North Carolina Pharmacist Spring Journal 2013

ion, onvent C l a u n An NCAP’s E DATE! H T SAVE

-22

Oct. 20

North Carolina

Pharmacist Vol. 93, Number 2

Advancing Pharmacy. Improving Health.

Spring 2013

Join us in Myrtle Beach August 2-3 for the

NCAP Community Care Practice Forum Meeting In Collaboration with NC Mutual Wholesale Drug Company More information at www.ncpharmacists.org • Diabetes Certificate Program • Immunization Training • CPR Renewal Course • “Precepting Pearl” • “A Comprehensive, Evidence-Based Review of the New Anticoagulants and their Place in Therapy” • “Navigating the Digital Marketing Landscape – How to Reach Today’s Mobile and Connected Customers” • “Providing MTM Services in Geriatric Patients: Pearls for Success” • “Zostavax: Myth vs Truth” • “How Successful Pharmacy Managers Make It Happen” • “Influenza and Pneumococcal: What’s New?” • “Is More Better than Less?: The Safety and Efficacy of Dual Antipsychotic Therapy & Other Therapy Antipsychotic Regimens”

Host Hotel Information: The Marina Inn at Grande Dunes will honor our group rates August 1-5 so bring your family and friends for a vacation!

Reservations: 1-877-913-1333 • marinainnatgrandedunes.com/ncap • Group Code: NC Assoc. of Pharmacists • Cut-off date: July 2

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

North Carolina

Pharmacist

JOURNAL STAFF

Vol. 93, No. 2

EDITOR Sally J. Slusher

Inside

EDITORIAL ASSISTANTS Linda Goswick Teressa Horner Reavis

BOARD OF DIRECTORS PRESIDENT Mary Parker PRESIDENT-ELECT Michelle Ames PAST PRESIDENT Jennifer Askew Buxton TREASURER Dennis Williams BOARD MEMBERS Randy Angel Andy Bowman Jennifer Burch Jenna 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.

Spring 2013

• From the President ........................................................ 4 • Pharmacy Day in the Legislature ................................... 6 • A Practical Guide to Billing

Medication Therapy Management ............................. 8

• Safety Solutions: Disclosing Unanticipated

(Adverse) Outcomes to Patients .............................. 12

• New Practitioner Network

Legislation and Advocacy:

An Introduction to Getting Involved .......................... 14

• NPN Spotlight: Jenn Waitzman .................................... 15 • Chronic Care Practice Forum Meeting Highlights ........ 16 • NCAP Award Nominations Sought ............................... 20 • Calendar of Events ...................................................... 20

Is your membership up to date?

If not, you could be missing out on our many member benefits.

Don’t get left behind, renew today!

North Carolina Pharmacist, Spring 2013 3

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

Dear Members, Your association has had an EXTREMELY busy and productive quarter. I am excited to have the opportunity to apprise you of several key accomplishments and partnerships as they move in conjunct with our strategic plan’s pillars of advocacy, education, and membership.

• The Executive Committee worked with our staff and lobbyist to coordinate a very successful North Carolina Pharmacy Day in the Legislature on March 26, 2013. We are grateful to our colleague organizations, North Carolina Retail Merchants Association and Association of Community Pharmacists, for their support and participation in this vital day. Attendance by pharmacists, students and legislators exceeded every expectation…and provided wonderful opportunities for continuing education and networking for our members.

We are excited to share that advocacy efforts continue to address key legislative efforts including immunizations, hazardous drugs, and Medicaid during the long session. NCAP’s focus for this session includes: • Support of expansion of immunization authority for pharmacists in House Bill 832 and companion Senate Bill 500. As of print time, H832 has cleared the NC House prior to crossover and will be slated for hearing soon on the Senate side.

• House Bill 644, Prevent Hazardous Drug Exposure, has also cleared the NC House and will be scheduled shortly.

Members of the NCAP Board of Directors will meet with officials at NC Medicaid in the coming weeks in an effort to enhance communication and foster collaboration in support of our members and NC citizens.

We will conduct or participate in over 30 hours of continuing education throughout the spring and summer months at NCAP. One hundred twenty persons attended, via webinar or in person, the “Updates in NC Pharmacy” sponsored by the UNC Eshelman School of Pharmacy. The NC Pharmacy Residents’ Conference is slated for July in Greensboro and will offer 7 hours of NC continuing education credits to attendees. The Community Care Practice Forum has unveiled its programming for early August that includes certificate programs in addition to a wonderful location at Myrtle Beach…make your reservations soon so you don’t miss this series!

Finally, the Board of Directors has approved a name change for the Acute Care Practice Forum to the Health Systems Practice Forum. This is the culmination of a year-long effort by the Ambulatory Care steering committee, chaired by Debra Kemp, in conjunct with the Acute Care Practice Forum Executive Committee, chaired by Alyce Holmes. This collaboration will enable members of both practice arenas to maintain state affiliation with the American Society of Health-System Pharmacists, and increase opportunities for joint programming in the future. There is much more coming on this new development…stay tuned!

NCAP’s Search Committee will conduct on-site interviews for the Executive Director position in the next several weeks. We hope to complete our search in the next month and implement a transition plan by summer. In the meantime, we are grateful that Fred Eckel, Executive Director Emeritus, has agreed to provide additional support and guidance to our office staff and will continue in this capacity for transition activities.

Thanks for all you do to support our organization and our profession in your day-to-day activities.

Please contact me at the office with any questions or via email at mary.h.parker@gmail.com.

Sincerely,

Mary Parker, PharmD, BCPS President mary.h.parker@gmail.com Advancing Pharmacy. Improving Health.

4 North Carolina Pharmacist, Spring 2013

North Carolina Pharmacist, Spring 2013 5

Pharmacy Day in the Legislature

Pharmacy Day in the Legislature, held March 26, was a huge success thanks to our members who attended and met with over 100 Legislators and their staff to discuss important pharmacy issues. The day began with a demonstration of pharmacists’ services followed by a CE program. Visits with Legislators filled the afternoon and a reception was held that evening at the North Carolina Museum of History.

Pharmacy Day was sponsored by the Association of Community Pharmacists, the North Carolina Association of Pharmacists, and the North Carolina Retail Merchants Association.

6 North Carolina Pharmacist, Spring 2013

North Carolina Pharmacist, Spring 2013 7

A Practical Guide to Billing Medication Therapy Management

By Ted Hancock, PharmD, CGP, BCACP, CPP, FASCP

In our current world of high volume dispensing, mail order pharmacy, drive thru, insurance and five minute fills, it’s often difficult to counsel and educate our customers as our predecessors once did.

There was even a time, a little further back, when pharmacists were called “Doc” and the nearest physician might be two counties away. Fortunately there is a growing push by government, payers, patients and other healthcare workers to improve quality and outcomes over volume. Even though the Centers for Medicare and Medicaid Services (CMS) do not currently recognize pharmacists as health care workers, there are a growing number of compensated ways in which we can contribute to improved patient care.

Many of you may be aware that Medication Therapy Management (MTM) is a billable service for Medicare recipients, as well as beneficiaries of a growing number of private insurance plans. However, you still may have questions about how to start the process and incorporate it into the business plan of your pharmacy or service.

The intent of this article is to provide some brief history on movement and provide some instruction on how to start billing for the valuable work you are already doing for your patients.

Background Medicare Part D went into effect in January 2006 providing prescription drug coverage for seniors. At that time a required, but still underutilized, component called the Medication Therapy Management Program (MTMP) was quietly introduce in section 423.153(d). According to CMS, it was designed to ensure that covered Part D drugs, prescribed to targeted beneficiaries, are appropriately used to optimize therapeutic outcomes through improved medication use. Per CMS, this service may be furnished by 8 North Carolina Pharmacist, Spring 2013

a pharmacist or other qualified provider.

The ambiguity of this section has resulted in some sponsors providing phone based services conducted by licensed practical nurses (LPN). Many fellow pharmacists feel that we need to increase our participation in this program in order to preserve its intended purpose, as well as increase our recognition as valuable members of the healthcare team. CMS describes three specific types of service: Medication Therapy Management (MTM): a patient-centric, comprehensive approach to improve medication use, reduce the risk of adverse events, and improve medication adherence.

Comprehensive Medication Review (CMR): an interactive review of a beneficiary’s medications, including prescription, over-the-counter (OTC) medications, herbal therapies and dietary supplements, that is intended to aid in assessing medication therapy and optimizing patient outcomes.

Targeted Medication Review (TMR): a review of a beneficiary’s medications to address specific or potential medication-related problems.

In 2010, CMS went further to establish a minimum level of MTM services as follows: • Interventions for prescribers and beneficiaries; • An annual Comprehensive Medication Review (CMR) with an individualized written summary for the beneficiary; • Targeted Medication Reviews (TMR) no less often than quarterly.

Recent Improvements • Beginning January 2013, Part D plans must offer an annual CMR to all eligible beneficiaries, regardless of setting, including those living in longterm care facilities.

• CMR summaries in CMS’ standard-

ized format must be given to beneficiaries effective January 1, 2013.

• CMR completion rate will be a display measure for 2013, and a proposed plan rating measure for 2014.

On the surface, the changes above may seem somewhat unremarkable. However, if you are a Long Term Care (LTC) pharmacist, the first bullet could have a significant impact on the business model for your firm. It means that you not only can perform your required Medication Regimen Reviews (MRR), typically as a loss leader for the pharmacy, but also can perform CMRs for those same patients and receive reimbursement from Medicare Part D plans. The second item ensures that patients (customers) receive a standardized report of the findings and solutions developed during the encounter. The final improvement establishes MTM type encounters as measureable and reportable ratings to help consumers select the highest quality plans.

The MTM provider or plan must deliver the following standardized documents to the MTM beneficiary within 14 days of the encounter. The documents can also be provided to other beneficiary’s healthcare providers.

• Cover letter • Medication Action Plan • Personal Medication List

Getting Started As promised, this article will provide some specific examples of how a pharmacist can meet the requirements outlined above with as little overhead as possible.

Find an MTM Plan Administrator A plan administrator is an organization that provides the connections and contracts with the major insurance companies. These agreements allow individual pharmacists to bill for their MTM services through a single source without the overhead of payer contracts, invoices, knowledge of insurance details, rejected claims

and other time consuming operations. A quick internet search will find many “hits” so it requires some further investigation to determine if the company is an MTM provider/administrator that employs pharmacists outside of their organization.

After a brief search, I was able find three national organizations that met the criteria above. The companies make similar, and sometimes conflicting, claims regarding performance and healthcare savings. The following are the three that I found with some brief success claims from their site: 1. OutcomesMTM (http://www.outcomesmtm.com/) a. Founded in 1999 by two chain pharmacists after completion of project IMPACT and a Blue Cross Blue Shield study. b. Claims to be the national leader in the design, delivery, and administration of MTM programs. c. Contracted with more than 40 health plans, provides MTM coverage to 5 million patients. The company links more than 60,000 local chain, independent, consultant and health-system pharmacy providers with contracted plans across the country.

2. Marixa (http://www.mirixa.com/) a. Founded in 2006 as a subsidiary of the National Community Pharmacists Association (NCPA). b. Claims to be the leading provider of MTM and targeted pharmacist-delivered services to health plans. c. With pharmacists in more than 43,000 partner pharmacies nationwide, the network is the nation’s largest and most comprehensive, and includes independent and chain pharmacies as well as call centers staffed by clinically trained pharmacists.

Register With One or More MTM Plan Administrators Registration involves a bit more than filling out a form and getting a user ID and password. The process may require detailed information about your company including license information, tax ID, NABP and NCPDP number. The provider/ administrator will send paper reimbursement checks to a specific address and recipient. It may take some effort to figure out where and who that will be within your own organization. Some providers may require you to become “credentialed” within their network.

Your relationship with a plan administrator is not an exclusive arrangement so do consider registering with more than one site. Here are how the plans discussed in this article approached registration.

1. OutcomesMTM a. If you click “Login” you are given the opportunity to create a new account. b. Requires license number, NPI and NABP (NCPDP) number. NABP administrator is copied in on registration status. My pharmacy is clinical with no dispensing component. I had to create a NCPDP number first. c. Registration was instant, however you must complete online training before submitting claims.

2. Marixa a. Registration request submitted as an email support ticket. Requires NCPDP number. b. I was assigned a ticket number in an email confirmation and have heard nothing further over the following three weeks. c. Unfortunately, I am unable to further evaluate the registration process and

any further processes for this plan administrator.

3. Pharm MD a. The company site asks you to send an unstructured email expressing interest in contributing to their comprehensive MTM services. The email address is pharmacists@pharmmd.com. b. Two attempts from two different pharmacists over a three month period yielded no response. Another pharmacist was unable to reach Pharm MD by phone. Note: the website demonstrated consistently poor response time with each registration attempt and while exploring the site in general. c. Unfortunately, I am unable to further evaluate the registration process and any further processes for this plan administrator.

Become Credentialed with the Plan Administrators OutcomesMTM requires each pharmacist to complete online training and pass a test before he or she can start submitting claims. Most pharmacists will be able to complete the training in less than two hours. The site offers two elective courses to improve productivity as well as several professional quality demonstration videos.

The elective courses also require passing posttests. OutcomesMTM has contracted with CheckMeds NC for reimbursement in North Carolina. Formerly claims were paid from the Tobacco Health and Wellness Trust Fund but are now billed to the insurance carriers as in other states.

Identify Eligible Beneficiaries If your site is a dispensing pharmacy, you may find that you receive TIPs (Targeted Intervention Program). Your customers are cross referenced with the

3. Pharm MD (http://www.pharmmd. com/) a. Founded in 2006 by two pharmacists. b. Claims to be the quality leader for MTM. c. PharmMD credentials experienced pharmacists to deliver MTM services and actively utilizes over 90% of network availability and has a direct relationship with over 40,000 pharmacies and manages millions of patients.

North Carolina Pharmacist, Spring 2013 9

first attempt to add the patient to your list before you begin the review.

beneficiary database and an automated “Clinical Engine” warns you of potential medication misadventures for specific patients. This process meets the CMS requirement for TMRs addressed above.

This system allows you to flag these patients for a CMR, often when they come for their next refills.

If, as with my site, you do not have traditional customers, you must build your patient list from demographic information you ask during the encounter. In some cases you may find that the patient is not eligible for a CMR. This may be because they have received a review at another pharmacy or that OutcomesMTM does not have a contractual agreement with the customer’s insurance plan. At my site we perform the medication review, even if we are not able to bill for the service.

Your business plan may demand that you

Conduct the Review and Document the Encounter If you work in an environment where the SOAP (Subjective/Objective/Assessment/Plan) approach is used, you will find that the CMR documentation requirements are mostly a subset of your typical encounter. However, if you do traditional retail pharmacy counseling, you may find the documentation requirements time consuming at first. In either case there will be some extra steps related to the level of encounter, especially with regard to specific pharmacotherapy recommendations.

The CMR is documented first and has some required elements. I have included an example (Figure 1).

As you can see from the second sec-

Figure 1 PATIENT INFORMATION ID NUMBER NAME DATE OF BIRTH GENDER GROUP

Redacted Redacted 07/14/1943 FEMALE CHECKMEDS NC

MTM CLAIM INFORMATION ENCOUNTER DATE REASON ACTION RESULT ECA LEVEL (SEVERITY) NOTES

MEDICAL CONDITION

03/05/2013 COMPLEX DRUG THERAPY (100) COMPREHENSIVE MED REVIEW (CMR) (200) CMR WITH ENCOUNTER (300) LEVEL 1 - IMPROVED QUALITY OF CARE PATIENT ARRIVED TO CLINICAL PHARMACY WITH HUSBAND TO DISCUSS REDUCTION OF MEDICATION REGIMEN. THE PRIORITY FOR THIS VISIT WAS COMFORT. THE PATIENT HAS 9 CHRONIC DISEASE STATES. SHE HAS 22 MEDICATIONS. THE PATIENT RECEIVED A MEDICATION LIST AND NOTE SUMMARY AT THE CONCLUSION OF THE VISIT. ASTHMA/COPD

tion, the pharmacist must make some decisions regarding reason, action taken, result and the Estimated Cost Avoidance (ECA).

The note requirements include clarification that this is a face-to-face visit, goal for review, the number of disease states and medications, and documentation that the patient has received an updated medication list or will within 14 days. You may include your full SOAP note, if available, as well. Beginning in January 2013, the medication list must follow the standard format available through cms.gov.

Next you will want to document specific recommendations, one at a time, and link those to the CMR. The linking is fairly straightforward and offered at the end of each intervention. See the Figure 2 for a linked encounter: Once again, you can see that there were several decisions made from drop down menus regarding the category and severity of the encounter.

Respond to Resubmit Messages A coding specialist with a very high level of expertise may approve your claim, request clarification, or ask for an update.

This is very common. Sometimes the expert will suggest an intervention level change which is usually in the upward, more highly compensated, direction.

Collect Reimbursement After about two months, your pharmacy will start to receive checks in payment for your interventions. OutcomesMTM typically waits until there is an amount that justifies the payment processing costs.

The reimbursement for the CMR is typically slightly less than the hourly pharmacist rate. Each intervention can pay up to

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! 10 North Carolina Pharmacist, Spring 2013

40% of the CMR amount depending on the outcome, which often must be documented in a follow up note.

Discussion There are testimonials on the plan administrator sites claiming that a pharmacy can make an extra $2000 or so in documenting their encounters. The web interface is slow and cumbersome overall and the extra documentation can take some valuable time, especially in the beginning.

I believe it is important to remember that this is a healthcare improvement initiative from CMS, and not intended as a lucrative pursuit. I view this as a step in the right direction for the effort to have pharmacists recognized as healthcare providers. I fear that if we don’t utilize this CMS provision, that lack of activity will be perceived as a lack of interest in contributing to the healthcare of our patients/customers.

This could jeopardize future efforts to be recognized for our education and valuable skill sets, as well as reducing potential new revenue streams in the future. So, take a deep breath, get registered and start getting paid for the counseling, education and recommendations we do best. v

Figure 2 PATIENT INFORMATION ID NUMBER NAME DATE OF BIRTH GENDER GROUP

Redacted Redacted 04/04/1942 FEMALE CHECKMEDS NC

MTM CLAIM INFORMATION ENCOUNTER DATE REASON ACTION RESULT ECA LEVEL (SEVERITY) NOTES

TWICE

02/28/2013 COST EFFICACY MANAGEMENT (105) PRESCRIBER CONSULTATION (205) INITIATION OF COST EFFECTIVE DRUG (305) LEVEL 2 - DRUG PRODUCT COSTS RECOMMENDED D/C VICTOZA FOR WHICH PATIENT WOULD PAY CASH. RECOMMEND START BYETTA WHICH IS ON THE PREFERRED DRUG LIST (PDL). START BYETTA 10MCG DAILY DUE TO NON-NAIVE TO GLP-1 AGONIST.

RESPONSE: ASSESSMENT & PLAN(Redacted, MD; 3/5/2013 5:10 PM) DM, UNCOMPLICATED, TYPE II (250.00)

IMPRESSION: DIABETES IS STABLE

TRY BYETTA SINCE INS WILL NOT COVER VICTOZA

REMINDED TO CONTINUE TO HAVE ANNUAL EYE EXAM

URGED COMPLIANCE

MEDICAL CONDITION

DIABETES

North Carolina Pharmacist, Spring 2013 11

Safety Solutions

Disclosing Unanticipated (Adverse) Outcomes to Patients

By Robyn Sayner, PharmD

Have you made a mistake that has caused harm to a patient? Have you thought about how and what you will say to a patient when an unanticipated outcome occurs? Do you know how a disclosure would occur in your pharmacy or at your hospital?

AM I AT RISK? Statistically, it is likely that you have or will be involved in an event that results in patient harm. In 2007, the Institute for Safe Medication Practices (ISMP) estimated that preventable medication errors could harm at least 1.5 million people annually in the community setting.1 The scale of the problem is magnified when you consider the harm to hospitalized patients.2 The goal of this article is to provide guidance on the disclosure process by outlining key objectives, readiness tips, and resources to be aware of when a patient has been harmed due to an unanticipated event.

DISCLOSURE IS PART OF ETHICAL PATIENT SAFETY PRACTICE The definition for disclosure in this article comes from the American Society of Healthcare Risk Management, which defines disclosure as “communication between a healthcare provider and a patient, family members, or the patient’s proxy that acknowledges the occurrence of an error, discusses what happened, and describes the link between the error and outcomes in a manner that is meaningful to the patient.”3 Disclosure is a critical component in patient-centered care that fosters an environment of transparency and trust. Disclosure is also a delicate matter that must be handled by appropriately trained individuals, following a thoughtful plan.

12 North Carolina Pharmacist, Spring 2013

GOALS OF DISCLOSURE Experts have suggested that the goals of disclosure can be one or more of the following4: 1) treat patients with compassion and respect, 2) maintain trust between patients and healthcare providers, 3) provide an opportunity for the patient and family members to understand what happened to begin the healing process, 4) promote transparency between the healthcare organization and the patient, 5) demonstrate the commitment to safety and quality of the healthcare organization, 6) enhance quality improvement after the event, 7) comply with laws, regulations, and professional standards, 8) lessen unfavorable media attention, and 9) reduce potential litigation.

A READINESS PLAN One of the first things to do is to find and review the disclosure policy of your organization. If no policy exists, the following have been suggested by experts as disclosure policy elements to help your organization get started5: • what types of unanticipated outcomes to disclose, • who should disclose this information to the patient, • when the outcome should be disclosed to the patient or their family members, • what information should be and should not be discussed, and • a plan to update the patient as new information is learned Frontline employees (including technicians, cashiers and decentralized pharmacists) are likely the first ones to receive a patient’s report of a medication error. A discussion of the basic customer service

skills is separate from the disclosure process and outside the scope of this paper.

WHAT YOU SAY AND HOW YOU SAY IT MATTERS The ECRI Institute suggests the following when disclosing information to the patient.6 If you are the person who will be disclosing the unanticipated event to the patient or family members, tell them what happened, sticking to the facts. Do not assign blame since the full story is rarely known. These details are not included in early disclosure discussions, even when the provider expresses remorse at a particular action or failure to take an action.

Explain what will be done to prevent future events. This may help the patient deal with the situation knowing that changes will be made to avoid this type of mistake from occurring to anyone else. Conduct these discussions in a quiet, private area that supports both confidentiality and the feelings of the patient and family. Be honest, professional, and reassuring while communicating with the patient and family members. Agree on a plan for ongoing communication. Above all else, listen and empathize with the patient.

A CHECKLIST FOR DISCLOSURE To prepare for how you will respond to an unanticipated event that resulted in patient harm, make a checklist. In your checklist, include the current disclosure policy for your organization, local or state laws and regulations along with accreditation standards requiring disclosure, the documentation plan for the disclosure, and the use of outside consultants or advisors in the disclosure process.

Most importantly, disclosure is not a one-time event, but rather an ongoing process between the provider and the patient.

FOR MORE INFORMATION The following sites provide informed resources about disclosure, in addition to your organization’s policies and procedures. The ECRI Institute also provides a

disclosure template that can be utilized as a starting point6. Beyond the scope of this article, there may also be local and state laws and regulations which may require disclosing information to patients after an unanticipated adverse event has occurred: • Agency for Healthcare Research and Quality (AHRQ) at www.ahrq.gov • American Society for Healthcare Risk Management at http://www.ashrm.org/ ashrm/news/newsletters/patient_safety/ resources.shtml • ECRI Institute at www.ecri.org • The Sorry Works! Coalition at http:// www.sorryworks.net

References: 1. A Call to Action: Protecting U.S. Citizens from Inappropriate Medication Use. A White Paper on Medication Safety in the U.S. and the Role of Community Pharmacists. Institute for Safe Medication Practices. [Updated 2007. Cited 2013 April 23].

Available from http://communitypharmacyfoundation.org/docs/CPF_Doc_312222.pdf 2. Kohn LT, Corrigan JM, Donaldson MS, eds. Committee on Quality of Healthcare in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.

3. Singh V, Cunningham CJ, Panda M, Hetzler DC, Stanley D. Disclosure and documentation of reported unanticipated medical events or outcomes: Need for healthcare provider education. J Healthc Risk Manag.

2012;32(1):14-22.

4. Oregon Adverse Event Disclosure Guide: A Resource for Physicians and Healthcare Organizations.

Oregon Patient Safety Commission. [Updated 2012.

Cited 2013 April 22]. Available from http://oregonpatientsafety.org/docs/tools/0_Oregon_Adverse_Event_ Disclosure_Guide_April_2012.pdf.

5. Weiss PM, Miranda F. Transparency, apology and disclosure of adverse outcomes. Obstet Gynecol Clin North Am. 2008 Mar;35(1):53-62, viii.

6. Disclosure of Unanticipated Outcomes. Healthcare Rick Control. Incident Reporting and Management.

ECRI Institute. [Updated 2008 January. Cited 2013 April 26]. Available from https://www.ecri.org/Documents/Patient_Safety_Center/HRC_Disclosure_Unanticipated_Events_0108.pdf About the Author...

At the time this article was written In April 2013, Robyn Sayner, PharmD was completing a PY4 Medication Safety clerkship at SecondStory Health, LLC in Carrboro, NC.

NCAP has partnered with the Connecticut Pharmacy Association to offer The Pharmacist Refresher Course, Online an online course designed for pharmacists who wish to Offerings: return to community pharmacy practice after an absence Pharmacist from practice for three or more years. The course consists Refresher of three modules, all of which have been approved for Course ACPE credits. The first two modules are online and com& QA/Law posed 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 North Carolina Pharmacist, Spring 2013 13

New Practitioner Network

Legislation and Advocacy: An Introduction to Getting Invoved Whether or not you are aware, legislative discussions and decisions are happening all around you.

Actions of state and federal government can have a profound impact on your

By Jason Chou & Jeff Reichard personal and professional lives. We often hear about legislation that affects us personally, such as tax reform, but it is important to understand these same types of impactful decisions are also being made with regards to your profession, pharmacy.

The great news is that the North Carolina Association of Pharmacists works with experts who assist the organization with legislative matters that are critical to improving patient care and advancing our profession. There is, however, a need for pharmacists to be involved with advocacy process at the grass roots level.

Evelyn Hawthorne, NCAP’s lobbyist, outlines three areas of legislation that practicing pharmacists should be aware of as well as tips for getting involved.

Legislative Areas of Interest • The impact of state and federal health care reform regarding reimbursement should be on the radar of every pharmacist.

With new Governor Pat McCrory recently taking office, changes impacting state Medicaid and other health programs are being discussed. Currently, a state budget sub-committee is meeting to make decisions focused on cost saving. As health care professionals we need to ensure that this does not come at the cost of quality and safety for patients.

• Pharmacist scope of practice changes are afoot with two particular areas including immunization administration changes,

14 North Carolina Pharmacist, Spring 2013

and a potential for “umbrella” licensing boards that would have purview of multiple professional groups.

• Lastly, other organizations, such as those associated with law enforcement, also influence health care legislature. A big focus for the current legislation session will be aimed at assisting law enforcement with cracking down on illegal drug use. Medication registries, access to information, and pseudoephedrine legislation are main topics up of discussion. Keeping in mind that mandated reporting and registry requirements come at the cost of health care organizations, this will be an area of interest to many pharmacists.

Getting Involved • Building a relationship with local and state representatives is one of the most important things pharmacists can do to advocate.

Simply introducing yourself and outlining the value the profession brings to constituents is a great start.

• Keeping up to date with legislation impacting pharmacy practice through state and national organizations.

• Contacting representatives about specific legislative issues you are passionate about and providing perspective that influences decision making. v

New Practitioner Spotlight: Jenn Waitzman Jennifer (Jenn) A. Waitzman, PharmD, BCACP is an assistant professor of pharmacy practice at Wingate University in Wingate, North Carolina. Jenn was born and raised in Ohio. After earning her Doctor of Pharmacy degree from the Raabe College of Pharmacy at Ohio Northern University, Jenn relocated to North Carolina to complete a PGY-1 community pharmacy practice residency with UNC Eshelman School of Pharmacy. Her clinical practice site was Kerr Drug in Raleigh. She primarily focused on medication therapy management (MTM), wellness screenings, diabetes education, and immunizations, with additional experiences in disease state management and anticoagulation. Following the completion of residency, Jenn decided to pursue the field of academia by participating in a year-long academic fellowship in the Pharmaceutical Care Lab (PCL) at UNC in Chapel Hill. During the fellowship, she practiced community pharmacy at both the outpatient pharmacy at UNC hospitals and Kerr Drug in Chapel Hill.

Upon conclusion of her academic fellowship, Jenn accepted an ambulatory care faculty position with Wingate University. She practices three mornings a week at the University Wellness Center on campus where she conducts wellness visits for employees and spouses covered by the university insurance policy. She also provides diabetes education for Union County employees. Jenn serves as the pharmacy manager for the University’s student health center pharmacy. She precepts third-year student pharmacists during a 5-week longitudinal ambulatory care IPPE rotation and co-advises two student groups on campus, Phi Lambda Sigma (PLS) and National Community Pharmacists Association (NCPA).

Jenn is an active member of professional organizations at the state and national levels. She is the Community Care Practice Forum liaison for the NCAP New Practitioner Network (NPN) Executive Committee, as well as a member of the Community Care Practice Forum Executive Committee. Jenn is active in the American Pharmacist Association (APhA) NPN, as a member of the Awards Standing Committee. She also belongs to the American Academy of Colleges of Pharmacy (AACP), where she participates in several special interest groups. She strongly believes that professional involvement is a rewarding experience, both personally and professionally. These groups are critical to the advancement of the profession of pharmacy, as they provide a unified avenue for pharmacists to come together and promote the profession forward, especially in times of great change. v

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NCAP Chronic Care Practice Forum Meeting NCAP’s 2013 Chronic Care Practice Forum meeting was held March 20 - 22 at the Ballantyne Hotel and Lodge in Charlotte, NC. Over 160 pharmacy professionals gathered for CE and networking.

Keynote Speaker Kelly Jones.

“Thank You” to our Platinum Sponsors

AbbVie Cardinal Health (left to right) Gianna Bryan, recipient of the Dale Jones Memorial Award for Excellence in Geriatrics, Cheryl Kendrick, Charlotte Matheny and Judy Turnage.

GeriMed Novo Nordisk, Inc. Walgreens and Exhibitors

Penny Shelton was the recipient of the Chronic Care Pharmacist of the Year Award for her outstanding contributions to the profession. The award was presented by Charlotte Matheny.

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AbbVie Assured Pharmaceuticals Boehringer-Ingelheim Cardinal Health GeriMed Healthpoint Lilly USA McKesson MHA NC MedAssist Novartis Pharmaceuticals Novo Nordisk, Inc. Sanofi Diabetes Smith Drug Company Walgreens

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NCAP Award Nominations Sought Deadline for Nominations: June 3, 2013 It is a privilege for the North Carolina Association of Pharmacists to recognize excellence within the profession. NCAP members are invited to nominate deserving members for the following awards to be presented at the Convention October 20-22 in Raleigh. Nominations must be in writing (see nominations form on the website or you may request one from Linda Goswick). Send nominations to the NCAP Awards Committee, c/o Linda Goswick, 109 Church Street, Chapel Hill, NC 27516, fax to 919-968-9430 or e-mail linda@ncpharmacists.org.

Bowl of Hygeia Award (sponsored by American Pharmacists Association Foundation and National Alliance of State Pharmacy Associations) Criteria for this award are: (1) Licensed to practice pharmacy in NC; (2) Has not previously received the Award; (3) Is not currently serving nor has he/she served within the immediate past two years on its awards committee or as an officer of the Association in other than an ex officio capacity; (4) Has compiled an outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession.

Cardinal Health Foundation Rx Champions Award This award recognizes a pharmacist for his/her work within the pharmacy community to raise awareness of the serious public health problem of prescription drug abuse.

Don Blanton Award Presented to the pharmacist who has contributed the most to the advancement of pharmacy in North Carolina during the past year. This award was established by Charles Blanton in memory of his father, Don Blanton, who served the North Carolina Pharmaceutical Association as President 1957-58.

Excellence in Innovation Award (sponsored by Upsher-Smith Laboratories) Presented to a pharmacist practicing in North Carolina who has demonstrated Innovative Pharmacy Practice resulting in improved patient care.

Distinguished Young Pharmacist Award (sponsored by Pharmacists Mutual Companies) Criteria for this award are: (1) Entry degree in pharmacy received less than 10 years ago (2003 or later graduation date); (2) Licensed to practice pharmacy in NC; (3) Actively practices retail, institutional, managed care or consulting pharmacy; (4) Participates in national pharmacy associations, professional programs, state association activities and/or community service. Please send nominations for this award to Kimberly Lewis, Chair of the New Practitioner Network, kimberly. lewis@sr-ahec.org.

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calendar August 2-3, 2013 Community Care Practice Forum Meeting Sheraton Myrtle Beach Convention Center, Myrtle Beach, SC August 2, 2013 Immunization Certificate Training Sheraton Myrtle Beach Convention Center Myrtle Beach, SC (in conjunction with the Community Care Practice Forum Meeting) July 19, 2013 Pharmacy-Based Immunization Delivery: A Certificate Training Program for Pharmacists Charoltte Marriott City Center Charlotte, NC July 12, 2013 Residency Conference Sheraton Four Seasons, Greensboro NC September 21, 2013 Student Leadership Conference Pinehurst, NC October 20-22, 2013 NCAP Annual Convention Raleigh Convention Center, Raleigh, NC March 19-21, 2014 NCAP Chronic Care Practice Forum Meeting The Ballantyne Hotel & Resort, Charlotte, NC

For more information visit www.ncpharmacists.org

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