Pharmacist Roles: Clinical Specialties

TSHP Annual SeminarApril 11, 2021

Ardath K. Plauche, PharmD, RN, BCPS, BCIDPInfectious Diseases Clinical Pharmacist

Memorial Hermann Katy

Overview

Who am I and why am I talking to you?

What is Clinical Pharmacy?

How do I get to a Clinical Pharmacy

role?

Is Infectious Diseases the best

specialty?**yes

How do I stay current in clinical

practice?Key Takeaways

Objectives(the official info)

1. Explore professional paths leading to clinical specialty practice2. Investigate Infectious Diseases as a pharmacy specialty practice area3. Summarize clinical specialty opportunities for continued personal

learning and development

This session will detail paths to clinical pharmacy practice, resources for education in clinical areas, and an overview of

infectious diseases as a clinical pharmacy specialty.

Who am I and why and I

talking to you?BS in Nursing Southeastern

Louisiana University

PharmDUniversity of

Oklahoma

PGY1, PGY2 Infectious Diseases

MEDVAMC

Infectious Diseases Clinical PharmacistPGY1 Residency Program Coordinator

Memorial Hermann Katy

A little more about me…

• Strategic Planning Committee, Chair• Certificate Program Committee, Chair• Communications Committee, Member• New Practitioner Committee, Member• Annual Seminar Poster Competition, Judge

• Immediate Past President• President, 2019-2020• New Practitioner Chair

• Antimicrobial Stewardship Committee

What is Clinical Pharmacy?What does Clinical Pharmacy mean to you?

What examples have you seen?Volunteer experiences?Rotations?Variety of work settings?

Do all areas of pharmacy involve clinical practice?

What is Clinical Pharmacy?Specialized advanced

education and training with clinical competency

to practice in team-based, direct patient care

Collaborate with other providers to deliver

comprehensive medication management

to optimize patient outcomes

Document in the patient’s medical

record the medication-related assessment and

plan of care

Maintain competence in clinical problem-solving, judgement, decision-making; communication and education; medical information management;

management of patient populations, and broad range of therapeutic knowledge domains

Work with other health professionals as members of the health care team to provide

high-quality, coordinated, patient centered care

Commitment to act in the best interest of the

patient and patient populations

Support of and participation in

research and scholarship

Beyond patient care: serve as educators,

researchers, preceptors/mentors,

administrators, managers, policy

developers, consultants

ACCP Standards of Practice for Clinical Pharmacists. Available at: https://www.accp.com/docs/positions/guidelines/standardsofpractice.pdf

How do I get to a clinical pharmacy role?

Specialized education and training

• PGY1 and PGY2 Residency• Fellowship• Graduate Programs• Board Certification• Post-Licensure Experience

Specialty Training Directories° ASHP Residency Directory

• https://accreditation.ashp.org/directory/#/program/residency

° ACCP Directory• https://www.accp.com/resandfel/search.aspx• Fellowship, Graduate Programs, Non-accredited Residency

• Fellowships: academic research, ambulatory care, cardiology, community, drug development, drug information, outcomes research, infectious diseases, toxicology

• Graduate programs: administration, pharmacogenomics, translational research

PGY1 and PGY2 ResidencyPGY1

° Pharmacy Practice

° Community-Based Pharmacy

° Managed Care Pharmacy

PGY2° Ambulatory Care° Cardiology° Pharmacogenomics° Corporate Pharmacy Leadership° Critical Care° Drug Information*° Emergency Medicine° Geriatrics° Health System Administration*° Infectious Diseases° Internal Medicine° Investigational Drugs and Research*

° Medication Use Safety/Policy*° Oncology° Medication Systems &

Operations*° Palliative/Pain Management*° Pediatrics° Pharmacotherapy*° Pharmacy Informatics*° Population Health and Data

Analytics ° Psychiatry° Solid Organ Transplant° Specialty Pharmacy

Administration*

*Combined PGY1/PYG2 programs available

Residency Options: How to Choose?

Geography

Proximity

Climate

Housing

Site Demographics

ASHP accredited vs. non-

accredited

Bed Size

Patient Population

Academic medical center vs. community

Program Environment

Co-residents

Work space

PGY2 availability

Culture•Environment•Mentorship

Program structure

Rotations•Core•Elective•Off-site

Teaching opportunity

Research

Staffing

Board Certification° Ambulatory Care ° Cardiology° Compounded Sterile Preparations° Critical Care° Geriatrics° Infectious Diseases° Nuclear Pharmacy° Nutrition Support° Oncology° Pediatric° Pharmacotherapy° Psychiatric° Solid Organ TransplantBoard of Pharmacy Specialties. 2019 Annual Report. Available at: https://www.bpsweb.org/about-bps/annual-reports/

Board Certified Pharmacotherapy Specialist (BCPS)° Most common pharmacy specialty (currently ~27,600)

° Eligibility requirements:• Graduation from a pharmacy program• Current, active license to practice pharmacy• Demonstration of practice experience

• 3 years of practice experience (after licensure) OR• Completion of a PGY1 residency

° Certification renewal:• Recertification examination OR• Continuing education – 120 hours of CE provided by ACCP or ASHP• Annual recertification fee

BPS. Available at: https://www.bpsweb.org/bps-specialties/pharmacotherapy

Board Certification Pass Rate

Certificate Programs

TSHP Certificates Coming Soon

Transitions of Care

Medication Reconciliation

ASHP Professional Certificates. Available at https://www.ashp.org/Professional-Development/Professional-Certificate-Programs

Infectious Diseases

Available at: https://sidp.org/Stewardship-Certificate

Infectious Diseases Clinical Pharmacy

Settings•Academic Medical

Center•Community•Inpatient•Outpatient

Roles•ID Consult Team•Interdisciplinary

Team•Antimicrobial

Stewardship

Professional•Preceptor•Interdisciplinary

Committees•Department

Collaboration

Antimicrobial Stewardship° Ensure optimal use of antimicrobials to achieve the best clinical outcomes

• Minimize adverse events• Mitigate factors that lead to resistance• Reduce costs attributable to suboptimal antimicrobial use

° Prudent antibiotic use is the key to delaying the emergence of resistance

http://www.antimicrobialstewardship.com

MHHS Antimicrobial Stewardship PiL.

Four Moments of Antibiotic Decision Making1. Does my patient have an infection

that requires antibiotics?

2. Have I ordered appropriate cultures before starting antibiotics? What empiric therapy should I initiate?

3. A day or more has passed. Can I stop antibiotics? Can I narrow therapy or change from IV to oral therapy?

4. What duration of antibiotic therapy is needed for my patient's diagnosis?

AHRQ Safety Program for Improving Antibiotic Use. 2018.

Goals of core antimicrobial stewardship activities•Think streamlining and appropriate durationAntibiotic selection/duration

•Trend antimicrobial use over timeAntibiotic utilization analysis

•Ensure optimal dose based on patient characteristicsDose optimization

•Utilize technology (TheraDoc®)Information technology

support

•Open communication is key; Leverage expertise Provider feedback

•Empower through educationEducation

MHHS Antimicrobial Stewardship PiL.

How do I stay current in clinical practice?• Table of Contents Alerts• RSS Feeds: Feedly; Email Alerts: EvidenceAlerts• Apps: Read by QxMD• Podcasts: ACCP, SIDP Breakpoints,, Puscast

Curated Primary Literature

• Guideline publications• Resource collections• Conferences• Networking

Professional Organizations

• Clinical Decision Support Systems• Apps: RxCalc, Hopkins Guides, CDC Vaccine Schedule• UptoDate• Lexicomp

Electronic Resources

Gandhi AS. Staying Current: Advice for New Practitioners. HOPA News 2020, Volume 17, Issue 3.

Social Media

Key Takeaways1

Clinical Pharmacy is a broad practice contributing to

direct patient care

2There are MANY

routes to a clinical pharmacy role.

3Infectious Diseases is challenging and

rewarding!

4There are MANY

resources available to stay current in

practice.

Question 1Available resources for specializing in a clinical pharmacy area include:

A. Residency and fellowship trainingB. Board certificationC. Certificate programsD. All of the above

Question 2Infectious Diseases Clinical Pharmacy practice includes the following:

A. Antimicrobial resistanceB. Antimicrobial stewardshipC. Provider, staff, and patient educationD. All of the above

Question 3Antimicrobial stewardship refers to:

A. Efforts to measure and improve how antimicrobials are prescribed by clinicians and used by patients

B. Use of punitive metrics to compare antimicrobial useC. Making a one-size-fits-all approach to optimize antimicrobial use

across all healthcare settingsD. All of the above

Question 4Which organization provides a residency directory listing information such as stipend, bed size, and census?

A. ASHP B. ACCP C. SIDPD. All of the above

Question 5Infectious disease clinical pharmacy includes opportunity to work in the following settings:

A. Inpatient – academic medical centerB. Inpatient – community hospitalC. Ambulatory careD. All of the above

Thank You

Twitter@ardathplauche

Emailardath.plauche@memorialhermann.org