North Carolina Pharmacist Winter 2015

Nor th Car olina

Phar macist Winter 2015

Advancing Pharmacy. Improving Health.

volume 95 number 1

NCAP Annual Convention Raleigh Convention Center October 2014

Official Journal of the North Carolina Association of Pharmacists 109 Church Street

Winter 2015 / Vol 95, No. 1

Nor th Car olina

Chapel Hill, NC 27516 800.852.7343 or 919.967.2237 fax 919.968.9430 www.ncpharmacists.org Like us on Facebook: https:/ / www.face-

Phar m acist

book.com/ page/ North-Carolina-Association-

NCAP's Relocation...................................................4

of-Pharmacists/ 136657113055347?fref=ts

President's Column.................................................5

Follow us on Twitter:

Annual Convention 2014 Wrap Up.....................7

NC Assoc of Pharm

Special Focus Section: Immunizations in North Carolina BOARD OF DIRECTORS

Advancing Immunization Practice in NC............8

PRESIDENT Ashley Branham, PharmD PRESIDENT-ELECT Stephen Eckel, PharmD PAST PRESIDENT Michelle Ames, PharmD

The Road to Expanding Immunization Authority.................................................................10 Statement on Immunizing Pharmacists...........14 Voices of Community Pharmacists...................15

TREASURER

Developing an Immunization Protocol............17

Tom D'Andrea, BS, MBA

Meeting the Critical Need of Vaccination........20

BOARD MEMBERS Randy Angel, PharmD Andy Bowman, PharmD Paige Brown, PharmD Jennifer Burch, PharmD Stephen Dedrick, BS, MS

Featured Articles How to Provide Feedback to Students and Residents................................................................23 New Practitioner Spotlight.................................25

Lisa Dinkins, PharmD Leigh Foushee, PharmD Ouita Gatton, PharmD

Developing, Delivering and Communicating Pharmacy Customer Service Standards...........26

Rhonda Gentry, PharmD Jennie Hewitt, PharmD Debra Kemp, PharmD STAFF Steve Caiola Fred Eckel Linda Goswick Sandie Holley Teressa Reavis

North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association Pharmacists. An electronic version is published quarterly. The journal is provided to NCAP members through allocation of annual dues. Subscription rate for nonmembers is $40 annually. Opinions expressed in the 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.

Happy 2015, NCAP members!

The end of my Presidential term arrived in the blink of an eye! Perhaps the most exciting news at the Association to close out 2014 is the official lease signing for NCAP?s next location. The decision to relocate the office was an agonizing topic the NCAP and Endowment Boards thoroughly deliberated for several months before reaching the conclusion the time for a move has arrived.

Church Street in the heart of Chapel Hill has long been home to NCAP, holding a lifetime of fond pharmacy memories within the four walls of the office. Devoted members poured their dedication and energy into building the Association, creating the foundation for what exists now. Throughout my years on the Executive Committee, I have been blessed to have long-standing members impart their warm memories of time spent at 109 Church Street, giving me a greater appreciation for the process of creating NCAP from a collection of the previous non-unified pharmacy groups.

Now, 15 years later, circumstances have changed. We have multiple schools of pharmacy with locations spread across the state. NCAP has watched neighboring properties fall to bigger retail spaces and apartments, all while property taxes have risen even more quickly. The Endowment Board entrusted with managing assets has expressed concern as property expenses have outgrown investment returns and most of the organization?s investments are entangled in real estate. In order to stay true to our mission and vision, the relocation of NCAP is a logical and necessary next step. The property currently housing NCAP is as valuable as ever, likely providing a timely and lucrative opportunity to sell. Transitioning investments from heavily real estate based into cash investments will afford us additional freedom to support our mission: legislative advocacy, education, and professional development of practitioners, students and technicians. While we will all be sad to close the doors for a final time in Chapel Hill, we are excited to embrace the change and the opportunities afforded by it.

Finally, I would be amiss for not recognizing those who have freely contributed their time to make my Presidential year a success. My fellow Executive Committee officers, Mary, Ashley, and Dennis, have supplied extensive insight and thought on the inner workings of NCAP. The commitment of the NCAP Board members have been unwavering, asked to make decisions on a number of difficult and critical issues. Practice Forum Chairs and Committee Chairs gave the best of themselves to develop the pieces of NCAP entrusted to them. As always, Linda, Sandie, and Teressa have upheld the fort and executed all tasks. And finally, to our membership: you are our foundation. My gratitude goes out to each piece of the intricate puzzle of NCAP!

Michelle Ames, Pharm.D. Past President

Change Brings Opportunities Dear Members, With the turn of the New Year, the NCAP staff and Executive Committee have been busy preparing for an exciting year. Change is ahead for our association, and I am excited to work with you to embrace these opportunities. As we embark on new experiences, the commitment of the Executive Committee to uphold the mission of NCAP is unwavering, and each day we are greeted with opportunities to make progress in uniting, serving our members, and advancing our profession.

To kick off 2015, several events have been planned for this winter. The AENC 2015 Legislative Reception was held January 28 in The Nature Research Center at the North Carolina Museum of Natural Sciences. Members of the Board represented NCAP at this event, and engaged legislators about provider status and key topics throughout the evening. Of course, NCAP will be relocating to a new site in March. Be on the lookout for updates and announcements on upcoming scheduled events to celebrate this exciting move. Additionally, the Chronic Care Practice Forum Annual Meeting is scheduled for March 4, 2015 through March 6, 2015, at the Sheraton Greensboro at Four Seasons. Registration is now open on the NCAP website. There are many hours that go into planning this successful event each year, and I sincerely thank Rhonda Gentry, Ted Hancock, and the entire Chronic Care planning committee for their leadership in organizing this event. Planning for Pharmacy Day in the Legislature is also underway for April 28. Please stay tuned for more information regarding this exciting event.

I hope that you will enjoy the content of this winter publication of NC Pharmacists. Thank you to our guest editors of this edition, Ouita Gatton , Macary Marciniak and Mary Parker. This issue of the journal is dedicated to the advancement of immunization practice in North Carolina since the passing of HB 832: Expanding the Role of Immunizing Pharmacist in 2013. In this issue, you will read about our journey to expanding immunizing authority for pharmacists, early experiences offering vaccines to patients in pharmacy settings, and the challenges that we face as healthcare providers to improve vaccination rates in our state.

Also included in this issue are highlights of our past annual convention held in October at the Raleigh Convention Center. I would like to extend a special thank you to co-chairs Sonia Everhart and Jenn Wilson and to our entire Education Committee for planning excellent education sessions. We were grateful for the opportunity to hold our annual meeting in conjunction with the NCAHC Annual Meeting and Community Care of North Carolina Annual Pharmacy Conference. This proved to be a successful event with record participation.

My hope is that we will stand together as we embrace the change ahead for NCAP. I am extremely privileged to work with our skilled staff and an incredibly talented Executive Committee: Michelle Ames, Stephen Eckel, and Tom D?Andrea. Most of all, I look forward to working with our entire membership so that together our unified voice may allow North Carolina to be the greatest state in the Union to practice pharmacy.

Sincerely, Ashley Branham, PharmD, BCACP President

NCAP Annual Convention Wrap-Up

Spotlighting New Practitioners: Advancing Immunization Practice in North Carolina

KIMBERLYL. NEALY, PHARMD, BCPS Past Chair , New Pr act it ioner Net wor k In this very exciting time, after the increased scope of practice for pharmacy immunizations, the NCAP New Practitioner Network (NPN) is proud to briefly highlight a few of the leaders within our network who are working to advance this practice and improve patient care across the state. Dr. John Schimmelfing, a community pharmacist at Harris Teeter in Chapel Hill, NC, serves a diverse patient population. He completed the immunization certificate training program in 2011 and has been actively involved in the practice since that time. Prior to starting with Harris Teeter, he completed a post-graduate residency at Virginia Commonwealth University and Kroger Pharmacy. It was then that he initiated and participated in both on-and off-site immunization clinics for influenza and herpes zoster vaccines. Additionally, he trained student pharmacists on appropriate immunization techniques in the community setting. Since completing his residency, he has recommended and administered numerous immunizations to patients while counseling on the benefits and potential for adverse reactions. Recently, Dr. Schimmelfing has been helping to educate colleagues and other NC pharmacists on the recent legislative expansion of this practice. His passion is evident as he states ?Being able to provide immunizations allows me to connect with patients better, have a more comprehensive understanding of their health status, and, ultimately, provide an avenue for me to make a more beneficial impact on their overall health.?

Meanwhile, in the mountains of North Carolina, Dr. Andria Eker, who completed her residency with Kerr Health in Asheville, is advancing immunizations practice at Blue Ridge Pharmacy. Blue Ridge Pharmacy is a unique, locally owned pharmacy offering long-term care, retail services, and a transition of care program known as Blue Ridge Access.

This setting allows her the opportunity to care for patients in a traditional community pharmacy role, in retirement communities, and during home visits as part of the Blue Ridge Access program. Dr. Eker shared the following advice for immunizing colleagues across the state ?Be proactive with vaccination consultations and community outreach. View immunizations as an opportunity to build and strengthen patient and community relationships while also improving public health.?

There are many recent triumphs in practice to celebrate. We are inspired by our fellow new practitioners like Drs. Schimmelfing and Eker. We look forward to hearing many more stories, both of successes and challenges, so we can continue to advance the profession in the years to come.

school-aged children.

The Road to Expanding I mmunization Authority in North Carolina Ryan Swanson, PharmD Ashley Branham, PharmD In the Spring 2010 publication of North Carolina Pharmacist, we co-authored a report detailing the plan to pursue expansion of immunization authority for North Carolina pharmacists. We return now, 5 years later, to report the journey to expanded immunization authority in North Carolina.

At the time of the 2010 publication, North Carolina?s rule stated that pharmacists who were certified to deliver immunizations may administer three types of vaccines ? influenza, pneumococcal, and zoster ? to patients 18 years and older. A consultation with the patient?s primary care physician (PCP) had to occur prior to the administration of pneumococcal or zoster by the pharmacist; if a patient did not have a PCP, the two vaccines should not be administered by the pharmacist.

Additionally, the pharmacist had to follow a written order, standing medical order, or other protocol under a licensed MD or DO for the administration of these vaccines.

The limited scope of immunizing pharmacist services in North Carolina was brought to light in the summer of 2009 with back-to-back member phone calls to the North Carolina Association of Pharmacists?(NCAP) office. The first call came from a community pharmacist who was interested in beginning a travel vaccine clinic in her pharmacy. Through her research, she found that pharmacists in other states had taken initiatives in establishing travel vaccine clinics to meet the needs of patients in their communities. Less than forty-eight hours later, the office received a call from a pharmacist who had been approached by her local health department to assist in the administration of Hepatitis B vaccines to the area?s middle

In both instances, our state?s immunization rule prevented these pharmacists from participating in vaccine-related patient care activities.

A Task Force Is Appointed In July 2009, a group of pharmacists gathered around a boardroom table with the charge of determining what broad changes, if any, should be made to the current rule. From that first meeting emerged two major objectives to focus our efforts in the coming months. Our goals would be (1) to expand the scope of vaccines that immunizing pharmacists in North Carolina were authorized to administer and (2) to lower the minimum age of patients to whom pharmacists were authorized to administer vaccines.

There was much talk of the ?details? at that first meeting, with questions like ?To which vaccines should this rule be expanded?? ?What lowered age should we target?,? and ?Will immunizing pharmacists need additional training beyond what is currently required?? all being debated. The Task Force decided these were questions that needed further research.

It was also very important to the group that the larger medical community be included in this dialogue. In the months that followed, members of the Task Force met with a number of groups with a vested interest in the outcome of any changes to the then-current immunization rule. These groups included representatives from the Board of Pharmacy; APhA; the NC Immunization Branch (a subgroup of the Division of Public Health within the Department of Health and Human Services); the NC Academy of Family Physicians; and the NC Pediatric Society.

During an initial meeting with a non-pharmacy-related group, a question was posed that caused us to re-evaluate our efforts and ensure we were not taking the wishes of the state?s pharmacy community for granted: ?If pharmacists are given expanded immunization authority, will they embrace it?? It was a good question, and one that we needed

to answer before we moved forward.

Was pharmacy prepared to take on additional responsibilities as immunizing providers? Consequently, Task Force members created a 13-question survey to gauge pharmacists?thoughts on a number of important aspects related to expanding immunizing services.

Utilizing a Board of Pharmacy-administered e-mail blast to all licensed pharmacists then practicing in the state, we sent a link to the survey to nearly 9,500 pharmacists. Of those, 952 pharmacists (10% ) completed the survey. The results of the survey yielded many passionate responses, with the overwhelming majority of those expressing support for our efforts to expand the current immunization rule.

Those respondents with reservations about broadening pharmacists?authority in this area provided valuable insight into current practice issues, citing time constraints as their primary concern.

Pharmacists, both then and now, remain the most accessible health care providers and were positioned to offer a tremendous public health service in this area. Our survey?s results reinforced the belief that North Carolina pharmacists were ready and willing to accept this challenge.

Which Route to Expand Pharmacist Immunization Authority?

There were two routes through which changes to the immunization rule could be made. The first was the ?rules route?: any changes made to the then-current rule had to receive unanimous approval from the NC Boards of Pharmacy, Medicine, and Nursing. The second route would need to pass directly through the NC General Assembly; the legislature would essentially pass a law granting pharmacists expanded immunizing authority. Both routes presented unique challenges to any efforts to change the rule.

After months of conversations and consideration, the decision was made to pursue these efforts legislatively. We knew going into this decision that NCAP?s efforts could be complicated by the fact

The Road to Expanding Immunization Authority (continued from page 10)

that the 2010 session of the NC General Assembly fell in a ?short session? year, meaning the legislature will meet for an abbreviated time-frame. In addition to having less time to consider new legislation, the General Assembly would face an incredibly difficult budget year, with a projected expenses-over-revenues gap of at least several hundred million dollars. If the time constraints of the short session prevented progress in 2010, we were prepared to continue adovacy efforts in the 2011 legislative session.

Collaboration in the Legislative Process With the Task Force assembled, research conducted and goals established, former NCAP lobbyist Evelyn Hawthorne began to actively advocate for this initiative with legislators and other stakeholders. By April 2010, co-chairs of the Joint Health Oversight Committee, Representative Bob England and Senator William Purcell, convened a meeting with organizations including NCAP, the NC Board of Pharmacy, the NC Medical Board, the NC Nursing Board, the NC Medical Society, the NC Nurses Association, the NC Pediatric Society, and the NC Academy of Family Physicians. Committee leaders wanted to get a sense of the level of opposition and support that existed before moving forward with this as an agenda item.

In October 2010, NCAP was invited to a formal hearing held by the Joint Oversight Committee and the Public Health Study Commission. Given the complexities of our state?s financial challenges? coupled with the continued questions and opposition regarding the issue? our proposal was not considered a priority agenda item for the short session. The issue remained a focus of advocacy for NCAP, and by the start of the following long session, legislative activity surrounding the expansion of pharmacist immunization authority was well underway.

NCAP?s initiative caught the attention of Senator Fletcher Hartsell, who identified this as an opportunity to enhance patient access to immunizations. Senator Hartsell became a bill sponsor of S 246, titled Expand Immunizing Authority for Pharmacists. NCAP advocated for passage of S 246, which would allow pharmacists to administer all vaccines recommended by the Centers for Disease Control and Prevention to persons 14 years of age and older under certain conditions (including prescriptions, standing orders, and protocols). The bill passed the Senate on a vote of 46-1 on June 8, 2011. The House Health Committee did not complete its review of the measure in time for final action during the session. Before the conclusion of the session, S 206, Facilitate Locum Tenens Physicians, was introduced; this bill was particularly relevant for pharmacists because it included a provision to extended pharmacists?authority to administer flu vaccines to persons 14 years of age and older. That authority was the content of the emergency rule implemented during the H1N1 outbreak that expired in 2010. NCAP worked with Rep. Mark Hollo and Rep. Tom Murry to include an amendment that basically reinstated the provisions of the emergency rule on S 206. The amendment to allow pharmacists to administer influenza vaccine to a broader group of people was part of a larger initiative to address public health concerns about lagging immunization rates across populations.

The amendment was approved without opposition, and subsequently passed the House and Senate on June 16 and 17, 2011, respectively. Former Governor Bev Perdue signed S 206 into law on June 27, 2011. Still determined to accomplish its broader goals, NCAP continued working with Rep. Tom Murry, Rep. Marilyn Avila , and Sen. Fletcher Hartsell to advocate for expanded pharmacist immunization authority. With the help of Gene Minton (President of the NC Board of Pharmacy), NC Association of Retail Merchants, Association of Community Pharmacists, and other pharmacy groups, consensus around the bill began to form.

With continued negotiations with legislators and the NC Boards of Pharmacy, Nursing, and Medicine, the language of the bill underwent many rounds of vetting before an agreement was reached. On July 3, House Bill 832, Expand Pharmacists?

Immunization Authority, was signed into law by Governor Pat McCrory.

Expanded Authority to Administer Immunizations We have come a long way since our initial 2010 report in NC Pharmacist. We advanced from being the fourth most restrictive 2015 Immunization Task Force Members state in terms of pharmacists?authority to administer vaccines to now setting a national precedent with our reporting requirement to the state?s immunization registry. Pharmacists can administer herpes zoster, pneumococcal conjugate, Michelle Ames Valerie Clinard Brian Holloman Jennifer Rinkes-Smith pneumococcal polysaccharide, hepatitis B, tetanus diphtheria (Td) or tetanus diphtheria, and pertussis (Tdap), meningococcal conjugate, and meningococcal polysaccharide to patients via protocol, influenza to patients 14 years of age and older, and any Ashley Branham Ouita Gatton Jodie Lumbrazo Ryan Swanson other CDC recommended vaccine to patients 18 years of age and older. As of July 2014, pharmacists have immunized and/ or documented over 58,000 doses into the North Carolina Immunization Registry. With the expanded immunization authority, Krista Burgin Betty Dennis Macary Marciniak Dennis Williams pharmacists are making a positive impact in immunization rates in North Carolina.

Statement on I mmunizing Phar macists in NC Tamer a Coyne-Beasley, M D, M PH, FAAP, FSAHM Dir ector, NC Child Health Resear ch Netw or k / Associate Dir ector, Com m unity Engagem ent NC Tr aCS Institute / Child Health Cor e Hom e of the UNC-CH Clinical and Tr anslational Science Aw ar ds (CTSA) Pr ofessor of Pediatr ics and Inter nal M edicine Division of Gener al Pediatr ics and Adolescent M edicine Univer sity of Nor th Car olina - Chapel Hill

Adult vaccinations ar e r ecom m ended on the basis of age, health conditions, occupation, lifestyle, pr ior vaccinations and tr avel for the pr evention of vaccine pr eventable diseases, som e w hich can be fatal. Unfor tunately, cur r ent levels of vaccination cover age am ong adults ar e low. Ther e ar e m any str ategies to incr ease vaccine uptake such as health-car e pr ovider s assessing patients' vaccine histor ies at ever y visit, str ongly r ecom m ending and pr oviding r outinely r ecom m ended vaccines, im plem enting r em inder and r ecall system s, and using standing or der s. W hile pr ovider and office based str ategies for adults ar e ideal as they r equir e m edical visits w her e health assessm ents and other m edical car e and counseling can be pr ovided, the cur r ent low levels of im por tant im m unizations suggest that additional innovations and par tner s ar e needed to im pr ove adult im m unizations. Phar m acists can be im por tant par tner s in our public health effor ts to im pr ove adult vaccinations. In NC, an im m unizing phar m acist is a licensed phar m acist w ho holds a cur r ent pr ovider level car diopulm onar y r esuscitation cer tification issued by the Am er ican Hear t Association or the Am er ican Red Cr oss, has successfully com pleted a cer tificate pr ogr am in vaccine adm inistr ation accr edited by the Center s for Disease Contr ol and Pr evention, the Accr editation Council for Phar m acy Education, or a sim ilar health author ity or pr ofessional body appr oved by the Boar d, m aintains docum entation of continuing education ever y tw o year s, designed to m aintain com petency in the disease states, dr ugs, and vaccine adm inistr ation, and has successfully com pleted tr aining appr oved by the Division of Public Health?s Im m unization Br anch for par ticipation in the NC Im m unization Registr y. Thr ough cr eative collabor ative par tner ships, phar m acists could also be im por tant par tner s in helping us to pr oactively r ecognize issues w ith patient noncom pliance w ith pr escr ibed m edications in our effor ts to im pr ove patient car e.

NCAP CALENDAR Chronic Care Practice Forum March 4-6, 2015 Board of Directors Meeting April 2, 2015 12 noon Pharmacy Legislative Day April 28, 2015 Board of Directors Meeting May 21, 2015 12 noon Residency Conference July 10, 2015 Winston-Salem Board of Directors Meeting July 23, 2015 12 noon Board of Directors Meeting September 24, 2015 12 noon Annual Convention November 1-3, 2015 Raleigh Board of Directors Meeting November 19, 2015 12 noon

VOICEOF...

COMMUNITY PHARMACISTS

By Lisa Dinkins, Phar m D, BCACP

Com m unity phar m acists acr oss the state of Nor th Car olina have taken action to pr ovide im m unization ser vices w ithin their pr actices. As ar guably the m ost accessible health car e pr ovider s, com m unity phar m acists have im pr oved vaccination r ates by answ er ing the call to becom e vaccinator s in alm ost ever y phar m acy in our state.

Pr actitioner s in both the r etail and independent settings have answ er ed the

"Have you had your flu shot?" blossoms into one-on-one conversations... call to obtain an im m unization cer tificate, CPR tr aining, NC Registr y tr aining, and develop im m unization pr otocols in or der to expand the car e they pr ovide to patients.

Com m unity phar m acists ar e w or king cr eatively to m anage their w or k flow to allow tim e for vaccine adm inistr ation, and they ar e being suppor ted by technicians w ho have also stepped up in suppor t of im m unization effor ts.

Im m unization ser vices have str engthened the r elationships phar m acists have w ith both patients and pr ovider s. The question of ?Have you had your flu shot?? blossom s into one-on-one conver sations as the phar m acist engages the patient dur ing vaccine adm inistr ation. Additionally, phar m acists and pr ovider s ar e w or king collabor atively to r educe vaccine pr eventable illnesses.

Im m unization ser vices have also opened m any oppor tunities for student phar m acists in the com m unity to be involved in patient car e, under the super vision of a phar m acist, thr ough scr eening, vaccine adm inistr ation, and docum entation.

We celebr ate the effor ts of com m unity phar m acists acr oss the state of Nor th Car olina w ho have r isen to the challenge and ar e im pacting the health and w ellness of their patients

thr ough im m unization ser vices. The voices of com m unity phar m acists, som e of w hom ar e highlighted below, ar e uniting to decr ease vaccinepr eventable disease in NC. "W ith the ability to give m or e vaccines, phar m acists ar e helping to r educe vaccine pr eventable illnesses.

Incr easing im m unization ser vices in the com m unity has opened new avenues for conver sations w ith patients and em pow er ed phar m acists to play a lar ger r ole in the healthcar e team . Patients now have easier access to car e and the unique oppor tunity to be m or e active in their ow n healthcar e."

Er in Dalton, Phar mD M oose Phar m acy Concor d, NC Phar m acist since 2011 NCAP m em ber since 2011 ?W hen I r ecom m end im m unizations to my patients, they ar e happy to discover they can r eceive them at their local phar m acy! Pr oviding im m unizations in my com m unity allow s m e to talk to m or e patients face to face and let them know that I am an accessible health car e

r esour ce for im m unizations and so m uch m or e.?

Amanda Gates, Phar mD Quality Dr ugs, Inc. Butner, NC Phar m acist since 2012 NCAP m em ber since 2008 ?Pr oviding im m unizations to my patients allow s m e another facet tow ar ds developing m eaningful r elationships. It also allow s an oppor tunity to advocate for the pr ofession and show case a valuable skillset of the health car e team .?

Dr. Gates adm inister ing a vaccination w hile at Quality Dr ugs, Inc.

M egan Smith, Phar mD UNC Eshelm an School of Phar m acy and Walgr eens, Chapel Hill, NC Phar m acist since 2013 NCAP m em ber since 2009 ?I love being able to pr ovide im m unizations for my patients. Phar m acists ar e som e of the m ost accessible health car e pr ovider s and this is just another w ay w e can car e for our patients and build those r elationships. It's nice to help patients pr event illness as w ell as tr eat it!?

Sar a Dawson, Phar mD Walgr eens Phar m acy Dur ham , NC Phar m acist since 2009 NCAP m em ber since 2005

Dr. Fox pr ovides im m unization for colleague.

Developing an I mmunization Pr otocol

standing or der ).

Cour tney Humphr ies, Phar mD

A pr ofessional favor ite is the Im m unization Action Coalition w ebsite w hich contains standing or der s for specific vaccines that can be utilized and incor por ated to update or cr eate a w r itten im m unization pr otocol for a phar m acy. Other gr eat r esour ces on the Im m unization Action Coalition site include: vaccine package inser ts, stor age and handling infor m ation, vaccine adm inistr ation char ts and m any m or e. Refer to Table 1 for a list of r esour ces available online.

Phar m acist, Har r is Teeter An im m unization pr otocol is a docum ent pr epar ed and signed by the super vising physician and im m unizing phar m acist that pr ovides a w r itten or der for the phar m acist to use w hen adm inister ing a vaccine. In Nor th Car olina, a phar m acist m ay adm inister cer tain vaccines to a patient under a w r itten pr otocol signed by a super vising physician that pr actices and r esides in Nor th Car olina. It can be difficult to find r esour ces for developing your ow n pr otocol or even an exam ple that m ay dem onstr ate the cr itical com ponents to include. The pur pose of this ar ticle is to pr ovide im m unizer s navigation and guidance on w r iting an im m unization pr otocol, as it applies to Nor th Car olina law. We hope this ar ticle w ill help guide you in developing an im m unization pr otocol that can ultim ately be used to pr otect patients fr om vaccine pr eventable illnesses.

The language of the im m unization law does not specify a tem plate or m odel, r ather allow s each phar m acy and super vising physician to deter m ine the details of the pr otocol. Because ther e is little infor m ation available on pr otocol w r iting standar ds and r equir em ents, gather ing exam ple pr otocols fr om other phar m acists w ho im m unize is one of the best places to star t w hen looking for w r iting infor m ation. Please r efer to Figur e 1 for an exam ple of an im m unization pr otocol cur r ently used in Nor th Car olina. Other suggestions for pr otocol tem plates include state health depar tm ents, boar ds of phar m acy, and phar m acy association w ebsites. The NCAP w ebsite m ay also be utilized to aid in the assem bly of a pr otocol so that your pr actice is in alignm ent w ith state r egulations. In addition, or ganizations such as the Am er ican Phar m acists Association and the Center for Disease Contr ol have im m unization standing or der s available on their w ebsites, w hich can be utilized to cr eate a pr otocol (see Figur e 2 for an exam ple of a

\Ther e ar e r equir ed com ponents that m ust be included in a Nor th Car olina im m unization pr otocol. The pr otocol should state w hich vaccines can be adm inister ed to a patient and cr iter ia of appr opr iate candidates w ho m ay r eceive them . It should be specific to the type of vaccine such as inactivated influenza or live attenuated influenza. The pr otocol should also state contr aindications for each vaccine to deter m ine ineligible patients. Other vaccine specific infor m ation should be included such as dose and r oute of adm inistr ation. Safety pr ocedur es ar e another com ponent that should include the pr ocedur es to follow, including any dr ugs r equir ed for tr eatm ent of the patient in the event of an adver se r eaction or em er gency (see Figur e 3). The pr otocol m ust also have a signatur e page, signed by the super vising physician, w hich defines the nam es of the phar m acists w ho have com pleted necessar y tr aining to adm inister im m unizations. Other item s for the pr otocol include pr ocedur es used to docum ent and com m unicate vaccine adm inistr ation and state r equir em ents, r epor ting r equir em ents of the im m unizing phar m acists to the super vising physician including content and tim e fr am e, locations the im m unizing phar m acist m ay adm inister the vaccines, tim e fr am e for the agr eem ent and pr ocedur es to m ake adjustm ents to the pr otocol. Each pr otocol should be r eview ed at least annually. Finally, specific appendices m ay be added to the pr otocol to enhance or expand infor m ation alr eady pr ovided in the pr otocol body.

(Developing an I mmunization Pr otocol, continued fr om page 17) These can be helpful docum ents or char ts for the adm inister ing im m unizer. Exam ples of appendices include vaccines that can be adm inister ed to pr egnant patients, stor age r equir em ents, or an em er gency pr otocol.

W hen developing an im m unization pr otocol, it is im por tant that you w or k closely w ith your collabor ating physician to ensur e all com ponents ar e clear ly outlined and com pr ehensive. If you have questions about this pr ocess, please consider contact the Nor th Car olina Association of Phar m acists?

Im m unization Com m ittee or r eview the Im m unizations Resour ces available at w w w.ncphar m acists.or g.

Table 1: Commonly Used Website Resour ces for Vaccine Pr actice*

Organization

Website

Type of Resources

Centers for Disease Control & Prevention

http:/ / www.cdc.gov/ vaccines

- ACIP schedules & recommendations - Pink Book - Travel Vaccine recommendations - Vaccine Adverse Event Reporting - Patient and Parent education - Vaccine administration

American Pharmacist Association

http:/ / www.pharmacist.com/ immuni zation-resources

- Vaccine administration & storage - Information statements - Vaccine safety - Standing Orders - Immunization Advocacy Resources - Immunization schedule

American Academy of Family Physicians

http:/ / www.aafp.org

- Vaccine schedules

American Academy of Pediatrics

http:/ / aap.org

- Pediatric vaccine schedules

NC Association of Pharmacists

http:/ / www.ncpharmacists.org

- Expanded resources available

NC Board of Pharmacy

http:/ / www.ncbop.org/ faqs/ Pharmacist/ faq_Vaccinations.htm

- Updates and links to NC laws - Links to required documents - Frequently Asked Questions

Immunization Action Coalition

http:/ / www.immunize.org/

- Standing orders - Vaccine package inserts - Vaccine information statements - Charts for vaccine administration & contraindications - Example patient questionnaire - Vaccine storage and handling

* Website list is not exhaustive.

Meeting the Critical Need of Vaccination: The Expanding Role of Immunizing Providers Commentary Provided By: Peter Morris, MD A public health emergency is emerging, visible now in our peripheral vision but already affecting our health in real and definable terms. Not Ebola or SARS or zoĂŤtic viruses mutating their way to threaten us, our friends, our neighbors, and our brothers and sisters across the oceans. It?s an emergency far closer to our home.

Vaccination is no longer a public health virtue. Vaccination has become a personal choice to be exercised not in accordance with clinical experience and best practice schedules designed to induce and boost immunity. At best, vaccination is considered an imposition and inconvenience, and at worst a sinister plot and threat to free will. The avoidance and refusal of vaccinations and the untimely administration of vaccines poses a real threat to both personal and community health.

Nothing in the history of public health has saved more lives than the availability of clean, potable water, the absence of which still kills millions across the globe. Improved nutrition and housing save millions more, but in the history of science and medicine nothing has saved more lives than vaccination. Declining vaccination rates tragically still places millions in harms way.

The risk is not from a distant foreign shore. The risk is next door.

Have we really forgotten the diseases that pushed Jenner and Salk and Sabin and Katz to invent and prevent the tragedy of smallpox and polio and measles? Have we really abandoned prevention expecting treatment to rescue us?

Do we really think vaccine preventable diseases do not threaten family and friends?

How is this possible?

It?s not ignorance, but complacency. A poor perception and calculation of risk? We fear the exotic and uncommon more than the commonplace even though the commonplace affects far more people.

Sociologists suggest that consciously or unconsciously we measure our choices against five criteria: acceptability, affordability, accessibility, quality and accountability.

This issue of NC Pharmacists certainly looks at the issue of accessibility but, too, the other criteria as well.

Accountability Traditionally vaccination has been considered the providence of medicine. Well, medicine and nursing. Oh, medicine and nursing and public health. Medicine, nursing, public health and, when epidemic, the conscripted and trained.

Vaccination has been proprietary. The right to administer vaccines has been regulated by statute.

The right to administer vaccines has been restricted by ?scope of practice.? Professions assiduously guard and protect the margins of their practice. Professionals and lobbyists patrol the halls of legislatures and licensing boards to assure that other professions do not encroach upon their scope of practice. With good reason as the public deserves professionals with the training and expertise to provide a quality service.

When it comes to the profession of pharmacy, the scope of immunization authority continues to expand. In the 1980?s less than 10 states authorized pharmacists to administer vaccines. Since this time, pharmacist involvement in vaccinations has advanced significantly. While laws and regulations differ from state to state, 44 states allow pharmacists to administer any vaccine and all 50 states allow pharmacists to administer the influenza vaccine to individuals 18 years of age and older. Over time, each state?s legislatures have granted pharmacists the privilege of administering vaccines, but only certain vaccines.

According a 2010 MMWR report, flu-associated deaths range from 3,000 to 49,000 cases annually.1 Moreover, 90% of influenza associated deaths occur among adults 65 years and older. In times of epidemic disease more die; and in pandemic the death toll is tragic.

Acceptability There are genuine and perceived concerns with vaccination, questions about manufacturing and doses and dosing

schedules and the precision of determining and protecting against an emerging and mutating disease without undue risk. If physicians and scientists are scientists how is it that the number and timing of doses seems to change with time?

Do they know what they are doing or are they experimenting. Don?t people get sick from vaccination? Can?t immunizations hurt? Not just the injection, but also the after effects? Can vaccines cause influenza or polio or devastate the central nervous system and cause autism spectrum disorder?

Scores of years of experience and adverse affect monitoring systems allow us to declare vaccination safe. In the history of vaccination, vaccines have been withdrawn or never introduced. Most recently the vaccine against rotavirus, perhaps the most common cause of diarrheal death in the world, was withdrawn when an unusual surgical condition was detected with increasing frequency. The vaccine was only reintroduced after additional testing and assurance of safety. A vaccine against respiratory syncytial virus (RSV), the most common cause of respiratory hospitalization among children less than a year old, was never introduced. The immune response it generated exacerbated the disease.

Batches of vaccine are removed from circulation when contamination or lack of efficacy is detected.

Yet we can ask: is it acceptable to willingly assent to an intervention that helps more than it hurts? Generally, we answer yes, it is. Air bags save lives. Air bags can harm. Speed limits save lives. We all submit to slower travel for the good of the whole.

A more puzzling question is why certain vaccines with amazing effects are declined. The human papilloma virus vaccine is the second vaccine in the history of the world that can rightfully claim to prevent cancer (cervical cancer) but the acceptance is low. Yet the hepatitis B vaccine, the first vaccine to prevent cancer (liver cancer), is widely accepted.

Quality Manufacturing and distribution issues are not common. Press coverage of any variation in quality and recall is extensive. Press coverage of the adverse affects of a lack of vaccination does get press when and if there is a local case to highlight.

The alleged toxicity of the diphtheria-pertussis-tetanus (DPT) vaccination series was loudly debated with conclusive scientific evidence that the vaccine did not cause encephalopathy and brain damage. Not all agree. A safer antigen, the acellular pertussis antigen was substituted when developed (DtaP) with a great decrease in side effects.

No one was happy with thimerasol, a preservative added to multi-dose vials of vaccine as a preservative and antiseptic to prevent contamination of the multi-dose vial. Thimerasol, in trace amounts, contaminated the large tanks in which vaccines were prepared. No longer. The only vaccine with trace amounts of thimerasol is the multi-dose vial of influenza vaccine and there are numerous single dose products to choose instead.

Affordability

For years vaccines of high and low cost have been made available to at risk persons through Federal purchasing contracts and public agencies. Vaccine administration has largely been a benefit of most health insurance and under provisions of the Affordable Care Act must be included in preventive health benefits.

Not to say that vaccines are inexpensive. Increasingly the newer vaccines are expensive. Cost benefit analysis measuring all the costs of illness that were preventable (medical costs, hospitalizations, and days missed of school or work) show all available vaccines are cost effective despite the market price.

Availability And now we turn to the crux of this particular article. Availability. When the availability of vaccines is limited by scope of practice laws and regulations it is the public who suffers.

Many of the barriers to timely vaccination have been successively addressed - acceptability, quality, affordability, and accountability, but vaccination rates lag and preventable illness and its consequences are all too common.

Physicians, hospitals and public health agencies along with some businesses have taken effective steps to improve the availability of vaccines. Longer office hours, immunization events, and an additional benefit and convenience to employees and (sometimes) families have made it easier to obtain timely vaccinations.

It has not been enough. Only 20% of high-risk individuals are protected by the pneumonia vaccine. Approximately 14.2% of adults have been vaccinated against pertussis (whooping cough), a dangerous and deadly disease in infants, spread not infant to infant but parent, grandparent and sibling to infant.2 Older children and adults are the carriers of pertussis, becoming ill with a ?mild? case that is transmitted to the infant with resulting serious illness.

Many states are now addressing this issue of availability by providing pharmacists with the privilege of administering vaccines. Not just any pharmacist, but pharmacists who receive supervised training that rivals, if not exceeds, the training of physicians in administering vaccines. Emergency protocols and standing orders are written, improved and monitored to assure the chain of safety. The results are conclusive for the annual influenza vaccine. Of approximately 300,000 licensed US pharmacists, more than two-thirds have trained to administer vaccine.3 Pharmacists are now vaccinating nearly 20% of the estimated 132 million doses of flu vaccine given to individuals nation wide. Pharmacies are offering this service on walk-in basis and submitting vaccine costs to most insurers for patient convenience.

Since legislation passed granting pharmacists administers additional vaccines in 2013, NC pharmacists are actively advocating, administering and documenting confirmation of vaccine administration in the North Carolina Immunization Registry. Physicians ?share? of the vaccinated has not fallen. Pharmacists are vaccinating people who do not go to their physicians for vaccination.

This is a public health success. But contention persists.

Are pharmacists over reaching by asking for expanded privileges of providing vaccines? The best argument against this expansion of privilege is the recognition that a primary care medical home is the best practice to assure that persons receive the appropriate preventive care they need to lead healthy lives. In a primary care medical home the patient and the physician are partners in assuring and providing comprehensive and coordinated care.

The comprehensive and coordinated care promised by the primary care medical home would usher in a new era of shared responsibility and accountability and has been shown to improve health outcomes. Unfortunately, the primary care medical home is not available to all and is not utilized by all.

Shouldn?t the public health and community health benefits of expanded access to the preventive effects of vaccination be assured? And monitored. If and when the primary care medical home is shown to be improving vaccination rates the State Health Director can recommend to the NC General Assembly that the laws change. Our public policy should always aim for the best results at the most reasonable cost for our friends, our neighbors and ourselves.

The best public policy emerges from a consideration of data, policy and will. The data about vaccinations, their effectiveness and their current availability speaks loudly of a public health failure. The strategies continue to evolve and be evaluated. Pharmacists do improve access to acceptable and affordable vaccines, providing a quality service with measured accountability.

It is will that has been lacking.

References: 1-Thompson MG et al. Updated Estimates of Mortality Associated with Seasonal Influenza through the 2006-2007 Influenza Season. MMWR 2010; 59(33): 1057-1062.

2-Centers for Disease Control and Prevention. Noninfluenza Vaccination Coverage Among Adults ? United States, 2012; MMWR 2014; 63(05); 95-102.

3-Rothholz MC. The role of community pharmacists/ pharmacists in vaccine delivery in the United States. Presented at: meeting of the Advisory Committee on Immunization Practices (ACIP); June 20, 2013; Atlanta, GA.

How to Pr ovide Feedback to Students and Residents Holly E. Causey, PharmD, BCACP, CPP, CDE Kimberly Lewis, PharmD, BCACP, CPP, CACP Pr oviding feedback to lear ner s r em ains a challenging skill for m any pr eceptor s and super visor s. W hat exactly is feedback? Sim ply put and in the case of pr ecepting, feedback is the pr ovision of infor m ation by a pr eceptor to a lear ner follow ing obser vation of per for m ance.1 Feedback is not synonym ous w ith encour agem ent, evaluation, constr uctive cr iticism or self-r eflection; how ever, it m ay include som e of these elem ents.2 For instance, w e tend to pr ovide feedback on dir ect obser vations thr oughout the cour se of the r otation and to com plete an evaluation m idw ay thr ough and upon com pletion of the r otation.

Feedback can be highly effective w hen str uctur ed. Som e techniques of pr oviding str uctur ed feedback include the sandw ich m ethod, W 3, 360 degr ees, and one m inute pr eceptor. The sandw ich m ethod r elies on pr oviding negative or constr uctive feedback sandw iched betw een positive feedback .

Unfor tunately, this type of feedback does not engage lear ner s in self-r eflection and goalsetting.2 Additionally, the positive feedback can outw eigh the negative feedback or w hat w e pr efer to call constr uctive feedback . The W 3 m ethod involves m or e self-r eflection as the lear ner is asked w hat w or ked w ell, w hat did not w or k w ell, and w hat he/she can do differ ently next tim e. The 360 degr ee m ethod elicits feedback fr om other lear ner s or cow or ker s w hile the one m inute pr eceptor m ethod involves the pr eceptor asking the lear ner a ser ies of questions to deter m ine how the lear ner ar r ived at an answ er.1 In addition to the above str uctur ed m ethods, w e have a few r ecom m endations for pr oviding

effective feedback . At the beginning of the r otation, set expectations for how the feedback w ill be given (i.e. electr onically, face to face, etc), how often it w ill be given, goals of the feedback , and expectations of any action item s that r esult fr om the feedback .3 Fir st, effective feedback is fr equent. At the star t of the r otation and w ith each new task , set up a tim eline that both the lear ner and pr eceptor agr ee upon as this pr om otes a sense of team w or k . Fr equent feedback can also pr om ote confidence in the lear ner by r einfor cing cor r ect thinking and actions w hile also cor r ecting er r or and helping the lear ner develop a plan to im pr ove. Second, effective feedback is accur ate and specific.

Consider keeping notes on the lear ner ?s per for m ance thr oughout the cour se of the r otation. These notes can include specific, objective exam ples of tasks, patient inter actions, etc. Lastly, effective feedback is pr ovided in a tim ely m anner. In gener al, it?s the m ost effective if it can be given im m ediately upon an er r or or pr esentation of incor r ect infor m ation.

Feedback is not alw ays positive; it allow s for pr eceptor s to point out ar eas of w eakness and give dir ection for im pr ovem ent.4 Ther e ar e alw ays challenges to pr oviding feedback . Ther e ar e tim es that lear ner s ar e not r eceptive to the feedback given, and it can have an em otional im pact that w e ar e not pr epar ed to tackle. W hile you cannot contr ol the r esponse you w ill r eceive, it is im por tant to be pr epar ed to handle it. In pr epar ing to give effective feedback , w e m ust ensur e that the appr oach is tailor ed to the individual, r ecognizing that w e m ust be sensitive to the em otional im pact it m ay have.5 Defensive r esponses m ust be dealt w ith calm ly, and it is im por tant to utilize one of the str uctur ed m ethods m entioned above.

In sum m ar y, w hile not alw ays pleasant, feedback is essential for gr ow th and developm ent of lear ner s. Constr uctive, effective feedback can som etim es pr oduce feelings of r esistance or hur t am ongst lear ner s, and it is our job, as pr eceptor s,

How to pr ovide effective feedback , (continued fr om page 20) to r em ain calm , listen, and pr ovide r einfor cem ent of appr opr iate thinking and actions. It is also im por tant to r em em ber that effective feedback is fr equent, accur ate, specific, and tim ely (FAST). W hen given in this fashion, feedback can be m or e im pactful.

Refer ences: 1. M ounce M L. Pr oviding Effective Feedback .

Educational Theor y and Pr actice. Apr il 1, 2014.

2. M edina M . Pr oviding feedback to enhance phar m acy students?per for m ance. AJHP 2007; 64: 2542-2545.

3. Gr over B, Hayes BD, Watson K. Feedback in clinical phar m acy education. AJHP 2014; 71:1592-96.

4. Lucas JH, Stallw or th JR. Pr oviding Difficult Feedback: TIPS for the Pr oblem Lear ner. Fam M ed 2003;35(8): 544-546.

5. Weitzel SR. Feedback That Wor ks: How To Build and Deliver Your M essage. CCL Pr ess, 2000.

SAVE THE DATE! NCAP ANNUAL CONVENTION RALEIGH CONVENTION CENTER NOVEM BER 1-3, 2015

New Pr actitioner Spotlight--Kim ber ly Lew is, Phar m D

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Kimberly Lewis received her PharmD in 2006 from The University of Tennessee College of Pharmacy. After graduation, she completed a PGY-1 Pharmacy Residency with an emphasis in community practice at Nationwide Children?s Hospital in Columbus, OH. During her residency, she also received a teaching certificate from The Ohio State University. After completion of her residency, she moved to North Carolina and became a member of NCAP shortly thereafter. She was one of the first members of the New Practitioner Network (NPN) Executive Committee. During her time in service to this committee, she has served as secretary, chair-elect, chair and past-chair. As she is now in her eighth year of pharmacy practice, Kim is transitioning off the committee.

During her time in practice, Kim has continued to develop professionally and is now a Certified Anticoagulation Care Provider (CACP), Board Certified Ambulatory Care Pharmacist (BCACP), and Clinical Pharmacy Practitioner (CPP). Currently Kim is a Clinical Assistant Professor of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences and she practices at Southern Regional Area Health Education Center (SR-AHEC). Within SR-AHEC, she conducts clinics for medication management, diabetes, and anticoagulation at a Family Medicine Residency Clinic. She precepts several students per year in this setting. In her various roles, Kim has certainly impacted patient care, education, and the practice of pharmacy in our state.

She is passionate about NCAP as she believes it unifies the pharmacists of the state to give us a stronger voice, no matter the practice setting. She states ?NCAP has been a true blessing to me. The many connections and friendships that I have made have been truly valuable. It has given me the opportunity to network with people that I would have never been able to otherwise.? We are truly going to miss Kim on the NPN Executive Committee and look forward to seeing her great influence through ongoing initiatives within NCAP.

Developing, Delivering, and Communicating Pharmacy Customer Service Standards Jeffrey Reichart, PharmD, and Kathryn Brown, PharmD As a patient, would you pay - out of pocket - for the cognitive services of a pharmacist? If you were a physician starting your own practice, would you hire a pharmacist as part of your team? If nurses hired their own patient care team, would they include pharmacists? The value proposition for pharmacy services, in any practice setting, comes down to the answers to those questions. What drives a ?yes??

How do we deliver on our unique abilities as medication management experts? Let us assume for this discussion that accountability for quality outcomes is well developed, measured, and communicated. Given that, our success in customer service creates the ?yes?, and could shape the future of our profession.

Customer service, in this context, applies to patients, physicians, nurses, and other team members, and stretches beyond the basics of polite problem solving and rapid turnaround times.

Pharmacists, technicians, and pharmacy support personnel must create valuable relationships with their customers, which have become less about the physical product, as the product is now the relationship. In order to do this, we must use their input to design pharmacy services that meet their needs, and then deliver them consistently and reliably. Establishing a service standard is the primary method used in other industries to achieve this end. Deliver a less than expected service, customers could shop elsewhere. Until recently, healthcare has not had the same pressure as outlined by the Patient Protection and Affordable Care Act. In this era, pharmacists have refocused around patient centeredness, through team-based delivery and expansion of clinical service models.

Patient satisfaction implications are financial and fully realizable through the Hospital Consumer

Assessment of Healthcare Providers and Systems (HCAHPS). The survey asks patients about such things as communication, responsiveness, and medication information.

In pharmacy however, we often have not articulated what our customers should expect from us, especially with regard to non-distributive services.

We organize pharmacy services in ways that we assume work well for our customers, deal with failures as they occur, and occasionally redesign things for marginal improvement. In the acute care setting for example, clinical monitoring services may be different based on the day, shift, or vacation schedule of a particular pharmacist; nurses probably cannot articulate exactly when where they can expect a new dose to be provided; and most patients don?t meet their pharmacist. If we ask physicians ?What value Service Standards do you receive from pharmacy services?? we will define the hear things like ?they expectations for monitor for allergies customers..... and interactions?. A nurse answers ?they help when I have a medication question?, and patients say ?they get the medications to me and make sure they are correct?.

These things don?t lack value, and certainly respect for our profession is well established, but is this what we want to hear? Is this the unique and customer-centric value we strive for? Wouldn?t we be truly delivering on our value if patients said something like ?my pharmacist is my medication specialist, no matter where I am being cared for they manage my treatment?, physicians said ?I couldn?t practice effectively without a pharmacist on my team, they manage my complex medication issues and ensure my patients have the best possible outcomes?, and nurses said ?the pharmacy team makes sure my patients and I always have the medication and information we need, when we need it??

At Novant Health, given the significant interactions

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between pharmacy staff and patients and internal customers, we assessed there was a need for a systematic approach for serving customers.

Pharmacy has engaged patients, fellow employees (e.g., physicians, nurses and other team members), and even competitors to define and deliver our Service Standards. Their input has clarified perspectives from customers, enabling a method to analyze pharmacy performance and support customer satisfaction. We are hopeful these Service Standards will define the expectations for customers, and followed by consistent performance, could create a new definition of value in pharmacy services.

We challenge our peers in all practice settings to do the same.

Gir ls of Phar macy Weekend at Gr ove Par k 2015 Over 45 attendees fr om Nor th Car olina enjoyed continuing education offer ings, fellow ship, and FUN at the Gir ls of Phar m acy w eekend! This annual m eeting w as held at the Om ni Gr ove Par k Inn w as held Januar y 16-18, 2015.