North Carolina Pharmacist Fall Journal 2013

North Carolina Pharmacist Vol. 93, Number 4

Advancing Pharmacy. Improving Health.

Fall 2013

y lights ing Authorit d more! h g i H z n n ventio n of Immuni Renamed a n o C 3 o rum • 201 • Expansi ice Fo t c a r P •

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

North Carolina

Pharmacist Vol. 93, No. 4

Fall 2013

EDITOR Sally J. Slusher ASSOCIATE EDITOR Fred Eckel EDITORIAL ASSISTANT Linda Goswick Teressa Reavis

BOARD OF DIRECTORS

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

• From the President ........................................................ 5

PRESIDENT Mary Parker PRESIDENT-ELECT Michelle Ames

• 2013 Convention Highlights and Awards........................ 6

PAST PRESIDENT Jennifer Askew Buxton TREASURER Dennis Williams BOARD MEMBERS Randy Angel Andy Bowman Jennifer Burch Jena Ivey Burkhart Valerie Clinard Thomas D’Andrea Stephen Dedrick Leigh Foushee Alyce Holmes Debra Kemp LeAnne Kennedy Kimberly Lewis Natasha Michaels 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.

• Expansion of Immunizing Authority

for Pharmacists in North Carolina............................. 10

• Ambulatory Care Practitioners Find a Home

Within NCAP’s Renamed Practice Forum................ 12

• New Practitioner Network

Member Spotlight: Ashley Branham.......................... 14

• NCAP Election Results................................................. 17

• Calender of Events ...................................................... 22 North Carolina Pharmacist, Fall 2013 3

From the Interim Executive Director

Still Smiling Things are alive and well at NCAP. At least that is my observation after returning as Interim Executive Director. I appreciate being asked by the Executive Committee to return and help again during another period of transition. It is always a transition when leadership changes. Your Executive Committee assumed that leadership role when Chris Gauthier decided to return to Maine. I am sure that when they assumed leadership they felt that a new Executive Director would be on board soon. Assuming an additional leadership role for people who are already busy professionals is not easy. As a member of NCAP, I want to extend my appreciation to the Executive Committee for stepping up to the plate and doing a great job. When I stepped in to provide day-to-day oversight, I found the same hard-working staff continuing to perform their roles well. I found that the Executive Committee had done well too, so there were no day-to-day problems that needed my immediate attention. I share this so we can all thank the Executive Committee for the job they have done.

Finances are a concern for most state pharmacy associations, and NCAP is no exception. Last year ended with a deficit. This year through October we have a positive cash flow of $96,335. Not that NCAP has turned the financial corner, but we are better positioned for when a new Executive Director is recruited. Until that happens I plan to stay at NCAP as Interim Executive Director. I enjoyed my time away from NCAP, but I am also enjoying being back at the helm in a half-time position. This still gives me time to do the other things that I enjoy.

This issue focuses on the recently completed Annual Convention in Raleigh. We had one of our largest crowds and many positive comments from participants were heard. If you did not attend, you missed a good meeting and a fun time. This year on Tuesday we offered joint programming with Community Care of North Carolina. This collaboration with an important North Carolina entity that has a national reputation made for excellent programming. It helps our members learn about coming changes and how they might be able to get involved. NCAP looks forward to continuing this collaboration.

We also acknowledge the passage of the expanded immunization legislation in this issue. Unfortunately, North Carolina pharmacy has not been a leader in advancing pharmacy’s immunization role. We are one of the last states to allow this expanded role.

Now pharmacy has to demonstrate that this expansion was a good public health initiative by helping to improve the adult immunization rates. As we demonstrate results we can then look forward to expanding this role to younger citizens.

Will there be another legislative initiative to follow? That is the question that your Board will be exploring. Nationally there is a collaborative effort to achieve provider status for pharmacists. Some states have been successful in making that happen at the state level. Should North Carolina pharmacy undertake such an effort? Can we get the support of the broad pharmacy community to make this happen? These are the questions the NCAP Board will be addressing. What do you think we should do? Contact me at fred@ncpharmacists.org and let me know what you think NCAP should do about state level provider status or anything else. We want to serve our members.

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

Dear Members, I am grateful to have had the opportunity to serve as your NCAP President. 2013 has been a busy and productive year, thanks to the commitment of the NCAP Staff, Executive Committee, Board of Directors, and Practice Forums and Networks. There is much to celebrate—here are a few highlights: • The NCAP Annual Meeting facilitated networking opportunities and continuing education for all members. Monday’s keynote discussion on provider status and its implications for pharmacy in the Affordable Care Act environment provided a great overview of our next challenge: provider status in North Carolina.

- During the Annual Meeting, I recognized Dennis Williams as the recipient of the President’s Service Award. Dennis has worked throughout this year to manage our successful legislative agenda in addition to serving as treasurer for NCAP. He will continues to serve on the Executive Committee through 2014.

- Special thanks for programming and planning to Minal Patel, Education Committee members, Jennifer Buxton, Past NCAP President, Sandie Holley from NCAP staff, and Fred Eckel, Interim Executive Director, for their leadership and vision in making this meeting a reality.

• We continue to move forward with implementation of expanded practice opportunities for immunizing pharmacists throughout the state. Members of the New Practitioner Network have provided a great summary of this effort and rollout opportunity within this issue of the journal.

• Informal discussions are underway to identify key partners and stakeholders in the provider discussions. As the merged organization representing the profession of pharmacy, NCAP’s involvement will be significant in these efforts moving forward. Stay tuned!

As we move into 2014, I am confident that Michelle Ames will provide outstanding leadership to our organization.

Thank you for a great year!

Sincerely, Mary Parker, PharmD, BCPS

Advancing Pharmacy. Improving Health.

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NCAP’s 2013 Annual Convention

Over 600 pharmacy professionals attended the 2013 Annual Convention held Oct. 20-22 at the Raleigh Convention Center. The three-day event included dynamic keynote speakers, continuing education programming for all pharmacy practice settings, award presentations, exhibits, a residency showcase and valuable networking opportunities.

Raleigh Mayor and pharmacist Nancy McFarlane delivered a welcome address on Monday morning.

Rebecca Snead, Executive VP and CEO of the National Alliance of State Pharmacy Associations delivered a keynote address.

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Past President Jennifer Buxton and keynote speaker Steve Simenson, President of APhA.

“Thank you” to our Sponsors...

Platinum Pharmacists Mutual Companies/PMG • ASHP Advantage • Campbell U. College of Pharmacy & Health Sciences • High Point University School of Pharmacy • Medical Learning Institute, Inc. • Rx Systems, Inc. • UNC Eshelman School of Pharmacy • Vemco MedEd, LLC • Wingate University 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!

AbbVie, Inc. Alcon Allied Pharmacy Products, Inc. American Regent Assured Pharmaceuticals AstraZeneca Pharmaceuticals BD RX Cardinal Health Cooper-Atkins Corporation Fresenius Kabi USA Hager Pharma Health Screening & Education/Students/ NC Pharmacy Schools Janssen Lilly USA, LLC McKesson Meda Pharmaceuticals MedCartWorks Medicine-On-Time Merck & Company, Inc. Minnesota Independent Cooperative Mutual Wholesale Drug Company NC Department of Insurance NC MedAssist NC Wise Woman North Carolina Immunization Branch Novo Nordisk, Inc. Omnicell, Inc. Pharmacists Mutual Companies PharMEDium PioneerRx PPSC Publix Pharmacy Rite Aid Pharmacy Sagent Pharmaceuticals, Inc. Sanofi Diabetes Script Your Future Sigma Tau Pharmaceuticals Smith Drug Company Tacy Medical, Inc. Triangle Compounding Pharmacy VigiLanz Corporation VIP Pharmacy Systems Walgreens Walmart/Sam’s Club Pharmacy Wellpartner

UNC won the OTC Jeopardy challenge. Team members: Carolyn Garland, Ben Ahlers, Brianna Glynn and Jayme Hostetter.

Keynote speaker NC Board of Pharmacy Executive Director Jay Campbell.

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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!

Dennis Williams received the President’s Service Award from NCAP President Mary Parker.

Mike Soucie received the Health-System Pharmacist of the Year Award from Forum Chair Alyce Holmes (not pictured).

President-Elect Michelle Ames presented the Excellence in Innovation Award, sponsored by Upsher-Smith Laboratories, to Stephen Eckel.

Jean Douglas received the distinguished Bowl of Hygeia Award from John Chapman of Boehringer-Ingelheim.

Amber McLendon received The Distinguished Young Pharmacist Award, sponsored by Pharmacists Mutual Companies, from representative Bruce Bauer.

Dan Ward of McKesson presented the McKesson Leadership Award to NCAP President-Elect Michelle Ames.

Campbell U. Community Practice Preceptor of the Year award recipient Stan Edmundson and presenter Paige Brown.

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Steve Hoffman of Cardinal Health presented the Cardinal Health Generation Rx Champions Award to Karin Suess.

President-Elect Michelle Ames presented the NCAP President’s Award to Mary Parker for her service in 2013.

Cambell U. Hospital Practice Preceptor of the Year award recipient Tim Lassiter and presenter Paige Brown.

Kim Leadon presented the UNC Preceptor of the Year Award to Ed Sredzienski.

NCAP officers for 2014 were installed. (l to r) President Michelle Ames, President-Elect Ashely Branham, Past President Mary Parker, Treasurer Dennis Williams.

Wingate U. APPE Preceptor of the Year award recipient Cathy Huie and presenter Brian Dial.

NCPA Leadership Award recipient Michelle Ames, Don Blanton Award recipient Mary Parker, and Past President Jennifer Buxton.

Wingate U. IPPE Preceptor of the Year award recipient Joe Talarico and presenter Wesley Haltom.

Ronnie Buchanan and Bill Williams were inducted into the Fifty Plus Club which honors members who have been licensed pharmacists for fifty years. Not pictured: James Robert Taylor, Gilbert Max Hatley, David Randall Lewis, Ted Norman VanDevere and Elliott Morrison Giffen II.

NC Senator Fletcher Hartsell was on hand to receive the Excellence in Government Award. NC Representative Marilyn Avila will also receive this award.

NCAP President-Elect Michelle Ames carries out the Rite of Roses Ceremony to honor members who have passed away since the last Convention.

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Expansion of Immunizing Authority for Pharmacists in North Carolina

By Amanda Gates, PharmD, Kerr Drug and Jeffrey S. Reichard, PharmD, MS, BCPS, Pharmacy Manager, Novant Health - Kernersville Medical Center

October 1, 2013 was a significant day for pharmacy practice in North Carolina, as a new law took effect that day allowing pharmacists more authority to administer vaccinations. It was a day nearly five years in the making for the membership and leaders of NCAP. NCAP collaborated with key stakeholders, such as the North Carolina Medical Society and North Carolina Academy of Family Physicians, to finally reach an agreement this past summer, resulting in Governor Pat McCrory signing into law House Bill 832 – An Act To Protect The Public’s Health By Increasing Access To Immunizations And Vaccines Through The Expanded Role Of Immunizing Pharmacists. “This is significant, whereas a unified pharmacy profession, alongside other health care organizations through significant deliberations agreed to this law,” said NCAP President Mary Parker, PharmD, BCPS. Moving Forward Before the law, practicing pharmacists in North Carolina with the credentials to immunize had the ability to vaccinate persons ages 14 and above for influenza without a prescription and qualified persons ages 18 and above presenting with a prescription for pneumococcal and herpes zoster vaccines, according to a protocol with a supervising physician. The expanded law allows

pharmacists to administer five additional vaccinations under a standing protocol to persons ages 18 and above without a prescription, in addition to influenza for persons age 14 and above.

The vaccinations included in this law are for hepatitis B, herpes zoster, meningococcal, pneumococcal, tetanus, diphtheria and pertussis. An additional aspect of the law allows for pharmacists to administer any other vaccine recommended by the Centers for Disease Control to any patient ages 18 and above presenting with a prescription. “This law is a significant advancement in immunization practices for pharmacists within North Carolina”, says Parker. NCAP and its leadership team believe this is a significant opportunity for pharmacists to play a larger role in the public health of citizens within this state.

The law will allow North Carolina pharmacists to join the ranks of colleagues in other states with a greater ability to impact public health through the authority to administer a wider array of vaccinations. The United States Department of Health and Human Services recognizes the expansion of vaccination services as one of its disease prevention efforts in the Healthy People 2020 goals. According to a review completed by the National Alliance of State Pharmacy Associations (NASPA) and the American Pharmacists Association (APhA) in July 2013, pharmacists in forty-three additional states and the District of Columbia have authority to administer all vaccines to various age groups. States also vary in their ability to access and record a patient’s vaccination status within immunization registries.

NC Immunization Registry (NCIR) Requirements While the law officially took effect on October 1, 2013, the NC Department of Health and Human Services Immunization Branch will allocate access to the NCIR and, therefore, the ability to give the vaccines included in the new law over the course of the next few months. This means that if pharmacists have not been contacted by their district managers, wholesalers, or a representative from the Immunization Branch, depending on the pharmacy, you cannot give the new vaccines under protocol just yet. Access to NCIR will be a phased roll out. The first allocation was on October 1, 2013, which had approximately 500 pharmacies. The phased roll out will be concluded at the end of the calendar year.

The documentation requirement in the new law necessitates that the vaccinating pharmacist first access the NCIR to make

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sure a vaccination has not been previously given. Then, after administering any vaccine, the pharmacists should also record it within 72 hours of the vaccination, in addition to reporting the vaccination to the patient’s primary care provider. If the patient does not have a primary care provider, pharmacists should advise patients about the importance of having a primary care provider.

The NCIR reports that only about 40% of adults in the state have an immunization record in the registry. “Currently, there are approximately 1,400 registered sites on the NCIR,” said Parker.

These sites most often include pediatrician offices and health departments. By expanding access to the NCIR to pharmacies, of which there are approximately 1,900 in North Carolina, pharmacists can record vaccines administered and any adverse reactions to vaccinations, allowing for safer immunization practices. A tremendous accomplishment!

Resources for Implementing Changes To provide more clarity on the new law, NCAP and the North Carolina Board of Pharmacy has provided resources on their websites. These resources include documents (e.g., safety screening questions and support documents about the NCIR registry), and a video that shows what the NCIR will look like for pharmacists to help answer many common questions. To watch the video, visit the NCAP website at www.ncpharmacists.org and go to the pharmacists’ CE & Training page. As part of their roll out with the immunization law, a trainer will be responsible for the practical training and education of pharmacists. The trainer will likely be a pharmacy manager for independent stores or district

pharmacy manager for chain pharmacy. The trainers have already been assigned and will be the pharmacies’ point of contact regarding the NCIR. NCAP is asking members to have an understanding of this law and if applicable, complete their required competencies to provide these new vaccinations. Additionally, we should all advocate to the public this significant change in the profession of pharmacy in North Carolina. A pharmacy may choose not to change their protocol to provide the new vaccinations within the new law now, but by June 30, 2014 all pharmacies in North Carolina will have to be in compliance with the new law.

The NCAP leadership team will be working alongside key stakeholders to implement this law and its effects on immunization rates within North Carolina. “We hope pharmacists will embrace the concept of immunizations and this tremendous opportunity to impact patient care,” said Parker. v For more information on the North Carolina Immunization Registry: Immunize.nc.gov For immunization schedules according to age and disease states, as well as VIS forms: www.CDC.gov References: 1. HB 832 (2013). Available from: www.ncleg.net/Sessions/2013/Laws/House/ PDF/H832v6.pdf 2. American Pharmacists Association. “Summary of pharmacist immunizing authority by type”. Available from: www.pharmacist.com.

3. Healthy People 2020 Summary of Objectives. Immunization and infectious disease. Available from: www.healthypeople.gov/2020/topicsobjectives2020/pdfs/ Immunization.pdf.

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Ambulatory Care Practitioners Find a Home Within NCAP’s Renamed Practice Forum “Acute Care Practice Forum” Renamed “Health-System Practice Forum”

By Debra W Kemp, PharmD, BCPS, BCACP Holly Causey, PharmD, BCACP, CPP, CDE Kira Brice Harris, PharmD, BCACP Jennie Hewitt, PharmD, BCACP

Mollie Ashe Scott, PharmD, BCACP, CPP

For years, NCAP members with a primary practice focus in ambulatory care have wondered where they belong within the NCAP Practice Forum structure. As created, NCAP offered members three practice forums to choose from: Acute Care, Chronic Care and Community Care. When NCAP was formed in 2000, these practice forums encompassed the vast majority of practice areas. Over the years, however, the number of ambulatory care pharmacy practitioners significantly increased throughout the state resulting in a growing percentage of the NCAP membership without a Practice Forum specifically dedicated to serving their advocacy, continuing education and overall practicebased needs.

Early discussions in 2012 among the NCAP Board and Executive Committee unveiled the complexity of finding ambulatory practitioners a “home forum.”

At first, many thought the Community Care Practice Forum was the most logical group. Considerations, though, had to be given to the specific associations (state and/or national) that support each forum and to the ambulatory care practitioners

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who were already actively involved and invested in one of the other forums. Discussions kept coming back to one main question: “What is the best decision to support the majority of this group, both NCAP members and non-members?”

This led to the formation of the NCAP Ambulatory Care Task Force.

The task force developed a survey targeted to all members of NCAP who selfidentified as ambulatory care practitioners.

Not unexpectedly, survey results revealed that not only were ambulatory care practitioners divided among all three forums, but over 30% were unsure which forum they belonged to or did not have a designated forum. The majority of responders did not feel their current forum met their needs as an ambulatory care practitioner and thus, advocated the creation of a forum specifically for ambulatory care practitioners. The top identified unmet needs included advocacy support for this practice area, ambulatory care specific programming at NCAP conventions and updates/discussions regarding reimbursement and collaborative practices.

These survey results sparked numerous questions. Were there enough members to support a new forum specifically for ambulatory care practitioners? If so, how would creation of a new forum affect existing forums? What national or state organization would the new forum align

with taking into account existing partnerships? Such support is crucial for success.

Of the existing affiliations, the American Society of Health-System Pharmacists (ASHP) was the organization whose mission and activities most aligned with the identified unmet needs and desires of ambulatory care practitioners. Understanding that ASHP affiliates with the Acute Care Practice Forum, the decision was made to create a “home” for ambulatory care practitioners within that forum and to change the name to encompass practitioners in both the acute care and ambulatory care environments.

In 2013, the Board of Directors approved the Health-System Practice Forum, a change from what was known as Acute Care, to serve the needs of practitioners who are actively involved in the various stages of transitions in care: acute to ambulatory. Understandably, there exist NCAP members who primarily practice in the ambulatory care setting and already strongly identify with either the Community Care or Chronic Care Practice Forums. We are not advocating that any member leave a forum that meets their professional needs. For ambulatory care practitioners, though, looking for a forum to specifically address ambulatory care issues, one can now find a home within the Health-System Practice Forum.

You are likely left with the following question: “Now what?” To date, administrative procedures for the new forum have been revised to ensure a balanced executive committee that includes representation from both practice environments. Members of this committee along with members of the task force recently met to determine the next steps. Be on the lookout in the near future for a survey to give you the opportunity to identify what the forum’s top priorities should be and how the forum can best serve all practitioners involved in transitions of care. Your response will be crucial to our success. v

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New Practitioner Network Member Spotlight

Branham Encourages Members to be Advocates for the Profession Ashley Branham, PharmD, BCACP is the Director of Clinical Services at Moose Pharmacy in Concord, NC and clinical pharmacist at Cabarrus Family Medicine Kannapolis. Branham received her bachelor of science in biology from the University of Kentucky in 2004 and her doctor of pharmacy from Campbell University in 2008. She then completed a PGY-1 community pharmacy residency at the UNC Eshelman School of Pharmacy and Moose Pharmacy in Concord. She also completed a PGY-2 community pharmacy residency with a focus in academia with the UNC Eshelman School of Pharmacy and Moose Pharmacy in 2010.

In her current role, Branham is involved in the implementation and enhancement of clinical activities including immunizations, medication therapy management services, women’s health consultations, insulin-pump training, adherence, and disease state management programs. She is currently a preceptor for student pharmacists completing advanced pharmacy practice rotations and residents completing a community pharmacy practice residency with the UNC Eshelman School of Pharmacy and Campbell University College of Pharmacy & Health Sciences. “When patients learn that they are diagnosed with a chronic disease it can be a very overwhelming experience. It is my goal to empower patients to improve their health by offering education, a strategy to realistically implement lifestyle modifications and designing a medication regimen that is most appropriate.”

Branham has been actively involved in NCAP since 2008. She has served as past-chair of the NCAP Community Care Practice Forum, chair of NCAP’s Immunization Task Force and will be starting her term as President-Elect in 2014. “NCAP provides pharmacists an opportunity to share innovative practice models and advocate as a unified voice for advancement in our profession. As our healthcare model faces significant reform, policy will be introduced that will impact our profession.

We must not remain silent about our ability to serve as integral members of the healthcare team. It is important for all pharmacists (student pharmacists, new practitioners and experienced practitioners) to be an active member of NCAP and join our efforts in advocating for the profession.”

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NCAP Election Results The 2013 Election results have been tallied. This year’s ballots were filled with very qualified candidates and many races were extremely close. We’d like to congratulate our newly elected leaders and encourage all of our members to become active in our association. Three-year terms for new officers begin January 1, 2014. The results are as follows: Board of Directors President-Elect: Ashley Branham At-Large Board Members: Paige Brown, Steve Dedrick, Jennie Hewitt Chronic Care Practice Forum Chair-Elect: Rhonda Gentry Executive Committee: Lori Edwards, Erin Marriott, Jason Moss Community Care Practice Forum Chair-Elect: Sara Dawson Executive Committee: Richard DeBenedetto, Amanda Gates, Jessica Lee Health-System Practice Forum (formerly Acute Care) Chair-Elect: Debra Kemp Executive Committee: Bill Hitch, Debra Pittman, April Quidley ASHP Delegate: Lynn Eschenbacher

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Online Offerings: Pharmacist Refresher Course and QA/Law Course

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 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

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calendar Jan 17- 20, 2014: Southeastern Girls of Pharmacy Leadership Weekend, Omni Grove Park Inn, Asheville, NC March 19-21, 2014: NCAP Chronic Care Practice Forum Meeting, The Ballantyne Hotel & Resort, Charlotte, NC July 18, 2014: Residency Conference, Sheraton Greensboro Hotel at Four Seasons, Greensboro, NC October 26-28, 2014: NCAP Annual Convention, Raleigh Convention Center, Raleigh, NC

For more information visit www.ncpharmacists.org

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