The Official Publication Of The Florida Pharmacy Association DEC. 2011
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A Pharmacist And A Lawyer Board of Pharmacy Licensure Disciplinary Proceedings Chapter 499 Violations, Pharmacy Audit Disputes Mergers and Acquisitions Commercial, Civil and Criminal Proceedings
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Florida Pharmacy Association
florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 19 Buyer’s Guide
VOL. 74 | NO. 12 DECEMBER 2011 the official publication of the florida pharmacy association
Pharmacy Quality Commitment – Putting Continuous Quality Improvement into Action Holiday Reminder: Put Your Medicines Up and Away and Out of Sight
FPA Calendar 2011-2012
PDMP Workshop Orlando, Florida
FPA Law Conference Sarasota, Florida
13-14 Florida Board of Pharmacy Meeting Gainesville, Florida 23 & 26 FPA Office Closed for Holidays
28 - 29 FPA Law and Consultant Conference Sandestin 31
Florida Board of Pharmacy Meeting St. Augustine
Awards nomination due
JANUARY 2012 2
FPA Office Closed for New Year’s Day
FPA GAC Conference Call
Legislative Session Begins
FPA Office Closed for Martin Luther King’s Birthday
Journal Board Conference Call
24-25 Pharmacy Days at the Florida Capitol 25
Florida Pharmacy Health Fair at the Florida Capitol
Deadline for the submission of FPA Election Ballots
APhA Meeting New Orleans, Louisiana
24-25 FPA Council, Committee and Board meetings April 6
Good Friday, FPA Office Closed
10-11 Florida Board of Pharmacy Meeting (TBA) 21-22 FPA Clinical Consultant Conference Tampa
For a complete calendar of events go to www.pharmview.com 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, 2011 or prior to licensure renewal. *For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact 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 www.pharmview.com
Mission Statements: 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 the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest 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 to secure appropriate advertising to assist the
Journal in its goal of self-support.
Advertisers EPC...................................................................... 10 Healthcare consultants........................ 3 Kahan ◆ SHIR, P.L............................................ 2 PPSC...................................................................... 2 Rx RElief.......................................................... 10
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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The President’s Viewpoint By GUEST COLUMNISTS Goar Alvarez, Pharm.D., President-elect and Eric Alvarez, Pharm.D., Vice-Speaker, HOD
Making Pharmacists ‘Indispensable’ was Focus of Professional Affairs Council in 2011
he Professional Affairs Council has been busy this year. The Council is made up of committed, energized and exceptionally talented people, a cross-section of pharmacists from all practice settings as well as pharmacy students and pharmacy technicians, who work tirelessly on the issues and tasks that you, the members, put to the Council to consider. The focus is on “the patients we serve, and the profession we love, and making pharmacists indispensable.”Over the last few years, the Council has concentrated on expanding the pharmacist’s scope of practice and simultaneously expanding the functions and responsibilities of pharmacy technicians to support pharmacists in improving patient care. Our president, Bob Parrado, asked us to share with you some of the highlights of what the Council has been doing on your behalf this year. The profession of pharmacy is now in a great position to truly become an integral clinical partner with other healthcare professionals. Therefore, our Council was charged with identifying ways in which the pharmacist’s role was “indispensable” to the healthcare team. Because membership continues to be one of the most critical ways that the Florida Pharmacy Association can communicate to legislators what it is that pharmacists can do for the patients of our state, our Council spent a significant amount of time in discussing and planning a strategy for membership recruitment. The legislators want to know how many pharmacists the FPA represents) and only with a strong number is OUR voice truly heard. As you may know, a significant
Goar Alvarez, Pharm.D. 2011-2012 FPA President-Elect
amount of financial and other resources are spent by the FPA in lobbying efforts to get OUR VOICE heard. First, the Professional Affairs Council has begun developing a simple “4 Graph” project to communicate to non-member pharmacists, students and technicians what the value of membership is. This PowerPoint presentation containing “4 graphs” will show potential members, through membership in their professional association, the importance of joining their voice to the collective ONE VOICE for Pharmacy in Florida that is the FPA. This ONE VOICE will communicate to the Legislature the indispensable value of the pharmacist in our state and nation. When completed, the 2-3 minute presentation (and other marketing materials) will be made available to unit association leadership to help recruit members. Both, the PowerPoint “4 Graph” project production and other recruitment marketing materials were
Eric Alvarez, Pharm.D. 2011-2012 Vice-Speaker, HOD
recently approved by the Board of Directors. Secondly, and along the same lines, the Professional Affairs Council recommended to the Board of Directors that the ad-hoc membership committee be made a permanent standing council, the Membership Council. This will create a new Council at the FPA that will focus on membership recruitment and retention. This recommendation was also approved by the Board of Directors. Both of these actions will likely improve membership numbers as there will be a focus on finding solutions to membership recruitment and retention issues. Other issues and challenges the Council faced were how to get our members to learn more about and become more engaged in Medication Therapy Management (MTM). The Council felt that this is a near future vision for the profession and that we should become engaged sooner than later. The plan is to work with the EdDECEMBER 2011
2011/2012 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work deligently all year long on behalf of our members.
Humberto Martinez............................................................. Chairman of the Board Robert Parrado .........................................................................................FPA President Goar Alvarez............................................................................................... President Elect Betty Harris ............................................................................................................Treasurer Suzanne Wise............................................Speaker of the House of Delegates Eric Alvarez.....................................Vice Speaker of the House of Delegates Preston McDonald, Director............................................................................ Region 1 Marcus Dodd-o, Director .................................................................................Region 2 Eva Sunell, Director ..............................................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 Jeffrey Parrado, Director ...............................................................................Region 5 Chris Lent, Director...............................................................................................Region 6 Paul Rohrbaugh, Director.................................................................................. Region 7 Raul Gallo, Director.................................................................................................Region 8 Paul Elias, Director.................................................................................................Region 9 Venessa Price.......................................................................................... President FSHP Michael Jackson........................................Executive Vice President and CEO
Florida Pharmacy Today Journal Board Chair......................................................Jennifer Pytlarz, email@example.com Vice Chair......................................................... Don Bergemann, firstname.lastname@example.org Treasurer....................Stephen Grabowski, email@example.com Secretary...................................................................Stuart Ulrich, Stuarx@aol.com Member.................................................Joseph Koptowsky, firstname.lastname@example.org Member........................Rebecca Poston, email@example.com Executive Editor................Michael Jackson, firstname.lastname@example.org Managing Editor...................Dave Fiore, email@example.com
ucational Affairs Council to provide more “how to” – “nuts-and-bolts” MTM educational programs and to identify and help remove barriers to MTM implementation by pharmacists, including provision of MTM services as independent practitioners (not linked to a specific pharmacy). The Council also recommends that the FPA voice to our national organizations our support of efforts to have pharmacists recognized as primary health care providers under the Social Security Act to allow pharmacists to provide and be paid for the delivery of services such as Medication Therapy Management, disease management and immunizations to our state’s population most in need of receiving the comprehensive services that only a pharmacist can provide. Our Council also worked on expanding pharmacist immunization services to include pneumococcal and herpes zoster vaccinations as well as allowing student pharmacists to immunize under pharmacist supervision. We recommended to the FPA Board of Directors to add epinephrine to the medications that pharmacists can administer. Currently, it is legal for anyone (under certain circumstances) to administer epinephrine for bee stings in schools. Why should pharmacists not be able to administer epinephrine? Other tasks assigned to the Council included work on a resolution passed by the House of Delegates asking the Association to look into ways to decrease the number of hours that a community pharmacy has to be open. This was to address some of our members’ requests to operate “specialty” type pharmacies that may require fewer hours of operation. The Council was made aware that no other healthcare profession has “hours-of-operation” requirements as part of their practices. This request was brought before the Board of Pharmacy, and at this writing is awaiting disposition by the Board. It is our understanding that the Board is contemplating a revision of the rule to allow for pharmacies to be open a minimum of 20 hours per week provided certain conditions are met. We also reSee “Viewpoint”, continued on page 11
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Executive Insight By Michael Jackson, FPA Executive by michael jackson,Vice RPhPresident/CEO
Carrying the Weight of America’s Health Care Challenges
t is clear to me that pharmacists have been carrying the weight of health care policymaking for a number of years. This has been very evident this year with policymaking that places pharmacy providers in the role of law enforcement of pill mills and pain clinics. Add to this the current upheaval in the job market and the downward pressure on pharmacy profits, and you have the makings of a perfect storm of epic proportions. At our recent law and regulatory conference in Sarasota, our membership was not shy about sharing their concerns with what is happening in the pharmacy space. Participants also received a toxic dose of all the advocacy tasks performed by your leadership, staff and governmental affairs consultants to defend against and advocate for quality patient care and support for small businesses. This month, there was a Congressional Senate hearing on the pending merger of America’s two largest pharmacy benefit managers. If you were not sure how this issue affects our industry, take some time out of your busy schedule to watch a video of the hearing. A link to that hearing can be found at http://www.senate.gov/fplayers/jw57/commMP4Player. cfm?fn=judiciary120611p&st=840 Even here in our own state there are a host of issues that the Florida Pharmacy AsMichael Jackson, B.Pharm sociation will be gearing up to manage. The 2012 legislative session begins in January this year, rather than March as has been the norm. The early start is due primarily to changing the geographic boundaries of voting districts as a result of the 2010 census. With Florida’s population growth, we have picked up a few new seats. Typically during this type of legislative session, controversial issues are more difficult to move. This could be both good and bad, depending on what side of the issue we may be on. Legislative bills with odd numbers have been filed in the House, with the even number bills in the Senate. The pharmacy-related issues to be seen this session may include: Bill No.
Relating to Preventing Deaths from Drug-related Overdoses
Preventing Deaths from Drug-related Overdoses: Designates act “911 Good Samaritan Act”; provides that person acting in good faith who seeks medical assistance for someone experiencing drug-related overdose may not be charged with specified offenses; provides that person who experiences drug-related overdose & needs medical assistance may not be charged for specified offenses if evidence was obtained as result of overdose & need for assistance; provides that protections from prosecution are not grounds for suppression of evidence in other prosecutions; provides that departure from lowest permissible criminal sentence is permitted when defendant was making good faith effort to obtain or provide medical assistance for someone experiencing drug-related overdose. Effective Date: October 1, 2012
Health Care Fraud
Health Care Fraud; Revising the grounds under which the Department of Health or corresponding board is required to refuse to admit a candidate to an examination and refuse to issue or renew a license, certificate, or registration of a health care practitioner; providing an exception; providing that all persons who were denied renewal of licensure, certification, or registration under s. 456.0635(3), F.S., may regain licensure, certification, or registration only by completing the application process for initial licensure; providing an exception, etc. EFFECTIVE DATE: July 1, 2012
DECEMBER 2011 |
da n he ist
Prescription Drug Abuse
Prescription Drug Abuse: Creates Florida Statewide Task Force on Prescription Drug Abuse & Newborns; provides legislative intent; provides for purposes, membership, meetings, & duties of task force; provides for reimbursement for per diem & travel expenses; requires report to Legislature. Effective Date: upon becoming a law
State Employees’ Prescription Drug Program
State Employees’ Prescription Drug Program: Requires DMS to authorize certain pharmacies to dispense 90-day maintenance prescription medication to certain patients; specifies dispensing fee for 90-day prescription supply. Effective Date: July 1, 2012
Eye Health Care
Eye Health Care: Authorizes Board of Optometry to adopt rules for administration & prescription of ocular pharmaceutical agents; authorizes certified optometrists to administer & prescribe ocular pharmaceutical agents; revises qualifications of certain members of formulary committee; revises provisions relating to licensure & regulation of clinical laboratories operated by practitioners for exclusive use; provides applicability to clinical laboratories operated by practitioners licensed to practice optometry; revises definition of “licensed practitioner” to include practitioner licensed under ch. 463, F.S.; requires clinical laboratories to accept human specimens submitted by practitioners licensed under ch. 463, F.S.; revises definition of “practitioner” to include certified optometrist for purposes of Florida Comprehensive Drug Abuse Prevention & Control Act; prohibits certified optometrists from administering & prescribing certain controlled substances. Effective Date: July 1, 2012
Preventing Deaths from Drug-related Overdoses
Preventing Deaths from Drug-related Overdoses; Cites this act as the “911 Good Samaritan Act;” providing that a person acting in good faith who seeks medical assistance for an individual experiencing a drug-related overdose may not be charged, prosecuted, or penalized for specified offenses in certain circumstances; providing that a person who experiences a drug-related overdose and needs medical assistance may not be charged, prosecuted, or penalized for specified offenses in certain circumstances; providing that the protections from prosecution for specified offenses are not grounds for suppression of evidence in other prosecutions; amending mitigating circumstances under which a departure from the lowest permissible criminal sentence is reasonably justified to include circumstances in which a defendant was making a good faith effort to obtain or provide medical assistance for an individual experiencing a drug-related overdose, etc. EFFECTIVE DATE: October 1, 2012
Alzheimer’s Disease; Directing the Department of Elderly Affairs to develop and implement a public education program relating to screening for Alzheimer’s disease; providing criteria for awarding grants; requiring grant recipients to submit an evaluation of certain activities to the department; authorizing the department to provide technical support; providing for implementation of the public education program to operate within existing resources of the department; providing that implementation of the memory-impairment screening grant program is contingent upon an appropriation of state funds or the availability of private resources; specifying the types of facilities where an employee or direct caregiver providing care for persons with Alzheimer’s disease may begin employment without repeating certain training requirements, etc. EFFECTIVE DATE: July 1, 2012
Collection and Disposal of Household Pharmaceuticals
Collection and Disposal of Household Pharmaceuticals: Requires DEP to establish grant program to reimburse local law enforcement agencies for expenses associated with collection & disposal of household pharmaceuticals; requires court to impose additional surcharge for specified offenses; provides for proceeds of surcharge to be deposited into Household Pharmaceuticals Collection & Disposal Trust Fund; provides for clerk of court to retain service charge. Effective Date: July 1, 2012
Medical Use of Cannabis
Medical Use of Cannabis: Proposes creation of s. 28, Art. X & s. 32, Art. XII of State Constitution to allow medical use of cannabis by citizens & allow Legislature to implement these provisions by general law. Effective Date: Not Specified
Physician Assistants: Revises composition of membership on Board of Medicine & Board of Osteopathic Medicine; provides for appointment of new members as vacancies occur & allow; deletes requirement that DOH issue license to physician assistant to prescribe medicinal drugs & requires only prescription number. Effective Date: July 1, 2012
Patient Brokering; Revising the definition of the term “racketeering activity” to include the offense of patient brokering; requiring that a prosecution for a felony violation of the offense of patient brokering be commenced within 5 years after the patient brokering violation is committed, etc. EFFECTIVE DATE: July 1, 2012
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Animal Control: Requires Board of Pharmacy to adopt rules relating to issuance of permits for certain controlled substances & legend drugs necessary for euthanasia & chemical immobilization of animals; authorizes Board of Pharmacy, at request of Board of Veterinary Medicine, to adopt rule to increase number of controlled substances & legend drugs available to euthanize injured, sick, or abandoned domestic animals or to chemically immobilize such animals; provides that only certain persons are authorized to possess & use such drugs; restricts use of intracardial injection to an unconscious animal; prohibits delivery of lethal solution or powder by adding it to food; requires that an animal control officer, wildlife officer, & an animal disease diagnostic laboratory report knowledge of any animal bite, any diagnosis or suspicion of grouping or clustering of animals having similar disease, or any symptom or syndrome that may indicate presence of threat to humans. Effective Date: July 1, 2012
Pharmacy: Revises types of vaccines that pharmacists may administer; authorizes pharmacy interns to administer certain vaccines; authorizes pharmacists & pharmacy interns to administer epinephrine autoinjection; revises protocol requirements for vaccine administration & duties of supervising physicians under such protocols; revises requirements for training programs, certifications, & patient records related to vaccine administration. Effective Date: July 1, 2012
Medical Care; Providing powers of the Department of Health with regard to access to patient health records; providing for the department to obtain patient records without written authorization from the patient under certain circumstances; authorizing the department to issue an emergency order to suspend or restrict the license of a health care practitioner under certain circumstances, etc. EFFECTIVE DATE: July 1, 2012
Household Pharmaceuticals Collection and Disposal Trust Fund/DEP
Household Pharmaceuticals Collection and Disposal Trust Fund/DEP; Creating the Household Pharmaceuticals Collection and Disposal Trust Fund within the Department of Environmental Protection; providing for sources of funds and purposes; providing for annual carryforward of funds; providing for the future review and termination or re-creation of the trust fund, etc. EFFECTIVE DATE: July 1, 2012, if Senate Bill 626 or similar legislation is adopted in the same legislative session or an extension thereof and becomes law
Collection and Disposal of Household Pharmaceuticals
Collection and Disposal of Household Pharmaceuticals; Requiring the Department of Environmental Protection to establish a grant program to reimburse local law enforcement agencies for the expenses associated with the collection and disposal of household pharmaceuticals; providing eligibility requirements; requiring that the court impose an additional surcharge for specified offenses; providing for the proceeds of the surcharge to be deposited into the Household Pharmaceuticals Collection and Disposal Trust Fund; providing for the clerk of the court to retain a service charge, etc. EFFECTIVE DATE: July 1, 2012
Euthanasia of Domestic Animals
Euthanasia of Domestic Animals; Requiring that the Board of Pharmacy adopt rules relating to the issuance of permits authorizing the purchase, possession, and use of certain controlled substances and legend drugs necessary for the euthanasia and chemical immobilization of animals; authorizing the Board of Pharmacy, at the request of the Board of Veterinary Medicine, to adopt a rule to increase the number of controlled substances and legend drugs available to euthanize injured, sick, or abandoned domestic animals or to chemically immobilize such animals; prohibiting the delivery of a lethal solution or powder by adding it to food; requiring that an animal control officer, a wildlife officer, and an animal disease diagnostic laboratory report knowledge of any animal bite, any diagnosis or suspicion of a grouping or clustering of animals having similar disease, or any symptom or syndrome that may indicate the presence of a threat to humans, etc. EFFECTIVE DATE: July 1, 2012
Workers’ Compensation Medical Services
Workers’ Compensation Medical Services; Revising requirements for determining the amount of a reimbursement for repackaged or relabeled prescription medication; providing limitations, etc. EFFECTIVE DATE: July 1, 2012
Health Care; Authorizing the Board of Optometry to adopt rules for the administration and prescription of ocular pharmaceutical agents rather than topical ocular pharmaceutical agents; authorizing certified optometrists to administer and prescribe ocular pharmaceutical agents under certain circumstances; amending provisions relating to licensure and regulation of clinical laboratories operated by practitioners for exclusive use; providing applicability to clinical laboratories operated by practitioners licensed to practice optometry; requiring clinical laboratories to accept human specimens submitted by practitioners licensed to practice under ch. 463, F.S.; revising the burden of proof that a claimant must demonstrate in order to prove medical negligence by a health care provider or an emergency health care provider; prohibiting certified optometrists from administering and prescribing certain controlled substances, etc. EFFECTIVE DATE: July 1, 2012, except as otherwise provided
Vaccination by Pharmacists
Pharmacists; Revising the types of vaccines that pharmacists are authorized to administer; authorizing pharmacy interns to administer the vaccines under certain circumstances; authorizing pharmacists and pharmacy interns to administer an epinephrine autoinjection under certain circumstances; revising protocol requirements for vaccine administration and the duties of supervising physicians under such protocols; revising requirements for training programs, certifications, and patient records related to vaccine administration, etc. EFFECTIVE DATE: July 1, 2012
Relating to Controlled Substances
Controlled Substances; Providing that the management of pain in certain patients requires consultation with or referral to a psychiatrist, rather than a physiatrist; requiring that a pain-management clinic register with the Department of Health unless the clinic is wholly owned and operated by certain health care professionals, including a board-certified psychiatrist or rheumatologist; authorizing a pharmacist to fill a prescription for drugs or medicinal supplies which is transmitted or written by a physician, dentist, veterinarian, or other practitioner licensed to practice in another state under certain circumstances; requiring the pharmacist to obtain proof to a reasonable certainty of the validity of the prescription under certain circumstances, etc. EFFECTIVE DATE: October 1, 2012
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The above proposed bills represent what is being filed as this article is being written. With the Florida legislature preparing to debate 2012 policy in January there are other bills that we believe are being prepared for debate. This includes efforts to manage pharmacy audits and issues surrounding closed pharmacy networks and mandatory mail order programs. There may even be bill language that may require prescribers to note on a prescription the intended use of the medication. These issues require heavy lifting by all of us playing an advocate role. The more involved our membership becomes on these health care proposals, the better our opportunities to ensure good public policy. Become directly involved by attending our legislative days and health fair events on January. You can find more information on the FPA website at www.phamview.com. n
“Viewpoint”, continued from page 6
viewed IPPE curriculums from a number of colleges in Florida to help formulate feedback to the colleges regarding standardization. Discussion and exploratory efforts determined that there already existed a significant amount of standardization and that some experiences should be left up to preceptors as this can lead to innovative practice models. As a request from student pharmacist members, the Council recommended that the Association lobby the Board of Pharmacy to change Intern to preceptor ratios from 1:1 to a maximum of 4:11. This ratio should be completely up to the preceptor and type of rotation, activities, etc. The discussion was that there are advantages to groups of students working collaboratively to solve pharmacy related issues and could be a great learning experience for all students involved in group projects assigned by preceptors. Lastly, the Council worked on adding a “statute of limitation-expunging of records” for minor infractions in which there was no patient harm. Again, the Professional Affairs Council has indeed been working very hard over the past year to position our Profession as an “indispensable” piece of the overall healthcare puzzle. Through continued lobbying, education and development of pharmacist-specific responsibilities, we can achieve our goal of being recognized as primary care providers and a true partner in the health care team. Your membership and the recruitment of future members in the organization remains a vital key in our continued success!REMEMBER TO COME OUT FOR LEGISLATIVE DAYS AND HEALTH FAIR TO ADVOCATE FOR OUR PROFESSION - JANUARY 24-25, 2012 AT THE CAPITOL - TALLAHASSEE EDITOR’S NOTE: This change will require modifying rule 64B16-26.2032. This issue was reviewed during the 2011 meeting of the FPA House of Delegates as a late filed resolution and ultimately referred to the Professional Affairs Council for their review and recommendation. The House has not adopted a position on this issue. n
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
Educational Services Office Assistant Stacey Brooks , ext. 210 Florida Pharmacy Today Board Chair............................................. Jennifer Pytlarz, Brandon Vice Chair...................Don Bergemann, Tarpon Springs Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member..................................... Joseph Koptowsky, Miami Member..............................Rebecca Poston, Tallahassee Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee
This is a peer reviewed publication. ©2011, 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: http://www.pharmview.com
DECEMBER 2011 |
Pharmacy Quality Commitment – Putting Continuous Quality Improvement into Action Implementing a sound quality assurance (QA) program takes time, but if you do it right, it may be the most valuable investment that you make all year. The primary reason to maintain a QA program is to provide the safest, highest level of quality care possible to your patients. It is also a sound business decision to strive to reduce the pharmacy’s exposure to potential errors by implementing processes to monitor, analyze discovered weaknesses, and develop a plan for improvement. A solid QA program often results in improvement in operations and eventually in a reduction in “redo” prescriptions. This ultimately translates into more free time for you to utilize elsewhere. Finally, if the pharmacy fills Medicare prescriptions it needs an operational Quality Assurance (QA) or Continuous Quality Improvement (CQI) program in order to meet third party contract requirements. What should you do if you are looking to implement or enhance a QA/CQI program in your pharmacy? First of all, you should make sure that you are participating in a program that provides protection for the safety of quality and error data, also referred to as patient safety work product (PSWP). It is very important to familiarize yourself with state reporting requirements and protections. Certain states require QA/ CQI programs to be implemented and others provide protection for patient safety data and its subsequent review. However, there are states that remain silent on this respective issue. The best way to ensure protection of the data is to arrange to report to a Patient Safety Organization (PSO). A PSO is a public and private entity, recognized by the Department of Health and Human Services, that is established to collect and analyze quality-related events (QRE). These QRE’s can include incidents that reach the patient whether they caused harm or not, near misses, and unsafe conditions reported by healthcare providers and healthcare entities. A PSWP that is reported to an approved PSO is protected from discovery at both the state and federal level. A PSO is essential in improving and moving patient-centered, pharmaceutical care forward in the context of our changing healthcare system; pharmacists report data to a PSO, evaluate it, implement plans for improvement in their pharmacy. It offers definite safety and legal protections afforded by legislation. In addition, PSOs provide valuable feedback and resources to its reporters. For more information on PSOs, visit http://www.pso.ahrq.gov/. For a QA/CQI program to thrive, owners and management must make a conscious commitment to quality and embrace the change that is necessary to move beyond the traditional “name and blame” mindset of medication errors. A positive culture change must come from the leadership. The staff must understand that the pharmacy needs to work togeth12
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er in a non-punitive environment that rewards proactive cooperation in order to reduce the chance of a medication error reaching the patient. The appointed QA supervisor should encourage participation from the staff and ensure training on maintaining confidentiality of patient safety data within the pharmacy’s patient safety evaluation system. The program should be easy to use as collection and ongoing monitoring demands that the recording of data be a simple and quick task that requires minimal disruption and easy incorporation into the daily workflow. Incidents that reach the patient should be collected, but certainly do not overlook the value of recording the “near misses” that might have caused harm had they not been caught. The collection and analysis of all quality-related event (QRE) data holds invaluable lessons to be learned for each pharmacy and can greatly contribute to reduction of error rates in pharmacy practice. The Alliance for Patient Medication Safety™ (APMS™), a federally listed PSO, offers a continuous quality improvement and reporting program specifically designed for pharmacies (Figure 1). Pharmacy Quality Commitment™ (PQC) provides the education and the process for pharmacies to securely report, study and protect patient safety data. (Figure 2). The manual details suggested workflow guidelines for the “stations” in the prescription process and offers 20 “pharmacy best practices” to consider in order to reduce the chance of a medication error. Pharmacies record any errors or nearmiss QREs through a simple, secure, web-based portal. Once a pharmacy starts reporting QREs, it will have instant access to charts and graphs of its data, which can provide extremely valuable insight into various trends. The QA supervisor can use this data to improve the dispensing process and decrease the likelihood of costly errors. Reviewing this data progressively over time enables the pharmacy to determine where potential weaknesses might be and how the processes in the pharmacy’s workflow can be improved. The pharmacy can implement and experiment with new processes to lower the incidence of the type of QRE targeted. Over time, data is accumulated and can be analyzed determine if there was an improvement. Through cycles of data-driven improvement, the pharmacy can continue to revise the workflow. This will allow maintaining and adhering to safety standards at an excellent level with relative ease.
Figure 1. Alliance for Patient Medication Safety, a Patient Safety Organization
Figure 2. Pharmacy Quality Commitment™ Continuous Quality Improvement “Loop”
A pharmacy gets a two-fold benefit from reporting to APMS as their reported PSWP data is aggregated with thousands of reported patient safety data from other pharmacies across the country. The APMS currently receives over 10,000 QRE reports each month, analyzes the aggregate, de-identified information and reports the national trends back to participating pharmacies. Pharmacies reporting through PQC™ receive recommendations on best practices and workflow processes to help reduce medication errors, improve medication use and enhance patient safety and health outcomes. Access to the APMS resource and online reporting site is easy. The PQC™ participant is assigned a unique, encrypted password and username that allows entry. Once logged in, the pharmacy is directed to a robust Resource Area that includes recent newsletters with guidance and recommendations, aggregate trending information, and other patient safety tips. Also posted is a PQC™ Quality Assurance Policy and Procedure template, a patient safety evaluation system for the pharmacy, reporting forms and tools, and ongoing resources for the Quality Supervisor. This includes instructions on how to set up a Peer Review process and how to maintain active reporting status for the pharmacy. Managed care organizations, regulatory bodies or other entities may have reason to want to know if a pharmacy is actively participating in a Continuous Quality Improvement program. APMS has developed criteria for determining if a pharmacy is considered “Continuous Quality Improvement – Verified” (CQI Verified) with the PQC program. Once training is completed and data is being reported on a consistent
basis, the pharmacy is able to print out a “CQI-Verified” certificate. Implementation of the program is simple and straightforward, but like any effective management process will require some time, effort and a commitment to improvement to be truly effective. The experts on staff at APMS have helped thousands of pharmacists successfully incorporate PQC™ into their workflow and are eager to help. Several PowerPoint training modules are available that range from “Getting PQC Started” to “Compliance Training”. The pharmacy also has the option to set up as many free individual one-on-one online training sessions as needed. They provide a toll-free line (866) 365-7472 and online access at email@example.com. In summary, the PQC™ program provides three things no other continuous quality improvement program offers: ■■ Access to forms, manuals, and ongoing training assistance (toll free number and online support) that makes sure PQC™ becomes a meaningful and ongoing program for improvement in the pharmacy - not simply another manual on a shelf. ■■ A secure, password-protected Patient Safety Organization (PSO) web portal for each pharmacy to enter patient safety data; to protect it from discovery so none of the patient safety data can be used against the pharmacy in a legal proceeding. ■■ A quick and easy way to print proof-of-use of a continuous quality improvement program. PQC™ can be ordered through a link on the state pharmacy association website or at www.pqc.net. The first year license fee is $300 and annual renewal is $200. APMS™ is dedicated to encouraging voluntary reports of patient safety work product and to performing analysis of aggregate information to improve quality of care provided by the pharmacy workforce. In support of these goals, APMS™ provides funding to state pharmacy associations to promote PQC™ and to provide QA/CQI education to pharmacists in their states. Questions Lead to Answers In the Pharmacy Quality Commitment™ (PQC™) program, any mistake, or “near miss”, which is caught by the system before it reaches the patient, is called a “success story” because quality assurance is judged to have worked and the pharmacy has data to study. Data is good, but data does not provide automatic answers. This will lead to the right questions being asked that can lead to answers. Pharmacies are encouraged to review generated charts at staff meetings in order to formulate questions and facilitate effective discussions on how to develop solutions. Let us consider the PQC™ “Where in the Process” chart from one hypothetical pharmacy over a 3 month period (Figure 3.). In this pharmacy 31% of all of the quality related events (QREs) were made during computer entry process. We know “where” but we don’t know why or how the process is breaking down. There does not seem to be a trend in the type of mistake, just where they are occurring. What could you do DECEMBER 2011
if this was your pharmacy? What questions come to mind to investigate? What solutions could be put into place? One suggestion is that for the next month the pharmacy concentrate on the computer entry process and incorporate at least one “best practice” that could either stop a QRE from occurring or would catch it before it reached the patient. This pharmacy could consider using the best practice “Take 5.” “Take 5” is the first step in a process, whereby the person’s first job is to check what occurred in the immediate step before. In this case, use “Take 5” in the new prescription filling process, which usually immediately follows computer entry and label generation. The person filling the prescription first takes a short amount of time (5 seconds) to compare the prescription against the label for accuracy before they go to the next step in the process. Are the patient’s name, drug name,
strength and directions correct? It has been estimated that “Take 5” will catch 95% of all mistakes occurring up to that point as it serves to focus the brain on a task for a short time for a specific goal. Train the staff, remind the staff and evaluate in a few weeks whether there was an effect. PQC™ provides tools and resources for the Quality Supervisor to aid in determining the root cause of the QREs and articles such as the “Enhancing your Continuous Quality Improvement Program with Effective Peer Review Practices”. Tara M. Modisett is the Executive Director for the Alliance for Patient Medication Safety
Figure 3. Pharmacy Quality Commitment™ “Where in the Process” Example
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Holiday Reminder: Put Your Medicines Up and Away and Out of Sight Source: Centers for Disease Control and Prevention
More than 60,000 young children end up in emergency rooms each year because they got into medicines while their caregiver wasn’t looking. Always put every medicine and vitamin up and away every time you use it. Families take medications and vitamins to feel well and to stay well. But did you know that more than 60,000 young children end up in emergency rooms every year because they get into medicines when their parent or caregiver isn’t looking? Any kind of medicine and vitamin – even one you buy without a prescription – can cause harm if taken in the wrong way or by the wrong person. All medicines and vitamins should always be kept up and away and out of your child’s reach and sight. Protect your child. Here’s how: ■■ Put medicines and vitamins up and away – out of reach and out of sight. Children are curious and put all sorts of things in their mouths. Even if you turn your back for less than a minute, they can quickly get into things that could hurt them. ■■ Pick a storage place in your home that your child cannot reach or see. Different families will have different places. Walk around your house and decide on the safest place to keep your medicines and vitamins. ■■ Put medicines and vitamins away every time. This includes medicines and vitamins you use every day. Never leave them out on a kitchen counter or at a sick child’s bedside, even if you have to give the medicine again in a few hours.
a locking cap that turns, twist it until you hear the click. Remember, even though many medicines have safety caps, children may be able to open them. Every medicine and vitamin must be stored up and away and out of children’s reach and sight. Teach your children about medicine safety. Teach your children what medicine is and why you must be the one to give it to them. Never tell children medicine is candy to get them to take it, even if your child doesn’t like to take his or her medicine. Tell your guests about medicine safety. Ask houseguests and visitors to keep purses, bags, or coats that have medicine in them up and away and out of sight when they are in your home. Be prepared in case of an emergency. Call your poison control center at 800.222.1222 right away if you think your child might have gotten into a medicine or vitamin. Program the Poison Control number into your home and cell phones so you will have it when you need it. Take the pledge. Visit the Up and Away website and take the pledge to store medications safely, make sure the safety cap is locked in place, teach children about medication, and program the Poison Control number in your phones. Learn more at www.UpAndAway.org.
Be prepared in case of an emergency: Program the Poison Control number into your cell phone 800.222.1222 Call your poison control center right away if you think your child might have gotten into a medicine or vitamin. ■■ Hear the click to make sure the safety cap is locked. Always relock the cap on a medicine bottle. If the bottle has DECEMBER 2011
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APhA Foundation and NASPA Bowl of Hygeia Awarded to a pharmacist for outstanding community service above and beyond professional duties. The use of the following selection criteria is required: ■■ The recipient must be a Florida licensed pharmacist and a member of FPA. ■■ ■■ T recipient has not previously received the award. ■■ on its award committee or an officer of the association in other than an ex officio capacity. ■■ has compiled an outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession. James H. Beal Award Awarded to the "Pharmacist of the Year." The criteria established for this award is that the recipient be a Florida registered pharmacist and a member of FPA, who has rendered outstanding service to pharmacy within the past five years. Criteria: ■■ must be a Florida registered pharmacist and a member of the FPA. ■■ has rendered outstanding service to pharmacy within the past five years. Technician of the Year Award Awarded annually to a Florida pharmacy technician who is recognized for his/her outstanding performance and achievement during his/her career. Criteria: ■■ Candidate must be a member of the Florida Pharmacy Association for at least 2 years. ■■ Candidate must have demonstrated contributions and dedication to the advancement of pharmacy technician practice.
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N om i n a t i on s ■■ Candidate must have demonstrated
contributions to the Florida Pharmacy Association and/or other pharmacy organizations. ■■ Candidate must have demonstrated commitment to community service. ■■ Candidate is not a past recipient of this award. R.Q. Richards Award This award is based on outstanding achievement in the field of pharmaceutical public relations in Florida. Criteria: ■■ recipient must be a Florida registered pharmacist and a member of the FPA. ■■ has displayed outstanding achievement in the field of pharmaceutical public relations in Florida. Frank Toback/AZO Consultant Pharmacist Award Criteria: ■■ Candidate must be an FPA member, registered with the Florida Board of Pharmacy as a consultant pharmacist in good standing. ■■ Candidate should be selected based on their outstanding achievements in the field of consultant pharmacy. DCPA Sidney Simkowitz Pharmacy Involvement Award Presented annually to a Florida pharmacist who has been active at the local and state pharmacy association level in advancement of the profession of pharmacy in Florida. Criteria: ■■ A minimum of five years of active involvement in and contributions to the local association and FPA. ■■ Candidate must have held office at local level pharmacy association. ■■ Member in good standing for a period of at least five years in the FPA and must have served as a member or chairman of a committee of the association. ■■ Candidate must have been actively involved in a project that has or could potentially be of benefit to members of the profession.
Pharmacists Mutual Companies Distinguished Young Pharmacist Award Awarded to a young pharmacist for their involvement and dedication to the practice of pharmacy. Criteria: ■■ Licensed to practice for nine (9) years or less. ■■ Licensed to practice in the state in which selected. ■■ Participation in national pharmacy association, professional programs, and/or community service. IPA Roman Maximo Corrons Inspiration & Motivation Award Interamerican Pharmacists Association created this award to honor the memory of Roman M. Corrons who inspired and motivated countless pharmacists to participate actively and aspire to take on leadership roles in their profession. Roman was always there with guidance and support that motivated pharmacists and encouraged visionary leadership, approachable active membership and succession planning. This award recognizes the motivators among us who inspire others to continue to advance the profession. Criteria: ■■ The recipient must be a Florida Licensed Pharmacist and a member of the FPA. ■■ Candidate should motivate others to excel within the profession by encouraging them to be leaders. ■■ Candidate is not necessarily an association officer, but guides, supports and/or inspires others. A brief description on the candidate’s motivational/inspirational skills must accompany the nomination. The Jean Lamberti Mentorship Award The Jean Lamberti Mentorship Award was established in 1998 to honor those pharmacists who have taken time to share their knowledge and experience with pharmacist candidates. The award is named in honor of long time FPA member Jean Lamberti for her effort in working with pharmacy students.
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Criteria: ■■ The recipient must be an FPA member. ■■ The recipient must serve as a role model for the profession of pharmacy. Upsher Smith Excellence in Innovation Award Awarded to honor practicing pharmacists who have demonstrated innovation in pharmacy practice that has resulted in improved patient care. Criteria: ■■ The recipient has demonstrated innovative pharmacy practice resulting in improved patient care. ■■ The recipient should be a practicing pharmacist within the geographic area represented by the presenting Association. Qualified Nominee: A pharmacist practicing within the geographic area represented by the presenting Association.
Cardinal Generation Rx Award The Cardinal Health Generation Rx Champions Award recognizes a pharmacist who has demonstrated excellence in community-based prescription drug abuse prevention. The award is intended to recognize outstanding efforts within the pharmacy community to raise awareness of this serious public health problem. It is also intended to encourage educational prevention efforts aimed at patients, youth and other members of the community. The nominee must be a pharmacist who is a member of the state association. Self-nominations are allowed. Applications will be evaluated based upon the following criteria: ■■ Commitment to community-based educational prevention efforts aimed
at prescription drug abuse ■■ Involvement of other community groups in the planning and implementation of prevention programs ■■ Innovation and creativity in the creation and implementation of prevention activities ■■ Scope/magnitude of prescription drug abuse efforts Demonstrated impact of prescription drug abuse prevention efforts
Deadline FOR NOMINATIONS: February 28, 2012 F PA A W AR D S NOMINATION F ORM I am pleased to submit the following nomination:
Date Submitted: Signature:
For the following Award: (Nomination Deadline February 28, 2012) APhA Foundation and NASPA Bowl of Hygeia James H. Beal Award
Please describe briefly below the nominee's accomplishments, indicating why you feel he or she should receive this award. (Attach additional sheets if necessary.)
R.Q. Richards Award Frank Toback/AZO Consultant Pharmacist Award DCPA Sydney Simkowitz Award Pharmacists Mutual Co. Distinguished Young Pharmacist Award Academy of Pharmacy Practice Practitioner Merit Award The Jean Lamberti Mentorship Award IPA Roman Maximo Corrons Inspiration & Motivation Award Upsher Smith Excellence in Innovation Award Technician of the Year Award Cardinal Generation Rx Award Mail nominatons to: Annual Awards, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS FEBRUARY 28, 2012
CALL FOR RESOLUTIONS TO THE 2012 HOUSE OF DELEGATES The House of Delegates Board of Directors will meet in March 2012 to review and approve resolutions for the Annual Meeting. The deadline for submitting resolutions is March 15, 2012! PLEASE NOTE THIS DEADLINE. The following information will be needed when submitting resolutions: 1. Name of organization: The name of the organization submitting the resolutions(s); 2. Name and telephone number of individuals: A contact in the event clarification Or further information is needed; 3. Problem: A statement of the problem addressed by the resolution; 4. Intent: A statement of what passage of the resolution will accomplish; 5. Resolution Format: (please type and use double spacing) Title of Resolution Name of Organization Whereas , and
Therefore be it Resolved (that the FPA or Subdivision of FPA)
Contact name and phone #: Problem: Intent:
Return this form to: Membership Coordinator, Florida Pharmacy Association, 610 North Adams Street, Tallahassee, Florida 32301 or fax (850) 561-6758
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Buyer’s Guide florida PHARMACY TODAY
ADVERTISERS: This is a special section designed to give your company more exposure and to act as an easy reference for the pharmacist.
PHARMACY RESOURCES Abbott Diabetes Care Michael J. Forker (239) 839-3313 Cerner Etreby Pharmacy Management Systems (800) 292-5590 PPSC Retail Pharmacy Purchasing Program (888) 778-9909
PHARMACY CONSULTANTS HCC Pharmacy Business Solutions Dean Pedalino (800) 642-1652 Mobile: (727) 460-1855 Empire Pharmacy Consultants Michael Chen PharmD., CPh President/CEO (786) 556-7825 Mobile (305) 374-1029 Office
PHarmaceutical WHOLESALER McKesson Drug Company Jim Springer (800) 804-4590 FAX: (863) 616-2953
TEMPORARY PHARMACISTs – STAFFING HealthCare Consultants Pharmacy Staffing Bob Miller (800) 642-1652 Empire Pharmacy Consultants Michael Chen PharmD., CPh President/CEO (305) 374-1029 Office Rx Relief (800) RXRELIEF
LEGAL ASSISTANCE Kahan ◆ Shir, P.L. Brian A. Kahan, R.Ph., and Attorney at Law (561) 999-5999
Advertising in Florida Pharmacy Today Display Advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ Guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. Professional Referral Ads: FPA Members: $50 per 50 words; Non‑members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt.
FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 487-4441 www.fdhc.state.fl.us/medicaid/ pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 www.pharmacist.com AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 www.ashp.com/main.htm Drug Information Center Palm Beach Atlantic University (561) 803-2728 firstname.lastname@example.org FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 www.doh.state.fl.us/mqa FLORIDA POISON INFORMATION CENTER NETWORK (800) 222-1222 www.fpicn.org National Community Pharmacists Association 100 Daingerfield Road Alexandria, VA 22314 703.683.8200 703.683.3619 fax email@example.com Pharmacy Technician Certification Board 2215 Constitution Avenue NW Washington, DC 20037 (800) 363-8012 www.ptcb.org firstname.lastname@example.org Recovering Pharmacists Network of Florida (407) 257-6606 “Pharmacists Helping Pharmacists” DECEMBER 2011