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May 23, 2014

Privileging Expands Pharmacists’ Role

Pharmacist privileging at Veterans Administration hospitals can extend past traditional pharmacist duties.

Pharmacist privileging at VA hospitals can extend past traditional medication management duties.

HOSPITALS THAT HAVE A STRONG CLINICAL PHARMACY PRESENCE are turning to their institutional privileging programs to expand the high-level patient care services that pharmacists can provide.

At The Johns Hopkins Hospital in Baltimore, a recently approved program will allow certain ward-based pharmacists to prescribe medications to inpatients.

“It’s about empowering some of our folks to practice at the top of their license and the top of what their knowledge base allows them to do,” said John J. Lewin III, division director of critical care and surgery pharmacy at Johns Hopkins. “That’s going to be good for patients in terms of efficiency, and accuracy, and care, and medication safety and its related outcomes.”

Lewin expects the pilot program to begin this summer in the hospital’s surgical ICU, where clinical pharmacists are fully integrated into the multiprofessional team and work there daily.

Writing Medication Orders

Under Maryland law, pharmacists can manage medication therapy by protocol, under the terms of a drug therapy management agreement between pharmacists and physicians.

“Our pharmacists do make the interventions now, but they’re not allowed to write medication orders,” Lewin said. Under the current system, any changes to the medication regimen must be performed by a resident, attending physician, or other prescriber.

John J. Lewin III

John J. Lewin III

“What we really heard from our physicians was, basically, ‘Why can’t you write the orders for this? You guys are the medication experts, and it would be good for patient care,” Lewin said.

He said allowing pharmacists to enter medication orders into the computer system will decrease the administrative burden on physicians and allow them to make better use of their time.

Ultimately, he said, about 20–30 unit-based pharmacists are expected to be granted prescribing authority. He said the expanded scope of practice will be available to clinical pharmacy specialists who have a Pharm.D. degree and postgraduate year 2 (PGY2) residency training or equivalent experience.

Lewin said hospital decision-makers concluded that modifying drug therapy is akin to prescribing, and that the hospital’s governing board should be responsible for assigning privileges to clinical pharmacists to encompass this work. The same process is used to permit physicians, nurse practitioners, and other qualified health care providers to order medications.

Lewin expects the pilot program to focus on renal dosage-adjustment protocols.

He said the protocols are designed to comply with state law and will allow pharmacists to use their professional judgment to make clinical decisions about drug therapy. He noted that different units will use different protocols that take into account the individual needs of the entire health care team and its patients.

Mirroring Physician Privileging

A similar privileging process is used at Fort Belvoir Community Hospital in Virginia, said U.S. Army Lieutenant Colonel Eric Maroyka, director of pharmacy for the joint services military treatment facility.

U.S. Army Lt. Col. Eric Maroyka

U.S. Army Lt. Col. Eric Maroyka

Maroyka said all hospital pharmacists are “core privileged” to perform routine tasks at the hospital. But about a dozen clinical pharmacy specialists with advanced training have been granted additional privileges that include the ability to prescribe medications in specific settings.

“We’re really mirroring what physicians and other midlevel practitioner providers do for their privileging,” Maroyka said.

For example, he said, one pharmacist in a patient-centered medical home setting specializes in diabetes care and is able to prescribe medications, monitor patients, and educate them about their drug therapy.

“She handles newly diagnosed diabetics and type 2 diabetics without complications,” Maroyka said. “If it’s more complex, like they need to be set up on [an insulin] pump or some other advanced regimen, then they would see the endocrinologist.”

Maroyka said credentials for supplemental privileges may include PGY2 residency training or the completion of a fellowship or other recognized educational activity.

For one pharmacist, he said, completion of the ASHP Research and Education Foundation’s three-part traineeship program in pain management and palliative care supported the attainment of advanced privileges to treat patients in need of such services.

The Council on Credentialing in Pharmacy, a coalition consisting of ASHP and nine other national pharmacy organizations, recognizes several groups that may credential or certify pharmacists in advanced practice areas. These include the Board of Pharmacy Specialties, the National Asthma Educator Certification Board, the American Heart Association, the National Certification Board for Diabetes Educators, the Commission for Certification in Geriatric Pharmacy, the American Academy of HIV Medicine, and the American Board of Applied Toxicology.

Click here to find resources that describe credentialing opportunities and related documentation.

Flexibility to Perform Advanced Functions

William Greene, chief pharmaceutical officer at St. Jude Children’s Research Hospital in Memphis, Tennessee, said 11 clinical pharmacists have been granted advanced privileges by the St. Jude governing board.

“These individuals have the authority to order and monitor laboratory tests and other items related to medication therapy and to adjust medication therapy [for] a broad number of medications,” Greene said.

He said most pharmacists practicing at this level have completed a PGY2 residency program and are board certified in oncology pharmacy. But he said the system includes enough flexibility to allow some highly qualified, experienced pharmacists who lack those credentials to perform advanced functions.

William Greene

William Greene

Greene said the decision to privilege pharmacists through the medical staffing process grew out of his concern that an auditor could potentially decide that clinical pharmacists were providing medication therapy services without a valid medication order.

The problem, he said, is that although Tennessee’s pharmacy practice act allows pharmacists and physicians to establish patient care relationships, the act doesn’t define collaborative drug therapy management.

Greene said that the hospital’s medical executive committee determined that clinical pharmacists are functioning as “midlevel practitioners” and should be credentialed and privileged as such. He noted that the determination coincided with the Centers for Medicare and Medicaid Services 2012 revision of its conditions of participation that allowed pharmacists to be considered part of a hospital’s medical staff.

“It was perfect timing,” Greene said.

ASHP’s Council on Education and Workforce Development recently recommended that the Society support the use of postlicensure credentialing, privileging, and competency assessment to establish qualifications for providing direct care to patients. The council agreed that credentialing programs should meet guiding principles established by the Council on Credentialing in Pharmacy.

ASHP’s House of Delegates, when it meets June 1 and 3 in Las Vegas, will consider these positions for adoption as an official ASHP policy.

–By Kate Traynor, reprinted with permission from AJHP
(volume 71, pages 686-687).

May 9, 2014

Pharmacist Speaks Out as Patient on Compounding Legislation

Filed under: Ambulatory Care,Clinical,Current Issue,Feature Stories,Quality — jmilford @ 4:25 pm
IMG_6888

Rep. Cathy McMorris Rodgers (R-Wash.) speaks with Michael Brandt about his experiences with an NECC-compounded medication.

WHEN MICHAEL L. BRANDT, PHARM.D., FASHP, heard reports last fall of contaminated injectable steroids prepared by the now defunct New England Compounding Center (NECC) in Framingham, Mass., he resolved not to panic.

He had been receiving injections of compounded methylprednisolone acetate (MPA) for nearly 18 months for pain from an unstable vertebra in his back, and he knew there was a chance that at least one of his injections came from lots linked to an outbreak of meningitis, so the first thing he did was investigate the origin of the shots he had received.

An Uncertain Risk Outlook

Initially, he met with good news:  His shots did not come from the lots authorities declared contaminated. But as the story of NECC unfolded, it soon became apparent to Brandt that lot numbers were nearly irrelevant.

“This wasn’t just a speck of dirt on a picture frame. The conditions were so deplorable, it was painfully obvious that they had existed for a long time,” said Brandt, clinical pharmacy supervisor at Kootenai Health, Coeur d’Alene, Idaho. “That raises the possibility that the lot I received was contaminated.” Indeed, when authorities inspected the facility, they found rust, mold, and filthy ventilation, all of which resulted in contaminating injections that have thus far killed 64 people and sickened another 686 more, many of them senior citizens.

The Centers for Disease Control have been tracking the number of patients who have fungal infections linked to the NECC steroid injections.

The Centers for Disease Control has been tracking the number of patients who contracted fungal infections from NECC steroid injections.

According to the U.S. Centers for Disease Control and Prevention (CDC), after the recall of NECC steroid medications last September, state and local health departments  identified approximately 14,000 people in 23 states who were potentially exposed to contaminated MPA, of which 11,000 received spinal or paraspinal injections.

Across the nation, patients who received MPA injections prepared by NECC in that timeframe are still being diagnosed with fungal infections. Thus far, the CDC has been unable to determine whether the infections take several months to incubate or whether patients are not diagnosed until the infections are several months along. For now, those who have received potentially contaminated injections have been informed of their risk.

Brandt says that he will relay the information to his care providers whenever necessary. “It will always be at the back of my mind. If I get headaches or other symptoms, [having received these shots] is something to put into the differential diagnosis.”

Keep Calm and Advocate

There are no tests to determine whether a fungus has taken up residence in the spinal fluid, but Brandt is determined not to let the uncertainty ruin his life.

“When I found out, I thought, ‘Okay, I’m not sick and I’m not immunocompromised, so my risk is probably lower than other people’s,’ ” he said. “But I know there’s a possibility that the fungus may be there and may one day make me sick or kill me. I just don’t want to waste a lot of personal energy worrying about something that may or may not happen.”

Instead, Brandt is channeling his energies into holding both the profession and the government to the highest of standards. “I’m disappointed in those [NECC] professionals who call themselves pharmacists who worked in and allowed those conditions. I would never sign off on that. I would quit first.”

I know there’s a possibility that the fungus may be there and may one day make me sick or kill me.

Although he acknowledges that most compounding pharmacies do a good job, Brandt points to NECC as evidence that a lack of government oversight leaves too much room for potentially lethal short-cuts.

“Why would [NECC] think that this is okay? Obviously, it’s greed. Doing the right thing is not cheap,” he said, noting the expense of the steps, materials, and labor required to maintain clean rooms and a sterile environment.

A Regulatory Gray Area

Brandt believes that the NECC case exemplifies how compounding pharmacies operate in a regulatory gray area with respect to how they prepare, market, and sell their products.

From left, Rachelle Albay, a Pharm.D. student at Washington State University College of Pharmacy at the time of this picture, and Michael Brandt pose in front of the Capitol Building.

“When going through pharmacy school, I learned that there was a big difference between manufacturing and compounding. Compounding was something specific to one individual. Manufacturing means making a large batch of sterile products that you sell to providers,” he said, questioning how NECC could have such a large operation that it could produce and sell so many injections in such a short period of time.

In September, Brandt flew to Washington, D.C., to talk to his senators and representative in favor of Senate Bill 959, the Pharmacy Quality Security and Accountability Act. This legislation was designed to create a new category of producer called “compounding manufacturer” that must register with and be inspected by the Food and Drug Administration.  He considers such cross-country endeavors to be a key part of the way he delivers care and advocates for patients, and it’s something he would have done even if he had not had to grapple with the NECC debacle on a personal level.

“We in the medical community need to do the right thing for the patient,” Brandt said. “Sometimes, factors such as regulation and lack of resources get in the way. Sometimes, the focus becomes a bit jumbled, but patient care should always be the top priority. I have a very strong moral guidance that way.”

A Step in the Right Direction

In October 2013, S. 959 was replaced with a less stringent bill in the House of Representatives, HR 3204, The Drug Quality and Security Act, which President Obama signed into law in November. The new law clarifies the Food and Drug Administration’s authority over compounded medications, establishes a new class of compounding manufacturer known as an “outsourcing” facility, and creates a national set of standards for tracking pharmaceuticals through the supply chain.

The new legislation, while not providing for tight oversight the way S. 959 would have, is a step in the right direction, said Brandt.

“It’s not exactly what we wanted, but it’s something. We got what we needed, and through ASHP and legislative activities, we raised awareness of the issue. I’d like to believe that even this may not have passed had we not gone through the efforts of lobbying,” he said.

Some sectors have criticized the new law, saying it fosters government encroachment on business, but Brandt dismisses such criticism out of hand. “Everyone else—health systems, hospitals, manufacturers—is regulated, so this fits into what government should be doing. We have a case where the compounding industry has not self-regulated and has not done due diligence, so now it’s necessary for the government to step in. The government didn’t ask for this. The industry failed.”

Government oversight is a matter of public safety, Brandt said. “It’s outbreaks like this one that we want to prevent. There are so many compounding pharmacies, and so many people who depend on their medications to be sterile and not dangerous. If these problems can be avoided by oversight, why would you risk them? It’s a no-brainer.”

 

—By Terri D’Arrigo

ASHP’s Medication Safety Collaborative

Filed under: Clinical,From the CEO,Quality — jmilford @ 2:34 pm
Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

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

ASHP is dedicated to building relationships within the health care community that strengthen medication and patient safety through interprofessional care.

We are excited to have the Society of Hospital Medicine’s (SHM) participation this year in our Medication Safety Collaborative. As health care practitioners, our number one goal is to deliver quality care to patients throughout the entire health care continuum. ASHP’s Medication Safety Collaborative helps to achieve this goal.

The collaboration between hospitalists and pharmacists is very important. As medication therapy experts, pharmacists—when working collaboratively with physicians, nurses and other health care practitioners—help to foster optimal models for team-based, patient-centered care. The Collaborative promotes this by offering a unique interprofessional, educational opportunity to bring together practitioners to build and exchange ideas on improving quality and patient care.

The feedback we received about last year’s Collaborative was phenomenal. Participants noted the great sense of community they felt after attending the Collaborative and the valuable resources and networking provided. Participants not only walked away from the Collaborative with continuing education credits in their field, but also with tangible solutions to integrate best practices and deploy new tools to optimize safety and quality outcomes. Our hope is to continue this momentum.

This year we have made the Collaborative an integral part of ASHP’s annual Summer Meetings—as one of three boutique conferences. I cordially invite you to attend and to be a part of this collective experience. As a registrant of the Collaborative, you will also have full access to all of the sessions and events occurring at our two other simultaneous conferences, the Informatics Institute and the Pharmacy Practice and Policy conference. We hope this access will allow you to customize your Summer Meetings’ experience, as you can stay in the Collaborative or attend any individual session of your interest.

The Collaborative’s interactive sessions and networking events, led by a faculty of distinguished patient safety experts, are thought-provoking and engaging. These unifying events bring together an invaluable assortment of knowledge and health care perspectives, like yours, which include: physicians, patient safety officers, nurses, pharmacists, medication safety officers, quality professionals, risk managers, and administrators.

Again, we invite you to attend ASHP’s Medication Safety Collaborative, and look forward to the insight and experience SHM’s members will bring to further enrich its discussions.

Click here for more information on the Medication Safety Collaborative and to register.

April 9, 2014

PCIP Helps Pharmacists Make Big Impact in ED

Filed under: Clinical,Current Issue,Feature Stories,Innovation,Managers,Quality,Uncategorized — Kathy Biesecker @ 3:58 pm

ASHP’s Patient Care Impact Program aims to create more ED pharmacist positions in hospitals across the country.

THE SPEED AND COMPLEXITY OF CARE for patients in emergency departments (EDs) is a well-known contributor to medication errors and adverse drug events (ADEs). Studies show that twice as many medication errors occur in EDs than in the inpatient setting.[1]

And of the approximately 110 million patients who receive ED care each year in the U.S., 35 percent experience ADEs. Seventy percent of those are thought to be preventable. [2]

In 2007, the Agency for Healthcare Research and Quality corroborated ASHP’s view that hospital emergency rooms around the country could benefit greatly from pharmacists’ medication knowledge and oversight. It provided funding for the ASHP Patient Care Impact Program (PCIP), a small but crucial six-month traineeship to help practitioners implement an emergency pharmacist role within their own institutions.

“Pharmacists in the ED have been shown to reduce preventable adverse drug events, improve medication reconciliation, and help reduce drug costs,” said Barbara Nussbaum, B.S.  Pharm., MEd, Ph.D., ASHP’s director of adult learning and education programs. “It’s a total win-win for the hospitals who implement a pharmacist position in the ED.”

A Challenging Environment

Up to 10 trainees are picked for the program each year. Nationally recognized expert emergency practitioner Daniel P. Hays, Pharm.D., BCPS, FASHP, specialist in poison information, Arizona Poison & Drug Information Center, Tucson, serves as the program mentor, advising PCIP participants on the clinical projects they have chosen.

The pharmacists then engage in brainstorming sessions and monthly teleconferences for status updates, group mentoring,  and problem solving, all while earning 25 hours of CE credit.

Daniel Hays, Pharm.D., BCPS, FASHP

Daniel Hays, Pharm.D., BCPS, FASHP

“My role is to act as a sounding board for trainees and to provide guidance in moving ED services forward within their institutions,” said Hays. “Implementing this kind of program is not easy, and I help the participants deal with unique challenges they face in the emergency-care environment.”

The high stakes and elevated tensions of an ED can be challenging for a pharmacist who is used to working in a centralized pharmacy, according to Hays. In a place where orders are processed stat, it’s not always clear how and where medication experts fit in.

“Unfortunately, a pharmacist who is not trained in the unique environment of the ED will not last long,” he said. “There may be personality conflicts, and it’s a uniquely chaotic environment. The ED pharmacist needs to be able to function within and to integrate with the team while helping with all aspects of patient care.”

Trainees feel they have gleaned myriad benefits from the program. Rachana Patel, Pharm.D., pharmacy clinical manager, St. John Medical Center, Westlake, Ohio, and her PGY1 resident Steve Margevicius, have used what they learned to help embed a full-time pharmacist in St. John’s emergency department (ED).

Rachana Patel, Pharm.D.

Rachana Patel, Pharm.D.

“We are excited to have hired a pharmacist with several years of critical care experience, and I’ll be using my PCIP experience to help him bridge the pharmacy’s clinical activities throughout a patient’s entire stay in the hospital,” Patel said, adding that she was also able to add three full-time medication reconciliation technicians to the ED.

Tiffany Mitchem, Pharm.D., an emergency room (ER) pharmacist with Mobile Infirmary Health, Mobile, Ala., used the program to get the emergency care skills she needed in lieu of an intensive residency. Mitchem recently led an initiative to expand ER pharmacist’s services in her hospital to seven days a week.

“At Infirmary Health, unless pharmacists are physically in the ER, there is no pharmacist supervision of medication orders there. So, it’s really critical to get these services into the emergency care environment,” Mitchem said, adding that the PCIP program made her much more confident in her clinical abilities.

Saving Lives

Given the fact that 70 pharmacists have completed the program to date, it’s not a stretch to say that the PCIP saves lives.

Cody Maldonado, Pharm.D.

Cody Maldonado, Pharm.D.

During his PCIP traineeship, Cody Maldonado, Pharm.D., clinical emergency department pharmacist, Saint Vincent Healthcare, Billings, Mt., undertook a project to decrease mortality and improve outcomes in patients with septic shock.

“We found that the key to improving outcomes was faster detection and administration of antibiotics and fluids,” Maldonado said. “So, we implemented a ‘sepsis swarm’ that would alert the physician, pharmacist, charge nurse, and bedside nurse to the life-threatening situation. By having a pharmacist deliver the antibiotic directly to the patient’s bedside, we decreased average time from sepsis recognition to administration of antibiotics from over three hours to less than one hour.

“This multi-disciplinary alert has greatly improved awareness about sepsis, and I believe that it is part of the reason why our sepsis mortality has decreased by over 50 percent.”

Sharing Knowledge

The six-month traineeship concludes with a poster presentation given by each participant at ASHP’s Midyear Clinical Meeting. The information that trainees share with the thousands of pharmacists who attend ASHP’s Midyear serves to sensitize many more practitioners to the special aspects of emergency care.

PCIP participants present the findings of their ED projects at ASHP's Midyear Clinical Meeting.

PCIP participants present the findings of their ED projects at ASHP’s Midyear Clinical Meeting.

Nussbaum noted the success of a specific 2013 poster on antibiotic stewardship in the ED.

“Understanding the resistance patterns of patients who are coming in from outpatient settings is a hot issue because of the upswing in more dangerous bacterial strains,” she noted, adding that trainees are developing processes to use the most-effective medications in the ED setting.

Other participants appreciate the opportunity the PCIP provides them to present on a profession-wide “stage.”

“The PCIP advanced several career goals of mine, including my desire to publish more within my specialty and to present the results of our project at Midyear,” said Nicole Abolins, Pharm.D., emergency medicine clinical pharmacist with Novant Health Forsyth Medical Center, Winston Salem, N.C.

Abolins presented a poster at the 2013 Midyear on “Expanding emergency department pharmacy services by decentralizing existing pharmacy staff resources.”

The Payoff

Despite the challenges of practicing in an emergency environment, the payoffs can be big, according to Hays. Working directly with critically ill patients requires special skills but can be a real gift.

“When a pharmacist works in the ER, not only is he or she providing safe medication use, but he or she is a key part of the care team’s front line,” Hays said. “I tell my mentees, ‘Don’t be afraid to get a warm blanket for someone.’ And I’ve never heard an ER pharmacist say, ‘That’s not my job.’ ”

 –By Evan Mulvihill



[1] Santell JP, Hicks RW, Cousins DD. Medication errors in emergency department settings—5 year review. Presented at American Society of Health-System Pharmacists Summer Meeting; June 2004; Las Vegas, NV. Abstract.

[2] Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Eng J Med. 1991;324(6):370-376.

April 2, 2014

Patient Safety Award Highlights Best of the Best

University of Wisconsin Hospital and Clinics, Madison, won the 2011 award for its innovative anticoagulation stewardship program. Above, Philip Trapskin, Pharm.D., BCPS, confers with Anne Rose, Pharm.D.

NO ONE KNOWS MEDICATION SAFETY like a pharmacist, and the ASHP Research and Education Foundation’s Award for Excellence in Medication-Use Safety has showcased many of the best programs in the country since its launch a decade ago.

“This award is associated with projects that help to expand the role of pharmacists. It’s a model for showcasing pharmacists’ abilities to lead interprofessional teams to yield organization-wide, safety and quality initiatives,” said Stephen J. Allen, R.Ph., M.S., FASHP, the Foundation’s chief executive officer.

Supported by a grant from the Cardinal Health Foundation, the award provides $50,000 each year to a pharmacist-led multidisciplinary team for implementing significant institution-wide system improvements relating to medication use. Two finalists also receive $10,000 each.

Since the first award was given to OhioHealth in Columbus for its adoption of mechanisms to consistently identify adverse drug events and provide a platform for best practices across the system, the number of applications has climbed steadily to more than 30 per year, and the types of programs recognized have expanded from medication reconciliation to include a range of care areas such as post-discharge follow-up, anticoagulation stewardship, post-transplant care, diabetes care, and oncology.

As pharmacy practice and health care have evolved, the award has evolved with the work becoming sophisticated with significant impact and touching all areas of healthcare,” said Dianne Radigan, vice president of community relations at Cardinal Health.

Assessing Success

To win the award, a program or initiative must be able to provide evidence that it has improved medication-use safety and patient care. There must be quantifiable outcomes, and the applicant must be able to record specific, concrete ways that pharmacists and other members of a multidisciplinary team have worked together to produce the best patient outcomes.

Amassing the data provides an opportunity to assess the success of a program, said Teri B. Cardwell, R.Ph., Pharm.D., M.H.A., senior director of population health at Novant Health in Winston-Salem, N.C.  Novant won the award in 2008 for its outpatient medication reconciliation program for patients older than 65.

“It’s interesting to write it all down and see it in front of you,” Cardwell said. “We thought we were doing well, but when we got someone to run the numbers and look at the program more in depth, we learned just how much we’d done, and where we might want to go next.”

[The award] shows physicians and surgeons what a great resource they have in pharmacists and how pharmacists optimize care and help patients understand their medications.

Winning the award provided a boost to the team at the Medical University of South Carolina in Charleston, honored in 2010 for its initiative to decrease length of stay, preventable re-admissions, and adverse drug events for kidney transplant patients. The award brought the team recognition within their health system and landed them another award, this time from the hospital itself, to extend the initiative to other hospital services.

“Because this is a multidisciplinary process, the Award for Excellence in Medication Use Safety highlights to hospital leaders outside pharmacy how pharmacists can affect outcomes directly,” said Nicole A. Weimert-Pilch, Pharm.D., MSCR, BCPS, clinical specialist in solid organ transplantation and clinical assistant professor.

“It shows physicians and surgeons what a great resource they have in pharmacists and how pharmacists optimize care and help patients understand their medications. The process is worth the application in and of itself. Even if you don’t get nominated or win, it highlights your program to internal leaders.”

James Rudolph, M.D., M.S.

James Rudolph, M.D., M.S.

James Rudolph, M.D., M.S., chief of geriatrics at the Boston VA Healthcare System, can vouch for that. The Boston VA won in 2012 for its Pharmacological Intervention in Late Life (PILL) Service, in which pharmacists conduct medication reviews and follow-up calls with older adults, particularly those with cognitive impairment. Rudolph said that working with the team drove home for him how important pharmacists are to such efforts.

“It’s critical to have a pharmacist involved. PILL never would have taken off without one,” he said, noting that the award has enabled the program to expand its reach and work with other groups of patients.

Rudolph said that physicians can learn more from pharmacists than any other specialty or discipline. “We don’t get enough pharmacology training in med school. It’s a learning process when you start practicing, and it’s eye-opening when you take care of a patient who is on 15 meds and see how a pharmacist can improve care.”

Leading the Profession to New Heights

Anne Rose, Pharm.D., anticoagulation stewardship program coordinator at the University of Wisconsin Hospital and Clinics in Madison, which won in 2011, points to the value of the national recognition that comes with award.

Patient education is often key to programs that win the safety award.

Above, Erin Robinson, Pharm.D., CACP, with University of Wisconsin Hospitals and Clinics, counsels a patient.

“We had a great year after we won, going on the radio media tour and speaking about our programs and anticoagulation needs in general,” she said. “It’s more than the award itself. It’s being able to meet others doing similar things or who want to do what you do, so you can share it with them.”

She said the publicity can only help the profession as a whole. “It goes to show how far we have come and how we are branching out. Hopefully, being able to show how we can provide care, lead medication management programs, and work beyond traditional pharmacy roles will help us attain provider status.”

Advancing the pharmacy profession comes back to the increasing sophistication of pharmacist-led programs, said Daniel D. Degnan, III, Pharm.D., M.S., CPPS, senior project manager at Purdue University’s Center for Medication Safety Advancement in

 “We see programs from all over the country that are on the cutting edge of medication safety. There is a diversity of projects, but also of the types of organizations that apply, from large systems that cover big geographic areas to smaller, more traditional hospitals.”

These programs demonstrate leadership, Degnan added. “When we do site visits, we see people who are passionate about pharmacy and medication safety. These are typically great pharmacists who are active in their professional associations.”

That kind of enthusiasm is crucial to driving change in the profession, said Allen, noting that the award reflects a key goal of ASHP’s Pharmacy Practice Model Initiative.

“We want to help systems across the country expand pharmacist responsibilities and broaden pharmacists’ direct patient care, so they are not in the basement, but working with physicians and nurses,” he noted.

“You can’t change pharmacy practice without leaders, and by recognizing the impact pharmacists have on coordinating quality, process, and project improvement design, this award is a wonderful showcase for the many ways in which pharmacists can lead improvements in patient care.”

By Terri D’Arrigo

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February 14, 2014

Pharmacists Seeking Specialty Certification Turn to Prep Courses for Support

BCPS review and recertification courses utilize real-life patient case studies, therapeutic guidelines.

PHARMACISTS ARE BUSY PEOPLE. Between their expanding clinical and administrative responsibilities and the ever-increasing number medications they must track, practitioners who wish to obtain or maintain specialty board certification have precious little time to sort through stacks of journals trying to guess what specific knowledge they will need to meet the requirements.

Enter ASHP’s review and recertification courses and core therapeutic modules, which are helping practitioners stay abreast of current guidelines, zero in on areas where they need improvement, and prepare for Board of Pharmacy Specialties (BPS) exams.

Last June, Jennifer Clemente, Pharm.D., BCPS, ambulatory care clinical pharmacy specialist at John D. Dingell VA Medical Center in Detroit, attended the ASHP/APhA Ambulatory Care Specialty Review Course and Recertification Program in the days leading up to the 2013 ASHP Summer Meeting.

“I don’t have as much time to study as I did seven years ago, when I became board certified in pharmacotherapy. Given that I am a practitioner with a busy schedule and home life, I wanted something that would narrow my focus and make sure I identified any weaknesses,” Clemente said. “ASHP’s course is a good way to pack a lot of information into two days. It did a great job in pointing out the kinds of things that will be on the exam.”

“Employers and patients want to know that pharmacists involved in patient care have the knowledge, skills, and abilities for their specific roles.” — David Witmer, Pharm.D.

ASHP’s review and recertification courses include case study presentations in which participants follow “patients” in real-life scenarios that include initial presentation, medical history, risk factors, and complications. Clemente said these case studies gave her knowledge that she can apply directly to patient care. “It’s not just about trying to remember what will be on the exam. The courses are active learning, with examples that we all see in practice.”

A Focus on Practicality

The courses are designed specifically with utility in mind, said Sandra Oh Clarke, R.Ph., ASHP’s senior director of certification development.

“We cannot possibly teach you everything you need to know before you take the exam, but we can help you identify areas where you may need improvement, provide resources for further study, and give you a process for making decisions in caring for patients,” Clarke said.

“The exams are evidence-based and all about standards and guidelines. With the courses, you see how those guidelines apply to making recommendations and revising those recommendations if necessary as a patient’s case changes.”

Samm Anderegg, Pharm.D., M.S., BCPS

Samm Anderegg, Pharm.D., M.S., BCPS

When Samm Anderegg, Pharm.D., M.S., BCPS, pharmacy manager for oncology services at Georgia Regents Medical Center in Augusta, Ga., was looking for options to help himself prepare for the examination in pharmacotherapy, he was drawn to the interactive nature of the ASHP course and the credibility of the instructors.

“The modules are taught by expert practitioners who go through the cases one by one, and take you through the material,” he said. “It’s engaging, as opposed to just reading through and memorizing like we did in pharmacy school.”

Anderegg appreciates the thoroughness of the instructional material that is offered in the courses.

“If a course is just paper-based, you have to be self-motivated and driven to get through it on your own, but ASHP’s course has direction and guidance.”

 Affording Flexibility

In the last 11 years, the number of pharmacists who have become board certified in a pharmacy specialty has risen from 3,600 to more than 19,000, at press time. As both newly minted and long-established pharmacists seek to distinguish themselves in a competitive job market via board certification, ASHP’s courses offer flexibility and a broad base of knowledge that will not only help them maintain their credentials, but enable them to move into new positions.

“I’ve been doing administrative jobs and not really practicing as a clinician, so the review helps me stay current,” said CDR Marc T. Young, Pharm.D., M.S., BCPS, director of project management at the United States Navy Medicine Information Systems Support Activity in San Antonio. CDR Young is currently preparing for recertification in pharmacotherapy and working his way through ASHP’s online Pharmacotherapy Recertification Package.

CDR Young, who is retiring from the Navy in June and is contemplating his next career move, is leaning toward informatics. “The review course got my mind focused like a clinician,” he noted. “In informatics, if you give a pharmacist a tool, you still have to remember how they will use it in treating a patient.”

CDR Marc T. Young, Pharm.D., M.S., BCPS

CDR Marc T. Young, Pharm.D., M.S., BCPS

CDR Young said he appreciates the way the literature package is fine-tuned to reflect current practice and research. “Having not practiced [in direct patient care] for a while, there are things I would not be cognizant of, but reading the articles gives me perspective. You get multiple opinions and coverage of multiple topics.”

ASHP offers Core Therapeutic Modules for pharmacists like Anderegg and CDR Young who wish to dive a little deeper into specialty exam preparation. Each of the 16 modules covers a particular clinical area, such as diabetes, gastrointestinal disorders, neurologic disorders, or management of shock, and pharmacists may choose one, several, or all of them.

The modules were developed after ASHP designed the review and recertification courses to address the need for niche coverage, according to Clarke.

“We realize that the courses move through material very quickly, but some pharmacists may want more study in certain areas once they’ve identified where their knowledge gaps are.”

Responding to Member Needs

Offering review and recertification courses and core therapeutic modules is part and parcel of helping ASHP members to advance their careers and the profession as a whole, especially as pharmacists become recognized as care providers, said David Witmer, Pharm.D., senior vice president and chief operating officer.

“Helping pharmacists prepare for board certification is about making sure the pharmacy workforce is ready to take advantage of the opportunities that will come with provider status,” Witmer said, noting the importance of board certification among young pharmacists in particular.

“The job market for young pharmacists will be more competitive, and they are seeking certification to make themselves stand out. We need to serve our membership in that capacity.”

Yet there is still a need to assist established pharmacists as the profession evolves, Witmer added. “Pharmacists will be providing care in a differentiated manner, like their medical counterparts. [Employers and patients] want to know that pharmacists involved in patient care have the knowledge, skills, and abilities for their specific roles.”

ASHP currently offers review and recertification courses in ambulatory care in partnership with APhA, pharmacotherapy, and oncology in partnership with the American College of Clinical Pharmacy. Early in 2013, BPS announced two new pharmacy specialties—pediatrics and critical care—for which it will offer board certification beginning in 2015. ASHP is currently developing review course materials for those new specialties, and the first course will be offered prior to the ASHP 2015 Summer Meetings.

 –By Terri D’Arrigo

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