CAPTKimberly Langley is the Chief Financial Officer for the DoD Federal Electronic Health Record Modernization office responsible for implementing a single, common federal electronic health record system for Department of Defense, Department of VeteranAffairs, Department of Homeland Security, and the National Oceanic and AtmosphericAdministration. CAPT Langley is a pharmacist in the U.S. Public Health Service (USPHS) Commissioned Corps and has been on continuous active duty since 2009. She has completed previous USPHS assignments at multiple duty stations across New Mexico and Arizona with Indian Health Service. During this time, CAPTLangley served in several diverse leadership positions including Pharmacy Manager, PGY-1 Residency Program Director, Cardiovascular Clinic Director, and IHSAgencyRepresentative to the Million Hearts Initiative. In 2015, CAPTLangley served as the Chief Pharmacy Officer for her team in Liberia as a part of the Ebola crisis response in WestAfrica.
CAPTLangley holds a Bachelor of Science in MedicalTechnology from Georgia Southern University; a Doctor of Pharmacy degree from Medical University of South Carolina; a Master of BusinessAdministration fromThe Citadel; and completed a Certificate in Business Process Management from Villanova University. She is also board-certified in Pharmacotherapy and served on multiple technical expert panels for Pharmacy QualityAlliance for the development of cardiovascular and diabetes quality measures. CAPTLangley is actively engaged inAzPA activities including serving on the Board of Directors as President, Director-at-Large,APhA House of Delegates Representative, member on several committees, faculty for 2 certificate programs, abstract peer reviewer, and conference speaker. In 2023, she was recognized as a fellow of theArizona PharmacyAssociation. Her leadership experience extends to various roles on multiple USPHS committees, workgroups, and mentoring programs.
DearAzPAMembers,
As my tenure as President of our esteemedArizona PharmacyAssociation draws to a close, I find myself filled with immense pride and gratitude. The past year has been a remarkable journey, one that has challenged us, united us, and ultimately strengthened us to shape a brighter future for the pharmacy profession.
Looking back, I am humbled by the support and dedication of our members, who have been the driving force behind our collective success. Our community has remained steadfast in the commitment to advancing the profession of pharmacy. We have fostered collaboration, shared knowledge, and advocated for the interests of our members and the patients we serve. Our collective efforts have not only unified us but have also strengthened us to be an influential voice in theArizona healthcare community
Atop priority has been advocating for improved workplace conditions and giving pharmacy professionals a voice. We heard directly from members about the challenges they face through townhalls, other meetings, and our first-ever workplace conditions survey to better understand the landscape of pharmacy practice inArizona.To no surprise, the results highlighted areas of concern like staffing shortages and burnout. There is still so much more to be done. I look forward to using this data and engaging with our members to guide and support future strategic initiatives.
The association achieved other milestones to support ourArizona communities.AzPApartnered with the Maricopa County Department of Public Health to launch the Stop Overdose Deaths Arizona (SODAZ) program. This collaboration has had noticeable success in increasing access to naloxone, a life-saving medication.AzPAis part of the collective effort to combat the opioid crisis in our state.
One of the most anticipated events of the year is our annual convention. This gathering has become a cornerstone of our community, bringing together pharmacy professionals from across the state and beyond. This year’s convention was particularly noteworthy, featuring innovative continuing education presentations and inspiring speakers who shared their insights and experiences, leaving us motivated and energized. The enthusiasm and engagement of our members during this meeting was truly remarkable!
As I have previously noted, change is inevitable.As much as I looked forward to reconnecting and meeting with our members and supporters at our annual convention, I knew that it would also mark the end of an era. One of the most significant changes we faced was the departure of our long-serving CEO, Kelly Fine, who has been an integral part of our association. This association has thrived under her leadership and dedication for more than 13 years. We congratulate Kelly as she starts this new chapter in her career while we also welcome the prospect of new possibilities and perspectives for our organization. With resilience and unity, we embrace this change, recognizing that it is an opportunity to reinvigorate our association and continue to build upon Kelly’s legacy of excellence.
In closing, I want to express my deepest gratitude to each member and supporter of our association.Your passion, commitment, and resilience have inspired me on this journey to advance the profession. It has been an honor to serve as your president and to work alongside such a dedicated and talented group of individuals.
Together, we have blazed a trail in this remarkable chapter of our history, and I am excited to see to how our journey will continue to unfold.As we transition into this new era, I am excited to witness the continued growth and success of our association filled with even greater accomplishments and lasting impact.
It has been an honor to serve as your president, and I am deeply appreciative of the trust you have placed in me.Thank you for the privilege of serving you. I look forward to continuing to work alongside you as we advance the profession of pharmacy together
Our kids are targets. With more than half of the seized U.S. fentanyl supply coming straight throughArizona, they sit at the epicenter of a three trillion dollar drug war overtakingAmerica.(1)To put this in perspective, that value equates to more than 11% of our 2023 U.S. gross domestic product (GDP).This past year, the Drug EnforcementAgency (DEA) seized 42 million fentanyl pills in our state alone-a logarithmic increase from the 28 million pills seized in 2022, and 12 million the year prior.(2) Trafficking is directed largely by the Sinaloa cartel operating in Mexico who coordinate product delivery of the lethal synthetic opioid, fentanyl, towardsAZ schools, playgrounds, shopping malls and other youthattracting venues.(3)
There are three trillion reasons why our kids are enticing accompaniments to this crime scene. They can be buyers and sellers to a generation of fellow youth seeking acceptance, entertainment and relief from mental health ailments. What they offer beyond the fentanyl is misperception of safety Not only has fentanyl been found lacing virtually every other class of abusable drugs, but it’s frequently pressed into pills that mimic legitimate pharmaceuticals (such as oxycodone, Oxycontin®, Xanax®).(4) Readily accessible online herbal and weight loss supplements are another novel supply chain and an emerging trend is to add flavors and colors that mimic gas station candy. With 7 out of every 10 pills now being confiscated by the DEA containing enough fentanyl to kill the averageAmerican adult (2 mg), escaping cartel entrapments seems a delusive venture.(4)
Not convinced?Ask the 75,000 people that lost their lives to synthetic opioids in 2023.(5)That same year, our state observed more than 1900 opioid-overdose deaths and 4000 non-fatal overdoses.(6)As for our kids, theArizona Child Fatality Review Program recorded at least eighty deaths in children due to opioids between 2021 and 2022, and 132 overdose events in 2023.(7) Nationwide, the data shows we lose a classroom worth of teenagers weekly.(8)
Schools offer a convenient opportunity to employ interventions. However, currentAZ laws (Ariz. Rev. Stat. § 15-341(A)(43)) fall short of enforcing requirements to ensure educational institutions are equipped with naloxone or that staff are trained to administer it. Likewise, there are no state or federal requirements for schools to train students on the topics of fentanyl, overdose management, or addiction.Recognizing the investment needed to create an overdoseprevention and management protocol, a number ofAZ schools— including public, private and charter—have elected to defer management of overdoses to emergency responders. With a mere three minutes to save a brain deprived of oxygen, few can afford to
wait for an off-campus responder And with no state requirements for schools to report potential overdoses or administration of naloxone, what little data we have on this topic likely underestimates true prevalence. School education is lacking.And the few private 501(c)3 and government agencies offering in-person student training are no match for the 2000 public schools in need of their curriculum.
So, what is the solution? The problem is massive, deeply rooted, and growing.The epidemic is now endemic and fueling statewide discussions on whether ‘too little too late’is reversible.All can agree that helping our kids escape the entanglement of opioid use disorder (addiction) and overdoses requires we build solutions as big as the problems.And when it comes to our kids, everything is on the table.
The STOP-ITInitiative
Solutions are on the horizon. Thanks to a collaborative effort between theArizona Department of Education and a team of medical, behavioral health, government and educational specialists, the state ofArizona is in the process of building a comprehensive intervention to tackle drug awareness and overdose prevention in schools.
An initiative titled the ‘School Training Overdose Preparedness and IntelligenceTaskforce’(STOP-IT) has been authorized to develop a state-wide, sustainable school opioid overdose education and preparation toolkit forAZ schools (Table 1). In tandem, the project will include tackling school policies, exploratory school surveys, overdose monitoring/reporting systems and naloxone supply chain plans.The taskforce is comprised of four subcommittees, each addressing specific issues:
1 Survey and Overdose Monitoring Subcommittee: Via a statewide school survey (K-12 and post-secondary), the group will thoroughly assess the current state of school opioid overdose preparedness (including availability of naloxone and training requirements), student and staff education processes, barriers to naloxone procurement and school viewpoints on student risks. The subcommittee will also address the creation of a statewide school opioid overdose reporting system. Follow-up surveys are planned following the intervention to measure impact.
2 Best Practices for Staff/StudentTraining Subcommittee:This subcommittee will evaluate currently available curriculum for students and staff on the topics of opioids, opioid use disorder (OUD), opioid overdoses and naloxone usage. The subcommittee aims to develop a training product that meets the needs of diverse learners and learning environments, limits the need for in-person
HEALTH SYSTEMS
1
2 training requirements and is adaptable to changing trends in the drug market. Social influencers will be integrated to help sell important points.
3 Policy Subcommittee:This subcommittee will review the current school district policies on opioid overdose management and compare to those developed in other states as well as policies written for other medical disorders. Their goal is to create standardized school district policy language able to be adapted across the state.The group will also correct gaps in the ‘Emergency Guidelines for Schools’documents and evaluate the necessity of legislation in these activities.
4 OpioidAntagonist Procurement Subcommittee: This subcommittee will address existing barriers to opioid antagonist procurement and develop long-term supply chain solutions to ensure adequate district, staff and student access.
The STOP-ITinitiative is readily underway. Commencing its first subcommittee meetings this past May, the team holds to a robust deadline of December 31st. STOP-ITmeetings are held monthly and are open to the public. With less than six months left ahead of them, the more than fifty members donating their time and energy to this life-saving project are to be commended. This undertaking represents the first of its kind in the nation and holds the potential to be reproduced in other states. With careful attention to ensure each intervention is paired with trackable outcomes, the value of this project will ultimately prove self-evident.
It’s time we end the generational impact of the opioid epidemic. Equipped with the right tools and knowledge, our youth can make the wise decisions that will save their lives and release the cartel’s grip on their future. The STOP-ITinitiative is a clear call to action forArizona communities to work together to solve this crisis.After all, if we don’t STOP-IT, who will?
1.Cheri Oz. More than half of the fentanyl pills seized by the DEA came throughArizona. Here’s why. KJZZ New Report. June 10th, https://www.kjzz.org/news/2024-06-10/more-than-half-thefentanyl-pills-seized-by-the-dea-came-through-arizona-heres-why ear in Review: DEAinnovates to fight https://www.dea.gov/press-releases/2024/01/18/yearreview-dea-innovates-fight-fentanyl.January 18, 2024.
Justice DepartmentAnnounces ChargesAgainst Sinaloa’s s Global Operations. https://www.justice.gov/opa/pr/justicedepartment-announces-charges-against-sinaloa-cartel-s-globalApril 14, 2023.
4.DEA.org. Share One Pill Can Kill Materials. .dea.gov/onepill.Accessed June 22, 2024.
5.U.S. Overdose Deaths Decrease in 2023, First Time Since https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2 024/20240515.htm. May 15, 2024.
6.Arizona Department of Health Services. .azdhs.gov/opioid/dashboards/index.php#nonfatalAccessed June 22, 2024.
Think for a moment about someone who has positively impacted your professional upbringing. Who are some of the individuals that come to mind? Perhaps you think of an influential professor, a passionate preceptor, a family member who fiercely believed in you, or a manager who saw your potential. What was the impact of those people on your professional growth? What attributes do those individuals possess? How have those attributes molded the type of pharmacist, preceptor, mentor, and leader that you are striving to become?
Reflecting on our own professional upbringing can cause our minds to shift from the present to the future. What are our current opportunities to share these qualities with others? How are we paying it forward to the next generation of pharmacy professionals?As we answer these questions, we may find ourselves listing examples of volunteerism, precepting, and role-modeling. But do we fully understand the “WHY” behind these actions?
The Golden Circle
Popularized in Simon Sinek’s viralTEDxTalk from 2009 based upon his book “Start with Why,” the Golden Circle visually describes that the success of our endeavors, personal and professional, begins first with a strong understanding of “Why” we do what we do.¹ ‚ ² This naturally flows to the “How”, and ends with the “What,” depicted as a series of three concentric circles (Figure 1).Although the most effective communication emanates outwardly from an individual or an institution’s “WHY” and connects people on a fundamental level grounded in beliefs, values, and emotions, our attention is more commonly fixated on the “What,” limiting the potential impact of what is most important to us.
Linking the initial questions posed in this article with the Golden Circle structure, we can reflect upon how connected we currently are to our “WHY.” We may ask ourselves questions such as, Why am I a pharmacist? Why was I inspired to go into this profession? Why am I a preceptor?Amanager? Why am I involved in the professional organizations that I’m involved in?
Dr. Joseph S.Alpert, Cardiologist and Professor of Medicine at the University ofArizona and Editor-in-Chief for theAmerican Journal of Medicine recently wrote a commentary titled: “The Meaning of Life: To Serve Others” opining on this very topic.³ He shared his reflective process stating “I spent a long time asking myself what my true north was, and how had this given my life meaning. I decided that my true north evolved as my life progressed.” He goes on to share “Now in the final decades of life, I wondered whether my true north had changed and, if so, where was north now? Immediately, the thought came to me: I want to continue to serve and to be useful to others including members of my family, my patients, my students and trainees, my colleagues, my institution, and my community. Once again, others must judge whether I will have been successful in achieving this final quest for service.”
As you consider your “WHY,” you may be inspired by pharmacist colleagues who responded to our call for examples of why individuals serve as healthcare preceptors. The responses we collected from colleagues are represented in a 3-minute video montage viewable on YouTube. What’sYour "Why"?The Habits of Preceptors ProjectMay 2024 (3 min) (youtube.com)
The Habits of Preceptors
Discovering and building upon our “WHY” is at the heart of the Habits of Preceptors Project, created to improve healthcare by cultivating the growth of clinician educators. It represents a passion project born out of a collaboration of like-minded individuals who sought a way to articulate habits of effective pharmacy preceptors, benchmark their level of skill acquirement, and provide a clear picture of growth as one advances along their precepting journey The Golden Circle of the Habits of Preceptors Project is displayed in Figure 2.
The Habits of Preceptors (HOP) website, www.habitsofpreceptors.org, is based upon the HOP Framework of 1 preceptor habits encompassed within three domains: clinician educator is a practice role model, clinician educator is an effective educator, and clinician educator provides high-quality assessment of learners.⁴ Full access to the website requires free registration.
Figure 1: The Golden Circle ¹ ‚ ²
• Figure 2. The Habits of Preceptors Project Golden Circle.
The suite of tools is designed to guide you through a personalized journey (Figure 3) of growth and development grounded in your “WHY.” Examples of some of these tools are described below:
•
• Based on the results of the HOP-Q, you are prompted to identify a habit of focus and craft a SMARTgoal aligned with your chosen habit.The platform provides space for goal setting, reflections, and revisiting your identified goal.
The Habits of Preceptors Questionnaire (HOP-Q) enables you to self-assess your precepting capabilities within each of the 11 habits and indicates your performance level as Newly Developing, Developing, Proficient,Accomplished, and Master
• The Preceptor Resources portion of the website encourages you to engage with a variety of resources curated by the HOP Forum members that specifically aligns with your habit of focus. Resources can be searched by type (e.g., video, podcast, journal article), habit, cost (freely accessible, may require membership/payment), and estimated completion time. For example, if you are seeking resources to help support the acquisition of Habit 3.1 focused on optimizing learner feedback, you can easily find freely available podcasts on effective feedback principles that are less than 30 minutes in length.
Accurate self-assessment is enhanced when information from multiple perspectives is included. Key stakeholders in precepting include learners, mentors, co-preceptors, colleagues, trainee/site coordinators, and patients who receive care delivered by learner: preceptor teams. For this reason, the External Review process was created to allow you to request specific feedback from trusted individuals on elements of your precepting capabilities.
Conclusion
We hope that as you reflect on your current and potential opportunities to help guide the next generation of pharmacy professionals, you are inspired to activate your “WHY” by engaging with the Habits of Preceptors Project at www.habitsofpreceptors.org.
PRECEPTOR CORNER
Figure 3. Creating a Personalized HOP Journey.
References
1 Sinek S. How great leaders inspire action [TEDx Talk]. TEDxPuget Sound; 2009. Simon Sinek: How great leaders inspire action |TEDTalkAccessed 2024 May 24.
2 Sinek S. Start with why: How great leaders inspire everyone to take action. London: Penguin Books; 2009.
3 Alpert JS.The Meaning of Life: To Serve Others.Am J Med. 2023 Oct;136(10):949-950. doi: 10.1016/j.amjmed.2022.11.006. PMID: 36473501.
4 Habits of Preceptors Project [Internet]. www.habitsofpreceptors.org.Accessed 2024 May 24.
AWARD WINNERS
CONGRATULATIONS
TO OUR 2024 AWARD RECIPIENTS!
Elias Schlossberg
Denise Erickson
Bowl of Hygeia
Jacqueline Campbell
Pharmacy Appreciation
Nancy Alvarez
Melinda Burnworth
Jacqueline Campbell
Brenna Darling
Chandima Deegala
Chris Edwards
Ivan Gong
Raman Kaur
Kimberly Langley
Tincy Maroor
Erin Raney
Valerie Richards
Jacob Schwarz
Thalia Vega
Katherine Vodovoz
Corporate Appreciation
Boesen & Snow Law
Incoming President Award
Jacob Schwarz
NCPA Pharmacy Leadership
Kimberly Langley
BOARD OF DIRECTORS!
OFFICERS
President: Jacob Schwarz
President-Elect: Jaime von Glahn
Past President: Kimberly Langley
Treasurer: Ryan Gries
Secretary: Brandy DeChellis
CEO: Vacant
DIRECTORS AT LARGE
Community Pharmacy: Brianne Spaeth
Health System Pharmacy: Mary Manning
Technician: Melinda Browning
Director at Large: Misty Brannon
Director at Large: Reasol Chino
Director at Large: Danielle Gilliam
Director at Large: Joseph Pellerito
Director at Large: Yousef Toma
Distinguished Young Pharmacist
Mohanad Znbaqa
Excellence in Innovation
Tincy Maroor
Exemplary Patient Care
Linda Williams
Student of the Year
Mikayla Gerdes
Technician of the Year
Nick Ruiz
Pharmacist of the Year
Sophia Galloway
Pharmaceutical Associates of the Year
Lindsay Davis
Angela Feldman
Legacy Interns
Marlen Cherop
Celine Evbuomwan
Ivan Gong
Leah Rios
Maria Sarwar
Christina Yamada
Sepideh Zakikhani
Hall of Fame
Matthew Bertsch
Mark Boesen
Melinda Browning
Vanthida Huang
Stephanie Spark
LIAISONS
University of Arizona
Student Chapter: Nguyen Pham
Dean’s Designated Representative: Nancy Alvarez
Midwestern University
Student Chapter: Cheleen An
Dean’s Designated Representative: Michael Dietrich
Creighton University
Student Chapter: Sahar Toluee
Dean’s Designated Representative: Jane Stein
Legal Counsel
Roger Morris
Preventing the Unseen Risk: A
Pharmacist Learning Objectives:
1 Explain the pathophysiological mechanisms underlying venous thromboembolism (VTE), specifically in hip and knee arthroplasty patients
2 Identify risk factors that contribute to increased VTE risk, specifically in hip and knee arthroplasty patients
3 Summarize different approaches for VTE prophylaxis, including both pharmacological and mechanical methods.
4 Explain current clinical practice guideline for VTE prophylaxis in the setting of hip and knee arthroplasty.
Review of Venous Thromboembolism Prophylaxis in Hip and Knee Arthroplasty
Venous thromboembolism (VTE) is a critical and significant postoperative complication that can commonly follow total hip replacement (THR) and total knee replacement (TKR). VTE can be defined as either a deep vein thrombosis (DVT), where clots form in deep veins, or as a pulmonary embolism (PE), when clots are found in the lungs. It is estimated that by the year 2030 there will be about 2.7 million total hip and knee arthroplasty procedures performed in the United States annually ¹ In patients who undergo these procedures some studies have estimated that 1.19% will have a development of a VTE.² This underscores an increasing health concern due to possible long-term complications of VTE that can include post-thrombotic syndrome and chronic pulmonary hypertension.³ Furthermore, it can lead to an increase in mortality, morbidity, and burden on the healthcare system. Effective VTE prophylaxis strategies are paramount to improve patient outcomes and reduce healthcare costs associated with this complication. This paper aims to review current guidelines and clinical evidence in VTE prophylaxis following total hip and knee arthroplasty, including pharmacological and mechanical methods, patient-specific risk factors, and emerging trends in prophylaxis.
Pathophysiology
The pathophysiological mechanisms of VTE in the setting of total hip and knee arthroplasty are multifaceted and can include genetic, environmental, and procedural factors that predispose patients to thrombus formation. Increased risk of VTE after total hip and knee arthroplasty stems from Virchow’s triad; venous stasis, endothelial injury, and hypercoagulability ⁴ ‚ ⁵
Venous Stasis⁵
For patients undergoing total hip and knee arthroplasty, decreased mobility during surgery and recovery causes venous stagnation.Additionally, there is a lack of contraction and relaxation of muscles that impedes blood flow during surgery, thus creating an environment favorable for clot formation.
Endothelial Injury⁵
Surgical trauma to the endothelium results in a chain of events that can lead up to clot formation. During surgical procedures, damage to the endothelial cells exposes underlying collagen and tissue factor which then trigger the coagulation cascade.Activation of the coagulation cascade combined with the release of proinflammatory cytokines increases VTE risk.
Hypercoagulability⁵
Surgery itself can lead to a hypercoagulable state where there is increased production of clotting factors while natural anticoagulant levels fall simultaneously. Other risk factors like patient’s age, hormonal therapies, cancer, and genetic predispositions can increase the risk for developing a thrombus. Increased activity in the blood coagulation processes with decreased fibrinolytic activity after surgery contribute to the hypercoagulability state of patients who undergo total hip and knee arthroplasty
Risk Factors
Individual patient risk factors also play a role in the development of VTE after total hip and knee arthroplasty One systematic review conducted on risk factors for VTE of total join arthroplasty examined potential risk factors in a population of more than one million patients over the course of 10 years.⁶ It was reported that factors such as age greater than 70 years, female gender, body mass index (BMI) greater than 30, and a surgery time greater than two hours were associated with increased risk of VTE after THAandTKA.⁶
Pharmacological Prophylaxis
The landscape of venous thromboembolism (VTE) prophylaxis in hip and knee arthroplasty over the last few decades continues to be shaped using various anticoagulant and antiplatelet agents. Each pharmacological agent offers a different mechanism to affect different parts of the clotting cascade to inhibit clot formation. Some of the most commonly used chemoprophylactic agents are vitamin K antagonists, low molecular weight heparin (LMWH), aspirin, and factor Xa inhibitors.⁷
Figure 1: Virchow’s triad
Vitamin KAntagonists⁷
Warfarin is a traditional oral anticoagulant that works by inhibiting the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X). Specifically, this occurs by preventing vitamin K from being metabolized into its active form which is needed to produce the clotting factors. Dosing is often highly individualized and targeted towards a goal international normalized ratio (INR) of 2.0 to 3.0 for patients for VTE. Due to the high risk of VTE after THR orTKR, it is recommended to bridge warfarin with LMWH or unfractionated heparin until INR is therapeutic.⁸
LMWH⁷
Low molecular weight heparin, such as enoxaparin, are derivatives of heparin that is naturally produced in the body by our anti-inflammatory cells. LMWH works by binding indirectly to factor Xa and causing a conformational change that will inhibit the conversion of prothrombin to thrombin. The dosing for VTE prophylaxis is typically 40 mg subcutaneous (SUBQ) once daily, however, this can differ depending on patient specific factors such as BMI and renal function.
Factor Xa Inhibitors⁷
Factor Xa inhibitors can bind both indirectly and directly to factor Xa depending on the individual agent. Common oral direct anticoagulants (DOACs) for factor Xa are apixaban and rivaroxaban. Unlike LMWH, these agents bind directly to factor Xa, which then inhibits clot formation by binding to antithrombin.The recommended dosing for VTE prophylaxis is apixaban is 2.5 mg oral twice daily and rivaroxaban 10 mg oral once daily Apixaban requires no dosage adjustment for renal function. Rivaroxaban should be avoided in patients with a creatine clearance less than 30 mL/minute. Routine coagulation testing is not needed to monitor therapy
Aspirin⁷
Aspirin (ASA) is the only pharmacological agent discussed here that does not work directly on the coagulation cascade. Instead, aspirin is an antiplatelet agent that works by binding to and acetylating cyclooxygenase-1 or cyclooxygenase-2 irreversibly This inactivates the enzyme that is needed for platelets to aggregate and form clots. Due to it binding irreversibly, the effects last the entire lifetime of the platelet, which is about 7 to 10 days. There has been a variety of different dosing strategies when used for VTE prophylaxis after total hip or total knee arthroplasty. Dosing can range from 81 mg oral once daily to 325 mg oral twice daily.⁹
Guidelines
There are a variety of different guideline recommendations for VTE prophylaxis following total hip and knee replacement. However, some of these are becoming outdated with more recent data from clinical trials and meta-analyses over the last couple years. Recommendations also tend to differ in terms of the preferred pharmacological agent to be used for VTE chemoprophylaxis.Although there is no clear consensus on choice of agent and duration, all the guidelines agree that VTE prophylaxis is needed in this patient population.¹⁰
American Society of Hematology 2019
TheAmerican Society of Hematology (ASH) 2019 guidelines for the management of VTE provide recommendations for the prevention of VTE in patients undergoing hip or knee surgery ¹¹ For these individuals the panel suggested using aspirin or anticoagulants, DOACs being the preferred anticoagulant over LMWH. If the patient is unable to use a DOAC, it is recommended to use LMWH over warfarin. The ASH guidelines also advocate for the use of mechanical prophylaxis methods, using intermittent compression devices, in addition to pharmacologic prophylaxis.
National Institute for Health and Care Excellence (NICE) 2018
¹²
The guidelines on "VenousThromboembolism in Over 16s: Reducing the Risk of Hospital-Acquired Deep Vein Thrombosis or Pulmonary Embolism" published in 2018 offer additional insights on the prevention of postoperative VTE in patients aged 16 and older undergoing total hip or knee surgery These recommendations were created by the National Institute for Health and Care Excellence based in the United Kingdom.Treatment recommendations are given for both elective hip replacement and elective knee replacement. For patients undergoing elective hip replacement surgery it is recommended that if VTE risk outweighs risk of bleeding that patients receive chemoprophylaxis. One VTE prophylaxis option is LMWH for 10 days followed by aspirin (75 mg or 150 mg once daily) for an additional 28 days.Another treatment option is LMWH alone for 28 days with compression stockings while admitted. Rivaroxaban can also be used; however, no dose or duration recommendations are provided. VTE prophylaxis is recommended for patients who are undergoing elective knee replacement whose VTE risk outweighs risk of bleeding. Either aspirin (75 mg or 150 mg once daily) for 14 days, LMWH alone for 14 days with compression stockings until discharge, or rivaroxaban.
AmericanAcademy of Orthopedic Surgeons (AAOS) 2012
TheAAOS guidelines on preventing VTE in patients undergoing elective hip and knee arthroplasty were published in 2012 with evidence-based recommendations reducing the incidence of postoperative VTE.¹³ They suggest the use of
Table 1: Guidelines on preventing VTE
Surgical Procedure
Pharmacologic prophylaxis recommended
·ASAfor 14 days
• ·LMWH for 14 days
• ·Rivaroxaban
•
•
• ·Anticoagulants
·ASAfor greater than 3 weeks
• (DOACs preferred over LMWH) for greater than 3 weeks
Pharmacologic prophylaxis recommended
pharmacologic agents and/or mechanical compressive devices for the prevention of VTE in patients undergoing elective hip or knee arthroplasty if the individual risk of developing a VTE was higher than the risk of bleeding. However, they were unable to give specific agent recommendations, stating that current evidence is unclear which therapy options are optimal or suboptimal.
Aspirin, LMWH, or DOAC?
As mentioned previously, the optimal VTE prophylaxis agent is currently unknown and could be considered an evolving landscape as new studies compare the efficacy and safety of different therapy options. One topic that has gained a lot of attention over the last decade is the use of aspirin versus LMWH.Arecent meta-analysis of randomized controlled trials studying VTE prophylaxis after total knee arthroplasty was recently published in 2023.¹⁴ The primary outcome of the study was the total incidence of VTE confirmed from diagnostic imaging.The meta-analysis included a total of six randomized control trials with a total of 6772 patients included for final analysis. Five of the included studies used aspirin 100 mg oral daily, only one used aspirin 325 mg oral daily. For LMWH five of the studies used enoxaparin 40-60 mg SUBQ daily and one study used dalteparin 2500 units SUBQ daily. Duration of treatment was either 14 or 30 days. The overall pooled data showed a statistically significant increased risk of VTE in those receiving aspirin compared to LMWH with a reported relative risk of 1.45 (95% CI: 1.16 to 1.84).There was no difference found in
• ·LMWH for 28 days
·LMWH for 10 days followed byASAfor 28 days
• Rivaroxaban
•
•
• ·Anticoagulants
·ASAgreater than 3 weeks
• (DOACs preferred over LMWH) for greater than 3 weeks
bleeding complication rates between groups.Astrength of this study is including recent large-scale randomized controlled trials, which helps improve the reliability of the findings on the effectiveness and safety of aspirin versus LMWH for VTE prophylaxis afterTKA.Alimitation is that the participants were not blinded to treatment groups, which introduces potential bias. In conclusion, this meta-analysis found that aspirin had a higher risk of VTE when compared to the use of LMWH in patients undergoingTKA.
Another meta-analysis that was recently published in January 2024 looked at antithrombotic prophylaxis following total hip arthroplasty.¹⁵ This was a Bayesian network meta-analysis that included data from 14 randomized controlled trials with a total of 31,705 patients.The objectives were rates of DVT, PE, and hemorrhage. It was found that apixaban 2.5 mg oral twice daily, fondaparinux 2.5 mg SUBQ daily, and rivaroxaban 30 mg oral twice daily were the most effective in reducing the rates of DVT ¹⁵ Rivaroxaban 30 mg twice daily was only used in one article that evaluated the dose-response relationship with rivaroxaban and VTE prophylaxis inTHR.¹⁶ However, major bleeding incidence increased dose dependently. It is important to note that rivaroxaban 30 mg twice daily is not used in clinical practice. Dabigatran 220 mg oral daily, apixaban 2.5 mg oral twice daily, and aspirin 100 mg oral daily were more effective in reducing rates of PE.15Apixaban 2.5 mg oral twice daily and aspirin 100 mg oral daily had the lowest rate of major hemorrhage.¹⁵ Astrength of this study is the systematic
CONTINUING EDUCATION
approach and incorporating a Bayesian network meta-analysis of multiple treatment options. This approach allowed for an effective comparison across different antithrombic regimens.Alimitation is that the study included only randomized controlled trials, which may not represent everyday clinical practice and limit its external validity. In conclusion, apixaban 2.5 mg oral twice daily is the most effective at preventing VTE while carrying a low risk of hemorrhage.
Conclusion
Prevention and proper management of VTE in total hip and total knee arthroplasty patients is extremely important and plays a crucial role in reduction of perioperative complication.Additionally, it helps reduce postoperative readmission and medical burdens to the healthcare system.This article illuminates the complex pathophysiology of VTE including the three essential factors of the clotting triad, venous stasis, endothelial injury, and hypercoagulability. Patient specific factors such as age, gender, BMI, and prolonged surgery, all play important roles in the process as well. Collectively, this information emphasizes the need for patient-tailored prophylaxis, including combined pharmacologic and mechanical methods. Vitamin K antagonists, LMWH, factor Xa inhibitors, and aspirin represent a range of pharmacologic options for preventing VTEs. Each agent has a unique mechanism of action and side effect profile.Abalance is thus found between efficacy in clot prevention and bleeding risk in order to individualize care for patient specific risk factors. Recent meta-analyses provide critical insight into the relative effectiveness of different prophylactic agents. The recent literature is pointing towards LMWH over aspirin in reducing VTE risk postTKR. However, agents such as apixaban and rivaroxaban have also shown to be effective. Ultimately, in order to prevent VTE in patients who receive total hip and knee arthroplasty, there needs to be a personalized approach based on patient individual risk factors to provide optimal patient outcomes.
1. Singh JA, Yu S, Chen L, Cleveland JD. Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample. The Journal of Rheumatology. 2019;46(9):1134-1140. doi:10.3899/jrheum.170990
2. Simon SJ, Patell R, Zwicker JI, Kazi DS, Hollenbeck BL. VenousThromboembolism inTotal Hip andTotal KneeArthroplasty. JAMANetwork Open. 2023;6(12):e2345883. doi:10.1001/jamanetworkopen.2023.45883
3. Lutsey PL, Zakai NA. Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol. 2023;20(4):248-262. doi:10.1038/s41569-022-00787-6
4. Fisher WD. Impact of venous thromboembolism on clinical management and therapy after hip and knee arthroplasty. Can J Surg. 2011;54(5):344-351. doi:10.1503/cjs.007310
5. Santana, D. C., Emara,A. K., Orr, M. N., Klika,A. K., Higuera, C.A., Krebs, V. E., Molloy, R. M., & Piuzzi, N. S. (2020).An Update on VenousThromboembolism Rates and Prophylaxis in Hip and KneeArthroplasty in 2020. Medicina (Kaunas, Lithuania), 56(9), 416. https://doi.org/10.3390/medicina56090416
6. Zhang Z hao, Shen B, Yang J, Zhou Z ke, Kang P de, Pei F xing. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC Musculoskeletal Disorders. 2015;16. doi:10.1186/s12891-015-0470-0
7. Etscheidt J, ShahienA, Gainey M, et al. Review of Therapeutic Options for the Prevention of VTE inTotal JointArthroplasty. Geriatrics. 2020;5(1). doi:10.3390/geriatrics5010018
8. Baser O, Supina D, Sengupta N, Wang L.Anticoagulation Bridging Therapy Patterns in Patients UndergoingTotal Hip orTotal Knee Replacement in a US Health Plan: Real-World Observations and Implications.Am Health Drug Benefits. 2011;4(4):240-248
9. Shafiei, S. H., Rastegar, M., Mirghaderi, P., Siavashi, B., & Mortazavi, S. M. J. (2023). Comparison of low-dose (162 mg) and high-dose (650 mg)Aspirin prophylaxis following total joint arthroplasty: a prospective cohort study Annals of medicine and surgery (2012), 85(5), 1461–1467. https://doi.org/10.1097/MS9.0000000000000366
10. Muscatelli SR, Charters MA, Hallstrom BR. Time for an Update?ALook at Current Guidelines for VenousThromboembolism ProphylaxisAfter Hip and KneeArthroplasty and Hip Fracture.ArthroplastToday. 2021;10:105-107. Published 2021 Jul 15. doi:10.1016/j.artd.2021.06.015
11.Anderson DR, Morgano GP, Bennett C, et al.American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. BloodAdvances. 2019;3(23):3898-3944. doi:10.1182/bloodadvances.2019000975
12. Overview | Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism | Guidance | NICE. Published March 21, 2018.Accessed March 29, 2024. https://www.nice.org.uk/guidance/ng89
13. Mont MA, Jacobs JJ.AAOS clinical practice guideline: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty JAmAcad Orthop Surg. 2011;19(12):777-778. doi:10.5435/00124635-201112000-00008
14. Meng J, Liu W, XiaoY,Tang H, WuY, Gao S.The role of aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis after total knee arthroplasty: a meta-analysis of randomized controlled trials. Int J Surg. 2023;109(11):3648-3655. Published 2023 Nov 1. doi:10.1097/JS9.0000000000000656
15. Migliorini F, Maffulli N, Velaj E, et al.Antithrombotic prophylaxis following total hip arthroplasty: a level I Bayesian network meta-analysis. J Orthop Traumatol. 2024;25(1):1. Published 2024 Jan 9. doi:10.1186/s10195-023-00742-2
16. Eriksson, B. I., Borris, L. C., Dahl, O. E., Haas, S., Huisman, M. V., Kakkar,A. K., Misselwitz, F., Muehlhofer, E., & Kälebo, P. (2007). Dose-escalation study of rivaroxaban (BAY59-7939)--an oral, direct Factor Xa inhibitor--for the prevention of venous thromboembolism in patients undergoing total hip replacement. Thrombosis research, 120(5), 685–693. https://doi.org/10.1016/j.thromres.2006.12.025
Continuing Education Assessment
1.Which of the following is a key component of Virchow's triad as discussed in the context of VTE in hip and knee arthroplasty?
A)Arterial stiffness
B) Bacterial Infection
C) Myocardial Infarction
D) Venous stasis
2.What is the recommended dosing of apixaban for VTE prophylaxis in patients undergoing hip or knee arthroplasty?
A) 5 mg oral twice daily
B) 2.5 mg oral twice daily
C) 10 mg oral once daily
D) 40 mg subcutaneous once daily
3.The 2019 guidelines from theAmerican Society of Hematology (ASH) recommend which of the following for VTE prophylaxis in patients undergoing hip or knee surgery?
A)Aspirin or direct oral anticoagulant (DOAC)
B) Warfarin over aspirin
C) Unfractionated heparin over DOACs
D) Mechanical methods alone
4.True or False:
Venous thromboembolism (VTE) in hip and knee arthroplasty patients is primarily caused by factors outside of Virchow's triad, such as bacterial infections and arterial stiffness.
5.True or False:
According to the 2019 guidelines from theAmerican Society of Hematology (ASH), aspirin is one of the recommended treatment options for VTE prophylaxis in patients undergoing hip or knee surgery
Rick G. Schnellmann, PhD Dean, University of Arizona College of Pharmacy
Nano-scale ionic liquids prove key to drug repurposing UArizona scientist develops novel therapies for infectious diseases
The drug delivery mission
AnAssistant Professor of Pharmaceutical Sciences at the R. Ken Coit College of Pharmacy and Director of its Drug Preformulation, Repurposing and Delivery (D-PReD) laboratory,Abhijit Date, PhD, is on a mission
.
“Since as long as I can remember, all I've been thinking about is pharmaceutical sciences, drug delivery, and how we can really make drugs better, safer,” he said. From his drug delivery studies as an undergraduate to predoc in Mumbai, India, to his work on treatments for infectious diseases in his postdoc and faculty appointments across the United States, Date’s work in the pharmaceutical sciences has focused on bringing vital, effective, accessible and appropriate treatment to those in need.
First drawn to the field through an interest in chemistry, Date credits his undergraduate and graduate research mentors Mrs. Sulabha Phadnis, Vandana Patravale, PhD, and Mangal Nagarsenker, PhD, for creating an engaging learning experience, increasing his awareness of drug chemistry, human physiology, disease pathology and other elements related to pharmaceutical science. Understanding of each of these, Date says, is key to developing effective drugs with appropriate delivery mechanisms.
With an extensive background in drug development and delivery, Date’s recent research has earned him the Coit College of Pharmacy’sA. Jay Gandolfi New Investigator Award in December 2023. Honored to receive the award, Date attributes the nomination to his work on repurposing drugs using nano-scale ionic liquids.
“University ofArizona,” he said, “provided excellent opportunities, facilities, and fantastic support to be able to expand further on the research that I was doing.”
Why repurpose drugs?
Research into anti-infective agents, particularly antibacterial and antifungal agents, Date said, is slow when compared to research into cancer treatment or certain antivirals. Companies invest less in drug development in these areas because it is considered less profitable.
“The issue is that with such diseases, the drug discovery efforts are fairly limited,” said Date, “so what we are left with is reimagining the tools that are currently there.”
So, scientists like Date must repurpose known drugs, adjusting their form and delivery to create viable treatments for diseases that do not benefit from new drug discovery research.
From a translational perspective, Date emphasized that ease of scalability also impacts drug development and affordability. Keeping this in mind, any reformulation he works on uses readily available components.
Nano-scale ionic liquids
Date’s recent reformulations and their scalability are made possible through technology he has patented since beginning his appointment at UArizona.
Ionic liquid is a delivery technology that allows Date to modify the physicochemical properties of drugs –including highly hydrophobic or highly hydrophilic ones, which are the most challenging to deliver – reformulating them to have better solubility, permeability and bioavailability. Combined, this allows for more effective treatments with fewer side effects, since these improvements help target the affected areas, with a minimal dose.
Abhijit Date, PhD
Ionic liquid technology can be applied to various drugs, allowing Date to utilize these liquids in multiple repurposing efforts – often in combination with nanoparticles.
Because nanoparticles are so small, they have excellent translocation capabilities, allowing them to move across barriers like tissue or cell membranes. Despite their size, when correctly engineered, these nanoparticles can contain a large quantity of the drug – or drug converted into ionic liquids – inside them and even prolong its release, allowing for fewer doses.
Key repurposing efforts
At UArizona, Date is working on repurposing and delivery of drugs targeting two main viral infections – herpes simplex virus (HSV) and human immunodeficiency viruses (HIV) – and cryptococcal meningitis, a fungal infection caused by Cryptococcus neoformans.
Ocular HSV
In 2022, Date began work as a co-PI on a five-year, translational research grant, awarded by the National Eye Institute, that funds research into a novel treatment of ocular HSV infections, which are a leading cause of infectious disease-related blindness. Since the current treatment involves taking eye drops five to nine times a day, patients are greatly in need of improved delivery
Together with the PI on the grant, Deepak Shukla, PhD, with the University of Illinois, Chicago, Date has been leading the repurposing and reformulation of an FDAapproved low-cost drug, phenylbutyric acid sodium, to treat ocular HSV infection.
“We have excellent data now,” Date said. “This drug and its reformulated version are really excellent in terms of efficacy.”
If all goes well, Date said, they may be able to file an Investigational New Drug (IND) application in a few years. If approved, they could begin human clinical trials. In a separate project focused on the mission of developing once-daily antiviral eye drops for ocular herpes therapy, Date, in collaboration with Shukla, has been able to create a nano-scale ionic liquid of antiviral drug that reveals excellent therapeutic outcomes in mouse models.
Cryptococcal meningitis
On another project in collaboration with Kirsten Nielsen, PhD, with the University of Minnesota, and Qing-Yu Zhang, PhD, at UArizona, Date works to repurpose a class of deworming agents, called anthelmintic benzimidazoles, to treat a fungal infection caused by Cryptococcus neoformans.
For the immunocompetent (those whose immune system is not compromised) this fungus is typically not detrimental, says Date. However, when people are
CONT UNIVERSITY & ALUMNI
immunocompromised because of HIV infection, a recent organ transplant or other factors, these fungi can cause issues with the lungs before invading the brain and causing cryptococcal meningitis – a life-threatening condition with a high mortality rate across the globe.
Current treatments for cryptococcal meningitis are few, are highly cost prohibitive and have many side effects.
Because most of the readily available deworming agents are intended for local action in the gut rather than translocation to the brain, Date has again utilized nanoscale ionic liquid technology to reformulate them.
“We have succeeded already,” said Date.
In mouse models, the fungi are so invasive that within 20 days, there is a 100% fatality rate in the untreated mice, Date said. When a particular benzimidazole is administered orally that rate declines to about 50%.
“But if we convert this drug into this delivery technology called ‘ionic liquids,’coupled with nanoparticles, we don’t have any mortality in the infected animals even after 75 days with good safety and low or no traces of fungi in the brain,” Date said. “So this is a very, very remarkable data and we have already filed another provisional patent on this data.”
HIV
In his third recent endeavor, Date has utilized this same nano-scale ionic liquid to develop more targeted anti-HIV drugs.
Awidespread disease, HIV is an immunocompromising disorder that currently requires a lifetime of treatment to mitigate the effects of the illness, but never fully eradicate it.
“Any discontinuation can actually lead to the rebound of the virus,” Date said, “because even though on the drug therapy, you are able to get the virus below the detectable level in your blood or in your plasma, the other sites –such as brain, or such as lymph nodes, or gut, or spleen or genital tract – they will still harbor the virus in its latent form and act as sanctuary sites for HIV.And the drugs actually are not able to adequately penetrate these sites.”
Date explains that while he had taken a break from research into HIV treatments, he has been able to renew his efforts due to the recent grant from the National Institute of Infectious Diseases, the breakthroughs in the patented ionic liquids technology and the institutional support he receives from the University ofArizona.
With these in place, Date said he has good, early data to indicate his reformulated drugs will penetrate the sanctuary sites more efficiently than the currently available formulations of anti-HIV drugs.
UNIVERSITY & ALUMNI
continued from page 25
Patient-centric research
As a pharmaceutical sciences researcher who also teaches pharmacy students in the clinical track, Date emphasizes that the two are interconnected – and the main goal of each is to deliver better patient care.
For pharmacists, this takes the form of direct patient interaction, personalizing patient therapies and calculating doses. While in work like Date’s in the pharmaceutical sciences, the aim of the research is to develop better therapies and technologies for patients.
“That,” said Date, “really is the ultimate goal.”
Written by Rachel Richardson.
Midwestern University College of Pharmacy
Mitchell R. Emerson, PhD Dean, Midwestern University College of Pharmacy
Greetings from the College of Pharmacy at Midwestern University!
Greetings from the College of Pharmacy at Midwestern University.As we get ready to welcome summer, we are reminded of the many accomplishments of our faculty, staff, students, alumni, and friends.As always, we want to highlight and celebrate all our milestones.
Campus life has been busy with the Class of 2024 Graduation ceremony onThursday, May 30th.The final day of rotations was May 10th and we hosted the class for an Awards Ceremony and BBQ. Graduation is scheduled on May 30th at 12pm with a festive reception following the ceremony All are welcome to celebrate the Class of 2024. The Class of 2024 will assume a tremendous variety of roles in their careers from community opportunities to residency and fellowship pursuits. The Class of 2024 had the highest percentage of the class match into a residency program to start their career! We wish all our graduates the best of luck as they pursue their pharmaceutical dreams all over the nation.
We are excited to get a refresh in Cholla Hall (home to much of the pharmacy program) this summer. We are set to welcome the Class of 2027 to campus for orientation starting May 28th and the first day of class on June 3rd. There is a full quarter of professional and personal development for the new students as we work with them to become exceptional pharmacists.Ahighlight of the first quarter is the CPGAlumni and Student Ice Cream Social. We are finalizing the date and will send out the information to our alumni and preceptors soon!
The events continue as we host our annual College of Pharmacy Dessert Reception in conjunction with the annual AzPAconference at the Hilton Phoenix Resort at the Peak. We hope you will plan to join us on Friday, June 7th on the FountainTerrace at 7:00pm.
We are looking forward to catching up with all of you and connecting at a future event. If you’re ever in the Glendale area, please reach out and stop by the campus. So much has changed, but still remains the same welcoming place.
Did you know we have a Midwestern University Job Board? If you’re looking to hire or looking for a new opportunity, please click here for more information https://www.midwestern.edu/alumni/alumnijob-finder
If you’ve recently moved or relocated, please ensure we have your updated contact information. Please email updates to your Manager ofAlumni Relations, Kimberly Hastings at KHastings@midwestern.edu
To follow us and learn more about our events and wins, join the MWU Pharmacy social media community:
Like us on Facebook: Midwestern University
Follow us onTwitter: @MWUpharmacy Follow us on Instagram: @MWUpharmacy
Creighton University College of Pharmacy
Jane Stein, PharmD Professor, Creighton University College of Pharmacy
Health Sciences Students in Phoenix Collaborate for a Stroke Simulation
Collaboration in healthcare is essential in ensuring quality patient care, so health sciences students at Creighton receive an interprofessional education.
The Creighton University Health Sciences Campus –Phoenix recently hosted an interprofessional event in its dedicated simulation space. Faculty and staff divided students into groups to run through a stroke simulation with standardized patients. Each group included a student representing one of seven healthcare professions: medicine, nursing, physician assistant, occupational therapy, pharmacy, physical therapy and paramedicine. The students then worked as a team to formulate the patients’ care plans from onset to discharge.
Chelsea Sandidge is the program manager for the Center for Interprofessional Practice, Education and Research (CIPER) at the Phoenix campus, and she believes that the stroke simulation truly captured the meaning of interprofessionalism.
“Every step of this simulation was a testament to collaboration and dedication to teamwork, from the faculty who planned the event to the students who participated. Together, we’re not just learning—we’re preparing to make a real difference in future patient care,” Sandidge says.
The simulation allowed students to showcase their role in the care of a stroke patient while learning about communication and team-based care. Students were able to better understand how their peers contributed to the care plan, which resonated with pharmacy student Delaney O'Brien.
"The stroke simulation was an extraordinary educational experience. We could see what it takes to treat a patient and how everyone has a part in it. I worked with nursing students, reviewing the medication, doses and times they needed to be dosed and worked with the MD and PA students to make sure the medications were suitable for the patient,” O’Brien says.
Faculty from each of the seven healthcare professions guided students through the simulation and imparted their interprofessional wisdom onto the students. Jane Stein, PharmD, assistant professor of pharmacy, values the event and its interprofessional perspective in practicing healthcare.
“This event allowed pharmacy students to hone their clinical skills within a team environment, improve communication skills within the team, enhance interdisciplinary collaboration for decision making and contribute to the delivery of high-quality care for patients,” Stein says.
An interprofessional education at the Creighton Phoenix campus does not end with events like the interprofessional stroke simulation. Students participate in Interprofessional Education Passport activities and work with students outside of their health profession. The Virginia G. Piper CharitableTrust Health Sciences Building is also home to a 35,000-square-foot interprofessional simulation space, where students practice skills with standardized patients and debrief afterwards.
Through interprofessional training, our faculty and staff prepare the next generation of healthcare professionals to provide team-based, collaborative care.
Pharmacist-Directed Hormonal Contraception Training
The Arizona Pharmacy Association is happy to announce that 2 years after the passage of SB1082 Arizona pharmacists can now dispense Self-Administered Hormonal Contraceptives to women 18 years and older pursuant to the newly adopted ADHS Statewide Standing Order!
Any pharmacist wishing to dispense self-administered hormonal contraceptives pursuant to this statewide Standing Order must be prepared to do the following:
Complete a 3-hour Training -AzPA has created one that is compliant with ARS 32-1979.01 and AAC R4-23-407 and R4-23-408-409.
Obtain necessary equipment to measure blood pressure.
Review the Standing Order, Standard Procedures, and Self-Screening Questionnaire. Establish SOP’s to ensure your pharmacy is compliant with all state laws.
Independent Pharmacies are NOT Safe from Cyberattacks
Have you ever had your credit card stolen, lost your wallet, or misplaced your social security card? Whether it has happened to you or not, you can imagine the pit of despair that settles in your stomach knowing that one malicious actor is all it takes to create dreadful issues in your life by misusing your information. The compulsion to protect your own credit cards and social security number has likely been engrained into your brain and safeguarding the information is second nature. What may surprise you, is that a valid set of payment card details is only worth a little over $5 on the black market and a social security number is only valued at around $0.50, according to a Trustwave Global Security Report1. What is even more surprising is the value of a health care record – one record goes for around $250. Some comprehensive health care records may even be valued as high as $2,000!
The data clearly shows there is a large financial incentive for malicious actors to target the healthcare sector The 2022Annual Report to Congress on Breaches of Unsecured Protected Health Information2 showed 68% of breaches reported to the Office for Civil Rights that affected 500 or more individuals were from health care providers, which supports the fact that all health care providers should be taking action to ensure the safety and security of their protected health information (PHI).
The 2022Annual Report to Congress also indicated 74% of those breaches were reportedly due to hacking/IT
incidents of electronic equipment or a network server. The compulsion to protect the pharmacy’s electronic PHI (ePHI) needs to be as important to pharmacy personnel as protecting their own credit card information and social security number The first step in that process is educating staff on cybersecurity. Whether you are the owner or an employee at a high-volume, multi-store pharmacy or a low volume, single-store independent pharmacy, your data is enticing to malicious actors and no pharmacy is safe from cyberattacks.
The IBM Cost of a Data Breach Report 20233 found that a malicious insider accounted for about 6% of the data breaches but was the most costly type of data breach, resulting in an annual cost of around $4.9 million dollars. Phishing and stolen or compromised credentials had an associated annual cost of $4.76 million and $4.62 million, respectively, but were more prevalent accounting for over 30% of the breach attack vectors.Additionally, only one in three organizations identified a breach using their organization’s own security team or tools—meaning, two out of three organizations had their breaches reported to them by law enforcement or the entity that unlawfully accessed their records (like when a ransom request was received to release their data). It also took an average of over 200 days from the date of the breach to identify that the breach occurred and another 73 days to contain the breach. Most pharmacies will take a full year to recover from a large data breach.
Rather than getting wrapped up in the financial and timeconsuming repercussions of a large breach, be protective. Cybersecurity training is essential to protecting your business, your reputation, and your ePHI. Having a tailored policy and procedure for protecting ePHI is only as good as the staff that adhere to those policies and procedures.Asingle careless or negligent employee can be the weak link broken by bad actors and may be the end of the pharmacy’s good reputation…and hard-earned money
PAASTips:
• Network connected medical device security
Know the top threats facing healthcare cybersecurity:
• Insider accidental, or malicious data loss
• Loss or theft of equipment and data
• Ransomware
• Social engineering
• Understand the components, and importance of a HIPAASecurity RiskAnalysis
• Perform and accurate and thorough assessment of the potential risk and vulnerabilities to the confidentiality, integrity, and availability of the pharmacy’s ePHI
•
• Identify and implement reasonable and appropriate physical, technical, and administrative safeguards as required by the HIPAASecurity Rule
Know the terms
• Vulnerability – a flaw or weakness in system security procedures, design, implementation or internal controls
• Threat – the potential for a person or thing to exercise a specific vulnerability (natural, human, and environmental)
• Risk – a function of the probability that a threat will attack a vulnerability and the resulting impact to the organization
• PAAS’FWA/HIPAACompliance Program4 provides pharmacies with a HIPAARiskAnalysis and Cybersecurity training
ByTrentonThiede, PharmD, MBA, President
at
PAAS
National , expert third party audit assistance, FWA/HIPAA and USP800 compliance.
The 2024Arizona State Legislature ended Sine Die the 56th regular legislative session on June 15, 2024, which was the 160th day after lawmakers narrowly passed a $16.1 billion budget filled with sweeps and cuts to state agencies and infrastructure projects. The legislative session was reminiscent ofTombstone,Arizona the “town too tough to die” and Wyatt Earp’s famous shootout at the O.K. Corral! However, outside of this theAzPAlegislative team was able to have a productive session.
On Wednesday, March 20, 2024, the annualAzPA Pharmacy Day at the Capitol was held. It was an enormous success! Over one hundred pharmacy professionals (Pharmacists, Pharmacy Technicians and Pharmacy Students) had meetings with forty legislators. Seventy-five legislators joinedAzPAmembers for lunch and conversation at the Wesley Bolin Plaza across from the Capitol. We had successes and setbacks with legislation.
The following Bills were introduced:
i SB 1085Test &Treat:AzPApartnered with theArizona RetailersAssociation, who introduced the bill. The bill failed to progress! We plan to take ownership of this bill in the next legislative session.
ii SB 1021 Sunrise Repeal: Signed on 04/24/2024; Chapter 75.This success will make it easier for expansion of scope of practice bills in the future.
iii SB 1164 Pharmacy Benefits Coverage; Exemptions: Passed House and awaiting Rules Committee action. This bill allows for coverage of existing non-formulary medications when a patient joins a new health plan.
iv SB 1165 PharmacyAudit Procedures; Prohibitions: Signed on 03/29/2024; Chapter 51. This bill will eliminate some penalties and procedures for the pharmacy being audited.
v. Provider Status.AzPAwas planning to introduce a pharmacist provider status bill this session. However, Blue Cross Blue Shield ofArizona reached out toAzPAwith a unique proposal that would allow pharmacists to be recognized as providers within the BCBSAZ Commercial provider network.
The upcoming legislative year will bring changes and new beginnings.This being an election year there will be fresh players at both the state and federal levels,AzPAwill experience a change as Kelly Fine,AzPAChief Executive Officer (CEO), has left us to assume a new chapter in her life serving as the Chief Executive Officer (CEO) of House of Refugee Sunnyslope. Mark Boesen and I want to thank Kelly for the tremendous successes she had leading AzPA.
Especially in the legislative arena, because of her hard work the profession of pharmacy has achieved profound respect among the Governor andArizona Legislature members and staff.TheAzPALegislative Committee wishes Kelly success in her new endeavor. However, Kelly will not leave us completely, as she will be involved in the PAPAprogram.And lastly a thank you to Diane McAllister of Public Policy Partners (P3). Diane serves as theAzPAlobbyist, who has worked tirelessly to helpAzPA navigate the complexities of theArizona Legislature.
