Jerry Fahrni

Tag: Pharmacy Practice

  • AJHP Podcast on PPMI with Dr. Henri Manasse of ASHP

    I just finished listening to an AJHP Podcast interview of Dr. Henri Manasse, CEO and Executive Vice President of ASHP and keynote speaker at the PPMI Summit last year.

    Overall it was an interesting interview. Dr. Manasse had some good things to say. One thing I found particularly interesting was a short section near the beginning of the interview where he spoke about using pharmacy residents to focus on issues brought up during the PPMI Summit.

    Every pharmacy resident is required to do a project during their residency. The projects range from investigational medication use, to antibiotic stewardship programs, to investigating new practice models. Most hold significant value not only to the resident, but the facility as well. Project time in many pharmacies is difficult to come by for pharmacists in a staffing role, so it makes sense to make use of pharmacy residents when appropriate.

    With over 1500 pharmacy residents each year it shouldn’t take long to knock out all those PPMI Summit recommendations.

  • Some friendly advice for pharmacy recruiters

    I get a fair number of emails and phone calls from pharmacy recruiters. The number has decreased over the past couple of years secondary to the change in demand for pharmacists, but I still get them. Lately I think it’s a byproduct of having a LinkedIn profile, which makes me wonder if LinkedIn is worth the time, energy and effort of keeping an online work profile up to date. That’s a post for another day.

    Regardless, most of the recruiters that contact me offend more than intrigue me, and here’s where they make their mistakes. (more…)

  • All good things must come to an end, and so goes the pharmacist shortage

    The pharmacist shortage was both good and bad for the pharmacy profession. On one hand it created demand which drove up salaries and improved work environments for some. On the other hand it created an environment of apathy where competition to become better dipped because frequently all you needed was a pulse and a license to get hired and/or keep your job.

    Well, times are changing. I noticed a slight change in pharmacist demand during my last two years in the hospital and many people that I’ve talked to across the country confirm what I’ve been thinking – the pharmacist shortage is over.
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  • Data visualization and dashboards

    A wise colleague of mine once told me that lots of people collect data, but few people know what to do with it. I didn’t understand what he was talking about at the time, but I’ve come to have a better understanding over the years. It basically boils down to the difficulty that many of us experience when it comes to the best way to handle information. Our brains do some amazing things, but fail to “see” things when the perspective is all wrong.

    Data surrounds us. It’s in everything we do, from the bank statements we receive in our personal life to the mountains of data collected by every healthcare institution. Regardless of the data collected, there are basically three things that can be done with it. Data can be ignored, it can be archived or it can be used. Unfortunately only one of those three things is truly useful; using it. Many people chose to ignore or archive data not because the information isn’t valuable, but because they are overwhelmed with the amount of information they receive and the way that the information is presented.
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  • Do larger hospitals have an edge? Maybe

    I’ve worked in several hospitals over the course of my career, ranging in size from 25 acute care beds to nearly 600 (584 beds to be exact). While 600 beds isn’t a large hospital, it certainly isn’t small. Regardless of the size of the hospital I’ve worked in, the operations inside the walls of the pharmacy are strikingly similar, including from the way pharmacists process orders to the way technicians handle distribution. There are differences to be sure, but the basics are the same. Differences to note include clinical services and use of automation and technology.
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  • Revisiting the idea of Shareable Ink

    EMR and HIPAA: “The interesting thing about Shareable Ink is that they provide such an interesting middle ground between a technical solution and continuation of paper. I remember about 5 years ago when I heard someone describe the perfect clinical documentation system. It was completely flexible. Required little to no training. Supported every possible documentation style. etc etc etc. Then, they acknowledged that what was being described was the paper chart. It was then that I recognized that while EMR can provide some benefits that paper charts can’t provide, paper charts also had some advantages that would be difficult to provide using an EMR.

    I think this background is why I found the Shareable Ink approach to documentation so fascinating. I really see it as an interesting way to try and capture the benefits of granular data elements and electronic capture of the data while still enjoying the benefits of paper.

    My simplified explanation of the Shareable Ink technology is as follows. You print out a form that you want to use for the patient visit. Each page that’s printed out has a unique background (although it just looks like a colored page to the naked eye). When you use the Shareable Ink pen to write on the printed out page, the pen uses a camera to record what you wrote on that page and where you wrote it. Then, once you sync the pen it recreates the document you wrote on in the system.”
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  • The ever expanding role of pharmacists

    Lately I’ve found myself thinking about how pharmacists are involved in healthcare. Despite popular belief pharmacists do more than simply work in the pharmacy.

    Throughout my career I’ve become accustomed to people viewing pharmacists as the stereotypically person behind the counter at the drug store “counting pills”. While that’s not all pharmacists do, I’ve learned to live with the general publics simplistic view. I don’t think most people realize that pharmacists are involved in every aspect of a patient’s care. If you’ve ever been in a hospital, received a prescription medication, had a loved one in a long term care facility, received intravenous medications at home like total parenteral nutrition (TPN) or antibiotics, received an albumin or intravenous immunoglobulin (IVIG) infusion in an outpatient infusion center or met with a pharmacist in a clinic setting for a medication therapy management (MTM) session, then you’ve been touched by a pharmacist.
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  • Another opportunity for pharmacist$

    Reuters: “During the current study, 21 percent of the 1506 participants said they had previously not taken medications because of money concerns. Another 5 percent said they were worried they might not be able to pay for drugs.

    The researchers, who published their results in the journal Academic Emergency Medicine, considered both groups to be “at risk” of nonadherence with future prescriptions.

    Looking at the responses to other questions on the survey, Rhodes and her team found that people were more likely to be at risk of nonadherence if they had money issues – for instance, they worried about money, didn’t have enough food, reported housing problems, and had inadequate health insurance. But they were also more likely to be at risk of nonadherence if they smoked, used illegal drugs, or experienced domestic violence, as either the victim or perpetrator.”
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  • Pharmacists and medication adherence

    WSJ: “”Retail pharmacists appear to be able to play a really substantial role in encouraging patients to use their medications better,” says William Shrank, an assistant professor of medicine in the division of pharmacoepidemiology at Brigham and Women’s Hospital in Boston. “They are an underutilized resource.”

    A study by researchers at the Walter Reed Army Medical Center in Washington, D.C., published in the Journal of the American Medical Association, found that a pharmacy-care program for 200 people age 65 and older who were taking at least four medications for chronic conditions boosted adherence to 97% from 61% after six months. Patients were educated about their medications, including usage instructions; medications were dispensed in blister packs that made it easier to keep track of whether they had taken their pills for the day; and pharmacists followed up with patients every two months.

    After 12 months, those who continued to get the pharmacy care kept their adherence at about 96%, while adherence among those for whom the program was discontinued dropped to 69%.”

    This ties back in to what I was talking about on Saturday, i.e. that better use of pharmacists in the community practice setting might be a good thing. And one way to get community pharmacists to spend more time with patients is to get them out from behind the counter and away from the phones using better automation and technology. The inability of a patient to adhere to their medication regimen costs the healthcare system in the United States millions of dollars each and every year, but for some reason we continue to sit idle and allow it to continue.

  • Where will automation and technology make the biggest impact in pharmacy?

    I was planning on writing a rant this morning about lack of motivation, leadership and dumbasses – hey, I was in a fould mood when I got up – but then I opened an email from a friend. He asked me “How can retail pharmacists get involved in this [pharmacy informatics] industry?”. My first thought was to say that retail pharmacy would be the death of our profession and that they have no business getting involved in pharmacy informatics. Harsh I know, but I told you I was in a foul mood.

    Then I did something I rarely do, I thought about the question a bit more before answering. After some time I came to the conclusion that retail, or more generally outpatient, pharmacy is exactly where more automation and technology is needed. I follow a few retail pharmacists on Twitter and one generalization I can make from reading their Tweets is that they all pretty much hate their jobs. Why? Because they spend precious little time working as pharmacists, instead spending most of their time physically filling prescriptions, chasing insurance claims, etc.

    What retail pharmacy needs is a super-sized dose of pharmacy automation, technology and greater pharmacy technician involvement. Nowhere in pharmacy is there a greater need for automation and technology than outpatient services. Much of what’s done in the outpatient pharmacy setting does not require a pharmacist. This echoes the words by Chad Hardy last week on the RxInformatics website. Chad states “The longer we rely on pharmacists to run the entire supply chain, the higher our risk of obsolescence.” He’s absolutely right, although the article he references insinuates that pharmacists will become obsolete secondary to technology. Nay, I say. Technology in the outpatient arena can offer pharmacists the opportunity to break away from the mundane and do a little more hands on patient care. In addition, the drive to implement automation and technology in the retail setting creates the perfect job opportunity for pharmacists interested in informatics.

    Of course we’ll have to prove to the retail boys upstairs that they can save money by using pharmacists in a more clinical role, but that’s what business cases are for. Unfortunately I couldn’t write a business case to save my life. In fact, a colleague of mine told me that pharmacists are terrible at creating business cases. I suppose that’s true as most of us didn’t become pharmacists to practice business. Instead we became pharmacists to provide patient care. Go figure.