"When one door closes, another door opens; but we so often look so long and regretfully upon the closed door, that we do not see the ones which open for us."
Alexander Graham Bell's famous quote has spoken to me many times in the past; this time, I've lost sight of the closed door as I'm being hurried through a newly opened door. I've had a chance to pause and reflect on this recent opportunity, so I thought it might be fitting to share with my ASHP Connect Community.
Reading Health System (my employer) recently created and approved a new position - Medication Quality and Safety Director. Jump back a few months to when I started working for Reading Hospital (part of Reading Health System) in August 2012. In my first few weeks on the job, my DOP and fellow pharmacy managers had many questions about pharmacy residency and the types of rotations/learning experiences I had encountered thus far in my early professional endeavors. My DOP was especially interested in my PGY2 Medication Safety rotations and my interests in safety-related projects. He expressed a desire to propose a Medication Safety Officer position to the CMO. I explained my residency involvement with the ISMP Medication Safety Self-Assessment for Hospitals, participation on the interdisciplinary Medication Safety Committee, and collaboration on a project to reduce discharge medication areas. I mentioned that I would be interested in learning more about a medication safety role if/when it was created at Reading Hospital. The need for a dedicated medication safety position became apparent when Reading Hospital underwent a new name (health-system), new logo, and new motto in early November 2012. A dedicated 1.0 FTE medication safety position was created, but subsequently on-hold ("frozen") due to financial performance in Q2 FY13.
Fast forward four months to mid-February 2013. Reading Health System had just launched the Epic inpatient modules. I spent the first two weeks of implementation on evening shift, helping our evening and night shift pharmacy staff to survive/prosper in our new EHR. On my first "day" back, my DOP called me into his office.
DOP: "What does your week look like. The CMO would like to set-up interviews with you for the Med Safety position."
Me: "Wha... WAIT. It's approved? I thought the position was still frozen?!?"
DOP: "We interviewed an outside candidate last week and everyone is really excited to meet you. Would you be able to start interviews on Thursday?"
I received a copy of the job description (JD) on Monday afternoon and had time to dust the cobwebs off my favorite interview questions/responses. On Wednesday afternoon, I received an email with an interview itinerary attached to it. In the body of the email, the CMO's Administrative Assistant warned me that she had to spread the interviews out over three days. While this was totally feasible because I was interviewing just 2 floors above my office, I did have to ensure that three business suits were cleaned and pressed. I opened the email attachment to review my three-day itinerary and was surprised at the number of interviews. I would be interviewing with twenty-six (26!!!!) different persons in three days. Whew. Most interviews were one-on-one and scheduled for thirty minute time slots. The group interviews, such as those with the Quality and Patient Safety Directors and Nursing Practice Directors, were slotted for one-hour blocks. Breathe in, breathe out. This interview process was going to be a marathon and definitely not a sprint!
In my current role (Sterile Products Manager), I am very much "in the pharmacy department" and have had limited opportunities to attend higher level, multidisciplinary meetings. In my seven months at RHS, I enjoy opportunities to interact with other healthcare providers, especially nursing, and provide safer medication therapy to our patients. I saw many opportunities that a Medication Safety person could be involved with from the get-go. So during those eleven hours of interviews, I had an opportunity to share "insider perspectives" about what this brand-new position could bring to the health-system. I spent thirty minutes discussing the opportunities for greater collaboration and communication between nursing and pharmacy with the Chief Nursing Officer. I talked about optimizing Epic to provide clarity in the Microbiology report read-outs with the Chief of Infectious Diseases. The current co-chair of Medication Safety Committee (a prominent Cardiologist in the Reading, PA area) picked my brain on opening an anticoagulation clinic, managed by Pharmacy, and how the newer oral anticoagulants have impacted patient safety. The Chief Medical Information Officer chose medication reconciliation as the main discussion point of our thirty minute interview, and asked how/what that would look like across the 63 locations in the health-system. My final interview was with the Chief Medical Officer. Why is it that the most important interview is always last?? Interestingly enough, our CMO first trained as a pharmacist before pursuing medical school/residency. He completed his medical residency at the University of Nebraska Medical Center, just a few hours from where I completed my pharmacy residency in Kansas City, KS. He is familiar with the progressive pharmacy practice models in the Midwest, and so we spent time talking about pharmacy involvement in medication reconciliation and transitions of care. He asked me what I envisioned that a Medication Quality and Safety person could work on in their first six months at RHS (remember- this position is brand-new), especially since I had direct exposure with front-line staff. Finally, I picked his brain about his vision for the health-system and major projects on his own/his hospital exec's plates.
So I'm sure you're sitting on the edge of your seats wanting to hear the end of this adventure. I was not offered the Medication Quality and Safety Director position. Actually, I was somewhat relieved because the more I sat through the interviews - the more I learned that the focus of the position was 70% Quality and 30% Medication Safety. During our hour long one-on-one, the CMO stated his need for an experienced Quality person to come in and do QA/QI on health-system level projects. How had my residency training prepared me for a Quality role? I was honest and shared that my interest in the position was 70% Medication Safety and 30% Quality, and I wasn't ready to give up "pharmacy" and interactions with direct patient care providers.
While the Medication Quality and Safety Director position door closed, other doors suddenly started opening. How many newer employees (within their first year of employment) have an opportunity to sit down one-on-one with the Chief Medical Officer and talk about everything from pharmacy and med rec to transitions of care and quality indicators? So it's pretty awesome that when I pass him in the hospital hallways, the CMO calls me by name and asks about our latest drug shortages in the Pharmacy. In the past two weeks, I was extended invitations to be a standing member on the Hospital Medication Safety Team and also the Pharmacy Representative on our Nursing Practice Council. These opportunities weren't core responsibilities on my job description, but are opportunities to work on bridging the nursing-pharmacy relationship that I talked about earlier. Speaking of nursing and pharmacy, I received a phone the other day from a nursing educator on the Labor and Delivery Unit. She was calling to request my assistance on a policy for high-dose magnesium use. Would I review from the pharmacy perspective before she sent it on? As I provided her with the information for concentration/diluent, current Alaris pump library settings, and the need for an entry to be built in Epic - I happened to ask how she was given my name. She responded with, "Oh, our CNO mentioned that you would be a good reference in pharmacy to touch base with."
Mr. Bell was right - when one door closes, another opens. And I'm pretty excited to be a Pharmacist and walk through these doors.