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September 28, 2021

Pharmacogenomics: Trailblazers Welcome

Amanda Elchynski, Pharm.D.

AMANDA ELCHYNSKI, PHARM.D., HAD AN ‘AH-HA’ MOMENT in her third year of pharmacy school. During her studies, she worked as a community pharmacy intern, counseling patients, and performing all of the other duties of a pharmacist. Like many other pharmacists and health care providers, she also became frustrated seeing patients respond inconsistently to their medications.

A New Career Direction

“During that same year, I took a course on pharmacogenomics, and it really opened my eyes as to why the patients I was seeing were having these variable responses,” said Dr. Elchynski, who at the time, was a clinical pharmacogenetics fellow at the Center for Pharmacogenomics and Precision Medicine, Department of Pharmacotherapy and Translational Research at the University of Florida (UF) College of Pharmacy. She pointed to research showing that genes may account for up to 95% of the variability in response to medications and that a growing number of gene-drug pairs can help guide prescribing to optimize treatment efficacy and safety.

After realizing the value of pharmacogenomics in patient care, Dr. Elchynski completed a rotation in pharmacogenomics in the outpatient setting, where she reviewed results directly with patients and found that many patients were relieved to understand why their medication wasn’t working or was causing side effects.

“Finding out the results also made patients more amenable to changing medications,” noted Dr. Elchynski, who is now a Pharmacogenomics Coordinator at Arkansas Children’s Hospital. “I want to deliver this up-and-coming care approach and also help expand it from being available only to select groups and locations to being widely used as a standard of care,” she said.

While pharmacogenomics is an exciting and cutting-edge field, one of Dr. Elchynski’s preceptors said that, partly because they have limited exposure to the topic during their studies, only a small subset of students wants to enter a career in the field.

Educational Programs in Pharmacogenomics

Emily Cicali, Pharm.D

“It’s hard to think about pursuing something as a career path if you only hear about it for two or three hours in your entire pharmacy curriculum,” said Emily Cicali, Pharm.D., clinical assistant professor in the department of pharmacotherapy and translational research at UF College of Pharmacy.

She said pharmacogenomics is spread throughout the didactic pharmacy curriculum at UF because “it is a concept that transcends any specific disease state.” UF pharmacy students learn about the topic through core courses as well as elective opportunities, like a clinical application course, a summer intensive research program for students in the Pharm.D. program, a fourth-year pharmacogenomics elective advanced practice rotation, and pharmacogenomics residencies and fellowships, she said. The residency/fellowship offers pharmacists the opportunity “to live and breathe everything pharmacogenomics,” Dr. Cicali explained.

“Once residents gain baseline knowledge of the topic, they start writing consult notes, either in the form of recommendations for clinical interventions or as part of a clinical trial,” she explained. “And every resident does a deep dive into one gene-drug pair and creates a best practice alert for providers in the electronic health record, and they participate in a research project that’s pharmacogenomics related.”

Pharmacists considering a career in pharmacogenomics can look forward to employing both clinical and research skills, Dr. Cicali enthused. “It’s an evolving field, so you can combine skillsets in really interesting ways, like collecting metrics for clinical practice in order to show growth and sustainability of the program,” she said. “Every day is different, which is one of my favorite things about this work.”

Encouraging Patient-Learners

To help pique his own students’ interest in the field, ASHP Fellow George E. MacKinnon III, R.Ph., Ph.D., M.S., Founding Dean of the School of Pharmacy and professor in the genomic sciences and precision medicine center at the Medical College of Wisconsin, Milwaukee, and his colleagues have created a first-year pharmacy class on pharmacogenomics that turns students into “patient-learners.”

Julie Johnson, Pharm.D.

In addition to presenting the course material through conventional pedagogical approaches, students submit their own saliva for pharmacogenomics testing if they are willing to do so. They then discuss the results with their peers, focusing on the relevance of the results to their or their families’ medication histories, Dr. MacKinnon explained.

“Getting some perspective as to what this testing really means gets students very excited about the topic,” he said. “The reality is that 97% of us have a clinically significant gene variant that could result in sub-optimal therapy or side effects, and these could be mitigated if we guide treatment with pharmacogenomics.”

MacKinnon is confident the field will attract an increasing number of students and pharmacists, given the growing importance he expects it to play in clinical practice.

“I think it will become our bread and butter and no different than what we started doing 30 years ago in the hospital setting, when pharmacists began pharmacokinetic monitoring in our patients receiving anti-infectives, theophylline, and other agents that were managed for optimal outcomes and reduced toxicities,” said Dr. MacKinnon.

Opportunities and Professional Growth

Trained graduates with expertise in pharmacogenomics can expect a growing number of job opportunities, agreed long-time ASHP member Julie Johnson, Pharm.D., Dean and Distinguished Professor of the UF College of Pharmacy said.

“The number of health systems hiring people with this expertise in the field is rapidly expanding,” she said, noting that UF has 16 faculty members focused on the clinical and research aspects of pharmacogenomics.

“I see a lot of demand moving forward, but if pharmacists are not there to lead pharmacogenomics at an institution, [administrative] leaders will turn to nurses or physicians or genetic counselors to do so,” she noted. “For people who are creative, innovative, and entrepreneurial, I think there are a ton of ways to be a trailblazer, like implementing pharmacogenomics in the healthcare setting, being a leader in research or working in the private sector to develop tools to help advance the field.”

 

By David Wild

 

 

November 12, 2020

ASHP’s Standardize 4 Safety Initiative Helps Pharmacists Reduce Medication Errors

Nathaniel Sims, M.D.

ASHP released its recommended list of concentrations and dosing units for intravenous continuous medications for pediatric patients in November 2020, representing the culmination of a multi-year, multidisciplinary effort to improve medication safety for children and adults nationwide.

The Standardize 4 Safety (S4S) initiative, funded by the U.S. Food and Drug Administration (FDA) and helmed by ASHP, is the first national, interprofessional effort to standardize medication concentrations to reduce errors resulting from confusion over non-standardized drug concentrations and errors that result from concentration differences when patients transition their care from one setting to another. Expert committees with the program previously released two lists—standardized concentrations for adult continuous infusions and compounded oral liquids.

ASHP standardization leadership

Many health care systems have developed their own local standardized concentrations, or formularies, for how drugs are mixed or compounded for administration, and have shared these widely, said Nathaniel Sims, M.D., a cardiac anesthesiologist and medical device developer at Massachusetts General Hospital (MGH) in Boston. Dr. Sims served on the expert committee to develop the MGH intravenous continuous medications for pediatric patients. However, the S4S initiative is “special in that it arose as a project of the FDA,” he said. Because the FDA does not have authority to mandate such lists, it partnered with ASHP and other entities with high credibility. “The S4S initiative is exceptionally well-positioned to influence clinical practice,” Dr. Sims said.

For over a decade ASHP has supported the creation of nationally standardized drug concentrations for adult and pediatric medications, but the work began in earnest in 2015, when the FDA awarded ASHP a three-year contract to develop and implement lists of such concentrations for intravenous and oral liquid medications. That contract, which was later renewed, was part of the FDA’s Safe Use Initiative—an effort to reduce preventable harm from medications by fostering and facilitating public and private collaborations within the healthcare community.

Through these efforts, ASHP gathered a variety of pharmacist, physician, and nurse experts from across the care continuum and partnered with national patient safety organizations such as the Pediatric Pharmacy Association, the Institute for Safe Medication Practices (ISMP), and the Association for the Advancement of Medical Instrumentation, as well as regional and local health care organizations.

Although additional lists are planned, finalization of the first three lists is timely. Concurrent with many hospitals launching ambitious initiatives to integrate drug infusion pumps with their clinical information systems for automatic programming. Dr. Sims noted that since smart IV pumps will not accept auto programming instructions unless there is a perfect match between the concentration in the pump’s drug library and the pharmacy order, hospitals including MGH are working hard to create compatible systems using the ASHP standard lists as a benchmark.

Benefits of standardization

Standardization is helpful in many ways, said Rachel Meyers, Pharm.D., B.C.P.S., B.C.P.P.S., F.P.P.A., a pediatric pharmacy specialist at Saint Barnabas Medical Center in Livingston, N.J., who served on the committee for the pediatric continuous infusion list. It can simplify medication ordering for providers; enhance efficiency for pharmacies, who can then purchase less stock; and streamline production and allow for the formulation of premixes.

Rachel Meyers, Pharm.D., B.C.P.S., B.C.P.P.S., F.P.P.A.

“It might sound meaningless, caring what concentrations other hospitals use,” said Dr. Meyers, also a clinical associate professor of pharmacy practice administration at Rutgers University’s Ernest Mario School of Pharmacy. “But it’s actually really important, because we often transfer our patients between hospitals. It helps a lot if we’re all using the same concentrations.”

Having a standardized library for syringe pumps also is beneficial, she noted. “When you think about smaller hospitals who might not have a pediatric pharmacist on staff, then when they get a pediatric patient admitted to the Emergency Department, they’ll have a syringe pump ready to go already programmed with the appropriate concentrations,” Dr. Meyers said. “It just makes this whole process that much safer for the patient, so we can fully utilize tools at our disposal to their maximum effect.”

In the pediatric population, wide variations of weight range, dosing units, and fluid tolerance need special consideration, Dr. Sims cautioned. These factors may require multiple concentrations. Out of about 43 unique drugs in the ASHP pediatric concentration list, approximately 10 have three recommended standard concentrations and 30 have two recommended standard concentrations.

The key benefits of ASHP’s lists are several-fold, Dr. Sims said. The ASHP standard concentrations were created by many health care system experts using a disciplined consensus process informed by best practices for all patient groups, from “micro-preemies” in the neonatal intensive care units to adults. They also include stability data and other information essential to validate the safety of these standard concentrations. ASHP can use its broad network to publicize the lists, as well as additional educational materials, including an online course directed by Dr. Sims. Launched in November, it covers a comprehensive overview of syringe pumps and considerations for use at low flow rates. The online course offers free continuing education credits for pharmacists, nurses, and physicians, emphasizing the importance of ASHP’s standard concentrations for the safe use of infusion pumps.

Pharmacists at the helm

Pharmacists, as the “original safety champions for drug safety,” are primed to help lead efforts to adopt these lists at their home institutions, said Jared Cash, Pharm.D., M.B.A., B.C.P.S., F.P.P.A., director of pharmacy at Intermountain Primary Children’s Medical Center, in Salt Lake City. “Pharmacists are both the production crew as well as the clinical crew involved with communication of medication information and assuring the correct dose.”

Jared Cash, Pharm.D., M.B.A., B.C.P.S., F.P.P.A.

Pharmacists can employ various strategies to help push for adoption of these lists at their hospitals and health systems, Dr. Sims said. For example, they can leverage a “sentinel safety event” to convene a discussion about adoption of S4S.

A second approach is to combine a discussion about the ASHP standards with a local initiative, such as a planned revision of infusion pump drug libraries. Additionally, pharmacists can create a multidisciplinary initiative within a hospital or health system to validate and benchmark the ASHP standard concentrations against what they already are doing. They could use the ASHP lists as a prompt to “spring clean” the infusion pump drug libraries, Dr. Sims suggested, or run queries in electronic medical record systems to capture utilization of each of the medications, and learn the range of real-world dose rates clinicians program into infusion pumps to see whether resulting flow rates match patient needs.

“Be aware of the lists as you’re reviewing your formularies and EMR product selections,” Dr. Cash added. “Many places are already compounding these items and to change their compounding to the specific concentration is strongly encouraged.”

Process improvements

Some hospitals have already adopted a list of standard concentrations for neonatal drug infusions that was published several years ago by the Vermont Oxford Network, a nonprofit voluntary group of healthcare professionals, and the ISMP, Dr. Meyers said, so there is a precedent. ASHP’s working group was conscientious to include considerations of that previous list in their own work, Dr. Cash noted.

“The ASHP list is bigger, and I think it’s important for pharmacists to stress the safety of standardizing those concentrations,” Dr. Meyers said. “It not only makes transfer between hospitals easier, but if you’re part of a health system, it can help make all processes of care safer, from your EMR to your syringe pumps.”

Experts working on the S4S standards hope that the work may motivate drug manufacturers to produce some of the recommended standard concentrations, Dr. Meyers added.

“One thing we really struggle with in pediatrics is we have to compound so many of these medications,” she said. “By making this list and selecting standards, we’re hoping some drug manufacturers will pick up on this and say it may be worth it to make these items, because we know that commercially available products are safer.”

While pediatrics may have the most to gain from standardized lists, Dr. Cash said, there is still a lot of medication safety the lists can improve for adults, too. “The amount of compounding within the adult population is more significant than people recognize, and having standardized concentrations for any of that compounding reduces risk,” he said.

 

By Karen Blum

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October 19, 2020

ASHP Members Highlight the Value of Board Certification

Katie Hughes, Pharm.D., BCPPS

WHEN SNEHAL BHATT, PHARM.D., BCPS, was going through pharmacy school and residency training, he noticed that the pharmacists and mentors he looked up to most all were board certified. So when he completed his training in 2001, he pursued his board certification in pharmacotherapy to achieve expertise in pharmacy practice and emulate those who inspired him.

Professional benefits

Dr. Bhatt, a clinical pharmacist in cardiology at Beth Israel Deaconess Medical Center in Boston, and an ASHP member since 1999, said this distinction comes in handy on a daily basis.

“Most of my patients have a variety of other disease states and comorbidities that aren’t necessarily cardiology-related, and that’s an area where I have just as important an impact in patient care,” said Dr. Bhatt, who also is a professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences University. “While I certainly help with recommending medications for patients’ primary cardiovascular problems, I often find myself having to help the team with non-cardiovascular medications, too. Being well-rounded as a pharmacist and well-versed in a variety of drug therapy options outside of your specialty is essential to pharmacy practice.”

Being well-versed in your field is just one of the professional benefits pharmacists can reap from becoming board-certified, said Angela Bingham, Pharm.D., BCPS, BCNSP, BCCCP, FASPEN,  an associate professor of clinical pharmacy at the University of the Sciences in Philadelphia. She is also a clinical pharmacist in the medical/surgical intensive care units at Cooper University Hospital, in Camden, N.J.

Angela Bingham, Pharm.D., BCPS, BCNSP, BCCCP, FASPEN

She and other pharmacists enjoy the validation of their clinical knowledge and competency beyond licensing requirements, she says. There also can be financial incentives related to salary, promotions, and new practice opportunities that emerge. With a seed grant from the Board of Pharmacy Specialties (BPS), Dr. Bingham and one of her residents are investigating the prevalence and value of board certification among pharmacy practice faculty at colleges and schools of pharmacy in the United States. A previous survey indicated that one of the most important benefits identified by participants was gaining personal satisfaction by accomplishing professional goals that were important to them.

Advanced practice opportunities

Dr. Bingham is board certified in three areas: pharmacotherapy, nutrition support, and critical care, and now works with ASHP on the critical care review and recertification programs. She first pursued pharmacotherapy board certification as a PGY-2 critical care pharmacy resident, then pursued certification in nutrition support and in critical care as those emerged as areas of passion and specialization for her after she completed a residency.

“It really impressed me that board certification is a gold standard for determining which pharmacists are qualified to contribute to advanced practice roles,” said Dr. Bingham, an ASHP member for 14 years. “I also was impressed by the rigorous processes BPS uses to help ensure that board certified pharmacists are trained to meet the expectations of interprofessional health care teams and saw specialization as an opportunity to improve patient outcomes. I was drawn to the complex, evolving nature of critically ill patients and the team structure of care within the ICU environment, which led me down this path.”

Improving confidence and becoming an expert in pediatric care inspired Katie Hughes, Pharm.D., BCPPS, to pursue board certification in pediatric pharmacy. Dr. Hughes had a long interest in working with children but found that she needed much more information during a pediatrics rotation in pharmacy school.

“It was overwhelming from a clinical and emotional/social perspective,” said Dr. Hughes, who now works with the pediatric ICU at Riley Hospital for Children at Indiana University in Indianapolis, as well as the burn and rehabilitation units. “I realized that a lot of the kids we were seeing then weren’t the textbook kids we looked at in school. They were different sizes, had different volumes of distribution, had different clearance rates, their organs were totally different, and we didn’t have black and white guidelines to tell us what to do.”

Dr. Hughes, an ASHP member since 2012, said she did appreciate helping patients through their illnesses and watching their incredible ability to bounce back and recover. When BPS introduced the pediatrics pharmacy board certification during her PGY-2 year, she jumped on it. She attended ASHP’s board prep meeting as part of her training. Now, Dr. Hughes helps ASHP develop curricula for its board recertification.

“The medical profession has some imposter syndrome, and I don’t think that’s uncommon in pharmacy either,” she said. “You want to make sure you know what you’re doing, and sometimes you’re hesitant because you don’t have that confidence. The board certification helped me with that, and making sure I was taking the best care of patients I could.”

Certification offerings

BPS recognizes 14 pharmacy specialties, of which ASHP has available resources, including review courses, for nine currently: Ambulatory care pharmacy, critical care pharmacy, cardiology pharmacy, compounded sterile preparations pharmacy, geriatric pharmacy, infectious diseases pharmacy, oncology pharmacy, pediatric pharmacy, and pharmacotherapy. Soon, ASHP and the American College of Clinical Pharmacy (ACCP) will offer a review package for the transplant pharmacist exam, including an online review course and practice exam.

ASHP and ACCP also partner to provide resources for the Ambulatory Care, Cardiology, Geriatric, Infectious Diseases, and Oncology specialties.

Whether to pursue board certification always will be a personal decision, Dr. Bhatt said. There are so many specialty areas now board-certified that it allows every practitioner to find their own home.

“For anyone who really has a desire to stay as advanced in their practice, and as broad-based and up-to-date as you can, board certification is one of the best ways to do so because it’s a very structured environment, and you know you’re getting high-quality education from your peers in terms of what matters for pharmacy practice,” he said.

ASHP programs

Dr. Bhatt originally had to make his own study guides from reading textbook chapters, guidelines, and primary literature. But more recently, while pursuing recertification, he has taken advantage of ASHP’s continuing education programs. Many of ASHP’s activities offer dual recertification credit for pharmacists with more than one specialty credential.

“There are several ways I can get board certification credits through ASHP throughout the year,” he said. “It allows us to fit those activities into our schedules in a convenient fashion so we can maintain our board certification without being intrusive to our day-to-day practices or family lives.”

Board certification is “certainly a commitment that can’t be taken lightly,” added Dr. Bingham. “But it can ultimately be very professionally rewarding.”

By Karen Blum

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March 12, 2020

ASHP Update on Activities During and in Response to the COVID-19 Pandemic

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

THE COVID-19 PANDEMIC is taking a major toll on people in the United States and around the world. The pandemic is taxing our entire healthcare system and public health apparatus and has or will affect all of our daily lives. ASHP wants you to know that we are here for you as you work on the front lines of patient care to help ensure your healthcare organizations are ready and that your patients get the best care possible. We understand that you and your loved ones may be at risk and the difficulty that this presents as you work to serve your communities and care for your patients during this crisis. We also know that the risks of drug shortages present major challenges in the care of your patients. ASHP and our colleagues at the University of Utah will continue to work to keep the ASHP Drug Shortages Resource Center updated, and we will continue to advocate on your behalf through continued outreach to policymakers as you stand ready to fight this public health emergency.

Last week, we developed two white papers detailing recommendations for federal and state policymakers to address the outbreak. Today, we also sent a letter to Vice President Mike Pence urging the Administration to take immediate steps to maximize pharmacist engagement in COVID-19 preparedness and response efforts. We also asked that decisive action by the Centers for Medicare & Medicaid Services be taken to remove barriers to pharmacists’ patient care services.

ASHP also developed a COVID-19 Resource Center, and we are continually updating it with new resources from various sources, including ASHP.

Due to the current COVID-19 developments, the “Safe, Effective, and Accessible High-Quality Medicines as a Matter of National Security” summit, originally planned for next week, will be postponed. We will be working with the other co-conveners, including the American Hospital Association, American Medical Association, and United States Pharmacopeia, to reschedule this important event in the coming months to continue to drive solution-focused recommendations that address global pharmaceutical manufacturing as a national security priority.

In addition, I would like you to know what we are doing to protect our staff, members and volunteers, and everyone we interact with at ASHP headquarters in Bethesda, Maryland. This includes preparing the organization for a scenario that could include closing our offices. However, we also recognize the need to be able to continue to serve our members even if our physical offices must be closed. We are prepared to run the organization remotely so that we can continue to work on your behalf and provide the tools and resources you need to care for your patients and yourselves.

Furthermore, I would like you to know that ASHP is also assessing all of our upcoming member events on a daily basis. The ASHP Regional Delegates Conferences that are taking place at the end of April in cities around the country are being planned to be held virtually if necessary.

In regard to the ASHP Summer Meetings that are scheduled to take place in Seattle in early June, it is too early to make a final decision. However, we will be fully prepared to make that difficult decision if there is any risk whatsoever to our participants. Safety comes first, no exceptions.

During this crisis, ASHP will remain focused on how we can best assist you, our members, and work at the local, state, and federal levels to be a partner in bringing this unfortunate public health crisis to an end. If you need our assistance, please don’t hesitate to contact ASHP. Please also continue to look to ASHP for up-to-date information and resources on the COVID-19 crisis. We will get through this difficult time together, and be stronger as a profession, citizens, and as a country and global community. In the meantime, ASHP will do everything we can to support you and the patients you serve.

Thank you for everything you do, and please know that we are here for you during this very difficult time.

Sincerely,

Paul

 

September 30, 2019

ASHP Opioid Task Force Focuses on Role of Pharmacists in Combating Opioid Crisis

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

This week we look forward to convening an Opioid Task Force meeting to address the important roles pharmacists play in combating the opioid crisis, a multifaceted issue that requires sustained efforts by all members of the interprofessional care team. While no easy fixes exist to end the opioid epidemic, ASHP and our 50,000 members have been working diligently to shape the solutions around opioids through the engagement of pharmacists on behalf of our patients and communities. Still, there is far more work to be done.

The interdisciplinary ASHP Opioid Task Force, chaired by Past President Lisa Gersema, is charged with identifying actionable solutions, tools, and resources to help address the national opioid epidemic through the engagement of pharmacists as medication therapy experts, clinicians, and providers on the interprofessional team. Key areas of focus include:

  • Identifying the roles that pharmacists play in initiating, building, and growing opioid stewardship.
  • Identifying best medication-related pain management prescribing practices that optimize the use of non-opioid therapies.
  • Identifying the public health roles that pharmacists play in their communities as related to the prevention and treatment of opioid use disorders.
  • Developing recommendations on a solutions-focused public policy agenda.
  • Identifying education, tools, and other resources to help hospitals and health systems address the opioid crisis, including in areas related to drug diversion prevention and mitigation.

The ASHP Opioid Task Force will examine how pharmacists can drive practice changes, community-wide opioid-related efforts, and policy solutions. The recommendations will be reinforced by the breadth and depth of expertise of each Task Force member, many of whom have direct experiences with developing opioid stewardship programs, policies to increase access to medication-assisted treatment, opioid-related community programs, and shaping the national agenda to address the epidemic. The Task Force will be working to finalize its recommendations in the forthcoming months. The outcomes of the Task Force will be published in a spring issue of the AJHP and shared widely with our membership, partners, and external stakeholders.

As discussed in a previous blog, ASHP is a sponsoring member of the National Academy of Medicine (NAM) Action Collaborative on Countering the U.S. Opioid Epidemic. ASHP will be sharing the outcomes of the Task Force with NAM to contribute and support the larger national dialogue around opioids. ASHP serves on the Action Collaborative’s Pain Management Guidelines and Evidence Standards Working Group and Prevention, Treatment, and Recovery Services Working Group. As the Action Collaborative works to further synthesize and amplify evidence-based medicine to prevent and manage opioid use disorder, ASHP is committed to highlighting the role of the pharmacist throughout.

We look forward to sharing more about our work with the ASHP Opioid Task Force and on ASHP’s ongoing efforts surrounding the opioid crisis, including creating various tools, education, and resources to support you in your practice.

As this work moves forward, I urge you to review ASHP’s current resources on the topic, including our toolkits on pain managementcontrolled substances management, and opioid management.

Click here to view the complete ASHP Opioid Task Force roster.

Thank you for being a member of ASHP, and for everything that you do for your patients.

Sincerely,

Paul

July 15, 2019

Mindfulness and Medication Safety: Pharmacist Brings Calm to Hospital Chaos

Lisa Hanlon Wilhelm, BS.Pharm., R.Ph., teaches a weekly meditation session to hospital staff to help build a resilient healthcare workforce.

IT’S WEDNESDAY AFTERNOON AT PENN STATE HEALTH HERSHEY MEDICAL CENTER, in Hershey, PA. The dimly lit hospital chapel has soft music playing, but the clatter from the cafeteria next door still seeps in. The only sources of light are the many windows around the room. An assembled group of pharmacists, nurses, and other hospital employees – looking for a few moments of inner peace – sit upright on benches, cushions, and stools.

The meditation group is led by Lisa Hanlon Wilhelm, BS.Pharm., R.Ph., the medical center’s Medication Safety and Compliance Specialist, who speaks soothingly to the participants. She helps them focus first on their posture, then their breathing and heartbeat, finally linking heart and breath. She encourages them to ignore the clanking of dishes from the cafeteria, the patter of feet in the hallway – to instead focus on concentrating on their breath and heart.

“When you first enter the room, all you hear is the noise coming from the cafeteria,” said Joanne Martin, LPN, an oncology nurse and participant in the class. “As we begin to meditate and focus on our breathing, the noise remains, but your awareness of it is no longer your focus. It always amazes me because no matter how unsettled I feel when I first arrive, I always walk out with a peacefulness.”

This practice, known as Heart Rhythm Meditation (HRM), is an ancient form of meditation, which begins with mindful breathing, and then focuses on your physical heart and spiritual center. “When you get your breathing in rhythm with your heartbeat it creates physiologic coherence,” says Wilhelm, who is certified in the HRM method. “Conscious breathing helps you feel more relaxed, reduces blood pressure, and slows the heart rate.”

Joanne Martin, LPN

Studies show that meditation can help with memory, creativity, and focus. And focus is essential when it comes to medication safety. “As pharmacists, we push ourselves beyond reasonable expectations at times. Our work is very exact; errors can be catastrophic,” said Ronald Lay, M.S., R.Ph., one of Wilheim’s first meditation students. “Our responsibilities are increasing to play a more prominent role in patient care. We push ourselves to do it all. It’s important to take time for ourselves, to step back and take a deep breath.”

Creating Mindfulness
Wilhelm, who completed an ASHP Executive Residency in 1995, has spent the bulk of her career at Hershey Medical Center in the Medication Safety Officer role. As part of her job, she teaches medical students, new nurses, and advanced practice clinicians about medication safety and regulatory compliance, and she reviews medication event reports.

The role is challenging, and she has seen first-hand how stress and burnout can lead to errors. She realized that while system changes could fix many medication safety problems, there are other issues at play as well.

“Sometimes I think [healthcare providers] need to stop and look at a medication label, or stop and read a patient’s chart or medical note, or stop and pay attention to a patient, a colleague, or a situation. Basically, just stop for a moment,” she said. “Taking that moment to pause and focus can avoid accidental errors made in haste.”

Wilhelm was always interested in meditation, but it was after she had completed a 2-year training program in HRM that she decided to try leading a weekly drop-in meditation class at the hospital. With the support of the Director of Pastoral Services, Wilhelm started her Wednesday program in October of 2017.

Meditation Improves Care
Ronald Lay, who was then working as the Director of Inpatient Pharmacy at the medical center, was one of the early participants in Wilhelm’s meditation class. Lay, a member of ASHP for 41 years, has since semi-retired and works part-time as a staff pharmacist. 

Over casual conversation, he heard about her meditation class and decided to try it. “I’ve been a pharmacist for 41 years, 37 of those in management positions,” explained Lay. He found himself dealing with issues that all pharmacy managers experience: personnel issues, increased regulation, budget cuts, and the expectation to do more with less.

Ronald Lay, M.S., R.Ph.

“I was becoming more tired and irritable and experienced classic symptoms of burnout. I ate lunch at my desk every day and took work home regularly,” he said. “I was having trouble sleeping. I realized I needed to slow down and take better care of myself.”

Lay tried the class, hoping it might help his sleep problems and stress level without medication or therapy. “The result? I find it does!” he said, “The biggest surprise was the level of physical and emotional relaxation. I felt like a whole different person after the meditation – like a weight was lifted off my shoulders. I walked out so much more slowly – no longer in a rush.”

The sessions also helped him work in a more focused way. “Now that I am working as a staff pharmacist, I still experience stress from the demands of patient care. It is easy for emotions like frustration or anxiety to take over, and to rush through the work. Meditation allows for a more calm and logical approach, which should reduce the opportunity for errors,” he said.

Martin agrees that meditation can be beneficial. As an oncology nurse, her job involves working with the outpatient cancer institute triaging phone calls from patients regarding symptom management, chemotherapy side effects, and other issues. “Meditation has helped me be more present for my patients, use more therapeutic communication, and overall just be more empathetic,” she said.

Mindful Moments
In addition to her weekly meditation sessions, Wilhelm has led a continuing education program for pharmacy staff at the hospital on meditation for stress reduction. For ASHP, she conducted a webinar and a meditation for pharmacy students at the 2018 ASHP Midyear Clinical Meeting. Wilhelm incorporates simple mindfulness techniques in her medication safety lectures and plans to expand more moving forward. She and a colleague recently led a meditation class for graduating medical students at Penn State College of Medicine held immediately after their lecture on loan repayment.

For healthcare providers interested in learning to incorporate these practices in their work, Wilhelm noted that mindful moments could be tucked in throughout your day. “Walking through the threshold of a patient’s room, or washing your hands, or getting ready to program an IV pump, or verifying a prescription … these can all be mindful moments if you stop for a moment to breathe and get centered,” she said. “Taking that pause to stop, think, assess, and review can lead to better communication, clearer focus, and ultimately, improved patient care.”

 

By Ann Latner

 

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