ARRx - The Arkansas Pharmacist - Summer 2013 by Arkansas Pharmacists Association

Summer 2013 Award Winning Quarterly Publication of the Arkansas Pharmacists Association

New APA President

Dana Woods Scoops Up Issues for Pharmacy

Support Group Offers Hope and Help for Pharmacists

Contents

Inside APA: Presidents and Governors

From the President: Enhancing the Role of Pharmacists

COVER: New APA President Dana Woods Scoops Up Issues for Pharmacy

Member Spotlight: Rob McNight, Kroger Pharmacy

RX and the Law: No Refills On Saturday

Safety Nets: Insulin Glargine

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

FEATURES: Support Group Offers Hope and Help for Pharmacists

Scott Pace, Pharm.D., J.D. Chief Operating Officer Scott@arrx.org

A Perspective on Addiction: Prescription for Progress

Legislator Profile: Senator Ron Caldwell (R-Wynne)

Eileen E. Denne, APR Senior Director of Communications Eileen@arrx.org

Mike Ross Fundraiser Nets $188,000

AFMC Quality Notes: Antimicrobial Stewardship Programs

Pharmacist Immunization Program: Arkansas Pharmacists Increase Adult Immunizations Up to 300 Percent

UAMS and Harding COP Reports: 2013 Salary Survey Results

Debra Wolfe Director of Government Affairs Debra@arrx.org

Arkansas Association of Health-System Pharmacists: Planning for Annual Fall Seminar Oct. 3-4

Office E-mail Address Support@arrx.org

APA Compounding Academy: Compounders Fight S.959; Warren Lee New President

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

2013 Annual Convention: APA Honors Individuals with 2013 Awards Thanks to our 2013 Annual Convention Exhibitors

Arkansas Pharmacists Association 417 South Victory Street Little Rock, AR 72201-2923 Phone 501-372-5250 | Fax 501-372-0546

Member Classifieds

2013 District Meeting Schedule and Calendar of Events

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 63. © 2013 Arkansas Pharmacists Association.

Cover photo by Bri Woods-Chaney Photography.

Directory of Advertisers 2

Pharmacists Mutual Life Insurance

18 Arkansas Association of Health-System Pharmacists

EPIC Pharmacies

37 Pace Alliance

UAMS Alumni Association

38 Retail Designs

Bell

38 The Law Offices of Darren O'Quinn

16 Arkansas Pharmacy Support Group

39 Pharmacy Quality Commitment

18 First Financial

40 APA Honors Morris & Dickson

APA Staff

Eric Crumbaugh, Pharm.D. Immunization Grant Coordinator Eric@arrx.org Matt Merrigan, MSOD Director of Membership and Meetings Matt@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org

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

AR•Rx

THE ARKANSAS PHARMACIST

APA Board of Directors

INSIDE APA

2013 -2014 Officers

Inside APA

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

PRESIDENTS AND GOVERNORS

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

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

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

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

Arkansas Association of Health-System Pharmacists

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

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

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

Mark Riley, Pharm.D. Executive Vice President

s I write this article, the 131st Annual Convention of the Arkansas Pharmacists Association has just ended. My, how time flies. I presided as President over the 103rd convention… it doesn’t seem that long ago. Our meeting was a huge success with increased attendance, great Continuing Pharmacy Education, a sold-out exhibit hall of great exhibitors, an awards ceremony packed with almost 250 people, a terrific party at the Museum of Discovery and a great Political Action Committee luncheon. All of the attendees seemed to have a really great time. The staff (Scott, Matt, Eileen, Celeste, Debra, and Eric) did a great job and we are already meeting to explore ways to improve the 132nd Annual Convention, which will be held at the Chancellor Hotel in Fayetteville on June 12-14, 2014. We thank the volunteer pharmacy students, particularly our June rotation student, Neil Roe. We couldn’t have done it without students’ help. But speaking of the presidency, outgoing President Dennis Moore did a great job of presiding over the various meetings and social events that transpired during the convention. It was a true pleasure to work with Dennis this year. He brought great ideas to the table and broadened my thinking on many pharmacy issues. One of his last official acts was to establish a committee to work on provider status and recognition for Arkansas pharmacists. This is a wonderful idea and we are grateful for Dennis’ leadership on this important issue.

I am also looking forward to Dana Woods’ leadership as president in the coming year. A personal friend for many years, Dana has served this association in the past as a board member and now his most recent board stint has led to the presidency. He brings a world of experience in community pharmacy as well as his work with the hospital in Mountain View. Plus, he can really make ice cream. Attendees at the Museum of Discovery were treated to Dana’s homemade ice cream. Thanks to Dana and Annette for providing this wonderful dessert! When you get this issue of AR•Rx, we will have held the fundraising event for Mike Ross for Governor. The former Congressman from the 4th district is also a former pharmacy owner and is married to pharmacist and APA member Holly Ross. During his days in Congress, Mike either sponsored or heavily supported all of our legislation. He has been a staunch advocate and spokesman for pharmacy at every opportunity. The pharmacy profession may never again have the opportunity to be this close to a Governor that will understand our complicated issues without extensive explanation. I encourage you to give to his campaign if you haven’t done so, and I thank all of you who gave so generously to the fundraiser. And now, back to figuring out healthcare exchanges and the Medicaid private option. That should take a few days... I’ll keep you posted. §

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THE ARKANSAS PHARMACIST

FROM THE PRESIDENT

From the President Enhancing the Role of Pharmacists

ollowing a great 2013 Annual Convention in Little Rock, I am looking forward to the year ahead as your APA president. There are several issues that I would like to pursue on behalf of pharmacists: medication adherence, prescription drug abuse, provider status and public awareness of pharmacists.

of controlled substances by providing data on who is prescribing and dispensing controlled prescription drugs. We hope the PMP program will lead to early intervention and prevention.

A recent study found that improper and unnecessary use of medications led to health care costs of more than $200 billion in 2012. The study went on to say that the costs can be attributed to patients either receiving the wrong medications or failing to take them. It calls for collaboration among providers, pharmacists, patients, payers, pharmacy manufacturers and policy makers. Medication adherence is something we can all get behind as a profession.

In addition to prescription drug abuse, another issue worthy of APA’s focus is pharmacists’ provider status. In June, past president Dennis Moore appointed a special committee of pharmacists and students who are volunteers or officers of national organizations for which this issue is a priority. The American Pharmacists Association (APhA), for example, has reengaged on the issue of the recognition and valuation of pharmacists’ clinical services and made it their top strategic priority for 2013. The APA committee will examine the issue and recommend to the Board how we can move forward in Arkansas and nationally to get provider status for pharmacists. The committee includes: Drs. Mark Riley, Dennis Moore, Nicki Hilliard, Stephanie Garner, Julie Hixson-Wallace, Tery Baskin, Rodney Richmond, Susan Newton, myself and Ms. Brandi Hamilton. I am excited about what this group can accomplish on our behalf.

Dana Woods, PD. President

92 percent of patients surveyed think that it is important for their pharmacist to be a member of the APA. Are your colleagues members?

We also need to continue to fight the battle of prescription drug abuse, including the abuse of both legend and controlled drugs, among all age groups, but particularly among teenagers. As Prescription Drug Monitoring Program (PMP) director Denise Robertson said during her convention presentation, Arkansas ranked among the top five states for nonmedical use of prescription pain relievers by persons aged 12 and older from 2010-2011. The goals of the PMP are to enhance patient care and limit the misuse and abuse

A final issue which I want to highlight is the marketing and public relations campaign which we started last fall. The campaign launched with television ads and continues with radio ads, plus media placements highlighting local pharmacists. We also have in-store opportunities to promote the profession. The most recent survey results indicate that 92 percent of patients surveyed think that it is important for their pharmacist to be a member of the APA. Are your colleagues members? Each of these initiatives builds on the efforts of the previous APA leaders. I would like to thank the board and Dennis Moore for laying the groundwork for an excellent year. APA members are blessed to have enthusiastic and energetic leaders to help us meet our goals. I hope to meet and talk to many of you about the issues that impact us at upcoming District Meetings. §

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THE ARKANSAS PHARMACIST

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THE ARKANSAS PHARMACIST

APA President

Dana Woods Scoops Up Issues for Pharmacy By Eileen E. Denne, APR

APA membership has safeguarded the profession and moved it forward. They have gone to bat for us lots and lots of times. My membership is invaluable in what it has done for me and my colleagues.

PA’s new President, Dana Woods, P.D., of Mountain View, has an unusual preoccupation – picking out new ice cream flavors for the Woods Old Fashioned Soda Fountain. Not only is he trying out frozen treats to entice customers, he is scooping up the background and knowledge to help the pharmacy profession statewide. “I’d like our members to know that I am interested in promoting pharmacy and I’m proud to be a pharmacist,” Woods says emphatically. “It’s a great profession and I enjoy working with people.” He currently works two to three days per week at Allied Healthcare in Melbourne where the pharmacist-in-charge is Mary Beth Duncan. Woods owned Woods Pharmacy and Soda Fountain in Mountain View for 28 years and recently sold the pharmacy to Eddie Mitchell, Pharm.D., a young pharmacist whom he watched grow up in Mountain View. “I wanted to turn over the business while it was successful and while I was still somewhat young,” says Woods. The change has meant less stress; he can go to work and

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THE ARKANSAS PHARMACIST

Photo by Bri Woods-Chaney Photography

APA President Dana Woods at the Woods Old Fashioned Soda Fountain in Mountain View.

doesn’t have to bring it home now. He really enjoys his job but senses there may be a bigger role for him in pharmacy. Time will tell, Woods says. Woods’ grew up in Jonesboro and graduated from Jonesboro High School. A close family friend led him to pharmacy. Pharmacy mentors in Jonesboro, Mountain View and Little Rock “Roger Harmon is a family friend,” says Woods. “Watching him had a big influence on me. Roger was active in community programs that I observed. My sister and Roger’s daughter Lisa are good friends and when I was a kid I threw newspapers to Roger Harmon, Albert Soo (Soo’s Pharmacy) and Bob Evans (Camp’s Medical Pharmacy) in Jonesboro. “I worked with Roger at St. Bernard’s while I was in college in Jonesboro. I attended a semester at Harding and two years at Arkansas State University doing pre-pharmacy courses before starting at University of Arkansas for Medical Sciences (UAMS). I graduated in 1982.” After graduation, Woods worked for Jerry Moody at Best Drug in Mountain View for two years then for Joe Wyatt for 13 months. On Jan. 1, 1986, Woods purchased Wyatt Drug Store from Joe and changed the name. He and his

APA PRESIDENT DANA WOODS

“That’s the biggest change from 30 years ago. The patient used to be fully responsible. Also, prescriptions were more affordable then than now if they didn’t have insurance.” While he enjoyed the monetary rewards, he most appreciated the relationships with so many good people and the opportunities to help when they didn’t have anywhere else to go. His patients didn’t always have money for their own or their children’s medicine. As a community business person, he could help them in lots of ways. APA membership at UAMS Like many students, Woods first became involved in APA as senior in pharmacy school at UAMS when he attended his first District Meeting. Dana Woods, P.D. and Eddie Mitchell, Pharm.D.

wife Annette built the new building and added the soda fountain in 1993.

“APA membership has safeguarded the profession and moved it forward,” Woods says. “APA has gone to bat for us lots and lots of times. My membership is invaluable in what it has done for me.”

In addition to Roger Harmon, Woods’ other pharmacy heroes include Don Rogers of Don’s Pharmacy in Little Rock, and Larry Tedford, who also served as a pharmacist there, as well as Jerry Moody.

Asked how he would advise new pharmacy school graduates, Woods said he would tell them to find a job that is fulfilling to them so they can help people. As far as APA is concerned, he advises students to become a member and get involved.

“Jerry Moody was an inspiration in many ways. I learned so much from both Jerry and Don. Don gave me the opportunity to learn and let me know about my mistakes. I also enjoyed working closely with Larry, who was very patient with me,” Woods says.

Challenges for pharmacy in Arkansas Woods describes the number one challenge for pharmacists in Arkansas as continued dealings with insurance companies and Medicaid expansion. “I think pharmacists should have and need to have a more direct role in patient care.”

Community pharmacy challenges During his years as owner of Woods Pharmacy and Soda Fountain, Woods found dealing with insurance companies and government most challenging. “People didn’t have insurance cards when I bought the pharmacy,” he says.

He considers APA’s three academies (Consulting, Compounding and Health-Systems) to be important because they set themselves apart in specific interests. He would like to see each academy develop programs that cater to their academy members, including Continuing Pharmacy Education or other things. In the coming year, Woods’ agenda for APA includes a focus on provider status and getting pharmacists more involved in patient care. He would like to see pharmacists get reimbursed for the things they are doing. The current marketing and public relations campaign promotes idea of pharmacists interacting with patients. He’d like to encourage pharmacists to interact more with patients while acknowledging that they are under pressure to produce prescriptions in a short period of time. When he is not serving Arkansas pharmacists, Woods and Annette, his wife of 34 years, are members of School

Woods Soda Fountain in Mountain View.

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THE ARKANSAS PHARMACIST

APA PRESIDENT DANA WOODS

Avenue Church of Christ. They continue to own and operate Woods Old Fashioned Soda Fountain and they are having fun coming up with new ice cream flavors. (The Woods’ ice cream was served at the Museum of Discovery party during the 2013 APA Annual Convention to rave reviews.) He has enjoyed being on the Mountain View Planning and Zoning Commission and currently serves as the chairman. He is also an avid pilot and has owned his own Cessna 182 for the past 26 years. The Woods’ son Hunter is 24 years old and lives in Denton, Texas, where he works as a flight instructor. Their daughter Brittney is 28, lives in Conway and is a photographer. Woods would like to see more membership involvement in the association and more communication with non-members to demonstrate what APA does. “APA,” he says, “represents your interests regardless of your practice specialty. APA benefits the entire profession. If a person has an interest in the profession, they ought to be a member. I think people have an obligation to give back and membership is one way to do that. It’s a pretty small investment for the return.” §

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THE ARKANSAS PHARMACIST

APA President Woods in the exhibit hall at the 2013 Annual Convention.

COMMUNITY PHARMACY MARKETING AND PUBLIC RELATIONS 101

MEMBER SPOTLIGHT

Rob McNight

Kroger Phar macy in t he Heights, Little Roc k

Pharmacy Practice: Retail.

Recent Reads: American Hunter magazine.

Graduate pharmacy school and year: University of Arkansas for Medical Sciences College of Pharmacy in 1999.

Fun Activities: Hunting and fishing with my wife Amber and children Alyssa, age 15; Mitchell, age 7; and Hudson, age 6. Playing golf and coaching baseball.

Years in pharmacy: I started out as a delivery boy for my father’s pharmacy in 1989. I have been “saving lives” at Kroger for 10 years.

Ideal dinner guest: Theodore Roosevelt. If not a pharmacist then…: The world's most frustrated high school baseball coach. §

Favorite part of the job: Teaching pharmacy student interns how to communicate and develop trust with our patients. Least favorite part of the job: The excessive paperwork involved with Medicare Part B prescriptions compared to other prescriptions. Oddest request from a patient/customer: A lady showed up at my counter with a baby squirrel in her purse. She wanted my advice on how to take care of it.

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THE ARKANSAS PHARMACIST

No Refills On Saturday 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.

at was working a long shift on Saturday at the Anytown Pharmacy. He was hoping for an uneventful day. Sometime after lunch, Mrs. Jones came in for a refill of her Keppra. When Pat looked at Mrs. Jones’ profile, he saw that there weren’t any refills remaining. To make matters worse, Mrs. Jones’ physician, Dr. Brown, had just recently retired and closed his practice. With no refills left and no one to call, Pat’s afternoon just got longer. The solution to Pat’s dilemma depends on his state’s pharmacy laws. Many states have regulations that deal with situations where no additional refills are authorized. In the old days, many pharmacists would give the patient enough medication to get them through until Monday when the physician’s office opened. However, there was no legal authority for doing this. That is not always true today. Consider this excerpt from a statute from Ohio that allows a pharmacist to dispense medication when a prescription is out of refills: (3) In the exercise of the pharmacist's professional judgment: (a) The drug is essential to sustain the life of the patient or continue therapy for a chronic condition of the patient. (b) Failure to dispense or sell the drug to the patient could result in harm to the health of the patient. (4) The amount of the drug that is dispensed or sold under this section does not exceed a 72-hour supply as provided in the prescription. If Pat was practicing in Ohio and believed that the Keppra was needed to continue therapy for Mrs. Jones’ chronic condition, then Pat could dispense a 72-hour supply. If Pat was practicing in Iowa, then a similar law2 would apply. The relevant parts are: (2) A pharmacist may exercise professional judgment by refilling a prescription without prescriber authorization if all of the following are true: (a) The pharmacist is unable to contact the prescriber after reasonable effort. (b) Failure to refill the prescription might result in an interruption of therapeutic regimen or create patient suffering. (c) The pharmacist informs the patient or the patient’s representative at the time of dispensing, and the practitioner at the earliest convenience that prescriber reauthorization is required. The major difference is that the quantity is not limited to a 72-hour supply. The limitation is for a period of time reasonably necessary to secure an authorization. In contrast, Alaska doesn’t have a similar provision. In fact, their regulation3 says: 'If there are no refill instructions on the prescription drug order, or if all refills authorized on the original prescription drug order have been dispensed, a pharmacist shall obtain authorization from the prescribing practitioner before dispensing a refill.'

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THE ARKANSAS PHARMACIST

But remember, Pat’s dilemma is a little more complicated than these laws address. Pat has no one to call on Monday morning; Dr. Brown has retired. Again, depending on state law, Pat may have his answer. Iowa has a regulation4 that provides: 'Prescription drug orders and medication orders shall be valid as long as a prescriber/patient relationship exists. Once the prescriber/ patient relationship is broken and the prescriber is no longer available to treat the patient or oversee the patient’s use of a prescription drug, the order loses its validity and the pharmacist, on becoming aware of the situation, shall cancel the order and any remaining refills. The pharmacist shall, however, exercise prudent judgment based upon individual circumstances to ensure that the patient is able to obtain a sufficient amount of the prescribed drug to continue treatment until the patient can reasonably obtain the service of another prescriber and a new order can be issued.' In this situation, Pat has little anxiety taking care of Mrs. Jones until she can make an appointment with her new physician. The first lesson we can learn from Pat’s dilemma is to make sure that we are familiar with our own state’s laws and regulations and to know where to look for these answers. What if we aren’t lucky enough to practice in a state where laws have been passed to address these situations? We, as well as Pat, are then faced with a legal and ethical dilemma. We are forced to use our professional judgment. Any further dispensing, which is a violation, must be weighed against the potential harm to Mrs. Jones. Is the medication essential to Mrs. Jones’ health? Is she likely to suffer harm if she goes without her Keppra? Essentially, this is performing the triage required in Ohio and Iowa. What is the correct answer? That will depend on the circumstances presented. A pharmacist can’t be forced to break the law, that is, to dispense a prescription drug without a valid prescription.5 But there could be circumstances where the pharmacist might want to put the patient’s welfare ahead of their own. That is the exercise of one’s professional judgment. That exercise will be easier and less stressful to perform if the pharmacist is prepared with a knowledge of their own state’s laws and regulations. § _________________________________________________________ © Don R. McGuire Jr., R.Ph., J.D., is General Counsel at Pharmacists Mutual Insurance Company. This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly. (1) ORC 4729.281 (2) Iowa Code 155A.29 (3) 12 AAC 52.470 (4) IAC 657-8.20 (155A) (5) Chiney v. American Drug Stores Inc., 21 S.W.3d 14 (Mo.App. W.D., May 2, 2000) 11

COMMUNITY PHARMACY MARKETING AND PUBLIC RELATIONS 101

UNIVERSIT Y OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

Insuline Glargine 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.

he computer generated prescription illustrated in Figure One was transmitted from a prescriber’s office to a community pharmacy in Southern Arkansas. The prescription was for a 48 y/o female. The pharmacist verified the E-Prescription for Lantus® Solostar® (insulin glargine [rDNA origin] injection) with direction to the patient of “inject 100 units subcutaneously once daily”. Following verification, the order was filled by a pharmacy technician and placed in line for final pharmacist verification and patient counseling. The pharmacist began the counseling session by instructing the patient how to use the Solostar® Pen device. He explained to the patient that she would need to administer two separate injections of 50 units each in order to receive the prescribed 100 unit dose [Note: according Figure One to the manufacturer, patients who require more than 80 units of insulin from a Lantus® Solostar® device should use two or more injections to achieve the dose]. At this point, the patient interrupted and said it was her understanding she was to administer 15 units of insulin per dose – not 100 units. The pharmacist reexamined the prescription and realized the patient “Directions” on the E-Prescription actually contained the insulin concentration of Lantus® Solostar® (100 units/mL), while the “label ins” (i.e. label instructions) contained the intended dose of 15 units daily. A telephone call to the prescriber confirmed the patient was to receive 15 units daily – not 100 units. After this, appropriate changes were made in the pharmacy computer, a corrected prescription label generated and the patient correctly counseled. Electronic or E-Prescriptions are transmitted from the prescriber directly into the pharmacy’s computer system. The use of this type of medication order continues to increase. Electronic prescriptions have been touted as having certain advantages over handwritten prescriptions including reducing the incidence of medication errors – especially those resulting from look-alike, sound-alike mix-ups. Electronic prescriptions may also reduce the risk of errors occurring during the order12

entry process. While electronic prescriptions may indeed reduce the likelihood of certain types of errors, their use does not guarantee an error-free order. In this case, the hazardous electronic prescription itself is the problem. The E-Prescription actually contains two different sigs: 100 units daily and 15 units daily. Each sig. is listed beside two separate headings – “Directions” and “Label Ins”. While checking the prescription for accuracy, the pharmacist verified the “Directions” (i.e. 100 units daily) and sent the order to the prescription filling station without noticing the “Label Ins” (i.e. 15 units daily) listed at the bottom of the order. This electronic prescription is confusing, hazardous and potentially deadly. This prescription format dug a pit that any busy pharmacists or technician could have stepped into, with catastrophic consequences. Fortunately for the patient in this case, the pharmacist performed Board of Pharmacy required patient counseling. If the pharmacist had not counseled and the patient had followed the incorrect instructions on the prescription label, the results could have been devastating. Patient counseling remains a pharmacist’s last – and best – safety net to prevent medication errors from reaching patients. Pharmacists for some time will be at the mercy of program writers who understand data processing, but not pharmacy. Whoever devised this: “Directions” and “Label Ins” never heard of USP requirements for a valid, safe prescription. It is scandalous to create – and purchase – a system that places patients at hazard and steers anyone toward a medication error. Electronic prescriptions are not guaranteed to be error-free. In fact, the legibility and neatness of electronic prescriptions may – in some cases – increase the risk of error compared to handwritten prescriptions which may be more carefully examined by the pharmacist. Pharmacists must remain careful to scrutinize all prescriptions – handwritten and electronic. § AR•Rx

THE ARKANSAS PHARMACIST

Support Group Offers Hope and Help for Pharmacists By Eileen E. Denne, APR

he first call is the hardest for most. Dr. Kim Light says denial of addiction is a tough thing, especially when every day aspects of life wear you down.

principles of support and accountability that guide us,” Light said. The ARPSG serves as a diversion program to which the Board may refer licensees, and as a source of treatment referral and recovery monitoring for those who wish to avail themselves of these services on a voluntary basis. Those in the group have experienced problems ranging from alcoholism to the abuse of various legal and/or illegal drugs.

Light, Professor of Pharmaceutical Sciences and Professor on Alcohol and Drug Abuse at the University of Arkansas for Medical Sciences College of Pharmacy, is often the first stop for pharmacists on the path to help and hope. He serves as executive secretary of the Arkansas Pharmacy Support Increased and often unconscious use of alcohol and other Group (ARPSG), a group of pharmacists drugs as a coping mechanism can be recovering from addiction illness, who According to Light, the a response to the many challenges in are now living healthy, normal and pharmacy today, whether dealing with national statistics suggest productive lives. In addition to work third parties, retail competition or finding and family obligations, they devote many that 15 percent or one the right job. hours each week to helping others. in eight pharmacists will As the use of alcohol or drugs increases, become addicted over the there is greater likelihood of dysfunction Addiction is a disease “Addiction is a disease of fear,” Light says. course of their career. and development of addiction in “It has such a strong grasp. Hitting rock individuals. Alcohol and drug problems bottom is a bit of a cliché. You have to get have maintained a prime position among to the point of ‘Ok, I’m changing and I am not willing to lose the threats to the individual professional as well as the this battle’. Reality is hard to face sometimes. Recovering profession as a whole. addicts ask themselves ‘Why did I wait so long?’ because they find life in recovery is so much better. What you get For the pharmacist, the diversion of controlled substances is so much more than that. It may be fear of what [addicts] may lead to felony charges/convictions that can – and do have to go through to get to recovery but most of the fear – severely restrict their professional opportunities. A felony is just fear. It is amazing to me how fear immobilizes us.” usually results in a much decreased chance of the individual obtaining a position in a dispensing practice, and this fact The ARPSG started in January 1983 when the first pharmacist robs the profession of the benefits of having a capable, with an addiction problem entered treatment under the skilled, and now sober – professional, practicing in a manner direction of the State Board. The first meeting of four to five that helps patients, the profession, and the individual. recovering pharmacists was in July 1987. Subsequently, in 1992 enabling legislation was passed that resulted in State According to Light, the national statistics suggest that 15 Board Regulation 10 – governing the ARPSG. percent or one in eight pharmacists will become addicted over the course of their career. “We owe so much to those early pharmacists and the ones who came in during the 1990s, because they carved out the

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THE ARKANSAS PHARMACIST

SUPPORT GROUP OFFERS HOPE AND HELP

including an addictionologist (physician who diagnoses addiction). Through the evaluation, the team determines or assigns a diagnosis of addiction. Once diagnosed, the team will recommend some type of treatment. Primary treatment is usually 60 or 90 days of intensive therapeutic treatment that is done immediately. Then their counselor will contact the Support Group to let them know how the pharmacist is doing and about the discharge date. “Once the pharmacist is discharged, they meet with the Support Group and sign a monitoring contract. The contract, which is generally for five years, outlines specific actions such as the minimum number of 12-step meetings, random drug testing and regular contact with their Support Group monitor (a committee member). As a monitor, we make regular contact with the recovering Dr. Kim Light talks about the help and understanding offered by the Arkansas Pharmacy pharmacist. Their contract requires Support Group. monitor contact at least once a week for the first two years and bi-weekly “It is an occupational hazard,” says Light. “A lot of people thereafter. The contract is in place to monitor and advocate think addiction is a matter of will power. In reality it is no for the pharmacist as they comply with the requirements of more a matter of will power than diabetes is a matter of will the State Board’s order specific to the actions taken on the power. Addiction is also not a disease that readily responds to pharmacist’s license.” punishment. It occurs at its core level, in the mid-brain regions that normally function to Support Group a safe haven for promote survival. That’s where addicting A lot of people think pharmacists drugs activate and they rewrite the script so addiction is a matter of The monitor, along with the committee, the drug equals survival. That's what makes will power. In reality it is ensures that the recovering pharmacist treating addiction hard.” is attending 12-step support meetings,

no more a matter of will power than diabetes is a matter of will power.

The ARPSG consists of Light, a fivemember executive committee and two alternate committee members, along with all recovering pharmacists who wish to participate, whether under contract or not. While Light is the main contact, the executive committee members, including alternates, provide the primary guidance for those who are referred to the ARPSG. Every member of the committee serves on a voluntary basis. One of the executive committee members, who asked to remain anonymous, explains the recovery process once a pharmacist is referred.

Diagnosis and the recovery process “From that first call after intervention, which could be Board of Pharmacy action or an employer action, the contact person is often Kim. He has all the numbers and contacts of treatment centers. There are several recognized as acceptable treatment centers. We recommend that the pharmacist get an evaluation over two to three days. This is done by a team

making regular contact, and remains in compliance with the drug testing program. They build a personal relationship with the pharmacist as well and become the pharmacist’s primary contact. When the pharmacist feels ready to return to work, the monitor is the first stop in the Support Group advocacy process. “A big part of recovery is helping others by sharing the message and helping someone walk the path that we walked. The things we look for is whether the pharmacist is engaged in a 12-step program, and attends on regular basis, whether they call their monitor every week and go for regular therapy. From the perspective of a recovered addict, we look to see if they are progressing. The monitor uses his or her own experience as a gauge.” “The Support Group is made up of regular people,” the monitor says. “People have preconceived notions of what an addicted pharmacist looks like. In fact, we’re regular people

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with a disease and continued recovery from that disease is through participation in the ARPSG." This paradigm of recovery monitoring as evaluated within similar professions has shown significantly high rates of sustained recovery. There are 5 to 10 pharmacists who are referred to or make contact with the Support Group per year. The demographics reflect the profession and participants range from students to older men and women of all races. “Being a pharmacist with an addiction problem is really no different from anyone with an addiction problem,” the monitor says, “other than the fact that we have easier access to drugs, which allows the disease to progress more rapidly. We want individuals to know they are a recovering person as opposed to a recovering pharmacist so it’s important for them to have some time to focus just on recovery before returning to practice. “The number one thing that keeps people from coming into the Support Group is shame and how much is involved when in you are in the middle of addiction. Just because you are a pharmacist doesn’t make you immune to addiction. “‘Living life on life’s terms’, an expression we use often in recovery, is the magic moment when the pharmacist starts to realize that their primary focus shouldn’t be the situations they are in but how they respond to those situations. This is an important component to recovery.” UAMS has required course on addiction Light says that in addition to Arkansas having the ARPSG, UAMS is the only College of Pharmacy in the country with a required course on addiction (since 1984). Members of the Support Group come to class and tell their stories.

“It is a tremendous gift for a recovering pharmacist to tell their story to students,” Light says. “Students can hear it from me but that’s not a personal perspective. When they experience someone else who is a pharmacist telling their story, it’s personal, and students can relate. A lot of students will say ‘that was one of the most important aspects of the course’.” One of the saddest things, Light says, is those who refuse assistance or don’t respond. Several have died of this disease and that is a loss for all of us. The other sad reality, he says, is those who end up with felony convictions and can’t get back to regular practice even though they have solid recovery and would be a good pharmacist. “It’s easy to see or hear about an addict and conclude that they just don’t care about others or the consequences of their actions. But addicts are just trying to survive, they’re not thinking ‘oh this could hurt someone else’, they’re acting on am impulse that pushes them to survive. They don’t know that part of their brain is not working properly. It’s a brain disease!” In order to help offer a deeper understanding of the realities of addiction as a disease that impacts pharmacists and recovery, here is an excerpt from an anonymous story offered by a pharmacist in the ARPSG. The ARPSG offers this final thought: sharing of experiences, strength and hope is a practice that has proven itself time and time again as the most effective way of reaching the individual who still suffers. It also turns out to be one of the most robust ways to maintain and grow in sobriety for the recovering individual.

Story from an ARPSG member:

“I’m Glad I Got Caught" “I went to a doctor because I thought I had pulled a muscle and was prescribed hydrocodone. This drug solved all my problems. It made me feel good; it took away any physical and emotional pain. I was able to work 12-hour days with ease. The great thing about taking hydrocodone (added with Soma in case I needed that extra good feeling) was that my drinking decreased. I could be feeling good, controlling my emotions or any other pain and no one knew I was taking anything - especially my family. I began by taking the broken tablets because all we were going to do was throw them away anyway. That was easily justifiable. As my tolerance

grew I began having to take pills out of the pharmacy by the pocketful…. On the morning of an interview for a new job, I got a call from the State Board of Pharmacy asking me to come down to the office to discuss something. I was certain I would be able to explain my way out of any trouble I might be in. However, I was confronted with everything I had been doing and all the paper trails I had been leaving. There was no way to explain away what had been happening except that I had a drug problem. I couldn’t deny it any longer. I signed an order saying (Continued)

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that I would not practice pharmacy until I got help and was asked to contact the ARPSG. The shame I went through in the next few months was horrible. I had let down the profession I loved so dearly and everyone I knew in it. I was sure every pharmacist in the state knew what a horrible person I was and what a fraud I had been. While I was deep into my addiction, one thing my husband and I really liked to do was to spend money, so naturally, I had no savings. All of a sudden I had no salary to pay the bills. My husband was also out of work. Through a series of small miracles, I was able to obtain an evaluation and enter a treatment program out of state. During that time I learned a lot about my disease and about myself. All my life I had believed that a pharmacist was what I was, not what I did. I came back home and found a job outside of pharmacy while I started putting recovery living into action. Ultimately the ARPSG advocated for me to return to

practice and went with me to the Board to discuss the possibilities. I was able to return to the practice of pharmacy for an extended probationary period which was completed several years ago. I now know what a privilege the opportunity to practice pharmacy really is. In recovery I have found what I was looking for all my life. I related to the very first person who shared their story. I began to hear people describe feelings I had been wrestling with for years. They told me to ‘Let us love you until you can love yourself.’ These people didn’t know me. How could they know I didn’t love myself? Living life on life’s terms is not always easy, but it is much easier to do when I am being honest with myself and not trying to hide who I really am. My life is good now. As much as I hate to admit it, I am glad I got caught. It was the best thing that could have happened to me. If I hadn’t been caught, I wouldn’t know the happiness and freedom that being in recovery can bring. I wouldn’t have the people in my life now that I love so dearly: my husband, my family, my friends and my Higher Power.”

The ARPSG meets the first Sunday of every month in a meeting room at St. Vincent’s Hospital in Little Rock. Get more information through the confidential support group hotline (870-636-0923) or email Arkansas.PSG@gmail.com. The phone is answered by a committee member of the support group. §

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PRESCRIPTION DRUG MONITORING PROGRAM

A Perspective on Addiction:

Prescription for Progress By Dennis F. Moore, Pharm.D.

Among the many tragedies of our current approach is the ealing with someone experiencing addictive disease (alcohol or other drugs) can be one of absolute waste of the national treasury and human potential. the most frustrating experiences in life. Most of The jails are full of inmates that are addicts—at an expense us are prisoners of old attitudes that no longer match the that is astronomical. The recidivism rate after incarceration current understanding of addiction, and those attitudes still is around 70 percent—for they do not understand the illness dominate most social policy. We have difficulty separating they have and the methods of control. If incarceration addiction from our own value systems. We look with disdain worked, that would be a reasonable approach. However, it on the opiate addict because as they secure their drug it is is clearly not working. Since our 40-year experiment with the many times under the cloak of illegality. Yet we condone— war on drugs began, drugs are more accessible and cheaper and even encourage—the promotion of tobacco products than ever before—while our prisons overflow. And with the that contain nicotine—one of our more addictive agents. ebb and flow of drug of choice—with the current being Additionally, we would be laughed at if we pointed the blame prescription opioids—the safety of our fellow professionals for alcoholism on suppliers. However, blaming suppliers for is threatened. There is another way. our current drug problems dominates our current approaches to resolution. Understanding this disease Progress is being made. In this AR•Rx you Our emerging scientific understanding will find a discussion of how Arkansas of addiction does not allow for these is a prescription for us is attempting to address the problem artificial distinctions we have made in moving forward. It is not of impairment among pharmacists. drugs over decades—the perils of trying only the smart thing to do I was first introduced to the problem to discuss addiction and drug control. of addiction among pharmacists (the as it relates to fiscal policy, leading cause of impairment) in the The most notable symptom that but also the right thing to 1970s when there were few avenues allows for the identification of the do from a humanitarian for support. We are fortunate to have disease of addiction is an appetite for made great strides in identification, the consumption of a drug in spite of perspective. intervention, treatment, and support for obvious consequences. The drug might our fellow professionals that have been be legal, illegal, prescribed or otherwise afflicted with the illness. However, there obtained. It may have varying effects on mood alteration, is much more to do, not just in our professional circles but but its defining characteristic is the ability to induce its own also society at large. consumption through the reward mechanisms of the brain. This is predominately a biological disease with psycho-social I would advocate that pharmacy—as a profession—take a consequences. Every day, millions of people make decisions leadership role in helping our nation deal with the nightmare to self-limit the supply of both recreational and prescription of addiction and drug control. A study of international drugs. However, some fail in that effort. The failure may be at approaches to addiction and drug supply reveals that we the time of first consumption, or it may occur after prolonged have a lot to learn. We are at a point in social consequences consumption combined with other risk factors. Thus when of addiction and drug control that it is compromising many we see someone with the inability to turn the consumption of our institutions, i.e., families, neighborhoods, courts, “off,” we can’t understand why they “can’t see what they are criminal justice, medical costs, etc. Perhaps it’s time we doing to themselves and others.” With that, we are brushing moved addiction to the public health arena and not criminal up against the “disease of addiction.” justice system—with health care, and pharmacy, leading the way. My prediction is that we will someday look at today’s AR•Rx

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A PERSPECTIVE ON ADDICTION

practice in dealing with addiction as archaic as when those with epilepsy were treated in psychiatric hospitals. It is not the intent of these comments to engage in all the ramifications of supply side reduction, the so called “war on drugs,” and the lack of identification of the illness of addiction (which creates the demand). However, I am taking the position that an understanding of addiction based on new scientific discoveries in brain electrophysiology, neuropharmacology, and genetics will go a long way in allowing one to have a much healthier approach to a condition that seems almost intractable. The American Society of Addiction Medicine (ASAM) advances the idea that “addiction is not about drugs, it’s about brains. Addiction is about what happens in a person’s brain when they are exposed to rewarding substances or rewarding behaviors. It’s about the external chemicals or behavior that turn on that reward circuitry.” Those with addiction have different responses in the nucleus accumbens, anterior cingulated cortex, basal forebrain and amygdala so that motivational hierarchies are altered. For those that have listened to the histories of addicts, it is obvious that the amount of addictive drugs consumed by those individuals—whether legal or illegal—is the demand that is driving so much of our society’s ills. I’ll never forget sitting in my office in the early 1980’s listening to a widow of a pharmacist explain to me her husband’s

death. It was in another state and he had committed suicide for he felt he had no options. He was a successful pharmacist, had been prescribed an opioid; but for reasons we don’t understand, he lost control. He got in over his head and could not see his way clear to face the consequences. Death was a more desirable option than the shame he felt in the condition he found himself and the resultant consequences that were going to be imposed. This widow was left with children to raise as a single parent. She was deprived of a partner, and our profession was deprived of a wonderful practitioner—all because of our inability to identify, treat, and support our fellow professional. To me, understanding this disease is a prescription for us moving forward. It is not only the smart thing to do as it relates to fiscal policy, but also the right thing to do from a humanitarian perspective. It should allow for healthier workplaces, less crime, more social responsibility, and a better understanding of our fellow human beings—some of which are close to us. About the Author Dr. Moore is past president of the APA with a long history of work experiences in the treatment of addiction in Georgia and North Carolina. He is an avid advocate for the recognition and treatment of addictive disease and a rethinking of our current approach to drug control. §

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LEGISL ATOR PROFILE

Senator Ron Caldwell

(R -Wynne)

District: District 23. Represents: Represents all of Jackson and parts of Cross, Woodruff, White, Lee, St. Francis and Monroe Counties.

Advice for pharmacists about the political process and working with the AR Legislature: Learn how to use the internet to stay informed and up-to-date on the legislative process and stay in personal contact with all legislators on the committees that affect you.

Years in Office: First year in office. Occupation: Real estate investor. Your pharmacist: My brother Max Caldwell at Caldwell Discount Drugs and my wife Brenda Caldwell, Baptist Hospital in Forrest City. Like most about office: Interaction with so many people from across Arkansas. Like least about office: Being away from my grandchildren.

Your fantasy political gathering would include: Ronald Reagan, Abraham Lincoln, and John Kennedy. Toughest issue of the past Session: Private Options to the Affordable Care Act, i.e. Medicaid Expansion. What do you do for fun: I love the outdoors. I deer hunt and turkey hunt in Arkansas. I duck and goose hunt in several states and Canada. Every Labor Day weekend, I host a classic southern Dove hunt. I am the biggest T-Ball fan in town. My grandkids are a precious gift. §

Upcoming election: 2016. Most admired politician: Ronald Reagan.

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MIKE ROSS FUNDRAISER

Mike Ross for Governor Fundraiser Nets $188,000

hanks to the enthusiastic support of pharmacists statewide, the Mike Ross for Governor Fundraiser held on June 25 was a great success!

Pharmacists raised more than $188,000 for the campaign. Event sponsors included American Pharmacy Cooperative, Inc. (APCI), EPIC Pharmacies, the National Community Pharmacists Association and APA. Former state senator Percy Malone introduced Ross, who stayed throughout the entire evening with his wife Holly, a pharmacist with Cantrell Drug. For 14 years, Mike and his wife, Holly, owned and operated a family pharmacy in Prescott, where they raised their family. Holly has been a career-long member of APA. Throughout Mike's 12 years in Congress, he was consistently rated as one of the most independent members of Congress and known for his hard work and for listening to his constituents. He has always been an advocate for Arkansas pharmacists. Ross projected that his campaign, likely to include a primary race and general election, may cost as much as $12 million. Thank you for supporting him in his bid for governor. §

APA’s Mark Riley looks at check presented to former Congressman Mike Ross.

(L to R) David Smith, Mike Smith and Mike Ross.

(L to R) Royce Wilson, Debra Wolfe, Lee Wilson and Paul Holifield.

(L to R) Mike Ross listens to APA President Dana Woods as he thanks APA’s Mark Riley for 10 years of service.

(L to R) Maxine and Don Stecks with Holly and Mike Ross.

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Antimicrobial Stewardship Programs

ntimicrobial usage, whether appropriately prescribed or not, has led to significant increases in morbidity and mortality in institutional health care settings due to hospital-acquired infections, such as those related to Clostridium difficile and multi-drug resistant pathogens.1 The World Economic Forum recently cited antibiotic-resistant bacteria as the greatest threat to human health, stating “we live in a bacterial world where we will never be able to stay ahead of the mutation curve … our resilience [depends on] how far behind the curve we allow ourselves to fall.”2 Contributing to this phenomenon are lax standards in antibiotic prescribing which has led to a plethora of antibiotic-resistant organisms and catapulted the health care industry into a state of emergency. Current literature suggests that in hospitals, an estimated 50 percent of antibiotic orders are unnecessary and potentially lead to the death of tens of thousands of Americans each year from infections caused by antibiotic-resistant pathogens.3 While the concept of antimicrobial resistance has been around since the emergence of modern antibiotics, antimicrobial stewardship programs (ASPs) have been recently developed as one of several multifaceted interventions used to combat this resistance while preserving the effectiveness of current and future antibiotics.4 Antimicrobial stewardship has been defined as “the optimal selection, dosage, and duration of antimicrobial treatment or prevention of infection, with minimal toxicity to the patient and minimal impact on subsequent resistence.”5 An ASP is a quality improvement intervention that can be initiated within several health care settings to reduce antimicrobial resistance; preserve current antibiotics from overuse, misuse and abuse; improve patient outcomes and safety; and reduce financial cost. Each health care setting should work within its resources, budget and personnel constraints to develop a team of participants, including an infectious disease physician and/ or pharmacist, who work in conjunction with other health care staff, hospital microbiology labs and epidemiology departments and administration to implement ASPs.4,5 Role of Pharmacists Pharmacists are well-positioned to develop and champion these institutional ASPs. In 2010, the American Society of Health-System Pharmacists (ASHP) released a statement citing pharmacists “have a responsibility to take prominent roles in antimicrobial stewardship and infection prevention and control programs in health systems ….. [T]hrough clinical endeavors focused on proper antimicrobial utilization and membership on relevant multidisciplinary work groups and committees within AR•Rx

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the health system.” ASHP recommends pharmacists promote optimal antimicrobial utilization, reduce infection transmission and educate health care professionals and patients.6 Being the medication experts, pharmacists can develop evidence-based treatment algorithms, antimicrobial order sets, intravenous-tooral switch programs for antibiotics with high bioavailability, antimicrobial pharmacy-based dosing programs, clinical conferences and newsletters on antimicrobial resistance, and electronic surveillance programs for antimicrobial prescribing practices. ASP Resources & Help There are many resources available to help pharmacists and other health care professionals with initiation and implementation of ASPs. The 2010 ASHP statement paper offers stepwise guidance for the aforementioned pharmacy responsibilities.6 Additionally, the Centers for Disease Control and Prevention released the Get Smart for Healthcare campaign in 2010 to help clinicians practicing in inpatient health care settings launch programs aimed at improving antimicrobial usage. This campaign offers a compendium of tools, resources and activities around ASPs and supporting efforts.7 As part of the Centers for Medicare & Medicaid Services’ 10th Statement of Work, the Arkansas Foundation for Medical Care (AFMC), the state’s Medicare Quality Improvement Organization, is collaborating with hospitals throughout the state to implement ASPs. For more information on how AFMC can assist you and your institution in ASPs, contact Dr. Christi Quarles Smith at csmith@afmc.com. A toolkit with more information about this effort is available at http://qio.afmc. org/HealthCareProfessionals/Hospitals.aspx. § REFERENCES 1. Spellberg B, Bartlett J, et al. The future of antibiotics and resistance. N Engl J Med. 2013;368(4):299-302. 2. Howell L, ed. Global risks 2013, eighth edition: an initiative of the Risk Response Network. World Economic Forum, 2013. 3. Dellit T, Owens R, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–177. 4. Chung GW, Wu JE, Yeo CL, Chan D, Hsu LY. Antimicrobial stewardship: A review of prospective audit and feedback systems and an objective evaluation of outcomes. Virulence. 2013;4(2):151-157. 5. Doron S, Davidson L. Antimicrobial stewardship. Mayo Clinic Proceedings. 2011;86(11):1113-1123. 6. ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control. Am J Health-Syst Pharm. 2010; 67:575-7. 7. Centers for Disease Control and Prevention. Get Smart for Healthcare. Retrieved from http:// www.cdc.gov/getsmart/healthcare. This article was written in collaboration with Talayia Johnson, BSN, MSN, NHCE. AFMC is the state's health care Quality Improvement Organization and contracts with the Centers for Medicare & Medicaid Services to give technical assistance to health care providers. AFMC's mission is to promote excellence in health and health care through education and evaluation.

PHARMACISTS INCREASE ADULT IMMUNIZATIONS

Arkansas Pharmacists Increase Adult Immunizations Up To 300% in 2012-2013

PA's Pharmacist Immunization Program between March 2012 and February 2013 increased the number of vaccinations administered in Arkansas pharmacies by 80 to 300 percent over the previous year. Compared to the previous year (March 2011 to February 2012), the number of pharmacist-administered immunizations for influenza increased 80 percent, pneumonia increased 114 percent, and shingles increased almost 300 percent. In 2012 the state of Arkansas was awarded a $1.8 million

cooperative agreement grant from the Centers for Disease Control and Prevention (CDC). The goal of the cooperative agreement was to increase the number of adults immunized using different healthcare settings and providers. APA was chosen as executor of part of the cooperative agreement and partnered with the CDC, the Arkansas Department of Health (ADH), and the Arkansas Center for Health Improvement (ACHI) to launch a campaign to encourage pharmacists to start or expand their immunization services and to educate pharmacists and the general public about the importance of adult vaccinations. APA hired Eric Crumbaugh, Pharm.D., to implement the program and to increase pharmacistadministered adult vaccines 10 percent by August 2013. Crumbaugh reached out to the 747 retail pharmacies in the state to educate pharmacists, their staffs and patients about adult vaccines and which vaccines adults need to keep themselves, their families, and their communities healthy. In order to make it easy for pharmacists participate in the immunization campaign, APA developed original educational materials, created an “Immunization” tab on its website, created a training component for pharmacists on the Arkansas immunization registry, collaborated with the ADH on a pharmacy protocol, took initiative to form a statewide immunization coalition, which launched in September 2012, and engaged Arkansas insurance companies to talk

about insurance coverage for pharmacist-administered vaccines. More than 110 pharmacists in Arkansas took a required CPR class and eight hours of training to learn how to administer immunizations during four free training opportunities in 2012 and 2013. Each of the retail pharmacies that requested

them received a 12-page immunization Toolkit, a 4 x 5 “We Vaccinate” window cling to go on pharmacy doors, 200 personal immunization record cards for patients and were encouraged to contact Dr. Crumbaugh with questions. Pharmacists were also sent 8 x 10 color posters promoting immunizations for flu, pneumonia, whooping cough and shingles to place prominently in their stores. In addition, APA launched an awareness campaign that included local media outreach to help educate adult Arkansans on the need to become immunized for flu, pneumonia, whooping cough and shingles. The program received an Honorable Mention award in “Overall Adult Immunization Activities - Beyond Flu” at the National Adult and Influenza Immunization Summit (NAIIS) on May 15. The NAIIS is led by the Immunization Action Coalition, the CDC, and the National Vaccine Program Office. The award recognized individuals and organizations that made extraordinary contributions towards improving adult and/or childhood influenza vaccination rates within their communities during the 2012-2013 influenza season. APA won honorable mention in a new award category recognizing immunization activities focused on the adult population, beyond influenza. §

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COLLEGES OF PHARMACY

UAMS and Harding University

Salary Survey Representing Two Colleges of Pharmacy Stephanie Gardner Pharm.D., Ed.D. Dean - UAMS

he May graduates from the University of Arkansas for Medical Sciences and Harding University Colleges of Pharmacy completed the annual salary survey. At graduation, 85 percent of the 151 students who responded had already accepted positions, with 77 percent accepting a position in a community pharmacy.

Fourteen students accepted a residency position. The average salary for a new graduate was $117,521, as compared to $117,223 last year. Seventy-four (58 percent) of the students accepted positions at places where they had previously worked or completed part of their experiential education.

Julie Hixson-Wallace Pharm.D., BCPS Dean - Harding

The average amount of debt for a graduating student has steadily increased over the last few years ($113,284). Overall, the marketplace for pharmacy has remained strong for our graduates. Fifty-four percent of the students ranked the opportunities as excellent or good, and 18 percent reported finding the exact position wanted. As the healthcare environment continues to evolve, we are hopeful that the opportunities for our students will only continue to expand. — Dean Stephanie Gardner and Dean Julie Hixson-Wallace

Arkansas Colleges of Pharmacy Graduates Salary Survey Results 2013 By Paul O. Gubbins, Pharm.D., Professor Professor, UAMS College of Pharmacy

Summary • 151 AR Graduating pharmacy students completed the survey (UAMS (n=107); Harding (n=44)). • 85% of respondents have accepted a position. • 54% of respondents believe the position opportunities available were excellent or good. • 77% of those who have accepted a position did so in a community/retail setting. • 14 students have accepted a residency/fellowship position. • 22% will receive a sign-on bonus and the average reported sign-on bonus is $18,125. • 37% of the students accepting positions will practice pharmacy in central Arkansas. Excluding residencies, graduate programs 38% of the students accepting positions will practice pharmacy in central Arkansas.

• Overall, 21% of the students accepting positions will practice pharmacy or do a residency out-of state. Excluding residencies and graduate programs, 19.8% of the students accepting positions will practice pharmacy out-of state. • Top benefits include: paid vacation, health insurance, paid holidays and retirement. These were unchanged from 2012. 8.5% of graduates will have their APA membership dues paid by their employer. • Average salary for a graduating pharmacy student from a Arkansas College of Pharmacy (excluding residency) position is $117,521; an increase of $298 (0.25% increase) from 2012. • Approximately 23% plan to own a pharmacy in the future. • Approximately 92% have student loans, with an average amount of $113,284. (Continued)

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

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ARKANSAS ASSOCIATION OF HEALTH-SYSTEM PHARMACISTS

Planning for Annual Fall Seminar October 3-4

esidents and technicians and Fall Seminar, oh my! We have a lot of exciting things going on for AAHP. There are an unprecedented number of 27 residents in the state for the 2013 – 2014 residency year! It is a dramatic increase from 10 to 15 residents about five years ago. We are so proud of the efforts made statewide to increase funding, available positions and awareness and interest in residency programs. Increased residencies continue to move the profession and practice forward.

Lanita S. White, Pharm.D. President

In keeping with moving practice forward, AAHP is providing pharmacy technicians with free programing called “Preparing for Certification.” This day-long certification review course will be held on the first day of Fall Seminar on Thursday, October 3, 2013 at UAMS in Little Rock. This session will be taught by students and faculty from Harding University College of Pharmacy and will prepare technicians to sit for the board certification test. The Annual AAHP Fall Seminar 2013 will be held at the Clarion Hotel Medical Center (formerly Hilton Hotel) in Little Rock on Thursday and Friday, October 3-4, 2013. This year’s keynote speaker is Dr. Douglas Scheckelhoff, American Society of Health-System Pharmacists (ASHP) Vice President of Professional Development. The Fall Seminar committee has planned a great line up of topics including: use of students for medication reconciliation and clinical

services, readmissions and the HENS collaborative, patientcentered medical homes and outpatient pharmacy services and the always-popular new drugs series. We will also have full-day student and technician sessions and the residency showcase on Friday, October 4th. For more information on the Fall Seminar or the Technician Certification Review Course, please visit our website at www.arrx.org/aahp. Lastly, we attended the ASHP Summer Meeting in Minneapolis, Minnesota, from June 1 –6. This meeting proved to be well worth the time. There were sessions on medication safety, billing for pharmacists services in ambulatory care clinics and how to engage members. We found that the same issues we are addressing on the state level are on the agenda nationwide. We were also pleased to find that AAHP, as an all-volunteer organization, is keeping pace and often setting the pace for best practices. A few of the initiatives that we were able to brag about included: offering a yearly residency showcase, involving students on the board of directors, providing technician and student programming and working on the PPMI initiative. We were indeed proud but it also gave us a “fire in the belly” to do even more for the practice in Arkansas. I look forward to seeing you at Fall Seminar in Little Rock and having the opportunity to share even more with you. Happy Summer! §

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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COMPOUNDING ACADEMY

Compounders Fight S.959 in Senate; Warren Lee New President

opefully everyone is having a wonderful summer. Compounders recently gathered in Washington, D.C., for the annual Compounders on Capitol Hill, hosted by the International Academy of Compounding Pharmacy (IACP). This was a very important year for compounders to get involved due to the current proposed compounding legislation, Senate Bill 959. There was record attendance from compounding pharmacists all over the nation. We had six pharmacists who visited our senators and congressmen in the Arkansas delegation. We had the opportunity to see all four Arkansas members of the House and our two Senators. S. 959 was written to prevent the New England Compounding Company (NECC) tragedy from happening again. NECC was the Massachusetts pharmacy which sent out contaminated injections resulting in fungal meningitis death and illness. The intent of this bill is good; however, in its current form it will have a negative impact on all compounders across the nation. Our message to our Senators and Congressmen was that as it is currently written, the bill is unworkable. IACP’s message was to "Protect the Public and Preserve Pharmacy Compounding." S. 959 creates more ambiguity and greater potential for confusion about which regulatory agency should oversee pharmacy compounding. As written, S. 959 is too far-reaching in its scope and micromanagement of practitioner decisions. S. 959 must be amended to eliminate unnecessary Food and Drug Administration (FDA) oversight of traditional compounding and assure the ability of physicians to make informed decisions about appropriate medication therapy. There were four specific points that we made regarding the bill: • S. 959 interferes with state regulation of pharmacy practice; • S. 959 unduly restricts access to ingredients and prescriber & pharmacist decision making; AR•Rx

• S. 959 confuses pharmacy Kristen Riddle, Pharm.D. practice with manufacturing; President • S. 959 does little to prevent the FDA’s lack of accountability which contributed to the NECC tragedy in 2012 For more information regarding this issue go to IACP's website, www.iacprx.org. Welcome Incoming Academy President Warren Lee The APA Compounding Academy welcomes Warren Lee, pharmacist-incharge of Lee Pharmacy in Fort Smith. Lee bought the pharmacy from his father, Gary Lee, past president of APA, in January 2000 and, soon after, dropped the retail end and became a “compounding only” pharmacy. Lee Pharmacy has 25 employees. Lee graduated from the University of Arkansas for Medical Sciences College of Pharmacy in 1997. He and his wife Tammy have three children: Megan, age 17, Michael, age 14, and Mason, age 12. §

(L to R) Kent Fields, Becca Mitchell, Kristen Riddle, Senator Boozman, Warren Lee, Adrienne Penn, Eddie Glover.

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2013 Annual Convention

he 131st APA Annual Convention, held June 6-8 at the Little Rock Marriott, was a very successful meeting that attracted 40 percent more pharmacist attendees than in 2012. APA members and guests were really pleased at how the Continuing Pharmacy Education (CPE) was organized in tracks, and enjoyed the social events in the Exhibit Hall and at the Museum of Discovery. Respondents to the survey following the 2013 Annual Convention had the following comments: "Best overall consistency of any

APA convention in 25 years," and "Excellent. Liked new format," and "Overall, some of the best programming in years." Ninety-six percent of respondents rated the quality of the CPE programs at good to excellent. And almost 75 percent were very satisfied with the CPE programs being organized in topical blocks followed by a panel discussion. The feedback will be used to plan the 2014 Annual Convention, to be held June 12-14 at the Chancellor Hotel in Fayetteville. We hope to see you there! §

APA Honors Individuals with 2013 Awards

2013 Pharmacist of the Year: Carl Collier, P.D., former owner of Collier Drug Stores in Fayetteville, was recognized for his career owning and operating eight Collier Drug Stores and his community service in northwest Arkansas.

2013 Distinguished Young Pharmacist of the Year: Zach Holderfield, Pharm.D., pharmacist and co-owner of Cornerstone Specialty Pharmacy in Fayetteville, was honored for his successful business practices and co-ownership of four community pharmacies in northwest Arkansas and North Little Rock.

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2013 Bowl of Hygeia Award: Vicki Fowlkes, P.D. and Karrol Fowlkes, Pharm.D., were honored for their service to their communities of Salem and Little Rock and for their contributions to the profession of pharmacy.

2013 Innovative Pharmacy Practice Award: Lanita White, Pharm.D., director of the University of Arkansas for Medical Sciences (UAMS) 12th Street Health and Wellness Center in Little Rock, was honored for her work developing the services and education for clinic patients.

2013 Charles M. West Leadership Award: Mr. Dylan Jones, a third-year student at the UAMS College of Pharmacy, Fayetteville campus, received a scholarship to support his leadership skills and contributions to the profession of pharmacy.

2013 Cardinal Health Generation Rx Award: Lelan Stice, P.D., MBA, owner of Doctor’s Orders Pharmacies in White Hall and Pine Bluff, was honored for his prescription drug abuse educational prevention efforts aimed at patients, youth, and other members of the community.

APA Thanks These Sponsors:

GOLF TOURNAMENT SPONSOR

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GOLD SPONSOR

PLATINUM SPONSOR

Thank You to Our 2013 APA Annual Convention Exhibitors!

Amanda Bair and Wen Grimes, Forest Pharmaceuticals.

(L to R) Sherri Bixey, Leigh Austin and Debra Boddington, UAMS COP.

(L to R) Jan Collins & Beverly McCaffery, Dear Cards - Greeting Cards.

Glenn Willis, Pfizer.

(L to R) Henry Dannehl and Charles Tarver

Samantha Timmermann, Pharmacy Development Services.

Jay Lloyd and Kelli Beavers, Merck.

(L to R) Niki Carver and Lanita White, AAHP. AR•Rx

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Hayley McDonell, National Community Pharmacists Association.

Mike Robinson and Brandy Cook, Smith Drug Company.

Charlene Kaiser, Amgen.

Lindsay Williams, LeadsOnline/LeadsOnLabs.

(L to R) Wendy Matson and Rachel Schwoeppe, Cardinal Health.

Kent Boling and Frances Bauman, Novo Nordisk Inc.

(L to R) Drew Hegi and Bo Garmon, First Financial Bank.

Penny Johnson, Minnesota Independent Coop.

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Vaughn Sutherland and Connie Hayes, McKesson Corporation.

(L to R) Russell Murrow and Ryan Smith, Computer-Rx.

Curtis and Barbara Woods, Pace Alliance.

Marc Bagby, Eli Lily.

Mary Beth Cain, PharMEDium Services, LLC.

Kevin Elder, Retail Designs, Inc.

Paula Peters, EPIC Pharmacies.

(L to R) Diana Boulton and Kay Whisenhunt, American First Response. AR•Rx

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(L to R) Randa Jankowski, Molly Bray, Julie Walker and Kyle Potts, AmerisourceBergen.

(L to R) Holly Sanders and Janie Huff, Takeda.

Larry Burris, TEC Laboratories.

Tracy Simpson, Otsuka.

(L to R) Alex Brantley and Stephanie Orman, RxMaster Pharmacy Systems.

Charles Heller, Parata.

Suzanne McClendon and Bret Rollins, H.D. Smith.

Christi Smith and Jerry Wicker, Arkansas Foundation for Medical Care.

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Nick Conway, Swisslog Automated Drug Management Systems.

(L to R) Joe Baker and Bobby Albrecht, Pharmacists Mutual.

(L to R) Flaviu Simihaian and Eugene O'Donnell, iMedicare.

(L to R) Kalena Jones, Sarah Rodgers, Wallace Montgomery, AR Healthcare Access Foundation.

(L to R) Don McNeely and Dennis Antici, QS/1.

Tim Howard and Julie Hixson-Wallace, Harding University COP, chat with convention attendees.

Sherri Fenteri, Liberty Software.

Brad Richardson from Bausch and Lomb.

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Member Classifieds For Sale: Two Kyocera ecosys FS-1030D printers and one Brother Intellifax 4100e fax machine. Please contact Bill at Park West Pharmacy. 501224-3499. (6/26/13) Pharmacy techs needed at Cantrell Drug in Little Rock. We are growing again! Cantrell Drug Company needs to fill 15 pharmacy technician positions ASAP. These positions are non-retail positions. They are full-time with a great benefit package. The successful candidate will want to work in a lab-type environment while demonstrating attention to detail and a focus on quality. Please send your resume to dconaway@cantrelldrug.com. (6/26/13) Pharmacist needed in Springdale: Immediate opening at Circle of Life Hospice for a contract Pharmacist to work as needed. Call 479-872-3366 for more information or email cpaladino@nwacircleoflife.org. (6/11/13) For sale: Approximately 150 QUIKWAY RX FILE BOX W/PRONG. New to good condition priced to sell at $10 per box. Contact Jill at 479-754-2180. (5/23/13) Pharmacist needed at PharMerica North Little Rock. PharMerica North Little Rock is recruiting a Per Diem Staff Pharmacist to join our team, working PRN, Saturdays and OnCall. The successful candidate will provide pharmaceutical services to long-term care and institutionalized patients in a manner that maximizes quality and patient safety. Participates in and oversees the dispensing of medication in accordance with federal and state regulations and PharMerica policy. Will consider recent graduates. Candidates should apply online at www.pharmerica.com/careers. For more information about the position contact Holly Duddy at 502-627-7580. (5/15/13) Need Pharmacy Technician at Little Rock Pharmacy. Experience in retail pharmacy preferred. Hours are 9 a.m. to 6 p.m. weekdays and 9 a.m. to 12:00 p.m. on Saturday. Contactjerry@pharmacylr.com. (5/7/13) Director of Pharmacy at Arkansas Heart Hospital. Arkansas Heart Hospital in Little Rock has an opening for a Director of Pharmacy. This position is responsible for planning, organizing, directing, executing and evaluating all aspects of the pharmacy services for the hospital. Qualifications include: • Education: Bachelor Degree in Pharmacy required; PharmD degree preferred. • Licensure/Certification: Current pharmacist’s license issued by the State Board of Pharmacy required. • Experience: Two years acute care hospital experience required. Two years of management experience preferred. Apply online at www.arheart.com. (5/3/13)

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Member Classifieds are free to APA members and $65 per issue for non-members. Contact eileen@arrx.org for more information. Full-time Pharmacist position in Fort Smith-Independent pharmacy looking for full-time pharmacist. Competitive salary and benefit package. Contact Ed or Daniel at 479-782-9210 or send resume to Princedrug@hotmail.com. (3/26/13) Walgreens Community Pharmacists neededWalgreens 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 you’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. 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) Northwest Arkansas Free Health Center in Fayetteville looking for pharmacy volunteers. We provide health and dental care to low income and uninsured individuals. Our

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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) 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)

2013 Calendar of Events & District Meeting Schedule August-September 2013 District Meeting Schedule Date District

President Location

Tuesday, Aug. 20 Thursday, Aug. 22 Thursday, Sept. 5 Monday, Sept. 9 Tuesday, Sept. 10 Thursday, Sept. 12 Tuesday, Sept. 17 Thursday, Sept. 19 Monday, Sept. 23 Tuesday, Sept. 24 Thursday, Sept. 26

Dean Watts Kristy Reed Clint Boone C.A. Kuykendall Stephen Carroll Lynn Crouse Stephen Carroll Dean Watts Chris Allbritton Chris Allbritton Casey McLeod

5 2 1 7 6 4 6 5 3 3 8

Grand Prairie Center, Stuttgart Jonesboro Country Club, Jonesboro* Embassy Suites Hotel, Little Rock* Holiday Inn City-Center, Fort Smith Lake Point Conference Center, Russellville* Camden Country Club, Camden Embassy Suites, Hot Springs* Monticello Country Club, Monticello Holiday Inn Express, Mountain Home* Embassy Suites Northwest Arkansas, Rogers* Harding University Cone Chapel, Searcy

*New locations in 2013.

OCTOBER Oct. 3-4 Arkansas Association of Health-System Pharmacists 49th 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 DECEMBER Dec. 8-12 American Society of Health-System Pharmacists Midyear Clinical Meeting and Exhibition Orlando, FL Dec. 7-8 APA Committee Forums and Board of Directors Meeting Crowne Plaza Little Rock Little Rock, AR 36

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