North Carolina Pharmacist Fall Journal 2011

North Carolina

Pharmacist Vol. 91, Number 4

Advancing Pharmacy. Improving Health.

Fall 2011

Introducing Christopher Gauthier NCAP’s New Executive Director

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Official Journal of the North Carolina Association of Pharmacists 109 Church Street • Chapel Hill, NC 27516 800.852.7343 or 919.967.2237 fax 919.968.9430 www.ncpharmacists.org

JOURNAL STAFF EDITOR Sally J. Slusher

North Carolina

Pharmacist Volume 91, Number 4

Fall 2011

Inside • From the Executive Director.......................................... 4

ASSOCIATE EDITORS Fred Eckel Ryan Swanson

• Message from the President ........................................ 5

EDITORIAL ASSISTANTS Linda Goswick Teressa Horner Reavis

• Introducing Christopher Gauthier NCAP’s New Executive Director..................................6

BOARD OF DIRECTORS PRESIDENT Cecil Davis PRESIDENT-ELECT Jennifer Askew Buxton PAST PRESIDENT Regina Schomberg TREASURER Dennis Williams BOARD MEMBERS Jennifer Burch Melinda Childress Valerie Clinard Stephen Dedrick Beth Mills Minal Patel Tracie Rothrock-Christian Kenneth Tuell Abbie Williamson

North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association of Pharmacists, published quarterly at 109 Church St., Chapel Hill, NC 27516. The journal is provided to NCAP members through allocation of annual dues.

Subscription rate to non-members is $40.00 (continental US). Overseas rates upon request. Periodicals postage paid at Chapel Hill, NC. Opinions expressed in North Carolina Pharmacist are not necessarily official positions or policies of the Association. Publication of an advertisement does not represent an endorsement.

Nothing in this publication may be reproduced in any manner, either whole or in part, without specific written permission of the publisher. POSTMASTER: Send changes to NCAP, 109 Church St., Chapel Hill, NC 27516.

• Annual Convention Highlights...................................... 8 • Safety Solutions: The Success of Technology is Dependent on Critical Thinking............................. 11 • The NC E-prescribing Experience and Patient Safety..................................14 • Take Time to Mentor Pharmacy Students.................... 16 • Community Care Practice Forum Meeting...................18 • New Practitioner Network: CPP Opportunties for the New Practitioner...............21 • Pharmacy Time Capsules............................................ 22 Join NCAP and pharmacists nationwide for

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North Carolina Pharmacist, Fall 2011 3

From the Executive Director

Living a Legacy I used this title on a talk I delivered when I received the

I want to thank the Search Committee and the NCAP Board for

Fred M. Eckel Leadership Award. This Award was established

a job well done. Some of you had the opportunity to meet Chris

by the Pharmacy Department at UNC Hospitals to honor annu-

at our Convention. Chris plans to be on board officially Novem-

ally a distinguished graduate of the training program conducted

ber 28th. So, if you are in Chapel Hill, drop by the office to

by the Department. Because of my role in the establishment of

meet him. I plan to be on the NCAP payroll for a few months to

the programs I was honored to be the first recipient and used this

help transition Chris in his new role. It is my hope that we will

occasion to share some ideas of the steps necessary to build and

be able to get him around the state to meet many of you in your

sustain a program. I like to take credit for a lot of what has been

community too.

accomplished in North Carolina pharmacy, but I know that I

In my 45 years associated with North Carolina Pharmacy,

was able to build on an existing foundation and it was the work

there have only been four individuals who have served as the

of many others who contributed to any accomplishments.

Executive Director of NCAP or its predecessor NCPhA. Chris

Now I come to another life milestone. I received my

becomes the fifth in more than 70 years. He has implied that

50-year pin from NCAP at the Convention, having spent 45 of

he would like this to be his last career move. If we want him

those years associated with North Carolina pharmacy. Still lov-

to serve NCAP for a sustained period, we as members need to

ing that association, still having the energy, strength and health

help him transition. Accept him as he is, but work with him

to contribute and still feeling that I have something more to con-

to become better at what he does. Keep paying your dues and

tribute makes me “count my blessings.” As I leave my role as

encourage others to join too. Volunteer when requests are made

NCAP Executive Director I plan to continue supporting NCAP

for help. If we do that, Chris can become a sustained asset to

in a volunteer role as I undertake a new professional challenge.

North Carolina Pharmacy.

In this issue we introduce to you my replacement, Chris-

Although I hope to be around to offer Chris some per-

topher Gauthier. Chris is a pharmacist who graduated from the

sonal mentoring and guidance, let me offer him a few sugges-

University of Rhode Island. He practices pharmacy on a full-

tions here. Learn to enjoy North Carolina barbeque, but don’t

time basis at Penobscot Health Clinic in Bangor, Maine, where

share your preference for Eastern or Western, chopped or sliced

he currently lives with his wife Trish. They have two children

style until you have been here a long time. It is okay to have

Nicholas and Megan. Chris became involved in a leadership

a favorite, but don’t share it. Learn to think biscuits instead

role in Maine Pharmacy as he moved through their elected

of bread at a meal. Forget the Patriots and Red Sox and think

leadership roles. He saw how the Maine Pharmacist Associa-

NASCAR instead. When you dress, think school colors first

tion struggled to survive, so he decided he could help change

because that tie color may be associated with some favorite

that situation by becoming on a part-time basis their Executive

team or someone’s least favorite team. Help us get tobacco out

Director. Thus, Chris continues what has been the tradition of

of pharmacy, but learn to enjoy Tobacco Road basketball. Since

NCPhA and now NCAP of having a pharmacist as Executive

there may not be an NBA season this year, college basketball in

Director. His contemporary practice in a Health Care Clinic

North Carolina will become a great substitute, but don’t sched-

gives him insights to how health care is changing to a more

ule meetings that conflict with the ACC tournaments. Grits are

team-based practice. His role as both a pharmacist and an As-

edible, but it takes a lot of butter and even then they may not

sociation Executive gives him the skill necessary to work with

taste good. Just go with the flow, and I am sure you will enjoy

other professionals in providing care as well as passing legisla-

the South.

tion. I believe those skills will prove useful as Chris moves to North Carolina to help lead North Carolina Pharmacy forward.

4 North Carolina Pharmacist, Fall 2011

Welcome to your new home.

Fred M. Eckel

North Carolina Association of Pharmacists 109 Church Street Chapel Hill, NC 27516 phone: 919.967.2237 • fax: 919.968.9430

Dear Members, In my mind I had been preparing to write regarding the de-professionalization of pharmacy for my last address to the membership. I had planned a real venting of my spleen in the waning moments that I occupied the bully pulpit of North Carolina pharmacy. It would be my magnum opus and change the course of pharmacy forever. Instead, I would like to relate an evening one year ago in Austin, Texas.

Fred Eckel and I had traveled to Austin for the Pharmacists Mutual/NASPA Leadership Conference. This conference is held to help prepare president-elects for their presidential year. The conference helps to train leaders in skills they will need as they seek to lead their boards. The conference also allows you to meet other officers and executive directors from around the nation. On the second night of the conference we had dinner at a barbecue place out in the desert. Texans have a funny idea of what constitutes barbecue but there is not enough room in this journal to address that problem. The bus ride out was long and I had the opportunity to talk at length with Fred on the ride out and back about the future of North Carolina pharmacy and the pharmacy profession as a whole. The conversation centered on the future of pharmacy and how pharmacists will practice and be reimbursed. Fred’s grasp of the opportunities that are available to pharmacy dwarfed my vision. I realized that I was thinking very small in reference to my profession. There is plenty written on a daily level on the problems that face pharmacy. Pharmacists rightly upset over hours, working conditions, reimbursement, schools of pharmacy, etc... However, the conversation with Fred showed me the opportunity for a bright future in pharmacy. The daily problems have to be addressed but we also need to be thinking ten, fifteen, twenty years down the road. What I took away from that conversation is that there is no reason to have a jaded vision concerning the future. He made me think about the possibilities of having pharmacists appropriately reimbursed for being experts in the use of medication. I did not step off the bus that night agreeing with everything that he said, but I did have a new hope for my profession. I had an expanded horizon for what may be possible if we take on a broad vision for our chosen profession. Encouraging that level of transformation in thinking is leadership.

Most of this past year has been taken up with finding the right replacement for Fred. The committee charged with the task has worked diligently and tirelessly. I think we have an excellent choice in Chris Gauthier. His task could be seen as difficult, trying to fill big shoes. In contrast, my conversations with Chris are reminiscent of my conversations with Fred in Texas. Chris sees challenge, opportunity and hope for a great future for pharmacy in our state. We now begin the task of transition to a new executive director. Fred, of course, will be part of that transition and will continue to encourage us to think of a broad and grand vision for pharmacy North Carolina pharmacists have been blessed to have Fred Eckel at the helm of NCAP. The next few months will give us an opportunity to thank him for his contributions to NCAP. We have come a long way from the separate organizations to a unified pharmacy presence in North Carolina. No one would deny that we have plenty of work to do as an organization. I hope that we can address this work with the vision and hope that has been established by our current Executive Director. Thank you, Fred, for your leadership and dedication to NCAP and the profession.

Cecil Davis President Advancing Pharmacy. Improving Health.

North Carolina Pharmacist, Fall 2011 5

Introducing Christopher Gauthier

G

reetings, colleagues, from your new Executive Director!

You have no idea how excited I am to be able to write those words to you. I wanted to take this opportunity to officially introduce myself and tell you a little bit about my background.

I’ve got some pretty big shoes to fill around here, and I hope that this little glimpse of me will start the process of earning your trust and making the transition from colleague to friend.

So let’s get to the obvious right off the bat – I’m a Yankee. There, I said it. It’s a flaw that I hope you will learn to overlook as we get to know each other, but it’s there. Admitting that you have a problem, as they say, is the first step to being cured; so feel free to educate me on the subtle nuances of southern living, and I’ll try to be open to criticism!

I was born in Providence, RI and grew up in Massachusetts (I know, that’s two strikes!). I relocated to Maine, after earning my pharmacy degree from the University of Rhode Island, and met the woman who would complete me – my wife Tricia. We settled in Bangor and started our family; a son, Nicholas, and daughter, Megan.

I’ve done quite a few things with my pharmacy career over the years in a variety of practice settings. I’ve been director of two hospital pharmacies, ran three very different retail pharmacies, had a successful ambulatory practice, and started a residency. I guess you could say I’ve spent the last sixteen years trying on a few different pairs of shoes while I looked for the pair that fit. What was the one constant? It is the passion, for the profession and for patients, that I have seen in the eyes of every one of my colleagues in each practice setting.

It is that passion that got me involved in Association work in the first place. In truth, isn’t that the reason we all get involved in the state association? Don’t we all believe that we can accomplish more for our profession through an association than as individuals? Rules, regulations, legislative issues and the practice of pharmacy are changing on a daily basis. Don’t we all believe that state associations, like NCAP, will help make this evolution a rewarding experience for the individual 6 North Carolina Pharmacist, Fall 2011

pharmacist, pharmacy or technician? I think that we can all agree on that, regardless of whether we are north or south of the Mason-Dixon Line.

So that brings us together now, and asks the question: “Where do we go from here?” First off, let’s all realize that I am not Fred Eckel, so I’m not going to try to be Fred Eckel.

Fred is an amazing person with a wealth of experience that I can only aspire to achieve. So rather than try to morph myself into him, I’m going to be my own person and work with all of you to move the association forward while honoring the legacy of those who came before us.

Now I said that I wanted to work with you, and I wasn’t lying. As members of NCAP, we all take ownership of the association. The association’s success is, in turn, our success. I challenge every member to take the time to bring one new member into the association this year – just one. Granted, if you bring more than one member into the fold it would be even better, but let’s start with small, digestible bites. Sound good? I certainly think so, and I don’t think that I am asking a lot from you. Clearly, as members, you recognize the value of NCAP. NCAP is there, in Raleigh, educating political leaders on what we do as pharmacists and pharmacy technicians.

We are out there as your one united voice for the profession, regardless of practice setting. NCAP knows the value of the individual pharmacists and pharmacy technicians in North Carolina. Our goal is to shout it from the rooftops to all who will listen. Our mission statement states that we exist to unite, serve and advance the profession of pharmacy for the benefit of society. That should be an easy sell to any pharmacist or pharmacy technician who is not already a member. There are approximately 9,000 pharmacists and 25,000 pharmacy technicians in North Carolina. Imagine what we all could accomplish if we can get even half to join us!

I’m not asking you to do this on your own. I plan on being out there with you, recruiting and meeting all of you. North Carolina is a big state, and it is probably going to take a while to see all of it, but I plan on trying. Don’t be surprised at all if I pop into your store, or show up at the hospital. I’m the kind of guy who likes to shake your hand and look you in the eye.

I don’t want to be the talking head at the legislature, so I plan

to be ready to video conference and connect with all of you at

to make sure that I know what you all do on a daily basis. The

every level. This may be something as simple as a Skype call

only way I know how to do that is to go out and meet you and

with me if you have an issue to get off your chest, or as com-

see what you struggle with every day. I even plan on keeping

plicated as a full Board of Directors web conference with input

my hands in the profession a few days a month. I could end up

from individuals all over the state. We need to be ahead of the

working right beside you from time to time!

technology curve, not catching up to it.

Membership is always important and very often is the

The other broader vision that I have lies at our schools of

cornerstone of any state association. The more members you

pharmacy. If you ever want to see limitless energy bottled up

have, the more relevance you have. It’s just the way it is.

in a fixed place, just gaze upon a student pharmacist. Student

However, membership is not the only thing that will continue

pharmacists are the lifeblood for the future of this or any other

to move NCAP forward. We need to identify the needs of our

state association. We need to engage these colleagues, men-

membership and fulfill those needs. So, what do you want?

tor them, and welcome them into our midst with open arms.

I’m seriously asking you this question. If NCAP is going to

Student pharmacists have the advantage of a fresh perspective

ask you to entrust us with your membership, NCAP needs to

everywhere they look. We can benefit immensely from what

know what you want in re-

they see, and they can learn

turn. I need to know. What

from our past experiences.

can I do for you? What do

It is truly a match made in

you want to see the profes-

heaven. I plan on being

sion evolve into? I am your

actively involved with the

Executive Director. Essen-

student organizations at all

tially, the Board of Direc-

of our schools of pharmacy

tors and you, as members,

and hope to take APPE

are my boss. I want to be a

students in the office for

good employee and do what

a hands-on view of state

I’m told. So tell me! Let me

association operations. We

prove to you that I am worth

need to engage our future

your time. The future of

now, so they will stay as

NCAP, and the profession,

active contributors after

resides in each of you. My

graduation. I challenge

job here is to try to make that

each of you to mentor as

future a reality.

many student pharmacists

These are goals that I

as you can. The energy you

think we can address right

expend is returned to you

out of the gate. We must, however, also keep a bit broader vision as we go for-

ten-fold and everyone wins NCAP’s new Executive Director, Christopher Gauthier, attended the Annual Convention in Greensboro, NC.

ward as well. I plan to work

– including our patients.

Well I certainly think that we have enough on our

with the Board of Directors to keep vigilant to the three-year

plate to start, don’t you? I am so excited to be working with

strategic plan for the association. We need to keep our eye on

all of you! This association is poised to move forward, and I

the prize and keep reaching for that brass ring. Planning for

want you all to be a part of it. I started this note by greeting

the future now will go a long way to making the strategic plan

my new colleagues, but I hope my ramblings have made you

feasible. One thing that I am going to ask the Board of Direc-

comfortable enough to consider me a new friend. Give me a

tors to consider is an update of our IT infrastructure. With

call anytime for anything, or better yet, stop by the office!

North Carolina being as geographically large as it is, we need to be sure that every pharmacist and every pharmacy techni-

Friends are always welcome.

cian has access to us, even if they are hours away. We need

Chris North Carolina Pharmacist, Fall 2011 7

NCAP’s 2011 Annual Convention “Safety Dance: Empowering Pharmacy for Medication Safety” October 23-25, Sheraton at Four Seasons, Greensboro, NC Over 700 pharmacy professionals attended NCAP’s three-day Annual Convention that included a range of topics for all pharmacy practice settings, dynamic speakers, exhibits, a Residency Showcase and pharmacy school receptions. Eric Cropp delivered a moving presentation entitled “Jail time for a medication error: Lessons learned from a pharmacy compounding error.” Cropp was the supervising pharmacist who approved an improperly mixed chemotherapy solution that resulted in the death of a two-year-old. And, back by popular demand, Keynote Speaker Don Yaeger, a four-time New York Times bestselling author and long-time associate editor of Sports Illustrated, shared his presentation, “What Makes the Great Ones Great.”

- Convention photos by Brian Decker

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ECRS Eric Cropp - Networking Session Forest Pharmaceuticals, Inc. HCC Janssen Pharmaceuticals, Inc. LexiComp Lilly USA LPL Financial McKesson McKesson Provider Technologies Merck & Co., Inc. Mutual Wholesale Drug Company NCPRN NECC Novo Nordisk, Inc. Pfizer Injectables Pharmacists Mutual Insurance PharMEDium Services, LLC Roche Diagnostics Rx Planning Solutions Divions of Display Options, Inc. Sagent Pharmaceuticals, Inc. Salix Pharmaceuticals, Inc. Sanofi Pasteur Script Your Future ScriptFleet Smith Drug Company Stericycle, Inc. Takeda Pharmaceuticals North America, Inc. Teva Respiratory Triangle Compounding Pharmacy URL Pharma VIP Pharmacy Systems Walgreens Walmart Pharmacy West-Ward Pharmaceuticals

Fred Eckel presented the Don Blanton Award to Troy Trygstad for his contributions to NC pharmacy.

Fred Eckel (right) presented the distinguished Bowl of Hygeia Award to John Johnson. The award is sponsored by the APhA Foundation and NASPA.

Cecil Davis presented the President’s Service Award to Regina Schomberg in appreciation for her service to the Association.

Bobby Melnick, of McKesson, presented the McKesson Leadership Award to incoming Association President Jennifer Buxton.

“Thank You” to our sponsors

• Analytical Research Laboratories • ASHP Advantage supported by an educational grants from Bristol-Myers Squibb and Pfizer • ASHP Advantage supported by an educational grant from Astellas Pharma Global Development, Inc. • Campbell University College of Pharmacy and Health Sciences • National Alliance of State Pharmacy Associations • Pharmacists Mutual Companies/PMG • Rx Systems, Inc. • Stericycle, Inc. • UNC Eshelman School of Pharmacy • Wingate University School of Pharmacy • Student scholarships were provided by the NCPhA Endowment Fund with a grant from the Pharmacy Network Foundation.

“Thank You” to our exhibitors

8 North Carolina Pharmacist, Fall 2011

Fred Eckel (left) received the NCAP “Board of Directors Recognition” award and Kevin Almond (right) paid tribute to Fred for his dedication, service and leadership as NCAP’s Executive Director from 2001 to 2011.

Cecil Davis (left) received the NCAP President’s Award from President-Elect Jennifer Buxton.

Whit Moose, past president of the National Community Pharmacists Association, presented the NCPA Leadership Award to Jennifer Buxton.

Bruce Bauer, of Pharmacist Mutual Companies, presented the Distinguished Young Pharmacist Award to Debra Kemp.

Fred Eckel (right) presented the Excellence in Innovation Award, sponsored by Upsher-Smith Laboratories, to Mary Parker.

Kim Leadon presents UNC’s Community Pharmacy Preceptor of the Year Award to Jennifer Keller.

Matthew Ransom receives the UNC Health System Pharmacy Preceptor of the Year Award from Kim Leadon.

Wesley Haltom presented the W.U. Introductory Pharmacy Practice Experience Preceptor of the Year Award to Becky Jo Sawyer.

Phillip Thornton presented the W.U. Advanced Pharmacy Practice Experience Preceptor of the Year Award to Paige Carson.

Paige Brown (center) presented C.U. Preceptor of the Year Awards to Gaye Moseman for Community Practice, and Phil Mentler for Hospital Practice.

The Fifty Plus Club honors members who celebrate 50 years as licensed pharmacists. Inductees included (left to right) Hugh Clark who was pinned by his wife, Betsy; Fred Eckel who was pinned by Regina Schomberg; Whit Moose who was pinned by his wife, Dot. Not present were Harold Usher and Julian Baker.

North Carolina Pharmacist, Fall 2011 9

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Safety Solutions

The Success of Technology is Dependent on Critical Thinking

By Alex Jenkins, PharmD, MS Medicaton Safety Officer Department of Pharmacy WakeMed Health & Hospitals

What if I told you that the implementation of information technology in healthcare organizations alone cannot improve patient safety? What if I said improving healthcare information technology only adds to an already complex system of healthcare delivery and makes it harder for the end user to provide safe patient care? Would I have your attention? While these assertions are exaggerated, there are elements of truth to them which emphasize the important point that healthcare information technology applications are only as good as the end user who operates them. This means that, regardless of any state-of-the-art functionalities technology may offer, safe delivery of patient care is ultimately still dependent on healthcare professionals making good decisions by demonstrating critical thinking skills.

Critical thinking has been defined in a variety of different capacities within healthcare literature but one common theme is that it must be hardwired into the culture of a healthcare organization because it is an active and dynamic process.1 Kyser provided the following definition of critical thinking: ions- Spring“Critical 2011 Ad thinking is a certain mindset or way of thinking, rather than a method or a set of steps to follow. Critical thinking is clear thinking that is active, focused, persistent, and purposeful. It is a process of choosing, weighing alternatives, and considering what to do. Critical thinking involves looking at reasons for believing one thing rather than another.” 2 The most important concept behind critical thinking is that it is predicated on the process of continuously working to make informed decisions rather than acting without understanding the decision that is being made. Moreover, demonstration of true critical thinking skills by consistently and continuously per-

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forming this process will result in “making good decisions and following up actively on problems.”3 Another vital component to critical thinking is asking questions such as “could what I am doing be wrong?” rather than making the assumption that what you are doing is right.4 In his book Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care, John Nance envisions a fictitious healthcare organization that has an established safety culture characterized by the 50-50 rule. The basic principle behind this rule is that you assume there is a 50% chance of error in everything you do. Therefore, you are much more likely to ask questions and think critically to make sure the right decision is made when delivering patient care.

There is no more important place to be exercising critical thinking than at the patient bedside, especially with respect to safe use of medications. At the patient bedside it is paramount that adequate safety checks be in place because this is the last chance to catch any errors that have occurred in the medicationuse process prior to administering that medication to the patient.

Because the administration step is the last chance to prevent an error in medication use from reaching the patient, many healthcare organizations have chosen to adopt barcode medication administration (BCMA) applications, but this technology is not without problems. According to an informatics survey distributed to Pharmacy Directors nationwide in 2007, approximately 24% of all hospitals had implemented BCMA systems at that time, and this number is probably closer to 50% now as many directors had indicated implementation plans were underway.5 However, even after successful implementation of a technology such as BCMA there are still many challenges to optimization because the human element cannot be ignored. It has been demonstrated in the literature that there are a variety of potential workarounds and misunderstandings associated with BCMA and electronic medication administration records (eMAR) because there is a tendency to make technology the focus of a process rather than the patient.6 For instance, a nurse who has scanned a medication three different times and gotten an alert for “wrong medication” may simply override the scan because the barcode wouldn’t scan correctly instead of doing what should have been done, verify that it is the correct medication. This is just one example of an everyday workaround that could be prevented by a nurse simply taking the time to step back and verify the accuracy of what he/she is about to do. Information technology applications like BCMA are ultimately designed to improve safety in medication use so we cannot lose sight of the patient when new technologies are incorporated into organizational workflow.

Recent literature has also shown that errors have resulted from misunderstanding of the audible beep made by the barcode scanner at the patient bedside.8,9 The causes of these errors are barcode scanners that beep only to indicate a barcode has in fact been scanned rather than indicating that the correct barcode was scanned. Consequently, the beep not only provides little value but it also introduces confirmation bias into the medication administration process. Hearing the confirmatory beep may prompt the nurse to assume everything has been done correctly rather than ask “what could have gone wrong up to this point?” Making North Carolina Pharmacist, Fall 2011 11

assumptions at the bedside may increase the risk of patient harm due to medication errors because assumptions inherently lead to uninformed decision-making caused by a lack of critical thinking.

Solutions to recurring problems and workarounds with healthcare information technology applications may be found by hardwiring critical thinking into the culture of an organization.

It has been said that culture is the stabilizing force that creates the perception of how healthcare professionals think, perform, and conduct themselves while providing patient care.9-11 Therefore, it is imperative that healthcare organizations establish clear values that emphasize critical thinking as a foundation for a safety culture. Regardless of the technology, successful implementation and optimization requires the consideration of the end user. Because technology is an additional safety measure (not a replacement safety measure), the end user must understand the value that technology brings to the medication-use process and incorporate it accordingly. By combining technology with sound decision-making, healthcare organizations can develop effective plans for improving patient safety, but the key is fostering a culture that embraces critical thinking. v

References: 1. Dailey MS, Loeb BB, Peterman C. Communication, Collaboration, and Critical Thinking = Quality Outcomes. Patient Safety & Quality Healthcare 2007; Available at: http://www.psqh.com/novdec07/quality.html 2. Kyser SP. Sharpening your critical thinking skills. Orthopaedic Nursing 1996;15(6):66-76 3. Hanston RI, Washburn M. Individual and organizational Accountability for development of critical thinking. Journal of Nursing Administration 1999;29(11):39-45 4. Nance JJ. Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care. Bozeman MT: Second River Healthcare Press. 2008 5. Pedersen CA, Gumpper KF. ASHP national survey on informatics: assessment of the adoption and use of pharmacy informatics in U.S. hospitals--2007. Am J Health Syst Pharm 2008;65(34):2244-64 6. Koppel R, Wetterneck T, Telles JL, Karsh. Technology evaluation: workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. JAMIA 2008;15:424-429 7. ISMP. Scanner beeps only means the barcode has been scanned. ISMP Medication Safety Alert! 2011;16(13):1-3 8. ISMP. What does a bar-coding scanner beep mean? ISMP Medication Safety Alert!

2009;14(19):1-3 9. ISMP. That’s the way we do things around here! Your actions speak louder than words when it comes to patient safety. ISMP Medication Safety Alert! 2011;16(4):1-3 10. Gherardi S, Nicolini D. The organizational learning of safety in communities of practice. Journal of Management Inquiry 2000;9:7-18 11. Permal-Wallag MS. Safety culture chapter. In: University of Michigan Health System Patient Safety Toolkit. The Regents of the University of Michigan

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Career Center North Carolina Pharmacist, Fall 2011 13

The NC E-Prescribing Experience and Patient Safety

By Kim Roberts, PharmD E-prescribing Program Manager Community Care of North Carolina Medication Management, LLC

Background The original goals for e-prescribing were to help to reduce medication errors and to improve overall patient safety. In 1996, the Institute of Medicine launched a concerted, ongoing effort focused on assessing and improving the nation’s quality of care.¹ Two reports that were published by the Institute of Medicine in 1999 and 2001 heightened awareness of medication errors and made governing entities realize that changes needed to be made to help improve patient safety.

The first report was published in 1999 and was entitled “To Err is Human: Building a Safer Health System.” Important findings from this study concluded that 98,000 people die annually as a result of a medical error. Adverse drug events and medication errors are included in this number. These deaths were believed to be preventable. Medical errors were ranked as the 8th leading cause of death at that time. ² As a result, the Institute of Medicine (IOM) made recommendations to use tools and innovation to help reduce these errors. The second report was entitled “Crossing the Quality Chasm: A New Health System for the 21st Century.” The 2001 report listed five imperatives for increasing the quality of healthcare in the United States. Those imperatives included reengineered care processes, effective use of information technologies, knowledge and skills management, development of effective teams, and coordination of care across patient conditions, services, and sites over time.3 It has been estimated that two-thirds of encounters in the outpatient setting result in a prescription. One study reported that US fatalities from acknowledged prescription errors increased by 243% between 1983 and 1998, totalling almost 10,000 per year.4 This percentage increase was greater than most any other cause of death and far outpaced the increase in the number of prescriptions in the same time period.4 Among physicians, the most common errors associated with handwritten prescriptions include inappropriate dosing, prescribing the wrong medication, and failure to monitor for side effects.5,6 Pharmacist errors are divided into mechanical and judgmental errors. Mechanical errors include dispensing the wrong drug, dosage form, directions, quantity, or strength or dose. Ineligible handwriting would result in a mechanical error. Judgmental errors include improper or no counseling, failure to detect drug interactions, and inadequate drug use review. 7 E-prescribing History and Purpose E-prescribing evolved as a system to help reduce medication errors. E-prescribing originated in 1977, but really did not get any press until 2003 when Congress passed the Medicare Modernization Act, which encouraged providers to adopt electronic prescribing technology. Utilization was still low until the HITECH act of 14 North Carolina Pharmacist, Fall 2011

2009 made available financial incentives to eligible providers.

Since that time we have seen this practice evolve and expand significantly.

Standalone systems and systems that are embedded in an electronic health record are the two types of e-prescribing software currently available. E-prescribing is more than the mere electronic entry or transmission of a prescription. It encompasses the secure real-time electronic delivery of patient specific information to providers and pharmacists. The information received may include patient eligibility and benefits, drug-drug interactions, warnings or recommended dose adjustments, medication refill history, and the availability of generics. Centers for Medicare and Medicaid Services (CMS) states that eligible professionals must adopt a “qualified” e-prescribing system which must consist of four distinct capabilities. First, the system must be able to generate an active medication list from electronic data from pharmacies and prescription benefit managers if available.

Secondly, the system must have the ability to select medications, print medications, electronically submit prescriptions, and conduct all alerts. Third, the system must be able to provide information related to lower cost, therapeutically appropriate alternatives (if any). The systems also need to provide information on formulary, or patient eligibility, and authorizations received from the patients’ drug plan if available.8 E-prescribing in North Carolina Community Care of North Carolina (CCNC) was responsible for launching an e-prescribing initiative support team in 2008. The CCNC infrastructure was an opportune mechanism for the education and dissemination of information to practices throughout the state. CCNC has 14 networks that cover all 100 counties in North Carolina. There are well established lines of communication with many practices and pharmacies. Eight clinical pharmacists contracted from Medication Management, LLC were disbursed throughout the state to work in conjunction with the CCNC networks and assist practices with e-prescribing implementation and training. The first one and a half years of the program were intensely focused on education and implementation. The number of pharmacists was reduced to 1.6 FTE in April of 2010 as the program moved its focus from statewide education and training to support. On February 12, 2010 the Office of the National Coordinator (ONC) created Regional Extension Centers (REC) across the United States to help more than 100,000 primary care providers meaningfully use electronic health records (EHRs). REC services include outreach and education, EHR support (e.g., working with vendors, helping choose a certified EHR system), and technical assistance in implementing health IT and using it in a meaningful way to improve care.9 CCNC recognized this as a unique opportunity to leverage its infrastructure and eRx team to help support the goals of the NC REC. The eRx team from CCNC started working with AHEC/ Regional Extension Center workforce. While the REC is focused on EHR adoption for medical practices, the CCNC team focused specifically on e-prescribing issues to help practices transition to using electronic health records within their practice.

Those of us working on the state e-prescribing initiative

have seen rapid adoption of e-prescribing by providers in North Carolina who were trying to meet the June 30th, 2011 deadline to avoid a payment adjustment in 2012 for not e-prescribing.

We have also seen a transition from the standalone e-prescribing systems to the systems that are embedded in the electronic health record. As with any new technology there has been an emergence of errors associated with electronic prescribing that are different from those common to written prescriptions.

E-prescribing is Still Evolving Errors that have been brought to my attention in North Carolina include inaccurate database entries, selection of the wrong drug, drug entry for the wrong patient, and technical and training issues for both pharmacies and providers. Selection of the wrong drug is also a common error if the system has poor usability and functionality. The drugs in some systems can appear difficult to differentiate from those that are similar.

A logistical issue that has arisen is the transition from faxing refill requests to sending electronic refill requests. Providers have seen an increase in duplicate refill requests for same patient and same drug from the same pharmacy to multiple providers on the same day. Failure to receive a timely response from prescribers is often confused with potential transmission errors. Prescribers and pharmacies must work together to resolve technical difficulties by providing feedback to vendors and by agreeing on response times that take into account both patient needs and staff workload limitations.

Some of the national issues that have been identified with e-prescribing are cognitive overload; loss of overview of the clinical situation; errors in data entry and retrieval; excessive reliance on electronic health data; disruptions of established workflow patterns and the tendency to infer that data entry equates to communication within and among health care teams. 10, 11 These new risks are the unintended and unanticipated consequences associated with the introduction of the electronic prescribing system. Unintended errors such as picking a wrong option from a drop down list or typing “100” instead of “10” are common.

It also seems that providers frequently try to make corrections electronically if an error is discovered after the prescription has been sent. The best practice is to call the pharmacy to alert them of the issue, so that they do not dispense the incorrect medication. Awareness of these new contributors to error potential, and adequate training with the systems, will improve these issues.

Pharmacists and Providers should document any safety issues in the Pharmacy and Provider E-prescribing Experience Portal (PEER). The purpose is to allow the Alliance for Patient Medication Safety (APMS), a patient safety organization, to gather detailed information that can be used to improve the quality and effectiveness of electronic prescribing technologies. To log entries go to https://www.pqc.net/eprescribe/disclaimer.aspx.

Certification to Create and Ensure Industry Standards Surescripts recently announced that they will start certifying vendors on NCPDP SCRIPT version 10.6 in the latter part of this year, with more widespread adoption next year. NCPDP SCRIPT version 10.6 is the standard for e-prescribing and related transactions. One of the key enhancements that SCRIPT 10.6 will make available is the drug codification system known as RX Norm, which will “provide a more accurate and exact drug selection list, enabling the pharmacist to select the correct drug

to dispense.” SCRIPT 10.6 also includes an enhanced “Sig” codification. SCRIPT 10.6 supports a medication-history source feature that can show where the history was obtained and the identity of the source. It includes the capacity to consolidate medication histories from different sources. 12 Collective use of all data standards such as Rx Norm, movement towards interoperability, and adoption of best practices should reduce the error potential.

Standards for e-prescribing are evolving and not all systems use the national standard. Vendors should move to this new standard as we move toward the goal of interoperability by 2015.

E-prescribing Resources Another valuable resource is the “The 2011 Updated Clinicians guide to e-prescribing.” 13 This is a best practice guide that emphasizes the important aspects of training and ongoing system maintenance. The report also recommends contacting a vendor whenever a problem occurs and contains a troubleshooting guide on different scenarios that may occur. I do not think enough emphasis can be placed on training. I recommend continuous communication among staff and team members to ensure that any given system will be used as it was originally intended in order to take advantage of these advanced tools for improved efficiency and patient care.

Summary E-prescribing is an evolving process. Currently, medication histories do not appear in all e-prescribing systems. As we move closer to interoperability, we will also move closer to having improved products. E-prescribing at its best will enable providers to review external medication histories and add these directly to their active medication list within their electronic record. This will improve the ability to do a complete medication reconciliation at the provider level and should lead to improved patient safety. v References 1. http://iom.edu/Activities/Quality/QualityHealthCareAmerica.aspx 2. http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Er r%20is%20Human%201999%20%20report%20brief.pdf 3. http://iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-QualityChasm/Quality%20Chasm%202001%20%20report%20brief.pdf 4. Phillips DP, Bredder CC. Morbidity and mortality from medical errors: an increasingly serious public health problem. Annu Rev Public Health. 2002;23:135150.

5. Abood RR. Errors in pharmacy practice. US Pharm. 1996;21(3):122-130.

6. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA. 1997;277:307-311.

7. Allan EL, Barker KN. Fundamentals of medication error research. Am J Hosp Pharm. 1990;47:555-571.

8. www.cms/gov/erxincentive.

9. http://healthit.hhs.gov/portal/server.pt/community/hit_extension_program/1495/home/17174 10. Ash JS, Sittig DF, Dykstra R, Campbell E, Guappone K: The unintended consequences of computerized provider order entry: Findings from a mixed methods exploration. International Journal of Medical Informatics 2009, 7(8):69-76.

11. Weiner JP, Kfuri T, Chan K, Fowles JB: e-Iatrogenesis: The Most Critical Unintended Consequence of CPOE and other HIT. Journal of the American Medical Informatics Association 2007, 14:387-388.

12 http://drugtopics.modernmedicine.com/drugtopics/Chains+%26+Business/ NCPDPs-SCRIPT-106-enhances-e-prescribing/ArticleStandard/Article/detail/ 739277?contextCategoryId=40159 13. http://www.surescripts.com/media/800052/cliniciansguidee-prescribing_2011.pdf North Carolina Pharmacist, Fall 2011 15

Take Time to Mentor Pharmacy Students

By Rich DeBenedetto Campbell University College of Pharmacy & Health Sciences Class of 2012

I remember very well the first immunization that I administered, perhaps not as well as my wife who received the inoculation, but very well. It was with a sense of pride and purpose that I slowly inserted the needle into my wife’s deltoid with my supervising pharmacist looking on. My wife grimaced the entire time thinking it hurt a lot more than she was told it would.

I didn’t use a 20 gauge needle, or stick her in the wrong spot, it was my technique and how long it took me to inject that was the problem. Over the years, I have administered every one of my wife’s annual influenza vaccines and, according to her, it has not hurt since that first one. As a first year student pharmacist, I still had much to learn about pharmacy. Now as a fourth year student pharmacist, I feel like I have just as much to learn.

I have all the therapeutics coursework behind me and I have made it through the feared internal medicine rotations, but the information I learned from classes and rotations keeps me thinking about how much I still have left to learn. How will I ever know everything about pharmacy?

How can I protect my patients if I don’t know everything? Enter the pharmacist mentor… Thank you Randy Arndorfer (Walgreens, Oconomowoc, WI) for being the pharmacist that every patient wanted to see, you were the role model who

encouraged me to become the healthcare provider patients come to first. Thanks, Heidi Worthington, (Walgreens, Apex, NC) for always supporting me and motivating me to do more. Thank you Julie Murray (Walgreens, Apex, NC) for being a great role model and encouraging me to care for patients as individuals, like I would want someone to care for my own family. Thanks, Kim Sever, (Walgreens, Durham, NC) for showing me the correct way to immunize and encouraging me to counsel patients. Thanks, Martha Thompson, (Target, West Allis, WI) for believing in my abilities and encouraging me to reach for the stars. Much thanks to Bob Cisneros (Campbell University) for telling me to get involved and being a constant source of support for me and all of his students. Thank you Mary Townsend (Durham Veterans Administration) for being a fountain of knowledge and helping me become a clinician. There are many more mentors to thank and only so much room in this journal. My pharmacist mentors have been much more than people I work under, they have been role models for how to act in a pharmacy, educators in areas where my knowledge was lacking, skills teachers to build my abilities, counselors to talk to about areas of concern, and caring people who have shaped how I view the role of pharmacist, as a caretaker.

I want to encourage every pharmacist out there to actively work at being the role model for a student pharmacist. Students need the real world pharmacy experience to excel in school, but more importantly, they need the caring pharmacist to help them through the process.

The paths to becoming a mentor are

varied, but all begin with being a caring pharmacist. Volunteer to help students at pharmacy school events. Hire student pharmacists to work shifts at your pharmacy.

Open your pharmacy for student pharmacy organizational events such as educational booths or immunization clinics. Keep your ears open, that technician working on Saturdays might just be a current student pharmacist or a future applicant to your Alma Mater.

Now that you have that young student, your blank canvas for shaping into a pharmacist, what do you do with them? I can start with what you do not do with them…

Do not stick them in the drive thru window and have them selling prescriptions to an endless line of cars. Show them each area of the pharmacy and have them work a bit in each, but train the student to do what you do. Having a student selling prescriptions is not inherently bad, but placing them in a situation where they feel like they are not doing work to prepare them to be a pharmacist is inappropriate. In fact, I enjoy working at the checkout counter where I have the ability to counsel each patient on their medications.

Do not assume that they have all the answers or know what to do. Student pharmacists want to have the answers and may have many of them, but they need to be observed and monitored so they do not get into a situation where they are not prepared to handle themselves. Guide them along the way and show them how to find answers they do not have so they can grow into independent pharmacists upon graduation.

Do not just give your student pharmacist the tasks you do not want to do.

Wilson Pharmacy Consulting

Retail, Long Term Care, Hospital, Infusion 8525 Scoggins Road Oak Ridge, NC 27310

Dr. Thomas Steve Wilson PD, MBA, MHA 336-317-0093 Wilconsult@aol.com 16 North Carolina Pharmacist, Fall 2011

Your student pharmacist is not a technician, cashier or someone to be hazed, they are a young you. Give them opportunities to try new things and sometimes the chance to fail. Give them support and structure so they know what to do, but more importantly so they know how and when to seek help.

Do not be the absolute authority.

Nobody knows everything, not even you! Continuing education exists for a reason. Show your student pharmacist that even you have to look up information and answers to questions. We need to see that pharmacists have to learn throughout their career and that learning is a lifelong process.

Be involved. Your student needs you to be involved. Get involved in their education, in your association, in advocacy, in everything. Show your student the importance of being involved with a variety of activities and you will help to build a stronger profession through the stronger professional you are mentoring.

Care for your patients. You already do this in your regular practice, but your student pharmacist needs to experience and witness the kindness and care you provide to your patients. Our profession is not

easy, on those hard days it is important for student pharmacists to be reminded of the impact we can have on a patient.

Press 8 for the run-around. After I tell you to not stick them in the repetitive role and not to give them the tasks you do not want to do, I tell you to do those tasks.

Do those tasks and share those tasks with your student pharmacist. It is important to see that pharmacists have to do all the tasks in the pharmacy. The student pharmacist can even gain experience from sitting on hold with a doctor’s office or insurance company. Give them the op-

portunity to see and perform every role in the pharmacy.

While I know that I have much more to learn and there are many more skills to master, my current and future pharmacist mentors will help me along the way.

Through their leadership and guidance patients in North Carolina will have another great pharmacist caretaker looking out for their health. Take time to mentor your own student pharmacist. v Rich DeBenedetto completed a pharmacy rotation at NCAP in September.

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Community Care Practice Forum Meeting The NCAP Communitiy Care Practice Forum Meeting was held August 5-6, 2011 at the Sheraton Myrtle Beach Convention Center Hotel in Myrtle Beach, SC. For the third straight year NCAP collaborated with North Carolina Mutual Wholesale Drug Company to host the event.

Highlights of the meeting included the presentation of two prestigious awards.

The NCAP Ambassador Award was presented to David S. Moody, Jr., RPh, who serves as CEO of North Carolina Mutual Wholesale Drug Company in Durham.

David Moody The award is periodically given to an NCAP member who exhibits outstanding national pharmacy leadership. Along with the day to day operations of a wholesale drug company, Moody is also involved in lobbying efforts on both the state and federal level on behalf of Mutual Drug members and serves in many capacities within HDMA including Chairman of the Board of

Directors, and member of the Governmental Affairs Committee, Political Action Committee (PAC), and the Government & Public Policy Council (GPPC). In addition, Moody sits on the Board of Directors for the Association of Community Pharmacists and Wholesale Alliance.

The Community Care Pharmacist of the Year Award was presented to Nathan Hemberg, PharmD, who is employed at Carolina Apothecary in Reidsville. Hemberg was recognized for his Medication Therapy Management work, his involveNathan Hemberg ment with the UNC Eshelman School of Pharmacy residency, and his work as a Clinical Pharmacist Practitioner.

The meeting was developed with Campbell University College of Pharmacy & Health Sciences and co-sponsored by UNC Eshelman School of Pharmacy and Wingate University School of Pharmacy.

NCAP has partnered with the Connecticut Pharmacy Association to offer The Pharmacist Refresher Course, an online course designed for pharmacists who wish to return to community pharmacy practice after an absence from practice for three or more years. The course consists of three modules, all of which have been approved for ACPE credits. The first two modules are online and composed of weekly study segments that allow course participants to work at their own pace, on their own time. The third module consists of a three-week, 90-hour live experience in a community pharmacy. Only those who participate in all three modules will earn a Pharmacist Refresher Course Certificate from Charter Oak State College. Those taking modules One and/or Two for personal enrichment will earn ACPE credits through CPA. This course will give home study law credit to any pharmacist wanting to learn about quality assurance strategies and North Carolina’s pharmacy laws.The QA/Law Course can be used to prepare for reciprocity into North Carolina, or for those who want an update on Pharmacy Law and

Online Offerings: Pharmacist Refresher Course & QA/Law

Quality Assurance. Students must follow a two-week course schedule. Online discussion boards and instructor monitoring and interaction keep you on track throughout the course. The course is offered the first two full weeks of every month. This course is accredited by ACPE for 15 hours of home study law education.

For more information visit www.ncpharmacists.org

18 North Carolina Pharmacist, Fall 2011

Yep, we’re a lifesaver!

A continuous quality improvement program can be a lifesaver ...

Protect your patients. Protect your pharmacy. Errors can injure your patients and put your pharmacy in financial jeopardy.

Pharmacy Quality CommitmentÂŽ (PQC) is a continuous quality improvement (CQI) program that supports you in responding to issues with provider network contracts, Medicare Part D requirements under federal law, and mandates for CQI programs under state law. Implemented, pharmacies improve efficiency, increase patient safety, and decrease error rate through an analysis of quality-related events.

Call toll free (866) 365-7472 or go to www.pqc.net for more information.

PQC is brought to you by your state pharmacy association.

North Carolina Pharmacist, Fall 2011 19

Pharmacists Say it Best …

“PTCB Certified Pharmacy Technicians continually demonstrate the highest excellence of professional performance across practice settings. I’ve had the pleasure to work with PTCB CPhTs and rely on their support to my pharmacist activities in providing patient care.

They are among the best qualified to participate in operational functions of dispensing and inventory management. Our pharmacy simply couldn’t function without our team of PTCB CPhTs.” —Jeanie Barkett, RPh, Long Term Care Pharmacy Lead Pharmacist, Providence Specialty Pharmacy Services, Portland, OR

Do it for your pharmacy.

Do it for your patients.

Do it for you.

Encourage your technicians to become PTCB certified today! Candidates may apply to take the Pharmacy Technician Certification Exam online at www.ptcb.org.

15 Years of Certification Excellence Since 1995, the Pharmacy Technician Certification Board (PTCB) has certified over 383,000 technicians nationwide and continues to operate as the national standard for pharmacy technician certification. PTCB’s certification program is the only pharmacy technician certification endorsed by the American Pharmacist Association, the American Society of HealthSystem Pharmacists, and the National Association of Boards of Pharmacy.

Support your pharmacy, patients, and colleagues by encouraging your pharmacy technicians to become PTCB certified.

NCAP’s Technician Review Seminar will help you prepare for the PTCB Exam. Check www.ncpharmacists.org for Seminar dates and locations.

CONNECT ONLINE:

20 North Carolina Pharmacist, Fall 2011

New Practitioner Network

CPP Opportunities for the New Practitioner

By Minal Patel, PharmD, BCPS and Brock Woodis, PharmD, BCPS, CPP

Over the last 10 years, pharmacists in North Carolina have had the opportunity to work as Clinical Pharmacist Practitioners (CPP) under the Clinical Pharmacist Practitioner Act. The rules that became effective in April 2001 have allowed many pharmacists to work as mid-level practitioners under a collaborative practice agreement with a supervising physician.

Pharmacists who apply to be CPPs must receive approval from both the North Carolina Medical Board as well as the NC Board of Pharmacy.

These pharmacists should demonstrate additional clinical training and experience in order to be considered for CPP registration. According to 21 NCAC 46.3101, in order to become a CPP, one must have completed an ASHP-accredited residency, BPS certification or CGP certification as well as two years clinical experience; PharmD degree, completion of a certificate program plus three years clinical experience; or BS degree, completion of two certificate programs plus five years clinical experience. In addition, policies and protocols developed with the supervising physician must be submitted for review. The supervising physician should allow for a weekly face-to-face review of orders placed by the CPP. Traditionally, CPPs have been in the ambulatory care setting including hospital outpatient clinics, physicians’ private practices, and long-term care practices.

However, there have been increasing opportunities for CPPs in the inpatient setting. According to a recent query of the NC Medical Board website, there are over 140 pharmacists who have either an active or inactive CPP license. The practice settings include community health clinics, physicians’ private practices, as well as several health systems from across the state.

With health care reform on the horizon, pharmacists can establish themselves as part of the multidisciplinary health care team as the drug therapy experts. Under the CPP Act, pharmacists are able to work along-

side physicians, providing patient-centered pharmaceutical care and in turn, receive reimbursement for services rendered.

A New Practitioner’s Experience Becoming a CPP

By Brock Woodis PharmD, BCPS, CPP

I was approved to practice as a CPP just last year. It has been a very rewarding experience which has allowed me outstanding opportunities to further expand my scope of practice and deliver more patient-centered care. My current position is through Campbell University College of Pharmacy and Health Sciences which provides me a practice site in ambulatory care pharmacy at Duke Family Medicine.

At Duke Family Medicine, I am able to work in a collaborative, multidisciplinary, patient-centered site. Patients are referred to me for assistance in management for a variety of chronic conditions including diabetes mellitus, hypertension, hyperlipidemia, asthma, and chronic obstructive pulmonary disease. I also provide medication reviews and consultations regarding polypharmacy. We are currently expanding my services to include post-hospital discharge counseling as well as contraception counseling. Be-

ing a CPP permits me to work in tandem, although independently, with other health care practitioners including physicians and physician assistants. Patients are referred by their primary care provider (PCP) and a one-on-one appointment is then scheduled with me. I am able to prescribe medications and order labs per my collaborative practice agreements. Notes are then dictated for documentation purposes and I follow-up with the PCP when necessary. All of my notes are reviewed and co-signed by my supervising physician. I am not billing for my services, but I am currently investigating this.

One of the most rewarding experiences of being a CPP has been the close relationships I have formed with my patients. I frequently see my patients multiple times for follow-up. Seeing them take ownership of their conditions and be personally invested in their healthcare is amazing. For instance, I recently had a patient achieve an A1c of 6.7%. She had not been at goal in the last twelve years!

Practicing as a CPP has been an incredibly worthwhile experience, especially when such positive outcomes occur. I feel that I am an integral member of the healthcare team at my practice, and I can honestly say that I love what I do! v

NPN Member Spotlight: Lisa Brennan It was a circuitous route to where I am today, with three careers before deciding on pharmacy. However, pharmacy was always in my differential, even listed as my major on my transcript my sophomore year at UNC over 20 years ago! I finally did earn my Doctor of Pharmacy degree at Creighton University. I then completed my PGY1 Pharmacy Practice Residency at UNC-Chapel Hill and my PGY2 Geriatrics Residency at the Durham VA Medical Center. I have been practicing as the Internal Medicine Clinical Pharmacy Specialist at Forsyth Medical Center (FMC) in Winston-Salem, NC since 2008. I recently became a Clinical Pharmacist Practitioner, the first one here at FMC. NCAP has provided me with many opportunities, from speaking at the Annual Meeting to serving as Education Committee co-chair. Through this organization, I have been able to meet pharmacists who have willingly provided guidance and support whenever I have asked. Through the Learning to Lead program offered by NCAP, I met innovative new pharmacists throughout the state, whom I have contacted when struggling with clinical or administrative issues. Pharmacy is a small world, and NCAP has made it a more friendly one for me.

North Carolina Pharmacist, Fall 2011 21

Pharmacy Time Capsules 1986 - Twenty-five years ago: • Food and Drug Administration approval of the first monoclonal antibody drug, Muronomab-CD3 (also known as Orthoclone OKT3), for treatment of transplant rejection.

• Total health care expenses for a population of approximately 244 million were approximately $477 billion.

• Average prescription price was $14.36 and the average number of new and refill prescriptions filled per year was 29,100 according to the Lilly Digest.

1961 - Fifty years ago: • Pharmacist Donald Hedgpeth and the Northern California Pharmaceutical Association indicted for violation of the Sherman Anti-trust Act for the development of a pricing schedule that incorporated a professional fee.

• Amitriptyline HCl (Elavil) was in-

troduced in the US by Merck Sharp & Dohme.

• Total health care expenses for a population of approximately 189 million were approximately $29 billion.

• Average prescription price was $3.25 and the average number of new and refill prescriptions filled per year was 15,100 according to the Lilly Digest.

Library and Museum, Cincinnati, OH

1936 - Seventy-five years ago: • Johnstown, PA was hit with a devastating flood on St. Patrick’s Day. Initial reports were that 27 out of 34 drug stores were destroyed. Pharmacists and manufacturers rushed aid to the city to assure that essential medicines were available.

1886 - One hundred twenty-five years ago: • The Brooklyn College of Pharmacy was formed in 1886. Renamed, it is now the Arnold and Marie Schwartz College of Pharmacy and Health Sciences of Long Island University.

One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America’s history. Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year.

To learn more, check out: www.aihp.org

calendar January 20, 2012: Girls of Pharmacy Leadership Weekend, Grove Park Inn, Asheville, NC March 22-23, 2012: Chronic Care Practice Forum Meeting, The Ballantyne Hotel, Charlotte, NC October 28-30, 2012: NCAP Annual Convention, Raleigh Convention Center, Raleigh, NC Other events are still to be determined. Check our website:

www.ncpharmacists.org

By Dennis B. Worthen, Lloyd Scholar, Lloyd

Statement of Ownership as required by the US Postal Service

22 North Carolina Pharmacist, Fall 2011

Gather your girlfriends for a weekend of fun, facts, and facials! Register today to ensure your spot at the 2012 Southeastern “Girls of Pharmacy” Leadership Weekend. Full registration includes: CE programming, event materials, two breakfasts, and one dinner reception with included drink ticket. Extra reception tickets can be purchased separately.

New for 2012! We have two optional events that you can sign up for with your registration. On Saturday we’ll be having a special cooking demonstration and lunch with one of the Grove Park Inn’s award-winning chefs. Tickets for this lunch and demo are $60. On Saturday evening we will be hosting a “Sips and Sweets” wine and dessert pairing event. The cost is $45 per person.

Rooms are available at the Grove Park Inn for $144 per night. Call (800) 4385800 to book your room today.

Spa appointments are available for reservation through the Grove Park Inn. You must be registered for the event to make reservations through SCPhA’s reserved appointment times. Attendees are entitled to a 15% treatment discount on services booked before noon on Friday, January 20th and after noon on Sunday, January 22nd. This discount is not valid on manicures or pedicures and cannot be combined with any other discounts or packages. Call the spa directly at 828-253-0299 to make your reservations today.

For questions, please call 803.354.9977.

South Carolina Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is eligible for ACPE credit; see final CPE activity announcement for specific details.

Name_____________________________________________ □ RPh □ Technician Lic/Reg #______ Address_____________________________________________________________________________ City, State, Zip________________________________________________________________________ Phone__________________ Email______________________________________________________ Registration Fees (Guest registrations DO NOT include CE credit but do cover meal function costs): □ Full Participating State Association Member (w/ CE) $220; State: □ GA □ KY □ NC □ SC □ TN □ VA □ Full Non-Member (w/ CE) $315 □ Full Guest rate (no CE, includes all meals) $145; Guest of:____________________________ □ Additional Friday Night Dinner Reception Tickets ($60 each) Qty. _______ x $60 = $______ □ I would like to add a student sponsorship ($145) Optional Events: Saturday Lunch/Demo: Qty.____ x $60 = $_____

Sips & Sweets: Qty.____ x $45 = $_____

Event PharmDiva Shirts (shirts will be slate grey with hot pink PharmDiva design): Short Sleeve ($20 each): ___Small ____Medium ____ Large ____ XLarge ____ XXLarge Long Sleeve ($25 each): ___Small ____Medium ____ Large ____ XLarge ____ XXLarge Additional PharmDiva apparel and accessory options are available for purchase at www.pharmdiva.com.

Total to be charged: $_______Method of Payment: □ Check; Check #_________ Please make checks payable to SCPhA Please charge my: □ Visa □ AMEX □ MasterCard □ Discover Credit Card #__________________________________________________ Exp. Date__________ CCV #______

Cancellation Policy: You must notify SCPhA in writing at least five business days before the meeting to be eligible for a refund, minus a $10 processing fee. No refunds will be given for late cancellations or no-shows. Please note that the threat of inclement weather shall not be sufficient to override our cancellation policy.

Return to SCPhA at 1350 Browning Road, Columbia, SC 29210 or via fax to 803.354.9207.

You can also register online at www.scrx.org.

North Carolina Pharmacist, Fall 2011 23

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   

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 ● prescription processing

● electronic billing

● accounts receivable

● Rx & OTC scanning at POS

● legend drug perpetual inventory

● OTC items perpetual inventory

● electronic signature capture

● interactive voice response

● electronic purchase orders

● barcoding for POS

● pre and post editing

● NDC scanning

● HIPAA Security Compliant

● long term care

● robotics interface

 Pharmacy Management System

for that ery mportant harmacy VIP Computer Systems, Inc. 138 North Churton Street Hillsborough, NC 27278

Phone (919) 6441690 Fax (919) 6441694 Email sales@vippharmacy.com