October 23, 2013

Leadership - Radio Spot for American Pharmacists Month

American Pharmacists Month October 2013
KRUI Radio Spot – University of Iowa


This October I had the idea of spreading the word about American Pharmacists Month through the University of Iowa student run radio station called KRUI.  It was a lot of fun to write my first radio spot.  The text and audio link are below. I hope you enjoy listening to it!

Did you know that October is American Pharmacists Month?  At the University of Iowa College of Pharmacy we want to celebrate by letting you know that pharmacists are medication experts and your most accessible health care provider.  Stop by your local pharmacy today to learn about how your pharmacist can provide a range of services from medication counseling to selecting over-the-counter medications, and also giving immunizations.  This October take the time to “Know Your Pharmacist, Know Your Medicine.”  This was a message from student pharmacists at the University of Iowa College of Pharmacy.



October 10, 2013

Leadership - Thank You Cards

Thank You Cards


 Sometimes a little thank you goes a long away! I made some thank you cards for all the people who support the APhA-ASP chapter. An order of 200 cards is on it's way!

September 12, 2013

Speaker - Ms. Sara Salem

APHA-IPSF Chapter Meeting
Speaker Ms. Sara Salem (9-9-2013)

 Conference Speaker


As the APHA-IPSF Coordinator at the University of Iowa College of Pharmacy, my role is to inform and engage students in all things related to international pharmacy and international health.  Over the past summer I was able to arrange for pharmacist Sara Salem to come speak to students about pharmacy in the United Kingdom.  Ms. Salem spoke this week to an auditorium filled to capacity about her experience of working as a pharmacist in the United Kingdom and the lengthy process she went through to practice in the United States.  It was great to listen to her presentation because I was able to relate and understand several of her experiences from having spent a few weeks this past summer learning about pharmacy in the UK.  She introduced the students to the retail chain she worked at, Boots, which is similar to Walgreens and also spoke to students about the General Pharmaceutical Council and the Royal Pharmaceutical Society, where I spent most of my time in the UK.  She also compared and contrasted her role working in a hospital both in the US and the UK and introduced students to the National Health Service in the UK.  It was great to see the event come together after all the planning over the past few months and I hope the other students enjoyed and learned from it as much as I did.  Looking forward to doing more great things for APHA-IPSF this year!

August 22, 2013

Awards - Stanley Graduate Awards for International Research

Stanley Graduate Awards for International Research





This summer I had the opportunity to be involved in the Stanley International Research Grant Program through which I traveled to The Hague, Netherlands to visit the headquarters of The International Pharmaceutical Federation and The International Pharmaceutical Student's Federation.  As part of my research, I visited a community, Regentesee Pharmacy, and a hospital, MCH Westeinde, pharmacy in The Hague.  While there, I talked to the pharmacists and observed pharmacy operations through which I learned about the pharmacists training, their current role, and was able to identify similarities and differences in pharmacy practice between the United States and the Netherlands. The Netherlands already has technicians verifying each other's work, while in the United States this idea is just starting to take ground.  This allows the pharmacist to devote more of their time to clinical activities and management of the pharmacy.  I also learned that the community pharmacist did not consider addiction to scheduled medications a major problem in the Netherlands though in the United States it is a big challenge.  The pharmacist also spoke of the record keeping they are required to do and the drug information resources they most utilized.  At the hospital pharmacy, I spoke with both the director of pharmacy and the current pharmacy resident and learned about the lengthy training that hospital pharmacists receive to practice in The Netherlands.  While spending time at the FIP headquarters, I interviewed the pharmacists to learn their current role at the organization and their career path leading up to the current role.  This was especially beneficial for me as a student because I was able to learn about the wide variety of work that pharmacists can be involved in.  In addition to the interviews, I wrote a short advertising piece for FIP’s annual 2013 conference.  I also helped Alexandra, the current IPSF chairperson of Media and Public Relations, by compiling World Congress Surveys to help gauge member feedback on various issues, which would hopefully influence the direction of IPSF.  

 

Following my time in The Netherlands, I traveled to London to spend two weeks at the Royal Pharmaceutical Society to continue my research.  During normal office hours at the RPS, I interviewed seven pharmacists with different roles at the organization to complete the main focus of my research. In addition, I assisted the research manager, Rachel Roberts, with analyzing data for the Community Pharmacy Prescription Interventions project.  My primary responsibility was to find discrepancies in the data and work to resolve issues so that the Excel files contained the correct totals before further analysis could be done.  I also did some preliminary analysis consisting of basic statistics and comparing different variables to each other.  I also spent time shadowing the pharmacists at the Heart Hospital, the Royal Free Hospital and the Green Light Community Pharmacist in London to see pharmacy in action.  I found my time at the community pharmacy interesting because I had the opportunity to observe the travel nurse giving immunizations and observe a patient taking part in a methadone program for which he had to drink his medication in front of the pharmacist. I was also told that all contraceptives are free in the United Kingdom and the cost to the patient is 7.85 pounds per item.  I also noticed that the method of dispensing is different in both countries where most medicines already come in 30 blister boxes instead of a stock bottle as it is the case in the United States. The boxes also contain braille on them which I though was a wonderful feature to have for the blind.  Since, it is hard to get a new license to open a pharmacy in the UK and most pharmacies are acquired by buying an existing pharmacy. 


My time abroad has been absolutely wonderful and I look forward to continue helping with the efforts of IPSF by taking on a leadership position in IPSF. Spending time abroad and staying with the IPSF leadership team helped me better understand both the work and rewards of being involved in IPSF at an international level.  The Stanley Grant was a great start and opportunity to begin making international connections since I do wish to be involved internationally in the future.  In addition to helping individual patients, I hope I can work on international health endeavors that improve the health of people around the globe. 

August 19, 2013

Confereces & Meetings - University of Utah School on Alcoholism and Drug Abuse

University of Utah School on Alcoholism and Drug Abuse




Having always lived in Iowa, I never thought I would be travelling to Salt Lake City to attend the internationally recognized School on Alcoholism and Drug Dependencies at the University of Utah. The week has really opened my eyes to the issues of alcoholism and drug abuse in the United States.  Though my time in Salt Lake City was short, it was packed with new and amazing experiences.  I met students from all over the country, developed better relationships with the students from my own school, learned about abuse issues through many amazing speakers, comedians, and meetings, learned about native American culture through traditional dancing, dined at local restaurants, and experienced the Utah Arts Festival.
I would rate the overall quality of my experience at the School as phenomenal.  As I grow older, I find that there are fewer and fewer experiences that change my perceptions of the world around me.  The School drastically altered how I view the issue of drug abuse.  I used to view drug abuse as something to catch through inventory at the pharmacy or searching for the patient in the current Prescription Monitoring Program in Iowa.  I now think about not just fighting drug abuse but rather using it as an opportunity to help and provide resources to patients who may be suffering from it.  My level of empathy for patients has increased drastically since attending the school, though I feel that I am still very limited in the help that I am able to provide for those patients.
The School did a great job of including some humorous sessions during the week to provide some emotional relief to the participants.  The hike and the garden walk were also great options to include some physical activity during the week.  The experience that made the greatest impression on me was the willingness of individuals to share their stories at the group therapy session.  First of all, it always caught my attention when individuals stood up and said their name and identified themselves as an abuser in front of a room full of strangers.  I am not entirely sure why but hearing this self-identification made me a little bit uncomfortable.  This is probably because of how honest they were being with themselves and others and I recognized that it must have taken a lot of courage and determination to reach to that point.  As different individuals worked through their various issues, I could definitely feel a great level of love and empathy in the room.  All the attendees were providing an incredible amount of emotional support.  During one of these meetings a pharmacy student stood up and told everyone that today her mom is sentenced to prison.  It was really powerful to hear her story and experience her strength because I had noticed her positive nature previously during the conference and would never have thought that she was facing these kinds of struggles.  It surprised me to see how many people were personally affected by abuse issues either through their own addiction or through the addiction of their family members. I now recognize that preventing abuse and helping individuals escape the cycle of abuse helps not only the person but all their loved ones around them.  From the single experience of various individuals being open and honest and willing to share their story, I have learned an incredible amount about the impact of drug abuse.
Prior to attending the School, I had always thought that the drug problems in the United States were primarily due to illegal drugs such as cocaine or methamphetamine, and learning from one of the speakers that prescription drug abuse was an even bigger problem was quite shocking.  This has made me realize that as a pharmacy student I need to be more vigilant in observing the red flags of drug abuse.  I have realized the importance of doing inventory on controlled substances to prevent drug abuse, but the hardest aspect of this will be identifying patients who may be abusing while still trying to have empathy for patients who are in actual pain.  Hearing stories of pharmacists who abused drugs and ways that they placed themselves in positions that would be in charge of the controlled medications showed me some of signs I should watch for and demonstrated that everyone is susceptible to this problem no matter how intelligent, educated, or important they are within the company.
Perhaps the most interesting part of the week has been listening to the Alcoholics Anonymous and the Al-anon to actually hear the stories and struggles of abusers and family members. The meetings were very emotional and helped me develop much needed empathy that I needed for patients. The stories of people trying to quit on their own and failing and the support that the group provides over the years is really wonderful.  Some of the seemingly happiest people at the conference had the courage to stand up and tell their stories to a room full of strangers.  The level of trust, honesty, and compassion in the room really touched my heart.  I never realized that not only the patient but also so many people in the patient’s life are affected by their abuse problem.  A single abuse problem can leave a trail of anger, resentment, and broken relationships in the whole family. 
Another major concept that I learned about was recognizing addiction as a disease rather than a choice. Prior to the School, I had never really understood addiction and certainly did not think of it as a disease.  As strange as it sounds, I had always thought that people chose to do drugs repeatedly until eventually they eventually became addicted. The session in which Steve Moore described a cat and it’s craving for milk was really phenomenal in understanding how an addict thinks about his addiction and also described some possible scenarios of how an addict might relapse into addiction by attending milk festivals or going to the grocery store and walking into the milk aisle.
An idea that was briefly mentioned during one of the sessions that stuck with me is that when patients come to the pharmacy, we give them medications to help them, but when an addict comes to the pharmacy, we are supposed to kick them out instead of helping them.  This is something that is inherently wrong with the system when addressing abuse issues and more needs to be done to help the patients rather than sending them away to search for an even worse way to feed their addiction. In conjunction with this idea, it is important to teach patients about proper storage of medications when they are not using the medications to prevent family members, friends, or burglars from stealing the medications.  

Another topic I learned at the School was not about drug abuse but rather about Native American Culture through traditional dancing.  The dance started with flute music and was followed by beating drums with an explanation of the various dances that the dancers were doing.  There were many types of dances which were the men’s traditional, men’s fancy, women’s traditional, women’s fancy, friendship dance, and my favorite the trick dance.  It was very hot that evening and it was impressive that the dancers were wearing the traditional dress and dancing in the heat so that we could learn about some of the unique characteristics of their culture. 
Overall the school informed us about the different aspects of addiction.  We learned about the science behind addiction through the pathophysiology of addiction and introduction to addiction issues session, the group meetings and therapy sessions helped us develop our knowledge of personal stories and develop our empathy, the case study of a recovering pharmacist showed us how even those that are highly educated can be affected by this issue.  The pharmacy section also helped individuals speak about their personal abuse issues and abuse issues of family members to help those who are being personally affected by this issue.
The School included three general session speakers with Chuck Jackson, David Mee Lee, and Jason Hewlett as speakers.  It was also great to see various individuals being recognized for their commitment to this field through the various awards at the general sessions. 
In Chuck Jackson’s session, we began with some physical exercises to help wake everyone up that morning.  He then discussed his town in Oklahoma to allow us to help us understand him better and concluded the presentation with talking about a box that represented abuse issues. The box had always been in the distance but as time progressed more and more people around him were affected by abuse issues and the box had come to the forefront and he recognized that he needed to deal with the box.   
David Mee Lee’s session was more scientific, and he discussed the advantages and disadvantages of recognizing addiction as a brain disease. By recognizing addiction as a disease, society goes from punishing the addict to help treat them out of addiction.  The disadvantage of recognizing addiction as a disease is that it allows the addict to escape responsibility for their addiction.  The session helped me realize that though recognizing addiction as a disease is important, there are certainly downfalls associated with this.
By far the most unique and perhaps even the weirdest general session of the week was by 
Jason Hewlett. In this session, he shared how he discovered his talent through a choir teacher and how he rejected a Las Vegas contract in order to do the work that he values. Though much of his presentation focused on Jason’s singing talents, his main message was how to recognize your own uniqueness to help make yourself standout and successfully develop your own path in life. He also encouraged us to be extraordinary no matter how ordinary a task we might be doing and he provided a great example of an airport shuttle driver who did just that. 
            I loved my time in Utah at the School and encourage all to attend next year!




June 23, 2013

Conferences & Meetings - Iowa Pharmacy Association Annual Meeting 2013

Iowa Pharmacy Association – Annual Meeting 2013


This weekend I attended the Iowa Pharmacy Association Annual Meeting in Coralville, IA.  The meeting began with a House of Delegates session which allowed me to observe pharmacists from across the state debate various IPA policies such as preferred pharmacy networks, regulation of compounding practices, and regulation of medications with abuse potential. Following the House of Delegates we heard from celebrity speaker Aaron Thomas.  This was my first time hearing Aaron’s story and it was quite moving to hear about how his family responded to adversity.  Next there was a poster and exhibit session which gave me an opportunity to learn about the various research and innovative pharmacy projects such as the Tech-Check-Tech program.  The day ended with the annual awards banquet which recognized many pharmacists, pharmacy technicians, and students in the state of Iowa.  The banquet and the overall meeting helped me realize the level of commitment that the so many people have for the profession of pharmacy and also gave me inspiration and motivation to continue in their footsteps. 


June 7, 2013

Rotation - IPPE2 Community Rotation Reflection


IPPE2 Community Rotation Reflection


For the last three weeks I have been working full-time at NuCara Pharmacy in a small town in Iowa.  NuCara is an independent chain of 23 stores in the Midwest and one store in Texas.  Having worked at Hy-Vee Pharmacy previously, NuCara gave me the opportunity to see a small town pharmacy in action. I especially liked this rotation because it gave me the opportunity to work at different stores. I mainly spent my time at the Nevada store and I also spent a day at the Story City, IA location, a telepharmacy in Zearing, IA, a compounding pharmacy in Ames, IA, a new acquisition in Paynesville, MN, and did a site visit in Carroll, IA. Most of my time at NuCara involved dispensing, though I also did some counseling, wrote a blog post for NuCara’s blog (link below), participated in journal club, and attended a meeting at OutcomesMTM office.  It was interesting to fly to Paynesville on the company plane to see the new pharmacy that NuCara was acquiring and while I was there I also helped with inventory.  When I was visiting the Carroll pharmacy with the vice-president of operations for a site visit, I had the opportunity to see more of the business matters as the financial aspects of the pharmacy were discussed. At the compounding pharmacy I saw the pharmacist making progesterone troches and also saw a pharmacy drive-thru in use. Overall it turned out to be a wonderful experience and I had the opportunity to work with great pharmacists and technicians!

http://yournucara.wordpress.com/2013/06/12/being-healthy-this-summer/

May 23, 2013

Compounding Reflection


Friday 5/24/2013
Compounding Reflection



A quick reflection on all the things I had the opportunity to compound during my first year of pharmacy school.  I did not know what compounding was until I started pharmacy school. As pharmacy school progressed, I slowly learned the science behind compounding and then started to actually make the products in lab. Some of the products we have made include: magic mouthwash, wart remover, sterile ophthalmic solution, cold sore medicated stick, suppositories, brushless shaving cream, dental powder, oral suspension, topical suspensions, lip balm, dry skin hand cream, external analgesic gel, antipruritic gel, and NSAID organogel.  Though I may not have always enjoyed compounding during the actual lab, looking back on it now, I find it pretty incredible that pharmacists can make such a wide range of products for their patients. Looking forward to seeing what fun products I will get to compound next year!

May 20, 2013

Semester Reflection



Semester Reflection
Second Semester of Pharmacy School

 

Another semester of pharmacy school done! It was definitely a whirlwind since we had tests and assignments due nearly every week. Overall, it was a decent semester though I definitely learned my strengths and weaknesses and learned to improve my time management skills.  I am looking forward to a wonderful summer and my Introductory Pharmacy Practice Experience rotation for three weeks in a community pharmacy. Time to apply the knowledge I have been learning for the past year to practice! Enjoy the summer everyone!

May 10, 2013

Cleveland Clinic Empathy Video



Cleveland Clinic Empathy Video


I learned about this video on empathy from a nursing student today.  Great way to explore a concept further that we learned in Social Aspects of Pharmaceutical Care this semester. Take a look at the link below!

April 29, 2013

Poster - Interdisciplinary Health Group


Interdisciplinary Health Group (IHG) Student Poster Session (4/23/2011)

I wanted to share the poster I have been talking about! It is easier to read when you click on the image. Really enjoyed making the poster and seeing the final product!

April 20, 2013

Conferences & Meetings - 2013 Governor’s Conference on Public Health


2013 Governor’s Conference on Public Health (4/9/2013)



I recently presented my poster on sleep and obesity at the Iowa Governor’s Conference on Public Health and it was a great learning experience.  This was my first poster presentation general session and lightning round and it was a lot less intimidating than it seemed at first.  The general audience asked really interesting questions and I enjoyed explaining my project and discussing how a lack of sleep could contribute to obesity.  I also attended some of the sessions, one of which included an explanation on the Robert’s Rules of Order.  I had no idea that there was actually a book on this and I was now able to better understand how committees work.  This will be helpful as I currently serve as the P1 representative for the curriculum committee at the University of Iowa College of Pharmacy.  Also, if I have questions, I can now go to the book and better understand the rules.  With my improved understanding of the Robert’s Rules of Order, I am looking forward to trying out the rules in practice at the next curriculum meeting.  

April 9, 2013

Awards - 15th Annual Jakobsen Graduate Conference


15th Annual Jakobsen Graduate Conference (4/6/2013)


Last weekend I attended the Jakobsen Graduate Conference at the University of Iowa which provides graduate students across campus an opportunity to share their research work.  At the beginning of the conference, I moderated the session titled “Planning Stronger Communities.”  I really enjoyed moderating which included introducing the speakers and the general housekeeping to keep the session flowing smoothly.  Next, I presented my own research that I conducted at Iowa State University titled “Subjective and Objective Methods to Study Sleep in Children and Adults.”  It was a fairly small audience so I appreciated having plenty of time to answer all the questions in detail.  The conference ended with an evening session and an awards ceremony, which was based on our research papers we had submitted prior to the conference.  I was surprised and happy to learn that I placed first in the professional student division!  I look forward to working on a new research project and presenting at the conference again next year!


April 3, 2013

Interactive Simulation on Aging


Interactive Simulation on Aging
Students for Interprofessional Education (3/27/2013)

 

Attending the Interactive Simulation on Aging last week helped me realize the physical challenges the elderly face in performing routine tasks. As part of the aging simulation, we were in small groups that consisted of health students and health professionals from numerous health areas such as nursing, medicine, pharmacy, and dental.  We first wore glasses which obscured our vision and tried to read and open a prescription bottle.  Next we wore gloves with stiff fingers that simulated arthritis and tried to write a check and button a shirt.  I never realized how difficult simple tasks such as reading a prescription or writing a check could be for the elderly and I will definitely keep that in mind as I work with elderly patients in the future.  Following the physical challenges simulation, we worked as a healthcare team to treat a simulated patient case about a woman who was brought into the ER for an assessment.  We looked at the lab values, thought of tests that need to be ordered, discussed her healthcare cost and insurance situation, and thought of different types of healthcare professionals we should to collaborate with to provide her the best possible treatment.  I really enjoyed attending the event, gaining a better understanding of aging issues, and meeting health students and professionals from various health fields.  I look forward to using a collaborative approach to patient care as a future health professional!

More information about aging events can be found here: http://www.uiowa.edu/~socialwk/agingstudies/calender.shtml
Aging resources:

March 27, 2013

Community Engagement - Alternative Spring Break


CSIL Alternative Spring Break (3-16-2013 to 3-21-2013)
Day 1: Grow Memphis



This spring break I decided to do something a little bit different and participated in a service learning trip to Memphis, Tennessee.  As preparation for the trip, our group of 15 students read the book “The Immortal Life of Henrietta Lacks” by Rebecca Skloot.  We also met weekly for five weeks before the trip to better prepare ourselves and better understand each organization that we were helping. 

On Day 1, we did urban gardening at two different gardens.  We tilled, raked, planted trees, and put up a partial fence.  Having a large group of students allowed everyone to pick the gardening task that they were most interested in. I helped to install the fence and quickly learned that it was a little bit more complicated that it looks!  The first garden was in the initial development stage, while the second garden we helped was further along with raised beds and growing produce.  It was inspiring to help people who do this work on a daily basis and to hear from them how much they appreciated our help. 

Day 2: Hope House


On Day 2, we played with kids at Hope House, which is a day care for children affected by HIV and AIDS.  The kids were great and loved having us all there to play with them.  Some of the kids had a lot of energy and played basketball while some of the other kids were a little bit quieter and we read to them.  It was great to see all the students being really engaged with the kids and seeing some really fun personalities come out.  In the afternoon we learned more about HIV and AIDS, followed by a short ice cream break, some yard work, and more playing with the kids.  We received an email the next day saying that they kids were asking about us and that they missed playing with us.

Day 3: Friends for Life


On our last day, we helped at Friends for Life, which is a support organization for persons affected by HIV/AIDS.  While there, we helped to make safe sex kits, stock the food pantry, do yard work, and filing.  Due to the lack of funding, they had not done any filing for almost a year.  In one day, we were able to do 3 months of filing for them which is pretty incredible.  They explained to us that they especially appreciated us helping with the filing because it allows them to focus and spend more time with the people they are helping. 

As I reflect on my time in Memphis, I most importantly feel grateful to have met everyone on this trip. It was wonderful to see everyone jump in at each site and help right away.  As a group we were able to accomplish so much more in a short time than each of us could have done alone. This trip has made me appreciate all the things I have to be grateful for and has inspired me to continue to stay involved in my own community.    



March 9, 2013

Conferences & Meetings - Legislative Day




             Last week on February 28th, I had the opportunity to attend Iowa Pharmacy Association's Legislative Day at the Iowa State Capitol.  The day began with a legislative briefing to provide an overview of issues that the pharmacists and student pharmacists can discuss with their legislators. Then we heard from the newly elected House Representative member, pharmacist John Forbes about his journey to being elected  and how he is involved in health related committees and how excited he is to represent the voice of pharmacy.  Following John Forbes, everyone visited the state capitol to speak to their legislator and I had the opportunity to volunteer for Generation Rx to teach about the proper disposal of unused medications. The afternoon session included learning about medicare part D and drug shortages, medication therapy management from the service provider, government, and health insurance company perspective, followed by a session with the newly appointed Iowa Insurance Commissioner on the rules governing PBM.  The last session gave pharmacists an opportunity to voice their concerns in dealing with health insurance companies and ensuring that they they are compensated for their services. I really enjoyed attending legislative day and was able to learn more about a different area of pharmacy.  I look forward to attending again next year! 

February 16, 2013

Speaker Dr. Jenny Bongartz


ASHP-UISHP Chapter Meeting
Speaker Dr. Jenny Bongartz, PharmD
Indian Health Service (2-11-2013)

Conference Speaker
           
This week Dr. Jenny Bongartz from the Indian Health Service spoke to us about the Indian Health Service.  Dr. Bongartz is a University of Iowa 2011 alum so it was interesting to learn about her career path, why she chose the Indian Health Service, and her experience in the ambulatory care pharmacy. The Indian Health Service offers wonderful benefits and loan repayment options to its pharmacy residents.  Dr. Bongartz also mentioned that diabetes and obesity are of big concern at her practice site and that she loves working to help patients through those health concerns.  It is also important to note that most sites in the Indian Health Service are ambulatory based, though there are a few inpatient practice sites as well.  I really enjoyed learning more about the Indian Health Service and it is an option I will definitely consider as I move forward through pharmacy school.  More information about the residency program, benefits, and sites can be found here:

January 30, 2013

Article - Why Pharmacy Compounding Has and Continues to be a Medical Necessity


Why Pharmacy Compounding Has and Continues to be a Medical Necessity

Providing a Solution to Drug Shortages: Compounding

In recent years, healthcare professionals and patients have had to deal with the growing problem of drug shortages, which seriously affect the vital category of sterile injectable drugs. According to the United States Food and Drug Administration (FDA), in 2010 there were 178 drug shortages of which 132 were sterile injectable drugs, and in 2011 those numbers increased to 251 drug shortages of which 183 were sterile injectable drugs.[1]  These shortages sometimes affect whole classes of drugs including essential drugs for cancer treatment, cardiovascular disease, and pain management.  Causes primarily include issues in production quality and manufacturing.  According to the American Society of Health-System Pharmacists, the end result for patients is that drug therapy may be adversely affected, medical procedures may be compromised or delayed, and medication errors may occur.[2]  Compounding provides one solution to solving drug shortages. 
Compounding pharmacies and pharmacists have been and continue to be called upon by patients, healthcare providers, and hospitals to compound medications that are commercially unavailable.   Compounding pharmacies are able to fulfill this need because they have access to the raw materials and the technical expertise required to formulate the needed medications.  Patients can contact compounding pharmacies directly to find prescribed medications that are in short supply, healthcare providers can utilize compounding pharmacies for drugs that are unavailable elsewhere, and hospitals can utilize compounding for intravenous admixtures when the supply of key injectable drugs is unavailable. The demand for compounded medications shows how essential compounding has been and continues to be—particularly in the case of drug shortages. 
In addition to the FDA drug shortages, there are many reasons why compounding continues to be a medical necessity and is an essential part of the healthcare system.  Even though many drugs are not on the FDA drug shortage list, available supplies can still be limited.  Manufacturers produce limited dosage forms, limited strengths, and often discontinue older drugs as they lose market share to produce newer and more profitable drugs.  Compounding is needed when drugs are not available in the needed combinations or when drugs need to be repackaged into the correct dose.  Treating rare medical conditions often requires small supplies of compounded orphan drugs.  Compounding is needed for pediatric formulations, geriatrics formulations, parenteral nutrition, cancer chemotherapy, pain management, and bioidentical hormone replacement therapy.  Diagnosing and treating diseases can be done using nuclear compounding. Compounding is needed for home healthcare, hospice, dental, dermatological, and ophthalmological patients.  When patients cannot tolerate the commercially available product due to non-intrinsic characteristics—such as dyes, preservatives, ethanol, flavor, dosage or delivery method—compounding readily resolves the issue.  The reasons why compounding is needed are endless, but, as a whole, compounding allows accessibility to medications that are not easily available and provides flexibility for patients to receive individualized care according for their health needs.
Compounding pharmacies have always been in the background working to help meet patient needs.  Recently compounding has gained national attention due to the meningitis outbreak stemming from the New England Compounding Center (NECC) in Framingham, Massachusetts. As of the end of November 2012, contaminated spinal injections of methlyprednisolone acetate prepared by NECC have sickened several hundred people and killed more than 30 in multiple states.  Due to the serious problems at NECC, Ameridose, an FDA registered manufacturer with the same founders as NECC, has voluntarily recalled all of its products.[3]  The shutdown of these facilities has only exacerbated the problem of drug shortages, which means that additional demand may be placed upon compounding pharmacies to remedy the situation.
The recent meningitis crisis may have negatively affected the field of compounding even though NECC was not a compounding pharmacy but rather a drug manufacturer.  This distinction is important to note because compounders work in a triad of patient, physician, and pharmacist relationship that helps to ensure the safety of the medications for the patient.  Drug manufacturers mass produce medications without taking into account the individualized needs of the patient. Drug manufacturers are not compounders, and more oversight is needed by the FDA to ensure patient safety when drug manufacturers masquerade as compounding pharmacies. Despite the recent news, there are many healthcare providers and patients that recognize the importance of and the need for compounding.  Moving forward, compounding pharmacists can use the spotlight of the meningitis outbreak to educate the general public that compounding is safe, effective, and an essential medical necessity, especially when faced with drug shortages. 



[1] Frequently asked questions about the drug shortage.  Food and Drug Administration Web Site. 
  http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050796.htm.  Updated August 24, 2012.  Accessed 
  November 21, 2012.
[2] Drug shortages.  American Society of Health-System Pharmacists Web Site.  https://www.ashp.org/shortages.   
  Accessed November 21, 2012.
 [3] Moyer CS.  Drug shortages worsen following pharmacy-related meningitis scare.  American Medical News.  
  December 10, 2012.  http://www.ama-assn.org/amednews/2012/12/10/hlsa1210.htm.  Accessed December 21,   
  2012.


January 26, 2013

Conferences & Meetings - Cold Night/Hot Topic The Meningitis Disaster


Special Event
Cold Night/Hot Topic – The Meningitis Disaster:  How Compounding Practices May Change the Roles and Responsibilities of Pharmacists – 1/24/2013

 

Over winter break a few of our professors at the University of Iowa College of Pharmacy organized an event to discuss in detail the compounding disaster at the New England Compounding Center.  As part of the event, I heard lectures on legal issues in pharmacy compounding, drug shortages, pharmaceutical manufacturing and quality, standards of practice in compounding pharmacy, issues in pain pharmacotherapy, and issues in drug product quality of compounding injectable steroids.  It was interesting to learn the thought process that goes behind injectable drugs and where along the spine the drugs should be injected to minimize the harm to the patient. Also, I learned about the drug shortages that the University of Iowa Hospitals and Clinics are facing and how they handle providing great patient care when faced with the drug shortages. I also heard from a compounding pharmacist who discussed the standard of practice in compounding and the PCAB accreditation that ensures that the drug products are compounded correctly.  It was a great event and I learned a lot about compounding.