The Kentucky Pharmacist Vol. 12, No.2 by Kentucky Pharmacists Association

THE KENTUCKY PHARMACIST Vol. 12, No. 2 March/April 2017 News & Informat ion for Members of the Kentucky Pharmacists Ass ociation

The Future of the Profession Advocating for their Future UKCOP and SUCOP students watched as SB 101, granting pharmacists authority to immunize to 9 years old, passed out of the House Health & Family Services Committee in early March. Pictured: KPhA President Trish Freeman; UKCOP PY4 Monica Roberts; Rep. Danny Bentley (KPhA Member); UKCOP PY2 Jaclyn Ochsner; Rep. Addia Wuchner (chair of the committee); SUCOP PY3 Kirill Braginsky; UKCOP PY2 Eric Marr; and Kentucky Board of Pharmacy Executive Director Steve Hart.

Table of Contents

March/April 2017 Naloxone Certification Training CE Article Guidelines Call for Resolutions for House of Delegates April 2017 CE — Interprofessional Education Update April Pharmacist/Pharmacy Tech Quiz Answer Sheet KPhA Emergency Preparedness KPhA New and Returning Members Pharmacy Time Capsules Government Affairs Contribution Pharmacy Policy Issues Pharmacy Law Brief Pharmacists Mutual Cardinal Health KPhA Board of Directors/KPERF Board of Directors 50 Years Ago/Frequently Called and Contacted/KPhA Staff

Table of Contents Table of Contents— Oath— Mission Statement President’s Perspective Campaign for Kentucky’s Pharmacy Future 139th KPhA Annual Meeting and Convention Farewell from your Executive Director KPhA Board Election APSC Online Journal 2016 Bowl of Hygeia Winners March 2017 CE — Anticoagulation Guideline Updates March Pharmacist/Pharmacy Tech Quiz Answer Sheet 2017 KPhA Professional Awards Reminder: Vaccine Information Statements

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Oath of a Pharmacist At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy. I will consider the welfare of humanity and relief of human suffering my primary concerns. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve. I will keep abreast of developments and maintain professional competency in my profession of pharmacy. I will embrace and advocate change in the profession of pharmacy that improves patient care. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Kentucky Pharmacists Association Vision — We are a unified pharmacy profession empowered to maximize patient and public health as fully integrated members of the healthcare team. Mission — The mission of KPhA is to advocate for and advance the profession through an engaged membership.

Editorial Office: © Copyright 2017 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association. Editor-in-Chief: Sam Willett Managing Editor: Scott Sisco Editorial, advertising and executive offices at 96 C Michael Davenport Blvd., Frankfort, KY 40601. Phone 502.227.2303 Fax 502.227.2258. Email ssisco@kphanet.org. Website http://www.kphanet.org.

The Kentucky Pharmacy Education and Research Foundation (KPERF), established in 1980 as a non-profit subsidiary corporation of the Kentucky Pharmacists Association (KPhA), fosters educational activities and research projects in the field of pharmacy including career counseling, student assistance, post-graduate education, continuing and professional development and public health education and assistance. It is the goal of KPERF to ensure that pharmacy in Kentucky and throughout the nation may sustain the continuing need for sufficient and adequately trained pharmacists. KPERF will provide a minimum of 15 continuing pharmacy education hours. In addition, KPERF will provide at least three educational interventions through other mediums — such as webinars — to continuously improve healthcare for all. Programming will be determined by assessing the gaps between actual practice and ideal practice, with activities designed to narrow those gaps using interaction, learning assessment, and evaluation. Additionally, feedback from learners will be used to improve the overall programming designed by KPERF.

THE KENTUCKY PHARMACIST

President’s Perspective

March/April 2017

PRESIDENT’S PERSPECTIVE Trish Freeman KPhA President 2016-2017

A Time of Transition We learned late in January that Bob McFalls, who has faithfully served as KPhA’s Executive Director since 2011, would be leaving KPhA to take a new position in Florida. While this is not what we anticipated hearing from Bob, we understand his desire to move back to Florida and respect his decision. OUR KPhA has benefited tremendously from Bob’s leadership and guidance, his thoughtful deliberations on issue ranging from PBM policy to the pharmacists’ role in public health, and his persistent promotion of our profession to all who would listen. We recognized Bob at a farewell reception Friday, February 24 -– his last official day with OUR KPhA – and were pleased that so many were able to join us in honoring Bob for his service to KPhA. As we enter this time of transition for our association, we want to assure you that OUR KPhA will continue to operate efficiently, moving forward with our strategic initiatives as outlined in KPhA’s recently approved 5-year strategic plan. A legacy of Bob’s tenure with us is an incredibly talented and committed staff who will continue to use their

time and talents to forward our association’s goals and objectives. The Board has appointed Mr. Sam Willett, a long-standing KPhA member who has served on the Board of Directors for 11 years, as interim executive director to oversee OUR KPhA’s daily operations while we begin the search for a permanent replacement. To that end, the KPhA Board of Directors has formed a Search Committee with broad representation of stakeholders from across the state. The Search Committee will recruit and screen applicants and provide names of two to three finalists to the KPhA Board of Directors, who will then interview candidates and make the final selection of a new executive director. We hope to have a new executive director named by July 1, 2017. The members of the Search Committee are:             

Chris Clifton, Co-Chair Trish Freeman, Co-Chair Jeff Arnold, Florence Ralph Bouvette, Frankfort Kim Croley, Corbin Kip Guy, Lexington Steve Hart, Frankfort Bob Oakley, Louisville Anne Policastri, Georgetown Donnie Riley, Bowling Green Stanley Scates, Lexington Richard Slone, Hidman Cindy Stowe, Louisville

We appreciate your continued support of OUR KPhA as we work through this transition. As always, we welcome your input and recommendations as we work to accomplish our vision of: a unified pharmacy profession empowered to maximize patient and public health as fully integrated members of the healthcare team.

The Campaign for Kentucky’s Pharmacy Future Leave a legacy by participating in the campaign to replace OUR KPERF/KPhA Headquarters! Learn more about options for payment and levels of recognition at http://www.kphanet.org/?page=buildingcampaign or call 502-227-2303. 3

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Campaign for Kentucky’s Pharmacy Future

March/April 2017

The Campaign for Kentucky’s Pharmacy Future

http://www.kphanet.org/?page=buildingcampaign

Donors to the campaign as of March 10, 2017                  

Jeff Arnold Ray Bishop William R. Brown Fred Carrico Matt Carrico Jessika Chinn J. Leon & Margaret Claywell Chris & Katy Clifton Marshall Davis David Dubrock Paul Easley Brian Fingerson Renie & Joseph L. Fink III Matt Foltz Andrew & Virginia France Trish Freeman Robert Goforth Cynthia Gray

                

George & Burnetta Hammons Christopher Harlow JCAP Don & Vicki Kupper Phil & Julie Losch Joe Mashni Bob Oakley Chris & Consuelo Palutis Duane Parsons Ron & Lisa Poole Richard & Zena Slone Kelly Smith Leah Tolliver Sam Willett Lewis & Kim Wilkerson Jacob & Carol Wishnia Michael & Mary Ann Wyant

THE KENTUCKY PHARMACIST

139th KPhA Annual Meeting and Convention

March/April 2017

Registration is open Reserve your room today! Gate Marriott Resort and Spa is the host hotel for the 139th at www.kphanet.org. Griffin KPhA Annual Meeting & Convention. Book your room now at a reduced rate of $139/night for single and double occupancy. Schedule is coming Overnight accommodations can be made online through a link at http://www.kphanet.org/?page=AnnualMeeting, or by calling 1-800-266-9432 before May 31, 2017 to receive the group rate. The soon! group name is Ky Pharmacist Association Annual Meeting 2017.

2017 KPERF Golf Scramble June 22, 2017 Griffin Gate Marriott Resort Golf Course Assemble your team now! Register online at www.kphanet.org. 5

THE KENTUCKY PHARMACIST

Farwell from Your Executive Director

March/April 2017

FARWELL MESSAGE FROM YOUR

EXECUTIVE DIRECTOR

Robert “Bob” McFalls Dear Colleagues and Friends, At the end of February— as many of you are aware — I transitioned from my leadership role as Executive Director of OUR Kentucky Pharmacists Association and the Kentucky Pharmacy Education & Research Foundation, as well as serving as your CEO of Rx Therapy Management, LLC. It was an honor and privilege to serve as your chief executive for the past five years and eight months. I enjoyed working with you as members and partners to advance the profession of pharmacy throughout the Commonwealth while simultaneously OUR KPhA was being recognized nationally for many of these legislative successes. Through our collective efforts, diligent focus and your engagement as members, we were able to advance legislative outcomes, increase knowledge and reach new heights together. I would like to express to you, individually and collectively, my sincere appreciation for the opportunity to serve as your leader. We assured fiscal integrity by developing and implementing new accounting procedures and internal controls. We implemented new partnerships and advanced our working relationship with the Department for Public Health in pharmacy emergency preparedness, with Cardinal Health, with APSC as our first gold sponsor and with so many others. We grew our participation with one another via social media. We brought back the mid-year conference in the form of a successful, annual Legislative Conference. We secured a new headquarters and launched a capital campaign to secure the association’s future. And the list goes on. Of particular satisfaction has been the joy of getting to know you in terms of your commitment to patient care, your passion as new practitioners and student pharmacists, your commitment to advance the profession of pharmacy throughout the state and to our being able to select and work with the great staff team that serves our

members daily. I also want to personally thank the six presidents, each of the individual KPhA and RxTM staff team members and every Board Member from one or more of the related organizations for their service and for the work that we shared and were able to advance together. I believe that OUR KPhA is stronger today because of your willingness to unite as a profession and to advance her mission. Keep up that great work — AND keep the light bright and focused for others who walk beside you and others who will follow. Until opportunity permits for us to meet again, I would like to close with these words from R. Buckminster Fuller: ”Never forget that you are one of a kind. Never forget that if there weren't any need for you in all your uniqueness to be on this earth, you wouldn't be here in the first place. And never forget, no matter how overwhelming life's challenges and problems seem to be, that one person can make a difference in the world. In fact, it is always because of one person that all the changes that matter in the world come about. So be that one person.”

THE KENTUCKY PHARMACIST

Farwell from Your Executive Director

March/April 2017

Thank You Bob! Members say good-bye to Executive Director Robert “Bob” McFalls

Rep. Danny Bentley presents Bob with a resolution from the Kentucky House of Representatives.

Director Matt Carrico presents Bob with a History of Pharmacy in Pictures print commemorating his service. The print will hang in the KPhA Executive Director’s Office.

THE KENTUCKY PHARMACIST

KPhA Board Election

March/April 2017

2017 KPhA Board Election posed me to sole responsibility for annual budgets of more than three quarChris Palutis ters of a billion dollars and as many as I want to open by saying thank you for 2,000 employees under my direction at any given time. Most recently, owning allowing me to serve as OUR KPhA's my own pharmacy now for eight years Treasurer for the past two years and for two years as a Director prior to that. has given me further intimate knowledge of our profession from a Both positions have been extremely rewarding and allowed me to become “grassroots” perspective. I believe my deeply immersed into our great profession as well as gain a vast understanding of our Association. I understand its moving parts and, more importantly, how those moving parts need to act synergistically President-Elect across all areas to maximize our impact on the profession as well as Chris Palutis continue to grow OUR KPhA. I greatly desire not only to continue, Treasurer but also to elevate my involvement Duane Parsons and be elected as OUR KPhA’s next President-Elect.

President-Elect

Candidates for Election to the KPhA Board of Directors

bers and the pharmacy profession. This can be attained by utilizing inhouse resources, as well as using the large number of locations in our group as leverage. Secondly, my goals will involve looking ahead at how the profession is evolving to include more clinical services provided by pharmacists, to ensure we are positioned in a way that will allow us to stay current and even ahead of the ever-changing pharmacy industry.

Treasurer Duane Parsons

Duane Parsons, RPh, is a 1974 graduate of the University of Kentucky College of Pharmacy. He resides in Richmond with his wife of 45 years, Linda. They have three daughters, Dana (Luke) Wingfield, Erin (Kenny) Director Stewart and Keri (Kent) Robbins and Since my involvement with OUR six grandchildren. Parsons has Angela Brunemann KPhA four years ago, I have beworked in retail pharmacy for 44 David DeCuir come increasingly passionate reyears. The last 27 were with Kroger garding the pharmacy profession. I Pharmacy as a Pharmacy MerchanRobert Goforth am not afraid of debate and voicing diser in charge of 157 pharmacies in not only my opinion, but the logic Kentucky, Tennessee, Indiana and Chris Killmeier behind my opinion as it relates to Illinois. He has been a member of Ethan Klein issues that will inevitably affect how KPhA throughout his professional we practice. Examples of such iscareer, actively involved in lobbying Don Kupper sues are the Collaborative Care pharmacy issues with KPhA and its Richard Slone Agreement, Pharmacists given lobbyists. He served as Treasurer “Provider Status,” a proposed board before serving as President-Elect, Tyler Stevens of pharmacy regulation dealing with President and Chair for KPhA. Parmandatory counseling, and most sons is a member and deacon at the track record of financial success and recently, regarding the proposal by the First Baptist Church in Richmond. He integrity within the corporate environKY Board of Pharmacy to implement strongly supports the ideals and misUSP 800. I vow to represent every one ment as well as my own pharmacy will sion espoused by KPhA in representof you with as much earnest as I would prove critical to my success as Presiing the pharmacists of the Commondent-Elect for OUR KPhA. represent myself in any situation. I wealth of Kentucky. Parsons feels have vast experience in fiduciary repharmacy is a very dynamic profession If elected, I will evaluate the current sponsibility as well as leading large that has the ability to serve the citizens programs in place to identify areas of numbers of direct and indirect reports. opportunity to improve our position to of the Commonwealth in such a variety My experience over the last 22 years help OUR KPhA provide a higher level of ways. After years of behind the with two Fortune 500 companies exof service and/or offerings to its mem- scenes service, Parsons thought it was 8

THE KENTUCKY PHARMACIST

KPhA Board Election

March/April 2017

time to take a more active role in ensuring that being a pharmacist remains one of the most respected professions in the country. He currently serves as Chair of the Kentucky Pharmacy Education & Research Foundation and is a Silver Bowl of Hygeia contributor to the Campaign for Kentucky's Pharmacy Future.

growing outpatient programs, such as Meds to Beds.

“I am applying to be on the Board of Directors because it is important to be an advocate for the profession and a leader within the industry. As pharmacists, it is our responsibility to protect our profession and make sure that we are holding ourselves to the highest of standards. It is important to protect the Directors profession as a whole, and I feel my (Three open seats) experiences would allow me to be a Angela Brunemann voice for a variety of pharmacy setAngela Brunemann is a 2012 Universi- tings. I feel privileged and grateful to be a pharmacist every day, and now I ty of Kentucky College of Pharmacy graduate. She lives in Union, Ky., with want to give back to my profession. Serving on the Board of Directors will her husband, Chris, and two daughters, Emma and Samantha. She start- allow me to do this. ed her career in pharmacy at the age David DeCuir of 16 as a technician at Kroger Pharmacy and knew instantly that pharma- David DeCuir has been a licensed pharmacist since 1998, and has been cy was her calling. Since graduating, she has worked as a staff and clinical involved in pharmacy in many areas. He has been a PIC at independent, pharmacist for Kroger in the Northern large and medium chain retail and long Kentucky area. She was privileged to work with many patients and be a part term care pharmacies. In those settings, he has seen a need for advocaof amazing programs, such as the cy for the Kentucky pharmacist. He is Transitions in Care study. She also became a Licensed Diabetes Educator an advocate for the pharmacy profesand naloxone certified during this time. sion, pro-independent and a problem solver. She has now taken a new role at St. Elizabeth Healthcare as Supervisor of “Attending meetings on electronic preAmbulatory Pharmacy. With this new scribing has reinvigorated my desire to role, she hopes to impact patients by be a part of the solution. I would like

the opportunity to help promote the future of pharmacy, especially in Kentucky by serving on the KPhA Board of Directors.” Robert Goforth After finishing undergraduate work at University of Kentucky, Robert graduated from Massachusetts College of Pharmacy with his Doctor of Pharmacy Degree in 2005. Since graduation, Robert has worked in a variety of practice settings, including retail, hospital and hospice. Most of Robert’s career had been focused as an independent owner until last year when he sold his stores to focus on a Substance Abuse Education Program for grades K-12, Project DARIS. Since Project DARIS was founded by Robert, Shannon Allen and Melissa Dye in 2016, they have presented substance abuse prevention education to more than 14,000 students across the state of Kentucky. The program includes material from Generation RX, Aware RX, KPhA train the trainer and many more resources. WKYT’s Miranda Combs aired a feature story on the program in January 2017. Robert has focused all of his efforts over the past decade to the practice of pharmacy, his communities and his family. Professionally, he is a member of Kentucky Pharmacists Association,

ELECTION DETAILS The election will be held electronically via the KPhA website at http://www.kphanet.org/?page=2017election. When you click on the link, you will be asked to log in. If you have trouble logging in, please email Scott Sisco at ssisco@kphanet.org. Paper ballots will be mailed to members who do not have an email on file. Paper ballots also will be provided on request by calling 502-227-2303. The election will be open until May 16, 2017. 9

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KPhA Board Election served on KPhA Government Affairs Committee in 2016, currently serving on the KPhA Emergency Preparedness Advisory Workgroup, UK Fellows Society, National Community Pharmacy Association, National Pharmacy Disaster Team and Phi Lambda Sigma Pharmacy Leadership Society. Robert’s family always has been supportive of his hard work and long hours he’s devoted to the profession of pharmacy. Robert’s pharmacy career successes have enabled him to give back to the communities he serves. Some of the great causes he supports are scholarships for UK College of Pharmacy school students, KPERF Committee of 100, annual Christmas gifts to the children of the communities, orphanages, local school functions, churches, March of Dimes, Relay for Life and many more. Robert always has had a passion for public service. At the age of 18, he signed up for the United States Army. His primary job in the Army was Combat Engineer. Combat Engineers are a group at the forefront of the military missions, breaching mine fields, demolition of bridges or any other obstacles that stand in the way of a troops’ mission. During his military service, Robert was awarded several service medals including AAM (Army Achievement Medal) for exemplary service. “It would truly be an honor to represent my colleagues as a member of the KPhA Board of Directors. My promise to you, I will always work with the other board members to represent you and make the best decisions possible for everyone in the profession. I’ll reach out to all practice settings of the pharmacy profession to make sure that we make the very best decisions for everyone practicing pharmacy. Hospital, retail, education, students, technicians, everyone’s voice must be heard. I want to be your voice on the KPhA Board of Directors.”

March/April 2017 Chris Killmeier Chris Killmeier, RPh, holds a B.S. in Biology from the University of Kentucky (1987) and a B.S. in Pharmacy from the University of Cincinnati (1990). Chris has been a member of the KPhA Board of Directors since 2013. Chris has been a pharmacist for Walgreens for 30 years and has held many positions within the company. Chris also is a member of and chairs the Kentucky Board of Pharmacy Advisory Council as well as serving on its PRN Committee. He also serves as an at-large member of KPhA’s Budget and Audit Committee. Chris has been married for 24 years to his wife Denise. They have two lovely girls, Bayley Shea, 19, and Olivia Blaire, 17. Chris and his family live in Louisville. Ethan Klein Ethan Klein was born and raised in Dallas, Texas. He moved to Louisville after earning his Doctorate of Pharmacy from the University of Charleston in West Virginia and completing a PGY1 residency at the North Chicago Veterans Affairs. He began his career in Louisville as a clinical coordinator for Walgreens, and for the last four years has served the Louisville area with Rite Aid. “As the 2014 KPhA Speaker of the House of Delegates, and with professional experience in multiple practice settings, I would be a valued asset to the Board of Directors for the Kentucky Pharmacists Association. I am keenly aware of the growing responsibilities that KPhA holds to the profession of pharmacy and the communities we serve. Over the past two years serving on the Government Affairs Committee and Professional Affairs Committee, I worked to advocate changes to the Onco360 Bill and vet the Board of Pharmacy nominees for the Board of Directors. I’ve met with my local repre-

sentatives to push for recognition of pharmacists as health care providers and travelled to Frankfort to discuss with legislators the importance of the MAC transparency bill. “I believe my diverse background has helped me develop a holistic approach to the practice of pharmacy, and my active participation with KPhA has given me insight into the significant challenges facing the profession. If elected to the board of directors, I will help drive support for the recognition of pharmacists as health care providers, support a strong anti-mandatory mailorder bill and continue our fight against MCOs.” Don Kupper Don Kupper resides in Louisville and is a 1981 graduate of the University of Kentucky College of Pharmacy and a member of Kappa Psi Graduate Chapter. He has practiced in retail, nursing home and hospital pharmacy practice settings. He has served the profession in various leadership capacities culminating as President with Jefferson County Academy of Pharmacy, as well as the Kentucky Society of Health System Pharmacists, again culminating as President of the Society. Today, he works as an independent healthcare consultant, providing services to hospitals, surgery centers and organizations developing USP 800 and USP 797 facilities to serve patients. With the exception of Norton Health Care (exception Audubon Hospital when it was a Humana facility), former Jewish Hospital and The Baptist System, he has worked in some capacity at the rest of the hospitals providing services in Louisville. His last position, and the one he found very rewarding was Vice President of Supply Chain, Chief Pharmacy Officer for The University of Louisville Hospital, also overseeing Lab, Rehab, Cardiopulmonary Services, Clinical Nutrition and the Brown Can-

THE KENTUCKY PHARMACIST

KPhA Board Election

March/April 2017

cer Center Pharmacy.

cease to achieve.

“I have been on the Board of Directors of the Kentucky Pharmacists Association for approximately 10 years. I’ve had the privilege to work with many great pharmacists and served as the chairman of the Government Affairs Committee for the last six years. This has given me an opportunity to work directly with our legislators, our lobbyist, our partners and our great staff. But the most important person I have had the opportunity to work with is you the member. This has not only given me an opportunity to serve and to be actively engaged in our profession but Richard Slone to realize the reality and expense that Richard Slone is an independent phar- pharmacy must endure to persevere macist and pharmacy owner in eastern and to move our profession into the Kentucky. His wife, Zena, is a pharma- future. As more opportunity and professional responsibilities are opened cist, his son is a pharmacist and his up and accepted by the profession of daughter in law is a pharmacist. He has two children, Katrina and Rick Jr., pharmacy, we must be ready and prepared to accept and deliver and deand three granddaughters, Scarlett, mand professional compensation for Laila and Kamdyn. any service pharmacists provide to our He has been a pharmacist for over 35 patients and the healthcare team. We years and has worked in pharmacy must never abdicate nor abandon our since he was 16 years old. historical legal responsibility of the distribution and management of profes“I have seen pharmacy practiced and sional knowledge and the physical respected for what the practice of pharmacy has historically been. I have drug product directly to the patient nor seen the profession of pharmacy seek to stop seeking adequate and professional reimbursement. out and embrace new and expanding practice models. I believe that anything “It is the responsibility of all our profesworth keeping is worth fighting for and sion to stay engaged and active and anything obtainable one must never financially support our profession. It “Someone would ask why I am a candidate for the Board of KPhA. My answer is simple, pharmacy has given me and my family (two brothers that are physicians and a sister that is a nurse, and many cousins working as pharmacists in our state) an avenue to provide care to the many folks of our state, and in return I feel the desire to give back to the very profession that has given me so much. Also, I am now in a position I can carve out the time to provide a voice and most importantly support for our great profession.”

has been an honor to serve our profession as a Board of Directors member. Tyler Stevens Tyler Stevens received his Bachelor of Science degree in biology from the University of Kentucky in 2002. Following undergraduate studies, he received the Doctor of Pharmacy degree from Virginia Commonwealth University, in Richmond, Virg., in 2006. After graduating from pharmacy school, he completed a Community Care Pharmacy Practice Residency with VCU and Buford Road Pharmacy. After completing the residency, he stayed at Buford Road Pharmacy as the clinical services director. From 2008 to 2016, he served as an assistant professor of pharmacy practice at VCU in the Department of Pharmacotherapy and Outcomes Science. While at VCU, he predominately taught and coordinated the Foundations of Pharmacy Practice (Skills) Labs in addition to teaching in other Community practice related areas (Communications & Pharmaceutical Calculations). In 2016, he returned home to Kentucky to join the faculty at UK in the Department of Pharmacy Practice & Science. “I genuinely wish to become more involved in the state pharmacy association in-order to advance the profession as well as, network and make connections within the Kentucky pharmacy family.”

Join the Committee of 100! Each contributor who pledges at least $5,000 over the next 5 years will be counted among the Committee of 100. Add your name to the list today by calling 502-227-2303 or log on to http://www.kphanet.org/?page=buildingcampaign

Contributions are tax deductible. 11

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APSC

March/April 2017

THE KENTUCKY PHARMACIST

The Kentucky Pharmacist Online

March/April 2017

NEW in 2017! Two of the six editions of The Kentucky Pharmacist will be published online only. To access the online version, go to www.kphanet.org, click on Communications and then on The Kentucky Pharmacist link. Continuing Education articles are available to KPhA Members electronically under the Education tab on the KPERF CE Articles page (log-in required).

Would you rather receive all of the journals electronically? Email ssisco@kphanet.org to be placed on the KPhA Green List for electronic delivery. Once the journal is published online, you will receive an email with a link to the online version. Contact Scott Sisco at ssisco@kphanet.org or call the KPhA Headquarters at 502-227-2303 with questions. 13

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2016 Bowl of Hygeia

March/April 2017

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March 2017 CE — Anticoagulation Guideline Updates

March/April 2017

Anticoagulation Guideline Updates and Emerging Medications By: Mallory Durham, PharmD; Amanda Jett, PharmD, BCACP; Sullivan University College of Pharmacy The authors declare no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-17-003-H01-P&T 1.5 Contact Hours (0.15 CEUs) Expires 2/28/2020

KPERF offers all CE articles to members online at www.kphanet.org

Goal: The goal of this program is to familiarize pharmacists and pharmacy technicians with the latest anticoagulation treatment recommendations outlined in the 2016 CHEST guideline update concerning antithrombotic therapy for venous thromboembolism (VTE) disease, which addresses both deep venous thromboembolism (DVT) and pulmonary embolism (PE). The program also will serve as a review of the newest anticoagulation medications and reversal agents as well as drugs in the pipeline. Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: 1. Recall the new recommendations from the 2016 Antithrombotic Therapy for VTE Disease CHEST guideline update; 2. Recall the role of a pharmacist in providing anticoagulation recommendations; 3. Identify the mechanism of action (MOA), indications, dosage, adverse effects and clinical pearls of edoxaban (Savaysa®) and idarucizumab (Praxbind®); and, 4. Recognize various pipeline anticoagulant reversal agents. VKA therapy. Second, NOACs are considered to be more convenient and patient friendly. NOACs do not have as many drug-drug/drug-food interactions as VKA therapy. Also, therapy with a NOAC does not require consistent monitoring like VKA therapy.

2016 CHEST Guideline Updates In February 2016, the American College of CHEST Physicians released an update to their 9th edition of the Antithrombotic Therapy for VTE guidelines. The guideline provides updates on 12 topics and addresses three new topics. Highlights of the new recommendations are listed below and in Table 1:



Anticoagulant Selection The 9th edition of the guidelines was published in 2012 and options for anticoagulant agents have since expanded. Therefore, the latest edition addresses the use of newer  agents such as edoxaban and other novel oral anticoagulants (NOACs). New recommendations regarding anticoagulant selection are provided below. 



In patients with DVT of the leg or PE and no cancer, long-term treatment (3 months) with dabigatran,  rivaroxaban, apixaban or edoxaban is recommended over vitamin k antagonist (VKA) therapy. (Grade 2B) If those agents are not used, then VKA therapy is recommended over treatment with low-molecular weight heparin (LMWH).1 (Grade 2C) The guideline panel recommends NOACs over VKA for several reasons. First, studies have shown less risk for intracranial bleeding with NOACs in comparison to 15

In the instance a NOAC cannot be used, VKA therapy is recommended over treatment LMWH. LMWH injections are burdensome and expensive. In addition, data has shown that there are lower rates of recurrent VTE in patients (without cancer) treated with VKA therapy and VKA therapy may be as effective as LMWH. In patients with DVT of the leg or PE and cancer (“cancer associated thrombosis”), long-term treatment with LMWH is recommended instead of VKA therapy, dabigatran, rivaroxaban, apixaban or edoxaban.1 (Grade 2C) LMWH is the preferred option for cancer patients for numerous reasons. First, studies have shown LMWH is more effective than VKA therapy and rates of recurrent VTE in patients treated with VKA therapy have been higher. It is also a challenge to keep cancer patients within therapeutic range when being treated with VKA therapy. LMWH is also a desirable option for patients who cannot sustain oral therapy due to GI effects of chemotherapy.

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March 2017 CE — Anticoagulation Guideline Updates Table 1: New Guideline Recommendations Summary

March/April 2017

Topic

Recommendation Treat with dabigatran, rivaroxaban, apixaban, or edoxaban for 3 months. If a NOAC is contraindicated, then warfarin (VKA) is an alternative. Treat with LMWH for 3 months. Temporarily switch anticoagulation treatment to LMWH. Increase dose of LMWH by ¼ to ⅓ Initiate aspirin (100 mg studied) to prevent recurrent VTE. Do not recommend routine use of compression stockings. Systemically administered thrombolytic is not recommended. If the patient has a low bleeding risk, then systemic thrombolytic therapy is recommended. Systemic therapy using a peripheral vein is recommended instead of CDT.

Leg DVT or PE treatment (+ no cancer) Leg DVT or PE treatment (+ cancer) Recurrent VTE despite treatment with VKA or NOAC Recurrent VTE on long-term LMWH Discontinuation of anticoagulation in patients with an unprovoked proximal DVT or PE PTS prevention Acute PE with hypotension Acute PE with status deterioration (w/o hypotension) Acute PE treated with thrombolytic Acute PE associated with hypotension and i. Low bleeding risk ii. Failed thrombolytic therapy iii. Shock

CDT is recommended.

bo for the prevention of recurrent VTE in patients with a first unprovoked proximal DVT/PE who have completed 3 to 18 months of anticoagulant therapy. One randomized, placebo-controlled trial investigated the daily use of aspirin 100 mg for the prevention of recurrent VTE in patients who completed anticoagulant therapy after their first episode of unprovoked VTE.2 There was no significant reduction in rate of recurrent VTE but there was a significant reduction in the composite secondary outcome including rate of VTE, myocardial infarction, stroke or cardiovascular death (8 percent per year with placebo vs. 5.2 percent per year with aspirin; HR 0.66; 95 percent CI 0.48-0.92; P=0.01).2 A meta-analysis of two randomized placebo-controlled trials found that aspirin 100 mg daily reduced recurrent VTE (7.5 percent per year with placebo vs. 5.1 percent per year with aspirin; HR 0.68; 95 percent CI 0.51-0.90; P=0.008).3

Recurrent VTE Prevention 

In patients who have recurrent VTE on VKA therapy (in the therapeutic range) or on dabigatran, rivaroxaban, apixaban or edoxaban (and are believed to be compliant), switching to treatment with LMWH at least temporarily is recommended.1 (Grade 2C)



When anticoagulation therapy fails, guidelines recommend the assessment of medication compliance, confirmation of recurrent VTE, evaluation of anticoagulant dosing and consideration of underlying malignancy. In the meantime, it is recommended to switch treatment to LMWH for at least one month. The basis of this recommendation comes from evidence that suggests LMWH is more effective than VKA therapy in preventing recurrent VTE episodes in patients with cancer. In a situation where a cancer patient develops an unexplained VTE while on anticoagulation, patients would be Post Thrombotic Syndrome (PTS) Prevention switched to a treatment dose of LMWH. PTS is a condition that may develop as a consequence of In patients who have recurrent VTE on long-term venous insufficiency following a DVT.4 Venous hypertenLMWH (and are believed to be compliant), increassion may arise due to thrombotic obstruction, and valvular ing the dose of LMWH by about one-quarter to onedamage can lead to symptoms of pain, vein dilation, edethird is recommended.1 (Grade 2C) ma, skin pigmentation and venous ulcers.4 Previously recIn patients with an unprovoked proximal DVT or PE ommended prevention of PTS included wearing compreswho are stopping anticoagulant therapy and do not sion stockings for two years after a DVT; however, new have a contraindication to aspirin, aspirin is recom- data suggests against the use.



mended to prevent recurrent VTE.1 (Grade 2B) 



Two randomized trials have compared aspirin to place16

In patients with acute DVT of the leg, routine use of compression stockings to prevent PTS is not rec-

THE KENTUCKY PHARMACIST

March 2017 CE — Anticoagulation Guideline Updates Table 2: Newly Approved Agents

Generic Name (Brand name)

Drug Class

Indications

Route/ Dose PO

Edoxaban (Savaysa®)

Factor Xa Inhibitor

Nonvalvular fibrillation, treatment of VTE

60 mg once daily

IV Idarucizumab Antidote (Praxbind®)

Reversal of dabigatran

Administer two 2.5 g doses no more than 15 minutes apart

ommended.1 (Grade 2B) 



A multicenter, randomized, placebo-controlled trial researched the use of compression stockings for two years after development of first proximal DVT.5 Incidence of PTS was 14.2 percent in the compression  stocking group vs. 12.7 percent in the placebo group (HR 1.13; 95 percent CI 0.73-1.76; P=0.58).5 From these results, it was concluded that there was no significant difference in reduction of PTS when comparing the use of compression stockings to placebo.

Thrombolytic Therapy for PE Systemic thrombolytic therapy has demonstrated to improve PE by lowering pulmonary artery pressure and increasing arterial oxygenation. However, it is important to balance these benefits with the risk of bleeding. 

In most patients with acute PE not associated with hypotension, systemically administered thrombolytic therapy is not recommended.1 (Grade 1B)



In selected patients with acute PE who deteriorate after starting anticoagulant therapy but have yet to develop hypotension and who have a low bleeding risk, systemically administered thrombolytic therapy is recommended over no such therapy.1 (Grade 2C)



March/April 2017

6,7



Adverse Effects

Pearls

Inhibits clotting factor Xa, thus preventing thrombus development

Bleeding

In treatment of nonvalvular atrial fibrillation, use is contraindicated when CrCl > 95 ml/ min; AWP $582.60 #50 (60 mg)

Monoclonal antibody that binds to dabigatran and neutralizes its anticoagulant effect

Infusionrelated reactions

AWP $2100 per 2.5g/50mL

MOA

In patients with acute PE who are treated with a thrombolytic agent, systemic thrombolytic therapy using a peripheral vein is recommended over catheter-directed thrombolysis (CDT).1 (Grade 2C) CDT involves the direct infusion of a thrombolytic into the pulmonary artery via a catheter. CDT is a good option for hemodynamically unstable patients. CDT uses a lower dose of thrombolytic, which decreases the risk of bleeding when compared to systemic thrombolytic therapy. Not much research has been conducted comparing CDT to systemic thrombolytic therapy. Therefore due to higher levels of evidence supporting use of systemic therapy, the panel recommends systemic therapy over CDT in patients who do not have a high risk of bleeding. In patients with acute PE associated with hypotension and who have (i) a high bleeding risk, (ii) failed systemic thrombolysis or (iii) shock that is likely to cause death before systemic thrombolysis can take effect (e.g., within hours), catheter-assisted thrombus removal is recommended (if expertise and resources are available).1 (Grade 2C)

CDT directly removes the thrombus, decreases pulmonary arterial pressure and improves right ventricular functioning while also having a lower risk of bleeding. This would be a good option for patients with high bleeding risk and are at Patients with acute PE who start to show signs of dete- risk of shock. rioration and begin to develop hypotension should be Newest Anticoagulation Agents treated with systemic thrombolytic therapy to prevent shock and myocardial damage. In January 2015, the FDA approved edoxaban (Savaysa®). 17

THE KENTUCKY PHARMACIST

March 2017 CE — Anticoagulation Guideline Updates

March/April 2017

This new anticoagulant is indicated for treatment of nonval- 3. Simes J, Becattini C, Agnelli G, et al. Aspirin for the vular atrial fibrillation and treatment of DVT and PE. In adprevention of recurrent venous thromboembolism: the dition to edoxaban, a novel anticoagulant antidote, idaruciINSPIRE collaboration. Circulation. 2014;130(13):1062zumab (Praxbind®) was introduced to the drug market in 1071. October 2015. Notable information about these latest anti4. Alguire PC, Mathes BM. Post-thrombotic (post coagulant agents is featured in Table 2. phlebitic) syndrome. In: UpToDate [online database] Waltham, MA. Accessed 2016 Oct 14. Pipeline Agents Currently, the factor Xa inhibitors rivaroxaban (Xarelto®), 5. Kahn SR, Shapiro S, Wells PS, et al. Compression apixaban (Eliquis®) and edoxaban (Savaysa®) do not have stockings to prevent post-thrombotic syndrome: a a drug-specific antidote. There has been an increasing randomised placebo controlled trial. Lancet. 2014;383 need to develop reversal agents to the newest anticoagu(9920):880-888. lants. Portola Pharmaceuticals has developed a drug called 6. Edoxaban. In: Lexi-Drugs [online database]. andexanet alfa, which is a recombinant protein that is being Hudson, OH. Accessed 2016 Sep 24. investigated as a factor Xa inhibitor antidote.8

7. Idarucizumab. In: Lexi-Drugs [online database]. A recent study evaluated the use of andexanet alfa in 67 Hudson, OH. Accessed 2016 Sep 24. patients who had acute major bleeding within 18 hours after administration with a factor Xa inhibitor (apixaban or 8. Andexanet alfa: FXa inhibitor antidote. Portola Pharmarivaroxaban).9 Preliminary analysis of the study shows adceuticals website. https://www.portola.com/clinicalministration of andexanet alfa resulted in substantial reducdevelopment/andexanet-alfa-fxa-inhibitor-antidote/. tions of anti-factor Xa activity with effective hemostasis ocPublished: unknown; accessed 2016 Sep 26. curring in 79 percent of patients.9 9. Connolly SJ, Milling TJ Jr, Eikelboom JW, et al. AndexPreliminary data demonstrates potential for this agent as a anet alfa for acute major bleeding associated with factor Xa inhibitor reversal agent. More research is warrantfactor Xa inhibitors. N Engl J Med. 2016 Sep 22;375 ed to investigate the safety and efficacy. Andexanet alfa is (12):1131-1141. currently undergoing phase 3b/4 clinical trials. 10. Ciraparantag (PER977): broad-spectrum anticoagulant In addition to andexanet alfa, Perosphere also has dereversal agent. Perosphere website. signed a reversal agent, ciraparantag.10 Ciraparantag is a http://perosphere.com/content/research/per977.htm. small, synthetic, water-soluble, cationic molecule that has Published: unknown; accessed 2016 Sep 26. been developed to serve as a broad-spectrum reversal 11. Ansell JE, Bakhru SH, Laulicht BE, et al. Ciraparantag agent.11This unique reversal agent is designed for UFH, safely and completely reverses the anticoagulant LMWH and the novel oral anticoagulants (NOACs). The effects of low molecular weight heparin. Thromb Res. molecule binds to these agents on a molecular level to re2016 Oct;146:113-118. verse anticoagulation.11 Data from Phase 1 clinical trials identified that doses of 100-300 mg were able to restore 12. Edoxaban [package insert]. Parsippany, NJ: Daiichi hemostasis within 10-30 minutes and was sustained for 24 Sankyo, Inc.; 2015. hours.11This pipeline medication is undergoing Phase 2 13. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban clinical trials. versus warfarin in patients with atrial fibrillation. N Engl References J Med. 2013 Nov 19;369(22):2093-2104. 1. Kearon C, Akl EA, Ornelas J, et al. 2016 Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. American College of CHEST Physicians. http://journal.publications.chestnet.org/article.aspx? articleid=2479255&resultClick=3. Published 2016 Feb; accessed 2016 Sep 18. 2. Brighton TA, Eikelboom JW, Mann K, et al. Low-dose aspirin for preventing recurrent venous thromboembolism. N Engl J Med. 2012;367(21):1979-1987.

Send potential continuing education topics to Scott Sisco at ssisco@kphanet.org

THE KENTUCKY PHARMACIST

March 2017 CE â&#x20AC;&#x201D; Anticoagulation Guideline Updates

March/April 2017

March 2017 â&#x20AC;&#x201D; Anticoagulation Guideline Updates and Emerging Medications 1. What is the recommended anticoagulant for the treatment of a cancer patient who has developed DVT of the leg? A. Rivaroxaban B. LMWH C. Warfarin D. Heparin

7. Idarucizumab is the antidote for which anticoagulant? A. Warfarin B. Apixaban C. Heparin D. Dabigatran 8. What is the route of administration of Idarucizumab? A. PO B. IV C. IM D. SC

2. Compression stockings should be used to prevent post thrombotic Syndrome (PTS). A. True B. False 3. In patients with unprovoked, proximal VTE who are stopping anticoagulant therapy, what is the recommended agent to prevent recurrent VTE? A. Clopidogrel B. Warfarin C. Ticagrelor D. Aspirin

9. Which of the following is the correct dosing of Idarucizumab? A. 5 g x two doses separated by no more than 5 minutes B. 2.5 g x two doses separated by no more than 15 minutes C. 1.5 g x two doses separated by no more than 10 minutes D. 1 g x two doses separated by no more than 5 minutes

4. What is the mechanism of action of edoxaban? A. Direct thrombin inhibitor B. Inhibits factors II, VII, XI, X C. Factor Xa inhibitor D. Platelet aggregation inhibitor 5. Which of the following is an indication for treatment with edoxaban? A. Nonvalvular atrial fibrillation B. Myocardial infarction C. Postoperative DVT prophylaxis D. Valvular atrial fibrillation

10. What is the name of the broad-spectrum reversal agent currently being studied in clinical trials? A. Ciraparantag B. Andexanet alfa C. P7125 D. Xa100

6. Use of edoxaban for the treatment of atrial fibrillation is contraindicated for which of the following CrCl values? A. 100 B. 80 C. 50 D. 25

Are you connected to YOUR KPhA? Join us online! Facebook.com/KyPharmAssoc Facebook.com/ KPhA Company Page @KyPharmAssoc @KPhAGrassroots

THE KENTUCKY PHARMACIST

March 2017 CE — Anticoagulation Guideline Updates

March/April 2017

This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 96 C Michael Davenport Blvd., Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile. Expiration Date: February 28, 2020 Successful Completion: Score of 80% will result in 1.5 contact hours or .15 CEUs. Participants who score less than 80% will be notified and permitted one re-examination. TECHNICIANS ANSWER SHEET. March 2017 — Anticoagulation Guideline Updates and Emerging Medications (1.5 contact hours) Universal Activity # 0143-0000-17-003-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9, A B C D 10. A B C D

Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No If yes, please explain on a separate sheet. Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________

Personal NABP eProfile ID #_____________________________ Birthdate ____________(MM/DD) PHARMACISTS ANSWER SHEET March 2017 — Anticoagulation Guideline Updates and Emerging Medications (1.5 contact hours) Universal Activity # 0143-0000-17-003-H01-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9, A B C D 10. A B C D

Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No If yes, please explain on a separate sheet. Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________

Personal NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education.

Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.

THE KENTUCKY PHARMACIST

2017 KPhA Professional Awards

March/April 2017

DEADLINE IS MARCH 31! Act Now!

Who will you nominate for the 2017 KPhA Professional Awards! Nomination forms and more information is available at http://www.kphanet.org/?58 Submit nominations to: KPhA Awards, 96 C. Michael Davenport Blvd., Frankfort, KY 40601; or via email to ssisco@kphanet.org.

THE KENTUCKY PHARMACIST

Vaccine Information Statements

March/April 2017

Reminder to Immunizing Pharmacists: Don’t Forget Required Vaccine Information Statements By: Monica Roberts, PharmD Candidate (2017) University of Kentucky College of Pharmacy Immunization has become commonplace in U.S. pharmacies, with more than 280,000 pharmacists trained to administer vaccines.1 In Kentucky, per-protocol immunization is part of the daily routine of most community pharmacies. As the immunization process becomes a habit, though, it’s important that all pharmacy personnel remain aware of the legal obligation to provide a Vaccine Information Statement (VIS) before every vaccine. VISs are produced by the Centers for Disease Control and Prevention (CDC). Federal law requires that all practitioners provide the patient with a current VIS before administering any vaccination listed in the National Childhood Vaccine Injury Act.2,3 Don’t let the name of the law fool you: Adults and children alike must receive a VIS before immunization. The Act’s covered vaccines are influenza; DTaP, DT, Td, and Tdap; MMR and MMRV; meningococcal; Hib; PCV-13; hepatitis A and B; polio; rotavirus; HPV; and varicella (chickenpox). For vaccinations given in a series, a VIS must be provided before every dose. If a combination vaccine doesn’t have its own VIS, a VIS must be provided for each component in the product. The CDC publishes a Multi -Vaccine VIS, but it should not be used for patients older than 6 years. Although a VIS is not legally required for other vaccines, including shingles, PPSV, rabies and typhoid, it is best practice to provide a VIS with all immunizations. The goals of the VIS requirement are to provide the patient with risk/benefit information immediately prior to the dose and to allow the patient to have all questions answered before being immunized. The VIS may be provided as a paper copy or electronically, and patients must have the opportunity to take a copy home.3 Pharmacists must use the CDC’s current VIS and should not make substantive changes or write their own versions. The pharmacist can provide additional instruction to the patient, including reading the VIS aloud, providing additional printed material or offering other verbal explanations, but none of these methods can replace providing a copy of the current VIS. The final step to ensure compliance is documentation. The pharmacist must record the VIS edition date and the date

the VIS was provided in the patient’s permanent pharmacy record. The VIS edition date can be found in the bottom right corner on the back page of the VIS. Additional documentation required for all immunizations includes the facility address and name, the date of immunization, the name and title of the pharmacist who administered the vaccine and the manufacturer and lot number of the vaccine given.3 The CDC partners with the Immunization Action Coalition to help distribute vaccine information. The Coalition’s website (www.immunize.org) is an excellent resource for VIS materials. In addition to ready-to-print versions of all VISs, the site maintains a list of VIS dates to help pharmacists ensure they are providing the most up-to-date copy. VIS translations in more than 30 languages also are available so the pharmacist can make every effort to ensure the VIS is provided in a format the patient can understand. Providing a VIS doesn’t replace the pharmacist’s responsibility to counsel the patient prior to immunization. The pharmacist still should talk to the patient about risks and bene-

THE KENTUCKY PHARMACIST

Vaccine Information Statements

March/April 2017

fits, expected side effects, when and how to report an adverse event and what diseases the vaccine will (and won’t) prevent. The VIS can be used as a tool to facilitate that discussion and to ensure that the patient is ready to be immunized. Providing an up-to-date VIS to every patient before administration is an important and mandatory step in the immunization process. As pharmacists play an ever-increasing role in improving immunization rates and promoting public health, we must make sure VIS provision is part of the routine.

KPERF Naloxone Certification Training The online training program can be found at the following link on the KPhA website: http://www.kphanet.org/? page=NaloxoneCert2015

References: 1. American Pharmacists Association (2017). Immunization Center. Accessed online on February 9, 2017 at http://www.pharmacist.com/immunization-center

The cost of the training is $5 for KPhA members, and $10 for non-KPhA members. After successfully completing the course, credit will be applied to your CPE Monitor Profile and you will be emailed a certificate of completion. Contact Scott Sisco at ssisco@kphanet.org or 502-227-2303 with questions.

2. Centers for Disease Control and Prevention (2016). Vaccine Information Statements (VISs). Accessed online on February 7, 2017 at https://www.cdc.gov/ vaccines/hcp/vis/about/facts-vis.html 3. Immunization Action Coalition (2016). It’s Federal Law! You must give your patients current Vaccine Information Statements (VISs). Accessed online on February 7, 2017 at http://www.immunize.org/catg.d/ p2027.pdf

The Kentucky Renaissance Pharmacy Museum offers several ways way to show support of the Museum, our state's leading preservation organization for pharmacy. While contributions of any size are greatly appreciated, the following levels of annual giving have been established for your consideration.

Friend of the Museum $100  Proctor Society $250 Damien Society $500 Galen Society $1,000 Name______________________________________ Specify gift amount________________________ Address ____________________________________ City____________________Zip______________ Phone H____________________W________________ Email___________________________________ Employer name_____________________________________________________for possible matching gift. Tributes in honor or memory of_____________________________________________________ Mail to: Kentucky Renaissance Pharmacy Museum, P.O.Box 910502, Lexington, KY 40591-0502 The Kentucky Renaissance Pharmacy Museum is a non-profit 501(c)(3) business entity and as such donations are tax deductible. A notice of your tax deductible contributions will be mailed to you annually.

For more information on the Kentucky Renaissance Pharmacy Museum, see www.pharmacymuseumky.org or contact Gloria Doughty at g.doughty@twc.com. 23

THE KENTUCKY PHARMACIST

Continuing Education Article Guidelines

March/April 2017

Have an idea for a continuing education article? WRITE IT! Continuing Education Article Guidelines

The following broad guidelines should guide an author  to completing a continuing education article for publication in The Kentucky Pharmacist.   

 

Average length is 4-10 typed pages in a word processing document (Microsoft Word is preferred).

Articles are reviewed for commercial bias, etc. by at least one (normally two) pharmacist reviewers. When submitting the article, you also will be asked to fill out a financial disclosure statement to identify any financial considerations connected to your article.

Articles are generally written so that they are pertinent to both pharmacists and pharmacy technicians. If the subject matter absolutely is not pertinent to technicians, that needs to be stated clearly Articles should address topics designed to narrow at the beginning of the article. gaps between actual practice and ideal practice in Article should begin with the goal or goals of the pharmacy. Please see the KPhA website overall program – usually a few sentences. (www.kphanet.org) under the Education link to see Include 3 to 5 objectives using SMART and meas- previously published articles. urable verbs.



Include a quiz over the material. Usually between 10 to 12 multiple choice questions.

Feel free to include graphs or charts, but please submit them separately, not embedded in the text of the article.

Articles must be submitted electronically to the KPhA director of communications and continuing education (ssisco@kphanet.org) by the first of the month preceding publication.

THE KENTUCKY PHARMACIST

KPhA House of Delegates Resolutions

March/April 2017

Call for Resolutions for KPhA House of Delegates OUR KPhA House of Delegates will meet at the 139th KPhA Annual Meeting and Convention June 22-25, 2017 at the Griffin Gate Marriott Resort in Lexington. All active pharmacist members in attendance are considered delegates. Resolutions, formal statements expressing the opinion, will or intent of a body of persons, may be submitted by individual members, district organizations, other associations or interests or committees. The most effective resolutions are carefully constructed to use as few words as possible to convey the basic issues and reasons for the stand. All proposed resolutions received prior to May 12, 2017 will be submitted to the KPhA Board of Directors, who will review them and make recommendations to the House of Delegates. The Board reserves the right to edit any proposed resolutions submitted and may, at its discretion and upon its own initiative, develop additional proposed resolutions. The Board will report all resolutions to the House of Delegates. Each resolution will carry with it the Board's action to recommend or not recommend, or with no recommendation. After the Board has considered all submitted resolutions, it will provide those resolutions for publication on the KPhA website (www.kphanet.org). These resolutions will be provided in writing to the Delegates. Following the action of the House of Delegates at the KPhA Annual Meeting, the resolutions adopted will be published on the website and in the next edition of The Kentucky Pharmacist. Submit resolutions to Scott Sisco (ssisco@kphanet.org) or via mail to KPhA, 96 C. Michael Davenport Blvd., Frankfort, KY 40601 by May 12, 2017.

The Campaign for Kentuckyâ&#x20AC;&#x2122;s Pharmacy Future

Donations to the KPERF/KPhA Building Fund are tax deductible! Leave a legacy by participating in the campaign to replace OUR KPERF/KPhA Headquarters! Learn more about options for payment and levels of recognition at http://www.kphanet.org/?page=buildingcampaign or call 502-227-2303.

THE KENTUCKY PHARMACIST

April 2017 CE — Interprofessional Education Update

March/April 2017

Interprofessional Education Update: 2016 IPEC Competencies and ACPE Standards 2016 By: Stacy A. Taylor, PharmD, MHA, BCPS, University of Kentucky College of Pharmacy and Leslie N. Woltenberg, MEd, PhD, University of Kentucky Center for Interprofessional Health Education There are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-17-004-H04-P&T 1.0 Contact Hour (0.1 CEUs) Expires 3/15/2020 Goal: To assist pharmacists and pharmacy technicians in understanding and applying the 2016 Core Competencies for Interprofessional Collaborative Practice.

KPERF offers all CE articles to members online at www.kphanet.org

Learning Objectives At the conclusion of this Knowledge-based article, the reader should be able to: 1. Explain the importance of interprofessional team-based patient care; 2. Discuss the Institute for Healthcare Improvement and World Health Organizations’ recommendations for employing interprofessional practice to improve health care; 3. Compare, contrast and discuss the importance of the 2011 and 2016 IPEC Core Competencies for Interprofessional Collaborative Practice; 4. Summarize the ACPE Standards 2016 Key Elements of Interprofessional Education; and, 5. Describe a model of interprofessional education that seeks to foster interprofessional team-based patient care skills. Introduction While frequently considered a contemporary and popular topic in both research and education, the concept of interprofessional collaboration has a history with roots early in the 20th century. Although occurring as early as the 1920s in Great Britain, the genesis of interprofessional collaboration in the United States dates back to the late 1940s with the development of hospital outreach teams.1 A resurgence began in 1972 in a series of publications from the Institute of Medicine (IOM) calling for, among other things, the need for interprofessional education as a method of transforming the health care system to meet the emerging needs for increased collaboration among providers.2 The landmark IOM reports, To Err is Human3 and Crossing the Quality Chasm4 published in 1999 and 2001, respectively, shed light on the poor quality plaguing the U.S. health care system and were considered a call to action. Evidence of a complex and fragmented system demanded a new vision, one in which coordinated, team-based, patient-centered care was the norm, not the exception. Interprofessional education (IPE) is one strategy that has been shown to improve communication and collaboration,5,6 increase one’s understanding of others’ roles and scope of practice,7 foster positive perceptions of other healthcare professionals and improve team performance.8,9 Interprofessional

practice has been linked to improved healthcare outcomes for patients, cost savings in health care delivery, reduced negative events and greater professional satisfaction. 10 The Accreditation Council for Pharmacy Education (ACPE) specifies that all students should competently “participate in experiential educational activities with prescribers/ student prescribers and other student/professional health care team members, including face-to-face interactions that are designed to advance interprofessional team effectiveness.”11 For this reason, interprofessional education within pharmacy curricula, especially in experiential rotations, has gained greater emphasis in recent years. Pharmacy preceptors are increasingly called upon to assess students’ interprofessional competence and team skills. While many preceptors have years of experience practicing in interprofessional, patient-centered care settings, some may not have had the opportunity to explore the underlying tenets of interprofessional education and practice theory. This document seeks to provide an overview of the strategic direction of key constituents in the interprofessional education arena, with an emphasis on the Interprofessional Education Collaborative (IPEC) and ACPE. Additionally, the model of foundational IPE training provided during the didactic portion of the Doctor of Pharmacy curriculum at the University of Kentucky will be described 26

THE KENTUCKY PHARMACIST

April 2017 CE — Interprofessional Education Update

March/April 2017

herein as an example of early student pharmacist exposure provide comprehensive care and optimal outcomes. This is to interprofessional education. markedly different from some of the earlier models of interdisciplinary practice in which resources such as space and Institute for Healthcare Improvement - Triple Aim staff might be shared but true collaboration in the contemIn 2008, the Institute for Healthcare Improvement develporary sense was absent. True collaborative practice aims oped the Triple Aim, which focuses on the simultaneous to involve the entire team of providers and the patients and pursuit of better care for individuals, better health for popu- caregivers in the decision-making processes.14 lations and lower per capita costs.12 Stimulated in part by the Affordable Care Act and the adoption of the Triple Aim Interprofessional Education Collaborative (IPEC) - 2016 Core Competencies framework as part of the national strategy for addressing health care, the Triple Aim has become increasingly central In 2009, six national associations of health professions to discussions of health care improvement emphasizing schools representing dentistry, nursing, medicine, osteoboth accountability and value. It is clear that achieving this pathic medicine, pharmacy and public health formed the aim requires a concerted effort which includes both current Interprofessional Education Collaborative or IPEC to adand future practitioners. Central to this effort is the engage- vance and synergize IPE.15 The IPEC agreed that a set of ment of current core interprofes15 practitioners in Table 1. 2016 IPEC Competencies sional compethe developInterprofessional Collaboration Domain tencies would ment of new promote coordiCompetency 1 Competency 2 Competency 3 Competency 4 practice modnation of health Values and Ethics els to provide professions edfor Roles and Interprofessional Teams and efficient, reliaInterprofessional Responsibilities Communication Teamwork ucation with Practice ble, patientregard to develcentered care. opment of cur10 10 8 11 At the same Sub-competencies Sub-competencies Sub-competencies Sub-competencies ricula, assesstime, national ment and acattention has been redirected toward a call for health care creditation standards and encourage consistency across education reform that prepares our graduates to become the health professions. Prior to the advent of the IPEC, the engaged participants in this transformative process. Addivarious health professions education programs initiated tional efforts are required to change health professions ed- interprofessional education using similar but unique methucation to embed collaborative philosophies and skills into ods and learning objectives. The most important impact of the educational process. As health care delivery and health the IPEC is the creation of common goals which form a professions education undergo rapid transformation, it is unified foundation to galvanize all health professions educritical that they not be developed in isolation. Delivery sys- cation programs in moving forward together. tem change must consider health professions education and educational reform must incorporate practice redesign The initial set of IPEC Core Competencies for Interprofessional Collaborative Practice published in 2011 outlined for transformation to endure. collaborative competencies in four domains: values and World Health Organization - Framework for Action ethics, roles and responsibilities, interprofessional communication and teams and teamwork.15 In 2016, the IPEC During this same time period, the World Health Organization (WHO) drafted a Framework for Action on Interprofes- Board expanded to include nine additional health professions including physical therapy, occupational therapy, opsional Education (IPE) and Collaborative Practice.13 The tometry, physician assistant and social work among others. Framework sought to define the current status of global In the 2016 revised IPEC core competencies listed in Table interprofessional collaboration and provide strategies for 1, the 15 national association health professions schools policy development encouraging interprofessional educasought to accomplish three overarching goals: First, a reaftion and collaboration. According to the WHO definition, interprofessional education occurs when students from two firmation of the value and impact of the core competencies; or more professions learn about, from and with each other second, a reclassification of the four domains to now be four core competencies each with associated subduring all or part of their professional training with the obcompetencies all falling under a singular domain termed jective of cultivating collaborative practice and improved “Interprofessional Collaboration;” and third, to broaden the outcomes. Collaborative practice is characterized by an competencies to include a focus on population health, thus interdependency across professions that is necessary to 27

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April 2017 CE — Interprofessional Education Update

March/April 2017

Table 2. Key Elements ACPE Standard 11: Interprofessional Education 11 11.1. Interprofessional team dynamics – All students demonstrate competence in interprofessional team dynamics, including articulating the values and ethics that underpin interprofessional practice, engaging in effective interprofessional communication, including conflict resolution and documentation skills and honoring interprofessional roles and responsibilities. Interprofessional team dynamics are introduced, reinforced and practiced in the didactic and Introductory Pharmacy Practice Experience (IPPE) components of the curriculum, and competency is demonstrated in Advanced Pharmacy Practice Experience (APPE) practice settings. 11.2. Interprofessional team education – To advance collaboration and quality of patient care, the didactic and experiential curricula include opportunities for students to learn about, from and with other members of the interprofessional healthcare team. Through interprofessional education activities, students gain an understanding of the abilities, competencies and scope of practice of team members. Some, but not all, of these educational activities may be simulations. 11.3. Interprofessional team practice – All students competently participate as a healthcare team member in providing direct patient care and engaging in shared therapeutic decision-making. They participate in experiential educational activities with prescribers/student prescribers and other student/professional healthcare team members, including face-

students graduating with the Doctor of Pharmacy degree.11 ACPE Standards 2016 discuss the importance of interproThe IPEC core competencies have been broadly incorpofessional practice in various places throughout the standrated into educational standards by the various health proards and have additionally devoted one specific standard, fessions education accrediting bodies. These accreditation Standard 11, to IPE. Interprofessional competence is constandards led to the integration of the competencies into sidered part of the preparation that students uniformly need the health education curricula such that students in differto enter patient care in a variety of settings. The ACPE ent health professions education programs receive similar Standards recognize that pharmacists need to be prepared training in regard to the importance of interprofessional colto contribute and collaborate with prescribers and other laborative care in the ultimate achievement of patient and health professionals as well. As such, they have articulated population health. Interprofessional competence is develclear interprofessional competencies pharmacy students oped over time as a continuous process as students mashould gain during their academic training. ture, with the goal that new health professions graduates will enter the workforce fully capable of practicing interpro- The Key Elements of Standard 11, shown in Table 2, are fessionally. interprofessional team dynamics, team education and team practice.11 Specifically, in regard to interprofessional team In addition to developing health professions students, the dynamics, pharmacy students should demonstrate an abilIPEC also has focused on training and developing faculty. Since 2012, IPEC has hosted 10 faculty development insti- ity to articulate the values and ethics of interprofessional tutes training interprofessional faculty teams on the basics practice, communicate effectively in an interprofessional of interprofessional practice theory and on quality improve- setting (including both verbal communication and written ment and patient safety in interprofessional education. Ad- documentation skills), be able to resolve conflicts and honor the roles and responsibilities of others. Concerning team ditionally, the IPEC has assisted in the compilation of an education, pharmacy students should have the opportunity online repository of IPE modules and teaching materials. to learn about, from and with other members of the interThe modules include resources relating to clinical patient professional team through specific interprofessional educacare cases, student and practice evaluation, health care tional activities. Of note, the ACPE Standards specify that quality improvement, patient safety, medical errors, comsome, but not all, may be simulations. In other words, our munication and professionalism. These are available free 16 educational curricula need to provide opportunities for eduof charge on the IPE PORTAL. cational interaction with real students who are in other Accreditation Council for Pharmacy Education (ACPE) healthcare training programs. And finally, in order to be- IPE in Standards 2016 come competent in interprofessional team practice, StandThe pharmacy-specific ACPE Standards 2016 also lay out ards 2016 require that pharmacy students participate in experiential education opportunities in which they provide specific interprofessional standards to be achieved by all allowing better alignment with the Triple Aim.

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April 2017 CE — Interprofessional Education Update

March/April 2017 Table 3. 2016-2017 iCATS Sessions

direct patient care and practice shared therapeutic decision -making skills with prescribers, other healthcare team members and students of those programs in face to face interactions.



Video introduction to iCATS curriculum



Small group discussion of individual academic programs



Panelists discussed scope of practice, interprofessional collaboration and dispelled myths of their profession



Small group debrief



Patients with complicated medical histories shared their perspective of the impact of interprofessional teamwork on the patient experience



Small group debrief



A. Facilitate integration of the Core Competencies for Interprofessional Collaborative Practice15 into health professions education;

Vicarious learning activity: Students used a communication rubric to evaluate a team case discussion



B. Identify and support interprofessional clinical experiences for health professions learners;

Provided additional details of a medical error for the patient in video case



Small group collaboration to prepare for the simulation

Simulation



Team-based medical error disclosure to standardized patient to practice the communication and teamwork skills acquired through participation in the iCATS sessions

Final Debrief



Electronic post-survey completion



Reflection and discussion of iCATS

Orientation

A Model of Interprofessional Education Professional Panel

Over the past few years, colleges of pharmacy have been collaborating with other health professions programs to implement and refine interprofessional education opportunities. In 2010, the University of Kentucky (UK) established an IPE center with a mission to collaborate with faculty to facilitate the development, validation, dissemination and promotion of interprofessional education. The Center for Interprofessional Health Education (hereafter referred to as “the Center”) is governed by the Deans of eight involved colleges: Communication & Information, Dentistry, Health Sciences, Medicine, Nursing, Pharmacy, Public Health and Social Work. The strategic priorities of the Center are as follows:

Patient Panel

Team Huddle

C. Support scholarly activity and dissemination of interprofessional healthcare education; and, D. Develop and support faculty, staff and students as interprofessional learners. Interprofessional Collaboration And Team Skills (hereafter referred to as iCATS) is the core interprofessional curriculum for first year students in each of the health care colleges at UK and affords students the baseline knowledge, skills and attitudes required to participate in intermediate and advanced interprofessional curricula. This curricular program, which began in 2013-2014, was developed intentionally around the IPEC core competencies. Each firstyear pharmacy student is placed into a faculty-facilitated team with nine other interprofessional students to learn with, from and about each other. Now in its fourth iteration, iCATS consists of six sessions (Table 3) spanning from October to February with objectives aligned to the following IPEC core competencies and respective subcompetencies.15 In iCATS, students learn about other health professions programs of study, scopes of practice of various health professions, effective team-patient communication modalities and are provided opportunities to collaborate to optimize patient outcomes in simulated settings. By using the IPEC competencies as a guide, the iCATS program best serves students from all participating colleges.

With interprofessional elements as accreditation requirements for all programs, IPEC is the common language and objective for all participants. While iCATS is important in laying the foundational tenets of interprofessional practice, it must be paired with additional interprofessional education opportunities in order to achieve ACPE Standard 11 on IPE. The UK College of Pharmacy incorporates IPE competencies into the Introductory Pharmacy Practice Experiences (IPPEs) and requires all student pharmacists to complete at least one direct patient care Advance Pharmacy Practice Experience (APPE) at an academic medical center to ensure all students have ample opportunity to directly interface and collaborate in therapeutic decision-making with a variety of health care professionals. Efforts are currently underway to develop a rubric that can be used across multiple health professions to assess interprofessional competence and

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April 2017 CE — Interprofessional Education Update team collaboration skills observed during clinical rotations. The UK College of Pharmacy is currently piloting the assessment rubric which will likely be fully launched during the 2017-2018 APPE rotation year.

March/April 2017

6. Devonshire L, Wozniak H. Working together: Developing eLearning activities to to promote interprofessional learning. Synergy 2006;23:25-27.

Conclusion Improved interprofessional collaboration is essential in transforming the health care system to achieve coordinated, team-based, patient-centered care.3,4,13,15 Interprofessional education has been shown to improve communication and collaboration,5,6 increase one’s understanding of others’ roles and scope of practice,7 foster positive perceptions of other healthcare professionals and improve team performance.8,9 In 2016, the Interprofessional Education Collaborative (IPEC) published an updated set of interprofessional competencies developed by 15 different health professions programs.15 ACPE Standards 2016 place additional emphasis on developing interprofessional competence among Doctor of Pharmacy students and contain a new standard specifically devoted to interprofessional education.11 Standard 11 on Interprofessional Education states that IPE competencies must be developed and practiced in both the didactic and experiential portions of the curriculum. For several years, colleges of pharmacy have been actively collaborating with other health professions education programs to implement and refine interprofessional education opportunities. Additional refinement, especially in the areas of assessing student IPE competence in the clinical arena is anticipated in the years ahead. References 1. Baldwin DC. Some historical notes on interdisciplinary and interprofessional education and practice in health care in the USA. 1996. J Interprof Care 2007;21 Suppl 1:23-37.

7. Ker J, Mole L, Bradley P. Early introduction to interprofessional learning: a simulated ward environment. Med Educ 2003;37:248-55. 8. Henrichs W, Youngblood P, Harter P, et al. Simulation for team training and assessment: Case studies of online training with virtual worlds. World J Surg. 2008;32(Special Issue):161-170. 9. Morey JC, Simon R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37:1553-81. 10. Reeves S, Zwarenstein M, Goldman J, et al. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2008:CD002213. 11. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the Doctor of Pharmacy degree (“Standards 2016”). Chicago, Illinois: Accreditation Council for Pharmacy Education; Approved Jan. 25, 2015. Released Feb. 2, 2015. 12. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008;27:759-69. 13. World Health Organization (WHO). 2010. Framework for action on interprofessional education and collaborative practice. Geneva, Switzerland: WHO Press. 14. Conigliaro R, Kuperstein J, Dupuis J, Welsh D, Taylor S, Weber D, Jones M. The PEEER© Model: Effective Healthcare Team-Patient Communications. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9360.

2. Institute of Medicine (IOM). 1972. Educating for the Health Team. Washington, D.D.: National Academy Press.

3. Institute of Medicine (IOM). 2000. To Err Is Human: Building a Safer Health System. L. T. Kohn, J. M. Corri- 15. Interprofessional Education Collaborative. 2016. Core gan, and M. S. Donaldson, eds. Washington, D.C: competencies for interprofessional collaborative pracNational Academy Press. tice: 2016 update. Washington, DC: Interprofessional Education Collaborative. 4. Institute of Medicine (IOM). 2001. Crossing the Quality

Chasm. Crossing the Quality Chasm: A New Health 16. MedEdPORTAL's Interprofessional Education collecSystem for the 21st Century. Washington, D.C: Nationtion. Available at www.mededportal.org/collections/ipe/. al Academy Press. Accessed Jan. 24, 2017. 5. Hall P, Weaver L. Interdisciplinary education and teamwork: a long and winding road. Med Educ 2001;35:86775.

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April 2017 CE — Interprofessional Education Update

March/April 2017

April 2017 — Interprofessional Education Update: 2016 IPEC Competencies and ACPE Standards 2016 1. The Institute of Medicine reports To Err is Human and Crossing the Quality Chasm shed light on all of the following EXCEPT: A. Poor health care quality. B. Fragmentation of care. C. Widespread use of electronic health records as the problem. D. Need for increased coordination among health care providers.

6. Differences between 2011 and 2016 IPEC Competencies include all of the following EXCEPT: A. 2011 Competencies were written by six health professions programs, whereas the 2016 version was written by 15 different programs. B. Addition of a new set of competencies relating to Values and Ethics in the 2016 version. C. 2016 Competencies were broadened to emphasize population health, thus better aligning with IHI’s Triple Aim. D. 2011 Competencies had four domains while the 2016 version grouped all the competencies under a single domain entitled “Interprofessional Collaboration”.

2. Interprofessional team-based patient care is associated with all the following EXCEPT: A. Improved patient outcomes. B. Decreased cost of care. C. Decreased negative outcomes and adverse events. D. Neutral impact on professional satisfaction.

7. All of the following concepts are included in ACPE Standards 2016 EXCEPT: A. Interprofessional competence is an essential competence needed by all Doctor of Pharmacy graduates, regardless of future practice site. B. The primary emphasis of ACPE IPE Standard 11 is on pharmacist interactions with physicians. C. IPE skills include effective verbal and written communication. D. A portion of experiential education opportunities must allow face to face interaction and shared decision-making between student pharmacists, prescribers, and other healthcare team members.

3. According to the IHI, which of the following is required to achieve the Triple Aim? A. Transformation of health care delivery models first, followed by health education reform B. Health education reform as the primary focus recognizing that future practitioners will change health care delivery models in the future C. Concurrent transformation of health care delivery models and health education reform D. None of the above are recommended by IHI 4. Which of the following is FALSE regarding the World Health Organization’s philosophy on collaborative practice? A. Collaborative practice occurs when one or more health care professionals work in the same clinic. B. Collaborative practice is characterized by interdependency across professions. C. Collaborative practice is characterized by shared decision making. D. Collaborative practice is cultivated when students from two or more professions learn about, from and with each other through IPE.

8. According to the ACPE Standards, none of the IPE opportunities may be obtained through simulations. A. True B. False

9. Ideal characteristics for an introductory, earlyprofessional IPE experience include all of the following components EXCEPT: A. Learning objectives aligned with the IPEC Core Competencies. B. Learning objectives which focus on effective team skills. C. Learning objectives which require the application of 5. The primary purpose of the IPEC Competencies is to clinical knowledge. encourage consistency across various health D. Learning objectives which complement ACPE professions education programs. Standards. A. True B. False 10. Which of the following statements is consistent with ACPE Standards 2016? A. Interprofessional team dynamics should be introduced in the didactic curriculum, reinforced in IPPE and practiced in APPE. B. Interprofessional team dynamics should be introduced and reinforced in the didactic curriculum and practiced in IPPE and APPE. C. Interprofessional team dynamics should be introduced in IPPE and practiced in APPE. D. Interprofessional team dynamics should be introduced, reinforced and practiced in the didactic and IPPE components; competency should be demonstrated in APPE.

Send potential continuing education topics to Scott Sisco at ssisco@kphanet.org

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April 2017 CE — Interprofessional Education Update

March/April 2017

This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 96 C Michael Davenport Blvd., Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile. Expiration Date: March 15, 2020 Successful Completion: Score of 80% will result in 1.0 contact hour or .1 CEUs. Participants who score less than 80% will be notified and permitted one re-examination. TECHNICIANS ANSWER SHEET. April 2017 — Interprofessional Education Update: 2016 IPEC Competencies and ACPE Standards 2016 (1.0 contact hour) Universal Activity # 0143-0000-17-004-H04-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B

9, A B C D 10. A B C D

Personal NABP eProfile ID #_____________________________ Birthdate ____________(MM/DD) PHARMACISTS ANSWER SHEET April 2017 — Interprofessional Education Update: 2016 IPEC Competencies and ACPE Standards 2016 (1.0 contact hour) Universal Activity # 0143-0000-17-004-H04-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B

9, A B C D 10. A B C D

Quizzes submitted without NABP eProfile ID # and Birthdate will not be accepted.

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Campaign for Kentucky’s Pharmacy Future

March/April 2017

The Campaign for Kentucky’s Pharmacy Future Donation Levels for KPhA and KPERF Building Fund Campaign Diamond Bowl of Hygeia Platinum Bowl of Hygeia Gold Bowl of Hygeia Silver Bowl of Hygeia Bronze Bowl of Hygeia E.M. Josey Memorial Cornerstones Builders Brick Layers

$100,000+ $75,000-$99,999 $50,000-$74,999 $25,000-$49,999 $10,000-$24,999 $5,000-$9,999 $2,500-$4,999 $1,000-$2,499 $1-$999

Pledges can be paid over 5 years. Gifts made to KPERF are tax deductible to the extent allowable by law. http://www.kphanet.org/?page=buildingcampaign or call 502-227-2303.

Pharmacists Mutual Insurance offers Medicare Surety Bond In 2009 the Centers for Medicare and Medicaid Services (CMS) implemented Surety Bond Requirements for suppliers of Durable Medical Equipment, Prosthetics and Supplies (CMS-6006-F). This ruling requires that each existing supplier must have a $50,000 surety bond to CMS.

the bond from $1,500 down to $250 for qualifying risks. To see if you qualify for a $250 Medicare Surety Bond, or would like information regarding our other products, please contact us:   

Pharmacists Mutual Insurance Company, through its subsidiary PMC Advantage Insurance Services, Inc. d/b/ a Pharmacists Insurance Agency (in California), led the way to meet this requirement by negotiating the price of 

Call 800.247.5930 Extension 4260 E-mail medbond@phmic.com Contact a Pharmacists Mutual Field Representative or Sales Associate http://www.phmic.com/phmc/ services/ibs/Pages/Home.aspx In Kentucky, contact Bruce Lafferre at 800.247.5930 ext. 7132 or 502.551.4815

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KPhA Pharmacy Emergency Preparedness

March/April 2017

Volunteer Volunteer Volunteer Pharmacist, pharmacy technician and student pharmacist recruitment is still underway for the Kentucky Pharmacists Association emergency preparedness program! Pharmacy professionals play a critical part in responding to emergency events such as a natural disaster or infectious disease outbreak. You may sign up as a volunteer on the KPhA website, completing a volunteer form below or simply sending an email directly to info@kphanet.org. Please join the emergency preparedness program and help to recruit other volunteers! We need all of you! For more information on how you can be involved in the KPhA Pharmacy Emergency Preparedness Initiative, contact KPhA at 502-227-2303 or by email at info@kphanet.org.

For more resources, visit YOUR www.kphanet.org and click on Resourcesâ&#x20AC;&#x201D;Emergency Preparedness.

KPhA Pharmacy Emergency Preparedness Volunteer Form Name: __________________

____

Status (Pharmacist, Technician, Student): ___________________

Mailing Address: ________________________________________City: __________________ State: _________ Zip: ___________ Email: _______________________________________ Phone: ________________________ County:

_______

T-Shirt size: ______________

Interest in serving as a Volunteer District Coordinator: Yes____ No _____ You also may join the Medical Reserve Corps by following the KHELPS link on KPhA Website to register (www.kphanet.org under Resources) Please send this information to KPhA via email at info@kphanet.org, fax to 502-227-2258 or mail at KPhA, 96 C Michael Davenport Blvd., Frankfort, KY 40601.

Donate online to the Kentucky Pharmacists Political Advocacy Council! Go to www.kphanet.org and click on the Advocacy tab for more information about KPPAC and the donation form.

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139th KPhA Annual Meeting & Convention

March/April 2017

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KPhA New and Returning Members

March/April 2017

KPhA Welcomes New and Renewing Members January-February 2017 Ann Abbott Louisville

Ryan Bussell Frankfort

Catherine Elmes Sarasota, Fla.

Cathy Adams Pineville

Amber Cann LaGrange

Paul Elmes Sarasota, Fla.

Gregory Aldridge Eddyville

Emily Caporal Cincinnati, Ohio

Kay Embrey Brandenburg

Karen Altsman Prospect

Shelia Carrico Lawrenceburg

Tony Esterly La Grange

Lisa Babb Guston

Carolyn Chou Louisville

Rebecca Farney Fort Thomas

Nathan Bales Frankfort

Carrie Christofield Ft Mitchell

Scott Ferguson Lexington

To YOU, To YOUR Patients To YOUR Profession!

Cathy Barker Flatwoods

David Clarke Lexington

Lindsay Ferrell Salt Lick

Lisa Goodlett Springfield

Jason Beals Louisville

Peter Cohron Henderson

Lindsey Flanders Bowling Green

Stephen Goodlett Lexington

Danny Bentley Russell

David Collins Mayfield

Matthew Flanders Bowling Green

Charles Gore Russell Springs

Stephen Blanford Louisville

William Conyers Glasgow

Matthew Foltz Villa Hills

Cynthia Gray La Grange

Gregory Blank Edgewood

Karen Cornelius Harrogate, Tenn.

John Fuller Versailles

Bernard Gregorowicz Prospect

Sean Boyle Louisville

Chad Corum Manchester

Lynn Fuller Versailles

David Guion Russellville

Erika Branham Versailles

Shana Crain Shelbyville

Randy Gaither Louisville

Dale Gunkel Madisonville

Jackson "Mac" Bray Frankfort

Lourdes Cross Louisville

Darrel Gentry Central City

Brandon Hale Murray

Larry Bright Campbellsville

Matt Cull Owenton

Elizabeth Gentry Central City

Catherine Hance Louisville

Amy Brown Greenup

Helen Danser Tyner

John Gentry Central City

Deborah Harden Campbellsville

Jeremy Bryson Louisville

Kecia Dawson Prospect

Mary Gilvin Mt. Sterling

Amanda Harding Louisville

Robert Bunting Alexandria

Eldon Depew London

Michael Goeing Melvin

David Harris Mayfield

Amanda Burton Danville

Emily Distler Louisville

Robert Goforth Somerset

Leanne Head Richmond

MEMBERSHIP MATTERS:

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KPhA New and Returning Members

March/April 2017

Daniel Hein Cincinnati, Ohio

Kevin Lamping Lexington

Ronald Moreland Falmouth

Sarah Raake Palmyra, Ind.

Jessica Hemmer Fort Thomas

Carl Lewis Owensboro

Jerri Murphy Louisville

Christi Ratliff Pikeville

Jolinda Henry Lexington

Martin Likins Greenville

Patrick Murphy Louisville

Clay Rhodes Crestwood

Larry Hill Williamsburg

Michael Lin Louisville

Anna New Owenton

Jill Rhodes Crestwood

Tashena Hill Marion

Julie Losch Bowling Green

Darvin Ngo Campbellsville

Laura Roberts Albany

Barry Horne Danville

Philip Losch Bowling Green

Kenneth Niemann Harrodsburg

Scott Ross Hopkinsville

Tawnya Hunt Greenup

Laura Madison Paducah

LeAnne Nieters Louisville

Thomas Russell Independence

John Hutchinson Lexington

Craig Martin Georgetown

Jenna Noetzel Lexington

Melody Ryan Lexington

Jane Ingram West Liberty

Tom Mattingly Olive Hill

Charles Oliver Glasgow

Lisa Sawvell LaGrange

Paul Jardina Louisville

Nancy Matyunas Louisville

Peter Orzali Cold Spring

Larry Schaefer Madisonville

Amanda Jett Louisville

James Maze Salt Lick

Beth Parks Coralville, Iowa

Jim Scott Earlington

Dale Johnson Corbin

Okey Mbadike Louisville

Kenneth Parsons Louisville

Scotty Sears La Grange

Jessica Johnson Louisville

Leeann McDonald Dunnville

Himati Patel Louisville

Catherine Shely Morehead

Diane Kelly Evarts

Charles McQuillan Florence

George Patterson Gilbertsville

Michael Sizemore Pittsburg

Rene Kendrick Taylorsville

Beverly Meeks Paducah

Sam Pilotte Prospect

Roberta Sloan Lexington

Christopher Killmeier Louisville

Ross Melton Mount Sterling

Anne Policastri Georgetown

Richard Slone, Jr. Lexington

John Knoop Louisville

Michael Montgomery Nicholasville

Bruce Polly Lexington

Sheel Slone Lexington

David Kramp Elmwood Place, Ohio

Pam Montgomery Lawrenceburg

Vicky Pulliam Bardstown

Sharon Small Louisville

KPhA Honorary Life Members Ralph Bouvette, Leon Claywell, R. David Cobb, Gloria Doughty, Ann Amerson Mazone, Kenneth Roberts

Justin Smith Williamsburg Vance Smith Harrodsburg

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Pharmacy Time Capsules

March/April 2017

Stephanie Southern Paducah

Angela Tracy Louisville

Karen White Lewisburg

Janet Stephens Scottsville

Michael Traylor Princeton

Beverly White Williamsburg

Robert Stone Glasgow

Andrew Tsapatsaris Hixson, Tenn.

Nina Whitehouse Lexington

Paula Straub Louisville

Sheryl Turley Horse Cave

Paul Williams Hardinsburg

Anthony Tagavi Louisville

John Turpin Harrogate, Tenn.

Brenda Wilson Danville

Meghan Tarter Russell Springs

Rob Warford Louisville

Kerri Woods Hamilton, N.Y.

Fred Toncray Maysville

Brian Wesselman Florence

Grady Wright Georgetown

Todd Toole Louisville

Tyler Whisman Union

Dan Yeager Lexington

Jane Yeager Lexington

Know someone who should be on this list? Ask them to join YOU in supporting OUR KPhA!

Pharmacy Time Capsules 2017 (First Quarter) 1992  The American Association of Colleges of Pharmacy (AACP) passed a resolution supporting a single entry level professional degree.  Psychiatric pharmacy recognized as a specialty by the Board of Pharmacy Specialties (BPS). 1967  Donald Brodie articulated the concept of drug use control which would become the central precept of clinical pharmacy and later pharmaceutical care. 1942  American Foundation for Pharmaceutical Education incorporated in 1942 to provide financial support to colleges of pharmacy in need during World War II and later finance the Elliott Report. 1892  Original passage of Utah Pharmacy Practice Act.  University of Minnesota College of Pharmacy founded by Dean Wulling. By: Dennis B. Worthen, PhD, Cincinnati, OH One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America's history. Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year. To learn more, check out: www.aihp.org

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KPhA Government Affairs Contribution

March/April 2017

KPhA Government Affairs Contribution Name: _______________________________Pharmacy: _____________________________

Email: ______________________________________________________________ Address: _____________________________________________________________ City: ___________________________________________ State: _________ Zip: ____________ Phone: ________________ Fax: __--_______________ E-Mail: _____________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPhA Government Affairs)

Mail to: Kentucky Pharmacists Association, 96 C Michael Davenport Blvd., Frankfort, KY 40601

KPhA sends email announcements weekly. If you arenâ&#x20AC;&#x2122;t receiving: eNews, Legislative Updates, Grassroots Alerts and other important announcements, send your email address to ssisco@kphanet.org to get on the list.

Kentucky Pharmacists Political Advocacy Contribution Form Name: _________________________________ Pharmacy: ___________________________ Address: _______________________ City: ________________ State: _____ Zip: ________ Phone: ________________ Fax: __--_______________ E-Mail: __________________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPPAC)

Mail to: Kentucky Pharmacists Political Advocacy Council, 96 C Michael Davenport Blvd., Frankfort, KY 40601

CONTRIBUTION LIMITS The primary, runoff primary and general elections are separate elections. The maximum contribution from a PAC to a candidate or slate of candidates is $1,000 per election.

Cash Contributions: $50 per contributor, per election. Contributions by cashierâ&#x20AC;&#x2122;s check or money order are limited to $50 per election unless the instrument identifies the payor and payee. KRS 121.150(4)

Individuals may contribute no more than $1,500 per year to all PACs in the aggregate.

Anonymous Contributions: $50 per contributor, per election, maximum total of $1,000 per election.

In-kind contributions are subject to the same limits as monetary contributions.

(This information is in accordance with KRS 121. 150)

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Pharmacy Policy Issues

March/April 2017

PHARMACY POLICY ISSUES: BARRIERS ASSOCIATED WITH IMPLEMENTATION OF HIV PRE-EXPOSURE PROPHYLAXIS (PREP) PART 2 Author: Matthew Westling, a native of Hilliard, Ohio, is a PY1 student at the University of Kentucky College of Pharmacy. He completed his pre-professional education at UK as a chemistry major. Issue: I heard a discussion regarding implementation of Pre-Exposure Prophylaxis (PrEP) as an approach to further containing the transmission of HIV. The concept of using PrEP is controversial and generates a great deal of discussion. Several barriers to implementation exist. What is all that about? the testing that requires the most visits to the doctor’s office per year This column is designed to is only logical. However, challenges address timely and practical arise concerning HIV screening such issues of interest to pharmacists, as cost and pharmacists’ knowledge pharmacy interns and pharmacy and awareness. A cross-sectional technicians with the goal being to survey of 173 New Mexico pharmaencourage thought, reflection and cists found that although nearly all exchange among practitioners. pharmacists understood how HIV Suggestions regarding topics for medications worked and the source consideration are welcome. Please of infections, there was a clear need send them to jfink@uky.edu. for improvement on the education of HIV screening and testing. However, this problem seemed to decrease as the pharmacists’ age As previously emphasized, a major barrier associated with decreased.3 PrEP is cost. However, other barriers such as access to care and physician/pharmacist attitudes and knowledge Contrary to this finding, another study reported that impleregarding the medications available still exist. In Kentucky, mentation of pilot HIV screening programs in pharmacies there is only one primary care provider and 1.1 pharmaacross the nation showed a positive ability to tap into the 1 cists for every 1,000 people. This shortage of health care potential of the local pharmacy with only a small amount of providers results in challenges when patients try to access effort. With simple objectives, by obtaining the necessary care, especially with regard to continuous therapy manwaivers, and by providing the necessary training sessions, agement that is required for the use of PrEP medications this study was able to successfully implement HIV testing such as Truvada® (emtricitabine/tenofovir). The 2014 CDC in 21 pharmacies, 17 of which planned to continue the serClinical Guidelines for the use of PrEP indicate that all pa- vice.4 tients receiving PrEP should receive HIV screening, pregOne pharmacy in Seattle, Wash., has successfully implenancy testing and medication adherence monitoring every mented what they call a “One-Step PrEP” program in the three months. In addition patients’ renal function should be hope of breaking down associated barriers and stigma. In monitored (Serum creatinine) and a complete Sexually this program, selected pharmacies provide 45 minute conTransmitted Infection (STI) screening should occur every 6 sultations where a pharmacist assesses the need for months.2 In certain areas where health care providers are PrEP, processes laboratory work and explores payment at a minimum, pharmacists can play a pivotal part in the options.5 Through collaborative care agreements and apspectrum of this continuing care. propriate processes, patients can then be prescribed PrEP One way pharmacists can assist in this care is by providing at the pharmacy. All this can occur within one hour. This HIV and pregnancy testing as well as through medication eliminates waiting times associated with provider appointadherence assessments. Since pharmacies are more ments and laboratory work. Since the pharmacists also readily accessible than physicians’ offices in locations help research payment methods, most patients receive throughout Kentucky, the idea of pharmacies conducting some financial consideration there as well. Since most paDiscussion: In the January installment of this column, issues surrounding HIV Pre-Exposure Prophylaxis (PrEP) in rural areas including portions of Kentucky were discussed. Some have suggested that community pharmacists play a stronger role in the distribution of information regarding PrEP and the continuity of care needed to maintain effective drug therapy. This installment will focus on how community pharmacists might assist with certain aspects of PrEP.

Have an Idea?

THE KENTUCKY PHARMACIST

Pharmacy Policy Issues

March/April 2017

tients are coming to the pharmacy to pick up other medica- References: tions, assessment of adherence can be more easily and 1. Kentucky Health Facts, The Foundation for a Healthy efficiently accomplished. The pharmacy providers report Kentucky, Louisville, KY. www.kentuckyhealthfacts.org. that costs for this program break even within 12 months. As 2. United States of America. Department of Health and of December 2015, all patients receiving these services 6 Human Services. Center for Disease Control and Prehave remained HIV negative. vention. Preexposure Prophylaxis for the Prevention of One significant issue some pharmacies might find with imHIV Infection in the United States: A Clinical Practice plementing a similar program is a possible shift in the attiGuideline. Atlanta, GA: Centers for Disease Control tude of the public in the community surrounding the pharand Prevention, 2014. Print. macy about the people being served there, since some people might not see HIV as a public health issue.7 An ide- 3. Pineda LJ, Mercier TD, Iandiorio M, Rankin S, and Jakeman B. "Evaluating Community Pharmacists' HIV ally direct way to address this problem is to make programs Testing Knowledge: A Cross-sectional Survey." Journal like this so common that people do not think twice about it. of the American Pharmacists Association. 2015(JulyHowever, programs like this are unlikely to appear rapidly Aug); 55:424-28. Print. due to the time and effort required for implementation. Another way to break down stigmas is through social campaigning regarding HIV and its impact as a public health disease that affects all segments of society. This is especially critical in states such as Kentucky where significant transmission occurs through injection drug abuse. This being said, the pharmacist is often a direct source of health care information for the general population and can be used in the best ways to help launch campaigns against stigma and for the health of the people they serve. Overall, the community pharmacist is in a good position to help implement a strong tool against HIV through testing, education and providing access to services in areas that are otherwise hard for health care providers to reach. Not only is implementing PrEP services in community pharmacies a good stepping stone for expanding access to care but it also can help decrease the spread of this disease throughout the state.

4. Weidle PJ, Lecher S, Botts LW, Jones L, Spach DH, Alvarez J, Jones R, and Thomas V. "HIV Testing in Community Pharmacies and Retail Clinics: A Model to Expand Access to Screening for HIV Infection." Journal of the American Pharmacists Association. 2014(SeptOct); 54:486-92. Print. 5. Salazar D. "Seattle Pharmacy Shares Preliminary OneStep PrEP Pilot Results." Drug Store News, 04 Dec. 2015. Web. 23 Jan. 2017. 6. Ross M. "4 Findings from a Successful HIV PrEP Program." Pharmacy Times. Pharmacy Times, 29 Dec. 2015. Web. 23 Jan. 2017. 7. Bland S. “Blueprint for HIV Biomedical Prevention: State of the State.” The O’Neill Institute, NMAC. http://www.law.georgetown.edu/oneillinstitute/research/ blueprint.cfm.

Laffarre wins Top Life Sales Award Bruce Lafferre, Kentucky Field Representative, was presented the 2016 Top Life Sales Award by Pharmacists Mutual Companies. This award recognized the Field Representative or Coverage Advisor having the highest life production total for the Pharmacists Life Insurance Company and PMC Advantage Insurance Services. Lafferre received his award at the 2017 Annual Sales Meeting in February.

THE KENTUCKY PHARMACIST

Pharmacy Law Brief

March/April 2017

Pharmacy Law Brief: The L.L.C. Form of Business Organization

Author: Joseph L. Fink III, B.S. Pharm., J.D., Professor of Pharmacy Law and Policy and KPhA Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy Question: Businesses organized as L.L.C.s rather than the traditional sole proprietorship, partnership or corporation seem to be popping up all over. What is an L.L.C. and how is it different from those other traditional ways of legal organization for a business?

Submit Questions: jfink@uky.edu Disclaimer: The information in this column is intended for educational use and to stimulate professional discussion among colleagues. It should not be construed as legal advice. There is no way such a brief discussion of an issue or topic for educational or discussion purposes can adequately and fully address the multifaceted and often complex issues that arise in the course of professional practice. It is always the best advice for a pharmacist to seek counsel from an attorney who can become thoroughly familiar with the intricacies of a specific situation, and render advice in accordance with the full information.

Response: You are indeed correct – the L.L.C. has rapidly become the most popular legal organizational form for businesses. It has some advantages over the other organizational forms and eliminates some of the disadvantages of the traditional approaches. Let’s begin with a brief review of some facets of those traditional approaches: 



Sole Proprietorship – All income of the business is considered taxable income to the owner. Also, there is no insulation of the owner’s personal assets from being used to satisfy debt obligations of the business.

single owner business; income from business operations is taxed at the individual’s tax rate.

Corporation – This business form does insulate the personal assets of the owners from debts of the business but also does subject the profits to double taxation, i.e., taxation of the profits of the business entity as a corporation and then taxation again at the personal level when those profits are distributed to the shareholders. Moreover, there are many formal legal operational requirements imposed on corporations that do not exist for L.L.C.’s.

business organization can be traced to legislation enacted in Wyoming during 1977.

Another possible advantage is that members have their liability exposure limited through the L.L.C. business organPartnership – All general partners have equal authori- izational form. So one’s personal assets can be insulated ty to bind the business organization to contracts, finan- from financial liabilities of the firm. cial obligations, etc. Moreover, there is joint and sever- L.L.C.s trace the roots of their core concepts or principles al liability for debts of the business, meaning that the to European legislation from the late 1800s as well as a partners may be held liable either individually or togeth- statute enacted in Pennsylvania during 1872. The contemer or both. porary movement to popularize use of the L.L.C. form of

In contrast, an L.L.C. has profits only taxed once, at the level of each individual, plus selection of the L.L.C. form of business organization insulates the owners’ personal assets from being used to satisfy debts of the business enterprise. Moreover, through an operating agreement crafted by the founders, an L.L.C. can get greater operational flexibility. That operating agreement may contain fewer requirements for legal formalities than would be seen with the corporate form, resulting in diminished administrative paperwork expectations and legally mandated recordkeeping. The L.L.C. organizational form may be a good match for a

A final word about appropriate lingo is necessary. An L.L.C. is a Limited Liability Company, not a Limited Liability Corporation as will so often be heard. Further, those who hold an ownership interest in an L.L.C. are referred to as members, not as shareholders or partners. The managing member is one of the owners who participates in the day-to-day management of the operation and who has authority to contract on behalf of the firm. And finally, it is possible to have an L.L.C. organized on a nonprofit basis, say for a charitable organization, but with the principal advantage of this business organizational form relating to taxation it is no surprise that one sees few nonprofits organized this way. Organizations operated on a not-for-profit basis don’t pay taxes on “profits.” A related business organizational form is the professional limited liability company or P.L.L.C. This organizational form can be organized by an individual or group of practitioners who will provide professional services requiring a

THE KENTUCKY PHARMACIST

March/April 2017

Pharmacy Law Brief license granted by Kentucky. This should be contrasted with a business organizational form that has been around longer, the professional service corporation (P.S.C.). As the name indicates, this is a corporation, not a limited liability company. Both organizational forms – P.L.L.C. and P.S.C. – are recognized in Kentucky but the former may have the advantages of being easier to launch and to operate. One final point is deserving of mention. While not encountered in Kentucky, some other states have a category of business organizational form known as a Professional Association. This results in the firm being known as XYZ, P.A.

It was the prior existence of that abbreviation for a business organizational form that led during the second half of the last century to the evolving occupation of physician assistant to adopt its professional abbreviation as P.A.-C. to represent Physician Assistant-Certified rather than merely using P.A. The choice of organizational form for operating a business is a complex, multi-faceted decision with numerous subtle nuances. That is a decision that should be made following consultation with legal counsel familiar with all the advantages and disadvantages of each business organizational form.

To kick off the 139th KPhA Annual Meeting & Convention, join us for the

KPERF GOLF SCRAMBLE Griffin Gate Marriott Resort Golf Course on June 22, 2017! Scramble begins at Noon EDT SHOTGUN START Griffin Gate Marriott Resort Golf Club, 1800 Newtown Pike, Lexington, KY 40511 Don’t miss this opportunity to support the Kentucky Pharmacy Education & Research Foundation and KPhA and join friends, new and old, for an afternoon of fun and networking. Prizes will be awarded and beverages will be available on course. Two drink tickets per golfer are included in the registration fee.

The Kentucky Pharmacy Education & Research Foundation (KPERF) is the tax-exempt charitable foundation formed by the Kentucky Pharmacists Association. Entry Fee:

Individual $100

Team $400

Hole Sponsor

REGISTRATION DEADLINE JUNE 15, 2017!

$150 ONE ENTRY FORM PER TEAM PLEASE

Team Name: _______________________________________ $400 Team

Player 1_________________________

Player 2__________________________

Player 3_________________________

Player 4__________________________

PLEASE MAKE CHECKS PAYABLE TO KPERF and SUBMIT PAYMENT TO: KPERF Golf Scramble, 96 C Michael Davenport Blvd., Frankfort, KY 40601

OR Individual:_________________________

Individual:_________________________

$100

Hole Sponsor:____________________________________________________ $150

(Text for Sign)

To pay by credit card, go to www.kphanet.org and register online, or call 502-227-2303

TOTAL $_____________

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March/April 2017

Pharmacists Mutual

THE KENTUCKY PHARMACIST

Cardinal Health

March/April 2017

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KPhA Board of Directors/KPERF Board of Directors

KPhA BOARD OF DIRECTORS

March/April 2017

HOUSE OF DELEGATES

Chris Clifton, Villa Hills chrisclifton@hotmail.com

Chair

Lance Murphy, Louisville lancemurphy84@gmail.com

Speaker of the House

Trish Freeman, Lexington trish.freeman@uky.edu

President

Amanda Jett, Louisville ajett@sullivan.edu

Chris Harlow, Louisville cpharlow@gmail.com

President-Elect

KPERF BOARD OF DIRECTORS

Brooke Hudspeth, Lexington brooke.hudspeth@kroger.com

Vice Speaker of the House

Chair

Secretary

Duane Parsons, Richmond dandlparsons@roadrunner.com

Secretary

Chris Palutis, Lexington chris@candcrx.com

Treasurer

Clark Kebodeaux, Lexington clark.kebodeaux@uky.edu

Treasurer

Jessika Chinn, Beaver Dam jessikachilton@ymail.com

Past President Representative

Chris Palutis, Lexington chris@candcrx.com

KPhA President

Directors

Trish Freeman, Lexington trish.freeman@uky.edu

Matt Carrico, Louisville* matt@boonevilledrugs.com

Paul Easley, Louisville rpeasley@bellsouth.net

Kevin Chen, Lexington kevin.chen@uky.edu

University of Kentucky Student Representative

Melinda Joyce, Bowling Green MBJoyce@chc.net

Chad Corum, Manchester pharmdky21@gmail.com

Bob Oakley, Louisville Boakley@BHSI.com

Matt Foltz, Villa Hills mfoltz@gomedcare.com

Kelly Smith, Lexington ksmit1@email.uky.edu

Cathy Hance, Louisville cathy@compoundcarerx.com

KPERF ADVISORY COUNCIL Christen S Bruening, Cincinnati, Ohio cmschenkenfelder@gmail.com

Cassy Hobbs, Louisville cbeyerle01@gmail.com Katherine Keeney, Louisville kkeene6675@my.sullivan.edu Chris Killmeier, Louisville cdkillmeier@hotmail.com Jeff Mills, Louisville jeff.mills@nortonhealthcare.org Richard Slone, Hindman richardkslone@msn.com

Sullivan University Student Representative

Matt Carrico, Louisville matt@boonevilledrugs.com Kim Croley, Corbin kscroley@yahoo.com Kimberly Daugherty, Louisville kdaugherty@sullivan.edu Mary Thacker, Louisville mary.thacker@att.net

KPhA/KPERF HEADQUARTERS

96 C Michael Davenport Blvd., Frankfort, KY 40601 502.227.2303 (Phone) 502.227.2258 (Fax) www.kphanet.org * At-Large Member to Executive Committee www.facebook.com/KyPharmAssoc ** On Leave from Board while serving as Interim Executive www.twitter.com/KyPharmAssoc www.twitter.com/KPhAGrassroots Director www.youtube.com/KyPharmAssoc Sam Willett, Mayfield** willettsam@bellsouth.net

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50 Years Ago/Frequently Called and Contacted/KPhA Staff

March/April 2017

50 Years Ago at KPhA PHARMACY BUILDING PROGRAM In the March issue of The Kentucky Pharmacist we gave you a resume of the progress of the building program. With a goal of $80,000.00, we are now nearing the half way mark with contributions to April 1 totaling $37,889.67, which includes interest on treasury notes. On March 23rd the building committee met in Louisville and decided to send a letter to those who have pledged, asking for a full or partial fulfillment of the pledge. The committee also decided that we could not consider starting on the building until we have at least two-thirds of the necessary funds. The following letter has been received in the office and we feel it should be printed for all of you to read: “Dear Sir: Please accept this donation as a small token of appreciation for all the profession has done for me in the past, what it is doing for me at present, and what I hope to gain in the future. I also have a nephew Philip Ray Clark, who will graduate form U. of K. Pharmacy School in May—a daughter, Nora Clark, just beginning her pre-pharmacy in June at Eastern. I hope all pharmacists respond to this call. Thank you, Edford L. Clark, Martin, Ky.” - From The Kentucky Pharmacist, April 1967, Volume XXX, Number 4.

Frequently Called and Contacted Kentucky Pharmacists Association 96 C Michael Davenport Blvd. Frankfort, KY 40601 (502) 227-2303 www.kphanet.org Kentucky Board of Pharmacy State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601 (502) 564-7910 www.pharmacy.ky.gov Kentucky Regional Poison Center (800) 222-1222

Pharmacy Technician Certification Board (PTCB) 2215 Constitution Avenue Washington, DC 20037-2985 (800) 363-8012 www.ptcb.org

American Pharmacists Association (APhA) 2215 Constitution Avenue NW Washington, DC 20037-2985 (800) 237-2742 www.aphanet.org

Kentucky Society of Health-System Pharmacists P.O. Box 4961 Louisville, KY 40204 (502) 456-1851 x2 (502) 456-1821 (fax) www.kshp.org info@kshp.org

National Community Pharmacists Association (NCPA) 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 info@ncpanet.org

KPhA Staff Sam Willett, RPh Interim Executive Director swillett@kphanet.org Scott Sisco, MA Director of Communications & Continuing Education ssisco@kphanet.org

Drug Information Center SUCOP 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu

KPhA Remembers KPhA desires to honor members who are no longer with us. Please keep KPhA informed by sending this information to eramey@kphanet.org. Deceased members for each year will be honored permanently at the KPhA office.

Angela Gibson Director of Membership & Administrative Services agibson@kphanet.org Elizabeth Ramey Receptionist/Office Assistant eramey@kphanet.org 47

THE KENTUCKY PHARMACIST

March/April 2017

THE

Kentucky PHARMACIST 96 C Michael Davenport Blvd. Frankfort, KY 40601

THE KENTUCKY PHARMACIST