Pharmacy News

Entries for August 2017

The Power of Reflection

By Kristin Griebe, Pharm.D., University of Michigan College of Pharmacy, 2017 Graduate

Looking back on my four years in pharmacy school, I reminisce on the time spent studying, attending professional organization events, learning facts and concepts in the classroom and applying that information to patients on experiential rotations. While I am proud of the robust knowledge and expertise I gained through obtaining my Doctor of Pharmacy degree, the most unexpected strength I acquired was the ability to learn through repetitive cycles of experiences and reflections and connect on a deeper level than before. From patients to peers, to strangers in passing, I developed a way to communicate better and understand others in a different way. Harnessing these soft skills carried me to the next level, allowing me to be more effective in implementing patient care interventions to improve clinical outcomes.

Interactions with patients provided me with the experiences I needed to practice, but that was not where the learning stopped. My mentors encouraged me to spend time reflecting on these experiences to assess and strategize how I could be better and do more for future encounters. I have never been one to journal, so I was hesitant to spend time writing my thoughts rather than spending it on tasks that seemed more purposeful. When I considered the benefits of setting aside time for reflection, I made a personal connection from another aspect of my life that helped me recognize the importance of including this process in my growth and learning. As a hockey player, I would never play the next game without reflecting on aspects of prior games, such as retrospectively thinking about how my team performed or how I played and how I can train to be better for next time. I thought, if I am constantly assessing and critiquing my performance as a hockey player, why shouldn’t I be assessing my performance as a learner and healthcare professional?

We know reflection is integral to learning and development; yet, we are reluctant to spend time on reflection due to the constant demands of studying and professional organizations. The first year of pharmacy school is the best time to start developing reflection as a habit. Think about what you learned so far and what you still need to learn. What worked best for you? How can you be a better learner in the future? Your second and third years build upon foundational knowledge; both good and bad habits are formed during these years. Spend time thinking about how you can retain what you are learning, how you would apply what you’re learning to a real patient and how you can best manage your time in periods of high demands and stress. Your fourth year is about reflecting on the clinical experiences and the interpersonal communication skills you develop. Avoid solely relying on evaluations from your preceptors as your only source of reflection and use your own reflections as guidance to build upon and improve.  It won’t be long before you are your own preceptor. Your reflections will lead you to recognize your untapped potential and allow you to fully develop in ways you never imagined. Student or not, if you find that time for reflection is falling off your schedule, consider how difficult it will be to become better tomorrow if you do not take the time to reflect on today. 

Posted in: Member News
The Balancing Act of Pharmacy School

By Briana Harris, Pharm.D. candidate 2018, Ferris State University College of Pharmacy

New beginnings normally bring new responsibilities and ways of life. That is exactly how I felt entering my first year of pharmacy school. I remember starting my P1 year ready and devoted to furthering my education. It was all I could think about. I was nervous, excited, ambitious and ready to focus on obtaining my Pharm.D. Although these dramatically different emotions were running through me, all I could think about was how to be a successful pharmacist at the finish line.

I began my pharmacy career completely devoted to my curriculum. Being a type-A person (as many of us are), I naturally focused on my grades. Whether it was a grade on an exam or a daily assignment, I made sure to be well-prepared. This behavioral trend stayed consistent for a while until the nerves died down, and I found myself exhausted. I noticed I did not feel the same ambition I once had at the start of the school year. I remember being in a state of confusion as I knew my goals and determination to become a successful pharmacist remained very important to me.

It was then I realized I could not remember the last time I read a book for pleasure or went on a stress-relieving run, two of my most enjoyed hobbies. Right then and there, I dropped my biochemistry book and put on some running shoes. I came back to my desk post-run feeling relieved and ready to get back to studying.

Around that same time I joined different pharmacy-related organizations and started volunteering in the community. I also shadowed in the diabetes eye clinic located next to our pharmacy building to gain experience interacting with patients and managing their medications. I again found myself pursuing my personal interests such as making time for reading, exercise and seeing friends and family.

Reshaping the way I managed my pharmacy schedule allowed me to comprehensively learn while in the classroom and study effectively while outside the classroom and still taking time for myself to appreciate what I personally enjoy doing. I not only felt a sense of control, but also felt the motivation I needed to spend time focused on school and the constant didactic learning.

No matter the type of student, balancing life through pharmacy school can be challenging. Although grades and learning the presented material is imperative, being balanced and well-rounded are also crucial characteristics of a pharmacist. Finding activities that relieve stress and take your mind off due dates and exam dates, even if it is just for a short time, is essential. Mastering the balancing act of school and personal life throughout these four years is difficult, yet rewarding when one side of the scale is not tipping too high. Pharmacy school is a great time to explore the different paths you can take with your career and balance can aid in finding the right one for you.

Posted in: Member News
Southeastern Michigan Society of Health-System Pharmacists Update

By Gladys Dabaja, Pharm.D., SMSHP president-elect, director of pharmacy, Henry Ford Wyandotte Hospital, Wyandotte, southeastern regional representative 

The Southeastern Michigan Society of Health System Pharmacists (SMSHP) continues to be busy with several continuing education (CE) programs during the second quarter of 2017. We have had very productive Board meetings each month with the primary emphasis on membership growth, community outreach and enhancement of our website. The website development committee is continuing to meet during the summer months to help upgrade the SMSHP website to ensure it will be more user friendly and easier to access. Additionally, we continue to see an increase in membership, especially for pharmacy technicians.  

SMSHP continues to host CE programs that are not only interesting but are also hot topics in pharmacy practice. On March 18, Kyle Burghardt, Pharm.D., assistant professor of pharmacy practice at Wayne State University, presented “An Introduction to Clinical Pharmacogenetics and Personalized Medicine.” He did a great job describing definitions and concepts pertaining to pharmacogenetics. He also discussed the clinical impact of specific genes on drug therapy response as well as the pharmacists and pharmacy technician roles. On April 12, we had the honor of hosting then American Society of Health-System Pharmacists (ASHP) President, Paul W. Bush, Pharm.D. M.B.A., FASHP, who is the chief pharmacy officer at Duke University Hospital, Durham, N.C.  Paul presented, “ASHP Update – Current Issues in Pharmacy Practice.” Paul’s lecture focused on advancing the role of pharmacy technicians that includes continuing education and mentoring. He also provided an overview of the Ambulatory Care and Pharmacy Advancement Initiative (PAI) that emphasizes how pharmacists can optimize patients’ medication outcomes across all healthcare settings. On May 10, Sarah E. Kelling, Pharm.D., M.P.H., BCACP, clinical assistant professor of pharmacy at the University of Michigan and Kristin C. Klein, Pharm.D., BCPPS, FPPAG, clinical associate professor of pharmacy at the University of Michigan, presented, “Expanding Practice and Research: Pharmacists Extenders.” They presented a great overview of the role of pharmacy extenders that included how to incorporate pharmacy extenders into a clinical and research practice settings. Lastly, we held our annual Pharmacy Technician Breakfast and Continuing Education Seminar on May 20. Cathy Poirier, B.S., Pharm.D., M.B.A. presented “Overdose Epidemic and Naloxone as a Rescue Agent for Overdose.”  Deeb Eid, Pharm.D., presented, “Pharmacy Technician Law Review: Who’s on First, What’s on Second, I Don’t Know is on Third.” Azadeh Ali – Moghaddam, Pharm.D., presented, “Medication Safety Pearls Quality Perspective.” The turnout at the technician seminar was one of the highest we have had; Denise Propes did a phenomenal job organizing the event!

As you can tell, so far it has been a very busy year with lots of great energy and enthusiasm from our Board and Committee members. We continue to strive to improve pharmacy practice and membership participation. There are many exciting things to come!

Posted in: Member News
The Need for Residency Program Development

By Courtney Carroll, Pharm.D., clinical pharmacist, University of Michigan C.S. Mott Children’s Hospital, Ann Arbor and Melissa Lipari, Pharm.D., BCACP, clinical pharmacy specialist, ambulatory care, St. John Hospital, and clinical assistant professor, Wayne State University, Detroit

This year, one of the focuses of the Michigan Society of Health-System Pharmacists (MSHP) Residency Committee was to further refine our “Mentor/Mentee Program,” which is dedicated to developing residency programs across the state. This program was initially rolled out in 2014 with the goal of supporting institutions seeking to start or expand residency programs. 

As the number of student pharmacists interested in pursuing a residency is on the rise, the demand for new residency positions also continues to surge. Furthermore, as the role of pharmacists within the multidisciplinary team expands, the desire to specialize within a specific area of practice has sparked an increase in the number of residents interested in continuing on to a PGY2 residency. Unfortunately, per the American Society of Health-System Pharmacists, there are currently only 28 specialized residency positions available in Michigan.2 The need for continued residency program development within our state is crucial in order to further strengthen the educational prospects of our future pharmacists.

The Residency Committee is dedicated to providing guidance on how to develop and expand residency programs through our Mentor/Mentee Program. This program provides pharmacists (clinical pharmacists, specialists, managers, residency program directors, etc) with the resources needed to initiate the process of building or extending their residency program. We encourage you to reach out to your leadership if you have an interest in supporting the development of residency positions within your institution!

A focus of our Committee is not only to support the growth and development of residency programs through our Mentor/Mentee Program, but also to provide those interested with additional resources for success which are available in our Michigan Residency Toolkit. This guide was developed in 2013 and contains key information regarding justification and expansion of residents, a checklist for developing a residency program, how to incorporate a resident within the practice model and tips on recruiting residents to your program (click here to access the toolkit).1

It is important to not be discouraged by what may seem to be an overwhelming process to either create a residency program or expand upon your available positions – take the first step today and contact us for guidance on what you should do next! For further information regarding how to become involved within the Mentor/Mentee Program, or for any questions regarding residency program development, please contact Jennifer Crawford, MPA staff liaison at Jennifer@MichiganPharmacists.org.

References

  1. Michigan Pharmacists Association. Residency Toolkit: Michigan Society of Health-System Pharmacists Residency Committee. MPA website. http://www.michigan pharmacists.org/Portals/0/mpa/sections/mshp/michiganresidencytoolkit.pdf. Accessed July 2017.
  2. American Society of Health-System Pharmacists. Online Residency Directory. ASHP website. https://accred.ashp.org/aps/pages/directory/residencyProgramDirectory. aspx?pageno=1. Accessed July 2017.

Posted in: Professional Practice
Pharmacy Informatics: It’s Not Always Just About Drugs – Implementation of Breast Milk Barcoding at a Large Academic Health Center

By Matt Enell, Pharm.D., clinical informatics pharmacist, Michigan Medicine, Ann Arbor

 

Michigan Medicine went live with Epic, our current electronic health record (EHR), in June of 2014. At that time, barcode scanning of human breast milk was deemed out of scope for several reasons. It was perceived as a labor-intensive workflow for nursing, and Epic was lacking in functionality at that time.

 

After our EHR went-live, there were a few near-misses and actual administrations of breast milk to the wrong patient. During this time, there were also a handful of incidents where patients received formula that conflicted with documented allergies.

 

Due to these events, a team was assembled to review both the workflow and Epic functionality as well as develop a barcoding solution to help prevent these incidents. Another impetus to implementing barcode scanning of breast milk was the Healthcare Information and Management Systems Society (HIMSS) Stage 7 certification as barcode scanning of breast milk is one of the required criteria.

 

We initially had to decide if we wanted to use Epic or partner with a third-party software to implement the scanning. Software features we compared were inventory management, allergy checking, cost, required interfaces, etc. Ultimately we decided to utilize Epic. While Epic’s functionality was fairly new and did not have all of the “bells and whistles” of the third-party software, it would not require any additional interfaces, costs would be minimal, and we would also be able to have allergy checking.

 

To prepare for this process, we converted all of our breast milk orders into medication records. We also converted all our enteral nutrition orders (both pediatric and adult) to medication records to take advantage of allergy checking. Though enteral nutrition orders were converted to medications, barcode scanning of all nutrition elements was out of scope for this project.

 

We estimated the project would take six months. This timeline included workflow discussions, Epic build, user acceptance and quality assurance testing, training and implementation. We considered the time needed to build the new orders, create new labels/label printing workflows and update order sets and reports so they displayed correctly.

 

We mimicked  current workflow as much as possible throughout this project. Even though we switched to medication records, they did not behave the same way as a typical medication order in our system. We restricted the orders from the electronic medication administration record (eMAR), relocating the scanning function to flowsheet documentation. Nurses would use existing active orders reports to know when to give the breast milk or formula. The orders were also blocked from the pharmacist verification queue. We deviated from Epic’s recommended workflow when it came to label printing as we have a milk room at our hospital responsible for the operations functions surrounding breast milk. It behaves in many ways just a pharmacy, but was not accounted for in Epic’s workflows.

 

Throughout the course of the project, we encountered many issues that we had to work to resolve. Most of the issues stemmed from trying to make Epic’s recommended workflows align with ours. The largest issue, however, was how these new breast milk/formula orders were displayed. Since they are nutrition orders, but built as medication orders, they were showing up in the medication section of the patient’s chart. Even though we provided education, this was confusing for staff. Therefore we continued to update reports, provide additional education and worked with Epic to correct this issue.

 

Since we have implemented breast milk barcode scanning we have not had any new incidents of a patient receiving the wrong breast milk or of an enteral nutrition formula given to a patient with a conflicting allergy. We did see a small uptick of risk reports after going live concerning patients missing a feeding because of how the orders were displayed. After actions were taken to address this, the incidence of these types of reports decreased. There was also a worry about increased workload for nurses prior to implementation, but after going live that was never realized, and the process was well received.

 

Overall, lessons learned with this project were the importance of workflow validation, the flexibility needed to customize this project to meet our needs, and how beneficial Epic’s involvement was in initial discussions.

Posted in: Professional Practice
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