APA Staff
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Mark S. Riley, Pharm.D. Executive Vice President and CEO Mark@arrx.org Scott Pace, Pharm.D., J.D. Chief Operating Officer Scott@arrx.org Eric Crumbaugh, Pharm.D. Director of Clinical Programs Eric@arrx.org Jordan Foster Director of Communications Jordan@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Support@arrx.org Publisher: Mark Riley Editor: Eileen Denne Design: Gwen Canfield - Creative Instinct Arkansas Pharmacists Association 417 South Victory Street Little Rock, AR 72201-2923 Phone 501-372-5250 Fax 501-372-0546 AR•Rx The Arkansas Pharmacist © (ISSN 0199-3763) is published quarterly by the Arkansas Pharmacists Association, Inc. It is distributed to members as a regular service paid for through allocation of membership dues ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 71.
CONTENTS 4 Inside APA: It's A Process, Not An
33 Clinical Programs: Using "WebIz" in
5 From the President: Practicing at the
34 UAMS Report: Twenty-Four Years of
7 COVER: Dean Gardner Builds Bridges
35 UAMS COP Class of 2015 Photos
Event
Top of Your License
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Growth and Change
to Future
12 APA Hosts Legislative Day January 28 16 Member Spotlight: Zhiva Brown, Little
in Curricular Effectiveness and Interprofessional Education Photos
19 New Drugs: 2015 New Drugs
38 Arkansas Academy of Health-System
20 FEATURE: Making Sense of the Track-
Pharmacists: Continuing to Move Forward on Pharmacy Practice Model Initiative
and-Trace Law
22 RX and the Law: That’s Not My State 23 Safety Nets: Careless Comma Leads to
Confusion
36 Harding Report: Increased Emphasis
37 Harding University COP Class of 2015
Rock
© 2015 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.
Pharmacy Practice
39 APA Compounding Academy: Doing
What’s Best for Patients and the Future of Compounding
24 APA 2015 Calendar of Events
40 2014 Bowl of Hygeia Recipients
25 APA 2015 Annual Convention
41 Note from Editor: Thanks for a Great
32 Compliance Corner: How to Prevent
42 Member Classifieds
Brochure
and Detect Diversion, Part 1: Site Security
Four Years
DIRECTORY OF ADVERTISERS 2 6 6 17 18 18 23
Pace Alliance Wright, Lindsey & Jennings, LLP Arkansas Pharmacy Support Group Pharmacists Mutual Insurance Retail Designs, Inc. UAMS Alumni Association Bell & Company
41 EPIC Pharmacies 42 Law Offices of Darren O'Quinn 43 First Financial Bank 43 Pharmacy Quality Commitment Back Cover: APA Honors McKesson Cover Photo: Johnpaul Jones, UAMS Creative Services
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APA Board of Directors
INSIDE APA
2014 - 2015 Officers
INSIDE APA
President - Brandon Cooper, Pharm.D., Jonesboro President-Elect - John Vinson, Pharm.D., Fort Smith Vice President - Eddie Glover, P.D., Conway Past President - Dana Woods, P.D., Mountain View
It’s A Process, Not an Event
Area Representatives Area I (Northwest) Michael Butler, Pharm.D., Hot Springs Village Area II (Northeast) Brent Panneck, Pharm.D., Lake City
Mark Riley, Pharm.D. Executive Vice President & CEO
Area III (Central) Clint Boone, Pharm.D., Little Rock
T
Area IV (Southwest/Southeast) Lynn Crouse, Pharm.D., Eudora
District Presidents District 1 - Denise Clayton, P.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 - Darla York, P.D., Salem
Academy of Consultant Pharmacists Rachel Hardke, Pharm.D., Carlisle
Academy of Compounding Pharmacists Lee Shinabery, Pharm.D., Jonesboro
Arkansas Association of Health-System Pharmacists Marsha Crader, Pharm.D., Jonesboro
Ex-Officio APA Executive Vice President & CEO: Mark Riley, Pharm.D., Little Rock Board of Health Member: Gary Bass, Pharm.D., Little Rock AR State Board of Pharmacy Representative: John 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 COP Student: Brett Bailey, Beebe Harding COP Student: Meredith Mitchell, Joplin, MO
Find the APA on Facebook, or visit our website at www.arrx.org 4
he title of this article is a quote from our contract lobbyist, Don Tilton, that he said to me shortly after he started working for us over 10 years ago. His point was that the results that come out of any one legislative session are a result of years of work and relationship building, framed by changes in constituent attitudes and the political climate. Bills that pass in one legislative session might not have a chance in another. There are simply a lot of moving parts. As I sit here on this last morning of the session, my mind is full of three months of thoughts, conversations, and observations about the 90th General Assembly of the Arkansas Legislature. As a result of the state’s term limits, which have seen change with a recentlypassed constitutional amendment, each session has a myriad of new faces, but this session also had the added interest of a new leader in the executive branch, Governor Asa Hutchinson. The session went pretty smoothly until the end when a few fireworks occurred but that is to be expected in any session. I am very impressed with the leadership the Governor and his staff showed during the session in fulfilling campaign promises to the people of Arkansas including addressing critical issues in the state (tax cuts, prisons, healthcare, and the budget). He let the legislative process work and allowed most legislative decisions to become law, only stepping in when he thought it was absolutely necessary to protect the state and ensure fairness to all groups. I saw the same kind of behind the scenes leadership of both President Pro Tem Jonathan Dismang and Speaker of the House Jeremy Gillam. I might add that this followed very similar non-partisan
leadership demonstrated last session by former Senate Pro Tem Michael Lamoreaux and former Speaker Davy Carter. The transition in leadership in Arkansas has been successful and effective. I look forward to being involved in the discussion that will occur in conjunction with the Legislative Task Force on Healthcare Reform. I am also particularly excited that one of the co-chairs of this committee will be Senator Jim Hendren who also co-chaired the task force charged with getting control of costs for the teachers and state employees group. He has demonstrated that he expects an evidence-based approach to solving problems with facts and data to support the decisions that are made. I am confident that the legislators appointed to this committee will look for common sense, fair, and cost effective solutions in addressing how we care for Arkansans in their healthcare needs. A very special thanks goes to Senators Ron Caldwell and Jason Rapert and Representatives Michelle Gray and Dan Douglas for being the lead sponsors on our three pieces of legislation. Lead sponsors on a bill put in an incredible amount of work in this process. Rep. Justin Boyd also helped to educate members about the PBMs role in prescription drugs and their abusive behavior. SB487, SB542, and SB688 (now Act 689, Act 1025, and Act 900) all passed by wide margins and were signed into law by Governor Hutchinson. I want to thank the many Senate and House members who supported and spoke publicly for our bills. I also want to thank you for contacting your elected officials and AR•Rx
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THE ARKANSAS PHARMACIST
FROM THE PRESIDENT
giving personal testimony of the importance of these bills in your ability to continue to serve your patients in communities all over Arkansas. A number of UAMS and Harding students, led by Dr. Nicki Hilliard and Rodney Richmond, also supported our cause. Pharmacies of all sizes and pharmacists from diverse practice settings put forth a unified effort in passing these critical pieces of legislation. The grassroots work that you did was the key to all of our success. Finally, I can’t find words to describe the great work that Government Affairs Director Debra Wolfe did, along with Sarah
Collins from the Roberts Law Firm and the aforementioned Don Tilton. They were tireless in their efforts. Courtney Shepherd and Randy Thurman were a big help as representatives of EPIC Pharmacies, as well as Polly Martin of the Retail Grocers and Merchants Association. I must also mention that our attorney Harold Simpson writes all of our legislation and provides sage council in the process. Scott Pace, our COO drove the process side of things (notices, calls to action, etc.) along with the rest of the staff to make our success possible. It is truly a team effort. §
FROM THE PRESIDENT
Practicing at the Top of Your License
P
racticing at the top of your license” is a phrase we hear fairly often in the pharmacy world. Many times, this catch phrase is used to encourage us to practice to the full extent of our education and training. It may also imply that anyone with clinical skills should use them effectively and not spend time on tasks that can be done by someone with fewer skills, presumably at a lower cost.
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In today’s evolving health care landscape, pharmacists must position themselves in a way to showcase their medication expertise and ability to ultimately provide the best care possible for patients—especially if this care ultimately results in decreased healthcare costs. This, I believe, will ensure the continued viability of our profession and fully realize the potential we all have to practice “at the top of our license.” In recent years, the APA has made great strides in providing an avenue for those pharmacists committed to differentiating their practice settings and adding to their knowledge base— those pharmacists who want to advance the profession in their own way. This has become evident in the ever-evolving Strategic Plan that the Board of Directors has developed for the upcoming years. Expanded roles for pharmacists through immunizations, MTM and patient-care services, provider status, and involvement in health care reform continue to receive constant attention by the APA Board of Directors and the staff. Continuing education programs and expert assistance offered by the APA is readily available to help you change and expand your area of practice. It is also exciting to see pharmacists taking advanced leadership positions in academic institutions, hospitals, and professional organizations that go beyond the “normal” scope of pharmacy practice. Deans Stephanie Gardner and Julie Hixson-Wallace, Nicki Hilliard, Dennis Moore, and now John Vinson have been a great source of inspiration to me personally and professionally as they continue to expand the
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horizons of pharmacy in Arkansas. Inserting pharmacists into such interdisciplinary roles only strengthens and promotes the advancement of our profession well into the future.
Brandon Cooper, Pharm.D. President
It is equally important to have a voice in government and the legislative arena. Having Justin Boyd to represent us in the Arkansas House is a great asset, not to mention his recent appointment to the Health Reform Task Force. Congratulations Justin! Unfortunately, when pharmacies and pharmacists are not adequately paid for their services it becomes increasingly more difficult to assert our importance in the health care arena. Those practicing in retail community pharmacies know how difficult it is now to operate with ever-eroding PBM reimbursements and MAC-pricing that many times fall well short of the actual cost of the medication. “Practicing at the top of our license” seems like an unattainable goal for many pharmacy owners who are contemplating how they can remain afloat in the rising tide of underpayments, preferred networks, mandatory mail-order, and other abusive PBM practices. In these situations it becomes a daily struggle between properly taking care of patients or getting lost in the constant game of searching for products or solutions that can help shield us from losing money by dispensing the prescription. Pharmacists, especially those in retail, continue to remain tied to the dispensing of medications while they search for new avenues to align themselves with stakeholders to prove how valuable they are in taking care of patients. Even as we, as an association, continue to push for expanded recognition and payment for services, we must also remain committed to providing sustainability through current payment models based on products provided.
(Continued)
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FROM THE PRESIDENT
I assure you the APA continues that commitment to advancing the profession of pharmacy in Arkansas while making sure pharmacists and pharmacies are adequately reimbursed for the valuable services they provide. It’s an ongoing process and I hope you’ll share your stories of successes and challenges to help us achieve that goal of “top-level” practice. §
I’d like to express my sincere gratitude for the outstanding work of our Director of Communications Eileen Denne who left the APA at the end of March to pursue other career opportunities. It was a pleasure to work with her over the past four years and the impact she had on our organization is truly immeasurable. She was instrumental in transforming many areas of APA including our communications, public relations, and strategic planning and made this organization better over her tenure. Good luck Eileen, we wish you well! Brandon Cooper, Pharm.D., APA President
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THE ARKANSAS PHARMACIST
UAMS College of Pharmacy Dean Builds Bridges to Future By Eileen E. Denne, APR
LEGACY OF VISIBILITY FOR COP AS DEAN STEPHANIE GARDNER BECOMES PROVOST UAMS COP Dean, Stephanie Gardner, Pharm.D., will become UAMS Provost on June 1. The Provost, as the Chief Academic Officer of the campus, is responsible for academic planning and budgeting; program evaluation, assessment and accreditation; educational policies and procedures; enrollment management; professional development, and strategic planning.
When asked about her legacy after 24 years at the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy (COP), 12 of those as Dean, Stephanie Gardner, Pharm.D., Ed.D., associate provost for society and health, cited the college’s greater visibility, growth in research and strong faculty and student leadership. “We have become more visible at the campus and state levels,” Gardner said in a recent interview, “where we have worked with Medicaid and the Employee Benefits Division. We have built lots of bridges that have made us visible in a very good way. At the national level, the student organizations have been recognized for their accomplishments. Our growth in research has been remarkable; we have a group of internationally recognized researchers in drug discovery and radiation health within the College of Pharmacy.”
Transition to Provost
Gardner will become UAMS Provost on June 1. The Provost,
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as the Chief Academic Officer of the campus, is responsible for academic planning and budgeting; program evaluation, assessment and accreditation; educational policies and procedures; enrollment management; professional development, and strategic planning, Gardner said. UAMS chancellor Dan Rahn, M.D., was enthusiastic about Gardner’s transition. “Working with Stephanie in her role as Dean of the College of Pharmacy has been one of the highlights of my time as Chancellor, which is why I am so glad that she accepted my invitation to serve as UAMS’s next Provost! She is a great leader who is unrelentingly positive and optimistic. She always encourages others and is driven to see faculty, staff, and students achieve all that they can achieve to advance the mission of UAMS. If everyone was like Stephanie Gardner, the world would be a better place.” A committee headed by current provost Jeanne Heard, M.D., Ph.D., is conducting the search for the new dean. Gardner
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Chancellor Rahn and Dean Gardner at the December 2012 opening of the UAMS 12th Street Health and Wellness Clinic.
hopes that anyone who wants to will apply and says that the ideal candidate will have academic experience, a history of research productivity, and a commitment to the profession and to improving the health of Arkansans. A high level of energy and passion will also be part of the criteria. Gardner gets high marks for her effectiveness as a leader from protégées and colleagues. Cindy Stowe, Pharm.D., dean of Sullivan University College of Pharmacy and former associate dean at UAMS COP, said Gardner’s leadership has
Working with Stephanie in her role as Dean of the College of Pharmacy has been one of the highlights of my time as Chancellor... She is a great leader who is unrelentingly positive and optimistic. Chancellor Dan Rahn, M.D., resulted in transformational advancements of every aspect of the UAMS COP. In addition, as a relatively new COP dean at Sullivan University, Stowe seeks to emulate Gardner’s caring, selflessness, inspirational presence, openness, ability to transform and persistence. “I am thrilled that I got the opportunity to work for Stephanie when she was department chair and as dean. She has made a remarkable impact on my career and continues to be a trusted friend and mentor. I will be forever grateful for the difference that she has made in my career,” Stowe said. Arkansas Pharmacists Association Executive Vice President and CEO Mark Riley, Pharm.D., called Gardner a good communicator and a tireless worker. “Those two things along with being smart and tenacious have made her a great leader and face of the UAMS COP. Her message carries weight with everyone she deals with because they know she has done her homework and knows
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what she is talking about. She has made sure her students are prepared and uses every opportunity to promote their ability to utilize that knowledge to help their patients.”
Roles as Teacher and Mom
Offering personal attention to help students be prepared is one of the roles Gardner says she will miss. She enjoyed teaching and one-on-one time with students before she became COP Dean in 2003. As dean, she found being in a position to aid a student or faculty member when they needed it most very rewarding. Helping students who needed a doctor’s appointment, an emergency loan, or someone to listen had her “going back and forth between the role of teacher and Mom.” She said that the biggest difference in her 2003 and 2015 performances as Dean was her level of confidence. “I tell our graduating students that the first year out of school is really about building confidence in your ability to solve problems and your ability to recognize when you don’t know the answer. I have the same passion for the school and for the profession, but my ability to solve new problems and knowledge of who to ask for help has improved by leaps and bounds over the years. I am more in position to help other people figure out what they should do.” She will also miss the interaction with faculty, who she said “are like my family,” and her relationships with pharmacists. “I have been here a long time and have become friends with preceptors and pharmacy alumni in Arkansas and across the country. That’s 20 years of relationships. I’m going to miss that a lot too. I am trying to convince myself that I will only be across the street but I know it will be different.”
Transforming the College of Pharmacy
Gardner led a 12-year period of transformational change at the COP. Former Chancellor I. Dodd Wilson, M.D., who appointed Gardner as Dean, said she was destined to be successful.
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Photo of Dean Gardner with UAMS COP Students receiving the 2015 Outstanding Dean award by the American Pharmacists Association Academy of Student Pharmacists (APhA-ASP).
“Dean Stephanie Gardner had all of the essential leadership qualities combined with the desire to be successful when she was appointed to lead the UAMS College of Pharmacy. She has had a stunning impact on UAMS and I am proud of her many and varied accomplishments.” Gardner cited the growth in research as the most remarkable change over her 24 years at the COP. The college has always had a strong program, good students and faculty, she said. But, the biggest opportunity for growth was in the area of federally funded research.
for their national accomplishments. After she became Dean, Gardner launched the alumni affairs department, added an alumni association, alumni magazine and the Dean’s Society. Charles Born, P.D., PhD., former COP professor said of Gardner’s leadership, “Stephanie is a person of enormous energy and enthusiasm. She vigorously pursued every opportunity and every problem that was presented to the College. Her support of students and their organizations was phenomenal.”
Gardner feels that the Gardner cited the growth in research as the most “Our first step was when Dr. COP’s increased visibility remarkable change over her 24 years at the COP. Martin Hauer-Jensen came. will help with recruiting a He brought a team with him new dean and that new and we ended up recruiting program people will Dr. Daohong Zhou. Dr. want to come to UAMS. Marjan Boerma was In her new role, she will already here. The Division be trying to help build of Radiation Health was bridges between colleges formed and their research is and thinks it will be easier internationally recognized. now because of the We also recruited Dr. Peter emphasis on team-based Crooks and he is growing care, interprofessional education, and teamthe area of drug discovery as well. Peter’s team now based science. includes several faculty members, grad students Another accomplishment and post-docs. A third area during her tenure was building the Northwest of research emphasis was pharmaceutical evaluation campus of the COP. This and policy and we recruited Dr. Brad Martin to lead the year they will graduate their third class. According to Gardner, effort. Today, the Division of Pharmaceutical Evaluation students love the Northwest campus. does retrospective data analysis on prescription claims data. They evaluate how drugs are used to guide policy “The Northwest faculty is a terrific team. We have built our ties recommendations based on drug use.” with that community and that’s been good. It is an attractive place for students who want to be closer to home or who want Another strength of the college, Gardner said, is student to be in an area where they can easily attend Razorback games. leadership. Thanks to current faculty member Dr. Eddie Dunn There are a significant number of COP students who choose the and former faculty member Dr. Charles Born, Gardner said, Northwest campus because they want to live in Fayetteville.” the student organizations have continued to be recognized Gardner encourages students at both campuses to never
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UAMS COLLEGE OF PHARMACY DEAN BUILDS BRIDGE TO FUTURE
stop learning. She said most of what students know when they graduate will be no longer relevant in five years. “It is critical that they read as much as they are able and that they surround themselves with people and opportunities that can help them grow as a pharmacist. It is different for every person. When I talk to people, I ask what they are excited about. For me, the pathway was an Ed.D degree and then the American Council on Education fellowship in 2013. Whatever your interest is, whether an MBA, hospital management, or an online course, ask a lot of questions.”
While good relations are historical, Stephanie has enhanced them and really connected with our membership through the Dean’s Society, Alumni Association, and other outreach programs.
Mark Riley, Pharm.D. APA Executive Vice President & CEO
Dean to Provost
Gardner did her own outreach when she became Dean by calling on two deans she greatly admired: Dr. Barbara Wells at the University of Mississippi and Dr. Steve Leslie at the University of Texas in Austin. She spent two days with each of them and they connected her with their development office, research departments and alumni associations. She was able to ask lots of questions and then could call all these contacts. When asked how she felt her experience as Dean has prepared her to become Provost, Gardner said she had opportunities to lead strategic planning retreats, to mentor faculty, to serve on a national accrediting board, to prepare college budgets and to build new programs. She had the advantage of serving as Dean at the same institution and believes that the relationships that she built and her institutional knowledge will help her be more effective than would otherwise be possible. “My primary job has been to help others accomplish their goals – such as a young faculty member creating an area of expertise, or a student who wants to be leader in APA.”
Advice for New Dean
In order for the new dean to maintain good relationships with the State Board, the APA and other colleges of pharmacy, Gardner hopes they will select someone who not only is highly competent, but who will show up and be a team player, get along with people, and be fun to be around. “Arkansas pharmacy is at its best when the State Board, APA, and Colleges have open communication and a commitment to working together on behalf of the profession. The new Dean should build relationships with members of the staff and the Board of both the APA and the Arkansas State Board of Pharmacy.” APA’s Mark Riley further explained the synergistic relationship: “APA, UAMS COP, and the State Board of Pharmacy have a legacy of having good working relationships. Of course, Harding University COP is part of that good relationship now also. While good relations are historical, Stephanie has enhanced them and really connected with our membership through the Dean’s Society, Alumni Association, and other outreach programs. She gets the importance of the
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Dean Gardner and APA’s Mark Riley prior to the 2013 Little Rock District Meeting.
relationship and has been supportive of issues when we need her as we have with her.” Riley went on to say that he hopes the next dean understands the importance of the relationships. “This cohesive nature does not exist in every state, therefore, if the new dean comes from the outside, he or she will have to establish and foster relationships and that will take some time. The fact that Stephanie will still be at UAMS as the Provost will help with that process.”
Unique Perspective on COP
Gardner thinks the COP’s most important new role will be in getting pharmacists recognized as being critical to patient outcomes and the financial bottom line. “Our pharmacy graduates are ready to assume a larger role and more accountability for outcomes. When they are allowed to practice at the ‘top of their license,’ they will create new roles in chronic disease management, which is 90 percent of what shows up in primary care. We’ll be paid for health outcomes. Pharmacists will end up in groups where, if everyone is doing their jobs, they’ll be rewarded. If they don’t recognizably contribute in a positive way, the opportunity to contribute will be minimal. Our students have skills that are unique among people who graduate. They should be able to apply what they already know.”
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UAMS COLLEGE OF PHARMACY DEAN BUILDS BRIDGE TO FUTURE
graduating in May – David from the UAMS COP and Erica from University of North Carolina at Chapel Hill. Erica is applying to graduate programs in audiology and David applied for hospital residency positions for the coming year. When the children were young, Gardner said, “One of the biggest things we committed to was having dinner together. It forced me to leave at the end of the day even if I had to work in the evening. We spent a lot of weekends in Greers Ferry when the kids were growing up and that was time away. We shared boats with a couple of families. We built a cottage with another family last year and it is absolutely wonderful. Biking and scuba diving are also things that I like to do. I biked a lot to work last year but I don’t know how my new schedule will work. I’ll continue to bike at least on the weekends.”
Final Award Dean Gardner checking out the countryside on her bike.
Gardner said that as part of the advancement of health care professional education, the COP’s new curriculum will focus on patient-centered collaborative team-based care, regardless of discipline or profession. Students will learn in teams so that they can, eventually, effectively practice in teams. She thinks we will see more teaching interprofessionally and more opportunities for experiential learning earlier and earlier in curriculum.
Work-Life Balance
Gardner’s advice to the new dean is to have fun. “Being dean of the UAMS College of Pharmacy is an honor and a large responsibility, but it is also a lot of fun. Don’t get so tied up in the day-to-day problems that you forget to enjoy the experience.” The most challenging part of being dean for her was juggling all the responsibilities, moving parts, and many constituencies to serve. “I sometimes felt torn in a lot of directions and had to work to maintain a healthy work/life balance.” Gardner and Alan, her husband of almost 32 years, have two children, David, age 24, and Erica, age 21. Alan serves as Chief Operating Officer for RxResults in Little Rock. Both children are
At the end of March, Gardner accepted a final award in her role as dean of UAMS COP at the American Pharmacists Association (APhA) Annual Meeting and Exposition in San Diego. She was named 2015 Outstanding Dean by APhA’s Academy of Student Pharmacists (ASP). The award recognizes school or College of Pharmacy Deans who have made significant contributions to APhA-ASP chapters and who have promoted, with distinction, the welfare of student pharmacists through various community service, leadership and professional activities. She hopes that pharmacists in the state recognize the strength of the pharmacy community here. “Arkansas pharmacists are the envy of the nation because of their leadership and commitment to the APA, their political advocacy, and their entrepreneurship. They are also just good people, and really talented people who are committed to the association, to their own businesses, and are politically active. That seems so obvious but it isn’t always the case. “I will miss seeing friends at the APA District meetings, beautiful drives through scenic parts of the state, and visiting alumni and preceptors in their stores and hospitals along the way. When I visit the other UA campuses in my new role, I won’t be able to resist stopping in a few pharmacies to visit old friends.” § Gardner family (L to R): Alan, David, Erica and Stephanie
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APA Hosts Legislative Day January 28 APA’s January 28 Legislative Day attracted pharmacists and legislators to a health fair at the Capitol, luncheon, CPE and the Legislative Reception. Pharmacists were in action at the Capitol on Jan. 28, as APA participated in the Legislative Health Fair sponsored by University of Arkansas for Medical Sciences (UAMS) and Harding University Colleges of Pharmacy students from 8:00. to 11:30 a.m. Students screened staff and legislators for cholesterol, blood glucose, BMI and checked on vaccine updates. APA hosted pharmacists at a luncheon at the Lester E. Hosto Conference Center, and then members walked to the Capitol to be formally recognized by both the House and the Senate. About 40 APA members participated in two hours of Continuing Pharmacy Education at the Old Supreme Court Chambers in the Capitol. APA’s Executive Director and CEO Mark Riley began by talking about possible pharmacy legislation to be introduced during this session. His remarks were followed by a presentation to update members on immunizations by APA’s Director of Clinical Programs, Eric Crumbaugh.
Pharmacists recognized in Senate Gallery
Forty pharmacists enjoyed the CPE in the Old Supreme Court Chamber
APA Welcomes New Legislators at Legislative Reception
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Pharmacists in House of Representatives Gallery
Sen. Cecile Bledsoe and UAMS P4 Grant Florer
House members applaud pharmacist guests
(L to R) APA President Brandon Cooper and Rep. Dan Sullivan
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THE ARKANSAS PHARMACIST
(L to R) APA Vice President Eddie Glover, Ron McNair, and Ken Henderson
(L to R) APA President Brandon Cooper, Joan and Rep. Dwight Tosh, and APA Area 2 Rep Brent Panneck
(L to R) APA's Mark Riley and District 2 President Kristy Reed
(L to R) Connie and Al Harkins and Rep. Gilbert Cornwell
(L to R) Area 1 Rep Michael Butler, Area 2 Rep Brent Panneck, and APA President Brandon Cooper
(L to R) Gailia and Rep. Brandt Smith and Brent Panneck
(L to R) Brandon Achor, Kaley Scott, Grant Florer, Rep. Justin Boyd, Lis Mathews, Talon Burnside, and APA Board member Brett Bailey
(L to R) Joe Larkin, APA’s Executive VP and CEO Mark Riley, and Keith Larkin
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APA HOSTS LEGISLATIVE DAY JANUARY 28
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(L to R) Kara Halverson, Sen. Ron Caldwell, David Dallas, and Daniel Hardison
(L to R) Rep. Jim Sorrillo, Rep. Brandt Smith and Gailia Smith, and Rep. James Sturch
(L to R) Mary and Wayne Padgett, Cassie and Rep. Justin Gonzalez
(L to R) Rep. Joe Jett, Rep. Chris Richey, and Denise Clayton
(L to R) Mike Smets and Rep. Matt Pitsch
(L to R) Rep. John and Rhonda Payton and Mark Riley
(L to R) Rep. Dan Douglas and Scott Pace
(L to R) Rep. Karilyn Brown and APA President-Elect John Vinson
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THE ARKANSAS PHARMACIST
APA HOSTS LEGISLATIVE DAY JANUARY 28
(L to R) Rep. Trevor Drown and Rep. Rebecca Petty
(L to R) Sen. Larry Teague, Rep. Brent Talley, and Rep. Matthew Pitsch
(L to R) Ronnie Norris and Tim Howard
Buffet table at Trapnall Hall
(L to R) Sen. Bobby Pearce and Justin Allen
(L to R) Sen. Keith Ingram and Rep. Justin Boyd
Pharmacy Students Conduct Health Fair
Harding University College of Pharmacy student Rebekah Knudson conducts a cholesterol screening in the capitol rotunda
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UAMS College of Pharmacy student Arturo Torres measures blood pressure during the health fair
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MEMBER SPOTLIGHT
Zhiva K. Brown, Pharm.D., CGP Pharmacy Practice: Inpatient Clinical Coordinator for
Pharmacy Service at the Central Arkansas Veterans Healthcare System (CAVHS), currently supervising 12 Clinical Pharmacy Specialists. I still maintain an Inpatient Geriatric Clinical Practice on the Geriatric Evaluation and Management Team at CAVHS at the NLR campus.
Pharmacy School & Year: University of Arkansas for
Medical Sciences College of Pharmacy in 2005. Completed a Pharmacy Practice Residency at the Central Arkansas Veterans Healthcare System in 2006.
Years in business: At the Central Arkansas Veterans Healthcare System since 2006; served as a pharmacy student and intern since 2000.
Favorite part of the job: My favorite part of my job still has
to be the direct patient care and medication management for the veteran patients on my service who have served to protect and defend this country. The value the GEM team places on having a clinical pharmacist present on the team and readily acknowledge that pharmacists are experts in the therapeutic use of medications. I am able to routinely provide medication therapy evaluations and recommendations to my team members, and maintain a scope of practice under my collaborating provider, which gives me prescriptive authority to properly manage medication therapies on my patients. I also enjoy the teaching and interactions with senior pharmacy and medical students, as well as pharmacy and medical residents and how they get first-hand experience with witnessing the value and luxury of having clinical pharmacists on their team. I also work with an AWESOME group of experienced clinical pharmacists who take just as much pride in their work and their patients as I do, which makes the managerial portion of my job that much easier and enjoyable from that perspective!
Least favorite part of the job: My least favorite part of
the job is not really related to the profession, but lies more with the bureaucracy of being a part of a Health System. There are always an endless amount of meetings that require the presence of pharmacy management in attendance but may not always be directly related to pharmacy service. Sometimes you have to figure out how each meeting can relate to the service indirectly and relay that information to your staff to see how we can help accomplish the goals of not only the service but the institution as a whole in the service of our veterans.
What do you think will be the biggest challenges for pharmacists in the next 5 years? I don’t want to sound like a broken record, but I’ll repeat with my colleagues and other pharmacists throughout the state have been stressing since I graduated from pharmacy school. The biggest challenge to the individual pharmacist is to maintain close oversight of dispensing functions while carving out adequate time to not only serve as a patient educator and advocate, but in 16
doing so while trying to grow their own clinical expertise and clinical services. Pharmacists are further supported and prepared for this role by participating in general practice residencies, specialized residencies, or obtaining advanced pharmaceutical certifications that further enhance and prepare the pharmacist for clinical responsibilities in complex care settings. Recognition that safety and quality in medication use is essential has led to positive steps to integrate pharmaceutical care in the hospital setting and has been a major contributor for the advancement and acceptance of clinical pharmaceutical services within the hospital. With that said, the biggest challenge to the evolution of the profession of pharmacy is to develop a reimbursement model for clinical services that is not linked solely to the cost of the medication but is commensurate with professional services provided.
Oddest request from a patient/customer: When I was a
senior pharmacy student on rotations, a woman once came into a local community pharmacy and asked the pharmacist and me if we could take a look at a rash and tell her whether or not we thought it was fungal or bacterial. We took her to the consultant’s room where she proceeded to show us her bare chest! The pharmacist wasn’t bothered in the least and made a sound recommendation but deferred her to her PCP for a true diagnosis. I, on the other hand, was speechless as I had not expected such a thing in a community setting but was used to that in a hospital or clinic setting. Just goes to show how much of a clinical value pharmacists can bring to all aspects of pharmacy practice!
Recent reads: World Without End by Ken Follett, The Wise Man’s Fear and The Name of the Wind by Patrick Rothfuss.
Fun Activities: Reading, snorkeling, rafting, and any sports activity (and yes, the occasional video game) with my family. Ideal Dinner Guests: Nikoli Tesla, the scientist at Pfizer
who invented Viagra, and Ellen DeGeneres to keep things interesting!
If not a pharmacist then..: Most likely a general practice physician as my tastes have always revolved around medicine and the care of others. § AR•Rx
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FDA Approves 18 New Molecular Entities/Biologics
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he FDA has approved 18 new molecular entities/biologics since our last column, with several receiving special designation as qualified infectious disease products, orphan drugs, or undergoing accelerated review.
Infectious Disease: Avycaz™ (ceftazidime/avibactam) and
survival in children when used as part of a multimodality regimen (surgery, chemotherapy, and radiation). Farydak® (panobinostat) received accelerated approval as the first histone deacetylase inhibitor to treat multiple myeloma. However, the drug has a boxed warning for severe and potentially fatal diarrhea and cardiac toxicities and is approved with a Risk Evaluation and Mitigation Strategy (REMS) program.
Zerbaxa™ (ceftolozane/tazobactam), the first cephalosporin/ β-lactamase inhibitor combination products, were approved to treat complicated intra-abdominal or urinary tract Chronic Care and Specialty Products: Savaysa™ infections. Xtoro™ (finafloxacin) is a quinolone approved for (edoxaban) is a new oral factor Xa inhibitor anticoagulant acute otitis externa caused by Pseudomonas aeruginosa indicated to reduce stroke risk from nonvalvular atrial fibrillation and Staphylococcus aureus. in renally impaired patients and in treating DVT and PE. Savaysa™ Cresemba® (isavuconazonium), has boxed warnings that caution an azole antifungal used to FDA has approved 18 new molecular treat invasive aspergillosis and against: reduced efficacy in patients entities/biologics, with several mucormycosis, was given priority with normal renal function (CrCl receiving special designation as review and orphan drug status. >95ml/min); risk of ischemic events qualified infectious disease products, Rapivab™ (peramivir), the first due to premature discontinuation; intravenous neuraminidase inhibitor and spinal/epidural hematoma. orphan drugs, or undergoing to treat acute uncomplicated Cosentyx™ (secukinumab), a firstaccelerated review. influenza, is approved as a singlein-class interleukin antagonist and dose for patients who have been first subcutaneous monoclonal symptomatic fewer than two days. antibody, was approved to treat Viekira Pak™ (ombitasvir, paritaprevir, dasabuvir, ritonavir) plaque psoriasis. Natpara® (parathyroid hormone) was is approved to treat hepatitis C including patients with approved as adjunct to calcium/vitamin D to control compensated cirrhosis, and is used with/without ribavirin hypocalcaemia in hypoparathyroidism but with a boxed depending on the genotype and presence of cirrhosis. warning for osteosarcoma and approved with a REMS Bexsero® is the second vaccine approved to prevent program. Cholbam® (cholic acid) was granted a rare pediatric meningococcal disease caused by Neisseria meningitidis disease priority review as the first treatment for bile acid serogroup B in individuals aged 10-25 years. Gardasil®9, a synthesis disorders in both pediatrics and adults, but a postnew vaccine that protects against five additional HPV types, approval long-term observational safety study is required. has the potential to prevent genital warts as well as 90% of cervical, vaginal, and anal cancers. The dosing schedule is the New Dosage Forms: Significant dosage forms that were same as Gardasil® and is approved for females (9-26 years) approved include: Dyloject™ (diclofenac injection) for mildto-moderate pain; Duopa™ (carbidopa/levodopa, enteral and males (9-15 years). suspension) and Rytary™ (carbidopa/levodopa, ER capsule) Oncology: Ibrance® (palbociclib), used with Letrozole, was for Parkinson’s disease; Dutrebis™ (lamivudine/raltegravir), granted accelerated approval for advanced breast cancer in Evotaz™ (atazanavir/cobicistat) and Prezcobix™ (darunavir/ postmenopausal women. Lynparza™ (olaparib), an innovative cobicistat) for HIV-1 infection; Glyxambi® (empagliflozin/ first-in-class poly(ADP)-ribose polymerase inhibitor, was linagliptin) for type 2 diabetes; Toujeo® (insulin glargine, granted accelerated approval to treat advanced BRCAU-300 strength) for diabetes; Prestalia® (perindopril/ mutated ovarian cancer. Lenvima™ (lenvatinib) was granted amlodipine) for hypertension; Triferic® (iron replacement) priority review and orphan drug status to treat differentiated via hemodialysate; Signifor®LAR (pasireotide intramuscular thyroid cancer in patients whose disease has progressed suspension) for acromegaly; Soolantra® (ivermectin cream) despite radioactive iodine therapy. Opdivo® (nivolumab) for rosacea; Saphris® (asenapine sublingual) for pediatric was granted accelerated approval in December to treat bipolar I; Saxenda® (liraglutide, higher dose) for chronic weight advanced melanoma, and then recently received expanded management; an abuse-deterrent Zohydro™ formulation; and approval for metastatic squamous non-small cell lung cancer Zarxio™ (filgrastim-sndz), the first biosimilar product in the US. § with progression on or after platinum-based chemotherapy. _____________________________________________________ Unituxin™ (dinutuximab) is a first for therapy aimed at highContributing Author: Timothy K. Cheum, PharmD Candidate, Harding risk neuroblastoma. Unituxin™ has been shown to prolong University College of Pharmacy WWW.ARRX.ORG
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Making Sense of the Trackand-Trace Law WHAT NEW FDA GUIDANCE SAYS FOR PHARMACISTS
By Eileen E. Denne, APR
T
here is a new law in town and pharmacists now need to pay attention to it. “The Drug Supply Chain Security Act,” or DSCSA, better known to pharmacists as the “trackand-trace” law, was signed into law in November 2013 and Section 202 defines requirements related to prescription drug tracing.
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MAKING SENSE OF THE TRACK-AND-TRACE LAW
According to Food and Drug Administration (FDA) guidance issued for industry, the law will “enhance FDA’s ability to help protect U.S. consumers by improving detection and removal of potentially dangerous products from the pharmaceutical distribution supply chain and by helping to prevent such products from entering the supply chain in the first place.”
Many independent pharmacies don’t have electronic inventory management or ordering systems and often use paper invoices, APhA pointed out.
“Although the big three wholesale distributors will provide online portals for pharmacies to access the information, independent pharmacies also may often contract with the Although the FDA recommendations for manufacturers, small regional distributors that in many cases give pharmacies repackagers, and wholesale distributors went into effect their start. These pharmacies now should be seeking to enter on January 1, 2015, the recommendations for dispensers into agreements with their distributors to maintain transaction including pharmacists will go into effect on July 1, 2015. The information, history, and statements on their behalf and to guidance is still in draft form but give access to the information, the law intends for stakeholders to including lot-specific information. rely on the draft guidance before This is because pharmacies would finalization. FDA’s guidance is not be overburdened if they had to legally enforceable unless specific independently capture and store regulatory or statutory requirements this information because of space are cited. if it’s paper, and because of lack of infrastructure if it’s electronic," Ghobrial said. The “products” are defined as “a prescription drug in a finished dosage form for administration to Many wholesalers already keep a patient without substantial further this data, and it may be determined manufacturing (such as capsules, that having access to records tablets, and lyophilized products of the medications a pharmacy before reconstitution).” has purchased will suffice as the Although the FDA recommendations pharmacy keeping up with the for manufacturers, repackagers, records. The pharmacy might Starting in 2015, trading partners and wholesale distributors went are required to provide the not have to store the information into effect on January 1, 2015, the itself if it is determined that this is subsequent purchaser with product recommendations for dispensers sufficient. The safe bet, however, tracing information in paper and/or electronic formats for prescription is for the pharmacy to keep up including pharmacists will go into drugs and they have to get and keep with the records. effect on July 1, 2015. the product tracing information for six years after the transaction date. The day-to-day routine at a The trading partners in the supply pharmacy should not be greatly chain, according to the law, “may only accept product if this affected. Additional time may be required to check in information is provided.” They will also have to verify and medication orders and to account for the transaction records. notify the FDA in cases pertaining to suspect or illegitimate product. There is still uncertainty how this will affect trading and loaning medication between pharmacies. Guidance has not stated The American Pharmacists Association (APhA) provided if the information for the particular lot of medication being insight about the new law in January: exchanged will need to accompany the exchange. Future guidance from the FDA will likely clear this up. § “The pharmacy must develop a standard operating procedure outlining what pharmacy personnel should do when Links to more information: APhA: http://www.pharmacist.com/track-and-trace-law-2015-deadlines-newunpackaging received drug orders,” said Michael H. Ghobrial, requirements-0 PharmD, JD, APhA Associate Director of Health Policy. For example, procedures should be set in place outlining the Copy of law: http://www.help.senate.gov/imo/media/doc/052213%20S.%20 957%20Drug%20Supply%20Chain%20Security%20Act%20Section%20by%20 pharmacy’s role in analyzing each drug product container Section.pdf to search for red flags, he said. If a suspicious product is found, it must be quarantined while determining whether the FDA PowerPoint on guidance: http://www.fda.gov/downloads/Drugs/ DevelopmentApprovalProcess/SmallBusinessAssistance/UCM388945.pdf suspicious product is, in fact, illegitimate. The pharmacy must notify immediate trading partners and FDA if the product is FDA’s draft guidance on implementation of DSCSA: http://www.fda.gov/ found to be illegitimate.” downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ UCM424895.pdf
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PHARMACY RESIDENCES
That’s Not My State 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.
O
ften you find yourself flipping through pharmacy news and see recent court decisions that affect the practice of pharmacy in a different state. You might think, “Well it’s not in my state, so who cares?”
right? Right. Your courts aren’t bound by them, right? Right. So we can totally disregard them, right? I wouldn’t. If the issue has yet to be decided in your courts, that outside opinion could play a big part in shaping your professional landscape.
Even though that decision may not pertain to your practice now, it could later. The extent to which it does stems from its persuasive authority. Persuasive authority is the characteristic of a judicial opinion that courts in other jurisdictions can rely on in deciding a case, but this authority is neither absolute nor guaranteed.
Persuasive authority comes into play when a court is looking at an issue for the first time. It has no previous decisions in their own jurisdiction, so they aren’t bound by any rule of law. It has to make the rule of law and apply it to the case at hand. This process is not to be taken lightly, so persuasive authority is used for guidance in creating mandatory authority.
Of course, there are the judicial opinions issued in your state that directly affect your practice of pharmacy. These are said to have mandatory authority. Once an opinion is rendered based on a particular set of facts, it becomes the rule of law that all lower courts in that jurisdiction (including the court it came out of) must follow from then on. There is no discretion over whether to follow this rule. The process of following decisions with mandatory authority is called stare decisis, meaning “let the decision stand.” Mandatory authority derived from stare decisis serves the purpose of continuity (so people know what the law is and how to act), as well as efficiency in not having to consider policy arguments every time the same issue is raised. Let’s look at Bobay v. Walgreen.1 In 2007, Pansey and Dennis Bobay filed a complaint against Walgreen alleging that the pharmacy owed Ms. Bobay a duty to warn her about potential adverse injuries that could result from taking cyclosporine, gemfibrozil, and Vytorin. The Bobays were trying to prove negligence and in order to do that needed to show Walgreen’s had a duty to warn Ms. Bobay about drug interactions. However, the rule of law was already established that pharmacists had no such duty unless directed by the prescribing physician. That rule came from a case previously decided by the Indiana Court of Appeals.2 Since the federal judge in the United States District Court for the Northern District of Indiana was deciding on an issue in which Indiana state law governed, he was forced to apply the rule, thus favoring defendant Walgreen. As a result, that claim was dismissed from court on a motion for summary judgment. The Bobays could not recover from Walgreen on that claim because the facts were similar enough to a case that had previously been decided within their jurisdiction. The court was bound by mandatory authority. But what about judicial opinions from courts that have no jurisdiction where you practice pharmacy? They’re not your laws,
Exactly how persuasive a decision is, though, relies on a host of considerations. The more similar the facts are, the more persuasive it is. Reasoning behind an opinion, the person that wrote it, and the court from which the decision came all matter, too. Whether a court shares a specific doctrine on the matter is also important. Even demographic and geographic comparisons are made. It’s difficult to tell with any certainty how persuasive an “outside” decision may be. So here we go again. Let’s get back to a pharmacist’s duty to warn a patient about adverse effects. The State of Washington looked at this issue for the very first time in McKee v. American Home Products Corporation.3 Here, Elaine McKee alleged that the defendant pharmacists were negligent and should have warned her about the addictive effects of Plegeline for appetite suppression, that its therapeutic effect diminishes after a few weeks, and that it is not a drug to be used for long-term duration. Since this was an issue of first impression the court looked outside the State of Washington for help. The court was persuaded particularly by factually similar cases that arose out of the Florida District Court of Appeals and Michigan Court of Appeals. There, they held that pharmacists had no such duty to warn of potential adverse effects, but only a duty to properly fill a prescription. Also, since Washington followed the “learned intermediary” doctrine they looked at decisions from other states that followed the same doctrine.4 Those states found no duty to warn on the part of the pharmacist because they did not know the nuances of a patient’s health. Even though the court wasn’t bound by those prior decisions, it chose to follow their rulings anyway. Maybe you might want to skim through that article after all. You can anticipate what the argument for or against an issue will be when it’s raised. Making yourself aware of what’s going on in other states helps to keep you aware of your own professional responsibilities and their evolution. §
__________________________________________________________________________________________________________________________________________________ © Phillip J. Schieffer, PharmD/J.D. is a Dual-Degree Candidate at Drake University. 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 2
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Bobay v. Walgreen Co., 2009 WL 1940727, (N.D. Ind. June 30, 2009). Ingram v. Hook’s Drugs, Inc., 476 N.E. 2d 881, 887 (Ind. Ct. App. 1985).
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McKee v. American Home Products Corp., 782 P.2d 1045 (Wash. 1989). Learned intermediary doctrine applied here means that it is the physician that has the duty to warn, because not only are they educated on drug therapy, but they also have comprehensive knowledge of a patient’s medical history, unlike the pharmacist.
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UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY
UNIVERSIT Y OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY
Careless Comma Leads to Confusion
Welcome to another issue of Safety Nets. This column illustrates the potential hazards associated with illegible prescriber handwriting. A community pharmacist from Central Arkansas reports the following potentially lifesaving intervention. Thank you for your continued support of this column, and to the pharmacist who shared this interesting case with our readers.
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pharmacy technician in Central Arkansas received the original handwritten prescription illustrated in Figure One. The technician entered the prescription information into the computer as: KeflexÂŽ (cephalexin) 500 mg Capsules, quantity 28, with directions to the patient of "take two capsules now, then two capsules four times a day." The prescription was filled by a second technician and placed in line for pharmacist verification and patient counseling. While Figure One verifying the prescription for accuracy, the pharmacist immediately questioned the high cephalexin dose and the short duration of therapy (four grams a day for 3 days). The pharmacist asked the patient if the prescriber had explained the directions. The patient said "He told me you would explain everything." At this point, the pharmacist decided to call the prescriber for clarification. The prescriber's nurse said the patient was to take two capsules the first dose, then one capsule four times a day. The nurse went on to say "I can see how the comma could be confusing." After this, a corrected prescription label was generated and the patient appropriately counseled. This case illustrates the hazards of using punctuation marks in prescription writing. In this case, a carelessly written comma nearly resulted in a medication error reaching the
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patient. Commas are not the only culprit. Carelessly written semicolons, colons and even periods have led to medication errors. Punctuation marks may be used in an attempt to save time when writing or to clarify specific parts of a prescription. In all cases, their use is potentially hazardous. Pharmacists must educate technicians about the potential hazards lurking in these types of prescriptions. In addition, pharmacists must avoid using punctuation marks and/or symbols when transcribing orders received over the telephone. Any careless mark on a prescription can result in a medication error reaching a patient. The use of "ii" rather than the Arabic numeral "2" in the Sig. further compounded the problem of the lurking comma. Any reader who sees the "ii" is set up for a confirmation bias to read "i" as another "ii". The safer practice would be to write for a dose of "2 capsules now, then 1 capsule four times a day." One could also argue that it would be well for the prescriber to add "until all doses are taken." That would assist the pharmacist in counseling to promote good adherence, and to make cure of the infection even more likely. The authors of Safety Nets thank this pharmacist for sharing this interesting case with our readers. §
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2015 Calendar of Events SAVE THE DATES
MAY
APA District Meetings:
May 9 Harding University College of Pharmacy Commencement Searcy, AR
District 6 August 25 Embassy Suites Hot Springs, AR
May 12-13 National Community Pharmacists Association Legislative Conference Hilton Crystal City Arlington, VA
District 4 August 27 Camden Country Club Camden, AR
May 15 UAMS College of Pharmacy Convocation Little Rock, AR May 16 UAMS Commencement North Little Rock, AR
JUNE June 6-9 International Academy of Compounding Pharmacists Compounders on Capitol Hill Washington, DC June 6-10 American Society of HealthSystem Pharmacists Summer Meeting Denver, CO June 9-10 Arkansas State Board of Pharmacy Meeting Little Rock, AR June 11-13 APA 133rd Annual Convention Embassy Suites Financial Parkway Little Rock, AR
AUGUST *August APA Board of Directors Retreat Mount Magazine State Park Paris, AR
District 5 September 29 Grand Prairie Center Stuttgart, AR
OCTOBER October 8-9 Arkansas Association of HealthSystem Pharmacists Marriott Hotel Little Rock, AR
SEPTEMBER District 1 September 3 Embassy Suites Hotel Little Rock, AR
October 10-14 National Community Pharmacists Association Annual Convention Gaylord National Harbor Washington, DC
District 5 September 10 Monticello Country Club Monticello, AR
*October APA Golden CPE Hosto Center Little Rock AR
District 3 September 14 Doubletree Hotel Bentonville, AR
October 30-November 1 American Society of Consultant Pharmacists Annual Meeting and Exhibition Las Vegas, NV
District 7 September 15 Holiday Inn City Center Fort Smith, AR
DECEMBER December 6-10 American Society of HealthSystem Pharmacists Midyear Clinical Meeting and Exhibition New Orleans, LA
District 8 September 17 Harding University Founders Room Searcy, AR District 2 September 21 Location TBD Jonesboro, AR
December 5-6 APA Committee Forum and Board Meeting Holiday Inn Airport Little Rock, AR
District 3 September 22 Big Creek Golf & Country Club Mountain Home, AR District 6 September 24 Lake Point Conference Center Russellville, AR
* Dates have not been finalized.
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Navigating the Healthcare Landscape
Navigating the Healthcare Landscape 133 RD APA ANNUAL CONVENTION • JUNE 11-13, 2015 The Arkansas Pharmacists Association’s (APA) 133rd Annual Convention will be held at The Embassy Suites in Little Rock from June 11-13, 2015. The conference theme, Navigating the Healthcare Landscape, reflects the environment of constant change for pharmacists and other healthcare providers. Pharmacists can stay up-to-date and informed with the Continuing Pharmacy Education sessions and networking opportunities planned at the convention. This annual conference will welcome up to 350 pharmacists, pharmacy technicians, exhibitors, students, and special guests. ________________________________________________
Why Attend ________________________________________________ Continuing Pharmacy Education: APA will offer up to 15.5 hours of Continuing Pharmacy Education credit with highly-regarded instructors on topics ranging from Medicare Part D to the latest in Healthcare Technology. 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: Join old and new friends at the convention social events. In addition to the lively Opening Reception at the Exhibit Hall, the Friday evening reception will be held at the Embassy Suites and feature the popular Dueling Pianos. Enjoy this fun entertainment as well as beverages and a dinner buffet. ________________________________________________
Accommodations ________________________________________________ The host hotel for the 133rd APA Annual Convention is The Embassy Suites at 11301 Financial Centre Parkway in Little Rock. Check-in is at 3:00 PM and check-out is 12:00 PM. For reservations, call 1-800-EMBASSY or 501-312-9000. Room rate starts at $124.00 plus tax. Mention Arkansas Pharmacists Association Group for group rate. Cut-off date for rooms is May 10, 2015. 26 262
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We appreciate the support of our Wholesale Business Partners!* AmerisourceBergen Cardinal Health McKesson Morris & Dickson Company, LLC Smith Drug Company * These organizations did not provide any financial support for continuing education activities. AR•Rx
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THE ARKANSAS PHARMACIST
(Schedule is subject to change) ________________________________________________
WEDNESDAY, JUNE 10, 2015
________________________________________________ 9:00 AM - 12:00 PM
APA Board of Directors Meeting
1:00 PM
APA Annual Golf Tournament Country Club of Arkansas (Maumelle)
THURSDAY, JUNE 11, 2015
________________________________________________ 7:00 AM - 4:30 PM
Registration
7:30 - 8:30 AM
Breakfast
8:45 AM - 12:00 PM Clinical Update CPE Block • New Drugs of 2015 • Using Genetic Testing to Guide Drug and Dose Selection 12:15 - 1:45 PM
Luncheon & Awards Ceremony
2014 President Dana Woods with 2014 Pharmacist of the Year Michelle Crouse. WWW.ARRX.ORG
4:45 - 5:30 PM
Arkansas Pharmacists Foundation Board Meeting and Past Presidents Council
5:30 - 6:00 PM
Presidents Reception
6:00 - 8:00 PM
Opening Reception in Exhibit Hall
133rd APA Annual Convention — June 11-13, 2015
SCHEDULE OF EVENTS
2:00 - 5:15 PM Evolving Practice CPE Block • Implementation of Pharmacy Services in a Primary Care Clinic • Biosimilar Insulins: Issues and Considerations before Clinical Use • Basic Insulin Therapy in the Treatment of Insulin Resistant Type 2 Diabetes: The Role of the Pharmacist in Ensuring Their Safe and Effective Use in Patients
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FRIDAY, JUNE 12, 2015
________________________________________________ 7:00 AM - 4:30 PM
Registration
7:30 - 8:30 AM
AP-PAC Breakfast and Speaker
8:45 AM - 12:00 PM Medicare Part D CPE Block • Understanding DIR Fees and Surviving Part D • Measuring Pharmacy Performance 10:00 AM - 12:00 PM
Arkansas Association of Health-System Pharmacists (AAHP) Board Meeting
10:00 AM - 12:30 PM
Spouse Trip Mark Twain Riverboat Cruise (lunch provided)
The Mark Twain is an American Legend and one of the premier attractions docked on the north shore of the Arkansas River. An authentic stern wheeler named after the beloved riverboat-era author, Samuel Clemens, the Mark Twain is classic, captivating, and comfortable. The first deck is climate-controlled for year-round comfort with large unobstructed panoramic windows. The second deck is open-air, offering a spectacular view of central Arkansas from the river. 27
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SATURDAY, JUNE 13, 2015
________________________________________________ 7:00 - 10:00 AM
Registration
7:30 - 8:30 AM
Continental Breakfast & State of the Association Address
8:45 AM - 12:30 PM Shots and Law CPE Block • Looking Forward and Looking Back: Immunization Update • Pharmacy Law Update Spouse Trip: Mark Twain Riverboat Cruise
12:15 - 1:45 PM
Luncheon in Exhibit Hall
2:00 - 5:15 PM
Managing your Practice CPE Block • Wake Up and Smell the Digital Healthcare Opportunities • Interviewing Potential Employees with a Purpose: Get Who and What You Want 6:00 - 6:30 PM 6:30 - 8:30 PM
Swearing in of New Officers APA’s Dueling Piano Lounge
Honoring APA’s Wholesale Partners: AmerisourceBergen, Cardinal Health, McKesson, Morris & Dickson Company, LLC and Smith Drug Company.
12:00 PM
Convention Adjourns
CONTINUING PHARMACY EDUCATION SESSIONS ________________________________________________
THURSDAY MORNING
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— CLINICAL UPDATE BLOCK — New Drugs of 2015 — Tom Frank, Pharm.D., Associate Professor of Pharmacy Practice, UAMS Regional Programs Northeast ACPE #0004-9999-15-060-L01-P 1.5 Contact Hours This CPE activity will be knowledge based. CPE Objectives: • Identify new trends in drug development. • List indications, pharmacology, adverse effects, and dosing. • Explain the role these products will play in the participant’s practice. • Describe the economic implication of these choices. • Examine products in the short-term pipeline that will be important to the practice of the participants.
You won’t want to miss the Ernie Biggs Dueling Pianos at the APA Dueling Piano Lounge. This event is an interactive musical experience that engages the audience and makes you part of the show! Like the song, Don’t Stop Believing that you will have an unforgettable time at the APA Dueling Piano Lounge. The Embassy Ballroom will be transformed in to a Lounge atmosphere that will have you singing along and making memories with your APA colleagues.
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Using Genetic Testing to Guide Drug and Dose Selection – Lindsay Elliott, Pharm.D., CGP, Assistant Professor, Harding University College of Pharmacy ACPE #0004-9999-15-061-L01-P 1.5 Contact Hours This CPE activity will be knowledge based. CPE Objectives: • List characteristics of the various cytochrome P-450 enzymes involved in the metabolism of the most commonly prescribed drugs. • Identify medications subject to significant drug-gene interactions. • Given a patient case, identify medication related problems (MRPs) based on drug-gene interactions. 28
THURSDAY AFTERNOON
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— EVOLVING PRACTICE BLOCK — Implementation of Pharmacy Services in a Primary Care Clinic – Alison Gray, Pharm.D., Clinical Pharmacist, Little Rock Family Practice Clinic ACPE #0004-9999-15-062-L04-P 1.5 Contact Hours This CPE activity will be knowledge based. CPE Objectives: • Define Patient Centered Medical Home (PCMH) care model. • Describe the clinical services provided by an ambulatory care pharmacist. • Identify the key elements for how to develop the service. • List at least 5 clinic operations that require consideration when building the service. • Describe the most common billing models for reimbursement. Biosimilar Insulins: Issues and Considerations before Clinical Use – Curtis Triplitt, Pharm.D., CDE, University of Texas Health Science Center at San Antonio ACPE # 0006-9999-14-022-L01-P/T 1.0 Contact Hours This CPE activity will be knowledge based. This program is organized by Horizon CME. This program is supported by Sanofi US. CPE Objectives: • Outline the differences between biopharmaceuticals, biosimilars, and generic medications. • Discuss the FDA guidance documents and abbreviated regulatory pathway available for the licensing of “biosimilar” products and the implications for insulin products. • Describe the potential impact that changes in manufacturing and sourcing of ingredients for biosimilar products may have on immunogenicity, safety, and efficacy. • Discuss the critical issues of naming, interchangeability, and pharmacovigilance with biosimilar products including biopharmaceuticals with a narrow therapeutic window such as insulin. • Identify the issues and considerations for clinical use of biosimilar insulin products. Basal Insulin Therapy in the Treatment of Insulin Resistant Type 2 Diabetes: The Role of the Pharmacist in Ensuring Their Safe and Effective Use in Patients – Susan Cornell, BS, Pharm.D., CDE, FAPhA, FAADE, Midwestern University ACPE # 0006-0000-15-013-L01-P WWW.ARRX.ORG
1.0 Contact Hours This CPE activity will be knowledge based. This program is organized by Horizon CME. This program is supported by Sanofi US. CPE Objectives: • Describe the reasons for the use of high concentration insulin formulations in the treatment of type 2 diabetes. • Discuss the clinical, pharmacokinetic and pharmacodynamic profiles for current and emerging basal insulins. • Implement strategies for safely converting between U-100 and concentrated insulin formulations using different syringes and pen devices in patients with type 2 diabetes. • Review currently available insulin pens and syringes used for the administration of insulin. • Explain and apply strategies to overcome the barriers to insulin-mediated glucose control. _______________________________________________
FRIDAY MORNING
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— MEDICARE PART D BLOCK — Understanding DIR Fees & Surviving Part D – Lonny Wilson, P.D. , Executive Director, Pharmacy Providers of Oklahoma ACPE #0004-9999-15-063-L04-P 1.5 Contact Hours This CPE activity will be knowledge based.
133rd APA Annual Convention — June 11-13, 2015
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CPE Objectives: • Evaluate the risk/reward for being a preferred pharmacy in Medicare Part D plans. • Describe the purpose of Direct Indirect Remuneration (DIR) Fees in Medicare Part D. • Explain how DIR fees will impact your bottom line in Medicare Part D plans. • List any Medicare Part D plans that are using DIR fees as a pay for performance incentive. • Develop a strategic business decision about whether it is better to be a preferred or nonpreferred pharmacy. Measuring Pharmacy Performance – Tripp Logan, Pharm.D., Vice President, Logan & Seiler, Inc., SEMO Drugs ACPE #0004-9999-15-064-L04-P 1.5 Contact Hours This CPE activity will be knowledge based. • Describe the current health care landscape and its transition away from fee for service. • Describe community pharmacy’s impact on quality measures. • Describe a community pharmacy quality incentive program or payment model. • Develop an action plan to effectively prioritize patient interventions to improve measurable patient outcomes and positively reflect pharmacy quality. 29
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Navigating the Healthcare Landscape
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FRIDAY AFTERNOON
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— MANAGING YOUR PRACTICE BLOCK — Wake Up and Smell the Digital Healthcare Opportunities – Bill Felkey, Professor Emeritus of Healthcare Informatics, Auburn University ACPE #0004-9999-15-065-L04-P 1.5 Contact Hours This CPE activity will be knowledge based. CPE Objectives: • Describe connectivity requirements mandated by healthcare reform across the continuum of care in general and pharmacy specifically. • List at least three system benefits derived from system connectivity that promote participatory healthcare when pharmacies employ interfaces and integration with both providers, patients, and their caregivers. • Discuss how clinical decision support systems can now be employed in the pharmacy and directly with patients to achieve new levels of patient safety and quality. • Recognize key steps in deciding what new technology to employ in your practice to achieve your business and professional goals. Interviewing Potential Employees with a Purpose: Get Who and what you Want – Grady McCorkle, Assistant Director, Dillard’s ACPE #0004-9999-15-066-L04-P 1.5 Contact Hours This CPE activity will be knowledge based. CPE Objectives: • Review the main areas for creating a compelling job description. • Discuss the basics of reviewing resumes and screening candidates. • Improve your interviewing skills to select the right talent the first time. • Establish appropriate onboarding procedures and evaluation periods. _______________________________________________
SATURDAY MORNING
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— SHOTS AND LAW BLOCK — Looking Forward and Looking Back: Immunization Update – Eric Crumbaugh, Pharm.D., Director of Clinical Programs, Arkansas Pharmacists Association ACPE #0004-9999-15-067-L01-P 2.0 Contact Hours This CPE activity will be knowledge based. 306
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• Review current US and Arkansas immunization rates. • Apply the current CDC immunization schedule to a patient based on age and/or disease state. • Discuss evidence-based strategies to inform patients’ decision on vaccinations. • Identify tactics that could be implemented into a community or hospital pharmacy to increase the number of patients protected from vaccinepreventable disease. Pharmacy Law Update – John Kirtley, Pharm.D., Executive Director, Arkansas State Board of Pharmacy ACPE #0004-9999-15-068-L03-P 1.5 Contact Hours This CPE activity will be knowledge based. • Analyze recent changes in Pharmacy regulations in Arkansas. • Discuss the reasoning behind changes to pharmacy regulations. • Demonstrate understanding of recent pharmacy regulatory changes and challenges. • Identify three practice changes to protect your controlled substance inventory. _______________________________________________ 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: The following educational activities have been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Pharmacy Education (ACPE) through the co-sponsorship of the University of Arkansas for Medical Sciences College of Pharmacy and the Arkansas Pharmacists Association. These activities will provide pharmacists up to 14 contact hours.
0004-9999-15-060-L01-P 0004-9999-15-063-L04-P 0004-9999-15-066-L04-P 0004-9999-15-061-L01-P 0004-9999-15-064-L04-P
0004-9999-15-067-L01-P 0004-9999-15-062-L04-P 0004-9999-15-065-L04-P 0004-9999-15-068-L03-P
These educational activities are open to all pharmacists. To receive credit, the pharmacy participant must complete and submit attendance forms and complete all online post-tests/program evaluation forms. If the attendance documentation is illegible then no credit can be issued. Partial credit will not be given for a session; you must attend each session in full to receive credit for that particular session. Credit will be uploaded to CPE monitor within 60 business days of completion of program. Participants will be notified via email when credit has been uploaded to the CPE monitor database. You may check the status of your CPE credit anytime by logging on to your CPE Monitor account at www. mycpemonitor.net. For questions regarding the activities listed above please contact the CPE Office at 501.686.5396 or via email ASPerry2@uams.edu. The University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. To receive continuing education credit for this program, participants must attend the conference, complete the Pre- and Post-Activity ARS surveys, and submit an activity evaluation which will be provided to you via email following the live activity. Once your evaluation is received statements of credit will be uploaded to participant NABP e-profiles via CPE Monitor within 30 days of completion of the program. Paper statements will not be mailed. These are ongoing programs with an initial release date of 12.05.14 and 04.24.15.
This event is co-sponsored with the UAMS College of Pharmacy.
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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 #:_________________________________
PHARMACIST FULL REGISTRATION PACKAGE Includes: All education sessions and CPE, receptions, exhibit hall admission, prize drawings, breaks and social event tickets for Thursday, Friday and Saturday. Cutoff date for early bird registration is May 15, 2015.
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& Spouse/Guest
TECHNICIAN REGISTRATION PACKAGE APA MEMBER NON MEMBER Full Registration
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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.
# of Students to Sponsor _____ @ $85 each = ________
ADDITIONAL CONVENTION ACTIVITIES Wednesday, June 10 Convention Golf Tournament - $65 # of Golfers ______ at $65 per player = _____________ Name(s) of Golfers ______________ _______________ ______________ _______________ Friday, June 12 Spouse Trip to Mark Twain Riverboat Cruise - $40 Name of Attendee: _______________________________
SOCIAL EVENT TICKETS - Friday, June 12 Social Event Tickets are included in the Full Registration Package.
APA Dueling Piano Lounge # of Additional Tickets: ______ @ $50 each = _________
PHARMACIST DAILY REGISTRATION PACKAGE Includes: All education sessions and CPE, receptions, exhibit hall admission, prize drawings, breaks and social events for the day of registration.
APA MEMBER NON MEMBER
RESERVATIONS Please let us know the number of attendees for each event you plan on attending. _____ Thursday, June 11- Awards Luncheon and Ceremony _____ Thursday, June 11- Opening Reception
Thursday Only Registration
$199
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_____ Friday, June 12- AP-PAC Breakfast
Thursday Only Registration and Spouse/Guest
$249
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_____ Saturday, June 13- Breakfast & State Of the Assoc.
Friday Only Registration
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Friday Only Registration and Spouse/Guest
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_____ Friday, June 12- APA Dueling Piano Lounge
PAYMENT Total Amount: _________________________ Pymt. Type: __Visa __AmEx __MC __Discover __Check Card# _________________________________
Exp______________ Sec Code____________ Made payable to Arkansas Pharmacists Association: 417 S. Victory St., Little Rock, AR 72201 Fax to: 501-372-0546. Or register at www.arrx.org.
Refund Policy By May 22, 2015, 50 percent refund will be issued. After May 22, 2015, no refund will be issued. All refund/cancellation requests must be submitted to APA in writing. Registrations are non-transferrable.
WWW.ARRX.ORG
133rd APA Annual Convention — June 11-13, 2015
APA 2015 Annual Convention
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How to Prevent and Detect Diversion, Part 1: Site Security
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iversion of controlled substances is a top issue on the minds of pharmacy regulators and practitioners these days. Each of you has heard horror stories, I am sure, of a trusted long-term employee who diverted thousands of hydrocodone tablets from a pharmacy before being caught. As the attorney for the Board of Pharmacy for six years, I saw many examples of pharmacists who were utterly blindsided by an inside job—no one ever thinks it could happen to them. The bad news is that diversion will happen to each and every one of you, eventually, because demand is so high and it is too tempting. But let me assure you, as pharmacists, pharmacists-in-charge and store owners, you can make small changes to your business and pharmacy practices that will: 1) make it much harder to divert and 2) make it much easier to catch when it does happen.
As pharmacists, pharmacists-in-charge and store owners, you can make small changes to your business and pharmacy practices that will: 1) make it much harder to divert and 2) make it much easier to catch when it does happen. In this series of articles, I will share best practices that will increase the security and the accountability of your controlled drug inventory. Let’s begin with physical/site security.
First, you must tightly control the keys.
This not only means limiting the employees who are key holders but also putting in other safeguards such as: stamping “do not duplicate” on the keys, re-keying the locks if a key is lost or an employee leaves, and keeping critical keys—such as to the controlled drug cabinet—locked up on site.
Second, manage your alarm system properly. Alarms
should be set up with separate access codes for each employee so that logs are created of each entry and exit. As with keys, all codes should be changed when an employee leaves. You may even want to set up separate codes for employees with access to the controlled drugs area.
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Third, install security cameras.
A visible camera directed at all controlled drug areas will serve as a deterrent to many employees. Be sure that the angles captured by the camera will allow you to recognize faces and see any movements near the controlled drug inventory. It is also very useful to have one or more hidden cameras installed nearby that none of the staff knows about. This is particularly true if you suspect diversion of a specific drug—a properly placed hidden camera will often allow you to catch the culprit.
Fourth, control access to your pharmacy.
Many of the worst instances of diversion I saw at the Board involved a trusted employee who was allowed to be alone in the pharmacy on a regular basis. The best practice is a strong policy that technicians, clerks, or other non-pharmacists cannot be present in the pharmacy unless the pharmacist is also present. If a repairman or other non-employee needs access, they should be escorted the entire time they are in the pharmacy.
Fifth, carefully consider where to store controlled drugs. The ideal location for your controlled drug inventory will keep it out of the customers’ view, so outside thieves will not be tempted by the 500-count bottles. But you will want the inventory to be in a high-traffic area of the pharmacy so that staff will not have any privacy to pocket a hydrocodone. Keeping all controlled substances in a locked cabinet or an area with a separate entry is also a good practice.
In the next installment of this series, we will discuss the policies and procedures you will need for ordering, receiving, transferring, and tracking controlled substances. § _____________________________________________________
About the author: Erika Gee represents clients in government relations, regulatory and compliance matters at Wright, Lindsey & Jennings LLP. She previously served as general counsel to the Arkansas State Board of Pharmacy for 6-1/2 years and as Chief of Staff and Chief Deputy Attorney General for Attorney General Dustin McDaniel. She uses her experience as general counsel for state agencies and licensing boards to assist clients to resolve regulatory and disciplinary disputes with state government.
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THE ARKANSAS PHARMACIST
CLINICAL PROGRAMS COLLEGES OF PHARMACY
Using the Arkansas Immunization Information System "WebIZ" in Pharmacy Practice By Eric Crumbaugh, Pharm.D.
I
n Arkansas, all immunization providers that administer vaccines to patients 21 years of age and younger are required to report these doses to the state’s immunization information system (IIS) called WebIZ. The Arkansas Department of Health and the Centers for Disease Control and Prevention (CDC) recommend all immunizations given to patients regardless of age should be reported to the state’s IIS. WebIZ is an online database of immunizations received by Arkansans. This new registry system replaced the Immunization Network for Children in June 2012. The website to access the registry is https://adhimmreglive.arkansas.gov/webiznet/ Login.aspx
Immunizations for over 22 years must be entered
The Arkansas Department of Health also maintains the International Travel Physician / Pharmacist Agreement which authorizes physicians and pharmacists to stock and administer yellow fever vaccine. The newly proposed agreement states, “As a requirement of this agreement, (immunization) doses given to individuals 22 years of age or older must be entered into the statewide immunization registry, unless specifically declined by the traveler.” Also, the registry can be used during these consults to query the traveler’s routine immunization history. Currently, most of the large chain pharmacies that offer immunizations electronically report these doses to Arkansas IIS, however, their systems do not have the bi-directional interface ability. Basically, this allows for a pharmacist to see the patient’s complete immunization record from WebIZ. This capability does currently exist, however limited resources have prevented it from being implemented. In the meantime, pharmacists are encouraged to obtain access to the online platform so that they can access a patient’s complete immunization record. Pharmacy technicians are also allowed to access the registry for reporting or querying purposes. To request access to the registry, go to: https:// adhwebizenrollment.arkansas.gov/ADHEnrollmentContent/ ShowHomePageContent.aspx
Registry access leads to other immunizations
“We’ve found that when pharmacists go into the registry and can look at the information, they see about four other immunizations patients are lacking,” said Lisa Tonrey, BSPharm, MHA, PhC, FAPha, who served as APhA President from 2003 – 2004. Pharmacists who have access to WebIZ can also provide a patient or parent with an official immunization record. WebIZ has vaccine-recommending software imbedded into
the program. If the patient’s vaccine record is up-to-date, this software will tell you which vaccines are indicated for this patient based on the CDC Immunization Schedule. Please note that these recommendations generated are not a replacement for clinical judgment. As Arkansas pharmacists continue to increase the number of immunizations given at their practice sites, it is vital that these doses get recorded into the immunization record. All healthcare providers in Arkansas including primary care providers are able to access patient records in the registry. Eventually, these documented immunizations will electronically flow into these primary care providers’ electronic health records. It is important to remember that if a patient cannot provide documentation of an immunization being administered by a healthcare provider, the CDC recommends a repeat of that immunization. While it is safe to repeat doses of immunizations, this may increase healthcare expenditures as well as discomfort to the patient. All healthcare providers that provide immunizations should report all of these doses to the Arkansas immunization information system WebIZ. This practice has been shown to improve overall patient care as well as affirm the role of pharmacists in the patient care continuum. Additional information as well as online trainings can be found at http://www.arrx.org/arkansas-immunization-registry--webiz or by contacting APA’s Dr. Eric Crumbaugh (eric@arrx.org). §
Author’s Note: The Arkansas Immunization Information System WebIZ replaced the Immunization Network for Children (INC) in June of 2012. This system has been online for less than 3 years, however the Arkansas Department of Health has worked vigorously to move records from the INC, provide access for Arkansas immunizers (including pharmacists), and work through technical issues as they have come up.
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UAMS REPORT
Twenty-Four Years of Growth and Change
W
hen Alan and I packed the car and strapped our 10-month old son, David, into his car seat for the trek from Cleveland to Arkansas, we would have never believed that 24 years later we would have had so many wonderful opportunities through our careers and met so many lifelong friends. Since 1991, I have had the chance to teach, collaborate on research projects, lead a department, complete a doctoral program in Higher Education Administration, and serve as Dean at one of the best pharmacy schools in the nation. Along the way, we were blessed to have a daughter, Erica. The growth that I’ve seen at the UAMS campus in a little over two decades has been amazing. The campus footprint has grown by leaps and bounds. The old dorm that many called home for a few years made way for a new hospital tower. The building cranes were on campus for several years. The Jackson T. Stephens Spine and Neurosciences Institute, the Harvey and Bernice Jones Eye Institute, the Donald W. Reynolds Institute on Aging, the Winthrop P. Rockefeller Cancer Institute, the Psychiatric Research Institute, and the Fay W. Boozman College of Public Health were added to the campus one by one.
The growth that I’ve seen at the UAMS campus in a little over two decades has been amazing. The campus footprint has grown by leaps and bounds.
Our educational and research programs have seen radical changes, as well. Today, our lectures are all archived and students can view the lectures at any time, from any location. Students are divided between two campuses but the connection for didactic work is synchronous and the students are able to join in classroom discussions regardless of their campus. The faculty is incorporating more objective, structured clinical exams (OSCEs) into teaching and learning, and the newest focus areas are on interprofessional education, flipped classroom techniques, and gaming technology for teaching. Our research program is nationally ranked among the top 25 and our work in radiation health, drug discovery, and
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Stephanie Gardner Pharm.D., Ed.D. Dean
pharmaceutical evaluation and policy are recognized among the best in the country. Our scientists are working on drug entities that may have long-term benefit in protecting the body from radiation in the treatment of cancer and that may have promising effects on organ systems in normal aging.
Our research program is nationally ranked among the top 25 and our work in radiation health, drug discovery, and pharmaceutical evaluation and policy are recognized among the best in the country. Our service has also evolved. We have clinicians in UAMS University Hospital, Arkansas Children’s Hospital, St. Bernard’s in Jonesboro, Mercy Hospital Northwest Arkansas, the Veterans Healthcare System of the Ozarks, and in regional health centers throughout the State. Pharmacy practice has become increasingly specialized and faculty work in areas such as pediatric infectious disease, cystic fibrosis, palliative care, and gestational diabetes. As the profession has evolved, the College has remained committed to helping solve problems related to prescription drugs and their appropriate use. In an effort to assist the State Medicaid program and the Employee Benefits Division of the Department of Finance and Administration, we developed an Evidence Based Prescription Drug Program. Today, the program has saved the State well over $100 million while ensuring that patients had access to therapy based on the best evidence available. Today, the future of pharmacy is bright. My son, who was 10 months old in 1991, will graduate from pharmacy school in May. I can’t imagine the changes that will occur during his career, but I predict a practice environment where he sees endless opportunities to grow and learn and give back…just as I have. I will always be grateful to each of you who have made this journey so enjoyable. § Note: Dean Gardner will leave her position at the College of Pharmacy and become Provost at UAMS on June 1.
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THE ARKANSAS PHARMACIST
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HARDING UNIVERSITY REPORT
Increased Emphasis in Curricular Effectiveness and Interprofessional Education at Harding COP
O
n February 2, 2015, the Accreditation Council for Pharmacy Education (ACPE) released revised standards under which all colleges and schools of pharmacy in the United States will be evaluated as of July 1, 2016. Thus, the new standards are referred to as Standards 2016. The current ACPE accreditation standards went into effect in 2007, so ACPE felt it was time to review the experience they had gained under the 2007 standards as well as to incorporate items the Institute of Medicine has deemed necessary to improve medication safety and patient outcomes. There was also an update to the American Association of Colleges of Pharmacy’s Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes in 2013 as well as to the Joint Commission of Pharmacy Practitioner’s Vision of Pharmacy Practice. The philosophical focus of Standards 2016 is on ensuring that, upon graduation, students are “practice-ready” and “team-ready.” ACPE has further defined this by saying that graduates should be, “prepared to directly contribute to patient care, working in collaboration with other healthcare providers,” (https://www.acpe-accredit.org/pdf/ FAQStandards2016FINAL.pdf).
The increased emphasis on interprofessional education is an exciting prospect for most pharmacy educators. True interprofessional education means learning, with, from, and about other health care providers.
In keeping with this philosophy, two of the big changes that colleges and schools have noted in Standards 2016 are an increased emphasis on curricular effectiveness (“practiceready”) and interprofessional education (“team-ready”). Of these two, one measure of curricular effectiveness known as the Pharmacy Curriculum Outcome Assessment (PCOA) is causing the most controversy and angst among pharmacy educators. The National Association of Boards of Pharmacy (NABP) developed the PCOA several years ago for schools and colleges to use as a way to assess student performance in the pharmacy curriculum. It is a psychometrically validated, 225-item, computer based exam that covers four content areas and 28 subtopic areas. Up until now, any college or
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Julie Hixson-Wallace Pharm.D., BCPS Dean
school of pharmacy could choose to administer the PCOA as many or as few times as they would like during the pharmacy curriculum at a charge of $75 per student per administration. Since the exam first became available, 59 schools and colleges of pharmacy (about 45% of all schools and colleges in the US) have utilized the PCOA at some point in their curriculum. However, Standards 2016 requires that all colleges and schools of pharmacy must administer the PCOA annually to students nearing the completion of the didactic curriculum, which is usually the third professional year of a pharmacy program. With this new requirement, NABP is going to allow each college or school one administration to students nearing the end of the curriculum at no charge, so you may hear chatter among pharmacy students and faculty about this new required national examination. The increased emphasis on interprofessional education is an exciting prospect for most pharmacy educators. True interprofessional education means learning with, from, and about other health care providers. For instance, at Harding University we have students in the health sciences studying communication sciences and disorders, speech language pathology, physician assistant studies, nursing, physical therapy, and pharmacy. In other related degree programs we have students studying mental health counseling, athletic training, and dietetics, just to name a few. An Interprofessional Education Steering Committee was formed last fall to begin looking in a more systematic way at how education among the health sciences and related degree programs can be more interprofessional. Several formal interprofessional events have been held involving students from several different disciplines such as simulations involving team-based care of a standardized patient exhibiting signs and symptoms of a stroke. In addition, faculty from different health professions have collaborated on a research project measuring the degree of improvement in students’ understanding of the value of team-based care. At HUCOP we feel ready to meet the challenges of Standards 2016 and appreciate your help and insight as preceptors as we move forward in this endeavor. §
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THE ARKANSAS PHARMACIST
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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS
Continuing to Move Forward on Pharmacy Practice Model Initiative
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here is health-system pharmacy after the 2010 Pharmacy Practice Model Summit? Following the summit, the American Society of Health-System Pharmacists (ASHP) set forth updated goals for health-system pharmacy termed the Pharmacy Practice Model Initiative (PPMI). These goals encompassed the development and support of a futuristic practice model that efficiently utilizes pharmacists as direct patient care providers. ASHP measures the progress of PPMI recommendations through its national dashboard and the hospital selfassessment tool (HSA). The national dashboard (Table 1) is compiled annually through ASHP’s national survey data. The hospital self-assessment tool is also very important to identify areas of improvement at both the state and national level. The Arkansas Association of Health-System Pharmacists (AAHP) encourages you to ask your hospital pharmacy manager(s) to complete this tool if they have not done so already. Even if your manager(s) have completed this tool, ASHP recommends completing the self-assessment annually to track both needs and improvements in reaching best practices within each health-system. After reviewing the most recent national dashboard, we are moving forward as a profession, but we still have room for improvement. I am proud that I continue to hear Arkansas hospital pharmacy practice models advancing and incorporating PPMI recommendations. AAHP is also continuing to help with PPMI initiatives.
Marsha Crader, Pharm.D.
PPMI Goal #2 has recently been President addressed by the Hospital Advisory Council which supported a waiver for a tech check tech pilot at two Arkansas hospitals. Successful implementation of the pilot programs may allow for review of hospital regulations by the Arkansas State Board of Pharmacy. The PPMI Goal #3 has been addressed by multiple groups within AAHP. This has included providing pharmacy technician certification training and the annual technician certification scholarship. Additionally, AAHP has provided support to new residencies, residency preceptors, and residents. AAHP has not technically addressed Goal #4, but many hospitals have seen large acceptance of these recommendations based on federal information technology requirements. Finally, regarding Goal #5, AAHP is moving forward with its outreach to encourage use of the Hospital Assessment Tool through its PPMI Taskforce. As more information is gathered from a pool of both large and small hospitals, the AAHP PPMI Taskforce can then better identify the needs of Arkansas health-system pharmacies. AAHP’s goal is to continue to support the recommendations of PPMI by supplying you with the education, tools, and networking opportunities that you need to promote
Specifically, PPMI Goal #1 has been supported by the Programs and Education Council. The council is continuing to provide state-wide collaboratives regarding adverse drug event reduction and antimicrobial stewardship. Both of these endeavors have provided educational and networking resources to help hospital pharmacists improve safety, clinical, and cost outcomes. They have also provided pharmacists with education in order to learn how to appropriately measure metrics.
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THE ARKANSAS PHARMACIST
PHARMACY PRACTICE MODEL INITIATIVE
pharmacists as an essential component of the health care team. For more information on the ASHP PPMI goals, findings from the 2014 Ambulatory Care Summit, and resources from our national affiliate, ASHP, please visit: http://www.ashpmedia. org/ppmi/index.html.
This is my last article to write as AAHP President, and I want to thank all AAHP members for the opportunity to serve you and the profession. AAHP has a great group of volunteers, and I hope to continue to be a part of an organization that continues to move forward. §
APA COMPOUNDING ACADEMY
Doing What’s Best for Patients and the Future of Compounding
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ow many of you have seen an increase in the number of out-of-state compounding pharmacies soliciting the doctors of Arkansas to send prescriptions to their pharmacies? I know I have seen many different ones. Many of these facilities are owned by businessmen and not pharmacists, and some of them, not all, are ruining our profession. They seem to only be after the profits and have no concern for the therapeutic outcome of the patient and definitely have no concern for the longevity of our profession. Many of these formulas are written for capsules with ingredients that have been shown to only be 5-15 percent bioavailable, ingredients that have no documentation to be given in powder form, some ingredients dosed at five times the highest documented dosing, and a duplication of ingredients that offers no increase in therapeutic outcome. Most of these formulas have no documentation that they will do harm. The only reason to do these this way is to make more money. The ingredients and doses of these formula are based on getting reimbursed at the highest possible rate. That reimbursement is great for sales now, but are they trying to do the best for our patients and the future of compounding? What about the insurance companies? They are not going to just sit around and pay these inflated prices. In the state of Arkansas not many insurance companies pay for compounds anyway. Many of the insurance companies nationwide are dropping or changing the way they cover compounds. The few that still cover compounds are dropping ingredients and bases from their covered lists because of this abuse of the reimbursement. Compounded products work, and they work really well! However, if we continue to allow this type of billing to continue we will hurt our profession and our patients in the future.
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Lee Shinabery, Pharm.D.
We need to talk with the doctors President in our area and let them know that most of these pharmacies care nothing about the patients and we do. I ask you to go through your formulas and make sure they are sound and therapeutically strong. Our profession relies on us to keep it viable and creditable. If we lose creditability then what do we have? Also, talk to your doctors about what some of these out-of -state facilities are offering them. Many doctors are not being told these offers may be Stark Law violations. The facilities are disguising these offers so they appear to be legitimate. The doctors could lose their Medicare privileges because of these violations. As for some of the pharmacies, they don’t care. They are owned by business people who are concerned more about making a buck than the integrity of the medical profession.
Compounded products work, and they work really well! However, if we continue to allow this type of billing to continue we will hurt our profession and our patients in the future.
Take this information and talk with your doctors. Let us try to help our prescribers, and in turn help our profession because if a doctor gets into trouble, it will come back on that compounding pharmacy and eventually through the grapevine to all of us. §
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THE ARKANSAS PHARMACIST
NOTE FROM EDITOR
Thanks for a Great Four Years
T
his is the last issue of AR●Rx the Arkansas Pharmacist that I will edit. It has been a great pleasure to work with APA members and the APA staff on enhancing APA’s communications during the past four years. The collective leadership, creativity, and desire to bring value to members through new communications vehicles such as the newsletters, AR●Rx, the PR and marketing campaign, and the website; the new 2014-2018 strategic plan; plus adding new staff and programs have all made working at APA a tremendously satisfying experience. You have an awesome team in Scott, Eric, Susannah, Celeste, Mark and Debra at APA! I am especially grateful to have had the chance to serve great pharmacy leaders including APA’s Executive Vice President and CEO Mark Riley and APA presidents including Mike Smets, Gary Bass, Dennis Moore, Dana Woods and Brandon Cooper. It was gratifying to work with the APA Board and committee volunteers who so generously supported new communications initiatives during my tenure. It will be exciting to watch as APA continues to innovate and pharmacists further develop their practices in the coming years. I am launching my own firm, Denne Consulting, to focus on helping small nonprofits and associations enhance their communications, strategic planning, and leadership development. I am excited about working with clients on some of the same challenges that I was able to help address at APA. Please feel free to say hello at eileen.denne@comcast.net. Thanks again for a great four years! – Eileen Denne
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Member Classifieds
Member Classifieds are free to APA members and $65 per issue for non-members. Contact communications@arrx.org for more information.
Pharmacist seeks one, two, or three days per week. Retail and hospital experience. Low and high volume experience. Immunization certified. BLS current. Contact at 501-231-1130 or timothylacey@msn.com. (3/24/15) Immediate opening for a Director of Pharmacy in Texarkana, TX. Please email linsy.mani@cardinalhealth.com or www. cardinalhealth.com/careers job #14012760. (3/17/15) PRN Pharmacist licensed in AR & TX available in Southwest Arkansas & Northeast Texas for retail or hospital pharmacy. Experienced pharmacy owner, staff pharmacist and director of hospital pharmacy, and nursing home closed pharmacy. Contact David Stewart, PharmD. 870-703-0736. (3/11/15) Seeking a pharmacist for independent pharmacy in West Little Rock. Please give me a call. Cornell Sanders at 817-707-9575. (2/24/15) Full-time pharmacist position in Dallas County. Looking for a pharmacist to manage an independent pharmacy in Dallas county. Potential for ownership. Send resume and questions to tfkh@ sbcglobal.net. (1/28/15) Seeking friendly, energetic, pharmacist for employment in Paris, Ozark, or Booneville. Candidate must possess excellent people skills. If interested, please call Robert Woolsey at 479667-7338. (1/14/15) Pharmacist available in Texarkana. Pharmacist in Texarkana licensed in Arkansas, Texas and Louisiana. I am immunization and diabetes certified. Can work in retail or hospital. Contact Joe Michalls, Pharm.D., 903-824-5093, michallsj@me.com. (1/13/15)
Looking for Pharmacist wanting to grow. One of the fastest growing FDA-registered pharmaceutical companies in the United States desires to hire a pharmacist that wants to grow professionally and financially. Highly specialized training will be provided in a very unique and innovative setting in Central Arkansas. If you are interested in learning new pharmaceutical skills, possess a strong work ethic, and are a team player, send your resume to: pwike@scausa.net. (12/1/14) Pharmacist available for employment. Pharmacist with 30 years experience in both hospital and retail seeks PT/FT work. Contact at alfaromeo@centurylink.net or 501-231-1130 (12/1/14) 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 staffrph1@att.net. 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 parttime situations. Please contact Christine Bommarito, Marketing and Recruiting Director, for information regarding current openings throughout Arkansas, including temporary as well as permanent placements. Let IvanRx4u help staff your pharmacy, call 417-8885166. We welcome your email inquiries, please feel free to contact us at: ivanrx4uchristine@centurylink.net. ยง
Residency-trained pharmacist can deliver diabetes education and/or management. Pharmacist in the Little Rock area looking for part-time work (8-32h/mo). If interested, please call 773.443.6454 or email navant2@att.net. (1/13/15) Independent pharmacy in Van Buren is seeking friendly, personable, efficient pharmacist. Duties will include the normal staff pharmacist duties as well as helping with MTM consulting, immunizations, etc. Store hours are MondayFriday 9 a.m.-6 p.m. and Saturday 9 a.m.-1 p.m. Send resume to kbarlow@pharmacyexpressvb.com or fax to (479) 4743131. (1/13/15) Part-time/Full-Time pharmacist wanted in Fort Smith. Independent pharmacy in Ft. Smith seeking Licensed Pharmacist for one to two nights a week and one weekend a month. Competitive salary, benefits. Send resume to 700 Lexington Ave. Fort Smith, AR 72901, email Anderson.1@live. com or call (479) 782-2881. (1/13/15) Experienced Relief Pharmacist Available. Experienced relief pharmacist (retail/hospital/IV) available in Central Arkansas. Willing to travel reasonable distances. Fred Savage 501-3501716; 501-803-4940; fred.savage47@yahoo.com. (1/8/15) Experienced Relief Pharmacist Available. Experienced relief pharmacist (retail) NW Arkansas(Fayetteville,Benton ville Area). Certified for immunizations. Looking for 1 to 2 days a week. Contact Jim Davis (479)619-6597 or jim@ bluegrassbanjo.org. (12/5/14)
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THE ARKANSAS PHARMACIST
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THE ARKANSAS PHARMACIST