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September 28, 2010

Fauquier Health Reveals the True Meaning of Teamwork

Margaret V. Rowe, Pharm.D., director of pharmacy at Fauquier Health in Warrenton, Va., poses with her staff.

How would you define the ideal pharmacy practice model?

The ideal pharmacy practice model is one where the pharmacist works side by side with other members of the health care team to design optimum drug regimens for patients. This is, of course, supported by a drug distribution system in which the right drug, in the correct dose, is in the hands of the nurse to be administered safely to the correct patient. At Fauquier Health, we have been seeking this ideal since the mid-1990s, when we began to decentralize our pharmacists. Our decentralization showed hospital leadership that pharmacists in a clinical role improve therapeutic outcomes and have a positive impact on reducing drug costs.

How do Fauquier Health pharmacists ensure safe and effective medication therapy?

As valued members of the health care team, our pharmacists are highly involved in all aspects of patient care. Pharmacists are staffed on our major inpatient nursing units Monday through Friday, from 7 a.m. to 3 p.m. While on the units, they participate in patient rounds. Pharmacists are also involved in reviewing and processing medication orders, reviewing patient profiles, and performing a variety of other clinical functions (e.g., pharmacokinetic dosing). After 3 p.m., and on weekends, pharmacists in our central pharmacy assume the patient-care responsibilities. All of these efforts have resulted in improved turnaround times for medications and patient outcomes, reduced medication errors, and better communication with all the members of the health care team.

What services are critical in supporting your new practice model?

The essential components of our clinical pharmacy program include pharmacokinetic dosing, total parenteral nutrition management, antimicrobial stewardship, renal dose adjustment, and clinical consultations with other members of the health care team. Our physical presence on the nursing units, including in the ICU, has also placed us in a prime location to intervene during urgent situations.

Another instrumental component is our team of highly trained and motivated pharmacy technicians. All of our technicians are certified pharmacy technicians (CPhTs). They have a strong understanding of the pharmacy and are valued members of our team.

What technologies have you implemented to help facilitate this change?

In addition to allowing pharmacists to access information and process orders from anywhere in the hospital, our computerized physician order management software allows physicians not only to document their histories, physicals, and consults electronically but also to receive and review labs and X-ray results. Our health care informa- tion system also includes an electronic medication administration record along with an electronic nursing documentation system. In 2012, we plan to begin implementing bedside medication verification. We are very wired for a 97-bed hospital.

What are your measures of success?

One major indicator of our success is the overall reduction in medication errors at our hospital. Three years ago, our medication error rate was 5 percent; currently, our data show us at 2.9 percent. Decreases in drug costs per adjusted patient day and demonstrated decreases in hospital-acquired warfarin ADRs are other indicators of the success of our program. Noticeable improvements in communication and collaboration with other members of the health care team, especially physicians, and an overall reduction in staff turnover rates (pharmacists and pharmacy technicians) are also important indicators of our success.

What are some key considerations for gaining employee buy-in?

Gaining acceptance from the pharmacy department, especially our more senior staff members, was critical. We quickly learned that pharmacists who had not functioned previously in a clinical role needed a different level of coaching and training than more recent graduates, who developed their clinical skills during pharmacy school.%%sidebar%%

Another approach we found to be extremely successful was implementing an active mentoring program for our staff members. We offered both formal and informal training and educational opportunities to pharmacists and pharmacy technicians.

How did you gain support of hospital administrators, physicians, and nurses?

We piloted our program with one clinical pharmacist stationed on the nursing unit providing targeted therapies on pharmacokinetics and renal dosing. Being physically present on the nursing unit had a positive impact on our relationship with the nursing team. The nursing staff appreciated being able to talk to the pharmacist in person and in real time.

Gaining acceptance from the medical staff, however, took more of a concerted effort. Our clinical pharmacists worked diligently to develop relationships with key members of the medical staff. To win over the more reluctant staff members, cost saving and outcomes data were presented to hospital leadership and during medical staff meetings.

June 2, 2010

Pharmacy in the Age of Social Networking

Illustrated by Matt Sweitzer ©2010 ASHP

LIKE OTHER CLINICIANS, pharmacists use online social networking to maintain friendships, expand their professional relationships, and even keep in touch with patients. But as more and more clinicians try their hand at blogging or setting up profiles on sites such as Facebook, Twitter, and LinkedIn, professional and personal lines can become blurred. Maintaining the right balance requires finesse and ultimately depends on two things: your comfort level and your judgment.

If You Post It, You Publish It
The first thing to remember about social networking is that once you post something to a site, whether a blog, a bulletin board, a profile, or a page, it is published. That means that this content is fair game for viewers to judge as they see fit. Considering that your viewers may be colleagues, potential employers, or supervisors, you should always be judicious about whom you quote, the kinds of political and religious opinions you post, the types of photos you publish, and the language you use, according to Marni Lun, Pharm.D., M.B.A, director of ASHP’s Pharmacy Student Forum.

“Assume that people are going to Google you,” she said. “What is going to pop up first? Facebook? A blog? What does that say about you?”

Most social networks like Facebook allow users to adjust their privacy settings so that only friends or certain groups of people can see their pages. Although that is a useful feature, you can’t control how other people use the service, Lun added. “Check your friends’ pages and see what’s visible. When in doubt, be a tad more cautious than you otherwise would be with what you allow them to share about you.”

Greg Leatham, M.B.A., ASHP’s director of Web Communications, agrees. “Social networking is a great way to share information, learn new things, and make contacts with like-minded peers, but make sure you understand what is personal and what is professional,” he said.
“I caution people, especially students, who are often a little more free with what they put on their site, that it doesn’t matter where you plan to work,” said Leatham. “Human Resources is going to Google you as part of their recruiting process.”

The same goes for pharmacy directors, residency directors, division chairs, and other administrators who can influence your career and chances of future employment.

Pharmacy students are especially vulnerable to being their own worst enemy when it comes to online social networking. In a study published in the November 2009 issue of the American Journal of Pharmaceutical Education, researchers found that incoming first-year pharmacy students used Facebook in much the same way they did as undergraduates.

Jeff Cain, Ed.D., M.S.

“This showed us that a lot of students aren’t aware of the issues involved in using social networks once they get to a professional school,” said Jeff Cain, Ed.D., M.S., director of education technology at the University of Kentucky College of Pharmacy in Lexington. “They’ve had Facebook for several years already and used it a certain way with their peers. They don’t realize that they’re no longer seen as a student but as a future professional.”

Cain, who has published widely on the issue and has presented at ASHP meetings about professionalism in the electronic age, believes that there is a disconnect between how Facebook was intended to be used—as a social hub—and how it may actually be used by some people—to gain insight into a person’s character, judgment, and professionalism.

Cain suggests that pharmacists ask themselves one question before posting anything online: Is it something you would want pharmacy faculty, your colleagues, or your patients to see?

Friendly Patients
Most online social networks allow members to connect as friends. With 400 million users on Facebook alone, sooner or later, you are bound to receive a friend request from a patient. How should you handle it?

“There’s an entire range of possible responses,” said Bill G. Felkey, M.S., professor emeritus of health care informatics at Auburn University’s Harrison School of Pharmacy in Auburn, Ala. “I have seen professionals who maintain a high level of professional distance. Others are very comfortable with including patients and look at it as a form of relationship building.”
Many professionals fall somewhere in the middle. “It’s a sticky situation,” said Cain. “It’s like a room. If patients come into that room, they’re coming into your social life. That’s a line that wasn’t crossed before.”

Many institutions are starting to enact professional policies regarding social networking and the requirements of “e-professionalism.” In the meantime, if you are not comfortable with “friending” patients, you can always deny the request. However, in the interest of diplomacy, you might wish to explain that you use your social networks for your family and close friends only. Better yet, if you have a professional site, point your patients to it.

Tools for Collaboration
Although it is wise to be cautious when using social networks, don’t be afraid to avail yourself of the opportunities they offer for collaboration. Some sites, like LinkedIn, have been designed solely for enhancing your career.

“LinkedIn is great for professional networking,” said Amy Baker, vice chair of ASHP’s Student Forum Executive Committee. “You can post your curriculum vitae and published papers there, link to your professional blogs, and integrate your Twitter tweets there.”

Cain noted that online social networks can help strengthen weak professional ties. “If you met someone at a conference,” he said, “you can reconnect when you get home and build from there. You can also find former classmates who are now colleagues.”

You can also branch out into video with a network like YouTube, Cain said. “YouTube can be very useful for education and training,” he said. “For the pharmacy classroom, you can learn or instruct someone in different techniques. It’s also valuable for public health education. For example, there are now videos that show patients how to use an asthma inhaler. YouTube is especially effective if you want to reach a broad audience.”

Baker, who is one of several contributors to the Society’s blog, ASHPConnect, added that writing about pharmacy practice in various social media benefits the entire field. “It’s great for projecting enthusiasm and advocating for pharmacy,” she said.

Regardless of which medium you use, Baker notes that if you approach it as you would approach colleagues directly, you can’t go wrong. “Put on your white coat, even if it’s only in your mind.” 

June 1, 2010

In Support of Collaborative Practice

Henri R. Manasse, Jr., Ph.D., Sc.D.

Henri R. Manasse, Jr., Ph.D., Sc.D.

IN THIS ERA OF HEALTH CARE REFORM, advanced pharmacy practice, and enhanced public focus on medication safety and efficacy, you might think that health care professionals would be on the same page in our approaches to team-based, quality patient care. Unfortunately, in the case of the American Medical Association (AMA), you would be wrong.

The AMA recently released its “Scope of Practice [SOP] Data Series: Pharmacists.” This members-only document seeks to define, describe, and prescribe the scope of pharmacy practice. And it does so using erroneous information, false statements, and pure errors of fact about pharmacists’ education, training, and scopes of practice.

It is a troubling look into the way that the AMA perceives today’s pharmacist—a point of view that is clearly out of the mainstream of contemporary practice. The SOP is devoid of what prominent national boards and regulatory bodies such as the Institute of Medicine, the National Quality Forum, the American Board of Internal Medicine, and many others are saying about the importance of collaborative care.

It is clear from the document that the AMA is concerned about the way that medication therapy management (MTM) and collaborative practice agreements are evolving. Pharmacists in hospitals and health systems and nurse practitioners are moving into areas of practice traditionally handled by physicians. But it is an evolution created by need. Drug misadventures are a reality.

With more than 18,000 FDA-approved chemical entities and dosage forms on the market and a practice model that allows any physician to prescribe any medication at any time, there has never been a more urgent need for medication experts. Pharmacists who practice in hospitals and health systems are those experts.

The current state of practice, including a greater demand for pharmacists’ clinical skills and a growing number of new practitioners seeking pharmacy residencies, further bears out the need for pharmacists’ medication management services in the context of team-based care.

Instead, even though collaborative drug therapy management is currently authorized in 45 states, the AMA has chosen to use their policy document to raise fears in the reader that pharmacists aren’t competent to conduct MTM.

ASHP will not passively stand by and allow this publication to go unanswered. I recently sent a letter to AMA Executive Vice President and Chief Executive Officer Michael D. Maves, M.D., M.B.A., in which I laid out the inaccuracies and untrue representations in the SOP and asked the AMA to retract the document or, at minimum, correct it.

In this new world of patient care, it will take every health profession working together to ensure that patients receive the safest, most effective care. Pharmacists are a critical component of that care delivery model, and ASHP continually stands at the ready to promote the importance of collaborative practice.

April 9, 2010

Cultivating a Deep Bench for Pharmacy

Michael Kelly, associate dean of the University of Iowa’s College of Pharmacy, works with a high school student.

MICHAEL KELLY, PHARM.D., is a recruiter for the University of Iowa. Instead of wooing young athletes for Hawkeyes sports teams, Kelly recruits potential clinical pharmacy talent.

In his attempts to pack a deep bench of talent among the student body at University of Iowa’s College of Pharmacy, where he is associate dean, Kelly has become an ambassador for health-system pharmacy in general.

“We are trying to move our recruiting down to middle school and early high school years,” Kelly said, adding that exposing young students to what pharmacists do helps to counter misperceptions about the profession and open the minds of young people to the rewards and challenges of a career in the field.

Attracting the Next Generation

“When you ask a little kid what they want to be, they usually don’t say, ‘I want to be a hospital pharmacist,’ ” noted Marni Lun, Pharm.D., M.B.A., director of ASHP’s Pharmacy Student Forum. Efforts such as those at the University of Iowa to educate students about careers in health-system pharmacy “help to ensure that we won’t miss out on valuable talent,” said Lun.

The College of Pharmacy works in partnership with other health sciences programs and with the university’s admissions office to host students, according to Kelly. Hundreds of middle and high school students from around Iowa and as far away as Chicago have participated in the program over the past several years.

In particular, the college is seeking to engage those students who don’t typically think of a career in pharmacy. “We’re focusing on underrepresented minorities,” Kelly says, including African American, Hispanic, and Native American students.

A “Hands On” Approach

RaShauna Applewhite, Spring 2010 Pharm.D. candidate at the University of Iowa

One young student impressed by a visit to University of Iowa’s College of Pharmacy was RaShauna Applewhite. As a freshman at Waterloo East High School in Waterloo, Iowa, several years ago, Applewhite visited the campus as part of a weeklong camp. The notion of a career in pharmacy intrigued her; this May, she expects to earn her Pharm.D. at University of Iowa.

“During one of the days, we visited the College of Pharmacy, and during that visit we made hand lotion,” Applewhite recalls. “Compounding the lotion was so fascinating, and I felt like pharmacy was a career that intrigued me.”

Hands-on activities seem to especially appeal to the students, according to Kelly. “When we get the glassware and chemicals out, they become engaged,” Kelly said, adding that he and his staff also teach students about how pharmacists work collaboratively with physicians and nurses on medical teams to care for patients.

%%SIDEBAR%%Kelly also takes the opportunity to debunk misperceptions about pharmacy, including the predominant view that pharmacists work only in retail settings dispensing medications.

Applewhite pointed to a black female pharmacist at the college, Lois Garland-Patterson, as someone who opened her eyes to the possibilities of a career in health-system pharmacy.

“She inspired me to pursue this career through her intelligence and passion for the profession,” Applewhite said. “Before meeting Lois, I had never met or talked to a pharmacist before, especially not an African American one. Throughout the rest of my high school career, I kept in touch with Lois. I knew when I prepared to graduate from high school that I definitely wanted to go to the University of Iowa.”

Applewhite first pursued a B.S. in microbiology at Iowa and then applied to the College of Pharmacy. At the time, “pharmacy was truly transitioning into a unique field,” she said, noting the profession’s increased patient-care focus.

“I’ve always known that I am a people person, and I like face-to-face interaction with patients daily,” she said. “I knew that with microbiology, I would probably be faced with isolation in a lab on a daily basis. I ultimately realized that pharmacy encompasses infectious disease as well as other disease states that I find  interesting.”

The University of Iowa’s outreach is important because “we don’t want to lose any good students,” said Kelly. Also, with younger students, Kelly is able to plant the seed they need to take four years of math and science in high school to have a realistic shot of getting into pharmacy school.

“We show them that there is a path, but you have to think about it earlier than later,” said Kelly.

“I am forever grateful to the people and opportunities in my life that encouraged me to go to pharmacy school and showed me that there are so many definitions to being a pharmacist,” Applewhite said.

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