ASHP InterSections ASHP InterSections

March 28, 2011

Use of Technology Growing, Pharmacists’ Roles Changing

OVER THE YEARS, ASHP’s National Survey of Health-System Pharmacy Practice has evolved into a powerful tool to track pharmacy developments. The results of the survey, which monitors both micro- and macrotrends, help highlight changes that can feel almost glacial in pace but that are critical to the profession’s future.

“Although we publish the overarching results of the survey in the American Journal of Health- System Pharmacy (AJHP) each year, the article alone doesn’t capture the trends over longer periods of time,” said Douglas Scheckelhoff, M.S., FASHP, ASHP’s vice president of professional development. “When you stand back and look at the larger picture, you see some startling and exciting changes in the profession.”

The survey, which has its roots in the Mirror to Hospital Pharmacy (published in 1964), was first fielded by ASHP in 1975. What initially began as an occasional survey, occurring once every few years, has become an annual effort at data collection. The new survey will appear in the April 15 issue of AJHP.

Since 1990, the survey has documented three important trends in health-system pharmacy: the influence of The Joint Commission (TJC’s) on national safety standards, the growth of technology in pharmacy practice, and the evolution of roles for pharmacists and pharmacy technicians.

Guiding Pharmacists, Policymakers, Stakeholders

Each year, approximately half of the survey focuses on two of six aspects of the medication-use system: prescribing, transcribing, dispensing, administration, monitoring, and patient education. The other half comprises of standard questions about staffing or current hot topics and evolving issues, such as informatics or the environmental impact of drug disposal.

The consistency of the survey’s questions gives it clout, according to Craig A. Pedersen, Ph.D., Pharm.D., FAPhA, a health care consultant in Mercer Island, Wash., and lead author of the forthcoming practice report in AJHP’s April issue.

“Our methods have been maintained over time, including the weighting and phrasing of the questions, and we’ve had a consistent team of investigators, so the trends are very likely real,” Pedersen said. “This survey is a trusted source of information not only to our profession, but to policymakers and other stakeholders.”

Pharmacists Respond to TJC

In recent years, survey responses have reflected the impact of TJC’s medication safety guidance. For example, after TJC announced national patient safety goals, the number of hospitals in which pharmacists read back verbal orders in detail, including spelling the drug’s name, increased from 30 percent of respondents to more than 83 percent of respondents within five years.

In 2006, 59 percent of hospital pharmacies did not offer after-hours review of orders. Now only 43 percent of hospital pharmacies do not perform after-hours review. There also has been a growth in the number of facilities that have affiliation agreements with other hospitals for order review and remote pharmacy services.

Hospital and health-system pharmacy has changed markedly in the years since ASHP first started surveying pharmacists about their practices. Photos courtesy of ASHP Archives.

“When The Joint Commission gets involved, hospitals step up to the plate with new processes,” said Pedersen. He noted the impact of TJC guidelines on medication reconciliation. “The Commission said we need to perform medication reconciliation, and now everyone is doing that,” he said. “The survey has enabled us to document our progress.”

Expanding Reach of Technology

ASHP’s national survey has captured a second pronounced trend: the growth of technology. In 2010, 34.5 percent of hospitals had adopted bar code medication administration, compared with just 1.5 percent in 2002. In 2010, 18.9 percent of hospitals had adopted computerized prescriber order entry with clinical decision support, compared with 2.7 percent in 2003.

Although seven- and eight-year trends demonstrate growth, longer trends illustrate just how far the use of technology in pharmacy has come, Scheckelhoff said.

“Think about computerization of the hospital pharmacy. In 1982, only 17.6 percent of hospital pharmacies were computerized. Now, virtually all are,” he said. Scheckelhoff noted that the near universal use of automated dispensing cabinets reflects the shift toward unit-dose drug distribution.

“All of these technologies improve efficiency and safety, and we’re able to take the information the survey provides about their use in forming practice models, to make sure these technologies are used to maximum effect,” Scheckelhoff added.

Changing Roles

The growth of technology has positively affected how pharmacists and pharmacy technicians go about their work, according to the survey.

“One could imagine technology replacing people, but we’ve seen the opposite,” said Scheckelhoff. “Technicians are doing more for prepping and distribution of medications, while pharmacists are moving into advanced roles with more direct patient care, such as working in the ER and going on patient care rounds.”

In 1982, pharmacists went on rounds in 13 percent of hospitals. Now, pharmacists go on rounds at 43 percent of hospitals overall and in nearly all hospitals that have 300 beds or more.

Philip J. Schneider, M.S., FASHP, clinical professor and associate dean at the University of Arizona College of Pharmacy in Phoenix, notes the increase in pharmacists’ responsibilities.

“Pharmacists are being delegated responsibility for prescribing or making changes in drug therapy without necessarily having to get physician approval, and we think that’s important,” Schneider said.

“The survey has shown us that there is a shift away from labor-intensive activities and toward pharmacist empowerment in terms of drug therapy management,” he said. “It’s clear that this is a vision for a lot of pharmacists, and it shows how hospitals are increasingly making better use of their pharmacists’ time to achieve that vision.”

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.

March 1, 2008

Career Transitions Offer Excitement, Challenges

Lisa Gersema, Pharm.D., BCPS, was in flux, moving into a new role as phar­macy director at United Hospital in St. Paul, Minn. After nearly two decades working as a clinical pharmacy manager, she was ready for a change.

Gersema, 46, was comfortable with the familiarity of being a clinical pharmacy manager, a position she held at both United and Saint Luke’s Hospital in Kansas City, Mo. She knew that feeling would disappear once she began the director position. The thought of accountability for an entire department was daunting. And she would need to build rela­tionships with new peers. Nonetheless, when the director position opened, she went for it.

Although Gersema hasn’t been a rookie for a long time, she was surprised at how challenging the transition has been.

“It was like putting on a different set of glasses and seeing things I hadn’t seen before. I will tell you I probably have had more sleepless nights and worries since I’ve been director, but I do enjoy the challenge,” she said.

Tumultuous Career Changes

Experts say it’s common to struggle and feel isolated in a new job, and pharmacists are not immune from those feelings. Age, experience, and expertise in your field can buffer the difficulty of moving into an unfa­miliar position, but those attributes don’t fully protect you. And whether fresh out of school, mid-career, or on the verge of retire­ment, ASHP members say career changes can be tumultuous even with solid skills and knowledge gleaned from previous positions.

Job transitions are different for each pharmacist. Mid-career pharmacists may not have fully mapped their futures but are looking for promotions that fit. Others are approached for positions they didn’t necessarily expect but are glad to accept. And young pharmacists often live in the moment and opt for the right positions as they emerge.

With a multitude of different oppor­tunities, today’s retirement-age pharmacists seem to be in flux. Some aren’t sure when they’ll stop working, while others work every day toward a set retirement date. Oth­ers leave the profession only to return in a different capacity.%%sidebar%%

Take 52-year-old Alicia Miller, M.S. She may retire at age 65, but “Who knows?” she said. In a U-turn back to work this year, Miller returned as a con­sultant after retiring as associate director of pharmacy at the Ohio State University Medical Center, Columbus, and assistant professor at the university’s College of Pharmacy.

Miller pursued the consulting posi­tion because she wanted to use her skills in pharmacy for something new. The stress is now less, but the change has meant that she has had to adjust both to more travel and the fact that she is called on now to make recommendations. In her previous position, she made decisions.

“You are not there to be a decision-maker, which was one of my primary roles in my previous life,” Miller said.

Living in the Moment

Transition came easy to Jillian Foster, Pharm.D., who has experienced job changes every year since she received her pharmacy degree from the University of Mississippi in Oxford in 2004.

“You’d think that it would be tiring to change, but it’s not. It’s rejuvenating. It’s motivating, and it doesn’t get old,” Foster said. “The transitions have been a whirlwind, but every experience has built on the previ­ous one.”

Foster, 28, currently works as a phar­macy benefits manager at North Mississippi Health Services’ Acclaim, Inc., a third-party administrator in Tupelo, Miss. Her profes­sional philosophy is to not worry about reaching specific career milestones, but to stay open to possibilities.

“I just like to knock on the door. I’m up for anything,” she said. “I have to remind myself not to get caught up with the future. What is my advice to new practitioners? Live in the moment, and nothing that you learn will be wasted.”

Changing careers can mean excitement, but it can also mean a welcome change in stress levels, according to Jordan Cohen, Ph.D., 65.

“I felt the intensity go away,” he said.

Before retiring last year as dean of the University of Iowa College of Pharmacy, Iowa City, for eight years, Cohen said his busy working schedule stretched into many nights and weekends.

Now a faculty member at the college, Cohen will eventually teach part time and spend his free time working as a consultant and writing about pharmacy-related topics.

“It really is time for me to pursue some other things with a little less pressure,” he said.

A Great Sense of Accomplishment

Pharmacists in transition sometimes call upon their mentors for support and assurance that their mentees are making the right decisions.

Before Sheila Mitchell, Pharm.D., FASHP, left her position as director of pharmacy services at Methodist LeBonheur Healthcare-Germantown Hospital in Memphis last year to become the found­ing dean of the Union University School of Pharmacy in Jackson, Tenn., the mid-career pharmacist consulted Grover C. Bowles, a close friend, former ASHP president, and Whitney Award winner.

Bowles, who retired as director of pharmacy at Baptist Memo­rial Hospital in Memphis in 1984, told Mitchell that the position at Union would be a new challenge filled with hard work. But he predicted that it would also rejuvenate Mitchell, offering her the greatest sense of accomplishment she would ever know.

“He was right,” said Mitchell, who serves on the ASHP Board of Directors. “I chose the opportunity and find every day to be a brand new day full of excitement and exhilaration.”

The shift to the academic world likely was the most difficult decision Mitchell has made. “It wasn’t something I had on my career plan,” she said. But “everything is falling into place beautifully. I have never regretted a single day. It has been a joy.”

Mitchell is thankful for the variety of career and leadership posi­tions she has held, saying that they readied her for her new position.

“I would strongly encourage anyone who is considering a career change to view it as an opportunity to build upon past experiences,” she said, adding that redefining one’s career path actually helps to redefine the profession of pharmacy in new and innovative ways.

Kenn Horowitz, Pharm.D., 66, has also had a pleasant career transition. Last year, Horowitz capped a 41-year pharmacy career when he retired as a pharmacist at Hemophilia Health Services (HHS), a division of Accredo Health Group in Los Angeles. Horowitz will continue working for HHS several days a week, a move he describes as “keeping my finger in the pie,” while also working as a staff pharmacist at Cedars-Sinai Medical Center, where he also was previously employed.

Horowitz’s retirement has meant more time to travel the world to visit camps and conven­tions for one of his favorite pas­times: Lindy Hop dancing.

“That’s one of my primary plans for retirement,” he said of the type of swing dance born in New York.

Career transitions are noth­ing new for Horowitz, who has worked for many different kinds of employers, including government health agencies and health sys­tems in New York, Montana and California.

“I’ve enjoyed the many hats I’ve worn in pharmacy. Every­thing has given me experience and knowledge. I wouldn’t trade my career for any other,” he said, adding that over the years, he’s coped with change by “pouring myself into it and doing the best I can.”

Charting a Specific Career Path

Some pharmacists have fine-tuned career maps. Take Rafael Saenz, M.S., Pharm.D., 32, operations manager for the pharmacy department at the University of Pittsburgh Medical Center, where he oversees the outpatient pharmacy. Saenz has diligently planned each step he will need to take to become a corporate or systems director.

In the meantime, Saenz is trying to learn about the many functions of the pharmacy where he works as he works toward becoming a pharmacy director one day.

“If you don’t plan out certain steps in your career, then you’re going to get tunnel vision and only see the department from one angle,” he said. “Hopefully, when the time is right, I’ll see an oppor­tunity to become director and I’ll move into that.”

Saenz admits that he struggled with his introduction to health-system work after spending so much time in pharmacy school and as a pharmacy resident, where many experiences are synthesized and mentoring is always available.

“Real-life situations come up ad hoc, and you have to respond to them as you go,” he said, crediting his success to thorough train­ing and a mindset of curiosity and openness to the perspectives of fellow healthcare professionals.

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