August 2012 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association AUG. 2012

West Nile Virus and Preventing Mosquito Bites

MEMBERSHIP MATTERS! Email Network Hotline Receive up-to-date and up-to-the-minute information on Legislative Developments, Board of Pharmacy changes and other topics affecting the profession of pharmacy. Call FPA Member Services at (850) 2222400 ext. 110 – cheil@pharmview.com.

Florida Pharmacy Association

Tax Resource Provides defense and protection of your assets when you are audited. Tax Resource will defend their clients for any income tax audit, Federal or State, for any tax year. Tax Resource pioneered the tax audit service business, and is the largest audit defense firm in the United States. Call (800) 92-AUDIT (800-922-8348).

In keeping with a tradition of offering our members real benefits, the Florida Pharmacy Association (FPA) is 1. Standing in front of the new Foundation exhibit Coupon Atlantic proud to announce (l-r) Pat Powers, EVP; Trustees Paul Ackerman, Gary Redemption Center Koesten and Todd Schmidt. Receive payment in 25 working days of the introduction of coupon’s face value plus a rebate of 1/6 sponsored Discount 2. Pat Powers dropped in the last ticket before the based on store volume. Call Meredith drawing with Al Tower (center) and Kencents Norfleet Benefits Program. McCord (800) 223-0398. doing a whole lotta shakin’. These vendors are Dee Dee and Charlie Stidham, Lake Placid, bought Florida Commerce dedicated3. to providing their brick for The Walkway of Recognition with a “Go Federal Credit Union an excellent value to Gators!” engraving. The chief objective of a credit union is not all FPA members and generating profits for stockholders, but to 4. Trustee Rod Presnell with his three grandsons at the associates. To take service to its member. The memIce Cream Social looking over the flavorsprovide of ice cream bers benefit by getting attractive returns on advantage benefits andof toppings. Decisions! Decisions! savings, loans made at fair rates of interest contact the vendors 5. The Ice Cream Social sponsored by Walgreens is plus enhanced and expanded services. This directly at the always a hitnumbers with the crowd. The Walgreens gang (l-r)one of the best deals around. is probably Keri Kratofil, Philip, Trustee Terry Gubbins and listed below andJeenu identify Call (850) 488-0035. Lince Jacob having fun dishing up the ice cream along yourself as a FPA with some laughs. Collection Services member and have your For past due accounts call I. C. System, Inc. membership ID number Call (800) 328-9595. handy.

Other Member Benefits

 Discounted Continuing Education Pro-

grams

 Monthly Issues of the Florida Pharmacy

Today Journal

Rental Car Discounts Now when you rent from Hertz, or Avis you can take advantage of special savings through either the Hertz Member Benefit Program or with an Avis member savings card. Florida Pharmacy Association members receive a discount off Hertz Daily Member Benefit Rates, Hertz U.S. Standard Rates; and Hertz U.S. Leisure Rates. Avis will be providing to members a discount off of weekly rates and a free weekend day for qualified rentals. You’ll be quoted the best rate for your rental needs at the time of reservation. See the FPA web site for more details or call the FPA office. Pharmacy Resource Materials FPA provides the most recent and relevant resources necessary to meet your professional needs. This includes the Continuous Quality Improvement Manual, Controlled Substance Inventory Booklets and Pharmacy Signs. We also have available a fraud, waste and abuse manual which includes a section on Board of Pharmacy required procedures for handling fraudulent prescriptions. Please call FPA Members Services for more information: 850222-2400 ext. 110. FPA Website Visit our FPA Website at ww.pharmview.com. The site, launched in December 2004 and revised in October 2008 and in July 2012, includes a members only section. The website offers a secure server so that you can register for CE programs, renew your membership or purchase resources materials with your credit card.

Is your technician enrolled in the FPA employer based technician training program? If so encourage them to consider becoming certified through the Pharmacy Technician Certification Board (PTCB) when they finish the program. For more information, contact the FPA at (850) 222-2400 or visit the PTCB website at www.ptcb.org.

florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 16 Buyer’s Guide

VOL. 75 | NO. 8 AUGUST 2012 the official publication of the florida pharmacy association

Features

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West Nile Virus and Preventing Mosquito Bites

Pharmacy Leadership Boot Camp a Success

Short Cycle Dispense: A Case Study in Implementation

AUGUST 2012

FPA Calendar 2012

SEPTEMBER 1

Deadline to submit nominations for FPA Office

Labor Day - FPA Office Closed

FPA Clinical Consultant Conference Fort Lauderdale October

9 - 10 Florida Board of Pharmacy Meeting - Tallahassee 13-17 NCPA Meeting San Diego, California 20-21 FPA Midyear Clinical Consultant and Nuclear Pharmacist Meeting Orlando

November 2-3

FPA Budget and Finance Committee and Board of Directors Meeting and council meetings Orlando

FPA office closed for Veterans Day

15-17 NASPA and ASPL Fall Meeting Tucsan, Arizona

Mission Statements: of the Florida Pharmacy Today Journal

The Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Pharmacy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent

15-17 ASCP Annual Meeting National Harbor, Maryland

with its expressed mission.

22-23 Thanksgiving - FPA Office Closed

of the Florida Pharmacy Today Board of Directors

DECEMBER 1-2

Sarasota Law Conference, Hyatt Regency Sarasota

11-12 Florida Board of Pharmacy Meeting Tallahassee 24-25 Christmas Holiday, FPA Office Closed

The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and executive editor of the Florida Pharmacy Today Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members to secure appropriate advertising to assist the

Journal in its goal of self-support.

For a complete calendar of events go to www.pharmview.com CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part of the required 30 hours general education needed every license renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2013 or prior to licensure renewal. *For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at www.pharmview.com

Advertisers EPC...................................................................... 10 FRIED.................................................................. 10 Healthcare consultants..................... 3 Kahan SHIR, P.L........................................... 14 PPSC.................................................................... 10 Rx Relief........................................................... 14

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Michael McQuone (850) 906-9333 U/F — Dan Robinson (352) 273-6240 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

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E-mail your suggestions/ideas to dave@fiorecommunications.com

The President’s Viewpoint GOAR ALVAREZ, FPA President

We are at a Threshold in Our Processional Revolution

I am excited to be your president this year. There is so much going on; so many opportunities. Over the last few months, I have had the distinct pleasure of meeting and speaking with a number of pharmacy leaders from around the state and around the country. These individuals are from many pharmacy associations and have constituents in all practice settings. The “talk” I’ve been hearing is about expansion of the role of pharmacists in the future health care system. I’ve heard things like, “disruptive innovation,” credentialing and accreditation, the need to be recognized as healthcare providers under the Social Security Act, expanded collaborative agreement models with our other healthcare colleagues, development of business models that pay pharmacists for providing patient care services and the like. I will share with you that in my discussions with these folks, there appears to be a healthy dose of frustration, and a sense of restlessness and anticipation. In my opinion, these feelings are signs that we are at a tipping point. We are in the process of evolution. In the words of our FSHP brethren, our profession is poised to “step into the future.” As the roles for pharmacists continue to change and evolve, the roles of our pharmacy technician colleagues will likewise change. Our pharmacy technicians will be asked to help support patient care activities delivered by pharmacists. As an integral part of the pharmacy team, technicians play a pivotal role in helping ensure the successful evolution of our profession. We all know how heavily we depend on them to help us take care of our patients. At the annual meeting in Marco Is-

land this past July, I was overjoyed to see so many students from each of the colleges of pharmacy in the state of Florida. At the “Student Summit” during convention, students were asked to discuss where they saw the profession going in the next five to 10 years. I saw the excitement and enthusiasm as they deliberated and shared their answers

As an integral part of the pharmacy team, technicians play a pivotal role in helping ensure the successful evolution of our profession. We all know how heavily we depend on them to help us take care of our patients. before the group. Many of the answers coalesced around the idea of direct patient care activities and integration as members of the healthcare team. Some of the panelists/moderators shared some of their experiences and how they had also been agents of change as students and new graduates. There was so much energy in the room that when the meeting ended the students continued to debate and to share their aspirations of what pharmacy can be. At the end of the summit and at

Goar Alvarez, 2012-2013 FPA President

many other instances during the meeting, students came up to me and asked how they might become involved in FPA. Needless to say, it is very encouraging to me to see these students wishing to participate in the shaping of our profession. The students are our future and I have taken great strides to ensure that students from each college of pharmacy in our state sit on each and every Council of the Florida Pharmacy Association. Because I believe we are at a threshold in our professional evolution, I have chosen forward -thinking Chairs and Council members to guide our Association. I appointed student pharmacist Jennifer Raquipo as Chair of the Professional Affairs Council. Jennifer has been very active at the FPA since her first year in pharmacy school. She is currently a fourth-year student. Jennifer brings energy and enthusiasm to the Council and is supported by an incredible team of experienced professionals. Her appointment is historic. AUGUST 2012

FPA Staff

Executive Vice President/CEO Michael Jackson (850) 222-2400, ext. 200

Director of Continuing Education Tian Merren-Owens, ext. 120 Controller Wanda Hall, ext. 211

Educational Services Office Assistant Stacey Brooks, ext. 210 Coordinator of Membership Christopher Heil, ext. 110

Florida Pharmacy Today Board Chair............................................. Jennifer Pytlarz, Brandon Vice Chair...................Don Bergemann, Tarpon Springs Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member..................................... Joseph Koptowsky, Miami Member..............................Rebecca Poston, Tallahassee Member.............................. Carol Motycka, St. Augustine Member....................................Cristina Medina, Hollywood Member................................. Norman Tomaka, Melbourne Member..............................Verender Gail Brown, Orlando Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2012, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. Florida Pharmacy Association

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web 6 Address: | Flo rhttp://www.pharmview.com i d a P h a r m a c y T o d aY

Jennifer holds the honor of being the first student pharmacist to have been appointed Chair of a Council in FPA. Carmen Aceves-Gordon was appointed Chair of the Organizational Affairs Council. Carmen has held a significant number of leadership positions in FPA. She has exceptional organizational skills, and I am highly confident she will ensure that our organizational structures and functions serve our members well. The Organizational Affairs Council also has the task of developing strategies to revitalize, support and strengthen our local unit associations. The Educational Affairs Council is chaired by Angela Clausen. Angela’s Council will focus on developing “how-to” and “nuts-and-bolts” programs that can be translated and applied in practice. These educational programs should empower our members to become more successful and to thrive in the healthcare system of today and tomorrow. Angela Garcia will lead the Public Affairs Council. One of her tasks is to develop materials that communicate the value of “the pharmacist” to the public. Once developed, these materials will be made available to our members for use in communicating the pharmacists’ value to patients as well as lawmakers. The Governmental Affairs Council is chaired by past president Humberto Martinez. Bert has already begun the process of prioritizing our legislative agenda. I have asked Bert to not only address the immediate needs of the members of the Association but also to strategize legislative and rulemaking plans to empower our members to practice to the full extent of their education and training. Our newest Council, the Membership Council, is headed by past president Don Bergemann. Don’s overarching charge is to develop a “value proposition” model for members and prospective members. As you know, nothing can be done on behalf of our profession if our Association does not represent a significant number of practicing pharmacists. The Association, in fact, the Profession, cannot

share our message without sufficient members; and not only members, but engaged members. The Health Fair and Legislative Day events are co-chaired by Angela Garcia and Suzanne Kelly. This committee will organize this year’s event during the legislative session at the Capitol in Tallahassee. I sincerely hope that student participation is encouraged by the deans of each of the colleges of pharmacy. Student participation last year was fantastic and we hope to have an even greater student involvement this year. Speaker of the House Eric Alvarez will ensure that the Councils stay focused and that information is shared among the members of the Councils so that all of us are working in unison. Lastly, I formed the first “High Council of Advisors” and named pharmacy legends Ed Hamilton, Jim Powers, Fred Lippman, and Michael Mone to this historic Council. They will be called upon to share their expertise and views on matters of importance to the association and the profession. I am thankful to each of them for having accepted their appointment and for their commitment to the association and the profession. I am inspired by the feedback I’ve gotten from pharmacists, students and technicians over this past year. There are forces both from within our profession, such as the student enthusiasm I spoke of earlier, and forces external to our profession, such as the “aging of America” and the decreasing number of primary care providers that I truly believe will help us to step across the threshold. I invite you to join the evolution revolution… and transform the practice of pharmacy. n Goar Alvarez, Pharm.D.

Executive Insight Michael Jackson, BPharm, EVP & CEO, Florida Pharmacy Association by michael jackson, RPh

Community Pharmacy Accreditation Pending

here used to be a time when a pharmacist completed his or her education, passed a board examination and began practicing in a pharmacy, that they happily went about their daily tasks knowing that their qualifications were all that were needed to provide care for the patients that they served. Our environment, however, has changed with the growth of managed care, the Medicare Part D program, the starving of state budgets and the drive toward quality and accountability. So what does all this have to do with community pharmacy accreditation? Read further, and see how this will affect you.

When did this discussion begin and why? FPA staff actually had an opportunity to sit in on an informal discussion during a National Association of Boards of Pharmacy District III meeting in Florida several years ago. The conversation was centered on some challenges that state boards have been experiencing with declining state revenue and having to scale back inspection services. In some states, pharmacies had not been visited by state inspectors for a number of years. The idea on the table was to make available an accreditation program in which pharmacy could become credentialed by a qualified neutral party and thereby reduce the need for repeated inspections by state agencies. For example, a pharmacy that was accredited may only have to be inspected once every three years rather than annually. This could reduce some costs to state government.

What is the current status of community pharmacy accreditation? Obviously, the issue has caught the attention of pharmacy organizations. We all know that the process of accred-

The idea on the table was to make available an accreditation program in which pharmacy could become credentialed by a qualified neutral party and thereby reduce the need for repeated inspections by state agencies. itation is not an inexpensive endeavor and could tax the limited resources of community pharmacy providers. If you are not sure, ask those pharmacies who have elected to become accredited durable medical equipment providers. Visit with hospital pharmacy directors and mention joint commission and note the reaction you see. During the FPA’s annual meeting this summer, a resolution was put before the House of Delegates. That resolution reads as follows: Whereas, both the American Pharmacists

Michael Jackson, B.Pharm

Association (APhA) and the National Association of Boards of Pharmacy (NABP) are collaborating on a national initiative to facilitate a voluntary community pharmacy accreditation program and; Whereas, the Florida Pharmacy Association does not have a position statement or policy on community pharmacy accreditation and; Whereas, Community pharmacy accreditation may be a significant event in community pharmacy practice where state advocacy organizations may need to provide or be available for input and; Whereas, pharmacist stakeholders in Florida should have an opportunity to be proactive on matters related to community pharmacy accreditation and; Whereas, community pharmacy accreditation may move forward absent input or comment by those most affected by any standards that are developed; Be it resolved, that the Florida Pharmacy Association support “voluntary” AUGUST 2012 |

2012 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work deligently all year long on behalf of our members.

Bob Parrado.............................................................................. Chairman of the Board Goar Alvarez ................................................................................................FPA President Terry Gubbins............................................................................................ President Elect Betty Harris ............................................................................................................Treasurer Eric Alvarez.................................................Speaker of the House of Delegates Gary Koesten.................................Vice Speaker of the House of Delegates Preston McDonald, Director............................................................................ Region 1 Michael Hebb, Director ......................................................................................Region 2 Eva Sunell, Director ..............................................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 Jeffery Parrado, Director ...............................................................................Region 5 Scott Tomerlin, Director.....................................................................................Region 6 Paul Rohrbaugh, Director.................................................................................. Region 7 Raul Gallo, Director.................................................................................................Region 8 Paul Elias, Director.................................................................................................Region 9 Constance Hogrefe.................................................................President Elect FSHP Michael Jackson........................................Executive Vice President and CEO

Florida Pharmacy Today Journal Board Chair......................................................Jennifer Pytlarz, jlc_rxdoc@hotmail.com Vice Chair......................................................... Don Bergemann, don@bceinfo.com Treasurer....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary...................................................................Stuart Ulrich, Stuarx@aol.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Member........................Rebecca Poston, rebecca_poston@doh.state.fl.us Member....................................................... Carol Motycka, motycka@cop.ufl.edu Member........................................................Cristina Medina, cmmedina@cvs.com Member................................................................Norman Tomaka, FLRX9@aol.com Member................... Verender Gail Brown, brownvgrx4304@hotmail.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com

participation in community pharmacy accreditation programs. To clarify, the intent of the above resolution was for the Association to endorse community pharmacy accreditation as an â&#x20AC;&#x153;option onlyâ&#x20AC;? for those pharmacies that wish to add that credential. It was not a policy of support for any new mandate. In many cases, initiatives will begin outside our zone of influence. This is a proposal that is beginning at the na-

The House of Delegates, which includes participating pharmacy stakeholders from throughout Florida and a host of practice settings, supported this resolution with no objection. tional level that could find its way into our state. We have a choice of either sitting back and allowing it to happen or finding a way to have a seat at the table to help shape its development. After all, you are either at the policy table or you are the main course on the menu. The House of Delegates, which includes participating pharmacy stakeholders from throughout Florida and a host of practice settings, supported this resolution with no objection. Are there standards for community pharmacy accreditation and who should develop them? As with any accreditation process, there are standards and criteria that pharmacies would be measured by. There is work being done in this area as you are reading this. What is most important is that these standards must be under the ownership of the profession and not government policymakers or pharmacy provider stakeholders. You may

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have at least some comfort in knowing that the Joint Commission of Pharmacy Practitioners, which includes all of the national pharmacy associations, is heavily engaged in influencing the discussions in this area. Also what is critically important is that any such accreditation process adopted should be site specific. Just like every pharmacy must have a unique permit, each pharmacy that opts in should have its own accreditation approval status. Blanket accreditation approval for affiliated pharmacies is not in keeping with a level playing field in the pharmacy market. What are the disadvantages of community pharmacy accreditation? ■■ Cost – As with any accreditation program, there are costs and fees that pharmacies may have to incur. Staff time and pharmacy resources would likely be expended to comply with accreditation standards. It is unknown if these costs could be

■■

recouped from the payer community. Use by Payer Community – This issue could easily be used by health plans, pharmacy benefit managers or other health maintenance organizations as a tool to limit their provider networks or tier their reimbursement.

What are the advantages of community pharmacy accreditation? ■■ Enhanced Reimbursement – It may be possible that pharmacies that elect to become accredited may be able to have their fees adjusted higher for advanced patient care services. ■■ Relief from Audits – While this may not be part of the discussions, perhaps being an accredited community pharmacy may be used as a tool to reduce the number of third audits. ■■ Relief from Inspections – The Board of Pharmacy could be encouraged

to adopt a policy of inspections every five years for accredited pharmacies rather than annually. No one wants additional burdens. Pharmacy providers are already overtaxed with policies and procedures, noise from PBM restrictions and “beat downs” from aggressive auditors. At the same time, the Association is aware that health plans also have to demonstrate evidence of their quality programs for their networks. We believe that they will be actively looking at community pharmacy accreditation as one of their tools to achieve their quality measures. If that is so, then this program should be under the ownership of the profession and not an outside party. n

The All-new FPA Website is Now Online Pharmview 3.0 offers more features, greater access and increased opportunities for member interaction. ■■ ■■ ■■

■■

Keep your dues current with the most accurate information in your membership accounts Register for conferences and educational programs Register online and you can print a receipt instantly without having to wait for one to be mailed to you Your continuing education credits earned through FPA programs will be published as transcripts and certificates in your member record

Take advantage of all the possibilities and visit your new website today at www.pharmview.com. AUGUST 2012

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Flo r i d a P h a r m a c y T o d aY

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West Nile Virus and Preventing Mosquito Bites Source: Centers For Disease Control and Prevention A single mosquito bite can make you sick. Why take a chance? Use repellent on yourself, your friends and your family. Many people who are bitten by an infected mosquito won’t get sick—many others aren’t as lucky. Since 1999, more than 30,000 people in the United States have been reported as getting sick with West Nile virus. Occasionally, an infected person may develop more severe disease such as “West Nile encephalitis,” “West Nile meningitis” or “West Nile meningoencephalitis.” Encephalitis refers to an inflammation of the brain, meningitis is an inflammation of the membrane around the brain and the spinal cord, and meningoencephalitis refers to inflammation of the brain and the membrane surrounding it. Almost 13,000 of the individuals who have been reported as having West Nile virus since 1999 have been seriously ill, and more than 1,200 have died. Another problem in some parts of the United States and many places in the tropics is dengue. The World Health Organization estimates there may be 50 – 100 million dengue infections in the world every year. Over 2.5 billion people are at risk of getting infected with dengue virus. The reasons one person becomes severely ill from diseases mosquitoes carry and another doesn’t are not entirely known, but why take a chance? Control what you can. Improve your odds of avoiding mosquito spread viruses by using a repellent on exposed skin and clothes while outdoors. Insect Repellent: It keeps you from being what’s for dinner. There are always excuses for not using repellent— forgot it, didn’t want to go back and get it, it doesn’t smell good, it’s not in the budget, or “mosquitoes don’t bite me”… Think of repellent as you would an important article of clothing, and increase your chances of avoiding weeks (or even months) of aches and fatigue that come with West Nile fever, dengue fever, or any number of other mosquito borne diseases. More severe problems are possible. Being hospitalized with swelling of the brain, or even worse, are possibilities from many of these diseases. What repellent should I use? CDC recommends a variety of effective repellents. The most important step is to pick one and use it. There are those that can protect you for a short while in the backyard or a long while in the woods. DEET, picaridin, IR3535 and the plant-based oil of lemon eucalyptus are all repellents recommended by CDC. All contain an EPA-registered active ingredient and have been studied to make sure they are effective and safe. EPA has a long listing of repellent brands in the

United States. Check out CDC’s traveler’s health page on repellents here. When should you wear repellent? Mosquitoes can bite anytime. Most of the mosquitoes that carry West Nile virus bite from around sundown to around sun-up (throughout the night). Put a few bottles or packets of repellent around—in the car, by the door, in a purse or backpack. Where are mosquitoes a problem? Almost all of the continental United States has had reports of people getting sick with West Nile virus. But there are areas of the United States where people are more likely to get severely ill, and these areas can change from year to year. The map at the right shows West Nile virus activity by state. Outbreaks of Eastern equine encephalitis (EEE), LaCrosse encephalitis, and St. Louis encephalitis are not as common as West Nile virus, but outbreaks can be severe. EEE has been a significant problem in the North East in recent years. Texas, Florida, and Hawaii have all reported people ill with dengue in recent years. Every year, Puerto Rico reports people getting ill with dengue virus. What to do about mosquitoes in my area? Mosquito control by your local government won’t get rid of every last mosquito, but when you also use repellents, you can markedly reduce your chances of getting bitten. Ask local officials about starting a mosquito control program in your city or county if it doesn’t exist already. 2012 West Nile virus update: as of August 21 Thus far in 2012, 47 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 1118 cases of West Nile virus disease in people, including 41 deaths, have been reported to CDC. Of these, 629 (56%) were classified as neuroinvasive disease (such as meningitis or encephalitis) and 489 (44%) were classified as non-neuroinvasive disease. The 1118 cases reported thus far in 2012 is the highest number of West Nile virus disease cases reported to CDC through the third week in August since West Nile virus was first detected in the United States in 1999. Approximately 75 percent of the cases have been reported from 5 states (Texas, Mississippi, Louisiana, South Dakota, and Oklahoma) and almost half of all cases have been reported from Texas.

AUGUST 2012 |

Short Cycle Dispense: A Case Study in Implementation By Jonathan Shaatal, R.PH., MS, Director of Pharmacy at Four Seasons Nursing & Rehabilitation Center and Carol Sirianni, R.PH., Vice President, Customer Programs and Solutions, AmerisourceBergen Drug Corporation The following article does not necessarily represent the views or opinions of the FPA or Florida Pharmacy Today Journal Inc and also should not be considered legal advice. In April 2011, the Center for Medicare and Medicaid Services (CMS) released the final rule implementing Section 3310 of the Patient Protection and Affordable Care Act, stipulating that patients living in skilled-nursing facilities, receiving coverage under Medicare Part D must receive their medications in supplies of 14-days-or-less. The ruling is slated to go into effect January 1, 2013. This rule promises to have a tremendous impact on how long-term care pharmacy (LTCP) providers serving skilled-nursing facilities will operate their businesses and serve facility residents. As a result, there are a number of challenges that both LTC providers and skilled nursing facilities must anticipate and prepare for in advance, including: 1. Increased Multi-Disciplinar y Teamwork – Shorter dispensing cycles will require LTC pharmacies and skilled nursing facilities to work closely together to retool and create a smooth workflow that is both safe and efficient. 2. Location of Patient for Administration – The acuity and mobility of skilled nursing facility residents have a dramatic impact on both workflow and the medication process because there are a variety of locations within a facility where a resident could be at any given time. 3. Higher Medication Through-puts in Pharmacy – Shorter dispensing cycles will result in at least two double the volume at the pharmacy level. Current processes will need to 12

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be examined to determine if waste can be eliminated in waiting, motion, inventory, re-work/correction, overproduction and information exchange. 4. Need for Change Management – The multidisciplinary team will need to work with the pharmacy and nursing staff to communicate the new process/policy and ensure successful cooperation throughout the workflow. 5. Making Technology Support Clinical Workflow – There is not a “onesize-fits-all” solution for every organization. Technology challenges will be compounded due to the additional volume of work, transactions and data requirements that will be taking place. As the compliance date nears, LTC pharmacies and skilled nursing facilities must work together to overcome these challenges by: ■■ Jointly determining the dispensing methodology (type of packaging and dispense quantity) for brand, generic and over-the-counter (OTC) medications ■■ Retooling operations ■■ Educating and training staff ■■ Assessing current and future information systems and dispensing technology ■■ Ensuring that reimbursement contracts and operational processes to support reimbursement changes are in place ■■ Protecting the bottom line and profitability of both the pharmacy and skilled nursing facility

The following article is a testament to the successful implementation and sustainability of short cycle dispensing. It details key observations and experiences Brooklyn, New York-based Four Seasons Nursing & Rehabilitation Center noted since implementing short cycle dispense. The case study details best practices and recommendations for selecting a method and quantity of dispensing, adaptation of workflow and the training of nursing and pharmacy staff. Operational and clinical results are discussed, as are cost savings and enhanced compliance. Four Seasons Nursing & Rehabilitation Center Transitions to Short Cycle Dispense Brooklyn, New York-based Four Seasons Nursing & Rehabilitation Center implemented seven-day medication dispensing of brand and generic medications in 2006 with the intent to increase operational efficiency and enhance patient care. Since that time, the facility – which serves approximately 2,500 residents, including 300 long-term care patients – has expanded seven-day dispensing as an option for adult-day patients, outpatients, and facility employees. Because of this, the facility has already met and exceeded compliance with the CMS short cycle dispense requirement. Since inception, Four Seasons had been served by an off-site vendor pharmacy. In 2006, with the goal of improving medication distribution for residents and expanding service to other

populations, the management team established an on-site pharmacy. This coincided with the enactment of Medicare Part D, which stipulated that reimbursed medications were no longer returnable to the pharmacy for reuse in the State of New York. As a result, Four Seasons needed to designate one full-time equivalent (FTE) employee, to collect, log and destroy the unused medications in order to comply with the new requirement. Since medication waste and the resulting staff time diverted for handling unused medications presented significant workflow challenges, Four Seasons wanted to implement an alternate method of medication distribution to ensure efficient, effective medication delivery. It evaluated and selected an automated system of multi-dose packaging based on a seven-day fill cycle – a significant transition from the 28-day cycle “bingo card” system, on which it was operating at the time. Because the process of transforming medication processes must start at the highest level of any organization, Four Seasons engaged senior administration and nursing representatives at the beginning of the process. Early buy-in from senior level executives and the use of multidisciplinary teams – including representatives from management, pharmacy and nursing – not only helped to ensure a smooth transition, but also worked to boost efficiency and adoption rates. Once the plan was in place, the pharmacy set out to identify and acquire the technology to help improve operational efficiency. This efficiency would free up pharmacists to spend more time on patient care. In addition to eliminating medication waste and staff time associated with handling unused medications, Four Seasons needed to ensure its electronic medical record (EMR) system was well-coordinated for expansion across the facility. After an indepth research process, the pharmacy selected the AmerisourceBergen FastPak EXP to handle all medication dispensing using compliance packaging. The FastPak EXP provided user-friendly, reliable software that boasted high accuracy rates and cost efficiency.

With any system change – especially related to automation – comes change to both overall workflow and individual tasks. Though pharmacy technicians were expected to be responsible for more than 90 percent of technology operations, Four Seasons set out to train and develop both pharmacy and nursing teams to ensure that all users were comfortable with workflow and process changes. To ensure an increase in efficiency and an improvement in patient service, each change was explained and reinforced. For example, because the automated system eliminated the need for traditional medication carts, nursing day-to-day systems changed radically. As a result, both nursing administration and nursing staff needed to undergo in-depth training to become familiar with the look and feel of the new system and ensure comprehension of each streamlined process for handling medication. Enhancements to Workflow At the pharmacy level, since implementing short cycle dispense and automated dispensing technology, Four Seasons has seen an 80-percent reduction in pharmacy packaging time – from five hours to one hour for a 40bed unit and an average of 10 to 12 medications per patient. Efficiency has improved, enabling the pharmacy to commit more time to their clinical work. On the nursing side, Four Seasons had originally estimated a 40-percent reduction in medication administration time. Coupled with the savings realized from the commingling of prescription medications using compliance packaging, Four Seasons was able to meet – and exceed – this goal. Approximately one year after the system went live, regular, standing orders for all over-the-counter (OTC) medications were incorporated into multidose packaging. This has cut medication administration time even further to 50 percent of the time required when Four Seasons was using unit-dose blister packs. In addition, Four Seasons is meeting the CMS mandate to pass medications within one hour of the prescribed time.

This reduction in medication pass time enables nurses to complete CMS-regulated documentation during their shifts – cutting down on overtime and associated costs. Four Seasons Nursing and Rehabilitation Center frequently dispenses medication for residents who leave the facility on pass. Fulfilling out-onpass prescriptions for residents who leave the facility for a period of hours or days has also been streamlined by the automated system and compliance packaging. Historically, these types of fulfillment requests were a pain point for both pharmacy and nursing teams, as they were generally sudden and last minute in nature. With commingled, compliance packaged medications, the need to prepare out-on-pass medications is eliminated since they are already labeled according to time of administration. If a resident wishes to temporarily leave the facility, the nurse simply tears off the needed medication based on the time of the planned absence and provides an instruction document, containing medication background, and any recommended precautions. This also helps ensure compliance with caretakers while the resident is in their care. As a result of enhancements and efficiencies achieved through pharmacy and nursing workflows, patient medication errors have been reduced. This means better quality care, an increase in patient safety, and higher overall patient satisfaction rates. Seven-day dispensing has also helped Four Seasons streamline the process of reimbursement and claims submission – generating additional labor and cost savings. Generating ROI and Cost Savings For many LTC pharmacies and skilled-nursing facilities, the cost to implement short cycle dispense might seem to outweigh the intended benefits. It’s important, however, to look beyond the initial investment, as longterm benefits are significant and vital to patient safety and future success in the continually evolving healthcare marketplace. Initially, Four Seasons saved about $110,000 per year in labor costs AUGUST 2012

– including salary and benefits for one FTE pharmacy technician and one FTE registered pharmacist. As the pharmacy has grown and expanded its patient population, labor cost savings have continued to increase over time. In addition, using an automated dispensing system has required the pharmacy to switch from purchasing unit-dose packaged medications to bulk medications (100-, 500- or 1,000-count bottles). This switch has resulted in a significant cost savings, as unit-dose medications cost typically three to five times more than bulk. Other cost savings included the cost associated with nurses “borrowing medications,” or using medication from another patient on the same prescription. Borrowing medications has virtually been eliminated through the

use of patient specific compliance packaged medications. Savings are estimated at $500 per month and elimination of missing medications by commingling of medications is also estimated at $500 per month. Beyond cost savings and enhancements to patient safety, short cycle dispense and automation helped Four Seasons expand patient populations and generate additional revenue streams. With a robust short-term rehabilitation program, Four Seasons discharges approximately 400 patients into the community each year. These patients can choose to receive their 30-day discharge medications in either vial or compliance packaging. Multi-dose compliance packaging is also available for adult day patients.

Conclusion Since transitioning to short cycle dispense and automated fulfillment techniques, Four Seasons pharmacy management and facility administration have experienced significant operational, financial and clinical benefits that have contributed to its overall success. Four Seasons is compliant well in advance of the January 2013 deadline for short cycle dispense implementation. Though LTC pharmacies and skilled nursing-facilities might feel overwhelmed with the impending short cycle dispense implementation date, the change will bring significant efficiencies and cost savings that will improve patient safety and quality of care.

With a robust short-term rehabilitation program, Four Seasons discharges approximately 400 patients into the community each year.

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Pharmacy Leadership Boot Camp a Success Pharmacy Leadership Boot Camp was a great success. Fifty-five pharmacists and technicians had such a powerful thirst for knowledge that they gave up their July 4th holiday to learn how to become better leaders. Although the course was designed for new and aspiring pharmacy leaders, most of the attendees were experienced pharmacists and technicians who came to hone their leadership skills. As one retired pharmacist said, “Your program was excellent, and I wish I had had it when I was working in retail.” These experienced professionals were taught that the best leader is a servant leader who focuses both on the employees and the mission, and creates a climate of trust and respect. The leader should manage the staff from a position of respect, with empathy for their individual needs while guiding, encouraging, empowering and expecting the team to be successful. The leader seeks the best in the staff and helps the individuals in the organization to reach their potential. When asked, “What did you learn today that you can apply immediately to your practice?” the answers covered the gamut of the course offerings, including communicating like you mean it, active listening, dealing with difficult people, patient safety practices, respectful confrontation, empowerment and establishing clear expectations for employees. Everyone took away at least one or two pieces of knowledge that were immediately useful. One pharmacist said, “I learned (about) motivational interviewing, which is a very useful technique in patient interviews. I’ll apply this technique and gain information that is vital for their medication management.” Participants learned that the leader sets the direction for the pharmacy with participation from upper management as well as the staff. The leader who engages the staff will build a cadre of followers committed to the pharmacy’s success. Followers who gain a sense of their purpose become stakeholders in changing the organization’s future. A superb leader focuses on the future direction of the organization while ensuring that the current standards are met…every time. The great pharmacy leader asks, “How can we get better?” and then develops a plan to get there. Attendees were encouraged to remember that success is a group activity and that no one succeeds alone. Success requires teamwork, but teamwork requires empowerment and

Attendees were encouraged to remember that success is a group activity and that no one succeeds alone. Success requires teamwork, but teamwork requires empowerment and delegation.

delegation. All staff members need to take personal responsibility for their actions to ensure all necessary tasks are accomplished. Each employee needs to strive every day to improve the pharmacy processes in order to provide the best possible pharmaceutical care. Last, but not least, was patient safety. Participants were reminded that “Patient Safety is Job No. 1.” They need to use their leadership skills to uphold the 5 Rights of Medication Safety: Right Patient, Right Drug, Right Dose, Right Route, and Right Time and to eliminate variation and complacency, participants found that Boot Camp was a valuable source of knowledge. As stated by one attendee, “This program inspires and enlightens me how to successfully lead a pharmacy (including) my responsibilities, duty tasks as a pharmacist, and (how) to improve the quality of the patient’s care.” Becoming an effective leader is a journey, not a destination. The skills needed for effective leadership are learned skills. They are not inherent. Although some people appear to be natural born-leaders, they actually have leadership traits that have been finely tuned through experience, training or study. So, all leaders aspiring, new and current must develop a life-long interest in leadership. By studying the basics, applying effective leadership skills and practice success will be ensured. The Boot Camp leaders, Dr. Reginal Harris, Ms. Gail Brown, and Colonel Wayne Cheatum (Retired), wish to thank the attendees for their enthusiasm, participation, and interest in enhancing their leadership skills.

Michael Jackson presents a scholarship award to FAMU student Janet Job on behalf of the Broward County Pharmacy Association. AUGUST 2012

Buyer’s Guide florida PHARMACY TODAY

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FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 487-4441 www.fdhc.state.fl.us/medicaid/ pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 www.pharmacist.com AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 www.ashp.com/main.htm Drug Information Center Palm Beach Atlantic University (561) 803-2728 druginfocenter@pba.edu FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 www.doh.state.fl.us/mqa FLORIDA POISON INFORMATION CENTER NETWORK (800) 222-1222 www.fpicn.org National Community Pharmacists Association 100 Daingerfield Road Alexandria, VA 22314 703.683.8200 703.683.3619 fax info@ncpanet.org Recovering Pharmacists Network of Florida (407) 257-6606 “Pharmacists Helping Pharmacists”