Official Newsjournal of the Illinois Council of Health-System Pharmacists

ICHP KeePosted

December 2017

Volume 43 Issue 10

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SeptOct2013 - Pharmacy Month

KeePosted Info

Features

A Six-Week Sprint: From Start to Finish

History of Organized Hospital Pharmacy in Illinois: 1970s

2013 Best Practice Winner: Home-Study CPE

PTCB Announcements

Columns

President’s Message

Directly Speaking

ICHPeople

Leadership Profile

Medication Safety Pearl

The GAS from Springfield

New Practitioners' Network

College Connections

My First Site Visit to Indian Health Services

Meet Our Executive Board

Takeaway from the ICHP Student Leadership Retreat

More

Officers and Board of Directors

Welcome New Members!

ICHP Pharmacy Action Fund (PAC) Contributors

Upcoming Events

KeePosted Info




Illinois Council of Health-System Pharmacists
4055 North Perryville Road
Loves Park, IL 61111-8653
Phone: (815) 227-9292
Fax: (815) 227-9294
www.ichpnet.org

KeePosted
Official Newsjournal of the Illinois Council of Health-System Pharmacists

EDITOR
Jacob Gettig

ASSISTANT EDITOR
Jennifer Phillips

MANAGING EDITOR
Scott Meyers

ASSISTANT MANAGING EDITOR
Trish Wegner

DESIGN EDITOR
Amanda Wolff

ICHP Staff
EXECUTIVE VICE PRESIDENT

Scott Meyers

VICE PRESIDENT - PROFESSIONAL SERVICES
Trish Wegner

DIRECTOR OF OPERATIONS
Maggie Allen

INFORMATION SYSTEMS MANAGER
Heidi Sunday

CUSTOMER SERVICE AND
PHARMACY TECH TOPICS™ SPECIALIST

Jo Ann Haley

ACCOUNTANT
Jan Mark

COMMUNICATIONS MANAGER
Amanda Wolff

LEGISLATIVE CONSULTANT
Jim Owen

ICHP Mission Statement
Advancing Excellence in the Practice of Pharmacy

ICHP Vision Statement
ICHP dedicates itself to achieving a vision of pharmacy practice where:
  • Pharmacists are universally recognized as health care professionals and essential providers of health care services.
  • Patients are aware of the training, skills, and abilities of a pharmacist and the fundamental role that pharmacists play in optimizing medication therapy.
  • Formally educated, appropriately trained, and PTCB certified pharmacy technicians manage the medication distribution process with appropriate pharmacist oversight.
  • Pharmacists improve patient care and medication safety through the development of effective public policies by interacting and collaborating with patients, other health care professionals and their respective professional societies, government agencies, employers and other concerned parties.
  • Evidence-based practices are used to achieve safe and effective medication therapies.
  • There are an adequate number of qualified pharmacy leaders within the pharmacy profession.
  • Pharmacists take primary responsibility for educating pharmacy technicians, pharmacy students, pharmacist peers, other health professionals, and patients about appropriate medication use.

KeePosted Vision
As an integral publication of the Illinois Council of Health-System Pharmacists, the KeePosted newsjournal will reflect its mission and goals. In conjunction with those goals, KeePosted will provide timely information that meets the changing professional and personal needs of Illinois pharmacists and technicians, and maintain high publication standards.

KeePosted is an official publication of, and is copyrighted by, the Illinois Council of Health-System Pharmacists (ICHP). KeePosted is published 10 times a year. ICHP members received KeePosted as a member benefit. All articles published herein represent the opinions of the authors and do not reflect the policy of the ICHP or the authors’ institutions unless specified. Advertising inquiries can be directed to ICHP office at the address listed above. Image disclaimer: The image used in the Pharmacy Tech Topics advertisement is the property of © 2013 Thinkstock, a division of Getty Images.

Copyright © 2013, Illinois Council of Health-System Pharmacists. All rights reserved.

Features

A Six-Week Sprint: From Start to Finish

by Cassidy McDonald, 2014 PharmD candidate, UIC-Rockford, and Jamie Tidaback, 2014 PharmD candidate, UIC-Rockford


Jamie and I cannot believe the end is near and how fast these weeks have gone by! Previously, we each mentioned our incentive for signing up for this rotation at ICHP: challenging ourselves and stepping out of our comfort zone. Our goal has been achieved! By the end of this rotation, we will have accomplished four publications, networking, taking part in professional meetings, and inserting our professional opinions into the revised Pharmacy Practice Act Rules.

We sat down and reflected upon the highlights of what we have experienced each week:

During week one, we reviewed the revised Pharmacy Practice Act Rules, and we each had questions about some of the revisions. We shared these with Scott Meyers, ICHP Executive Vice President (and he may have been impressed?!). Some of the issues we brought up to Scott were things we simply wanted clarifications on, which he was happy to explain. We were also kept busy e-mailing local residency directors regarding the Residency Showcase for the 2013 ICHP Annual Meeting and Gala. This year’s meeting is “near and dear” to ICHP’s heart because it is their 50th Anniversary Meeting.

At the start of week two, we participated in the Government Affairs conference call regarding the revised Rules. The purpose of this call was to discuss the draft with everyone on the call and compile a document of the comments from the Government Affairs members. Later that week, we attended the Pharmacy Board of Directors meeting in Chicago at Via Carducci. These meetings are exclusively for pharmacy directors, but they are allowed to bring a resident and/or student. The company, atmosphere, discussions, and of course, food was wonderful! The NABP Executive Director was present and shared recent updates regarding Prescription Monitoring Program (PMP) and future narcotic check systems and new regulations in batch compounding.  We were also given the opportunity to write a Career Center article. The article we decided to write was divided into two parts and was directed toward students in pharmacy school. It included tips that could possibly help them from P1 to P4 year.

The highlight of week three was participating in the ICHP Champions Program. The Champions Program is offered for pharmacists, pharmacy technicians, and students who need CPE credit. A conference call takes place where a guest lecturer presents a topic, and in our case, we listened to a lecture on hypertension in the elderly. These sessions typically last 30 minutes and give the listeners an opportunity to ask the speaker questions and follow along with the presentation via conference call. The Champions Program is offered on two different days at different times for convenience. It is a great way to obtain CPE credit, and we both agreed that we would participate in the Program if we were pharmacists!

Week four concentrated on preparing for the ICHP Student Leadership Retreat at Midwestern University College of Pharmacy. This was the first year a Student Leadership Retreat has been held, and it was a success. The day started with checking students and faculty in from University of Illinois at Chicago/Rockford, Southern Illinois University Edwardsville, Midwestern University, Chicago State University, Rosalind Franklin University, and Roosevelt University. Everyone then enjoyed bagels and coffee and the lectures began. There were two speakers from Northwestern Memorial Hospital discussing the role of leaders. Discussion took place in the classroom where students shared experiences about when their role as a leader had been challenged. A break took place between the lectures, and students were provided with a variety of tasty snacks to satisfy everyone there! After the second lecture, students mingled and ate lunch from a local pizzeria. At the end of the day, there was an ICHP presentation from Scott Meyers and an opportunity for interactions between the various ICHP chapters to discuss fundraising, attendance, member recruitment, and networking ideas. We highly recommended that ICHP e-board students attend the annual ICHP Student Leadership Retreat! We were also busy this week reading the Medical Marijuana bill after hearing the recent news of Governor Quinn signing the bill to legalize medical marijuana.

Following the weekend of the student retreat, week five contained a New Practitioner Network conference call meeting. We also sat in on the ICHP Board of Directors meeting. Reports were given by each board member regarding the Annual Meeting, committee updates, and any other new information from the last meeting. A lot of work was accomplished during that meeting, which included voting on motions, awards, and nominations that were presented.

Here we are into week six, and we sit here reflecting upon our experiences. However, the experiences are not over as we have a journal club presentation later in the week. We will also be attending a P1 White Coat Ceremony with Scott, who is invited each year to coat the incoming P1 students at University of Illinois - Rockford.  We will end the week with a lunch gathering with the ICHP staff.

Miscellaneous tasks that Cassidy and I completed over the time at ICHP included helping Jo, Maggie, Amanda, Jan, Heidi, and Trish with any day-to-day work they needed assistance with. Overall, Cassidy and I had an amazing experience during our six weeks at ICHP. We have thoroughly enjoyed working with Scott and the rest of the ICHP staff during this rotation. This type of elective rotation is great for showing the different avenues that are available for pharmacists. The pharmacists that are involved with ICHP are helping pave the future for all pharmacists and should be thanked for all the work they do, including the work done behind the scenes.


History of Organized Hospital Pharmacy in Illinois: 1970s

ICHP HistoryEditor’s Note: The August Keep Posted brought readers through the history of organized hospital pharmacy in Illinois to 1971.

Continuing Education
At the July 7, 1971, meeting there was a call communicated from IPhA for individual and organizational opinions on mandatory continuing education, repeal of antisubstitution legislation, and inclusion of drug name and strength on prescription labels. It was noted that the Dean’s Advisory Committee had spent much time on the topic of continuing education: mandatory versus voluntary. “The Council consensus was that until some of the loopholes can be removed, continuing education should remain on a voluntary basis. The possibility of a foundation with representation from all Illinois pharmacy organizations which would have as its purpose the supervision of a viable continuing education program was mentioned.”

Reorganization
At that same July meeting Chairperson [Weldon] Johnson “urged that the incoming officers give consideration to possible changes in the Council’s structure. Suggested was the formation of a statewide hospital pharmacy organization, which could conceivably accommodate outlying pharmacists in areas that presently do not have adequate representation. In contrast to the present Council structure, membership would be extended to all practicing hospital pharmacists. To be taken under advisement.”

The new officers picked up his challenge at the August 21, 1971, meeting. At that meeting, SISHP’s representative Jim Curtin stated that the Council problems were related to the unclear affiliation policy of ASHP and that before anything else this needed to be resolved. To this end the Council adopted the following proposal for submission to ASHP: “Whereas, the strength of ASHP is in its affiliated chapters, and Whereas, there is a discrepancy in the types of affiliated categories regarding the various local or state affiliates, therefore, be it resolved, that the Illinois Council of Hospital Pharmacists strongly recommends, that this problem be given prime consideration at the October ASHP council meeting and that some decision be reached.”

At the April 18, 1972, meeting “a general discussion on the Council, its organization and structure, effectiveness in acting upon matters relative to institutional practice, and its future roles was initiated. The discussion was ended due to limitations of time with the general consensus that the Council structure was worth saving but needed the leadership of an individual who could devote more time and insight than any one in the recent past has been able to give the Council. Concern is that the individual can be found and that the special problems of hospital pharmacy will not be neglected even by those of us who practice the specialty.”

Academy of Pharmacy Practice
Roger Cain, Executive Director of IPhA along with John Hegarty, Director-at-Large, was present at the Council meeting on June 21, 1972, to propose formation of an Illinois Academy of Institutional Pharmacy Practice. “Discussion followed; questions were raised as to who would be the executive of the Academy, what type of financial arrangement would exist, would there be a need for additional dues from the members, etc.? Mr. Cain expressed discontent with the current structure of the Council and felt he did not know who to go to when a situation arose involving institutional practice. The consensus of the Council was that the proposal would be taken under consideration. It was felt that the Council would be going through a reorganization next year and that it was too soon to make a commitment to IPhA.” Later at that same meeting the Academy proposal was again discussed with the decision being that the Council be given one year to reorganize. If the Council does not improve over that time, then the Academy proposal would again be considered.

At the October 24, 1972, meeting, Ed Barcus, President-elect, IPhA, and Tom Gulick spoke briefly to the Council in regard to the proposed Academy of Institutional Practice. At this same meeting, Sister Mary Louise Degenhart (formerly Mary Matthew) was appointed to chair the Constitution and Bylaws Committee to look at the possibility of revising the constitution to the extent that it would represent all the hospital pharmacists of the state. This committee appointment was not an automatic exclusion of the Academy structure – that study was to go on at the same time. There is a reminder in the minutes “that IPhA has a seat on the Council with full voting privileges that they do not take advantage of at this time.”

It was also in October, 1972, that NISHP transferred Keep Posted as its publication to ICHP. Henceforth, the Council would use Keep Posted as its publication and no longer use the IPhA Journal for its Hospital Pharmacist publication. John Lewis was willing to continue to serve as editor for ICHP’s Keep Posted.

ASHP had heard of the Academy Proposal as evidenced by a call from Dave Almquist, Director of Bureau of Administrative and Membership Services, ASHP, to Ronald T. Turnbull, ICHP Chairperson. Mr. Almquist requested that he be kept informed on the progress of these meetings and he was informed of the Council’s intention to revise the Constitution and Bylaws. “Discussion was held regarding recognized state chapters and the position of the local affiliated chapters. The ASHP Constitution recognizes only one state chapter. The Council was asked to pass this information on to their local chapters.”

Much of 1973 was devoted to study of the Academy proposal and revision of the Constitution and Bylaws. On October 17, 1973, Chairperson Walter Obermeyer called a special meeting to discuss the needs of institutional practitioners as outlined by the Executive Committee of NISHP under the following headings: education, continuing education, lobbying, information transfer, facility for arbitration, cooperating services, employment services, publications, public relations, recruitment, and data gathering.

Full Membership Organization
Minutes of January 30, 1974 indicated that Sister Mary Louise Degenhart, chairperson of the Constitution and Bylaws Revision Committee, presented each member of the Council with a copy of the new Constitution and Bylaws and a copy of a suggested plan for implementation. The ICHP Chairman Walter Obermeyer was directed to send a cover letter with the new Constitution and Bylaws to ever NISHP and SISHP member explaining what is to be accomplished by the new Constitution and Bylaws. At the March 20, 1974, meeting it was reported that the new Constitution and Bylaws was approved by almost a 90% margin. At that same meeting, Sister Mary Louise Degenhart, chairperson of the nominating committee, presented a full slate of 16 persons for the offices of ICHP and the regional vice presidents. Thus has the Council moved from a structure of delegates from each affiliate chapter to a full membership organization for the entire state.

– Sister Mary Louise Degenhart
Historian


2013 Best Practice Winner: Home-Study CPE
Development of a Urinary-Specific Antibiogram for Gram Negative Isolates: Impact of Patient Risk Factors on Susceptibility

by Nicole Rabs, Pharm.D., Sarah M. Wieczorkiewicz, Pharm.D., BCPS, Michael Costello, PhD, and Ina Zamfirova, BA

1.  Department of Pharmacy, Advocate Lutheran General Hospital, Park Ridge, Illinois
2.  Russell Institute for Research and Innovation, Advocate Lutheran General Hospital, Park Ridge, Illinois
3.  Department of Microbiology, ACL Laboratories, Rosemont, Illinois  
 
Address correspondence to Sarah M. Wieczorkiewicz, Pharm.D., BCPS, Department of Pharmacy, Advocate Lutheran General Hospital, 1775 W. Dempster Street, Park Ridge, IL 60068 (sarah.wieczorkiewicz@advocatehealth.com)

LEARNING OBJECTIVES:
  1. Recognize the limitations of a standard hospital antibiogram.
  2. Identify patient characteristics that have been shown to influence antimicrobial susceptibility.

ACPEACCREDITATION: This program is sponsored by the Illinois Council of Health-System Pharmacists. The Illinois Council of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is will provide 0.5 contact hours (0.05 CEUs) of pharmacy continuing education for pharmacists. This program is free to ICHP members only.

ACPE Universal Activity Numbers: 0121-0000-13-068-H04-P
Type of Activity: Knowledge-based

At the present time, neither the Pharmacy Technician Certification Board (PTCB) nor the Illinois Board of Pharmacy requires technicians to participate in only ‘T,’ or only technician-specific continuing education for re-certification or relicensure purposes. Therefore, technicians are welcome to participate in programming that is either ‘P’ or ‘T’ and will receive CPE credit for either type, provided they meet all applicable program requirements.

FACULTY DISCLOSURE: It is the policy of the Illinois Council of Health-System Pharmacists (ICHP) to ensure balance and objectivity in all its continuing pharmacy education programs. All faculty participating in any ICHP continuing pharmacy education programs are expected to disclose any real or apparent conflict(s) of interest that may have any bearing on the subject matter of the continuing pharmacy education program. Disclosure pertains to relationships with any pharmaceutical companies, biomedical device manufacturers, or other corporations whose products or services are related to the subject matter of the topic.

The intent of disclosure is not to prevent the use of faculty with a potential conflict of interest from authoring a publication but to let the readers know about the relationship prior to participation in the continuing pharmacy education activity. It is intended to identify financial interests and affiliations so that, with full disclosure of the facts, the readers may form their own judgments about the content of the learning activity.

The authors’ submission has been peer reviewed with consideration and knowledge of these potential conflicts and it has been found to be balanced and objective. The authors have no real or apparent conflict(s) of interest that may have any bearing on the subject matter of this continuing pharmacy education program.

THIS PROGRAM IS SUPPORTED BY AN EDUCATIONAL GRANT FROM MERCK & CO., INC.


Abstract

OBJECTIVE.  Traditional antibiograms guide clinicians in selecting appropriate empiric antimicrobials however; they lack data on syndrome/disease specific susceptibility, isolate location, polymicrobial infections, and patient risk factors. The aim of this study was to develop a urinary-specific antibiogram and to determine the impact of risk factors on antimicrobial susceptibility.

DESIGN/SETTING.  Retrospective, descriptive study utilizing culture and susceptibility data from January 1 to December 31, 2012.

METHODS.  Development of a urinary antibiogram specific for: Escherichia coli (EC), Proteus mirabilis (PM), Klebsiella pneumoniae (KP), and Pseudomonas aeruginosa (PA). Urinary and standard antibiogram susceptibilities were compared. Urinary isolates were then stratified by risk factors to determine impact on antimicrobial susceptibility: residence prior to admission, age, systemic antimicrobial use = 30 days, hospitalization = 30 days, and hospital unit.

RESULTS.  There were 2,284 urinary isolate encounters. Overall antimicrobial susceptibility was decreased and the prevalence of ESBL-producing isolates were significantly greater [KP 14% vs. 7% (P = 0.001); EC 13% vs. 9% (P < 0.001); PM 18% vs. 10% (P = 0.004)] in the urinary versus the standard antibiogram. Healthcare (HC) facility residence had the greatest impact on susceptibility for all urinary isolates; specifically, fluoroquinolone susceptibility for EC and PM.

CONCLUSIONS.  Utilizing a syndromic antibiogram and incorporating patient risk factors into susceptibility data may be more useful in aiding clinicians to select more appropriate empiric therapy.  

Antimicrobial resistance to gram negative pathogens has increased considerably, impacting morbidity and mortality, and leading to more challenging therapeutic management.1 Significant  increases in Klebsiella pneumoniae (KP) resistance to third-generation cephalosporins, extended-spectrum ß–lactamase-producing Enterobacteriaceae, and Pseudomonas aeruginosa (PA) resistance to fluoroquinolones are particularly concerning and have been well documented by national Antimicrobial Surveillance Programs.2-4 Gram negative pathogens have been shown to impact costs and length of stay (LOS). In one analysis, gram-negative resistant pathogens incurred a 29.3% higher total hospital cost and a 23.8% increase in LOS compared to their susceptible counterparts.5 Increased antimicrobial resistance can also affect the utility of currently available antimicrobials and this, combined with a lack of new antimicrobials in the pipeline, can make therapeutic management more difficult.

An antimicrobial regimen is often selected before culture data is available, but studies have shown that empiric treatment with broad-spectrum agents can increase harm to patients,6-10 hospital costs,4 and antimicrobial resistance.5 One study examined the impact of inappropriate first-dose antimicrobial selection and delayed antimicrobial administration on the mortality of septic patients with bacteremia and found an increased mortality rate with both factors.11 In this study, inappropriate initial therapy selection had a significant impact on healthcare-associated and hospital-acquired infections for 42.6% (n=29) patients with the greatest inappropriate selection reported for genitourinary site infections (n=20 patients, 27.9%).11 Based on these findings, risk factors for drug-resistant organisms and local antimicrobial susceptibility patterns should be considered when selecting empiric regimens.

There are several limitations to standard antibiograms including lack of (1) syndrome or disease-specific advice, (2) organism site distribution, (3) information on polymicrobial infections or the usefulness of combination antimicrobial therapy, and (4) information on patient risk factors that influence susceptibility.12

A recent study used a weighted-incidence syndromic combination antibiogram (WISCA)12  to identify causative organisms of two common infectious syndromes [urinary tract infection (UTI) and abdominal biliary infection (ABI)] and compare susceptibilities of the WISCA to a traditional antibiogram. For UTIs, the WISCA-UTI demonstrated decreased susceptibility for fluoroquinolone (62%) and ceftriaxone (71%) susceptibility compared to the traditional antibiogram (84% and 97%, respectively). This study also revealed that patient risk factors, such as age over 65 years, recent ER/inpatient visit, and fluoroquinolone exposure in the past 30 days impacted susceptibility.

In an attempt to decrease inappropriate empiric antimicrobial selection for UTIs, a syndromic antibiogram was created to determine the impact of patient risk factors on antimicrobial susceptibility. The primary objective was to determine if antimicrobial susceptibility differs from both the standard antibiogram published annually by our microbiology laboratory and the urinary-specific antibiogram for the four most common gram negative urinary isolates – Escherichia coli (EC), Proteus mirabilis (PM), Klebsiella pneumonia (KP), and Pseudomonas aeruginosa (PA).  Patient risk factors were incorporated to determine their impact on susceptibility and to provide more specific UTI guidelines at our institution and potentially reduce inappropriate empiric antimicrobial selection.








METHODS

This study was conducted at Advocate Lutheran General Hospital/Advocate Children’s Hospital (ALGH/ACH) in Park Ridge, IL. ALGH/ACH is a 638-bed teaching, research, and referral hospital with a level I trauma center, level III neonatal intensive care unit (NICU), and large nursing home patient population.

This was a retrospective, descriptive study. Antimicrobial culture and susceptibility data for the four most common urinary organisms isolated (EC, KP, PM, and PA) were collected from microbiology laboratory reports between January 1 and December 31, 2012. Urinary isolates from the inpatient and outpatient setting were included and those isolates other than the four aforementioned gram negative pathogens were excluded.


Urinary Antibiogram

The urinary antibiogram was constructed in congruence with ALGH/ACH’s standard antibiogram in which all urinary isolate encounters over a one year period were included, regardless of a final diagnosis (ICD-9) code consistent with a urinary tract infection (UTI) and colony-forming units (CFU)/ml threshold. The most resistant urine culture was selected for patients with multiple positive urine cultures for the same isolate during one admission and intermediate antimicrobial susceptibility was considered resistant. Antimicrobial susceptibility was calculated as a percentage by dividing the number of cases susceptible to the total number of cases (susceptible + nonsusceptible) for each urinary isolate. The urinary antibiogram was compared to the same four gram negative isolates in the standard antibiogram that represented overall susceptibility of isolates collected from all body sites.


Inclusion of Subject Risk Factor in Urinary Antibiogram

For each urinary isolate, subject risk factor data were obtained from the microbiology reports and through direct review of subjects’ electronic medical record (EMR).  The five subject risk factors assessed included age (i.e. ≥ 18 years, 19-64 years,  65 years), residence prior to admission, hospitalization within  30 days (admission  48 hours), antimicrobials within ≤ 30 days ( 1 dose(s) of antimicrobials), and hospital unit (i.e. intensive care unit [ICU] versus non-ICU).  Residence immediately prior to admission was classified as healthcare (HC) facility setting (i.e., skilled nursing facility, long-term care facility, or nursing home) or community setting (i.e., home or assisted-living facility, etc.) as documented in the EMR.  The impact of antimicrobial susceptibility was further analyzed when one and two subject factors (i.e., age  65 years and healthcare facility) were present.


Data Analysis

Descriptive statistics (N, %) were reported on all variables. To compare the difference in susceptibility between the two antibiograms and the differences with regard to subject risk factors, Chi-square or Fisher’s exact test were performed. In all analyses, a two-tailed p-value of < 0.05 was considered statistically significant. All statistical calculations were performed using SPSS, version 20.0.13 Sample sizes of antimicrobial susceptibility and risk factors varied for each urinary isolate. As a result, variables were weighted to account for unequal sample sizes.


RESULTS

There were a total of 2,284 urinary isolate encounters from January 1 to December 31, 2012. Of the 2,284 urinary isolates, 1,509 (66%) had a documented ICD9-code for primary or secondary UTI diagnosis. Subject background characteristics are shown in Table 1.


Standard Antibiogram

Most antimicrobial susceptibilities are > 80% for the four isolates, consistent with CDC recommendations of  80% susceptibility for empiric antimicrobial use. However, there are a few antimicrobials that are < 80% susceptible to more than one isolate. For example, the susceptibility of ciprofloxacin is 71% for EC, 56% for PM, and 76% for PA; ampicillin and ampicillin-sulbactam susceptibility is 48% and 61% for EC; trimethoprim-sulfamethoxazole susceptibility is 71% for EC and 68% for PM.  The prevalence of ESBL-producing pathogens is greatest with PM isolates (10%). Missing cells represent unavailable susceptibility data due to a drug not routinely tested for a specific isolate or < 30 isolates.


Urinary Antibiogram

Of the 5,415 included gram negative isolates, 2,284 were obtained from urinary cultures (Table 2). Overall, antimicrobial susceptibility was greater in the urinary antibiogram when compared to the standard.  Consistent with susceptibility in the standard antibiogram, ciprofloxacin was 77% (P < 0.001) susceptible to EC and 62% (P = 0.152) susceptible to PM; ampicillin and ampicillin-sulbactam were 58% (P < 0.001) and 67% (P < 0.001) susceptible to EC respectively; trimethoprim-sulfamethoxazole was 76% (P = 0.001) susceptible to EC and 74% (P = 0.161) susceptible to PM. The susceptibility of levofloxacin is presented in the urinary antibiogram, but is not commonly reported nor displayed in the standard antibiogram as it had non-formulary drug status at the time of the current study. In addition, there were a greater percentage of urinary ESBL-producing isolates in comparison to the standard antibiogram, with the largest incidence seen in urinary PM isolates at 18% (P = 0.004).


Impact of Individual Subject Risk Factors on Antimicrobial Susceptibility for Urinary Isolates

Overall, HC facility had the greatest impact on antimicrobial susceptibility. Minimal to no impact was seen when hospital unit was considered for each of the four urinary isolates. Fluoroquinolone susceptibility was greatly impacted by subject factors, specifically HC facility and age  65 years. All five risk factors were obtainable from subject’s EMR except for prior residence data on 63 encounters.


E. coli

The susceptibility of ampicillin, ampicillin-sulbactam, ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole was < 80% prior to stratification and decreased further upon stratification of risk factors. Of the five risk factors, all except hospital unit impacted susceptibility.  The largest impact resulted when EC was stratified to HC facility. The susceptibility was decreased by > 50% for ciprofloxacin (49% vs. 81%, P < 0.001) and levofloxacin (50% vs. 82%, P < 0.001).   Age also impacted the susceptibility of fluoroquinolone with ciprofloxacin decreasing from 94% to 81% and 70% respectively (P < 0.001), and levofloxacin decreasing from 95% to 82% and 70% respectively (P < 0.001) when stratified to age (≤ 18 years, 19-64 years,  65 years). Similar outcomes resulted in subjects with hospitalization and antimicrobial exposure ≤ 30 days (Table 3).


P. mirabilis

Stratification of PM isolates showed similar results to EC. The susceptibility of ampicillin, ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole was < 80% prior to and after risk factor stratification. HC facility was shown to have the largest impact on susceptibility with fluoroquinolone susceptibility decreasing by approximately 40%. However, the susceptibility of ciprofloxacin (38% vs. 77%, P < 0.001) and levofloxacin (47% vs. 79%, P < 0.001) was < 80% in both the HC facility and community setting. When stratified by age group, susceptibility decreased for ciprofloxacin (100% vs. 66% vs. 54%, P < 0.001) and levofloxacin (100% vs. 70% vs. 60%, P < 0.001). Aminoglycoside susceptibility increased in subjects  65 years old compared to subjects 19-64 years (gentamicin 94% vs. 83%; tobramycin 89% vs. 94%).  Hospitalization and antimicrobial exposure ≤ 30 days had minimal impact on susceptibility (Table 4).


K. pneumoniae

Susceptibility of all antimicrobials in the urinary antibiogram was > 80%. Of the risk factors, HC facility had the greatest impact on susceptibility. The susceptibility of ciprofloxacin (79% vs. 94%, P < 0.001) and levofloxacin (79% vs. 94%, P < 0.001) was decreased, in comparison to susceptibility in the community respectively, but remained near 80% in the HC facility setting. Age had minimal impact on susceptibility in contrast to results seen for EC and PM isolates. The susceptibility of aminoglycosides was > 80% when stratified to risk factors; however gentamicin susceptibility was minimally impacted in comparison to tobramycin (Table 5).


P. aeruginosa

The urinary antibiogram demonstrated 75% susceptibility to ciprofloxacin and 78% to imipenem-cilastatin. HC facility residence, versus community residence, significantly impacted susceptibility resulting in > 30% decrease in susceptibility of fluoroquinolones (ciprofloxacin 50% vs. 90%, P < 0.001; levofloxacin 50% vs. 79%, P = 0.001), carbapenems (imipenem 70% vs. 97%, P < 0.001; meropenem 71% vs. 96%, P < 0.001), gentamicin (63% vs. 85%, P = 0.004), piperacillin-tazobactam (70% vs. 100%, P < 0.001), and aztreonam (65% vs. 92%, P < 0.001).   Susceptibility was increased in subjects hospitalized and exposed to antimicrobials within ≤ 30 days; this finding was not seen with the other three isolates (Table 6).


Impact of Two Risk Factors on Antimicrobial Susceptibility for Urinary Isolates

Study results determined HC facility and age  65 years, individually, had the greatest impact on antimicrobial susceptibility. Susceptibility was further assessed to determine the impact with the inclusion of both risk factors. Similar antimicrobial susceptibility findings were noted for EC and PM isolates when stratified to both, HC facility and age  65 years, and individual risk factors.

Susceptibility for EC, PM, and KP isolates did not fall below 80%, except for fluoroquinolone susceptibility to EC and PM in which susceptibility of ciprofloxacin (EC 49%; PM 38%) and levofloxacin (EC 50%; PM 46%) was < 80% when stratified to individual risk factors.  The susceptibility of antimicrobials in PA isolates was < 80%, except for tobramycin at 90%, and similar to susceptibility findings of individual risk factors.  Of the antimicrobials for PA, the susceptibility of cefepime was significantly impacted with a decrease to 49% susceptibility in subjects from a HC facility and age  65 years, in comparison to 100% susceptibility in subjects from the community and age < 65 years (Table 7).


DISCUSSION

UTIs, commonly caused by gram negative bacteria, are frequently occurring infections encountered in clinical practice. Resistance to gram negative isolates has significantly increased over the years with only 10 new FDA approved antimicrobials since 1998 and very few in the pipeline,14 making empiric antimicrobial selection challenging for clinicians. In addition to a hospital’s standard antibiogram, the Infectious Diseases Society of America (IDSA) has published guidelines on antimicrobial therapy for UTIs.   Nitrofurantoin and trimethoprim-sulfamethoxazole are recommended first-line agents for acute uncomplicated cystitis.15 However, these antimicrobials are not routinely recommended as empiric therapy at our institution. Nitrofurantoin is contraindicated in patients with an estimated creatinine clearance of less than 60 ml/min, excluding the majority of our patient population, and trimethoprim-sulfamethoxazole has a high rate of local resistance with susceptibility at 76% for EC and 74% for PM.     

An additional concern with nitrofurantoin in the hospital setting is that it is only indicated for acute uncomplicated cystitis and should be avoided in systemic infections. The susceptibility of nitrofurantoin in the urinary antibiogram was > 90% for EC, but < 30% for KP isolates. It may however, be considered for patients without contraindications for the appropriate indication.

Overall, the urinary antibiogram demonstrated an increase in antimicrobial susceptibility and the prevalence of ESBL-producing EC, PM, and KP urinary isolates in comparison to our current standard antibiogram. Susceptibility was greater in our institution’s urinary antibiogram than susceptibility findings in the WISCA-UTI. This may be a result of analyzing the susceptibility of four causative gram negative urinary isolates individually versus combining all likely isolates causative of a UTI as demonstrated in the WISCA-UTI.12

Common pathogens of community-acquired and hospital-acquired UTIs at ALGH/AHC may be empirically treated with ciprofloxacin ± gentamicin or tobramycin. However, current literature suggests a global increase in fluoroquinolone resistance in gram negative pathogens over the years. The Study for Monitoring Antimicrobial Resistance Trends (SMART) began tracking likely gram negative UTI isolates in 2009. From 2009-2010, a total of 3,845 gram negative isolates were submitted from hospitalized patients and of these, 1,116 (29%) isolates were resistant to fluoroquinolones.16 Fluoroquinolones, aminopenicillin, cephalosporins, and penicillin prior use,17 in addition to recurrent UTIs and female sex18 are factors associated with increased antimicrobial resistance in community-acquired UTIs with ESBL-producing pathogens, namely EC. Fluoroquinolone resistance was portrayed in our institution’s standard and urinary antibiogram with the greatest impact on susceptibility in EC, PM, and PA isolates. Although there was no susceptibility data for levofloxacin in the standard antibiogram, in an effort to determine differences amongst the class, levofloxacin data was included. Presumably due to high use in the community and HC facility, levofloxacin has poor susceptibility similar to that found with ciprofloxacin.

Recent studies suggest frequent fluoroquinolone use in nursing home residents with poor susceptibility.12,19 Our study demonstrated a significant difference in ciprofloxacin susceptibility between HC facility and community residence for EC (ciprofloxacin 49% vs. 81%, p < 0 .001) and PM (ciprofloxacin 38% vs. 77%, p < 0.001) isolates. Overall antimicrobial susceptibility was decreased in all four urinary isolates when stratified to HC facility. This was not a surprising finding as HC facility residence is a well-known risk factor on susceptibility.

Another known risk factor contributing to antimicrobial resistance is age. The incidence of certain uropathogens and antimicrobial resistance was greater in the elderly than other age groups owing to the increase in number and duration of hospital admissions with age.20 Our study findings correlate with current literature demonstrating minimal impact on antimicrobial susceptibility in subjects ≤ 18 years old in comparison to subjects 19-64 and ≥ 65 years old. Of the antimicrobials, fluoroquinolone susceptibility was significantly decreased across older age groups. Ciprofloxacin susceptibility was significantly decreased in subjects  65 years in contrast to young children for EC (70% vs. 94%), PM (54% vs. 100%), and PA (74% vs. 93%) isolates respectively presumably due to low use of fluoroquinolones in children. As a result of the findings in fluoroquinolones, our empiric use guidelines will be modified to include a warning about use in patients  65 years and nursing home residents. Contrary to the fluoroquinolones, aminoglycoside susceptibility increased for PM isolates in subjects  65 years.  This finding may be owed to therapeutic drug monitoring of aminoglycosides and increased renal dysfunction in this population.

Recent hospitalization and antimicrobial use within ≤ 30 days of a documented gram negative urinary pathogen had little to no impact on antimicrobial susceptibility. Hebert et al., observed a decrease in antimicrobial susceptibility when stratified to recent ER or inpatient visit in the past 6 months and fluoroquinolone exposure in the past 30 days. The greatest impact was seen with recent fluoroquinolone exposure decreasing ciprofloxacin’s susceptibility from 62% vs. 20%.12 There is not strong evidence suggesting an average duration of antimicrobial use in which resistance begins to develop, however recent data suggests frequent or inappropriate use of antimicrobials leads to increased resistance.21 In contrast to another published study, our study demonstrated an increase in susceptibility with recent hospitalization and antimicrobials use within ≤ 30 days of a documented gram negative pathogen for PA isolates.22 Anderson et al. also found the reliability of antimicrobial susceptibility to PA pathogens to be shorter in the ICU.22 However, our study did not observe a difference in susceptibility when stratified by hospital unit, but this may be due to the fact that there were few urinary cultures obtained in the ICU setting to conduct an appropriate analysis. A limitation to our findings may be due to specific inclusion parameters of  1 antimicrobial doses and recent hospitalization for  48 hours within 30 days that supersede the most resistant cultures.

There are several potential limitations to our study. The urinary antibiogram was created following the same procedures as the standard antibiogram annually produced by the microbiology laboratory. The urinary antibiogram one year of susceptibility data and included all first isolates; unless multiple cultures were obtained during one admission then the most resistant was included. All urinary isolates were included regardless of a CFU/ml threshold or documented ICD-9 code for a primary or secondary UTI diagnosis. Risk factors for urinary isolates were collected through manual chart review and culture data. The manual data collection process was time consuming and limiting in terms of reproduction. A better system is needed to help streamline culture data to have more up-to-date antimicrobial susceptibility information that includes or incorporates patient risk factors.


CONCLUSION

Our study revealed increased susceptibility with a syndromic antibiogram and the impact of risk factors on antimicrobial susceptibility, concerning specifically age and residence prior to admission. An institution’s ability to incorporate risk factors along with isolate specific susceptibility would better aid clinicians in selecting a more appropriate empiric therapy for the individual patient and diagnosis.


ACKNOWLEDGEMENTS

We thank the Department of Pharmacy and the Russell Institute for Research and Innovation, Advocate Lutheran General Hospital, as well as the Department of Microbiology, ACL Laboratories, for their support at all stages of this study.


 
REFERENCES
  1. Kallen AJ, Srinivasan A. Current epidemiology of multidrug-resistant gram-negative bacilli in the United States. Infect Control Hosp Epidemiol 2010;31:S51-54.
  2. NNIS System; Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Center for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003; 31(8):481-498.
  3. Jones RN. Resistance patterns among nosocomial pathogens: trends over the past few years. Chest 2001; 119(2)(suppl):397S-404S.
  4. Fridkin SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med 2001; 29(4)(suppl):N64-N68.
  5. Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA. Attributable Hospital Cost and Length of Stay Associated with Health Care-Associated Infections Caused by Gram-Negative Bacteria. Antimicrob Agents Chemother 2010 Jan; 54(1): 109-115.
  6. Stone PW, Larson E, Kawar LN. A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000. Am J Infect Control 2002;30:145-152.
  7. Lee S, Kim Y, Chung DR. Impact of discordant empirical therapy on outcome of community-acquired bacteremic acute pyelonephritis. J Infect 2011;62:159-164.
  8. Micek ST, Welch EC, Khan J, et al. Resistance to empiric antimicrobial treatment predicts outcomes in severe sepsis associated with gram-negative bacteremia. J Hosp Med 2011;6:405-410.
  9. Zilberberg MD, Shorr AF, Micek ST, et al. Hospitalizations with healthcare-associated complicated skin and skin structure infections; impact of inappropriate empiric therapy on outcomes. J Hosp Med 2010;5:535-540.
  10. Paul M, Shani V, Muchtar E, Kariv G, Robenshtok E, Leibovici L. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother 2010;54:4851-4863.
  11. Lueangarun S, Leelarasamee A. Impact of inappropriate empiric antimicrobial therapy on mortality of septic patients with bacteremia: a retrospective study.  Interdiscip Perspect Infect Dis 2012 Aug; 1-13.
  12. Hebert C, Ridgway J, Vekhter B, Brown EC, Weber SG, Robiscek A. Demonstration of the Weighted-Incidence Syndromic Combination Antibiogram: An Empiric Prescribing Decision Aid. Infect Control Hosp Epidemiol 2012;33:381-388.
  13. IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.
  14. Doron S, Davidson LE. Antimicrobial Stewardship. Mayo Clin Proc 2011 Nov;86(11): 1113-1120.
  15. Gupta K, Hooton TM, Naber KG, et al.  International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103-120.
  16. Bouchillon S, Hoban DJ, Badal R, et al. Fluoroquinolone Resistance Among Gram-Negative Urinary Tract Pathogens: Global Smart Program results, 2009-2010. Open Micro J 2012;6:74-8.
  17. Rodrigueq-Bano, J, Alcala JC, Cisneros JM, et al.  Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli.  Arch Intern Med 2008 Sept;168(17):1897-902.
  18. Meier S, Weber R, Zbinden R, et al. Extended-spectrum ß-lactamase-producing Gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy. Infection 2011 Apr;39(4):333-40.
  19. Das R, Perrelli E, Towle V, et al.  Antimicrobial Susceptibility of Bacteria Isolated from Urine Samples Obtained from Nursing Home Residents.  Infect Control Hosp Epidemiol. 2009 Nov; 30(11):1116-1119.
  20. Linhares I, Raposo T, Rodrigues A, et al. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study. BMC Infect Dis 2013;13:1-14.  
  21. Mandal J, Srinivas Acharya N, Buddhapriya D, et al. Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant Escherichia coli. Indian J Med Res 2012 Nov;136(5):842-49.
  22. Anderson DJ, Miller B, Marfatia R, et al. Ability of an antibiogram to predict Pseudomonas aeruginosa susceptibility to targeted antimicrobials based on hospital day of isolation. Infect Control Hosp Epidemiol 2012 Jun;33(6):589-93.





PTCB Announcements

Dear State Associate:

As noted in the June/July issue of the State Associate Brief, we have created new section on PTCB's web site for State Associates to access PTCB marketing materials and a regularly updated map reflecting legislative and regulatory activities for each state. State Associates may distribute the marketing materials at meetings and events and place them in publications and communications. To access this new section which is password-protected, please use this username: ptcbsaprogram and password: sapresources.

For other PTCB information and programs including the general State Associate page, please visit us at www.ptcb.org.



Another reminder: PTCB's updated PTCE Exam begins November 1, 2013. Click here to learn more.



Columns

President’s Message
People Don’t Care How Much We Know Until…

by Tom Westerkamp, ICHP President

A year ago, I selected the theme of “Caring” for ICHP and asked members to reconnect with their patients, to be compassionate, to make a difference, and to get involved. I reminded all of us of why we chose careers in pharmacy, and how important it is to show others that we care. After talking to dozens of members, including students and technicians, I know that many of our members do care, do get involved, and do make a difference. I was thrilled and so proud to see that the New Practitioners Network and several student chapters participated in charity events again this year, proving that ICHP does care, and that pharmacy is a caring profession.

Since the Annual Meeting in September 2012, this year has flown by for me. It started with our Leadership Retreat where we put into motion a plan to continue to make ICHP more relevant and more responsive to its members. I attended local affiliate meetings, Director of Pharmacy dinner meetings, a Clinical Practitioners networking meeting, and Board of Directors meetings. I met a fantastic group of students on Legislative Day, got interviewed by students for a senior class project, and squeezed in trips to my alma mater to represent ICHP at the Senior Awards Night and White Coat Ceremony. What a year!

I have met many members this past year and learned so much. I am now more convinced than ever that ICHP is a vibrant professional organization, with an outstanding office staff, and we, as a team, are headed in the right direction. Is everything in Springfield going well and are all practice issues resolved? No, there are challenges facing us, but I know that ICHP is well-positioned to continue to respond, is always there to inform and support its members, is one of the best local providers of continuing education, and without a doubt helps provide direction for the practice of pharmacy.

I am grateful to Scott, Trish, Maggie, Jan, Jo, Heidi and Amanda for their dedication, to Chris Rivers for her guidance, to the Executive Committee for their insights, and to the Division Directors and the many committee members for their efforts in carrying out the strategic plan. I want to acknowledge the efforts of the student chapters and their advisors at the colleges for keeping us informed of their activities, and for pulling together the first Student Leadership Retreat. I also want to thank Jacob Gettig and Jen Phillips for their editorial assistance with KeePosted, and the hard work done by the Regional Directors and the local affiliates. These individuals work hard without much attention or fanfare, and deserve the entire organization’s recognition and gratitude.

As I pass the baton into the experienced hands of our new ICHP president, Mike Fotis, I leave you with a famous quote that applies really well to the pharmacy profession we have all chosen, and regardless of where we practice, should remind all of us how important it is to care:

“The high road to service is travelled with integrity, compassion, and understanding…People don’t care how much we know until they know how much we care.”  Author Unknown

It has been an honor and a privilege to lead this organization this past year and have the opportunity to work closely with such a dedicated, caring team.

Thanks for caring…



Directly Speaking
The Movers and the Shakers

by Scott A. Meyers, Executive Vice President

On Friday evening, September 20th, I had the privilege and pleasure to stand before nearly 250 pharmacists, pharmacy technicians, pharmacy students, ICHP staff, their spouses and guests and speak about ICHP Leaders. Many of those leaders were sitting right there in that beautiful ballroom! Most all of them are my good friends and those that aren’t will hopefully become ones soon!

I began with this quote from Benjamin Franklin – “All mankind is divided into three classes: those that are immoveable, those that are moveable and those that move.”

I couldn’t agree more! For 50 years, the Illinois Council of Health-System Pharmacists has been an organization of movers and shakers! There can be no argument with that. The leaders of ICHP have made the profession move forward pulling, pushing and prodding those who would move and leaving behind those who would not. From the early 1940s when hospital pharmacy was just beginning to establish itself as a career path for pharmacists, those early leaders began laying a strong foundation for ICHP.

While I wasn’t around in the early days of the Council, then the Illinois Council of Hospital Pharmacists, I have had the pleasure of meeting, working with and truly getting to know many of those early ICHP pioneers. Over the past 36 years, I’ve spent many long conversations with Herb Carlin, ICHP’s 2nd Chairman; Sister Mary Louise Degenhart, ICHP’s 3rd Chairman; ICHP’s 7th President Weldon Johnson; and its 12th President, Harland Lee. As a matter of fact, I’ve met and gotten to know all but 6 of ICHP’s Past Presidents or Chairmen and worked with 37 of the 50 ICHP Presidents during my career as a volunteer and now as staff member of the Council. I’ve learned a lot from these incredible leaders! In addition to the Presidents I’ve already mentioned, I’ve had the pleasure of working with early leaders like David Vogel, lost way before his time, Lee Simon, Marcia Palmer, Dennis Tribble and Bill Wuller. I enjoyed working with presidents who were more my contemporaries like Caryn Bing, Mary Moody, Steve Marx, Bruce Dickerhofe, Andy and Ed Donnelly, Kevin Colgan, Trish Wegner, Tom Westerkamp, and don’t forget the Mikes - Mike Novario, Mike Rajski, Mike McEvoy, Mike Weaver, Mike Short, and now Mike Fotis. And more recently I’ve had the pleasure of working with younger leaders like Ann Jankiewicz, Carrie Sincak and Chris Rivers. The presidential line at ICHP is full of movers.

But ICHP has benefited from the efforts of more leaders who never became or have yet to become its President. The Council’s success has also relied upon the commitment to its activities and objectives by its past and current Board Members and its legions of volunteers. Without the individuals who did the heavy lifting whenever asked, ICHP would not have accomplished all that it has. People like Regis Kenna, Charlie Lev, Louie Gdalman, Roger Klotz, Sister Margaret Wright, Ernie Steinbaugh, Mary Maranti, Ron Betz, Karen Nordstrom, Jim O’Donnell, Kathy Chase, Kathy Benderev, Edna Dooley, Ken Witte, LeRoy Hayes, Helen Calmes, Nan Lundquist, Alan Weinstein, Jackie Kessler, Miriam Mobley-Smith, Mary Ann Kliethermes, Linda Fred, Mary Lee, Jan Keresztes, Holly McMaster, John McBride, Brian Kawahara, Jacob Gettig, Jennifer Phillips, Stan Kent, Kathy Komperda, and many, many more through their many years of dedication, have made and will make ICHP and Pharmacy stronger. And the best news for ICHP is that the pipeline continues to feed us more volunteer rising star leaders like Desi Kotis, Kathryn Schultz, Jennifer Ellison, Jennifer Arnoldi, Scott Bergman, Ginger Ertel, Mark Luer, Liz Engebretson, Diana Isaacs, Sheila Allen, Antoine Jenkins, Fatima Ali, Lisa Lubsch, Pete Antonopoulos and many more to come! I see a long line of Presidential candidates in this pipeline! I apologize if I’ve missed anyone, but being involved as a volunteer and staff member of ICHP for 29 years and a member for 37 means I’ve met quite a few outstanding pharmacists, technicians and students!

But ICHP’s leaders’ legacy goes much further! The Council has been fortunate to have been a training ground for four ASHP Presidents, Herb Carlin, Mick Hunt, Kevin Colgan and Stan Kent, and a fifth if you count Paul Abramowitz, ASHP’s current Executive Vice President and CEO, having been elected President of ICHP only to leave for Minnesota just prior to the beginning of his term of office. And let us not forget the role Henri Manasse played while at the University of Illinois as its Dean, working with the Council and seeking ICHP’s input and support on many efforts, not the least of these being the movement to the Pharm.D. degree. And yes, youngsters, that was a controversial issue at one time not so long ago! Who knew that years later, ICHP would work with Henri again, in a completely different capacity as he led ASHP from 1997 through 2011 as its Executive Vice President and CEO!

ICHP members have also ventured forth and served in leadership roles in other organizations. Herb Carlin served as not only an ICHP and ASHP President but also as an APhA President. Jan Engle, an ICHP member for many years, served not that long ago as another APhA President from Illinois. Two Illinois Deans have served as the President of the American Association of Colleges of Pharmacy, Henri Manasse and Jerry Bauman, and Jerry also served as the President of the American College of Clinical Pharmacy.

As you can see, ICHP has been blessed with great leaders! And in turn, ICHP has shared these leaders to bless all of Pharmacy! It’s not hard to see why ICHP has been so successful, you just need to look around and see all of its leaders! All of its movers and shakers!



ICHPeople

Jerry BaumanCongratulations to ICHP Member, Jerry Bauman, who was appointed to serve a 2-year term on the Pharmacotherapy Board of Directors for the American College of Clinical Pharmacy (ACCP). For more, please visit http://www.accp.com/report/index.aspx?iss=0913&art=12.





Adina MayaCongratulations to ICHP member, Diana Isaacs! She and her husband welcomed baby girl, Adina Maya, on Tuesday, September 10 at 9:41am. Baby was 7 lbs, 11 oz and 20.5 in long and all are doing well.



Leadership Profile
Elizabeth Engebretson, CPhT

What is your current leadership position in ICHP?
ICHP Board Member; Technician Representative

Where did you get your pharmacy technician certification?
William Rainey Harper College, Palatine, IL.

Trace your professional history since certification: where have you trained / worked any special accomplishments?
Once I was certified I knew at once that I wanted to work in a progressive hospital, preferably a teaching hospital. My first position was with Northwestern Memorial Hospital. From there, I went to work for Evanston Hospital after a teacher from Harper College contacted me about a job there. Working in the IV room was my preference, where I staffed most of the time.  After leaving Evanston Hospital, I took a position with a home health care facility. I started there in the IV room and later moved to purchasing coordinator. That purchasing experience has carried over to each job I’ve had since then. My next position, in a clinic pharmacy, required that I be a certified pharmacy technician. In addition to my regular duties of preparing prescriptions, the budget, inventory and accounting were the responsibility of the technician.  It was a unique and educational experience.  From there I was recruited back to Evanston Hospital by a former supervisor as Lead Pharmacy Technician, where I work today.

Describe your current area of practice and practice setting.
I am one of two Lead Pharmacy Technicians at Evanston Hospital. My area of responsibility is for IV services for inpatient and operating room pharmacies. I train both pharmacists and technicians to be IV certified and re-certify them yearly. Our hospitals and medical practices are 100% electronic physician order entry (EPOE) with bedside bar code medication verification.

What initially motivated you to get involved?
I read an article in the Chicago Tribune about certificate programs for pharmacy technicians. That motivated me to look for a program nearby. I was in the first year of a pharmacy technician certificate program offered at Harper College. I also took the first Illinois technician certification test offered through ICHP.

And what benefits do you see in being active in a professional association such as ICHP? 
The first benefit is education; it is so important to hear and learn about what is new in the pharmacy profession. The second benefit is learning how and why pharmacy is a prominent beneficial member of multidisciplinary teams. Thirdly, having the opportunities to see and learn how peers, educators, employers, institutions etc. struggle with, address, and/or resolve concerns similar to yours. Lastly, exposure to national associations such as ASHP (American Society of Health-system Pharmacists),learning about legislation that could affect my practice though the KeePosted, the “Legislative Day” trip to Springfield (where I learned so much!), and onsite access to vendors and educators at both state meetings are also benefits.

Is there an individual you admire or look up to, or a mentor that has influenced your career?
Susan Moreland-Wilkins for her guidance, perspective and advice which I trust and value.

Do you have any special interests or hobbies outside of work?
Gardening at home and local garden walks
Art Galleries and museums
Embroidery and drawing

Do you have a favorite restaurant or food?
Lady Baltimore Cake and Intelligentsia Coffee

What is your favorite place to vacation?
The island of St. Martin or Smithsonian Museum in Washington, DC

What is the most interesting/unique fact about yourself that few people know?
I used to be scared to death of needles and syringes, now they are a daily part of my work. 

What 3 adjectives would people use to best describe you?
Diligent, detail-oriented and knowledgeable


Medication Safety Pearl
List of Peer Reviewers for Medication Safety Pearls

The following individuals reviewed medication safety pearls published between October 2012 – September 2013.  The Division of Professional Affairs thanks them for their insight and efforts.

Jaime Borkowski
Diana Isaacs
Kim Janicek
Mary Lee
Jen Phillips
Nicole Rabs
Jeff Wieczorkiewicz
Rebecca Zaworski



The GAS from Springfield
Slow and steady wins the race!

by Jim Owen and Scott Meyers

As usual we’re referencing the tortoise and the hare, one of Aesop’s fables when we use that term and we compare it to a process that seems to take forever while slowly moving forward. That’s the case on the most recent update of the Pharmacy Practice Act Rules. But that’s just fine with us because we want to make sure everyone has a chance to weigh in on the drafts and that even if you don’t like what you see, you can begin to prepare for the inevitable.

This draft of rules has a couple of inevitable issues that some will dread and other embrace. According to the first draft and what we’ve hear about the second one, soon to be released, compounding in general will be governed by USP-NF standards. A majority of States have already adopted USP Chapter 797 and the accrediting agencies are looking for compliance if you mention that chapter anywhere in your policies. While the jury is out on the overall impact of implementing 797, it has to be better than what we’ve heard some pharmacies are doing! In discussions with the Department staff, it is clear that they understand the impact this requirement will have on many facilities and they also understand that compliance will come with a price tag and significant delays for planning, construction and training. We will work with them to provide as much guidance as possible regarding enforcement timelines. We won’t desert you!

An issue to truly be embraced is the opportunity to implement Tech-Check-Tech in onsite institutional pharmacy practice. Hospitals with established clinical pharmacy programs (no definitions in the rules but you had better make sure what you sell as a clinical program is easily defensible) may use Certified Pharmacy Technicians to check the filling of other technicians (Certified or non-certified) for floor stock, automated dispensing and storage systems, and unit dose cart fills. The pharmacists must conduct on-going quality assurance to ensure effective checking and the Pharmacist-In-Charge (PIC) must establish appropriate training and validation processes for the Certified Pharmacy Technicians involved in the checking. Policies and Procedures will also be an intricate part of this process. This process does provide a great opportunity to get more pharmacists out on the patient care units and provides some of your Certified Pharmacy Technicians with more responsibility and job satisfaction.

There are a lot of small issues the rules address and we’ve provided feedback on many of them. The next draft of the rules should be out shortly so watch your email for a notice of their posting on the ICHP Website.

In other governmental news, the good news is that there is no election this year! The bad news is the ICHP Pharmacy Action Fund contributions reflect that. Plus the fact that we did not conduct a fundraiser at either the Spring Meeting or Annual Meeting this year. We will be kicking it up a notch come next legislative session because 2014 will not only feature an election of all the House and a good portion of the Senate in Illinois but also all of the State’s constitutional officers are up for election. There have been a variety of candidates jump into the Governor’s race, and a few have already jumped out! It should be a fun one.

If you have ever thought of getting more involved in ICHP, and if you’ve gotten this far in this article, chances are you’re ready to join the Division of Government Affairs. A monthly conference call and a trip to Springfield in March is usually all we ask of members of the division along with the occasional bill review responsibility when the legislature is in session. If this sounds like something you’re ready for, give Scott a call at (815) 227-9292 or drop him an email at scottm@ichpnet.org. We’ve got plenty of room for you!



New Practitioners' Network
Obtaining Certifications: What Do All Those Letters Mean?

by Diana Isaacs, PharmD, BCPS, BC-ADM

The job market for pharmacy is getting tighter. One way that new practitioners can distinguish themselves from other graduates is by obtaining certification. This article will provide an overview of the different types of certifications available to pharmacists along with specific requirements and where to go for more information. As a caveat, these requirements may not be all-inclusive and may change over time. For the most up to date information, please check out the specific organization websites listed in each section.

BPS (Board of Pharmacy Specialties)
BPS certification is only available to pharmacists, unlike many of the disease state certifications which are open to a variety of healthcare professionals. BPS certification includes ambulatory care pharmacy (BCACP), nuclear pharmacy (BCNP), nutrition support pharmacy (BCNSP), oncology pharmacy (BCOP), pharmacotherapy (BCPS), and psychiatric pharmacy (BCPP). Pediatric pharmacy and critical care pharmacy have also been approved with the initial exams expected to be offered in 2015. The exams are offered annually. In order to be eligible for any of the BPS certifications, one must have graduated from an ACPE accredited pharmacy program, have an active pharmacy license, and pass the respective exam. Each specialty has additional training requirements. For example, to be eligible for BCPS, the pharmacist must complete a PGY-1 residency or have three years of pharmacy experience with at least 50% of the time spent in direct pharmacotherapy related activities. To be eligible for nuclear pharmacy, one must have 4000 hours of training/experience in nuclear pharmacy practice. Please see the BPS website for specific requirements for the other specialties. There is also an option to obtain added qualifications in cardiology (AQ-Cardiology) or infectious diseases (AQ-ID), which require submitting a portfolio documenting specific training and experiences in these areas. The duration for all of the BPS certifications is seven years. During that time, one can recertify by obtaining 120 hours of continuing education (CE) credit specifically approved by BPS or taking a recertification exam.

Disease State Certifications:
These certifications are for those who desire to specialize in a specific disease state. They are generally open to other healthcare professionals with the exception of the geriatrics and the HIV specialized pharmacist certifications, which are only available to pharmacists. Many require a minimum amount of experience working with the respective disease state.

Anticoagulation: For those that work in anticoagulation, one can become a  Certified Anticoagulation Care Provider (CACP). Eligible candidates must be licensed in the respective health profession for at least two years and have completed 750 hours of active anticoagulation patient management accrued in the 18 months prior to submitting the application. There is also an exam which is offered two to three times per month. Recertification is required every five years.

  • National Certification Board for Anticoagulation Providers website for CACP: www.ncbap.org

Asthma: Those who specialize in asthma education can become a Certified Asthma Educator (AE-C). To obtain this certification, individuals must have an active license in the respective health profession, document a minimum of 1,000 hours of direct patient asthma education and counseling, and pass the exam which is available year round. Recertification by exam is required every seven years.

  • National Asthma Educator Certification Board website for AE-C: www.naecb.org

Diabetes: There are two diabetes certifications which include the Certified Diabetes Educator (CDE) and the Board Certification in Advanced Diabetes Management (BC-ADM). These are intended for healthcare professionals who have job responsibilities that include the direct provision of diabetes self-management education (DSME). The CDE requires proof of licensure, a minimum of two years of professional practice experience in the discipline (ex. as a registered pharmacist), 1000 documented hours of DSME experience with a minimum of 400 hours in the past year, 15 hours of diabetes related CE credit in the past two years, and passing the exam. The CDE has two annual testing windows in the fall and the spring. The BC-ADM requires an advanced level degree (ex. PharmD), 500 hours within the past two years in advanced diabetes management, and passing the exam. The BC-ADM test is available twice per year in June and December. Both the CDE and BC- ADM require renewal every five years.   

Geriatrics: Those that work with the geriatrics population can become a Certified Geriatric Pharmacist (CGP). Applicants must have a minimum of two years as a licensed pharmacist and pass the exam. There are four testing windows throughout the year. Recertification is required every five years.

  • Commission for Certification in Geriatric Pharmacy website for CGP: www.ccgp.org

HIV Management: The American Academy of HIV Medicine offers certifications for HIV Expert (AAHIVE) and HIV Specialized Pharmacist (AAHIVP). AAHIVP was introduced in 2011 and is specific to pharmacy and is different from the HIV Specialist (AAHIVS), which is open to other healthcare professionals, exclusive of pharmacy. To obtain the AAHIVP, pharmacists must hold an active license and have direct, ongoing involvement in the care of at least 20 HIV patients in the two years prior to the application.  The AAHIVE requirements are similar except that experience can be in leadership in HIV care that is obtained without direct patient care. For both certifications, a minimum of 30 HIV related CE hours must be obtained in the two years prior to application and one must pass the exam which is offered annually.

  • American Academy of HIV Medicine website for AAHIVP and AAHIVE: www.aahivm.org

Lipids: For those who provide care to patients with dyslipidemia and related cardiometabolic conditions, there is an option to become a Clinical Lipid Specialist (CLS) through the Accreditation Council for Clinical Lipidology (ACCL). While this certification is open to multiple healthcare professionals, specific requirements for pharmacists include holding an active license, having a PharmD or 1 year of postgraduate training, relevant academic practice or faculty appointment in lipid practice, clinical research or scholarly publications in the management of lipid disorders, and lipid CE.  Each of these activities is assigned points and a total of 200 points must be earned. Please see the ACCL website for specific details. Pharmacists are also required to have documented 2,000 patient care hours. A curriculum vitae (CV) detailing experience and credentials is required. The applicant must then pass the exam which is available in three testing windows each year. Recertification is required every 10 years. 

Nutrition Support: The National Board of Nutrition Support offers the Certified Nutrition Support Clinician (CNSC). Applicants must be licensed in their respective healthcare profession and pass the exam which is offered during three cycles throughout the year. It is recommended, although not required, that applicants have at least two years of experience in specialized nutrition support. Recertification is required after five years.

Pain: There are two pain certifications which include the Certified Pain Educator (CPE) and the Credentialed Pain Practitioner (CPP). To obtain CPE, a candidate must be a member of the American Society of Pain Educators (ASPE), hold a current license as a healthcare professional, have at least two years of full-time experience or four years of half-time experience in a position in which at least 10% of the time is devoted to providing pain-related education to clinical peers or patients. A minimum of 400 hours must have accrued within the last five years. The applicant must also complete at least 30 hours of pain-related CE and pass the exam, which is available throughout the year. Recertification is required every five years. To become a credential pain practitioner (CPP), one must have a current license, three typed letters of reference from colleagues rating knowledge, experience and skills related to practice as a pain practitioner, CV or resume, and pass the exam, which is available throughout the year.  Recredentialing is required every four years and during that time 100 hours of CE related to pain management must be obtained.

Certificates:
Certificates are shorter trainings based on a specific skill or therapeutic area. They are different from certifications in that they are typically done one time without the need to be maintained or renewed.  Examples of certificate programs offered through the American Pharmacists Association (APhA) include pharmacy-based immunization delivery and pharmacist and patient-centered diabetes care. The University of Florida also has several online certificates. Certificates can be included on one’s CV, but typically do not add to the letters behind the name.

Obtaining certification can help you stand out in a competitive job market; it may help you land a certain job or even earn a pay raise. Keep in mind that while accruing letters behind your name can showcase your specialized knowledge, each of these certifications requires passing an exam, which usually translates into a significant amount of time studying. The exams cost money (i.e. BPS is $600) and most require a yearly maintenance fee (i.e. $100/year for BPS), as well as a fee to recertify or obtain CE credit to maintain the certification. Therefore, one should be strategic and think carefully about career goals when deciding which certifications to pursue.

Additional Resources:





College Connections

My First Site Visit to Indian Health Services

by Tramaine Hardimon, PS-3, ICHP Board Representative, Chicago State University College of Pharmacy

The Indian Health Service (IHS) is an organization that is governed by the U.S. Department of Health and Human Services. The primary purpose of this agency is to provide adequate health care to both Native Americans and Alaskans. I had the opportunity to visit an IHS site over the summer. Before selecting a specific site to visit, I researched the various locations. I was under the initial impression that facilities were only located in the southwest section of the country. Upon further review, I found that they were dispersed throughout the United States even in the Midwest, and the South. I was shocked to discover that the reservations were so widespread.

My next course of action was to determine what opportunities were available to students. I found that sites were available in ambulatory care, institutional, and public health. I was again surprised to learn that pharmacists were able to take advantage of practicing in multiple areas within the IHS.

I spent a day at the San Xavier Health Center, which is located in the San Xavier District in southern Arizona just south of Tucson. They largely provide services to the Tohono O’odham Tribal Nation. The San Xavier Health Center offers a variety of ambulatory care services. The center believes in a comprehensive approach to patient care. It operates under an interdisciplinary fashion, employing pharmacists, nurses, dentists, physicians and other associated health professionals.

I was introduced to services such as anticoagulation and a novel program known as the Improving Patient Care (IPC) initiative, which is based on a collaborative health care model. The goal of the IPC is to manage patients’ multiple chronic disease states. I became very interested in this program because it provides pharmacists with the opportunity to provide direct patient care by performing such duties as reconciling medications. There is a special refill program that allows the pharmacist to assume the role of the provider. I found out that this sort of initiative requires a collaborative practice agreement between the pharmacist and the physician.

The pharmacist that conducted our tour was a commissioned officer with the IHS. One of the things that she impressed upon me was the importance of understanding the specific culture of the Tohono O’odham Tribe. I was taught that it was imperative to be aware of cultural convictions, especially when dealing with the individual tribes. Not all tribes are the same and belief systems can vary; there can be differences in dietary needs and recommended herbal treatments. Rituals can occur during specific times of the year, and the healthcare provider needs to be cognizant of those times since certain treatment modalities can be affected. For example, as a pharmacist, it is important to determine if medication or lifestyle adherence can be compromised during a time of spiritual refreshing. With regard to herbal treatment, I learned that it is the pharmacist’s responsibility to determine the patient’s stance on why he or she feels compelled to take a specific remedy. For instance, the pharmacist may need to determine if a patient would need to completely stop herbal treatments and just continue with medications prescribed by the physician. If it was decided that herbal treatment was not beneficial; he or she would need to explain to the patient that continued use could have adverse effects. The pharmacist would then have a dialogue with the physician for further guidance.

In conclusion, my visit to Indian Health Service proved to be a unique experience. I believe that making an effort to understand cultural issues was the most valuable lesson that I learned during my visit, and this is a skill that I wish to further develop and use for all patients I encounter. Overall, I learned to provide patient care via a team-based model; health care members with different types of training working together to achieve one common goal—optimal outcomes for the patient. The pharmacists I shadowed were very compassionate and caring with regard to each individual’s beliefs, convictions, and way of life. I believe that the ultimate goal of the IHS is to close the gap between disenfranchised communities and those with adequate access to quality healthcare.




Meet Our Executive Board

by Breanna Wyman, SIUE Class of 2015

The SSHP executive board at Southern Illinois University Edwardsville School of Pharmacy wants you to get to know our chapter! We have answered an assortment of questions to help you do just that. We hope this gives a glimpse into the unique and dynamic personalities that have come together to foster student advancement and involvement, not only in our organization but academia at large.
  • Why do you want to be a pharmacist?
  • Where do you see yourself in 5 years?
  • If you were to write a book about yourself, what would the title be?
  • If you could have an unlimited storage of one thing, what would it be?
  • If you could develop a drug to cure only 1 disease, what would it be and why?

Zak Vinson, President
My name is Zak Vinson and I grew up in the small town of Clinton, Illinois, which is about 40 miles east of Springfield. Since my freshman year in high school, I have known that I wanted to become a valuable member of the medical team. When it came time to decide on a college to attend, I started to job shadow multiple medical-based careers, and I fell in love with pharmacy. There is nothing like the impact a pharmacist can have on a patient. Whether it’s in the community setting, counseling patients on the appropriate way to take medications, or in a health-system setting, working with multiple medical professions to make life-changing decisions on patient care, a pharmacist will always be an essential part of patients’ lives. If I wrote a book about myself, it would be titled “Surviving Pharmacy School: One Disease State at a Time.” If I could cure only one disease, it would be hypertension. Hypertension is a major risk factor for numerous other disease states, so by curing hypertension, we could effectively reduce the rate of myocardial infarctions, strokes, etc.

Kimberlee Kabbes, President-Elect
My name is Kimberlee Kabbes, and I am originally from Effingham, Illinois. I want to be a pharmacist to help others by educating them about their disease states, lifestyle modifications, and proper use of medications. In five years, I hope to be a clinical pharmacist working in the field of either pediatrics or oncology. The title of a book describing my life up to this point would be, “Who Knew?” because life has taken me down paths that I would have never thought I’d be traveling down.

Megan Herman, Vice President
Hi! My name is Megan Herman and I am from a small town about an hour south of St. Louis called Ste. Genevieve, Missouri. I wanted to be a pharmacist because I like to learn how the human body works and because I love to help people. If I wrote a book about myself, the title would be “Runner’s High.” If I could have an unlimited storage of one thing it would be ice cream. If I could develop one drug to cure a disease it would be cancer. I choose cancer because I have family members and friends that are affected or have lost a loved one to the disease.

Breanna Wyman, Secretary
My name is Breanna Wyman and I am from the small town of West Union, Illinois. I completed a B.S. in Chemistry at Indiana State University before attending pharmacy school. I want to be a pharmacist because of the opportunity that this profession presents to serve as a valuable resource to the community. If I could cure 1 disease, it would be cystic fibrosis. A childhood is a precious thing and you only get one in a lifetime, and no child should have to spend it taking pills, breathing treatments, going to doctor’s appointments, and knowing that they will never be cured.

Bryant McNeely, Treasurer
I am Bryant McNeely and I am from the small town of Modesto, Illinois. I am a true small town kid and love to spend my free time outdoors. I want to be a pharmacist to not only help improve patient health, but also to help solidify the link between patients and physicians. In 5 years I hope to be working within a hospital. I would title a book about myself as “The Secret Life of a Pharmacy Student.” If I could develop a drug, I would cure all cancer. This disease claims too many lives each year to not have an effective way to treat it consistently.

Hannah Sheley, Fundraising Chair
My name is Hannah Sheley and I am from Lincoln, Illinois. I have wanted to be a pharmacist since I started working at Walgreens at 16 years of age and was so frustrated that I had to refer all patients’ questions to the pharmacist. I want to be the one answering those questions! If I wrote a book about myself it would be called “The Daily Struggle of a Pharmacy Student” describing my daily efforts to get myself ahead in my studies, which we all know rarely happens. If I could have an unlimited storage of one thing it would be chocolate, without a doubt. Also, it would never melt.

Nathan Lindley, ICHP Liaison 
My name is Nathan Lindley and I am from Bloomington-Normal, Illinois. I completed my undergraduate work at SIUE where I earned my B.S. in Biology, medical science. I feel that as a pharmacist I can have a strong impact directly on the lives of patients and indirectly through interactions with other healthcare professionals. What I would most like to have an unlimited storage of is pharmacy knowledge, but if I have to choose something tangible, I would want an unlimited storage of dress clothes. If I could develop a drug cure to any disease I would want to cure cystic fibrosis because in the past few years, I have seen the devastating effect it can have on both the children and adults affected by this disease, in addition to the tolls it can have on their friends, families, and care-takers. While the prognosis for those with cystic fibrosis has improved recently, the quality of life and life expectancy is still way too low.

Anna Arthur, Membership Chair 
My name is Anna Arthur and I am from Collinsville, Illinois. Similar to many people, I got into this field because I really wanted to help people. For me specifically, I really want to work with kids in the healthcare setting and pharmacy has always just seemed to fit for me. If I were to write a book about myself, I would title it “Busy Bee.” I would want an unlimited supply of Target (yep, the whole store counts as one thing—I would like an unlimited supply of everything in it). OK, or pumpkin spice lattes.

HollyAnn Russell, Professional Practice Chair
My name is HollyAnn Russell and I was raised in the U.S. Air Force and have lived in Texas, Alaska, North Dakota, and now Illinois. In 5 years I hope to have completed a PGY2 and be a clinical faculty member for a School of Pharmacy. If I were to write a book about myself the title would be, “I Rock!” I love rock climbing and try my hardest at everything I do, and am a strong believer that everyone has this same potential. If I could develop a drug to cure any disease it would be Alzheimer’s. My grandmother died of this disease and her state was too advanced for me to ever get to know her.


Cortney Spradling, Community Service Chair
Hi, my name is Cortney Spradling and I am from Greenville, Illinois, which is a small town about 45 minutes east of Edwardsville. I have always known that I wanted a career in the healthcare field and was attracted to pharmacy specifically. This is mainly because I have a passion to help others, but I also enjoy interacting with patients and have a strong interest in medicine. If I could have an unlimited storage of one thing, I would choose H2O. If I could develop a drug to cure a disease, it would be cancer. I would choose this because there are so many individuals who are affected by this disease in one way or another and those diagnosed with cancer are truly fighting for their life.



Takeaway from the ICHP Student Leadership Retreat

by Kevin Chang, P-2 Student, University of Illinois at Chicago

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” – John Quincy Adams

As I sat listening to Dr. Noelle Chapman at ICHP’s first Student Chapter Leadership Retreat, the aforementioned quote made my stomach turn. Even though I had been elected President-Elect of the UIC ICHP chapter several months ago, it was the presentation of this quote that made me realize just how much responsibility I had acquired. I felt as if the weight of a truck had been placed on my shoulders as I questioned whether I could do all these things for so many people. But as the presentation went on, I learned more about the true nature of a leader and the characteristics that make leaders great. It was after the days’ discussions that I came to understand what type of leader I wanted to become.

One of Dr. Chapman’s most important points on becoming a leader was to establish a “visionary self” who would direct you to who you wanted to be as a leader. Part of this vision was to create a personal mission statement that would guide you in your actions. Before the retreat, my goal going into this year was to continue the success of past events, to uphold ICHP’s professional reputation on campus, and to provide members with continued information and opportunities to learn about health systems pharmacy. However, I realized that being a visionary leader and abiding by a progressive mission statement involved more than upholding expectations; it meant exceeding expectations. As I soaked in all the knowledge Dr. Chapman was presenting about leading change, I found a sudden urge to develop my own personal mission in order to begin my path to becoming a leader. As the lecture went on, I found my goals being molded into what I believed would guide me as the future President of UIC ICHP: To better the lives of those around me through leadership and responsibility so that the individuals and organizations that I affect may be benefitted and progressed through my actions thus forth. I breathed a sigh of relief as I convinced myself that I could in fact live up to the ICHP standard of excellence. But just as I thought I had received the thumbs up from John Quincy Adams, Dr. Desi Kotis made me realize I hadn’t reached full clarity on the characteristics of a great leader just yet.

Following Dr. Chapman, Dr. Desi Kotis expanded the discussion on leadership to the pharmacy field as a whole. She explained that “we need a balance of better safety and quality care—especially chronic care—and constraining cost” and how the one thing all health care providers have in common is doing the best for the patient. I slowly began to understand that my goals as a leader were too narrow and that my purpose, like ICHP itself, should involve exceeding expectations for the field of pharmacy, ICHP, and for our future patients - not solely focusing on our school chapter’s success. My hand flew to my pen again as I wrote down the edited and most all-encompassing personal mission I could muster: To better the lives of those around me through pharmaceutical knowledge (knowledge pending), compassion, leadership, and altruism so that the field of pharmacy and the future of those I affect may be benefitted through my actions thus forth.

So now that I have rambled on about my climactic epiphanies at the leadership retreat, you may be wondering: why is he telling all of this in such excruciating detail? I shared my story because Dr. Chapman and Dr. Kotis taught me that being a leader means more than acting within your title. If you are a successful leader it involves every action you make. I now believe that my job as the future president of ICHP and the job of all student leaders of ICHP should not be to act within the bounds of our position, it should be to go beyond those bounds and to progress ICHP and the field of pharmacy to the best of our ability; in essence to “dream more, learn more, do more, and become more.”




More

Officers and Board of Directors

TOM WESTERKAMP 
President
224-948-1528 
tom_westerkamp@baxter.com

CHRIS RIVERS 

Immediate Past President 
Chairman, Nominations Committee 
708-202-7240 
criversrx@gmail.com

MIKE FOTIS
 
President-Elect 
michael.fotis@northwestern.edu 

MIKE WEAVER 
Treasurer 
815-599-6113 
mweaver@fhn.org 

KATHY KOMPERDA 
Secretary 
630-515-6168 
kkompe@midwestern.edu

TRAVIS HUNERDOSSE 
Director, Educational Affairs 
Travis_Hunerdosse@rush.edu

EDWARD RICKERT 

Director, Government Affairs 
618-402-7416 
erickert@kdlegal.com 

JENNIFER ELLISON 
Director, Marketing Affairs
Jennifer.C.Ellison@osfhealthcare.org

JENNIFER PHILLIPS
 
Director, Professional Affairs 
Assistant Editor, KeePosted 
630-515-7167 
jphillips@midwestern.edu 

LINDA FRED 
Director, Organizational Affairs 
217-383-3253 
linda.fred@carle.com

ANN JANKIEWICZ
 
Chairman, House of Delegates 
312-942-5706 
ann_m_jankiewicz@rush.edu

ELIZABETH ENGEBRETSON 

Technician Representative 
815-756-1521x153346 
EEngebretson@northshore.org

DAVID TJHIO
 
Chairman, Committee on Technology 
816-885-4649 
david.tjhio@cerner.com

JENNIFER ARNOLDI
 
Chairman, New Practitioners Network 
JeArnol@gmail.com 

JACOB GETTIG 
Editor & Chairman, KeePosted Committee 
630-515-7324 fax: 630-515-6958 
jgetti@midwestern.edu 

DESI KOTIS 
Regional Director North 
312-926-6961 
dkotis@nmh.org

MARK LUER 
Regional Director South 
mluer@siue.edu

SCOTT BERGMAN 
Regional Director Central 
scbergm@siue.edu 

EMMA CARROLL 
President, Student Chapter
University of IL C.O.P. 
emmacarroll620@gmail.com 

NADIYAH CHAUDHARY 
President, Rockford Student Chapter 
University of IL C.O.P. 
nadi925@gmail.com

JANEY YU 
President, Student Chapter
Midwestern University C.O.P. 
janey.yu@mwumail.midwestern.edu

BERNICE MAN
 
President, Student Chapter 
Chicago State University C.O.P. 
bman@csu.edu 

TRAMAINE HARDIMON 
Student Representative 
Chicago State University C.O.P 
thardimon@csu.edu 

ZAK VINSON 
President, Student Chapter 
Southern Illinois University S.O.P
zvinson@siue.edu

ALEX MERSCH 

President, Student Chapter 
Roosevelt University C.O.P. 
amersch@mail.roosevelt.edu

JENNIFER AGUADO
 
President, Student Chapter 
Rosalind Franklin University C.O.P. 
jennifer.aguado@my.rfums.org 

SCOTT MEYERS 
Executive Vice President, ICHP Office 
815-227-9292 
scottm@ichpnet.org 


ICHP AFFILIATES 


JENNIFER PHILLIPS
 
President, Northern IL Society (NISHP) 
630-515-7167 
jphillips@midwestern.edu 

JULIA SCHIMMELPFENNIG 
President, Metro East Society (MESHP) 
jschimmelpfen@sebh.org 

MEGAN METZKE 
President, Sangamiss Society 
memiller8@yahoo.com

ED RAINVILLE
 
President, West Central Society (WSHP) 
309-655-7331x 
ed.c.rainville@osfhealthcare.org

Vacant Roles at Affiliates — 
President, Rock Valley Society; Southern IL Society; Sugar Creek Society


Welcome New Members!

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New Member Recruiter
Keneshia Berkley

Necibu Boru
Danielle Bozzardi Anna Arthur
Abigail Buchman Anna Arthur
Charles Buell
Alexander Chew Chris Rivers
Neha Chug Bernice Man
Jalmine Desai
Rachel Dobersztyn
Jaquita Douglas
Sarah Engberg Jennifer Ellison
Erielle Anne Espina
Jennifer Ferreri
Mallory Fowler
Amy Francis Michael Lutz
James Freeman
Krystina Geiger
Christina Godwin
Anna Golebiowski
Marlee Grabiel
Magdalena Gut
Elijah Harrington
Kate Henderson Anna Arthur
Philip Hodur
Brian Hoff
Jaymi Holloman Anna Arthur
Qudus Ibrahim Bernice Man
Haley Ilcewicz Anna Arthur
Rashida Issa
Andrew Jeon Bernice Man
Jessica Kerwin Anna Arthur
Tracy Knobeloch Anna Arthur
Antonia Kraljevic
Mary Lenfsky Liz Gorski
Evelina Lin Robin Ye
Abbie Lyden
Rhynn Malloy Travis Hunerdosse
Bushra Maraywid Chris Rivers
Katarzyna Marek Bernice Man
Amani Memon
Sima Merai
Nkuti Ndely
Michele Nettles
Thanh Ngo
Celia Nguyen
Imran Nizamuddin
Uzoma Okeagu
Whitney Palecek
Dipa Patel Jennifer Splawski
Nirav Patel
Meera Patel
Ankit Patel
Dharti Patel
Reema Patel
Randall Patula
Brett Pierce Elizabeth Short
Lyle Pratt Anna Arthur
Zeshan Qureshi Bernice Man
Gary Robb Ginger Ertel
Kelsey Robertson Anna Arthur
Allie Ruggless
Katherine Sandison
Sonia Shah
Bob Simko
Nicole Staton
Fatima Thalji Bernice Man
Jamie Tidaback
Ryan Tungate
Sara Vander Ploeg
Kristine VanKuiken
Sara Wagner Anna Arthur
Sylvia Walsh
Brenna Wyman Anna Arthur
Liweza Yalda
Sarah Young Debbie Moody



ICHP Pharmacy Action Fund (PAC) Contributors

GENERAL ASSEMBLY GUILD - $1000 & More    
Scott Bergman
Dan Ciarrachi
Kevin Colgan
Edward Donnelly
Andrew Donnelly
Dave Hicks
James Owen Consulting Inc.    
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Scott Meyers
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Michael Rajski
Edward Rickert
Carrie Sincak
Avery Spunt
Michael Weaver
Patricia Wegner
Thomas Westerkamp
    
SPRINGFIELD SOCIETY - $500-$999    
Stephanie Crawford
Rauf Dalal
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Kathy Komperda
Leonard Kosiba
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Huzefa Master
William McEvoy
Christina Rivers
Miriam Mobley-Smith
JoAnn Stubbings
    
CAPITOL CLUB - $250-$499    
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Sandra Durley
Vern Johnson
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LINCOLN LEAGUE - $100-$249    
Anonymous    
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Marie Williams
    
CONTRIBUTOR - $1-$49    
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Laura Woskobnick
Izabela Wozniak


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Upcoming Events

Regularly Scheduled

Visit the ICHP Calendar for the most up-to-date events!

Tuesday, October 1
Call for Posters! 2014 ICHP Spring Meeting
Deadline for Submission: Wednesday, January 15, 2014

Wednesday, October 2
CPE Event! NISHP CPE Live Program: Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery
Rush University Medical Center | Chicago, IL

Tuesday, October 8
CPE Event! Sangamiss Society CPE Live Program: New Drugs, New Problems: Reversal Options for New Anticoagulants
St. John's Hospital | Springfield, IL

Tuesday, October 15
Submission Deadline: 2013 ICHP Student Chapter Video Contest

Monday, November 4 and Wednesday, November 13
CPE Event! Champion Webinar: Mr. ROSS
LIVE Webinar

Wednesday, November 6
CPE Event! NISHP Live CPE Program: Sedation
Midwestern University | Downers Grove, IL

Thursday, December 5
NISHP Live Program: TBA
Location TBA

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