ASHP InterSections ASHP InterSections

June 26, 2013

ASHP Celebrates 50 Years of Residency Accreditation

 

Photo courtesy of ASHP Archives.

Photo courtesy of ASHP Archives.

WHEN YOU THINK OF THE 1960s, chances are you think of the civil rights movement, the passage of the Medicare law, the women’s movement, and peace protests… all substantial forces for change. But the ‘60s were also a pivotal time in the evolution of pharmacy training.

In 1962, the Board of Directors of ASHP—then the American Society of Hospital Pharmacists—adopted the ASHP Statement on Accreditation of Hospital Pharmacy Internship Training Programs, which laid out objectives for post-graduate programs that would provide in-depth training.

To distinguish these programs from those geared toward meeting the legal requirements for licensure, that same year ASHP dropped the term “internship” and replaced it with “residency.” In 1963, ASHP began the process of surveying the first 32 hospitals accredited for residency in hospital pharmacy.

Over the last 50 years, the form and function of accredited residency programs have shifted several times. The 1980s saw residencies divided into hospital, clinical and specialty programs. This format gave way to the pharmacy practice and specialty residencies of the 1990s and early 21st century.

ASHP Past-President Paul G. Pierpaoli, M.S., inspects sterile solutions while a resident at the Univ. of Michigan. Photo courtesy of ASHP Archives.

At the same time, ASHP created post-graduate year two (PGY2) residencies, which prepare residents for specialty pharmacy practice in areas such as ambulatory care, infectious diseases, and oncology.

“Residency standards have evolved from focusing on systems and production to focusing on patient care and clinical services,” said Douglas Scheckelhoff, M.S., FASHP, ASHP’s vice president of professional development. “Now students are able to build upon their skills and actually apply them as they go through their residencies.”

More than 32,000 pharmacists have completed ASHP-accredited residency programs since 1963, and the number of accredited programs has grown to 1,577.

It has been a long but necessary journey, one that serves to propel pharmacists into rewarding careers and to advance the profession as a whole.

 

Benefits for Residents

Daniel M. Ashby, M.S., FASHP

“Accredited residency programs ensure competency that is rooted in knowledge, skills and abilities,” Ashby said. “Accreditation is our profession’s Good Housekeeping Seal of Approval, signifying that certain requirements in training have been met.”

Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP, associate dean of academic and student affairs and associate professor, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, and a member of ASHP’s Board of Directors, added that accreditation is testimony to the atmosphere of the program in which the resident has trained.

Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP

Participating in an accredited program also gives residents an edge in seeking employment, said Janet L. Teeters, M.S., ASHP’s director of accreditation services.

“Many jobs require applicants to have had a residency,” she said. “The current market is prompting health systems to ratchet down on costs, and they are scrutinizing who they hire. When they see that someone has been through an accredited residency program, they automatically know what kind of skills and training the person has.”

At the Department of Veterans Affairs (VA), which has 585 accredited residency positions spread across 140 programs, accreditation levels the playing field, said Lori J. Golterman, Pharm.D., national director of pharmacy residency programs and education for the VA.

“Each student has different experience because they all come from different schools, and accredited residency provides an opportunity for consistent training,” she said.

 Benefits for Hospitals and Other Health Care Settings

For organizations seeking accreditation, the benefits start accruing long before their ASHP surveyor visit. Simply completing the preliminary RU Ready Assessment Tool for Pharmacy Residency Programs will be enlightening, said Smith.

“The self-assessment helps organizations review their own compliance with each element or standard. It gives them a good idea of how they are doing and what their strengths and weaknesses are.”

The number of residencies in ambulatory clinics and community pharmacies is growing. Above, Brooke Hudspeth, Pharm.D., a former PGY1 resident at the University of Kentucky College of Pharmacy, measures a patient’s blood pressure at Kroger Pharmacy, Lexington, Ky.

“It comes back to the environment,” she said. “A lot of people want to be involved with the programs and work in systems with that kind of culture and recognition.”

Brian Swift, Pharm.D., vice president and chief pharmacy officer at Thomas Jefferson University Hospital in Philadelphia, the very first site surveyed for accreditation back in 1963, agrees.

“Accreditation adds credibility. It carries an association with a large body of individuals [ASHP members] who have already traveled the path [of training and experience], and includes the organization in a legacy of outstanding practitioners and leaders in the pharmacy world,” he said.

And then there is the reimbursement. “Hospitals that run accredited residencies can get Medicare pass-through funding for allied health postgraduate educational programs,” said Teeters. “If 40 percent of their patients are Medicare patients, having an accredited program will enable them to get 40 percent of the cost of their PGY1 residency program funded.”

Benefits for the Profession

Accredited residency programs advance pharmacy within organizations and among other clinicians in the allied health professions. Indeed, preparing to apply for accreditation prompts pharmacy departments to become more cohesive and visible, said Golterman.

From left, Katie Long, Pharm.D., a University of Kentucky PGY2 oncology resident, consults with Stephanie Sutphin, Pharm.D., Clinical Pharmacy Specialist, Outpatient Hematology/Oncology.

“Everyone needs to be involved in the training to give the residents an optimal experience. If the chief of pharmacy or other professionals don’t want to teach or be involved, residency directors need to communicate the importance of their programs to them and change that.”

Because administrators must provide approval to seek accreditation, the process offers an opportunity to shine the light on the profession, said Swift.

“It helps to illustrate where pharmacy should fit in, and it forces pharmacy departments to push for recognition of their programs throughout the organization.”

Accredited residencies also drive practice innovation, which will help expand pharmacy into additional patient-care areas and promote the inclusion of pharmacists as vital members of the care team. For example, at Jefferson, residents conduct research projects and marry those projects with the needs of the pharmacy department in a way that fosters organizational and practice change, said Swift.

“We turn to residents more as practitioners and welcome creative practice methods. We look to them for their insight and energy in breaking down barriers in areas where traditional pharmacy practice may sometimes be limited.”

—By Terri D’Arrigo

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February 25, 2013

Pharmacists Integral to Continuity of Care at Scott and White Memorial Hospital

DISCHARGE FROM HOSPITAL TO HOME or a long-term care facility is a busy time for both patients and care providers. When administrators at Scott and White Memorial Hospital, a 600-bed academic medical center in Temple, Tex., found that the computer-assisted discharge medication reconciliation process wasn’t robust enough, they tapped pharmacy staff for a solution.

Seizing the opportunity to demonstrate leadership, the pharmacy staff devised a plan, and with the hospital administration’s approval, the High-Risk Medication Team (HRMT) was born. Their endeavor successfully implements ASHP’s Pharmacy Practice Model Initiative recommendation for pharmacist involvement in establishing processes to ensure medication-related continuity of care.

Getting Off to a Good Start

Seeking to expand pharmacist duties often requires making a case to management, but at Scott and White, the administration had full faith in pharmacy staff from the start.

From left, Kurt Bradley Anderson, Pharm.D., staff pharmacist, consults with patient care pharmacists Lori Jackson-Khalil, Pharm.D., and Qing Xu, Pharm.D.

“We were fortunate that our leadership was in tune to this vulnerable period for patients,” said Tricia A. Meyer, M.S., Pharm.D., FASHP, of the HRMT. “They saw this as an opportunity for pharmacists based on our understanding of patient medication profiles and discharge medications.”

Tasked with providing options to the administration, the pharmacy staff set about devising several plans from which to choose. They met with the hospitalist, nursing staff, and leaders from different units to get their input and learn about their discharge processes.

Team members also called other institutions where they knew pharmacists had responsibilities similar to those they were seeking to obtain.

“We decided it would be a great opportunity for a new group of pharmacists to focus strictly on discharge,” said Meyer. “We already have pharmacists who focus on patient care, but they don’t have the time to dedicate to discharge.”

The team came up with three potential plans: One would cover medication review for every discharge; one would focus on high-risk patients and medications; and one would focus solely on anticoagulation. Administration opted for the second program, which focuses on high-risk.

From there, Meyer searched for a pharmacist who had expertise in patient interaction and counseling, and two additional team members who were ambulatory care specialists comfortable with counseling patients and reviewing medication profiles.

Working Past the Challenges

Although the pharmacy team did not have to worry about administrative buy-in, implementing the HRMT program was not without its challenges.

Patient care pharmacist Qing Xu, Pharm.D., consults with a physician about a patient’s medications.

“One of the initial barriers we had was easily knowing when patients were to be discharged,” Meyer said. “Sometimes even the attending physician doesn’t know when the patient will be discharged. Test results or a change in the patient’s condition can extend or shorten a stay, and the physician might not know until rounds.”

The team tapped into several resources around the hospital, consulted with inpatient pharmacists, and accessed data from outpatient clinics, according to Lori Jackson-Khalil, Pharm.D., patient care specialist. “For example, the anticoagulation clinic has a list of patients, and we review that list each day. The cath lab would send us a list of patients on their schedule every day, as well.”

At first, software presented a challenge, said Jackson-Khalil. “We started with a spreadsheet in Excel, and we would manually input patient data. The trick was to set up the spreadsheet to give us the information we needed.”

The team decided to err on the side of caution and create detailed records.

“We kept data on everything—every visit to a patient’s room, every call to a physician, all categorized by drug and service. The team spent a lot of time documenting,” said Meyer. “But it was worth it. In the first six months or year of a new program, you are vulnerable. You have to show that you are accomplishing the goals the administration has given you. You can never keep too much data when trying to justify a program and its growth.”

Laborious data entry may soon be a thing of the past, however. The hospital is currently switching over to a new system that the staff believes will make it easier to identify which patients are about to be discharged.

Expanding Responsibilities

Once patients on high-risk medications are identified as transitioning to discharge, their orders are scanned to the pharmacy. Initially, the HRMT would review the orders and consult with prescribers as necessary regarding additions, possible errors in omissions, and unsafe prescribing conditions.

But as of November 2012, pharmacists are able to add medications or modify discharge orders. Their new responsibilities came about in part because they were able to demonstrate their impact on patient care through the data in their spreadsheets. For example, between January and June 2011, the team identified and successfully intervened in 42 unintentional omissions of high-risk medications such as phenytoin, warfarin, clopidogrel, and prasugrel.

“Now the administration sees us as a very effective team, and physicians call us and request that we add drugs to our oversight list,” said Meyer.

Pharmacy leadership in medication-related continuity of care is currently expanding. The team has begun counseling and oversight for patients with congestive heart failure in the hope that pharmacist-provided medication management at discharge will decrease readmissions.

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