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As a leader one of our jobs is to hold our people accountable so the advice in a recent Mind Tools Club Holding People Accountable Helping People Take Ownership of Their Work article may be helpful.

  • Is this story true in your workgroup? There was an important job to be done and Everyone was sure Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody’s job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done. Pharmacy since it takes several people to complete most transactions is easily this story.
  • Accountability boils down to one thing: responsibility so when you hold people accountable, you make sure they achieve the goals, standards and deadlines agreed to.
  •  If as a leader you don't hold everyone accountable you are being unfair to those who do take responsibility, i.e. your good performers.
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Just when I thought I’d figured out the whole recertification module layout and flow…BOOM! The script is flipped and I’m back on my toes.

This module was a little different than others I’ve completed thus far. It included the 48 page European Society Guidelines on Acute Pulmonary Embolism, a study on the impact of pneumococcal vaccination in the U.S., and a review article on community acquired pneumonia. No overt stats articles, which is surprising given the focus on stats through BCPS certification and recertification thus far. The assessment questions, however, did sneak in a few stats concepts. Overall, this module was very patient oriented; many questions involved patient scenarios requiring assessment and/or pharmacotherapy recommendations. I am somewhat out of the "patient specific recommendation" pharmacist role and generally think of things from a more global patient perspective in my day to day role as a Drug Policy Pharmacist. I did appreciate the module focus on potential areas of pharmacist interventions, specifically in the management and prevention of PE from the European perspective.
As I continue to work through the modules, I’ve fine tuned my approach. I tend to slowly chip away at the modules, rather than set aside a large portion of the day. I am not sure if this will change come winter, but it is especially true now since the weather’s nice and the FIFA Women’s World Cup is in full swing! It’s been nice to set goals of completing a few questions here or there, which decreases fatigue that may come with completing these modules. The module feature that I am most thankful for is the Notes feature. The Notes feature allows me to write notes to myself in each question, as well as pin the question for followup. I’ve found that it has also helped me to quickly review concepts covered and pick back up where I left off.
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This month I completed the BCPS re-certification credit which dealt with issues in pharmacogenomics, an area in which I have very limited experience or knowledge. The module was a podcast from a presentation at an ASHP meeting. Initially, I was not too thrilled about sitting in front of the computer to listen to 2 hrs and 45 minutes of a podcast. After completion, even though the presentation was a little long, I was very happy with what I was able to learn from this experience. Coming in, I had very little knowledge of this intricacies of this subject; just a broad understanding, ie, dosing problems with warfarin and 2C9 and VKOR1.

The information presented was at a basic level, but it was not too basic. I left learning a lot about pharmacogenomics. This is a topic in which there seems to be a whole lot of research done, however, the clinical implications of this genetic monitoring has not been widely shown. Currently, oncology seems to be an area in which pharmacogenomics is used for multiple medications, but not really in any other subject fields. It will be interesting to see how pharmacogenomics expands over the course of my career. 
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Two very interesting perspectives from Larry Rosen, a psychologist and Alexandra Samuel, a technologist, Managing Yourself Conquering Digital Distraction HBR June 2015 provide the following insights/advice for us.

  • Digital overload maybe the defining problem of today’s workplace as we are bombarded with so many messages and alerts that even when we want to focus it’s nearly impossible
  • The Information Overload Research Group reports in that knowledge workers in the US waste 25% of their time dealing with their huge and growing data streams costing the economy $997 billion annually
  • The evidence shows that multitasking isn’t always successful because doing two things well at the same time is possible only when at least one task is automatic
  • Research has found that many people regardless of age check their smartphones ever 15 minutes or less
  • Rosen suggests three strategies which involves turning a way from technology to regain focus
    • First check all your modes of e-communication then shut them down and set an alarm for 15 minutes and when it rings allow yourself one minute to check and then repeat the process until you are comfortable being off-grid.
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We are expanding training to our pharmacist to include TPN management. Can anyone share dosing service protocols and/or quick but thorough training material successfully used for staff development?
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June is more than halfway over already!  How did that happen???  June is supposed to be my “slow” month since I’m going to be out of town or have visitors every weekend in July and the first half of August, so I’m really wishing June would be longer!  Anyone else shocked how fast the summer is going by???

This month, I went back to the Literature Review Modules and did 1C: Pulmonary (VTE & Pneumonia).  As a reminder, I am provided the recertification materials for free from ASHP, but the opinions in this blog post are entirely my own.

This module included only 3 articles: the ESC Guidelines for the diagnosis and management of pulmonary embolism, a study about the rate of pneumonia hospitalizations after a decade of pneumococcal vaccination, and a review article on community-acquired pneumonia.  Notice no article directly about stats!  The guideline document is very lengthy, so I anticipate that’s why there were only 3 articles in this module.  I likely would not have read these guidelines in as much detail if it weren’t included in this activity, and it was pretty interesting to see the similarities and differences between the structure of these European guidelines and some U.S. guidelines.

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The July HBR has a very interesting series on Beyond Automation. Strategies for Remaining Gainfully Employed in an Era of Very Smart Machines by Davenport and Kirby.

  • Automation/computerization is coming to knowledge work in the form of artificial intelligence in the foreseeable future such as CPOE systems screening for allergies, contraindications, perform kinetic calculations, etc.
  • Eras of automation
    • 19th Century-machines take away the dirty and dangerous industrial tasks and relieves humans of onerous manual labor
    • 20th Century-machines take away the dull tasks such as routine service transactions and clerical chores.  Think of airline kiosks and phone trees
    • 21st Century-machines take away decision making with intelligent systems to make better choices than humans reliability and fast.
  • It is important to rather than ask what mental tasks currently performed by humans will soon be done more cheaply and rapidly by machines but rather what new feats might we be able to achieve with the assistance of machines
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Yesterday marked the last day of my first APPE rotation during which I had the opportunity to learn more about ambulatory care practice at a rural community hospital. This regional medical center offers progressive pharmacy services to several financially disabled patients. Working with clinical pharmacists to provide care for this patient population was rewarding. I enjoyed transitioning from the classroom to clinical rotations.

It was fulfilling to finally be able to apply my knowledge and provide direct patient care. I was pleased to realize how big of an impact I could have in some of our patients’ lives. I had the opportunity to provide medication therapy management, anticoagulation care, and warfarin counseling. I was also able administer vaccines, counsel patients on their new/chronic medications, deliver discharge medications at bedside, and participate in the hospital’s care transition program to help optimize post-discharge care.

Some of my encounters were big eye-openers. For example, one of our patients was discharged on eleven new medications including levalbuterol inhalation solution and insulin. After speaking to him, I realized that the patient did not own a nebulizer and had never used an insulin pen before. He wasn’t aware of what medications he had been prescribed and had several questions about his home medications. This patient interaction made me realize how big of an impact pharmacists can have in patient care. It also made me appreciate how important interprofessional communication is and how crucial our role is in improving transitions of care.

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It never ceases to amaze me how fast May always goes by. It is like it is here and then you blink you eyes and it is gone. It is already June 11th? When did that happen? I did finish the Cardiology 1a literature study module for BCPS re certification credit it May. It over all was an amazing experience. I was able to get caught up on actual literature and draw my own conclusions from it. The activity is also set up to be a very active experience, so for those like me who have the attention span of a nat you stay engaged (trust me, if chronic cardiology conditions can keep me engaged, then anyone can be engaged!) Now that June is here, I am wanting to complete 1b and 1c and am very much looking forward to a great experience with them as well!
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As a leader are you sensing that a more formalized mentoring program for your staff, leaders and residents would be beneficial?  Implementation and Outcomes of a Pharmacy Residency Mentorship Program in the newly acquired AJHP Residents Journal June 1, 2015 issue, which can be found online offers the following.

  • An online author video interview at
  • A good review of mentoring references and the established value
  • Program pre-implementation challenges.
    • Mentorship was viewed as more of an art than a science hence a flexible structure is appropriate.
    • Clearly distinguishing between a mentor (long term career) and a preceptor (short term and specific topic) is needed.
    • The need to customize/individualize the relationship so allow people flexibility
    • Not everyone is motivated to become a mentee nor mentor so don't try and force it
  • Guidelines (included in the article) versus a strict structure were used
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I had the pleasure yesterday of participating in an invitation-only event at the White House on antibiotic stewardship.  In March, President Obama released a National Action Plan to Combat Antibiotic-Resistant Bacteria, which outlined key actions to be taken or overseen by the Departments of Health and Human Services (HHS), Defense, State, Agriculture, and Veterans Affairs; Centers for Disease Control and Prevention (CDC); and other federal agencies.  The event was part of that initiative.  The morning session started with comments from Secretary of Health and Human Services Sylvia Burwell, Secretary of Agriculture Tom Vilsack, Director of the CDC Tom Frieden, and the Assistant to the President for Science and Technology Policy John Holdren.  

The Forum included almost 150 leaders from many sectors of society, including CEOs and other officials of various healthcare organizations; agriculture, food, and pharmaceutical industries; consumer groups and other stakeholders all working together toward the development of solutions to minimize the spread of bacterial resistance, and to improve antibiotic use.  It was truly an honor to be there representing our members and the patients they serve.
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With the school year ending, residency year wrapping up, and the Summer Meeting around the corner, it is certainly the time of the year for transitions.  But before the New Practitioner’s Forum Practice Advancement Initiatives Advisory Group (NPF PAIAG) finishes our term, we wanted to share the exciting things we were able to accomplish this year.

Still on the fence regarding board certification?  Wondering what board certification is?  Or just want more information regarding board certification?  We can help provide information to answer those questions.  PAIAG members worked to compose a webinar focused on the benefits of board certification, the process of obtaining board certification, and resources for both obtaining and maintaining board certification.  The best part?  It was entirely put together by and will be presented by new practitioners including individuals who recently obtained board certification, those who are going through the process, and those who are thinking about achieving board certification.  Additional information regarding the webinar ("To Take or Not to Take: The Importance of Board Certification")

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General : Leadership, Membership, PPMI, Professionalism  Audience : New Practitioners, Resident

Career Pathways in Pharmacy Informatics

Anuj Thirwani

When I began pharmacy school, I had no idea what “informatics” was. I had been drawn to the profession by the allure of working in healthcare and caring for patients in an accessible setting, such as a community pharmacy. While I definitely identified as a technophile, I had not expected to combine that aspect of my life with my professional pursuits. The path that eventually led me to my current role as a clinical applications pharmacist began with repeated discussions with various preceptors, who lamented the lack of sophistication in the technology they used in their practice settings. I may be paraphrasing, but “I wish a pharmacist who knew and understood our workflow was involved in designing this system” was a frequent complaint I heard. I felt that, just maybe, I could contribute to bridging that gap. Flexing my IT muscles revealed that this specialty within pharmacy practice that I had stumbled upon did have a name: “pharmacy informatics.”

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Most of the students I have worked with over the past year on their APPE rotations have recently graduated, and while I don't always forge close relationships (I may only precept them a day or two in our ED - rotation spots are reserved for the 20+ residents in our system), I do offer to help anyway I can.  Besides offering some advice on residency showcase, applications, etc - the main question I am asked is about testing for licensure.  I am sure I was the same way, nervous about the NAPLEX and law test(s), even after the viewing the stats regarding pass rates on NABP's website.  After sharing my study materials (study calculations!) the recent grad often comments on how great it will be to never have another test again.  I have to be the bearer of bad news, there are ample opportunities for certifications (e.g. BCPS, CGP).  I don't have any statistics, but suspect many practitioners will at least consider going through the process at some point in their career. The licensure tests represent an important transition, but its unlikely to be the last important test ever.
Like many newly BCPS-certified practitioners finding the right program for maintaining certification is a priority; I am very glad to trial ASHP's online presentation program for BCPS recertification.  Especially because when I first saw the price tag for some of these programs I definitely considered just re-testing in 7 years.  Much like the new grads prepping for NAPLEX, etc finding the program that best fits my busy schedule, teaches me worthwhile and reasonably priced is a difficult and fairly confusing process (my preceptors have had wildly different experiences with various programs for recertification).  ASHP's current online BCPS recert program fits both of my criteria nicely.  
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Raise your hand if you thrived on getting good grades in school… I mean thrived as in you were on a (non-pharmacologic) high as soon as you saw that 97% (or maybe more realistically for pharmacy school, that 82%…). I know I can’t be the only one because to make it where you are in your career you have to be a hard worker, maybe a little Type A, somewhat of a perfectionist (no? just me?), and what person possessing any of those qualities doesn’t like to see the fruits of their labor??

Well, it has been a minute since my last test (thank goodness), so I had forgotten how good this felt. But this week I have been making my way through some more modules for recertification through ASHP’s learning portal, and I gotta say… I still love a good grade (even if a 75% is all I needed…did I mention I’m a little bit of a perfectionist?).  

I also have been surprised over the last few months how rewarding it is just to keep my head in some literature on a consistent basis. Ideally, reviewing the latest literature would be an everyday habit for me in my practice, but we all know how easy it is to get busy and let it slide for another day.

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Good Evening Everyone!

I hope everyone is enjoying the spring weather and getting their summer plans in place as we head into June.  Like all of you, I have been extremely busy planning vacations and finishing projects for residency.  I also had the opportunity to attend the MAD-ID conference in Orlando earlier this month and recently visit the University of Iowa Hospitals and Clinics as well as the VA center in Iowa City as part of a trip my residency class took to learn about another institution.  It was a mutual sharing of ideas, and we plan to bring back things we learned to our own site in order to improve pharmacy practice.

One thing that both UIHC and the VA are very strong in is ambulatory care, and we learned a lot about how pharmacists manage patients independently in a variety of clinics.  One common disease state that these pharmacists are managing is dyslipidemia and hypertension.  The new 2013 ACC/AHA guidelines were published as I was graduating pharmacy school and beginning my first year of pharmacy residency.  Given the controversy surrounding the guidelines, they weren't really incorporated into clinical practice during my PGY-1 residency year.  As a PGY-2 specializing in infectious diseases in an acute care setting, I don't often think about a patient's lipid panel and what statin therapy (or lack thereof) the patient is receiving.  As such, I began the ASHP
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Work, hobbies, life in general. This can sometimes get demanding in one sector and the others tend to fall to the wayside for a little while. It is all one delicate balancing act. Sometimes, it gets a little out of whack. That has certainly happened to me these past few weeks with lots of late evening and weekend shifts in the ED, along with some new and exciting job responsibilities. Early summer in the south can keep a hospital hopping and Memphis is no exception. 

That's one of the beautiful things about this re-certification study program. It allows you to work at your own pace. No need to feel guilty about stepping away for a little bit to care of a myriad for other responsibilities. Keeping up with the latest advancements and new trends in pharmacy can be a daunting task, and that's the other beautiful thing about this program. The topics are up to date and provided from peer reviewed journals. 

Now, plans for the future. Work life should be calming down and becoming more steady in my neck of the woods, so stay tuned for a thorough review of one of the video review modules. I am huge fan of the Jurassic Park movies, and in honor of the newest movie release, how about a little focus on pharmacogenomics?! 
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(Written by Allie Vecchiet*) Do you ever come home at the end of the day and think to yourself, “I was so busy today; what did I actually accomplish?” There are so many distractions in our daily lives that it makes it difficult to think clearly, make good decisions, and accomplish the tasks that matter most. Franklin Covey, in his new book, “The 5 Choices: The Path to Extraordinary Productivity,” offers 5 time management techniques to help us make concious decisions about how we spend our time, pay attention, and maintain our energy throughout the day.

  1. Act on the Important, Don’t React to the Urgent
    • Practice being concious and intentional about everything you do.
    • Use the Time Matrix – “Pause, Clarify, Decide” (PCD) – to ask and answer the question in a brief instant, “is it important?”
    • There are many things that come up during the day that are urgent, but not important. They feel like they need to be done now, but really, there are no serious consequences if you don’t do them. These are the needless interruptions, unnecessary reports, irrelevant meetings, unimportant emails, etc.
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I just downloaded the PPN app for my iPad and got around to reading a summary of the ISMP webinar on Medication Safety that documented what the Joint Commission (TJC) identified as a 2-year "slump" in compliance with medication safety standards. It was somewhat alarming (Pharmacy Practice News Volume 41, September 2014).

It reinforced my perception that we have a hard time keeping safety at top-of-mind. The work pressures we face on a daily basis focus on productivity, not on safety. And, with an inspection that only occurs every few years, it's not like we get constant reinforcement for the right things to do. This results in a known human bias called the normalization of deviance.

Any of us who has ever had a speeding ticket knows about the normalization of deviance. We go by signs every day telling us what the speed limit is, often at speeds well above the posted limits. Mea maxima culpa.

What happens is that we do it, and nothing bad happens, so we do it again, and again, until it becomes normal. If we get stopped for speeding, our driving changes for a little while, but pretty soon we are back where we were. And if it appears that everyone around us is speeding, the trip back there is even faster.
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Well this month, ASHP Recertification this month involved some pulmonary diseases, including the use of magnesium in asthma attacks and some various issues with COPD. The part of this study which was very interesting to me were the 2 studies involving the use of magnesium in asthma attacks (in both pediatrics and adults). This topic is something that is always discussed, but there are not a wide array of studies that show a benefit or adverse effect or actually any effect at all in using magnesium for these attacks. It is also a good time to think about this, when I am sure asthma attacks are increasing as spring allergies arrive and the heat of the summer. The studies involving the magnesium were good examples of this use in asthma and provide some good thoughts for its use in clinical practice. Of course, there is still not enough data to make a true clinical statement about this use, but these studies show that there may possibly be a benefit for this, however, it will be only a rare instance. 

I am looking forward to continue to expand on my knowledge throughout further studies in this series. 

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