AUG. 2012

The Official PublicationOf The Florida Pharmacy Association

West Nile Virus and Preventing Mosquito Bites

1. Standing in front of the new Foundation exhibit (l-r) Pat Powers, EVP; Trustees Paul Ackerman, Gary Koesten and Todd Schmidt.

2. Pat Powers dropped in the last ticket before the drawing with Al Tower (center) and Ken Norfleet doing a whole lotta shakin’.

3. Dee Dee and Charlie Stidham, Lake Placid, bought their brick for The Walkway of Recognition with a “Go Gators!” engraving.

4. Trustee Rod Presnell with his three grandsons at the Ice Cream Social looking over the flavors of ice cream and toppings. Decisions! Decisions!

5. The Ice Cream Social sponsored by Walgreens is always a hit with the crowd. The Walgreens gang (l-r) Keri Kratofil, Jeenu Philip, Trustee Terry Gubbins and Lince Jacob having fun dishing up the ice cream along with some laughs.

Email Network HotlineReceive up-to-date and up-to-the-minute information on Legislative Developments, Board of Pharmacy changes and other top-ics affecting the profession of pharmacy. Call FPA Member Services at (850) 222-2400 ext. 110 – cheil@pharmview.com.

Tax ResourceProvides defense and protection of your assets when you are audited. Tax Resource will defend their clients for any income tax audit, Federal or State, for any tax year. Tax Resource pioneered the tax audit service business, and is the largest audit defense firm in the United States. Call (800) 92-AUDIT (800-922-8348).

Atlantic Coupon Redemption Center Receive payment in 25 working days of coupon’s face value plus a rebate of 1/6 cents based on store volume. Call Meredith McCord (800) 223-0398.

Florida Commerce Federal Credit Union The chief objective of a credit union is not generating profits for stockholders, but to provide service to its member. The mem-bers benefit by getting attractive returns on savings, loans made at fair rates of interest plus enhanced and expanded services. This is probably one of the best deals around. Call (850) 488-0035.

Collection Services For past due accounts call I. C. System, Inc. Call (800) 328-9595.

Other Member Benefits Discounted Continuing Education Pro-

grams Monthly Issues of the Florida Pharmacy

Today Journal

Rental Car DiscountsNow when you rent from Hertz, or Avis you can take advantage of special savings through either the Hertz Member Benefit Program or with an Avis member savings card. Flori-da Pharmacy Association members receive a discount off Hertz Daily Member Benefit Rates, Hertz U.S. Standard Rates; and Hertz U.S. Leisure Rates. Avis will be providing to members a discount off of weekly rates and a free weekend day for qualified rentals. You’ll be quoted the best rate for your rental needs at the time of reservation. See the FPA web site for more details or call the FPA office.

Pharmacy Resource Materials FPA provides the most recent and relevant re-sources necessary to meet your professional needs. This includes the Continuous Quality Improvement Manual, Controlled Substance Inventory Booklets and Pharmacy Signs. We also have available a fraud, waste and abuse manual which includes a section on Board of Pharmacy required procedures for handling fraudulent prescriptions. Please call FPA Members Services for more information: 850-222-2400 ext. 110.

FPA Website Visit our FPA Website at ww.pharmview.com. The site, launched in December 2004 and re-vised in October 2008 and in July 2012, in-cludes a members only section. The website offers a secure server so that you can register for CE programs, renew your membership or purchase resources materials with your cred-it card.

In keeping with a tradition of offering our members real benefits, the Florida Pharmacy Association (FPA) is proud to announce the introduction of sponsored Discount Benefits Program. These vendors are dedicated to providing an excellent value to all FPA members and associates. To take advantage of benefits contact the vendors directly at the numbers listed below and identify yourself as a FPA member and have your membership ID number handy.

MEMBERSHIP MATTERS!

Florida Pharmacy Association

Is your technician enrolled in the FPA employer based technician training program? If so encour-age them to consider becoming certified through the Pharmacy Technician Certification Board

(PTCB) when they finish the program. For more information, contact the FPA at (850) 222-2400 or visit the PTCB website at www.ptcb.org.

A U G U S T 2 0 1 2 | 3

VOL. 75 | NO. 8AUGUST 2012The OfficiAL pUbLicATiON Of ThefLOridA phArmAcy ASSOciATiONP H A R M A C Y T O D A Y

florida

Departments 4 calendar

4 Advertisers

5 president’s Viewpoint

7 executive insight

16 buyer’s Guide

FeaturesWest Nile Virus and preventing mosquito bites

Short cycle dispense: A case Study in implementation

pharmacy Leadership boot camp a Success

11

12

15

4 | f L O r i d A p h A r m A c y T O d A y

E-MAIl yOUR SUGGESTIONS/IDEAS TO

dave@fiorecommunications.com

Mission Statements:of the florida pharmacy Today JournalThe Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Phar-macy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.

of the florida pharmacy Today board of directors The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and execu-tive editor of the Florida Pharmacy Today Journal in the establishment and interpreta-tion of the Journal’s policies and the manage-ment of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members to secure appropriate advertising to assist the Journal in its goal of self-support.

AdvertisersEPC .....................................................................10FRIED .................................................................10HEAlTHCARE ConsulTAnTs ....................3KAhAn ShIR, P.L. .........................................14PPsC ...................................................................10Rx RElIEF ..........................................................14

2012

FPA Calendar SEPTEMBER

1 Deadline to submit nominations for FPA Office

3 Labor Day - FPA Office Closed

8 FPA Clinical Consultant Conference Fort Lauderdale

OCTOBER

9 - 10 Florida Board of Pharmacy Meeting - Tallahassee

13-17 nCPA Meeting San Diego, California

20-21 FPA Midyear Clinical Consultant and nuclear Pharmacist Meeting Orlando

NOvEMBER

2-3 FPA Budget and Finance Committee and Board of Directors Meeting and council meetingsOrlando

12 FPA office closed for Veterans Day

15-17 nAsPA and AsPl Fall MeetingTucsan, Arizona

15-17 AsCP Annual MeetingNational Harbor, Maryland

22-23 Thanksgiving - FPA Office Closed

DECEMBER

1-2 Sarasota Law Conference, Hyatt Regency Sarasota

11-12 Florida Board of Pharmacy Meeting Tallahassee

24-25 Christmas holiday, FPA Office Closed

CE CREDITS (CE cycle)The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part

of the required 30 hours general education needed every license renewal period.Pharmacists should have satisfied all continuing education requirements for this

biennial period by September 30, 2013 or prior to licensure renewal.*For Pharmacy Technician Certification Board Application, Exam Information and

Study materials, please contact the FPA office.For More Information on CE Programs or Events:Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at

www.pharmview.com

CONTACTSFPA — Michael Jackson (850) 222-2400FsHP — Michael McQuone (850) 906-9333u/F — Dan Robinson (352) 273-6240FAMu — leola Cleveland (850) 599-3301nsu — Carsten Evans (954) 262-1300

DISClAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the under-standing that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

For a complete calendar of events go to www.pharmview.com

A U G U S T 2 0 1 2 | 5

I am excited to be your president this year. There is so much going on; so many opportunities. Over the last few months, I have had the distinct pleasure of meeting and speaking with a number of pharmacy leaders from around the state and around the coun-try. These individuals are from many pharmacy associations and have con-stituents in all practice settings. The “talk” I’ve been hearing is about expan-sion of the role of pharmacists in the fu-ture health care system.

I’ve heard things like, “disruptive innovation,” credentialing and ac-creditation, the need to be recognized as healthcare providers under the so-cial Security Act, expanded collabora-tive agreement models with our other healthcare colleagues, development of business models that pay pharmacists for providing patient care services and the like.

I will share with you that in my dis-cussions with these folks, there appears to be a healthy dose of frustration, and a sense of restlessness and anticipation. In my opinion, these feelings are signs that we are at a tipping point. We are in the process of evolution. In the words of our FShP brethren, our profession is poised to “step into the future.”

As the roles for pharmacists contin-ue to change and evolve, the roles of our pharmacy technician colleagues will likewise change. Our pharmacy technicians will be asked to help sup-port patient care activities delivered by pharmacists. As an integral part of the pharmacy team, technicians play a piv-otal role in helping ensure the success-ful evolution of our profession. We all know how heavily we depend on them to help us take care of our patients.

At the annual meeting in Marco Is-

land this past July, I was overjoyed to see so many students from each of the colleges of pharmacy in the state of Florida. At the “Student Summit” dur-ing convention, students were asked to discuss where they saw the profession going in the next five to 10 years. I saw the excitement and enthusiasm as they deliberated and shared their answers

before the group. Many of the answers coalesced

around the idea of direct patient care activities and integration as members of the healthcare team. Some of the panelists/moderators shared some of their experiences and how they had also been agents of change as stu-dents and new graduates. There was so much energy in the room that when the meeting ended the students contin-ued to debate and to share their aspira-tions of what pharmacy can be.

At the end of the summit and at

many other instances during the meet-ing, students came up to me and asked how they might become involved in FPA. needless to say, it is very encour-aging to me to see these students wish-ing to participate in the shaping of our profession. The students are our future and I have taken great strides to ensure that students from each college of phar-macy in our state sit on each and every Council of the Florida Pharmacy Asso-ciation.

Because I believe we are at a thresh-old in our professional evolution, I have chosen forward -thinking Chairs and Council members to guide our Asso-ciation. I appointed student pharma-cist Jennifer Raquipo as Chair of the Professional Affairs Council. Jennifer has been very active at the FPA since her first year in pharmacy school. She is currently a fourth-year student. Jen-nifer brings energy and enthusiasm to the Council and is supported by an in-credible team of experienced profes-sionals. her appointment is historic.

We are at a Threshold in our Processional Revolution

As an integral part of the pharmacy team,

technicians play a pivotal role in helping ensure

the successful evolution of our profession. We all know how heavily we depend on them to help us take care of our

patients.

The President’s ViewpointGOAR AlvAREZ, FPA PRESIDENT

Goar Alvarez, 2012-2013 FPA President

E-MAIl yOUR SUGGESTIONS/IDEAS TO

dave@fiorecommunications.com

6 | f L O r i d A p h A r m A c y T O d A y

Jennifer holds the honor of being the first student pharmacist to have been appointed Chair of a Council in FPA.

Carmen Aceves-Gordon was ap-pointed Chair of the Organizational Affairs Council. Carmen has held a significant number of leadership posi-tions in FPA. She has exceptional or-ganizational skills, and I am highly confident she will ensure that our or-ganizational structures and functions serve our members well. The Organi-zational Affairs Council also has the task of developing strategies to revi-talize, support and strengthen our lo-cal unit associations.

The Educational Affairs Council is chaired by Angela Clausen. Ange-la’s Council will focus on developing “how-to” and “nuts-and-bolts” pro-grams that can be translated and ap-plied in practice. These educational programs should empower our mem-bers to become more successful and to thrive in the healthcare system of to-day and tomorrow.

Angela Garcia will lead the Pub-lic Affairs Council. One of her tasks is to develop materials that commu-nicate the value of “the pharmacist” to the public. Once developed, these materials will be made available to our members for use in communicat-ing the pharmacists’ value to patients as well as lawmakers.

The Governmental Affairs Council is chaired by past president Humber-to Martinez. Bert has already begun the process of prioritizing our legisla-tive agenda. I have asked Bert to not only address the immediate needs of the members of the Association but also to strategize legislative and rule-making plans to empower our mem-bers to practice to the full extent of their education and training.

Our newest Council, the Member-ship Council, is headed by past pres-ident Don Bergemann. Don’s over-arching charge is to develop a “value proposition” model for members and prospective members. As you know, nothing can be done on behalf of our profession if our Association does not represent a significant number of practicing pharmacists. The Associ-ation, in fact, the Profession, cannot

share our message without sufficient members; and not only members, but engaged members.

The Health Fair and legislative Day events are co-chaired by Ange-la Garcia and Suzanne Kelly. This committee will organize this year’s event during the legislative session at the Capitol in Tallahassee. I sincerely hope that student participation is en-couraged by the deans of each of the colleges of pharmacy. Student partic-ipation last year was fantastic and we hope to have an even greater student involvement this year.

Speaker of the house Eric Alvarez will ensure that the Councils stay fo-cused and that information is shared among the members of the Councils so that all of us are working in unison.

Lastly, I formed the first “high Council of Advisors” and named pharmacy legends Ed hamilton, Jim Powers, Fred Lippman, and Michael Mone to this historic Council. They will be called upon to share their ex-pertise and views on matters of im-portance to the association and the profession. I am thankful to each of them for having accepted their ap-pointment and for their commitment to the association and the profession.

I am inspired by the feedback I’ve gotten from pharmacists, students and technicians over this past year. There are forces both from within our profession, such as the student enthu-siasm I spoke of earlier, and forces ex-ternal to our profession, such as the “aging of America” and the decreas-ing number of primary care provid-ers that I truly believe will help us to step across the threshold. I invite you to join the evolution revolution… and transform the practice of pharmacy.

Goar Alvarez, Pharm.D.

Executive Vice President/CEOMichael Jackson

(850) 222-2400, ext. 200Director of Continuing Education

Tian Merren-Owens, ext. 120Controller

Wanda Hall, ext. 211 Educational Services Office Assistant

Stacey Brooks, ext. 210Coordinator of Membership

Christopher Heil, ext. 110

FlORIDA PHARMACy TODAy BOARDChair............................................. Jennifer Pytlarz, BrandonVice Chair ..................Don Bergemann, Tarpon SpringsTreasurer ..............................Stephen Grabowski, TampaSecretary ........................Stuart Ulrich, Boynton BeachMember .................................... Joseph Koptowsky, MiamiMember .............................Rebecca Poston, TallahasseeMember ............................. Carol Motycka, St. AugustineMember ...................................Cristina Medina, HollywoodMember ................................Norman Tomaka, MelbourneMember .............................Verender Gail Brown, OrlandoExecutive Editor ........Michael Jackson, TallahasseeManaging Editor ........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2012, FLORIDA PHARMACY JOURNAL, INC.ARTICLE ACCEPTANCE: The Florida Phar-macy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today.

The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board.

FLORIDA PHARMACY TODAY, Annual sub-scription - United States and foreign, Indi-vidual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax.

FlorIDA PhArmAcy AssocIATIon

610 N. Adams St. • Tallahassee, FL 32301850/222-2400 • FAX 850/561-6758

Web Address: http://www.pharmview.com

FPA STAFF

A U G U S T 2 0 1 2 | 7

The idea on the table was to make available an accreditation program in which pharmacy could

become credentialed by a qualified neutral

party and thereby reduce the need for repeated inspections by state

agencies.

There used to be a time when a pharmacist completed his or her education, passed a board exami-

nation and began practicing in a phar-macy, that they happily went about their daily tasks knowing that their qualifications were all that were need-ed to provide care for the patients that they served. Our environment, how-ever, has changed with the growth of managed care, the Medicare Part D pro-gram, the starving of state budgets and the drive toward quality and account-ability. So what does all this have to do with community pharmacy accredita-tion? Read further, and see how this will affect you.

When did this discussion begin and why?

FPA staff actually had an oppor-tunity to sit in on an informal discus-sion during a national Association of Boards of Pharmacy District III meeting in Florida several years ago. The con-versation was centered on some chal-lenges that state boards have been ex-periencing with declining state revenue and having to scale back inspection ser-vices. In some states, pharmacies had not been visited by state inspectors for a number of years. The idea on the ta-ble was to make available an accredita-tion program in which pharmacy could become credentialed by a qualified neu-tral party and thereby reduce the need for repeated inspections by state agen-cies. For example, a pharmacy that was accredited may only have to be inspect-ed once every three years rather than annually. This could reduce some costs to state government.

What is the current status of community pharmacy accreditation?

Obviously, the issue has caught the attention of pharmacy organizations. We all know that the process of accred-

itation is not an inexpensive endeav-or and could tax the limited resources of community pharmacy providers. If you are not sure, ask those pharmacies who have elected to become accredited durable medical equipment providers. Visit with hospital pharmacy directors and mention joint commission and note the reaction you see. During the FPA’s annual meeting this summer, a resolu-tion was put before the House of Dele-gates. That resolution reads as follows:

Whereas, both the American Pharmacists

Association (APhA) and the National Association of Boards of Pharmacy (NABP) are collaborating on a national initiative to facilitate a voluntary community pharmacy accreditation program and;Whereas, the Florida Pharmacy Association does not have a position statement or policy on community pharmacy accreditation and;Whereas, Community pharmacy accreditation may be a significant event in community pharmacy practice where state advocacy organizations may need to provide or be available for input and;Whereas, pharmacist stakeholders in Florida should have an opportunity to be proactive on matters related to community pharmacy accreditation and;Whereas, community pharmacy accreditation may move forward absent input or comment by those most affected by any standards that are developed; Be it resolved, that the Florida Pharmacy Association support “voluntary”

Community Pharmacy Accreditation Pending

Executive InsightBy MICHAEl jACkSON, RPHMICHAEl jACkSON, BPHARM, EvP & CEO, FlORIDA PHARMACy ASSOCIATION

Michael Jackson, B.Pharm

8 | f L O r i d A p h A r m A c y T O d A y

The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work deligently all year long on behalf of our members.

Bob Parrado ............................................................................. Chairman of the BoardGoar Alvarez ...............................................................................................FPA PresidentTerry Gubbins ........................................................................................... President ElectBetty Harris ............................................................................................................TreasurerEric Alvarez ................................................Speaker of the House of DelegatesGary Koesten ................................Vice Speaker of the House of DelegatesPreston McDonald, Director ...........................................................................Region 1Michael Hebb, Director ......................................................................................Region 2Eva Sunell, Director .............................................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 Jeffery Parrado, Director ..............................................................................Region 5 Scott Tomerlin, Director ....................................................................................Region 6Paul Rohrbaugh, Director ................................................................................. Region 7Raul Gallo, Director ................................................................................................Region 8Paul Elias, Director ................................................................................................Region 9Constance Hogrefe ................................................................President Elect FSHPMichael Jackson .......................................Executive Vice President and CEO

Florida Pharmacy Today journal Board

Chair......................................................Jennifer Pytlarz, jlc_rxdoc@hotmail.comVice Chair ........................................................ Don Bergemann, don@bceinfo.comTreasurer ...................Stephen Grabowski, sgrabowski@seniormmc.comSecretary ..................................................................Stuart Ulrich, Stuarx@aol.comMember ................................................Joseph Koptowsky, docjik1215@aol.comMember .......................Rebecca Poston, rebecca_poston@doh.state.fl.usMember ...................................................... Carol Motycka, motycka@cop.ufl.eduMember .......................................................Cristina Medina, cmmedina@cvs.com Member ...............................................................Norman Tomaka, FLRX9@aol.comMember ..................Verender Gail Brown, brownvgrx4304@hotmail.comExecutive Editor ...............Michael Jackson, mjackson@pharmview.comManaging Editor ..................Dave Fiore, dave@fiorecommunications.com

2012 FPA Board of Directorsparticipation in community pharmacy accreditation programs.

To clarify, the intent of the above reso-lution was for the Association to endorse community pharmacy accreditation as an “option only” for those pharmacies that wish to add that credential. It was not a policy of support for any new man-date. In many cases, initiatives will be-gin outside our zone of influence. This is a proposal that is beginning at the na-

tional level that could find its way into our state. We have a choice of either sit-ting back and allowing it to happen or finding a way to have a seat at the table to help shape its development. After all, you are either at the policy table or you are the main course on the menu. The house of Delegates, which includes par-ticipating pharmacy stakeholders from throughout Florida and a host of practice settings, supported this resolution with no objection.

Are there standards for community pharmacy accreditation and who should develop them?

As with any accreditation process, there are standards and criteria that pharmacies would be measured by. There is work being done in this area as you are reading this. What is most impor-tant is that these standards must be un-der the ownership of the profession and not government policymakers or phar-macy provider stakeholders. You may

The House of Delegates, which includes

participating pharmacy stakeholders from

throughout Florida and a host of practice settings, supported this resolution

with no objection.

A U G U S T 2 0 1 2 | 9

have at least some comfort in know-ing that the Joint Commission of Phar-macy Practitioners, which includes all of the national pharmacy associations, is heavily engaged in influencing the discussions in this area. Also what is critically important is that any such ac-creditation process adopted should be site specific. Just like every pharmacy must have a unique permit, each phar-macy that opts in should have its own accreditation approval status. Blan-ket accreditation approval for affiliat-ed pharmacies is not in keeping with a level playing field in the pharmacy market.

What are the disadvantages of community pharmacy accreditation?

Cost – As with any accreditation program, there are costs and fees that pharmacies may have to incur. staff time and pharmacy resources would likely be expended to com-ply with accreditation standards. It is unknown if these costs could be

recouped from the payer commu-nity.

use by Payer Community – This is-sue could easily be used by health plans, pharmacy benefit managers or other health maintenance orga-nizations as a tool to limit their pro-vider networks or tier their reim-bursement.

What are the advantages of community pharmacy accreditation?

Enhanced Reimbursement – It may be possible that pharmacies that elect to become accredited may be able to have their fees adjusted higher for advanced patient care services.

Relief from Audits – While this may not be part of the discussions, per-haps being an accredited communi-ty pharmacy may be used as a tool to reduce the number of third au-dits.

Relief from Inspections – The Board of Pharmacy could be encouraged

to adopt a policy of inspections ev-ery five years for accredited phar-macies rather than annually.

no one wants additional burdens. Pharmacy providers are already over-taxed with policies and procedures, noise from PBM restrictions and “beat downs” from aggressive auditors. At the same time, the Association is aware that health plans also have to demon-strate evidence of their quality pro-grams for their networks. We believe that they will be actively looking at community pharmacy accreditation as one of their tools to achieve their quali-ty measures. If that is so, then this pro-gram should be under the ownership of the profession and not an outside party.

Keep your dues current with the most accurate information in your membership accounts

Register for conferences and educational programs

Register online and you can print a receipt instantly without having to wait for one to be mailed to you

Your continuing education credits earned through FPA programs will be published as transcripts and certificates in your member record

The All-new FPA Website is Now Online

Take advantage of all the possibilities and visit your new website today at www.pharmview.com.

Pharmview 3.0 offers more features, greater access and increased opportunities for member interaction.

10 | f L O r i d A p h A r m A c y T O d A y

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West Nile Virus and Preventing Mosquito Bites Source: Centers For Disease Control and Prevention

A single mosquito bite can make you sick. Why take a chance? Use repellent on yourself, your friends and your family.

Many people who are bitten by an infected mosquito won’t get sick—many others aren’t as lucky. Since 1999, more than 30,000 people in the United States have been reported as getting sick with West nile virus. Occasionally, an infected person may develop more severe disease such as “West nile encephalitis,” “West nile meningitis” or “West nile menin-goencephalitis.”

Encephalitis refers to an inflammation of the brain, men-ingitis is an inflammation of the membrane around the brain and the spinal cord, and meningoencephalitis refers to in-flammation of the brain and the membrane surrounding it. Almost 13,000 of the individuals who have been reported as having West nile virus since 1999 have been seriously ill, and more than 1,200 have died.

Another problem in some parts of the united states and many places in the tropics is dengue. The World health Orga-nization estimates there may be 50 – 100 million dengue in-fections in the world every year. Over 2.5 billion people are at risk of getting infected with dengue virus.

The reasons one person becomes severely ill from dis-eases mosquitoes carry and another doesn’t are not entirely known, but why take a chance?

Control what you can. Improve your odds of avoiding mosquito spread viruses by using a repellent on exposed skin and clothes while outdoors.

Insect Repellent: It keeps you from being what’s for dinner.

There are always excuses for not using repellent— forgot it, didn’t want to go back and get it, it doesn’t smell good, it’s not in the budget, or “mosquitoes don’t bite me”…

Think of repellent as you would an important article of clothing, and increase your chances of avoiding weeks (or even months) of aches and fatigue that come with West nile fever, dengue fever, or any number of other mosquito borne diseases. More severe problems are possible. Being hospital-ized with swelling of the brain, or even worse, are possibili-ties from many of these diseases.

What repellent should I use? CDC recommends a variety of effective repellents. The

most important step is to pick one and use it. There are those that can protect you for a short while in the backyard or a long while in the woods. DEET, picaridin, IR3535 and the plant-based oil of lemon eucalyptus are all repellents recom-mended by CDC. All contain an EPA-registered active in-gredient and have been studied to make sure they are effec-tive and safe. EPA has a long listing of repellent brands in the

United States. Check out CDC’s traveler’s health page on re-pellents here.

When should you wear repellent? Mosquitoes can bite anytime. Most of the mosquitoes that

carry West nile virus bite from around sundown to around sun-up (throughout the night). Put a few bottles or packets of repellent around—in the car, by the door, in a purse or back-pack.

Where are mosquitoes a problem? Almost all of the continental united states has had reports

of people getting sick with West nile virus. But there are ar-eas of the united states where people are more likely to get severely ill, and these areas can change from year to year. The map at the right shows West nile virus activity by state. Outbreaks of Eastern equine encephalitis (EEE), LaCrosse en-cephalitis, and St. Louis encephalitis are not as common as West nile virus, but outbreaks can be severe. EEE has been a significant problem in the north East in recent years. Texas, Florida, and hawaii have all reported people ill with dengue in recent years. Every year, Puerto Rico reports people get-ting ill with dengue virus.

What to do about mosquitoes in my area?Mosquito control by your local government won’t get rid

of every last mosquito, but when you also use repellents, you can markedly reduce your chances of getting bitten. Ask local officials about starting a mosquito control program in your city or county if it doesn’t exist already.

2012 West Nile virus update: as of August 21Thus far in 2012, 47 states have reported West nile virus

infections in people, birds, or mosquitoes. A total of 1118 cas-es of West nile virus disease in people, including 41 deaths, have been reported to CDC. Of these, 629 (56%) were classi-fied as neuroinvasive disease (such as meningitis or encepha-litis) and 489 (44%) were classified as non-neuroinvasive dis-ease.

The 1118 cases reported thus far in 2012 is the highest number of West nile virus disease cases reported to CDC through the third week in August since West nile virus was first detected in the United States in 1999. Approximately 75 percent of the cases have been reported from 5 states (Texas, Mississippi, Louisiana, South Dakota, and Oklahoma) and al-most half of all cases have been reported from Texas.

12 | f L O r i d A p h A r m A c y T O d A y

In April 2011, the Center for Medi-care and Medicaid services (CMs) re-leased the final rule implementing Sec-tion 3310 of the Patient Protection and Affordable Care Act, stipulating that patients living in skilled-nursing facil-ities, receiving coverage under Medi-care Part D must receive their medica-tions in supplies of 14-days-or-less. The ruling is slated to go into effect January 1, 2013.

This rule promises to have a tremen-dous impact on how long-term care pharmacy (lTCP) providers serving skilled-nursing facilities will operate their businesses and serve facility res-idents. As a result, there are a number of challenges that both lTC providers and skilled nursing facilities must an-ticipate and prepare for in advance, in-cluding:

1. Increased Multi-Disciplinary Teamwork – shorter dispensing cy-cles will require lTC pharmacies and skilled nursing facilities to work closely together to retool and create a smooth workflow that is both safe and efficient.

2. Location of Patient for Adminis-tration – The acuity and mobility of skilled nursing facility residents have a dramatic impact on both workflow and the medication pro-cess because there are a variety of locations within a facility where a resident could be at any given time.

3. Higher Medication Through-puts in Pharmacy – shorter dispensing cycles will result in at least two dou-ble the volume at the pharmacy lev-el. Current processes will need to

be examined to determine if waste can be eliminated in waiting, mo-tion, inventory, re-work/correction, overproduction and information ex-change.

4. Need for Change Management – The multidisciplinary team will need to work with the pharmacy and nursing staff to communicate the new process/policy and ensure successful cooperation throughout the workflow.

5. Making Technology Support Clin-ical Workflow – There is not a “one-size-fits-all” solution for every orga-nization. Technology challenges will be compounded due to the addition-al volume of work, transactions and data requirements that will be tak-ing place.

As the compliance date nears, LTC pharmacies and skilled nursing facil-ities must work together to overcome these challenges by:

Jointly determining the dispensing methodology (type of packaging and dispense quantity) for brand, generic and over-the-counter (oTC) medications

Retooling operations Educating and training staff Assessing current and future in-

formation systems and dispensing technology

Ensuring that reimbursement con-tracts and operational processes to support reimbursement changes are in place

Protecting the bottom line and prof-itability of both the pharmacy and skilled nursing facility

The following article is a testament to the successful implementation and sustainability of short cycle dispens-ing. It details key observations and ex-periences Brooklyn, new York-based Four seasons nursing & Rehabilitation Center noted since implementing short cycle dispense. The case study details best practices and recommendations for selecting a method and quantity of dispensing, adaptation of workflow and the training of nursing and phar-macy staff. Operational and clinical re-sults are discussed, as are cost savings and enhanced compliance.

Four Seasons Nursing & Rehabilitation Center Transitions to Short Cycle Dispense

Brooklyn, new York-based Four seasons nursing & Rehabilitation Cen-ter implemented seven-day medica-tion dispensing of brand and gener-ic medications in 2006 with the intent to increase operational efficiency and enhance patient care. Since that time, the facility – which serves approxi-mately 2,500 residents, including 300 long-term care patients – has expand-ed seven-day dispensing as an option for adult-day patients, outpatients, and facility employees. Because of this, the facility has already met and exceeded compliance with the CMs short cycle dispense requirement.

Since inception, Four Seasons had been served by an off-site vendor phar-macy. In 2006, with the goal of improv-ing medication distribution for resi-dents and expanding service to other

Short Cycle Dispense: A Case Study in ImplementationBy jonathan Shaatal, R.PH., MS, Director of Pharmacy at Four Seasons Nursing & Rehabilitation Center and Carol Sirianni, R.PH., vice President, Customer Programs and Solutions, AmerisourceBergen Drug Corporation

The following article does not necessarily represent the views or opinions of the FPA or Florida Pharmacy Today Journal Inc and also should not be considered legal advice.

A U G U S T 2 0 1 2 | 13

populations, the management team es-tablished an on-site pharmacy. This co-incided with the enactment of Medi-care Part D, which stipulated that reimbursed medications were no lon-ger returnable to the pharmacy for re-use in the State of new York. As a re-sult, Four Seasons needed to designate one full-time equivalent (FTE) employ-ee, to collect, log and destroy the un-used medications in order to comply with the new requirement.

since medication waste and the re-sulting staff time diverted for handling unused medications presented signif-icant workflow challenges, Four Sea-sons wanted to implement an alternate method of medication distribution to ensure efficient, effective medication delivery. It evaluated and selected an automated system of multi-dose pack-aging based on a seven-day fill cycle – a significant transition from the 28-day cycle “bingo card” system, on which it was operating at the time.

Because the process of transform-ing medication processes must start at the highest level of any organization, Four seasons engaged senior admin-istration and nursing representatives at the beginning of the process. Early buy-in from senior level executives and the use of multidisciplinary teams – in-cluding representatives from manage-ment, pharmacy and nursing – not only helped to ensure a smooth transition, but also worked to boost efficiency and adoption rates.

Once the plan was in place, the phar-macy set out to identify and acquire the technology to help improve operation-al efficiency. This efficiency would free up pharmacists to spend more time on patient care. In addition to eliminating medication waste and staff time asso-ciated with handling unused medica-tions, Four Seasons needed to ensure its electronic medical record (EMR) system was well-coordinated for ex-pansion across the facility. After an in-depth research process, the pharmacy selected the AmerisourceBergen Fast-Pak ExP to handle all medication dis-pensing using compliance packaging. The FastPak ExP provided user-friend-ly, reliable software that boasted high accuracy rates and cost efficiency.

With any system change – especially related to automation – comes change to both overall workflow and individ-ual tasks. Though pharmacy techni-cians were expected to be responsible for more than 90 percent of technolo-gy operations, Four Seasons set out to train and develop both pharmacy and nursing teams to ensure that all users were comfortable with workflow and process changes. To ensure an increase in efficiency and an improvement in patient service, each change was ex-plained and reinforced. For example, because the automated system elimi-nated the need for traditional medica-tion carts, nursing day-to-day systems changed radically. As a result, both nursing administration and nursing staff needed to undergo in-depth train-ing to become familiar with the look and feel of the new system and ensure comprehension of each streamlined process for handling medication.

Enhancements to WorkflowAt the pharmacy level, since imple-

menting short cycle dispense and au-tomated dispensing technology, Four seasons has seen an 80-percent reduc-tion in pharmacy packaging time – from five hours to one hour for a 40-bed unit and an average of 10 to 12 medications per patient. Efficiency has improved, enabling the pharma-cy to commit more time to their clini-cal work.

On the nursing side, Four Seasons had originally estimated a 40-per-cent reduction in medication admin-istration time. Coupled with the sav-ings realized from the commingling of prescription medications using com-pliance packaging, Four Seasons was able to meet – and exceed – this goal. Approximately one year after the sys-tem went live, regular, standing orders for all over-the-counter (oTC) medi-cations were incorporated into multi-dose packaging. This has cut medica-tion administration time even further to 50 percent of the time required when Four seasons was using unit-dose blis-ter packs.

In addition, Four Seasons is meeting the CMs mandate to pass medications within one hour of the prescribed time.

This reduction in medication pass time enables nurses to complete CMs-regu-lated documentation during their shifts – cutting down on overtime and associ-ated costs.

Four seasons nursing and Reha-bilitation Center frequently dispens-es medication for residents who leave the facility on pass. Fulfilling out-on-pass prescriptions for residents who leave the facility for a period of hours or days has also been streamlined by the automated system and compliance packaging. historically, these types of fulfillment requests were a pain point for both pharmacy and nursing teams, as they were generally sudden and last minute in nature. With commingled, compliance packaged medications, the need to prepare out-on-pass medica-tions is eliminated since they are al-ready labeled according to time of ad-ministration. If a resident wishes to temporarily leave the facility, the nurse simply tears off the needed medica-tion based on the time of the planned absence and provides an instruc-tion document, containing medica-tion background, and any recommend-ed precautions. This also helps ensure compliance with caretakers while the resident is in their care.

As a result of enhancements and ef-ficiencies achieved through pharmacy and nursing workflows, patient medi-cation errors have been reduced. This means better quality care, an increase in patient safety, and higher overall pa-tient satisfaction rates. Seven-day dis-pensing has also helped Four seasons streamline the process of reimburse-ment and claims submission – gener-ating additional labor and cost savings.

Generating ROI and Cost Savings

For many lTC pharmacies and skilled-nursing facilities, the cost to implement short cycle dispense might seem to outweigh the intended ben-efits. It’s important, however, to look beyond the initial investment, as long-term benefits are significant and vital to patient safety and future success in the continually evolving healthcare mar-ketplace. Initially, Four Seasons saved about $110,000 per year in labor costs

14 | f L O r i d A p h A r m A c y T O d A y

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– including salary and benefits for one FTE pharmacy technician and one FTE registered pharmacist. As the pharma-cy has grown and expanded its patient population, labor cost savings have continued to increase over time. In ad-dition, using an automated dispens-ing system has required the pharma-cy to switch from purchasing unit-dose packaged medications to bulk medica-tions (100-, 500- or 1,000-count bottles). This switch has resulted in a significant cost savings, as unit-dose medications cost typically three to five times more than bulk.

other cost savings included the cost associated with nurses “borrow-ing medications,” or using medication from another patient on the same pre-scription. Borrowing medications has virtually been eliminated through the

use of patient specific compliance pack-aged medications. Savings are estimat-ed at $500 per month and elimination of missing medications by commin-gling of medications is also estimated at $500 per month.

Beyond cost savings and enhance-ments to patient safety, short cycle dis-pense and automation helped Four sea-sons expand patient populations and generate additional revenue streams. With a robust short-term rehabilita-tion program, Four Seasons discharg-es approximately 400 patients into the community each year. These patients can choose to receive their 30-day dis-charge medications in either vial or compliance packaging. Multi-dose compliance packaging is also available for adult day patients.

Conclusionsince transitioning to short cycle dis-

pense and automated fulfillment tech-niques, Four Seasons pharmacy man-agement and facility administration have experienced significant operation-al, financial and clinical benefits that have contributed to its overall success. Four seasons is compliant well in ad-vance of the January 2013 deadline for short cycle dispense implementation. Though lTC pharmacies and skilled nursing-facilities might feel over-whelmed with the impending short cy-cle dispense implementation date, the change will bring significant efficien-cies and cost savings that will improve patient safety and quality of care.

With a robust short-term rehabilitation program, Four Seasons discharges approximately 400 patients into the community each year.

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The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

A U G U S T 2 0 1 2 | 15

Pharmacy Leadership Boot Camp was a great success. Fifty-five pharmacists and technicians had such a powerful thirst for knowledge that they gave up their July 4th holiday to learn how to become better leaders. Although the course was designed for new and aspiring pharmacy leaders, most of the attendees were experienced pharmacists and techni-cians who came to hone their leadership skills. As one re-tired pharmacist said, “Your program was excellent, and I wish I had had it when I was working in retail.”

These experienced professionals were taught that the best leader is a servant leader who focuses both on the employees and the mission, and creates a climate of trust and respect. The leader should manage the staff from a position of respect, with empathy for their individual needs while guiding, en-couraging, empowering and expecting the team to be suc-cessful. The leader seeks the best in the staff and helps the in-dividuals in the organization to reach their potential.

When asked, “What did you learn today that you can ap-ply immediately to your practice?” the answers covered the gamut of the course offerings, including communicating like you mean it, active listening, dealing with difficult people, patient safety practices, respectful confrontation, empower-ment and establishing clear expectations for employees. Ev-eryone took away at least one or two pieces of knowledge that were immediately useful. One pharmacist said, “I learned (about) motivational interviewing, which is a very useful technique in patient interviews. I’ll apply this technique and gain information that is vital for their medication manage-ment.”

Participants learned that the leader sets the direction for the pharmacy with participation from upper management as well as the staff. The leader who engages the staff will build a cadre of followers committed to the pharmacy’s success. Followers who gain a sense of their purpose become stake-holders in changing the organization’s future. A superb lead-er focuses on the future direction of the organization while ensuring that the current standards are met…every time. The great pharmacy leader asks, “how can we get better?” and then develops a plan to get there.

Attendees were encouraged to remember that success is a group activity and that no one succeeds alone. Success re-quires teamwork, but teamwork requires empowerment and

delegation. All staff members need to take personal respon-sibility for their actions to ensure all necessary tasks are ac-complished. Each employee needs to strive every day to im-prove the pharmacy processes in order to provide the best possible pharmaceutical care.

Last, but not least, was patient safety. Participants were reminded that “Patient Safety is Job no. 1.” They need to use their leadership skills to uphold the 5 Rights of Medication Safety: Right Patient, Right Drug, Right Dose, Right Route, and Right Time and to eliminate variation and complacen-cy, participants found that Boot Camp was a valuable source of knowledge. As stated by one attendee, “This program in-spires and enlightens me how to successfully lead a pharma-cy (including) my responsibilities, duty tasks as a pharmacist, and (how) to improve the quality of the patient’s care.”

Becoming an effective leader is a journey, not a destina-tion. The skills needed for effective leadership are learned skills. They are not inherent. Although some people ap-pear to be natural born-leaders, they actually have leadership traits that have been finely tuned through experience, train-ing or study. So, all leaders aspiring, new and current must develop a life-long interest in leadership. By studying the ba-sics, applying effective leadership skills and practice success will be ensured.

The Boot Camp leaders, Dr. Reginal harris, Ms. Gail Brown, and Colonel Wayne Cheatum (Retired), wish to thank the attendees for their enthusiasm, participation, and interest in enhancing their leadership skills.

Pharmacy Leadership Boot Camp a Success

Attendees were encouraged to remember that success is a group activity and that no one succeeds alone. Success requires teamwork, but teamwork requires empowerment and delegation. Michael Jackson presents a scholarship award to FAMU student Janet Job

on behalf of the Broward County Pharmacy Association.

16 | f L O r i d A p h A r m A c y T O d A y

PHARMACy RESOURCES

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Cerner EtrebyPharmacy Management systems(800) 292-5590

PPSCRetail Pharmacy Purchasing Program(888) 778-9909

PHARMACy CONSUlTANTS

HCC Pharmacy Business SolutionsDean Pedalino(800) 642-1652Mobile: (727) 460-1855

Empire Pharmacy ConsultantsMichael Chen PharmD., CPhPresident/CEo(786) 556-7825 Mobile (305) 374-1029 Office

lEGAl ASSISTANCE

Kahan ◆ Shir, P.L.Brian A. Kahan, R.Ph., and Attorney at law(561) 999-5999

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McKesson Drug CompanyJim springer(800) 804-4590 FAx: (863) 616-2953

TEMPORARy PHARMACISTS –

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bUyer’S GUideADVERTISERS: This is a special section designed to give your company more exposure and to act as an easy reference for the pharmacist.

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AHCA MEDICAID PHARMACY SERVICES2727 Mahan DriveTallahassee, FL 32308(850) 487-4441www.fdhc.state.fl.us/medicaid/pharmacy

AMERICAN PHARMACISTSASSOCIATION (APhA)Washington, D.C. (800) 237-2742www.pharmacist.com

AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTSBethesda, MD (301) 657-3000www.ashp.com/main.htm

DRug INFORMATION CENTERPalm Beach Atlantic university(561) 803-2728druginfocenter@pba.edu

FLORIDA BOARD OF PHARMACY4052 Bald Cypress WayBin #C04Tallahassee, FL 32399-3254(850) 245-4292www.doh.state.fl.us/mqa

FLORIDA POISON INFORMATION CENTER NETWORK(800) 222-1222www.fpicn.org

NATIONAL COMMuNITY PHARMACISTS ASSOCIATION 100 Daingerfield Road Alexandria, VA 22314703.683.8200703.683.3619 faxinfo@ncpanet.org

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