ARRx - The Arkansas Pharmacist - Spring 2014 by Arkansas Pharmacists Association

Spring 2014 Award Winning Quarterly Publication of the Arkansas Pharmacists Association

Practicing Innovative Patient Care in Hospitals

Pharmacy Residencies Well Worth Time and Financial Commitment

APA Staff Mark S. Riley, Pharm.D. Executive Vice President and CEO Mark@arrx.org Scott Pace, Pharm.D., J.D. Chief Operating Officer Scott@arrx.org Eileen E. Denne, APR Senior Director of Communications Eileen@arrx.org

Eric Crumbaugh, Pharm.D. Director of Clinical Programs Eric@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org

CONTENTS 4 Inside APA: Disappointment and Hope in Washington

27 Drug Update: Seven New Drugs to Date in 2014

Debra Wolfe Director of Government Affairs Debra@arrx.org

5 From the President: Provider Status and Pharmacists as Medication Experts Themes for 2013-2014

28 UAMS Report: Team-Based Learning at UAMS COP

Office E-mail Address Support@arrx.org

6 APA Staff Highlights 7 COVER: Practicing Innovative Patient Care in Hospitals 13 Member Spotlight: Denise Clayton, RxResults, Little Rock 14 RX and the Law: Are You Ready for the Unexpected? 15 FEATURE: Pharmacy Residencies Well Worth Time and Financial Commitment 21 Legislator Profile: Senator Bruce Maloch (D-Magnolia)

29 Composite of 2014 UAMS Graduates 30 Harding Report: Road to Accreditation Long and Winding 31 Composite of 2014 Harding Graduates 33 APA 2014 Annual Convention Brochure 40 Arkansas Academy of Health-System Pharmacists: Mix or MATCH! 41 APA Compounding Academy: IACP Submits List of 2,400 Bulk Drug Substances to FDA

22 Safety Nets: Methotrexate

42 2013 Bowl of Hygeia Recipients: APhA Foundation & NASPA

23 Marketing Ideas from Pharm Fresh Media: Making Your Brand Work for You

43 2014 Calendar of Events and District Meeting Schedule

24 Quality Notes from AFMC: Quality Improvement 101: How to Get Started

44 Member Classifieds

26 Innovative Clinical Programs: APA Takes Pharmacist-Delivered Immunization Message to Local Civic Organizations

Cover Photo: Baptist Health-North Little Rock pharmacist Natalie Ohrenberger and PGY 1 resident Jackie Acuña talk to a patient about her care.

Publisher: Mark Riley Editor: Eileen Denne Design: Gwen Canfield - Creative Instinct Arkansas Pharmacists Association 417 South Victory Street Little Rock, AR 72201-2923 Phone 501-372-5250 Fax 501-372-0546 AR•Rx The Arkansas Pharmacist © (ISSN 0199-3763) is published quarterly by the Arkansas Pharmacists Association, Inc. It is distributed to members as a regular service paid for through allocation of membership dues ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 67. © 2014 Arkansas Pharmacists Association.

POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist 417 South Victory Little Rock, AR 72201 Opinions and statements made by contributors, cartoonists or columnists do not necessarily reflect the attitude of the Association, nor is it responsible for them. All advertisements placed in this publication are subject to the approval of the APA Executive Committee. Visit us on the web at www.arrx.org.

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12 Arkansas Pharmacy Support Group Pace Alliance 20 Retail Designs First Financial Bank 20 Brick Walkway of Honor CPE In Paradise UAMS Alumni Association 25 Law Offices of Darren O'Quinn 32 Bell & Company EPIC Pharmacies AR•Rx | THE ARKANSAS PHARMACIST

32 Pharmacy in Arkansas Print 46 Pharmacy Quality Commitment 47 Pharmacists Mutual Life Insurance Back Cover - APA Honors Smith Drug (Don's Pharmacy)

APA Board of Directors

INSIDE APA

2013-2014 Officers

INSIDE APA

President - Dana Woods, P.D., Mountain View President-Elect - Brandon Cooper, Pharm.D., Jonesboro Vice President - John Vinson, Pharm.D., Fort Smith Past President - Dennis Moore, Pharm.D., Batesville

Disappointment and Hope in Washington

Area Representatives Area I (Northwest) Michael Butler, Pharm.D., Hot Springs Village Area II (Northeast) Brent Panneck, Pharm.D., Lake City Area III (Central) Eddie Glover, P.D., Conway Area IV (Southwest/Southeast) Lynn Crouse, Pharm.D., Eudora

District Presidents District 1 - Clint Boone, Pharm.D., Little Rock District 2 - Kristy Reed, Pharm.D., Jonesboro District 3 - Chris Allbritton, Pharm.D., Springdale District 4 - Lise Liles, Pharm.D., Texarkana District 5 - Dean Watts, P.D., DeWitt District 6 - Stephen Carroll, Pharm.D., MBA, Arkadelphia District 7 - C.A. Kuykendall, P.D., Ozark District 8 - Casey McLeod, Pharm.D., Searcy

Academy of Consultant Pharmacists Larry McGinnis, Pharm.D., FASCP, Searcy

Academy of Compounding Pharmacists Warren Lee, Pharm.D., Fort Smith

Arkansas Association of Health-System Pharmacists

Lanita S. White, Pharm.D., Little Rock

Ex-Officio APA Executive Vice President & CEO: Mark Riley, Pharm.D., Little Rock Board of Health Member: John Page, P.D., Fayetteville AR State Board of Pharmacy Representative: John Clay Kirtley, Pharm.D., Little Rock UAMS College of Pharmacy Representative (Dean): Stephanie Gardner, Pharm.D., Ed.D., Little Rock Harding College of Pharmacy Representative (Dean): Julie Hixson-Wallace, Pharm.D., Searcy Legal Counsel: Harold Simpson, J.D., Little Rock Treasurer: Richard Hanry, P.D., El Dorado UAMS College of Pharmacy Student Representative: Dylan Jones, Fayetteville Harding College of Pharmacy Student Representative: Mark Egbuka, Searcy

Scott Pace, Pharm.D., J.D.

he old saying that March “roars in like a lion” has probably never been truer than this year. Of course that saying generally applies to the weather, and winter weather roared into the entire state the first week of March, but this year it also applies to Congress’ action on pharmacy issues.

under the Medicare program. This “provider-status” initiative is being driven by the Patient Access to Pharmacists’ Care Coalition (PAPCC), a diverse stakeholder group representing patients, pharmacists and pharmacies. Among the members in PAPCC are

The Centers for Medicare and Medicaid Services (CMS) issued a guidance document earlier this year that outlined many needed changes for Medicare Part D for the 2015 benefit year, including an “any willing provider” provision that would allow any pharmacy to elect to participate in a preferred network, if they agreed to the terms of the network. CMS held an open comment period and they received hundreds of comments from pharmacists around the country urging them to implement the any willing provider provision for 2015.

This is a major setback for patient choice, it’s a major setback for pharmacy access, and it’s counter-intuitive to the fundamental capitalistic ideal that competition in the marketplace is a good thing.

Unfortunately, political pressure from the PBM industry and pharmaceutical industry caused both Congress and CMS to cave and remove the any willing provider language. This is a major setback for patient choice, it’s a major setback for pharmacy access, and it’s counter-intuitive to the fundamental capitalistic ideal that competition in the marketplace is a good thing. The fight continues and APA, with national partners, will continue to make this a high profile issue. On a positive note, Congressman Brett Guthrie (R-KY) introduced a bipartisan bill, HR 4190, that would amend the Social Security Act and add pharmacists to the list of providers

all of the major national pharmacy organizations, including American Society of Consultant Pharmacists, American Pharmacists Association, American Society of Health-System Pharmacists, National Association of Chain Drug Stores, and National Community Pharmacists Association. This is a great development for the profession and would provide millions of patients further access to pharmacists’ professional services. Lastly, I encourage you all to attend APA’s 132nd Annual Convention June 12-14th at The Chancellor Hotel in downtown Fayetteville. Under the umbrella theme “Learn, Implement, Change,” we have a wonderful lineup of continuing pharmacy education (CPE), including CPE focused on: team-based healthcare, the ABCs of

Find the APA on Facebook, or visit our website at www.arrx.org 4

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FROM THE PRESIDENT

MTM, Medicare Star Ratings, Adherence, Clinical Updates, Pharmacy Law and Prescription Monitoring Program Update. In addition, our Friday social event will be “The Art of Wine” presented by the Walton Arts Center. It will be an exciting convention and a great way to network with your colleagues

FROM THE PRESIDENT

and earn your CPE! The great American comedian Bill Cosby said “The past is a ghost, the future is a dream. All we ever have is now.” Despite our current challenges, let us remember to dream big dreams for our professional future and fight hard to achieve these dreams. But we also need to embrace the now. §

Provider Status and Pharmacists as Medication Experts Themes for 2013-2014

his has been a fast year. This is my final “President’s Column” before Brandon Cooper is installed as president on June 13. My advice to Brandon regarding his focus for 2014-2015 is to help the profession keep pushing for provider status and to continue to position pharmacists as medication experts, as APA has been doing with our terrific marketing and public relations campaign. Past president Dennis Moore launched the Provider Status Task Force as he was leaving office last year. We knew reaching provider status would be a daunting challenge but we also hit it at the right time. National pharmacy organizations and others are currently working on the issue. It will take expertise from national and state organizations to move the needle but we have to start somewhere. Several states like California already have laws on the books. We may look back and see that we haven’t accomplished everything, but these first steps have been important. Passing the Maximum Allowable Cost (MAC) pricing law was also important in 2013. I am disappointed in the difficulties we’ve had with MAC pricing but that’s another issue on which we’ve got to keep pushing. As President, I enjoyed attending District meetings in the fall, visiting with people and trying to keep interest going in all of APA’s activities. A major highlight of the year has been generating more interest in all sectors of the profession. Continuing a tradition that Dennis began, I also helped thank pharmacists when they rejoined APA as members. A few people also called me with questions regarding the association and I appreciated that. Regarding lessons learned, one of my biggest observations is that underneath the current, there are lots of things that the APA office works on that the general membership doesn’t know about such as state employee benefits, or putting out fires before they have grown. And

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as members, we never know about the fires because they get put out. APA staff is constantly working on things on behalf of the membership.

Dana Woods, P.D. President

In addition to having a better appreciation of the staff, I also appreciate our Board of Directors, which is made

As President, I enjoyed attending District meetings in the fall, visiting with people and trying to keep interest going in all of APA’s activities. A major highlight of the year has been generating more interest in all sectors of the profession. up of some of the best pharmacists in the state who are always ready and able to step up to help when there is problem. I have also been really impressed with the Arkansas Association of Health System Pharmacists (AAHP). We’re lucky to have them under the umbrella of APA – as a group they are forward looking and very organized. They do a great job. As for parting wisdom, I think pharmacists need to keep pushing for things like provider status even though it may seem unattainable. We need to keep positioning ourselves as the medication experts because savings are there for our patients and the quality of health care is greater. My hope for next year is that there will be continued communication with the Board and with pharmacists in the state, to identify problems and to take advantage of the opportunity to improve things. §

APA Staff Highlights Meet APA’s Newest Staff Member: Susannah Fuquay APA’s Director of Membership and Meetings, Susannah Fuquay, is the ideal individual to lead the planning for APA’s 2014 Annual Convention in Fayetteville. She knows the territory! Susannah brings a wealth of experience in meeting planning and membership marketing to APA. Before joining APA in February, Susannah was the director of special events at the Rogers-Lowell Area Chamber of Commerce. Before that she worked for Little Rock web services firm Aristotle and for the Arkansas Department of Parks and Tourism. She graduated in 2006 from the University of Arkansas at Fayetteville with a bachelor’s degree in Recreation with a concentration in Event Management. She and her husband Tommy, who works for McKibbon Hotel Group in Little Rock, live in west Little Rock. Susannah enjoys do-it-yourself home projects, and anything related to technology and travel.

Congratulations to Dr. Eric Crumbaugh, winner of APhA’s Immunization Champion Award APA’s Director of Clinical Programs, Dr. Eric Crumbaugh, was named the national winner of the 2014 American Pharmacists Association (APhA) Immunization Champion Award recognizing the value and extraordinary contributions pharmacists provide to improving the vaccination rates of their communities. The award was presented on March 30 during the APhA Annual Meeting and Exposition in Orlando. APA President and CEO Mark Riley, Pharm.D., said “Eric’s work has contributed to a healthier Arkansas as he trains pharmacists to provide more immunizations to our citizens. We’re proud of his efforts and of the tremendous increase in pharmacist-administered vaccinations since 2012. We hope that program will continue to grow.” APhA’s awards recognized six categories including individual practitioner, friend of pharmacy’s immunization efforts, corporation/institution, partnerships with other healthcare providers and public health, community outreach and pharmacy team member. Nominees were evaluated based on the areas of impact, collaboration, originality, overcoming challenges and opportunities created for pharmacists. These awards highlight contributions to the immunization neighborhood by pharmacists, pharmacy technicians and pharmacies. Pharmacist Brenna Neumann from Collier’s in Fayetteville nominated Eric and was on hand at the ceremonies. Eric was one of two national winners in the Individual Category. §

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Practicing Innovative Patient Care in Hospitals By Eileen E. Denne

Angie Powell, Pharm.D., demonstrates scanning technology at Baxter Regional Medical Center in Mountain Home.

he Affordable Care Act (ACA) has already brought many changes to health care, impacting the 700 pharmacists who practice at Arkansas’s 185 hospitals. It will drive innovation in patient care as pharmacists continue to move from a centralized model to providing more decentralized clinical care. Hospital pharmacists are finding ways to participate in interdisciplinary rounds, use new technologies, enhance medication reconciliation, and offer more outpatient services. Four pharmacists from regional hospitals in Jonesboro, North Little Rock, Mountain Home and Rogers shared their thoughts about current and future patient care practices:

Health-NLR has 248 beds and is part of a system of eight hospitals in the state which will soon be nine when the facility in Conway opens. There are nine full-time and four part-time pharmacists, one resident, 10 full-time technicians and an average of seven students on rotation each month.

Christy Agee, Pharm.D., BCPS, Clinical Pharmacy Coordinator/ICU Clinical Specialist and UAMS Clinical Assistant Professor at Mercy Hospital Northwest Arkansas in Rogers. Mercy is a 150-bed hospital. Agee works with eight fulltime and five part-time pharmacists Hospital pharmacists are and they have between one to six finding ways to participate students on rotation each month.

in interdisciplinary rounds, use new technologies, enhance medication reconciliation, and offer more outpatient services.

Marsha Crader, Pharm.D., Associate Professor, Pharmacy Practice, University of Arkansas for Medical Sciences (UAMS) and Clinical Pharmacy Specialist at St. Bernards Medical Center in Jonesboro. St. Bernards is a 438-bed facility with 24 full-time pharmacists, including two residents, and five part-time pharmacists. St. Bernards also has between one to five pharmacy students on rotation each month plus three to four pharmacy technician students.

Kevin Robertson, Pharm.D., BCPS (Board Certified Pharmacotherapy Specialist), Clinical Assistant Professor, Pharmacy Practice/UAMS, and Pharmacy Clinical Coordinator and Residency Program Director, Baptist Health Medical Center-North Little Rock (NLR). Baptist AARR••RRxx | |T HTEH EA RAKRAKNASNASSA SP HPAHRAMR A MCAI CS ITS T

Angie Powell, Pharm.D., Director of Pharmacy, Baxter Regional Medical Center in Mountain Home. Baxter Regional is a 268-bed hospital in Mountain Home with 13 full-time and five part-time pharmacists. They average one to two students per month on rotation.

Decentralization of pharmacy

Expanding pharmacists’ role has been a main focus for Marsha Crader, Pharm.D., at St. Bernards Medical Center in Jonesboro. When she started working there more than eight years ago, the hospital did not offer many clinical pharmacy services. The department changed its focus to provide hospitalwide clinical services in addition to operational services. 77

INNOVATIVE PATIENT CARE IN HOSPITALS

Pharmacists at St. Bernards Medical Center in Jonesboro.

Kevin Robertson, Pharm.D., BCPS, in front of IV medication storage area at Baptist Health Medical Center-North Little Rock

In Fall 2012, the pharmacy department became fully decentralized. As a result, all staff pharmacists were adequately trained to meet required clinical competencies.

autonomy to adjust other therapies based on predefined clinical endpoints, such as white cell count response and gastrointestinal tract postoperative recovery.

“Physicians were

“Physicians were asking three clinical Patient interaction asking three clinical pharmacist full-time-equivalents to do Seven St. Bernards’ pharmacists rotate pharmacist full-timemore than they could handle, so now every duties in the neonatal and adult intensive pharmacist has a clinical role,” Crader care units. Rounding services are provided equivalents to do said. “Now the decentralized pharmacists Monday through Friday as part of an more than they could provide pharmacokinetic and renal interdisciplinary team. In addition, Crader handle, so now every said, “Our pharmacist interventions with dosing, IV to oral conversions, clarification pharmacist has a on medication reconciliation, and assist chronic obstructive pulmonary disease clinical role.” with order entry. Our pharmacists are also (COPD) inpatients have begun to show involved in anticoagulation monitoring, benefit by reducing re-admissions. hospice care and pain management, and Focus on appropriate devise use, patient are becoming more involved in outpatient adherence, and discharge prescribing clinic services. If nurses or physicians have questions, the has resulted in improved patient outcomes. Community pharmacists are readily available to answer them.” pharmacists are an important resource to successful outcomes by supplying the inpatient pharmacists with At Baptist Health Medical Center – NLR, pharmacy patients' medication histories and related insurance services were decentralized in 1995. “I came through as information." a senior student a year after the implementation,” said Kevin Robertson, Pharm.D., BCPS. “It was great to witness At Mercy Hospital Northwest Arkansas, there is one team those practitioners laying a foundation that we continue to doing interdisciplinary rounding in the Intensive Care Unit expand on today.” (ICU) consisting of physician, pharmacist, dietician, charge nurse, bedside nurse and respiratory therapist, according In addition to the traditional clinical activities like to Christy Agee, Pharm.D., BCPS. pharmacokinetic dosing and total parenteral nutrition (TPN) management, Baptist Health-NLR pharmacy is involved “Clinical pharmacists within all Baptist Health hospitals are in medication reconciliation, direct patient education, expected to provide an increasing degree and number of antimicrobial and anticoagulation stewardship activities, clinical services these days,” said Robertson. and ensuring application of evidence-based medicine (e.g., venous thromboembolism (VTE), prophylaxis, Robertson has three shifts of pharmacists assigned to antibiotic selection for pneumonia patients, and limiting direct patient care areas – one floats between central post-operative antibiotic duration). Pharmacy has pharmacy and patient care. They interact with all the other

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INNOVATIVE PATIENT CARE IN HOSPITALS

health care professionals seven days per week. “With these increased expectations, we continue to expand the roles of technicians and senior pharmacy students to ensure we get it all done each day.” In addition to focusing on clinical care, new technologies are allowing healthcare teams at hospitals to take better care of patients.

New Technologies

Baxter Regional Medical Center implemented computerized physician order entry (CPOE) for a pilot group of physicians three years ago, and are now almost fully implemented, said Angie Powell, Pharm.D. The pharmacists receive a notification when a physician has electronically written discharge medication orders so they can review them for accuracy and completeness. This helps provide a cleaner transition for the patient out of the hospital and back to community providers. Baxter Regional also uses automation to give pharmacists more time to leverage their knowledge, Powell said. In Oct. 2011, Baxter Regional started a pharmacy medication history service. When a patient presents to the hospital, a team of pharmacists and certified pharmacy technicians are responsible for collecting their home medication list and transcribing it into the computer so when the physician writes admission orders, he or she has the best information possible. This service is provided seven days per week, to patients in the emergency room, direct admits from the community, as well as for patients during their pre-surgery visit. “When we’re interviewing patients, we have found that they are sometimes poor historians,” Powell said. “Getting a good medication history is like being a detective. The team makes lots of calls to community pharmacists and to physician clinics to get the rest of the story. We also have a software vendor that provides adjudicated prescription data for our patients; it shows the patient’s fill history for the last six months. “

“Getting the medication history right is the first step to the patient having a successful medication regimen while they are in the hospital. It is also foundational to the patient on the back end. If you don’t know what the patient was taking when they came in, how are you going to tell them what to take when they go home?”

on average a little over one clinically significant error for every patient medication history collected, Robertson said. All home medication histories collected by a student or technician are reviewed by a clinical pharmacist who addresses discovered issues. P4 students do discharge patient education on two of the medical/surgical nursing units daily. They also counsel every patient being discharged on warfarin and the newest anticoagulants (e.g., Xarelto™). “Hospital payment is now heavily based on a positive patient experience and application of evidence based medicine, as it should be,” Robertson said. “We have demonstrated that clinical pharmacists can have a big impact in this regard, at all Baptist Health hospitals.”

Antimicrobial stewardship

Another technology used by hospital pharmacists to help with patient care is data mining software to assist with antimicrobial stewardship. Powell said Baxter Regional doesn’t have an infectious disease pharmacist or physician, so they are striving to do the best they can without a formal antimicrobial stewardship team. “We have an interest and have taken it upon ourselves to learn everything we can. We started with a microbiology

She added, “Getting the medication history right is the first step to the patient having a successful medication regimen while they are in the hospital. It is also foundational to the patient on the back end. If you don’t know what the patient was taking when they came in, how are you going to tell them what to take when they go home?” At Baptist Health-NLR, patient education and home medication history collection has had a positive impact on patient care. In 2009, they began allowing specially trained technicians and students to complete home medication history collection. During a student project, they discovered Marsha Crader, Pharm.D. from St. Bernards, is president-elect of the Arkansas Association of Health-System Pharmacists. AR•Rx | THE ARKANSAS PHARMACIST

This year at the Expo pharmacy staff focused on medication reconciliation in the community with a “Got Meds” theme. Attendees were encouraged to consult with their community pharmacists for an updated list of medications or questions.

Patient services and community education Christy Agee, Pharm.D., (right) at Mercy Hospital, reviewing patient record.

monitoring program several years ago. We have Sentri7, software that compares pharmacy and lab data and give us dashboards that pharmacists watch every day for opportunities to optimize antimicrobial therapy, as well as a host of other pharmacist interventions. To help close the knowledge gap, three of our pharmacists are enrolled in an infectious disease certificate program. Our goal is to find an infectious disease physician with whom we can have a telemedicine relationship and then we’ll be closer to having a formal team.” At Baptist Health clinical surveillance software such as TheraDoc™ and EPIC™ are used to review antibiotics and culture results, IV to PO conversion, and allow for renal dosing adjustments of antibiotics with autonomy. These data are used for de-escalation and suggested modification of therapies. At St. Bernards, Crader is also directly involved in antimicrobial stewardship. She helped start the antimicrobial services that have been transitioned to the decentralized staff. She helps with ongoing student, resident, and staff training for antimicrobial stewardship competencies. On a day-to-day basis, Crader and students review patient profiles for appropriate antimicrobial therapy. “We review antimicrobial regimens for appropriate empiric therapy and opportunities to de-escalate or discontinue therapy,” Crader said. “We also work with the Epidemiology and Pharmacy and Therapeutics Committees to monitor and improve antimicrobial therapy in the institution.” Agee at Mercy Hospital uses data mining software called Vigilance. With this program, pharmacists can quickly evaluate antibiotic regimens for appropriateness of therapy, de-escalation of therapy, and culture results. They can also use the software search patient records and data mine for other types of pharmacy interventions, like renal dosing, and drug interactions.

A unique patient education service offered at Mercy Hospital is called “M in the box.” Agee says the education is to prevent readmission. If a patient is starting new medication for a chronic disease state, the nurse will put an M next to his or her name. As the patient is released, the nurse talks to them about their medications to be sure they have multiple exposures. Once the patient is comfortable, the nurse can take the M away. “We plan to decentralize our pharmacists to help with educating patients,” Agee said. “It will make a difference in patient, readmission, patient understanding, and reimbursement.” The exciting part about her job, said Agee, is that, “I don’t have the same day two days in a row. There are always new challenges and I am constantly learning. I get to make an impact and I know I am helping provide the best patient care possible, even though the patients don’t always know I’m there.” St. Bernards is doing more community education to help better inform the public about their medications. Each year they sponsor a Health and Fitness Expo in April. This is a free event, including health screenings and healthy living education and demonstrations. This year at the Expo pharmacy staff focused on medication reconciliation in the community with a “Got Meds” theme. They distributed flyers instructing attendees to keep a current list of all medications. Medication storage bags were also provided for ease of keeping medications together when going to the doctor’s office or hospital. Attendees were encouraged to consult with their community pharmacists for an updated list of medications or questions.

“I tell staff they need to speak three languages: to physicians to make them more efficient, to nurses to make sure the medications are on time, correct and properly prepared, and to the hospital administration – who want to know about cost-effective care.”

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Baptist Health-NLR uses P4 pharmacy students as patient care extenders to increase the impact of pharmacy without increasing full time staff positions. “I tell staff they need to speak three languages: to physicians to make them more efficient, to nurses to make sure the medications are on time, correct and properly prepared, and to the hospital administration – who want to know about cost-effective care,” Robertson said. “Whether you like it or not, the administration pays bills and makes decisions and if we can provide data to them that tells the big picture, we’re better off.”

value [on adherence] because they don’t understand what the medications are for. We’ve looked at models where pharmacists do discharge counseling and follow-up phone calls. Pharmacy itself is continuing to expand and we’re basically physician extenders to help out with patient care.” Part of Baptist Health’s success is their PGY-1 pharmacy residency program, another innovative program Robertson said few nonprofit hospitals unassociated with a teaching facility have in place.

Robertson said one of their goals is to increase their Hospital Consumer Assessment with Healthcare Providers and Systems (HCAHPS) scores. Patients receive a questionnaire when they leave hospital that asks whether they understood the purpose of their medications.

“By having this program, the quality of the pharmacy department and our services make gains.” Robertson said. “The staff has taken greater ownership and their level of commitment is stepped up. The resident coordinates the medication education for the cardiac rehab clinic. The resident facilitates the service by using P4 students. Once a month, they do five sessions a day.”

Agee at Mercy Hospital has similar goals. “In the future,” Agee said, “especially with ACA, the readmission statistics will become even more important. We’ll be making a bigger effort to make sure patients are educated so they know what medications they’re taking. Often patients don’t put

Like Agee, Robertson finds his work very rewarding. “I enjoy being part of the nursing and physician team. I put a lot of energy into hiring right people. I want to help and find ways to expand our role. It wouldn’t be possible if I didn’t have the right team.” §

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Member Spotlight

Denise Clayton — R X R ESULTS IN L ITTLE R OCK Pharmacy practice: Manager, Clinical Initiatives, RxResults, Pharmacy Benefit Risk Management Company in Little Rock.

Least favorite part of the job: Waiting for a client to make a decision to add MTM to their benefit package! (I am not very patient!!)

Graduate pharmacy school and year: UAMS College of Pharmacy 1989.

Recent reads: His Needs, Her Needs by Willard F. Harley, Jr. and Battlefield of the Mind by Joyce Meyer.

Years in business: 13 years in hospital pharmacy with Baptist Health in Little Rock, nine years as a clinical consultant for CVS/Caremark, two years as a relief pharmacist for USA Drug, and 1-1/2 years for RxResults.

Fun activities: I love to watch Razorback sporting events! My husband and I like to work out at the gym. We also have road bikes and enjoy riding many miles when the weather will cooperate.

Favorite part of the job: I am very passionate about patient care. I believe that Medication Therapy Management is an important tool for pharmacists to use to help patients live healthier lives. Although I am not currently practicing in a patient care setting, my position at RxResults allows me to help other AR pharmacists provide MTM services for our client’s members. It’s all about the patient and helping them to gain the knowledge they need to be healthier and live more productive lives.

Ideal dinner guests: Jesus, Pope Francis, my husband and kids. I would be in heaven! If not a pharmacist then… I would love to spend more time volunteering for several organizations that I am interested in and in helping those organizations raise money for their cause. §

My favorite mantra: “Knowledge is power; the more you know the better you do.”

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Are you ready for the unexpected?

(2) If there is no surviving issue but the decedent is survived by a he phone call occurred that no one wants to get. Joe Plum, the parent or parents, one-half (1/2) of the intestate estate; owner of Plum’s Pharmacy, had passed away during the night. It was unexpected and the staff at the pharmacy was very upset to (3) If there are surviving issue of the deceased spouse, one-half hear the news. Their grief and sorrow turned into anxiety over the (1/2) of the intestate estate. nextThis few series, days when they and learned that Joe had diedby without a will. Mutual (b) As to community property: Pharmacy the Law, is presented Pharmacists Insurance Company and the Arkansas Pharmacists Association Whatthrough did thePharmacy future hold for Plum’s Pharmacy? (1) The one-half (1/2) of community whichcommunity. belongs to the Marketing Group, Inc., a company dedicated to providing quality products and services toproperty the pharmacy decedent passes to the surviving spouse. Like most pharmacy owners, Joe had planned and was prepared for 15-2-103. Share of heirs other than surviving spouse. The part contingencies that would affect his business; changes in prescribing of the intestate estate not passing to the surviving spouse under section 15-2-102 of this part, or the entire intestate estate if there habits, changing in reimbursement rates, and the addition of more is no surviving spouse, passes as follows: patient-centered services. But he failed to plan for what would happen if he wasn’t there. When you don’t plan, the state does it (a) To the issue of the decedent; if they are all of the same degree for you through laws called intestate succession. These laws vary by of kinship to the decedent they take equally, but if of unequal state and may distribute your estate in a completely different manner degree, then those of more remote degree take by representation; than you would. Here are a couple of examples: (b) If there is no surviving issue, to his parent or parents equally; (c) If there is no surviving issue or parent, to the issue of the DELAWARE parents or either of them by representation; § 502 Share of spouse. (d) If there is no surviving issue, parent or issue of a parent, but The intestate share of the surviving spouse is: the decedent is survived by one (1) or more grandparents or (1) If there is no surviving issue or parents of the decedent, the issue of grandparents, half of the estate passes to the paternal entire intestate estate; grandparents if both survive, or to the surviving paternal (2) If there is no surviving issue but the decedent is survived by a grandparent, or to the issue of the paternal grandparents if both are deceased, the issue taking equally if they are all of the same parent or parents, the first $50,000 of the intestate personal estate, plus one half of the balance of the intestate personal estate, plus degree of kinship to the decedent, but if of unequal degree those a life estate in the intestate real estate; of more remote degree take by representation; and the other (3) If there are surviving issue all of whom are issue of the surviving half passes to the maternal relatives in the same manner; but if there be no surviving grandparent or issue of grandparents on spouse also, the first $50,000 of the intestate personal estate, plus either the paternal or the maternal side, the entire estate passes one half of the balance of the intestate personal estate, plus a life to the relatives on the other side in the same manner as the half. estate in the intestate real estate; (4) If there are surviving issue, one or more of whom are not issue of the surviving spouse, one half of the intestate personal estate, Overlooking some of the legalese, you can see that this situation plus a life estate in the intestate real estate. becomes complicated very quickly and the results can differ by states and by family situation. The reason for the staff’s anxiety is § 503 Share of heirs other than surviving spouse. readily apparent. Who will end up owning the pharmacy – Joe’s The part of the intestate estate not passing to the surviving spouse spouse, his children or maybe even his parents? Are any of these under § 502 of this title, or the entire intestate estate if there is no possibilities what Joe wanted? surviving spouse, passes as follows: (1) To the issue of the decedent, per stirpes; Many people are reluctant to do estate planning. They are (2) If there is no surviving issue, to the decedent's parent or parents uncomfortable talking about death. But not talking about it and not equally; planning passes the problem on to those left behind. Planning is (3) If there is no surviving issue or parent, to the brothers and sisters more likely to leave the business that you worked so hard to build in a more viable condition to continue. Wills, however, are not the and the issue of each deceased brother or sister, per stirpes; (4) If there is no surviving issue, parent or issue of a parent, then only way to do estate planning. There are other options for both your to the next of kin of the decedent, and to the issue of a deceased business life and your family life. Consult your local attorney to find next of kin, per stirpes; out what options are right for you and your family. While this may (5) Any property passing under this section to 2 or more persons not be the most pleasant way to spend an afternoon, the result will passes to such persons as tenants in common. be well worth it. The legacy you leave behind will be the one that you choose. § IDAHO ___________________________________________________________ © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk 15-2-102. Share of the spouse. The intestate share of the surviving Management & Compliance at Pharmacists Mutual Insurance Company. spouse is as follows: This article discusses general principles of law and risk management. It is not intended as (a) As to separate property: legal advice. Pharmacists should consult their own attorneys and insurance companies (1) If there is no surviving issue or parent of the decedent, the entire for specific advice. Pharmacists should be familiar with policies and procedures of their intestate estate;

The Drug Quality and Security Act

employers and insurance companies, and act accordingly.

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For the entire intestate succession provisions, see Delaware Code Title 12 Sections 501 to 512. For the entire intestate succession provisions, see Title 15 Idaho Probate Code 15-2-101 to 15-2-114.

AR•Rx

THE ARKANSAS PHARMACIST

Pharmacy Residencies Well-Worth the Time and Financial Commitment By Eileen E. Denne

Students talk to representatives from different facilities at the 2013 AAHP Residency Fair.

he number of institutions offering residencies and pharmacy students seeking residencies has almost tripled since 2006, said Amy Franks, Pharm.D., associate professor and Chair of Pharmacy Practice at the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy. In 2006-2007, there were 10 resident positions in the state for pharmacy. This year, Franks says, there are 27 slots. “We’ve had good growth and increased interest on the part of students wanting to fulfill residency training and institutions wanting to offer them,” Franks said. “Institutions are seeing the value of what residencies can do for their pharmacy services. Nationally, the growth is a trend.”

December to February. The Residency Showcase at the ASHP Midyear meeting is one of the main meeting places for programs and candidates to get to know one another. After the interviews are complete, the residency programs and the applicants submit rank lists. The matching is all done electronically based on the submitted preferences and the results are considered binding agreements between the applicants and residency programs. If the institutions don’t fill all their positions, there is a post-match "The opportunity to scramble to fill positions that don’t develop those skills in one match in the original match.

to two years is well worth the trade-off for the time and financial commitment that they make."

Further, Franks offered, “Residency training is a great way to develop pharmacy leaders. That’s how we will keep pushing pharmacy forward. It’s a given that students do residencies to get the best skills. It’s a good investment of time. The opportunity to develop those skills in one to two years is well worth the trade-off for the time and financial commitment that they make.” Franks described the matching process. The American Society of Health-System Pharmacists (ASHP) Resident Matching Program (the “Match”) places residency applicants into both postgraduate year one (PGY1) and postgraduate year 2 (PGY2) pharmacy residencies across the country. Students apply to the programs in which they are interested, and the facilities interview candidates from A R •A RR x •| R Tx H E| AT RHKEA ANRS KAAS NPSHAAS R PMHAACRI M S TA C I S T

In addition to hospital residencies, there are positions in corporations, community pharmacy and ambulatory care. “We try to encourage the students to look at all of the residencies including ambulatory care, community, and hospital,” said Julie Kissack, Pharm. D., professor and Chair of Pharmacy Practice at Harding University (HUCOP). “When pharmacy students come in for a week-long orientation as they start our program, we encourage students to begin thinking about residency training.” “I believe it’s a very valuable step in the training of a pharmacist,” said Kissack. “Residencies allow early career pharmacists to gain three to five years of experience in a one-year time period. Ultimately that helps them to provide optimal patient care at their chosen practice setting. We are thrilled when our students are accepted into residency programs.”

PHARMACY RESIDENCES

The inaugural HUCOP class was eligible to begin residency training in 2012. Kissack added, “The residency training is useful to the young pharmacist to develop clinical skills quickly. It does position the person to be a leader in their profession of pharmacy.”

Dr. Justin Piker graduated from Harding University College of Pharmacy in 2013. He is at White River Medical Center in Batesville.

To better organize themselves, residents in Arkansas have formed a new group called Pharmacy Residents of Arkansas Leadership Organization. According to Cody Null, one of the group’s volunteer leaders and a resident

Dr. Sarah Lewis graduated from UAMS College of Pharmacy in 2013. She is a Community Pharmacy Resident at Kroger Pharmacy.

"There are lots of organizations for students and pharmacists,” Null said, “But the residency year is a big transition year. We wanted to find out how to help students see the benefits of residency programs and help them pursue it." at Baptist Health Medical Center-Little Rock, the group has tried to gather residents in the state to figure out what they can do to advance residents and pharmacy. They are educating students about what a resident does. “There are lots of organizations for students and pharmacists,” Null said, “But the residency year is a big transition year. We wanted to find out how to help students see the benefits of residency programs and help them pursue it, and we wanted to figure out how to help the community so there is a volunteer focus as well. Our big project is working with the transition-of-care clinic – targeting congestive heart failure patients. We’re gathering in other disciplines for patients who have recently been discharged and looking at medication adherence.”

AR•Rx asked five 2013-2014 residents about their experiences. Dr. Cody Null received his undergraduate and Pharm.D. degrees in 2013 from Wilkes University in Wilkes-Barre, Pennsylvania, and is doing his residency at Baptist Health Medical Center-Little Rock. Dr. Jessica Cowart-Binz graduated from UAMS College of Pharmacy in 2013. She is a Community Pharmacy Resident at Harp’s.

Dr. Kevin Barton graduated from UAMS College of Pharmacy in 2013. He is a Community Pharmacy Resident at Walmart Home Office.

1. When and how did you become interested in pharmacy and pharmacy school? CODY- I focused on pharmacy towards the end of high school. I was interested in health care and also enjoy educating others. Pharmacy is a nice blend in that you can positively impact patient care through educating patients and other healthcare providers. JESSICA- My mom attended UAMS College of Pharmacy when I was a teenager. I became interested after I got my first job in a pharmacy the summer after I graduated from high school. I really enjoyed working with patients, and UAMS was the only place I really considered when applying for pharmacy school. KEVIN- When I was a senior in high school, I was in search of a career that simply involved math and sciences. My dad had a good friend by the name of Mike Smets, owner of Coleman Pharmacy in Fort Smith, who happened to be a pharmacist. After talking with Mike and his experience in pharmacy, my dad suggested taking the path to pharmacy. From day one of my undergraduate studies, I pursued the necessary prerequisites of becoming a potential candidate for pharmacy school without knowing, other than what my dad had described, what exactly a pharmacist did. JUSTIN- I became interested in the profession of pharmacy as an adolescent. I watched the positive impact my local pharmacist had on my community and the vital role he played in their health. I chose to go back to school later in life, but when I did pharmacy was an easy choice for me. I knew that I wanted to be a valuable resource to my community and have a fulfilling career. SARAH- I first became interested in a career in pharmacy after my Sunday school teacher, Sharon Powell, encouraged me to apply for a pharmacy technician job at the pharmacy where she worked. After working as a technician I decided to pursue my undergraduate requirements and apply to pharmacy school. I am from the area and UAMS was my first and only choice.

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2. Why did you decide to apply for a residency program?

3. What did you hope to get out of a residency program?

CODY- I knew by completing a residency program I would gain both clinical experience as well as leadership skills. Residencies offer you a broader view of health system pharmacy and open opportunities you might not otherwise have the chance to pursue. Throughout my program I have been challenged to provide direct patient care for diverse patient populations, exposed to health system management, and allowed to pursue my primary area of interest, emergency medicine.

CODY- I learned a lot in school but it is really different transitioning from what the book says to, “Here’s a great way to apply this to patients.”

JESSICA- I felt like I wasn't finished learning. I wanted to better myself, and set myself apart from my classmates that were not doing a residency. I knew the experiences would be unlike anything else I had seen before, and that excited me and scared me all at the same time. KEVIN- The residency program I am currently undergoing is unique. During pharmacy school, understanding the business of pharmacy really drew me in but never did a residency cross my mind. When UAMS announced its partnership with Walmart to create the company’s first community residency program at their Home Office, I couldn’t pass up the opportunity to be involved in creating innovative services that would impact patients nationwide. JUSTIN- I applied for a residency because most of the hospital jobs that were available were seeking candidates that had completed a residency. I saw it as a way to distinguish myself as a candidate for employment. I knew that residents got to learn and experience things that many pharmacists do not get to experience. SARAH- I considered residency training the whole time I was in pharmacy school. I was very interested in clinical pharmacy and teaching, so residency would be a way for me to gain to training needed to further my career in those areas.

Gathering of students looking at possible residency locations at the 2013 AAHP Annual Fall Seminar Residency Fair AR•Rx

THE ARKANSAS PHARMACIST

JESSICA- I wanted to learn how to start up a clinical program, improve upon my teaching skills, and open doors that would otherwise be closed if I did not complete a residency.

"I chose to go back to school later in life, but when I did pharmacy was an easy choice for me. I knew that I wanted to be a valuable resource to my community and have a fulfilling career."

KEVIN- I wanted to optimize my leadership skills to develop myself, student pharmacists, and colleagues into driving further improvements and innovations to the pharmacy profession. I also wanted to gain an understanding of what challenges large companies face and what solutions are initiated to overcome these obstacles. JUSTIN- I hoped to gain the knowledge and skills necessary to make me a successful clinical pharmacist from my residency. While working in the hospital setting as a pharmacy resident I offer services to patients that were not normally offered. SARAH- I had a desire to work in an environment that was innovative and forward thinking, I wanted to be trained to do more. I also hoped to gain experience in teaching. 4. What have you learned in your program to date? CODY- I have experienced the real-world; I left the ivory towers and am now seeing how things get done in the

PHARMACY RESIDENCES

hospital. I can take and apply my knowledge so it is useful and helpful for patients. Residency does a good job of getting you better at that. I have also learned the value of working in a multidisciplinary team setting. I’ve had the chance to educate other disciplines including nurses and physicians. This brings respect to our profession and has helped me grow professionally. JESSICA- I have implemented an immunization program and am working on implementing MTM in our 31 stores. I have learned management skills, how to improve my teaching style, and the best way to implement a program. I have learned so much I could write about it forever, but those are the skills I am particularly proud of. KEVIN- The knowledge I have gained during this residency has far exceeded my initial expectations! From gaining a better understanding of the healthcare industry to learning from the business, I truly feel I have gained 3-5 years of experience in the corporate side of pharmacy. The residency also gives me an opportunity to provide some of these clinical services hands-on at the store level, which has also enhanced my experience in understanding optimal delivery of communication from Home Office to the pharmacy. JUSTIN- In my experience as a resident I have learned that there are many opportunities both inpatient and outpatient for expansion of pharmacy services. I have learned that in most cases involving patient care there is room for improvement and expansion of pharmacy services. I believe that residency programs are the way for pharmacists to have expanded roles in healthcare. SARAH- I have learned to be a clinical pharmacist and to better care for my patients. The most surprising thing for me has been how differently I practice pharmacy now, as opposed to when I started the program. I am able to see my growth and the impact I can have professionally, and that encourages me to continue to learn more every day. 5. What’s the biggest obstacle to people doing residencies? CODY- There are many more people applying than places that have residencies available and it’s a shame to have to turn people away. Meeting the demand is an obstacle. We would like to see if more sites have the ability to expand their programs and offer residencies to more new grads. JESSICA- For me it was committing to a year of learning without a guarantee I would have a job in one year that differed from my classmates that did not complete a residency.

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KEVIN- The concern that I remember hearing in pharmacy school was the compensation a resident would receive compared to working in the field immediately after becoming a pharmacist. Through my experience, having passion and motivation to succeed in the residency program more than compensates for any “loss” in salary a resident may have. I understand that some students may think a residency is not worth their time after many years in school, but my challenge to them would be to think of what a residency can offer long term, not just the present. JUSTIN- One of the biggest obstacles to doing a residency is the lower salary associated with residency programs. It is hard as a new graduate to see the cost/benefit ratio when looking at differences in salaries for a pharmacist compared to a resident. Another major issue is the current cost of obtaining a degree in pharmacy. SARAH- Most people don't understand what a communitybased residency is and why anyone would want or need to do one. A lot of people can be negative about it, but I really believe in what I'm doing. I think another big issue people face is that they feel they can't sacrifice the time and money to do extra training. 6. Would you recommend that all pharmacy students do residencies? CODY- Yes, and we hope the Pharmacy Residents of Arkansas Leadership Organization will help to do that. JESSICA- I would absolutely recommend a residency to all pharmacy students that are interested. I don't believe ALL pharmacy students have what it takes to complete a residency. Residencies take hard work and dedication, and without a drive to succeed a student would merely complete the bare minimum without getting the true benefit of a residency. If forced to complete residencies, I don't believe students would get the value they do from voluntary residencies. KEVIN- I would recommend pharmacy students to pursue what their heart desires. Residencies are only for those who truly want to further develop themselves in ways they not have been able to in pharmacy school and who believe the resources provided from a residency can undoubtedly be utilized to further impact patient care. If the heart and mindset are not there, then I don’t believe a residency is the best path to take for a new graduate. JUSTIN- I believe that residencies can be highly beneficial to pharmacists looking to expand their opportunities. I do not believe that a residency is for everyone. In my opinion, residency is for those looking for expanded opportunities such as teaching, clinical pharmacy, management, and/ or specialization in a particular area of pharmacy practice.

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PHARMACY RESIDENCES

SARAH- I do not recommend that all pharmacy students do residencies, but I think it makes sense for some people based on their career plans. I do think that all pharmacy students should consider doing a residency, and that they should keep an open mind about what they want to do

upon graduating. As the profession moves forward, I hope that the curriculum is able to keep up with the growing demands for pharmacists to perform not just dispensing services, but also cognitive ones, and that students recognize these changes when considering their plans. §

2014-2015 Residency Matches

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AR•Rx

THE ARKANSAS PHARMACIST

Senator Maloch and daughter Lauren Mitchell, Pharm.D.

Legislator Profile

Senator Bruce Maloch District: 12 Represents: All or parts of Columbia, Clark, Dallas, Grant, Nevada and Ouachita Counties. Years in Office: Served three terms in the House of Representatives, from 2005 through 2010. Began first term in the Senate in 2013. Occupation: Banker; Attorney; Rancher. Your pharmacist: Lauren Maloch Mitchell (my daughter) with Peoples Drug and Gifts in Stamps, Arkansas. Like most about office: Being able to help constituents find the appropriate help with a state agency, and cut through red tape if necessary, is gratifying. I have also been on the Joint Budget Committee since entering the legislature and enjoy helping craft the state's budget and monitoring projected revenue and expense items. I am proud of our state's budgeting process. Like least about office: Some increased partisanship/ political spin at the state level, though I am pleased there is little of that in the State Senate. Balancing time between my job at the bank and the legislature is also challenging. Upcoming election: 2016. I am in the middle of a 4-year Senate term and will simply be able to enjoy watching other races this election cycle.

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(D-MAGNOLIA)

Advice for pharmacists about the political process and working with the AR Legislature: Get to know your State Representative and Senator and keep up with legislation that affects your profession. While we rely on paid lobbyists and government relations personnel, no one has the influence of a local constituent. Your fantasy political gathering would include: William Wilberforce, Abraham Lincoln, Nelson Mandela, Ronald Reagan, Bill Clinton, David Pryor and Mike Beebe. Wilberforce, Lincoln and Mandela fought through human rights issues of slavery and apartheid. Reagan and Clinton had charisma and personal skills to bring people together. Senator Pryor was mentioned above and Governor Beebe has such a knowledge of state government at the legislative and executive level. I would just sit back, listen and learn from all of these. Toughest issue of the past Session: Passing the Private Option. I am concerned this will be an issue going forward, but am hopeful people will education themselves and understand that the negative or controversial provisions of the Affordable Care Act (reduced Medicare reimbursement rates, mandates, etc.) would not have been affected by our failure to pass the Private Option. What do you do for fun: I enjoy spending time at the farm and hunting, both of which I now enjoy doing with grandchildren. I am also an auctioneer (for charity auctions only) and have enjoyed calling over 500 auctions, helping raise several million dollars for charitable causes over the past 30+ years. §

Most admired politician: Former Governor and Senator David Pryor. He showed an interest in me from high school days to this day. I interned for him in the U. S. Senate in 1979. I have always admired his humble, sincere approach and focus on recognizing and encouraging others.

AR•Rx

THE ARKANSAS PHARMACIST

UUNNI IVVEERRSSI ITTYY OOFF AARRKKAAN CE ES C CO OLL LL E G GE E O O FF PP H HA A RR M MAACCYY NSSAASS FF O OR M E D I C A L S C I E N C

Methotrexate Welcome to another issue of Safety Nets. This column illustrates the potential hazards associated with illegible prescriber handwriting. A community pharmacist from Central Arkansas reports the following potentially lifesaving intervention. Thank you for your continued support of this column.

he prescription illustrated in Figure One was electronically transmitted from a prescriber’s office to a community pharmacy in Central Arkansas. The pharmacist who examined the prescription immediately questioned the daily dosing interval for methotrexate. The pharmacist had previously received methotrexate prescriptions indicated for rheumatoid arthritis or psoriasis, but the prescribed dosing interval for these prescriptions had always been once weekly – never daily. While the pharmacist was still examining the prescription, the patient arrived at the pharmacy. The pharmacist asked the patient why she had been prescribed methotrexate. The patient said the medication was for “my arthritis.” At this point, the pharmacist realized the prescriber may have inadvertently prescribed a daily methotrexate dosing interval rather than the recommended weekly dosing interval for rheumatoid arthritis.

Figure One

The pharmacist asked the patient if the prescriber had explained how to administer the medication. The patient said “my doctor told me you would explain it.” The pharmacist decided to telephone the prescriber’s office for clarification of the methotrexate dosing interval. After listening to the pharmacists’ concerns, the nurse verified the prescribed methotrexate dosing interval on the electronic prescription was, in fact, incorrect. The nurse apologized and said she would immediately transmit a corrected E-prescription for this patient (the second E-prescription is illustrated in Figure Two). The pharmacist noticed two changes had been made to this second prescription: (1) the quantity had been changed from 30 tablets to 24 tablets and (2) the Sig. had been changed from one tablet daily to one tablet six times per week. Confused by this new Sig., the pharmacist decided to call the prescriber’s office a second time for further clarification. This time the pharmacist bluntly asked the nurse “how does the prescriber

want the patient to administer methotrexate?” The nurse replied the patient was to take six tablets every Saturday weekly. The nurse went on to say “I couldn’t find any patient directions in our system for six tablets every Saturday – the closest I could find was six times per week so I just sent that instead.” After requesting a verbal prescription order, the pharmacist entered

Figure Two

the prescription information into the computer as methotrexate 2.5 mg tablets, quantity 24, with patient directions of “take six tablets by mouth every Saturday.” After this, the pharmacist filled the order and appropriately counseled the patient. The medication order in this case illustrates the potential hazards associated with electronic prescriptions. While E-prescriptions may reduce the incidence of certain types of medication errors, their use does not guarantee error-free prescriptions. In fact, the legibility and neatness of electronic prescriptions – in some cases - may actually increase the risk of a medication error reaching a patient compared to a handwritten prescription, which may be more carefully examined by the pharmacist. This case also clearly illustrates that pharmacists are at the mercy of program writers who understand data processing, but not pharmacy. The prescribing software utilized by this clinic prevented the nurse from including the exact patient directions into the electronic prescription. In this case, a traditional handwritten prescription would have been much safer for the patient. Computer programmers must create software templates that allow accurate entry of any appropriate Sig. Fortunately for the patient in this case, the pharmacist was not working in a robotic fashion and questioned both methotrexate orders. If the pharmacist had dispensed methotrexate according to either electronic prescription, the results could have been tragic. The authors of Safety Nets thank him for sharing this case with our readers. §

AR•Rx

THE ARKANSAS PHARMACIST

MARKETING IDEAS

Making Your Brand Work for You Marketing Ideas from Pharm Fresh Media By Liz Tiefenthaler

enowned TED speaker Simon Sinek says, “People don’t buy what you do, they buy why you do it.” People want to do business with companies whose brand is about the why and not the what. Before launching an effective marketing campaign, you will need to have a clear understanding of your pharmacy brand. What do you stand for and who do you serve? Being able to answer these seemingly simple questions is paramount to creating a marketing plan. Let’s take a look at some ways that you can grow your brand and how having a strong brand will guarantee your success.

Let’s take a look at one of the world’s greatest brands. If Apple’s brand were driven by what they do, their marketing message would sound like this, “We make great computers. They are beautifully designed. Would you like to buy one?” Not very inspiring, is it? Instead their message is driven not by what they do, but instead by why they do it. “Everything we do is based on that we believe in thinking differently. We show this by making beautifully designed computers that are easy to use. Would you like to buy one?” That brand message of innovative thinking that translates into products that consumers want resonates so well with people, that they Great brand strategy is offering your are willing to buy phones and customers something that is so relevant to MP3 players and televisions, them that they don’t think they can get it all from a company whose anywhere else in just the same way. core business is making computers. That is having a brand work for you!

Before you can set up a marketing plan to attract new customers, you first need to know who you are. Not what you offer, but instead what drives the heart beat of your pharmacy. What are your strengths and weaknesses? Who are you and why should that matter to me? If your strengths do not match up with the values of the customers you are hoping to attract, what will you need to do to become that pharmacy?

I had a store call me bemoaning his lack of traffic. He had recently moved into an Hispanic neighborhood in a city in Texas. “I know a lot about pain management,” he told me. “I don’t know why that is not resonating.” When we took a good look at the neighborhood he was located in, we discovered that it was primarily Spanish speaking families with children. This pharmacy was not involved in community outreach, had no programs in place for well babies or vitamins for children and no help available for caregivers of older adults. Also, no one in the pharmacy spoke Spanish. You can see the disconnect between what the man wanted for his pharmacy and what the population of the people around him needed. I like to think of it this way. What would your customers find missing in their lives if your brand went away? Great brand strategy is offering your customers something that is so relevant to them that they don’t think they can get it anywhere else in just the same way. Done well, you can get long time fans of other brands to switch to you. That’s what it means to have your brand work for you. A R • AR Rx •|R Tx H E| AT RHKEAANRSKAAS NPSHAAS R PMHAACRI M S TA C I S T

One of my favorite customers runs a very busy pharmacy that routinely fills 1,000 prescriptions in a day. He really understands his brand. His pharmacy belief is based on meeting the needs of adults who are 55 and older. Sounds simple, right? The difference is in his execution. He is so passionate about understanding what this age groups needs and how they want to be treated that he doesn’t even waste time or money marketing to other audiences. His word-of-mouth referrals are through the roof and he finds patients willing to fight Pharmacy Benefit Managers and mail order and Medicare Part D changes in order to stay at his pharmacy. That is having your brand work for you. Why do you go to work every day? What is the passion that drives your brand? Start by answering these questions and you will be well on your way to establishing a strong brand that will work for you. § About Liz Tiefenthaler: Liz is the President of Pharm Fresh Media, a marketing services company serving Independent pharmacy. She is a columnist for America's Pharmacist and Drugstore Canada as well as a frequent presenter for NCPA.

PHARMACIST IMMUNIZATION PROGRAM

Quality Improvement 101: How to get started oday, many local, state and national initiatives T underscore the need for widespread quality improvement (QI) in both health care delivery and patient

health outcomes. However, oftentimes the fundamental principles and techniques of QI are not delineated. In order to best implement and comply with current health care initiatives and best practices, baseline knowledge of QI is required. In 2007, Drs. Batalden and Davidoff defined QI as “the combined and unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, payers, planners, and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.”1 This three-pronged definition, linked by the intrinsic efforts of everyone involved in the health care system, contributed to the development of Dr. Berwick’s “Triple Aim” in 2008 which is characterized by better health care for individuals, better health for the population, and lower per capita costs of health care through improvement.2 This Triple Aim, shortened to “Better Health, Better Health Care, Lower Costs,” as well as the aforementioned QI definition, provide a reference on which to base all QI projects and initiatives. Additionally, the Institute of Medicine’s Crossing the Quality Chasm: A New Health System for the 21st Century report, described six aims for health care improvement – safety, efficacy, patient centeredness, timeliness, efficiency and equality – around which all QI efforts should be built.3

Root Cause Analysis

Once a general knowledge of QI is established, it is time to embark on a QI initiative. Prior to taking action to resolve any problem, the underlying “root” cause of that problem must be identified in order to truly improve. A root cause analysis (RCA) should be performed at the beginning of each QI initiative in order to determine the primary reason(s) for the problem, adverse event, or trend identified in the chosen initiative and the focus of this RCA should always be on a system or process that has the potential for redesign. There are various tools and methods available to assist in the performance of RCAs

including Cause-and-Effect Diagrams, Process Mapping, and the 5 Whys method. The Cause-and-Effect Diagram, or Fishbone Diagram, visually illustrates the relationship between various causal factors and a given outcome. Process Mapping allows for step-by-step mapping of a system or process that led to the given outcome. The 5 Whys method starts with the given outcome and asks “why is this problem happening?” continually until an answer is eventually reached. This method is typically the easiest method to complete because it does not always require intense data collection and analysis.

Plan-Do-Study-Act

Once a causal factor has been identified by an extensive RCA, it is important to develop and implement interventions that directly relate to that factor and are aimed at improving the given outcome. And although all improvement efforts require change, it is important to recognize that not all change result in improvements. Therefore, it is important to implement new interventions in short increments while collecting data to ensure efficiency and improved outcomes. The best model with which to accomplish this rapid-cycle improvement is the Plan-Do-Study-Act (PDSA) Cycle. The PDSA Cycle was developed by Dr. W. Edwards Deming and allows for short tests-of-change on a small scale. As outlined in Figure 1, the PDSA cycle begins with methodical planning of implementation details and definition of data collection metrics, and transitions into an action phase where those plans are executed. After a short timeframe, the “Study” phase brings all participants together in order to perform data analysis and trending and to share best practices and lessons learned. The last phase of the cycle involves translating the gathered information into improvements to the intervention and plans for the next PDSA Cycle. The continuous nature of this cycle allows for interventions to be rapidly perfected prior to large-scale spread within an organization.

Recommendations for Pharmacists

Determining which QI initiative to undertake is a collaborative process to be addressed among all organizational members including health care

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professionals, senior leaders and staff. Pharmacists are well poised to be the key players in many local, state and national QI initiatives that aim to reduce adverse drug events, reduce antipsychotic usage in long-term care facilities, improve antimicrobial usage and reduce 30-day readmission rates. For more information on how you and your staff can engage in a QI initiative contact Dr. Christi Quarles Smith (csmith@afmc.org). § REFERENCES 1. Batalden PB, Davidoff F. What is “quality improvement” and how can it transform health care. Qual Saf Health Care. 2007;16(1):2-3. 2. Berwick DM, Nolan TW, et al. The triple aim: care, health, and cost. Health Affairs. 2008;27(3):759-769. 3. Institute of Medicine (IOM). 2001. Crossing the Quality Chasm. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press. _________________________________________________________ Christi Quarles Smith, PharmD, is a pharmacy specialist at the Arkansas Foundation for Medical Care (AFMC), and is the team lead for AFMC's reducing adverse drug events and care transitions projects. She is a graduate of the University of Arkansas for Medical Sciences (UAMS) and completed a Pharmacy Practice residency at UAMS. She can be reached at csmith@afmc.org. AFMC is the state's health care Quality Improvement Organization and contracts with the Centers for Medicare & Medicaid Services to give technical assistance to health care providers. AFMC's mission is to promote excellence in health and health care through education and evaluation.

Figure 1. Plan-Do-Study-Act (PDSA Cycle)

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QUALITY IMPROVEMENT 101

Innovative Clinical Programs

APA Takes PharmacistDelivered Immunization Message to Local Civic Organizations

ver the last year, Director of Clinical Programs Eric Crumbaugh, Pharm.D., has spoken to civic organizations such as Kiwanis and Rotary in Batesville, Camden, Crossett, Searcy and Pocahontas. Eric’s 30-minute talk describes his community pharmacy practice residency and time spent as a clinical pharmacist. Then he discusses the profession and how pharmacists are an integral part of the healthcare team, ensuring that all medications are appropriately taken by patients and monitored for adverse effects and efficacy. Finally, he discusses routine adult immunizations such as tetanus / diphtheria / acellular pertussis (Tdap), shingles, flu, and pneumonia. Eric provides an Adult Immunization Checkup list for attendees as well as a personal immunization card. If any one of these indications applies to those in the audience, he encourages them to talk to their local pharmacist about getting the indicated immunization. At the conclusion, Eric answers questions about specific vaccines and tries to correct any misinformation regarding vaccinations. Each group has had a lot of good questions. Several pharmacists have reported that their patients who attended the meeting followed up on Eric’s recommendation to ask about getting vaccinations. The APA is happy to provide talking points and resources to any member who would be interested in conducting a similar meeting at a civic club, senior center, or similar setting. If you are not comfortable speaking, contact Eric (Eric@arrx.org) 501-372-5250, to coordinate a day when he can attend your community meeting to talk about the profession of pharmacy and the importance of immunizations. § 26

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Seven New Drugs to Date in 2014

o far in 2014 seven drugs have received FDA approval, four of which are orphan drugs that received priority review. Three additional drugs have been approved for diabetes mellitus, COPD, and pulmonary hypertension. Iclusig®, a drug that was withdrawn from the market in 2013 due to cardiovascular concerns, will be reintroduced but with new safety requirements; it is indicated in chronic myeloid and acute lymphoblastic leukemias. Anoro™ Ellipta™ (umeclidinium/vilanterol) is the first oncedaily inhaler that combines a long-acting anticholinergic with a long-acting β2-agonist and is indicated as maintenance therapy for COPD. Its side-effect profile is comparable to other aerosol powder inhalers with similar ingredients. Farxiga® (Dapagliflozin) is the second drug in a new class of sodiumglucose cotransporter 2 inhibitors used to treat diabetes mellitus, type II in adults. Farxiga® is contraindicated in patients with severe renal disease, and caution should be taken in patients with impaired renal function, those taking diuretics, or the elderly due to an increased risk of hypotension. Farxiga® is not recommended for patients with active bladder cancer, and patients should be counseled about an increased risk of UTI. Orenitram™ (Treprostinil) is a prostacyclin vasodilator available as extended-release tablets for treatment of pulmonary arterial hypertension. Bioavailability is poor (17%) but improves when given with food. Patients should not abruptly stop the drug and should avoid alcohol. There is an increased risk of bleeding in patients taking anticoagulants, and the tablets can become lodged in the diverticulum in patients with diverticulosis. Drug interactions exist with antihypertensives drugs that are strong CYP2C8 inhibitors. Hetlioz™ (tasimelteon), a melatonin receptor agonist, is an orphan drug that received priority review and is the first approved treatment for non-24-hour sleep-wake disorder. Non-24 is a chronic, circadian rhythm disorder that occurs in totally blind people and affects approximately 100,000 Americans. The complete lack of light perception prevents their body clock from synchronizing with the 24-hour light-dark cycle and results in reversed sleep patterns. Hetlioz™ improves the ability to sleep at night and to be active during the day. Northera™ (Droxidopa) is an orphan drug indicated for treatment AR•Rx

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of symptomatic neurogenic orthostatic hypotension in patients with primary autonomic failure (Parkinson disease, multiple atrophy, pure autonomic failure), dopamine beta-hydroxylase deficiency, or non-diabetic autonomic neuropathy. As a prodrug of norepinephrine it causes vasoconstriction which helps maintain adequate blood pressure upon standing. Midodrine is the only other drug approved for neurogenic orthostatic hypotension and has shown inconsistent efficacy. Adverse effects are primarily cardiovascular (supine hypertension, arrhythmias, ischemic heart disease, heart failure exacerbation), and symptoms resembling neuroleptic malignant syndrome have also been reported. Vimizim® (Elosulfase), a recombinant form of human lysosomal enzyme N-acetylgalactosamine-6-sulfatase (GALNS), is the first approved treatment for Morquio A syndrome. This genetically inherited metabolic disorder occurs in 1 in 200,000 births and is characterized by the absence or marked reduction in GALNS activity, leading to accumulation of glycosaminoglycans keratan sulfate and chondroitin-6-sulfate throughout the body causing widespread cellular, tissue, and organ dysfunction. Symptoms usually start between ages 1–3 and include heart disease, skeletal abnormalities, vision/hearing loss, difficulty breathing, and early death. Of primary concern are hypersensitivity reactions, including anaphylaxis which has occurred as early as 30 minutes into the first infusion and as late as the 47th infusion. Vimizim® also has orphan drug status and was the first drug to receive a rare pediatric disease priority review. Myalept™ (Metreleptin), a leptin analogue, is indicated as replacement therapy adjunct to diet in treating leptin deficiency complications in congenital or acquired generalized lipodystrophy. Lipodystrophy is a group of rare syndromes which causes widespread loss of fat tissue under the skin. This in turn causes a deficit in the hormone leptin, leading to multiple metabolic complications. This orphan drug will be exclusively available through Accredo, Express Scripts’ specialty pharmacy. § _____________________________________________________________ Contributors: Brian Knoske, Pharm.D./MBA Candidate and Mary Menezes, Pharm.D .Candidate, Harding University College of Pharmacy _____________________________________________________________ Rodney Richmond, RPh, is Associate Professor, Pharmacy Practice, at Harding University College of Pharmacy in Searcy.

COLLEGES OF PHARMACY

UAMS

Team-Based Learning at UAMS COP

f you decided to attend a pharmacy class today, you may be surprised by the changes you’d see.

The classroom is becoming more active with students working together and independently on classroom exercises such as discussions and problem solving. The lectures and readings are done prior to class resulting in the reversal of the typical lecture-homework cycle, a technique called the “flipped classroom.” In the flipped classroom, students learn much of the content prior to attending class through reading materials or videotaped lectures with application exercises in the classroom to facilitate higher-level learning. An example of this active learning method is team-based learning (TBL). The TBL classroom (on the first floor of the main library) looks more like a These types of active learning “learning laboratory” sessions serve as excellent where tables for up methods to begin to transition to six students fill the room. At the students to the practice beginning of class, setting. students take an individual readiness assurance test (IRAT) to assess their own understanding of the material. This is followed by a group readiness assurance test (GRAT) in which students take the same quiz as a group, with an opportunity to debate with and learn from each other prior to reaching a group response. The teacher can quickly determine if the material is understood, or if there are issues that remain confusing. The remainder of the classroom time can be spent discussing material or cases that illustrate the main points.

Stephanie Gardner improve learning even the “typical” Pharm.D., Ed.D. classroom lecture has had an Dean enhancement. All lectures are now videotaped and archived so that students can quickly retrieve lecture information and fast forward to review material that was initially unclear.

Other changes in our educational program include more emphasis on preparing students to communicate effectively with patients and other health care providers, and more emphasis on interprofessional education. Over the next two years, we will develop a curriculum that allows all students to learn “from, with and about” each other. In the new era of health care reform, practitioners will have to work as an effective team, using evidencebased decisions to guide therapy and to appropriately document patient outcomes. Our primary goal is to focus on learner-centered teaching that is a strategic initiative of the College. As teachers, we understand that ultimately learning is far more important than teaching. We remain committed to preparing the next generation of pharmacists to be lifelong learners, to provide the highest quality of patient care, and to uphold ethical standards of practice. §

Among the numerous benefits to the student include enhanced problem-solving skills and the promotion of teamwork. These types of active learning sessions serve as excellent methods to begin to transition students to the practice setting. Despite the growing popularity of TBL, our traditional lecture format remains the most common approach. In an effort to

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COLLEGES OF PHARMACY

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COLLEGES OF PHARMACY

HARDING UNIVERSITY

Road to Accreditation Long and Winding

he road to accreditation for a new college or school of pharmacy is a long and winding one. There are many bumps and detours along the way but also some amazing sights to see and lessons to learn! The Accreditation Council for Pharmacy Education (ACPE) process for accreditation of a new college or school of pharmacy includes three stages of preaccreditation and accreditation: Precandidate, Candidate, and Full. Preceding these three stages, there is an ACPE new Doctor of Pharmacy application process that involves submission In August 2008, the inaugural of documentation to class was seated at Harding the ACPE Board of Directors who then University College of consider whether or Pharmacy. At its June 2012 not a new program will Board meeting, ACPE rendered be granted an initial its decision to grant Harding Precandidate on-site Full accreditation status. evaluation visit. Harding submitted its new program application in December 2006 followed by Harding representatives appearing before the ACPE Board in San Diego, CA during their January 2007 meeting. At that time, Harding was granted an on-site evaluation visit which was scheduled for May 1-2, 2007. After the May 2007 visit, Harding withdrew its request for consideration of Precandidate status by the ACPE Board at its June 2007 meeting and requested a second Precandidate onsite evaluation visit which was granted and subsequently occurred November 13-15, 2007. Following that visit, the ACPE Board at its January 2008 meeting granted Harding Precandidate accreditation status. Precandidate accreditation is the first of the two preaccreditation statuses. It is granted by ACPE to a new Doctor of Pharmacy program that meets all eligibility criteria but that has no students enrolled. In August 2008, the inaugural class was seated at Harding University College of Pharmacy. Once the first class was seated, the College turned toward seeking the next stage of accreditation. March 17-19, 2009, ACPE sent an evaluation team to assess Harding for advancement to Candidate accreditation status. Candidate accreditation is the second of the two preaccreditation statuses. It is granted by ACPE to a new Doctor of Pharmacy program previously awarded Precandidate status and that has students enrolled but that has not yet had a graduating class.

These two preaccreditation statuses Julie Hixson-Wallace are the public recognition that ACPE Pharm.D., BCPS Dean grants to a new Doctor of Pharmacy program for a limited period of time that signifies that the program is progressing towards accreditation and is likely to attain accreditation before the expiration of that limited time period. The time period allowed that preaccreditation (Precandidate and Candidate status combined) is five years. Harding was granted Candidate status by the ACPE Board at its June 2009 meeting with a focused on-site evaluation scheduled for March 3-4, 2010. All went well during the March 2010 focused visit and a followup focused visit was scheduled for March 10-11, 2011. The following year, April 9-11, 2012, Harding hosted a comprehensive ACPE on-site evaluation for the purposes of considering advancement to Full accreditation status. This visit coincided with the graduation of the inaugural class in May 2012. At its June 2012 Board meeting, ACPE rendered its decision to grant Harding Full accreditation status and assigned a follow-up focused visit for the spring of 2014. This two-year post-Full accreditation status visit is customary for all new schools. I am happy to report that on March 4-5, 2014, even in the midst of an ice storm during which the university was officially closed, an ACPE-appointed evaluation team made its way to campus for our most recent focused visit. So seven years and seven site visits after my move to Searcy, Arkansas, from Atlanta, Georgia, Harding University College of Pharmacy is well on its way to maintenance of ACPE Full accreditation status. While the final decision of the ACPE Board of Directors is still pending its June 2014 meeting, the exit report we received from the most recent evaluation team bodes well for continued accreditation for the remaining four-year period of our initial six-year Full accreditation cycle. The seven evaluation teams that have visited Harding have left behind many excellent ideas regarding our degree program and we are so grateful to our pharmacy education colleagues for the time spent on the site visits. We are also exceedingly grateful for the many hours of time invested by volunteer preceptors who have attended our ACPE site visits and who instill wisdom to our students every day during their introductory and advanced pharmacy practice experiences across the state. Harding wouldn’t be where it is today were it not for the support we have received from the Arkansas pharmacy community. On behalf of the faculty, staff, and students, let me say THANK YOU!! We look forward to many more years of collaborating with you all. § AR•Rx

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INFORMATION and ACCOMMODATIONS

132ND APA ANNUAL CONVENTION L E A R N . I M P L E M E N T. C H A N G E . Following healthcare reform, pharmacists who want to be successful will have to learn new skills, implement innovative practices and change the way they think about patients. The Arkansas Pharmacists Association’s (APA) 132nd Annual Convention will offer the educational programming to help meet those needs. The 132nd APA Annual Convention will be held at The Chancellor Hotel in Fayetteville from June 12-14, 2014. During this annual gathering, pharmacists can stay upto-date and informed with the Continuing Pharmacy Education sessions and networking opportunities planned at the convention. This Annual Convention will welcome up to 350 pharmacists, pharmacy technicians, exhibitors, students, and special guests.

We appreciate the support of our Wholesale Business Partners.

W H Y AT T E N D Continuing Pharmacy Education: APA will offer 15 hours of Continuing Pharmacy Education with highly-regarded instructors on topics ranging from pharmacists’ role in the Patient-Centered Medical Home to CMS Star Ratings. The CPE is conveniently organized into themed blocks: Thursday AM-

Team-Based Healthcare

Thursday PM-

The ABCs of MTM

Friday PM-

Clinical Update

Friday AM and PM- Shoot for the Medicare Stars

LEARN. IMPLEMENT. CHANGE.

Saturday AM-

Protecting Your License

Comprehensive Exhibition: Exhibitors including pharmacy wholesalers, manufacturers, insurers, Colleges of Pharmacy, hospitals, and software vendors will be on hand to discuss their newest products and services that will benefit the practice of pharmacy in Arkansas. Be sure to visit with these professionals to learn about their innovative products.

A C C O M M O D AT I O N S The Chancellor Hotel at 70 North East Avenue is the host hotel for the 132nd APA Annual Convention in Fayetteville. Check-in is at 3:00 PM and check-out is 12:00 PM. For reservations, call 1-855-285-6162. Room rate is $109.00 plus tax. Mention Arkansas Pharmacists Association Group for group rate. Cut-off date for rooms is May 18, 2014.

Social and Networking Events: Connect with old friends and meet new colleagues! In addition to the always popular Opening Reception at the Exhibit Hall, the Friday evening reception will be held at the Walton Arts Center on Dickson Street. The 14th Annual Art of Wine event will be the party of the summer. You can choose from a selection of more than 400 different wines from around the world and food from the area’s best restaurants - all in a festive party atmosphere in the heart of Northwest Arkansas’ entertainment district. Or, take your family to AQ Chicken House for a delicious dinner. The Chancellor Hotel lobby. A R • R x2 | 34

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SCHEDULE OF EVENTS W E D N E S D AY, J U N E 1 1 , 2 0 1 4 9:00 AM - 12:00 PM

APA Board of Directors Meeting

CPE Block Two: The ABCs of MTM

4:45 - 5:30 PM

Arkansas Pharmacists Foundation Board Meeting/ Past Presidents Council Meeting

5:30 - 6:00 PM

Presidents Reception

6:00 - 8:00 PM

Opening Reception in Exhibit Hall

__________________________________________________

F R I D AY, J U N E 1 3 , 2 0 1 4 7:00 AM - 4:30 PM

Registration

7:30 - 8:30 AM

Breakfast, AP-PAC Speaker Representative Tim Griffin

SCHEDULE OF EVENTS

(Schedule is subject to change) ________________________________________________

2:00 - 5:15 PM

Officer Installation

Stonebridge Meadows Golf Club

APA Annual Golf Tournament Stonebridge Meadows Golf Club (Fayetteville)

________________________________________________

T H U R S D AY, J U N E 1 2 , 2 0 1 4 7:00 AM - 4:30 PM

Registration

7:30 - 8:30 AM

Breakfast

8:45 AM - 12:00 PM

CPE Block One: Team-Based Healthcare • Pharmacists Role in Reducing Readmissions • Pharmacists’ Role in the Patient-Centered Medical Home • Panel Discussion with Session Presenters 12:15 - 1:45 PM

Luncheon & Awards Ceremony

In 2013, APA President Dennis Moore presented the Bowl of Hygeia Award to Vicki and Karrol Fowlkes. AR•Rx | THE ARKANSAS PHARMACIST

CPE Block Three: Shoot for the Medicare Stars • Measuring Quality Performance Standards and the CMS STAR rating system: The Plans Know Your Numbers. Do You? • Medication Adherence: The Impact on National Healthcare and Your Pharmacy Practice • Panel Discussion with Session Presenters 10:00 AM - Noon

AAHP Board Meeting

10:00 AM - 12:30 PM

Spouse TripTerra Studio

(Transportation and lunch provided)

The home of the Original Bluebird of Happiness® and the Pink Bird of Hope®, Terra Studios is a wonderland of art, a popular Northwest Arkansas tourist attraction and a family friendly destination. Watch as their collectible glass bluebirds are proudly made by skilled Arkansas crafts people. They showcase American arts and crafts, Ozark crafts, handmade collectibles and unique gifts created by local artists.

Terra Studio entrance. 353

APA 132 ND ANNUAL CONVENTION - JUNE 12-14, 2014

1:00 PM

8:45 AM - 12:00 PM

SCHEDULE OF EVENTS

12:00 - 1:30 PM

Luncheon in Exhibit Hall

2:00 - 5:15 PM

CPE Block Four: Clinical Update • 2014 Pharmacology and Therapeutics Update • Computer Alert Fatigue – Don’t Ignore These Important Drug-Drug Interactions • Panel Discussion with Session Presenters

________________________________________________

T H U R S D AY, J U N E 1 2 , 2 0 1 4

Team-based Healthcare Block (8:30 AM – Noon) 8:45 - 10:00 AM

Pharmacists Role in Reducing Readmissions ACPE # 0004-9999-14-100-L04-P (1.5 hours) This CPE activity will be Knowledge-based Presenter: John Vinson, Pharm.D., Clinical Pharmacy Director, UAMS West 7:00 - 9:00 PM

Walton Arts CenterArt of Wine Honoring APA’s Wholesale Partners: AmerisourceBergen, Cardinal Health, McKesson, Morris & Dickson and Smith Drug (See Family Dinner option below as an alternative to Art of Wine.) Friday night at Art of Wine is the party of the summer. You will be able to choose from a selection of more than 400 different wines from around the world and food from the area’s best restaurants - all in a festive party atmosphere in the heart of Northwest Arkansas’ entertainment district. This evening will feature a silent auction which will include unique art, wine and entertainment items. So come and enjoy the tasting experience and discover your new favorite wines! 7:00 - 8:30 PM

LEARN. IMPLEMENT. CHANGE.

CONTINUING PHARMACY EDUCATION SESSIONS

Family DinnerAQ Chicken House Nothing beats the delicious crisp taste of old-fashioned pan fried chicken, the way Grandma used to make it. The AQ Chicken House has been serving pan fried chicken for more than fifty years. The AQ stands for “Arkansas Quality” and the restaurant has been voted Best Restaurant in Northwest Arkansas as well as being named the place to find the Best Pan Fried Chicken, the best BBQ ribs, the best plate lunch, and the best overall restaurant. ________________________________________________

S AT U R D AY, J U N E 1 4 , 2 0 1 4 7:00 - 10:00 AM

Registration

7:30 - 8:30 AM

Breakfast & State of the Association Address

CPE Objectives: • Identify the five most common causes of hospital readmissions. • Explain the financial implications of a patient being readmitted to a hospital within seven days of discharge. • Create an action plan for inpatient pharmacists to discharge the patient to an ambulatory or community pharmacist. • Identify five activities that pharmacists can integrate into their workflow that will assist in reducing readmissions. 10:10 - 11:25 AM

Pharmacists’ Role in the Patient Centered Medical Home (PCMH) ACPE # 0004-9999-14-101-L04-P (1.5 hours) This CPE activity will be Knowledge-based Presenter: Jeremy Thomas, Pharm.D., Associate Professor, UAMS College of Pharmacy Arkansas Blue Cross Blue Shield CPE Objectives: • Describe the essential pieces of a patient-centered medical home. • Explain how patient-centered medical homes are structured. • Identify the infrastructure requirements for an optimal PCMH. • Describe barriers and opportunities that exist to implementing the PCMH model. • Discuss PCMH pockets of excellence in Arkansas and understand the roles that pharmacists play in these PCMHs.

8:45 AM - 12:00 PM

11:30 AM - 12:00 PM

12:00 PM

(You must attend the panel discussion to receive credit for the two prior sessions.)

CPE Block Five: Protecting Your License • Integrating the PDMP into Your Practice • Pharmacy Law Update & Diversion Protection Tools • Panel Discussion with Session Presenters

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Convention Adjourns

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Panel Discussion with Session Presenters Panelists: John Vinson, Pharm.D. and Jeremy Thomas, Pharm.D.

CPE Objectives: • Define services conducted by community pharmacists in the every-day work flow that are encompassed within Medication Therapy Management. • Discuss tactics to document and bill for routine pharmacy clinical services such as drug-drug interactions. • Identify MTM tasks that a pharmacy’s technicians, clerks, and interns can perform. • Describe the top 5 pharmacist intervention opportunities that will directly affect the store’s star ratings.

_______________________________________________

F R I D AY, J U N E 1 3 , 2 0 1 4

8:45 - 10:00 AM

Measuring Quality Performance Standards and the CMS STAR Rating System: The Plans Know Your Numbers. Do You? ACPE # 0004-9999-14-103-L04-P (1.5 hours) This CPE activity will be Knowledge-based Presenter: Elliott Sogol, Ph.D., RPh. FAPhA, VP Professional Relations, Pharmacy Quality Solutions, Inc. CPE Objectives: • Describe Value Driven Health Care. • Describe the CMS Star ratings process as it relates to medications. • Identify performance improvement strategies related to medication measurement in the Star ratings process. • Explain the reasoning for measuring the quality of medication management and medication use. • Discuss where plans are headed related to the quality of medication management and medication use. 10:10 - 11:25 AM

Medication Adherence: The Impact on National Healthcare and Your Pharmacy Practice ACPE # 0004-9999-14-104-L04-P (1.5 hours) This CPE activity will be Knowledge-based Presenter: Richard Logan, Pharm.D., Co-Owner, MedHere Today, LLC AR•Rx

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11:30 AM - 12:00 PM

Panel Discussion with Session Presenters Panelists: Richard Logan, Pharm.D. and Elliott Sogol, Ph.D., RPh. FAPhA (You must attend the panel discussion to receive credit for the two prior sessions.)

Clinical Update Block (2:00 – 5:00 PM) 2:00 - 3:15 PM

2014 Pharmacology and Therapeutics Update ACPE # 0004-9999-14-105-L01-P (1.5 hours) This CPE activity will be Knowledge-based Presenter: Glen E. Farr, Pharm.D., Professor & Associate Dean, University of Tennessee College of Pharmacy CPE Objectives: • Describe the mechanism of action and the therapeutic application of several recently introduced drugs. • Identify essential information to more effectively counsel patients on changes in the therapeutic application(s) of existing drugs, such as the recent recommendations for the treatment of hypertension, lipids and mental health disorders. • Compare and contrast changes in the current therapeutic approach to various disease processes, including drugs used in mental health, pain management, cardiovascular health, diabetes, women’s health and miscellaneous conditions. • Evaluate evidence-based studies to appropriately respond to questions and concerns from prescribers and patients on recent reports in the health professions literature. 3:25 - 4:40 PM

Computer Alert Fatigue – Don’t Ignore These Important Drug-Drug Interactions ACPE # 0004-9999-14-106-L01-P (1.5 hours) This CPE activity will be Knowledge-based Presenter: Daniel C. Malone, RPh, PhD, Professor, University of Arizona College of Pharmacy 375

APA 132 ND ANNUAL CONVENTION - JUNE 12-14, 2014

Shoot for the Medicare Stars Block (8:45 AM – Noon)

CPE Objectives: • Explain the history and significance of medication adherence. • Describe the economic impact of medication adherence. • Recognize pharmacy’s impact on medication adherence. • Describe medication adherence’s impact on pharmacy practice. • Explain the interest third party payers have in medication adherence. • Explain the relationship between narrow contracting networks and medication adherence.

CONTINUING PHARMACY EDUCATION SESSIONS

2:00 – 5:15 PM The ABCs of MTM Block ACPE # 0004-9999-14-102-L04-P (3.0 hours) This CPE activity will be Knowledge-based Presenter: Eric Crumbaugh, Pharm.D., Director of Clinical Programs, Arkansas Pharmacists Association

CONTINUING PHARMACY EDUCATION SESSIONS

CPE Objectives: • Identify factors that contribute to computer generate alert fatigue • Describe the basic mechanisms for drug-drug interactions. • Identify medications involved in clinically relevant interactions. • Given selected drug-drug interactions, determine possible management strategies to avoid or minimize harm. 4:45 - 5:15 PM

Panel Discussion with Session Presenters Panelists: Glen E. Farr, Pharm.D. and Daniel C. Malone, RPh, PhD (You must attend the panel discussion to receive credit for the two prior sessions.) _______________________________________________

S AT U R D AY, J U N E 1 4 , 2 0 1 4 Protecting Your License Block (8:45 AM – Noon) Integrating the PDMP into Your Practice ACPE # 0004-9999-14-107-L04-P (1.5 hours) This CPE activity will be Knowledge-based Presenter: Scott Pace, Pharm.D., Esq., Chief Operating Officer, Arkansas Pharmacists Association

LEARN. IMPLEMENT. CHANGE.

8:45 - Noon

CPE Objectives: • Explain the growing problem of prescription drug abuse in Arkansas. • Describe the trend of prescription drug abuse among teens in Arkansas. • Identify trends amongst the most commonly prescribed prescription drugs in Arkansas. • Summarize how to enroll in and use the PDMP. • Describe workflow considerations and best practices for when to access the PDMP.

11:30 AM - 12:00 PM

Panel Discussion with Session Presenters Panelists: Scott Pace, Pharm.D., Esq. and John Clay Kirtley, Pharm.D. (You must attend the panel discussion to receive credit for the two prior sessions.) _______________________________________________ The University of Arkansas for Medical Sciences College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of Continuing Pharmacy Education. Continuing Education Credit: These programs are open to all pharmacists. To receive credit, the pharmacy participant must complete & submit attendance forms and complete all online post-tests/ program evaluation forms. If the attendance documentation is illegible then no credit can be issued. Partial credit will not be given for a session; you must attend each session in full to receive credit for that particular session. Credit will be uploaded to CPE Monitor within 60 business days of completion of program. Participants will be notified via email when credit has been uploaded to the CPE monitor database. You may check the status of your CPE credit anytime by logging on to your CPE Monitor account at www.mycpemonitor.net. This event is co-sponsored with the UAMS College of Pharmacy. For questions regarding CPE credit please contact the CPE Office at 501.686.5396.

10:10 AM – 11:25 AM

Pharmacy Law Update & Diversion Protection Tools ACPE # 0004-9999-14-108-L03-P (1.5 hours) This CPE activity will be Knowledge-based Presenter: John C. Kirtley, Pharm.D., Executive Director, Arkansas State Board of Pharmacy CPE Objectives: • Analyze recent changes in Pharmacy regulations in Arkansas. • Discuss the reasoning behind changes to pharmacy regulations. • Demonstrate understanding of recent pharmacy regulatory changes and challenges. • Identify three practice changes to protect your controlled substance inventory. A R • R x6 | 38

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West Dickson Street in charming downtown Fayetteville. 38

APA 2014 Annual Convention Register online at www.arrx.org First Name: ______________________________________ Last Name: _____________________________________ Designation: P.D. Pharm.D. Technician Student Other Nickname (for badge): ____________________________ Home Address: __________________________________ City: _________________ State: ___ Zip: ____________ Cell Phone:_____________ Work Phone: _____________ Email: ___________________________________________ Employer: _______________________________________ Pharmacist License # (e.g. PD01234): ________________ NABP E-Profile #:_________________________________ Date of Birth: Month ______________ Day ___________

APA MEMBER NON MEMBER* Full Registration

$175

$210

Thursday Only Registration

$120

$140

Friday Only Registration

$120

$140

Saturday Only Registration

$120

$140

CONVENTION REGISTRATION FORM

REGISTRATION FORM

TECHNICIAN REGISTRATION PACKAGE

*Non-member price includes 2014 APA Membership.

PHARMACY STUDENT SPONSORSHIP Pharmacy Student Sponsorship - $85

Sponsor a student pharmacist to provide the opportunity for a UAMS or Harding College of Pharmacy student to attend the APA convention for free.

Number of Students to Sponsor ___ @ $85 each ______

ADDITIONAL CONVENTION ACTIVITIES Wednesday, June 11 Convention Golf Tournament - $65

Cutoff date for early bird registration is May 16, 2014.

Number of Golfers ___ at $65 per player = __________ Name(s) of Golfers ______________ _______________ ______________ _______________ Friday, June 13 Spouse Trip to Terra Studios - $25

Includes: All education sessions and CPE, receptions, exhibit hall admission, prize drawings, breaks and social event tickets for Thursday, Friday and Saturday.

APA MEMBER

Before 5/16 After 5/16

NON MEMBER*

Before 5/16 After 5/16

Full Registration

$259

$289

$354

$384

Full Registration

$359

$389

$454

$484

& Spouse/Guest

*Non-member price includes 2014 APA Membership.

PHARMACIST DAILY REGISTRATION PACKAGE

Includes: All education sessions and CPE, receptions, exhibit hall admission, prize drawings, breaks and social events for the day of registration. APA MEMBER NON MEMBER Thursday Only Registration

$199

$249

Thursday Only Registration and Spouse/Guest

$249

$299

Friday Only Registration

$199

$249

Friday Only Registration and Spouse/Guest

$249

$299

Saturday Only Registration

$149

$199

Saturday Only Registration and Spouse/Guest

$199

$249

Name of Attendee ________________________________

RESERVATIONS & PAYMENT

Please let us know the number of attendees for each event you plan to attend. ___ Thu., June 12- Luncheon & Awards Ceremony ___ Thu., June 12- Opening Reception ___ Fri., June 13- AP-PAC Breakfast ___ Fri., June 13- Art of Wine at Walton Arts Center OR ___ Fri., June 13- Family dinner at AQ Chicken House ___ Sat., June 14- Breakfast & State of Association Address Extra Tickets to Social Events — Friday, June 13

Social Event Tickets are included in the Full Registration package. Additional tickets may be purchased for guests.

Art of Wine at Walton Arts Center Number of tickets_______ @$80 = ___________ (OR) Family dinner at AQ Chicken House Number of tickets_______ @$15 = ___________ Total Amount: ___________________ Payment Type:

Visa

AmEx

Discover

Check

Card#____________________ Exp_______ Sec Code_____ Made payable to Arkansas Pharmacists Association: 417 S. Victory St., Little Rock, AR 72201 Fax to: 501-372-0546. Or register at www.arrx.org.

Refund Policy By May 23, 2014, 50 percent refund will be issued. After May 23, 2014, no refund will be issued. All refund/cancellation requests A R • R x must | T H be E Asubmitted R K A N S A to S PAPA H A RinMwriting. A C I S T Registrations are non-transferrable.

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APA 132 ND ANNUAL CONVENTION - JUNE 12-14, 2014

PHARMACIST FULL REGISTRATION PACKAGE

ARKANSAS ASSOCIATION OF HEALTH-SYSTEM PHARMACISTS

Mix or MATCH!

hen we refer to “matching” we are usually referring to socks, shoes, clothes, even wall colors and décor. But, in the world of pharmacy it means so much more. For pharmacy students and residents, it refers to securing the place to learn, grow and practice during the next one to two years. It serves as a springboard into a career and for many it guides Between the two their future career path. universities, we have

more than 30 students matched to a residency or fellowship program. They will be traveling to 14 different states and Arkansas will be getting residents from eight different states – talk about an exchange of knowledge and ideas.

We have seen an increased interest in postPharm.D. education as students work to separate themselves from other graduates with the same educational background. The interest in residencies and fellowships is being celebrated by colleges of pharmacy, national organizations and those practicing the profession.

Friday, March 21, 2014, was an historic day for the class of 2014, when students across America learned that their dream to secure a residency spot had been fulfilled. It was MATCH DAY! The excitement leading up to the morning when the results were released was extraordinary and filled with hope. A common theme was the satisfaction of achievement followed by nervousness about going to a new place. As we work in the state to increase the number or residencies, both in health-systems and in community pharmacies, it is very reassuring that students are interested and are clamoring for the opportunities that post Pharm.D. training provide.

We are very proud of the students Lanita S. White, Pharm.D. President from Harding University and University of Arkansas for Medical Sciences (UAMS). They have made this one of the best recruitment years for our state. Between the two universities, we have more than 30 students matched to a residency or fellowship program. They will be traveling to 14 different states and Arkansas will be getting residents from eight different states – talk about an exchange of knowledge and ideas. Arkansas will have a record 26 residents around the state! Congratulations to everyone! For all of the residents in Arkansas, AAHP is committed to providing residency program directors and preceptors with the tools necessary to craft an excellent program and develop excellent preceptors. We have partnered with Harding University, University of Arkansas for Medical Sciences (UAMS) and Baptist Health to provide Residency Learning System (RLS) training for programs and preceptors. It will be held Saturday, May 17, 2014, from 8:00 a.m. to 5:00 p.m. at UAMS. This same programming is offered annually at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting. The RLS is created by the ASHP to help programs use a systematic approach to residency training. During this session, programs will be guided through a residency program specific review and will have an expert trainer on site for questions and ideas. The goal is to support Arkansas programs in residency accreditation efforts and provide preceptor development opportunities. We are looking forward to growing and learning. For more information, please visit www.arrx.org/aahp. §

AAHP Board Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Susan Newton, Pharm.D., Russellville President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lanita Shaverd-White, Pharm.D., Little Rock President-Elect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marsha Crader, Pharm.D., Little Rock Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Willie Capers, Pharm.D., Jonesboro Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sharon Vire, Pharm.D., Jacksonville Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Wendy Koons, Pharm.D., Jonesboro Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Maggie Miller, Pharm.D., Batesville Member-at-Large. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Niki Carver, Pharm.D., Little Rock Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .James Reed, Pharm.D., Conway Technician Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Janet Liles, MS, CPhT, Searcy 40

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THE ARKANSAS PHARMACIST

COMPOUNDING ACADEMY

IACP Submits List of 2,400 Bulk Drug Substances to FDA

he Drug Quality and Security Act (DQSA) contains requirements for the Food and Drug Administration (FDA) to develop lists of drugs that may or may not be compounded, and lists of bulk drug substances that may be used in compounding. Specifically, section 503A specifies that to qualify for the exemptions under section 503A a compounder may only use bulk drug substances to compound if:

Warren Lee, Pharm.D. To that end, The International President Academy of Compounding Pharmacists (IACP) has submitted a list of more than 2,400 bulk drug substances which are regularly used by compounders but which have neither an official USP monograph nor appear to be a component of an FDA-approved drug product.

The IACP also submitted for approval the drugs and standards • The bulk drug substances comply with the standards of contained within the following official compendia recognized an applicable United States by the FDA but which were Pharmacopoeia (USP) or not explicitly included in the National Formulary (NF) DQSA: The Homeopathic Section 503B specifies that an monograph; or Pharmacopeia of the United • The drug substance is a States, British Pharmacopeia, outsourcing facility may only compound component of an FDAEuropean Pharmacopeia, with a bulk drug substance which approved human drug Japanese Pharmacopeia, appears on an FDA-established list of product; or Food Chemicals Codex and bulk drug substances for which there is • The drug appears on a list of the USP Dietary Supplements bulk drug substances for use Compendium. a clinical need or which are on FDA’s in compounding developed drug shortage list. by FDA. The IACP has requested that the FDA’s Pharmacy Section 503B specifies that an Compounding Advisory outsourcing facility may only compound with a bulk drug Committee accept and approve all of the bulk drug substance which appears on an FDA-established list of bulk substances in these compendia as acceptable APIs for the drug substances for which there is a clinical need or which preparation of compounded medications under Section are on FDA’s drug shortage list. 503A and 503B of the DQSA. Sections 503A and 503B also prohibit compounding drugs that are on a list of drugs that present demonstrable difficulties for compounding, as published by FDA. FDA has published notices requesting nominations for these lists.

The IACP’s requests to the FDA may be found online at the following address: http://www.iacprx.org/displaycommon. cfm?an=1&subarticlenbr=876

http://www.fda.gov/Drugs/ GuidanceComplianceRegulatoryInformation/ PharmacyCompounding/ucm375804.htm#Nominations

Arkansas State Board of Pharmacy President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Steve Bryant, P.D., Batesville Vice President & Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Larry Ross, Sherwood Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lenora Newsome, P.D., Smacko Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stephanie O’Neal, P.D., Wynne Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kevin Robertson, Pharm.D., North Little Rock Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tom Warmack, P.D., Sheridan Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Joyce Palla, Arkadelphia Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Vacant

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CALENDAR OF EVENTS

2014 Calendar of Events MAY

May 7-8 National Community Pharmacists Association Legislative Conference Washington, D.C. May 10 Harding University College of Pharmacy Commencement Searcy, AR May 16 UAMS College of Pharmacy Convocation Little Rock, AR May 17 UAMS Commencement Little Rock, AR May 17-20 International Academy of Compounding Pharmacists Compounders on Capitol Hill Arlington, VA

JUNE

May 31-June 4 American Society of Health-System Pharmacists Summer Meeting & Exhibition Las Vegas, NV June 10-11 Arkansas State Board of Pharmacy Meeting Little Rock, AR June 12-14 APA 132nd Annual Convention The Chancellor Hotel Fayetteville, AR

APA District Meetings AUGUST

District 6 Tuesday, August 19 Embassy Suites, Hot Springs

SEPTEMBER

District 1 Thursday, September 4 Embassy Suites Hotel, Little Rock District 4 Tuesday, September 9 Camden Country Club, Camden District 5 Thursday, September 11 Monticello Country Club, Monticello District 6 Monday, September 15 Lake Point Conference Center, Russellville District 7 Tuesday, September 16 Holiday Inn City Center, Fort Smith District 3 Wednesday, September 17 DoubleTree, Bentonville District 3 Thursday, September 18 Big Creek Golf & Country Club, Mountain Home District 5 Tuesday, September 23 Harding University Cone Chapel District 2 Thursday, September 25 Jonesboro Country Club, Jonesboro District 8 Tuesday, September 30 Grand Prairie Center, Stuttgart

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MEMBER CLASSIFIEDS

Member Classifieds Independent pharmacy in Ft. Smith seeks part-time pharmacist. Local independent pharmacy in Ft. Smith, AR seeking Licensed Pharmacist for one to two nights a week (6 -10 pm) and every other weekend Sat. & Sun. (14-hr shift). Send resume to 700 Lexington Ave Ft. Smith, AR 72901 or emailanderson.1@ live.com or call 479-782-2881. (3/27/14) 10 Pharmacy Te c h n i c i a n positions open in Little Rock. SCA Pharmaceuticals, one of the fastest growing pharmaceutical companies in the US, is recruiting ten pharmacy technicians to provide sterile compounding services for hospital clients in all fifty states. Sterile compounding experience is preferred but SCA has an excellent training program. SCA hires for attitude and trains for skill. Join a dynamic team of professionals dedicated to providing the highest quality products and outstanding service to our hospital pharmacy clients. SCA is a “people oriented” company where each individual is treated with respect, professionalism, and growth opportunities. Excellent salary, benefits, bonus, etc. SCA is an FDA registered Outsourcing Facility located in Little Rock. Contact: Phyllis Wike; pwike@ scausa.net; (877) 550-5059; (501) 312-3200, Fax (501) 312-2805. (3/24/14) Pharmacy for sale in Jonesboro. This is a great opportunity for someone to purchase their own profitable pharmacy. Average 1.5 million in annual sales, large front-end with gifts. Pharmacy located in a medical building with 25 physicians and 5 APN's. Business and building are for sale, but can be sold separately. There has been a pharmacy in this location for more than 24 years. For more information email, cmrx@ outlook.com. (3/24/14)

Member Classifieds are free to APA members and $40 per month for non-members. Contact eileen@arrx.org for more information.

Relief pharmacist in Van Buren. Independent pharmacy in Van Buren, AR is seeking friendly, efficient relief pharmacist with possible opportunity for permanent position. Preferably experienced and certified to give immunizations/vaccinations. Days and hours vary. Store hours Monday-Friday 9 am-6 pm and Saturdays 9 am-1 pm. Send resume to kbarlow@pharmacyexpressvb.com or fax to (479) 474-3131. (3/19/14) PRN Pharmacist at North Metro Medical Center in Jacksonville, AR. Education: Bachelor's Degree in Pharmacy required; Pharm.D. preferred. Licensure/Certification: Current pharmacist's license issued by the Arkansas State Board of Pharmacy required. Experience: Two years acute care hospital experience preferred. Apply online www.northmetromed.com. (2/27/14) Pharmacy building for sale in HARRISON, AR. Formerly USA Drug/ Consumer Pharmacy since 1971. 1960sq ft, all brick, built 1971, renovated 2011 at cost of over $200,000. Two drive-thrus, lot 175 x 190, perfect condition, directly across the street from Boone County Hospital. Close to multi doctors' offices. Call Dan Drewry 417-343-7838. (2/3/14) Seeking position. 2013 UAMS graduate looking to gain experience as a retail pharmacist PT/FT 501-664-4223. Pharmacists needed at Cantrell Drug in Little Rock. We are growing again! Cantrell Drug Company needs to fill pharmacist positions for evening shift (3:30 p.m. – 12 a.m.). These positions are non-retail positions. They are fulltime with a great benefit package. The successful candidate will want to

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work in a lab-type environment while demonstrating attention to detail and a focus on quality. Please send your resume to chutts@cantrelldrug.com. (1/16/14) Pharmacy Tech needed in central Arkansas. Contact John Norris for more information at 501-202-2462 or john. norris@baptist-health.org. (1/16/14) Pharmacy Tech needed in North Little Rock. Independent retail pharmacy located in North Little Rock. Please call 501-353-1984 for more information or email lakewood@cornerstonepharmacy. com to send resume. (1/16/14) For Sale: Germfree Laminar Flow Glovebox/Isolator (Class 10). Fourfoot-wide work area with 3 glove ports, airlock antechamber, and stainless steel stand. In excellent condition. Pictures available upon request. Contact Laura Beth Martin at Family Pharmacy (870)777-5713. (1/7/14) Harp's Pharmacy in Cabot needs part-time tech. The applicant must be friendly, have good people skills, courteous, hard-working and able to learn and follow computer software. The job entails a mixture of pharmacy clerking and tech duties. Contact Greg Orlick or Noah Rabb at 501-843-3374, Mon.-Fri. 9 a.m. to 7 p.m. (1/6/14) Pharmacy Technician needed in Little Rock. Compounding- fulltime, excellent hours (M-F 9am-5:30pm), competitive pay plus performance bonus, and great work environment. Experience necessary - Frederica Pharmacy & Compounding, 400 W. Capitol Ave., Little Rock, AR - email resume tofreiderica1@att.net (1/6/14)

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MEMBER CLASSIFIEDS

Pharmacy techs needed at Cantrell Drug in Little Rock. We are growing again! Cantrell Drug Company needs to fill 10 pharmacy technician positions ASAP. These positions are non-retail positions. They are fulltime with a great benefit package. The successful candidate will want to work in a lab-type environment while demonstrating attention to detail and a focus on quality. Please send your resume to dconaway@cantrelldrug. com. (9/23/13) Walgreens Community Pharmacists needed- Walgreens is currently seeking community pharmacists throughout Arkansas, specifically in the following cities: Bryant, Cabot, Conway, Forrest City, Fort Smith, Jonesboro, Little Rock, Magnolia, Malvern, Monticello, Mountain Home, North Little Rock, Paragould, Pine Bluff, Rogers, Russellville, Searcy, Sherwood, Springdale and West Memphis. Please send resume to pharmacyjobs@walgreens.com if youâ&#x20AC;&#x2122;re interested! (3/22/13) Northwest Arkansas Free Health Center in Fayetteville looking for pharmacy volunteers. We provide health and dental care to low income and uninsured individuals. Our pharmacy hours are Wednesday 1-3 and Thursday 6-8. Contact Monika Fischer-Massie at mfischerm@ nwafhc.org or call 479-444-7548. (12/12/12) Relief Pharmacist AvailablePharmacist with compounding experience looking for relief pharmacy work in Arkansas. Please contact Buzz Garner at 479-234-1100 or drbuzz@arkansas.net. (5/8/12) Charitable Clinic Needs Service Minded Pharmacists- Want to be thanked dozens of times a day? Tired of dealing with insurance? Join our

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team at River City Charitable Clinic in North Little Rock. We are looking for volunteer pharmacist to take an active role in the healthcare of low income, uninsured, unassisted patients. Volunteer(s) are needed specifically for a new "refill clinic". You can pick your ideal clinic time on Monday, Wednesday, or Thursday. Staff it weekly or share with a friend. Interested pharmacists can contact Pam Rossi at PRRossi@uams.edu or call Anne Stafford, RN Medical Manager at 501-376-6694. (2012) Experienced Relief Pharmacist Available- Experienced relief pharmacist (retail/hospital/IV) available in Central Arkansas. Willing to travel reasonable distances. Fred Savage 501-350-1716; 501-8034940; fred.savage@sbcglobal.net. (5/7/12)

off, vacations, emergencies -- ALL your staffing needs. Also seeking pharmacists for full or part-time situations. Please contact Christine Bommarito, Marketing and Recruiting Director, for information regarding current openings throughout Arkansas, including temporary as well as permanent placements. Let IvanRx4u help staff your pharmacy, call 417-888-5166. We welcome your email inquiries; please feel free to contact us at: ivanrx4uchristine@ centurylink.net. (2011) STAFF RPH, Inc.- Pharmacist and Technician Relief Services. We provide quality pharmacists and technicians that you can trust for all your staffing needs. Our current service area includes AR, TX, OK and TN. For more information call Rick Van Zandt at 501-847-5010 or email staffrph@att.net. (2011)

Volunteer Pharmacists Needed at Hot Springs Charitable ClinicWanted: VOLUNTEER pharmacists to assist in dispensing prescriptions, checking prescriptions, and counseling for low income and uninsured patients at a charitable clinic in Hot Springs. Volunteers are needed for bi-weekly evening clinics from 6 p.m. to 9 p.m. and daily clinics, Tuesday and Wednesdays from 9 a.m. to 3 p.m.. Interested pharmacists should call or email Reita Currie at 501-623-8850,reitacurrie52@yahoo. com, at the Charitable Christian Medical Clinic, 133 Arbor Street, Hot Springs, AR 71901. (2011) IVANRX4U, Inc., Pharmacist Relief Services, Career PlacementsRelief pharmacists needed - FT or PT. Based in Springfield, MO and now in Arkansas. Staffing in Missouri, Arkansas, Eastern Kansas and Oklahoma. We provide relief pharmacists for an occasional day

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