North Carolina Pharmacist Fall Journal 2012

North Carolina

Pharmacist Vol. 92, Number 4

Advancing Pharmacy. Improving Health.

Fall 2012

NCAP Annual Convention “Making Your Voice Heard” October 28-30, 2012, Raleigh Convention Center

808 Highway 18 W | Algona IA 50511

How does your

Professional Liability

measure up?

&RYHUDJH %HQHÀWV Our Professional Liability Policy is VSHFLÀFDOO\ GHVLJQHG DV H[FHVV FRYHUDJH \HW LW FDQ EHFRPH \RXU ÀUVW OLQH RI GHIHQVH ZKHQ QR RWKHU FRYHUDJH LV DYDLODEOH ‡ $GGLWLRQDO SURWHFWLRQ for you above that provided by your employer. ‡ Covered KRXUV D GD\ anywhere in the United States, its territories and possessions, Canada or Puerto Rico. ‡ &RYHUV FRPSRXQGLQJ DQG LPPXQL]DWLRQV (if legal in your state). ‡ On-staff SKDUPDFLVW DWWRUQH\V DUH DYDLODEOH WR FRXQVHO policyholders. ‡ 5LVN PDQDJHPHQW DVVLVWDQFH that may reduce pharmacy professional exposure.

(QGRUVHG E\

$SSO\ 2QOLQH

*R WR ZZZ SKPLF FRP, DQG FKRRVH WKH 3KDUPDFLVW /LDELOLW\ $SSOLFDWLRQ XQGHU WKH 2QOLQH 6HUYLFHV WDE

)RU PRUH LQIRUPDWLRQ SOHDVH FRQWDFW \RXU ORFDO UHSUHVHQWDWLYH

Bruce Bauer

800.247.5930 ext. 7121 910.515.6272

Ron Stoll, LUTCF

800.247.5930 ext. 7137

*Compensated Endorsement Not licensed to sell all products in all states.

Form No. PM PhL 196

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

Vol. 92, No. 4

EDITOR Sally J. Slusher

Inside

ASSOCIATE EDITOR Christopher R. Gauthier EDITORIAL ASSISTANTS Linda Goswick Teressa Horner Reavis

BOARD OF DIRECTORS PRESIDENT Jennifer Askew Buxton PRESIDENT-ELECT Mary Parker PAST PRESIDENT Cecil Davis TREASURER Dennis Williams BOARD MEMBERS Michelle Ames Ashley Branham Jennifer Burch Valerie Clinard Stephen Dedrick Jennifer Gommer Kira Brice Harris LeAnne Kennedy Beth Mills North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association of Pharmacists. An electronic version is 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 nonmembers is $40.00. annually. 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.

Fall 2012

• From the Executive Director .......................................... 4 • From the President ........................................................ 5 • 2012 NCAP Annual Convention Highlights .................... 6 • NCAP Election Results ................................................ 13 • New Practitioner Network:

Research Tools for the New Practitioner .................. 14

• NPN Spotlight: Amber N. McLendon .............................14 • A Student Perpective:

Reflections on Project Flu Shot ................................ 16

• Safety Solutions:

Safe Use of Opioids is a Team Effort ........................ 18

• Be Heart Healthy .......................................................... 21 • Pharmacy Time Capsules ............................................ 23 • Calendar of Events ...................................................... 23 • Member Spotlight: Stacy Walton .................................. 24

Is your NCAP membership current?

Many members renew at the end of the year.

Don’t get left behind, renew on time!

North Carolina Pharmacist, Fall 2012 3

From the Executive Director

A Spectacular Finish to 2012 What a great way to end my first year! The 2012 NCAP Convention was everything that I could have hoped for! It was amazing to see over eight months of planning materialize into a fantastic show.

From the very first packed box to the final presentation, NCAP delivered exactly the type of varied programming that our members demand. We offered fourteen hours of quality continuing education. We saw first hand how we are healthcare providers, and how the US Public Health Service Model can be a blueprint to the future of pharmacy practice thanks to CDR Mike Lee. We stretched our imaginations and got a real grip on how to “juggle” the stressors in all of our busy lives with Dan Thurmon. It was great to see that Jennifer Noped is more than just a great pharmacist. I do believe that she may have a second career if she chooses! No matter your practice setting, we had something for you. We explored such difficult issues as Medical Marijuana, took a closer look at the Patient Centered Medical Home, addressed the Pharmacy Practice Model Initiative in North Carolina, got a handle on Patient Medication Adherence counseling, banded together to look to the future of Community Pharmacy Practice, and much more! With five educational tracks, we were sure to include topics that interested EVERY area of pharmacy practice, engaged our student pharmacists, and made sure to include our most precious commodity – our pharmacy technicians.

We also honored our North Carolina pharmacy colleagues with a variety of awards and recognitions. You will read more about that and see plenty of pictures of the honorees. I’m so glad to be able to call these talented individuals colleagues and friends. It makes me proud to be your leader and even more proud to be a pharmacist.

I want to take the rest of this message to thank some very important people that made this convention a reality.

First off, I need to thank the education committee under the fantastic leadership of Minal Patel (our newly anointed Acute Care Pharmacist of the Year)! The committee was engaged from the start. They had wonderful ideas, challenged the norm, and made sure that I provided NCAP members with a convention to be proud of. Minal was an absolute gem to work with.

She was timely, organized, and made my life so much easier!

Thanks, Minal. I’m very honored to be able to work with you.

Secondly, I couldn’t do anything without the support and encouragement of our Board of Directors and specifically our Executive Committee. They have been behind me 110% since day one. Even when they were unsure about some of my crazy Yankee notions (ha-ha), they trusted me enough to see how it played out. Our success with this convention, and throughout the year, is due in large part to their support. Jenn, Mary, 4 North Carolina Pharmacist, Fall 2012

Cecil, and Dennis, thanks for being there and allowing me to be who I am. You make it a joy to come to work everyday, and I look forward to many more successful events in the future.

Of course, I need to thank the NCAP staff. Talk about being a lucky man! I inherited a fantastic group of ladies who are really the heart and soul of the association. From Sally whose work on the media and communications portion of the event gave us the national look we wanted, to Teressa who was able to work with our database and make the registration seamless, to Linda who kept us all organized and on task, to Sandie whose expertise in meeting planning was clearly seen in EVERY area of the convention; these lovely ladies worked tirelessly to give members a most unforgettable experience. I can’t possibly put into words my gratitude to all of them for a job well done. The next time you call the office, make sure to let them know how much their hard work meant to you.

I also want to thank Fred Eckel. He has grown into far more than “the former Executive Director” in my eyes. He has grown into a mentor and a friend. He challenges me, questions me, and makes me question myself. He really has helped me lead this organization well, and I’m eternally grateful.

Lastly, I need to thank our convention attendees, all 642 of you. This show was for you. Everything from the big screen, the TV cameras, the smartphone app, the online downloadable handouts, the food, the unicycle, to the programming was NCAP’s gift to you and to pharmacy in North Carolina. You are the reason that I come to work every day and the reason I love my job.

Essentially, the convention closed out my first year here at NCAP. It has been wonderful, challenging, nerve wracking, stressful, confusing, and rewarding. I wouldn’t change a thing, and I look forward to 2013 with a glint in my eye and a spring in my step. I have fantastic members and colleagues that I have been able to make my friends. I look forward to all of us moving the profession forward and changing the practice of pharmacy together.

Thanks for a great convention, a great first year, and I wish you all a very Happy Thanksgiving and holiday season.

Sincerely,

Christopher R. Gauthier, RPh Executive Director chris@ncpharmacists.org

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

Dear NCAP Members: First and foremost, I want to take the time to thank you for the honor and pleasure of being chosen to serve as your NCAP President this year. I have been constantly amazed at the hard work and dedication of both NCAP members and staff; and it has been inspirational to work side-by-side with the Executive Committee, the Board of Directors, Forum and Network leaders, and Task Force members. I am so proud to share the profession I love so much with others who love it equally.

And what better way to draw my presidency to a close than to participate in a FANTASTIC Annual Convention? It was so great to see all of you there! I truly hope you all enjoyed the educational and networking opportunities as well as our phenomenal special guests. And thank you so much to the exhibitors and residency showcase participants for featuring your programs and products with us. If there was something you particularly liked (or disliked, for that matter), please let NCAP staff or me know. I can tell you “from the inside” that NCAP truly does strive to meet the needs of its members. However, in order to meet these needs, staff and leadership need to know what these needs are.

In my messages this year, I have encouraged you to give back to your profession, become a mentor, and allow your profession to give back to you. In this, my final message, I would like to urge you to thank those who have given to, mentored, or led you.

I recently spoke at the NCAP Student Leaders Forum in Pinehurst. When preparing for this presentation, I came across a clip of a presentation by Drew Dudley, a leadership development expert, regarding everyday leadership. In this clip, Mr. Dudley asks participants in the audience to think of “a moment where someone said something or did something that you feel fundamentally made your life better.” Then he asked, “how many of you have told that person they did it?” (Of course, not many hands go up.) He goes on to say that we have all done or said something that made someone else’s life better, but we could be one of the people that hasn’t been told. These little things that we do for one another are the things that Dudley suggests make “everyday leaders.”

This clip really resonated with me. There are so many people, both personally and professionally, who have done things for me – both big and little – that I have not thanked them for but should have. I need to thank my husband for his love and patience, my parents for their constant support, and my sister for being my best friend. I need to thank my employees for putting up with my being away to work with NCAP, my boss for supporting me in doing so, and my most important mentor (you know who you are) for getting me involved in my state and national pharmacy associations to begin with.

I also need to thank Chris Gauthier, Linda Goswick, Sandie Holley, Sally Slusher, and Teressa Reavis for all the big things they do for NCAP and for all the little things they’ve done to make my presidential year easier.

I need to thank my Executive Committee – Mary Parker, Dennis Williams, and Cecil Davis – for all their hard work, flexibility, and dedication to NCAP. I need to thank my Board of Directors, my Task Force members, and the Forum and Network leaders. You have all done so much to make NCAP successful this year. Finally, I would like to thank ALL NCAP members! Thank you for allowing me to serve you this year; thank you for seeing the importance of state association membership; and thank you for contributing to the advancement of pharmacy in North Carolina.

So, as my final charge to you, go out and thank those who have made differences in your personal and professional lives. Mr. Dudley notes that “we celebrate birthdays where all you have to do is not die for 365 days, and yet we’ve got people who have made our lives better that walk around without knowing it.” So please go out and thank those people. And thank you to all of you for a wonderful year!

Sincerely,

Jennifer Buxton, BS, PharmD, CPP President jbuxtonunc@gmail.com Advancing Pharmacy. Improving Health.

North Carolina Pharmacist, Fall 2012 5

NCAP’s 2012 Annual Convention

Almost 650 pharmacy professionals attended

the 2012 Annual Convention held Oct. 28-30 at the Raleigh Convention Center. The three-day

event included dynamic keynote speakers, con-

tinuing education programming for all pharmacy practice settings, award presentations, exhibits, a residency showcase and valuable networking opportunities. We can’t wait until next year!

Keynote speaker Dan Thurmon spiced up his presentation with spectacular feats of juggling and acrobatics.

CDR Michael P. Lee of the US Public Health Service Pharmacy delivered a keynote address.

NC Board of Pharmacy Executive Director Jay Campbell closed the convention with an update on NC pharmacy.

6 North Carolina Pharmacist, Fall 2012

NC State Treasurer Janet Cowell addressed health plans.

Raleigh Mayor (and pharmacist) Nancy McFarlane made a surprise appearance.

Wingate University took top honors in OTC Jeopardy. (left to right) Evan McDonald, Christina Tyrrell, Morgan Miller, and Stephanie Hazle. Congratulations!

Making Your Voice Heard North Carolina Pharmacist, Fall 2012 7

Awards & Honors Each year NCAP recognizes members who have gone above and beyond the call of duty to further our association and the practice of pharmacy. We are honored to have such dedicated individuals in our ranks and would like to say “thank you” not only to them, but to all members of our our association. Your support is most appreciated!

Ashley Branham, recipient of the President’s Service Award and NCAP President Jennifer Buxton.

Practice Forum Chair Jennifer Gommer (l) presented the Acute Care Pharmacist of the Year Award to Minal Patel.

The National Community Pharmacists Association Leadership Award winner Mary Parker and NCAP President Jennifer Buxton.

NCAP President Jennifer Buxton and Beverly Lingerfeldt, recipient of the Bowl of Hygeia Award sponsored by the APhA Foundation and NASPA.

Andrew Muzyk, recipient of the The Distinguished Young Pharmacist Award sponsored by Pharmacists Mutual Companies, and NCAP President Jennifer Buxton.

Mary Parker, recipient of the McKesson Leadership Award and NCAP President Jennifer Buxton.

ASHP Leadership Award recipient Jennifer Gommer and NCAP President Jennifer Buxton.

8 North Carolina Pharmacist, Fall 2012

NCAP President Jennifer Buxton and Mollie Scott, recipient of the Don Blanton Award.

Incoming President Mary Parker and President Jennifer Buxton who received the NCAP President’s Award.

Paige Brown presented the Campbell University Preceptor of the Year Award to Lisa Jackson and Casey Johnson (not present).

Brian Dial of Wingate University presented Preceptor of the Year Awards to Amina Abubakar and Urundi Moore.

NCAP officers for 2013 were installed. (l to r) Past President Jennifer Buxton, President Mary Parker, Treasurer Dennis Williams and President-Elect Michelle Ames.

(l to r) NCAP President Jennifer Buxton, Huyla Coker, recipient of the Excellence in Innovation Award sponsored by Upsher-Smith Laboratories, and NCAP Executive Director Chris Gauthier.

(l to r) NCAP President Jennifer Buxton, Cardinal Health Generation Rx Champions Award recipient Jerry McKee, and Cardinal Health representative Steve Hoffman.

Phillip F. Crouch and George C. McLarty, Jr. were inducted into the Fifty Plus Club which honors members who have been licensed pharmacists for fifty years. Not pictured: Joseph O. Hicks, Seth M. Smith, Jr., David R. Work, and Frank F. Yarborough.

Kamakshi Rao received the UNC Preceptor of the Year Award from Kim Leadon.

Not present was award recipient Monique Alford.

NCAP President Jennifer Buxton carries out the Rite of Roses Ceremony to honor members who have passed away since the last Convention.

North Carolina Pharmacist, Fall 2012 9

“Thank you” to our Sponsors...

• Campbell University College of Pharmacy & Health Sciences • McKesson • National Alliance of State Pharmacy Associations • Pharmacists Mutual Companies/PMG • Rx Systems, Inc. • The France Foundation • UNC Eshelman School of Pharmacy • Student Scholarships to attend Convention were provided by the NCPhA Endowment Fund with a grant from the Pharmacy Network Foundation.

and Exhibitors!

Abbott Ameridose AmerisourceBergen Assured Pharmaceuticals AstraZeneca Pharmaceuticals, LP Campbell University College of Pharmacy & Health Sciences Cardinal Health Cooper-Atkins Corporation Dan Thurmon Eurus Pharma Formulary Financial Planning Fresenius Kabi USA Helmer Johnson and Johnson Health Care Systems McKesson McKesson Provider Technologies Automation Group Medicure Merck & Co., Inc. Merck Vaccines NC MedAssist NC Mutual Wholesale Drug Company Novo Nordisk Omnicell, Inc. Otsuka America Pharmaceutical Pharmacists Mutual Companies PharMEDium Services, LLC PPSC Rite Aid Pharmacy Sagent Pharmaceuticals, Inc. Sanofi Pasteur Script Your Future Sigvaris, Inc. Smith Drug Company Takeda Pharmaceuticals USA, Inc. Triangle Compounding Pharmacy UCB Congratulations to VIP Pharmacy Systems Sriramam Rayasam who Walgreens visited all of our exhibitors Walmart and won a new iPad! Zymogenetics, Inc. 10 North Carolina Pharmacist, Fall 2012

North Carolina Pharmacist, Fall 2012 11

The North Carolina Association of Pharmacists presents

CE & Ski

Winterfest Weekend January 25 - 27, 2013 Chetola Mountain Resort, Blowing Rock, NC

Join us in the mountains for a unique CE opportunity. Are you ready for some skiing, fun with family, exploring the Blowing Rock Winterfest Celebration, and 6 hours of ACPE approved live education? Then save the date and book your room now at Chetola Resort. Call 1-800-CHETOLA and let them know you are with the NC Association of Pharmacists. Two night minimum stay is required and the cut-off date to reserve your room is January 4, 2013. Rooms range from $153 to $170.

Online registration for CE & Ski will be available soon.

Cost: $220.00 for NCAP members or partnering state association members $315 for non-members.

Questions? Call NCAP at 919-967-2237

12 North Carolina Pharmacist, Fall 2012

NCAP Election Results

e-Prescribing PEER Portal is open for business!

The Pharmacy and Provider e-Prescribing Experience Reporting Portal and instructions on how to report can be found at: https://www.pqc.net/eprescribe Help us save lives‌ Report eRx problems TODAY!

Congratulations to NCAP members who have been elected to serve in the following positions:

ASHP Delegates: Jenna Minton Huggins Dennis Williams

NCAP Board of Directors President-Elect: Michelle Ames NCAP Board Members: Randall B. Angel J. Andrew Bowman Thomas D’Andrea Leigh L. Foushee Debra Wobbleton Kemp

Chronic Care Practice Forum Chair-Elect: Ted Hancock Executive Committee: Heather R. Eaton-Erskine Rhonda Reichert Gentry Dianne S. Higgins

Acute Care Practice Forum Chair-Elect: Becky Szymanski Executive Committee: Leigh Anderson Peek Jodi H. Peoples Tracie Rothrock-Christian

Community Care Practice Forum Chair-Elect: Lisa Dinkins Executive Committee: Ouita Davis Macary Weck Marciniak Erin McGavin Jennifer Rinkes-Smith Jennifer Waitzman

North Carolina Pharmacist, Fall 2012 13

New Practitioner Network

Research Tools for the New Practitioner

By Kira Harris, PharmD,BCPS, Kimberly Lewis, PharmD, CACP, BCACP, and Kim Nealy, PharmD, BCPS

The New Practitioner Network has been working to prepare a resource toolkit to help North Carolina pharmacists with research and scholarship needs. A survey to assess perceived needs in this area indicated that many pharmacists are interested in conducting research, publishing, or participating in other scholarly activities, even if it is not a required component of their current position. Survey responders identified “tips on manuscript writing” and “choosing an appropriate journal for submission” as their two biggest areas of interest. Below, we summarize some recommendations regarding these two topics.

In order to ensure publication of a manuscript, it is crucial to choose an appropriate journal for submission. When searching for a journal, some important considerations include the journal’s scope, article types, and impact factor. The topic of the manuscript should fall within the journal’s scope. For most pharmacists, this will include pharmacy-related journals but may also include journals specific to the area of practice or disease state discussed. For example, a manuscript on

the use of a new agent for the management of chronic hypertension may fit in a pharmacy related journal but may also be considered in a family medicine or primary care based journal. Contacting the journal’s editor is a great way to determine if the topic of your manuscript would be of interest to the journal. In addition, different journals prefer different publication types; some are more likely to publish review articles or drug information responses than solely original research. A visit to the journal’s website can reveal the various types of manuscripts accepted.

Lastly, the impact factor of a journal provides an estimation of the influence of the journal. A higher impact factor indicates higher influence. A great resource that provides a search engine and rank listing for medical journals can be found at http:// www.scimagojr.com/journalrank.php.

Once a journal is chosen, it is important to review the author guidelines, which give general submission requirements.

This can be found in the author’s section on the journal webpage. Next, it is important to consider what type of manuscript will best present your information (review article, case report, original research, etc). No matter the type of manuscript, a literature review should be performed and

the end-product visualized. Preparation of the manuscript should begin with the development of an outline to establish a general flow of the manuscript. When putting together the different sections, such as the introduction, body, and discussion, make sure that each section is unique and presents different information. You do not want to duplicate information between sections. Once the manuscript is complete, find someone to review and revise what you have written. Having another set of eyes is always helpful! Also, don’t forget to include the resources used!

There are a number of resources available that guide you through the manuscript writing process. One particularly helpful for the most common types of manuscripts written by pharmacists is “Tips for Writing and Publishing an Article” (Ann Pharmacother 2008;42:273-7).

Further resources and recommendations on these topics will be posted on the North Carolina Association of Pharmacists website and the NCAP Facebook page. Additional topics in development for the research toolkit will focus on statistics, grant writing and IRB navigation. Stay tuned for updates and add your own comments and recommendations as well! v

New Practitioner Spotlight: Amber N. McLendon, PharmD Amber N. McLendon is an Assistant Professor with Campbell University College of Pharmacy and Health Sciences and the Geriatrics Clinical Pharmacy Specialist at Glenaire, Inc., a Presbyterian Homes continuing care retirement community in Cary, NC. She received a BS in Chemistry from Duke University in 2001 and her PharmD from the University of North Carolina in 2005. Amber completed a geriatrics residency with the University of Texas and the South Texas Veterans Health Care System in 2006 and subsequently worked as a consultant pharmacist for SeniorMed covering assisted living facilities in Texas and Louisiana.

In her current role, she instructs fourth year student pharmacists in geriatrics, performs medication management for assisted living and skilled nursing residents and conducts home visits with independent living residents. Amber began her involvement with NCAP as a student at UNC and upon returning to North Carolina, served as chair of the Web Resources committee. She currently serves on the Chronic Care Forum Executive committee.

“I enjoy sharing my enthusiasm for serving older adults with student pharmacists. I have found Glenaire to be an ideal site to train students in the expression “age is just a number.” The development of a new clinical site with three levels of care has been challenging, however, I work with a great care plan team including a consultant pharmacist, who have all welcomed the students and me with open arms. NCAP has provided networking opportunities with other pharmacists who share my interests in geriatrics, teaching and advancing our profession. The New Practitioner Network provided leadership opportunities early in my career and has been a great place to get involved with other pharmacists from across the state. I enjoy keeping up to date on the legislative issues and openings for our profession and learning how we as pharmacists can advocate for future advancement.”

14 North Carolina Pharmacist, Fall 2012

North Carolina Pharmacist, Fall 2012 15

A Student Perspective:

Reflections on Project Flu Shot

By Desiree Elekwa-Izuakor P4 Student Campbell University College of Pharmacy and Health Sciences

As part of my rotation at NCAP, I had an interesting experience working on Project Flu Shot during the month. Project Flu Shot is an NCAP initiative to help protect the public’s health by increasing access to vaccines through the expanded role of immunizing pharmacists. Part of my responsibility with Project Flu Shot entailed calling pharmacists around North Carolina and encouraging them to invite their local representative to their respective pharmacies for an influenza vaccine. The goal is to help increase awareness and advocacy on our state and increase support for pharmacists as providers.

On commencing my project, putting together the spreadsheet of NC representatives was the easy part. Filling it up with willing pharmacists would prove to be a bit more challenging. On my journey, I was unprepared for the vast diversity in viewpoints regarding pharmacists as immunizers, the role of advocacy in the pharmacy profession and the interest of pharmacists in advancing the pharmacy profession.

I was distressed over the multitude of rejection, but reenergized when I got a solitary spark of interest. Below are some of the perspectives I heard, while calling pharmacists around our state, inviting them to participate in advocacy for pharmacists as immunizers: • “Pharmacists should not be immunizers. That should be left up to the doctors. I believe Pharmacists should only immunize in emergency/disaster situations.”

• “We do not give immunizations because most of our patients are on Medicare.”

• “We do not give immunizations because the liability insurance is too high.”

• “The Pharmacy profession has gone to pot.”

• “Do I have to invite both Democrats and Republicans?”

• “Are you crazy?”

• “That is not my place.”

• “I can’t do it because it is not politically correct. I live in a small town and I do not want to be stepping on anyone’s toes. I can’t do it until I think it is okay.”

• “We do not do injections. Not now. Never.”

• “Really?”

• “Are you serious?”

• “Not today.”

• “I am not interested.”

• “What do I get from this?”

• “How much do I have to pay?”

• “They would not want to do that.”

16 North Carolina Pharmacist, Fall 2012

• “This is crazy” • “It’s Monday.”

• “We are really busy.”

• “Pharmacists as immunizers is a sham.”

• “We will pass.”

• “We do not have time to immunize.”

• “Why are you calling me?”

• “How did you get my number?”

• “We have lots of customers to attend to.”

• “What the hell are you talking about?”

• “Call back later.”

• “Call back on Thursday.”

• “Call back tomorrow.”

• “Call back next week.”

• “Honey, I am just filling in.”

• “This is hilarious.”

• “This is ridiculous.”

• “LOL.” • Click.

On the flip side, there are many more strong advocates who are interested in the initiative. Their repsonses were more like: • “Excited!”

• “What a wonderful idea!”

• “Where do I sign up?”

I thought to myself, “That’s more like it.”

However, I was very intrigued by a resounding theme from some of my conversations. I was told, “Maybe you should have called earlier. Don’t you think the representatives have already gotten their flu shots?” They had hit the nail on the head. The earlier the better. There is no time to delay. Advocacy is a neverending process. It does not have specific start and stop dates. It is ongoing. We cannot stop; otherwise we become complacent and accept the status quo. Let us not rest on the laurels of our forerunners. Pharmacy has been in a whirlwind of constant change, progress and development. Pharmacy is currently at a crossroads. Every pharmacist and student pharmacist is responsible for their little part in driving the pharmacy profession forward. We must take hold of pharmacy’s current momentum and help guide the profession.

The concept of advocacy was further exemplified by our recent 2012 NCAP convention. This theme of advocacy reverberated throughout NCAP’s 2102 Annual Convention, “Making Your Voice Heard.” Please join me in making and keeping our voices heard by taking advantage of this ideal opportunity to educate state senators and representatives about pharmacy’s contribution to public health. NCAP encourages all qualified immunizing pharmacists to vaccinate lawmakers against the flu and to use the visit as an opportunity to tell your pharmacy story. If you are interested in participating in Project Flu Shot please contact NCAP for more information and support materials. v

North Carolina Pharmacist, Fall 2012 17

Safety Solutions

Safe Use of Opioids is a Team Effort

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

Opioid analgesics have become one of the drug classes that are most frequently associated with adverse drug events (ADEs) despite the simple truth that these medications are effective and safe if used appropriately. ADEs caused by opioids most commonly include nausea, vomiting, constipation, dizziness, sedation, delirium, hallucinations, falls, hypotension, and aspiration pneuomia.1-3 Despite there being a variety of potentially concerning ADEs that are attributable to opioid treatment, the highest cause for concern is the risk of a patient being oversedated and experiencing respiratory depression. While these more severe adverse events are mostly associated with the acute care setting, they are even more of a concern in the community setting where the necessary medical interventions (i.e administration of naloxone for reversal, intubation, jaw thrust, etc.) are not immediately accessible.

To put things in perspective, the number of unintentional deaths resulting from overdose of opioid analgesics has grown to approximately double the number of deaths caused by cocaine according to a 2010 report from the Centers for Disease Control and Prevention.4 Several celebrity/ athlete deaths (Whitney Houston, Junior Seau, and Heath Ledger to name a few) have been at least associated with medication overdose even if opioid analgesics

18 North Carolina Pharmacist, Fall 2012

were not found to be the sole attributable cause of death. While celebrities and professional athletes tend to get the most media coverage, there are countless other fatal medication overdoses that go uncovered by the media.

Regardless of the patient care setting, ADEs attributed to use of opioids are often due to drug-drug interactions with other opioids, benzodiazepines, and other sedating medications (i.e. Promethazine).

However, ADEs and drug-drug interactions can be prevented when there is a comprehensive patient plan of care in place that spans the continuum of care and involves a contributing effort from every member of the healthcare team including the patient.

When used appropriately, opioid analgesics can provide patients with essential pain relief for a variety of medical conditions including post-operative pain, cancer, and trauma that other non-narcotic analgesics are incapable of providing. The challenge to healthcare practitioners is identifying the appropriate pain management regimen which properly addresses chronic pain needs as well as breakthrough pain while minimizing the risk of ADEs. Developing a successful pain management plan requires that a practitioner have complete information in order to make an informed decision. Obtaining the proper information should be accomplished by involving all the key contributors which may include the physician, pharmacist, nurse, case manager, physical therapist, imaging services technologist, family member, and, most importantly, the patient. Critical questions for healthcare providers to ask include: 1. Has the patient received opioid analge-

sics before? If so, how much in the last 24 hours?

2. What is the underlying need for pain management?

3. Has the patient received any other opioids, benzodiazepines, or other potentially sedating medications?

4. Does the patient have any risk factors (i.e. elderly, obesity, history or sleep apnea, renal insufficiency, etc.)?

Potentially, the most critical need for safety measures related to management of opioid therapy is found in care transitions when accurate and complete information must be passed off between healthcare providers. Maintaining safety in care transitions is a challenge due to the expansive list of formulations, strengths, and sound-alike/ look-alike drug names (i.e. morphine and HYDROmorphone) available with opioid analgesics. With such a variety in available options as well as the challenge of performing effective dose conversions, there is a heightened risk of medication errors associated with product selection and dosing.

Improving the safety of opioid pain management starts with enhancing the knowledge amongst healthcare providers.

If we, as healthcare providers, lack critical knowledge of potency differences between opioid analgesics, then how will we ever expect our patients to be able to safely administer their pain management regimen?

The classic example of misunderstanding with respect to equi-analgesic dosing between opioids is morphine versus hydromorphone. Some healthcare providers still prefer to select HYDROmorphone over morphine simply because the dose is a smaller number. In a prospective, randomized, double-blind, clinical trial conducted in the Emergency Department of an academic medical center it was found that most physicians and nurses were more comfortable using HYDROmorphone 1-1.5mg than morphine 7-10mg as an initial intravenous dose.5-6 The estimated relative potency of HYDROmorphone to morphine is 7.5:1, which emphasizes the point that having any dosage form greater than 1mg available in an acute care setting such as an Emergency Department is dangerous because it could be administered to a patient with risk factors and/ or one that is opiate-naive. Medication errors associated with opioid analgesics

are most frequently reported to involve HYDROmorphone and morphine, but the risk of ADEs will continue to be prevalent with many of the available opioids until healthcare providers can achieve a greater understanding for safe management of opioid therapy.

Recently, fentaNYL patches have been nationally publicized as a high risk for causing ADEs although the risk is not a new one. Multiple reports have been published by the Institute of Safe Medication Practices relaying various examples of fentaNYL patches being managed inappropriately (i.e. patients found with multiple patches, patients missing patches, patches being misplaced, etc.), but the National Alert Network Alert that was released in April was especially eye-opening. It brought to light a heartbreaking story of a 2-year old boy who went into respiratory arrest and died after swallowing a fentaNYL patch that was pulled off his grandmother and not disposed of appropriately.7 Because this occurred within a hospital, the story highlights the point that proper handling and disposal of fentaNYL patches is paramount in all patient care settings. Recommendations and consumer safety tips can be found through

the ISMP website using the following link: www.ismp.org/docs/FentanylBrochure.pdf.

HYDROmorphone and fentaNYL represent two well documented examples of opioids attributed to ADEs but there are many more undocumented ADEs associated with these two drugs as well as other opioids.

Many ADEs that occur in the outpatient/ community setting are the result of opioid misuse or abuse, which often includes family members or friends in addition to the patients to whom the medications are prescribed. Long-acting (or extendedrelease) opioid formulations are a particular safety concern because they tend to be stronger products that are released over a longer period of time. However, because the long-acting products are stronger, they also are more highly associated with abuse or misuse which is why a new Risk Evaluation and Mitigation Strategy (REMS) for the entire class of long-acting opioids was approved in July 2012. This new REMS has been approved to ensure certain requirements such as physician training, patient counseling, and other risk reduction strategies are followed.

The importance of responsible use of opioids in pain management, which includes all steps in the medication use

Division of Display Options, Inc. Assisting Pharmacists since 1973 Rx Planning Specialists Craig Ashton • Roland Thomas 70 years combined experience in over 2,000 pharmacies.

process (i.e. prescribing, transcribing, dispensing, administering, and monitoring) as well as medication storage, cannot be emphasized enough. Safe management of opioid analgesics in patient care requires that every member of the healthcare team contribute to a collaborative approach that ensures complete and accurate information pass off, complete understanding of potency versus potential adverse events, and standardization of therapeutic options whenever possible in order to minimize the risk of preventable ADEs. v References: 1. Sentinel Event Alert. The Joint Commission 2012;49:1-4.

2. McPherson ML. Strategies for the management of opioid-induced adverse events. Advanced Studies in Pharmacy 2008;5(2):52-57.

3. Davies EC, et al. Adverse Drug Reactions in Hospital In-Patients: A Prospective Analysis of 3695 Patient-Episodes. PLos ONE 2009;4(2):e4439.

4. Unintentional Drug Poisoning in the United States.

Centers for Disease Control and Prevention 2010.

5. Chang, et al. Safety and efficacy of hydromorphone as an analgesic alternative to morphine in acute pain: a randomized clinical trial. Ann Emerg Med 2006;48(2):164-172.

6. Adverse Drug Events with HYDROmorphone: How Preventable are They? PA Patient Safety Advisory 2010;7(3):69-75.

7. Proper disposal of fentaNYL patches is critical to preventing accidental exposure. National Alert Network 2012:1-3.

Compounding Labs Pharmacy Planning & Design Patient Consultation Areas Merchandising Stocking Lozier Distributor Retail and Pharmacy Fixtures Custom Wood Work Professional Installation and Delivery

9517 Monroe Road, Suite A • Charlotte, NC 28270

1-800-321-4344 www.displayoptions.com

North Carolina Pharmacist, Fall 2012 19

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

Yep, we’re 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.

20 North Carolina Pharmacist, Fall 2012

Be Heart Healthy Take a minute, save a life. The statistics on cardiovascular health in this nation are sobering. Not only is heart disease, including stroke, the leading cause of death in the United States, but every 25 seconds an American will have a coronary event, and about every minute someone will die from one. Heart disease isn’t known as “the silent killer” without a reason.

The importance of adherence is especially heightened with cardiovascular medications, which can pose a greater risk of adverse events if doses are missed or suddenly stopped, even if the patient is “feeling fine” while their blood pressure skyrockets.

In his presidential address, Ralph Sacco, MD, FAHA, president of the American Heart Association, said that “we are facing a global crisis, and must work together to improve the health of our patients, the public, and ourselves.” To that end, his association has set an ambitious, 10-year goal to improve the cardiovascular health of all Americans, by reducing the occurrence of cardiovascular diseases and stroke deaths by 20 percent by the year 2020. The AHA has identified seven factors and behaviors for ideal cardiovascular

health, something we at the National Community Pharmacists Association (NCPA) believe every community pharmacist can have a hand in promoting, both through improving medication adherence and patient education.

They are called “Life’s Simple Seven,” core elements to building healthier lives.

Sacco noted that these factors are not new, but the approach to addressing them is. By making the distinction of referring to them as ‘health factors’ as opposed to “risk factors,” the AHA believes that this will help patients to “understand and embrace the benefits of healthy living.” What are they?

A combination of ideal levels (blood pressure, blood sugar, and cholesterol), and lifestyle choices (diet, physical exercise, appropriate weight, and non-smoking), something community pharmacists counsel their patients on every day. Reinforcing adherence can be a simple act; taking a minute to discuss diet or check blood pressure, done consistently can make a real difference. There’s a good chance many of your patients are not meeting their goals, so don’t pass up the opportunity to talk with them about their health factors when-

ever they are picking up a new prescription, or you’ve noticed a dosage increase in their medications.

The AHA acknowledges that they will not be able to improve the cardiovascular health of the country alone, and that what’s needed is more collaboration and interdisciplinary partnerships. NCPA sees their goal as being synergistic with what we are trying to achieve with medication adherence and can’t wait to see what community pharmacists can do to improve the heart health of their patients.

Take a minute to talk to your patients about the ABCs of heart disease: A, as in hemoglobin A1C B, for blood pressure C, for cholesterol Who knows, with those ABCs, you might just save a life.

Do you have an adherence idea, tip, or program that is working in your pharmacy? Let us know. Send an e-mail to adherence@ncpanet.org. v Reprinted with permission from National Community Pharmacists Association in the February 2011 issue of America’s Pharmacist. For more information about NCPA, visit www.ncpanet.org.

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 Online after an absence from practice for three or more years. The course Offerings: consists of three modules, all of which have been approved for ACPE credits. The first two modules are online and composed of weekly Pharmacist study segments that allow course participants to work at their own Refresher pace, on their own time.

The third module consists of a three-week, 90-hour live experience Course in a community pharmacy. Only those who participate in all three & QA/Law 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 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 North Carolina Pharmacist, Fall 2012 21

NCAP has partnered with Konvoke, Inc. to create a new member benefit to support the awareness and growth of our association. We’re helping pharmacists like you make informed buying decisions about healthcare products and services by connecting you with others who have already made these decisions.

You now have free access to www.konvoke.com, an online forum where you can find unbiased advice through peer written product reviews. More importantly, you can assist your colleagues by providing feedback and writing your own product reviews. Review content on Konvoke is exclusive to healthcare based professionals and is 100% confidential.

As a result of this partnership, NCAP will receive revenue each time you write a product review. Your reviews will help your colleagues make great purchasing decisions and help NCAP generate funds so we can better serve your needs. It’s a win-win for everyone! Should you choose to not participate, you may easily opt out at any time.

Members of several other state pharmacy associations are taking advantage of this great benefit. We hope you are too.

Please remember to Konvoke before you buy! www.konvoke.com

22 North Carolina Pharmacist, Fall 2012

Pharmacy Time Capsules

By Dennis B. Worthen, Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH

1987 - Twenty-five years ago: • Clinical Sciences Section formed within the American Pharmaceutical (now Pharmacists) Association Academy of Pharmaceutical Research and Science.

1962 - Fifty Years Ago: • Legislation introduced (unsuccessfully) to allow the FDA to inspect pharmacy prescription files.

• Paul Parker at the University of Kentucky established first formalized Drug Information Service.

• Merrell removes Mer-29 (triparanol) from market for adverse eye events.

1937 - Seventy-five Years Ago: • Over 100 people were poisoned by S. E. Massengill Company’s Elixir of Sulfanilamide. This led to 1938 legislation requiring proof of safety as a condition for marketing.

• Loronzo L. Skaggs opened the first store of a new chain of self-service drugstores in the Midwest. Original name was “PayLess” later changed to Osco Drug.

1912 - One hundred Years Ago: • International Pharmaceutical Federation (FIP) established as an international federation of national pharmacy organizations.

• The Journal of the American Medical Association (JAMA) reports the first diagnosis of death by heart attack.

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 November, 2012 NCAP Technician Review Seminars 11/10, Hickory 11/11, Charlotte November 15, 2012 Immunization Administration Training Program NCAP/Institute of Pharmacy, Chapel Hill, NC. January 11-13, 2013 Southeastern Girls of Pharmacy Leadership Weekend, Grove Park Inn, Asheville, NC January 25-27, 2013 CE & Ski Chetola Mountain Resort, Asheville, NC March 21-22, 2013 Chronic Care Practice Forum Meeting The Ballantyne Hotel, Charlotte, NC March 26, 2013 Pharmacy Day in the Legislature Legislative Building, Raleigh, NC July 12, 2013 Residency Conference Sheraton Four Seasons, Greensboro NC For more information visit www.ncpharmacists.org

North Carolina Pharmacist, Fall 2012 23

Member Spotlight Q&A: Stacy Walton, CPhT, AAS ,

Stacy Walton, CPhT, AAS, completed an Associates of Applied Science in Pharmacy Technology from Forsyth Tech Community College in May of 2010 and is currently pursuing a bachelor’s of science in Public Health from UNCG while working as the Pharmacy Technician Project Coordinator at Novant Corporate Pharmacy in Winston-Salem, NC. The Novant Corporate Pharmacy is the administrative pharmacy office to 13 hospitals, all varying in size, as part of the Novant Health system. They work with Novant Medical Group, Piedmont Hematology Oncology Associates, and Winston-Salem Healthcare Pharmacy, which are also part of Novant Health.

Recently, she’s been involved with many projects including: • Transforming healthcare throughout the Novant system.

• Streamlining communication throughout the pharmacy system and assisting communication through building internal websites which enable out-of-the-box communication to take place about department processes.

• Tracking and assisting in the coordination of many pharmacy leadership projects.

• Pharmacy personnel are informed about changes through a bimonthly corporate pharmacy newsletter she co-writes.

• Publishing an online calendar listing live CE events throughout NC, SC, and VA, to inform staff of the learning opportunities available to them.

24 North Carolina Pharmacist, Fall 2012

• Informing pharmacy technicians about professional growth opportunities including the associate degree of pharmacy technology. This is done through guest lecturing at local community colleges, national forums including ASHP meetings, lecturing at hospitals, electronic communication, and talking to technicians one-on-one.

“My advice for new AAS Pharmacy Technicians is to be open-minded in an ever changing profession. We live in a world where our healthcare system is constantly changing and pharmacy is an integral part of that change. Our role in pharmaceutical care is expanding and we must always remember to keep patient safety our number one priority,” she said.

“Upon graduation in 2010 I looked for ways to become more involved in the pharmacy community. The vice president of Novant Pharmacy Services, Michael Nnadi, suggested I look into NCAP. I value NCAP because it allows me to network with diverse pharmacy personnel across the state including technicians, AAS Pharmacy Technology leaders, pharmacists, and vendors at the annual meetings. As a technician working at an institution which requires pharmacy technician certification, I value the tech certification seminars as a great resource for our staff. Many technicians have found the seminars helpful in passing the PTCB certification exam,” she added.

Stacy is currently a member of the 2012 NCAP Education Committee. v

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

North Carolina Pharmacist, Fall 2012 25

26 North Carolina Pharmacist, Summer 2012