Official Newsjournal of the Illinois Council of Health-System Pharmacists

ICHP KeePosted

December 2017

Volume 43 Issue 10

Print Entire Issue

2015 Sept/Oct - Pharmacy Month

KeePosted Info

Features

Attention ASHP Pharmacist Members

Celebrate Pharmacy!

Dr. Deborah Sanchez provides special opportunity for ICHP members!

Collaboration = Better Outcomes

Columns

President's Message

Directly Speaking

2015 Best Practice Winner

New Practitioners Network

Board of Pharmacy Update

Government Affairs Report

Leadership Profile

Educational Affairs

ICHPeople

Hi Tech

College Connections

Benefits of Working During Pharmacy School

Introductory Pharmacy Practice Experience and Leadership Growth

Addiction Is a Disease

More

Welcome New Members!

Officers and Board of Directors

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 SPECIALIST
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 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 © 2015 Thinkstock, a division of Getty Images.

Copyright © 2015, Illinois Council of Health-System Pharmacists. All rights reserved.


Features

Attention ASHP Pharmacist Members
It’s Time to Elect Delegates to ASHP’s House

by Scott A. Meyers, Executive Vice President

The ASHP Summer meeting for 2016 will be held in Baltimore, and in 2017 it could be anywhere! For 2017, ASHP hasn’t identified the city yet and who knows which cities are high on the list with ASHP at decision time?  

Regardless of where the meetings will take place, ICHP needs to elect two delegates to join Carrie Sincak, Ann Jankiewicz and Jennifer Phillips as the Illinois delegation for 2016 and then continue on in 2017. Delegate candidates must be ASHP pharmacist members, planning on attending the ASHP Summer Meetings for both 2016 and 2017 at their own expense, attend one of the Chicago-based Regional Delegate Conferences each May, and provide their own nomination via email, fax or mail to the ICHP office by October 23, 2015. Nominees must provide nomination statements which include years of membership in ASHP, current employment position, pharmacy association memberships, volunteer experiences related to pharmacy associations and any other relevant information the potential candidate would like to include. However, candidate statements must be limited to 250 words or less. The ICHP Committee on Nominations will select the final four candidates for this year’s ballot. The two candidates receiving the highest vote totals will be credentialed as delegates for 2016 and 2017, and the remaining two candidates will serve as alternate delegates for 2016 only.

The 2016 Summer Meeting is scheduled for June 11-15, 2016 at the Baltimore Convention Center in Baltimore, Maryland. No date or site has been set for the 2017 event, but we know it should be in early June of that year. Delegates and alternate delegates are reimbursed for expenses related to attendance at the Regional Delegate Conferences only and all other expenses are the responsibility of the delegates and alternate delegates. ASHP’s House of Delegates is the policy making body within ASHP and is responsible for approving all ASHP position statements and practice guidelines.

This is a great opportunity for someone who has served at the State level for some time and wishes to move up within ASHP. It is probably not a good match for someone with no pharmacy association volunteer experience.  

Elections will be held in November with all ASHP pharmacist members eligible to vote via the internet. Election results will be announced in the January issue of KeePosted. Interested individuals should send their letter of intent and candidate statement to Scott Meyers at the ICHP office via fax at (815) 227-9292 or email to scottm@ichpnet.org.




Celebrate Pharmacy!

by Scott A. Meyers, Executive Vice President

If you ever planned on celebrating pharmacy, October is the month to do it! October is American Pharmacist Month, the third week of October (18-24) is National Hospital and Health-System Pharmacy Week, and Tuesday, October 20th is National Pharmacy Technician Day!

All of these are great reasons to celebrate and only your own imagination can limit the ways in which you could celebrate. So get busy and think of something creative, plan it, do it and make sure you take lots of pictures of it. Then send them to me at the ICHP office (scottm@ichpnet.org), and if you send me enough pictures, you won’t even need to write anything up – the pictures will tell the story!

ICHP members love to look at pictures and more importantly see themselves in photos on our website, so do something that is fun, educates your patients and other health professionals, or however you want to celebrate pharmacy, but just do it and share it!



Dr. Deborah Sanchez provides special opportunity for ICHP members!

Dr. Deborah Sanchez is presenting the ICHP November Champion continuing pharmacy education (CPE) webinar for our members on the topic of “Establishing Inpatient Medication Therapy Management Billing”. This is a great opportunity for our members as Dr. Sanchez is one of the few in the country who speaks on the topic of inpatient billing for MTM services. She won the ASHP Best Practices Award as co-author of a paper on the successful implementation an inpatient MTM program.

Dr. Sanchez is currently the Pharmacy Practice and Residency Director for Asante Rogue Regional Medical Center in Medford, Oregon, and has been at Asante since 2002. Dr. Sanchez is also a preceptor at Asante for Advanced Pharmacy Practice Experiences and is an adjunct clinical instructor with Pacific University.

Dr. Sanchez is a PharmD graduate of the University of Wyoming in Laramie, and has a Masters in Healthcare Administration, and is a recent graduate of the ASHP Pharmacy Leadership Academy (PLA). Her many certifications include: BCPS, ACLS, Diabetes Resource Subject Matter Expert, CPR for the professional rescuer, and APhA Immunization. She completed her postgraduate residency training in Primary Care and Nutrition Support at Columbus Regional in Columbus, Georgia.

Dr. Sanchez is a very active volunteer for the profession of pharmacy and serves on many professional committees, including the Board of Directors of the Western States Conference for Residents, Fellows, and Preceptors; the Asante System-wide Medication Reconciliation Team; Residency Advisory Committee; Chemotherapy Improvement Team; and PPMI Leadership Taskforce. Dr. Sanchez is a member of the Oregon Society of Health System Pharmacists and ASHP.

ICHP is proud to offer this learning opportunity to our members. Below are the learning objectives for Dr. Sanchez’ program.

The learning objectives for pharmacists include:
  1. Identify services eligible for inpatient MTM billing that meet state and federal regulations.
  2. Describe how to develop a charge master coding system for clinical pharmacy services.
The learning objectives for pharmacy technicians include:
  1. Describe types of services eligible for inpatient MTM billing. 
  2. Describe a method of ranking MTM based on complexity.
When: November 11, 2015: 12:00-12:30pm & November 17, 2015: 3:00-3:30pm.

How:  To access this CPE webinar, contact your work site’s Champion, who will receive all the information on how to sign in to the program.
  
Be sure and put these dates and times on your calendar, let your co-workers know, and join us for one or both of Dr. Sanchez’ presentations.

If you do not know who your Champion is, or you want to learn how to become a Champion for your facility, visit the Champion webpage at http://www.ichpnet.org/champions/. Check out the Champion job description and a list of Champion program sites and Champions, updated monthly. Or send an email to trishw@ichpnet.org with your questions. We will be posting more information on Dr. Sanchez’s presentation on this webpage as it becomes available, so check back often. 

Finally, watch for the biweekly ICHP CPE News Brief emails that list all the available free CPE for ICHP members.





Collaboration = Better Outcomes

by Trish Wegner, BS Pharm, PharmD, FASHP

What’s the old saying – “Two heads are better than one”? That certainly seems evident based on the messages of many of our speakers at the Annual Meeting. The overall theme was “collaboration”. Collaborating with legislators on achieving provider status; collaborating with state organizations to advance the profession of pharmacy for both technicians and pharmacists; collaborating with physicians, nurses and other healthcare providers to improve patient outcomes and quality of life; collaborating with industry and each other to improve personal and patient safety…the list goes on. 445 attendees came together at our Annual Meeting to explore these ideas and more!

Keynotes
Primary points mentioned during the keynote presentations included:
  • Achieving provider status is about giving patients access to care that improves safety, quality, outcomes and decreased costs. Pharmacists are one of the few healthcare providers who do not have provider status. Right now pharmacists are not recognized under the Social Security Act as healthcare providers, so it is important to collaborate with your legislators to promote House Bill 592 and Senate Bill 314 now!
  • An ASHP survey shows that in 2014, the pharmacist vacancy rate was 2.2% compared to 2000 when it was 8.9%. By 2025, there will be an estimated surplus of close to 49,000 pharmacists. Now that does not take into account new services that could be offered if Provider Status is obtained, and we enter into collaborative healthcare agreements.
  • In order to have specialized pharmacists to work in collaborative agreements, residency positions need to grow by 56% or 1,515 positions to meet the demand. Collaborate with ASHP to initiate or expand your residency programs.
  • To advance the training and education of pharmacy technicians, ASHP and ACPE collaborated to form the Pharmacy Technician Accreditation Commission (PTAC). This collaboration took place in 2014, and as of 2015, new standards, guidelines and procedures have been established for accredited technician education/training programs. As of 2014, there were only 275 accredited programs. More are needed to meet the 2020 goal of PTCB to require all technicians sitting for the exam to be graduates of a PTAC accredited education/training program.
  • Collaborative approaches to incorporating pharmacists as part of healthcare teams has a positive impact on patient outcomes as well as healthcare costs – the goal is to improve communications, decrease the perception of silo responsibilities and increase health record interoperability.
  • Change is happening in the delivery and payment models for care, transforming into team and outcomes based care – so the team is accountable for both.
  • Changes are needed including: adopting a professional attitude focused on patient care; accepting the call to service; developing strong relationships and communication; getting involved WHERE change is happening so we can impact WHAT change happens; and recognizing that the training and skills of ALL team members are symbiotic when combined in the patient care arena.
  • A major key to change – training WITH each other – two or more professions learn with, from and about each other to improve collaboration and the quality of care – and that will create teams and relationships based on trust, respect and focused on improving patient care!
  • USP <800> is intended to promote patient safety, worker safety, and environmental protection when handling hazardous drugs (HDs) and addresses (among other things) receipt, storage, compounding, dispensing, administration and disposal of HDs; applies to all healthcare personnel who handle HDs; and applies to all healthcare entities that store, prepare, transport, or administer HDs.
  • USP <800> will be a federally-enforceable regulation that applies to both sterile and nonsterile compounding with state regulations for enforcement as well.
  • Your HD List needs to include a review of the NIOSH list (antineoplastic, non-antineoplastic; reproductive hazard, drugs that are hazardous to personnel, which is different from EPA-hazardous). Identify the meds you stock and determine the containment strategies. 
  • Your handling options need to treat all HDs the same and use all the containment strategies in <800>; plus you will need to assess risk and stratify by identifying drugs, dosage form, risk of exposure, packaging, manipulation, use and documentation of alternative containment strategies and/or work practices for specific dosage forms of HDs that are not antineoplastic agents or are not API; and perform this review annually and document your results.
  • Training requirements for USP <800> and <797> include didactic, expert oversight, monitoring, media fill test (initial and requalifying), gloved fingertip test (initial and requalifying), surface sampling; training materials will include site policies and procedures, device manufacturers as well as NIOSH, ASHP and Critical Point information and guidelines. 

In the Technology sessions, multiple practical pearls were presented to help pharmacy departments select technology appropriate for their site. The pharmacy technician sessions included an in depth exploration on nonprescription drug interactions with prescription drugs, the scope of pharmacy technician practice, and also quality and safety strategies and practices.

The Residency Project Pearls are a popular session in our Pharmacy Practice track, with four excellent presentations by residents. We also explored how to structure abstracts and how to translate study results into publication worthy articles.

We want to thank all the students and residents who joined us and hope you had an opportunity to network during the Residency Showcase and NPN Mixer. We changed the format of the ever-popular Residency Roundtables this year to a panel, to allow for better comfort for all the student attendees. Student evaluations indicate that they liked this new format better, but we will continue to play with the format and student access to the panelists based on our students’ feedback.

Our Supporters
With decreasing educational grants being awarded for programming, support from our industry partners during the Exhibit Program is key to maintaining lower registration costs for you. We greatly thank the 51 vendors who participated in the Exhibit Program! Special thanks also to the following meeting sponsors and supporters:
  • PharMEDium – Educational grant provider
  • Merck – Platinum Sponsor
  • Novo Nordisk – Platinum Sponsor
  • Baxalta – Gold Sponsor
  • Baxter – Gold Sponsor
  • Essai – Silver Sponsor
  • McKesson – Silver Sponsor
  • Sagent – Silver Sponsor
  • Theradoc/Premier – Silver Sponsor
  • United Pharmacy Staffing – Silver Sponsor

We do not plan any educational programming during the Exhibit Program to encourage all of our attendees to visit with our vendors so that they continue to partner with us and exhibit. Without their support, ICHP would have to increase the price of the meeting registration fee to cover expenses. At all meetings, we encourage you to use the time to network with our industry partners and learn about the new products and services they offer.

Award Winners
Stars were shining brightly during the Award Ceremony.

ICHP’s highest award, the Pharmacist of the Year Award, was given to Michael Rajski for his years of service to the profession and to ICHP. Mike served as President of the Northern Illinois Society of Health-System Pharmacists as well as ICHP; and Director of Marketing Affairs where he still volunteers as a member. He also continues to attend Legislative Day where he serves as a group leader and also sits on the Division of Government Affairs. Mike has worked in a variety of hospital settings including as Director of Pharmacy at St. Anthony Hospital in Chicago from 1990-1994, Assistant Director and Pharmacist Practitioner at the University of Illinois Hospital from 1994-1997 and Pharmacy Services Manager at John J. Madden Mental Health Center from 1997-2010. In 2010, Mike moved to become the Manager of Operations at Advocate Good Samaritan Hospital in Downers Grove. In addition to overseeing operations at Good Sam, Mike oversees a variety of pharmacy students on rotations for both Introductory and Advance Pharmacy Practice Experiences. Mike Rajski’s dedication to pharmacy and ICHP continue to shine through his commitment and participation.

The Amy Lodolce Mentorship Award was created in memory of Amy Lodolce who passed away in August of 2012. Amy was a great mentor to her students, residents and colleagues. Nominees for this award must meet the following criteria: 1) be a current ICHP pharmacist or pharmacy technician member; 2) be a preceptor, professor or mentor of students, residents, technicians and/or new practitioners; 3) demonstrate efforts to advance the practice of pharmacy; 4) demonstrate strong mentorship capabilities; 5) exhibit clear community service participation; and 6) have impacted the nominator’s career. Amy’s husband, James Lodolce, presented the award to Carrie Sincak of Midwestern University Chicago College of Pharmacy for her commitment to mentoring students, residents, and young pharmacists. She built strong relationships with Interprofessional teams when at Loyola University. Carrie is also the recipient of the Golden Apple Award, an award that signifies excellence in teaching at her institution. One nominator said, “Despite her prestigious titles and demanding responsibilities, she has served as a readily accessible resource and has provided continuous support in the endeavors of the ICHP Student Chapter Executive Board members and all aspects and functions of the student chapter.” We were also honored to have Amy’s mother, Diane Vuletich, in attendance.

The President’s Award was given to Desi Kotis of Northwestern Memorial Hospital (NMH) by ICHP President Linda Fred. The President’s award recognizes a member of ICHP for contributions to the Council that are considered above and beyond the normal volunteer member. These contributions may be on behalf of ICHP or pharmacy in general and may be made at the local, state, or national level. The President of ICHP has the sole responsibility of the selection of the recipient. Desi is the Director of Pharmacy services at NMH and has been an inspiration to Linda in her professional life.

Margarita M. Villarreal-Flores won the new ICHP Pharmacy Technician of the Year Award. Established this year, this award is given to a PTCB certified pharmacy technician member who has demonstrated exceptional contributions to the practice of pharmacy in Illinois, either at his/her worksite, and/or as an ICHP volunteer member. Margarita has been PTCB certified since 1998 and has worked at the University of Illinois Hospital & Health Sciences System since 1994, holding the position of pharmacy technician specialist in the Investigational Drug Services since 2007. Margarita holds a high level of responsibility, including managing the storing, handling, and dispensing of investigational drugs, accountability records, perpetual inventory and expiration logs, as well as records on IRB approvals and patient consent forms. Margarita has made and continues to make exceptional contributions to the pharmacy department, the hospital, and the university.

The Outstanding Volunteer Award was presented to Kathryn Schultz of Rush University Medical Center for her service as the Director of the Division of Government Affairs where she coordinated the comments for USP’s Chapter 800 and for guiding efforts on other key legislation. Kathryn had been helpful with the ICHP Clinical Practice and Research Network and also serves as the President of the Northern Illinois Society of Health-System Pharmacists. This award is presented by the Executive Committee to the volunteer leader of ICHP who has stepped up and through outstanding effort has significantly made many accomplishments on behalf of the Council.

The New Practitioner Leadership Award was presented to Jennifer Arnoldi of Southern Illinois University Edwardsville. Jennifer epitomizes this award through extensive involvement in ICHP through service as the NPN Chair, member of the ICHP Meeting Planning Committee, Central Region Director, as a member of the Divisions of Professional Affairs and Organizational Affairs. Jennifer is a great example for all new practitioners and is very deserving of this award.

The Industry Award was presented to Lori Kroth of Novo Nordisk, Inc. This award is given to a member of industry who steps up and makes unique contributions to health-system pharmacy in Illinois and supports and encourages participation by others in ICHP through membership, meeting attendance and organizational activities. Lori has assisted in the provision of several meeting sponsorships and is the go-to person for advice when discussing and implementing services related to pharmacy industry.

The Shining Star award was created to recognize volunteer members who have stepped up their volunteer involvement a notch over the past year. The 2015 Shining Stars are:
  • Amy Boblitt
  • Lara Ellinger
  • Mary Ann Kliethermes
  • Huda-Marie Kuttab
  • Bryan McCarthy
  • Gary Peksa
  • Jared Sheley
  • Karin Terry
The Student Chapter Award went to the Chicago State University College of Pharmacy chapter for promoting the mission of ICHP through their many activities throughout the year. This is the second year in a row that they have won. The selection criteria are divided into three categories: presence of the student chapter at ICHP activities, activities the student chapter uses to promote the mission of ICHP, and documentation of how the activities promote the ICHP mission through submission of an essay.

The 2015 ICHP Best Practice Award went to Kuntal Patel, Pharm.D. from Sinai Health System. His co-authors are Pavel Prusakov, Pharm.D., BCPS and Heather Vaule, MS, RD, LDN, CNSC. The title of his submission was “Better Bones for Babies”. Dr. Patel was presented with a $1,000 check to his pharmacy department and a plaque by keynote speaker, Dr. Janet Silvester. ICHP would like to thank PharMEDium for supporting the award with a grant. Continuing pharmacy education credit is available as home-study for member pharmacists and technicians through the ICHP website. Search under the new title of “Osteopenia of Prematurity”.

ICHP congratulates all the award winners who truly are bright stars for ICHP and for Pharmacy! ICHP also wishes to thank Linda Fred, immediate past-president, for her leadership over the past two years as president-elect and president. ICHP welcomes Jennifer Phillips to take over “the gavel” and marshalling the organization to continued collaboration.  

ICHP brought many players together for a special and engaging educational and networking experience. We all learned that each of us has an integral part to play in advancing excellence in pharmacy for our patients. So don’t be shy – let’s all do our part and put our heads together to collaborate and improve patient care!

Please join ICHP at the Spring Meeting, April 8-9, 2016 at the Embassy Suites East Peoria – Hotel & Riverfront Conference Center in East Peoria, IL, where we will focus on leadership in pharmacy – “Find a Leader: Look in the Mirror”!

For photos of the 2015 Annual Meeting, please visit our ICHP Facebook page!



Columns

President's Message
The Year in Review

by Linda Fred, ICHP President

A few weeks ago, I ended my term as President and joined the ranks of the Past Presidents Club. I want to take a few minutes to reflect on the accomplishments of the organization over the last year and thank the many people who helped us complete another successful year.

We had two excellent meetings under the exemplary leadership of our Division Chair for Educational Affairs, Travis Hunerdosse. They found topics around my presidential theme of collaboration including many successful examples of collaborative practice and culminating in one of our keynote addresses at the Annual Meeting about experiences in team-based care at East Tennessee State University – presented by Dr. Reid Blackwelder and Dr. L. Brian Cross. Both meetings were full of examples of pharmacists working in group practices in ambulatory settings and inpatient team-based rounding services. These sessions provided a lot of information about collaboration opportunities available to all of us in our respective practice sites.

Our Government Affairs Division was very busy this year. Our Director, Kathryn Schultz, did a phenomenal job of keeping us informed on legislative activity and helping to develop ICHP’s position on a wide variety of topics, including the Heroin Task Force, Technician Continuing Education, “Right to Try” legislation, Medical Cannabis Rules evolution, Biosimilars, and Provider Status. They also worked on a response to the proposed USP 800 Rules.

Carrie Vogler and our Marketing Affairs Division continued to look for innovative ways to meet our members’ needs. They updated our Champions Brochure to better represent the important role our ICHP Champions play in actively engaging our members, and they added an ICHP Bucks incentive to the Champions program. They also created a new award category for our Annual Awards Presentation. We presented our first ever Technician of the Year Award to Margie Villareal-Flores, a drug information technician at UIC Hospital, at our Annual Meeting in September. They are working on initiating an Ambulatory Care Network, as well.

The Division of Organizational Affairs does a lot of a less glamorous but still necessary work of keeping the organization alive and well (and I can safely say that part about less glamorous as a former Chair of that Division myself). This year, Kathy Komperda and her team worked on some revisions of the ICHP Bylaws and assisted NISHP in revising theirs. That Division is also responsible for working with our Student Chapters to ensure they have appropriate governing documents.

I started to go back and count up all the Position Statements reviewed or developed by our Professional Affairs Division, under the leadership of Desi Kotis – but there were a LOT! So I’ll just leave it at that. There were a lot. I do also want to recognize that they do a tremendous amount of work behind the scenes in identifying and sharing best practices. I would also be remiss if I didn’t mention that Desi was my selection for this year’s President’s Award. Desi, in addition to all her work with the Professional Affairs Division and many years of active participation in NISHP as well as ASHP, is also a strong mentor to her many students, residents, and staff – and a role model for us all. 

I need to recognize the rest of the Executive Committee for all their efforts this year. I have appreciated the input of our Immediate Past President, Mike Fotis, and our President-elect, Jennifer Phillips. Thanks to Ginger Ertel as Treasurer and Charlene Hope as Secretary for the organization. Those people – along with our staff – created a strong Executive Team that helped the organization stay on the strong course set by our predecessors.

I would like to recognize the remainder of the Board of Directors for the year. There is a small army of Regional Directors, and Committee Chairs, and Network Chairs, and Student Chapter Reps, and the Tech Rep. It truly takes a village.

Finally – thank you to all our staff at the ICHP Office. They are a tremendously dedicated group of people who have the best interests of the organization and the profession in their hearts and their heads.

My presidential theme for the year was collaboration. Last month, my KeePosted article was about collaboration gone wrong. This, my last KeePosted article is about collaboration done right – the ICHP leadership, our Divisions and Committees, and our members. If you are interested in getting more involved in one of these roles, please reach out to an existing leader or the office staff. I am confident it will be for you another example of excellent collaboration in your professional life just as it has been for me.



Directly Speaking
Annual Meeting Town Hall

by Scott A. Meyers, Executive Vice President

ICHP’s 2015 Annual Meeting was my 23rd Annual Meeting as an employee and the Council’s 40th overall! This Annual Meeting hosted ICHP’s 4th Town Hall Meeting in two years and several important issues were discussed. Two of the issues dealt with training and education of the pharmacy workforce.

The first of these two issues was residency training. How do we expand the number of available positions and sites in Illinois? How do our members start a residency program if they haven’t already? What can ICHP do to help?

These are very important questions. ICHP is, can, and will be helping. We hope to provide training on the ASHP Residency Learning System at one or more of our upcoming statewide meetings. In addition, we regularly provide educational programming that focuses on precepting skills for students and residents. In the coming few months ICHP plans to create a platform for online communities which may be the most important piece to the puzzle. Online communities for residency directors and for residents themselves could have a dramatic impact on residency programs across the State. Idea sharing and assistance in problem solving are two great benefits from online communities, and the two aforementioned groups could have a lot of issues to discuss.

An interesting observation from this Town Hall Meeting is that there was no pushback about whether or not residency training was necessary. The issue never came up. Maybe because it has been discussed at length in a variety of circles or maybe the current feeling is it is inevitable someday just like the PharmD debates of the 1990’s that became the requirement of 2001. It’s hard to say, but it was nice that the topic didn’t surface.

The second issue related to training and education was PTCB’s proposal to require accredited education and training prior to sitting for the Pharmacy Technician Certification Examination (PTCE) in 2020. While this is currently a proposal, most pharmacy organizations are working on a plan to meet it should it become a requirement. In Illinois there are only a handful of accredited training program located in places like Harvey, Chicago, Springfield, Peoria, and Quincy. The current curriculum and standards for accreditation by the ASHP/ACPE joint venture are substantial and to some seem more than needed. The recently formed joint venture between ASHP and ACPE is a step in the right direction, and that group must act quickly to revise standards, not to dumb down the training but to make the training reasonable enough to make it feasible for all pharmacy employers to move toward it willingly.  

In addition, there are many non-accredited training programs and a few accredited programs that are gouging the technician students with exorbitant tuition because they know that students can obtain student loans for this training. This action takes advantage of students in the worst possible way creating substantial debt for a career that often starts at little more than minimum wage. Community colleges seem to have the most affordable and supportable approach to the training, but because there is no legal requirement for completion of these programs currently, they struggle to retain students through the completion of the programs. ICHP encourages all employers of pharmacy technicians to allow their technician hires to complete the programs once they have started.

ICHP is always communicating with potential providers of technician education and training, and we work to support programs that are affordable and comprehensive. ICHP will not support programs that take advantage of students or rotation sites. One exciting potential provider is Pharmacy Technician University. They are working on an online training program that provides the didactic and at least some of the simulation components of the current ASHP/ACPE curriculum. This program will be available to pharmacy organizations at what will be a hopefully very reasonable fee. This program could provide individual pharmacies, health-systems or community colleges that presently do not offer accredited pharmacy technician training with an inexpensive platform to serve as a foundation for establishing new programs.

At the Town Hall, members were encouraged to work with their local community colleges to establish new accredited pharmacy technician training programs, as students who need financial assistance will have a better chance of receiving it within those programs and the overall cost to individual pharmacy departments will be substantially reduced. The community college system provides great partners for pharmacies and pharmacists as they work toward this goal.

To paraphrase former ASHP Executive Vice President, Henri Manasse, pharmacy technician training in the U.S. is our (pharmacy’s) dirty little secret right now. No other health care personnel outside of dietary workers (not dieticians) and housekeepers can do their jobs without some form of formal required training and education. This is a dirty little secret that we must all work together to put to bed for good!

One topic related to training and education of the pharmacy workforce that surprisingly wasn’t raised was the oversupply of pharmacist graduates and pharmacy schools. Maybe it’s a topic that has been beaten to death or maybe those in attendance have just given up complaining? Or maybe many of those in attendance have ties to academia? Regardless, I was pleased it wasn’t raised, or we probably wouldn’t have gotten to any other topic. It could be a topic for another day, another “Directly Speaking” or another Town Hall Meeting, but this is all the exposure I hope to give it for a while!

You can access a formal summary of the Annual Meeting Town Hall notes on the ICHP website.



2015 Best Practice Winner
Osteopenia of Prematurity (Better Bones for Babies)

The 2015 Best Practice Award Winner, Osteopenia of Prematurity (aka Better Bones for Babies), is available as a home-study for CPE credit. To earn your CPE credit, you must read the manuscript below in the September/October 2015 issue of KeePosted and then go to CEsally.com to answer the self-assessment questions and complete your credit. Once you have logged in to your CEsally.com account, search on Osteopenia of Prematurity, add to your To Do List, be sure and save CE, and then go to your To Do List to complete the process. For information on how to set up your CEsally account, go to http://ichpnet.org/pharmacy_education/cesally/cesallycom.php.

The 2015 ICHP Best Practice Award Program is supported by an educational grant from PharMEDium.


INTRODUCTION

Among all of the complications encountered in the management of preterm infants, osteopenia, a metabolic bone disease, is often overlooked in its early stages. The true incidence of osteopenia of prematurity (OP) is unknown up to 20% of infants born at a birth weight of < 1000 g go on to develop radiographic changes consistent with osteopenia.1 Early gestation, concomitant disease states such as bronchopulmonary dysplasia and necrotizing enterocolitis, and exposure to medications such as loop diuretics and corticosteroids are additional risk factors for osteopenia.2 Radiographic changes are typically identified 10 to 16 weeks following birth, when at least 20% bone demineralization has occurred, often delaying the diagnosis of OP.3 Regular surveillance of biochemical markers becomes an important strategy in managing preterm infants at high-risk for developing OP.
 
Adequate supplementation with calcium, phosphorus, and vitamin D is another important parameter in promoting optimal bone health. Approximately 80% of calcium and phosphorus accretion into bone occurs during the third trimester of pregnancy, this is a critical developmental period that is lost in preterm infants.4 As a result, preterm infants have unique intake requirement in regards calcium, phosphorus and vitamin D requirements in comparison to infants born at term. Guidance in determining goal intake of these critical vitamins and minerals has largely been limited to full-term infant in the United States. Recently, calcium, phosphorus, and vitamin D intake goals have been proposed for orally fed preterm infants; however, the outcomes associated with targeting these goals is currently unknown.5 The American Academy of Pediatrics (AAP) now recommends a daily intake of 150-220 mg/kg elemental calcium, 75-140 mg/kg elemental phosphorus, and 200-400 international units of vitamin for oral fed preterm infants. The objective of our study was to determine the impact of implementing a formal monitoring service to target these intake goals in preterm infants meeting high-risk criteria for OP.5 

Figure 1. High-risk criteria for osteopenia in preterm infants
AAP Criteria5
• < 27 week gestation
• < 1000 g birth weight
• Parenteral nutrition for ≥ 4 – 5 weeks 
• Severe bronchopulmonary dysplasia with the use of loop diuretics and fluid restriction
• History of necrotizing enterocolitis
• Failure to tolerate formulas or human milk fortifier with high mineral content



METHODS

Intervention
In April of 2014, a multidisciplinary service entitled “bone rounds” (BR) was implemented in the neonatal intensive care unit (NICU). This service entails identification of infants at high risk for osteopenia, monitoring of serum biochemical markers related to bone mineral disease, optimizing calcium, phosphorus, and vitamin D intake on a patient specific basis. Oral intake goals for calcium, phosphorus, and vitamin D are based on American Academy of Pediatrics recommendations.5 Goals for parenterally fed infants are extrapolated from these recommendations and are based on average oral absorption of calcium, phosphorus, and vitamin D. The BR service was implemented and is led by a clinical pharmacist and clinical dietitian in collaboration with the neonatology group. The multidisciplinary team evaluated patients on a weekly basis. High-risk infants were identified using a modified version of the criteria provided by the American Academy of Pediatrics.5 A complete list of criteria is displayed in Figure 2.


Figure 2. The modified AAP criteria is used to identify infants in need of continuous monitoring
Modified AAP Criteria
• < 27 week gestation
• < 1500 g birth weight
• Parenteral nutrition for ≥ 3 weeks 
• Severe bronchopulmonary dysplasia with the use of loop diuretics and fluid restriction
• History of necrotizing enterocolitis
• Failure to tolerate formulas or human milk fortifier with high mineral content
• 1500 g birth weight and one of the following:
o Severe cholestasis
o Renal disease
o Malabsorption
• Long-term steroid use
• History of ALP > 1000 units/L 
• Chronic low phosphorus (< 4 mg/dL) for  1 week



Patient Characteristics
This was a retrospective chart review from April 2013 to September 2014. Patients were identified using our hospital electronic chart. Patients were included in our analysis if they met any of the following criteria: < 27 weeks gestational age, birth weight < 1500 g, use of parenteral nutrition for ≥ 3 weeks, use of corticosteroids or loop diuretics  7 days, history of alkaline phosphatase > 1000 units/L, or chronically low phosphate (< 4 mg/dL) for  1 week. We excluded any infants who were able to tolerate oral feeding with preterm infant formula at goal.

Data Collection
For the patients included in this analysis, the following baseline data were collected: gestational age, birth weight, and duration of parenteral nutrition. The following serum levels were collected every other week for orally fed infants and at least once weekly for parenterally fed infants: calcium (mg/dL), phosphorus (mg/dL), 25-OH vitamin D (ng/L), total bilirubin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase (units/L). These laboratory values were collected for our analysis for the duration of the study period.  Additionally, the doses and duration for furosemide, dexamethasone, and hydrocortisone were collected, as these were the medications identified as most likely to contribute to the development of osteopenia. Also, the amount of elemental calcium (mg/kg) and elemental phosphorus (mg/kg) within parenteral nutrition were collected. When available, radiographs were collected for outcomes analysis. The data collected from April 2013 to March 2014 represented the year prior to implementation of the monitoring service (pre-BR group) and the data from April 2014 to September 2014 represents the six months following the implementation of regular monitoring (BR group). 

Outcomes
The primary outcome of our study was radiographically confirmed osteopenia. Secondary outcomes included osteopenia-related bone break on radiograph and a laboratory diagnosis of osteopenia. Laboratory diagnosis of osteopenia was defined as alkaline phosphatase > 600 units/L along with serum phosphorus < 4.5 mg/dL or serum calcium < 8.0 mg/dL. An independent radiologist read available radiographs. 

Statistical Analysis
Normally distributed continuous data is reported as mean and standard deviation while median and interquartile ranges are reported when distribution was found to be nonparametric. A t-test or Mann-Whitney U analysis were performed for continuous variables as appropriate while Fisher’s Exact Test was performed to assess outcomes data. A p-value of less than 0.05 was considered to statistically significant in the analysis.


RESULTS

Baseline Characteristics
Sixty-seven patients met the criteria for analysis in this study, 42 patients in the pre-BR group and 25 patients in the BR group. Patient characteristics were not significantly different between study groups at baseline and are summarized on Table 1. The median gestational age and birth weight of our study population were 29 weeks and 1125 g, respectively. Overall, male infants represented 43.2% of the patients included in the study.

Table 1.

Pre-BR (n=42)* BR (n=25)* P-value
Gestational Age (weeks) 29 (27.65-31) 30.0 (28-31.5) 0.3689
Birth weight (kg) 1 (0.8-1.44) 1.20 (1.03-1.45) 0.3057
Male (%) 16 (38.1) 10 (40) -
Calcium (mg/dL) 9.4 (9.11-9.72) 9.44 (9.28-9.44) 0.5418
Phos (mg/dL) 5.15 (4.44-5.9) 5.29 (4.56-5.25) 0.9897
Vitamin D (mg/mL)** 49 (47-80) 37.25 (24-36.5) n/a
Furosemide (mg/kg/day) 1.22 ± 0.47 1.13 ± 0.24 0.9575
Furosemide duration (days) 18 (1-48) 18 (1.5-14) 0.8246
Hydrocortisone (mg/kg/day) 2.08 ± 0.51 ± 0.12 1.0
Hydrocortisone duration (days) 6.5 (3-10.75) 11.5 (7-16) 0.2371
Dexamethasone (mg/kg/day) 0.16 ± 0.05 0.29 ± 0.17 0.1172
Dexamethasone duration (days) 4 (1.5-96.5) 6 (4.5-5.5) 0.7378
TPN Duration (days) 29.5 (23-47.75) 21 (15-21) 0.0799
* Values are reported as median (interquartile range) or as mean + standard deviation  
** Vitamin D values were available for 3 and 18 patients in the Pre-BR and BR groups, respectively


There were no significant differences for serum calcium and phosphorus values throughout the duration of hospital stay between our two study groups. The median calcium and phosphorus values were 9.40 and 9.44 mg/dL (p=0.5418) and 5.15 and 5.29 mg/dL (p=0.9897), respectively. Of the 25 patients in our BR group, 18 patients had a vitamin D values available for analysis; however, only 3 of 42 patients in the pre-BR group had available vitamin D values. As a result, no statistical analysis was performed between groups in regards to vitamin D.

The analysis of the use of loop diuretics and corticosteroids during hospitalization in the NICU was performed and there were no significant differences in doses or duration in the use of furosemide, hydrocortisone, and dexamethasone. The mean doses of furosemide, hydrocortisone, and dexamethasone were 1.22, 2.08, 0.16 mg/kg/day, respectively in the pre-BR group and 1.13, 2, and 0.29, respectively in the BR group. Median duration of use for furosemide, hydrocortisone, and dexamethasone were 18, 6.5, and 4 days, respectively in the pre-BR group and 18, 11.5, and 6 days, respectively in the BR group. The median duration of parenteral nutrition was 27 weeks.

Biochemical Markers
Alkaline phosphatase values were significantly reduced in the BR group. Median alkaline phosphatase values were 318 and 246 units/L (p=0.0431) in the pre-BR and BR groups, respectively. There was a significant difference in peak alkaline phosphatase values between groups. The mean peak alkaline phosphatase values were 486 and 386 units/L (p=0.0382) in the pre-BR and BR groups, respectively. Median AST, ALT, and total bilirubin values were not found to be significantly different between study groups. These results are summarized on Table 2.

Calcium & Phosphorus Supplementation 
There was a mean of 46.68 mg/kg/day of elemental calcium in parenteral nutrition for the pre-BR group compared to 66.96 mg/kg/day in the BR group, and this difference was statistically significant (p=0.0012). The amount of elemental phosphorus was not significantly different between study groups. These results are summarized on Table 2.

Table 2.

Pre-BR (n=42)* BR (n=25)* P-value
ALP (units/L)
318 (242.5-399.5)
246 (186.75-243.5) 0.0431
Peak ALP (units/L) 486 ± 243 386 ± 167 0.0382
Tbili (mg/dL) 4.14 (3.2-6.21) 4.4 (3.45-4.33) 0.907
AST (units/L) 32.5 (26-41.25) 28 (20.5-27.5) 0.1341
Elemental Calcium IV to PO (mg/kg/day) 46.68 ± 17.29 66.96 ± 21.85 0.0012
Elemental Phos IV to PO (mg/kg/day) 45.8 ± 14.97 42.39 ± 17.68 0.5974
* Values are reported as median (interquartile range) or as mean + standard deviation


Outcomes
There were 3 (7.1%) patients identified with a laboratory diagnosis of osteopenia compared to none in the BR group. Laboratory identification of osteopenia in these patients occurred at a median of 75 days from birth. Of the 67 patients in the study, there were 37 (55.2%) patients with available radiographs for analysis. There were 25 from the pre-BR group and 12 patients from the BR group included in our radiographic analysis. In the pre-BR group, there were 8 (32%) patients identified with osteopenia on radiograph compared to 2 (16.7%) patients in the BR group (p=0.445). These changes were seen at a median of 47 and 44.5 days after birth in the pre-BR and BR groups, respectively. There were 2 (8%) patients identified in the pre-BR group with bone breaks on radiograph. Bone breaks in the pre-BR were identified at a median 118.5 days after birth. No bone breaks were identified in the BR group. These results are summarized on Tables 3 and 4.


Table 3.

Pre-BR (n=42)* BR (n=25)* P-value
Osteopenia Lab Diagnosis, n (%)* 3 (7.1) 0 -
Time to Lab Diagnosis, day** 75 (62-91) - -
*Lab diagnosis of osteopenia was defined at ALP > 600 units/L + Phos < 4.0 mg/dl or ALP > 600 units/L + Ca < 8.0 mg/dl
**Values are reported as median (interquartile range) 


Table 4.

Pre-BR (n=25)* BR (n=12)* P-value
Osteopenia on Radiograph, n (%) 8 (32) 2 (16.7) 0.445
Time from birth (days)** 47 (27-59.5) 44.5 (33-80.5) -
Break or Fracture on Radiograph, n (%) 2 (8) 0 -
Time from birth (days)** 118.5 (104-133) - -
*25 and 12 radiographs from patients in the Pre-BR and BR groups, respectively, were available for analysis
**Values are reported as median (interquartile range)



DISCUSSION

We implemented a monitoring service for infants at high-risk for developing osteopenia. The BR service consists of serial monitoring of biochemical markers, and increasing utilization of enteral and parenteral nutrition in order to meet calcium, phosphorus and vitamin D intake goals. In our study, we saw a trend towards a decrease in osteopenia, bone breaks on radiographs, as well as osteopenia laboratory diagnosis with the implementation of our BR service.

At baseline, we had no significant difference in gestational age, gender, or birth weight between our groups. The pre-BR group represented the year preceding the implementation of regular monitoring and targeting specific intake goals. The BR group represented the outcomes following implementation of said monitoring and subsequent intervention.

Although we were unable to find a statistically significant difference in radiographic outcomes, likely due to a small sample size, we saw promising results. The story of our findings lies in comparison of biochemical markers between our study groups. We saw no significant difference in serum calcium and phosphorus values between groups, which represents the basis for the findings of our study. The importance in these findings lie in the fact that we also saw significantly improved calcium utilization in our BR group. Our results highlight the inappropriateness of monitoring serum calcium as a marker for bone turnover. In our patients, serum calcium values were not influenced by the amount of calcium supplementation provided, and it can be hypothesized that much of this calcium was being utilized for bone mineralization. This hypothesis is supported by the finding of significantly lower alkaline phosphatase values in the BR group, both overall and peak alkaline phosphatase. In order to support our hypothesis, it was important for us to identify additional sources of alkaline phosphate such as the liver. We saw no significant differences in total bilirubin, AST, and ALT between our study groups.

In clinical practice, serial monitoring of biochemical markers represents a simple method to monitor bone status and any progress associated with strategies to improve bone mineralization. Radiographic evidence is a better long-term indicator of the success of treatment strategies. In this study, we saw a trend in improved outcomes on radiographic analysis. We saw 8 cases of osteopenia, 2 of which were bone breaks, in our pre-BR group compared to only 2 cases of osteopenia with no bone breaks in the BR group. Although limited, our results point out what others have also highlighted, that elevation in alkaline phosphate is suggestive of bone mineral disease.6-13 However, as seen in the patients in this study, there were no significant differences in radiographic outcomes between groups. This result may be to due to expansion of the BR criteria to included and encourage monitoring of potentially more intermediate-risk patients. A prospective, adequately powered study with similar methods would likely detect a significant difference in radiographic outcomes. 

This study had some important limitations. This was a retrospective chart review of a limited number of patients. At our institution, we care for a largely inner-city, urban patient population so our results may not have broad external validity. Another important limitation was the number of radiographs available for outcomes analysis. Of the 67 patients in the study, only 55.2% had radiographs that could be utilized. This is largely related to the retrospective nature of the study and may have limited the findings. Additionally, the radiologist involved in this study specifically evaluated osteopenic changes.

We were able to complete a meaningful analysis of the benefit derived from vigilant monitoring of high-risk infants and the outcomes associated with targeting specific calcium, phosphorus, and vitamin D intake goals, tailored to preterm infants. In conclusion, regular monitoring of high risk infants and targeting recent intake goals set by the American Academy of Pediatrics led to a trend in improved outcomes in this patient population. The authors support these recently published intake goals and recommended monitoring of high-risk preterm infants. 




References:
  1. Koo WW, Sherman R, Succop P, et al. Fractures and rickets in very low birth weight infants: conservative management and outcome. J Pediatr Orthop. 1989;9:326-30.
  2. Begany M. Identification of Fracture Risk and Strategies for Bone Health in the Neonatal Intensive Care Unit. Top Clin Nutr. 2012; 27: 231-249.
  3. Ardran GM. Bone destruction not demonstrable by radiography. Br J Radiol. 1951;24(278):107-109.
  4. Vachharajani AJ, Mathur AM, Rao R. Metabolic Bone Diseases of Prematurity. NeoReviews. 2009; 10(8): e402-411.
  5. Abrams SA and the Committee on Nutrition. Calcium and Vitamin D Requirements of Enterally Fed Preterm Infants. Pediatrics. 2013;131;e1676-1683.
  6. Koo WW, Succop P, Hambidge KM. Serum alkaline phosphatase and serum zinc concentrations in preterm infants with rickets and fractures. Am J Dis Child. 1989;143(11):1342-1345.
  7. Catache M, Leone CR. Role of plasma and urinary calcium and phosphorus measurements in early detection of phosphorus deficiency in very low birthweight infants. Acta Paediatr. 2003;92(1):76-80.
  8. Hung YL, Chen PC, Jeng SF, et al. Serial measurements of serum alkaline phosphatase for early prediction of osteopaenia in preterm infants. J Paediatr Child Health. 2011;47(3):134-139.
  9. Backstrom MC, Kouri T, Kuusela AL, et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatr. 2000;89(7):867-873.
  10. Glass EJ, Hume R, Hendry GM, Strange RC, Forfar JO. Plasma alkaline phosphatase activity in rickets of prematurity. Arch Dis Child. 1982;57(5):373-376.
  11. Kovar I, Mayne P, Barltrop D. Plasma alkaline phosphatase activity: a screening test for rickets in preterm neonates. Lancet. 1982;1(8267):308-310. 
  12. Walters EG,Murphy JF, Henry P, Gray OP, Elder GH. Plasma alkaline phosphatase activity and its relation to rickets in pre-term infants. Ann Clin Biochem.1986;23(6):652-656.
  13. Lam HS, So SW, NG PC. Osteopenia in Neonates: A Review. HK J Paediatr (new series). 2007;12:118-124.




New Practitioners Network
What I Wish I Would Have Known – Reflections of a PGY-1 Residency

by Mary Lenefsky, PharmD, Drug information/Investigational Drug Service Pharmacist

When a task is daunting, it is best to break it down. This article is not a reflection on clinical rotations, staffing experiences, or P&T meetings. Those things matter less in the long run. There are other phases of  PGY-1 year which truly stood out as monumental in the development of my professional and personal career. I intend to share those now.

When I first began my PGY-1 residency, I was ecstatic. Traveling alone to a new destination, with only my dog, Truffle, to accompany me was…simply thrilling. On day 1 of my residency, I met the other PGY-1s for the first time. Our class became extremely close throughout the year. We were a very tight knit group. My 9 other co-residents and their support are the reason I made it through this year. Allow me to rephrase…the 9 other people I call my family are the only reason I succeeded this year. I intend to stay close to my family and watch each of them develop into the impeccable pharmacists I know they will become. This led me to the first conclusion I made during the year:

No matter where you are in life - physically, emotionally, or professionally - your success, which is directly related to your happiness, is contingent on having strong and meaningful relationships with those around you. In a fluid world where nothing is set in stone, having pillars to cling to in times of duress and need can sometimes be the only thing keeping one afloat.

I knew the learning curve would be steep in residency training, but nothing could have prepared me for the slope with which the mountain of knowledge ultimately hit me. The first half of the year was mind boggling. I learned to think and adapt to new ways of conceptualizing patients and problems. I remember calling my dad one day and saying, “Dad, if I worked out my body as hard as my mind, I would be absolutely ripped.”   

Many months I left work mentally and emotionally drained. When sitting down with my preceptor, frequently I was grilled with one question after another. My favorite go-to phrase quickly became, “I don’t know. I’ll look it up.” This type of questioning allowed me to progress, however. I soon learned to anticipate questions and what preceptors expected me to know, and realized that my pharmacy education had prepared me for this type of “boot camp.” Besides the clinical knowledge I learned, my pharmacy school exams were designed similarly to what I was experiencing in residency. The difference now though, was the level of expectation. In residency, knowledge and performance expectations grew immensely. This led me to my second conclusion:

There is no way a pharmacist can ever know it all. However, one can learn to think in an anticipatory fashion. If one can learn to think like their mentors, one learns to challenge oneself to remain one step ahead.This type of self-challenge leads to a higher level of thinking and allows for the highest expansion of knowledge.

I have always participated in activities requiring scoring or feedback and am comfortable speaking with others about my performance. However, I was not prepared for the amount of feedback I would be subjected to this year. There are many types of feedback. The most useful type is made up of concrete examples showing ways to better myself and become a more advanced pharmacist. However I also sometimes received feedback that was not as helpful and therefore could be frustrating. Feedback should always allow one to reflect and become a well-rounded person. This leads me to my third conclusion:

Feedback is something to receive with an open-mind. There is no way to please everyone - so also make sure to work on pleasing yourself. When giving feedback, one should always give concrete examples that allow a person to learn from themselves and their actions. Those in a position to do so will always provide you with feedback. Filter through the remarks for those that are constructive, learn from yourself and others, and do not dwell on observations that do not promote success or enhancement. Remember, this is a learning and a growth process. 

In retrospect, I didn’t make enough time for myself in the beginning of my residency year. When I attempted to create personal time, I usually felt guilty for not completing pharmacy-related tasks instead. This mentality quickly got the best of me, and I realized I needed to change my perspective. At the end of December, I joined the gym again. I figured I could participate in activities that would consistently provide positive reinforcement and an ability to relieve stress. During the rest of winter and into spring, I went to the gym at least three times a week. Over the next couple of months I was able to re-prioritize my life and goals. I made an effort to try and participate in more activities outside of work. As mentioned earlier, success for me is directly related to having a positive outlook. If I am not positive, I cannot be successful. This led me to my fourth conclusion: 

Prioritize goals in life. Understand what will make you happy and what you need to succeed. There will always be challenges and even people that may stand in the way – but your happiness and how you attain it is the most important goal in life. If you don’t take the time to ensure happiness by taking care of your body and mind, you won’t be successful in taking care of anything else.

If I had to do it all over…would I? Absolutely! The friendships I have created, the clinical knowledge and experiences I have gained have given me invaluable insight into the world around me, which is priceless. The PGY-1 residency year taught me much more than just how to be a pharmacist. I have also learned how to make lasting and meaningful friendships, how to sift through a broad spectrum of feedback and internalize what is valuable, and I have learned most importantly,  how to best take care of myself. With these new tools, I head into my second year of residency as a much more capable, experienced, and confident person.



Board of Pharmacy Update
Highlights from the September Meeting

by Scott A. Meyers, Executive Vice President

The September 15th Board of Pharmacy Meeting was held at the James R. Thompson Center at Randolph and LaSalle Streets in Chicago. These are the highlights of that meeting.

Department Newsletter – The Department Secretary, Bryan Schneider, reported that the first issue of the re-established newsletter had gone out to all pharmacy registrants. The intent is to publish the newsletter quarterly, and the Secretary asked all interested parties to submit articles for future issues.

MPJE – Board members Milenkovich, Weinert and Carter went to NABP and reviewed 3,000 existing and new questions for the Multi-State Jurisprudence Examination for Illinois in late August. This is done annually to ensure relevance and consistency with Illinois statutes and regulations. The Board also discussed a request by a non-Board member to write questions for the MPJE. The Board voted to limit item writing to Board members and IDFPR staff that work in the Pharmacy Division. The Board will welcome recommendations from outside the Board on types and topics for questions.

NABP District IV Meetings – The 2015 District IV Meeting will be held in Milwaukee, WI and will be hosted by Concordia University College of Pharmacy and the Wisconsin Board of Pharmacy on November 4-6. The 2016 District IV Meeting will be held in Chicago and co-hosted by the University of Illinois at Chicago College of Pharmacy and the Illinois Board of Pharmacy on November 2-4 at the Crowne Plaza Hotel on Halstead.

Legislative Update – A summary of this summer’s overtime legislative session was provided by Garth Reynolds, IPhA Executive Director. The bills discussed have been summarized in previous issues of KeePosted and appear in this issue in the Government Affairs Report.

Open Discussion – Garth Reynolds asked the Department staff if there has been any progress in hiring new inspectors. The staff reported that because of a recent change in the Pharmacy Practice Act requiring that all new inspectors shall be pharmacists with at least five years of experience in pharmacy practice, the application screening process needed to start over. It is expected that new inspector candidates will be interviewed in a month or so.

Next Board of Pharmacy Meeting – The next meeting of the Illinois Board of Pharmacy will be held at 10:30 AM on Tuesday, November 10th at the Thompson Center in downtown Chicago. Announcements and agendas are posted at least 14 days in advance on the IDFPR pharmacy website. The profession is welcome to attend the open portion of this meeting.



Government Affairs Report
No End in Sight for Overtime

by Jim Owen and Scott A. Meyers

We knew it was going to be a long drawn out session this summer (actually fall by presstime) and neither side appears to be giving. Although the House did fail to override the Governor’s veto of a labor bill that would have removed the negotiation power with government unions away from the Governor and to an appointed arbitrator. That was the first defeat in decades for House Speaker Madigan. The budget continues to be held with the Democrats accusing the Governor of asking for things unrelated while the Governor contends that almost all things are related. With more than 70% of the State’s expenses now court-mandated to be paid, it may be a long time before we actually see any movement on this issue.  

We’ve told you about most pharmacy legislation that was acted on this session, but here’s a quick recap of the more important bills that made it out of the General Assembly and actually received a signature from the Governor.

Bill Number Sponsor Bill Description Final Action ICHP Position
HB1 Rep. Lang, D-Chicago Amended nearly 25 Acts to fight the spread of heroin use and overdoses in Illinois. The bill allows pharmacists to dispense naloxone to patients upon request through a standing order by the Department of Public Health. It also creates wider Medication Take Back programs through law enforcement. Requires prescriber to note screening for opioid abuse when providing prescriptions for three 30-day supplies of opioids. Makes changes to PMP reporting. Governor amendatory veto is overridden by both chambers. Effective in 180 days from September 9th. Support
HB1335 Rep. Harris, D-Chicago Right To Try Bill, allows terminally ill patients to petition for access to investigational drugs that have entered phase II testing. It does not mandate compliance by the manufacturer. Governor signed. Oppose
HB3137 Rep. Brady, R-Normal Allows early refills of eye drops, insurance providers may not deny coverage. Governor signed. Support
HB3219 Rep. Zalewski, D-Riverside Creates 1-year voluntary pilot project for locking med closures on CII prescriptions. Requires Certified Pharmacy Technicians to obtain 20-hours of CE credit every two years. Requires all new pharmacy inspectors to be pharmacists. Governor signed. Support
SB455 Sen. Munoz, D-Chicago Requires passive reporting by the pharmacist whenever a biologic product is dispensed. Governor signed. Oppose
SB689 Sen, Murphy, R-Palatine Allows APN/RN/PA to pick up hospice patients’ prescriptions from the pharmacy. Governor signed. Support

The ICHP Division of Government Affairs is now working on drafting proposed changes to several Acts in the spring in order to obtain provider status for pharmacists in Illinois. This effort will require a variety of changes to multiple Acts but could create significant opportunities for pharmacists once passed. In addition, our hope is to assist physicians in managing their patients’ medication therapies, so that they may see more patients and increase access to primary care providers. Stay tuned for more details and an eventual call to action to every member.



Leadership Profile

by Lynn Fromm, RPh

What is your current leadership position in ICHP?
Co-Director for the Southern Region

What benefits do you see in being active in a professional association such as ICHP?
Networking, education, and political advocacy

What initially motivated you to get involved in ICHP?
I have always been interested in knowing what is going on outside my own sphere of influence.

Where did you go to pharmacy school?
St. Louis College of Pharmacy
University of Colorado School of Pharmacy

Where have you trained or worked? 
I have always worked in a small to midsized hospital. The last 20 years I have been the Pharmacy Director at Anderson Hospital in Maryville, Illinois.

What special accomplishments have you achieved?
When I started in pharmacy, computer applications were just being started. I feel that I have been involved in the implementation of technology from the ground up.

Describe your current area of practice and practice setting:
I serve as the Pharmacy Director at Anderson Hospital, which is a 150-bed community hospital in Maryville, Illinois. 

What advice would you give to student pharmacists?
Use every opportunity that you can to learn and become involved. Treat every experience as an interview for a job that you might want some day.

What pharmacy related issues keep you up at night?
Drug shortages and their potential impact on my patients. 

Do you have any special interests or hobbies outside of work?
Art – I like to draw. Photography – but mostly of family. I enjoy putting the two together and do a lot of scrapbooking.

What is your favorite place to vacation?
Vacations for me always include sightseeing activities, so I usually try and schedule some place that I have not been to.

What 3 adjectives would people use to best describe you?
Focused
Conscientious
Adaptable



Educational Affairs
Health Literacy in Pharmacy

by Renee Papageorgiou, PharmD, Clinical Pharmacy Specialist, NorthShore University Health System

From reading instructions on a prescription bottle to signing a consent form, health-related information can be complex for patients. Approximately 90 million people have difficulty understanding health-related information.1 Many individuals, including pharmacists, are unaware of how many patients are missing the necessary skills to fully understand health-related terminology and documents. A study in Illinois that surveyed pharmacists of various specialties, showed that only 32% of pharmacists who completed the survey were able to properly identify the percentage of the US population that has limited health literacy skills.2

The Institute of Medicine defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”1 One’s health literacy level may or may not be related to their literacy level. Literacy is comprised of print literacy, oral literacy, numeracy and conceptual knowledge.1 Print literacy involves one’s ability to understand what they read and write. Communication skills such as understanding what an individual is saying, or having the ability to speak involves oral literacy. Numeracy includes the capacity an individual has to look at a number, integer or value, for example, and understand what message is being conveyed. This can include information that is depicted in a chart or simply written out. Conceptual knowledge involves all the information an individual learns from their family, their surroundings, and/or their culture.1,3

Given that literacy is made up of many components, an individual may be able to successfully communicate on a daily basis, but may not be able to apply the same skills in a health-related setting and/or fully understand health-related materials. An individual with low literacy may also have low health literacy. However, an educated, literate, individual may also have difficulty with health related material, resulting in the individual having low health literacy. Health-related situations vary from environment to environment, and person to person. Other factors such as age, income, and ethnicity may impact a patient’s literacy and may also play a role in one’s health literacy level.1


Impact of Health Literacy

Approximately half of the adult American population lacking basic health literacy skills,1 and studies show an association between low health literacy and increased medical costs, poor disease management, and low medication adherence. Patients with low health literacy are less likely to get annual physicals and/or other preventative services, which leads to increased hospitalizations.1 This increases inpatient costs, with individuals with low health literacy requiring an additional $993, on average, per hospitalization compared to individuals of adequate health literacy.4

When assessing the impact of health literacy in individuals with chronic obstructive pulmonary disease (COPD), patients with low health literacy were less likely to have had access to usual care for COPD treatment. When comparing patients’ understanding of COPD, patients with low health literacy were more likely to believe that COPD is not a chronic, long-term disease.5 Another study showed that approximately 48% of patients who were diagnosed with diabetes or hypertension and had low health literacy had significantly less knowledge about their disease, how to self-manage, and how to implement lifestyle modifications.6

In the pharmacy setting, health literacy impacts how a patient interprets medication information and what they understand about various pharmacy services that are available to them. According to the Agency for Healthcare Research and Quality (AHRQ), approximately 12% of adults have adequate health literacy, including having the ability to properly interpret a prescription label.7 This can lead to patients taking their medications incorrectly or not adhering to their regimen. In addition, low health literacy costs the United States an estimated $106 to $238 billion per year due to more emergency room visits, hospitalizations, and medication errors and less use of preventative services.1


How to Assess Health Literacy

A patient’s health literacy can be formally evaluated using a health literacy assessment, but there are alternative signs pharmacists can use to help identify patients who might have low health literacy (Table 1). There are numerous health literacy assessments available for use in many healthcare settings. The Short Assessment of Health Literacy (SAHL) is available in both English and Spanish by the AHRQ. The SAHL, a validated, 18-item multiple-choice assessment that tests both word recognition and comprehension, takes a few minutes to administer.8,9 Patients are presented with a stem word, a key word, and a distractor word on a notecard. The patient is to read the stem word and then associate it to the key word. If four or more associations are missed when conducting the assessment, it can be concluded that the patient has low health literacy.

The Test of Functional Health Literacy Assessment (TOFHLA) is a 50-item reading comprehension test and 17-item numerical test, which takes approximately 22 minutes to administer. An abbreviated version (36-item reading comprehension and 4-item numeracy) and shortened version (36-item reading comprehension) are also available. The TOFHLA is available in both English and Spanish.10

The Rapid Estimate of Adult Literacy in Medicine (REALM-SF) is a validated seven-item word recognition assessment that has been modified from the 66-item Rapid Estimate of Adult Literacy in Medicine (REALM) assessment. In this assessment, patients are given a card with seven words on it and asked to read them aloud. When the REALM-SF is graded, the results indicate a patient’s reading level and help associate it to the patient’s ability to read health-related information. For example, a score of five would conclude that a patient is able to read at a seventh to eighth grade level, and that the patient may struggle reading most health-related information.9,11

There are numerous other health literacy assessments that may be used by pharmacists. Not all assessments have been discussed in this article, but additional information may be found on the AHRQ website at http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy/index.html.   

Table 1
Alternative Identifiers of Patients with Low Health Literacy12
• Frequently miss scheduled appointments 
• Incomplete health-related documents
• Not taking their medications properly, or not at all 
• Unable to identify the need for their medications
• Identifying pills by color/shape
• Not knowing a medication’s purpose or how to take it
• Avoid asking questions
• Poor historian
• Do not follow-up on tests and/or referrals


Pharmacist’s Impact on Health Literacy 

As pharmacists, we interact with patients in many different settings. It is important to make sure our patients process and understand information regarding their medications and disease states. In order to get a better understanding of health literacy, it is important for pharmacy students to see the value of assessing a patient’s understanding early in their education. A study found that students who completed course work that included a health literacy topic felt more comfortable identifying and assessing patients with lower health literacy.13 

Pharmacists can play a role in helping patients better understand health related materials (Table 2). For pharmacists in the workforce, there are also many resources available. The AHRQ Pharmacy Health Literacy Center has five toolkits available for pharmacists:7
  1. Pharmacy Health Literacy Assessment Tool & User’s Guide
  2. Training Program for Pharmacy Staff on Communication
  3. Guide on How To Create a Pill Card
  4. Telephone Reminder Tool To Help Refill Medicines On Time
  5. Explicit and Standardized Prescription Medicine Instructions  
Due to the complexity of health literacy, it is important to keep in mind that communication, whether written or verbal, may be confusing for patients. For some individuals, verbal communication may require using lower-grade level words. For written communication, some patients may require simple and comprehensible auxiliary labels.14

Table 2
Strategies to Overcome Health Literacy Barriers12,15
• Speak to the patient using plain language (ie: diabetes vs. high blood sugar)
• Use Teach-Back Method to confirm patient’s understanding
• Use pictures to demonstrate situations
• Limit the amount of information presented (focus on what is essential to know)
• Use open-ended questions
• Be specific (don’t generalize information)
• Encourage questions 
• Offer interpreter services if needed
• Assist with referrals and/or documents
• Create a welcoming environment

Health literacy is a big component of a patient’s health management. It is essential as pharmacists to recognize patients with varying health literacy, and to try to assess patients to make sure they understand how to take their medications, why they are taking their medications, and how to properly self-manage their diseases.



References: 
  1. Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: a prescription to end confusion. Washington, DC: The National Academies Press; 2004. 
  2. Devraj R, Gupchup GV. Knowledge of and barriers to health literacy in Illinois. J Am Pharm Assoc. 2012;52:e1830e193.
  3. Health literacy. National Network of Libraries of Medicine. Nnlm.gov/outreach/consumer/hlthlit.html#A1. Accessed June 23, 2015. 
  4. Howard DH, Sentell T, Gazmararian JA. Impact of health literacy on socioeconomic and racial differences in health in an elderly population. Journal of General Internal Medicine, 2006, Aug;21(8):857-61.
  5. Kale MS, Federman AD, Krauskopt K, et al. The association of health literacy with illness and medication beliefs among patients with chronic obstructive pulmonary disease. PLoS ONE. 10(4):e0123937. 
  6. Williams MV, Baker DW, Parker RM, et al. Relationship of functional health literacy to patient’s knowledge of their chronic disease: a study of patients with hypertension or diabetes. Arch Intern Med. 1998;158:166-172. 
  7. AHRQ Pharmacy Health Literacy Center. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/quality-patient-safety/pharmhealthlit/index.html. Accessed June 23, 2015. 
  8. Lee SD, Stucky BD, Lee JY, et al. Short assessment of health literacy – Spanish and English: A comparable test of health literacy for Spanish and English speakers. HSR: Health Services Research. 2010;45(4):1105-1120. 
  9. Health Literacy Measurement Tools (Revised). Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy/. Accessed June 25, 2015. 
  10. Baker DW, Williams MV, Parker RM, et al. Development of a brief test to measure function health literacy. Patient Educ Couns. 1999;38:33-42. 
  11. Arozullah AM, Yarnold PR, Bennett CL, et al. Development and validation of a short-form, rapid estimate of adult literacy in medicine. Med Care. 2007;45(11):1026-1133. 
  12. Health literacy: hidden barriers and practical strategies. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/tool3a/index.html. Accessed September 20, 2015.
  13. Trujillo JM, Figler TA. Teaching and learning health literacy in a Doctor of Pharmacy program. American Journal of Pharmaceutical Education. 2015;79(2). 
  14. Locke MR, Shiyanbola OO, Gripentrog E. Improving prescription auxiliary labels to increase patient understanding. J Am Pharm Assoc. 2014;54:267-274. 
  15. Maybank KA, Dickson T. Breaking down health literacy barriers. http://www.cecity.com/aoa/healthwatch/jun_08/print5.pdf. Accessed September 20, 2015. 



ICHPeople

ASHP has launched a new steering committee on Women in Pharmacy Leadership. ICHP members Despina Kotis and Jennifer Tryon are a part of the committee and pictured here.  A networking event is scheduled for the Midyear Clinical Meeting in New Orleans. The committee hopes to provide many educational, informational materials and programs for those interested in a variety of leadership opportunities.


Congratulations to Lisa Lubsch Bimpasis and her husband, Nick, who welcomed daughter, Phoebe Kay on September 21, 2015. Baby arrived 7 lb. 10 oz. and 20.5 in. long. Lisa says big brother, Alex, is excited (for now).















Hi Tech
Announcing changes to the Pharmacy Tech Topics™ Website!

The Illinois Council of Health-System Pharmacists (ICHP) now offers the convenience of purchasing either an online only or a paper by mail subscription from the Pharmacy Tech Topics™ website. Please visit PharmacyTechTopics.com to learn more about this great home study CE program for certified pharmacy technicians.

But don’t forget that ICHP Pharmacy Technician members receive Pharmacy Tech Topics™ subscriptions for free as a member benefit! This is a great value for all certified pharmacy technicians living and/or working in Illinois. So please be sure and share this information with all your co-workers.


  


College Connections

Benefits of Working During Pharmacy School

by Elizabeth Eitzen, UIC College of Pharmacy Class of 2017, ICHP Student Representative

The benefits of working during school are always told to us as students whether it’s at the high school, collegiate or professional level. Since the time I turned sixteen, people always talked about time management skills, work ethic and overall personal development that came from having a job. However, if I am being honest, the only benefit I ever saw from my jobs in high school and college was having money to save up for a nice pair of shoes or a fun night out with my friends. I am sure we can all agree extra cash is never a bad thing, but as pharmacy students is this still the real benefit of having a job?

The answer is a resounding “No!” When it comes to working through pharmacy school, the money is a bonus and experience is the true payment. As a first year pharmacy student, I realized that I needed to get a pharmacy job to help build “pharmacy experience” but I didn’t actually understand what an important part of my education this working experience would be.

So far in pharmacy school I have had two pharmacy-related jobs. The first was in a community setting and the second was in an inpatient setting. It was through these two jobs that I finally started to believe what my parents and teachers had been telling me about the actual benefits of working during school. First, keeping a job during semesters of hard coursework and increased extra-curricular involvement helped me immensely to build my time management skills and work ethic. More importantly, my work experience has helped provide focus and direction in my pharmacy education. Working has allowed me to witness firsthand the various roles pharmacists have in patient care. Seeing the importance of the drug specific knowledge that they have has helped me focus on my schoolwork and realize just how valuable all that information is. The pharmacists I work with provide me with more than an example of what to strive for; they also offer me the lessons of their own experiences through the advice that they give me. I know that these relationships are mainly possible through working and they have served as mentors as I make professional decisions throughout school.

In addition to coursework, my pharmacy work experience has helped me decide to which of the pharmacy organizations I should dedicate my energies. Witnessing the impact of clinical and distributive pharmacy within a health system naturally directed me to ICHP. This association is unique among student organizations in its focus on all aspects of the pharmacy’s role within a health-system. It’s this well-rounded approach that has guided me even more towards a career in clinical pharmacy.

Overall, my work life in pharmacy school has played an indispensible role in shaping the kind of pharmacist I will one day become. The relationships I have forged and the experiences I have collected will one day ensure I am able to confidently and compassionately provide care to patients.




Introductory Pharmacy Practice Experience and Leadership Growth

by Anolan Garcia Hernandez, PS-3, SSHP-ICHP Board Representative, Chicago State University College of Pharmacy

Learning is a continuous process that happens at every moment in life. During my last introductory pharmacy practice experience (IPPE), my preceptor at Edwards Hines Jr. VA Hospital, Dr. Li, tremendously influenced me. Her guidance and dedication made me reflect about my leadership skills and the possible paths I could pursue in the future. 

This rotation was a unique and valuable experience for me since I had very limited experience in this setting. Learning about the role of a pharmacist through shadowing is always interesting to me. Over the past several months, not only did I learn about the institutional setting, but also how important it is to work in integrated teams. I discovered that pharmacists are an important link in the healthcare chain. The role of a pharmacist as part of a healthcare team is significant in patient care. For instance, during patient care rounds, pharmacists are often asked about drug doses and recommendations for certain medical conditions. I am realizing that pharmacists can greatly influence health outcomes and quality of life for patients under their care. Participation in committees is another tool that I found very helpful in recognizing the importance of pharmacists. This represents another avenue for them demonstrate their skill set at their respective institution. At this rotation, I had the chance to observe pharmacists during a Nursing and Pharmacy Committee meeting. One of my learning objectives for this rotation was to learn more about committees; I was able to meet my goal and expand upon my knowledge on hospital committees from my didactic courses.  

The time that I spent with Dr. Li also helped me to reflect on my leadership skills. I asked myself, “Am I ready to take charge and demonstrate my skills?” I tried to find the answer but every time I would come to the same conclusion; I needed to take action and put my skills into practice. Thus, I decided to become more than a member on the roster in student organizations. Being part of the SSHP executive board and other student organizations has given me the opportunity to demonstrate and enrich these skills. 

Additionally, this IPPE allowed me to learn via a different platform, and I am greatly appreciative of the opportunity. I was able to “connect the dots” and understand how to practically apply more of the information I was taught in the classroom. For example, I learned that pharmacists must always be prepared to answer questions “on the spot.” Thanks to interactions with my preceptor, I was able to build up my confidence in such scenarios. She asked me questions in such a manner that helped me to organize my thoughts and apply my knowledge. As part of this rotation, I was required to complete a weekly reflection on the site visit. During my reflections, I thought about the answers I provided for questions that were posed to me, and then tried to improve my responses for practical purposes. I learned when answering questions, you should always be quick, yet accurate. 

The most relevant aspect that I gathered from this experience is that it helped me to finally make a decision I had contemplated since I started school. I have always known I want to do more after obtaining my degree. Finally, thanks to my preceptor’s remarkable guidance and my leadership growth, I have decided to pursue an institutional based residency!




Addiction Is a Disease

by Tina Messenger, P-4 and Jenny Kasen, P-2, ICHP Liaison, SIUE School of Pharmacy

It was the summer of 1986, and my older sister and I were home alone babysitting our younger siblings. Around 10pm, all four of us went to bed only to be awakened from a deep sleep a couple hours later to the sounds of our mother yelling,“Stop, stop!” My stepfather was screaming and hitting my mother. The pair of them had been to a party and had been drinking. My older sister ran out into the living room to save my mother from being hurt; however my stepfather then turned on her. Seconds later, my older sister ran into my room instructing me to call 911. This was a pivotal moment in my life because I froze. I could not move, could not speak and ultimately could not pick up the phone to do as my sister said. After intense examination about my lack of action that night, I eventually came to the conclusion that I did not act because I was afraid. I was afraid of the possible negative consequences that my mother would face. On the flip side, I was afraid that nothing would come of it...there would be no change.

The next day, I was told that my stepfather had mixed cocaine with alcohol, and that is what brought on the rage. I was also told you should never mix the two. So did that mean that one or the other was okay when ingested alone? It was obvious to me that what was happening was wrong, but I never told anyone that both of my parents had substance abuse problems. As a result of my silence and the continued substance abuse, the domestic abuse continued.

Eventually, the dreaded day came…my stepfather tried to kill my mother after being on a crack binge for a week. I looked for help, but this was in the 1990’s. Unfortunately, due to a lack of resources and public awareness/education, I realized that I still did not have a voice, nobody wanted to discuss addiction, and nobody knew how to help even if the discussion occurred. There was still such a stigma around addiction. Addiction was still considered a defect in a person’s willpower. It was not until I found sobriety later in my own life that I realized that I DO have a voice, addiction IS a disease, and there are SO MANY resources to help those who are looking for a positive and lifelong change. Like my parents, I was sick, I had a disease, and there was a cure.

The above story is the main reason that I wanted to attend the Inaugural session of the APhA Institute on Alcoholism and Drug Dependencies in Salt Lake City, Utah. The Institute consisted of a weekend of education, personal development, networking and ideas related to the disease of addiction. This experience turned out to be so much more for me. The Institute encouraged me to take a hard look at myself and reflect, this forced me to seek out individuals to speak with regarding my experience. I realized through this experience that if I keep working hard to help educate individuals regarding addiction and keep the communication open, that MAYBE I can change one person’s viewpoint or even help one individual. I know I cannot change or help everyone but the more I discuss the subject the more others may reflect.

------- Reflection Provided by Tina Messenger

The education provided at the Institute on Alcohol and drug dependencies gives us, as pharmacists, the tools needed to get the community involved in this ongoing issue. At SIUE, SSHP is working with other organizations to start a lock-in within our community. This will allow us the opportunity to give students and parents an education they are not getting anywhere else. It will provide a safe environment for the younger generation to learn, and ask questions without judgement. It will also give us the opportunity to educate parents who are unaware of the issues their children may be facing. We will also be able to help anyone find help who needs it.

Alcohol and drug dependency hits very close to home for many of us, but it doesn’t have to be going on in our own homes for us to know how important it is to address it publicly and socially. Tina’s participation in the Institute of Alcohol and Drug Dependencies will make us more prepared to address this issue with everyone in our community.





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Welcome New Members!

New Member Recruiter
Sarah Abbasi
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Officers and Board of Directors

JENNIFER PHILLIPS 
President
630-515-7167 
jphillips@midwestern.edu 

LINDA FRED 
Immediate Past President
217-383-3253 
linda.fred@carle.com

JENNIFER TRYON 
Treasurer 
jennifer.tryon@uchospitals.edu 

CHARLENE HOPE
Secretary
708-783-5933

TRAVIS HUNERDOSSE 
Director, Educational Affairs 
thunerdo@nmh.org

CARRIE VOGLER
Director, Marketing Affairs
217-545-5394

DESI KOTIS 
Director, Professional Affairs
312-926-6961 
dkotis@nmh.org

CAROL HEUNISCH 
Director, Organizational Affairs 
847-933-6811

KATHRYN SCHULTZ
Director, Government Affairs
312-926-6961

MIKE WEAVER 
Chairman, House of Delegates 
815-599-6113 
mweaver@fhn.org

ANA FERNANDEZ
Technician Representative
312-926-6980

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

REBECCA CASTNER
Chairman, New Practitioners Network
773-821-2164

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

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

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

Regional Directors

NOELLE CHAPMAN 
Regional Director North
312-926-2547
nchapman@nmh.org 

ED RAINVILLE 
Regional Director Central 
ed.c.rainville@osfhealthcare.org 

LYNN FROMM 
Co-Regional Director South
618-391-5539

TARA VICKERY GORDEN 
Co-Regional Director South
618-643-2361 x2330
tvgorden@hmhospital.org

Student Chapter Presidents

KATHERINE SENCION 
President, Student Chapter
University of IL C.O.P. 
ksenci2@uic.edu 

JOANNE CHA 
President, Rockford Student Chapter 
University of IL C.O.P. 
cha17@uic.edu

JESSICA PENG 
President, Student Chapter
Midwestern University C.O.P. 
jpeng54@midwestern.edu

BRITTANY HUFF
 
President, Student Chapter 
Chicago State University C.O.P. 
bhuff@csu.edu

WHITNEY MAHER 
President, Student Chapter 
Southern Illinois University Edwardsville S.O.P
whitney.maher@gmail.com

JORDAN FAISON 
President, Student Chapter 
Roosevelt University C.O.P. 
jfaison@mail.roosevelt.edu

VALENTIN PACURARU 
President, Student Chapter 
Rosalind Franklin University C.O.P. 
valentin.pacararu@my.rfums.org


ICHP Affiliates 


KATHRYN SCHULTZ 
President, Northern IL Society (NISHP)

JARED SHELEY 
President, Metro East Society (MESHP)
jpsheley@gmail.com 

AMY BOBLITT 
President, Sangamiss Society
Boblitt.amy@mhsil.com

ED RAINVILLE
 
President, West Central Society (WSHP)  
ed.c.rainville@osfhealthcare.org

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


ICHP Pharmacy Action Fund (PAC) Contributors

Names below reflect donations between October 1, 2014 and October 1, 2015. Giving categories reflect each person's cumulative donations since inception.

ADVOCACY ALLIANCE - $2500-$10000
Kevin Colgan
Edward Donnelly
Dave Hicks
Frank Kokaisl
Scott Meyers
Michael Novario
Michael Weaver
Thomas Westerkamp

LINCOLN LEAGUE - $1000-$2499
Scott Bergman
Andrew Donnelly
Ginger Ertel
Linda Fred
James Owen Consulting, Inc.
Ann Jankiewicz
Jan Keresztes
Kathy Komperda
Despina Kotis
William McEvoy
Michael Rajski
Christina Rivers-Quillian
Carrie Sincak
Avery Spunt
JoAnn Stubbings
Patricia Wegner

CAPITOL CLUB - $500-$999
Sheila Allen
Margaret Allen
Rauf Dalal
Leonard Kosiba
George MacKinnon
Janette Mark
Mary Lynn Moody
Jennifer Phillips
Edward Rainville
Kathryn Schultz
Jill Warszalek

GENERAL ASSEMBLY GUILD - $250-$499
Peggy Bickham
Jaime Borkowski
Brad Dunck
Nancy Fjortoft
Joann Haley
Travis Hunerdosse
Kim Janicek
Mary Lee
Karen Nordstrom
Peggy Reed
Kristi Stice
Heidi Sunday
Tara Vickery-Gorden
Marie Williams

SPRINGFIELD SOCIETY - $100-$249
Jill Borchert
Noelle Chapman
Kathy Cimakasky
Christopher Crank
Joan Hardman
Glenna Hargreaves
Robert Hoy
George Lyons
Dylan Marx
James Sampson
Brandi Strader
Carrie Vogler
Amanda Wolff

GRASSROOTS GANG - $50-$99
Gunchoo Chadha
Lara Ellinger
Jennifer Ellison
Bella Maningat
Robert Miller
Julio Rebolledo
Jerry Storm

CONTRIBUTOR - $1-$49
Marc Abel
Anchalee Ardharn
Skylar Boldue
Antoinette Cintron
Janet Engle
Linda Grider
Heather Harper
Ina Henderson
Antoine Jenkins
Connie Larson
Barbara Lindberg-Mancini
Michelle Martin
Natalie Schwarber
Karin Terry


Upcoming Events

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

Tuesday, October 13
Using MRSA Nasal Swabs as a Predictor for MRSA Pneumonia
Sangamiss Program
Pharmacist and pharmacy technician-specific CPE programming
PAO Bistro (Pacific Coast Cuisine) | Springfield, IL

Sunday, October 18 - Saturday, October 24
National Hospital and Health-System Pharmacy Week

Tuesday, October 20
National Pharmacy Technician Day

Thursday, October 22 & Wednesday, October 28
USP 797: Upholding Standards as a Pharmacy Technician
Pharmacy technician-specific CPE programming
Champions Program | LIVE Webinar

Saturday, October 24
APhA's Pharmacy-Based Immunization Delivery
Hosted by IPhA
IPhA Office | Springfield, IL

Sunday, October 25
APhA's Pharmacy-Based Travel Health Services
Hosted by IPhA
IPhA Office | Springfield, IL

Tuesday, October 27
CPRN Meeting
Collaborative Research in Illinois
UIC COP | Chicago, IL

Thursday, October 29
Targeted Oral Anticancer Agents: Not just for oncology providers
NISHP Program
Pharmacist and pharmacy technician-specific CPE programming
Advocate Lutheran General Hospital | Park Ridge, IL

Wednesday, November 4
New Lipid Lowering Drugs: PCSK9 Inhibitors – Blockbusters or Bust?
WCSHP Program
OSF Saint Francis Medical Center | Peoria, IL

Thursday, November 5
The Clinical Impact of Rapid Blood Culture Identification (BCID)
MESHP Program
St. Elizabeth's Hospital | Belleville, IL

Saturday, November 7
NPN Volunteer Opportunity
Lurie Ronald McDonald House | Chicago, IL

Saturday, November 7
APhA's Pharmacy-Based Cardiovascular Disease Risk Management
Hosted by IPhA
IPhA Office | Springfield, IL

Tuesday, November 10
The Golden Age of Heart Failure Therapy: A focus on sacubitril/valsartan
Sangamiss Program
Lake Pointe Grill | Springfield, IL

Wednesday, November 11 & Tuesday, November 17
Establishing Inpatient Medication Therapy Management Billing
Pharmacist and pharmacy technician-specific CPE programming
Champions Program | LIVE Webinar



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