journey to achieve this goal.

Leadership in clinical practice and effectively working collaboratively on interprofessional teams are what drives practice change. And, through a number of initiatives, ASHP and the Foundation are dedicated to assisting pharmacists across the complete spectrum of their career… from student, to new practitioner, to emerging clinical and administrative practice leaders, and, ultimately, as experienced leaders.

No other pharmacy organization has the depth and level of commitment to your practice leadership development that ASHP does. Please let me review with you this level of commitment and showcase examples of leadership development opportunities that ASHP and the Foundation are offering our members.

Pharmacy Leadership Academy

The Pharmacy Leadership Academy (PLA) has been in existence for five years, and nearly 400 practitioners have completed this transformational leadership development program. The Academy is helping to launch talented new clinical practice leaders and assisting other established leaders in reaching new heights in their careers.

At the Foundation’s ASHP Summer Meeting Donor Breakfast, I heard three pharmacists speak about their life-changing PLA experiences. I was touched and thrilled to hear their heartfelt stories of professional success, and I suggest that you read their inspiring messages and view the video on the Foundation’s website.

What impressed me about the graduates’ messages was their self-confidence, poise, passion, and full commitment to their patients and to leading our profession to new heights. This month, 68 pharmacists began the year-long, distance-based PLA program. They are poised to reach new heights in practice leadership.

If you are interested in catapulting your career, I encourage you to consider enrolling in the next class. In addition, directors and chief pharmacy officers should also identify members of their staff who are primed for success and enroll them in the 2014 class.

leadersINNOVATION Masters Series

ASHP and the Foundation also offer the leadersINNOVATION Masters Series, which consists of two, six-week distance-learning programs: “Developing Transformational Leadership Skills” and “Designing Transformational Change: Strategy and Tactics.”

This leadership development series is an excellent option for pharmacists who may not be able to fulfill a year-long commitment, or who seek a program before the start of the next PLA class. The leadersINNOVATION Masters Series begins August 18. Courses position practitioners to deal effectively with rapid changes in the health care environment and to position pharmacy for the type of transformational change that can expand and advance pharmacy practice.

The series is ideally suited for an emerging leader, a recent pharmacy resident graduate, or for an established leader needing guidance on how to move pharmacy practice to the next level. It also may be exactly what you need for your own professional development or what you have been seeking for one or more of your staff.

leadersEDGE Webinar Series

The new leadersEDGE Webinar Series is another leadership development program that will be launched by the Center for Health-System Pharmacy Leadership in September 2013.

This 90-minute program will address major, cutting-edge leadership challenges facing pharmacy practitioners in health systems. The first program will address the current state of the “Business of Pharmacy.” Webinar faculty will focus on the critical capability and capacity necessary to transform practice. It is the perfect program for pharmacists interested in staying in front of major leadership issues facing our profession.

Opportunities for Students, Residents

At ASHP, we believe that our student pharmacists and pharmacy residents are the lifeblood of our profession.

Pharmacy students face a competitive environment when they graduate and are looking for opportunities to develop and ultimately showcase their leadership talents. ASHP has a host of opportunities through the Student Societies of Health-System Pharmacy, Leadership Speakers BureauASHP Student Leadership Award ProgramStudent Leadership Development Workshops, and the national Clinical Skills Competition.

The future of our profession is in the hands of our pharmacy students and pharmacy residents. ASHP remains committed to providing leadership opportunities for them, including the Visiting Leaders Program, which has been developed explicitly for pharmacy residents.

Showcasing ASHP’s Many Leadership Offerings

During my many years working in hospitals and health systems, I relied upon ASHP, as my professional organization, to assist me in that journey at all steps along the way. It was a challenge for me to keep up with the many offerings of ASHP, and I know many of you face the same challenge.

That is why, at this critical juncture, I am taking the time to showcase ASHP’s commitment to our leadership development programs. Please take the time to share this message, and have your colleagues or your staff members review these fantastic program opportunities.

Feel free to share your thoughts with me about your leadership development needs, and remember that focused and effective leadership is central to pharmacy practice advancement at the bedside, in the pharmacy, in the clinic, and in the administrative office.

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.

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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 26, 2013

ASHP Celebrates 50 Years of Residency Accreditation

 

Photo courtesy of ASHP Archives.

Photo courtesy of ASHP Archives.

WHEN YOU THINK OF THE 1960s, chances are you think of the civil rights movement, the passage of the Medicare law, the women’s movement, and peace protests… all substantial forces for change. But the ‘60s were also a pivotal time in the evolution of pharmacy training.

In 1962, the Board of Directors of ASHP—then the American Society of Hospital Pharmacists—adopted the ASHP Statement on Accreditation of Hospital Pharmacy Internship Training Programs, which laid out objectives for post-graduate programs that would provide in-depth training.

To distinguish these programs from those geared toward meeting the legal requirements for licensure, that same year ASHP dropped the term “internship” and replaced it with “residency.” In 1963, ASHP began the process of surveying the first 32 hospitals accredited for residency in hospital pharmacy.

Over the last 50 years, the form and function of accredited residency programs have shifted several times. The 1980s saw residencies divided into hospital, clinical and specialty programs. This format gave way to the pharmacy practice and specialty residencies of the 1990s and early 21st century.

ASHP Past-President Paul G. Pierpaoli, M.S., inspects sterile solutions while a resident at the Univ. of Michigan. Photo courtesy of ASHP Archives.

At the same time, ASHP created post-graduate year two (PGY2) residencies, which prepare residents for specialty pharmacy practice in areas such as ambulatory care, infectious diseases, and oncology.

“Residency standards have evolved from focusing on systems and production to focusing on patient care and clinical services,” said Douglas Scheckelhoff, M.S., FASHP, ASHP’s vice president of professional development. “Now students are able to build upon their skills and actually apply them as they go through their residencies.”

More than 32,000 pharmacists have completed ASHP-accredited residency programs since 1963, and the number of accredited programs has grown to 1,577.

It has been a long but necessary journey, one that serves to propel pharmacists into rewarding careers and to advance the profession as a whole.

 

Benefits for Residents

Daniel M. Ashby, M.S., FASHP

“Accredited residency programs ensure competency that is rooted in knowledge, skills and abilities,” Ashby said. “Accreditation is our profession’s Good Housekeeping Seal of Approval, signifying that certain requirements in training have been met.”

Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP, associate dean of academic and student affairs and associate professor, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, and a member of ASHP’s Board of Directors, added that accreditation is testimony to the atmosphere of the program in which the resident has trained.

Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP

Participating in an accredited program also gives residents an edge in seeking employment, said Janet L. Teeters, M.S., ASHP’s director of accreditation services.

“Many jobs require applicants to have had a residency,” she said. “The current market is prompting health systems to ratchet down on costs, and they are scrutinizing who they hire. When they see that someone has been through an accredited residency program, they automatically know what kind of skills and training the person has.”

At the Department of Veterans Affairs (VA), which has 585 accredited residency positions spread across 140 programs, accreditation levels the playing field, said Lori J. Golterman, Pharm.D., national director of pharmacy residency programs and education for the VA.

“Each student has different experience because they all come from different schools, and accredited residency provides an opportunity for consistent training,” she said.

 Benefits for Hospitals and Other Health Care Settings

For organizations seeking accreditation, the benefits start accruing long before their ASHP surveyor visit. Simply completing the preliminary RU Ready Assessment Tool for Pharmacy Residency Programs will be enlightening, said Smith.

“The self-assessment helps organizations review their own compliance with each element or standard. It gives them a good idea of how they are doing and what their strengths and weaknesses are.”

The number of residencies in ambulatory clinics and community pharmacies is growing. Above, Brooke Hudspeth, Pharm.D., a former PGY1 resident at the University of Kentucky College of Pharmacy, measures a patient’s blood pressure at Kroger Pharmacy, Lexington, Ky.

“It comes back to the environment,” she said. “A lot of people want to be involved with the programs and work in systems with that kind of culture and recognition.”

Brian Swift, Pharm.D., vice president and chief pharmacy officer at Thomas Jefferson University Hospital in Philadelphia, the very first site surveyed for accreditation back in 1963, agrees.

“Accreditation adds credibility. It carries an association with a large body of individuals [ASHP members] who have already traveled the path [of training and experience], and includes the organization in a legacy of outstanding practitioners and leaders in the pharmacy world,” he said.

And then there is the reimbursement. “Hospitals that run accredited residencies can get Medicare pass-through funding for allied health postgraduate educational programs,” said Teeters. “If 40 percent of their patients are Medicare patients, having an accredited program will enable them to get 40 percent of the cost of their PGY1 residency program funded.”

Benefits for the Profession

Accredited residency programs advance pharmacy within organizations and among other clinicians in the allied health professions. Indeed, preparing to apply for accreditation prompts pharmacy departments to become more cohesive and visible, said Golterman.

From left, Katie Long, Pharm.D., a University of Kentucky PGY2 oncology resident, consults with Stephanie Sutphin, Pharm.D., Clinical Pharmacy Specialist, Outpatient Hematology/Oncology.

“Everyone needs to be involved in the training to give the residents an optimal experience. If the chief of pharmacy or other professionals don’t want to teach or be involved, residency directors need to communicate the importance of their programs to them and change that.”

Because administrators must provide approval to seek accreditation, the process offers an opportunity to shine the light on the profession, said Swift.

“It helps to illustrate where pharmacy should fit in, and it forces pharmacy departments to push for recognition of their programs throughout the organization.”

Accredited residencies also drive practice innovation, which will help expand pharmacy into additional patient-care areas and promote the inclusion of pharmacists as vital members of the care team. For example, at Jefferson, residents conduct research projects and marry those projects with the needs of the pharmacy department in a way that fosters organizational and practice change, said Swift.

“We turn to residents more as practitioners and welcome creative practice methods. We look to them for their insight and energy in breaking down barriers in areas where traditional pharmacy practice may sometimes be limited.”

—By Terri D’Arrigo

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