ASHP InterSections ASHP InterSections

December 20, 2011

Building Upon ASHP’s Legacy for a New Future

Editor’s Note: Paul W. Abramowitz, Pharm.D., FASHP, began his job as ASHP Executive Vice President and CEO January 1, replacing Dr. Henri R. Manasse, Jr., Ph.D., Sc.D.  Dr. Abramowitz was formerly the associate hospital director for professional services and chief pharmacy officer at the University of Iowa Hospitals and Clinics, and Professor and Assistant Dean at the College of Pharmacy, Iowa City. InterSections sat down with Dr. Abramowitz to get a sense of what he sees ahead for ASHP and health-system pharmacy.

What do you foresee as the biggest challenges for ASHP, and for you as its new leader?
Very high on my agenda is to meet the goals set forth at the Pharmacy Practice Model Initiative (PPMI) Summit to change our practice model. In addition, we need to achieve our objective of expanding residency training so that all new graduating pharmacists in health systems are residency trained by 2020. I would also like to see ASHP work to enhance the public’s understanding of what we do as pharmacists, so that patients insist that their health care team always includes a pharmacist. It would also be timely for us to again look at our membership organizational structure and our policy-making process to see if we can better serve our members and more rapidly accomplish some of the things they would like us to do. Of course, all of this will require that ASHP has a robust “product line” providing value and generating the necessary revenues to support our membership services.

How has your background in health care, as a practitioner and an administrator, prepared you for being CEO?
I’ve worked in hospitals and health systems in various roles for 34 years. So I think I bring to this position a good understanding of many aspects of health-system pharmacy practice. I also served three terms on the ASHP board of directors, including as president and treasurer. When I put that together—a strong practice perspective as well as a strong understanding of ASHP organizational and professional issues—I feel very comfortable stepping into the office.

Why did you want to become CEO?
If I’ve accomplished anything in my years as a pharmacist, it’s been due to three things: great teams of people I’ve worked with in various organizations; the many colleagues and mentors who have helped me along way; and, perhaps most importantly, ASHP itself. Throughout my career, I’ve found that ASHP has provided me not only with a wealth of both professional and scientific information, but also many colleagues, friends and networking. I am greatly indebted to ASHP, and I want to continue to give back to ASHP. This position will allow me to do that and also help advance health-system pharmacy. For me, this is my ideal job. So that’s what attracted me to the position, and that’s what I told the search committee and the board of directors during the interview process.

How would you describe your style of leadership?
I have a very open, informal style, and I’m very participatory by nature. I like to involve, very significantly, the people that I work with. I may have ideas and thoughts about directions, but I believe the power of collective wisdom is much greater than that of an individual and should be used to help guide decision making. However, I recognize that a leader needs to make decisions and I will not hesitate to do so. If I had to apply a management term, my style is participatory but situational, depending on what needs to be done.

What changes would you like to see in clinical pharmacy practice?
I anticipate that in five to 10 years, health-system pharmacists will be seen as an absolutely necessary member on every patient care team. I hope that the extent and provision of services outlined in the PPMI become universal in all hospitals, health systems, clinics and ambulatory care centers. I also hope that patients insist that pharmacists be very involved in their care and recognize how we can help them improve the outcomes of their medication therapy. I hope that collaborative practice expands and evolves to the point that pharmacists can make full use of their knowledge and abilities for our patients.

How can ASHP help to achieve those goals?
ASHP must change and evolve to ensure that across the nation, we support the needs of everything from 25-bed critical-access to 1,000-plus bed hospitals. We need to be able to support our members practicing in all of those facilities. ASHP must also provide the support and encouragement for what I believe will become a fast-growing part of our membership—pharmacists practicing in ambulatory clinics of all sizes.

What else would you like to say to ASHP members and staff to introduce yourself?
I believe that the dedication and participation of our entire membership is unparalleled. We have exceptional volunteer leaders and the most talented and hard-working staff of any professional association in the world. When one puts those three ingredients together, it says that ASHP can accomplish anything we set our mind to. I’m honored to be in this position to build upon the legacy of my three CEO predecessors and help lead ASHP to even higher levels.

March 28, 2011

Gazing into the Crystal Ball

Illustrated by Matt Sweitzer ©2011 ASHP

AS PHARMACY PRACTICE EVOLVES from a profession that primarily supervises medication distribution to one that provides services such as medication therapy management and disease prevention, one of the main questions that remains unanswered is, “how long will this transformation take?”

Although no one can predict how fast it will happen or what path it will take, practice model change is being driven by economic realities, safety and quality concerns, political influences, and pharmacists who desire to be more involved in the care of patients in their institutions.

David Chen, ASHP’s director of pharmacy practice sections, said that despite the fact that pharmacists provide direct patient care in many practice settings across the country, services offered and distribution are uneven.

“We know that outcomes are better for patients when there is pharmacist involvement, but now we have to support pharmacy practice leaders in determining the most effective way to implement pharmacy, technicians, and technology in their settings,” he said.

Although each hospital and health system will need to tailor practice models to meet its own goals, the consensus is that there is ample opportunity for pharmacists to shape the future of their profession. Many have already begun to seize the day.

Work Flow and Collaboration

Pharmacists’ success in providing direct patient care hinges on their ability to collaborate with other health professionals. As part of its patient-centered practice model, the University of Wisconsin Hospital and Clinics has decentralized its pharmacy staff. Every pharmacist is assigned to a unit or group of patients for which he or she provides medication order review, pharmacokinetic dosing, medication reconciliation, and medication education.

“This model forges relationships between pharmacists and physicians and establishes trust between pharmacists and medical staff,” said Steve Rough, M.S., B.S.Pharm, director of pharmacy. “Medical staff comes to trust that we are consistently going to optimize what is best for the patient’s care in the process of making our recommendations.”

Rough added that demonstrating value and accountability ensures continued pharmacist involvement in multidisciplinary teams. “When we need buy-in for integrating pharmacists into a new care team or service, we prepare a succinct business case demonstrating the value proposition for the hospital,” he said. “Then, once we add additional pharmacist resources to the budget, we document and present the promised outcomes.”

Technology

Technology has been a boon to pharmacists by increasing patient medication safety and enabling pharmacists to delegate task-oriented work to highly trained pharmacy technicians. Automation such as robotic dispensing cabinets frees up pharmacists’ time, while analytics enhance clinical decisions.

Christopher R. Fortier, Pharm.D., manager of pharmacy support and services and clinical assistant professor in the Department of Pharmacy Services at the Medical University of South Carolina, Charleston, notes the increasing importance of mobile technology in the hospital setting.

“Remote and mobile technologies such as iPads, tablets, and smart phones enable us to take information with us to the patient’s bedside,” said Fortier. “We’re not stuck behind a desktop computer, and with real-time information at hand, we don’t have to go to five different places to get information and provide care to patients.”

Barbara Giacomelli, Pharm.D., M.B.A., director of pharmacy at Shore Memorial Hospital in Vineland, N.J., believes pharmacists are well suited to take leadership roles in developing technology for use in practice models.

“We can partner with medical staff in developing rules and setting up order entry screens to be user-friendly and provide the correct levels of alerts,” she said.

Informatics is an expanding field in which pharmacists will find plenty of opportunity, Giacomelli added. “Most of the people I have spoken with have developed into an informatics role by having a strong interest in it,” she said. “However, if you don’t have a pharmacist who understands it, you’ll have to recruit for it. There are limited resources out there, but this specialization is in demand, and the demand will only increase with time.”

Pharmacist Education

If new pharmacy practice models are to take hold, it is critical that pharmacy students and residents are prepared for the hands-on work in direct patient care that awaits them. At the University of Colorado in Aurora, students and residents work together with pharmacists. Residents assist with consultations, particularly with respect to chronic disease states such as hypertension, dyslipidemia, and diabetes. Students assist with data collection and medication reconciliation to the extent allowed by law.

“While students can’t practice independently, they are licensed interns and can certainly provide a significant amount of help in providing clinical patient care under the guidance of pharmacists,” said Joseph Saseen, Pharm.D., FCCP, BCPS, professor at the University of Colorado Schools of Pharmacy and Medicine, Aurora. “They can do more than just shadow. “Students must be supervised, but collecting data, providing medication reconciliation, interpreting patient care data, and drafting clinical recommendations are all valuable roles that can be filled by students.”

According to Rough, of the University of Wisconsin Hospital and Clinics, residents offer an excellent return on investment, particularly when it comes to the aforementioned technology.

“We have 16 pharmacy residents on board, and everything we do involves them,” he said. “The complexity of drug preparation and distribution technology oversight has increased drastically over the last five years. Overseeing pharmacy operations is now seen as a patient care role, and we are currently developing residents with expertise in that area.”

Evolving Technician Roles

Pharmacy technicians with the appropriate education, training, and credentials stand poised to take on more responsibility and perform tasks that were once solely the domain of pharmacists. By dispensing medications, taking prescriptions over the phone, and documenting patients’ medication information for pharmacist review, technicians free up pharmacists’ time for direct patient care.

“When you talk about staffing and resources, you have to ask where you get the most value out of each of the key participants,” said Brian T. Marden, Pharm.D., director of pharmacy at Maine Medical Center in Portland. “Clearly, a pharmacist’s best value is direct patient care, but unfortunately, in many systems that does not happen because a lot of pharmacists are still doing things that well-trained technicians could do easily and safely.”

According to Marden, pharmacists have to be prepared to let go of traditional nonclinical roles, and pharmacy leaders should create the technician infrastructure to allow for it.

“One strategy that has proven to be very effective for Maine Medical Center was the decision two years ago to hire the necessary staff to decentralize our pharmacy technicians,” he said, adding that the decision “created a sense of pride amongst our technicians that they were truly having a positive impact on patient care, right on the front lines.”

Education is of the utmost importance, not only for getting value from pharmacy technicians but also for maintaining adequate staffing, Rough believes. He speaks from experience.

“We had problems with tech turnover,” Rough said. “When we went to Human Resources, we learned that during exit interviews, the techs said that the job was not professional enough, and that they didn’t feel adequately trained for the work we were demanding of them.

“So, we made a business case for expanding technician training, showing how it was an investment in patient care,” he said. Now the University of Wisconsin system offers a nine-month ASHP-accredited pharmacy technician program.

“If you are looking for ways that pharmacists can take care of a larger population without adding more staff, the key is technician education,” Rough added.

Learning From Best Practices

The future of pharmacy depends on making the most of the resources you have, said ASHP’S Chen. “There aren’t unlimited resources, so the question comes back to, What is the most effective way to deploy allocated staff and technology? We can learn from best practices in the field, and, while recognizing that every hospital will be at a different point in the process and every state has different laws, working together, we can determine the best direction for the profession.”

Editor’s Note

In 2009, ASHP and the ASHP Foundation launched the Pharmacy Practice Model Initiative (PPMI), with the goal of developing new practice models that support the most effective use of pharmacists as direct patient care providers. Last November, thought leaders throughout hospital and health- system pharmacy came together at the PPMI Summit in Dallas to take stock of the Initiative’s progress, discuss challenges and opportunities in pharmacy, and reach consensus on next steps. In the above article, InterSections talks with some of the key leaders who attended the Summit to get their thoughts on what the future of the profession might hold.

June 1, 2010

Summer Meeting Focuses on Medication Safety

THE 2010 SUMMER MEETING, June 6-9 in Tampa, will be a gold mine of best practices in medication safety. With a special focus on the role pharmacists can play in transforming medication safety leadership, the meeting will energize and enlighten attendees about what they can do within their own institutions. (more…)

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