Pharmacy News

Entries for November 2018

Whole Health and Pharmacy Integration

By Carson Hutchinson, Pharm.D., and Samantha Edgar, Pharm.D., PGY1 pharmacy residents, Aleda E. Lutz VA Medical Center, Saginaw

Whole Health is an approach to healthcare that empowers and equips patients to take charge of their health and well-being and live their life to the fullest.1 It involves focusing on the person as a whole including their well-being, self-care, complementary therapies and medical care. All medical professionals should be involved in order to have a successful Whole Health implementation. This includes physicians, pharmacists, nurses, dietitians, mental health professionals, chaplains and any other team member, all working for the patient’s goals.3 Whole Health is a complete shift in culture at the Veteran Affairs.

 

Through Whole Health, patients are encouraged to become a more active partner in their healthcare plans and empower them to improve their health.1 Along with current health issues the patient is facing, the mission of Whole Health also includes preventative care to lower future disease risk and the focus is to increase longevity of high quality life. 

Patients are generally seen in the clinic only a few times a year for a limited amount of time at each visit. Due to this, it is imperative for patients to build and practice routine self-care skills between visits. In Whole Health, self-care skill areas include: working your body, surroundings, personal development, food and drink, recharge, family, friends and co-workers, spirit and soul and power of the mind.1 Patients are encouraged to start by focusing on two or three of these areas and then expand further.2 The Personal Health Plan (Figure 1) is a necessary tool within Whole Health and allows patients to map out their goals with their providers.2 It is personalized, proactive and patient driven, and it links self-care, professional care and community care.

Figure 1: Personal Health Plan (from the VHA Office of Patient Centered Care & Cultural Transformation)

Because Whole Health is a complete shift in culture at the Veteran Affairs, it is necessary to have all healthcare providers educated properly. Aleda E. Lutz Veterans Affairs Medical Center was selected to be a flagship facility for Whole Health integration. Initial intensive training involved select clinicians who became leaders and coaches for Whole Health. Thereafter, all employees received half-day trainings which continue at this time. Training objectives include gaining an understanding of the vision of Whole Health, enhancing resilience and innate healing, collaborating with veterans to find proactive opportunities that support a healing response, mindful awareness and changing the conversation clinicians have with veterans to be grounded with what matters to the Veteran in his/her life.1   

As an easily accessible healthcare professional, pharmacists can play a crucial role in aiding a patient through Whole Health. Medication counseling is an opportunity to teach patients the purpose, benefit and importance of their medications. This means going deeper than simply stating “this medication is for your heart,” but to actually explain its mechanism, expanding on other benefits this medication can provide and why certain side effects or drug interactions may occur. In turn, patients will have the knowledge to feel better equipped to take charge of their health, becoming more active participants in making their Personal Health Plan a reality.  

It takes all medical professionals to support Whole Health. Amongst these medical professionals, pharmacists are equipped for this culture change. Each patient and their journey toward Whole Health is different, and it is important to be able to aid these patients however necessary.

References:

  1. U.S. Department of Veteran Affairs. Whole Health: Information For Veterans. http://projects.hsl.wisc.edu/SERVICE/veteran-materials/new/WHItStartsWithMe_508.pdf.
  2. U.S. Department of Veteran Affairs. Passport to Whole Health. http://projects.hsl.wisc.edu/SERVICE/key-resources/Passport%20to%20WH,%203rd%20edition,%202018%20FINAL.pdf.
  3. U.S. Department of Veteran Affairs. VHA Whole Health: Personalized Health Planning Staff Guide. http://projects.hsl.wisc.edu/SERVICE/key-resources/VA%20Whole%20Health%20-%20Personalized%20Health%20Planning%20Staff%20Guide.pdf.
Posted in: Professional Practice
Narcotic Diversion: Are You or Your Health-System at Risk?

By Julie Schmidt, Pharm.D., BCPS, clinical pharmacist, Bronson Methodist Hospital, Kalamazoo


It is safe to say we have all heard of the opioid epidemic currently happening in our nation and the effects it is having in our communities. If you are not aware of this situation, please refer to our mainstay pharmacy reference, Google, where you will find countless articles regarding the detrimental effects these medications are having on people and communities. What may not be the first article that pops up is an article about a local pharmacist with an opioid addiction, or a nurse caught for pocketingthe fentanyl she pulled from an automated dispensing cabinet that was really supposed to be given to a patient. While you may not exactly find these specific stories on Google, I can assure that you will find plenty that share extreme similarities. While the rest of the nation continues to fight the opioid epidemic in the streets, perhaps we should take a little closer look in our own workplaces.

 

Data from the American Nurses Association report that about one in 10 nurses are thought to be abusing drugs and may be impaired while taking care of patients. While the overall incidence of drug abuse is about the same in healthcare workers compared to the general population, healthcare workers have some exclusive patterns to their population regarding drug abuse. For example, healthcare workers are more likely to misuse prescription medications as compared to street drugs since prescription medications are often easy to access. While healthcare workers experience every day stressors just like the general population, they are also known to experience stress from handling patient illness and death, long hours and demanding work. Unfortunately, the misuse of these medications not only affects the one abusing them, but they may also directly impact patients. As a result of diversion in a healthcare setting, patients may receive diluted medications, infections from contaminated needles/syringes and potential errors if the healthcare professional is impaired.

 

How do we avoid medication diversion in our own workplace? First off, expect it. This does not mean it is acceptable, but rather it means that steps need to be taken in order to prevent it in the first place. This may include, but is not limited to, ensuring access is only given to necessary personnel, regular auditing and utilizing technology such as automated dispensing cabinets (ADCs). ADCs may be helpful in tracking medication diversion by recording trends, keeping a rolling inventory of medications and ensuring there is a systematic way to document waste. Together with ADCs, hospitals and other healthcare systems should have established policies to identify those responsible for drug diversion, ensure reporting is completed on a routine basis and execute disciplinary action as necessary.

 

In addition to the steps listed above, many helpful resources are available online when evaluating your own workplaces policies and procedures regarding medication diversion. See references below for access to some of these resources. By regulating controlled substances in our workplace and making sure policies and procedures are followed, we can help protect not only ourselves and coworkers from potential misuse, but also our patients from unnecessary negative impacts.

 

References:

  1. Brummond PW, Chen DF, Churchill WW, et.al. ASHP Guidelines on Preventing Diversion of Controlled Substances. Am J Health-Syst Pharm. 2017;74:325-48.
  2. Diversion Central. Omnicell website. https://www.omnicell.com/diversion. Accessed Oct. 1, 2018.
  3. Diversion and Loss Prevention. BD website. https://www.bd.com/en- in/our-products/integrated-analytics-solutions/diversion-and-loss-prevention. Accessed Sept. 30, 2018.
Posted in: Patient Safety
Leadership for the Medical Community

By Ryan Bickel, Pharm.D., MHA, pharmacy manager, Mercy Health – Saint Mary’s, Grand Rapids and Diana Behnam, Pharm.D., pharmacist, Genesys Medical Regional Center, Grand Blanc 

Pharmacists and many other healthcare professionals utilize leadership skills in their practices on a daily basis. Some hold formal leadership positions (e.g., manager), while others who do not possess an official title still rely on these skills sets. Because of this, many healthcare team members have the desire to expand upon or hone the leadership skills they learned in their formal education and training. This can be achieved through a variety of methods, including seeking graduate degrees, mentorship and professional development courses. Two formal training programs available to Michigan pharmacists include the Michigan Pharmacy Foundation’s (MPF) Healthcare Professional Leadership Academy (HPLA) and the American Society of Health-System Pharmacists (ASHP) Foundation’s Pharmacy Leadership Academy® (PLA).

The HPLA program is led by Brenda Wagenknecht-Ivey, a professional leadership consultant and coach, in conjunction with Michigan Pharmacy Foundation (MPF) leadership. It is a nine-month program designed to teach and apply leadership skills and knowledge. While most participants are pharmacists, the program is open to all healthcare team members, including physicians, nurses and pharmacy technicians. HPLA consists of four mandatory day-long seminars in Lansing, six monthly webinars, a main project, personal goal setting and more. The program offers some individualization, as each participant selects a project and creates personal goals. Each participant is also assigned a project advisor to help guide, discuss and answer questions. In addition, participants receive live continuing education (CE) credits for attending the in-person seminars. Visit www.MichiganPharmacists.org/foundation/initiatives to learn more. 

As a direct participant of HPLA, the experience was remarkable. Live sessions were fun and filled with multiple interactive games, while learning valuable life skills. The lessons learned are used throughout daily life; they are not limited to work-related environments. The program assists in building character, discovering more about yourself and understanding the outside world from a different perspective. Leadership is more complicated than the perceived individual in a position of authority. True leadership exists in everyone, irrespective of status or titles. The program, which is filled with individuals who lead by example, is inspiring in its delivery.                                                        

-Diana Behnam

 

The ASHP Foundation’s PLA is a year-long program comprised of seven, six-week modules, which focus on various aspects of leadership with a specific emphasis on strategic orientation, change leadership and impact and influence. ASHP fellows and other recognized, national pharmacy leaders serve as the facilitators and utilize similar methods of instruction as the HPLA program. Group discussions and presentations are facilitated using a web-based conferencing system. Participants receive 15 hours of ACPE-accredited CE upon completion of each module. In addition, participants earn credits towards a Master’s degree (MBA, MHA, MS) at five different colleges/universities. Upon completion of the program, graduates may use the designation Diplomate, Pharmacy Leadership Academy (DPLA).

Having participated in Great Lakes Young Pharmacists Leadership Conference [a predecessor to the MPF’s HPLA program], I was interested in continuing my leadership development.  After researching my options, I felt that ASHP Foundation’s PLA was the best choice for me. The program allowed me to participate via webinar, which allowed me to spend more time at home with my young family. I enjoyed interacting with pharmacy thought leaders and fellow pharmacists from across the nation. Many of the relationships that I formed continue to this day. Finally, the program offered college credit at several graduate programs, which greatly appealed to me. After the program, I transitioned directly into a Master of Healthcare Administration program, as did a significant portion of my fellow PLA classmates. Overall, I found the PLA to be an exceptional experience.

-Ryan Bickel

While multiple methods of leadership development exist, HPLA and PLA are unique as participants have the opportunity to network with colleagues and pharmacy leaders. Pharmacy professionals seeking further leadership development are encouraged to research their options and determine what program or method best fits their needs. Program fees and other associated costs are often covered or subsidized by employers or through professional association grants.

Posted in: Continuing Education
Northern Michigan Society of Health-System Pharmacists Regional Society Update

By Matt Satkowiak, Pharm.D., BCPS, clinical pharmacist, Munson Medical Center, Traverse City, northern region representative

 

The Northern Michigan Society of Health-System Pharmacists (NMSHP) is off and rolling with our fall programming for the 2018-19 year. Our first event of the season was a sponsored dinner exploring a novel treatment for distributive shock. Daniel Gerard, R.Ph., a critical care pharmacist from northern Michigan, presented this topic at the Otsego Club and Resort in Gaylord in early October. Our next meeting in late October featured NMSHP member Adam Utley, Pharm.D., BCPS, presenting on an antibiotic near and dear to every pharmacist’s heart, vancomycin. This meeting was broadcasted across northern Michigan from Munson Medical Center in Traverse City, where Adam discussed literature updates and dosing strategies for this prevalent medication.

 

After our October meeting, NMSHP commenced its winter break until April, when we will offer our second continuing education event at MidMichigan Medical Center in Alpena. During our meeting hiatus, we hope to host social events that will allow our members to enjoy the winter weather and network with each other.

 

For more information on upcoming meetings, please contact NMSHP president Keith Nowak at Keith.Nowak@midmichigan.org.

Posted in: Member News
Advancing Pharmacy Services

By John S. Clark, Pharm.D., M.S, BCPS, FASHP, associate chief of pharmacy, Michigan Medicine, Ann Arbor; clinical associate professor, University of Michigan College of Pharmacy, Ann Arbor and president-elect, Michigan Society of Health-System Pharmacists

What does advancing pharmacy services mean to you? Advancing the professional goals of pharmacists? Advancing the technology in pharmacy? Fancy high tech buildings with palatial spaces? Provision of care to patients? Providing support for other clinicians? Patient counseling? Potentially all of these?

In the spirit of President MacDonald’s theme, “Demonstrating Our Value,” it is imperative that pharmacists and pharmacy extenders consider when we advance pharmacy services, what value is gained from the advancement. Do we improve patient outcomes? Do we free up pharmacist time? What are the pharmacists doing in that newly available time? What value is added for the patients?

All of these questions are critical to the creation of the future of pharmacy practice. However, as the profession’s responsibilities grow in scope, we have a beacon to assure us of our direction. Our patients will guide us to the most critical services they need from the profession of pharmacy.

Do I mean ask patients directly? Only, sort of. Patients should be part of the focused group that suggests services that are needed from pharmacy. Additional input from physicians, nurses, respiratory therapists, PAs, NPs and health-system administration can inform what service weaknesses there are for patients. With a clear focus on what patients need, this well-informed team can suggest, design and assist in implementation of patient care services. After implementation, measurement of impact or value is often neglected. We must measure our changes to enhance our understanding of what services are of value to our patients.

As we consider this, our profession must ask: how are we going to create our future? What is our profession’s moonshot? Our big hairy audacious goal?

It’s our duty to create this in collaboration with all of our stakeholders! Are you up to the challenge? Are you the leader we need? Get involved in your own pharmacy departments and the Michigan Society of Health-System Pharmacists!

This is an exciting time in our profession. Be on the front line of creating the future of pharmacy practice.

Posted in: Innovative Practice
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