News
glucose monitoring that hospital patients undergo. “It sounds counterintuitive, but all you need to do is compensate for the calories that you’re delivering,” he said. “In a diabetic patient, it’s preferred not to dominate the diet with carbohydrate calories, but dextrose solution contains small-tomoderate amounts of carbohydrates.” Armitstead said establishing and maintaining i.v. line access accounts for the vast majority of i.v. solution use at Lee Memorial, with far less going toward
fluid replacement. He said the hospital uses alerts in the electronic health record system to remind prescribers about the shortage and ask them to select another fluid, if appropriate. The multihospital system typically maintains a three- to four-week supply of i.v. saline and had about three weeks’ worth on hand when news of the shortage broke, Armitstead said. “Through our conservation, we projected that we’d turn that three-week supply into, in essence, a six-week supply,” he
Specialization key to evolving health care environment
A
s health care models evolve, so do pharmacy practices, and the profession’s increased emphasis on specialized training has a vital role to play in the process. “We’re in what I believe is the era of accountability for health care . . . and that has demanded the expansion of clinical knowledge and competence of all pharmacists,” said William Ellis, executive director William Ellis of the Board of Pharmacy Specialties (BPS). “We’re truly moving beyond a distribution model to being directly involved in affecting patient outcomes.” John Clark, director of pharmacy services at the University of Michigan Hospitals and Health Centers, said that from his perspective as an employer, specialized training helps guide hiring John Clark decisions. “One of the things that specialization and board certification allows us is an opportunity to look at practitioners that are beyond residency-trained individuals,” Clark said. “There are fewer
522
positions available than there were a few years ago. And this allows us to be more selective as employers.” And from the profession’s standpoint, specialization and credentialing are viewed as keystones of so-called provider status—the recognition of the pharmacy profession as health care providers under Medicare. “While we believe that all pharmacists should be recognized as providers, we also realize that . . . decision-makers will want to know that the pharmacists who are providing care possess the requisite knowledge and skills to provide that care competently,” said ASHP Chief Operating Officer David Witmer David Witmer. Witmer said that through its work with the Council on Credentialing in Pharmacy, a collaborative effort involving 10 national pharmacy organizations, ASHP “strives to create a framework for credentialing and privileging that empowers pharmacists to assume a more significant role in patient care.” Specialization today. BPS today awards credentials in six specialty areas
Am J Health-Syst Pharm—Vol 71 Apr 1, 2014
said, adding that his group purchasing organization has been able to consistently supply the health system. “We’re still under conservation mode, but we never ran out and we don’t expect that we will,” Armitstead said in late February. “So we are not directly impacted in patient care needs situations.” —Kate Traynor DOI 10.2146/news140025
and next year will allow pharmacists to take examinations for two additional areas—pediatric pharmacy and critical care pharmacy. But that’s a tiny fraction of the more than 150 specialty and subspecialty areas in which physicians can be credentialed through the Board of Medical Specialties. “Pharmacy is probably behind the curve in specialization,” Ellis said. “Our colleagues in medicine and nursing have had board certifications and specialties for probably a good 30 or 40 years prior to pharmacy.” Ellis said the needs of patients and the health care system will ultimately determine the appropriate number of specialty areas for the pharmacy profession— presumably, a much smaller number than for physicians. He said one reason fewer specialty areas are needed is that pharmacists’ knowledge encompasses a broad range of patient care situations, whereas physicians, especially those who are board certified, tend to have a narrow practice focus. “Pharmacists . . . understand overall medication therapy beyond a specialty area. And that can be a very valuable addition to the health care team,” Ellis said. Witmer noted that hospitals and payers expect physicians to undergo credentialing and privileging in order to care for
News
patients, and he said pharmacists should be subject to the same process. “A license provides a very broad assurance that a health care professional is adequately prepared to function as a professional, but [licensing] does not assure competence in the provision of specific patient care services,” Witmer said. Clark likewise said it makes sense for the pharmacy profession to align with the certification model used by physicians. He said physicians with whom he has spoken appreciate the credibility that comes with board certification of their pharmacy colleagues. Ellis said the number of BPS-certified pharmacists doubles about every five years, and 19,000 pharmacists currently hold board-certification credentials. He said BPS has set a goal of certifying 30,000 pharmacists by 2017. Care settings. Health care reform efforts that emphasize pay for performance, medical homes, and accountable care organizations have put pressure on health care providers to deliver highquality care. One way to accomplish this is by relying on credentialed health care professionals in team-based environments to deliver that care, Ellis said. He said such care is increasingly being demanded in outpatient settings, and pharmacists appear to be aware of this trend. “We’re seeing the biggest growth area come in one of the newer board-certified specialties, and that’s ambulatory care,” Ellis said. “Currently, ambulatory care is the third-largest BPS specialty, even though we’ve only offered the examination for three years.” He said that ambulatory care “is really where the patients are,” including people transitioning from hospital care and those who need help managing chronic conditions. “The pharmacist is in an ideal position to provide those services,” Ellis said. Provider status. Clark said that from the time he started practicing pharmacy 14 years ago, he has expected the profession to attain provider status. And he believes that residency training and board
certification will be important criteria on which to ultimately base provider-status decisions. Kasey Thompson, vice president of ASHP’s office of policy, planning and communications, said that the goal of provider status is not limited to pharmacists with specialized credentials. But, he noted, “it is safe to Kasey Thompson assume that many residency trained and BPS-certified pharmacists are and will be well positioned to take advantage of provider recognition as a means to support the team and care for their patients.” Pharmacists in California were recently granted provider status by the state, and regulations governing the state’s advanced-practice pharmacist
designation are under development. North Carolina and New Mexico likewise allow qualified clinicians to be designated as advanced-practice pharmacists. “Provider status may happen first at a state-by-state level before it happens nationally. It’s hard to say,” Ellis said. He noted that he expects California to recognize BPS certification as a foundation for attaining the advance-practice pharmacist designation. Attaining provider status for pharmacists is one of ASHP’s stated advocacy priorities, and the organization has been working with other pharmacy groups to move the issue forward at the federal and state levels. —Kate Traynor DOI 10.2146/news140026
Atlanta’s pharmacy personnel persevere
W
hen ice and snow hit Atlanta this winter, hospitals’ power stayed on, as did pharmacy personnel. “Many of them spent 48 hours in the hospital,” said Scott McAuley, senior director of pharmacy and clinical nutrition at Piedmont Atlanta Hospital. The late-January storm that left many people stranded overnight in cars Scott McAuley on Atlanta’s roads kept pharmacy personnel at hospitals and prevented most replacements from arriving, said McAuley and Grady Health System’s Rondell Jaggers, executive director of pharmacy and clinical nutrition. Can’t get in, can’t get out. The storm started around 2 p.m. January 28, Jaggers said. “I don’t think we realized quite what was about to happen to us.” Sleet and snow had started falling. Cars clogged highways and streets be-
fore the road crews could do their work, he said. Personnel arriving for the evening shift at Grady Memorial Hospital were told to plan on staying longer, Jaggers said. “We had people who were not even able to make it in for that evening or night shift.” A core group of day- and evening-shift pharmacists and pharmacy technicians stayed overnight at the hospital, he said, with two evening-shift pharmacists and two evening-shift technicians working Continued on page 524
Appointment Karl Gumpper, BCPS, has been appointed team leader for pharmacy informatics at Boston Children’s Hospital in Massachusetts; previously he was the director of the ASHP Section of Pharmacy Informatics and Technology.
Am J Health-Syst Pharm—Vol 71 Apr 1, 2014
523
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
glucose monitoring that hospital patients undergo. “It sounds counterintuitive, but all you need to do is compensate for the calories that you’re delivering,” he said. “In a diabetic patient, it’s preferred not to dominate the diet with carbohydrate calories, but dextrose solution contains small-tomoderate amounts of carbohydrates.” Armitstead said establishing and maintaining i.v. line access accounts for the vast majority of i.v. solution use at Lee Memorial, with far less going toward
fluid replacement. He said the hospital uses alerts in the electronic health record system to remind prescribers about the shortage and ask them to select another fluid, if appropriate. The multihospital system typically maintains a three- to four-week supply of i.v. saline and had about three weeks’ worth on hand when news of the shortage broke, Armitstead said. “Through our conservation, we projected that we’d turn that three-week supply into, in essence, a six-week supply,” he
Specialization key to evolving health care environment
A
s health care models evolve, so do pharmacy practices, and the profession’s increased emphasis on specialized training has a vital role to play in the process. “We’re in what I believe is the era of accountability for health care . . . and that has demanded the expansion of clinical knowledge and competence of all pharmacists,” said William Ellis, executive director William Ellis of the Board of Pharmacy Specialties (BPS). “We’re truly moving beyond a distribution model to being directly involved in affecting patient outcomes.” John Clark, director of pharmacy services at the University of Michigan Hospitals and Health Centers, said that from his perspective as an employer, specialized training helps guide hiring John Clark decisions. “One of the things that specialization and board certification allows us is an opportunity to look at practitioners that are beyond residency-trained individuals,” Clark said. “There are fewer
522
positions available than there were a few years ago. And this allows us to be more selective as employers.” And from the profession’s standpoint, specialization and credentialing are viewed as keystones of so-called provider status—the recognition of the pharmacy profession as health care providers under Medicare. “While we believe that all pharmacists should be recognized as providers, we also realize that . . . decision-makers will want to know that the pharmacists who are providing care possess the requisite knowledge and skills to provide that care competently,” said ASHP Chief Operating Officer David Witmer David Witmer. Witmer said that through its work with the Council on Credentialing in Pharmacy, a collaborative effort involving 10 national pharmacy organizations, ASHP “strives to create a framework for credentialing and privileging that empowers pharmacists to assume a more significant role in patient care.” Specialization today. BPS today awards credentials in six specialty areas
Am J Health-Syst Pharm—Vol 71 Apr 1, 2014
said, adding that his group purchasing organization has been able to consistently supply the health system. “We’re still under conservation mode, but we never ran out and we don’t expect that we will,” Armitstead said in late February. “So we are not directly impacted in patient care needs situations.” —Kate Traynor DOI 10.2146/news140025
and next year will allow pharmacists to take examinations for two additional areas—pediatric pharmacy and critical care pharmacy. But that’s a tiny fraction of the more than 150 specialty and subspecialty areas in which physicians can be credentialed through the Board of Medical Specialties. “Pharmacy is probably behind the curve in specialization,” Ellis said. “Our colleagues in medicine and nursing have had board certifications and specialties for probably a good 30 or 40 years prior to pharmacy.” Ellis said the needs of patients and the health care system will ultimately determine the appropriate number of specialty areas for the pharmacy profession— presumably, a much smaller number than for physicians. He said one reason fewer specialty areas are needed is that pharmacists’ knowledge encompasses a broad range of patient care situations, whereas physicians, especially those who are board certified, tend to have a narrow practice focus. “Pharmacists . . . understand overall medication therapy beyond a specialty area. And that can be a very valuable addition to the health care team,” Ellis said. Witmer noted that hospitals and payers expect physicians to undergo credentialing and privileging in order to care for
News
patients, and he said pharmacists should be subject to the same process. “A license provides a very broad assurance that a health care professional is adequately prepared to function as a professional, but [licensing] does not assure competence in the provision of specific patient care services,” Witmer said. Clark likewise said it makes sense for the pharmacy profession to align with the certification model used by physicians. He said physicians with whom he has spoken appreciate the credibility that comes with board certification of their pharmacy colleagues. Ellis said the number of BPS-certified pharmacists doubles about every five years, and 19,000 pharmacists currently hold board-certification credentials. He said BPS has set a goal of certifying 30,000 pharmacists by 2017. Care settings. Health care reform efforts that emphasize pay for performance, medical homes, and accountable care organizations have put pressure on health care providers to deliver highquality care. One way to accomplish this is by relying on credentialed health care professionals in team-based environments to deliver that care, Ellis said. He said such care is increasingly being demanded in outpatient settings, and pharmacists appear to be aware of this trend. “We’re seeing the biggest growth area come in one of the newer board-certified specialties, and that’s ambulatory care,” Ellis said. “Currently, ambulatory care is the third-largest BPS specialty, even though we’ve only offered the examination for three years.” He said that ambulatory care “is really where the patients are,” including people transitioning from hospital care and those who need help managing chronic conditions. “The pharmacist is in an ideal position to provide those services,” Ellis said. Provider status. Clark said that from the time he started practicing pharmacy 14 years ago, he has expected the profession to attain provider status. And he believes that residency training and board
certification will be important criteria on which to ultimately base provider-status decisions. Kasey Thompson, vice president of ASHP’s office of policy, planning and communications, said that the goal of provider status is not limited to pharmacists with specialized credentials. But, he noted, “it is safe to Kasey Thompson assume that many residency trained and BPS-certified pharmacists are and will be well positioned to take advantage of provider recognition as a means to support the team and care for their patients.” Pharmacists in California were recently granted provider status by the state, and regulations governing the state’s advanced-practice pharmacist
designation are under development. North Carolina and New Mexico likewise allow qualified clinicians to be designated as advanced-practice pharmacists. “Provider status may happen first at a state-by-state level before it happens nationally. It’s hard to say,” Ellis said. He noted that he expects California to recognize BPS certification as a foundation for attaining the advance-practice pharmacist designation. Attaining provider status for pharmacists is one of ASHP’s stated advocacy priorities, and the organization has been working with other pharmacy groups to move the issue forward at the federal and state levels. —Kate Traynor DOI 10.2146/news140026
Atlanta’s pharmacy personnel persevere
W
hen ice and snow hit Atlanta this winter, hospitals’ power stayed on, as did pharmacy personnel. “Many of them spent 48 hours in the hospital,” said Scott McAuley, senior director of pharmacy and clinical nutrition at Piedmont Atlanta Hospital. The late-January storm that left many people stranded overnight in cars Scott McAuley on Atlanta’s roads kept pharmacy personnel at hospitals and prevented most replacements from arriving, said McAuley and Grady Health System’s Rondell Jaggers, executive director of pharmacy and clinical nutrition. Can’t get in, can’t get out. The storm started around 2 p.m. January 28, Jaggers said. “I don’t think we realized quite what was about to happen to us.” Sleet and snow had started falling. Cars clogged highways and streets be-
fore the road crews could do their work, he said. Personnel arriving for the evening shift at Grady Memorial Hospital were told to plan on staying longer, Jaggers said. “We had people who were not even able to make it in for that evening or night shift.” A core group of day- and evening-shift pharmacists and pharmacy technicians stayed overnight at the hospital, he said, with two evening-shift pharmacists and two evening-shift technicians working Continued on page 524
Appointment Karl Gumpper, BCPS, has been appointed team leader for pharmacy informatics at Boston Children’s Hospital in Massachusetts; previously he was the director of the ASHP Section of Pharmacy Informatics and Technology.
Am J Health-Syst Pharm—Vol 71 Apr 1, 2014
523
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
