Pharmacy News

Entries for September 2019

Improving Patient Care Across the Continuum with Pharmacy Technicians

By Lindsey Clark, Pharm.D., MBA, pharmacy manager, Transitions of Care and Emergency Services, Michigan Medicine, Ann Arbor

The American Society of Health-System Pharmacists (ASHP) Practice Advancement Initiative (PAI) empowers the pharmacy profession to leverage pharmacy technicians to improve patient care across acute and ambulatory care settings.1 At the intersection of the acute and ambulatory care settings, patients experience transitions of care (TOC), which is defined as the movement of patients between healthcare practitioners, settings, and home as their health condition and care needs change.2 At each TOC, patients are at greater risk of experiencing an adverse drug event, which may lead to costly readmissions and emergency department visits.3 With their knowledge and expertise on the medication use process, pharmacy technicians are well-positioned to help facilitate a safe TOC for our patients. There is also tremendous opportunity to implement advanced and innovative roles for pharmacy technicians in TOC. At Michigan Medicine, advanced pharmacy technician roles have been implemented to improve patient care across the continuum. In doing so, the team strives to advance both patient care and the profession, in alignment with the recommendations established by the ASHP PAI.
The TOC pharmacy discharge team consists of six pharmacy technicians and one student pharmacist who provide medication access, discharge medication planning and bedside delivery services to inpatients being discharged home, through a program called MiRxExpress. These services are provided in collaboration with both inpatient and outpatient pharmacists, as well as providers, nurses, social workers and case managers. The team also participates in hospitalist patient care rounds, serves on hospital committees related to the discharge process and helps to ensure that discharge prescriptions for patients identified for an early discharge are filled in a safe and timely manner. The team also focuses on using Lean process improvement methodology to improve workflow efficiencies. Over the past year, the team has helped more than 6,000 patients gain access to their discharge medications. The service has proven to be a significant patient satisfier, with over 95 percent of patients indicating that they were very satisfied with the convenience, timeliness and quality of the service provided. Additionally, over 97 percent of patients served indicated they would very likely recommend the service to others.
The TOC pharmacy clinic team consists of nine pharmacy technicians who offer medication access assistance to patients receiving care in the dermatology, gastroenterology/infectious disease, hepatology, pulmonary/nephrology, post-kidney transplant and rheumatology Taubman Outpatient Clinics and the metabolism, endocrinology and diabetes clinic at Domino’s Farms. At these locations, TOC pharmacy technicians are integrated into the interdisciplinary healthcare team and are highly relied upon for their expertise and services. The pharmacy technician services have significantly improved the timeliness with which patients gain access to their medications. They have also eased provider, nurse and medical assistant workload within the clinics, allowing these professionals to focus more time on other important patient care functions. Nearly 100 percent of respondents to a clinic staff satisfaction survey indicated they were very satisfied with the services provided. Due to the team’s positive impact on patient care and clinic workflow, expansion to additional clinics within the health system is ongoing. 
1. American Society of Health-System Pharmacists, ASHP practice advancement initiative overview, education and tools and resources. American Society of Health System Pharmacists. Available at:
2. Clark, K, Doyle, J, Duco, S, et. Al. Hot topics in health care: Transitions of care. The Joint Commission. Available at:
Hume, AL, Kirwin J, Bieber HL, et. Al. Improving care transitions: Current practice and future opportunities for pharmacists. ACCP White Papers. Pharmacotherapy 2012; 32 (11): e326-e337.
Posted in: Professional Practice
Update from the Capital Area Pharmacists Association

By Cathleen Edick, Pharm.D., CDE, pharmacy program coordinator, McLaren Greater Lansing, Lansing

The Capital Area Pharmacists Association (CAPA) is usually pretty quiet in the summer months, but we did fit in a little fun and community service during the months of May, June and July.

On May 9, CAPA held a fundraising dinner at the Blaze Pizza in Frandor, where we were able to raise almost $50 for the CAPA scholarship fund. On June 19, things may have got a little chilly as the evening went on, but CAPA members enjoyed an Ignite soccer match and a free dinner at the Cooley Law Stadium in downtown Lansing. It was a great time to socialize and have some fun with other CAPA members and their families. Then, on July 27, instead of the usual fifth Saturday of the month of June, CAPA members provided and served a meal at the Advent House in Lansing.
The CAPA Executive Board will meet in early September to plan more future events; however, some have already been planned for 2019, including the following events:
  • Oct. 15 – Wits & Wagers: New Literature Pearls CE
  • Nov. 30 – Dinner to be served at the Advent House
  • Dec. 2019 (date TBD): Annual Law CE
In addition, please keep watch for another Blaze Pizza fundraising event sometime this fall to help to continue to raise money for the CAPA scholarship fund. The two $500 CAPA scholarships will be awarded in December this year. Please encourage any student pharmacist to apply. This year’s deadline is Nov. 1. Additional information about the scholarship criteria can be found at
Posted in: Member News
Residency and Resiliency

By Iva L. Keene, Pharm.D., PGY-1 pharmacy resident, Aleda E. Lutz VA Medical Center, Saginaw
Brian J. Seigfried, Pharm.D. PGY-1 pharmacy resident, Aleda E. Lutz VA Medical Center, Saginaw  

A survey of 329 health system pharmacists by Durham et al. showed that over 53 percent of pharmacists stated they were at a high degree of burnout.1 Burnout is a major problem and needs to be addressed. Organizations like the National Academy of Medicine acknowledge work life integration as a factor impacting the well-being of healthcare workers.2 Residency cannot be excluded, especially when residents have family at home. This scenario brings a different perspective into the burnout potential of a pharmacy resident. As new practitioners, failing to take the necessary steps to counter burnout may negatively impact self-confidence, ability to learn and communicate with others. This has the potential to not only impact one personally, but it may also impact the effectiveness as a member of the healthcare team. As new residents, the authors seek to identify and share their personal challenges and tips to combat burnout. 

Iva: Being a new mom, wife and resident brings some challenges, such as, juggling doctor appointments, residency assignments, family time, and sleep. Yet, as a new resident, the challenges become easier when I do the following: 

  • Make time for yourself – Schedule 30 minutes per day to read, a biweekly massage or anything that you might do for you. 
  • Be intentional with your family and set weekly family time, whatever it may include.
  • Make sure you eat (more than the occasional granola bar); it is too easy to get lost in the work. Keep a shared calendar of everyone’s (partner/children) appointments and tasks (residency/work/fun). 
  • Do not be afraid to ask for help, whether it be for someone watching your child, so you can finish a project or asking your preceptors for more guidance.  
  • Sustain your motivation by asking yourself why you are doing what you are doing. 
  • Be flexible to change, shortcomings and things not going your way. 

Brian: I have the habit of looking ahead to the next task on my to-do list before I finish the task at hand, frequently failing to recognize what I just accomplished. Being a husband and father of three under the age of five, it can be easy to lose focus and become overwhelmed. When peers ask how I managed, I share the following: 

  • Find and engage in a hobby, whether it be artistic, exercise, sports or medieval role-playing – having a way to decompress with something you enjoy has helped me stay grounded and not feel like I have to give up who I am in order to succeed. 
  • Make and keep a routine or schedule – It may seem impossible at first, but once you get into a rhythm, you can be amazed at what you can fit into one day. 
  • Hydration – Who forgets to drink water? I know I do. I like to add flavor pack to mine to encourage me to drink it. 
  • Remember your motivation – Mine from the beginning was my family. 
  • Exercise – Let’s try to live the way we educate our patients to live. Even if it is just a walk around the block to clear your mind. 
  • Have the courage and humility to ask for help. 

Do not just take our word for it. This is topic that is being discussed by state and national organizations in webinars, journals and conventions3. The American Society of Health-System Pharmacists (ASHP) has provided a variety of resources to help develop resilience and well-being, with a particular focus on residents and those in healthcare systems. Some of ASHP's recommendations include3: 

  • Monitoring stress level 
  • Finding a mentor 
  • Developing meaningful social connections
  • Embracing change 
  • Starting a daily gratitude practice (gratitude journal)

Overall, burnout is real and it happens often. As residents, we tend to have tunnel vision about what we have to do next and forget about ourselves. It is important to prioritize yourself and keep the balance between residency, life and family because if you do not, burnout will occur and the career you once wanted will no longer be your desire.  

1. Durham ME, Bush PW, Ball AM. 2018. Evidence of burnout in health-system pharmacists. Am J Health-Syst Pharm. 75(23):s93-s100. 
2.National Academy of Medicine. Factors affecting clinician well-being and resilience. (Accessed 2019 Jul 18) 
3. American Society of Health-System Pharmacists. Wellbeing and You. (Accessed 2019 Jul 18) 

Posted in: Member News
Committee Current State of Credentialing and Privileging for Health System Pharmacists

By Lynette Moser, Pharm.D., associate clinical professor, Wayne State University, Detroit

The importance and process of credentialing and privileging pharmacists are crucial discussions as the profession of pharmacy prepares for provider status; be it through national, state or third party payer designations. In 1999, 10 professional pharmacy organizations formed the Council on Credentialing in Pharmacy (CCP) to create resources to assist organizations and individuals who choose to introduce credentialing and privileging for pharmacists in any health care setting.1 Their work resulted in a resource paper that was published in 2014.2 

A pharmacist’s credentials validate the individual’s education through licensure, practice experience and specialty board examination. Training programs within an institution that culminate in a competency assessment may also be considered a credential. An institution will consider a variety of credentials in their “credentialing” process, which may then support the “privileging” of pharmacists and expanded pharmacy services. Privileging is the process by which an institution grants an individual the right to perform specific duties.

The Michigan Society of Health-System Pharmacists (MSHP) Committee for Professional and Legal Affairs has been charged with evaluating the status and providing recommendations for credentialing and privileging of pharmacists in Michigan. Current interpretation of the Michigan Public Health Code gives pharmacists broad latitude to provide patient care services. As we advocate for provider status, we want to assure that pharmacy practice in the state maintains a focus of providing care to patients with all disease states and includes all drug therapy. Credentialing and privileging efforts may have a focus on specific therapies and disease states. Credentialing and privileging can benefit pharmacy departments and pharmacists by assuring competency, enhancing the scope of practice for pharmacists and demonstrating pharmacists’ value in the patient care setting. Patients will benefit from increased access to care (particularly in the ambulatory setting) and improved quality and safety. Institutions should see a benefit from a reduction in uncompensated care encounters, improved billing using a broader range of billing codes and ongoing assurance of quality and competency by pharmacists care providers (as part of the credentialing process).

When a pharmacy department decides to establish a credentialing process, they first need to assure support of leaders within the health system. A concise, cogent argument for the process to the corporate suite should focus on improved quality, patient satisfaction and cost savings/increased reimbursement. Data are available in the primary literature to support these benefits and should be shared. However, there is limited data highlighting which aspects of the pharmacist’s clinical role are the most effective and cost-effective.3 Pharmacists and pharmacy departments should take every opportunity to document and publish their work to demonstrate improved quality and cost savings. This will provide support for expansion of pharmacy services on a broader scale.

After obtaining institutional support for credentialing and privileging, each institution must determine which clinical services to provide, what external credentials will be accepted and expected, and what internal processes to use to assure pharmacists competency to provide high quality patient care services.

Pharmacist credentialing and privileging provides a process to allow our pharmacists to optimize their services and further validates a pharmacist’s education, licensure, practical experience, and preparation for specialty care by the institution. This is the same process currently used for midlevel providers such as nurse practitioners or physician assistants. A credentialed and privileged pharmacist can be granted the authority to perform specific services that can be billed as a provider in addition to the facility visit. MSHP will be providing a document that may be used to make the argument for privileging and credentialing to the corporate suite; as well as a guidance document for the pharmacy department to use in implementation. 

1. Council on Credentialing in Pharmacy. Guiding principles for post-licensure credentialing of pharmacists [2011]. (accessed July 23, 2019).
2. Council on Credentialing in Pharmacy. Credentialing and privileging of pharmacists: A resource paper from the Council on Credentialing in Pharmacy 2014;71:1891-1900.
3. Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: Current insights. Integr Pharm Res Pract 2017;6:37-46.

Posted in: Professional Practice
Highlights of the 2019 ASHP House of Delegates

By Ryan Bickel, Pharm.D., MHA, FASHP, pharmacy manager, Mercy Health Saint Mary's, Grand Rapids

In June, the American Society of Health-System Pharmacists (ASHP) House of Delegates (HOD) convened its 71st session in conjunction with the 2019 ASHP Summer meeting in Boston, MA. The HOD session consisted of participation in two delegate caucuses with two respective HOD meetings. Other society business activities, such as the presidents and treasurers reports, were also presented during the meetings. The delegates representing Michigan this year included Jesse Hogue, Mike Ruffing, Jim Lile and Ryan Bickel. Other Michigan Society of Health-System Pharmacists (MSHP) members participating in this year's HOD were Kathleen Pawlicki, ASHP President-elect, and Paul Walker, ASHP Board Member.
During the session, the HOD reviewed 18 policy recommendations, reviewed one resolution, and brought forth one new business item.  Four of the policy recommendations and the resolution were approved without amendment.  The remaining policy recommendations required some minor revisions.
Therapeutic Use of Cannabidiol Policy
Most of the policy recommendations were reviewed and amended relatively quickly; however, a significant amount of time was spent debating the Therapeutic Use of Cannabidiol (CBD) policy.  The delegates were torn between taking a hardline stance opposing the use of CBD products and a more neutral stance.  Some were concerned about the public perception of this statement, as many states, including Michigan, allow the use of medical marijuana and CBD oil.  This was further complicated, as the Food and Drug Administration's (FDAs) stance on CBD is rapidly evolving with respect to its status as a nutritional supplement. Many were concerned that there is a lack of strong clinical studies supporting the therapeutic benefits of CBD.  Ultimately, the HOD voted to "oppose use of CBD-containing products not regulated by the FDA."  As a data driven profession, it was felt that this was the most appropriate action to take.
Other Policies
In the May 2019 MSHP article, Jesse Hogue highlighted several policies that he felt would be of particular interest to MSHP members.  Here is a brief update of what transpired on some of policies that he referenced in his article:
  • Safe Administration of Hazardous Drugs – The draft was amended to include all healthcare settings, rather than focusing on just hospital settings.
  • Compounded Sterile Preparation Verification – No significant changes from the draft version, but a great deal of passionate debate amongst a small group of ASHP members ensued on ASHP Connect wanting this policy to be worded more strongly.
  • Credentialing and Privileging by Regulators, Payers and Providers for Collaborative Practice – A clause was added to advocate for pharmacist inclusion as providers in the Medical staff bylaws.
  • Pharmacy Technician Training and Certification – A clause was added to advocate for a national standard.  It was felt that this policy is still consistent with the goals of MSHP.
I encourage you to visit the ASHP website to view a summary of all of the final policy statements: 
The resolution dealt with the minimum educational qualifications standards for pharmacists.  It was written in response to a 2017 U.S. Office of Personnel Management (OPM) decision, which specified the basic educational requirement for pharmacists is a Doctor of Pharmacy (Pharm.D.) or Doctor of Philosophy (Ph.D.) degree. The resolution supports minimum educational qualification standards for pharmacists to practice pharmacy that are consistent with the licensing standards of state boards of pharmacy.  Currently, all 50 states allow pharmacists with a Bachelor's of Pharmacy (B.S.Pharm) degree to qualify for licensure.
New Business
The new business item was entitled “Pharmacists can Mitigate the Primary Care Physician Shortage.”  The purpose was to highlight the important role pharmacists play on interdisciplinary teams and advocate for incorporating more pharmacists into primary care models.  The HOD approved moving this business item along for further review and assignment by the ASHP Board of Directors.
In Closing
The highlight of the 2019 ASHP Summer Meeting for the Michigan delegates was not the HOD session; rather, it was getting to witness the installation of MSHP member Kathleen Pawlicki as the ASHP President.  More information about this can be found on page 33 of the July-Sept. 2019 edition of Michigan Pharmacist.
Posted in: Member News
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