By Kyle Schmidt, assistant professor of pharmacy practice, Ferris State University College of Pharmacy, Grand Rapids

To round out 2019, the Western Michigan Society of Health-System Pharmacists (WMSHP) continued the tradition of hosting excellent educational networking events, highlighting accomplished speakers who provided attendees with well-developed, practical updates on a wide variety of topics. This past fall, WMSHP hosted three different continuing education events. In September, Julie Schmidt, cardiology clinical pharmacist with Bronson Methodist Hospital, guided attendees through the treatment of acute myocardial infarction, from door to discharge. October featured an engaging session, led by Ferris State University (FSU) College of Pharmacy associate professor Katie Axford, using gamification to explore the various social determinants of health in pharmacy. The 2019 offerings were capped off with a great review of recent updates from the realm of infectious diseases led by Juliet Chijioke, the PGY-2 infectious disease pharmacy resident from Munson Medical Center.

In addition to the educational networking sessions, WMSHP maintained a high level of involvement promoting pharmacy residency training. As a new initiative, WMSHP hosted its inaugural mock residency interview and curriculum vitae event in September for pharmacy students interested in preparing themselves for the upcoming residency interview season. Many area preceptors and pharmacy leaders provided individualized attention and advice to a substantial number of prospective pharmacy residents. In October, WMSHP co-hosted, along with FSU’s College of Pharmacy, its annual pharmacy residency showcase in Grand Rapids. Student turnout was great. Looking forward, WMSHP is excited to continue to facilitate these events, as well as explore additional ways to positively impact the region’s health-system pharmacy practice.

As each year passes, we also get the opportunity to welcome the next batch of newly-elected WMSHP leaders to the executive board of directors. The most recent election results for 2020 are as follows:

• President-elect: Julie Schmidt
• Treasurer: Jordan Posey
• Technician: Marie Mitchell

Board Members:

• Tara McAlpine (incumbent)
• Andrea Borst (incumbent)
• Thomas Beuschel
• Natalie Washburn (incumbent)

Resident-at-Large:

• Tawnie McGraw (Mercy Health Muskegon PGY-1)

If you would like more information about WMSHP, please visit our website at www.wmshp.net. We wish everyone a fruitful and successful 2020!

Curtis Smith, Pharm.D.
Professor at Ferris State University College of Pharmacy and Pharmacist with MSU Trauma Service at Sparrow Health System
Member Since: September 2000
 

Something interesting about yourself that you would like to share: I graduated from pharmacy school with Dianne Malburg, MPA chief operating Officer and MSHP executive vice president. My first pharmacy job was as an intern in health-system pharmacy at Memorial Medical Center (now Spectrum Health) in Ludington.

Describe Your Role/Day In the Life: My primary clinical role is as a pharmacist on the MSU Trauma Service at Sparrow Health System in Lansing. This entails evaluating and improving drug therapy in all patients admitted to the trauma service, as well as trauma and surgical intensive care patients. In my academic role I teach P4 students who are completing their internal medicine APPEs. This entails reviewing all of their patients on a daily basis and teaching them pharmacotherapy management of common inpatient medicine disease states.

Why You’re an MSHP/MPA Member: I believe that in order to fully develop their professional identity, pharmacists need to interact with other pharmacists outside of their normal work environment on a local and state level. This is best done by joining and being active in a professional association. Since MSHP and MPA are recognized nationally as top state pharmacy organizations, it makes sense to become a member so I can collaborate professionally with my colleagues locally and across the state. Also, our voices are stronger when we join together and champion the causes that are most important to pharmacists in Michigan. Finally, being a member has given me the opportunity to improve my leadership skills and advance the profession that has provided a fulfilling career for me for over 30 years.

Recent Accomplishments: MSHP President (2020), Ernie Koch Striving for Excellence Award (2019), Fellow, American College of Clinical Pharmacy (2016), Michigan Pharmacist of the Year (2011)

How MSHP/MPA Has Helped You Achieve Any Accomplishments: MSHP has provided me an outlet to serve health-system pharmacists in the state and that has culminated in my election to serve as President of the organization. Since the Ernie Koch award is for commitment to a local pharmacy association, the MPA has given me the privilege to serve my local Capital Area Pharmacists Association colleagues for almost 20 years. Without the association, I would not have had these valuable leadership opportunities.

By Joan Zhang, Pharm.D.; Christina Sudyk, Pharm.D.; Laura McKeown, Pharm.D., PGY1 residents at Spectrum Health, Grand Rapids

Per the Centers for Disease Control and Prevention (CDC), pneumonia accounts for roughly 1.7 million emergency department visits a year.¹ It affects over 5.6 million patients annually and results in over $12 million in healthcare costs.²

In October 2019, the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) released updated guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP). A summary of the major differences between the new and old guidelines can be found in Table 1.

One of the most notable changes is the removal of the healthcare-associated pneumonia (HCAP) designation. The concept of HCAP was originally introduced in the 2005 ATS/IDSA hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) guidelines due to concerns that patients meeting criteria for HCP were at an increased risk of multi-drug resistant organisms (MDRO). However, increasing evidence since then has found that those factors were not very predictive of MDRO.³ This term was also abandoned earlier in the 2016 ATS/IDSA HAP/VAP Guidelines.

Other changes include the recommendation to not add anaerobic coverage for suspected aspiration pneumonia unless lung abscess or empyema is suspected.³ It is now recommended to cover for MRSA and P. aeruginosa only if the patient has a prior history of the pathogen and/or they have severe CAP with recent hospitalization requiring IV antibiotics and locally validated risk factors for either pathogen.³

Summaries of the recommended empiric therapies for patients in the outpatient setting and inpatient setting are provided in Table 2 and Table 3 respectively.

Overall, these guidelines address the recent shift in health care regarding the diagnosis and treatment of pneumonia and the common causative community acquired pathogens. To note, HCAP is no longer a commonly utilized diagnosis given findings from recent literature. Additionally, empiric coverage of P. aeruginosa or MRSA in a patient diagnosed with CAP is not indicated for all patients just like the recommendation to no longer cover for anaerobic organisms in patients with aspiration pneumonia. Much of the driving force behind antibiotic selection will also be dependent on the local resistance rates and institution specific antibiogram patterns. It is important to keep these new recommendations in mind in order to assist with antimicrobial stewardship efforts to reduce antimicrobial resistance, decrease undesirable patient outcomes and side effects to mediations, and reduce the burden of cost to patients and institutions. As the medication experts on the patient care team, it is our duty to ensure that the selected therapies are not only appropriate, but also the gold standard for our patients as determined by the available guidelines.

References:
1. Pneumonia. Centers for Disease Control and Prevention. https://www.cdc.gov/pneumonia/index.html. Published Oct. 22, 2018.
2. Brar NK, Niederman MS. Management of community-acquired pneumonia: a review and update. Ther Adv Respir Dis. 2011;5(1):61-78. doi:10.1177/1753465810381518.
3. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581st.
4. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis. 2007;44(Suppl 2):S27-S72. doi:10.1086/511159.

By Stephen M. Stout, Pharm.D., MS, director, clinical content, Wolters-Kluwer Health, Ann Arbor, co-chair, MSHP Organizational Affairs Committee

The Michigan Pharmacists Association (MPA) annual House of Delegates will convene on Feb.23, 2020, at the MPA Annual Convention & Exposition to review MPA bylaws and discuss policy resolutions. The 2020 House of Delegates session will cover 14 resolutions: 10 new and four from the 2019 session.

Detailed information on the purpose, composition, duties and rules of the MPA House of Delegates is available in the MPA House of Delegates section of the MPA website and in an informational YouTube video. Full acceptance of a resolution and adoption in MPA policy requires it to pass votes in two separate delegate sessions. In the first, the House of Delegates must vote to adopt the resolution, with or without amendments to the original wording. In the second, the House of Delegates will vote on whether to adopt a resolution as MPA policy, considering recommendations from the MPA Executive Board and other MPA organizational units. Resolutions may be submitted by any member or delegate of MPA. Those received by Jan. 15 are eligible for consideration by the House of Delegates session in the same calendar year. Details on resolution submission and formatting as well as an archive of submitted resolutions are available on the Resolutions section of the MPA website.

The resolutions under consideration by the 2020 House of Delegates are below. Summaries for consideration by delegates also include background information and, when applicable, recommendations from the MPA Executive Board and organizational units. This additional information is not included below but is available on the Resolutions section of the MPA website. Only the actual resolution wording labeled as the "be it resolved" portion included below is the subject of voting and potential adoption, not the accompanying information.

New resolutions for 2020

• 20-01: Technician Administered Immunizations
  MPA create a model collaborative practice agreement/protocol that includes fully licensed and nationally certified pharmacy technicians trained in the administration of immunizations.
• 20-02: Third Party Payment for Sharps Containers for Diabetics
  That the MPA and the Third Party Committee work with the legislature to promote legislation that requires the third party payor to reimburse pharmacies for sharps containers that are prescribed via a valid prescription.
• 20-03: Any Willing Provider
  The Michigan Pharmacists Association should work with State and Federal governments to regulate pharmacy benefit managers and introduce “Any Willing Provider” legislation to prohibit narrow networks.
• 20-04: Preventing Burnout and Enhancing Well-being Among Pharmacy Professionals 
  That MPA work to develop resources related to professional resilience and burnout, including training and tools to teach strategies and skills to enhance professional well-being.
• 20-05: Addressing Pharmacy Workplace Conditions
  That MPA create a committee or subcommittee to assess working conditions in Michigan, study strategies that other states are undertaking, and develop solutions to address the growing problem of workplace conditions that is seriously impacting the level of care provided to our patients each and every day.
• 20-06: Accelerated Response and Follow-up to HOD Resolutions
  That all resolutions that pass the House of Delegates be reviewed for approval by the relevant boards and committees and by the Executive Board by July 30 and appropriate action(s) taken prior to, and reported on, at the next House of Delegates session. Resolutions that are rejected by the MPA Executive Board would be addressed at the next House of Delegates session.
• 20-07: Independent Vaccine Administrative Authority for Pharmacists
  The MPA pursue legislative changes to allow independent vaccine administrative authority for pharmacists in Michigan for patients.
• 20-08: Increasing Patient Access to Buprenorphine and Naltrexone by Pharmacists
  That MPA work to explore the pharmacist role, including yet not limited to a collaborative practice agreement, in increasing access to buprenorphine and Vivitrol to the governor’s goal of decreasing opioid overdose deaths by half over the next five years.
• 20-09: Marihuana and Cannabinoid Awareness Training
  That MPA work with the Michigan Board of Pharmacy and Bureau of Marihuana Regulation to develop requirements for a one-time Marihuana and Cannabinoid Awareness Training for all pharmacists with a controlled substance license.
• 20-10: Empowering Pharmacy Technicians as Immunizers
  That MPA work with state and national organizations and legislators to develop pathways for immunization-trained, licensed and certified pharmacy technicians to administer vaccinations under a pharmacist’s supervision.

Resolutions from previous years, eligible for adoption as MPA policy

• 19-01: Developing Resources to Alleviate Medication Shortages
  That MPA work to develop a toolkit for pharmacy practitioners containing resources to identify and manage medication shortages.
• 19-02: Removal of Marijuana-Infused Edibles Category, so as not to have it allowed through retail sale
  That the MPA use this time-related opportunity to engage the Michigan State Legislators to work to remove the “edibles” category, so this marihuana category will not be allowed for retail sale.
• 19-04: Pharmacist Led Cannabis Task Force
  That MPA pursue avenues to create a pharmacist-led interdisciplinary Cannabis Task Force that will develop evidence-based recommendations on the safety and efficacy of cannabis products and disseminate to the legislature, governor of Michigan and Michigan Pharmacists Association.
• 19-05: Methadone for Opioid Addiction
  That MPA work with state and federal policy and regulatory entities, including but not limited to Michigan Department of Licensing and Regulatory Affairs (LARA), to modernize the prescribing and dispensing of methadone for the treatment of opioid dependence.

Delegates who are members of the Michigan Society of Health-System Pharmacists are also encouraged to attend a delegate caucus breakfast hosted by the MSHP Organizational Affairs Committee, held the morning of the House of Delegates session. Invitations for the caucus session have been distributed. Please contact me, Stephen Stout or Melody Arnst for details.

By Rebecca Maynard, Pharm.D., pharmacist, Bronson Methodist Hospital, Kalamazoo and MSHP President-elect

As we head into the final year of our 2018-2020 strategic plan, our Michigan Society of Health-System Pharmacists (MSHP) President, Curtis Smith, is leading us forward with a theme of Being Pharmacy Champions. Beginning my term as President-elect for MSHP, I feel invigorated by this year’s theme and its focus on communicating the work we have done over the last two years in demonstrating our value and achieving patient care outcomes. As part of the development and implementation of our first three-year strategic plan, we have focused heavily on identifying and executing who we want to be as an organization and how our vision and mission can be realized through clearly defined goals, objectives and charges.

As Curtis described in his January MSHP Monitor article, we must utilize creative communication to implement change. The 2020 charges for MSHP Committees reinforce his vision of communicating creatively to support, encourage and promote the great work that health-system pharmacists and pharmacy technicians are doing throughout the state. At our January Committee Day, it was incredible to see the confluence of so many members working together on their committees’ charges. If you haven’t done so already, I highly encourage you to review our 2020 Chapter Manual for the various committees’ purpose, responsibilities and activities and see what actions our committees will be taking over the next year. There are some great examples of creative ways our committees will be communicating the impact of health-system pharmacists, like the charge for our Ambulatory Care Pharmacy Practice Committee to develop a recorded webinar, video or podcast about strategies used to create methods for documenting and tracking outcomes in the ambulatory setting.

Being a pharmacy champion can occur at any level – from demonstrating excellence in your clinical practice, fighting for expansion of pharmacy services within your organization, advocating for people in underserved areas of Michigan to have pharmacist providers who can perform comprehensive medication management, to supporting national efforts to advance pharmacy practice. This past month, the American Journal of Health-System Pharmacy (AJHP) published two future-forward reports—the Practice Advancement Initiative (PAI) 2030 recommendations and the ASHP Foundation Pharmacy Forecast 2020 report.^1,2 These reports provide further direction for advancing patients’ health and health outcomes, and move pharmacy practice forward, especially as we move deeper into the digital age.³ The reports are not expected to be accurate predictions for the future, but should encourage us to think provocatively about what needs to happen in every hospital and health-system, and how those needs can be addressed through MSHP.

As we ponder how we can be pharmacy champions this year, consider the PAI 2030 themes for practice change: optimize care via pharmacist-provided comprehensive medication management, advance pharmacy technician roles, harness data to improve patient health, integrate pharmacy enterprise for convenient and cost-effective care, adopt personalized, targeted therapies, and public health opportunities in social determinants, chronic illness and addiction. The report provides five domains in which we can impact those practice changes:

1. patient-centered care
2. pharmacist’s role, education and training
3. technology and data science
4. pharmacy technician role, education and training
5. leadership in medication use and safety

Each of these domains have three subdomains in which recommendations are targeted at a specific level:

1. practice-focused (primarily front-line care)
2. organization-focused (relates to pharmacy departmental or institutional leadership)
3. profession-focused (implementation must be profession-wide)

Again, since being a pharmacy champion isn’t done at just one level, I challenge you to review the initiatives and find a few that speak to you on personal practice, hospital/health-system and professional organization levels. What areas is MSHP addressing well? How can we best communicate that to other organizations? What areas should MSHP be developing? Within the three focus areas of our strategic plan (pharmacy practice advancement, Michigan patients and their care, and MSHP members), what are a few initiatives in the 2030 report that we should be focusing on for MSHP’s 2021-2023 strategic plan?

The word champion implies a strong level of involvement and action. This year, we are called to act on the plans we have been building over the last two years and decide on our future focus for advancing our practice, the care of our patients and the members of MSHP. Be a pharmacy champion this year. Speak publicly about the ways we positively impact our patients’ lives. Promote the value of pharmacists and pharmacist extenders in all levels of care. Defend our patients’ right to have a pharmacist that can ensure both the safety and effectiveness of medication use through comprehensive medication management, regardless of their means or location. As stated in the editorial for the PAI 2030 report, “We cannot be passive in this time of change.”³ Please continue to be involved or challenge yourself to increase your involvement in MSHP to help shape our future.

References:
1. Vermeulen LC, Swarthout MD, Alexander GC et al. Pharmacy forecast 2020: strategic planning advice for pharmacy departments in hospitals and health systems. Am J Health-Syst Pharm. 2020;77:84-112.
2. ASHP Practice Advancement Initiative 2030: New recommendations for advancing pharmacy practice in health systems. Am J Health-Syst Pharm. 2020;77(2):113-121.
3.Abramowitz PW, Maroyka EM, Scheckelhoff DJ. Achieving the PAI 2030 vision: Leading and navigating transformative change. Am J Health-Syst Pharm. 2020;77(2):66-67.