Important Notice - Please Read: After lengthy discussions regarding the best way to conduct WMSHP elections, the WMSHP Executive Board has decided to adopt a method of voting that is similar to the voting structure of both MSHP and MPA. The new WMSHP voting structure is also in-line with our current bylaws. Each active WMSHP member will be mailed an official ballot. The ballot may be mailed back to Brad Miller, WMSHP Secretary, handed in to an Executive Board member, or turned in at the October WMSHP meeting in Grand Rapids or the November WMSHP meeting in Kalamazoo. To eliminate the possibility of voting multiple times, there will not be extra ballots available at the monthly meetings. Please do not attempt to fax the ballots. To verify that WMSHP has your current address, log in to our website at www.wmshp.net and select "Update Address".

We are still working on developing the best process to obtain CE and funding for our monthly meetings with the new Pharmaceutical Research and Manufacturers of America (PhRMA) guidelines. The updated code will take effect January 2009. We are still not sure how this will affect our monthly meetings, but we will be sure to let you all know as soon as possible.

Volunteer Opportunity: The Michigan Pharmacy Week Health Fair is being held in Baldwin, MI on Saturday, October 18 from 11 a.m.-3 p.m. at St. Ann's Human Services Center on 690 9th Street. Volunteers are needed to help with medication reviews and screening activities.

Please join us for our October meeting being held in at Tre Cugini Grand Rapids. Gregory Pratt, Emergency Preparedness Coordinator for the Michigan Pharmacists Association will be speaking on Bioterrorism.

PRESIDENT-ELECT
Natalie Paul received her Pharm.D. from Purdue University and completed a residency with McKesson Medication Management at Mercy Hospital and Medical Center in Chicago, IL. After completion of her residency she worked for Ferris State University as an Assistant Professor of Pharmacy Practice with a focus of Internal Medicine. Recently, Natalie has taken the role of Clinical Specialist- Staff Development and Residency Program Director of the PGY-1 Residency at Spectrum Health. She has been a member of the WMSHP board since 2005.

SECRETARY
Brad Miller is a clinical pharmacist in the Emergency Department at Spectrum Health's Butterworth Campus. He is a graduate of Ferris State University, and completed a pharmacy practice residency at Spectrum Health. He has served as WMSHP's Secretary since 2004, and has maintained WMSHP's website since 2003

BOARD MEMBERS:
Andrea Goodrich is a clinical pharmacist at St. Mary's Health Care in Grand Rapids. Andrea received her B.S. in pharmacy from Ferris State University in 2001 and Pharm.D. from Midwestern University in 2006. Andrea currently works on the orthopedics/neurology unit and the Anticoagulation Management Service at St. Mary's Hospital. Other professional areas of interests include internal medicine and infectious disease/HIV medication therapy. Andrea has been a member of WMSHP since 2001 and is serving as a committee member for MPA membership committee since 2007. Andrea's professional affiliations also include ACCP, MPA, MSHP, and ASHP.

Angela Green currently serves as the Pharmacy Education Coordinator and geriatrics specialist for Mercy Health Partners and is a residency preceptor and adjunct professor for Ferris State University. She graduated pharmacy school from Ferris State University in 2006 and completed a residency with ambulatory focus at Mercy General Health Partners in 2007. She has been an active member of WMSHP since 2007.

Kali Schulz is a 2007 graduate of Ferris State University, College of Pharmacy. Upon graduation, she went on to complete a PGY-1 Residency at Saint Mary's Health Care in Grand Rapids. While enrolled in the PGY-1 Residency program, she also completed the Teaching and Learning Certificate Program at FSU. Schulz most recently accepted a position as an Assistant Professor of Pharmacy Practice at Ferris State University College of Pharmacy. This opportunity has allowed her to return to Saint Mary's while precepting fourth-year pharmacy students on their internal medicine clerkship. Schulz has been a member of WMSHP for two years and was the 2005 recipient of the WMSHP Scholarship. She is also an active member of ACCP and MPA.

Bridgette Sharif graduated with her Doctor of Pharmacy degree from Wayne State University in 2004 and subsequently completed a pharmacy practice residency at the University of Wisconsin Hospital and Clinics. She relocated to western Michigan in 2006 and has since been working as a clinical pharmacy specialist at Borgess Medical Center in Kalamazoo, Michigan. Her primary interest areas are cardiology and anticoagulation management. She has been a WMSHP member since 2006.

Once again it is time for another fall session of WMSHP. I hope that you all had a wonderful summer and are looking forward to a great year of education and networking within WMSHP.

During the summer the WMSHP Executive Board has been busy preparing for the year ahead. We are currently seeking nominations for Executive Board members. According to the WMSHP bylaws, only active members of WMSHP may be nominated for executive board positions. If you are interested in being a board member or know of other interested candidates, please submit their name, contact information, and a brief description of current practice and professional interests to WMSHP Secretary, Brad Miller, at email: webmaster@wmshp.net.

Another important item to mention is the new code established by the Pharmaceutical Research and Manufacturers of America (PhRMA) to guide the interactions of pharmaceutical representatives and healthcare professionals. The new guidelines became effective July 2009 and may affect the ability of pharmaceutical companies to sponsor continuing education programs. To get an event sponsored, WMSHP may have to apply for educational grants each month. We will let you know more specific information as the effect of the new guidelines becomes clearer.

Hope you can make it to our first meeting being held at Bravo Restaurant and Cafe in Portage (Kalamazoo). Dr. Jihad Mustapha will discuss the use of LMWH in the advanced cardiac setting.

Spring has sprung! The return of Spring reminds me of our upcoming WMSHP Spring Seminar, which is scheduled for May 22, 2008 at the 28th Street Hilton in Grand Rapids. Make sure you put it on your calendar.

Another Spring event is the selection of a recipient for the annual WMSHP scholarship. One scholarship in the amount of $1000.00 is awarded to a 3rd year pharmacy student from Ferris State University, the University of Michigan, or Wayne State University. The pharmacy student must be a native or current resident of the Western Michigan area, demonstrate involvement and/or leadership within professional organizations, and express an interest in health-system pharmacy upon graduation. The applicant must fill out an application form before the deadline of March 31. The scholarship recipient will be selected by the WMSHP board and the scholarship will be presented at the Spring Seminar.

Hopefully many of you were able to make it to the MPA ACE meeting. A highlight for WMSHP was the recognition given to our current Past-President, Ryan Bickel. Ryan received the MPA Distinguished New Pharmacist Practitioner award. This is the 3rd year in a row that a member of WMSHP has won this award. Previous winners were Jodie Backus and Jesse Hogue. Congratulations, Ryan!

Our next meeting will be held April 10, 2008 at Sam's Joint in Plainwell. Two area pharmacy residents will be presenting their Great Lakes Pharmacy Residency Project. Bailee Wienke is a pharmacy practice resident at Spectrum Health in Grand Rapids. Her project is entitled "Heparin Induced Thrombocytopenia in the Critically Ill: Value of the 4T Score and Compliance with Evidence-based Guidelines". Betsy Hoida is a pharmacy practice resident at Mercy General Health Partners in Muskegon. The title of Betsy's project is "A Pharmacist-Managed Medication Reconciliation Process".

As in years past, our April meeting will feature continuing education presentations from 2 local pharmacy residents. It is good practice for the residents and a great way to highlight some of the remarkable and interesting projects that take place at health-systems in western Michigan. Each resident will present their major residency project. This is the same project that they will discuss at the Great Lakes Pharmacy Residency Conference at the end of April. Ten area residents submitted descriptions of their project. The WMSHP board selected projects submitted by Bailee Wienke, Pharm.D. and Betsy Hoida, Pharm.D.

Bailee Wienke is a pharmacy practice resident at Spectrum Health in Grand Rapids. Her project is entitled "Heparin Induced Thrombocytopenia in the Critically Ill: Value of the 4T Score and Compliance with Evidence-based Guidelines".

Betsy Hoida is a pharmacy practice resident at Mercy General Health Partners in Muskegon. The title of Betsy's project is "A Pharmacist-Managed Medication Reconciliation Process".

Our next meeting will be held March 13, 2008 at Pietro's Italian Restaurant in Grand Rapids. Tracey Mersfelder, Pharm.D., BCPS will be discussing therapy for neuropathic pain.

With spring right around the corner, don't forget about our annual WMSHP Spring Seminar scheduled for May 22. More information will be sent out in the future.

Well, I guess we can say that winter is finally here. I hope you are all staying warm and safe on those icy Michigan roads. The results are in from our membership survey regarding the ACPE guidelines for standards for commercial support. The majority of our membership wish to continue with our current format of dinner and a live CE presentation. To accomplish this it is likely that the average meeting time will lengthen by about a half-hour.

As the WMSHP representative, I attended my first MSHP board meeting and committee day on January 17. MSHP has been working hard on the 2nd version of Changing Perceptions, a promotional brochure aimed at accurately presenting what clinical activities pharmacists do. Changing Perceptions is used to promote the profession of pharmacy to state and federal legislators as well as the general public. The initial version of Changing Perceptions is still available in pdf form on the MSHP website at http://www.michiganpharmacists.org/pharm_prof/changing_perceptions.htm.

The new version will be available sometime in the next few months. I encourage all of you to get involved and join a MSHP committee. What a great way to positively affect our profession and network with other pharmacists from across the state of Michigan.

Don't forget to attend the 2008 MPA Annual Convention and Exposition February 29-March 2 in Dearborn. Registration information can be found on MPA's website at www.michiganpharmacists.org .

Coming soon: Please note that our next meeting will be held on February 21, 2008 at the Sol World Cafe in Kalamazoo. Dr. Kahn Nedd will be discussing the use of beta blockers in hypertension.

In the February WMSHP Newsletter, Chelsey Skiba, a Ferris State University Pharm.D. Candidate, writes of the benefits of pharmacists performing medication reconciliation.

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Question
Are pharmacists more effective at promoting patient safety by performing medication reconciliation compared to other healthcare professionals?

Evidence Based Answer
Evidence suggests that pharmacists do promote patient safety by performing medication reconciliation more effectively than other health care professionals (Strength of Recommendation [SOR]: C-, based on six pilot studies). Pharmacists performed more complete medication histories by identifying a higher average of home mediations per patient than other health care professionals (SOR: C-, based on four pilot studies). Pharmacists identified more discrepancies between home medication orders and medication histories than nurses (SOR: C-, based on two pilot studies).

Evidence Summary
An accurate and complete medication history is important because if it is incorrect it can lead to inappropriate drug treatment. According to a pilot study carried out by Nester and Hale, patients who had a pharmacist take their medication histories rather than a nurse received a significantly larger fraction of clinical interventions (34% vs. 16%, p<0.001). It was also found that nurses had significantly fewer patients noted as taking a herbal/nonprescription medication than the pharmacists (70% vs. 98%, p<0.001). Patients' community pharmacies were also contacted significantly more often by pharmacists than by nurses for clarification (24% vs. 4%, p<0.001).¹ Nester concluded that pharmacists are more effective at taking medication histories than nurses, but a small sample size and representation are limitations to this study.

In a pilot study performed by Gleason et al, pharmacists conducted medication histories and reconciled the information received with the patients chart history, which was first obtained by doctors and nurses. When a medication discrepancy was noted between the two histories the pharmacist would alert the doctor and if the doctor acted on the discrepancy it was defined as an error and was then accessed for its potential to have caused patient harm. Physicians adhered to pharmacists suggestions about the discrepancies the bulk of the time (n = 69/97 or 71%). Complete omission of a drug that a patient was on prior to hospitalization was the discrepancy requiring intervention most frequently (n= 41/97 or 42%). The authors then used the National Coordinating Council for Medication Error Reporting and Prevention's (NCCMERP) 9-point rating scale to determine potential patient harm if the intervention had not been made in the first 24-48 hours of admission. They noted 38/69 (55%) of the discrepancies fell into the least likely to cause harm category (A-C). On the contrary, if 15/69 (22%) of the discrepancies had not been intervened by a pharmacist the patient outcome could have resulted in harm (categories E & F).² Gleason concluded that medication reconciliation by a pharmacist may have prevented patient harm, but this is up to interpretation due to the descriptive nature of their statistics. Lessard et al performed a similar study to describe medication discrepancies in senior patients and found that the majority (57%) of the discrepancies noted were omissions also. They used a modified version of the NCCMERP and found that a portion (25.8%) of the discrepancies fell into the category that could have necessitated monitoring and/or intervention to prevent harm (category D).³

A pilot study completed in a hospital's inpatient behavioral health unit comparing nurse and pharmacist obtained medication histories found that pharmacists identified a significantly higher average number of medications per patient than nurses (5.3 vs. 4.0, p<0.05).⁴ A pilot study carried out in a hospital Emergency Department (ED) had 252 patients complete medication histories by an ED provider and then by a pharmacist. ED providers only identified 817 home medications from the same patients that pharmacists identified 1096 home medications.⁵ Another study in the ED compared the effect a pharmacist had on a hospitals medication reconciliation form that was usually filled out by a nurse and found that pharmacists had significantly less errors upon completion of the form than the nurses (3% vs. 59%, p = 0.001). The nurses also recorded significantly less allergy documentation than the pharmacists (79% vs. 100%, p = 0.001).⁶

Author Comments
The 2008 National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) necessitate that "medications are accurately and completely reconciled across the continuum of care." JCAHO rational stated that medication reconciliation is "essential in the reduction of transition related adverse drug effects."⁷ Although JCAHO does not recommend a specific health care professional be responsible for medication reconciliation the American Pharmacists Association recommends that "pharmacists be responsible for reconciling medication use when patients move between practice settings within the continuum of care".⁸ The American Society of Health-Systems Pharmacists set a goal for their 2015 initiative for pharmacists to be "involved in managing the acquisition, upon admission, of medication histories for the majority of inpatients with complex and high-risk medications in 75% of hospitals".⁹

References:

1. Nester TM, Hale LS. Effectiveness of a pharmacist-acquired medication history in promoting patient safety. Ann J Health-Syst Pharm. 2002;59(22):2221-25.
2. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitilzed patients. Am J Health-Syst Pharm. 2004;61(16):1689-95.
3. Lessard S, DeYoung J, Vazzana N. Medication discrepancies affecting senior patients at hospital admissions. Am J Health-Syst Pharm. 2006;63(8):740-3.
4. Lizer MH, Brackbill ML. Medication history reconciliation by pharmacists in an inpatient behavioral health unit. Am J Health-Syst Pharm. 2007;64(10):1087-91.
5. Carter MK, Allin DM, Scott LA, Grauer D. Pharmacist-acquired medication histories in a university hospital emergency department. 2006;63(24):2500-2503.
6. Hayes BD, Donovan JL, Smith BS, Hartman CA. Pharmacist-conducted medication reconciliation in an emergency department. 2007;64(16):1720-3.
7. Joint Commission on Accrediation of Healthcare Organizations. 2008 National Patient Safety Goals.http://www.jointcommission.org/NR/rdonlyres/82B717D8-B16A-4442-AD00-CE3188C2F00A/0/08_HAP_NPSGs_Master.pdf (accessed 2007 Sept 24).
8. American Pharmacists Association. Final Report of the 2007 APhA House of Delegates.http://www.pharmacist.com/AM/Template.cfm?Section=Search1&section=About_APhA1&template=/CM/ContentDisplay.cfm&ContentFileID=3311 (accessed 2007 Sept 24).
9. American Society of Health-Systems Pharmacists. 2015 Health-System Pharmacy Initiative. http://www.ashp.org/s_ashp/docs/files/2015_Goals_Status_0307.pdf 

Happy Holidays and Happy New Year.

You will see a mix of new and familiar faces within the leadership of WMSHP this year. Contact information for the 2008-2009 WMSHP leadership can be found on our website (www.wmshp.net). As always, please contact me or another board member with any questions or concerns.

We look forward to a year filled with some changes. One of the biggest changes has come from modifications to the Accreditation Council for Continuing Medical Education (ACPE) guidelines for continuing education. To meet the guidelines, WMSHP must separate dinner from each monthly presentation. We are currently conducting a survey to determine how best to comply with this standard. Surveys were distributed at the November meeting and will again be distributed at the January meeting. A copy of the survey is also included with this month's newsletter. If you did not attend the November meeting and are not able to attend the January meeting and would like to take part in the survey, you can e-mail me at danastaat@ferris.edu or fax me a copy of the survey at (616) 752-6434. Results of the survey will be disseminated to the membership on our website. The changes to our meeting design will go into effect for the February meeting.

The January meeting will be held at the Saint Mary's Health Care Lacks Grand Room. Kevin Furmaga, Pharm.D., BCPP, Saint Mary's Health Care and Pine Rest Psychiatric Hospital, will be speaking about the clinical use of buprenorphine/naloxone.

Wow! This year has gone by fast. Thank you for allowing me to serve as your president. It has been an honor. I would also like to thank the current board for sharing all of their time and talents with WMSHP. It has been a pleasure working with all of them. I would especially like to recognize the outgoing members, Jesse Hogue, Ted Riley, and Shaun Phillips, for their dedication over the last several years. Finally, congratulations to the newly elected board members:

President-Elect Cherie Woodhams Treasurer Kim Melgarejo Technician Member Bill Kriel

Board Members Michelle Brodin Adam Drzewicki Renee Marana Sarah Paulson

I have one last order of business to share with you before I turn the reigns over to Dana Staat, your incoming president. The MPA has just called for WMSHP to select three delegates to send to the 2008 MPA House of Delegates. The Session of the House will be held on Saturday, March 1st, from 1:00 - 4:00 P.M. at the Dearborn Hyatt Regency. If you are an active MPA member and are interested in representing WMSHP as a delegate or would like to obtain more information, please contact me via e-mail at ryanbickel@borgess.com by Monday, December 31, 2007. The Session of the House is held during the MPA Annual Convention & Exposition (ACE), but participation in the ACE is not mandatory. Delegates, who choose to only participate in the Session of the House, will have their registration fee waived for that event.

Finally, if anyone would like to offer a resolution to the House of Delegates, please notify myself or another WMSHP board member by the January 10th meeting. This will give us adequate time to discuss it and file it with the Secretary of the House for consideration.

To vote, WMSHP members should fill out the ballot which has been mailed to them. Return the completed ballot via U.S. Mail (postmarked by Nov. 2nd), give it to any Board member, or take it to the November meeting.

President-Elect

Cherie Woodhams is a 1991 graduate of Ferris State University with a Bachelors of Pharmacy degree. She has experience as a staff and clinical pharmacist on Cardiology, Pediatrics, and the Neonatal ICU. In her current position as Pharmacy Educator, she is involved in training and orientation of pharmacists and pharmacy technicians. She is also presently on the Advisory Board of Everest Career Training Institute.

Treasurer

Kim Melgarejo is currently a Pharmacy Manager at Borgess Medical Center and Borgess Pipp Hospital. She graduated from West Virginia University with her pharmacy degree and then pursued a pharmacy practice residency at Riverside Methodist Hospital. Soon after her residency she moved to Michigan and has worked at BMC as a clinical pharmacy specialist, clinical pharmacy manager, and now a pharmacy manager. She has been a board member of WMSHP since 2005.

Board

Michelle Brodin graduated in 2003 with a Doctorate in Pharmacy from South Dakota State University. She completed a pharmacy practice residency at Mercy General Health Partners in Muskegon in 2004. Dr. Brodin is currently serving as the Pharmacy Education Coordinator and Residency Program Director at MGHP. She has a passion for clinical pharmacy and has presented numerous at ASHP Midyear Clinical Meetings focusing on clinical advancement of the profession of pharmacy.

Melanie Crain graduated from Ferris State University College of Pharmacy in 2006. She completed her Pharmacy Practice Residency at Saint Mary's Health Care in August 2007, and currently works at Metro Health Hospital as a Clinical Pharmacy Specialist.

Adam Drzewicki graduated with his Pharm.D. from the University of Michigan in 2000. After graduation, he completed a Pharmacy Practice Residency at Parkview Hospital in Fort Wayne, Indiana. He then accepted a clinical pharmacist position in cardiology at Borgess Medical Center in Kalamazoo. Today his position is as a clinical pharmacist in both cardiology and pharmacy system applications.

Andrea Goodrich is a clinical pharmacist at St. Mary's Health Care in Grand Rapids. Andrea received her B.S. in pharmacy from Ferris State University in 2001 and Pharm.D. from Midwestern University in 2006. Andrea currently works on the orthopedics/neurology unit at St. Mary's Hospital. Other professional areas of interests include internal medicine and infectious disease/HIV medication therapy. Andrea has been a member of WMSHP since 2001 and is serving as a committee member for MSHP in 2007. Andrea's professional affiliations also include ACCP, MSHP, and ASHP.

Renee Marana graduated from Ferris State University with her Pharm.D. in 2003. She went on to complete a PGY1 residency at Bronson Methodist Hospital in Kalamazoo, Michigan. Upon completion of her residency, she accepted a decentralized pharmacist position on the General Medical and General Care Units at Bronson, where she continues to practice. In the fall of 2006, she became the residency program director for the Bronson residency program. She has also served on the educational committee and currently serves on the residency committee for the Michigan Society of Health-System Pharmacists.

Kym Moline works at St Mary's Health Care in Grand Rapids as a clinical pharmacist in the area of Drug Information and Medication Safety. Kym is an adjunct instructor for Ferris and precepts pharmacy externs and residents. She received her B.S and Pharm.D. degrees from Ferris and M.S.A. from Central Michigan University.

Jackie Morse recently completed a community pharmacy practice residency with Meijer, Pfizer and Ferris State University. She currently holds a shared position as Assistant Professor of Pharmacy Practice with Ferris State University and Disease Management Pharmacist with Meijer Pharmacy in Grandville. Jackie is an active member of ASHP, APhA and currently sits on the Michigan Pharmacists Association's New Practitioner Advisory Committee.

(Incumbent) Sarah Paulson attended Ferris State University and graduated with her Pharm.D. in 2005. She completed a general pharmacy practice residency at Saint Mary's Health Care in 2006. She is currently a clinical pharmacist at Saint Mary's Health Care assisting in coverage of the inpatient orthopedic unit, neurology unit, and inpatient pharmacy. Sarah has been a member of WMSHP since 2005 and has served as a board member since June 2007. She also has membership with ACCP, ASHP, MPA, MSHP, Phi Lambda Sigma, and Lambda Kappa Sigma.

Technician

(Incumbent) Bill Kriel worked at Spectrum Health Butterworth for 10 years prior to starting at Saint Mary's Health Care 7 years ago. Bill currently compounds chemotherapy medications and NICU TPNs.

Suzanne Rodgers has been a pharmcacy technician at Borgess Medical Center since February 2005. She graduated in January '05 from Olympia Career Institute with her technician degree. She became a member of WMHSP in '05 and has since attended many CE Dinners. Her outside involvement is with the jail ministry, ministry with community, retention, and nursing home ministry with her local church.