December 2022 Florida Pharmacy Today

THE ROLE OF THE PHARMACIST IN THE INFLUENZA SEASON

DECEMBER

14-15 Florida Board of Pharmacy Meeting Orlando

22 Board of Directors Meeting Zoom

23-2 Christmas HolidayFPA Office Closed

JANUARY

2 New Years - FPA Office Closed

16 MLK holiday

22 Board of Directors Meeting Orlando

CE CREDITS (CE cycle)

FEBRUARY

4-5 FPA Clinical Meeting via ZOOM

8-9 Florida Board of Pharmacy Meeting

Mission Statements:

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 with its expressed mission.

Florida Pharmacy Today Board of Directors

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. There is a two-hour CE requirement for pharmacists on the dispensing of controlled substances effective this biennial renewal period. The Reducing Medication Errors course is needed for pharmacists and technicians.

Pharmacists should have satisfied all continuing education requirements for this biennial period by Sept. 30, 2023, or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by Dec. 31, 2022.

For the Pharmacy Technician Certification Board application, exam information and study materials, please contact the FPA office.

For more information on CE programs or events, please contact the Florida Pharmacy Association at (850) 222-2400 or visit our website at www.floridapharmacy.org

CONTACTS

FPA — Tian Merren-Owens (850) 222-2400

FSHP — Tamekia Bennett (850) 906-9333

UF — Emely McKitrick (352) 273-5169

FAMU — Dr. Selika Sampson (850) 599-3301

NSU — Carsten Evans (954) 262-1300

DISCLAIMER

Note: The views of the authors do not necessarily represent the views or opinions of the Florida Pharmacy Association, Florida Pharmacy Today or any related entities.

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 is 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.

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.

The President’s Viewpoint

Tis the Season to Be Merry, Safely!

The holiday season brings a lot of joy and excitement for many people, however, it is also important to recognize some of the dangers of the season and to know that there are those who struggle during the holidays with Substance Use Disorder (SUD).

Substance Use Disorder is included in the DSM-V and is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress. As written in the ASAM principles of addiction medicine, it encompasses many different facets, such as polydrug use, comorbidity with other disorders, predisposition, drug use history, and environmental context.

The holiday season can exacerbate use of substances for some if feelings of isolation or loneliness are exaggerated as individuals see others celebrating with friends and family. This is a good time for us to consider the many blessings we have and share our fortune with others, whether it be with donations or charitable offerings, or by finding ways to spend time with those

who are lonely. If COVID taught us anything, it is that we need each other, and it is amazing what a visit can do to brighten a person’s spirit.

For others, substance use may increase as they spend time with friends and family as alcohol and other substances are shared at parties and gatherings. This can be a particularly challenging time for those with alcohol use disorder. Remember to be cognizant of those who do not wish to partake in a shared drink as we may not know or understand the struggles they may be facing.

You can provide support by accepting someone’s decision not to have that toast with you at midnight or to provide sparkling apple juice for those who prefer it. It is also recommended to keep naloxone with you if possible as we continue to see the number of overdoses skyrocket throughout the community. Over 107,000 people in the U.S. died last year from overdose, and synthetic opioids are the biggest cause for these staggering numbers.

Fentanyl can be found in nearly

every pill purchased from illicit sources, which has prompted the “One Pill Can Kill” campaign by the Florida Attorney General, as adolescents and adults experimenting even one time are dying at an alarming rate.

The holidays also often create extra work for people and can add stress for pharmacists by creating increased workloads due to patients wishing to fill prescriptions before trips or the end

CAROL MOTYCKA, PHARM.D., CHSE

Carol Motycka, Pharm.D., CHSE

FPA STAFF

Executive Vice President, CEO Helen Sairany, ext.200

Director of Continuing Education Tian Merren-Owens, ext. 120

Continuing Education Coordinator Stacey Brooks, ext. 210

Coordinator of Membership Ranada Howard, ext. 110

FLORIDA PHARMACY TODAY BOARD

Chair David Mackarey, Boynton Beach

Vice Chair Matt Schneller, Tampa

Treasurer Eric Jakab, Gainesville

Secretary Julie Burger, Pensacola

Member Aiya Almogaber, Tampa

Member Michael Finnick, Jacksonville

Member Carol Motycka, Jacksonville

Member Teresa Tomerlin, Rockledge

Member Greta Pelegrin, Hialeah

Technician Member Julie Burger, Pensacola

Executive Editor Helen Sairany, Tallahassee

Managing Editor Dave Fiore, Tallahassee

Journal Reviewer Dr. Melissa Ruble

Journal Reviewer Dr. Angela Hill

This is a peer-reviewed publication.

©2022 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 ASSOCIATION

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web address: www.floridapharmacy.org

of the year. There are also increased numbers of patients requiring vaccines before spending time with loved ones, additional illness among co-workers and family members, and an influx of visitors from out of town bringing new patients to care for.

It is important to take care of ourselves during the busy time, but also to look out for our colleagues as we can only take the best care of our patients if we also take care of ourselves. Remember that the PRN (Professional Resource Network) is available as a resource for healthcare professionals who are struggling. They provide confidential referrals for practitioners who “have or may have a potentially impairing health condition that is the result of the misuse or abuse of alcohol, drugs, or both, or a mental or physical condition that could affect the practitioner’s ability to practice with skill and safety.” Information on Florida’s PRN services can be found at https://flprn.org/

We should, of course, be cognizant of the increased risks of driving under the influence during the holidays, but

we may not always consider the risks at holiday parties and gatherings, which can be disastrous for children as accidental alcohol or other substance poisonings increase during this time.

It is important that substances of any kind be kept out of reach from small children and that all alcoholic beverages are cleaned up before the end of the evening. It is not uncommon for children to ingest a sugary drink left over from a party the evening before. Symptoms may look like intoxication in a small child with confusion and drowsiness, but alcohol in small children can cause severe hypoglycemia mimicking intoxication. It is imperative that a child is provided emergency care if they ingest alcohol and are showing signs such as these.

I want everyone to have a very safe and joyous Holiday Season, and that can start with us. Please take care, everyone, and I look forward to all that 2023 has to offer our great profession of pharmacy! n

Executive Insight

HELEN SAIRANY, BA, PHARMD, MBA, RPH, BCACP EXECUTIVE VICE PRESIDENT & CEO

Burnout Among Frontline Heroes

The impact of the pandemic on the mental health of healthcare workers, including pharmacists, has been well documented. Every day, we hear reports about rising exhaustion, burnout and staff turnover in our community.

It has been said that frontline healthcare workers are experiencing a level of mental health distress comparable to what is seen in soldiers who serve in combat. As a traumainformed pharmacist who personally has served at the frontline in combat zones, I believe such comparison is warranted.

The human brain is not designed for uncertainty. It is designed for survival. In times of extreme distress and uncertainty, the neocortex – where higher-level thinking takes place – is overtaken by the parts of the brain that govern emotion and survival. We can become more self-centered and less collaborative, giving and empathetic. It’s a self-defense mechanism that can negatively impact our work and our relationships.

In our healthcare culture, stress and trauma affect many people who do not qualify for the diagnosis of PTSD. Finnish researchers, writing in the British Journal of Psychiatry in 2005, found, quite remarkably, that people undergoing a “life event”— relatively ordinary stresses and emotional losses such as relationship issues and work problems —suffered more PTSDlike symptoms such as bad dreams or emotional numbing, than more obviously traumatized people who had endured war or disaster.

Healthcare faced a different kind of

trauma caused by fear of the unknown. Additionally, what healthcare workers faced early in the pandemic is a type of PTSD called “moral injury.” This is a feeling of guilt or shame after having participated in an extraordinarily high-stress situation that required immediate and often life-or-death decision making without having all the answers, tools and resources to do their job well.

It has been said that frontline healthcare workers are experiencing a level of mental health distress comparable to what is seen in soldiers who serve in combat.

Due to the demand and stress pharmacists are exposed to, they are likely to suffer more from PTSD than the general population. It’s easy to understand why. Pharmacists bear witness to their patients’ suffering, and many lack complete control over their work conditions and their ability to maintain personal safety. New demands created by COVID-19 are fueling these stress responses—further raising the risk of PTSD.

A recent survey revealed that over 60% of pharmacists report experiencing a high level of burnout in practice,

which is one of the highest rates among all healthcare professionals. This finding is even higher than surgeons, oncologists or emergency and trauma unit practitioners. Research shows that members of the healthcare team, pharmacists included, are more prone to making errors when under a lot of pressure. This is particularly concerning when considering that medical errors are the third-leading cause of death in the United States, with cardiovascular disease and cancer being the first and second.

The most toxic consequence of work-related trauma is when we lose our ability to care—for anyone or anything. It starts with mild irritation leading to a lack of concern, and eventually outright dismissal of our patients. This is demonstrated in the words of industrial/organization psychologist, Dr. Zubin Austin: “People

Helen Sairany, BA, PharmD, MBA, RPh, BCACP

can be intellectually aware of the symptoms and problems associated with depersonalization, but because of emotional and cognitive overload, lack the resources to address the problem. For many individuals, the boundaries between unproductive occupational stress and outright burnout breaks down when the last vestige of care—for anyone or anything—is gone.”

Trauma may explain the suffering of CEOs, leaders and college deans. In life-related trauma, individuals are haunted by events of the past. In workrelated trauma, individuals are haunted by intolerable fear of the future. Instead of flashbacks, individuals have flash-forwards of panic, which neuroscientists have shown can affect the same parts of the brain as real-life experiences.

Work-related trauma is exacerbated when leaders begin to ignore their own suffering and dehumanize themselves in order to “get through it.” By numbing themselves to the damage that is happening, they stay in unhealthy work conditions and dysfunctional situations far longer than they should, layering damage on damage and risking dehumanizing those around them.

We go into this profession to help,

but we often don’t know how to help ourselves. We are educated and trained in a culture that values self-reliance but are not equipped to discuss personal vulnerability. We are trained to care for others and receive no training on how to better care for ourselves during times of occupational stress. Gabor Mate, trauma specialist, outlines a clear connection between stress and the body’s physiological response to it. High levels of cortisol impair our rational thinking and memory storage.

In these extremely difficult times, as social creatures, we need those deep connections to soothe our body and pain. The Very Happy People’s Study by the Harvard Medical School reports that deep social connections have a 0.7 correlation with happiness. However, we are seeing a 300% increase in reports of loneliness among Americans, 50% of which are CEOs and healthcare professions.

As a health threat, loneliness can be more harmful than smoking or obesity. This makes one wonder if there is such a thing as work life balance? To have a balance in life, we absolutely must feel psychologically safe and well. The importance of psychological safety can be best explained through Maslow’s

Hierarchy of Needs, a psychological theory of motivation proposed by Abraham Maslow in 1943. His theory states that there are five categories of human needs that determine individual behavior: physiological needs, safety needs, love and belonging needs, esteem needs, and self-actualization needs. As a humanist, Maslow believed that individuals are born with a desire to become self-actualized – or to be all they can be in life. As you can see, our need for safety follows our immediate basic physiological needs. Physiological needs include protection, security, law, stability and safety for our loved ones.

For humans to achieve their full potential in a company, basic psychological safety needs and wellbeing must be met first. If we look at these hierarchal needs in the context of working in a toxic work environment, instead of self-actualization, employees are worried about their psychological wellbeing. In essence, there is no balance between work and personal lives when we are burned out.

As leaders in the profession, it is time for us to wake up to the unbearable work conditions that our fellow pharmacists are under. Long work hours, a lack of resources, the inability to take needed breaks, and the added responsibilities of meeting the demand created by the pandemic, are among the challenges that community pharmacists live with daily.

While I am excited to see associations pay attention to pharmacists’ wellbeing, I feel that most initiatives have been pharmacist-centered and very few have been system-centered. When you put pharmacists in a system that induces stress, there is little room for pharmacist wellbeing.

We can’t solve the problem if we can’t prove the problem exists. Telling your stories can help bring about positive change. n

2023 Election Information

The election for FPA president elect, treasurer and regional directors will be done by computer again this year. An email containing instructions on how to cast your vote will be sent to you shortly. If your email address that we have in your FloridaPharmacy.org profile is incorrect, you need to contact the FPA office.

To participate in the election, you will need to go to the election website and log in with the special member ID and password provided to you by special email. If you live in regions 2, 4, 6, or 8 you will not be voting for a regional director. Those regions will have their election next year. You will however have an opportunity to select the next president elect and treasurer board member.

If you live in regions 1, 3, 5, 7 or 9, make your selection for your regional director and treasurer. Remember that the system will allow you to vote only one time. The results will be tallied by the canvassing committee appointed by the president of the Florida Pharmacy Association in accordance with FPA bylaws. The last day to vote will be Jan. 31, 2023. If you do not receive your email invitation, please contact us at rhoward@pharmview.com.

Below is candidate information for you to review prior to voting.

CANDIDATE FOR FPA PRESIDENT ELECT

William Mincy FPA Member Since 2006

My name is Bill Mincy and I am asking for your vote to be your next FPA President-Elect. As a fourth-generation pharmacist, I bring knowledge, experience, and a deep commitment to address the diverse professional and business challenges faced by Florida pharmacists, pharmacy owners, students and technicians.

BIOGRAPHICAL DESCRIPTION

I joined the Florida Pharmacy Association in 1976, following graduation from the University of Florida College of Pharmacy, back when it was named the Florida Pharmaceutical Association. I previously served as the Assistant Executive Director of the Florida Pharmacy Association under Jim Powers in 1977-1978. I returned to serve the FPA in 1984 as the Chief Operating Officer and first employee of PPSC, one of the nation’s first retail pharmacy buying groups, and a subsidiary of the FPA. I served on the leadership team at PPSC for over 25 years as Vice President Business Development and Government Affairs. At PPSC, I worked with thousands of independent pharmacy owners and pharmacists throughout Florida and other states to enhance their businesses and advocate for their pharmacies before State legislatures, Congress and numerous state and federal regulatory agencies.

Over the past several years, I have had the privilege to closely work with the FPA Board of Directors, Government Affairs Committee members, Executive Vice President/CEO, lobbyists, and staff to promote the passage of meaningful legislation that benefits the FPA membership and other Florida pharmacy stakeholders. I have also collaborated with the Empower Patients Coalition and Florida Pharmacy Legislative Coalition and its member organizations to represent the business and professional interests of Florida pharmacy owners, pharmacists, students and technicians before the Florida Legislature, Florida Board of Pharmacy, Agency for Health Care Administration (AHCA) and other state agencies.

I am currently serving my second year as the FPA Treasurer. During my tenure as FPA Treasurer, I have worked closely with the FPA Budget and Finance Committee, Board of Directors, and the past and current Executive Vice President/CEO to establish FPA operational budgets, monitor monthly and annual financial performance and provide fiscal leadership.

POSITION STATEMENT

As your FPA President-Elect, I will work closely with the FPA membership, Board of Directors, Councils, Committees, Executive Vice President/CEO and staff to safeguard the profession, move the Association forward, advocate for pharmacist provider status and PBM reform legislation, address workplace issues and task-based metrics, and tackle future professional and industry challenges that come our way. Thank you for your vote.

CANDIDATE FOR FPA TREASURER

Alex Pytlarz FPA Member Since 2002

church and enjoys working in the children's ministry. She was awarded the Frank Toback AZO Consultant Pharmacist Award 2022 and the DCPA Sydney Simkowitz Pharmacy Involvement Award in 2018.

POSITION STATEMENT:

There are many challenges facing the profession of pharmacy at this time. By representing the pharmacists in the Region 1 area, I will bring forward issues to the leadership that are affecting our members. Increasing membership in the Florida Pharmacy Association and strengthening the bond between local units and the FPA will help our profession be more visible to legislators and show our strength in unity.

CANDIDATE FOR FPA REGION 1

(Escambia, santa Rosa, okaloosa, Walton, HolmEs, WasHington, bay, Jackson, calHoun, gulf, gadsdEn, libERty, fRanklin, lEon, Wakulla, JEffERson, madison, tayloR, Hamilton, suWannEE, lafayEttE, dixiE, gilcHRist, columbia, bakER, union, bRadfoRd, alacHua and lEvy countiEs)

Joy Wright

FPA Member Since 2009

I am excited to continue serving in a leadership role with the Florida Pharmacy Association. I am looking forward to supporting Helen Sairany as she comes in as the new CEO/EVP of FPA. As a regional director, I take great responsibility in surveying the members in my region and bringing their issue to leadership and encouraging the local associations in my region.

BIOGRAPHICAL DESCRIPTION

Joyanna "Joy" Wright is an ambulatory care pharmacist with UF Health Shands Hospital in Gainesville, Florida. She is the consultant pharmacist of record for 10 sites. She is a preceptor for the University of Florida, most recently attaining the honorary title of Clinical Professor as well as influencing dental, medical and social work students in her clinic. She is the 2022-2023 President of the Alachua County Association of Pharmacists, currently is the Region 1 Director for FPA and is the chair of the Public Relations Council. She also is a member of FSHP and has actively participated in their Ambulatory Care Forum. Besides her professional activities, she is working on a certification in Functional Medicine, and is a member of the Alachua County Medical Reserve Corp. She continues to hold her pharmacist license in Ontario, Canada and is a member of the Ontario Pharmacists Association and Canadian Pharmacists Association. She is an active member of her

Other issues that affect pharmacists are increasing scope of practice without increasing support in community and ambulatory settings, updating the disease states covered by collaborative practice agreements and the outdated prescribing list for pharmacists as well as legislation encouraging transparency with insurance and pharmacy benefit managers. Expanding coverage for pharmacist services through Medicaid and private insurance companies is another priority, as this can provide more opportunities for employment for all the recent graduates.

Pharmacists must also be encouraged to take an active role in comprehensive medication management for every patient to improve adherence and decrease medication misadventure, reducing the waste of unnecessary healthcare spending. I look forward to working with pharmacists across the state to accomplish the priorities of the association.

CANDIDATE FOR FPA REGION 3

Hello, my name is Matt Schneller and I would like to serve as your Region 3 Director with the Florida Pharmacy Association (FPA). While serving in this role for the last year, I worked with fellow directors and local unit leadership on several issues. Recently, with the direction of the FPA president, we created an Ad-Hoc committee to revamp the structure of local unit associations. The goal of this committee would be to further improve communication and ensure every FPA member knows how to advocate for their profession.

(citRus, HERnando, Pasco and PinEllas countiEs)

Matt Schneller

FPA Member Since 2012

BIOGRAPHICAL DESCRIPTION

Dr. Matthew (Matt) Schneller is currently employed with Walgreens Co. where he serves his patients as a specialty pharmacist. In this current role, Dr. Schneller strives for patient autonomy and interprofessional care with a focus on complex disease states such as infections disease, transplant and cardiology.

Dr. Schneller developed a passion for individual patient care working for independent and chain community phar macies during his undergraduate time in Wisconsin. Dr. Schneller graduated from the University of Wisconsin Osh kosh with his B.S. in 2012 and obtained his Pharm.D. from the University of South Florida College of Pharmacy in 2016.

In his Pharm.D. program, Dr. Schneller gained extensive experience which led to holding multiple leadership positions within local, state and national organizations, including the Florida Pharmacy Association (FPA), the American Pharmacists Association and the American Society of Health-System Pharmacists. After his Pharm.D. program, Dr. Schneller pursued a postgraduate fellowship at Nova Southeastern University, (NSU) College of Pharmacy focusing on the impact of pharmacists within value-based healthcare.

In addition to his current employment with Walgreens, Dr. Schneller currently serves his profession in leadership positions with the FPA on their Board of Directors and their local unit affiliate, the Tampa Bay Pharmacy Association (TBPA) as the Treasurer.

POSITION STATEMENT

As your current Region 3 director, I have enjoyed representing pharmacy stakeholders in Citrus, Hernando, Pasco and Pinellas Counties. In addition to this role, I serve as Treasure for the Tampa Bay Pharmacy Association, who is the local unit association for the FPA. When I joined TBPA, I made an effort to change the membership format to one that if you are a member of FPA, you are automatically a member of your local unit.

After changing TBPA's membership structure, I worked to partner with the Hillsborough County Pharmacy Association to further represent pharmacy stakeholders in Hillsborough and Polk Counties. As I look forward, I see membership to the FPA as the goal for all local units to ensure we have one collective voice.

Together, as members of the FPA, we are the strongest tool to advocate for our patients and the profession of pharmacy in Florida.

CANDIDATE FOR FPA REGION 5

Amanda Haddad FPA Member Since 2015

My name is Amanda Haddad and I would like to serve as your Region 5 Director with the Florida Pharmacy Association (FPA). I currently serve as an executive board member of the Hillsborough County Pharmacy Association (HCPA). Additionally, I had the rare opportunity to serve as Secretary of the association for Alachua County's executive board and lead Ad Hoc committees while leading as the student liaison for the local APhA student chapter. As a practicing pharmacist of 3 years I hope to make a positive impact on policy and patient care through thoughtful leadership and effective collaboration.

BIOGRAPHICAL DESCRIPTION

Dr. Amanda Haddad is currently employed by CVS Health in Tampa, Florida, where she leads her team as the Pharmacy Manager and District Captain for COVID-19 testing. She is currently working towards completing her Master of Business Administration with a Healthcare Management focus. She strives to provide optimal patient care by creating meaningful relationships with patients.

She graduated from the University of Florida College of Pharmacy in 2019 and has one year of hospital residency experience. She plans to continue in her pursuit to make a positive impact on policy and patient care through thoughtful leadership and effective collaboration. She is a current executive board member of the Hillsborough County Pharmacy Association and has served on the Florida Pharmacy Association Membership Council for 3 years.

POSITION STATEMENT

As a current executive board member of the HCPA and Membership Council member of the FPA, I have had the opportunity to serve in roles that provide pharmacists with the tools for optimal patient care. My current goal is to rally pharmacists to connect with like-minded professionals postpandemic and to further pharmacist involvement in efforts to advocate for policy to improve patient care.

(HillsboRougH and Polk countiEs)

CANDIDATE FOR FPA REGION 7

(HEndRy, lEE and Palm bEacH countiEs)

Damien Simmons

FPA Member Since 2013

BIOGRAPHICAL DESCRIPTION

Dr. Damien Simmons completed his PharmD at Nova Southeastern College of Pharmacy in Florida. Upon graduation Dr. Simmons began his career at Publix Pharmacy at the same store he worked at in high school that fueled his ambition to become a pharmacist. A few short years after Dr. Simmons branched out on a business endeavor to be a manager at the newly franchised independent pharmacy, Medicap. In addition to his managerial responsibilities, Simmons took part in precepting pharmacy students.

Currently, Dr. Simmons is the owner and manager of Atlantis Pharmacy located next to JFK Hospital in Atlantis, FL. It is here that Simmons practices pharmacy at the highest level by offering a number of enhanced services including adherence packaging, compounding for both humans and animals, immunizations, INR monitoring, cholesterol screening and comprehensive medication reviews. Atlantis Pharmacy is the site of a community pharmacy residency program sponsored through Palm Beach Atlantic University as well as a member of Community Pharmacy Enhanced Service Network (CPESN). Dr. Simmons is a preceptor for the residency program and pharmacy students and holds the position of Vice President for the Palm Beach County Pharmacy Association. In addition, Simmons received the Excellence in Innovation Award in 2017 from FPA and was a companion medalist for the 2018 American Free Enterprise hosted by Palm Beach Atlantic University.

POSITION STATEMENT

I am running for this position to help pharmacists and the pharmacy profession get back to the basics of being the most trusted and most accessible profession in healthcare.

CANDIDATE FOR FPA REGION 9

BIOGRAPHICAL DESCRIPTION

Goar Alvarez, BPharm.,Pharm.D.,C. Ph.FASCP received his BPharm degree from Florida A&M University (FAMU) and his Pharm.D. degree from Nova Southeastern University (NSU) Colleges of Pharmacy. He is Assistant Dean, Pharmacy Services at NSU overseeing NSU Pharmacy as well as two managed care centers, ICUBAcares, serving a Florida health plan and the other serving accountable care organizations in South Florida. He is also Director of Pharmacy at South Florida State Hospital.

Goar is past President of the Dade County Pharmacy Assn., past Speaker of the HOD as well as past President of the Florida Pharmacy Assn. He currently serves on the Board of Directors of the Dade County Pharmacy Assn. as well as the Broward County Pharmacy Assn. He has served as Chair on several councils at the Florida Pharmacy Association. He is a member of a number of pharmacy organizations including American Pharmacists Association (APhA), National Community Pharmacists Assn. (NCPA), American Society of Consultant Pharmacists (ASCP), Florida Pharmacy Assn. (FPA), Florida Society of Health Systems Pharmacists (FSHP), Dade County Pharmacy Assn. (DCPA), Broward County Pharmacy Assn. (BCPA), and Inter-American Pharmacists Assn. (IPA).

Goar has served as delegate representing Florida at the APhA and NCPA for several years. He serves as advisor to the student chapters of APhA and NCPA at NSU College of Pharmacy. Goar has received several FPA awards including Bowl of Hygiea, Pharmacist of the Year, RQ Richards Award, and the IPA M. Corrons Inspiration and Motivation Award. He served on the Florida Board of Pharmacy and was chair of the Tri-Partite Committee as well as served on the Rules committee on the Board.

(bRoWaRd county)

Goar Alvarez FPA Member Since 1976

The Role of the Pharmacist in the Influenza Season

Heather D. Taylor, PharmD Consultant Pharmacist Guardian Consulting Services, Inc.

Mariette Sourial, PharmD, CPh Associate Professor of Pharmacy Practice Director of Interprofessional Education Palm Beach Atlantic University Gregory School of Pharmacy

Joy Wright, B.Sc.Phm, Pharm.D., CPh, BCPS, TTS, CFMS Clinical Pharmacy Specialist, UF Health Shands Hospital Clinical Professor, University of Florida College of Pharmacy

1. Role of the Pharmacist as Immunizers

a. The CDC recommends everyone at or above the age of 6 months receive the influenza vaccine.

b. Pharmacists who are certified as immunizers through a board of pharmacy approved training can help meet those recommendations by identifying patients and populations that would benefit most from the influenza vaccine and administering it. Pharmacists are one of the most accessible healthcare professionals and can play a pivotal role in increasing vaccination accessibility to patients, particularly high-risk patients during the influenza season.

c. According to the 2022 Florida Statues, Chapter 465 - 465.189 Administration of vaccines and epinephrine auto-injection.

A registered intern or registered pharmacy technician who administers an immunization or vaccine under this subsection must be supervised by a certified pharmacist at a ratio of one pharmacist to a maximum of five registered interns or registered pharmacy technicians, or a combination thereof.

2. A pharmacist who is certified under subsection (7) may administer influenza vaccines to individuals 7 years of age or older within the framework of an established protocol under a supervising physician licensed under chapter 458 or chapter 459.

3. In order to address any unforeseen allergic reaction, a pharmacist may administer epinephrine using an autoinjector delivery system within the framework of an established protocol under a supervising physician licensed under chapter 458 or chapter 459.

4. A pharmacist may not enter into a protocol under a supervising physician licensed under chapter 458 or chapter 459 or administer an immunization or vaccine under this section unless he or she maintains at least $200,000 of professional liability insurance and has completed training in administering vaccines authorized under this section.

5. A pharmacist administering immunizations or vaccines under this section shall maintain and make available patient records using the same standards for confidentiality and maintenance of such records as those that are imposed on health care practitioners under s. 456.057. These records shall be maintained for a minimum of 5 years.

6. The decision by a supervising physician licensed under chapter 458 or chapter 459 to enter into a protocol under this section is a professional decision on the part of the practitioner, and a person may not interfere with a physician’s decision as to entering into such a protocol. A pharmacist may not enter into a protocol that is to be performed while acting as an employee without the written approval of the owner of the pharmacy. Pharmacists shall forward vaccination records to the department for inclusion in the state registry of immunization information.

7. Any pharmacist, registered intern, or registered pharmacy technician seeking to administer vaccines under this section must be certified to administer such vaccines pursuant to a certification program approved by the board in consultation with the Board of Medicine and the Board of Osteopathic Medicine. The certification program shall, at a minimum, require that the pharmacist attend at least 20 hours of continuing education classes approved by the board and the registered intern complete at least 20 hours of coursework approved by the board. The registered pharmacy technician shall have immunization-related training and continuing education as provided in s. 465.014. The certification programs shall, at a minimum, have a curriculum of instruction concerning the safe and effective administration of such vaccines, including, but not limited to, potential allergic reactions to such vaccines.

8. The written protocol between the pharmacist and supervising physician under this section must include particular terms and conditions imposed by the supervising physician upon the pharmacist relating to the administration of vaccines by the pharmacist pursuant to this section. The written protocol shall include, at a minimum, specific categories and conditions among patients for whom the supervising physician authorizes the pharmacist to administer such vaccines. The terms, scope, and conditions set forth in the written protocol between the pharmacist and the supervising physician must be appropriate to the pharmacist’s training and certification for administering such vaccines. Pharmacists who have been delegated the authority to administer vaccines under this section by the supervising physician under the protocol shall provide evidence of current certification by the Board of Pharmacy to the supervising physician. A supervising physician shall review the administration of such vaccines by the pharmacist pursuant to the written protocol be-

tween them, and this review shall take place as outlined in the written protocol. The process and schedule for the review shall be outlined in the written protocol between the pharmacist and the supervising physician.

9. The pharmacist shall submit to the Board of Pharmacy a copy of his or her protocol or written agreement to administer vaccines under this section.

d. Many PharmD programs offer their students Immunization Delivery Certificate Training as part of their curriculum which allows them as pharmacy interns to administer certain vaccines in accordance to state laws or regulations

e. Under the Public Readiness and Emergency Preparedness (PREP) Act, the declaration authorizes pharmacists to both order and administer, and pharmacy interns as well as pharmacy technicians to administer, ACIP recommended childhood vaccinations without regards to state laws or regulations

2. Role of the Pharmacist in Combatting Vaccine Hesitancy

a. Pharmacists can help combat vaccine hesitancy in patients by serving as a drug information resource and providing patients with accurate facts about the vaccines, particularly the influenza vaccine, including data on its safety and efficacy. They can dispel myths and misconceptions regarding the influenza vaccine and build vaccine confidence by addressing any concerns or fears that patients may have.

3. Role of the Pharmacist in Prescribing Influenza Antiviral Medications

a. Recently, Florida Statues have been amended to include “the testing or screening for and treatment of minor, nonchronic health conditions pursuant to Section 465.1895” in the definition of the practice of the profession of pharmacy. It also added new language outlining the practitioner requirements, agreements and protocols that must be met in order to provide these services. Minor, nonchronic health conditions includes influenza, and this expansion in the pharmacist’s scope of practice includes the prescribing of influenza antiviral medications in accordance with a collaborative practice

agreement. Through this, pharmacists can screen patients for influenza illness, complete brief physical assessment and point-ofcare rapid diagnostic test and either refer or treat based on an established collaborative practice agreement protocol under a licensed prescriber.

Section 465.1895, Florida Statutes, provides that a pharmacist who tests or screens for and treats minor, nonchronic health conditions must meet the following requirements:

i. Hold an active and unencumbered license to practice pharmacy in this state.

ii. Have completed an initial 20-hour course approved by the board, in consultation with the Board of Medicine and Board of Osteopathic Medicine.

iii. Maintain at least $250,000 of professional liability insurance coverage. However, a pharmacist who maintains professional liability insurance coverage pursuant to s. 465.1865 satisfies this requirement.

iv. Have established a system to maintain records of all patients receiving services within the framework of a written protocol for a period of 5 years from each patient’s most recent provision of service.

Other Considerations for Flu vaccine

Many people are aware that some of the flu vaccines contain egg proteins, but did you know some of them also contain trace amounts of antibiotics like gentamicin and neomycin? It is always important to document patient allergies in your software system and to ask again before giving a vaccine.

Also, if your patient is 65 years or older, it is recommended they get the high dose flu vaccine. These vaccines will help older patients create a stronger immune response to improve the ability of the vaccine to prevent illness in older adults. This year there are 3 vaccines approved for use in those over age 65, Fluzone High-Dose Quadrivalent, Flublok Quadrivalent recombinant and Fluad Quadrivalent adjuvanted flu vaccines. However, if these 3 vaccines are not available at the time of administration, older adults should get a standard-dose flu vaccine instead. CDC recommends that the flu vaccine be given in September or October, however it can still provide protection if given later in the year as well, since flu season does not peak until February and can last until May.

Ingredients

Vaccine Egg Protein (trace) Antibiotics (trace) Mercury (Thimerosal) Latex Notes

Afluria Quadrivalent Yes Neomycin, polymyxin B MDV only

*approved for 6 months and older Do not puncture MDV more than 20 times.

Fluad Quadrivalent Yes Neomycin, Kanamycin No *approved for 65 yrs and older

Fluarix Quadrivalent Yes Gentamicin No *approved for 6 months and older

FluLaval Quadrivalent Yes No No *approved for 6 months and older

Fluzone/Fluzone HD Quadrivalent Yes No MDV only

Not made with natural rubber latex

*approved for 6 months and older(0.5mL), HD is 0.7mL for 65 and older

Flublok Quadrivalent No No No *approved for 18 years and older

Flucelvax Quadrivalent No No MDV only *approved for 6 months and older

References:

1. Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022–23 Influenza Season. MMWR Recomm Rep 2022;71(No. RR-1):1–28. DOI: http://dx.doi.org/10.15585/mmwr.rr7101a1.

2. https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm#Information-for-Health-care-Professionals-for-Administering-FluVaccine-during-the-COVID-19-Pandemic Accessed 11/5/2022

3. Package Insert: Afluria (3/22), Fluad (3/2022), Fluarix (7/2022), Flulaval (2022), Fluzone (11/2022), Fluzone HD (1/2019), Flublok (2022), Flucelvax (3/2022)

Types of Flu Strains and Vaccines

On March 3, 2022, the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted on the influenza strains recommended for inclusion in the influenza vaccines for the 2022-2023 season. The egg based Quadrivalent formulations of the influenza vaccine should include the following strains: n an A/Victoria/2570/2019 (H1N1)pdm09-like virus; n an A/Darwin/9/2021 (H3N2)-like virus; n a B/Austria/1359417/2021-like virus (B/Victoria lineage); and n a B/Phuket/3073/2013-like virus (B/Yamagata lineage)

The cell culture or recombinant Quadrivalent formulations of the influenza vaccine should include the following strains: n an A/Wisconsin/588/2019 (H1N1)pdm09-like virus; n an A/Darwin/6/2021 (H3N2)-like virus; n a B/Austria/1359417/2021-like virus (B/Victoria lineage); and n a B/Phuket/3073/2013-like virus (B/Yamagata lineage).

The influenza vaccines available in the 2022-2023 season are included in the table below.

Trade Name

Manufacturer Age Indication Route

Afluria Quadrivalent** (PFS & MDV) inactivated Seqirus >3years (PFS) >6months (MDV) Intramuscular

Fluarix Quadrivalent** (PFS) inactivated GlaxoSmithKline >6months Intramuscular

FluLaval Quadrivalent** (PFS) inactivated GlaxoSmithKline >6months Intramuscular

Fluzone Quadrivalent** (PFS, MDV, & SDV) inactivated Sanofi Pasteur >6months Intramuscular

Flucelvax Quadrivalent^ (PFS & MDV) inactivated Seqirus >6months Intramuscular

Fluzone High Dose Quadrivalent** (PFS) inactivated Sanofi Pasteur >65 years Intramuscular

Fluad Quadrivalent** (PFS) inactivated Seqirus >65 years Intramuscular

Flublok Quadrivalent* Sanofi Pasteur >18 years Intramuscular

Flumist Quadrivalent** Live attenuated AstraZeneca 2-49 years Intranasal

PFS-pre-filled syringe; MDV- multidose vial; SDV-single dose vial ^ cell cultured based

* Hemagglutinin recombinant

** egg based

REFERENCES

1. Influenza vaccines – United States, 2022-23 influenza season. CDC.gov. https://www.cdc.gov/flu/professionals/acip/2022-2023/ acip-table.htm. Published 2022. Accessed October 14, 2022.

2. Influenza Vaccine for the 2022-2023 season. FDA.gov. https://www.fda.gov/vaccines-blood-biologics/lot-release/influenzavaccine-2022-2023-season. Published 2022. Accessed October 14, 2022.