ARRx - The Arkansas Pharmacists Spring 2013 by Arkansas Pharmacists Association

Spring 2013 Award Winning Quarterly Publication of the Arkansas Pharmacists Association

Community Pharmacy Marketing & PR 101 Arkansas Launches Prescription Drug Monitoring Program

Contents 4 Inside APA: So…Where Do We Fit In Health Care System? 5 From the President: Professional Identity & Recognition 7 COVER: Community Pharmacy Marketing and Public Relations 101

13 Member Spotlight: Lee Shinabery, Shinabery’s Community Pharmacy 14 RX and the Law: Discovery 101 15 Safety Nets: Morphine 16 FEATURE: Arkansas Prescription Drug Monitoring Program Launches in 2013 18 Legislator Profile: Representative Marshall Wright (D-Forrest City) 19 Pharmacists in the News and In Memoriam 19 2013 District Meeting Schedule

Eileen Denne Director of Communications Eileen@arrx.org

Eric Crumbaugh, Pharm.D. Immunization Grant Coordinator Eric@arrx.org Office E-mail Address Support@arrx.org

33 2013 Harding Graduates

Publisher: Mark Riley Editor: Eileen Denne Art & Design: Gwen Canfield - Creative Instinct

34 Arkansas Association of Health-System Pharmacists: Volunteering is the Price You Pay

36 2012 Bowl of Hygeia Recipients: APhA Foundation & NASPA 37 2013 Legislative Reception 38 Member Classifieds 40 2013 Calendar of Events

Directory of Advertisers

Celeste Reid Director of Administrative Services Celeste@arrx.org

32 Harding COP Report: Advocacy Class Helps Pass HB1185

35 APA Compounding Academy: Attend Compounders on Capitol Hill June 1-4

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Matt Merrigan Director of Membership & Meetings Matt@arrx.org

22 Pharmacist Immunization Program: Pharmacists Collaborate to Improve Vaccination Rates

31 2013 UAMS Graduates

Cover photo: “the biggest, baddest sign” in front of Stanley Pharmacy in Searcy

Scott Pace, Pharm.D., J.D. Associate Executive Vice President Scott@arrx.org

Debra Wolfe Director of Government Relations Debra@arrx.org

30 UAMS COP Report: UAMS Named National APhA-ASP Chapter of the Year

Mark S. Riley, Pharm.D. Executive Vice President Mark@arrx.org

20 AFMC Quality Notes: Antipsychotic Use in Nursing Homes

23 2013 Annual Convention Brochure: Dispensing Knowledge for Better Health

APA Staff

McKesson EPIC Pharmacies UAMS Alumni Association Pace Alliance First Financial Bank Law Offices of Darren O’Quinn UAMS College of Pharmacy CPE Bell

THE ARKANSAS PHARMACIST

Arkansas Pharmacy Support Group RxMaster Pharmacy Systems Merck Arkansas Association of HealthSystem Pharmacists Pharmacy Quality Commitment Pharmacists Mutual Life Insurance APA Honors Smith Drug

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 01993763) 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). Nonmembers subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 62. © 2013 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

APA Board of Directors

INSIDE APA

2012 -2013 Officers

Inside APA

President - Dennis Moore, Pharm.D., Batesville President-Elect - Dana Woods, P.D., Mountain View Vice President - Brandon Cooper, Pharm.D., Jonesboro Past-President - Gary Bass, Pharm.D., Little Rock

So… where do we fit in the health

Area Representatives

care system?

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 Jim Griggs, P.D., Fayetteville

Academy of Compounding Pharmacists Kristen Riddle, Pharm.D., Conway

Arkansas Association of Health-System Pharmacists

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

Ex-Officio APA Executive Vice President: 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: Andy Roller, Fayetteville Harding College of Pharmacy Student Representative: Jackie Dabbour, Searcy

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

Mark Riley, Pharm.D. Executive Vice President

s discussions continue on the changing landscape of health care and its affordability, I spend a fair amount of time trying to decide where pharmacists fit and how we can contribute to improved outcomes for patients. With increasing focus on the “Patient Centered Medical Home” model (emphasis on ‘patient centered’), most agree that we are ultimately moving to a place where when a particular patient need is being addressed, we ask, who is the most qualified as a result of education and training to engage the patient concerning their need. Dr. Dan Rahn, chancellor of the University of Arkansas for Medical Sciences, refers to this concept as all health professionals “practicing at the top of their license.” I suggest we put several things in place if we want to offer value to the overall health care environment.

cholesterol, blood sugar, etc.) and communicated to the prescriber with recommendations. Is the patient taking the medications as directed? Pharmacists are in the best position, by far, to answer this question. And, everyone in the health care equation wins: the drug company wants the drug prescribed, the prescriber wants the patient to take the drug, the patient wants to get well, and the payer wants the drugs to help avoid more costly problems.

We need to focus on what we are trained in and know best: drugs and their use in prevention and management of disease. The largest gap in our health care continuum is the space from the point of practitioner diagnosis (and prescribing) to the point at which that practitioner engages the patient on follow-up. Pharmacists are singularly positioned to help manage the patient in that space and could have dramatic effect on patient outcomes and costs, particularly in the area of chronic disease.

On this last point, why would anyone pay for medications if they don’t believe that there is long-term cost benefit (i.e. avoiding exacerbated disease leading to unwanted hospitalizations and unwanted surgeries or other treatment)? Pharmacists can and must help payers maximize their investment in medications as part of an overall better health outcome. You may have heard of Star Ratings for Medicare Part D plans. The profitability of these plans hinges on the ability to raise and maintain high Star Ratings. Patient adherence is a large part of those ratings. Plans have to be able to demonstrate that effective adherence programs are in place. Can you say “Opportunity?” Health-system pharmacists are engaged in these types of activities on a regular basis now and community pharmacists need to provide the continuum of care when the patient is discharged.

Are the drugs prescribed working as intended? That is a question that could be answered by intermittent screening (i.e. checking blood pressure,

On that subject, we are excited to have Karen Pellegrin, Ph.D., coming to our convention to talk about a cutting-edge program in Hawaii called

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FROM THE PRESIDENT

“Pharm2Pharm.” This is a grant-funded program where health-system pharmacists communicate directly with a patient’s community pharmacist when the patient leaves the hospital. The intent, of course, is for seamless continuity of patient medication oversight and to prevent problems that may cause readmission to the hospital or other negative health outcomes, all of which increase costs. Pharmacists across the nation are addressing adherence issues in innovative ways. One that is working particularly well is Medication Synchronization where all of the patient’s medications are synchronized to be refilled at one time and can be scheduled to maximize the pharmacist’s time. Patient reminders are sent in various means of communication and the pickup day is scheduled on a day that is normally less

busy. This allocation of resources in the pharmacy has proven to be very beneficial to both patients and pharmacists engaging in these programs. Part of our discussion is that all of these services have to be paid for in some way. I encourage you to begin to think of ways that you can make your pharmacy and its services absolutely essential to health plans. Providers are looking for partners to better take care of their members and to help them control costs. As we continue to represent you in the health care debate, please help by giving APA and your board of directors ideas about how pharmacists can be a part of the solution. §

From the President Professional Identit y and Recognition

s a child growing up in rural Arkansas, time stood still. Christmas or a birthday seemed to never arrive. As I approach the sunset of my professional career, time flies. It has been almost a year since I assumed the presidency of the APA, yet it seems like yesterday. Perhaps the message in that phenomenon is that as we age, our appreciation of the need to focus is enhanced. It has been a joy and a privilege to meet new friends around the state during the past year under the umbrella of advancing our profession and its mission. By nature, we are an independent lot in Arkansas. A recent bill was introduced in the legislature (HB1473 – TO CREATE THE TRUTH IN HEALTHCARE PRACTITIONER ADVERTISING ACT, that will probably have been resolved prior to you reading this), will potentially stir controversy because it tells us how to present ourselves. However, it has triggered a few thoughts that I want to explore. After we have matriculated through pharmacy school, the health care system and its participants are pretty well known to us. However, for the majority of the public, our professions and the various groups of professionals is a foreign concept. That leaves an opportunity for ambiguity and confusion as to whom they are relating in a community pharmacy; for example, there are multiple players who connect with a patient—a technician, the pharmacist, and perhaps a front end clerk. If you provide Durable Medical Equipment, you may also employ a technician who provides that service. If you provide Diabetes Self Management Education, you

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might employ a nurse or a dietician to help with the education. And for anyone who goes to a physician’s office or a hospital, the plethora of various professionals is dizzying for most of us.

Dennis Moore, Pharm.D. President

HB1473, if enacted, will force us to better identify ourselves to the public. For those of you in small communities, where everyone in the county knows you, that might seem intrusive. However, I’d suggest that we should feel obligated to clearly identify ourselves. I know that in a hospital setting, I want to know when I’m relating to a physician versus a technician. But for many, such distinctions are difficult even within your own pharmacy. It might create a bit of feel that big brother is imposing something on me, but I feel it is a matter of pride and professionalism that we should endorse and support. With the terms pride and professionalism, perhaps this is where I want to end my comments as the 110th president of the APA. With all our daily struggles and annoyances, this profession has been wonderful to me and will be to you. As change occurs, individual skills, personal decisions, luck and some things outside our control will determine where you and the profession fit within the larger health care system. The APA depends on engaged and excited members—displaying pride and professionalism—to continue to move us forward. God bless! §

www.arrx.org/annual-convention

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Community Pharmacy Marketing and Public Relations 101

By Eileen E. Denne

By Eileen E. Denne, APR

e live in the digital age where messages are bombarding us constantly, whether through the air waves, on our computers or by telephone. The “noise” makes it challenging for even the best retail marketers’ products to be seen and heard. At independent pharmacies, if retaining old patients and attracting new ones is a principal goal, make marketing and public relations a priority. The mix of marketing, advertising and PR tactics should include traditional and new media, plus good community relations. In addition, Gabe Trahan, Senior Director of Store Marketing and Operations for the National Community Pharmacists Association (NCPA), says store appearance is key. “If a store doesn’t look alive from the outside, the average person won’t go inside.” Trahan is an integral part of NCPA’s program, Gabe Trahan Front-End Overhaul. He travels to pharmacies across the nation offering one-on-one help with floor planning, product placement, merchandising, pricing strategies and marketing tools. Attract customers from the outside According to Trahan, there are three ways to attract new patients: curbside appeal, marketing and word-of-mouth. “I get tons of calls about floor design,” Trahan says. “Pharmacists say, ‘Business is slow, I need to remodel.’ I often ask them, ‘Why would you remodel without doing

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Signs that win Trahan’s approval: Cantrell Drug in Little Rock identifying its compounding specialty; Stanley Pharmacy in Searcy with the time and temperature display, and the word pharmacy in a larger size than the name of the pharmacist at Parker Road Pharmacy in Jonesboro.

something to the front of your store first?’ Remodeling and not advertising out front is like winking at a girl in the dark.” To attract new patients, Trahan says, curbside appeal is a great place to start; you need to look like you are in business. He recently helped a pharmacist in Alabama, who asked his patients, “How did you hear about us?” The pharmacist invests in TV, radio, and newspaper ads, and he has a digital sign out front. Overwhelmingly, the digital sign won as the way new patients noticed the retailer. “Here is a tip,” Trahan says. “Be sure it has the time and temperature on it. This trains people to look at the sign.” For digital signs, he also suggests making a calendar 6 months in advance of exactly what you want flashing on the sign. “Keep the message to 9 words or less,” Trahan says. “Because if it is 10 words, you’ll be selling them wound care because they just drove off road.” He calls for extending curbside appeal with a banner, billboard and/or digital sign. Trahan recently counseled store owner Kristy Reed, Pharm.D., of Super V Drugs in Jonesboro about her store’s exterior. “Gabe gave me a number of helpful suggestions,” Reed said. “Although we met at NCPA’s Jumpstart program in Alexandria, Virginia, he advised me by phone about how to spruce up the exterior and interior of the store.” After seeing photos of Reed’s store, Trahan’s suggestions for Super V Drugs included the following: • Clean up landscaping in front and plant low shrubs and flowers. This also serves as a security measure so people can’t hide in bushes. • Replace the store’s front awning – make it simple, black and be sure it says pharmacy. • Be sure the drive-thru sign also says pharmacy.

COMMUNITY PHARMACY MARKETING AND PUBLIC RELATIONS 101

• Update the colors inside (get rid of pink counters) • Put the Super V Drugs phone number on the Matthews Street sign. “Everyone knows who we are.” Trahan warns retail pharmacists not to get complacent about their location and identity. He Before photos of Super V Drugs exterior and Matthews Street sign. says it is a fallacy that “everyone knows who you are” in small town retail pharmacies. “One out of 11 people in the U.S. moved in 2010,” he reports. “I have given talks in every state and people say the same thing. ‘It’s not like that here.’ Recently, I helped a store that had been there 64 years. It is on the main street. When I went to visit, the owner said ‘yes, I After photos reflect Trahan’s suggestions to update Super V Drugs’ signage in Jonesboro. know, I need to remodel.’ He expanded and bought a depends on the market. Smaller, more rural markets cost bigger sign. People started less. The main advice is to determine an annual advertising coming in. They said ‘I didn’t know you were here.’” budget that your business can afford on an ongoing basis – even if it is small. Consistency is the key to success. Starting Word-of-mouth no substitute for marketing and stopping wastes money.” “One of the biggest problems is that independent pharmacists think word-of-mouth is increasing their business,” Trahan According to NCPA Digest Financial Benchmarks of 2012, says. “People die and these patients need to be replaced. 2011 expenditures on advertising totaled 0.4 percent of sales, Chains are very good about replacing former patients because averaging $15,326 per store annually. they have a marketing plan.” Trahan often quizzes those pharmacists he teaches in NCPA’s Front-End Overhaul The media mix for advertising will be determined by the One Day Intensive program and 75 percent of them say market and pharmacy trade area, as well. In some cases the that they increase their business through word-of-mouth. local newspaper will cover the entire town. In other areas, Word-of-mouth only works, according to Trahan, if a doctor pharmacists may want to hit a very defined geographic area or a neighbor asks your patient where he or she goes to using outdoor or cable. The key is to talk to customers about fill prescriptions. Or, if patents switch from one pharmacy their media habits and then build a strategy that matches the to another. It doesn’t happen that much, Trahan cautions. people's habits pharmacists see most often. Instead, he suggests local newspaper and radio advertising, among other Regarding the advertising message, Trahan says people things. want to know what’s in it for them. A frequent mistake for local pharmacists is that they talk about themselves. Determine the advertising mix and “Unfortunately, nobody cares. They don’t care that you’ve message been in business for years or are family-owned; they want to When asked how much money know how it will be a better experience in your store than annually pharmacists should devote any other store. Family-owned is not a bad thing, but tell me to advertising, Sharon Tallach why it is good for me. Show them why family-owned means Vogelpohl, President of Little Rock extra care, and then you are fine. When you shine light on advertising and PR agency Mangan yourself and forget your patients, they forget you.” Holcomb Partners (MHP) says, “It Sharon Vogelpohl, MHP

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COMMUNITY PHARMACY MARKETING AND PUBLIC RELATIONS 101

Darling Pharmacy in Newport has successfully used Knowing your target audience is critical, Vogelpohl says. television ads running on cable to promote itself as the local Pharmacists should target adults 18 years and older with an pharmacy choice when USA Drug closed its store there last emphasis on women. Women make more than 80 percent of fall. Jamie Darling, daughter of all healthcare decisions and are the owner Jim Darling, P.D., said her “I would make sure everyone primary healthcare decision maker brother produced the ads (he works driving by knows I am a pharmacy, for their families and parents/infor a production firm in Little Rock) laws. and they run via service provider I compound, I have a great SuddenLink at a very cost-effective nutrition center, or diabetic Reed targets women in her billboard price. Although she couldn’t cite ads with color and symbols. The support. There should be no the number of customers resulting accent color in the ads is fuchsia from the ads, Darling said they guessing about what I sell. If you and she uses the symbol for women have gotten positive feedback and only have a limited budget, buy ♀ in her ads. The tag line is “Think lots of comments. The Darling Local.” the biggest, baddest sign you can Pharmacy ads can be seen on YouTube: http://www.youtube. afford. And, the biggest word on Trahan suggests that if you have a com/watch?v=XlA1rdhx5lk. the sign should be pharmacy, not well-crafted ad that is convincing, don’t let patients down. “If you your name.” -- Gabe Trahan, NCPA Trahan agrees with Vogelpohl promise great customer service, on advertising frequency and you better be able to excel at it. consistency. Another mistake independents make when they Sometimes pharmacists are 100 percent behind their ads and create an ad, he says, is to run it once a month. “I recommend the rest of employees are clueless.” you advertise as often as you can afford. Short and often is better than longer and less often.” Local Publicity Vogelpohl says paid advertising efforts, large or small, should Paid advertising isn’t for everyone. Debbie Bastian, P.D., always be complemented with public relations initiatives pharmacist and owner of Debbie’s Family Pharmacy in to extend reach and continue to position pharmacists Rogers, says she doesn’t find advertising to be an effective as important health care experts. Often, people don’t tactic to build business. “I have only used ad campaigns when understand the difference between advertising and public I purchased the pharmacy in 1993 and again in 2000, when relations. Vogelpohl offers the distinction here: I relocated to Pinnacle Point in Rogers. Our philosophy of providing a fast, extensive delivery-based service is the most “Advertising is paid exposure in which the advertiser [the effective marketing tool I utilize! We have grown from one pharmacist] controls the message. Public relations – or, delivery vehicle in 1998 to five today. Those vehicles and the as most people think of it, ‘media relations’ – is working professionalism of the drivers who interact with my patients with news media outlets to gain exposure through articles, are the best outside marketing activity I could imagine for interviews, coverage, etc. Ultimately, the media controls the my business model.” [Bastian’s fleet morphed from yellow message. Beyond media, public relations can include other VW Beetles to Prius’.] types of ‘non-paid’ exposure such as speaking engagements, event marketing, etc.”

Branded delivery vehicles for Debbie’s Family Pharmacy in Rogers and billboard ad for Super V Drugs in Jonesboro.

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COMMUNITY PHARMACY MARKETING AND PUBLIC RELATIONS 101

She lists the top three things pharmacists can do to publicize pharmacists to emphasize their specialty services, because their stores. Her tried and true strategies for pharmacists it differentiates them from other stores. City Pharmacy in include: Little Rock, for example, provides 1. Offer to speak at local civic/ compounding and diabetes “Pharmacists should ensure their community organizations such management services. So we made as Rotary/Lions/Kiwanis Clubs, visual branding is consistent, sure to emphasize those specialized Schools, Churches, etc. on topics (look, feel, colors and fonts), services on their website and print of interest. materials. In addition, pharmacists throughout all communications. 2. Actively participate in and should ensure their visual be visible in the community The audience will vary in age and branding is consistent in terms of by hosting and/or plugging in how tech-savvy they are, so colors and fonts throughout their into health-related events and clean design and easy navigation communications.” screenings as appropriate. 3. Position yourself as an accessible is very important for health careCanfield continues, “Clean design and knowledgeable resource for related marketing and websites.” and easy navigation are important health information with local for health care-related marketing community media outlets. -- Gwen Canfield, Creative Instinct because the audience will vary in Examples include interviews/ age and in how tech-savvy they serving as expert quote sources with TV, radio and print are. To add a personal touch, include photos of the pharmacy and submitting guest articles to print outlets, community/ and staff.” business newsletters on topics of interest. She cites the elements pharmacists should have on their In addition, Vogelpohl reminds APA members that APA’s websites as: Director of Communications Eileen Denne works in • Prominent logo and phone number; collaboration with MHP in developing a monthly news • Photos of the pharmacy and staff; ‘pitch’ for statewide media and would be happy to share • A map pinpointing the location; materials and background information developed for that • Description of all of the services; purpose for use on the local level. A similar process may • A refill order form; be used for ‘proactive response’ message points for state/ • Positive testimonials from patients; national news and speaker presentations developed for APA • And, an online form for Q and A from patients. executives. Digital presence is important Vogelpohl goes on to recommend that pharmacies launch and maintain their own websites. “Whether we like it or not as health care professionals,” she says, “volumes of research confirm that the Internet is the FIRST place people look for healthcare information. Having a professional-looking website that is a good source of information about your business and the type of information people are looking for from a pharmacy/pharmacist is the first step to building credibility and preference." Graphic designer Gwen Canfield, principal of Creative Instinct and designer of APA’s logo, website and AR•Rx journal, says pharmacists who are looking to upgrade their image should start with their logo.

Gwen Canfield

“The core of any brand is a strong logo," Canfield says. “That’s really where it all starts in terms of visual branding. Then, examine your ads, print materials and business card design. It's very important for

City Pharmacy & Compounding recently launched its new website, designed by Gwen Canfield—Creative Instinct. Visit the site at www.citypharmacylr.com.

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COMMUNITY PHARMACY MARKETING AND PUBLIC RELATIONS 101

After updating your website design, Vogelpohl says, “The second step, and just as important, is how your website is positioned to be preferred by search engines through Search Engine Optimization (SEO) techniques. This process helps place your business towards the top of the ‘organic’ search results on search engines like Google, Bing and Yahoo so your customers and potential customers/patients can find you.”

healthy living tips or feature members of their staff, deliver patient testimonials, and other information through an e-newsletter.” Another way to stay connected to customers is through Twitter, Vogelpohl says, to reinforce your position as a health care expert and bring in new customers. “In a sophisticated program, you can monitor keywords on Twitter in specific locations/geography. This means you can actually reach out and engage with people who are looking for a pharmacy or needing to get a prescription filled in a certain area that might not have reached out directly to the pharmacy on Twitter.”

It’s not the media, it is the message NCPA’s Trahan says that pharmacists can use whatever She suggests that social media platforms like Facebook and medium they want, but it needs to be a compelling message. Twitter should also be part of the marketing mix. “Having a “It doesn’t matter how many people follow you, it is the Facebook page will help your pharmacy stay ‘top of mind,’ message that you are giving. Ask yourself if you are getting educate/reinforce your position as a any new customers from your healthcare expert, and interact with “Advertising is paid exposure advertising or PR? A web page can current customers. It also gives your keep the customers you have happy. customers a direct platform to refer in which the advertiser [the If you think you’ll drive customers to potential business to the pharmacy, pharmacist] controls the your store with a web page, you will and gives potential customers the message. Public relations... be disappointed, unless you come up ability to engage with, and get a feel with good SEO.” for the pharmacy before ever walking is working with news media in the door. Posting on Facebook outlets to gain exposure through Vogelpohl adds, “The key is to have is vitally important to having a articles, interviews, coverage, the right strategic message and to successful Facebook presence. be consistent in the delivery of the Having a few trusted co-workers or etc...Beyond media, public message to your target audiences. a digital agency monitor your page relations can include other types Extensive primary research daily, write relevant and engaging of ‘non-paid’ exposure such as with pharmacists and Arkansas content and respond to customer consumers informed the messages speaking engagements, event questions are must dos.” we are deploying for APA right now. marketing, etc.” Our research indicates that easy Canfield adds, “It’s important to access to health care experts is the -- Sharon Vogelpohl, MHP integrate your social media into your most important decision factor for website so that Facebook posts, for consumers in Arkansas.” example, become an information source on your homepage. Pharmacists always need to put Piggyback on APA’s marketing and public awareness a link to their website in their Facebook and LinkedIn posts campaign so that patients can easily get from one to the other. And, APA is currently conducting a marketing and public awareness if pharmacists want to collect email addresses from their campaign on behalf of Arkansas pharmacists. Advertisements patients, they could communicate store specials, provide are running on the radio and 30-second public service announcements are running on television. Key messages of the campaign are that pharmacists are medication experts, accessible and care for Visit these Arkansas pharmacy websites: their patients. Each of APA’s radio and TV ads City Pharmacy & Compounding - www.citypharmacylr.com is accessible for listening and viewing on APA’s Coleman Pharmacy in Fort Smith - www.colemanpharmacy.com website at http://www.arrx.org/pr-campaign. Coleman Pharmacy of Alma - www.colemanrx.com Local pharmacists can take advantage of the TV Cornerstone Pharmacies - www.cornerstonepharmacy.com and radio ads that are currently on the air by: Medi-Sav Pharmacy in Fort Smith - http://medisav.com Shinabery’s Community Pharmacy in Jonesboro - www.scpharm.com 1) Working to make the patients' inpharmacy experience easy, accessible and as

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COMMUNITY PHARMACY MARKETING AND PUBLIC RELATIONS 101

accommodating as possible. Go the extra mile to deliver on the promise of a rewarding interaction and valuable family health resource. 2) Posting in-pharmacy reminders to patients that you (the pharmacist) are available to answer any questions the patient may have, and take time to do so. 3) Using local media – like your hometown newspaper or radio station – to extend the message in your community and associate it with your pharmacy by running the APA messages tagged with your pharmacy information.

Eileen Denne

APA’s Denne can assist you in identifying appropriate media in your market and providing you access to customizable media materials. She also knows when and where APA’s paid schedules are running, providing the opportunity to optimally time your placements, as well as approach outlets about potential PR/”nonpaid” opportunities in conjunction with the paid activity. Her contact information is Eileen@arrx.org, 501-372-5250. §

Where To Get Help Help is available if you determine that your store needs a facelift or a boost in marketing or PR. For help with branding, logos, website, brochures and other marketing tools, contact Gwen Canfield at Creative Instinct, 501-244-0573, gwen@creativeinstinct.biz. NCPA’s Trahan gives regular seminars on improving store appearance each year and he is available to counsel owners: Gabe Trahan, Office: 802-922-1205; Fax: 802893-4773, email gabe.trahan@ncpanet.org. In addition, the next One Day Front-End Profit Building Seminar will be in Alexandria, Virginia, on August 26, and at the NCPA Annual Convention in Orlando, October 11, 2013. Register for either seminar at www.ncpanet.org. To more effectively market your store, consider contacting a local advertising and/or PR firm. MHP’s Vogelpohl can be reached at sharon@manganholcomb.com, 501-376-0321. At the 2013 APA Annual Convention, on Friday morning, June 7 at 8:45 a.m., Vogelpohl will be conducting CPE on “Communicating the Value of Pharmacists: Engaging Stakeholders through Effective Public Relations and Marketing.” Her presentation will be followed at 10 a.m. by Samantha Timmermann, Senior Marketing Manager, Pharmacy Development Services, on “Brand Management vs. Brand Damagement - the Pharmacy Professional's Guide to Leveraging Social Media.” Register for the APA Annual Convention at www.arrx.org/annual-convention.

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DENNIS MOORE VIEWS PHARMACY FROM 5,000 FEET

MEMBER SPOTLIGHT

Lee Shinabery

Shinaber y’s Community Phar macy in Jonesboro

Pharmacy Practice: Retail with specialty in compounding. Graduate pharmacy school and year: UAMS College of Pharmacy 1998, Fellowship and Board Certification in Anti-Aging, Regenerative and Functional Medicine 2008. Years in pharmacy: 2 years at Walgreens, 13 years in current practice. Favorite part of the job: I really enjoy compounding, working with physicians to solve their medication needs and patient problems. I also enjoy working with a wide variety of specialists, whether it is an OB-GYN calling for my help to alleviate a woman’s hormonal symptoms, a Pain Specialist calling for help to rid a patient of the pain he or she is having so they can continue to work, or a hospital needing a medication they can no longer find.

The only thing that seemed to help was when he scratched them with a butter knife. I really don’t want to have dinner at his house. Recent Reads: The Shack by William P. Young. Fun Activities: I enjoy coaching my daughters Ashlee, Allison and Anna’s sports teams. I also enjoy deer and duck hunting and playing golf and tennis. Ideal dinner guest: A backyard cookout with family and friends. If all my grandparents could come back and attend it would be the BEST. If not a pharmacist then…: Before I decided to pursue pharmacy, I studied architecture. I thought it would be really great to do landscape architecture. I wanted to eventually get into designing golf courses. §

Least favorite part of the job: The few occasions when I am not able to help a patient take their medication or a doctor find a solution to a problem. Oddest request from a patient/customer: With compounding all orders are different, but once a patient asked us to make a hemorrhoid medication for him. He said, he had tried everything and nothing had relieved the itch.

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Discovery 101 This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and the Arkansas Pharmacists Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

sk anyone who works in the claims department at an insurance company and they will tell you that the Discovery phase of litigation is the most time-consuming and expensive part of the process. But if you don’t work in the claims department or a law firm, could you readily explain what Discovery is and why it is so costly? Discovery is defined by Rules 26 to 37 of the Federal Rules of Civil Procedure.1 Discovery is a process where opposing sides in the litigation share information about the case with each other. This process is mandatory, although compliance with the rules is generally self-enforced by the parties. This sharing of information takes many forms and helps each side to evaluate the strengths and weaknesses of their case prior to trial. These forms include: 1. Depositions by Oral Examination 2. Depositions by Written Questions 3. Interrogatories to Parties 4. Producing Documents, Electronically Stored Information, and Tangible Things, or Entering onto Land for Inspection and Other Purposes 5. Physical and Mental Examinations 6. Requests for Admissions Depositions, whether written or oral, are one of the largest cost drivers in the Discovery process. Little use of Depositions by Written Questions is seen in most cases, so I will concentrate on Deposition by Oral Examination. The main reason that this exchange consumes so much time and money is that virtually anyone connected with the case can be deposed. The parties, employees of the parties, fact witnesses, and expert witnesses can all be deposed. Depending on the complexity of the case, the deposition can be a half day, whole day or potentially even multiple days. Coordinating witnesses’, parties’, and attorneys’ schedules can be a nightmare. This is multiplied in multiple defendant cases or class action cases. Depositions are important because they give a preview of what a witness is going to say on the stand at trial. Witness testimony is crucial to evaluating a case. Preparation for a deposition, taking the deposition and analysis of the answers is time consuming for your attorney. If the number of Depositions is large, Discovery is well on its way to being the most expensive part of litigation. Interrogatories are written questions that can only be submitted to the opposing party. They cannot be used to gain information from witnesses or other non-parties. There is a limit to the number of Interrogatories that can be served on the opposition. Many times Interrogatories are used to gather background facts such as date of birth, address, work history, arrest records, etc. As with Deposition questions, it is permissible to object to questions, but the objecting party must have a good faith basis to object beyond just not wanting to answer. 1 I will use the Federal rules for this article because they are consistent nationwide. Many states mimic them for their own rules, but you should make sure which approach your state takes.

Producing Documents, Electronically Stored Information, and Tangible Things, or Entering onto Land for Inspection and Other Purposes is comprised of two parts. The inspection of land and/ or buildings occurs when relevant, but the bigger issue here is documents. In the not too distant past, this rule dealt almost exclusively with documents. Not so today. This rule encompasses not only paper documents, but e-documents, e-mail, spreadsheets, photos, drawings, and almost anything else that you can imagine. Recent changes to the rule require that electronic documents be produced electronically to preserve the metadata. Metadata (describes how and when and by whom a particular set of data was collected, and how the data is formatted) and its implications are a topic of their own, but be aware that metadata can have a dramatic impact on the evidentiary value of the documents themselves. When the case involves a complex issue and/or a long running issue, it doesn’t take too long these requests for production to take on a life (and an expense) of their own. Parties may also request that the opposing party undergo a physical or mental examination. This is not automatic. The request must be approved by the court. The examination must be relevant to some issue in the case, so this cannot be requested without reason. This is usually used in situations where the party wants an independent opinion on, or verification of, the opposing party’s condition. The last form of Discovery is the Request for Admission. This is a written request to the opposing party asking them to admit the truth of some facts, application of the law to the facts, or the genuineness of documents. As you might have guessed by now, the item in question must be relevant to the case at hand. The responding party must admit as requested, deny or object to the request. Making an admission under this rule renders the issue decided and the issue is not debated at trial. This rule has the potential to actually shorten a trial. Discovery is self-governed by the parties and the rules provide deadlines for responding to the various forms of requests. Also, the parties cooperate to establish an overall schedule for Discovery to take place so that depositions, etc. are completed during a reasonable timeframe. Disputes about discovery make their way in front of a judge. The judge can order the parties to participate in Discovery and can impose further sanctions, up to and including dismissal of the case, for failure to do so. Discovery is a very important part of the litigation process, but it can be very time-consuming and expensive to comply with. This is especially true for the pharmacist defendant who has to take time away to be deposed or spend valuable time searching for and organizing records. Your attorney does realize the impact that Discovery has on your life, but your attorney also knows the potential downside for failure to comply. § _______________________________________________________ AR•Rx

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UNIVERSIT Y OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

Morphine Welcome to another issue of Safety Nets. This column illustrates the potential hazards associated with illegible prescriber handwriting. Thank you for your continued support of this column.

physician telephoned the following CII order to a community pharmacist: “morphine concentrate oral solution, 20 mg/ mL, quantity 30 mL, take 0.25 mL by mouth every 30 minutes as needed for pain”. [Note: the physician made a notation on the original order that he “read back and verified verbal order”.] The order was for a terminally ill hospice patient living at home with a caregiver. After the physician telephoned the order to the pharmacist, the nurse faxed the original morphine order to the pharmacy (Figure One). The pharmacist who transcribed the telephone order entered the information into the computer as morphine 20 mg/mL, quantity 30 mL, with directions of “take 2.5 mL (not the prescribed 0.25 mL), by mouth, every 30 minutes as needed for pain.” This misplaced decimal point directed the patient to administer a ten-fold morphine overdose (50 mg instead of the prescribed 5 mg of morphine per dose). The pharmacist did not compare the order received over the telephone against the original order that was faxed to the pharmacy. [Note: the telephone order and the faxed order were both received at the pharmacy on a Sunday morning.] Later that morning, the patient’s caregiver arrived to pick up the prescription. The pharmacist counseled the caregiver according to the directions printed on the prescription label (i.e. 2.5 mL per dose, not the prescribed 0.25 mL). After this, the caregiver paid for the prescription and left.

Figure One

Upon arriving at the patient’s house, the caregiver immediately administered a 2.5 mL dose to the patient. That afternoon, a hospice nurse made a scheduled home visit where she found a heavily sedated patient with pinpoint pupils. Upon examining the morphine container, the nurse realized the patient had received a ten-fold morphine overdose. The nurse immediately contacted the prescribing physician and explained the situation. Since only one dose had been administered – and the patient was breathing normally – the physician decided not to administer naloxone and to leave the patient at home for observation. Later that evening, the patient was fully alert with no untoward effects. After talking with the hospice nurse – and examining the FAXED order – the pharmacist relabeled the morphine container with a corrected prescription label instructing the patient to administer 0.25 mL, not 2.5 mL.

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This case demonstrates how easily a tenfold mistake can occur. Two points occur that can deepen our effectiveness at the point of counseling. The first is that a 5 mg dose of morphine for breakthrough pain is entirely reasonable. That is clearly the purpose for this dose. One should question the correctness of a 50 mg morphine dose for breakthrough pain. Unless the patient is taking an extremely large daily morphine dose (on the order of 2400 mg or more), a 50 mg breakthrough dose would not be appropriate. The second point is more subtle. The physician’s order provided the patient with 30 mL of morphine solution (20 mg/mL). By the incorrect label, this would yield only 12 doses for breakthrough pain (30 mL ÷2.5 mL/dose). The intended correct dose would have provided 120 doses. This is more reasonable since 12 doses could be used up in only 4 hours. The pharmacist in this case was the best placed person to notice the inadequate days supply of breakthrough morphine. It is also worth noting the restraint shown by the hospice nurse and the prescriber. They both realized the patient had received an overdose of morphine. However, they also took into account that the dose had been given some hours earlier. The half-life of morphine is relatively short. One would assume that a significant portion of the overdose had already been metabolized by the time it was discovered. Furthermore, the patient’s clinical condition was not alarming. The pinpoint pupils would not, as a single finding, be a surprise. This was a patient, after all, who takes morphine on a chronic basis. The expression “heavily sedated” is not a full guide to action. The patient may have been more sedated than usual. However, a patient whose troubling breakthrough pain had finally been treated successfully could simply be in a deep sleep, after days of restlessness. The best choice by the nurse and the physician was to withhold naloxone. Since the patient was breathing normally there was no immediate reason for naloxone treatment. Indeed, the effect of injecting naloxone could reverse morphine’s effects causing a sudden and severe pain crisis. The antique motto: “First, do no harm” was clearly the best guide here. Not every tenfold overdose will prove to be as benign as this one. For that reason, patient counseling remains the greatest protection for the patient. We pharmacists, however, are the best prepared to make subtle inferences, such as asking, “Why am I dispensing only 12 doses of breakthrough morphine?” §

Arkansas' Prescription Drug Monitoring Program Launches in 2013 PMP Administrator Denise Robertson, P.D., answers questions about Arkansas' Prescription Drug Monitoring Program.

rkansas’ Prescription Drug Monitoring Program (PMP) was created through Act 304 of 2011, which called for implementation in March 2013 if funding was procured. Arkansas Department of Health (ADH) Director Paul Halverson was committed to establishing the program under the ADH. First, the ADH had to apply for grant funding, which they received from the U.S. Department of Justice. The PMP also received funding from the Arkansas Attorney General’s office to help sustain the program. Forty-four states already have active PMPs; the first PMP program was launched in California in 1939. Each of the states surrounding Arkansas except Missouri has a PMP program. Arkansas is benefitting from the other states’ previous knowledge and solutions to issues. Pharmacists will have a chance to learn more directly from Denise Robertson, P.D., PMP Administrator, on Friday, June 7 from 2 to 3:15 p.m. when APA offers a Continuing Pharmacy Education program on PMP at the 131st Annual Convention in Little Rock. PMP Administrator Denise Robertson, P.D., answered questions for AR•Rx about the program: What is your background? I am a 1985 graduate of Xavier College of Pharmacy in Louisiana. I have 27 years of combined experience in retail, consulting and long-term care. I am a licensed pharmacist in Arkansas and Louisiana. I am also licensed as a consultant pharmacist in Arkansas. In 2008, I was involved with the implementation and supervising of the Medication Therapy Management Program for Harvest Foods pharmacies. In 2010, I was directly involved with the implementation of new pharmacy system software for USA Drug in Arkansas. As the AR PMP administrator, I am responsible for the day-to-day

administration, educational awareness and support of the program for the state of Arkansas. How has your experience prepared you for this role at PMP Administrator? My previous years in retail pharmacy has given me firsthand knowledge of the extent of prescription drug abuse and the need for a state PMP. Being directly involved in pilot testing and implementation of new pharmacy software for two different companies gives me a unique perspective on the needs of our PMP. Why do you think it is housed at the Department of Health? I think that Dr. Paul Halverson’s direct interest in how the program pertains to the health and welfare of Arkansans played a huge part of the PMP being housed at the ADH. Who will have access to the data? Prescribers and dispensers will have direct access. Those with indirect access will include law enforcement pursuant to a search warrant, regulatory boards pursuant to an active investigation and the state medical examiner. Who reports to this registry? Dispensers report data weekly to the PMP. And they will also initially be reporting six months of retroactive data. When will pharmacists have access to the data? Software vendor Health Information Designs (HID) is currently working on web portals for registration for pharmacists. It is estimated to be ready by June 1. If a pharmacist discovers the appearance of misuse or abuse, what is required? This program makes it easier to determine use and misuse of controlled substance prescription drugs. The PMP does not

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PRESCRIPTION DRUG MONITORING PROGRAM

change how a pharmacist will use that knowledge. It only makes it easier to attain it. The pharmacist may alert other practitioners to check the PMP. The prescriber can then make a decision as they would in any other circumstance. What action will be taken if a pharmacist or physician sees prescription abuse or over prescribing? The action taken will be left up to the involved practitioner. Will law enforcement be able to use records from the PMP as evidence? This will be up to the individual law enforcement agency. If pharmacists have access to this information, does this increase their liability? According to Act 304, it appears that it will not. The data is uploaded to the registry on a weekly basis; do you have plans to make it a real-time database? We are working toward this in the future depending on additional funding required. Currently only one state, Oklahoma, is attempting real-time reporting. Is there training available once pharmacists can access the database? HID will have online tutorials available. There is a 24-hour help desk. The phone number is 855-729-8917. Or go to arpmp-info@hid.inc.com. It is a total online process.

What happens if a pharmacy doesn’t report to the PMP? A report will be generated monthly of those pharmacies not reporting weekly. They will be sent a reminder email. I don’t think that non-reporting will be a problem. It hasn’t been an issue in other states. People are telling me they are so glad that this is in place. When you’re working in retail, you get bombarded every day with suspected abuse and diversion and you get frustrated. There is great hope for this. How do you think the program will be helpful? We hope to help curtail misuse and abuse of prescription drugs including doctor shopping. I think the PMP will be a good tool for pharmacists. It will save them a little time and will help physicians with their initial interview with patients to know what controlled substances they are currently taking. They will be able to tell if someone is doctor shopping, especially if they use it on the front end. What have we learned from other states? The other states have actually seen the scope of prescription drug abuse in their own state. PMP assisted with changing prescribing habits for opioids and helped cut down on the number of doctor shoppers. Because we have an active PMP, it will also be harder for these organized groups to divert controlled substances. The PMP is not meant to hinder the legitimate use of controlled substances. It will actually help identify those with legitimate needs. §

Will technicians or interns have access to it? According to Act 304, access is for prescribers and dispensers. Additional information can be found at: www.arkansaspmp. com and www.arkleg.state.ar.us/assembly/2011/2011R/Acgts/ Act304.pdf. If during a week of reporting, if a pharmacy or prescriber does not dispense a controlled substance, are they still required to report that they do not dispense controlled substances? Yes. This is called Zero Reporting. Who should pharmacists contact if they have technical problems? HID: There is a 24-hour help desk. The phone number is 855729-8917. Or go to arpmp-info@hid.inc.com. Why was this particular software vendor chosen? A Request for Proposal was developed and bids were accepted last year. Based on the requirements, HID was chosen. We’re very fortunate to have them as our software vendor because they have implemented 17 other states PMPs, so they are experienced. What role, if any, does the Arkansas State Board of Pharmacy play in the PMP? They were involved in the development of the legislation that led to the PMP.

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LEGISL ATOR PROFILE

Rep. Marshall Wright

(D-For rest City)

District: 49 Represents: The counties I represent are parts of St. Francis, Monroe, and Cross.

the House, I have come to realize that the Association, and the people that represent them, specifically Mark Riley and Debra Wolfe, always have the best interest of the Association and its members in mind. There is no doubt that the pharmacists are well represented.

Years in Office: This is my third year in office. Occupation: Lawyer/small business owner. Your pharmacist: Vernon Lockhart (retired) is/was my hometown pharmacist. Like most about office: I have the opportunity to truly help the people of Arkansas. I consider that an honor. Like least about office: That the job requires me to spend time away from my family. Most admired politician: My most admired politician is a tie: My father Clyde Wright (former Little River County Judge) and Governor Mike Beebe.

Your fantasy political gathering would include: My fantasy political gathering would include: My father, Governor Mike Beebe, President Bill Clinton, former Senator David Pryor and Tim Massanelli. Toughest issue of the Session: The toughest issue of the session for me is trying to meet the demands of being the Chairman of the Judiciary Committee in addition to all the other duties of a legislator. What do you do for fun: Spend time with my family. No matter what we are doing, spending time with my amazing wife Kristen, and my children Collier and Syble, is no doubt the most fun I could possibly have. ยง

Advice for pharmacists about the political process and working with the Arkansas legislature: My advice to pharmacists about the political process and working with the Arkansas legislature is to rely on the Arkansas Pharmacists Association. During my time in

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PHARMACISTS IN THE NEWS The diabetes self-management education (DSME) program at Conway Regional Medical System will be highlighted at the American Association of Diabetes Educators AADE13 Annual Meeting. Dr. Melissa Max from Harding University will present the topic of the pharmacist as a member of interdisciplinary care for CPE credit highlighting CRHS program results. The 90-minute oral presentation scheduled for the August 2013 AADE Annual Meeting in Philadelphia is titled "The Pharmacist as a Member of Interdisciplinary DSME: Improved Patient Outcomes." Learning objectives include understanding the unique role of the pharmacist in the provision of diabetes self-management education (DSME), describing the benefit of individualized pharmacotherpeutic regimen review and patient adherence to diabetes standards of care, and identification of improved clinical and behavioral outcomes expected with the inclusion of a pharmacist as a member of the interdisciplinary team. Dr. Max received her PharmD degree from the University of Arkansas for Medical Sciences. She is a certified diabetes educator (CDE) and is board certified in advanced diabetes management. Dr. Max serves as an Assistant Professor of Pharmacy Practice at Harding University College of Pharmacy and her clinical practice is with Conway Regional Medical System's outpatient DSME program. She provides individualized pharmacotherapeutic regimen review and recommendations for patients, focusing on safe and appropriate medication use and patient goal attainment.

2013 DISTRICT MEETING SCHEDULE Date District Location Tuesday, Aug. 20 5 Grand Prairie Center, Stuttgart Thursday, Aug. 22 2 Jonesboro Country Club Jonesboro Thursday, Sept. 5 1 Embassy Suites Hotel Little Rock Monday, Sept. 9 7 Holiday Inn City-Center Fort Smith Tuesday, Sept. 10 6 Lake Point Conference Center Russellville Thursday, Sept. 12 4 Camden Country Club Camden Tuesday, Sept. 17 6 Embassy Suites, Hot Springs Thursday, Sept. 19 5 Monticello Country Club Monticello Monday, Sept. 23 3 Holiday Inn Express Mountain Home Tuesday, Sept. 24 3 Embassy Suites Northwest Rogers Thursday, Sept. 26 8 Harding University Cone Chapel, Searcy

Do you have a story to share for Pharmacists in the News? If so, please contact Eileen Denne (eileen@arrx.org) or 501372-5250. ยง

IN MEMORIAM Tammy Lasley, age 49, passed away on Friday, Jan. 25, 2013, in Greenbrier. She was born in Conway. She was a pharmacist at Fred's in Greenbrier and earned the Presidential Award there four years in a row. She loved all her customers and considered it a privilege to serve them. She was a member of the Enola Church of Christ and a key leader in the community. She was a two-time All-American Shortstop. ยง

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Antipsychotic Use In Nursing Homes: How Consultant Pharmacists Can Help

ardiovascular disease (CVD) and stroke are among the most serious and costly health care issues facing our nation today. Despite the declining mortality rate over the past 30 years, CVD remains the leading cause of death nationwide.1 In 2008, approximately 2 million Americans suffered a heart attack or stroke, and CVD accounted for 1 of every 3 deaths in the United States.2 According to a 2005 analysis from the Centers for Disease Control and Prevention (CDC), a total of 3 million people nationwide reported being disabled because of heart disease or stroke. 3 In Arkansas, heart attack and stroke are the number one and number three causes of death, respectively.4 The death rate from cardiovascular disease in Arkansas is the fifth highest in the United States; the age-adjusted rate in 2009 was 218.8 per 100,000 population, compared with a national rate of 180.1.1 The state’s death rate from stroke is the second highest in the country, at 50.8 per 100,000 population, compared with 38.9 nationwide.1 In addition to these staggering statistics, heart disease and stroke accounted for more than $444 billion in health care costs and lost economic productivity in 2010, and that figure is estimated to top $1 trillion by 2030.4 Antipsychotic medications are not approved by the Food & Drug Administration (FDA) for use in elderly patients with dementia-related behavioral symptoms; however, high prevalence rates of antipsychotics usage in this population are still being reported. In 2005, the FDA issued a black-box warning due to the increased risk of cardiovascular death in

this population.1 One source estimated “For every 100 patients with dementia treated with an antipsychotic medication, only 9-25 will benefit, and 1 will die.”2 Due to their age and incidence of dementia, nursing home residents are most vulnerable to the adverse effects of antipsychotics. The Centers for Medicare & Medicaid Services (CMS) reported 39.4 percent of nursing home residents nationwide exhibiting both cognitive impairment and behavior problems without psychotic or related conditions received antipsychotic medications for the third quarter of calendar year 2010.3 More recently, data from the publically available Nursing Home Compare website indicated long-stay residents in Arkansas as having one of the highest antipsychotic medication usage rates in the nation for the first three quarters of 2012 (Figure 1). In addition to the dangers associated with antipsychotic usage in this population, these medications are also costly to the health care system. In 2007, atypical antipsychotic medications accounted for nearly 5 percent of drug expenditures in the United States at more than $13 billion in costs.4 CMS partnership to improve dementia care in nursing homes In March 2012, CMS announced a national initiative aimed at reducing antipsychotic medication rates in nursing home residents by 15 percent. This campaign encourages nursing homes to partner with state survey agencies, professional associations, provider groups, Quality Improvement Organizations (QIOs), residents, families, ombudsmen and other key local and national stakeholders. The goal of this initiative is to improve the quality of care for nursing home residents with dementia via enhanced provider education, heightened public awareness, provision of technical assistance to nursing homes, improved regulatory oversight and public reporting of measures. Strategies for reducing avoidable antipsychotic medication rates include obtaining senior leadership commitment, convening an interdisciplinary team within the nursing home, assessing the facility’s current practices and baseline data, developing new practice guidelines, educating staff on these guidelines, and routine monitoring of progress.

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QUALITY NOTES: ANTIPSYCHOTIC USE IN NURSING HOMES

Role of consultant pharmacists Consultant pharmacists are uniquely positioned to aid nursing homes in reduction of antipsychotic medication usage rates. Being medication experts, consultant pharmacists offer nursing homes an invaluable service towards meeting the goals of this CMS initiative by providing clinical pharmacy services on a monthly basis. During each resident assessment, consultant pharmacists can make the following interventions: ensure that each antipsychotic medication is clinically indicated and dosed to meet the resident’s assessed needs, recommend timely and appropriate gradual dose reductions (GDRs) for antipsychotic medications and document the outcome of each attempt, address modifiable causes of behavioral symptoms (i.e. pain, medications, environment, etc.), and provide nonpharmacological recommendations (i.e. graded staff assistance, music, pet therapy, light exercise, etc.) for residents with behavioral symptoms of dementia. Consultant pharmacists can also help nursing homes develop antipsychotic medication use guidelines, develop staff and family educational materials around these guidelines, and provide staff in-service trainings around antipsychotic medication reduction.

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AFMC can help Reducing antipsychotic medication use in nursing homes will require all partners and providers working together to induce a patient-centered culture change. The Arkansas Foundation for Medical Care (AFMC), the Medicare QIO for Arkansas, and long-term care stakeholders are working with nursing home staff and consulting pharmacists in the state to promote this CMS initiative and reduce inappropriate antipsychotic medication use in residents with dementia. For more information on how AFMC can assist you and your nursing home in promoting and achieving success in antipsychotic medication rate reduction, contact Christi Quarles Smith at csmith@afmc.org. § REFERENCES 1 FDA, “Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances” (April 5, 2005) 2 Independent Drug Information Service (IDIS) Restrained Use of antipsychotic medications: rational management of irrationality. 2012 3 CMS, MDS Quality Measure/Indicator Report, Psychotropic Drug Use, July/September 2010, Measure 10_1_HI 4 Alexander G, Gallagher S, Mascola A, et al. Increasing off-label use of antipsychotic medications in the United States, 1995-2008. Pharmacoepidemiology and Drug Safety. 2011;20(2):177-184

Pharmacists Collaborate to Improve Vaccination Rates By Eric Crumbaugh, Pharm.D., - APA Immunization Grant Coordinator Newscaster Greg Dee of Fox 16 watches as Dr. Eric Crumbaugh administers a shingles vaccine to Dr. Gary Wheeler of the Arkansas Department of Health.

n March 2012, the Pharmacist Immunization Program this vaccine and that the pharmacy is able to bill the patients’ conducted a survey of Arkansas pharmacies that were insurance. Pharmacists may also partner with these local not offering immunization services to try and identify clinics by selling single doses of the zoster vaccine to the barriers to immunization. Twenty-five percent of the clinics for use in patients whose insurance does not cover the vaccine at the pharmacy. responding pharmacies reported that they did not provide immunization Pharmacists are also a services because they were concerned The Arkansas Department of Health that local physicians would think the very trusted profession recognizes the benefit of pharmacypharmacists were trying to infringe on and a study found that up based immunization services. A health their clinics' immunization services. to 94 percent of people department physician is such a strong Some pharmacists even reported that proponent of pharmacists providing local physicians told them if they responded to a pharmacist’s vaccinations that he signed a statestarted providing these services, they recommendation and 74 wide immunization protocol that would encourage patients to use other percent were more likely to includes flu, pneumococcal vaccine, community pharmacies. Tetanus, Diphtheria, Pertussis (Tdap), be vaccinated if prompted and zoster for pharmacies that cannot However, we have found that offering by their pharmacists. find a local physician to sign their immunization services in community store’s immunization protocol. Several pharmacies actually increases the APA members are using this protocol public’s awareness of vaccine-preventable disease and leads for their immunization programs. If your pharmacy is to more people getting vaccinated, and does not “steal” interested in using this protocol, please contact Dr. Eric patients away from local physicians. Crumbaugh at eric@arrx.org. Steven Mostow, M.D. and chairman of the Colorado Coalition (Influenza Alert), helped orchestrate some of the first drug store clinics. “I spent 20 years trying to convince doctors to give flu shots, and it was a big failure. My first year [of the Coalition], doctors wrote me nasty letters saying that I was taking their business away and sending it to grocery stores, but they were wrong. It increased overall awareness of immunization. There were 100,000 [doses] given in doctors’ offices when we started, and last year there were 700,000.”1 Pharmacists need to collaborate with other health care providers in their community. Let them know that pharmacybased immunization services are not competing with other health care providers but an additional access point for patients. Also, with the addition of the zoster vaccine to the Medicare Part D benefit, most physicians are not able to bill for this expensive vaccine. They also have concerns about the storage and high cost of the vaccine. This offers an opportunity for pharmacists to collaborate with these local clinics. Let them know that your pharmacy offers and stocks 22

Vaccination rates in Arkansas and across the country are dangerously low. With an aging population and new medical indications for vaccinations, if nothing is done to improve these statistics, vaccination rates will start to decline and there will be an increased likelihood of an outbreak of vaccine-preventable disease. Pharmacists are the most accessible health care providers and in some rural Arkansas communities may be the only health care provider. Pharmacists are also a very trusted profession and a study found that up to 94 percent of people responded to a pharmacist’s recommendation and 74 percent were more likely to be vaccinated if prompted by their pharmacists. Pharmacists have a unique opportunity to increase the public’s vaccination rates. Start collaborating with local health care providers and protect your community from the serious consequences of vaccine-preventable diseases. § Reference: 1 Debrovner D. Colorado’s crusade. Am Druggist. 1994;(Dec):22-

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131st APA ANNUAL CONVENTION

SCHEDULE OF EVENTS

(Schedule is subject to change)

Wednesday, June 5, 2013 9:00 AM - 12:00 PM

APA Board of Directors Meeting

1:30 PM

APA Annual Golf Tournament Country Club of Arkansas (Maumelle)

Golf Tournament Sponsor: McKesson Corporation The Arkansas Pharmacists Association’s (APA) 131st Annual Convention will be held at the Marriott (formerly the Peabody Hotel) in Little Rock from June 6-8, 2013. The conference theme, Dispensing Knowledge for Better Health, reflects all the ways that pharmacists help patients in today’s health care system. Pharmacists can stay up-to-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. Dress during the convention is business casual.

Why Attend?

Continuing Pharmacy Education: APA will offer 15 hours of original and topical Continuing Pharmacy Education with highly-regarded instructors on topics ranging from Medication Therapy Management to the new Prescription Drug Monitoring Program.

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Thursday, June 6, 2013 7:00 AM - 4:30 PM

Registration

7:30 - 8:30 AM

Continental Breakfast/ 340B Roundtable Discussion

8:45 AM - 12:00 PM

Innovative Clinical Programs CPE Block • Medication Therapy Management: Making MTM a Core Competency in all Practice Settings • The Pharm2Pharm Model: Improving Care in Rural Hawaii • Panel Discussion with Session Presenters

12:15 - 1:45 PM

Lunch & Awards Ceremony

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. 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 party will be held at the newly-renovated Museum of Discovery in Little Rock’s exciting River Market District. Enjoy exploring the interactive exhibits as well as beverages and a buffet of delectable dishes.

Accommodations

The host hotel for the 131st APA Annual Convention is the Marriott Hotel at Three Statehouse Plaza in Little Rock. Check-in is at 3:00 PM and check-out is 12:00 PM. For reservations, call 1-800-732-2639. Room rate is $154.00 plus tax. Mention Arkansas Pharmacists Association for group rate. Cut-off date for rooms is May 6, 2013.

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2:00 - 5:15 PM Health Care Law CPE Block • 2013 Arkansas Pharmacy Law Update • Healthcare Reform Update • Panel Discussion with Session Presenters 4:45 - 5:30 PM

Arkansas Pharmacists Foundation Board Meeting

24 Dispensing Knowledge for Better Health

5:30 - 6:30 PM

Presidents Reception

6:30 - 8:30 PM

Opening Reception in Exhibit Hall

the Clinton Presidential Library and Museum features exhibits, special events and educational programs. The museum includes replicas of the Oval Office and the Cabinet Room. Following the museum tour, guests will be served lunch in Forty Two, the restaurant named after our nation’s 42nd president, President Bill Clinton. 12:15 - 1:45 PM

Lunch in Exhibit Hall

2:00 - 5:15 PM

Controlled Substances CPE Block • The New Arkansas Prescription Drug Monitoring Program (PMP) • Pharmacists’ Responsibility in Appropriate Controlled Substance Dispensing • Panel Discussion with Session Presenters

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Friday, June 7, 2013 7:00 AM - 4:30 PM

Registration

7:30 AM - 8:30 AM

Continental Breakfast/ Preceptor Roundtable Discussion

8:45 AM - 12:00 PM

Promoting Your Own Brand CPE Block • Communicating the Value of Pharmacists: Engaging Stakeholders through Effective Public Relations and Marketing • Brand Management vs. Brand Damagement: the Pharmacy Professional’s Guide to Leveraging Social Media • Panel Discussion with Session Presenters 10:00 AM - 12:30 PM

Spouse Trip to Clinton Presidential Library (Transportation & lunch provided)

The Clinton Presidential Library and Museum is located within the Clinton Presidential Center and Park. In addition to the archival collection and research facilities,

Photo provided by Museum of Discovery.

6:00 - 8:00 PM Museum of Discovery Party and Officer Installation Honoring APA’s Wholesale Partners: AmerisourceBergen, Cardinal Health, McKesson, Morris & Dickson and Smith Drug Established in 1927 as the Museum of Natural History and Antiquities, the Museum of Discovery is the oldest museum in Little Rock. It was completely renovated in 2011. Its mission is to ignite a passion for science, technology and math in a dynamic, interactive environment. Heavy hors d’oeuvres and beverages will be served.

Photo provided by the William J. Clinton Foundation.

• R ST x Annual | T H E Convention A R K A N S A S P-HJune A R M A6-8, C I S T2013 APAA R131

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UAMS Class Reunions: Classes of 1953, 1958, 1963, 1968, 1973, 1983, 1988, 1993, 1998, 2003, and 2008 will hold reunions at APA’s Museum of Discovery Party. UAMS’ Alumni Association will especially honor the class of 1963 for their years of practice as graduates of UAMS. Reunions are open to all alumni regardless of graduation year and their guests.

CONTINUING PHARMACY EDUCATION SESSIONS

__________________________________________________

Presenter: Dan Rodriguez, RPh, Pharmacist Provider Services, Outcomes

Saturday, June 8, 2013 7:00 - 10:00 AM

Registration

7:30 - 8:30 AM

Continental Breakfast & State of the Association Address

8:45 AM - 12:00 PM Clinical Advances CPE Block • New Drugs 2013 • Advances in Vaccines and Vaccine Technology • Panel Discussion with Session Presenters 12:15 - 1:45 PM

Lunch and AP-PAC Guest Speaker All Annual Convention attendees are welcome to attend.

2012 AP-PAC luncheon speaker Senator Mark Pryor (second from left).

1:45 PM

Convention Adjourns

2:00 - 5:00 PM

Post Convention Session: CPR Certification / Recertification Session in addition to regular convention programming.

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__________________________________________________

Thursday, June 6, 2013 8:45 - 10:00 AM

Medication Therapy Management: Making MTM a Core Competency in all Practice Settings

ACPE # 0004-9999-13-002-L04-P (1.5 hours) This CPE activity will be Application based. CPE Objectives: • Describe MTM services. • Explain manners that MTM can be incorporated in every practice setting. • List MTM core competencies that every pharmacist should be mindful of with every patient encounter. • Describe the role MTM can play in continuity of care between discharge and reentry into the community. • Present data to decision makers and payers that builds the value proposition for paying pharmacists to perform MTM services. __________________________________________________ 10:10 - 11:25 AM The Pharm2Pharm Model: Improving Care in Rural Hawaii Presenter: Karen Pellegrin, PhD, Director, Center for Rural Health, University of Hawaii - Hilo ACPE # 0004-9999-13-003-L04-P (1.5 hours) This CPE activity will be Knowledge-based. CPE Objectives: • List the 3 aims of the CMS Innovation Center. • Describe previous obstacles to community pharmacy innovation. • Identify current gaps in care as patients transition from hospital to outpatient settings. • Describe the key elements of the Pharm2Pharm model designed to reduce medication-related hospitalizations and ER visits. __________________________________________________ 11:30 AM - 12:00 PM Panel Discussion with Session Presenters Panelists: Dan Rodriguez, RPh and Karen Pellegrin, PhD _________________________________________________ 2:00 - 3:15 PM 2013 Arkansas Pharmacy Law Update Presenter: John Clay Kirtley, PharmD, Executive Director, Arkansas State Board of Pharmacy ACPE # 0004-9999-13-004-L03-P (1.5 hours) This CPE activity will be Knowledge-based.

26 Dispensing Knowledge for Better Health

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.

Arkansas State Board of Pharmacy Executive Director John Clay Kirtley, PharmD.

__________________________________________________ 3:25 - 4:40 PM Health Care Reform Update Presenter: Scott Pace, PharmD, JD, Associate Executive Vice President, Arkansas Pharmacists Association ACPE # 0004-9999-13-005-L03-P (1.5 hours) This CPE activity will be Knowledge based. CPE Objectives: • Detail the status of the federal health care reform implementation. • Discuss the impact that Medicaid expansion will have on Arkansans. • List how pharmacists are impacted under the new health care reform laws. • Explain opportunities for pharmacists to improve patient care because of health care reform. __________________________________________________ 4:45 – 5:15 PM Panel Discussion with Session Presenters Panelists: John Kirtley, PharmD and Scott Pace, PharmD, JD __________________________________________________

Friday, June 7, 2013 8:45 - 10:00 AM

Communicating the Value of Pharmacists: Engaging Stakeholders through Effective Public Relations and Marketing Presenter: Sharon Vogelpohl, Principal, Mangan Holcomb Partners ACPE # 0004-9999-13-006-L04-P (1.5 Contact Hours) This CPE activity will be Knowledge based. CPE Objectives: • Discuss the importance of the PR/Marketing activities that APA is undertaking on behalf of pharmacists in Arkansas. • R ST x Annual | T H E Convention A R K A N S A S P-HJune A R M A6-8, C I S T2013 APAA R131

• List stakeholders to whom it is important that pharmacists promote themselves. • Describe the difference between public relations and marketing/advertising. • Discuss both PR and marketing activities that each pharmacist can do to advance the profession and their respective practice. • Implement at least one strategy in their practice to advance pharmacy’s PR campaign message. __________________________________________________ 10:10 - 11:25 AM Brand Management vs. Brand Damagement – the Pharmacy Professional’s Guide to Leveraging Social Media Presenter: Samantha Timmermann, Senior Marketing Manager, Pharmacy Development Services ACPE # 0004-9999-13-007-L04-P (1.5 hours) This CPE activity will be Knowledge-based. CPE Objectives: • Explain the difference between “Brand Management” and “Brand Damagement.” • Recognize the opportunity that exists in content-based marketing and how it can help your patients live healthier lives. • List at least five ways you can leverage your pharmacy education through various social media platforms. • Explain how social media can hurt and strengthen your reputation as a health care professional and how to protect your image. • Describe how you can create your own brand that positions you as a medication expert. __________________________________________________ 11:30 AM - 12:00 PM Panel Discussion with Session Presenters Panelists: Sharon Vogelpohl and Samantha Timmermann __________________________________________________ 2:00 - 3:15 PM The New Arkansas Prescription Drug Monitoring Program (PMP) Presenter: Denise Robertson, RPh, PMP Administrator ACPE # 0004-9999-13-008-L04-P (1.5 hours) This CPE activity will be Knowledge based. CPE Objectives: • Discuss the legislative process that led to the creation of the PMP. • Describe the requirements for controlled substance prescription submission to the Arkansas Department of Health. • Discuss how to appropriately use the PMP in your practice. • Develop a strategy to incorporate the PMP into your workflow. • Explain how to navigate the PMP to retrieve appropriate data.

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3:25 - 4:40 PM

Pharmacists’ Responsibility in Appropriate Controlled Substance Dispensing Presenter: Mary Jo Carden, RPh, JD, Director of Regulatory Affairs, Academy of Managed Care Pharmacy ACPE # 0004-9999-13-009-L04-P (1.5 hours) This CPE activity will be Knowledge-based. CPE Objectives: • Explain the Drug Enforcement Administration’s definition of the “corresponding responsibility” between prescribers and pharmacists to ensure that controlled substance medications are only dispensed to patients based on prescriptions written for a legitimate medical purpose and in the normal course of professional practice, including the pharmacist’s responsibility in conducting due diligence. • Describe current initiatives by the DEA, Food and Drug Administration, Office of National Drug Control Policy and general state policies to curb misuse, abuse and diversion of controlled substances and their relationship to pharmacy practice. • List current initiatives by third-party payers, the Medicare Part D program and state Medicaid programs to curb misuse, abuse and diversion of controlled substances. • Discuss practical approaches and actions that can be taken by the pharmacist and the pharmacy staff to reduce the likelihood of misuse, abuse and diversion of controlled substances. • Develop a checklist for the pharmacy staff to use in conducting due diligence, including identifying prescribers and patients that may be involved in potentially inappropriate prescribing. • Discuss available resources to develop effective, comprehensive controlled substance dispensing protocols in pharmacies. __________________________________________________ 4:45 - 5:15 PM Panel Discussion with Session Presenters Panelists: Denise Robertson, RPh and Mary Jo Carden, RPh, JD __________________________________________________

Saturday, June 8, 2013 8:45 - 10:00 AM New Drugs 2013 Presenter: Tom Frank, PharmD, BCPS, AHEC Pharmacy Director ACPE # 0004-9999-13-010-L01-P (1.5 hours) This CPE activity will be Knowledge-based. CPE Objectives: • Assess new trends in drug development. • Recognize indications, pharmacology, adverse effects and dosing of the products discussed. • Determine the role these products will play in the participant’s practice. • Evaluate the economic implications of the choices. • Examine products in the short-term pipeline that will be important to the practice of the participants.

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10:10 - 11:25 AM

Advances in Vaccines and Vaccine Technology Presenter: Eric Crumbaugh, PharmD, Immunization Grant Coordinator, Arkansas Pharmacists Association ACPE # 0004-9999-13-011-L01-P (1.5 hours) This CPE activity will be Knowledge-based. CPE Objectives: • Explore newly developed vaccinations and their role in prevention of disease. • Discuss available medical devices for the administration of vaccinations. • Evaluate 2013-2014 seasonal influenza vaccination formulations and their appropriate patient populations. • Review recent changes and updates to the adult immunization schedule. • Evaluate patients’ medication histories to identify indications for certain vaccinations. __________________________________________________ 11:30 AM - 12:00 PM Panel Discussion with Session Presenters Panelists: Tom Frank, PharmD, BCPS and Eric Crumbaugh, PharmD __________________________________________________ 1:45 PM Convention Adjourns __________________________________________________ 2:00 - 5:00 PM Post-Convention Session: Basic Life Support for Health Care Providers Presenter: American First Response Book and certification card included with registration.

__________________________________________________ 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:

This program is open to all pharmacists. The program provides pharmacist participant up to 15 contact hour(s) (1.5 CEUs). To receive credit, the pharmacy participant must follow the attendance procedure of the program and complete all online program evaluation forms. If the attendance documentation is illegible then no credit can be issued. Credit will be uploaded to CPE monitor within 60 days after completion of the program and participants will be notified via email when credit has been submitted.

Grievance Procedure:

This procedure represents a formal mechanism whereby any pharmacist may obtain a review of a complaint of unfair treatment. A pharmacist must file the grievance in writing within 30 days of the incident/activity generating the complaint. The complaint will be reviewed by the Director of Continuing Education and every effort will be made to resolve the problem of the complainant. If the complaint is not satisfactorily resolved, the complaint will be forwarded to the UAMS COP Dean for disposition.

28 Dispensing Knowledge for Better Health

APA 2013 Annual Convention

REGISTRATION FORM 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 #:_________________________________ Guest Name: _____________________________________

Full Registration Package

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 5 Convention Golf Tournament - $65.00 per player Number of Golfers ___ at $65 per player = _________ Name(s) of Golfers ______________

______________

Friday, June 7 Spouse Trip to Clinton Presidential Library - $25.00 per person

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

Name of Attendee _______________________________

Cutoff date for early bird registration is May 10, 2013.

Saturday, June 8 Post-Convention Session - $45.00 per person

APA MEMBER

NON MEMBER*

Before 5/10

After 5/10

Before 5/10

After 5/10

Full Registration

$259

$289

$354

$384

Full Registration & Spouse/Guest

$359

$389

$454

$484

*Price includes 2013 APA Membership.

Daily Registration Package

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

NON MEMBER

Name of Attendee _______________________________

Extra Social Event Tickets

Tickets for the following events are included in the convention registration package. Additional tickets may be purchased for guests. Friday, June 7 Evening Party at Museum of Discovery and UAMS COP Class Reunions - $40 per person Number of tickets _____ @ $40 per ticket = _________

Payment

Thursday Only Registration

$199

$249

Total Amount: ______________________

Thursday Only Registration and Guest

$249

$299

Payment Type:

Friday Only Registration

$199

$249

Friday Only Registration and Guest

$249

$299

Card #______________________ Exp________ Sec Code______ Make check payable to Arkansas Pharmacists Association: 417 S. Victory St., Little Rock, AR 72201 Fax to: 501-372-0546. Or register at www.arrx.org.

Saturday Only

$149

$199

Saturday Only Registration

$199

$249

Registration

Visa

AmEx

Discover

Check

Refund Policy

and Guest â&#x20AC;˘ R ST x Annual | T H E Convention A R K A N S A S P-HJune A R M A6-8, C I S T2013 APAA R131

By May 16, 2013, 50 percent refund will be issued. After May 16, 2013, no refund will be issued. All refund/cancellation requests must be submitted to APA in writing. Registrations are non-transferrable.

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COLLEGES OF PHARMACY

UAMS

UAMS Named National APhA-ASP Chapter of the Year Stephanie Gardner Pharm.D., Ed.D. Dean

ohn Quincy Adams said “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” Over the last month, I realize how fortunate I am to be surrounded by so many incredible leaders among our student body, our faculty, and my pharmacist colleagues. I am constantly amazed by the energy and enthusiasm of our students. They continue to reach out to the community with their innovative ideas. Once again, they were named as the American Pharmacists Association – Academy of Student Pharmacists (APhA-ASP) National Chapter of the Year during the annual convention in March. This is the fourth time since 2000 that the College’s chapter has won this prestigious award in competition with almost 120 other colleges of pharmacy in the nation. The award is based on all the components of leadership that you would want to develop in future pharmacists… advocacy, service, and outreach. Our students excel in these areas year after year, but they couldn’t achieve nearly as much without the faculty leaders who help them. Dr. Eddie Dunn and Dr. Melanie Claborn serve as their advisors and spend countless hours of their “free time” making sure that the students have the support that they need. Allison Hollis served as ASP President in 2011-12 and Andy Roller is the ASP President for 2012-13. Allison and Andy, along with their entire team of officers, organized events, motivated their classmates to participate, and wrote reports summarizing their activities. These activities outside of the classroom greatly enrich their experiences during their time at UAMS. In addition to the success of the student chapter, our third year student Brandi Hamilton was installed during the same meeting as national president of the APhA-Academy of Student Pharmacists. Over the next year, Brandi will continue to travel across the country visiting colleges and schools of pharmacy. I am very pleased that she was selected by her peers to serve as the national representative of student pharmacists and I am confident that she will make all of us proud. 30

Brandi joins alumna and faculty member Nicki Hilliard (’83,’96), who was sworn in as president of the APhA-Academy of Pharmacy Practice and Management (APPM), and Tery Baskin (’77, ’00), who serves as the Association’s Treasurer. Natasha Jackson (’07), also a UAMS graduate, is the APhAAPPM New Practitioner Officer. I would be remiss if I didn’t also recognize the national office held by our APA Executive, Dr. Mark Riley. Mark will be installed in October as National President of the National Community Pharmacists Association. The pathway to the Presidency within NCPA takes many years of dedication and leadership. He goes above and beyond to serve the profession.

During my “State of the College” address a few weeks ago to the students and faculty, I stressed the fact that we have 12 student organizations. Over the past year, each organization has accomplished great things in our community. They have conducted health screenings, provided tutoring, raised money and collected canned goods for charities. This column doesn’t provide enough space to elaborate on all the successes of our student, faculty, and alumni leaders. It does provide an opportunity, however, for me to thank everyone who contributes to their success. To every preceptor, mentor, donor, and leader in our State, I appreciate what you do. You inspire all of us to “dream more, learn more, and become more.” §

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COLLEGES OF PHARMACY

HARDING UNIVERSIT Y

Advocacy Class Helps Pass HB1185

he beginning of the spring semester at Harding has been busy as usual. All of the student Julie Hixson-Wallace organizations and student body have Pharm.D., BCPS joined together in providing a wide Dean array of events and activities related to Script Your Future, a national campaign to raise awareness about medication adherence (www.scriptyourfuture.org). Our students are participating with more than 60 other schools and colleges of pharmacy in the Medication Adherence Team Challenge sponsored by the American Association of Colleges of Pharmacy, the National Association of Chain Drug Stores Foundation, the American Medical Association, and the National Community Pharmacists Association. The challenge took place in February during which time HUCOP students provided daily medication adherence tips via Facebook (www.facebook.com/HUCOPSYF) and Twitter. They also educated the public through face-to-face interactions in venues ranging from elementary schools to retirement centers. Last year HUCOP won the national social media component of the challenge so they have high hopes of bringing home a prize again this year!

Most recently, I attended the National Governors Association Arkansas In-State Policy Workshop on Reducing Prescription Drug Abuse. The meeting featured speakers who have lost loved ones to prescription drug abuse. Other speakers gave an update regarding best practices for prescribing opioids and previewed the recently released Arkansas state opioid prescribing guidelines. The afternoon was spent in smaller workgroups developing action items the state can use in creating a plan to combat this extremely serious public health problem. A focus of the workshop was relating to health care providers the benefits that can be realized by fully utilizing the Arkansas Prescription Drug Monitoring Program (PMP) that has just been launched. The PMP is an additional weapon we now have against the prescription

Members of the HUCOP political advocacy elective course have also been very busy this spring. They have spent many hours working in conjunction with the Arkansas Pharmacists Association and state legislators in getting HB 1185 passed. HB 1185, now Act 274, will allow pharmacists to make Governor Mike Beebe signing HB1185. (L to R) Bill's sponsor, Rep. Marshall Wright therapeutic substitutes when indicated on (D-Forrest City), Harding COP Advocacy Class members Tyler Staten, Abby Cooper, the prescription by the prescriber. After Chris Hill, Kejal Patel, Dr. Rod Richmond, APA's Debra Wolfe and Dr. Mark Riley. counseling the patient on their options, the pharmacist can then substitute a product that lowers patient out-of-pocket costs (co-pays) and then drug abuse epidemic. As pharmacists we can play a key notify the physician of any substitutions within 24 hours. The role in fighting the epidemic as well by organizing and intent of this bill is to improve efficiency for pharmacists and participating in medication take back events with local patients along with maximizing cost savings. The bill was law enforcement and embracing and utilizing the Arkansas run by Rep. Marshall Wright (D-Forrest City) and Senator PMP. Many community and civic groups have also taken Jonathan Dismang (R-Beebe). HUCOP students testified up the prescription drug abuse cause. The Rotary Clubs of before the Senate Public Health Committee in support of the Arkansas have taken a very active role in partnering to end prescription drug abuse by providing take back toolkits to bill. The HUCOP students were excited to be present when Governor Beebe signed the bill into law on March 1. To their members. I highly encourage all of us as pharmacists end the semester, students in the political advocacy elective and citizens of Arkansas to do what we can to become more course are planning a legislative reception on April 29, to be aware of this issue and fight it as best we can. ยง held on the Harding campus. We invite anyone interested to come and meet local legislators and hear updates on political advocacy issues facing the profession of pharmacy. 32

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ARKANSAS ASSOCIATION OF HEALTH-SYSTEM PHARMACISTS

Volunteering is the Price You Pay

olunteering is the price you pay for the space you take up in the profession.” Lanita S. White, Pharm.D. When I heard Diane Ginsberg, Past President President of the American Society of Health-System Pharmacists (ASHP), say these words it caught my attention. It captured my feelings about my love of volunteering for my profession. As officers and board members of AAHP, we are an all-volunteer group and it is a joy to serve you and the profession of pharmacy in Arkansas and beyond. "

for questions and education about them. Finally, they had the opportunity to meet the ASHP Pharmacy Student Forum Director, Diana Dabdub. In the fall, the students in the UAMS chapter conducted a health screening at the Arkansas Center for Respiratory Technology Dependent Children Family Resource Day this past fall. During this event for caregivers of the children, they provided blood pressure, glucose, and cholesterol screening along with counseling based on the results. They also participated in the UAMS employee health screenings. The UAMS chapter also made an impressive showing at the ASHP Midyear Clinical Meeting with Kate Merrell presenting a poster and Gavin Jones and Lucy Nguyen competing in the national clinical skills competition.

As a board, we have been busy working on a strategic plan for the next three years. We recently held an all-day strategic planning session led by Teresa Hudson, Pharm.D. Board members took a day away from their normal duties to brainstorm the direction we would like to take as an organization and as health-system pharmacists in Arkansas. This exercise was exciting as it included members who: have practiced less than 10 and more than 20 years, work in small rural and large teaching hospitals, and work in academia and practice as technicians. Even with this variety of experiences and practice settings, we all recognized the same need and shared a common goal. We embraced the need to position ourselves to be recognized as providers and viewed as partners in healthcare delivery and decision making. We shared the common goal of moving pharmacy forward through innovative practice models and partnering with other professionals to serve as resources for care. We will be releasing the full strategic plan this spring and look forward to your On left: Dr. Diana Dabdub and Dr. Rayanne Story with Harding SSHP Chapter. feedback. I hope you will be as excited as we are about the direction we are taking. The spirit of volunteering continues to resonate with our In the spirit of volunteering, our Student Society of Healthstudents and I am amazed and so proud of the work they System Pharmacists (SSHP) Chapters at Harding University are doing at their schools, in the community, and nationally and the University of Arkansas for Medical Sciences (UAMS) through ASHP. have been hard at work. As you can see, our students and the board of AAHP are hard The Harding chapter students held events to raise money at work volunteering for the profession. We would love to for the Susan G. Komen Race for the Cure which included have you join us. Please consider giving a small portion of a bake sale. They honored pharmacists in October for your time to help us continue moving in the right direction. National Pharmacist’s Month by making and distributing gift As an organization, we are learning, growing, and changing baskets. The Harding chapter showed up in full force with constantly and we need your help to keep the momentum 16 students attending the ASHP Midyear Clinical Meeting in going. Please contact me at LSWhite@uams.edu or any of Las Vegas, NV and presented three scientific posters. They your board members to ask questions and find out where you held a residency program roundtable to provide a forum can help. I look forward to hearing from you! §

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COMPOUNDING ACADEMY

Attend Compounders on Capitol Hill June 1-4

s most of you know, regulation of sterile compounding is a hot topic on Capitol Hill. Arkansas has an excellent State Board of Pharmacy which regulates our compounding pharmacies using the voluntary standards, United States Pharmacopeia (USP) <797> and <795>. Unfortunately, few states regulate at this level. Lack of regulation played a role in the tragic fungal meningitis outbreak caused by tainted products produced by the New England Compounding Centers. Some support regulation being under the Food and Drug Administration (FDA), while others support regulation remaining at the state level. Many propose all states must adopt USP <797> and <795> into their books and state inspectors need to be trained in these standards. Since legislators will make decisions this year which will affect our profession, it is a very important year to attend Compounders on Capitol Hill (CCH) which is hosted by the International Academy of Compounding Pharmacy (IACP). This year CCH is in Arlington, Virginia, just outside Washington, D.C., in the Crystal Gateway Marriott. It is a four-day conference from June 1 to June 4. Usually you can fly in Saturday and fly out Tuesday night. Every year attendees participate in a Saturday night kickoff party, two days of CE and compounding updates on Sunday and Monday, and the final day is spent on the Hill meeting with legislators. I encourage Arkansas compounders to visit our Senators and Representatives as a group. It is very powerful when we come in united to discuss our issues.

CCH is always a lot of fun and very rewarding. Hopefully we will have a strong representation from Arkansas this year. If you are interested in attending please visit www.iacprx. org to register.

Kristen Riddle, Pharm.D. President

In addition to sterile compounding, veterinary compounding will be discussed at CCH. IACP has confirmed that the American Veterinary Medical Association (AVMA) will head a panel at CCH as part of an overview of how compounding issues are being addressed by professional organizations representing prescribers. There is a possible veterinary pharmaceutical industrysponsored amendment that will have an impact on veterinary compounding pharmacy. IACP was asked to review the draft amendment by the Animal Health Institute (AHI). AHI is proposing to potentially restrict the compounding of certain Active Pharmaceutical Ingredient (API)-based preparations to a “positive” list which the FDA would create and maintain. IACP has stated that it is opposed to such a list and believes that as written, the proposed AHI concept is clinically unworkable. Whether or not you are involved in sterile compounding or veterinary compounding, it is important to unite with other compounders and protect the profession! §

Arkansas State Board of Pharmacy President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ronnie Norris, P.D., McGehee Vice President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Steve Bryant, P.D., Batesville Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Justin Boyd, Pharm.D., Fort Smith Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lenora Newsome, P.D., Smackover Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stephanie O’Neal, P.D., Wynne Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tom Warmack, P.D., Sheridan Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Larry Ross, Sherwood Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Joyce Palla, Arkadelphia

Arkansas Association of Health-System Pharmacists 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

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2013 Legislative Reception

(L to R) Reps. Charlotte Douglas and Charlene Fite with spouses.

Sen. Ron Caldwell and Stacy Riley.

(L to R) Reps. John Edwards and Chris Richey.

(L to R) Rep. David Whitaker, Lisa Whitaker and Cindy Stowe.

(L to R) Reps. Jeff Wardlaw, Tommy Thompson, Stephen Magie and Sen. Bobby Pierce.

UAMS College of Pharmacy students.

(L to R) Speaker Davy Carter, John Kirtley and Stephen Carroll.

(L to R) Former Sen. Percy Malone and Sen. Bruce Maloch.

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THE ARKANSAS PHARMACIST

Member Classifieds 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) For Sale: Sony Picture Maker Kiosk. Like New. Upgraded to New Machine. Great Starter System or Parts. Call 870-373-0083. (2/25/13) Full-time Pharmacy Technician needed at Conway pharmacy: Experience in retail pharmacy is preferred. Email resume to rxjrb@aol.com. (2/25/13) Full-Time Pharmacist Position in Melbourne. Staff pharmacist for LTC pharmacy located in Melbourne. No nights or weekends, but on-call rotation required. Consulting experience a plus. Send resume to AHS, P.O. Box 769, Melbourne, AR 72556 or mduncan@alliedhc.net. (2/12/13) Staff Pharmacist - North Arkansas Regional Medical Center. A partial list of duties includes order entry, preparation of intravenous medication solutions, selected clinical responsibilities, drug utilization review, and communicating recommendations to other healthcare professionals. NARMC offers a tremendous benefits package including healthcare, dental, and 401K. The successful candidate must be motivated to continually improving patient care and licensed in the state of Arkansas or eligible for licensure. Hospital experience is preferred, but not required. NARMC is a 174 bed acute care facility serving a regional area in the heart of the Ozark Mountains. Harrison, Arkansas is a great place to live, and NARMC is a great place to work. Harrison offers an outstanding quality of life including low crime rates, excellent public schools, low cost of living, and extensive outdoor recreational activities. A strong commitment to superior care backed with improved technology and resources makes NARMC your best choice for a rewarding career. Please submit your resume and application to: donna.copeland@narmc.com. Phone 870-414-4689. Fax:(870) 414-4544. EOE. (1/18/13) 38

Member Classifieds are free to APA members and $65 per issue for non-members. Contact eileen@arrx.org for more information.

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) Director of Pharmacy, St. Bernards Medical Center in Jonesboro. Full time, days. Comprehensive Benefits Package Included. JOB REQUIREMENTS: Education- Graduation from an accredited school of pharmacy with at least a Bachelor of Science in Pharmacy (BSPH) degree or Doctor of Pharmacy (PharmD) degree required. Must be licensed to practice pharmacy in the state of Arkansas, such licensure granted by the State Board of Pharmacy after passing the required examinations or by reciprocity based in passing such examinations in another state. Experience-Previous experience in hospital pharmacy is required. Previous management experience in the hospital and/or ambulatory setting is preferred. Physical- Normal hospital environment. Close eye work. Hearing within normal range. Operates computer, typewriter, calculator. Finger dexterity. Eye-hand coordination. Frequent sitting, standing and walking. May lift and carry up to 35 lbs. Some exposure to chemical hazards when making chemotherapy. JOB SUMMARY: Must be familiar with professional and commercial phases of pharmacy. Must have a working knowledge of pharmaceutical purchasing, compounding, dispensing, and control procedures. Must understand the role of the pharmacy department in the hospital, its interrelationships with other departments, and the functions of a department head. Must know principles of personnel management. Contact Tonya Riney, Recruiter,triney@sbrmc.org. (11/19/12) Pharmacy technician positions availableCantrell Drug Company is currently seeking to fill multiple non-retail pharmacy technician positions. These full-time positions will be on 2nd and 3rd shifts, to include weekends. The successful candidate will have proven experience in compounding while demonstrating an attention to detail and a focus on quality. Please send resume to dconaway@cantrelldrug.com. (11/19/12)

Licensed pharmacist with compounding experience available for relief- Please contact Pegah at 479-236-2244 or pegah@mtnsystems.com. I have been fortunate to train under the direction of highly professional pharmacists who have coached and mentored me. I am experienced in both retail and hospital, and have worked at Wal-Mart for 6 years. With my outgoing personality and energy and dedication, I believe I can provide the best customer service and make an immediate contribution to your team.(9/4/12) Pharmacist needed in Jonesboro- New pharmacy business locating in Jonesboro, Arkansas. Seeking full-time pharmacist. Competitive salary plus bonus structure and benefits. Ownership opportunity available. Motivated applicants can email resumes to jonesboropharmacy@yahoo.com. (8/15/12) Relief Pharmacist Available- Pharmacist 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) IVANRX4U, Inc., Pharmacist Relief Services, Career Placements- Relief 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 off, vacations, emergencies -- ALL your staffing needs. Also seeking pharmacists for full or part-time situations. Please contact Christine Bommarito, Marketing and Recruiting Director, or Mike Geeslin, President 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: Ivanrx4u@aol.com or Ivanrx4u-tracy@hotmail.com. (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)

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THE ARKANSAS PHARMACIST

AR•Rx

THE ARKANSAS PHARMACIST

2013 C ALENDAR OF EVENTS MAY May 7-8 National Community Pharmacists Association Legislative Conference Washington, D.C. May 11 Harding University College of Pharmacy Commencement Searcy, AR May 12 UAMS College of Pharmacy Commencement Little Rock, AR JUNE June 1-4 International Academy of Compounding Pharmacists 19th Annual Compounders on Capitol Hill Washington, D.C. June 6-8 APA 131st Annual Convention The Marriott Hotel (formerly the Peabody) Little Rock, AR AUGUST-SEPTEMBER Aug. 20 - Sept. 26 APA District Meetings (see schedule on page 19) OCTOBER Oct. 3-4 Arkansas Association of Health-System Pharmacists 47th Annual Fall Seminar Clarion Hotel (formerly University Hilton) Little Rock, AR Oct. 12-16 National Community Pharmacists Association Annual Convention Walt Disney World Swan and Dolphin Orlando, FL NOVEMBER Nov. 19-22 American Society of Consultant Pharmacists Annual Meeting and Exhibition Washington State Convention & Trade Center Seattle, WA

ARâ&#x20AC;˘Rx

THE ARKANSAS PHARMACIST

AR•Rx

THE ARKANSAS PHARMACIST