ASHP InterSections ASHP InterSections

June 22, 2016

From Teaching to Oncology Pharmacy: A Winding Path to a Fulfilling Career

Editor’s Note: This is the second story in a series examining the growing number of women in pharmacy leadership and ASHP’s work to support them.

Jill Bates, Pharm.D., M.S., BCOP

Jill Bates, Pharm.D., M.S., BCOP

JILL BATES, PHARM.D., M.S., BCOP, did not begin her career as a pharmacist. This may come as a surprise to those who know her as Clinical Pharmacy Specialist in Hematology/Oncology and Residency Program Director for the PGY2 oncology residency at University of North Carolina (UNC) Healthcare System, where she’s been for eight years.

In her clinical role at UNC Health Care, Dr. Bates primarily cares for patients with lymphoma and myeloma, seeing them for symptom management, medication management, chemotherapy education, and other medication-related needs. When it comes to educating patients, however, Dr. Bates’ first career may have helped prepare her for a teaching role.

Challenges Along the Path to Pharmacy

Dr. Bates began her professional career as a high school science teacher in Texas. Although she loved teaching, the hours were long, and the pay was less than ideal. Dr. Bates decided to switch vocations after attending a healthcare career seminar but needed to return to school to complete a master’s degree for prerequisites. During that time, she attended a session on the changing roles of the pharmacist.

I never knew pharmacists worked with patients until I went to that session,” she recounted. “I liked that, as I really wanted to work directly with patients.” That, combined with the fact that her father, as manager of a Jewel-Osco Pharmacy in Illinois, had worked closely with pharmacists and always spoke highly of them, drove Dr. Bates’ choice to be a pharmacist. And that’s when the challenges began.

It wasn’t easy going back to school after being in the workforce for several years. Dr. Bates married prior to pharmacy school and found that the sudden loss of income was more challenging than she and her husband had anticipated. “The demands of training were difficult on my marriage,” she said. “I put having a family on hold to complete my training, and that led to some duress wondering about my future role as a mom.”

I see a direct connection between the pursuit of residencies and other advanced credentials and the advancement of pharmacy. Patients stand to benefit tremendously from pharmacists’ ability to provide higher-level care.

Dr. Bates graduated from pharmacy school and eventually had two children. Being a new practitioner while pregnant posed some daunting challenges. She developed gestational hypertension with both pregnancies, and preeclampsia led to hospitalization and bed rest during the second.

“The sheer chronic exhaustion that comes from the physical demands of all those changes in your body and working full time as well is something that many young professional women experience,” she said. Despite this, Dr. Bates was able to not only survive but thrive.

Of course, there was some help along the way. “I stand on the shoulders of giants… too many to list, honestly,” said Dr. Bates. “Blessings that I did not deserve happened mostly at the beginning of my career during my training. I continue to feel incredibly grateful.”

Dr. Bates believes in the “pay it forward” model and consistently looks for opportunities to support fellow pharmacists in their own career journeys. She is a member of ASHP’s Women in Pharmacy Leadership Steering Committee, the former chair of ASHP’s Section of Clinical Specialists and Scientists, and former vice chair and chair of the ASHP Council on Therapeutics. Dr. Bates is currently focusing on growing the residency program at UNC Health Care.

“I see a direct connection between the pursuit of residencies and other advanced credentials and the advancement of pharmacy,” she said. “Patients stand to benefit tremendously from pharmacists’ ability to provide higher-level care.”

A Perfect Balance of Patient Care and Scholarship

Dr. Bates’ interest in hematology/oncology arose even before she went to pharmacy school. As she researched the effects of polyamine analogs on transformed malignant cell cultures for her master’s degree, Dr. Bates became intrigued by oncology and has maintained that passion throughout pharmacy school and a residency, to her position today. “What makes my job worthwhile is that I am doing meaningful work,” she said. “I am making a difference in people’s lives.”

Specialties like oncology pharmacy offer a great avenue to showcase pharmacists’ patient-care expertise.

What Dr. Bates enjoys most about her position is the combination of relationships and scholarship. In addition to deep collegial relationships with coworkers, every year she develops relationships with pharmacy residents and students, medical oncology fellows, nurses, pharmacy technicians, and others. But Dr. Bates finds that the most rewarding aspect of being a pharmacist is getting to know her patients.

“I love learning their stories and working together to improve their health,” she said. “It is a privilege to be their pharmacist. I see true heroes every day.”

Dr. Bates’ passion for learning new information helps her to thrive in a difficult yet innovative workplace.

“The physicians I work with really push me to do things that I just never thought a pharmacist could do,” she said. “It provides me with the ability to practice at the top of my license. Many times, the only thing holding me back is my own fear.”

Words of Wisdom for Fellow Women Leaders

Dr. Bates is glad that ASHP is embarking on a journey to focus on the needs of women pharmacist leaders. “I feel that women experience an internal struggle with respect to leadership positions. For example, the fact that many leadership roles require more travel and time away from home can be difficult to manage,” she said.

Having faced the challenges she did over the course of her career has sparked a passion in Dr. Bates for the issue of women in pharmacy leadership.

“I strongly believe that when you encounter a problem, you should be a part of the solution,” she said, adding that she places a high priority on activities that grow women pharmacists’ ability to shine in practice.

What makes my job worthwhile is that I am doing meaningful work. I am making a difference in people’s lives.

“I have been so fortunate in terms of the large number of people who have helped me over the years that I feel it is my responsibility to offer my service to our profession,” she noted.

So what does Dr. Bates recommend for women rising in the profession?

“Maintain focused intensity,” she said. “It wasn’t until I became very honest with myself and clear on my passions/goals that I started to feel some harmony between my professional and personal life.” Dr. Bates suggests putting goals in writing, setting goals for all aspects of life (not just professional), and reevaluating them periodically. She also advises establishing habits that support a single-minded focus.

“For example,” she said, “I spend one hour a day early in the morning doing professional development work. Building habits makes it easier to get things done.”

Dr. Bates believes it’s important for women pharmacists to support each other; in particular, she recommends sponsoring other, younger female professionals who show potential. “I also think it’s important to be open about issues you face as a woman. Don’t hide the fact that you are a mom, wife, or any other variable that describes you as a woman. Talk about it publicly.”

And her advice for men?

“I think it is very important for women to always consider their male counterparts in these discussions,” said Dr. Bates. “The changing roles of women affect men, and it’s important to support them as we all adapt to a new norm. I believe that the changing demographics in pharmacy allows for new perspectives to be heard. And I think that it generally leads to better decision making and improved productivity. Having more women in pharmacy leadership ultimately benefits everyone—our profession, our healthcare organizations, and our patients.”

— By Ann W. Latner, JD

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May 23, 2016

Opportunities Abound for Increased Pharmacists’ Role in Treating Patients with HIV

"Shara Elrod, Pharm.D. (standing left) and Elizabeth Sherman, Pharm.D  (seated right), administer a rapid HIV test to a patient.

Shara Elrod, Pharm.D. (standing left) and Elizabeth Sherman, Pharm.D (seated right), administer a rapid HIV blood test to a patient.

AN AGING POPULATION OF PATIENTS with human immunodeficiency virus (HIV), comorbidities, and increasingly complex drug regimens is making pharmacists an “indispensable partner in HIV care,” according to a recent editorial in AJHP.

Patients with HIV are living longer thanks in part to more-effective antiretroviral therapy. According to the National Institutes of Health, more than half of all individuals with HIV are now at least 50 years of age. A significant proportion of new infections are also occurring in older adults.

The AJHP editorial accompanies a new set of ASHP guidelines outlining the many roles — from HIV testing to helping patients achieve better drug adherence — that pharmacists are taking on as part of interprofessional teams in caring for individuals with HIV.

“Pharmacists in all care settings are well positioned to meet the unique needs of HIV-infected patients because the cornerstone of effective HIV care is individualized and complex medication therapy,” said Elizabeth Sherman, Pharm.D., Assistant Professor of Pharmacy Practice at Nova Southeastern University’s College of Pharmacy, Fort Lauderdale, Fla., and co-author of the ASHP guidelines. “This is precisely the area in which we, as pharmacists, are educated to assist.”

The Effect of Comorbidities on HIV Care

Jason Schafer, Pharm.D., MPH, BCPS, AAHIVP

Jason Schafer, Pharm.D., MPH, BCPS, AAHIVP

Jason Schafer, Pharm.D., MPH, BCPS, AAHIVP, lead author for the new “ASHP Guidelines on Pharmacist Involvement in HIV Care” and Associate Professor of Pharmacy Practice in the Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, said a graying population brings with it an increasing number of comorbid health conditions. This is another area in which pharmacists are bringing their clinical expertise to bear.

“Pharmacists can improve care and outcomes for many of the comorbid conditions that we see in HIV patients, such as heart disease, cancer, and diabetes,” explained Dr. Schafer.

A 2015 study showed as much, demonstrating that when pharmacists were involved in interdisciplinary care for HIV patients who also had diabetes, hypertension, or hyperlipidemia, patients’ lipids were better managed, smoking cessation rates increased, aspirin was used more appropriately, and the cost of care per patient was $3,000 lower than when care did not involve a pharmacist.

Helping Patients Navigate the Healthcare System

One important function pharmacists can play as part of an interdisciplinary HIV care team is to screen and test for HIV and comorbidities and help patients receive treatment as early as possible, said Dr. Schafer. “For HIV specifically, the earlier patients connect with an appropriate provider, the sooner they can start antiretroviral therapy, and the better their outcomes are likely to be.”

Alice Pau, Pharm.D., (third from left) participates in clinical patient rounds at the National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Alice Pau, Pharm.D., (third from left) participates in clinical patient rounds at the National Institute of Allergy and Infectious Diseases, National Institutes of Health.

AJHP editorial co-author Alice Pau, Pharm.D., Clinical Staff Scientist and Pharmacy Specialist in the Division of Clinical Research at the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md., added that pharmacists are also well-positioned to ensure that HIV treatment is seamless across the continuum of care.

The need is great, according to Dr. Pau, because her team often finds that patients who come in for treatments after hospitalization are discharged without having their prescriptions filled, leading to a lapse of weeks without treatment.

“As pharmacists, we can work collaboratively with a social worker or case manager at discharge to help ensure patients have their prescriptions filled or have arrangements in place to get them filled outside the hospital,” she said.

More and More Physicians Relying on Pharmacists

A large number of comorbidities and the use of polypharmacy in patients with HIV mean that physicians are relying more than ever on pharmacists’ drug expertise, according to AJHP editorial co-author Henry Masur, M.D., Program Support Specialist at NIH’s Critical Care Medicine Department.

“It’s hard for primary care physicians to remain up-to-date on the efficacy and safety of HIV medications and on the increasingly complex pharmacokinetic interactions and overlapping toxicities of drugs in multidrug regimens for patients who also have comorbidities,” he said.

ASHP guidelines co-author Dr. Sherman noted that pharmacists also can improve care of patients with HIV by identifying potential drug interactions, helping to ensure treatment adherence, linking patients with appropriate care, or providing a host of other services. The results are impressive: greater HIV viral suppression, reduced rates of viral resistances, increases in patient survival, improvements in quality of life, and fewer secondary HIV transmissions.

Dr. Sherman’s own experience caring for patients and helping other providers optimize their treatments has confirmed pharmacists’ valuable role in caring for patients with HIV. “I’ve learned what a pharmacist can be: an ally to the HIV patient, a service to the community, and a pioneer who is contributing to a rapidly growing body of clinical knowledge,” she said.

–By David Wild

 

 

March 7, 2016

2+2 Curriculum Ensures Broad Patient Care Experience

Filed under: Current Issue,Feature Stories,Managers,Students,Uncategorized — Tags: , , , , , — Kathy Biesecker @ 7:01 pm

Touro pharmacy students worked with patients during the Harlem Healthy Soul Festival in September 2015.

A NON-TRADITIONAL “2+2” CURRICULUM at the Touro School of Pharmacy in Harlem, N.Y., is paying big dividends for students and their future employers. Founded in 2008, Touro has differentiated itself by requiring students to spend twice the amount of typical time in clinical rotations during their four-year Pharm.D. experience.

Traditional “3+1” pharmacy programs designate a single year for clinical rotations after three years of coursework.

Touro’s “2+2” curriculum, modeled on medical school education, offers two years of classroom instruction followed by two years of clinical experience. The expanded exposure to real-world practice creates more opportunities for students to impress potential employers and helps them narrow their postgraduate and professional options.

“The additional rotations helped me discover my professional interests, fine-tune my career plans, and ultimately decide that I wanted to pursue an academic career,” said Emmanuel Knight, Pharm.D., a 2015 Touro graduate and now an academic fellow at the school.

“And if you make an impact at a clinical site, they’re more likely to consider you for residencies, fellowships, and jobs.”

Pharmacy Immersion Helps Chart Professional Paths

During the two-year clinical component, students complete six-week rotations at affiliate sites to learn first-hand about areas such as ambulatory care, general medicine, and institutional and community pharmacy practice. To pack the equivalent of six semesters of coursework into just four terms, Touro’s semesters last 19 weeks instead of the usual 13 to 15 weeks.

Tova Berman

Tova Berman

Tova Berman, a third-year pharmacy student, noted that the early immersion in fieldwork allowed her to map out a professional path with greater confidence.

“By starting my clinical rotations in my P3 year, I have been able to think about my future pharmacy career in much more concrete terms,” said Berman. “Also, while classroom learning is an extremely important component of our education, experiencing hands-on clinical work at an early stage has helped bring the material to life. I see it for myself on a daily basis: various illnesses, medication management, and how pharmacists play an integral role in patient care.”

Touro stresses that every clinical rotation is an opportunity for a potential employer or residency program to assess a student, according to Ronnie Moore, Pharm.D., assistant dean of clinical affairs and associate professor at Touro. The augmented rotation timetable also gives students a chance to repeat rotations at desired clinical sites.

“The extra time that students spend on rotation gives the staff at those sites a good gauge on students’ individual capabilities,” Dr. Moore said, adding that the amount of information that students retain grows exponentially in an actual practice setting.

Ronnie Moore, Pharm.D., assistant dean of clinical affairs and associate professor at Touro.

Ronnie Moore, Pharm.D.

By the second half of their third year, he added, most students are already honing in on a particular practice area. They also still have plenty of time left to choose additional rotations that best prepare them to meet their goals.

That was true for Touro alumnus Michelle Friedman, Pharm.D. When Dr. Friedman began pharmacy school, she had intended to become a community pharmacist. But during her second year of clinical work, she gravitated toward clinical pharmacy. After graduation and two years of residency, Dr. Friedman became a clinical faculty member at Touro and a preceptor at Kingsbrook Jewish Medical Center, Brooklyn, N.Y., for students who are completing their internal medicine rotations.

“My early rotations opened my eyes to new experiences and helped me decide what I wanted to do,” she said. “What I’m doing today is the best of both worlds for me because I love teaching, and I love clinical pharmacy.”

A Commitment to Public Health, Service

Organizations that hire Touro graduates say they, too, benefit from students’ additional clinical exposure.

“The Touro student we hired had already completed multiple rotations with us,” said Hinnah Farooqi, Pharm.D., director of pharmacy at Harlem Hospital Center. “She became familiar with our staff and our work environment, which shortened her training time and helped her become readily accepted as a colleague.”

Touro students participated in the American Hearth Association Heart and Stroke Walk in September 2015.

Another facet of Touro’s hands-on ethos is the school’s curricular obligation to public health and community service.

“We strongly believe that a student’s education is greatly enhanced when it reaches beyond the four walls of the school into the surrounding community,” said Dr. Moore.

For instance, among their various service work commitments, Berman assisted at an immunization clinic at a local senior center.

Dr. Friedman and fellow students spoke to Staten Island high schoolers about drug abuse, and Dr. Knight helped to set up a volunteer program in which residents at a long-term care facility were transported to and from concerts and religious services.

“We had many opportunities to do those types of things during our last two years when we didn’t have to focus on coursework,” he said. “It allowed me to give something back to the community.”

–By Steve Frandzel

November 12, 2015

Future Pharmacy Leaders Making a Difference Today

Bryan C. McCarthy, Jr., Pharm.D., M.S., BCPS

Bryan C. McCarthy, Jr., Pharm.D., M.S., BCPS

WHEN BRYAN C. McCARTHY, JR., Pharm.D., M.S., BCPS, and David P. Reardon, Pharm.D., BCPS, first met at the Minnesota Pharmacy Residency Research Forum in 2010, they realized that they had the same enthusiasm for pharmacy and the same desire to change the profession for the better.

What they didn’t know was that over the next three years, they would dive into the world of publications management and dedicate thousands of hours to an effort that would give pharmacy residents a powerful way to share their research: The Journal of Health-System Pharmacy Residents (JHPR), now AJHP Residents Edition.

A Winding Road to a Different Future

Dr. McCarthy, now interim director of ambulatory care pharmacy services at the University of Chicago Medicine and program director of the newly established PGY1-2 pharmacy administration residency, graduated from the University of Rhode Island (URI) College of Pharmacy. He then landed in Minneapolis as Hennepin County Medical Center’s first PGY1/PGY2 pharmacy administration resident. However, Dr. McCarthy almost didn’t have a residency to go to in the first step of his career path. That’s because he had interned in two settings, CVS and South County Hospital in Narragansett, R.I., which would have sent him down another career path entirely.

“The URI College of Pharmacy program is largely a community pharmacy-driven curriculum, attributable in part to the CVS brand influence in the college and area,” said Dr. McCarthy. “It’s also near the ocean without many large academic medical centers or hospitals nearby, so internship opportunities tended toward community practice or long-term care.”

Though the experiences with CVS and South County were valuable, Dr. McCarthy sought more, and his preceptors encouraged him in his quest. One arranged a meeting between Dr. McCarthy and AstraZeneca Regional Clinical Science Manager Raymond Mastriani, Pharm.D., M.B.A. Dr. Mastriani assumed a mentoring role and suggested that a residency would serve Dr. McCarthy well. However, by that point, residency applications were already due.

When he later found himself unmatched, Dr. McCarthy sent emails to the 150 hospitals with open residency positions. Three responded, including Hennepin, which had filled the position he was inquiring about but had just received funding for its pharmacy administration residency.

“They were impressed that I had exposure to profit-and-loss statements and medication utilization evaluations, and I wouldn’t have had that exposure if my rotation preceptors hadn’t been so flexible with my interests,” Dr. McCarthy said. “I’m a firm believer that everything happens for a reason, and my landing at Hennepin is a testament to that.”

David P. Reardon, Pharm.D., BCPS

David P. Reardon, Pharm.D., BCPS

Dr. Reardon, now a solid organ transplant clinical pharmacist at Yale-New Haven Hospital, arrived in Minneapolis with slightly more breathing room, as he had been matched with Mayo Clinic Health System at Mankato for a PGY1 pharmacy practice residency. But even that was a bit of a surprise.

Not only had Dr. Reardon decided to apply for matching “at the 11th hour,” but he was also already on the path to retail pharmacy, having worked as a pharmacy technician for a Keaveny Drug store and interned at two Wal-Mart pharmacies.

“I didn’t have a lot of hospital experience, and suddenly I was at one of the top hospitals in the world,” Dr. Reardon said. “It shows what can happen when you take yourself out of your comfort zone.”

Diving into the World of Clinical Publishing

While completing his residency, Dr. McCarthy also pursued a master of science in social and administrative sciences. The residency put him in a position to notice an unmet need in pharmacy, and his work on his master’s put him in a position to find a solution.

“As part of the accreditation process for pharmacy residents, you have to write a manuscript, but I quickly found that many of the high-profile pharmacy journals aren’t publishing a lot of resident research,” Dr. McCarthy said. “Since there are more than 1,000 residents in hundreds of residency programs in the U.S., I wondered where all of their manuscripts were going.”

Dr. McCarthy said that academic publishing models came up often in casual conversations with fellow students and professors in his master’s program, and one night everything came together in a eureka moment.

“I was sitting at my desk one night doing homework, and it hit me that we could have a magazine for pharmacy residents perhaps called Resident Rx, and later expand that to Resident MD, Resident RN, and so on,” said Dr. McCarthy. “Then the name—Journal of Health-System Pharmacy Residents—came into my head and that was it.”

Collaborate. Network. Go out and experience whatever you can experience, and if someone gives you an opportunity, the answer should always be ‘yes.’

After mulling it over for a month, Dr. McCarthy set about making arrangements. “It was really like a full-time job,” he said.

Meanwhile, Dr. McCarthy and Dr. Reardon’s friendship had grown from simply networking to recreational get-togethers such as ice-fishing and nights out in Minneapolis. In July 2011, Dr. Reardon moved to Boston to complete a PGY2 critical care residency at Brigham and Women’s Hospital, but the two met up again at the ASHP Leaders Conference in October 2011, where they decided to work together on the journal.

“I knew I needed David’s help. I just didn’t know exactly how yet, so we started off by tag-teaming it from the Leaders Conference,” Dr. McCarthy said.

“Bryan identified the niche for the journal, and as he told me about it, the wheels started spinning,” Dr. Reardon said. “How big could it be? What would be the scope? Who will be involved? How do you get it going? What is the ultimate goal? We wanted residents to have a place to publish their work, but also a place where everyone, not just residents, could read what is being done at the resident level.”

From there, it was a matter of Dr. McCarthy and Dr. Reardon rolling up their sleeves and digging in. The journal’s website went live in December 2011, with options for submissions, subscriptions, and requests for volunteers to be on the editorial board. The duo reached out to residency program directors and deans of colleges of pharmacies in a massive, targeted campaign to raise awareness.

The journal took off. It received 200 submissions in the first year alone, and more than 200 in the first half of the second year. But by the end of the second volume, the demands of publishing began to outstrip the time and resources Dr. McCarthy, Dr. Reardon, and the editorial board had to devote to it.

“We started to wonder how much more of this we could actually do ourselves,” Dr. Reardon said.

By the second half of 2014, they had their answer. With their careers blossoming, it was time to turn to an organization with the resources to meet the demands of publishing a quarterly peer-reviewed journal: ASHP.

Transitioning to a New Paradigm

Through a series of calls at the end of 2014, Dr. McCarthy, Dr. Reardon, and ASHP staff ironed out the details of the transition. In June, ASHP published the first issue of what is now the AJHP Residents Edition, published quarterly as an online supplement to AJHP.

Dr. McCarthy and Dr. Reardon now serve on AJHP’s editorial board, working with Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, editor in chief. Papers that originally appeared in JHPR will be republished in AJHP Residents Edition to ensure that they remain in the published literature and are indexed in PubMed along with all new submissions.

“It’s a win-win situation,” said Carol Wolfe, ASHP’s vice president of publications and drug information systems. “Over the years, we’ve received many more resident papers at AJHP than we could accommodate. AJHP Residents Edition is the perfect showcase for this great work, allowing residents to contribute to the academic literature while gaining the exposure and attention they need as they advance in their careers.

AJHP Residents Edition also aligns perfectly with ASHP’s longstanding leadership in advancing residency training and supporting residents, preceptors, and program directors.”

Wolfe had high praise for Drs. McCarthy and Reardon. “It’s quite impressive how quickly they launched a successful publication, all while completing their residencies and then embarking on their careers,” she noted. “They represent the leadership trajectory of many pharmacy residents, spanning clinical, administrative, acute, and ambulatory care roles.”

As he looks toward the future, Dr. Reardon wanted to share some hard-won advice with current pharmacy residents.

“Realize that this is your profession. If there is something you don’t like, change it. If there is a direction you think the profession needs to take, it’s your responsibility to make it happen,” he said. “Collaborate. Network. Go out and experience whatever you can experience, and if someone gives you an opportunity, the answer should always be ‘yes.’ ”

Dr. McCarthy couldn’t agree more. “There’s really no secret to this. If you want to accomplish something, you can. It’s a matter of the sacrifice you’re willing to make. Through AJHP Residents Edition, more people can learn of the things you do, so take advantage of the opportunities you have. You’re only a resident once.”

–By Terri D’Arrigo

Editor’s Note: Interested in publishing in AJHP Residents Edition? See the links below.

Author Guidelines: AJHP Residents Edition

Residency Research Tips – ASHP Foundation

AJHP Research Fundamentals Series

October 27, 2015

Pharmacists Find Ways to Make ADCs Work in the ED

Filed under: AJHP News,Clinical,Current Issue,Innovation — Tags: , , , — Kathy Biesecker @ 11:03 am

PHARMACISTS SAY AUTOMATED DISPENSING CABINETS (ADCs) can bring efficiencies to the care of patients in the emergency department (ED), but it’s important to ensure that nurses aren’t worried about being administratively locked out of the devices during a crisis.

PatriciaKienlePatricia C. Kienle, director of accreditation and medication safety for Cardinal Health Innovative Delivery Solutions, gave two examples of how such a crisis might come about: “A patient presents as a ‘John Doe,’ or it’s a trauma patient who you just have to take care of right away.”

At such times, she said, patient care trumps everything—including the usual procedures for logging the patient into the electronic medical record (EMR) system, routing medication orders to the pharmacy for verification, and releasing the drugs to nurses at the ADC.

“It happens in every hospital,” Kienle said. And, she said, hospitals devise different solutions to give ED nurses quick access to medications in such situations.

Michelle C. Corrado, system director of pharmacy services for Hallmark Health System Inc., of Medford, Massachusetts, said her organization’s ED nurses can use a “911 dummy” account in the Pyxis ADC when medications are needed for a patient whose information has not been entered into the EMR system.

“This was a way . . . for them to get access to the life-saving meds that they need without the patient’s name,” Corrado said. “It’s [for] somebody who’s unresponsive or unconscious or has no identification, and there’s no family there to help with the registration process, and they just need meds to get the patient out of the critical stage.”

William W. Churchill, chief of pharmacy services at Brigham and Women’s Hospital in Boston, said there’s no such dummy account to allow urgent access to the Omnicell ADCs in his institution’s ED. But nurses can manually create an entry in the devices for specific patients whose information isn’t available when a medication is urgently needed.

“They might type in ‘Smith, John, medical record number 123456789.’ And the Omnicell will accept that, and the nurse can get the drug,” Churchill said.

Corrado said any medication in the ADC can be removed by using the 911 dummy account. But she said the nursing staff is expected to use the patient’s correct account as soon as it’s available instead of continuing to remove medications using the 911 dummy code.

Both pharmacists said these solutions require pharmacy staff to be diligent about following up to make sure their dispensing records are accurate.

“Our informatics team gets a report of all the 911 entries that are made,” Corrado said. “So we can go back and get the information from the nurse in terms of who is ultimately attached to that so that we can get all the billing and everything correct.”

MichelleCorradoCorrado said the reconciliation process isn’t difficult, but it does involve manual data entry to correct the patients’ accounts.

A critical component of ADC use at Brigham and Women’s was the development of a list of medications subject to automatic pharmacy verification through the EMR system. Nurses can pull those medications from the ADCs, effectively overriding the pharmacy review.

“We have a defined list, which was done collaboratively between the ED, medical, nursing, and pharmacy. And we also collaborated and agreed upon which orders would be ‘autoverify’ and which would require a pharmacist’s review,” Churchill said.

He said an ADC in a trauma room will contain more autoverify medications than a dispensing device located elsewhere in of the ED.

“When a patient is in need, we need to be able to provide that drug,” Churchill said.

Overrides, like dummy accounts, must be reconciled, he said.

“We get a report that’s generated the next day. Then we ask the pharmacists that are staffing in the area to take a look at the overrides and make sure that they’re appropriate,” Churchill said.

Andrew Kaplan, pharmacy supervisor at St. Catherine of Siena Medical Center in Smithtown, New York, said his hospital installed ADCs in the ED nearly a decade ago after consulting with the ED staff about which medications to stock in the cabinets.

For situations when seconds count, as during “an absolute emergency,” Kaplan said, “we’ve created a dummy patient account called ’emergency patient’ to allow them to pull something out that’s urgently needed.”

We’re trying to leverage our electronic medical record and our automated dispensing cabinets to improve patient care.

In somewhat less urgent situations (e.g., a patient is not yet registered), nurses can type whatever information they have about the patient directly into the Pyxis unit and then obtain the medications, he explained.

“We encourage them to put in as much information as possible, so at least it gets entered as a temporary patient,” Kaplan said.

He said the hospital’s Epic EMR system is the brains behind the successful deployment of the Pyxis unit in the ED and the ability to reconcile dispensing records.

“Our Epic EMR knows everything that happens in Pyxis. So there’s a linkage between the two,” Kaplan said.

Kaplan said ADCs allow the pharmacy to store and manage “hundreds of units of medicines” in the ED and improve the drug delivery process in various ways.

“We’re trying to leverage our electronic medical record and our automated dispensing cabinets to improve patient care,” Kaplan said.

For example, he said, the Pyxis unit in the ED has “auxiliary towers” for the storage of i.v. antimicrobials and large-volume medication preparations. With this feature and changes to the EMR system, he said, nurses no longer “run back and forth from the emergency department to the pharmacy” to obtain i.v. aztreonam for patients with penicillin allergy. Now, he said, the drug is administered within an hour of ordering 64% of the time, compared with 16% of the time before the changes were made.

Linda Lipsky, director of pharmaceutical services at Methodist North Hospital in Memphis, Tennessee, since 1992, recalled that drug dispensing in the ED used to be “kind of a free-for-all,” with nurses essentially taking whatever they needed for their patients from medication carts.

When ADCs were first introduced, they didn’t really fix that problem, she said.

“There was no control over it at that point, because we didn’t have profiles,” Lipsky said, referring to the system through which the pharmacy views information in the EMR and reviews and verifies drug orders, allowing the release of medications from the ADCs. Without the profile process, she said, every medication in the ADC was essentially on override status.

Now, she said, her community hospital uses Omnicell ADCs with profiling enabled to ensure that a pharmacist reviews the orders before administration, with overrides allowed for emergencies.

Lipsky said pharmacy, nursing, and medical staff worked together to create the override list. Once the nurses became familiar with the profiling capabilities and the override drugs, the ADCs were better accepted, Lipsky said.

“Like any change that you make, it’s slow when you start because you’re not real familiar. But then once you get into it, it’s no big deal,” she said.

–By Kate Traynor, reprinted with permission from AJHP
(November 15, 2015; volume 72, pages 1921-1922)

 

 

 

 

August 25, 2015

Creating an Army of Provider Status Advocates: One Member’s Story

Felicity Homsted, Pharm.D., BCPS

Felicity Homsted, Pharm.D., BCPS

AN UNEXPECTED EMAIL REQUEST this past June launched Felicity Homsted, Pharm.D., BCPS, on an unanticipated mission: to muster the support of Maine legislators for the Pharmacy and Medically Underserved Areas Enhancement Act.

If signed into law, the bill, now before congressional committees in the House and Senate, would grant pharmacists provider status in medically underserved areas and make them eligible for reimbursement under Medicare Part B.

“I didn’t hesitate. I just said, ‘Yes!’ and leveraged all of the relationships I’ve built over the years to get more people to push for provider status,” said Dr. Homsted, director of pharmacy at Penobscot Community Health Care in Bangor, Maine.

By the end of the day, she had called or emailed colleagues and administrators at more than a dozen health centers, health advocacy groups, and insurers; handwritten letters to Maine’s four-person congressional delegation; and quickly persuaded the CEO and CMO of her facility to do the same.

Within a week, Dr. Homsted had reached out to directors of pharmacy representing all of the health systems in the state. By the end of the second week, she added three presentations, a television interview, and more emails and calls. The entire PCHC pharmacy staff joined the efforts with technicians, pharmacists and residents all voicing their support. In under a month, she had confirmed that at least 50 support letters from all across the state had gone out to the Maine congressional delegation.

The results of her team’s hard work followed quickly. On July 7, Sen. Susan Collins signed on as a cosponsor of the Senate version of the bill S. 314. Sen. Angus King responded with a declaration of support for the bill.

Persistence Pays Off

The initial email appeal that Dr. Homsted received came from Joseph Hill, director of ASHP’s Government Relations Division. He knows he got far more than he bargained for.

“Felicity has been a pacesetter for the kinds of outreach we need from members to help us drive support for provider status,” said Hill. “The thing I find most inspiring about her advocacy is the persistence she demonstrated in reaching out to people and organizations. Felicity sets the gold standard for grass roots activity. If she can inspire others to do half of what she does, we will definitely get these bills across the finish line.”

Dr. Homsted tailored her pitch for every person she coaxed toward advocacy. “If I had just asked them, ‘Will you support us?’ many people – even many pharmacists wouldn’t understand why this is such a big deal,” she said. “But when I explain how provider status will help improve patient care and reduce healthcare costs on the individual level for their patients or organization, people really begin to understand the value of the legislation.”

Issues that matter-edits

Left, Robert Picone, host of the weekly public television show “Issues that Matter,” invited Dr. Homsted (right) to enlighten his viewers about provider status.

In the midst of Dr. Homsted’s advocacy blitz, another unexpected overture led to the most memorable moments of her campaign. Robert Picone, a board member of the Greater New England Chapter of the National Multiple Sclerosis Foundation and host of the weekly public television showIssues that Matter,” invited her as a guest on the program to enlighten viewers about provider status.

ASHP staff prepared Dr. Homsted for the interview by coaching her to ignore the cameras and take the time to consider each answer. They also recommended that she focus on a few simple, consistent messages and circle back to them at every opportunity; keep her answers succinct so that viewers understand what is at stake; and remember a few on-camera tips, including smiling slightly and avoiding clothing with patterns.

After the show appeared on YouTube, Dr. Homsted said she was amazed by how many people got in touch with her to find out what they could do to help. The most poignant response came from a good friend who texted, “I’ve never really understood what you do until I watched the show. Now I know how important your job is, and I want to thank you for all the things you’re doing to make healthcare better.”

Educating the Public about Pharmacists’ Roles

According to Dr. Homsted, consumers and legislators don’t fully understand the contemporary roles of pharmacists. “People are just beginning to appreciate that we add far more to the healthcare equation than just counting pills,” she noted, adding that educating the public as well as pharmacists about what provider status means is critical for passage of the legislation.

Dr. Homsted (second from far right) is supported in her provider status outreach efforts by her pharmacy residents and other members of her team at Penobscot Community Health Care in Bangor, Maine.

Dr. Homsted (second from far right) is supported in her provider status outreach efforts by her pharmacy residents, members of the Penobscot Community Health Care C-suite, and other members of her pharmacy team.

“Pharmacist provider status goes well beyond reimbursement; it is a mechanism to expedite pharmacist integration into care teams, ultimately improving care value, quality, safety and most importantly patient health.”

Dr. Homsted and her team’s advocacy efforts continue. She recently began enlisting universities and recruiting pharmacy students and residents (within and beyond Maine) to the ranks of active supporters.

“We want to create a small army of pharmacists who can go out and inform people about the importance of provider status,” she said. “I tell them to start with people they know well and with whom they can have an immediate impact, and then let those successes fuel more ambitious targets. Our goal is to get the entire Maine delegation to cosponsor the legislation. Anything else is unacceptable.”

–By Steve Frandzel

Editor’s Note: Want to find out how to support ASHP’s provider status efforts in your state? Check out our advocacy toolkit with a variety of activities to get you started!

 

 

 

 

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