ASHP InterSections ASHP InterSections

July 7, 2017

Jennifer Askew Buxton Unpacks Her Mentor Toolbox

Dr. Buxton (Right), mentors Allison Stilwell (Center), a student on rotation from the Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill, as she counsels a patient prior to administering a vaccine.

THE MOST IMPORTANT PIECE OF ADVICE that Jennifer Askew Buxton, Pharm.D., CPP, FASHP, gives her students and residents is to create a mentor toolbox. People have different skills, noted Dr. Buxton, and having an assortment of mentors (a mentor toolbox) helps to provide a full breadth of expertise.

Although Dr. Buxton always knew that mentors were crucial to success, she didn’t at first realize the particular importance of having female mentors. “I was probably five to eight years into practice before I recognized the gender gap,” she said. “I realized that all my mentors were men, and I began to seek out female mentors who were pharmacist leaders and outstanding mothers.”

Making the Most of Mentors
Dr. Buxton considers herself fortunate to have had two strong mentors early on: her stepfather, a physician, and ASHP Past President Bruce Canaday, Pharm.D., FAPhA, FASHP, her Residency Director at Southeastern Area Health Education Center in Wilmington, N.C. Dr. Buxton credits her mentors with teaching her the importance of volunteerism and advocacy, both in associations and in the community.

Growing up, she had always leaned toward math and science, and her stepfather, J. Paul Martin, M.D., inspired her to go into a healthcare field. Dr. Martin, now a specialist in both addiction medicine and occupational medicine, was a family medicine physician in Asheville when Dr. Buxton was growing up. “He taught me about the importance of volunteering,” said Dr. Buxton. “He would take me with him when he volunteered at the local free clinic, and later on I did the same with my students.”

Dr. Buxton credits Dr. Canaday as being influential as well. “He has a passion for pharmacy association work that I don’t find in most people,” she said. “He has incredible problem-solving skills.” The two hit it off when Dr. Canaday was Dr. Buxton’s preceptor. “To this day, I seek his wisdom,” she said. “Whenever we are at the same meeting, we always share a meal, and he is always available by email or phone to help me make decisions.”

The Volunteer-Leadership Connection
Today, Dr. Buxton is Chief Pharmacy Officer and Co-Director of Mental Health Services at Cape Fear Clinic, in Wilmington, N.C., where she was a volunteer for almost a decade before accepting her current position. The clinic provides medical care to under- and uninsured, low-income patients in four counties in North Carolina. “It’s not a patient-centered medical home, but it works like one,” said Dr. Buxton, who runs all the pharmacy-related services, including immunization, clinical services, medication therapy management, medication synchronization, chronic disease management, and the clinic’s mental health program.

In North Carolina, pharmacists can have prescribing privileges, and Dr. Buxton manages the medication for clinic patients who are being seen by counselors, licensed social workers, and psychologists. “I’m practicing at the top of my license,” she said.

Dr. Buxton serves as the Chief Pharmacy Officer at Cape Fear Clinic, where she takes pride in providing pharmacy services to underserved patients.

She is also Director of the PGY1 Community Pharmacy Residency Program at Wingate University School of Pharmacy, Wingate, N.C., and she regularly precepts pharmacy students from all North Carolina schools of pharmacy. “I always encourage my students to ask for mentors,” she said. “Whether it’s me or someone else, it must be someone you connect with.”

Dr. Buxton is active in local, state, and national pharmacy associations. Dr. Buxton was elected to the Executive Committee of ASHP’s Section of Ambulatory Care Practitioners as Director at Large and has served as a member of numerous ASHP committees and advisory groups. She was recognized for her dedication to volunteer work with ASHP’s Distinguished Service Award and has served as President of the North Carolina Association of Pharmacists.

Influential Mother Network
When Dr. Buxton began seeking out female mentors, it was because “I wanted to speak with other women in healthcare management about how to navigate a male-dominated work environment,” she said. “The women were there — I just hadn’t started to cultivate those relationships.”

A few years later, as she was thinking about having children, she realized that her female mentors didn’t have children. This led to a search for a network of professional female mothers. “I started to reach out to women-mother mentors in a more formal way,” she said. “That’s how I rounded out my mentorship toolbox.”

What did she learn from her mother mentors? “I was terrible at work-life balance, and I realized I needed to do something about that. I’m very passionate about work — full time doesn’t mean 40 hours; it means however many hours it takes,” she said.

Dr. Buxton’s mentor network taught her several valuable lessons, including that sometimes family takes priority and sometimes work takes priority. Dr. Buxton learned that work-life balance doesn’t necessarily mean 50/50, but it is essential to have quality time dedicated to home and to not blur the lines between work and home. “Your goals don’t change, but how you achieve them might,” said Dr. Buxton, who gave birth to a daughter in December. This is where family is important, she added. She credits her husband as a total partner in parenting, and her younger sister, mother to a 9-month-old, as a role model.

ASHP Mentors
Dr. Buxton values ASHP because it’s where she can go for support, advice, and motivation. She cited ASHP Past President Diane Ginsburg, R.Ph., Ph.D., FASHP, as an inspiration for being a strong female leader. “I was so impressed with her accomplishments. I saw her as an excellent example of what women can achieve,” said Dr. Buxton.

ASHP staff has been very helpful to Dr. Buxton as well. “I have a circle of three mothers at ASHP who help me talk through time commitments with leadership roles so I can choose what I do and do it well,” Dr. Buxton said.

One of the most important lessons that Dr. Buxton learned from her mother network and her ASHP mentors is that she would be serving as a role model for her daughter. “She’ll watch me and look to me as someone who can show her how to be involved with community and profession,” she said. In other words, Dr. Buxton plans to lead by example, as she learned from her own mentors.

By Ann Latner

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March 28, 2011

Reforms in the Middle East, Changes in Pharmacy

Diane Ginsburg, M.S., FASHP

AS I WRITE THIS, the world is witnessing amazing changes in the Middle East. Citizens from Tunisia to Egypt–and now in Libya–are rising up, demanding an end to totalitarian regimes that have long suppressed their human rights. What has struck me as I’ve watched the news reports is just how organic the changes have been, how they started with ordinary citizens, and how no one seems to have been able to fully predict the swiftness or totality of changes that are happening.

This relates to pharmacy in a very real way, I believe. We are on the cusp of huge changes in our country’s health care system. Health care reform is pushing many of us to look with new eyes at the ways in which we ensure patient safety and quality of care. This issue of InterSections offers a peek into the future of our profession in several different, and fascinating, stories.

The cover story, “Gazing Into the Crystal Ball” features conversations with top pharmacy leaders about the ways in which ASHP’s Pharmacy Practice Model Initiative might potentially change the way we work. From a better use of properly educated, well-trained technicians; to improved work flow and collaboration with other health-care providers; to the introduction and deployment of new technologies, the world of pharmacy will look much different in the coming years from what many of us know.

Another story, “ACOs in the Age of Health Care Reform,” reveals how the Patient Protection and Affordable Care Act of 2010 provides a plethora of opportunities for pharmacists to optimize their patient-care services. As health systems and physicians, groups create ACOs (Accountable Care Organizations) to reach the performance measures laid out in the Medicare Shared Savings Program, they are turning to pharmacists to fine-tune the management of chronic diseases, reduce hospital readmissions, and improve medication safety.

Sometimes in looking at where we’re going, it helps to look backward and see where we’ve been. The pace of change in pharmacy is readily apparent when you look at the innovations revealed by ASHP’s National Survey of Health-System Pharmacy Practice in the story titled “Use of Technology Growing, Pharmacists’ Roles Changing.” Each year, 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 focuses on staffing or current hot topics and evolving issues. This story is a fascinating overview of just how far we’ve come in terms of pharmacists’ roles.

I hope you enjoy this issue of InterSections. It offers a real glimpse into the ways in which our profession is changing for the better!

December 26, 2010

Innovating the Pharmacy Technician’s Role

Illustrated by Matt Sweitzer ©2010 ASHP

AS PHARMACISTS EXPAND THEIR ROLES and carve out new niches in an era of health care reform, they are counting more and more on highly skilled pharmacy technicians to take on added responsibility.

Pharmacy technicians in practice sites around the country are performing tasks that were once considered solely the domain of pharmacists, such as dispensing medication, taking prescriptions over the phone, and managing error-reduction efforts. The result is tandem evolution: When pharmacy techs handle these duties, it frees pharmacists up to counsel patients and grow as key members of multidisciplinary health teams.

“Highly trained, skilled technicians are critical elements in a high-functioning pharmacy team,” said ASHP President Diane Ginsburg, M.S., R.Ph., FASHP. “If pharmacists are to achieve their highest calling—direct patient care—we must be able to rely on our technician workforce as our support system.”

In order for technicians to shoulder more responsibility, they will need more training and education. The push is on nationwide for standardization and accreditation.

“With the advancing role of pharmacists, we need technicians who are properly trained,” said Lisa S. Lifshin, R.Ph., director of program services and coordinator of technician program development in ASHP’s Accreditation Services Division. “Consumers are more in tune with their own safety, and they want someone who is trained to handle their medications safely.”

Portable, High-Level Skills

Heather Stremick, a student in the North Dakota State College of Science Pharmacy Technician Program in Wahpeton, checks the stock for a medication

The requirements for ASHP-accredited programs are stringent. Students must complete at least 600 hours of training and education that combine didactic components such as lectures and textbook learning, hands-on experience through lab work, and actual experiential rotations in real pharmacy environments.

The result of such an intensive mix of education is a thoroughly prepared pharmacy technician. This new type of worker has skills that are portable not just from environment to environment but also from region to region as more and more states ratchet up their standards and require pharmacy technicians to register with boards of pharmacy.

“We are a mobile society, and when techs train under accredited programs, there is an assurance that they have the same broad knowledge and training,” said Barbara Lacher, assistant program director and associate professor at the North Dakota State College of Science (NDSCS) Pharmacy Technician Program in Wahpeton. “They are not trained just to be a retail technician or a hospital technician. They have across-the-board training, and you know that anyone you hire out of an accredited program has had experience with things that nonaccredited programs might not offer, like vaccines, sterile products, IV preparation, and stress management.”

ASHP is not the only organization advocating for the professionalism of the pharmacy technician workforce. The National Association of Boards of Pharmacy, which has several technician training task forces, is advocating that technicians complete an education and training program that meets minimum standardized guidelines. It also recommends the use of a single accrediting agency
and a program that is developed by an established pharmacy organization.

Innovations in Pharmacy Tech Education

As the demand for highly trained pharmacy technicians grows, educators are using local resources creatively to offer comprehensive instruction to students. In Florida, Orange County Public Schools (OCPS) offers accredited pharmacy technician programs through technical schools such as Westside Tech in Orlando and Winter Park Techin Winter Park, where students range in age from 16 to about 40.

A pharmacy technician at Wishard Health Services, Indianapolis, utilizes the pharmacy’s electronic inventory.

“One of the toughest things [about setting up a program] was finding a way to educate full-time adult students and part-time high school students,” said Lori DeVeau-Diem, CPhT, a pharmacy technician instructor at Westside. “We had to juggle the schedule to ensure that the part-time students would get all of the necessary instruction and the full-time students wouldn’t have stretches of unoccupied time.”

The answer was to craft a modular program in which students can proceed at the pace that works best with their schedules and allows for one-on-one time with instructors as well as interaction with other students.

The heterogeneity of the student population benefits all involved, said John Diem, CPhT, director of pharmacy technician programs for OCPS. “Our students work extremely well together. The high school students challenge the adults academically, and the adults give them an example of professionalism and maturity,” he said. “It prepares them for working in the real world, where they’ll be working alongside people of all ages.”

At Southeastern Technical College, which has three campuses in southeastern Georgia, the pharmacy technician program stresses hands-on experience indifferent environments.

“My students do a lot of community service,” said Karen Davis, CPhT, pharmacy technology instructor at the Vidalia campus and former president of the Pharmacy Technician Educators Council. “They will work in patient assistant programs, do paperwork, conduct inventory, request medications, type labels, and more.”

Students in Southeastern’s program can rotate through different facilities as interns, where they learn how to be part of a multidisciplinary health team. “What students get in the classroom and lab should be reinforced at the work site,” said Davis. “By the time they have to take their tests for certification, they know how to do everything from data entry to IVs to total parenteral nutrition. The ASHP requirements are designed not for us to teach but for students to do.”

Looking Ahead

The future for pharmacy technicians is a bright one. The Bureau of Labor Statistics predicts that employment of pharmacy technicians will increase 31 percent by 2018 compared with 2008 figures, not only because pharmacists are expanding into more clinical roles, but also because prescription drug use will increase overall as the population ages.

%%sidebar%%The projected growth of programs is not just in hospital systems and traditional academia, said ASHP’s Lifshin. “We are getting a lot of calls from community and chain pharmacy representatives about how they can start an accredited program,” she said. “Health care is always a good avenue for schools to explore, and accreditation is their way of becoming more competitive. The voice of accreditation is a lot louder than it was just a few years ago.”

Davis sees pharmacy technician education evolving as the role of pharmacy technicians evolves. “Lick, stick, and pour jobs are all but gone,” said Davis. “Now that techs are working in triage, diabetes clinics, veterans’ programs, and so on, I think that eventually we will need national minimum standards. I can see the technician’s role expanding to the point where it will require an associate’s degree.”

Davis also predicts different levels of practice for pharmacy technicians and eventually specialization. “Pharmacists are asking for it,” she said. “They want technicians to be able to do things like take scrips over the phone. I can see someone calling us to request a technician for job placement and asking for a Level 1 pharmacy technician for one level of care, a Level 2 tech for more involved care, and so on.”

She added that pharmacy technicians and their educators should stay abreast of legislative changes within their states and continue to push for standardization and accreditation.

Pharmacy Job Market Changing

Richard Montgom­ery, R.Ph., MBA, administrative director of pharmacy at Florida Hospital in Orlando

newly minted pharmacists were assured of placement in their desired residencies and jobs. With a broad job market and options in hospital, health-system, and community retail pharmacy, recent graduates were offered signing bonuses by recruiters and hiring managers eager to fill open slots.

Today’s graduates, however, may need to make a few concessions if they want to be gainfully employed, particularly when it comes to location. According to figures posted by the Pharmacy Manpower Project, which compiles and analyzes data to determine the demand for pharmacists by state and geographic region, there appears to be a dip in demand for pharmacists in New England and the Mid Atlantic. Likewise, competition is heating up for hospital positions in urban areas, particularly in states where there are several pharmacy schools.

Increased Competition

Several factors are affecting the pharmacy job market, according to Richard Montgomery, R.Ph., MBA, administrative director of pharmacy at Florida Hospital in Orlando.

“We used to compete with retail chains [for pharmacists]” said Montgomery, “but now that we have multiple pharmacy schools in state, the pool of applicants has increased even as retail chains have gone to a centralized fill model requiring fewer pharmacists on staff.” Hospital cutbacks due to reduced patient volume are also complicating the picture.

Nicole Metzger, Pharm.D., BCPS, clinical assistant professor of pharmacy practice at Mercer University College of Pharmacy and Health Sciences in Atlanta, has noticed a tightening in the market as well.

“When I graduated in 2006, there was room for salary and benefit negotiation,” Metzger said. “Qualified students who wanted to do a residency easily found programs to fit their needs. In contrast, last year many graduates in the area were struggling to find work and had to relocate to more rural areas to ensure employment.”

Metzger’s words describe a broader trend, one affecting young pharmacists and residents like Jessica B. Winter, Pharm.D., PGY1 pharmacy practice resident at UC Health–University Hospital in Cincinnati.

“I do worry about job placement after my completion of a PGY2 residency next year,” Winter said. “I’m sure I’ll have to be flexible in terms of location and salary. With seven schools of pharmacy in the state, positions in more densely populated areas like Cincinnati are harder to come by.”

Make It Work

%%sidebar%%Although there appears to be a decrease in demand in certain geographic areas, there is still plenty of work for clinical pharmacists. For those willing to go west, there are more jobs than pharmacists in the south-central region of the country (Ark., La., Okla., and Tex.) and the Pacific region (Alaska, Calif., Hawaii, Ore., and Wash.). Rural areas are another option.

Location isn’t everything, however. New practitioners can take a number of steps to appeal to recruiters and pharmacy directors, including being flexible regarding the kinds of jobs one is willing to take, according to Montgomery.

“Take a part-time or per diem job, work that odd shift, and show that you can be part of the team,” he said. “Try to find a niche; many pharmacists have built their careers by seeing an opportunity and running with it. The more creative and entrepreneurial you can be, the better your chances are.”

Taking advantage of leadership opportunities in professional associations such as ASHP is a great way to gain a foothold in a tight hiring market, according to ASHP President Diane Ginsburg, M.S., R.Ph., FASHP. “Getting involved in a large community of successful practitioners allows you to hone your leadership skills,” she said. “Tapping into that network also gives you access to some of the top leaders in health-system pharmacy.”

Finally, Metzger suggests getting involved in research or scholarly activity to work toward becoming a well-rounded professional. “The more skills you have, the more leadership positions you fill, and the more you network, the more it will set you apart,” she said.

A Time to “Be Bold And Be Urgent”

Diane Ginsburg, M.S., FASHP

I WRITE THIS COLUMN having just returned from an incredibly energizing, exciting Pharmacy Practice Model Initiative (PPMI) Summit in Dallas. Pharmacy thought leaders from across the country came together to reach consensus on how we, as hospital and health-system pharmacists, should be practicing our profession in the future.

Summit attendees looked at a number of overarching principles for future pharmacy practice models and came to an agreement on the following principles:

• We, as pharmacists, must move closer to the patient.
• The role of a qualified technician workforce and the use of technology must be greatly expanded.
• Pharmacy departments are accountable for the development and implementation of medication-use policy to ensure safe and effective use of medications.
• Pharmacists are accountable for patient outcomes.

As Billy Woodward urged, we need to “be bold and be urgent” in our work to enact practice change. We need to embrace our common commitment to our patients and be accountable for their positive outcomes.

Stay tuned in the months and years ahead as the Pharmacy Practice Model Initiative gains momentum. As a tangible outcome of the Summit, we envision that every pharmacy department in the country will be engaged in examining how it deploys its resources. It’s a truly exciting time to practice pharmacy!

InterSections is a great place to catch a glimpse of some of the most innovative practice models happening today. Our cover story (page 8), about the enhanced role for educated, trained, and certified pharmacy technicians, shows just how important this segment of the pharmacy workforce is. As pharmacists move into direct patient-care roles, we’ll need to rely more and more on our professional technician partners.

Also in this issue, you’ll find a story on exciting work being done in the prevention of venous thromboembolism (VTE). Pharmacists in five hospitals around the country are being mentored in cutting-edge VTE practices through an ASHP Advantage program called Stop VTE. This interprofessional initiative is designed to increase the rate of thromboprophylaxis in hospitalized patients and promote the safe use of anticoagulants.

As the country continues to struggle under the weight of an economic downturn, pharmacyschool graduates are beginning to feel the pinch. The story on page 12 focuses on the strategic choices that recent graduates and new practitioners are facing regarding how and where to practice pharmacy.

%%sidebar%%Finally, ASHP’s recent Drug Shortages Summit highlighted an unfortunate trend in medicine today. Drug shortages cause significant disruptions in patient care, including canceled or delayed medical treatments and procedures. They also lead to adverse events caused by medications that may have the potential for greater harm than the first-line therapy that is unavailable due to a shortage. In the story on page 14, read about how pharmacists are stepping into this gap, coming up with processes and approaches that minimize risks to the patient.

I hope you’ll be informed and inspired by what you find in this issue of ASHP InterSections!

Diane Ginsburg, M.S., FASHP

September 28, 2010

Finding Inspiration in Many Places

Diane Ginsburg, M.S., FASHP

This issue’s cover story, on page 8, about the many ways in which pharmacists care for our nation’s wounded veterans, really touched me. Official combat operations in Iraq ended this summer, but the men and women who served during this long war will likely need help for many years. And pharmacists stand ready as members of the patient-care team.

The exciting news is that, for years, the U.S. Department of Veterans Affairs and the Department of Defense (DoD) have recognized how important pharmacists are to the health of active-duty soldiers and veterans alike.

For instance, the VA has many pharmacist-managed clinics and pharmacists embedded in primary-care teams. And now clinical pharmacists are moving into new patient-care areas, such as mental health and women’s health. As ASHP members plan for the future of practice as part of the Pharmacy Practice Model Initiative (PPMI), we will be looking to our colleagues in the federal services for innovative, cutting-edge ideas.

The FDA’s Risk Evaluation and Mitigation Strategy (REMS) program has really geared up over the past few years. With more than 100 medications included in the program, and additional drugs being added each day, pharmacists are struggling to keep up with REMS requirements. The story on page 14 sheds light on the challenges of REMS as well as how ASHP members are staying ahead of the curve.

Innovation can be found in almost every hospital and health-system pharmacy in the U.S. In this issue, we highlight the work of the staff at Women & Children’s Hospital of Buffalo, N.Y., to develop a fail-safe intravenous medication delivery system. The work of this interdisciplinary team created a 99 percent compliance rate and measurable evidence of prevented errors. Check out this inspiring story on page 12.

As ASHP gears up for the PPMI Summit in November, we have been talking to pharmacy directors across the country about how they are implementing new models within their own institutions. On page 20, you’ll be interested to read about what the pharmacy staff at Fauquier Health in Warrenton, Va., has been doing to redefine its practice model.

Beginning with decentralizing pharmacy services in the mid-1990s, the team there has steadily moved into almost every clinical area of the hospital. As a result, medication error rates fell from 5 percent to just over 2.9 percent in three years. In addition, drug costs were lowered, and communication and collaboration with fellow health care professionals improved markedly.

I hope that you find much inspiration within the pages of this issue and that it serves as a source of energy to advance the pharmacy practice model within your own institution. Pharmacists everywhere, and ASHP members in particular, are doing amazing things for patients!

Diane Ginsburg, M.S., FASHP

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