1 Career Pearls: Days in the Lives of Health System Pharmacists Shhhhhhh #ASHPmidyear Who are Health System Pharmacists? Education B.S. or Pharm.D. Licensure Post Graduate Training Residencies and Fellowships Residencies: PGY 1 and/or PGY 2 Fellowships: Industry or Research Masters Programs Business Administration Hospital Administration Public Health Doctoral Programs (Ph.D.) 1
2 Where do Health System Pharmacists Practice? Hospitals Ambulatory Care Clinics Home Care Long term Care Facilities Health Maintenance Organizations Universities and Academic Health Centers Government and Uniformed Services Other components of the health system What do Health System Pharmacists do? Recommend safe and effective therapy Assist in the management and prevention of medication errors Advise physicians and other health care practitioners Counsel patients and caregivers on proper medication use Supervise medication storage, dispensing and distribution Maintain medication supplies Why Health System Pharmacy? Health system pharmacy allows for: Collaborative approach to medication management Hands on decision making Direct patient care Provides pharmacists with opportunities to meet the challenges of today s health care environment while advancing the pharmacy profession 2
3 PEARLS Goal provide you with pearls of wisdom (we wish we would have known) to help with you select the best career path for you! Group 1 Critical Care Specialist: Stacey Folse, PharmD, MPH, BCPS Management and Administration: Michael Nnadi, PharmD, MHS Academia: Lindsey Elmore, PharmD, BCPS Pediatric Specialist: Lisa M. Lubsch, PharmD, AE C Small/Rural Hospital Practice: Debbie Cameron Sisson, RPh, MS, PharmD OR/Anesthesia Specialist: Christopher G. Murray, PharmD, MS Clinical Specialist Stacey L. Folse, PharmD, MPH, BCPS Clinical Pharmacy Specialist, MICU 3
4 About Me Stacey L. Folse Credentials : MPH, PharmD, BCPS Position/Title : Medical ICU Clinical Pharmacy Specialist and PGY 2 Critical Care Residency Director Organization : Emory University Hospital Primary Specialty : Medical Intensive Care Unit Other Specialties : Critical Care Overview of Clinical Specialist Education/Training Required Doctor of Pharmacy Mercer University School of Pharmacy and Health Sciences in Atlanta, GA in 2005 Post Graduate Training PGY 1 Residency at The Johns Hospital in Baltimore, MD in 2006 PGY 2 Critical Care Residency at Virginia Commonwealth University in Richmond, VA in Overview of Clinical Specialist Type of patient population served Sepsis Pneumonia Hypertensive crisis Alcohol withdrawal Diabetic ketoacidosis Complications of solid organ transplant Oncologic emergencies Drug overdose Pulmonary hypertension Asthma, COPD, and heart failure exacerbations Complications of cirrhosis Infectious disease 4
5 Overview of Clinical Specialist Responsibilities and Roles Clinical Round with multidisciplinary team Provide recommendations for patients pharmacotherapy regimens to other healthcare providers Speak with patients and families regarding patients home medications, allergies, and current drug therapy Educate physicians, medical and pharmacy residents and students, and nurses Overview of Clinical Specialist Responsibilities and Roles Administrative Member of institutional committees Develop and implement institutional protocols Research and Scholarship Conduct clinical research Involved in medical writing Advice for Students Pursuing this Career Path Have a passion for what you do and for learning Take advantage of every opportunity Find a mentor or mentors Pursue post graduate training Get involved with pharmacy organizations as a student and stay involved as a practitioner Constantly changing profession therefore stay current in the literature 5
6 Management and Administration Michael Nnadi, Pharm.D., MHS, D.Sc. (Hons) Corporate Vice President Pharmacy Services Novant Health About Me Position/Title: Corporate VP Pharmacy Services Organization: Novant Health (13 hospital health system) Presence in 3 states Primary Specialty: Pharmacy Administration Specialties: Provide leadership in core functional areas of pharmacy: People; Medication Safety; Clinical services Operation; Business development; Information technology Financial management; Regulatory compliance Pharmacy administration Education/Training Required BS, PharmD, MHA Leadership, financial management, human resources courses Type of patient population served All Responsibilities and Roles Provide leadership for 13 hospital pharmacies; ~3000 beds; >450 employees Roles Strategic planning Operation; Medication Safety; Clinical services Quality Assurance Business development; Information technology Financial management; Regulatory compliance 6
7 How I got here.. Hard work, Taking every opportunity to learn Set reasonable goals and deliver Held numerous positions Clinical manager; Director System director; Regional director Operation director; Consultant Senior Director And now VP Pharmacy Services Challenge myself and set the bar higher Passion for getting things done and for improvement Where do you start? Turn every opportunity into a learning experience Residency in pharmacy administration Get involved with ASHP section of pharmacy leaders MHA/ MBA with focus on health care administration will help Find role models or mentors Volunteer to lead or help with projects and do a good job Learn from your mistakes and improve Develop good relationships with the staff, your department leaders, hospital leaders, and possibly everyone Administration what else do I do? Care for my family ASHP section of pharmacy managers Teach at various schools of pharmacy Member of two schools of pharmacy dean s advisory board State pharmacy association (NCAP) Local university MBA/MHA program advisory board Local community colleges technician advisory boards 7
8 Advice for Students Pursuing Administration Have a passion for leadership Is a promise Process of moving a group of people in a direction that is in their long term best interest Develop personal goals and work hard to achieve them Never go on a journey unprepared Network with other leaders and peers Get involved with ASHP section of pharmacy practice leaders A leader has to have knowledge; also behavior. Your behavior says everything about you. Advice for Students Pursuing Administration Be humble Commit to life long learning Develop others as you grow Be willing to be challenged Ethical rightness Be persistently consistent Be resilient My Contact Information Michael Nnadi, Pharm.D., MHS, D.Sc (Hons) Corporate Vice President Pharmacy Services Novant Health 1900 S Hawthorne Road Suite 201 Winston Salem, NC Tel: C:
9 Academic Pharmacy Career Pearl Lindsey Elmore, PharmD, BCPS My Current Position McWhorter School of Pharmacy Private, Christian university in Birmingham, AL Assistant Professor of Pharmacy Practice Director of Community Pharmacy Residency Program 100% employed Practice Site FMS Pharmacy Independent community pharmacy in Bessemer, AL Part of a chain of 3 independent pharmacies Mostly Medicare, African American population My Training Graduated BS, Chemistry; University of Alabama Birmingham PharmD; University of California San Francisco Licensure Alabama, California, North Carolina Post Graduate Residency Training PGY1, Princeton Baptist Medical Center. Birmingham, AL PGY2, New Hanover Regional Medical Center. Wilmington, NC Certifications Board Certified Pharmacotherapy Specialist 27 9
10 How am I evaluated? Teaching Didactic teaching in the classroom and online Precepting at practice site Scholarship Published peer reviewed manuscripts Posters Invited platform question Service Much more nebulous Residency program direction, education of residents Care for ambulatory care patients, grant writing School, university, local, state, national committee work Where do I spend my time? Theoretical % Effort Actual % Effort Teaching Scholarship Service Teaching Scholarship Service What do I do during the day? 8:00 am 9:00 am 10:00 am Monday Tuesday Wednesday Thursday Friday Preceptor Series FMS Pharmacy 11:00 am 12:00 pm FMS Pharmacy FMS Pharmacy 1:00 pm IRB Committee 2:00 pm Lecture Department practice meeting P&T 3:00 pm session Meeting Conference Conference 4:00 pm Call Office Hours Call 5:00 pm Edits Edits FMS Pharmacy Headache Lecture #1 Meeting with students Proctor exam Interview P&T Planning Headache Lecture #1 Residency seminar 10
11 What does my to do list look like? Teaching Scholarship Service 1. Submit HA test questions 2. Motivational interviewing patient cases 3. Post office hours on online system 4. Teaching reflection 5. Trend data 1. Edit coconut oil paper 2. Write intro to HIV paper 3. Copyright release for preceptor paper 4. Submit slides for influenza talk 5. Grant due November Posters for next meeting 7. Peer review paper Other 1. Turn in time off, request additional time off for spring 2. Prep P&T dossier 3. Give ASHP rep $$ for t shirt 1. Edit resident abstract 2. Review IRB application 3. Edit APPE student blog post 4. Create 2 week objectives for 6 week rotation 5. Poll for residency dinner How do I become an academic pharmacist? Make connections early and often Complete residency training. Likely PGY1 and PGY2 Take advantage of opportunities to teach. Aim for diversity Get a few publications Ask for feedback about teaching style and content and evaluation questions Be persistent! Academic Pharmacy Career Pearl
12 Pediatric Pharmacy: all the Cool Kids do it Lisa Lubsch, PharmD, AE C About Me Lisa Lubsch, PharmD, AE C BCPPS coming soon (hopefully) Specialties are General Pediatrics, Pulmonology Pediatric Clinical Pharmacy Specialist, Cardinal Glennon Children s Medical Center Clinical Associate Professor, Southern Illinois University School of Pharmacy Overview of Pediatric Pharmacy Postgraduate year 1 accepted, postgraduate year 2 preferred Vast population to care for Neonates infants toddlers children adolescents Variety of specialties Neonatal Critical Care Nutrition Hematology / Oncology Infectious Disease Cardiology Pulmonology Transplant Ambulatory Care Leadership Other: safety, investigational, neurology, emergency 12
13 Advice for Students Pursuing this Career Path Get Involved, Get Involved, Get Involved Network Work Pharmacy Experience Volunteer Research Stop being boring and be on the path that leads to awesome ~ Kid President Small and Rural Hospital Pharmacist s Day Debbie Cameron Sisson About Me Debbie, R.Ph., M.S., Pharm.D. Pharmacist Grand Itasca Hospital, Grand Rapids Minnesota Generalist Volunteer Pharmacist at Project Care 13
14 Overview of Small and Rural Hospital Education/Training Required Small Town Neighbors, friends, coworkers Vacationers/Tourists Dispensing pharmacist, Infusion pharmacist, clinical pharmacist, ED Pharmacist, Peds pharmacist, IT pharmacist, anything that needs to get done pharmacist Advice for Students Pursuing this Career Path Be a team player Know your neighbors You are part of the healthcare community Get involved Be engaged Be flexible Keep in touch with your friends in BIG, Urban, hospitals Operating Room & Post anesthesia Care Unit Clinical Pharmacist Presenter: Christopher G. Murray, PharmD, MS 14
15 Christopher G. Murray About Me Credentials: PharmD, MS Position/Title: Manager, Perioperative Services Organization: Duke University Hospital Primary Specialty: Surgery and Anesthesia Overview of OR Clinical Pharmacist Education/Training Required PharmD/BSPharm Hampton University School of Pharmacy / William R. Harvey Leadership Institute University of North Carolina School of Pharmacy (Master of Science in Health System Pharmacy Administration) Optional Residency (PGY1 and/or PGY2) Type of patient population served Adult & pediatrics Elective procedures, trauma, transplant General, Ortho, Cardiac, Neuro, OHN, Plastics, Uro, Gyn, Eye Responsibilities & Roles Locations covered OR & PACU Offsite areas (ECT suite, EP, radiology [vascular/interventional]) Operational Drug distribution Sterile compounding preparation & checking Controlled substance reconciliation Clinical Order verification Non traditional rounding service Drug information resource Formulary and policy review Medication safety event reporting oversight Research 15
16 My Day At A Glance Morning Rush!!! Dispense drug kits Verify pre operative orders Dispense anesthesia specific drips and antibiotics Check automated dispensing cabinet (ADC) meds Provide dosing recommendations for patient specific compounding needs (IV acetaminophen, DDAVP, antibiotics) Check patient specific compounded products The Rest of the Day Reconcile controlled substances (ADC reports and product returns) Check sterile compounded batch Answer drug information questions What is the particle size of Hextend? Can you give lactated ringers with someone on a ketogenic diet? Advice for Students Pursuing this Career Path Predictably unpredictable Amenable to change Fast paced environment High tolerance for stressful situations Majority interactions are interdisciplinary (Anesthesia [ ologist, CRNAs, techs], Surgeons, OR nurses, PACU nurses, patients, family members) Group 1 Panel Discussion 16
17 Group 2 Oncology Specialist: Bradley Burton, PharmD, BCOP, CACP Ambulatory Care: Mary Ann Kliethermes, BS, PharmD Emerging Sciences Pharmacogenomics: Kristine Crews, Pharm.D., BCPS Emergency Medicine Specialist: Melinda J. Ortmann, PharmD, BCPS Informatics: David P. Mulherin, PharmD, BCPS Medication Safety: Jaclyn A. Jeffries, PharmD Oncology Pharmacy Presenter: Bradley Burton, PharmD, BCOP, CACP About Me Bradley Burton, PharmD, BCOP, CACP Position: Clinical Pharmacy Specialist Employer: The Johns Hopkins Hospital Primary Specialty: Medical Oncology Other Specialties: Oncology Anticoagulation 17
18 Required education: Pharmacy degree Residency experience (?) Overview of Oncology Population served: Adult inpatients and outpatients with solid malignancies Patients with cancer and thromboembolic disorders End of life Direct patient care Responsibilities and roles Teaching Patients and caregivers Students Residents Other pharmacy colleagues Research Advice for Students Pursuing this Career Path Keep an open mind Research your specialty before you specialize Be flexible, open minded, and ready for change Prepare to become a lifelong learner 18
19 Advice for Students Pursuing this Career Path Prepare to become a lifelong learner Oncology Drug Approvals from January 2012 through October 2013 Bosutinib Enzalutamide Liposomal vincristine Ziv aflibercept Carfilzomib Pertuzumab Vismodegib Axitinib Glucarpidase Dabrafenib Afatinib Ponatinib Abiraterone Cabozantinib Omacetaxine Ado trastuzumab emtansine Ambulatory Care Pharmacist Presenter: Mary Ann Kliethermes, BS, PharmD About Me Mary Ann Kliethermes, BS, PharmD Vice Chair Ambulatory Care, Associate Professor Chicago College of Pharmacy, Midwestern University Downers Grove, IL Primary Specialty: Adult Primary Care Other Specialties: Medication Therapy Management Patient Centered Medical Home Accountable Care Organizations Medication Adherence Drug Related Problems 19
20 Overview of Ambulatory Care Pharmacist Education/Training Required: PharmD degree Residencies in ambulatory care (PGY1, PGY2) desirable Type of patient population served: Any patient population is primary care Needs may be more with the elderly or disadvantaged Responsibilities and Roles Medication management Clinic management Quality measurement and fiscal responsibility Medication Management Collect Monitor or transition Assess Evaluate Develop plans Implement Access Adherence Med Rec Medication Monitoring Patient Education ADEs Multiple Hospitalizations Disease state Management Dose Escalation Medication Adjustments Drug Interactions Other? EBM adherence Drug Information High Risk Medications Quality/cost prescribing Patient Conditions Top 10 Average 5 6 conditions 1. Hypertension 2. Hyperlipidemia 3. Diabetes Type 2 4. Stoke/CVA 5. Depression 6. Anemia 7. Heart Failure 8. Obesity 9. Osteoarthritis 10. Coronary Artery Disease 20
21 Advice for Students Pursuing this Career Path Have passion Enjoy interacting with patients Thrive on every day being different Strong communication skills Keep abreast of health care changes Enjoy problem solving ( it is never like the book!) Have vision you may be starting something brand new! Clinical Pharmacogenomics as a Career Path Kristine R. Crews, Pharm.D., BCPS St. Jude Children s Research Hospital About Me Kristine R. Crews, Pharm.D., BCPS Translational Research Laboratory Director St. Jude Children s Research Hospital, Memphis TN Specialty: Clinical pharmacogenomics Secondary Specialty: Translational research 21
22 Move promptly to ensure that a high level of expertise in pharmacogenomics resides within the pharmacy department. ~From ASHP publication, Pharmacy Forecasts : Strategic Planning Advice. How is Pharmacogenomics Integrated into Clinical Practice? A patient is a CYP2D6 ultra rapid metabolizer: can she safely receive codeine for pain? # What is the correct starting dose of warfarin in a patient with CYP2C9 *1/*3 and VKORC1 ( 1639G>A) AA genotypes?* A patient with acute coronary syndrome requires antiplatelet therapy. His CYP2C19 genotype is *2/*2. What are the choices for therapy? # No choose another analgesic. *0.5 2 mg/day warfarin Pa ent should not receive clopidogrel reduced platelet inhibition Roles Clinical pharmacogenomics specialists serve as liaisons between lab based researchers and clinicians. Interpret pharmacogenetic results and advise other clinicians how drug therapy is affected My daily roles include: Analyze research data Interpret patient pharmacogenomic results make recommendations for therapy Present educational seminars/lectures Write manuscripts for publication Train residents 22
23 Advice for Students Pursuing Pharmacogenomics as a Career An understanding of translational research is helpful. Pursue residency training and consider fellowship training. St. Jude Children s Research Hospital has the first ASHPaccredited PGY2 Residency in Clinical Pharmacogeneticsnow training our 3 rd resident. Having more training will not hurt your career path! Pharmacists will emerge as the natural leaders in individualized medicine through pharmacogenomics. Emergency Medicine Melinda J Ortmann, Pharm.D., BCPS The Johns Hopkins Hospital Baltimore, MD About Me Melinda J Ortmann, Pharm.D., BCPS Position: Clinical Pharmacy Specialist, Emergency Medicine Program Coordinator, PGY 2 Emergency Medicine Pharmacy Residency at JHH Adjunct Faculty at the University of Maryland School of Pharmacy and the University of Pittsburgh School of Pharmacy Organization: The Johns Hopkins Hospital, Baltimore MD Primary Specialty: Emergency Medicine Other Specialties: Pediatrics 23
24 Overview of Emergency Medicine Clinical Specialist Education/Training Required PGY 1 Pharmacy Practice Residency PGY 2 Emergency Medicine Residency (Recommend) Developing field of practice, so PGY 2 opportunities are a mix of accredited and unaccredited programs Board Certification with BPS (Strongly Recommend) Overview of Emergency Medicine Clinical Specialist My Story Completed PGY 1 Pharmacy Practice Residency with a focus in Pediatrics Clinical Pharmacist position at a Children s Hospital in Tampa with a focus in PICU and Pediatric Oncology (5.5 years) Transitioned to Adult Emergency Medicine with some Pediatric EM practice (5 years) Overview of Emergency Medicine Clinical Specialist Type of patient population served EVERYONE! Primarily adult patients of all acuity levels Acute and chronic disease state management Toxicologic emergencies and drug overdose Urgent care needs Critically ill patient resuscitation trauma and medical All socioeconomic classes 24
25 Responsibilities and Roles Resuscitation Resuscitation General ED Population The Other General Stuff. ED Population The Other Stuff Teaching Responsibilities and Roles Resuscitation General ED Population Teaching The Other Stuff Medical /trauma resuscitation Stroke/ MI Response Team Clinical consultation, drug information and therapy recommendations in critical situations Provide assistance with medication procurement and admixture Prospective/retrospective patient profile review Clinical consultation, drug information services for both provider and nursing staff (DM, HTN, Pain, ID) Patient interview and education Medication reconciliation IPPE/APPE students PGY 1 and PGY 2 residents EM physician resident education Nursing education Institutional service on various ED and Pharmacy Committees Protocol and policy development Medication safety Information systems maintenance Research Publications Organization participation Advice for Students Pursuing this Career Path Ask yourself why? (It s not just another Critical Care option) Rotation during your APPE experiences If this is not an option, take initiative and set up a shadowing experience Interview pharmacists working in the ED in different hospital settings Identify PGY 1 residency programs with this rotation experience Talk to current PGY 1 and PGY 2 residents about their ED experiences Strongly consider PGY 1 and PGY 2 residency training 25
26 Pharmacy Informatics David Mulherin, PharmD, BCPS About Me David Mulherin, PharmD, BCPS, HIT Pro CP Assistant Professor of Pharmacy Practice Lipscomb University College of Pharmacy Practice Site: Clinical Informatics Systems, Vanderbilt University Medical Center Primary Specialty: Clinical Informatics Pharmacist & Academia Other Specialties: CPOE, Clinical Decision Support (CDS) Overview of Pharmacy Informatics Education/Training Required PharmD University of Tennessee College of Pharmacy PGY1 Pharmacy Practice Regional Medical Center at Memphis PGY2 Pharmacy Informatics University of Michigan Hospitals and Health Systems Available options Residency training PGY2 Pharmacy Informatics PGY1/PGY2 Combined residencies Fellowships Masters or PhD degrees Certifications 26
27 Overview of Pharmacy Informatics Type of patient population served Patients: All populations (varies by setting) Customers : Physicians, nurses, pharmacists and other healthcare providers Responsibilities and Roles Varies by practice area Design, develop, implement, maintain, and improve medication related systems (CPOE, CDS, pharmacy, BCMA, Smart Pumps, automation) Ensure safe and efficient use of information and technology to improve patient outcomes Advice for Students Pursuing this Career Path Most important qualification: Pharmacy & clinical knowledge! Prior computer science / IT / engineering experience is helpful, but certainly NOT required Must be flexible and ready for a challenge Seek opportunities for experience Introductory and Advanced Pharmacy Practice Experiences Ask questions about technology, express an interest Informatics rotations, internships, shadowing Talk to informatics specialists & get involved with research Join ASHP s Section on Pharmacy Informatics and Technology Pharmacy Safety Officer Presenter: Jaclyn A. Jeffries, Pharm.D. 27
28 About Me Jaclyn A. Jeffries, Pharm.D. Position, Title Health First Pharmacy Safety Officer Courtesy Clinical Assistant Professor, University of Florida College of Pharmacy Organization/Employer Health First Integrated Delivery Network Cape Canaveral Hospital Holmes Regional Medical Center Palm Bay Hospital Viera Hospital Health Insurance Medical Group Outpatient Services Primary Specialty Medication Safety Overview of Medication Safety Education/Training Required Graduated from the Purdue University College of Pharmacy in 2012 Completed a Medication Safety Residency in 2013 at the Purdue University College of Pharmacy Center for Medication Safety Advancement Started position as the Pharmacy Safety Officer at Health First in July 2013 Certifications PGY1 Medication Safety Residency Certificate Lean Six Sigma Yellow Belt Certificate Indiana Pharmacy Teaching Certificate Medication Safety Essentials Certificate Overview of Medication Safety Positions/Titles Medication Safety Officer, Medication Safety Manager, Medication Safety Coordinator, Pharmacy Safety Officer, etc. Report to pharmacy, risk management, quality, patient safety, or senior leadership Type of patient population served All patients admitted to the 4 hospitals within the system Pediatrics through geriatrics, cardiology, oncology, trauma, ortho 28
29 Overview of Medication Safety Responsibilities and Roles Pharmacy Safety Leader Operations and clinical practice, merged Collaboration with other disciplines More than just pharmacy Committee Involvement (Lead/Member) Lead the system wide Medication Safety Committee meeting Quality No Harm, P&T, Patient Satisfaction, Nursing Leadership, Chemo Task Force, Heparin Subcommittee, etc. Precept PGY1 Residents/PharmD Students/Interns Overview of Medication Safety Daily variety Daily review of hospital reported medication errors Trend medication errors and adverse drug reaction data Review external data/safety alert notifications Identify patterns of concern Develop action plans Develop or refine processes (policies and procedures) Collaborate to ensure regulatory compliance Utilize methodology/tools when appropriate EHR stakeholder/leveraging technology Quality assurance monitoring Education Advice for Students Pursuing this Career Path Patient centered Collaboration is key! (interdisciplinary) Seize opportunities offered to you, be open minded Use your gut (intuition) Find balance (regulatory, patient safety, employee safety, workflow) The safest option isn t always the most popular Medication safety is like an onion you just keep peeling back the layers your job is never done! It s a small world use it to your advantage! 29
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