May 2020 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association MAY 2020

Assessing the Attitudes, Knowledge and Awareness of HIV Vaccine Research Among College Students in a North Florida College Town

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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President's Viewpoint

VOL. 83 | NO. 5 MAY 2020 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

7 Executive Insight

23 Regional Directors 24 News & Notes

16 18 22

Assessing the Attitudes, Knowledge, and Awareness of HIV Vaccine Research Among College Students in a North Florida College Town OPINION: End to Occupational Regulation for Pharmacy is Not Worth the Risk Mistake-Proofing a Hole in the Safety Net Highlights of Evidence-based Practices to Reduce Point of Sale Errors

Miami pharmacy on front lines of COVID fight

MAY 2020

FPA Calendar 2020

JUNE

AUGUST

2-4

Florida Board of Pharmacy Meeting Conference call

House of Delegates registration deadline

25-26 Tampa Board of Pharmacy meeting

JULY 3

Independence Day recognition, FPA office closed

9 - 12 130th Annual FPA Meeting and Convention Virtual meeting

37th Annual Southeastern Gatherin’ Destin

SEPTEMBER 1

Deadline for Officer and Director Nominations

Labor Day, FPA office closed

12-13 FPA Clinical Conference Dania Beach

Events calendar subject to change

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. There is a two-hour CE requirement for pharmacists on the dispensing of controlled substances effective this biennial renewal period. Pharmacists and pharmacy technicians must also complete a one-hour Florida Board approved continuing education on human trafficking by Jan. 1, 2021. Pharmacists should have satisfied all continuing education requirements for this biennial period by Sept. 30, 2021, or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by Dec. 31, 2020. 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 FSHP — Tamekia Bennett (850) 906-9333 UF — Emely McKitrick (352) 273-5169

FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300

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

FOR A COMPLETE CALENDAR OF EVENTS GO TO WWW.FLORIDAPHARMACY.ORG

FPA — Michael Jackson (850) 222-2400

Mission Statements:

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.

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.

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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 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.

4 |

FLORIDA PHARMACY TODAY

EMAIL YOUR SUGGESTIONS/IDEAS TO dave@fiorecommunications.com

The President’s Viewpoint DAVID "CHACHI" MACKERAY, RPH

Pharmacists Prescribing Hormonal Contraceptives

his particular subject matter is a personal and important issue that means a great deal to me. About six years ago, when this subject first surfaced, I became very interested in its intent and value. Maybe because at the time my daughter was a teenager in high school, or I saw a great opportunity to advance the pharmacy profession, or possibly a little of both. Either way, I knew in my heart that I wanted to make this my mission: To get a Florida law passed that allows pharmacists – after counseling their patients on the options available regarding hormonal contraception – to be able to prescribe, furnish or dispense, in accordance with state laws. So, about five years ago, the first formal decision I personally chose to make was submit a resolution to the FPA House of Delegates. After much debate and discussion during the reading of this resolution to the congregation, I educated them on all the benefits this potential law could have on so many young patients in Florida. I also mentioned that so many other states already had such laws passed with their programs functioning successfully. While at the microphone defending my resolution, I reminded everyone that about 15 years earlier, Florida was the 45th out of 50 states to pass the immunization program, which happens to be one of the most important and successful services we do for our patients and profession. So why the hesitation? Do we wait again to become one of the last states to pass this vital service or maybe this time become one of the leaders and show others how Florida has advanced? The resolution was referred to the FPA Professional Affairs Committee for

further review and better clarification. It needed to be reintroduced to the FPA HOD for reconsideration. However, this time around has brought forth much more specific, important and educational information from states participating

I knew in my heart that I wanted to make this my mission: To get a Florida law passed that allows pharmacists – after counseling their patients on the options available regarding hormonal contraception – to be able to prescribe, furnish or dispense, in accordance with state laws.

in one capacity or another. The role of pharmacists in family planning services is exploding with more states allowing trained pharmacists to prescribe hormonal contraception and emergency contraception. In 2013, California was the first state where contraception-specific legislation was proposed and passed, with most states using statewide protocols/ standing orders to give the right to par-

David Mackeray, RPh

ticipate in this important health care program. According to a 2019 APhA report, there are 11 states and the District of Columbia allowing pharmacists prescribing self-administered hormonal contraception, and another 10 states having introduced legislation in 2018-19 to pass a similar law. Eight states have implemented their programs, while West Virginia, New Hampshire, and the District of Columbia are in the regulatory process pending protocol approval. Tennessee is pending pharmacist training. These figures may have since changed since press time. Each state may have their own specific rules and regulations regarding such topics such as contraceptive methods, age restrictions, prescribing duration, service delivery restrictions and even the fees pharmacists are allowed to collect. However, most participating states have agreed upon similar protocols regarding pharmacists trainMAY 2020

2019-2020 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 diligently all year long on behalf of our members.

Angela Garcia.....................................................................................................Board Chair David Mackarey..........................................................................................FPA President Kimberly Jones.......................................................................................... FPA Treasurer Joseph Scuro............................................................................................ President Elect Gary Koesten..............................................................................Speaker of the House Eric Larson.......................................................................Vice Speaker of the House Bill Kernan................................................................................................... FSHP President Preston McDonald............................................................................. Region 1 Director Neil Barnett............................................................................................Region 2 Director Larry Alaimo..........................................................................................Region 3 Director Cheryl Rouse.........................................................................................Region 4 Director James Alcorn.......................................................................................Region 5 Director Barbara Beadle...................................................................................Region 6 Director Paul Delisser.......................................................................................... Region 7 Director Carmen Gordon...................................................................................Region 8 Director Mitchell Levinson...............................................................................Region 9 Director Julie Burger.......................................................................................Technician Director

Florida Pharmacy Today Journal Board Chair.............................................................. Carol Motycka, motycka@cop.ufl.edu Vice Chair....................................................Cristina Medina, cmmedina@cvs.com Treasurer.........................................................Eric Jakab, ericjakab@hotmail.com Secretary............................................. Julie Burger, julieburger133@gmail.com Member.................................................. Michael Finnick, michaelfinnick@ufl.edu Member.....................................................David Mackarey, dmackarey@aol.com Member.......................................................Matt Schneller, schnem18@gmail.com Member..........................................Teresa Tomerlin, teresapharmd@cfl.rr.com Member............................................Greta Pelegrin, gretapelegrin@yahoo.com Technician Member........................Julie Burger, julieburger133@gmail.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com Journal Reviewer....................... Dr. Melissa Ruble, mruble@health.usf.edu Journal Reviewer....................................Dr. Angela Hill, ahill2@health.usf.edu

ing, documentation, reporting, practice model and the legislative scope of the bill itself. Also, many states had success passing the HC Bill with parallel bills, introduced in the same legislative session or previously, that allow pharmacists to provide other clinical services such as dispensing naloxone for opioid overdose rescue and nicotine replacement products and devices for smoking cessation.

I’m aware of the many challenges that this HC Bill brings forth, including those involving personal rights and choices, religious beliefs, privacy for minors, state medical associations, Planned Parenthood and even political division. Most importantly, there is the choice of the pharmacist to participate or not in autonomously prescribing contraception. Will their decision risk their employment security? I believe it’s the personal choice of the pharmacist to participate, similar to the other services we offer like immunization. No pharmacist should ever be forced to perform any service they are not comfortable doing. Another issue of concern is billing and reimbursement. I’m glad to report that has also improved lately. Most states have moved away from allowing a set pharmacist fee in legislation or See President's Viewpoint, continued on Page 8

6 |

FLORIDA PHARMACY TODAY

Executive Insight BY MICHAEL JACKSON, RPH MICHAEL JACKSON, BPHARM, EVP & CEO, FLORIDA PHARMACY ASSOCIATION

The Practice of Pharmacy is Changing in Florida: Now What?

ast month, we shared with you some pretty earth-shaking news on pharmacy here in our state. In a showing of support for the value of pharmacists, we saw several things happen. First of all the Florida Legislature reversed course on years of resisting changes to the pharmacy practice act and made some sweeping revisions to Florida Statute 465. Consultant pharmacists got their authority expanded to modify and discontinue prescription drug therapy and also were given expanded authority to order and evaluate clinical testing. All other pharmacists saw that beginning July 1, and after the implementation of Board rules, prescription drug therapy can be initiated, modified or discontinued for patients. We will have the ability to order and evaluate laboratory tests. We will also be able to assess, manage and treat patients with chronic and non-chronic diseases. Anyone reading this article and wondering why all this is happening is also someone that has no idea what COVID-19 is or has no clue what the skills that Florida’s pharmacist can bring to the health care practices marketplace. We have been given this wonderful opportunity to make a difference in the lives of those we care for every day. The pandemic that society is grappling with now has created strong interest by policy makers to get our most qualified health care providers with knowledge of drug therapy management on the front lines. In case you were not aware, that qualified provider happens to be the person who has a “PS” license card in their wallet. If you have one, that is you. If you are applying for one, that is you as well.

We have seen a retraction of pharmacy jobs over the past few years. Many of our stakeholders that I met with over the years are not shy about expressing their concerns over lack of employment. Indeed, we have experienced a tsunami effect where the growth of pharmacies have declined. We have also experienced situations where hundreds of

The pandemic that society is grappling with now has created strong interest by policy makers to get our most qualified health care providers with knowledge of drug therapy management on the front lines.

independent pharmacies have closed and others have rolled back operational hours in an effort to save payroll. Of course, others may point at the number of graduates entering the market each year and wonder why the Florida Pharmacy Association can’t get in front of that trend. The cold reality is that the FPA or any other pharmacy organization has no ability to force any institution of higher learning to temper its educational offerings and student en-

Michael Jackson, B.Pharm

rollment any more than you and I can tell seafood restaurants to take fish off their menu. What we can do as your professional association is to advocate for and create changes within the practice that builds new career opportunities. Your FPA successfully did that this legislative session. It is now up to those of us with the “PS” and “PU” license cards to take the necessary steps to make these changes a reality and a standard of practice. Our physician colleagues can benefit greatly from our efforts to collaborate. Those that are doing that today enjoy working with us and are reluctant to “round the wards” without their pharmacist consultant at their side. Those that are not doing that will come to know what a difference that we can make to their practices and how we can improve the quality measures that are necessary for a sustained and viable payment model. MAY 2020 |

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

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

Continuing Education Coordinator Stacey Brooks, ext. 210 Coordinator of Membership Christopher Heil, ext. 110

FLORIDA PHARMACY TODAY BOARD Chair............................... Carol Motycka, St. Augustine Vice Chair.........................Cristina Medina, Hollywood Treasurer.................................... Eric Jakab, Gainesville Secretary............................. Julie Burger, Pensacola Member.........................Michael Finnick, Jacksonville Member.............David Mackarey, Boynton Beach Member....................................... Matt Schneller, Tampa Member............................Teresa Tomerlin, Rockledge Member...................................... Greta Pelegrin, Hialeah Technician Member..........Julie Burger, Pensacola Executive Editor.......Michael Jackson, Tallahassee Managing Editor...................Dave Fiore, Tallahassee Journal Reviewer........................... Dr. Melissa Ruble Journal Reviewer....................................Dr. Angela Hill This is a peer-reviewed publication. ©2020 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 address: www.floridapharmacy.org.

Executive Insight, from Page 7

The changes from this year’s legislation can open a number of doors for those wishing to advance their practice. These doors will not open by themselves. There is some preparatory training that needs to take place and now is the time to get ready for that. If this new practice model takes flight as it has done so in other states, there is no reason to doubt its positive effect on the pharmacy job market here in Florida. n

President’s Viewpoint, from Page 6

protocol language, but instead have implemented flat pharmacist prescribing fees ranging from $25-$50. Some states have expanded their provider status, (which Florida hasn’t passed yet), to include pharmacists to aid in billing. It’s also worth noting that participants were willing to pay for the convenience the pharmacy offered with better hours and accessibility to them. The report from APhA showed while some patients’ insurance covered the cost, 80 percent paid out-of-pocket for the screening and 50 percent paid out-of-pocket for the medication. I believe those figures represent proof and value in this service. Let’s be totally honest here. The pharmacy profession must be continually advancing our services, as the most accessible health care providers should be doing, to be highly regarded and respected, while creating other financial opportunities. Traditional pharmacy practices alone will not allow our profession to survive or advance, so let’s utilize our knowledge and move forward to the best of our ability, allowing pharmacy the status it truly deserves. I personally feel that we owe this professional service opportunity to our upcoming and future pharmacists, as my predecessors did for my generation many years ago. Think about how many other health care professionals keep advancing their scope of practice, especially physician assistants and nurse practitioners. Don’t think that either of them wouldn’t want to get a piece of the pharmacy pie if we’re not careful. Remember, the Florida Legislature passed an automation dispensing bill that could easily become something larger and damaging to our profession. Let’s stop ignoring the writing on the wall, turning our backs to something that is not working well, hoping it will go away or resolve itself, and become more proactive, innovative and aggressive, we then can become “Passionate People Proudly Protecting Pharmacy Profession.” n FROM THE MEMBERSHIP

“The conference was excellent and went quite well as we all learned more about Zoom. It may interest you to know that my late father, Rufus Thomas, was a past president of FPA and a founding member and president of the Volusia County Association. I have literally been going to meetings since I was in utero, not kidding. I did not choose the same leadership pathways as my father, but I have always been a more silent supporter and advocate of FPA and the county associations and the profession of pharmacy. You are doing an awesome job with the organization. Thank you.” Betty Gunter Attendee, May Law and Regulatory Conference

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Assessing the Attitudes, Knowledge and Awareness of HIV Vaccine Research Among College Students in a North Florida College Town Authors: Antonio J. Carrion, Pharm.D., MPH, AAHIVP, CPh Associate professor of pharmacy practice Florida Agricultural and Mechanical University College of Pharmacy and Pharmaceutical Sciences Tallahassee, FL 32307 Antonio.carrion@famu.edu Phone: (850) 412-7376 Briana Journee, Pharm.D., MBA, AAHIVP, CPh (Corresponding Author) Assistant professor of pharmacy practice Florida Agricultural and Mechanical University College of Pharmacy and Pharmaceutical Sciences Tallahassee, FL 32307 Briana.journee@famu.edu Phone: (850) 599-3687 Tonya Martin, PharmD Associate professor of pharmacy practice Florida Agricultural and Mechanical University College of Pharmacy and Pharmaceutical Sciences Jacksonville Instructional Site Tonya.martin@famu.edu Phone: (904) 391-3906 Jovan D. Miles, Pharm.D., AAHIVP, CPh Assistant professor of pharmacy practice Florida Agricultural and Mechanical University College of Pharmacy and Pharmaceutical Sciences Tallahassee, FL 32307 Jovan.miles@famu.edu Phone: (850) 599-3301 Key words: HIV, Awareness, Antiretroviral therapy (ART), College Students Disclosure: The authors of this article report no financial or commercial relationships with any pharmaceutical or medical education companies.

FLORIDA PHARMACY TODAY

Introduction: Human immunodeficiency virus is a potentially fatally microorganism that attacks the immune system and can decrease the bodyâ&#x20AC;&#x2122;s ability to fight off infections. If the immune system is weakend bellow a certain threshold (CD4 cell <200 cells/mm3), an HIV-infected patient may develop acquired immunodeficiency syndrome, or AIDS. The Centers for Disease Control and Prevention estimates that about 1.2 million people in the United States are living with HIV infection, with approximately 50,000 new infections each year.1 In 2013, there were an estimated 47,352 new HIV infections and nearly two thirds of these new infections occurred in men who have sex with men (MSM).1 Moreover, there were an estimated 5,377 and 6,132 newly reported HIV infections in 2013 and 2014 respectively. This represents a 12 percent increase from 2013.2 In north Florida alone, there were approximately 1,472 persons living with HIV/AIDS in 2013.2 More specifically, in 2013, eight out of the 10 ZIP codes in Leon County accounted for more than 30 cases of total adults living with HIV/AIDS in the north Florida area.2 There are numerous antiretroviral medications that slow the progression of the virus, but none that prevent or cure the infection itself. Despite many efforts from various researchers, no vaccination has been developed to prevent the acquisition and transmission of the virus. A clinical trial was conducted in Thailand in 2009 in which vaccination with ALVAC and AIDSVAX to prevent the infection of HIV was studied. In 2015, a clinical trial called HIV Vaccine Trials Network 100 was launched in South Africa to study an investigational HIV vaccine regimen for safety and the immune response it generates in study participants.3 It is the latest study after the first investigation in Thailand demonstrated that a vaccine could protect people from HIV infection. After two years, safety and immune response results will determine future efficacy investigation in South Africa.4 The HIV pandemic continues to affect many individuals in the United States, including college students, and it is important for the public to be aware of the prevention methods being investigated to counteract this issue. College students are the future leaders and scientists of the world and they should have a strong knowledge base and awareness of what is occurring in the realm of HIV/ AIDS. Our goal is to increase the awareness of HIV vaccine research and development against the virus, in order to help minimize the spread of the disease and further educate the community.

Methodology: SURVEY/PARTICIPANTS

A 27-point questionnaire was developed by Allen et al. to assess attitudes among the general population and selected race/ethnic groups in the U.S.5 The purpose of the survey was to validate key HIV vaccine research themes and messages identified by focus groups and a media content analysis in the U.S. A modified version of the HIV vaccine research survey was developed to collect data from our target population, which is based in north Florida. The prior survey did not include Florida in its research. The survey collected demographic information and student responses through the use of a Likert scale and true/false questions. For a three-month period from November 2014 through January 2015, investigators surveyed 204 college students who attend a Florida State University System university and randomly recruited them to complete the HIV vaccine survey questionnaire. All participants were at least 18 years old and were initially screened in a pre-survey questionnaire to ensure they met the inclusion criteria. Eligibility criteria for inclusion were: (1) students

enrolled at the identified SUS univeristy; (2) age 18 years and above. Those individuals that did not meet the criteria of being above the age of 18 and or enrolled at the identified university were excluded from the study. All participants completed a printed copy of the questionnaire and the average time of completion was 15 to 20 minutes. SURVEY QUESTIONNAIRE

To ascertain and validate the preliminary key themes and messages, a 27-point survey was developed by Allen et al.5 The survey was then modified into a 24-point questionnaire in order to capture information pertaining to the selected target population. The survey questions were organized into categories including: (1) Knowledge of HIV/AIDS, (2) Attitudes concerning HIV vaccine research, (3) Knowledge of HIV vaccine research, (4) Interest in support of HIV vaccine research and (5) general demographic information. A variety of ordinal variables were used for a majority of the questions including standard, balanced five-point Likert-type scales with corresponding labels attached to each point on the scale (“Strongly agree,” “Agree,” “Neither agree nor disagree,” “Disagree,”

Table 1: Demographic Information Characteristics

Number

Percentage

SEX: Male Female Transgender

75 129 0

37% 63% 0

RACE/ETHNICITY: African-American Caucasian Asian Latino/Hispanic Hawaiian Native/Pacific Islander Native American/Alaskan Native Other:

169 16 6 10 0 2 2

83% 8% 3% 5% 0 1% 1%

AGE GROUP: 18 – 21 22 – 25 25 – 30 30 and above

88 87 19 9

43% 43% 9% 4%

RELIGION: Buddhist Jewish Muslim Christian/Baptist Greek Orthodox No religious affiliation Other: Kareemism, Catholic, Adventist, Hindu, Cophic orthodox

4 0 2 176 1 10 12

2% 0% 1% 86% 0 5% 6%

SEXUAL ORIENTATION: Heterosexual Homosexual Bisexual Choose not to answer

185 8 4 5

92% 4% 2% 2% MAY 2020 |

“Strongly disagree”), a few unbalanced five-point scales with labels attached (“Extremely interested,” “Very interested,” “Somewhat interested,” “Not that interested,” “Not at all interested”), and some true-or-false questions. The original survey was reviewed by the U.S. Office of Human Subjects Protection and classified as exempt from institutional review board review/approval.5 The original survey was then approved by the U.S. Office of Management and Budget.5 The modified version of the survey questionnaire was approved for use by the identified university’s Institutional Review Board in November 2014. Participant recruitment, survey dissemination, and data collection occurred over the course of the following three months (November 2014 to January 2015).

within the age ranges of 18-25 (86 percent). The racial breakdown of the respondents was 83 percent African American, 8 percent Caucasian, 3 percent Asian, 5 percent Latino/Hispanic, and 1 percent other. Compared to the university’s demographics in 2009, the female population was nearly the same (66 percent), and the African American population was similar (94 percent) in reference to student population. Yet there was a slight difference in the overall racial distribution, meaning lower percentages of Caucasian, Asian and Latino/HisFigure 1: Majors of Students

Results: PARTICIPANTS

Surveyors enlisted the participation of 204 students. Many of these students – 179 or 86 percent –belonged to highly impacted populations. More specifically, 169 participants were African American and 10 were Hispanic; no men-who-havesex-with-men were identified. Table 1 depicts study population demographic information. Among the total population sample, the majority of participants belonged to the following categories: African American (83 percent), female (63 percent), Pharmacy major (50 percent), heterosexual (92 percent), and

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FLORIDA PHARMACY TODAY

Brian A. Kahan, R.Ph., J.D.

LICENSED Florida Pharmacist and Attorney STAT EW I DE R EPR E SEN TAT ION 561-392-9000 bkahan@kahanlaw.com 7000 W. Palmetto Park Rd., Suite 210 Boca Raton, FL 33433 The hiring of a lawyer is an important decision that should not be based upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

Table 2: Survey Questionnaire and Responses Strongly Agree/ Agree %

Questions Asked on Survey

Strongly Disagree/ Disagree %

HIV/AIDS KNOWLEDGE Acquired Immune Deficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus (HIV).

*95%

*5%

HIV is transmitted through the exchange of blood, semen, and vaginal fluids.

*99%

*1%

There is a vaccine to prevent or cure the transmission of HIV. HIV/AIDS is the most urgent health problem being faced at the present time.

*15% 65%

*85% 14%

HIV vaccines are the best hope of controlling the global AIDS epidemic. Research to develop an HIV vaccine is just as important as programs to educate the public about HIV prevention. I have read or heard some news within the past 12 months about research efforts to develop a vaccine thatprevents HIV infection.

57%

20%

93%

34%

49%

ATTITUDES CONCERNING HIV VACCINE RESEARCH It is possible to develop vaccines that prevent HIV infection. I have confidence that scientists will develop HIV vaccines. I trust the U.S. government to protect people who volunteer to test HIV vaccines.

62% 67% 37%

8% 9% 37%

KNOWLEDGE OF HIV VACCINE RESEARCH HIV vaccines being tested today cannot cause infection in volunteers who get vaccinated. An HIV vaccine already exists but is being kept a secret. Vaccines are tested on thousands of humans before they get approved for everyone to use. Vaccines work 100% or nearly 100% of the time.

15% 38% 48% 23%

40% 28% 24% 48%

INTEREST IN SUPPORT OF HIV VACCINE RESEARCH How supportive would you be of someone you knew who was thinking of volunteering in one of these studies? It is important for me to help support HIV vaccine research, what would be your level of interest in learning more about research a develop vaccines preventing HIV infection?

^46%

^19%

^54%

^11%

*Question required a True or False response

^Question required a response of interest: Extremely/very interested or Not that/not at all interested

panic enrolled students. From the total population, 185 participants identified themselves as heterosexual, eight as homosexual, and four as bisexual. The breakdown by majors listed pharmacy as the most involved, providing 50 percent of all respondents. The College of Social Science and School of Allied Health Sciences represented 11 percent each. The study population was comprised of respondents representing seven different academic units within the university. Pharmacy and allied health science majors were 50 percent and 11 percent, respectively. Figure 1 lists the academic units represented in the study. NON-HIGHLY IMPACTED POPULATION

The next comparison relates to responses and statistical comparisons of survey questions related to HIV/AIDS awareness, knowledge and attitudes in the general population sam-

ple. Notably, only 15 percent of the students interviewed believed there is a vaccine to prevent or cure the transmission of HIV. Moreover, 37 percent of the participants believed that an HIV vaccine already exists but is being kept a secret, while 35 percent neither agreed nor disagreed. Nearly half, 41 percent, of the participants had not read or heard any news within the past 12 months before completing the survey regarding research efforts to develop a vaccine that prevents HIV infection. A quarter, 25 percent, of participants had an interest in learning more about research to develop vaccines and to help support HIV vaccine research and 35 percent provided a neutral response to that interest. Despite these findings, a resounding 64 percent of participants feel that HIV/AIDS is the most urgent health problem being faced at present time with 20 percent giving a neutral reponse. In a cross analysis, female participants were less likely to MAY 2020

have heard or read about research efforts for a vaccine within the last 12 months. Despite these findings, both male and female comparisons for all other questionnaire questions were relatively close as far as percentage of response. HIGHLY IMPACTED POPULATIONS

Within the highly impacted sample group, 29 percent of African Americans and 50 percent of Latino/Hispanics had heard or read news regarding HIV vaccines within the last 12 months. More than a third, or 38 percent of African Americans and 30 percent of Latino/Hispanics trust the government to protect people who volunteer to test HIV vaccines. Nearly half, 40 percent from both groups, believe that there is a vaccine that the government is keeping a secret. Slightly more than half, 52 percent of African Americans and 40 percent of Latino/Hispanics believe that HIV vaccine research is important and would be interested in learning about it and helping. Discussion: Some bias in the research was that the participants were mainly pharmacy students. This creates bias in the results because most pharmacy students are knowledgeable and more aware when it comes to HIV and health disparities. Also, the variety of the participants was not very broad because there were mainly heterosexual, African American females. The study did not have enough men who have sex with men, which is a population that is at high risk. The majority of participants were African American females within the age range of 18-25. Also, half of the participants were pharmacy students. Women made up 20 percent (9,500) of the estimated 47,500 new HIV infections in the United States in 2010. The majority of these, 84 percent, of these new infections (8,000) were from heterosexual contacts.1 When comparing groups by race/ethnicity and gender, the fourth-largest number of all new HIV infection in the United States in 2010 (5,300) occurred among African American women with heterosexual contact. Of the total number of estimated new HIV infections among women, 64 percent (6,100) were in African Americans.2 In 2013, an estimated 9,278 women aged 13 years or older received a diagnosis of HIV infection in the United States (20 percent of the all estimated diagnoses during 2013), down from the 10,686 new diagnoses among women in 2009. Women accounted for 24 percent (6,424) of the estimated 26,680 AIDS diagnoses among adults and adolescents in 2013 and represent 24 percent (242,178) of the 1,184,618 cumulative AIDS diagnoses in the United States from the beginning of the epidemic through the end of 2013. Due to underrepresentation of racial groups other than African Americans, investigators were unable to identify awareness gaps among races. Regarding the development of a vaccine, 66 percent believed it was possible for a vaccine to be developed. The sentiment of mistrust from the majority sample may stem from HIV conspiracies, more specifically unethical medical research and sabotaging suffered by African Americans who trusted the government, such as the Tuske14

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gee study of untreated syphilis. Also, attitudes can be affected by the popular media’s focus on adverse effects related to vaccines. More than half of participants believed HIV was a health problem. Unlike other studies our study showed that participants understood how an HIV vaccine works. This is attributed to there being a large number of health professional students in the study. Conclusions: Awareness, knowledge and attitudes toward HIV vaccine research varies by population and study participants responded positively to the questions posed by the survey. The study shows that there is a need to educate students about HIV vaccines and other information concerning the virus itself overall. HIV is a disease that affects the entire world and more efforts should be geared towards increasing the knowledge and awareness surrounding this pandemic. Research should be expanded to include members of the local community, as well as students from the other universities/colleges (Florida State University, Tallahassee Community College) in the area. Continuation of Research: As previously noted in the discussion, the demographics of participants in the study also served as a limitation to the data collected. With this in mind, we plan to further expand our research to include a more diverse study population (i.e. students from other majors) to properly assess the attitudes of groups that were under-represented. In addition, we would like to compare data from this study to future data to determine if the knowledge of HIV vaccine research has increased. If it has increased, this data can allow us to compare and speculate why those differences exist (e.g. social media, more diverse population, etc). We welcome any additional feedback or comments that will assist us in continuously improving our research. References:

1. Centers for Disease Control and Prevention. HIV Surveillance Supplemental report, Monitoring Selected National HIV Prevention and Care objectives by Using HIV Surveillance Data – United States and 6. U.S. Dependent Areas – 2011. Atlanta, GA: Centers for Disease Control and Prevention, 2013; CDC publication 18 (5). 2. HIV/AIDS & Hepatitis Program. Epidemiological Profile Report for Target Area 2B. Tallahassee, FL: Florida Department of Health, 2013. http://www.doh.state.fl.us/disease_ctrl/ aids/index.html (accessed 2015 May 29) 3. Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S et al. (2009). Vaccination with ALVAC and AIDSVAX to prevent HIV-1 Infection in Thailand. NEJM. 361(23); 2209-2220. 4. National Institutes of Health. NIH-Sponsored HIV Vaccine Trial Launches in South Africa, HIV/AIDS News, Aidsinfo. http://www.niaid.nih.gov/news/newsreleases/2015/Pages/ HVTN100.aspx (accessed 2015 May 29) 5. Allen M, Liang T, LaSalvia, T et al. Assessing the Attitudes, Knowledge, and Awareness of HIV Vaccine Research Among Adults in the United States. Journal of Acquired Immune Deficiency Syndrome, 40(5): 617-624.

“I’M ALWAYS WATCHING OUT FOR MY PATIENTS, BUT WHO’S WATCHING OUT FOR ME?”

WE ARE. We are the Alliance for Patient Medication Safety (APMS), a federally listed Patient Safety Organization. Our Pharmacy Quality Commitment (PQC) program: • • • •

Helps you implement and maintain a continuous quality improvement program Offers federal protection for your patient safety data and your quality improvement work Assists with quality assurance requirements found in network contracts, Medicare Part D, and state regulations Provides tools, training and support to keep your pharmacy running efficiently and your patients safe

Call toll free (866) 365-7472 or visit www.pqc.net PQC IS BROUGHT TO YOU BY YOUR STATE PHARMACY ASSOCIATION MAY 2020

OPINION: End to Occupational Regulation for Pharmacy is Not Worth the Risk By Naida Rivera, fourth-year doctor of pharmacy candidate, Florida A&M University

Abstract Occupational regulatory programs can have an adverse impact on professional licensed individuals in Florida. Feb. 17, my first day on the AssociaNaida Rivera tion management rotation, is a day I will always remember. It was the day I was able to witness firsthand the excitement of different bills being recognized in the state Legislature. One bill caught my attention. SB 1124 and its House companion, HB 707 caught my interest because of my status as student. Imagine losing the one thing that attests to your hard work and tenacity. The possibility of practicing in a profession that is licensed and controlled and having it taken away from you after eight challenging years of proving your determination. Pharmacy school is no walk in the park. Hard work, sleepless nights, sweat and tears have gone into my path of one day becoming a licensed pharmacist. I can finally see the light at the end of the tunnel, just a few more months until graduation day and … another predicament to surmount. Introduction SB 1124, otherwise known as the Occupational Regulation Sunset Act, will have anyone with a professional license on the edge of their seat. Occupational licensure is a regulatory system that requires people to have some kind of 16

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credential in order to be qualified to provide a service. These licenses are required by the state of Florida to practice certain trades and professions. When implemented efficiently, occupational licensure helps to protect the public’s health and welfare and enhances the quality of goods and services. Conversely, occupational licensure may create unintended consequences by creating obstacles for people who are not licensed and potential workers entering the labor market. Colorado was the first state to implement a sunset review process in 1976. Later, 36 states adopted sunset legislation. Thus far, Colorado performed two sunrise and 15 sunset reviews.1 In most of these states, the common results of sunset reviews were not terminations of agencies and boards as was projected and feared, but managerial and fundamental alterations. By 1990, six states had abolished their sunset laws and another six had postponed the process.2 There are more than 100 occupational regulatory programs in Florida. The bill’s intent is to have the legislature review each program before the scheduled effective date of repeal of the

program. The review will permit the program to be terminated, reinstated with or without revisions, or one of the other suitable measures.3 An example of an unintended consequence due to a sunset provision not being addressed is the health access dental license. Florida laws allowed out-of-state licensed people in good standing with no discipline to practice in the state of Florida without sitting for the board exam. The dental licensure did good for the community by increasing access to underserved public community health centers and county health departments. A sunset provision in Florida laws resulted in a removal of the out-of-state licensed dental services in our state. There are now efforts in place fighting to reinstate that section of Florida law. To avoid the troubling process of reinstatement, the matter of verbiage of SB 1124 should be addressed before history repeats itself. The bill provides: “Within 60 days after the date on which any occupational regulatory program is allowed to expire through scheduled repeal under this act, the personnel positions which are

IN MOST OF THESE STATES, THE COMMON RESULTS OF SUNSET REVIEWS WERE NOT TERMINATIONS OF AGENCIES AND BOARDS AS WAS PROJECTED AND FEARED, BUT MANAGERIAL AND FUNDAMENTAL ALTERATIONS. BY 1990, SIX STATES HAD ABOLISHED THEIR SUNSET LAWS AND ANOTHER SIX HAD POSTPONED THE PROCESS.2

responsible for carrying out the program shall be abolished, and all unexpended balances of appropriations, allocations, or other funds for such program shall revert to the fund from which they were appropriated or, if that fund is abolished, to the General Revenue Fund. Except as authorized under this section, all 60 regulatory activities related to the repealed program shall cease after the date of repeal.” This bill has intentions of providing more opportunity for relaxing regulation and increasing job opportunity. With a broad opening for no longer regulating a profession that was once licensed, this would allow people who have the skills to be employed without the hurdle of licensing. An example would be an instance where people may have the skills of a licensed barber or cosmetologist, but not granted that same employment opportunity because they may have fallen short of licensure requirements. Some professions are an accumulation of skills and knowledge acquired over the years and can be selftaught. I do believe in creating more jobs and opportunities, but there are also jobs that must be taught through hours, months or years of learning and skills development to shield consumers from harm. On one hand, these licenses are being regulated for the safety of the public. The people deserve to have services rendered by a competent person that will not put them in harm’s way. If someone is practicing negligently, ramifications can impact that person’s license. Having a license holds that person to professional standards and expectations. If someone takes their mother’s prescription to the pharmacy after being diagnosed with heart failure, there should be a licensed pharmacist behind the counter catching mistakes, reviewing medication interactions and making sure their mother is being given the most optimal care possible. SB 1124 allowed for deregulation of any license if not reviewed on the date it was set to be reviewed by the Legislature. This proclamation leaves room for licenses to sunset because lawmakers were not able to review it in time. There are some professions that should

be considered essential and should not be up for debate. A deregulated profession would have the opportunity to become saturated with less knowledgable practitioners making unsuitable decisions that will place the public in jeopardy. Does the public need complex services provided by personnel with limited training? Licensure facilitates a way to make sure that a provider is qualified and reliable. I do understand the intent is to deregulate, however, if licensure is taken away, this could create massive disruptions in the pharmacy career space. More than 33,000 Florida licensed pharmacists will have their lives changed. Let us take a closer look into the profession of pharmacy. The years of education, the student loans and hours of practice, experience and preparation alone calls for a separation of non-licensed individuals and pharmacy doctorate graduates. If this bill would have found its way to the governor’s desk, I could see poor medication compliance or possibly an increase in hospital bills. Pharmacists help bridge the understanding of what the medications are for and the importance of taking them for your health. Hypertension, the silent killer, takes thousands of lives a year. Without a pharmacist in place managing medications and counseling, the numbers would only increase. The profession of pharmacy gives patients and other health care professionals further support and peace of mind when it comes to the patient’s medications and health. A pharmacist’s obligation is not merely preparing the medications which are prescribed by a general practitioner or other health professionals. It is to provide optimal pharmaceutical care by evaluating the appropriateness of the medication for each patient, taking into consideration their medical history, as well as possible side effects and interactions with other medications that are being used. A critical fact of a pharmacist’s patient care services also includes commitment and interaction with patients, so that patients have basic knowledge of the medication, its functions, targets, effects and the dosage regimen. Pharmacists also

embark on health promotions, such as delivering education on specific areas of health and disease prevention. There are pharmacy practices that even concentrate on, for example, asthma or diabetes care and deliver individualized support, guidance and essential services. Without the help of a licensed pharmacist, a wide array of problematic errors can come about. Deregulation can result in stiff job competition, lower costs and lower prices to consumers, but still follow with a greater cost to the consumer. In achieving these targets, thousands of companies can be forced out of business, resulting in lower earnings and the creation of oligopolies through mergers and acquisitions.4 With a competitive job market, employee compensation pay would have to be forfeited to lower the cost to consumers. Smaller business may have to close their doors because their customers are now dispersed elsewhere, and income would not be enough to stay above water. SB 1124 and its house companion HB 707 did not appear to have made it past the finish line this legislative session. There is always room for improvement, but the chance of deregulating pharmacy should not be the choice of policy makers. I am thankful that the Florida Pharmacy Association kept a close eye on this matter. Reference

1. Hentze I. Improving Occupational Licensing with Sunrise and Sunset Reviews. https://www.ncsl.org/ research/labor-and-employment/ improving-occupational-licensingwith-sunrise-and-sunset-reviews.aspx. Accessed February 24, 2020. 2. CLEAR - Sunrise, Sunset & Agency Audits. https://www.clearhq.org/ page-486181. Accessed February 24, 2020. 3. The Florida Senate: Bill Analysis and Fiscal Impact Statement.; 2019. https:// www.clearhq.org/page-486181. Accessed February 24, 2020. 4. Collins M. Did Deregulation Work? | IndustryWeek. https://www. industryweek.com/the-economy/ regulations/article/22007281/didderegulation-work. Published 2016. Accessed March 9, 2020.

MAY 2020

Mistake-Proofing a Hole in the Safety Net HIGHLIGHTS OF EVIDENCE-BASED PRACTICES TO REDUCE POINT OF SALE ERRORS By Alliance for Patient Medication Safety PSO staff in consultation with Chief Medication Safety Officer John M. Kessler, BS Pharm., Pharm.D.

FLORIDA PHARMACY TODAY

Note: Keep in mind that in this article, the use of automated technologies that link the register sale to the dispensing computer, in safety terms, is a “forcing function.” A detailed review of intake and filling errors that occur earlier in the dispensing workflow have been intentionally excluded from this brief POS review. The pharmacist hangs up the phone in disbelief after hearing from a long-time patient that her husband is in the hospital. He was dizzy and nauseous the night before, and when his wife looked at the Rx vial, she realized that there was someone else’s name on his prescription. The pharmacist’s gut clenches as she wonders, “We have safety checks, how could we have given a long-time patient the wrong medication?” You are careful, but mistakes happen. This article will summarize four primary strategies to reduce the risk of POS errors and offers some practical suggestions to reduce the chance of an error happening in your pharmacy and reaching the patient. Point of sale errors are fundamentally defined as “wrong patient” errors due to a mix-up in which prescriptions are bagged and dispensed to a patient. Depending on the pharmacy’s workflow, POS errors can occur when the prescription is handed to the wrong patient or, earlier in the process. For example, when a medication is placed in the wrong patient’s bag, when medications from two or more patients are placed in the same bag, or an intended medicine is omitted from the bag and fails to be dispensed. Additional errors can occur when the bag contains the patient leaflet intended for a different patient. Also, misreading the bag, or the patient identifiers, can result in POS errors. Regardless of the cause, the safety steps to prevent and detect these errors before they reach the patient and cause harm are similar. To reduce the chance of a medication error, integrate some of these safety tactics into your pharmacy’s workflow. ■ Establish policies and procedures that focus on preventing error such as standardized workflow with built-in redundancies, checklists, and reminders. ■ Automation and implementation of “hard stops.” ■ Forcing functions that do not allow advancement of a task without additional verification steps1, including POS bar code verification prior to completing the sale/transfer to the patient. Forcing functions are highest on the spectrum of effectiveness while standardization of procedures is ranked moderately high in its ability to prevent errors from reaching the patient. The absence of standardized procedures for the pharmacist, technician, and register clerk results in the inability to expect improvement in rates of POS errors. A shared understanding among the entire pharmacy team of medication safety policies and procedures is key. While the pharmacy may have implemented safety checks to prevent mix-ups, the effectiveness of the strategies is only as good as the overall compliance in using each check. Some questions the pharmacist could ask are below: ■ Is everyone in the pharmacy aware of the safety policies and procedures? ■ Are they followed, or have work-arounds and short cuts replaced them in everyday operations?

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Does the overriding culture in the pharmacy focus on safety or has a competing focus resulted in unconscious support and encouragement of shortcuts and workarounds that deviate from policies and procedures?

The pharmacy manager or safety officer could conduct discrete direct observations of the actual workflow from receipt of the prescription through dispensing and counseling, noting variations in practice or deviations from standardized procedures. Self-Assessments and Recommendations Below are recommendations and suggestions for your pharmacy, with a corresponding self-assessment checklist for each, that may help you determine some areas for improvement. Here are some tips on how to tackle self-assessments efficiently so that you can begin implementing effective safe practices into your pharmacy workflow: Set aside adequate time for the assessment. This is a time for thoughtful, honest reflection and evaluation of your pharmacy and pharmacy team. Be prepared with a writing utensil and a hard-copy for answers, notes and ideas. Be ready and excited to implement some tools and best practices into your workflow and to reduce the risk of POS errors in your pharmacy. 1. Dispensing/fill baskets are recommended practices to keep the prescription workflow area organized while min-

THE ABSENCE OF STANDARDIZED PROCEDURES FOR THE PHARMACIST, TECHNICIAN AND REGISTER CLERK RESULTS IN THE INABILITY TO EXPECT IMPROVEMENT IN RATES OF POS ERRORS. A SHARED UNDERSTANDING AMONG THE ENTIRE PHARMACY TEAM OF MEDICATION SAFETY POLICIES AND PROCEDURES IS KEY.

MAY 2020

imizing the risk that the wrong product becomes part of a different patient’s supply. The basket system is critical when more than one patient’s medications are prepared on the same counter at the same time. Each patient must have their own basket – with NO exceptions (e.g., for twins/siblings; spouses/partners; parent/child), even if two patients’ prescriptions are on the same written/faxed order. Keep in mind that baskets can help organize the work counter; however, their safety value is easily defeated if any stock is allowed to be placed on the counter outside a basket, or unlabeled vials are placed in the workflow, or vials and labels are not kept within the basket; or there is no single pharmacist or technician who can claim “ownership” of a given basket before it is handed off to the next workflow step. ■ ■ ■ ■

■ ■ ■ ■

Pharmacy has a standardized written procedure for: Use dispensing/filling baskets for every patient (regardless of the number of prescriptions being filled). Ensure that each pharmacist and technician processes only a single patient’s prescriptions at a time. Ensure that each basket is “owned” by a designated pharmacist or technician at a stage in the workflow. Ensure that baskets are appropriately sized and not stacked or nested in a manner that would allow a vial or label to fall or “spill” into another patient’s basket. 2. Patient counseling is a multi-step process that includes: Determining when counselling is needed. The quality of the professional counselling. The patient’s comprehension of the information. Achieving expected patient behaviors.

A discussion of the counseling process itself is beyond the scope of this brief. Most importantly, none of the above steps will be relevant if the patient does not accept an offer to counsel. Therefore, improving the effectiveness of patient counseling begins with increasing the number of patients who accept offers for counseling. Counseling is expected to improve the accuracy of the patient’s medication list and detect medication related problems such as therapeutic duplication, interactions, allergies, excessive medication use, and problems with medication adherence and disease prevention measures, such as improving the vaccination rate for pediatric and adult patients. Counseling is also expected to detect potential medication errors before they “reach the patient.” Root cause analysis of serious medication errors has demonstrated that even the most basic information exchanged during a counseling session would have alerted the patient or the pharmacist to prescribing and dispensing errors, including wrong drug, wrong dose, wrong frequency, wrong patient, drug allergy and drug interactions. The primary quality improvement outcome is to measure the patient acceptance rate of the offer to counsel and then continuously increase that rate. Pharmacy has a standardized written procedure for patient counseling and: 20

COUNSELING IS ALSO EXPECTED TO DETECT POTENTIAL MEDICATION ERRORS BEFORE THEY “REACH THE PATIENT.” ROOT CAUSE ANALYSIS OF SERIOUS MEDICATION ERRORS HAS DEMONSTRATED THAT EVEN THE MOST BASIC INFORMATION EXCHANGED DURING A COUNSELING SESSION WOULD HAVE ALERTED THE PATIENT OR THE PHARMACIST TO PRESCRIBING AND DISPENSING ERRORS, INCLUDING WRONG DRUG, WRONG DOSE, WRONG FREQUENCY, WRONG PATIENT, DRUG ALLERGY AND DRUG INTERACTIONS.

FLORIDA PHARMACY TODAY

■ ■ ■

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The will-call/pick-up location has adequate privacy protections to promote counseling. The offer to counsel is made in a positive manner, encouraging the patient to accept. The pharmacy teaches and uses scripted language to encourage acceptance of the offer to counsel. Such phrases include: ● “The pharmacist would like to talk with you about a change in your prescription”. ● “The pharmacist would like to talk with you about some important new information about your prescriptions.” ● “The pharmacist would like to discuss with you some important safety information about your prescription.” The pharmacist flags the prescription bag in an obvious manner to inform the clerk that the pharmacist must speak with the patient. The pharmacy has a procedure to require pharmacist counseling for selected medications or changes in the prescription including narrow-therapeutic index drugs; high alert drugs, pediatric patients; complex dosing or administration instructions; and changes in dose. The pharmacy uses a “triaged” approach to counsel-

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ing (versus an “all-or-none” plan), applying professional judgment to determine when and how much information should be disclosed during the counseling session. Patients are encouraged to ask questions or raise concerns, even after leaving the pharmacy. Patient questions, either in person or over the phone are always treated with respect and taken seriously.

3. Open the bag (a.k.a show and tell) Mix-ups can occur when a correctly verified prescription is placed in the bag for a different patient. Once bagged, a high percentage of these errors will reach the patient. Opening the bag and showing the patient at the time of pickup can decrease most types of mix-up errors by more than 50 percent. This is a safe-transfer strategy that is independent from patient counseling; the latter which can only be conducted or supervised by a pharmacist. The show-and-tell method is further enhanced when the patient becomes a partner is assuring their own safety and asked to confirm the dispensed prescriptions (drug, dose and directions) are the expected items. When used in combination with other safety strategies, the risk of an error reaching the patient drops even further. While mix-ups can occur with any drug and with any patient, a triaged strategy would focus on prescriptions with a greater risk of causing harm. Pharmacies should develop mandatory open-the-bag policies for pediatric prescriptions and high alert medications, with notable examples including warfarin, insulins, hydralazine/hydroxyzine and methotrexate. Pharmacy has a standardized written procedure to open, review and show bag contents to patient ■ The will-call/pick-up location has adequate privacy protections to enable the pharmacy employee to “show, tell and discuss” with the patient. ■ At the time of pick-up, in the presence of the customer and with the customer’s involvement, or prior to home delivery with a second person, the bag is opened and the contents matched to the receipt, inspecting for omitted or extra items. ■ The patient is asked to confirm if these are the prescriptions and doses they expected. At any hint of concern or question, automatic pharmacist review is required. ■ Written medication guides and/or leaflets are included and matched with each prescription dispensed. ■ Patients are encouraged to ask questions or raise concerns, even after leaving the pharmacy. ■ There is a defined list of high alert medications that require an open-the-bag procedure. ■ All pediatric prescriptions, new and refills, require an open-the-bag procedure. 4. Patient identification procedures Adopting a standardized two-identifier procedure is an evidence-based practice to reduce the risk of mix-ups at the POS. Improving the accuracy of the practice is an appropriate strategic target for quality improvement. Weak and error-prone identification procedures will:

■ ■ ■

Fail to have the patient state their name and identifiers. Allow employees to use their judgment in deciding when to apply the procedure. Assume another employee has already checked the patient’s identity. The pharmacy’s two-identifier procedure should define the acceptable identifiers.

The two most acceptable are the patient name (first and last) and the date of birth (not age). Phone numbers and addresses are not reliable primary identifiers and should be avoided or used only as a third confirming identifier in select situations. At a minimum, employees should be trained to: ■ Use auditory and visual cues to detect identification errors. ■ Say “for your safety” as part of a verbal script to help the patient understand, minimizing any potential social awkwardness for regular customers. ■ Integrate the two-identifier procedure into the show-andtell procedure for maximum efficiency. Each pharmacy has strategies and procedures to increase compliance with patient identification procedures ■ The pharmacy requires employees to ask for and the patient to identify themselves using two unique identifiers at the time of pick-up. ■ Pharmacy employees are trained on the contributing factors that often lead to patient-mix ups. Examples include: patients with similar names living at the same address, failing to ask patients to actively state their identifiers (versus responding to a name called out by the pharmacy from the pick-up window); prescription pick-up for more than one person in the household (e.g. siblings, twins, father- son/mother-daughter); patients with compound family names (common in Latino, South American, and Middle Eastern cultures); and prescriptions for persons with intellectual or cognitive disabilities. ■ Pharmacy employees are empowered with a pharmacy safety rule that requires the patient to disengage from a cell phone call during the patient identification and pickup process. Signage should signify mandatory “cell phone free” zone to ensure patient safety. 1. Pharmacy Times. April 1, 2007 Michael J Gaunt, PharmD The Best Error-prevention Tools for the Job The mission of APMS® is to foster a culture of quality within the profession of pharmacy that promotes a continuous systems analysis to develop best practices that will reduce medication errors, improve medication use and enhance patient care. Pharmacies work with APMS® to look for inherent risks in the pharmacy’s workflow. Their program, Pharmacy Quality Commitment +TM (PQC+) is an interactive CQI program that provides tools and resources for the pharmacy workforce to identify, report, and analyze quality-related patient safety events. APMS is a 501 c 3 supporting organization of the National Alliance of State Pharmacy Associations.

MAY 2020

Miami Pharmacy on Front Lines of COVID Fight

h dnah no noitautis eht ,desaerced yltnacifingis sah c eht evres ot ytiliba rieht taht gnivorp dna yalp yeht

Luis O Delgado, PharmD & Staff

As the COVID-19 pandemic spread aggressively across the globe, independent pharmacies were caught right in the middle of this disaster. Amidst the chaos and uncertainty, they and provide otalugewere R roable ineStoAstep DF up-toffthe atSplate & Dm rah P ,odafor gletheir D O comsiuL munities in ways that many did not think they could. Here in Florida, Village Pharmacy & Compounding, in Miami, met this challenge head-on and never looked back. As news spread of the virus, they were quick to find that their community was getting increasingly worried. Many patients would come into the pharmacy with questions and concerns and they immediately realized that their role in this crisis was going to be critical. Owner Luis Delgado, a born and raised Miamian who obtained his pharmacy degree from the University of Florida, advised his staff to prepare for what was ahead. Changes were made and the workload significantly increased. Staff were advised to protect themselves by wearing masks and sanitizing throughout the day. Face shields were provided, especially when dealing directly with the public. The pharmacy switched the bulk of its workload to delivery or curbside but still kept the pharmacy open, allowing one person in at a time. The pharmacy needed to ensure its staff was protected and make certain it did everything so staff could to stay healthy and continue providing to their community during this time of most need. As the pandemic played out locally, patients worried about medication shortages and requests for refills came in nonstop. Sourcing medications became a challenge as the ordering volume for all pharmacies significantly increased. Nonstop searches for various medications, rationed out by several wholesalers, became the new norm and something they did daily to provide for their community. Apart from finding 22

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these critical meds for their patients, the pharmacy also made it a point to reassure its community that it was not going anywhere, that it would stand by them and continue to provide throughout the crisis. This was something patients really appreciated, and it served to calm their nerves. Apart from medication shortages, essential items also became hard to find. Among these items were masks, gloves, alcohol, thermometers and sanitizer, all of which the community was in desperate need of. Village Pharmacy promptly took to finding and providing these items for its community. Delgado would spend day and night searching for these essentials. He wanted to ensure that his community had them readily available. His efforts paid off, and the role his pharmacy played in providing these critical items was vital. One of the most crucial items in this process was hand sanitizer. Responding to FDA-provided guidance encouraging compounding pharmacies to start producing hand sanitizer, Village Pharmacy immediately took action. Efforts began with non-stop searches for alcohol and continued with pharmacy staff working late hours to generate a critical item that no one else was able to provide at the time. During a few short weeks, the pharmacy was able to generate and donate sanitizer to numerous local clinics, postal workers, police officers, fire departments, doctors, nurses, assisted living facilities and hospices.

VILLAGE PHARMACY & COMPOUNDING HAS CONTINUED TO PROVIDE FOR ITS COMMUNITY IN WAYS NO ONE COULD HAVE IMAGINED A SMALL, INDEPENDENT PHARMACY COULD. Village Pharmacy & Compounding has continued to provide for its community in ways no one could have imagined a small, independent pharmacy could. They have made changes to their operations and continue to evolve on a daily basis to meet the needs of their community. While the number of independent pharmacies has significantly decreased, the situation on hand has brought them to the forefront, showing the critical role they play and proving their ability to serve the community can be unparalleled.

FPA Regional Directors Do you know your Regional Director? Take a look at the map below and follow this link to reach out. https://www.floridapharmacy.org/general/custom.asp?page=FPAlRegionalDiectors

What issues do you see at your practice site? Reach out to work with others facing similar issues in your community.

Regional directors have the most up-to-date information related to pharmacy issues and legislation affecting your areas.

MAY 2020

FPA News & Notes DeSantis Extends Executive Order, Extends COVID-19 Testing Gov. Ron DeSantis extended the pandemic state of emergency in Florida for another 60 days with Executive Order 20-52. That order, paired with a directive from the stateâ&#x20AC;&#x2122;s surgeon general, means pharmacists can continue to order and administer COVID-19 testing. The Florida Pharmacy Association has compiled a frequently asked questions file on their website; please note the answers to these questions should not be considered legal advice and may not represent the official position of any state agency. Florida Pharmacy Association Joins Groups Calling for DIR Reform The Florida Pharmacy Association joined 242 groups in calling for direct and indirect reimbursement reform. The groups sent a letter to U.S. Majority Leader Sen. Mitch McConnell, Minority Leader Sen. Charles Schumer, House Speaker Rep. Nancy Pelosi and House Minority Leader Rep. Kevin McCarthy urging action.

Petsos Wins FPA Region 6 Election Kathy Petsos, a Cape Canaveral pharmacist, won the Region 6 runoff election. She will serve on the Florida Pharmacy Association Board of Directors on behalf of members in Brevard, Manatee, Hardee, Okeechobee, Highlands, Desoto, Sarasota, Charlotte, Glades, Martin, St. Lucie and Indian River counties. She will be installed into office this summer. Board of Pharmacy Rule Revision on Pharmacy Technicians Introduced The Florida Board of Pharmacy Rules Committee reviewed a change to the rule regarding delegation to and supervision of pharmacy technicians. The rule, 64B16-27.4001, allows for the use of technology when supervising tasks that may be delegated to technicians. The FPA raised concerns about the definition of technician direct supervision. This issue, discussed at the boardâ&#x20AC;&#x2122;s last meeting, will likely be included in discussions at the next meeting.

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A Cyberspace Adventure!

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130th Annual Meeting and Convention Schedule

“P A S S

Thursday, July 9

PASSIONATE PEOPLE PROUDLY PROTECTING PHARMACY

8:00am-8:30am

Welcome and Instructions, FPA President David Mackarey

8:30am-9:00am

FPA Annual Business Meeting

9:00am-11:00am

FPA House of Delegates First Session

11:00am-11:30am

Break

11:30am-1:00pm

Legislative Update 2020, 1.5 hrs GCE/TECH Michael Jackson

1:00pm-2:00pm

KEYNOTE ADDRESS, 1 hr GCE/TECH/STU Emily Jerry’s Story - “From Heartbreak to Victory”- Saving Lives by Preventing Tragedies Before They Happen! Christopher Jerry

2:00pm-2:30pm

Break

2:30pm-4:30pm

FPA House of Delegates Second Session

4:30pm-5:30pm

Installation of House Leadership Presentation of House Awards Recognition of 50 Year Pharmacists

Friday, July 10

PASSION FOR THE PROFESSION

7:30am-7:45am

Welcome and Instructions

7:45am-9:15am

Putting Nutrition and Supplementation Therapy Into Pharmacy Practice, 1.5 hrs GCE/TECH/RC Lynn Lafferty

9:20am-10:50am

Nutrition Plans to Improve Overall Health, 1.5 hrs GCE/TECH/RC Marile Santamarina

11:00am-12:00pm

Poster Presentations, 1 hr GCE/TECH

12:00pm-1:00pm

Exhibit Showcase

1:00pm-2:30pm

Biologics and Biosimilars: The Wave of the Future? 1.5 hrs GCE/TECH/RC Dana A. Strachan and Harm Maarsingh

2:35pm-4:05pm

Multiple Sclerosis: The Disease of Many Faces, 1.5 hrs GCE/TECH/RC Lillian Smith

4:30pm

A Cyberspace Adventure Social

MAY 2020

Saturday, July 11

PROUD OF OUR PROFESSION

7:30am-7:45am

Welcome and Instructions

7:45am-9:15am

Opioids: Past, Present and Future, 1.5 hrs GCE/RC Joshua D. Lenchus

9:20am-10:50am

Marijuana â&#x20AC;&#x201C; From Past to Present, 1.5 hrs GCE/RC Carol Motycka

11:00am-1:00pm

Exhibit Showcase

1:00pm-2:30pm

Oncology Pharmacy 101: What You Need to Know, 1.5 hrs GCE/TECH/RC Irvin Molina

2:35pm-4:05pm

Pharmacogenomics 101: An Overview of Key Concepts and Case Study 1.5 hrs GCE/TECH/RC Sue Paul

5:00pm

Presentation of FPA Awards

Sunday, July 12

PROTECT OUR PROFESSION

7:00am

Welcome and Instructions

7:05am-7:45am

Installation of 2020-21 FPA Leadership

7:45am-9:45am

Reducing Medication Errors through Implementing a Continuous Quality Improvement Program, 2 hrs GCE/TECH Michael Jackson

9:50am-10:50am

HIV/AIDS Update, 1 hr GCE/TECH Briana Journee

11:25am-12:25pm

Human Trafficking in Pharmacy, 1 hr GCE/TECH Ann Pimental Kerr

12:30pm-2:30pm

Validation and Counseling of Prescriptions for Controlled Substance and Opioids, 2 hrs GCE/TECH Bob Parrado

CONTINUING EDUCATION CODE KEY: GCE = General RC = Recertification Consultant TECH = Technician STU = Student 26

FLORIDA PHARMACY TODAY

FPA 130th Annual Meeting and Convention July 9-12, 2020  Comforts of Your Home

Participant Information

Name: _____________________________________________________ Name _______________________________________________ Address______________________________________________ Badge Name: _______________________________________________ City, State, Zip_________________________________________ Mailing Address: ____________________________________________ Phone___ ________________________ City, State, Zip: _____________________________________________ Email________________________________________________

Daily Education Registration

Daily registration includes continuing education and any event offered the day selected. Handouts will be posted on the website the week of the convention. Before July 3

Amount

FPA Member

$165

$_______

Phone: (W) (H)_______________________ Practice Setting________________________________________

Non Member

$215

$_______

License: PS______________ PU _____________RPT_________ Fax: ______________________________________________________

Member Technician

$65

$_______

NABP Date of Birth___________ License:e-profile#__________________ PS________________ PU_________ Other State________

Non Member Technician

$90

$_______

Emergency Contact Name/Number_________________________

Member Student

$50

$_______

Non Member Student

$70

$_______

Registration

Registration includes up to 21.5 hours Continuing Education Credit, House of Delegates, Poster Presentations, Exhibit Showcase, Cyber Social, and Installation of Officers. Handouts will be available the week of the convention on the

website, www.floridapharmacy.org.

Please select the day(s) you will attend: Thursday

Friday

Payment

Saturday

Sunday

Total Enclosed: $______

Before July 3

Amount__

$345

$_______

Non Member

$525

$_______

Pharmacist BEST Value

$540

$_______

Member Technician

$155

$_______

Non Member Technician

$175

$_______

Technician BEST Value

$185

$_______

Billing Address ________________________________________

Student Member

$150

$_______

$170

$_______

Signature ____________________________________________

2FPA Member

3Non Member Student

Check (To: FPA) AMEX Discover MasterCard Visa Account # ____________________________________________ Security Code _________________ Expiration Date __________

(BEST Value includes Registration & Membership)

House of Delegates

House of Delegates (Non-convention registrants)

Before June 11

Amount

$165

______

Four Ways to Register

Mail: FPA, 610 North Adams Street, Tallahassee, FL 32301 Phone: 850-222-2400 Fax: 850-561-6758 Web: www.floridapharmacy.org

Schedule and Fee Subject to Change

MAY 2020

Pharmacy Insurance

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