The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast

https://www.samhsa.gov/medication-assisted-treatment

https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions

http://www.tamingthesru.com/blog/iii-recaps/buprenorphin-a-helping-hand

https://www.acep.org/opioids/

The post Episode 28: Buprenorphine Medication-Assisted Therapy (MAT) for Opioid Use Disorder wIth Dan McCollum and RJ LaCoursiere appeared first on The Pharm So Hard Podcast.

• What is an HSPA Residency
  1.  The Health-System Pharmacy Administration and Leadership (HSPA-L) Residency is a 24-month post- Doctor of Pharmacy training program. The PGY1 and PGY2 years are designed to flow seamlessly together, with no need to re-apply or participate in the early commitment process.

1. (ASHP) discerns leadership as an executive obligation to impact patient care and advance the profession.
   • In an ASHP Foundation Scholar-in-Residence report, Sara White identified a leadership gap within the pharmacy profession due to a disproportion of pharmacists with interest and preparation to engage in formal leadership positions.
   • Criteria for implementation of a HSPAL residency program conventionally includes the following components: business proposal, rotation development, preceptor recruitment, marketing plan, financial provision, and ASHP accreditation
   • An inquiry with response measurement from health-system pharmacy administration and leadership (HSPAL) residency program directors and residents to distinguish variances between the programs and identify enhancement opportunities for key stakeholders

• Nearly half of the residency program directors within the listserv (40.74%, 33/81) participated in the survey.
  • The recognized areas of opportunity by residency program directors include community pharmacy leadership, professional organization involvement, sterile compounding, and supply chain management.
  • About a third (32.54%, 41/126) of the residents participated in the survey.
    1. Residents reported the least exposure to community pharmacy leadership, human resources, informatics, professional organizations, and ambulatory care/specialty rotations. The overall recommendations for HSPAL residency programs are to incorporate C-suite level experiences, improve alumni engagement, develop longitudinal human resource experiences, and encourage resident credential obtainment.
  • RPD Survey
    • More than half of participants came from academic facilities of > 1,000 beds
    • 70% Stated program design was Traditional PGY-1 experience and administrative PGY-2 experience
    • 48% of HSPA actively managed or supervised < 10 team members
    • Over 80% participation in recruiting and hiring decisions
      1. A similar result in the resident survey
    • Over 80 % have some/limited involvement in HR mgmt. decisions
      1. A similar result in resident survey ~ over 70%
    • Over 60% of the residents end up as a pharmacy manager or ops manager
      • A similar result in the resident survey
      • The resident survey showed diverse ideal positions upon completion operations, clinical, ambulatory, and policy/safety

• Incorporate C-suite level experiences –>essential for residents to acquire exposure to the perception of pharmacy and understand pharmacy expectations from C-suite officials
  • Encourage Alumni engagement –> networking/mentorship opportunities
  • HR mgmt. as longitudinal experience à residents may need to assume more supervisory roles –> recruitment/disciplinary/coaching experiences
  • Finance experience as longitudinal –> Budgeting is a continual process.  Residents should be exposed to proactive methods of productivity and cost mitigation strategies to help prepare for future roles.

Oscar Santalo, PharmD, MHA, MBA, BCPS, Joelle Farano, PharmD, MBA, Jacqualine Igwe, PharmD, Niaz Deyhim, PharmD, Survey of health-system pharmacy administration and leadership residencies, American Journal of Health-System Pharmacy, Volume 77, Issue 6, 15 March 2020, Pages 449–456, https://doi.org/10.1093/ajhp/zxz327

The post Episode 27: Survey of Health-System Pharmacy Administration & Leadership Residencies appeared first on The Pharm So Hard Podcast.

The post Episode 26: The B52 is Trash! Going from the B52 to the 55 Blitz with Dan McCollum. appeared first on The Pharm So Hard Podcast.

• Situation
  • Pantoprazole 80 mg in NS 100 mL drip is being used for GI Bleeds due to ulcers
  • Problem:
    • Evidence not being clear on optimal dosing strategy
  • Opportunity to:
    • Standardize dosing strategies for upper and lower GI bleeds
    • Follow best practice strategies

• Dosing Strategies for GI Bleeds
• Bleeding ulcer: Note: For clinically significant upper GI bleeding prior to endoscopy. Optimal IV dosing regimen has not been established;
• IV: Intermittent dosing:
  • Loading dose of 80 mg, followed by 40 mg every 12 hours
• IV: Continuous infusion:
  • Loading dose of 80 mg, followed by 8 mg/hour infusion

• Remove 80 mg in NS 100 mL order product
• Pursue intermittent strategy
  • Loading dose of 80 mg, followed by 40 mg every 12 hours
• Increase medication access in Pyxis
• Can be prepared on the unit

• Br J Clin Pharmacol. 2010;69(3):245-251. doi: 10.1111/j.1365-2125.2009.03575
• J Med Assoc Thai. 2012;95(3):349-357
• ANZ J Surg. 2007;77(8):677-681. doi: 10.1111/j.1445-2197.2007.04185
• Ann Intern Med. 2010;152(2):101-113. doi: 10.7326/0003-4819-152-2-201001190-00009
• Ann Intern Med, 2009, 150(7):455-64.
• JAMA Intern Med. 2014 Nov;174(11):1755-62. doi: 10.1001/jamainternmed.2014.4056.
• Adv Biomed Res. 2017 Sep 21;6:120. doi: 10.4103/abr.abr_59_16
• Gut Liver. 2019 Jan 15;13(1):40-47. doi: 10.5009/gnl18222

The post Episode 25: Pantoprazole Continuous infusion vs Intermittent Bolus Formulary Nugget by Oscar Santalo appeared first on The Pharm So Hard Podcast.

The post Episode 24: Procainamide for Stable Wide Complex Tachycardia appeared first on The Pharm So Hard Podcast.

http://www.medicalhf.org/epharm/index.html

https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/emergency-care/Justification-referenced-document.ashx

http://embasic.org/

https://www.healthleadersmedia.com/clinical-care/using-clinical-pharmacists-improve-your-emergency-department

https://www.acep.org/patient-care/policy-statements/clinical-pharmacist-services-in-the-emergency-department/

https://pharmertoxguy.files.wordpress.com/2016/07/what-your-ed-pharmacist-wishes-you-knew-handout-hayes-aaem-2016.pdf

The post Episode 23: How Physicians Can Best Utilize EM Pharmacists appeared first on The Pharm So Hard Podcast.

https://pharmertoxguy.com/

https://www.ashp.org/Pharmacy-Practice/Resource-Centers/Emergency-Care

https://www.ashp.org/news/2019/06/06/emergency-medicine-certificate?loginreturnUrl=SSOCheckOnly

REQUIRED COMPETENCY AREAS, GOALS, AND OBJECTIVES FOR
EMERGENCY MEDICINE POSTGRADUATE YEAR TWO (PGY2)
PHARMACY RESIDENCIES

• https://www.ashp.org/-/media/assets/professional-development/residencies/docs/pgy2-emergency-medicine-cago-2018.ashx

https://www.bpsweb.org/wp-content/uploads/Emergency-Medicine-Petition-BPS-2019.pdf

ASHP Guidelines

https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/emergency-medicine-pharmacist-services.ashx

ACMT Position Statement

https://www.acmt.net/_Library/Positions/ACMT_Position_Pharmacists.pdf

ACEP Position

https://www.acep.org/patient-care/policy-statements/clinical-pharmacist-services-in-the-emergency-department/

The post Episode 22. History and Outlook of EM Pharmacy with Bryan Hayes, PharmD, DABAT, FAACT, FASHP appeared first on The Pharm So Hard Podcast.

• Recognize the process of recruitment
• Understand the methods of candidate selection
• Review the components of staff retention

• Position description
• Sources
• Pre-interview information

• Position title, control number
• Duties, responsibilities, job functions
• Licensure, education, training requirements
• Reporting relationships
• Other specifications

Depend on position type > Recruitment plan
Internal applicants > Increase retention/loyalty
Pre-interview info
◦ CV, Letters of Rec, academic records

Ads in professional journals, newsletters, online
Placement services ($)
Recommendations from colleagues ($)
Visit to training programs

• Recruiting firms ($)
• Tuition assistance programs
• Prospect list
• Internet job site postings
• Job fairs
• Sponsored events

Goal
◦ Best available candidate for a specific position
Initial screening interview
◦ Phone interview
Background verification

• Mgm should provide to the candidate
  • ◦ Institution info, Agenda, Position info, Travel directions
• Carefully planned
• Providing adequate time
  • ◦ Including a tour of the facility
• Interviewers should be prepared with candidate info

• Review the agenda
• Incorporate travel time
• Try manage meal and bathroom breaks
• Make sure suit is prepared
• Take some time to review your notes before

Project confidence, good body posture, and try to notice nervous ticks
Be energetic and flexible
Take notes (in case you forget)
Be yourself
Make sure you understand the questions (repeat if needed) and take your time with responses

• Phone
  • ◦ Reschedule if you have to
  • ◦ Clear the room and don’t get interrupted
  • ◦ Don’t be eating or drinking
  • ◦ Take notes
• Video
  • ◦ Test connection, web came, and audio
  • ◦ Try to connect in advance
  • ◦ No distracting back wall
  • ◦ Suit up (fully or w/e)
  • ◦ Smile and make eye contact with the web came
  • ◦ You can post your notes to help you stay on track

• About me
  • ◦ Name > Current role > what you do in that role briefly (think applicable to what your applying for) > Schools graduated from > why you pursued this field and why you are excited about the position

• Weaknesses
  • Always try to pick characteristics that you can flip into strengths
  • ◦ Example, perfectionist or being critical of oneself
  • ◦ Or simply state something you would like to improve on
  • ◦ Writing, public speaking, etc > But be able to explain how you are going to work on them

• Description of employee benefits
• Initial salary may be discussed
• Work schedule review
• Tour of region
• Follow up letter

• Staff turnover is costly
• Factors
• ◦ Training period
• ◦ Intent to stay
• ◦ Job satisfaction > Recognition, Awards
• ◦ Pay and benefits
• ◦ Performance mgm

• Thank you notes, Commendations, Awards
• Professional meetings, Tuition, Scheduling
• Promotion opportunities, Motivations
• Job design, Staff development
• Peer Relations, Kinship Responsibilities
• Physical work conditions
• Exit interview

• Best recruiting tools
• Interview tips and tricks
• Sings of turnover
• Who is on your team?

The post Episode 21. We Belong Together – How to Interview like a boss with Oscar Santalo and Jonathan Richardson appeared first on The Pharm So Hard Podcast.

• Twitter
• Instagram

• Twitter
• Instagram

Out-of-hospital tracheal intubation is an accepted practice that has increased in frequency due to advancements in aeromedical technology and transport.

A flight nurse, sometimes referred to as a transport nurse, is an RN who is specially trained to provide medical care to patients during aircraft transportation. As part of a team that usually includes flight medics, physicians, and other medical providers, flight nurses board helicopters, rescue flights and more to give medical attention to injured or ill patients in emergency situations. These nurses must keep patients stable until the aircraft arrives at the proper healthcare facility. Flight nurses work in both civilian and military environments.

Training, protocols, oversight, and frequency of individual provider intubation all might influence success rates and clinical outcome, and previous reports may not represent success rates possible from highly skilled clinicians working in high volume systems

A typical flight or transport nurse job description can include any of the following:

• Minimum of 5 years of experience in ICU/ED/Trauma
• Ability to work autonomously in a confined space with other team members
• Advanced critical care knowledge including ventilator experience
• Fitness ability for the physical requirements of the job
• Ability to work varied shifts including overtime and 24/7 on-call rotation
• Strong leadership skills and ability to communicate and work with a variety of people, often in stressful situations
• Flight experience preferred

Running a Code (in Tight Quarters)

http://www.tamingthesru.com/blog/acmc/running-a-code-in-tight-quarters

Mason R, Latimer A, Vrablik M, Utarnachitt R. Teaching Flight Nurses Ultrasonographic Evaluation of Esophageal Intubation and Pneumothorax. Air Med J. 2019;38(3):195‐197. doi:10.1016/j.amj.2018.11.007

Pugh D. Flight nursing down under: a perspective. Accid Emerg Nurs. 2000;8(3):141‐143. doi:10.1054/aaen.2000.0151

De Jong MJ, Dukes SF, Dufour KM, Mortimer DL. Clinical Experience and Learning Style of Flight Nurse and Aeromedical Evacuation Technician Students. Aerosp Med Hum Perform. 2017;88(1):23‐29. doi:10.3357/AMHP.4697.2017

https://www.registerednursing.org/specialty/flight-nurse/

The post Episode 20: RSI From the Sky: Caring for Intubated Patients as a Flight Nurse with Everett Moss II, BSN, RN, NRP appeared first on The Pharm So Hard Podcast.

1. In 2003 – 2014 inpatient hospital costs ranged from $3,018 to $5,040 per admission for a primary DVT diagnosis
2. Average DVT LOS can range from 4.9 – 7 days
3. Recurrent VTE that requires readmission could be up to 48% more costly than the initial event
4. Protocols for outpatient DVT management found a cost reduction of $2,470 per patient with enoxaparin
5. 36% of patients have expressed the inability to afford medications
6. In Burnett’s, et al study that discusses the DOAC patient selection criteria for DOAC use included:
   1. Adherence, patient follow up, confirmed ability to obtain DOAC
7. Falconieri’s and colleagues, et al found that none of 106 patients developed VTE recurrence on outpatient therapy
8. Did not experience clinically significant bleeding
9. Pharmacist-managed DVT program in the ED had a 91% initial clinic follow up
10. Rivaroxaban Starter Packs (RPAKs) given at discharge increases proper dose transition and overall adherence

Adult patients had to be stable and have a non-complicated lower DVT

• Workflow
  • The patient has confirmed DVT and meets inclusion criteria –> Provider enters order set and RPh verifies protocol–> Central pharmacy team labels then dispenses RPAK –> RN administers 1st dose out of pack and documents RPAK sent home with the patient –> Care navigation and TOC team follow up with the patient

1. Dispensed appropriate and compliant with Florida Limited Community Permit 64B16-28.810
   1. (e) A “multi-dose medicinal drug” as used in this rule means, but is not limited to, commercially available multi-dose packages such as inhalers, ocular products, insulin vials or pens, otic products, bulk antibiotic suspensions, topical agents, and methylprednisolone dose packets dispensed to inpatients, provided in containers that may exceed a three (3) day supply, and are intended to be continued by the patient on an outpatient basis but not to be re-filled by the hospital.

1. Early directed DVT with rivaroxaban starter packs have been proven to reduce admissions at 8 weeks
2. This research demonstrates how hospitals can be compliant with regulatory standards, pharmacy services, and serve the community by providing no additional out-of-pocket costs for the packs
3. Considering an estimated 900 admissions for uncomplicated DVT annually, our health system will have a projected cost savings of $2,678,901

https://rebelem.com/tag/dvt/

Fernandez MM, Hogue S, Preblick R, Kwong WJ. Review of the cost of venous thromboembolism. Clinicoecon Outcomes Res. 2015 Aug 28;7:451-62. doi: 10.2147/CEOR.S85635. eCollection 2015.

Davis KA, Miyares MA, Price-Goodnow VS. Optimizing transition of care through the facilitation of a pharmacist-managed deep vein thrombosis treatment program. J Pharm Pract. 2013 Aug;26(4):438-41. doi: 10.1177/0897190012465953. Epub 2012 Nov 19.

Burnett AE, Mahan CE, Vazquez SR, et al. Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis. 2016 Jan;41(1):206-32. doi: 10.1007/s11239-015-1310-7.

Falconieri L, Thomson L, Oettinger G, et al. Facilitating anticoagulation for safer transitions: preliminary outcomes from an emergency department deep vein thrombosis discharge program.  Hosp Pract (1995). 2014 Oct;42(4):16-45. doi: 10.3810/hp.2014.10.1140.

Beam DM, Kahler ZP, Kline JA. Immediate Discharge and Home Treatment With Rivaroxaban of Low-risk Venous Thromboembolism Diagnosed in Two U.S. Emergency Departments: A One-year Preplanned Analysis. Acad Emerg Med. 2015 Jul;22(7):788-95. doi: 10.1111/acem.12711. Epub 2015 Jun 25.

Castelli MR, Saint CA, Nuziale BT, et al. Effect of a Rivaroxaban Patient Assistance Kit (R-PAK) for Patients Discharged With Rivaroxaban: A Randomized Controlled Trial. Hosp Pharm. 2017 Jul;52(7):496-501. doi: 10.1177/0018578717721105. Epub 2017 Jul 25.

The post Episode 19: Early ED Discharge in Patients with low-risk VTE with DOACs with Jimmy Pruitt and Oscar Santalo appeared first on The Pharm So Hard Podcast.