Official Newsjournal of the Illinois Council of Health-System Pharmacists
Volume 45, Issue 1
Illinois Council of Health-System Pharmacists
4055 North Perryville Road
Loves Park, IL 61111-8653
Phone: (815) 227-9292
Fax: (815) 227-9294
Official Newsjournal of the Illinois Council of Health-System Pharmacists
ASSISTANT MANAGING EDITOR
EXECUTIVE VICE PRESIDENT
VICE PRESIDENT - PROFESSIONAL SERVICES
DIRECTOR OF OPERATIONS
CUSTOMER SERVICE AND
PHARMACY TECH TOPICS™ SPECIALIST
Jo Ann Haley
ICHP Mission Statement
Advancing Excellence in the Practice of Pharmacy
ICHP Vision Statement
ICHP dedicates itself to achieving a vision of pharmacy practice where:
• Pharmacists are universally recognized as health care professionals and essential providers of health care services.
• Patients are aware of the training, skills, and abilities of a pharmacist and the fundamental role that pharmacists play in optimizing medication therapy.
• Formally educated, appropriately trained, and PTCB certified pharmacy technicians manage the medication distribution process with appropriate pharmacist oversight.
• Pharmacists improve patient care and medication safety through the development of effective public policies by interacting and collaborating with patients, other health care professionals and their respective professional societies, government agencies, employers and other concerned parties.
• Evidence-based practices are used to achieve safe and effective medication therapies.
• There are an adequate number of qualified pharmacy leaders within the pharmacy profession.
• Pharmacists take primary responsibility for educating pharmacy technicians, pharmacy students, pharmacist peers, other health professionals, and patients about appropriate medication use.
As an integral publication of the Illinois Council of Health-System Pharmacists, the KeePosted newsjournal will reflect its mission and goals. In conjunction with those goals, KeePosted will provide timely information that meets the changing professional and personal needs of Illinois pharmacists and technicians, and maintain high publication standards.
KeePosted is an official publication of, and is copyrighted by, the Illinois Council of Health-System Pharmacists (ICHP). KeePosted is published 10 times a year. ICHP members received KeePosted as a member benefit. All articles published herein represent the opinions of the authors and do not reflect the policy of the ICHP or the authors’ institutions unless specified. Advertising inquiries can be directed to ICHP office at the address listed above. Image disclaimer: The image used in the Pharmacy Tech Topics advertisement is the property of © 2013 Thinkstock, a division of Getty Images. The image used in There’s an App for That! is property of Medscape® Mobile from WebMD®.Copyright © 2013, Illinois Council of Health-System Pharmacists. All rights reserved.
Each year, U.S. Poison Centers receive more than four million poisoning exposures calls. The Illinois Poison Center (IPC) handles over 80,000 calls annually via its toll-free, confidential hotline (1-800-222-1222). Of those calls, almost half involved children 5 years of age and under but the most serious cause involved an adult. Calls range from people exposed to a variety of substances that can be potentially harmful causing minimal to fatal reaction (medications, vitamins/supplements, plants, chemicals household/automotive products, insect/animal bites and stings, lead, carbon monoxide, etc.)
For children ages 18-36 months, poisoning is the #1 cause of injury-related hospitalization and death
In Illinois, there are more people hospitalized for poisonings than for injuries from firearms and motor vehicle collisions combined
Nine out of 10 poisoning deaths are caused by drugs/medications
It's Easy to Make a Difference...simply share FREE poison prevention information with your family, friends, coworkers and community:
· First...Know the Basics: If you haven’t already done so, complete the IPC’s quick, free online Poison Prevention Education Course and learn more about poison prevention, poison centers and how to win!!!
· Then, Order Free IPPM Promotional Items: magnifier bookmark/rulers, keychain flashlights, children's activity sheets, wallet/key cards (limited supplies available, order before Feb. 15, 2013)
· Invite Kids/Students to play/view a variety of poison prevention computer games and videos
· Visit and Share the new "My Child Ate..." resource library
· Download the FREE Poison Center Help App now available in the iTunes store
· Save the Number to your phone (and encourage others to do so as well): 1-800-222-1222
· Place the Following Message at the end of every email you send during the month of March: "Join me in celebrating Illinois Poison Prevention Month (March 1-31) and get Free Poison Prevention Materials and Prizes!"
· Post the same message on your Facebook wall
· Tweet "I'm Celebrating Illinois Poison Prevention Month (March 1-31). No question or issue too big or small just call 1-800-222-1222!"
In light of the looming fiscal battles both at the federal and state levels, it has never been more important for you to urge your elected officials to maintain funding for Illinois’ only remaining poison control and prevention center.
It's estimated that for every $1 invested in the IPC, there is a $13 savings in reduced health care and lost productivity costs.
If full State and Federal funding for the Illinois Poison Center (IPC) is not appropriated, drastic cuts could translate into decreased educational services (poison awareness and poison prevention and treatment in Illinois). As costs continue to rise, the IPC could be unable to continue providing Illinoisans with access to vital poison control, treatment and education services.Click Here Now (even if you've already done so before!)
Taken directly from the Illinois Poison Center Website at http://illinoispoisoncenter.org/IPPM
Illinois Council of Health-System Pharmacists 2013 Spring Meeting
Join us for stellar educational programming, an Exhibits program featuring the latest in industry advancements, poster presentations, and valuable networking.
SOME HIGHLIGHTS OF THE MEETING:
Keynote: Leadership as a Professional Journey
Lunch Symposium: 2013 Diabetes Clinical Practice Recommendations and Treatment Algorithms: What’s New!
Practice Management Sessions
10.5 Hours of CPE!
Save with Early Bird Rates thru 3/22/2013!
The objective of the Best Practice Award program is to encourage the development of innovative or creative pharmacy practice programs or innovative approaches to existing pharmacy practice challenges in health systems within the state of Illinois.
Applicants will be judged on their descriptions of programs and practices employed in their health system based on the following criteria:
Past winners include:
Online entry form: http://www.ichpnet.org/professional_practice/best_practices/
Instructions for preparing manuscript
The manuscript should be organized as a descriptive report using the following headings:
All applicants will be notified of their status within three weeks of the submission deadline. Should your program be chosen as the winner:
Non-winning submissions may also be considered for publication in the ICHP KeePosted, but your permission will be obtained beforehand.
Join hundreds of pharmacy professionals at the State Capitol on March 13, 2013!Represent your profession and speak directly to legislators and staff regarding the critical issues facing pharmacists. It is vital that your legislators become more knowledgeable on the role of pharmacy in augmenting healthcare. Learn about key issues and how to discuss them with your legislators. Join your fellow pharmacists and become part of the solutions. Don’t miss this opportunity to let your collective voices be heard!
PHOTO ID: All persons visiting the Capitol Building must present a government issued photo ID.
MOTORCOACH: Bus transportation to and from Springfield will be available. Be sure to mark your pickup location below. Departure times to follow via email.
PARKING: Parking will be available in the parking garage attached to the Hoogland Center for the Arts.
SCHEDULE OF EVENTS:
Registration is available online at IPhA's website.
By registering for Pharmacy Legislative Day, you are giving IPhA and ICHP permission to use photographs or video of yourself taken at the event. IPhA and ICHP intend to use such media only in connection with IPhA and ICHP official publications, media promotions, websites, or social media sites, including but not limited to Facebook, Twitter, and YouTube, and these images may be used without further notifying you.
by Tom Westerkamp, ICHP President
Over the holidays I got a chance to go to the movie theater. My extended family was in from out of town and stayed at our house, so it was good to get out with everyone and go to a large movie complex so everyone could select the movie they wanted to see. Lucky for us, most of the films we wanted to see started at about the same time, so we loaded up a few vans and piled out to the theater. As we waited in line to buy our tickets, clumps began to form, and soon several consensuses were reached, with some selecting a comedy, others an action flick, but I had wanted to see the movie “Lincoln” for a while. It was powerful.
The movie provided insights into a man who had a political agenda to do what was right. He had a passion to correct the wrongs of many generations. The movie showed in great detail the strategy he employed to gather the needed votes to pass the amendment to abolish slavery. It was not easy, and his efforts to persuade, convince, cajole, and even twist arms when needed were inspiring.
The film provided insights into the day to day activities of the politicians in those days, and showed how things got accomplished in Washington when someone really cares about, and is passionate about, an idea. I am sure the same tactics are (or could be) employed today in Springfield. It takes people talking to the politicians to urge them, to persuade them, to provide insights to them on key bills and pending legislation.
The movie also showed the human side of several politicians, especially Lincoln. Abraham Lincoln had a tender side, a passion to do the right thing; he was devoted to his family, and cared deeply for his wife and sons. He had a sense of humor, was compassionate, and cared for others, regardless of their social status, military rank or political affiliation – characteristics about our famous President that are not evident in history books.
What I took away from the film was that many politicians, especially Abraham Lincoln, are human, and basic dialogue can be a wonderful thing when you are trying to communicate an idea or share an issue. People do not want to be lectured at, but simply talked to. Lincoln had great success talking to people. Not everyone agreed with his way of thinking, but he was an effective communicator.
With Pharmacy Legislative Day coming up next month on March 13th, I warmly invite you to join me in Springfield to participate in our legislative process. I assure you, it is not difficult. Our Senators and House Representatives want to hear what’s going on in Pharmacy. They want to hear from us about pending bills that impact the practice of pharmacy. They want to hear from pharmacists, technicians, and pharmacy students what Pharmacy is all about. Our legislators love to hear from their constituents. That’s you and me.
The ICHP office, working together with IPhA, makes it easy to get there and back. They handle the logistics. They arrange the meals and the transportation. They work hard so that our part is easy. Once in Springfield, they help summarize the important bills that involve pharmacy practice and prepare us with key talking points. The staff and volunteers will point you in the right direction, and tour leaders will help you find your local legislators. You can be in a group and follow the crowd, and share your thoughts on what is going on in Pharmacy today.
Consider investing a day away from work and come mingle with the students, talk with your old friends and colleagues, enjoy refreshments on the motor coaches (complete with clean restrooms), watch an exciting or funny movie, walk around and get some insights into how our state government works. If things in Springfield are not working perfectly, this would be a good time to respectfully share your thoughts.
Come join us and see the area that Lincoln worked in while living in Springfield. It will inspire you. Get a glimpse into our local government at work. Talk to a legislator and let them know what pharmacy practice means to you. I hope to see you there. Click here for more information, or to register for Legislative Day.
Thanks for caring.
by Scott A. Meyers, Executive Vice President
There’s been a lot of discussion lately relating to pharmacy credentialing, and I thought as an “old-timer” I should finally weigh in. My guess is that most of you that read this column have yet to go out onto the ASHP Connect Platform to sign up and weigh in on discussions there. Many of you are probably signed up with LinkedIn but probably haven’t signed on the ASHP discussion page there either. Both of these sites have been actively discussing credentialing or something that could relate for some time now.
Even though I have self-identified as an “old-timer” (I can’t believe I’m actually admitting it, but most ICHP members have now been in practice for less time than me!), I am signed on to both of these aforementioned sites plus Twitter (don’t use it much at all) and Facebook (I use it to mostly keep up with family and friends). I’ve seen discussions on Connect and LinkedIn especially regarding credentialing from two perspectives recently.
The first discussion revolves around credentials required to enter into a collaborative agreement with a physician and more importantly for provider status for pharmacists. Some proponents believe that if the physician and pharmacist or groups of one or both can agree that that the pharmacists are qualified to manage a collaborative agreement, that should be sufficient credentials to provide the services. Another camp believes that some additional credential (BPS Certification, residency or other national certification) should be required before the agreement and/or provider status are granted.
The other discussion is in regard to ASHP Policy Position 0701 Requirement for Residency that reads: “To support the position that by the year 2020, the completion of an ASHP-accredited postgraduate-year-one residency should be a requirement for all new college of pharmacy graduates who will be providing direct patient care.” The discussions have been predominated by individual pharmacists that believe this is not an appropriate goal and creates unfair barriers for those pharmacists who have been out in practice for some time. Now it has been said that one-year of residency training is equivalent to three years of pharmacy practice experience, and I think that is probably a fair analogy. However, complaints have been raised that residency trained pharmacists without experience are receiving preferential selection over other pharmacists with strong work experience and skills. On the other hand, pharmacy students complain (and rightly so) that there are not enough residency programs to meet the current needs, let alone achieve the 2020 mandate anytime soon. The sad thing about this discussion is that this policy position was approved by the ASHP House of Delegates more than 5 years ago, and now the debate is beginning to heat up!
One recent responder to the discussion on residency requirement made an excellent point that having not completed a residency even though he had obtained a two-year add-on PharmD long before the PharmD was required was a handicap to his future career options. But rather than give up and settle for the few “staff” positions that are left these days, he recently took the BCPS exam and passed it handily. This BCPS credential should prove to be the great equalizer. Because he finished his formal pharmacy education long before residencies were widespread and sought after, he can now provide proof that he has the “knowledge” and the “experience” to qualify for many clinical positions.
There are other Board of Pharmacy Specialties certifications in Nutritional Support, Psychiatry, Oncology, Ambulatory Care, and Nuclear Pharmacy with additional specialty certifications coming for Pediatrics and Critical Care very soon. I believe that these credentials in addition to the Certified Diabetic Educator (CDE) credential available from the National Certification Board for Diabetes Educators and the Certified Geriatric Pharmacist (CGP) credential provided by the American Society of Consultant Pharmacists will provide that needed credential or equalizer that solves both discussions.
Pharmacists who have graduated more than 10 years ago and feel they should be able to provide patient care services that are reimbursed separate from providing the medication should seek Board certification that is most appropriate for their type of practice. Their years of experience make up for much of the residency training they may have missed. Certainly there could be gaps, but my experience, long ago as it was, something tells me that the missing training is there when you’re working if you pay attention and want to learn.
In addition, pharmacists seeking new positions who have obtained the appropriate Board certification should be considered equally and fairly when compared to new pharmacists who have completed their PGY1 and even PGY2 residencies in some cases. Experience is a great equalizer and Board certification indicates a dedication to a higher standard than is now required in many places. Yes, Board certification is required already in some institutions to be considered for any position, but most hospitals, while beginning to embrace residency training (and hopefully providing it, too) have yet to make that important Board granted credential an absolute requirement.
It seems to me that if experienced pharmacists who may not have had chances at residencies want to provide cognitive services for a fee, enter into a collaborative practice arrangement with a physician or physician group, or even seek another position that will advance their career, in all cases, they ought to be willing and able to prove their knowledge with some sort of Board certification.
Because the nature of the certification process in general is based on legal principles of fairness, because the individuals seeking certification jobs depend on it being fair and unbiased, it seems to me that this is the only fair route to take. We can continue to build more and more layers to enter the profession, but we must provide an avenue for those already in it to achieve equal status. Board certification does that and does not discriminate. It is the equalizer.
by Cambrea Hilst, Toby Thomas, Agnieszka Wasilik, Shirin Patel, Greg Kozeny, and Jipal Shah, Student Roosevelt University College of Pharmacy. Reviewed by Cara Brock, Clinical Instructor-Director of Professional Labs, Roosevelt University College of Pharmacy
Studies have shown that 55% of patients do not correctly follow their medication regimen as prescribed. One of the major barriers to patient adherence is self-efficacy. Self-efficacy is the lack of belief that the patient can manage their disease as prescribed by the doctor.1 This lack of belief translates into the patient’s inability to take their medication. Health care professionals, especially pharmacists, play a vital role in patient adherence. By providing motivation and information to the patient, the pharmacist can have a direct effect on patients’ behavioral change and improve their self-efficacy.
The current method for dealing with medication adherence problems is counseling from the pharmacist. However, this process is limited due to the fact that pharmacists often only have a short amount of time with the patient as well as the fact that the counseling is usually more directed toward side effects and administration directions. One underutilized technique to aid the patient with overcoming this barrier is motivational interviewing (MI). MI is “a collaborative, person-centered form of guiding to elicit and strengthen motivation for change.”2 In a general sense, MI is used to strengthen a person’s own motivation for and commitment to change.2 A pharmacist with knowledge of MI has the ability to identify adherence issues and utilize MI tools to help the patient improve their behaviors and health outcomes.
Using motivational interviewing can help the patient self-identify their barriers to adherence, realize the risks and benefits, and acknowledge the need for change as well as readiness for change. Through this process, the patient can set realistic goals in addition to drawing their own conclusions and plan of action. One of the tools of motivational interviewing involves eliciting the patient to talk by asking open-ended questions. This will help the pharmacist identify some of the barriers to adherence, rate their confidence levels, and target behavior change. In addition, using open-ended questions will allow the patients to draw their own conclusions. When the patient comes to their own realizations about their behaviors, they can effectively improve their behavior and apply the principles of self-efficacy to their medication regimen and health status.
Below is a list of additional resources on MI. Websites and resources like these can be utilized to gain a better understanding of MI and aid the pharmacist in incorporating motivational interviewing into their practice. Doing so will enhance the pharmacist’s ability to improve their patients’ self-efficacy and adherence to medication and lifestyle changes.
by Jim Owen and Scott Meyers
During the infamous 2013 “Lame Duck Session” of the 97th General Assembly, not much really happened. Yes, illegal immigrants can obtain a driver’s license, and yes a gaming bill passed and awaits a potential Governor’s veto, but one bill that didn’t make it is causing quite a stir at the Illinois Department of Financial and Professional Regulation (IDFPR). The bill was blocked by the efforts of the Illinois State Medical Society (ISMS), and soon physicians and their patients may be the ones to suffer!
The bill would have placed $9.6M from the Local Government Tax Fund into the Illinois Medical Disciplinary Fund to cover the IDFPR’s operating costs for the Medical Division for the coming year. There were two aspects of the bill that caused the ISMS to cry foul.
First, the funds being placed in the Disciplinary Fund were placed there as a loan – a loan that had to be paid back! That fact, by itself was not the rub. The rub is that nearly that entire amount was raided by previous General Assemblies to go into the General Revenue Fund to pay unrelated bills over the past decade or more!
The second rub for all the docs was that the loan repayment plan was short-term and would require a sizable jump in license fees (new and renewal) for the 2014 renewal! So the proposed relief for the Department hinged on a fee increase had their Disciplinary Fund not been raided in the first place. And by the way, the Illinois Pharmacy Disciplinary Fund has seen more than $7M taken for the General Revenue Fund over that same period of time! So start thinking about that while you read “A(n) Open Letter to Illinois’ Licensed Physicians from the Department of Financial and Professional Regulation”:¹
Dear Healthcare Provider:
Please be advised that effective January 15, 2013, the Department of Financial and Professional Regulation’s Medical Unit (“Department”) will reduce its head count from 26 to eight employees. The Department has worked tirelessly to avoid these lay-offs, which will negatively impact the medical profession.
Beginning in the summer of 2012 and continuing through January 8, 2013, the Department repeatedly informed the Illinois State Medical Society (“ISMS”) that it required an infusion of $9.6 million to avoid the significant reduction in personnel. On multiple occasions, the Department informed ISMS of the dire consequences of allowing these layoffs to occur -- delays between 12 and 18 months to process a medical license and severe constraints to the Department’s ability to prosecute physicians who pose a risk to the health and safety of Illinois citizens.
Despite these calamitous consequences, ISMS actively lobbied against a bill to preserve the Department’s Medical Unit; the proposed bill would have allocated the required $9.6 million enabling the Medical Unit to maintain its 26 employees. Although the Department will now have significantly less resources, it will continue to prioritize and protect the welfare of the citizens of Illinois to the best of its ability.
Physicians’ fees have remained the same since 1987. Since this time, the Department’s required costs have approximately doubled. Due to these rising costs, the Department spends approximately $1.8 million more in responsibly administering the mandated duties of the Medical Practice Act than it collects from the licensing fees paid by physicians.
As a direct result of ISMS’ actions, the layoffs will occur. Please be further advised that the Department will have one employee to handle all physician licensing requests in Illinois. Licenses for new physicians and for physicians transferring to Illinois will take between 12 and 18 months to process. Graduating medical students seeking to match with hospitals in Illinois will experience the same delays. Currently licensed physicians will need to renew their licenses in 2014, and will experience delays of up to 18 months to renew their license. Physicians’ current licenses will almost certainly expire before a renewal can be processed. It is unlawful for anyone to provide medical services without holding a valid medical license.
Physicians may wish to contact their employer, affiliated hospital(s), and insurance company to make the necessary preparations in advance of the lengthy licensing delays. Nurses, physicians’ assistants, pharmacists, and other healthcare professional may wish to discuss this situation with any physicians with whom they affiliate, as it may affect their ability to provide services to these physicians.
All we can say is, “Wow!” The Illinois Department of Financial and Professional Regulation is going to put fiscal tactics in front of safe and effective health care in Illinois! Maybe this is the Department’s version of the “fiscal cliff”? Maybe the Department leadership has been directed from higher up to make this an issue because the General Assembly and Governor can’t balance a budget, can’t fix our existing problems, and are more concerned about getting elected than they are about the health care of Illinois?
The shootout between IDFPR and ISMS is going to be bloody! It is going to have an impact on every profession regulated by IDFPR one way or another. And because this is happening in Illinois, the land of political dysfunction, it’s not going to end well regardless of who wins. Illinois is Not OK fiscally, Not OK politically, and Not OK ethically if this goes much further. We’ll report back in the next edition who is winning, who is losing and what total carnage results from the “Shootout at the Not OK Corral!”
by David Tjhio, Pharm.D., Chairman of Committee on Technology
Name of App: Medscape® Mobile from WebMD®
App Category: Medical/Clinical
iOS or Android: Available on iOS® (iPhone® and iPad®), Android®, and Kindle Fire® (modified Android)
Target Audience: Medical Professionals
Review: This is a very comprehensive app that provides a lot of clinical information via smartphones or tablets. There is a great deal of reference information as well as current medical and clinical news. Some useful features include the clinical calculators, drug reference and interaction checkers, and the ability to access information offline. As pharmacists become more mobile through decentralized workflow and participation in clinical rounds, being able to access reference information through both a smartphone and a tablet app is very handy. The clinical content provided should, of course, be evaluated and used with clinical discretion; however, WebMD® and Medscape® have both been long-time players in online clinical information and enjoy a solid reputation in the industry.
Where did you go to pharmacy school?
University of Missouri – Kansas City
Trace your professional history since graduation: where have you trained / worked, any special accomplishments?
Describe your current area of practice and practice setting
I currently work in the Illinois Referral Division of Hospital Sisters Health System based out of St. John’s Hospital and I my areas of practice include St. Francis Hospital Pharmacy and St. John’s Hospital Home Infusion Services, as well as the pharmacy project manager for Computerized Provider Order Entry.
What initially motivated you to get involved, and what benefits do you see in being active in a professional association such as ICHP?
The benefits of being active in a professional organization such as ICHP include: giving back to the profession and helping young professionals, networking, learning about different practice settings, professional development, and participating in the development, advancement, and legislation for the profession of pharmacy.
What advice would you give to a new practitioner eager to become more involved within ICHP? to the new grad? to the student?
I would recommend: get involved, pick a committee in an area of interest to you and volunteer to be on the committee and actively participate.
Is there an individual you admire or look up to, or a mentor that has influenced your career?
I have several mentors that have influenced me through my career. I would advise all young pharmacists or students to find a mentor and someone to help guide you through your career, there is a lot to be learned from those who have gone down the road before us.
As a newer practitioner, what is your vision for pharmacy in the future? Or what would you like to able to see accomplished within pharmacy?
I would like to see pharmacy sit at the table with nurses and physicians in areas pertaining to patient care. There is a significant need for healthcare providers and pharmacists have a unique opportunity to fill a gap in healthcare, in terms of prescribing and managing medication therapy. Pharmacy needs to embrace the use of pharmacy technicians, allow them to practice at the top of their license and create a career for technicians. Pharmacist need to move towards board certification, billing for services, and working side by side with physicians. It was not that long ago when physicians and other healthcare providers moved to requiring board certification and I feel pharmacy is next.
What three adjectives would people use to best describe you?
Do you have any special interests or hobbies outside of pharmacy / work / school?any special accomplishments?
Outside of work I raise Balancer® cattle; which is a blend of Angus and Gelbvieh genetics.
Do you have a favorite restaurant/food?
Italian, preferably in Italy
What is your favorite place to vacation?
What is the most interesting/unique fact about yourself that few people know?
I breed and raise cattle, I am a SCUBA instructor, I am a welder, I went to college on a Rodeo scholarship
by Kyle R. Mays, PharmD Pediatric Pharmacy Resident Children’s Hospital of Illinois at OSF Saint Francis Medical Center
In 2001, guidelines for preventing medication errors in the pediatric population were published as a collaborative effort between the Pediatric Pharmacy Advocacy Group (PPAG) and the Institute for Safe Medication Practices (ISMP). These guidelines provided numerous risk reduction strategies to consider when developing or improving an organization that is dedicated to the care of pediatric patients.1 These strategies range from the implementation of pre-printed medication order forms to the development and implementation of a pediatric satellite pharmacy. Despite the strategies outlined in current guidelines, medication errors continue to occur throughout the nation.
The Children’s Hospital of Illinois is a full service tertiary hospital with 127 beds and more than 100 pediatric sub-specialists located in Peoria, Illinois. At the Children’s Hospital of Illinois, medication errors continued to occur despite efforts to reduce these problems. As a result, several different committees were developed for the continual improvement of patient and medication safety. One of these committees, the Medication Safety Committee, developed a small work group in response to a commonly reported dosing error among physicians, medical residents, and advanced nurse practitioners that was identified through the reporting of several different adverse drug events involving under- and over-dosing medications.
The error involved medication orders that did not contain the proper documentation of the weight-based dosing utilized when ordering medications. The majority of these cases occurred when prescribers continued medications from home without verifying the doses on the prior-to-admission medication list. As a result, these medications would be continued in-house until a member of the medical service identified the error. After the error was identified, it would be corrected and reported to the respective safety committee. Consequently, the established work group was assigned the task of identifying barriers to utilizing proper weight-based dosing in our pediatric patients and creating a resolution to the problem if possible.
The first step taken to resolve this issue was to identify barriers to utilizing proper weight-based dosing when ordering medications. In order to identify these barriers, the work group conducted a monthly audit of ten medication orders entered by every pediatrician, pediatric medical resident, and pediatric advanced nurse practitioner. Through this auditing process, the work group identified two key barriers that may be preventing prescribers from utilizing weight-based dosing when ordering medications. The first barrier was a lack of standard buttons and/or drop-down menus for weight-based dosing within the electronic medical record for several classes of medications, including anti-psychotics and anti-epileptics. The second barrier was a lack of recommended dosing information at the time of order entry.
After the barriers were identified, the work group created several different possible solutions. The work group ultimately decided to add weight-based dosing buttons and drop-down menus for the drug classes that lacked these features. Furthermore, a link to MicroMedex® was added to the order entry screen to help facilitate proper dosing of medications if the prescriber was unfamiliar with the dosing parameters for that medication.
After everyone in the work group agreed to the solution outlined above, the team contacted the corporate informatics pharmacist and the appropriate members of the information technology department to facilitate implementation of standard dosing buttons, drop-down menus, and links to an online drug information resource. This process went smoothly and the solutions outlined were implemented within two weeks.
Of note, after these process improvements were implemented into our system, several new types of medication errors occurred. These errors were the result of physicians being unfamiliar with the new dosing buttons and drop-down menus. As a result, several of the physicians misread the dosing buttons to read “mg/kg/dose” instead of “mg/kg/day” or vice-versa. This issue was addressed by sending out education material to all of the prescribers that highlighted the changes that were made to the order entry process.
Currently, the work group continues to meet regularly to audit medication orders to ensure weight-based dosing is being utilized for every order entered for a pediatric patient. Data collected thus far has shown a significant improvement in weight-based dosing compliance rates, but new barriers have been identified by the work group that has prevented a 100% compliance rate. However, as stated earlier, medication errors may continue to occur despite an organization’s best attempts to resolve this issue. At the Children’s Hospital of Illinois, we have found that the best solution to preventing medication errors is to continually assess and implement new or improved strategies to reduce medication errors.
by Kristi Stice Pharm.D. BCPS
You are an ICHP member. Are you putting it to use? I definitely feel that I have received the maximum return on my dues year after year as I continue to use the resources and connections I have made through the organization. Please let me remind you of a few ways you can maximize your membership as well.
ICHP Membership Directory/Profiles
Some may just see the membership directory as a list. I view it as a valuable resource. As a member, you have a list of ICHP contacts at your fingertips, searchable by name and specialty. Each person has given permission for his/her information to be published and each has the ability to add a specialty or interest. I have used this directory several times to find someone in a specialty area to help with an issue encountered in my practice. It has been a great way to make connections. I have also used this resource post-meeting to find someone I connected with at the meeting but forgot to get his/her contact information.
You ask for them and the divisions work hard to deliver! ICHP has a variety of toolkits to help with everything from developing a student internship to medication disposal. Four new toolkits were added in 2012 and cover the following topics: REMS, Interview Skills, Residency Tips for Students, and Staff Development. I personally have used several of the toolkit resources including the power point to promote the profession at a local career fair. Check out all that is offered and I am sure you can find something to enhance your practice site or professional life.
Don’t have an ICHP Champion at your site? No worries. That will not keep you from being able to access all the great programming offered through the program. Need CE or just want to be updated on some hot practice topics? Check out the Champion webinars, which are available live or pre-recorded. Want to know what is going on with ICHP? Read through the most recent Champion News Brief. It is a great way to stay in touch with all that is happening in ICHP. The staff at my site - pharmacists and technicians alike - have benefited from the great programming offered through this program. You can too!
CPRN (Clinical Practice and Research Network):
The name may sound intimidating, but I promise it is just a great group of practitioners who want to get together and talk about some hot topics affecting the profession. Even if you are not from the Chicagoland area, you can still benefit from this network and the great topics discussed. I have attended both in person and via phone and always have had something to take back to my practice. Don’t want to go alone? Bring any pharmacy friend. Even non-members are invited to join in on the conversation. (Hopefully they will see the benefits of ICHP and join afterwards, of course!). Come join the fun and fellowship as well as learn a few things along the way. Check the ICHP website for the next scheduled event.
In closing…There is not enough room to mention all of the great benefits ICHP membership offers in one article, but hopefully I have highlighted a few that are worth mentioning to any practitioner - new or seasoned. As an active member of ICHP, I know how hard the staff and volunteers at ICHP work to make sure that the membership has great resources. Much time and effort has been spent planning, creating, and updating all the content available to members. Please take a moment to realize all that ICHP has to offer and make the most of your membership.
by Scott A. Meyers, Executive Vice President
The January 8th Board of Pharmacy Meeting was held at the James R. Thompson Center in Chicago. These are the highlights of that meeting.
Board of Pharmacy Vacancy – One public member vacancy remains on the Board with the resignation of Joe Conover in early 2012. Any recommendations for a non-pharmacist to be appointed to the Board can be made by contacting Governor Quinn’s office directly.
Prosecutions – The largest number of cases being investigated and prosecuted by the Department continue to be in the area of diversion. Scott Gold, pharmacy prosecutor for the Department, reported that the Department also continues to work diligently to investigate and potentially discipline medication errors that cause patient harm.
Dr. Amin, Pharmacy Compliance Coordinator reported that some pharmacies have begun to use the Self-Inspection form available on the Department’s website, but most pharmacies are not using it currently. He urged all attendees to encourage colleagues to use the form. The form, however, is applicable to community practice and does not work well for hospitals. The Department in conjunction with the ICHP will be working on a Hospital Self-Inspection form this year.
Investigator Positions Open – Two investigator positions are open currently and both positions have had postings that are now closed. One position is in the Springfield area with interviews beginning in early January. The other position is in the Chicago area with interviews yet to be scheduled.
Pharmacy Technician Renewals – Registration renewal is underway for pharmacy techs in Illinois. Previously registered Certified Pharmacy Technicians and Student Pharmacists will be eligible to renew online. Only approximately 1,500 pharmacy technicians who were registered after January 2008 will be required to register with paper forms to provide proof of certification or current attendance at an ACPE accredited college of pharmacy. If you know of a pharmacy technician who has received a Certified Pharmacy Technician previously as a result of erroneous online renewals but has in fact not passed an NCCA accredited certification exam like the PTCB exam, you are encouraged to report them to the Department. In prior years, website glitches have allowed a few pharmacy technicians to obtain incorrect registrations and these technicians should become certified by exam as the pharmacy practice act prescribes. It is incumbent on all pharmacists in charge to assure that those technicians working in the pharmacy that claim to be certified can provide proof should an investigator ask.
Legislative Update – The 98th General Assembly was to be sworn in the day after the Board meeting, so no legislation has been introduced at this time. No significant pharmacy-related legislation was expected during the final day of the 97th General Assembly. Bills expected to be introduced this year include Medical Marijuana and Insurance Audit Transparency.
Sterile Compound Preparation Standards Task Force – A Task force of nearly 50 pharmacists and IDFPR staff has made two passes at draft regulations with a third draft expected to be released later in the week. The regulations mirror USP 797 closely with limited details but significant clarity over other State’s attempts. A conference call and final draft are expected before the end of the month. The final draft will be provided to the Board of Pharmacy for final review and then sent to the Joint Committee on Administrative Rules for final approval. It is hoped that the new rules will be approved in May.
Automated Storage and Dispensing Systems for Long-term Care – Representatives of Omnicell presented a request to provide automated storage and dispensing systems in long-term care facilities to replace pharmacy provided emergency tackle boxes. First doses are usually taken from the emergency boxes for new orders and new admissions for the most commonly used medications for doses until the pharmacy can send a full prescription with a courier or delivery person. General Counsel for the Board was absent due to illness, so the Board deferred any ruling on the proposal until Counsel could weigh in.
Next Board of Pharmacy Meeting – Is scheduled for Tuesday, March 12th at 9:30 AM on the 9th floor of the James R. Thompson Center in downtown Chicago. Pharmacists, pharmacy students and pharmacy technicians are welcome to attend the open portion of the meeting.
First thank you to all of you who ran for a delegate position this year! We appreciate your dedication and commitment to representing Illinois at the ASHP House of Delegates. The results of this year's election are as follows:
Desi Kotis – 2012-2013*
Carrie Sincak - 2012-2013*
Andy Donnelly – 2013-2014
Miriam Mobley-Smith – 2013-2014
Chris Rivers - 2013-2014
*elected to a two-year term last year
What should we feature in next month’s ICHPeople? Send suggestions, pictures and info to Amanda Wolff at AmandaW@ichpnet.org.
by Amanda Bryant, P3, ICHP Member and Anthony Vu, P4, ICHP Member Chicago State University- College of Pharmacy
When I decided to attend the 2012 ASHP Midyear Clinical Meeting, I quickly learned this would be the largest pharmacy meeting I could imagine. There was so much happening all at once in this huge hotel in Las Vegas. I was surprised that there was so much programming about residencies, and it made me feel - more than ever - that I should pursue one because of all of the benefits. I think the best part of completing a residency would be the confidence gained during that year. At the residency showcase, there were so many students wearing their suits and waiting and preparing for the opportunity to go into the showcase and talk to representatives from the different programs.
The student programming was great; the interviewing sessions were especially helpful. Skits were performed demonstrating good and bad ways to answer interview questions. There was also a session to help get students to start thinking about money and finances, which I found interesting. There were many people there to hear former president Bill Clinton’s speech; many of us had to watch in the overflow rooms because there were not enough seats in the event center. In addition, I was glad I was able to make it to the special session about the Emily Jerry story, and the lessons learned from that fatal medication error. Being a student and hearing this story, it really touched me, and made me want to be sure that I am extremely cautious when I am working as a pharmacist.
To make next year’s Midyear Meeting even better, I plan to do my “homework” on the different residency programs I am interested in, so that I can ask them questions that cannot be answered simply by looking at their website. I will be sure to bring plenty of snacks because unfortunately, it is difficult to get food because of the long lines of people at the food court and the fact that the sessions may be too close in time to allow one to grab food. I would advise those who can afford it to try to go to the midyear meeting before your fourth year, because there is much to benefit from attending.
As the plane landed, I felt the warmth of the sun shining on my face which, in turn, awakened me from my peaceful slumber. This warmth was very different from how the weather was in Chicago at the time, which was cold and wet. At that point, I felt two things 1) glad that the six hour flight (which included a layover) was over and 2) excited to attend my first ASHP Midyear Clinical Meeting (having it located in Las Vegas only added to the excitement). I absolutely could not wait for all the events that were to come in the next couple of days.
When I got to the hotel, I quickly settled down and looked over some information for the Student Society Showcase. A colleague and I were selected to present our school’s poster this year. This event showcases the achievements of the Student Societies of Health-System Pharmacy (SSHPs) around the country.
The next day I had to wake up early to get in line for the key note speaker, Bill Clinton. I was astonished by how long the line was to enter the auditorium! He talked about health care and how pharmacists can play an important role in improving patient’s lives. After that was the Student Poster Session, so I walked around and looked at some of the other student posters. Soon after that was the Residency Showcase, during which residency programs from across the country host booths and talk to interested students about their programs. This was a very hectic event because there were so many programs there and the place was packed with people. One piece of advice for students who are interested in pursuing a residency is to prepare for the showcase ahead of time. What I personally did was make a list of the programs that I was interested in. Then I went to the ASHP website to find out when each program was going to be there, and lastly, I found the booth number for each program so I could locate them quickly.
There were also events where I had the chance to network with other students, such as the ICHP Reception and the Students Night Out. This was a good time to make new connections. Overall, the ASHP Midyear was a great experience for me. I am glad that I attended and I am definitely planning to go back next year as a resident.
by Daniel Willhoit (P-3), Treasurer of SSHP Southern Illinois University Edwardsville School of Pharmacy
When exam times come around, I man my familiar post at the kitchen table with laptop, books, and notebooks spread out before me. Often, my studying is accompanied by several visits by my two young boys to see if I am doing anything exciting. When they see that the process is not flashy or exciting or after boring themselves pretending to be studying as well, they run off to find mommy again to play. The distractions are welcome breaks from the intense concentration needed to master most pharmacy subjects. I tried studying on campus once or twice thinking that I might get more done, but I could never make it work. It was always just too quiet.
Last semester, in particular I recall studying for an exam at the table. It had been too cold to venture outside, but the cold snap was lifting. My boys could tell, as they could see our neighbors’ children outside already. Mommy tied shoes on eager feet and zipped up reluctantly donned coats. When he finished getting ready, my older son asked my wife, “Is daddy coming out, too?” Mommy gave a good answer about how important it was that I did my homework and got good grades, thinking that if I had a little time to myself it might help me get more of those good grades that she was mentioning. My son understood, although he was disappointed, until he got outside and forgot all about me and my studying.
Soon afterward, I went outside in spite of the test I was studying for. My older son was learning how to pedal his bike, and his younger brother was pushing himself along in a ride-on toy with his feet. It was no different from the days we had had before it got cold. But that day, being outside with my boys surely seemed more important than receiving an A on a test. There would always be time for studying later when the sun went down or when the kids went to bed. Life for my family while I am in pharmacy school, is “a great balancing act,” to borrow a phrase from my son’s favorite Dr. Seuss book.
Our first child came the year before I started pharmacy school. Our second came just before the second year started. Our hope is that we will have a third in my fourth and final year of the program. I want more than anything to let my fellow students to know that it is at least possible to start their own families even with the demands of pharmacy school. However, in this great balancing act you should expect some sacrifices.
One sacrifice I chose to make when entering pharmacy school was quitting a job that I loved. For financial and some purely emotional reasons, my wife and I made it a goal not to have our children attend day care. I became a full-time dad and student while my amazing wife became the breadwinner working 12-hour night shifts on the weekends so she could be at home while I was at school. It was not an ideal situation by any stretch of the imagination, but this was the way we balanced what we wanted to do with what we had to do.
As expected from the story above, my priorities changed as well. As an undergraduate I was a compulsive grade-checker. Now I prioritize mastery and application of the curriculum. Grades became a result and not a goal. Also gone are the days of late-night cramming, replaced by going to sleep an hour earlier on test days in case one of the boys wakes up in the middle of the night. As my time available to study decreased, I became more efficient as a student out of necessity.
When pharmacists counsel their patients, it is important to list both the benefits and the risks. You may have seen some of both in what you have already read above. The good is readily apparent when starting a family. The smallest parts of your child’s life are cherished moments like the otherwise ordinary day outside became. When beginning a family in pharmacy school, I am hesitant to label anything as the bad part of having a family, though it is different and sometimes very different than before. You should expect sacrifices, but you might not know what they will be. Life is, after all, a great balancing act.
|CHRIS RIVERS||Immediate Past Presidentfirstname.lastname@example.org|
|TRAVIS HUNERDOSSE||Director, Educational Affairs||312-926-6124||THunerdo@nmh.org|
|EDWARD RICKERT||Director, Government Affairsemail@example.com|
|JENNIFER ELLISON||Director, Marketing Affairs||Jennifer.C.Ellison@osfhealthcare.org|
|JENNIFER PHILLIPS||Director, Professional Affairs; Assistant Editor, KeePostedfirstname.lastname@example.org|
|LINDA FRED||Director, Organizational Affairsemail@example.com|
|ANN JANKIEWICZ||Chairman, House of Delegatesfirstname.lastname@example.org|
|ELIZABETH ENGEBRETSON||Technician Representative||815-756-1521 x 153346||EEngebretson@northshore.org|
|DAVID TJHIO||Chairman, Committee on Technologyemail@example.com|
|JENNIFER ARNOLDI||Chairman, New Practitioners Network||
|JACOB GETTIG||Editor & Chairman, KeePosted Committee||630-515-7324 fax: firstname.lastname@example.org|
|DESI KOTIS||Regional Director Northemail@example.com|
|MARK LUER||Regional Director Southfirstname.lastname@example.org|
|SCOTT BERGMAN||Regional Director Centralemail@example.com|
|MARC MCDOWELL||President, Student Chapter, University of IL C.O.P.||firstname.lastname@example.org|
|ALEXANDRA HABANEK||Student Representative, University of IL C.O.P.||email@example.com|
|CHRIS RADUNZ||President, Rockford Student Chapter, University of IL C.O.P.||firstname.lastname@example.org|
|AYUMI ODA||President, Student Chapter Midwestern University C.O.P.||email@example.com|
|BRANDON ORAWIEC||President, Student Chapter, Chicago State University C.O.P.||firstname.lastname@example.org|
|KRISTINE MAN LIMOS||Student Representative, Chicago State University C.O.P||KmanLimo@csu.edu|
|KELCEY CORRELL||President, Student Chapter, Southern Illinois University S.O.Pemail@example.com|
|ANTHONY ALBIANI||President, Student Chapter, Roosevelt University C.O.P.||firstname.lastname@example.org|
|JOANNA KASPER||President, Student Chapter, Rosalind Franklin University C.O.P.||email@example.com|
|SCOTT MEYERS||Executive Vice President, ICHP Officefirstname.lastname@example.org|
|JENNIFER PHILLIPS||President, Northern IL Society (NISHP)||email@example.com|
|JULIA SCHIMMELPFENNIG||President, Metro East Society (MESHP)||firstname.lastname@example.org|
|MEGAN METZKE||President, Sangamiss Societyemail@example.com|
|ED RAINVILLE||President, West Central Society (WSHP)||firstname.lastname@example.org|
Vacant Roles at Affiliates —
President, Rock Valley Society; Southern IL Society; Sugar Creek Society
|Lori Uildriks||Donna Clay|
|Abigail Reeder||Brandi Strader|
|Viral Mehta||Nora Flint|
|Vincent Metzger||Gary Peksa|
|Katherine Steel||Claresta Bergman|
|Hina Patel||Carol Heunish|
|Andrew Merker||Pete Antonopoulos|
ICHP PHARMACY ACTION FUND (PAC) Contributors
Contributions listed consist of donations from the past 12 months.
GENERAL ASSEMBLY GUILD - $1000 & More
James Owen Consulting Inc.
SPRINGFIELD SOCIETY - $500-$999
John & Joycelyn McCann
CAPITOL CLUB - $250-$499
Drury Lane Theater
LINCOLN LEAGUE - $100-$249
MWU COP Student Chapter
GRASSROOTS GANG - $50-$99
CONTRIBUTOR - $1-$49
Ann Marie McDermott