This week we will be discussing the future of the profession of pharmacy. There are a number of aspects that could be discussed; to give you some background, I would like you to review 2 documents. The first is the Joint Commission on Pharmacy Practice vision for the pharmacist of 2015. The other is a similar position statement from the American College of Clinical Pharmacy. Please review these documents and be familiar with the main points of each.
Additionally, please view the video below from InstyMeds and think about the use of technology and robotics. Threat or opportunity?
Friday, August 29, 2008
Future of the Profession
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16 comments:
Christine:
Intsy Meds is a marvelous innovation because we can now access medications at any time and any place without having to wait for pharmacists to fill prescriptions. I know what it's like for the weekend to roll in, and my children would get sick when times are not convenient for me to approach a doctor or have a pharmacist fill my prescriptions from emergency clinics. But I have not seen any yet around here in Monroe, NC.
It is not that I am anxious to have Intsy Meds but because I am now going to pharmacy school to become a pharmacist, I am somewhat mixed in how I really feel about it. Is Intsy Meds going to replace pharmacists eventually? I hope not. I have a huge loan to pay back, if you know what I mean. I hate to become useless after working so hard to become a pharmacist.
Christine
Of the mentors, how many have done a residency and do you feel that it provides superior patient care? Should it be required of every pharmacy graduate?
How do you think robotics will mesh with the idea of progressive pharmaceutical care?
What are some of the benefits for having automated script filling? Is there a certain example that you can provide from your personal experience?
I completed a community pharmacy residency in conjunction with Kerr Drug and the Medical University of South Carolina. During my residency I was exposed to many more opportunities then my rotations allowed and it opened even more doors for me once I completed the residency. Residencies should not be a requirement for every pharmacy graduate, but a way to set yourself apart from all the other PharmDs that will be graduating. Residencies help you break out from the traditional pharmacy opportunities of retail and hospital.
Robotics will enable pharmacists to use what they went to school for and that means working more closely with the patients and other healthcare professionals to optimize patient care. Instead of spending time counting and labeling, pharmacists could educate patients on the importance of their medications to treat their disease state and rounding with the healthcare professionals in institutional settings to assist with appropriate medication therapy.
When I was a technician prior to pharmacy school we had what was called a Baker Cell which contained the top 20 medications. This cut down on a lot of time that was spent counting tablets and capsules. However, there was always room for human error since the cells were loaded by either a pharmacist or technician. It was always helpful to have two people double check the medication before it was emptied into each cell.
How do you think the public will respond to pharmaceutical robotics? Will this have a large impact on all areas of pharmacy, or mainly the community setting?
Where do you think the future of pharmacy is headed? Do you feel that technology is or will pose a threat to your position?
I have to agree with what Rebecca said in regards to the experience I gained during residency. I completed a pharmacy practice residency with a focus in Ambulatory Care. During my residency I was exposed not only to new things but I was able to gain more knowledge and expertise in the areas of pharmacy that I wanted to focus my career (ie Ambulatory Care). You are exposed to many things your fourth year of pharmacy school however I bet most of you will find that there are certain areas that peak your interest more so that others. Due to the time limit of each rotation you have to transition from rotation to rotation and probably feel like you are becoming "a jack of all trades but a master of none" (or that is at least how I felt). This is where residency comes into play. It is a year directly focused to perfecting your clinical skills so you can provide optimal pharmaceutical care and feel comfortable and confident in your decisions. I will also agree with Rebecca's comment that completing a residency affords you many more opportunities and will open doors for you that you most likely otherwise wouldn't be able to obtain early on in your career. I do not feel though that a residency should be a requirement. It is a huge commitment and I don't think it should be forced. I do feel however if you plan to go into any type of hospital pharmacy, even as a staff pharmacist that a residency is extremely valuable.
The concept of robotics has already been implemented in many aspects of pharmacy. For example, the healthcare system in which I completed my residency, had various types of robotic systems. The inpatient setting had a large robotic system that filled 100s of prescriptions each day. The outpatient facilities had a smaller robotic system, similiar to the system that Walgreens uses, to fill "fast mover" drugs. I think the uses of robotics helps to utilize time more efficiently and allows pharmacists to focus more so on pt care and troubleshooting.
I agree, yet disagree with the points about doing residencies. I think that if you want to specialize in a certain area of pharmacy then a residency would be great opportunity. I wanted to specialize in ocology when I graduated, but I did not see why I should be required to do a generalized residency that would basically be a repeat of the rotations I just did in my 4th year of pharmacy school. As far as the Ambulatory Care or Community Care residencies, they will set you apart, but I think the PharmD program gives you a "general pharmacy practice" residency of sorts with your rotations.
As for robotics, they can be seen as both good and bad. They still need someone to load them and make sure the correct product gets into the correct location and the patient "packets" going to the floors still need to verified for accurracy by a human eye as well as the orders. I have had the opportunity to work with several different kinds of robotics. When I was doing my rotations in Georgia, the teaching hospital was adding robotics to the central filling pharmacy and they were having to load the machine by hand and verify each patient cart before it went out...it still made mistakes, but it was a new system and there were kinks they were working out. With my current company I have worked with the aforementioned Baker Cells (which usually work with the fewest problems) and a robot called the Parata. This robot tends to need a babysitter to feed it vials for filling and lids for the vials and it can have temper-tantrums and has on occasion trown vials at people. When they get the robotics to work properly with a little less "work," they will be good help.
In response to technology such as InstyMeds, I honestly do not think that it will have a direct impact on retail pharmacy. As we all our aware, the U.S. population is by far elderly. It has been my experience that the elderly do not like advanced technology, especially something like the InstyMed system (seems VERY impersonal). In fact, they want to converse with their health care professionals! Technology can never replace the one-on-one interactions we as retail pharmacists have with our patients. I realize that most retail pharmacists struggle with finding ample time to counsel (due to volume mostly), but that can change given willing personnel/management. For instance, I work in a pharmacy that fills an average of 700-800 prescriptions per day. We will offering our patients, through a brown bag program, the chance to speak with our pharmacists more in-depth about their medications during the month of October. My hope is that this will continue through the year and not just in October.
I did not complete a residency after pharmacy school partialy becasue there are few available for my current practice area of long-term care. I agree with the other posts that indicate that it should not be forced but rather be a choice based upon where you would like to practice. I feel that if you are heading towards a particular area for which you would like to specialize then you should strongly consider a residency if one is avialable.
I have also seen the good and bad of robotics. The good is that is allows pharmacists to be more integrated into the interdisciplinary care team and enforces our clinical value. However, I have seen medical errors occur when using robotic systems again due to human error in filling the machines.
Robotics unfortunately can not be avoided. It is the future of pharmacy. However, in my opinion they are only as good as the team running them. The retail setting that I work in has the ScriptPro system in several of there stores trying them out in the higher volume stores. I do like the fact that it frees up time to talk to patients. Then megative is that in several of these stores it is not the pharmacist that removes the filled bottles from the machine or even fills the machine. The responsible members make mistakes and in several location Med. Errors have actually increased. Pharmacist tend to be more laxed because there where assured the machines dont make errors. It a catch 22 to me. I dont trust robotics yet. There are not enough checks and balances to fully cover human error.
As for residencies I agree that they are great for individuals that want to make the next step in pharmacy. As for required residencies for post-grad students. I dont think that is a step that pharmacy should take. After all not everyone wants that kind of responsiblities. Not every area of pharmacy requires that kind of specialed training.
Although I haven't been exposed to it recently, I have worked with the ScriptPro machine in the past and I have a mixed opinion about it. I think that robotics are a great advantage to the pharmacy world, but I do remember that the machine would make counting errors. I didn't see that mentioned in any other posts, so maybe the issue was fixed. Keeping that in mind, I agree with some about the need for a more secure way to check the work that the employees are doing when loading cells. This was an issue, too. But our pharmacist normally caught the error before it reached the patient because they would still have to verify the medication after it was dispensed from the machine. All in all, I'm looking forward to the future advancements that we'll see in the pharmacy.
I agree with Nicole and Rebecca on their perspectives regarding residency training. I completed a Community Practice residency and am currently working toward completing a PGY2 Ambulatory Care residency. As mentioned previously, a residency allows you to gain additional experience and specialized knowledge which may allow you to be more qualified for more clinical pharmacy positions.
In addition, they also allow and encourage pharmacists to progress their involvement and the profession of pharmacy in the medical field. I do not believe that technology will replace pharmacists any time in the near future; however, it is important for pharmacists to secure their position within the medical team. By increasing our involvement “out from behind the pharmacy counter and outside of our small corners in the basement,” it helps to ensure that our profession will not become obsolete or minimize the number of pharmacists required in healthcare. Residencies have helped make this possible due to their ability to test new methods and innovative ways to offer new pharmacy services. For example, several components of the MTM programs have been researched and improved utilizing data and techniques from residency research projects from Community Practice Residencies. You may also find evidence of the value of pharmacy services or use of innovative techniques based on residency projects in many general and specialized areas of pharmacy. Being a resident allows you to be present where many other pharmacists are not able or allowed to be due to their time limitations or scope of practice. Pharmacy residents are allowed to be present to improve their learning experience or to serve as an extension of the pharmacy. In this environment, residents are capable of demonstrating the value of pharmacists to other healthcare professionals. And this is something that technology/robotics will not easily replace.
I have never had the opportunity to work in a pharmacy that has a robot so I really don't know how I feel on that issue. Personally, I believe that pharmacists will always have a role in health care. The technology of things such as InstyMeds will enable pharmacists to do things such as counsel and help patients manage their disease states more so than they are currently able to do. Technology is a part of this society and it contributes to the fast paced lives that we all live.
As far as the residencies, I would agree with Rebecca who stated that residencies are a good way to set yourself apart from the other graduates. I don't believe that it should be mandatory.
I think residencies should remain an option to those who want to pursue them. In addition, I feel certain areas are more likely to require additional training than others, such as Ambulatory Care. My residency in Ambulatory Care was essential in my growth as a pharmacist, especially when it comes to interviewing patients. I think sometimes we as a profession are afraid to distinguish ourselves from one another but is that not what other healthcare professionals do? Nurses can become NP's or nurse anesthetist. MD's go into Family Practice or Cardiology or research. We all have something to offer and everyone should be able to decide as individuals as to where their career takes them.
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