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MAR 2009

In Session The Key Issues

Pharmacists Should Be Watching

S t. A u g u S t i n e , F l o r i d A

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Florida Pharmacy TodaY

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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 11 FPA NEWS 22 Poster Abstracts 23 Buyer’s Guide

VOL. 72 | NO. 3 MARCH 2009 the official publication of the florida pharmacy association


12 14 16 20

Medicine Safety: Who’s At Risk and What You Can Do The Walkway of Recognition Follow The Redbrick Road FPA 119th Meeting & Convention Health System Pharmacy Highlights

MARCH 2 0 0 9



FPA Calendar 2008-2009

MARCH 21-22 FPA Committee and Council

JUNE 9-10



APhA Meeting San Antonio, Texas

10 Good Friday - FPA Office Closed 14-15 Board of Pharmacy Meeting Tampa 18-19 FPA Regulatory and Law Conference Tampa

Board of Pharmacy Meeting Fort Lauderdale JULY


ASCP Midyear Clinical

11-13 NCPA Legislative Conference Washington, D.C. 30

FPA Leadership Retreat

of the Florida Pharmacy Today Journal The Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Pharmacy Association can communicate with


FPA Office Closed for Independence Day

the profession on advances in the sciences of


FPA Annual Meeting St. Augustine, Florida

pharmacy and newsworthy items of interest

18-22 AACP Annual Meeting Boston, Massachusetts 25

FPA Legislative Committee Meeting Orlando

May 1 Legislative Session Ends

Mission Statements:

August 9-12 Southeastern Education Gatherin Villages at Baytowne Wharf 11-12 Board of Pharmacy Meeting Orlando 14-16 Southeastern Officers Conference 29-30 FPA Committee and Council Meetings Orlando

pharmacy, socio-economic issues bearing on to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.

of the Florida Pharmacy Today Board of Directors The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and executive editor of the Florida Pharmacy Today

Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members

For a complete calendar of events go to CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part of the required 30 hours general education needed every license renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2009 or prior to licensure renewal. *For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact Ranada Simmons in the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Michael McQuone (850) 906-9333 U/F — Dan Robinson (352) 273-6240 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

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to secure appropriate advertising to assist the

Journal in its goal of self-support.

Advertisers Dr. OJO................................................................ 2 HAYSLIP & ZOST............................................. 13 Healthcare consultants..................... 3 Kahan ◆ SHIR, P.L........................................... 9 McKesson....................................................... 24 MEDICAL STAFFING...................................... 13 PHARMACY MAX............................................. 9 PHARMACY PROVIDER SERVICES (PPSC)........................................ 21 Rx RElief.......................................................... 21 UNited Drugs................................................. 6 UF College of Pharmacy..................... 21

E-mail your suggestions/ideas to

The President’s Viewpoint by Norman Tomaka FPA PRESIDENT

Pharmacists are the Prescription for Health Care Reform


he buzzword in health care once again is “reform.” Justifiably, the new leadership in Washington has recognized that our nation can no longer continue to appropriate the current level of funding for the growing healthcare needs of our patients. Florida’s elected representatives are struggling to construct a budget that copes with bloating health care expenditures. Pharmacists, too, have long been calling for meaningful changes to the health care delivery system that integrate our training and unique accessibility to the consumer. Recently, leadership from both sides of the aisle in Congress and the State has been referring to a concept pharmacists are involved with every day — “Prevention!” Today, members of the public are better informed than in the past and are willing to take more personal responsibility for their own health status. As economic pressures rise, our patients want to obtain as much information as possible from expert sources to help them take appropriate action in their health care. Consumer research demonstrates that Floridians recognize the pharmacist as an authoritative source of information and advice. Patient “self-care” as a means of cost-effective preventative health care is a growing opportunity for all pharmacists in every practice environment. The patient is calling on pharmacists to proactively provide expert advice more than ever before. Patient “self-care” includes the prevention of undesirable conditions by appropriate diet, exercise, consumption of, at most, only moderate amounts of alcohol, smoking cessation, refrain-

ing from use of other tobacco products and avoiding misuse of drugs. When preventative measures fail, self-medication, which is the treatment of symptoms that the patient has observed for himself with medicines available without prescription, should be responsible. Essentially, self-treatment becomes preventative, allowing the patient to heal

Today, members of the public are better informed than in the past and are willing to take more personal responsibility for their own health status. without more costly and inappropriate care as ailments worsen. As one of the primary means of healing the current economic strain, government and health insurers are on a mission designed to encourage responsible selfcare and improve the health of our nation. Will it happen? Florida’s pharmacists must be allowed to initiate new cost-reducing practices if health care reform is to be successful. The demographics in Florida have long favored pharmacists’ unique position to lead reformation in the medication delivery system. One example of an opportunity available to all pharmacists is the ability to administer influenza vaccines. During the past

Norman Tomaka, 2008-09 FPA President

year, Florida’s pharmacists improved the consumer’s commitment to influenza prevention by providing information and access to the vaccine. If meaningful health care reform is to produce substantial savings and improved patient health, pharmacists must be at the forefront helping to reduce unwarranted use of more costly health care interventions by reviewing effective selfcare opportunities. Other examples of where pharmacists can make meaningful changes include: 1) improved access to all vaccines and subsequent administration; 2) provide information on effective community-based smoking cessation programs and adjunct OTC therapy; 3) provide information on comprehensive prenatal care including OTC vitamin compliance and blood monitoring; 4) provide information on dietary intervention related to cardiovascuMARCH 2 0 0 9



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lar health and associated medication therapy; and 5) provide innovative and intense management of select medications with the highest risk of adverse reactions including anticoagulants, immuno-modulators and drugs with an invasive route of administration. Members of the FPA have unique access to advanced training and necessary medication therapy experience through upcoming programs and new initiatives. The time has come to expand cost-effective initiatives that include pharmacist monitoring as a major component of the required patient consultation. Numerous studies have been presented documenting reduced emergency patient care when a pharmacist was involved in each of the five aforementioned examples. From expectant mothers with anemia and the COPD patient addicted to nicotine to the heart patient beginning statin therapy, pharmacists can make a dramatic impact and reduce costs. It’s time for the health care payers, including the patient, to shift funding to preventative care provided by the pharmacists. There has been a lot of talk about elected representatives working together on behalf of the U.S. taxpayer. There should be more talk about insurance corporations and pharmacists working together on behalf of their customer- the patient! Our health care delivery system must invest in the expert care pharmacists are already educated to provide. For health care reform to provide substantial savings, the “managed care” arena must utilize pharmacists in proven initiatives to deliver cost savings to their customer. The time is NOW to end alienating audits and exclusive care arrangements that have not reduced costs. Let’s terminate tired old cost-ineffective insurance industry practices that interfere with the patient’s ability to access the expertise of their pharmacist! For change in the delivery of health care to be cost-effective, all health care professionals must be involved with the patient. Instead of segregating the patient from their pharmacist, the insurance industry should embrace pharSee "Viewpoint" continued on page 10

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Executive Insight By Michael Jackson, FPA Executive by michael jackson, Vice RPh President/CEO

Managing Public Health Care Policy During a Budget Crisis


here is no secret that we are experiencing one of the most significant budget challenges in recent years. The U.S. economy is being simultaneously buffeted by three major shocks: ■■ Home prices have fallen at the national level for the first time since the Great Depression (down 17% so far). ■■ Financial markets are experiencing their worst credit crunch since the late 1980s at best – maybe since the Great Depression, and ■■ The U.S. recession is spreading globally, causing additional feedback loops. Florida has been hit particularly hard by the two housing-related shocks: home prices and credit tightening. With all these issues pending, it is likely that the Florida Legislature currently meeting in Tallahassee until May 1 will focus much of its attention on finding new dollars and writing a budget with lower expenditures. Our state’s pharmacy school programs are being hit especially hard, creating significant challenges and impeding growth. Still, in pharmacy health care we are working to find ways to continue our focus on patient care programs through medication therapy management. This year, the FPA leadership has elected to not file any legislation to revise the pharmacy practice act and instead will focus our efforts on closely monitoring general health care issues and funding of the Medicaid program. When there is evidence of a health care funding crisis, the profession and business of pharmacy is generally quite vulnerable. We must keep a close watch

on policy that directs revenue to ensure that pharmacy services are adequately supported. We must also ensure that health policy decisions reviewed do not adversely affect pharmacists’ ability to deliver services. Below is a short summary of various pieces of legislation that we are observing during the legislative session. You can follow their progress through the FPA Web site at bills/.

Florida has been hit particularly hard by the two housingrelated shocks: home prices and credit tightening. Formulary Systems in Nursing Homes SB 1868 sponsored by Senator Durell Peaden - Authorizes the use of an institutional formulary system in a Class I institutional pharmacy at which, with certain exceptions, all medicinal drugs are administered from individual prescription containers to the patient and medicinal drugs are not dispensed on the premises.

Michael Jackson

Expansion of the Cancer Drug Donation Program SB 1866 sponsored by Senator Durell Peaden - Renames the Cancer Drug Donation Program as the Prescription Drug Donation Program. Revises definitions and expands the drugs and supplies that may be donated under the program. This legislation expands the types of facilities and practitioners that may participate in the program. Conforms provisions to changes in terminology and removes obsolete language relating to the adoption of initial rules. Prohibiting Use of Prescription Drug Information SB 1402 sponsored by Senator Dave Aronberg - Prohibits the licensure, transfer, use, or sale of records of information relating to drug prescriptions containing certain identifiable data regarding patients and prescribers. The legislation does not prohibit certain activities involving prescription information or the collection, use, transfer, or sale of information that does not idenMARCH 2 0 0 9



FPA Staff Executive Vice President/CEO Michael Jackson (850) 222-2400, ext. 200 Director of Continuing Education Tian Merren-Owens, ext. 120 Controller Wanda Hall , ext. 211 Membership Coordinator Ranada Simmons , ext. 110 Educational Services Office Assistant Stacey Brooks , ext. 210 Florida Pharmacy Today Board Chairman................................................... Dick Witas, Odessa Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member...........................Betty Harris, Lighthouse Point Member..................................... Joseph Koptowsky, Miami Member...................................... Jennifer Pytlarz, Brandon Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2009, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. Florida Pharmacy Association

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web Address: 8 |

Florida Pharmacy TodaY

tify a patient or prescriber, etc. Relating to Health Care Clinic Purchasing of Prescription Drugs SB 1144 sponsored by Senator Durell Peaden - Prescription Drugs/Manufacturers and Purchasers; Redefines the term “manufacturer” as it relates to the Florida Drug and Cosmetic Act. This bill revises the business entities that are eligible for a permit as a health care clinic establishment in order to purchase prescription drugs. Pharmacy School at the University of South Florida SB 1120 sponsored by Senator Mike Fasano and HB 75 sponsored by Representative Seth Mckeel - Univ. of South Florida/Pharmacy Degree Program This bill seeks to authorize a doctor of pharmacy degree program at the University of South Florida. Relating to Racial and Ethnic Minority Health Care SB 1028 sponsored by Senator Eleanor Sobel and HB 343 sponsored by Representative Yollie Roberson - Racial and Ethnic Minority Health Care – This legislation requires the Department of Health (DOH) to develop and implement plans relating to effective community outreach and to increase the number of racial and ethnic minority health care professionals. The bill requires the DOH to collaborate with universities, colleges, and others on development of courses on cultural competency, sensitivity, and health literacy, etc. Relating to Prescription Drugs Donation to Correctional Facilities SB 984 Prescription Drugs; Cites this act as the “Drug Donation Program Act.” Creates said act for the state correctional system. The bill provides conditions for the acceptance of drugs and supplies into the program, inspection of drugs and supplies, and dispensing of drugs and supplies to eligible prisoners. Requires the Department of Health to establish and maintain a participant facility registry, etc.

Electronic Health Information Technology SB 876 sponsored by Senator Don Gaetz and HB 1097 sponsored by Representative Denise Grimsley - Authorizes the release of patient records to certain additional health care practitioners or providers. This bill also authorizes a health care provider to release or access an identifiable health record without the patient’s consent in an emergency. The is additional authorization granted for the results of a clinical laboratory test to be sent to certain health care practitioners or providers involved in the care or treatment of a patient, etc. Relating to Supervision of Physician Assistants SB 720 sponsored by Senator Durell Peaden and HB 249 sponsored by Representative Jimmy Patronis - Supervision of Physician Assistants - Provides that a supervising physician may not be required to review and cosign a physician assistant’s charts or medical records. The bill deletes certain supervisory physician requirements related to prescribing and dispensing medications noted in appropriate medical records. ARNP Prescribing Authority for Controlled Substances SB 426 Advanced Registered Nurse Practitioners Controlled Substance Prescribing Authority sponsored by Senator Mike Bennett - Redefines the term “practitioner” for purposes of the Florida Comprehensive Drug Abuse Prevention and Control Act to include advanced registered nurse practitioners. If signed into law by the governor this bill would allow ARNPs in Florida to prescribe controlled substances. Expansion of Optometrist Prescribing Authority SB 326 sponsored by Senator Charlie Dean and HB 507 sponsored by Representative Juan Zapata - Expansion of Optometrist Prescribing Authority Revises definitions to conform to provisions authorizing the oral administration of ocular pharmaceutical agents by certain practitioners. The bill would require the Board of Optometry to adopt

rules governing the administration and prescription of oral ocular pharmaceutical agents. The legislation also redefines the term “practitioner” for purposes of the Florida Comprehensive Drug Abuse Prevention and Control Act to include certified optometrists, etc likely granting the ability to prescribe controlled substances. Reproductive Health Services and Family Planning SB 310 sponsored by Senator Nan Rich and HB 129 sponsored by Representative Audrey Gibson, Reproductive Health Services and Family Planning Creates the “Prevention First Act.” The legislation provides duties of licensed health care practitioners and facilities relating to the treatment of rape survivors. This bill requires the Agency for Health Care Administration (AHCA) to provide for enforcement and impose penalties. This bill also requires licensed pharmacies to dispense certain forms of contraception without delay and defines how a person can file

a complaint with the DOH if he or she believes that a violation of such provisions has occurred, etc. Alzheimer’s Disease Education Program SB 260 Alzheimer’s Disease Education Program sponsored by Senator Stephen Wise - This legislation directs the Department of Elder Affairs to develop and implement a public education program relating to screening for Alzheimer’s disease. The bill requires grant recipients to submit an evaluation of certain activities to the department and authorizes the department to provide technical support. The bill includes a requirement for the submission of an annual report to the Legislature and the department to conduct or support a study on memory-impairment screening, etc Relating to Vaccines Containing Mercury Compounds/Regulation SB 200 sponsored by Senator Mike Bennett, SB 154 sponsored by Sena-

A Pharmacist And A Lawyer Board of Pharmacy Licensure Disciplinary Proceedings Defense of Chapter 499, Pedigree Laws Violations Mergers and Acquisitions Commercial, Civil and Criminal Proceedings

tor Jeremy Ring and HB 39 sponsored by Representative Michael Scionti Vaccines Containing Mercury Compounds/Regulation; This bill creates the “Vaccine Safety Act” and prohibits the sale, purchase, manufacture, delivery, importation, administration, and distribution of vaccines containing organic or inorganic mercury compounds in excess of a certain amount. Pharmacy Services in Schoolbased Health Centers SB 190 sponsored by Senator Federica Wilson - School-based Health Centers – This legislation defines the term “school-based health center” for purposes of the School Health Services Act. The bill provides that such a center is a health care entity acting as an instrument of the state for purposes of certain limitations on liability. The legislation appears to create pharmacy services in a school based health center. Electronic Health Records SB 162 sponsored by Senator Jere-

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my Ring - Electronic Health Records – This legislation expands access to a patient’s medical records to facilitate the electronic exchange of data between certain health care facilities, practitioners, and providers and attending physicians. The bill creates the “Florida eHealth Initiative Act” and requires the Agency for Health Care Administration to award and monitor grants to certain health information organizations, etc. School Nurses/Epinephrine Auto-injectors SB 70 sponsored by Senator Dave Aronberg and HB 721 sponsored by Representative Adam Fetterman School Nurses/Epinephrine Auto-injectors – This legislation provides that a district school board may authorize a school nurse to maintain supplies of prefilled epinephrine auto-injectors at schools in the school district. The bill provides requirements for prescriptions and authorizes use for emergency treatment, etc. Relating to Prohibited Discrimination HB 397 sponsored by Representatives Garcia; Heller; Jenne; Kiar; Kriseman; Long; Pafford; Porth; Randolph; Sachs; R. Saunders; Soto; Steinberg; Waldman – This legislation prohibits discrimination based on sexual orientation, gender identity or expression, pregnancy, familial status, and marital status on pharmacies and other businesses. The bill defines terms and conforms terminology. Relating to Medicaid Prescribed Drugs/Purchasing SB 894 sponsored by Senator Michael Bennett and HB 5433 sponsored by Representative Ken Roberson - Medicaid Prescribed Drugs/Purchasing – This legislation would require providers of Medicaid prescribed drugs to give purchasing preference to drugs manufactured or repackaged at certain facilities. The bill defines the term “qualifying facility” and provides for the Department of Health’s recognition of a qualifying facility. The bill requires the department to adopt procedures and criteria for the recognition of 10


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a qualifying facility. Prescription Drug Monitoring Programs SB 1356 sponsored by Senator Mike Bennett, SB 614 sponsored by Senator Dave Aronberg, SB 462 sponsored by Senator Mike Fasano, HB 583 sponsored by Representatives Skidmore, Nehr, Pafford and Porth and HB 143 sponsored by Representative Domino. The majority of these bills either direct the Department of Health (DOH) or the Agency for Health Care Administration (AHCA) to establish a comprehensive electronic system to monitor dispensing of certain controlled substances. The bills may require those who dispense certain controlled substances to submit specified information to Department or Agency and provides exceptions to reporting requirements. There are additional requirements that information be submitted in approved electronic format within time periods for information submission. There are criminal penalties for violations of this chapter, etc. SB 614 and HB 143 would require pharmacies to purchase biometric scanners. Public Records Exemption Bills for Prescription Drug Monitoring Programs SB 1354, SB 612, SB 440, HB 585 and HB 145 are all bills that grant a public records exception for data submitted to the Department or Agency under the prescription drug monitoring program bills from above. Members need to be aware that these are the bills that we have identified at the time of this publication. At any time, proposed legislation can be found favorable or not favorable. Legislation passed by the Florida House and Senate will need to be reviewed and approved by the Governor’s Office. The outcomes will not be known until several weeks after the session has ended. For a report on the outcome of the session plan to visit with us at the FPA annual meeting in St. Augustine, Florida. You may need to register early as the number of rooms available are limited. n

"Viewpoint" continued from page 6

macists’ cost-savings potential. An initiative that has the locked potential to produce substantial savings includes pharmacist management of uncoordinated care. Insurers should empower pharmacists to directly assist those patients utilizing excessive numbers of prescriptions, therapeutically duplicative drugs, frequently changing drug therapies, multiple prescribers and multiple concurrent pharmacies. Patients involved with uncoordinated care represent less than 10 percent of the patient population but account for 46 percent of all drug costs. It’s time to utilize pharmacists in realtime claims analysis to educate patient and prescriber about potentially adverse therapies and wasteful expenditures. Preventing negative outcomes from new drug therapy is proactive, preventative health care. The FPA will provide educational information and training regarding uncoordinated care at the 119th Annual Meeting in St. Augustine July 8-12. Check it out at! Washington and Tallahassee have long recognized that constructive changes to our health care delivery system can improve the health of our economy. Once again, the taxpayer and patient are waiting for change that empowers the pharmacist to deliver the prescription for cost savings and improved preventative-health outcomes. Will our elected leaders have the courage to advocate for this change? n

FPA NEWS Broward County Pharmacy Association CE Meeting

ABOVE BCPA President Aneesh Lakhani addressing more than 200 pharmacists at the beginning of the CE meeting. RIGHT Broward County Pharmacy Association President Aneesh Lakhani presenting a check for $2600 to Toby Bogorff, Vice President, Children’s Cancer Caring Center. The money was raised by the Broward County Pharmacy Association at the 2008 Christmas Boat Parade in Ft. Lauderdale. BELOW Michael Jackson, Executive Vice President and CEO of the Florida Pharmacy Association, speaking to the same group. Awards won by BCPA at the 2008 FPA convention were on display.

FPA Election Results The 2009 canvassing committee of the Florida Pharmacy Association is pleased to announce the results of the 2009 election. In a very close race, members elected Hialeah pharmacist Humberto Martinez as President Elect of the Florida Pharmacy Association. The FPA's next Treasurer will be Don Bergemann of Tarpon Springs, Florida. The District 7 representative will be Kim Murray. Congratulations to each of these candidates. The installation will take place during the president's breakfast at the annual FPA meeting in St. Augustine, Florida.

Humberto Martinez, President Elect

Don Bergemann, Treasurer Elect

Kim Murray, District 7 Representative Elect

MARCH 2 0 0 9



Medicine Safety: Who’s At Risk and What You Can Do

Today’s medicines cure infectious diseases, prevent problems from chronic diseases, and alleviate pain for millions of Americans. But medicines can also cause harm. Adverse drug events cause over 700,000 emergency department visits each year. Patients and their families can do a number of things to help reduce the risk of harm from medicines, and pharamcists are often the first line of defense in educating them. The following information from the Centers for Disease Control and Prevention may be a good starting point for discussing these important issues. What Is Medication Safety and What Are Adverse Drug Events? Medication safety includes a number of things that patients can do to make sure that they get the most benefit from medications with the least risk of harm. When someone has been harmed by a 12


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medication, they have had an adverse drug event. Are Adverse Drug Events a Big Problem? There are many ways to measure the size of the problem of medication safety. Recent work at CDC has focused on the short-term, severe problems of medicines taken by people outside of hospital settings. It is estimated that there are more than 700,000 visits to emergency departments for adverse drug events each year in the United States. Nearly 120,000 of these patients need to be hospitalized for further treatment. This is an important patient safety problem, but many of these adverse drug events are preventable. Who Is At Risk for Adverse Drug Events? Anyone who takes medicines has some risk of a harmful effect. How

high that risk is depends on the individual patient’s health, the particular medicines a patient is using, and how patients use their medicines. Nevertheless, national data suggest there are some key risks and risk groups: ■■ Young Children: Children less than 5 years old are twice as likely as older children to be taken to emergency departments for adverse drug events (nearly 98,000 emergency visits each year). Most of these emergency visits are due to young children finding and eating or drinking medicines on their own, without adult supervision. ■■ Older Adults: Older adults (65 years or older) are also twice as likely as others to come to emergency departments for adverse drug events (over 177,000 emergency visits each year). Older adults are nearly seven times more likely to be hospitalized after an emergency visit, but most


of these hospitalizations are due to just a few drugs known to require careful monitoring to prevent problems. Common drugs that can require monitoring are blood thinners (e.g., warfarin), diabetes medications (e.g., insulin), seizure medications (e.g., phenytoin), and digoxin (a heart medicine). All Adults: The death rate from unintentional prescription drug overdoses is highest among middleaged adults (40–49 years old). In 2004, over 7,500 Americans died of unintentional overdoses of opioid (or narcotic) analgesics (pain medications such as methadone, oxycodone, and hydrocodone), more people than from cocaine or heroin.


Parents of young children ■■

What Can Patients Do? All patients ■■

Know your medicines. Keep a list of the names of your medicines, how much you take, and when you take them. Include over-the-counter medicines, vitamins, and supple-

ments and herbs. Take this list to all your doctor visits. Follow the directions. Take your medicines exactly as prescribed. Don't take medications prescribed for someone else. • Ask questions. If you don't know the answers to these questions, ask your doctor or pharmacist. • Why am I taking this medicine? • What are the common problems to watch out for? • What should I do if they occur? • When should I stop this medicine? • Can I take this medicine with the other medicines on my list?


Store medicines safety. Keep all medicines stored securely, out of the reach of children. Leave medicines in their original packaging and make sure the caps are always secured. Never tell children that medication is candy. Avoid unnecessary medicines. Antibiotics and cough and cold med-


ications will not cure most colds, coughs, flu, sore throats, or runny noses. These medicines can sometimes cause more harm than good. Adults and older adults ■■


Take pain relievers only as directed. If you are taking opioid pain relievers, be sure to tell your doctor about all other medicines you are taking because some medicines, when taken with pain relievers, can cause an adverse drug event, such as an overdose. Ask if you need blood testing. If you take any medicines that require special testing, pay particular attention to taking these properly and get regular blood testing. Common medicines that can require monitoring are blood thinners (e.g., warfarin), diabetes medications (e.g., insulin), seizure medications (e.g., phenytoin), and digoxin (a heart medicine). Source: Centers for Disease Control


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The Walkway of Recognition Follow The Redbrick Road At the recent Florida Pharmacy Association’s (FPA) C. E. program held in Sandestin, FL, the Florida Pharmacy Foundation set up a table and displayed the newest sign advertising the availability of purchasing a Gift Brick, to be engraved for one’s self or in honor of someone special. The Redbrick Road, the Walkway of Recognition, leads to the front entrance of the FPA office, which will replace the much-needed old sidewalk. The Mincys, Bill and Cyndi, who are both Trustees, passed out brochures, and Bill made a presentation on behalf of the Foundation to the more than 200 pharmacists in attendance. Jim Powers and Pat Powers, Executive Vice President of the Foundation, answered questions and took the orders for the sale of the bricks; giving each a lapel pin that said “I Bought One.” 2








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1. Cyndi and Bill Mincy, Bought Two Bricks 2. Holding a sample Gift Brick is Pat Powers, who Bought One 3. They Bought One – Jane and Ronald Clayton 4. Maita Singer wearing her I Bought One lapel pin 5. Jim Powers (l) Bought one and Don and Dianna (not shown) Lanier Bought One 6. Suzanne Kelly plans to recommend Escambia County PA buy a brick




Have you been searching for just the right gift or thought of placing your name in perpetuity? If so, then consider purchasing an engraved brick for you or someone else. The main sidewalk at the Florida Pharmacy Association needs replacing. The Florida Pharmacy Foundation has undertaken the project to repair and beautify the sidewalk with engraved personal bricks purchased by pharmacists or friends of pharmacy. Engraved 4x8 bricks can be purchased for $250.00 each with the donor’s name engraved (3 lines available) or you could also purchase an engraved brick for someone you feel should be honored or remembered. The monies earned from this project will be used to fulfill the goals and future of the Foundation. There are a limited number of bricks available – so, it is first come first served.


The Walkway of Recognition

❑ YES, I want to order _______ concrete brick/s at $250.00 each. (Please copy form for additional inscriptions). PL E A S E P R INT I NSC RIP TION

The concrete bricks are 4x8 and can be engraved with up to 14 characters per line, three lines available, spaces and punctuation count as one character. Please find enclosed my check for $_________ for _________ bricks. PLEASE PRINT: Please charge my

❑ Master Card


Contributions to the Florida Pharmacy Foundation are tax deductible as a charitable contribution for federal income tax purposes. Consult your CPA for complete details. Fed Emp. I.D. #59-2190074

❑ Visa EXP. DATE





Send to Florida Pharmacy Foundation, 610 N. Adams St., Tallahassee, FL 32301, or fax to (850) 561-6758.



MARCH 2 0 0 9





Florida Pharmacy TodaY

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Health System Pharmacy Highlights Dawn R. Sollee, Pharm.D, DABAT, Assistant Director Florida Poison Information Center/Jacksonville At Shands Jacksonville

Clinical Toxicology as a Career Editor’s Note: The world of Pharmacy offers a variety of diverse career opportunities; this column continues to highlight the role of health-system pharmacists practicing in unique settings.

Clinical toxicology is an exciting career path available to pharmacists today. Specializing in clinical toxicology can lead to positions in health-systems, poison information centers, industry, and/or academia. There are only a handful of residencies in the United States available to train pharmacists to become clinical toxicologists. Unfortunately, funding for these programs remains an ever-present issue. The goal of these residency training programs is to produce a candidate who can successfully achieve the status of a Diplomate of the American Board of Applied Toxicology (DABAT). Graduates of these specialized twoyear residencies often become directors or assistant directors of poison centers, emergency medicine pharmacists, college of pharmacy faculty, or employees of pharmaceutical companies. As the assistant director of a poison center, a snapshot of a typical day starts at 7:00 a.m. with rounds in the Emergency Department, and rounding on patients with toxicology issues who have been admitted to the hospital. Each day of a patient’s admission, I visit the patient, recommend changes to the management plan and document these recommendations in the medical record to optimize treatment of the toxic patient. Since our poison center is located on the campus of an academic 20


Florida Pharmacy TodaY

teaching hospital, there are also multiple opportunities for teaching and interacting in a multi-disciplinary environment. On a given day, the on-call toxicologists supervise pharmacy residents, emergency medicine residents, pediatric emergency medicine fellows, pediatric medicine residents and pharmacy students during toxicology rounds. To ensure understanding of a core list of topics, group discussions reviewing toxin assessment and management, and review of ongoing cases occur daily. My role also involves administrative functions for the poison center including quality improvement activities, research, revision of policy and procedures, updating of treatment protocols, scheduling of Specialists in Poison Information (SPI), and coordination of student and resident schedules. The clinical toxicologists at our Poison Center share on-call, 24-hour-a-day availability for consultation to physicians and other health care providers to assist in the treatment of the poisoned patient. Access to the poison center can be obtained by calling the toll-free national number for poison control 1-800222-1222. When dialed, calls are routed to the appropriate poison center covering the geographic area of the caller. In Florida, there are three poison centers that comprise the Florida Poison Information Center Network with locations in Jacksonville, Tampa and Miami. Phones are answered by Specialists in Poison Information (SPIs) who are specially-trained health care students, pharmacists, nurses, and/ or physicians. Higher acuity calls are usually triaged to the on-call toxicologist for input.

Dawn R. Sollee, Pharm.D, DABAT

National Poison Prevention Week, observed March 15-21, 2009, provided pharmacists in all practice settings with an opportunity to play a role in decreasing the incidence of therapeutic errors. Medication/therapeutic errors account for approximately 10 percent of exposures reported to poison centers. This does not include adverse drug reactions, which are responsible for an additional 2 percent of calls. Poison prevention education and medication counseling are examples of important ways pharmacists can impact the safety of the community. Pharmacists who are interested in providing poisoning prevention education can contact their local poison center at 1-800-222-1222, to request additional information including brochures, poison information hotline stickers, etc.

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July 8 - 12, 2009 Renaissance Resort at World Golf Village ♦ St. Augustine, Florida Poster Session: Friday, July 10, 2009, 4:30-6:00PM

The FPA Poster Presentations are open to PHARMACY STUDENTS ONLY. Complete and submit this COVERSHEET for each abstract submission. Submissions must be received no later than Monday, May 4, 2009. Abstracts will NOT be accepted after this date. Mail or E-mail this application along with the abstract submission to: Tian Merren Owens, MS, PharmD, Director of Pharmacy Services Florida Pharmacy Association 610 N. Adams Street Tallahassee, FL 32301


Contact Information: Presenter's Name (MUST BE A STUDENT):________________________________________________________________


Level Pharm.D.

Post B.S. Pharm.D.

Address: ________________________________________________________________________________________ City, State, Zip: ___________________________________________________________________________________ Telephone No: _____________________E-Mail Address: _________________________________________________ Abstract Title: ____________________________________________________________________________________ Primary Author: __________________________________________________________________________________ (Students must be listed first to be considered for the Award. Presenter will be notified by mail of acceptance). Co-Author(s): _________________________________________________________ Student



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Posters will be eligible for 1 , 2 , and 3 place prizes to be presented at Convention. (Only one prize is given for each winning poster)

Free Registration:

Three entry level students from each Florida College of Pharmacy will be eligible for a complimentary Florida Pharmacy Association Convention Student registration. (Student Registration does not include CE or hotel accommodations) I am interested in being considered for this registration





ABSTRACT FORMAT The abstract form submitted should be the equivalent of one page. The abstract should include:

Title (Include authors’ names and name of College of Pharmacy), Purpose, Methods, Results, and Conclusions. Abstracts will not be accepted if it is not in this format. Do not include figures or graphs.

Please direct all questions and concerns to:

Tian Merren Owens ♦ (850) 222-2400 ext. 120 ♦ DEADLINE DATE: MONDAY, MAY 4, 2009

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FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 487-4441 pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 Drug Information Center Palm Beach Atlantic University (561) 803-2728 DRUG INFORMATION CENTER Florida A&M University College of Pharmacy (800) 451-3181 UF College of Pharmacy Gainesville, FL (352) 395-0408 FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 FLORIDA POISON INFORMATION CENTER NETWORK 1-800-282-3171 pcc/fpicjax.htm National Community Pharmacists Association 100 Daingerfield Road Alexandria, VA 22314 703.683.8200 703.683.3619 fax

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March 2009 Florida Pharmacy Journal  

March 2009 Issue