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APOLOGY LIABILITY Five things pharmacists need to know about saying “sorry”

EXPIRATION DATE Get the most out of your expired products with a returns company

A Shot at Flu Success The business case for providing flu vaccines in your pharmacy


In a recent survey by Hammacher of independent pharmacy stores, 73% of pharmacists surveyed said their front-end business is either growing or holding steady.

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The business magazine for independent pharmacy

STAFF & CONTACTS Matthew Shamet – Publisher and Editorial Director Kirsten Hudson – Editor Kellie Paxton – Art Director Chloe Holt – Contributing Writer Kathleen Barbosa – Contributing Writer Paige Fisher – Graphic Designer INTERESTED IN ADVERTISING? elements@pbahealth.com

Contents Departments 5 NEWS:

MTM: The Newest Quality Metric Look out for MTM to become bigger in 2016. 6 TRENDS:

If The Glove Fits Tips for choosing the right medical gloves for your pharmacy. 8 RETAIL:

Pharmacist-Recommended Research-backed tips for increasing OTC recommendations and sales. 11 SOLUTIONS:

Lead, Engage, Connect Expert advice to become a compelling leader.



Scheduling Synchronization Improve patient outcomes and pharmacy operations with the appointment-based model. 24 MONEY:

Expiration Date Get the most out of your expired products with a returns company. 30 OUTLOOK:

Apology Liability Five things pharmacists need to know about saying “sorry.” 34 NOTES:

Return-to-Stock The business problem of abandoned prescriptions.

Feature: A Shot at Flu Success


The business case for providing flu vaccines in your pharmacy.

Find more strategies, tips and expert advice to improve your business at pbahealth.com/elements.

5 High Margin Back-End Opportunities

Give your sales a boost with these back-end opportunities you might be missing. Read more at pbahealth.com/5-high-margin-back-end-opportunities.

ELEMENTS is published quarterly by PBA Health. Copyright© 2015 PBA Health. All rights reserved. Neither this publication nor any part of it may be reproduced without written permission by PBA Health.


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MTM: The Newest Quality Metric Look out for MTM to become bigger in 2016

By Chloe Holt

A new Star Ratings measure is coming. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) revealed that it will add a new quality measure to the 2016 Star Ratings: a metric for the completion rate of Comprehensive Medication Reviews (CMRs) within the Medication Therapy Management (MTM) program. Although the new measure won’t go into effect until January 1, 2016, pharmacies need to start preparing now. “It’s very important for pharmacists to understand that while this is a new metric coming out, they need to be ahead of the game,” said Elliott Sogol, Ph.D, R.Ph., F.A.Ph.A, vice president of professional relations for Pharmacy Quality Solutions, a quality assessment service company. “You don’t want to play catch up.” MTM CHALLENGES Even though CMR completion rates will only be given a weight of “1” in the Star Ratings, you don’t want to ignore them. They’re intertwined with other metrics, including medication adherence and high-risk medications, so their impact will be much greater. “Besides getting credit

for MTM, you’ll be improving your other metrics, as well,” Sogol said. One challenge will be getting patients to opt into the service. “Your score factors in all eligible patients, even if they refuse the service,” Sogol said. “You’re held responsible for getting patients to participate. As a health care professional, your role is to help patients fully understand the importance of this service.” BUSINESS ISSUES Even though Star Ratings are currently only assigned to health plans and not to pharmacies, your performance on these metrics can— and does—matter. Health plans are using Star Ratings to determine which pharmacies to include in their quality-based networks. “It used to always be cost-based but now it’s shifting to be a cost and quality component,” Sogol said. “The score the pharmacy receives today will ultimately influence how well they do within a given preferred network or quality network moving forward,” he said. “Starting next year, these quality metrics will be widely utilized to determine who belongs in preferred or quality networks.”

VALUE OF PHARMACISTS Pharmacists create positive outcomes for patients and the health care system—and CMS has noticed. “CMS has seen that when patients have CMR services, they see a lower health care cost down the line,” Sogol said. “Pharmacies impact the health plan summary score Star Rating by almost 50 percent today. And, the more pharmacists provide this service, the more overall health care expenditures decrease.” “I think moving forward pharmacies will gain more and more opportunities to practice at the top of their license, and this is one of them,” Sogol said. “Working one-on-one with the patient, really focusing on their specific health care needs around medication use and management, and helping them understand the importance of all of this—this is what it means to be a pharmacist.”

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If The Glove Fits Tips for choosing the right medical gloves for your pharmacy By Kathleen Barbosa

All gloves are created equal. That’s the biggest misconception pharmacists have about medical gloves, according to Chris Wright, CEO of Shepard Medical Products, a company that develops infection protection products. Instead, each material—latex, vinyl, nitrile or synthetic—offers protection for different situations. “A pharmacist needs to know, ‘How am I going to use this product?’” Wright said. If you’re using—or selling— the wrong type of gloves for the task, you might be inadvertently putting yourself, your staff or your patients in harm’s way.


The Right Fit When choosing a glove, pharmacists often make a common mistake—size. “Everybody thinks they need to be skintight,” said Chris Wright, CEO of Shepard Medical Products. “But when you’re wearing a glove all day long, you want to wear a glove that’s loose fitting.” Exam gloves are molded with the thumb straight up. And because your thumb isn’t naturally in that position, a too-tight glove can cause pressure and tension, creating thumb fatigue. “The second problem with tight gloves is that they tear more easily because they’re under stress,” he said. “If you touch something that’s just the least bit sharp, it will penetrate the glove more easily.”

WHAT TO LOOK FOR When it comes to purchasing medical gloves, there’s one word you need to look for. “The key word is ‘examination,’” Wright said. “If it doesn’t have ‘examination’ or ‘exam’ on the package, you really don’t want it. Often times I find pharmacies have gloves that say ‘latex gloves’ or ‘disposal gloves’ but if they don’t have the words ‘exam’ or ‘examination’ on them, it’s a product that’s not suitable for infection protection.” Gloves labeled “examination” or “exam” are medical grade gloves. They’re vigorously tested and meet the standards set by the Food and Drug Administration (FDA). “The glove has to pass the water-leak test, the elongation test, and the tensile strength test,” Wright said.

“When handling drugs in a pharmacy, those chemicals are on the surface of the glove,” Wright said. “When you take a powdered glove off, anything that’s on your hands is now in the air and you’re breathing it in.”

THE POWDER PROBLEM Powdered gloves may be easier to get on, but you should always choose powder-free gloves for your pharmacy. Powdered gloves are usually banned in nursing homes, continued care facilities and hospitals because they increase the chance of spreading infection.

LATEX “If you just want to keep your hands clean from infection, then almost any exam glove will do the job,” Wright said. This includes latex gloves. One problem with latex gloves, however, is that the material can cause allergy concerns, especially when the glove is powdered.

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TYPES OF GLOVES VINYL Vinyl gloves are low-cost and offer basic protection against infection, but keep in mind that the thinner the glove, the more likely it is to tear. “There are all levels of quality and thickness, and vinyl gloves are at the lower end of that spectrum,” Wright said. “The thinner you go—down to about 4 mils in thickness—the more likely they are to tear.”













First aid, vaccinations



Chemotherapy, home infusion, compounding, handling drugs

“When you take off a powdered latex glove, the powder and the antigens from the rubber are released into the air,” Wright said. “People can have anaphylactic shock syndrome as a result of breathing the air where rubber gloves were being used.” Even if none of your employees are allergic to latex, patients might be, and latex allergens go into the air even with powder-free gloves. When purchasing a latex glove to stock in your front end for first aid or wound treatment, Wright recommends looking for a latex glove that is powder-free and polymer coated. VYTRILE™ “Vytrile is a unique synthetic,” Wright said. “It’s softer, more flexible, and has greater tactility than a vinyl glove.” Vytrile offers three times the amount of strength as vinyl gloves, too. Vytrile is a great hypoallergenic substitute for latex. “It’s a safe alternative to latex, but closer to latex than vinyl,” Wright said. “For a very nominal difference in cost, you could choose Vytrile over vinyl and have a better product that offers complete protection from

viral penetration and alcohol permeation.” Vytrile is also powder-free. Vytrile gloves work well for general first aid use and for administering vaccinations. NITRILE For the highest level of protection, Wright recommends using nitrile gloves. “There isn’t another glove that has greater non-permeability factors to it,” he said. The synthetic material is good for several applications in the pharmacy. “Nitrile is good for chemotherapy, home infusion, compounding, or handling drugs inside the pharmacy,” he said. While nitrile gloves are marginally more expensive, they offer superior protection. And according to Wright, when pharmacies choose gloves based on price alone, they put themselves at risk. “If you’re really sincere about protecting yourself, your employees and your customers from infection or from contamination from drugs, you want the best possible protection you can get, and that means you pay a little more,” he said.

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PharmacistRecommended Research-backed tips for increasing over-the-counter recommendations and sales How often do you recommend front-end products to patients? Pharmacist recommendations are vital to improving front-end sales, according to Pharmacist and Patient Conversations at Independent Pharmacy, a recent report from Hamacher Resource Group, a research and marketing firm specializing in consumer health care, and the Healthcare Distribution Management Association (HDMA). Now’s the time to start suggesting front-end products to patients. Pharmacy front ends are doing well overall. Eighty-six percent of pharmacies reported that their front-end sales are growing or holding steady when comparing sales from 2012 to 2013. This is an improvement from an earlier study, when only 73 percent of independent pharmacies reported increased or holding front-end sales. Boost front-end sales even more by increasing the number of front-end product recommendations you make to patients. Here are some tips. 1. MAKE USE OF TIME You only get a few moments with patients in your pharmacy, so it’s important to make the most of the time. “Assess how time with patients is being spent and consider using it more efficiently to include non-prescription recommendations during patient conversations when appropriate,” said Tom Boyer, director of national sales at Hamacher. Incorporating a recommendation can make your conversation more profitable. If you’re not sure where to


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start, consider endorsing one of the product types that the survey found pharmacists recommend the most, like adult internal pain relief, vitamins or supplements, or adult allergy relief. 2. STRATEGICALLY POSITION PRODUCTS The area surrounding the pharmacy counter is valuable retail space. The surveyed pharmacies with the highest recommendation rates made nearly six out of 10 recommendations for products that were moved closer to the pharmacy counter or were already near the counter.


In your pharmacy, move categories that are commonly recommended or frequently asked about closer to the pharmacy counter. Placing products close to the counter can help remind pharmacists to make a recommendation. According to the survey, 71 percent of pharmacists make a recommendation for an over-the-counter pairing with a prescription less than 30 percent of the time. Simply having a vitamin or supplement close can help increase that number. Boyer suggests taking it a step further. “Use small countertop displays that feature frequently recommended supplements that replenish nutrients depleted by certain prescription regimens,” he said. These displays can remind both the pharmacist and the patient about complementary add-ons. 3. BE PROACTIVE Conversations about front-end products only accounted for 14 percent of exchanges between patients and pharmacists, according to the survey. Moreover, patients initiated the conversation about recommendations 61 percent of the time. Take the initiative to start a dialogue with patients and improve your number of recommendations. Starting a conversation about recommendations doesn’t have to be boring and stale. “Seek out creative avenues to boost recommendations other than the traditional, verbal, ‘Have you tried this product?’” Boyer said. “‘Ask Our Pharmacist’ signs are very effective and can get the conversation started. Personalize them with the name or picture of the pharmacist when possible.” 4. USE PHARMACISTS’ KNOWLEDGE Tap into pharmacists’ knowledge on front-end products by training your front-of-store staff to direct patients to pharmacists for questions. According to the survey results, independent community pharmacies make only six to 10 non-prescription recommendations each day on average. By training your staff to prioritize recommendations, you can quickly grow that number. Preparing staff can also help. “Use store meeting time to discuss categories that are most often asked about,” Boyer said. “Provide staff with ideas for the best ways to engage customers.” 5. CREATE A MOST-RECOMMENDED DISPLAY Put together a display of your pharmacy’s mostrecommended front-end items. Boyer suggests using

end caps near the counter to highlight your mostrecommended items. “End caps have enough shelf space to display products from several categories and are easily changed when popular treatments fluctuate by season,” he said. 6. USE RESOURCES FROM PARTNERS Take advantage of the resources offered by distributors and manufacturers—like planograms or end cap displays—to boost front-end sales. Focus on resources that promote categories poised for growth, like vitamins and supplements, cough and cold, digestive health, pain relief, and first aid and wound care. Also, scope out fresh in-store displays at tradeshows or other industry events. “You’ll find new and unique ideas you can bring back and utilize in your store,” Boyer said.

Numbers to Know Front-end sales are growing. Take a look at the trends in independent pharmacy today and see how your pharmacy compares.

Percent of independent pharmacies indicated their front end was growing or holding steady

Percent of recommendation conversations are initiated by the patient

Percent of conversations between patients and pharmacists are about ancillary products

Percent of pharmacies make over-the-counter recommendations less than three out of 10 times

Source: Pharmacist and Patient Conversations at Independent Pharmacy; Hamacher Resource Group, Healthcare Distribution Management Association

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Lead, Engage, Connect Expert advice to become a compelling leader What does it mean to be a great leader? And why should you work to be a great leader in your pharmacy? Your ability to be a strong leader to your employees and patients can lead your business to success—but it takes work. “You can’t just default to normal communications and hope you come across as a really strong leader,” said Don Hutson, CEO of U.S. Learning, LLC, and author of “Selling Value: Principles of Value-Based Selling.” “You have to make the effort to achieve your desired leadership outcome.” The first step to becoming a strong, effective leader, Hutson said, is the decision to commit to studying and developing your leadership skills. And it doesn’t happen overnight. “You need to accept the premise that school’s never out,” Hutson said.

“We’ve got to maintain a hunger for knowledge, an excitement for new information and an absolute commitment to stay on the cutting edge rather than the trailing edge.” “Part of leadership is business acumen; it’s people skills; it’s customer satisfaction; it’s entrepreneurship,” he said. “All of these things are critically important.” And if you push yourself, you’ll notice a difference. “When you develop a compelling leadership style, then you start to notice that employee turnover has decreased and customer satisfaction has increased,” Hutson said.

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“If leaders do a good job of keeping their employees happy, they’ll make their customers happy too.” SKILLS TO LEARN It’s important to devote time and energy to learn skills that weren’t part of your formal education. Hutson recommends starting with books about business and leadership, or even subscribing to online educational programs. Continuing education sessions are another way to develop additional skills. “You have to do your homework to get really good at it,” Hutson said. Along with learning, you also have to put your leadership skills into practice. “I think the worst thing that pharmacists can do today is get in their cocoon behind the counter and not engage with employees and customers,” Hutson said. “It’s called professional cocooning.” As you develop your unique leadership style, you’ll find that certain common traits foster great leadership. Hutson points to community involvement, follow-up and follow through, and integrity as common traits of successful business leaders. “Integrity is huge,” he said. “Being a trusted advisor is so important when you’re dealing with patients in a pharmacy environment. Being a trusted advisor means establishing respect in your field and earning trust in everything you do.” SELL TO LEAD One skill that’s often overlooked when it comes to leadership in a pharmacy setting is selling. “Regardless of the title on your business card, everybody’s in sales,” Hutson said. Pharmacists don’t typically think of themselves as salespeople, but Hutson suggests taking a fresh look at the role of sales in your pharmacy. When it comes to communicating with your patients, your employees and your business partners, selling is built into these relationships. “Every time we speak, we want to be articulate, convincing and persuasive, which will enable us to get our desired outcome from that relationship. One key caveat is to be sure those desired outcomes are ‘win-wins’ in nature, not manipulative.” You have to sell your vision for your pharmacy to others, and get them involved. “People will buy in to the degree that you ask them to be part of a given initiative.

When you give them opportunities for authorship, they will feel more ownership.” “We all sell, and we need to know how to do it right,” he said. “The greatest leaders know how to persuade rather than demand.” EDUCATE TO INNOVATE You can’t move your pharmacy forward if you’re still relying on the business tactics and leadership skills of yesterday. Staying engaged in your own education and constantly pursuing new knowledge is essential. “I know that when I let my guard down and quit learning, I’m going to become obsolete,” Hutson said. “Being a pharmacist is exactly the same.” The more you work to stay on top of your own skill development and the emerging trends in your profession, the more you’ll establish yourself as a trusted advisor, and the more you’ll be able to incorporate innovations into your business practices. This will allow your pharmacy to stay competitive, too. “We’ve got to maintain a hunger for knowledge, an excitement for new information and an absolute commitment to stay on the cutting edge rather than the trailing edge,” Hutson said. Don Hutson is a Hall of Fame Speaker and New York Times #1 best-selling author. He is the CEO of U.S. Learning based in Memphis, Tenn. Learn more at donhutson.com.

Don Hutson has more expertise to share. Learn about leadership and communication skills in a pharmacy setting during Hutson’s continuing education session at the Connect 2015 PBA Health Conference & Business Seminar, July 10-12, 2015 in Kansas City, Mo. Learn more and register to attend at pbahealth.com/conference.

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A Shot at Flu Success The business case for providing flu vaccines in your pharmacy By Kirsten Hudson

For El Dorado TrueCare Pharmacy in El Dorado, Kan., planning, prepping, organizing and marketing its flu program is an almost never-ending project—but well worth it. “Our flu shot season runs from the end of August through January or February,” said Jennifer Clausing, R.Ph., staff pharmacist at El Dorado TrueCare Pharmacy and head of its vaccination program. And once the season ends, it’s time to prepare for the next one. “In February, I start to get my numbers together to analyze what was used in the past season and to plan what to order for the next year,” she said. “By March, I’ll place my vaccine order.” Despite the extra work involved, offering flu vaccines is a revenue-generating service for independent community pharmacies. Pharmacies can earn a decent margin on every flu shot they provide, which can number


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in the hundreds. “Profitability for influenza vaccines are 50 to 100 percent above the cost of the vaccines alone,” said Luke Noll, director of vaccine product sales and corporate accounts at FFF Enterprises, a supplier of critical-care biopharmaceuticals, plasma products and vaccines. Besides margins, offering flu shots can also get patients in your store. “Running a pharmacy-based influenza vaccine program during flu season can bring increased exposure and traffic into your pharmacy,” Noll said. Improving the bottom line is always good, Clausing said. “But there’s also that extra touch, that extra time with the patient that’s very valuable. You can talk about diabetic shoes or do another vaccine. Maybe they need a pneumonia shot or the Zostavax® vaccine. There’s a lot of ways you can tie in those extra services.”

El Dorado TrueCare Pharmacy has offered flu shots for the past five years. Ordering well is a big part of making the flu program successful each year. Clausing said she places her flu vaccine order during the last week of March. Called pre-ordering, many flu vaccine vendors recommend booking before March 31. “We encourage pharmacies to estimate and book their vaccines as early in the season as possible because supplies of some of the preferred vaccine products can be sold out by late spring,” Noll said. “The choice of delivery dates is also better if you order early.” Determining how many—and which—vaccines to order can be tricky to calculate, especially if it’s your first time offering flu shots. If you’re just starting out, keep it simple. “When starting a program, I would recommend starting out slow the first year and determining what you feel is a comfortable level of vaccinations to handle based on your staffing, the population size of your immediate community and your current number of pharmacy customers,” Noll said. El Dorado TrueCare Pharmacy built its flu shot program gradually. “We didn’t start doing 800 shots our first year,” Clausing said. “We did maybe 100, and we built up to where we are now.” Pharmacies that have offered flu shots for a year or more can look at their numbers to determine what to order. “Keep track of the total number of doses given in the season and when you see the greatest turnout,” Noll said. “Does the greatest demand occur in September? October? That way you can better plan for the next year.” Every flu season, Clausing keeps detailed records. For example, she keeps track of how many flu shot patients paid with Medicare, private insurance or cash. “Last year we did 835 flu shots; 500 of those were billed to Medicare, 150 were cash, 164 were commercial plans and 21 were to employees.” This year, she predicts the number of commercial patients will increase because more commercial plans are paying for flu shots. She also looks at the price of the vaccines before ordering. “It’s a balancing act,” she said. “When I’m analyzing, I look at what Medicare paid last year on each vaccine. There are three or four different vaccines from different manufacturers, and depending on what Medicare is reimbursing and what I can buy for, I analyze which one I’m going to order in.”

WORKING WITH DOCTORS Increasingly, patients are turning to pharmacies instead of doctors’ offices to get their flu shots. “About 20 percent of influenza vaccinations are given today in the retail pharmacy setting and growth is expected to continue,” Noll said. “Pharmacies offer the convenience of extended hours, close proximity to where patients live, and pharmacists are becoming more valued as partners on patients’ health care teams,” he said. When El Dorado TrueCare Pharmacy first got into the vaccine arena, the staff wasn’t sure how local doctors would react. “One of our concerns was that we would be stepping on local doctors’ toes,” Clausing said. But they found that their local physicians were happy to send patients their way.

What’s Trending? Expect more patients to request the Fluzone® High-Dose vaccine Don’t be surprised if many of your patients are asking for the Fluzone® High-Dose vaccine this season. The Fluzone High-Dose vaccine, which is specifically for patients 65 years of age and older, is increasing in popularity, according to Luke Noll, director of vaccine product sales and corporate accounts at FFF Enterprises. The vaccine has four times the antigen of a regular flu shot and can provide a stronger immune response in older adults. Pharmacies are seeing patient interest in the vaccine, too. “Last year was the first year I ordered the Fluzone HighDose vaccine and I used it up really quickly,” said Jennifer Clausing, R.Ph., staff pharmacist at El Dorado TrueCare Pharmacy in El Dorado, Kan. “I took it to an assisted living facility and I had a lot of requests for it in the store, so this year I’m going to order more.”

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10 Tips to Create a Successful Flu Program

1. Plan early Planning for next year’s flu season should start with collecting data during the prior flu season. 2. Order early Order your vaccines early for the best selection and delivery times. You can order as early as January or February. Many flu vendors cut off pre-ordering March 31. 3. Set procedures Be sure to establish vaccination procedures and protocol in your pharmacy to keep your program running smoothly. 4. Educate Make sure all of your staff members are aware that you’re offering flu vaccine services and that they’re up-to-date on your procedures. 5. Learn state laws It’s important to be familiar with your state’s laws, regulations and policies for pharmacy vaccinations. Check with your state pharmacy association and your state board of pharmacy to learn more. 6. Streamline Make sure patients don’t have to wait a long time to get their flu shots. Schedule vaccinations into your


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workflow, so a pharmacist is always available to step away and give a vaccine. 7. Create a space Designate a private space to give vaccines in your pharmacy. Use a partition or, if you have one, a separate room. 8. Enroll in Medicare Part B Make sure you’re able to adjudicate vaccination claims for Medicare Part B. You’ll need to enroll as an immunizer for Medicare, which you can do by filling out form CMS-855B. 9. Work with physicians Develop relationships with your local physicians to let them know your pharmacy offers vaccination services. Physicians often refer patients elsewhere for vaccinations. 10. Advertise your program Promote your program to the public and to your current patients. Hang up posters or signs on the inside and outside of your pharmacy. Provide educational materials about flu shots when you dispense prescriptions. Sources: FFF Enterprises; PRS Pharmacy Services

“We find that each year, more and more doctors aren’t wanting to do shots in their offices, and we’ve seen more patients coming to our pharmacy,” she said. El Dorado TrueCare Pharmacy also offers flu shot clinics to employers, assisted living facilities, senior centers and senior residences. “You can do 50, 60, 70 shots in two hours and it’s really easy,” Clausing said. The clinics increase volume and help reach patients who may not normally come into the pharmacy. Between the extra business from doctor referrals and the flu shot clinics, Clausing has even needed to order more vaccines mid-season. If that happens, it isn’t usually a problem for pharmacies to secure more vaccines. “Reorders of vaccines during influenza season are common,” Noll said. “We usually purchase additional vaccines from our manufacturing partners and have them in stock and immediately available for next day deliveries.” At the end of the season, you can even return leftover vaccines for credit. “All injectable vaccines sold during the influenza season have a return allowance, and this usually ranges from 20 to 30 percent of the total influenza vaccine ordered,” Noll said. “It’s common for leftover vaccines to be eligible for up to 100 percent return credit.” OBSTACLES TO SUCCESS One of the biggest challenges of starting a flu shot program is finding the time to do it. How do you give 800 shots in a flu season on top of your normal work? El Dorado TrueCare Pharmacy solves this problem by incorporating vaccines into its regular workflow, and the staff handles them like normal prescriptions. “When patients come in for a flu shot, we have them fill out the screening form and the technician starts processing the claim, just like a regular prescription,” Clausing said. “When it’s given to the pharmacist for verification, the pharmacist gathers the supplies and gives the shot.” “It does get busy, but I think we all enjoy the extra business,” she said. The pharmacy has three vaccinating

pharmacists and typically also gets a student to help administer vaccines during flu season. Even though pharmacies face obstacles when implementing a flu program, they can use that knowledge to improve the next year. “Make observations during the season and make notes of what worked well and what needs to be refined,” Noll said. “Did you have enough staff? Were patients waiting too long? Was the process smooth? Did you have the billing in place? And, what can be changed to make the program better?” Clausing said it’s also important to talk to all of your staff members. “We discuss how the season went and what goals we want to put in place for next year,” she said. “Maybe we want to add another flu clinic or see how a trend is going to change.” For the upcoming flu season, Clausing is planning to put together vaccination kits to streamline the process. “We’ll put together kits in plastic bags that include everything needed to give the vaccination: the syringe, gloves, alcohol swabs and bandages,” she said. “When you go to give the vaccination, you can just grab one of those kits to make it real quick and easy.” POLICIES AND PROCEDURES When it comes to running a compliant flu vaccine program, you need to stay up-to-date with constantly changing policies and procedures. These include state regulations, federal regulations, state board of pharmacy requirements and more. “The legal requirements vary from state-to-state regarding which vaccine a pharmacist is able to administer, the age limits on the patients you can administer to, or other restrictions as defined by state boards of pharmacy. Pharmacists must check with their specific state board of pharmacy before initiating any immunization service to determine their specific authority to immunize,” said Scott Weaver, R.Ph., vice president of pharmacy at PRS Pharmacy Services. PRS Pharmacy Services recommends paying attention to protocols, as this is an area pharmacists tend to

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Cold Storage The do’s and don’ts of properly storing flu vaccines Do use thermometers that monitor and track temperatures. They’re not required by law, but are highly recommended. Do choose a refrigerator of sufficient size to ensure stable temperature. Do check and document the refrigerator’s temperature at least twice daily, at the beginning and end of the workday. Do have a plan in place to address temperature anomalies and loss of power. Do store influenza vaccines under refrigerated conditions at a temperature of 2 to 8 degrees C (35 to 46 degrees F). Don’t over pack the refrigerator. Don’t place vaccines in the door or bins. Air needs to circulate evenly. Don’t store vaccines with other products, food or drinks. Don’t store expired or unusable vaccines with usable vaccines. Sources: FFF Enterprises; PRS Pharmacy Services

forget. State governments often require pharmacists to document and to provide information to the state when a vaccine is administered. Make sure you pay attention to patient PCP notification, state-required protocols and state and local registries. If an adverse reaction or vaccination error occurs, you may also need to report the vaccine administration to the Vaccine Adverse Event Reporting System (VAERS). In the event of an error or oversight, you’ll want to make sure that your general malpractice liability


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policy covers vaccinations ahead of time. “The wording you want is ‘medication administration’ or ‘errors and omissions,’” said Joshua Potter, director of compliance at PRS Pharmacy Services. Pharmacies with an immunization program also need to have an infection control program in place to educate staff and to help reduce the potential for exposure to blood-borne pathogens. And, don’t forget to hand out the required vaccination information sheets to patients or guardians. “Those are updated a couple of times a year, so you need to make sure you’re providing the correct version,” Potter said. If you don’t want to handle all of the documentation yourself, programs are available to make the process easier. IMMUTrack from PRS Pharmacy Services is an online program that helps pharmacies set up all of the policies and procedures needed to offer a safe, efficient and effective immunization program. “In order to run a good immunization program, pharmacists must make a commitment to stay up-todate with policies and procedures, and that’s where our program comes in,” Weaver said. “We’re providing the up-to-date policies, the new regulations and protocols that occur and much more. With our program, they don’t have to go out and search the Internet and take that extra time and effort. It’s all provided for them.” HELPING YOUR PATIENTS It takes time to develop a flu program that runs smoothly. But when you do, making the most of flu season can help your patients and your business. “There’s usually a multiplier effect,” Noll said. “Vaccinations drive traffic into the store, where patients will purchase other items on that same visit.” When you get new patients in the door to get a flu shot, you have an opportunity to build a relationship with them. Clausing said they have a name for the phenomenon at El Dorado TrueCare Pharmacy. “We call it a touch,” she said. “They get that touch, that one-onone time with a pharmacist. And that touch turns into new customers down the line. It’s invaluable and you can’t market for that.” For Clausing, the best part of offering vaccines comes down to that extra time with the patient. “Having that time with them is personally fulfilling,” she said. “It’s why I became a pharmacist.”

Going Needle-Free How needle-free technology can improve the vaccine experience Needles are a big reason many patients opt out of protecting themselves with vaccinations. A survey conducted by Harris Interactive on behalf of Target Corp. found that about a quarter of adults who would skip the flu vaccine indicated that they would do so because they don’t like needles. A 2012 study published in the journal Vaccine found that 24 percent of parents and 63 percent of children fear needles, and that these fears lead to immunization non-compliance for 7 percent of parents and 8 percent of children. One company, however, is working to eliminate needles from the vaccine process entirely. “The PharmaJet Needle-Free Injector minimizes injection-associated fear and anxiety, and since there is no needle, there is no chance of needlestick injuries or needle reuse,” said Ron Lowy, chairman and CEO of PharmaJet. NEEDLE-FREE TECHNOLOGY The PharmaJet Needle-Free Injector eliminates the use of needles by delivering vaccines intramuscularly or subcutaneously. A narrow, precise fluid stream carries the vaccine through the skin, administering the vaccine safely and effectively and in less than one-tenth of a second. Although the technology is still new, initial responses from patients and health care providers have been positive. A PharmaJet survey of patients who received

the Needle-Free flu shot found that 96 percent were satisfied with the experience, 93 percent would choose it again and 92 would recommend it to others. And, a survey of health care providers found that nearly half believe PharmaJet Needle-Free technology has the potential to increase vaccination rates by 10 percent or more. Currently, PharmaJet technology is FDA-approved for use with the AFLURIA® flu vaccine, and it holds the Performance, Quality and Safety pre-qualified certification from the World Health Organization. “PharmaJet is the first and only jet injector company to have completed a clinical trial specifically designed to demonstrate safety and non-inferior immune response with a flu vaccine,” Lowy said. PHARMACY USE The PharmaJet Needle-Free Injector could be the boost your pharmacy’s vaccination program needs to grow and succeed. “In a market that has historically been very competitive, the needle-free option provides a unique and compelling differentiator for independent pharmacies to attract and maintain customers,” Lowy said. For more information on the PharmaJet Needle-Free Injector, visit pharmajet.com.

Why eliminate needles? Needle-free vaccinations have the potential to reduce many problems surrounding vaccines today. Check out these numbers about needles and health care. 800 million – Number of injections administered worldwide each year for immunizations 42 – Percent of injections administered worldwide each year with reused equipment

18 – Outbreaks of viral hepatitis in the U.S. due to unsafe injection practices between 2001 and 2011 150,000 – Number of patients affected by unsafe injection practices in the U.S. since 2001 800,000 – Number of needlestick injuries that occur each year in the U.S. Sources: World Health Organization; One & Only Campaign led by the Centers for Disease Control and Prevention; Occupational Safety & Health Administration, U.S. Department of Labor ELEMENTS | pbahealth.com/elements



Scheduling Synchronization Improve patient outcomes and pharmacy operations with the appointment-based model

The appointment-based model of medication synchronization (ABM) is a pharmacy service that’s here to stay. “This is an emerging methodology that allows pharmacists to take control of something that easily spirals out of control—patients’ ability to manage their own medications,” said Samuel Stolpe, Pharm.D., senior director of quality strategies at Pharmacy Quality Alliance. ABM helps patients stay adherent to their medications by synchronizing their refills to a single day each month. The method also includes reaching out to patients regularly with pre-appointment phone calls. Once implemented, ABM has the potential to improve much more than just medication adherence. It can transform your entire pharmacy.


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“It’s a paradigm shift,” Stolpe said. “You’re changing the way you do business and the way you interact with your patients.” “Once a pharmacy has around 50-80 patients enrolled and gets used to synchronizing patients and making monthly outbound connections with each enrolled patient, that pharmacy starts seeing substantial increases in workflow efficiency, inventory turns, patient satisfaction and pharmacist satisfaction,” he said. GOOD FOR PATIENTS Medication adherence is a huge problem in health care today. Seventy-five percent of people don’t take their medicine as directed, one-third of patients never fill their prescriptions, and 125,000 people die each year because of non-adherence.


ABM is a highly effective method for improving patient adherence and, correspondingly, overall health outcomes. This is largely due to the pre-appointment phone call—the key feature of ABM—according to Stolpe. The pre-appointment call ensures regular interaction between patients and pharmacists, and that the pharmacist is tuned in to the patient’s treatment. “The connection point with the patient keeps them in sync and engaged with their own health care; it helps the pharmacist and the patient work together to manage medications in a more meaningful way,” Stolpe said. The benefits of ABM for patients are almost universal. “Any patient who’s on two or more oral chronic medications is usually a terrific fit for the program,” Stolpe said. “This constitutes the vast majority of patients who are in most pharmacies’ normal panel of patients.” It might not seem like many patients are excited about this service, but Stolpe says this is due to lack of awareness. “Most patients value the service intrinsically, but they simply don’t know that it exists,” Stolpe said. “You need to spread the word. Explain the benefits of the program and get them enrolled.” Stolpe suggests handing out brochures that explain the program in simplified language as an easy way to get patients to sign up. Pharmacists should also actively find opportunities to explain the service to patients during normal interactions. “You’ll find that patients migrate to this forward way of thinking very quickly because it just makes sense with how both patients and pharmacies prefer to have care delivered.” GOOD FOR PHARMACISTS For pharmacists, ABM allows you to take control of your time in the pharmacy. With this model of medication synchronization in place, you’re less subject to the whims of patients who walk into your store, and you’re able to schedule more of your workday without worrying about frequent interruptions. “Any interruption to workflow that occurs significantly increases the chance that pharmacists make mistakes,” Stolpe said. “ABM leads to efficiencies in care delivery that help reduce these errors tremendously.”

ABM takes much of the guesswork out of operations. You’ll know exactly when you need a patient’s medication in stock, and if needed, you can contact the physician in advance for additional refills or prior authorizations, instead of having to step away from your normal workflow to handle what Stolpe calls “pharmacy fires.” “ABM allows you to resolve prescription problems during the natural lulls that occur within community pharmacy practice,” Stolpe said. “Pharmacists get to decide when they’re meeting those additional needs.” “With ABM, you’re implementing an improvement in workflow,” he said. “It’s a no-brainer from my standpoint as a pharmacist.” GOOD FOR BUSINESS If implemented correctly, ABM can boost your pharmacy’s bottom line in more ways than one. “Pharmacies can expect to see about three additional refills per patient per medication per year once they’re enrolled in the

Get In-Sync Take the first step toward incorporating the appointment-based model (ABM) of medication synchronization into your independent community pharmacy practice. Attend “The Value of Being “In Sync” with Your Patients,” a continuing education session presented by Samuel Stolpe, Pharm.D., at the Connect 2015 PBA Health Conference and Business Seminar July 10-12, 2015 in Kansas City, Mo. Stolpe will review how to implement ABM and he will speak more on the overall value of the service. For more information and to register to attend, visit pbahealth.com/conference.

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The Appointment-Based Model in 3 Steps Samuel Stolpe, Pharm.D., of Pharmacy Quality Alliance explains how the appointment-based model of medication synchronization operates in a pharmacy. 1. Refill scheduling

The pharmacy aligns the patient’s medication refills to a single day each month. 2. Patient interaction

Instead of waiting for patients to request refills, the pharmacist calls patients five to seven days before their refill pick-up day each month. This pre-appointment call serves to confirm the refill, identify any issues and offer additional services. 3. Pick-up day

The patient picks up the prescription on the appointment day and receives any additional services previously scheduled.

program. That’s a substantial sales increase for the pharmacy,” Stolpe said. “ABM is just good for business.” A sales increase isn’t the only benefit you can expect. Being able to predict when certain medications need to be in stock means you’ll experience substantial increases in inventory turns, and it can help improve your pharmacy’s performance on CMS Star Rating quality measures. “Improvements on Star Ratings position pharmacies to procure better contracts with health plans that are interested in having a high-performing network, and to perform better on most pay-for-performance programs’ quality measures,” Stolpe said. All of this is accomplished because ABM helps patients better adhere to their medications.


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And, ABM gives pharmacists the opportunity to market additional services, such as flu vaccinations or medication therapy management. Scheduling these additional services during the pre-appointment call ensures that a pharmacist will be available to deliver the service on the appointment day, and that the patient has made time to receive it. “This can enhance the patient’s experience and overall health, and change their entire perception of the pharmacy,” Stolpe said. GOOD FOR THE FUTURE The potential for growth with this model of medication synchronization is high. Stolpe estimates that no more than 15 percent of independent community pharmacies currently have ABM in place, but he predicts this will soon change. “I expect that this will become the standard of pharmacy practice within the next five to 10 years,” he said. Independent pharmacies should consider implementing this model now to set their businesses apart. “I suspect that nationwide we’ll see this be just a normal way of pharmacies doing business,” Stolpe said. “This is an opportunity for independent pharmacies to get an early leg up by making sure their patients have access to it faster than their competitors do.” ABM may be the way of the future, but Stolpe points out that there are three things that need to happen before this model can be fully implemented into the health care system. Pharmacies need to adopt ABM, patients need to demand it, and health plans need to recognize its value and pay pharmacists for this service. Stolpe is confident that the presence of ABM in pharmacies can only grow. “People don’t leave this model once they get in because patients love it,” he said.

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Expiration Date Get the most out of your expired products with a returns company When expired products go unreturned, you leave money on the shelf. In an independent community pharmacy where every dollar counts, those expired drugs can add up fast. That’s where a returns company comes in. Returns companies can help navigate the challenges of returning drugs for credit, and partnering with one will help you get the most out of your pharmacy’s expired products. Some pharmacies don’t participate in a returns program because they don’t think it’s worthwhile, said Adrienne Vandergriff, director of sales at Return Solutions, a pharmaceutical reverse distributor. But expired products are worth money, and pharmacies are often surprised by the amount of credit they can get from manufacturers. “Our average customer receives about $20,000 a year in credit from their returns,” Vandergriff said. EASY RETURNS, MORE MONEY Pharmacies that attempt to handle returns on their own will likely find that it’s not an easy process. “It’s extremely difficult for pharmacies to return items themselves and get any kind of credit for it,” Vandergriff said. An average return will include between 50 and 75 different manufacturers, she said. A pharmacy that does returns on its own would need extensive knowledge about manufacturers’ strict and widely varying return policies. These policies often differ from one manufacturer to another, and even from one drug to another. Not to mention many manufacturers won’t accept returns directly from pharmacies at all. “Most pharmacies don’t have someone who can just sit and do nothing but returns all the time,” said Michael Ayres, president of Return Solutions. A returns company,


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Do you have unreturned expired drugs sitting on your pharmacy’s shelves? If so, your pharmacy could be missing out on credit you deserve. on the other hand, has the expertise, infrastructure and manpower to accomplish returns more efficiently. “What we do in a few hours would take days, if not weeks, for somebody in a store to do,” he said. Pharmacies that do try to ship expired drugs directly to manufacturers often run into logistical problems, such as shipping to the wrong manufacturer or even the wrong address. When this happens, the pharmacy loses out on the chance to receive credit, but Ayres said if a pharmacy uses a returns company and a mistake like this happens, the returns company will reimburse the pharmacy for lost credit. Tracking credit is another challenge for pharmacies that try to handle returns on their own. Often pharmacies develop what Ayres calls an “out-of-sight, out-of-mind” mentality. Ayres explained that this mindset occurs when pharmacies send in their expired products and get reimbursements from various manufacturers a little bit at a time. If they’re not carefully tracking the credits, then the pharmacy might not be getting all of the credit it’s due.

INTRODUCING THE NEW FILLMASTER PLUS DISPENSE & FLAVOR FASTER THAN EVER BEFORE ATTRACT NEW CUSTOMERS If there’s one market that’s always full of new potential, it’s pediatrics. Successful pharmacies use the flavoring service to bring in new customers and capture an entire family’s prescription business. It’s a great reason for new people to visit your pharmacy.

GROW THE BOTTOM LINE Our top performing pharmacies charge $3 for flavoring. They understand the value of the service and their time. In addition to the script and flavoring fee, you can expect increased OTC and front-store sales.

GAIN EFFICIENCY The Fillmaster PLUS saves valuable time in your everyday workflow, freeing you up to do the things that will keep your business thriving. On average, you’ll save 3 to 4 minutes per prescription.

REWARD YOUR EMPLOYEES An investment in technology like the Fillmaster PLUS demonstrates to your team that you’re committed to making their jobs easier. Flavoring is also a “technician friendly” service. With your approval, they will run with the program and have fun in the process.

CUT COSTS Bar code scanning saves time, reduces errors and cuts down on waste. It also confirms you’ve used the appropriate amount of water for reconstitution, reducing the risk of half-fills.


“The Fillmaster PLUS makes reconstitution and flavoring much easier and more accurate. We don’t hesitate to offer flavoring now because it’s so much faster. It has even helped us bring in new customers.” -Mark W. RPh, Foster Drug

When a child gets to choose the flavor of her medication, compliance rates go up dramatically. This holds true for both acute and chronic conditions. With the Fillmaster PLUS, you can even recommend best flavors to a parent, specific to the medication prescribed.

IMPROVE CUSTOMER SERVICE The ability to dispense and flavor faster means wait times are reduced. Couple that with going above and beyond to make a child’s medicine taste better, and you’ve just created a “Wow!” experience for that parent. They’ll stick with you for life.


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17 Reasons Drugs Aren’t Returnable Returns companies help track these credits, and make sure your pharmacy receives the full amount manufacturers owe you. Without a returns company, your pharmacy also runs the risk of violating environmental regulations by improperly disposing of expired drugs. “There are numerous environmental issues associated with doing returns and that risk is transferred to the returns company instead of the pharmacy,” Ayres said. A returns company can also protect you legally. If the Drug Enforcement Administration or your state board of pharmacy audits your pharmacy, your returns company can provide documentation to show how your pharmacy legally and safely disposes of expired drugs. OPTIONS FOR YOU Typically, pharmacies have two methods for returning expired drugs when working with a returns company: mail-in or in-person consultation. With a mail-in service, the pharmacy removes the expired drugs from the shelves every few weeks, inventories them online and ships them to the returns company themselves. An in-person consultation is when a representative from the returns company visits the pharmacy, goes through the shelves, removes expired products, inventories them and takes them away. Both options have pros and cons. A mail-in service is usually less expensive, but you have to pull the expired drugs from your stock yourself. “If you’re going to do a mail-in, you have to do a great job scanning the shelves,” Ayres said. This isn’t always an easy job, and often, when pharmacies try to pull items themselves, they miss expired items. “It’s such a difficult and time-consuming task to actually look at every single bottle, look at the expiration date, and pull it off the shelves,” Ayres said. “A lot of times product is left on the shelves and it goes too far past the expiration date, so when pharmacies do eventually find it and send it to us, it’s too old to return for credit.”    With a returns company representative scanning the shelves, pharmacies get the benefit of a trained professional who knows manufacturers’ specific rules. The representative knows when to pull product to get you the most for your returns. This option also saves you the time of sorting through your inventory.

Manufacturers won’t issue credit for certain returned products. Return Solutions, a pharmaceutical reverse distributor, compiled a list of the most common reasons drugs aren’t returnable. The first 13 reasons are the most common, and the others are used in rare circumstances. 1.

Manufacturer does not accept returns


Product sold on a non-returnable basis


Manufacturer doesn't accept partials


Repackaged product


Product is too far past expiration date


Product doesn't meet minimum quantity


Product is not in original package


Prescription label is on product


Label defaced or the product is otherwise damaged

10. Lot number is non-returnable 11. Product doesn't meet minimum dollar value 12. Sample product 13. Free or complimentary item 14. Overfilled container 15. Product too far in-date 16. Destroy at customer request 17. Other

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While the in-person service is typically more expensive, it’s also more helpful for pharmacies in states that require you to take an inventory of all of your expired drugs before you return them. Many states just require an inventory of controls. In both cases, the representative will complete the inventory of the expired products for you. BUSINESS ADVICE Returns companies also offer a less obvious, but valuable advantage—their advice. You’ll get tips on how to get the most out of your returns, and how to improve your inventory management practices. For example, Ayres recommends purchasing smaller quantity bottles. Manufacturers don’t accept partial returns, so when you only use some of the pills from a large bottle, the rest of the bottle is ineligible to receive credit. “If it’s a 500 count bottle and you use

50 tablets, and then it goes out of date, you just lost money on 450 tablets,” he said. Also, wait to put prescription labels on products until the last possible minute. Manufacturers won’t issue credit for a product with a label on it, so if a product expires without a patient picking it up, you lose credit you could have gotten from the return. Ayres also recommends not stocking large quantities of slow-moving products, and taking advantage of nextday delivery options to keep your inventory as efficient as possible. “You don’t need to stock a dozen bottles of one particular slow-moving item,” Ayres said. With the expert advice and knowledge of a trusted returns company, you can improve your business by getting the most credit from your returnable drugs. “It’s a significant financial way to add money back into the pharmacy,” Vandergriff said. “If you’re not doing returns, then you’re missing out.”

Questions to Ask When searching for a returns company for your pharmacy, here are eight questions to ask. 1. Is the returns company reputable? 2. Does the company have recommendations or partnerships with industry leaders that I trust? 3. Does the company require me to sign a contract, or am I free to end the service whenever I am unsatisfied? 4. Has the company been around long enough to understand the environmental, legal and economic complexities of drug returns?

5. Does the company innovate new solutions to improve the returns process? 6. Is the company trustworthy? 7. Does the company have the industry relationships necessary to get me the most for my returns? 8. Will the service get me the value I deserve for the price I want to pay?

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Apology Liability Five things pharmacists need to know about saying “sorry” By Kathleen Barbosa

What does the phrase, “I’m sorry,” mean to you? Is it a statement of empathy, or an admission of guilt? That gray area can get pharmacists into trouble. Saying sorry can go a long way in easing the situation when an error occurs in the pharmacy, but before you apologize, here are five things you need to know about apologies, liability and pharmacy errors.

LEGAL LIABILITY VARIES Thirty-six states have adopted legislation to protect health care professionals. Known as “apology laws,” these state regulations make many or most statements of sympathy, empathy and apology inadmissible as evidence in a lawsuit. Among these 36 states, liability coverage for pharmacists varies greatly. Some state laws cover all health care professionals, while others only provide protection for physicians. You can check with your state pharmacy association to find out if you’re protected. While it’s good to know the apology law in your state, other legislation or regulations could have an even greater effect on this issue. “The key is making sure that pharmacists are considered providers in their state, and that’s a major priority for state associations right now,” said Rebecca Snead, CEO and executive vice president of the National Alliance of State Pharmacy Associations.


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SORRY HAS MULTIPLE MEANINGS Using the word “sorry” doesn’t always constitute an admission of fault in court. “If you say ‘I’m sorry; I’ve made a mistake,’ that’s admissible, but just saying you’re sorry that the patient had an adverse event is not typically used against health care professionals,” Snead said. Snead recommends using different types of apologies for different situations. “If a patient comes in because they think they got the wrong thing, say, ‘I’m sorry, let me look into what happened and I’ll get back to you,” she said. Apologize for the inconvenience, but hold off on saying sorry for the mistake until you’re sure what went wrong. “Then, tell them what happened—just stick to the facts—and explain what you’re going to do to prevent future errors from occurring,” she said.

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HELP IS AVAILABLE If you’re unsure what type of apology to make—or if you should apologize at all—ask for help. Consult with your risk manager, insurance company or state pharmacy association. “State pharmacy associations are heavily invested in helping pharmacists understand what their state laws are and how to improve patient safety,” Snead said. Snead also recommends continuously updating your knowledge. “Nine states require some sort of continuing education in medication safety and prevention of medication errors,” she said. “Research related to communicating with patients if an error occurs is included in these programs.”

APOLOGIES DETER LEGAL ACTION Empathy and apologies can potentially deter lawsuits, litigation and settlements, according to Sorry Works!, an advocacy group promoting medical professionals’ use of disclosure, empathy and apologies. These tactics can reduce anger, making patients and their families less likely to pursue legal action. And, states with laws protecting medical professionals who express sympathy saw the greatest reduction in the average payment size and settlement time in cases involving severe patient outcomes, according to a 2010 research study conducted by the University of Houston.

3 Patient Safety Organizations to Work With Rebecca Snead, CEO and executive vice president of the National Alliance of State Pharmacy Associations, advises pharmacies to partner with a federally listed Patient Safety Organization (PSO) to protect error data. These three PSOs specialize in retail pharmacy.

To get the most value out of an apology, Snead recommends creating a pharmacy policy before an error occurs. “Be sure to include a checklist, so everyone stays consistent,” she said. “Saying you’re sorry should be the first item on your checklist.”

MAKE APOLOGIES OBSOLETE Good apology practices start with error prevention. Implementation of a strong continuous quality improvement (CQI) program helps a pharmacy track and study near misses and incidents that reach the patient. “Collection and analysis of patient safety events allows the pharmacy to learn priceless lessons about operations that can reduce potential errors and improve patient safety,” Snead said. The Patient Safety and Quality Improvement Act (2005) made it easier for providers to learn from patient safety work. “Say you make a mistake and an error occurs,” Snead said, “the facts associated with that case are not protected, but your patient safety work and analysis is protected by your federally listed Patient Safety Organization (PSO).” If your pharmacy isn’t working with a PSO, then your patient safety records could be used against you if the patient takes legal action. “As pharmacists become more visible, and provide more patient care services, they’re going to be more vulnerable to lawsuits,” Snead said. “You need to learn from mistakes, but you also want to protect yourself.”

1. Alliance for Patient Medication Safety (APMS), medicationsafety.org 2. Quantros Patient Safety Centers quantros.com 3. The PSO Advisory, thepsoadvisory.com For more information about PSOs, visit The Agency for Health Care Research and Quality’s website at pso.ahrq.gov.

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Return-to-Stock The business problem of abandoned prescriptions

When you have a bunch of prescriptions hanging in the bin for more than 10 to 14 days, several business issues can emerge. “Return-to-stock prescriptions are a part of retail pharmacy life, but too many might represent a problem for the business,” said Jason Poquette, R.Ph., of the Honest Apothecary blog. Here’s how to tell if your business has a problem, and how to handle it. BUSINESS PROBLEMS Besides wasted effort and resources, return-to-stock prescriptions can also contribute to poor inventory control. “Returned prescriptions can result in overstock and reduced inventory turns, which means wasted dollars sitting on the shelf,” Poquette said. “They might also leave you with medication that can’t be returned to the wholesaler, and can’t be sold unless another prescription is received for the same item.” There’s also the clinical issue. “Worst of all is that too many returnto-stock prescriptions might represent potential patient adherence concerns, which is bad for patients and can negatively impact the pharmacy’s Star Ratings,” Poquette said. FOLLOWING PROCEDURE Returning prescriptions to stock takes considerable effort. Pharmacies have to follow the correct procedures by referring to their state board of pharmacy’s regulations. “This usually includes removing any private patient


ELEMENTS | pbahealth.com/elements

information from labeling, while ensuring the label still contains the exact NDC, drug name and expiration date,” Poquette said. Pharmacies are also responsible for reversing the claim for the prescription through the third party payer, if applicable. “Most pharmacy software systems handle and track this process to make sure it’s done correctly,” Poquette said. “But if the claim can’t be reversed online, the pharmacy should contact the payer for a manual reversal.” SOLVING THE ISSUE Limiting return-to-stock occurrences is a win-win for your business and for your patients. Poquette suggests talking with patients to discuss the importance of taking their medications and to work through side effects and effectiveness issues. “Communication is the most valuable tool,” he said. Adherence programs are an option worth exploring. You can also use automated messages and text alerts to notify patients when a prescription is ready. “Personal phone calls are great, too,” Poquette said. Jason Poquette, R.Ph., regularly writes about topics related to the pharmacy profession at thehonestapothecary.com.

Why do patients abandon scripts? “That’s a tough question, and the fact is there are lots of reasons,” said Jason Poquette, R.Ph., of the Honest Apothecary blog. “Statistically, the higher the copay, the more likely the prescription is to not get picked up. Additionally, a lot more ‘first fill’ prescriptions tend to get abandoned than refills, indicating that patients need more education at the start of treatment on the importance of their prescribed medications and on what to expect. Sometimes patients simply forget or haven’t understood that a prescription was ordered for them. And for some, transportation may be an issue.”

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Feel the twinge in your stomach after reading the above? Get used to the feeling. Court rulings in November of 2014 have opened the door for retail pharmacies to be sued under various state laws using HIPAA as the “Standard of Care.” This is bad news for all types of providers, pharmacies included. HIPAA Auditors are no longer your biggest worry for HIPAA Privacy violations; local attorneys are now the biggest threat. With recent settlements in the millions of dollars, you cannot afford to be one of the 80% of independent pharmacies that think they are compliant, but are not. Fortunately, the protection you need is available and affordable.

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ONE STEP FURTHER BUD (Beyond-Use-Date) studies provide important information on the stability of a compounded preparation. Accurate results ensure that a medication has maintained its compounded dosage form.

KEY FEATURES OF MEDISCA’S ORAL BUD STUDIES + Target 90 day BUD using DYE-FREE oral bases + Studies conducted using validated stability indicating assays + Performed in collaboration with renowned institutions and researchers, such as Hospital for Sick Children, University of Montreal and University of British Columbia + Published studies available online



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Elements Magazine - Vol.4 Iss.2 June 2015  

Elements Magazine - Vol.4 Iss.2 June 2015  

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