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.

The American Council for Pharmacy Education (ACPE) recently changed some of their standards, which will effect the way we offer our educational programs. The two changes which effect us most are: 1) continuing education (CE) presentations cannot be given while the participants are eating a meal and 2) presentations should have a different set of questions for pharmacists and technicians. To address the first change, WMSHP's Board will be surveying the membership some time in the next couple months to determine the importance of ACPE-accredited CE (Michigan Board of Pharmacy's CE standards have not changed yet), the importance of offering dinner, and reasonable meeting times. To address the second change, the Board decided to accredit our own CE credits for our technician members. Not only will this solve the issue of separate questions, but it will also save the organization some money, as we currently pay $5 per credit hour of ACPE-accredited CE per person.

Speaking of technician CE, did you know that any pharmacist can approve continuing education (CE) credits for Certified Pharmacy Technicians (CPhTs)? The Pharmacy Technician Certification Board (PTCB) will allow CPhTs to obtain up to 10 CE credits per licensure period for participating in inservices and other education activities. To obtain credit, a pharmacist must complete PTCB's Universal Continuing Education form, which can be found at their website, www.ptcb.org (click on "CE Credits" under the "CPhT Services" menu).

It is election season again. WMSHP's board has the following open positions: president-elect, treasurer, board member (4), and technician member. You will be receiving a ballot in the U.S. Mail in the next couple days. Please take the time to fill it out and return it to us. You may return the completed ballot via U.S. Mail, give it to any Board member, or take it to the November meeting. The results will be tallied and announced at the November meeting.

The November meeting will be held on November 8th at the Food Dance Cafe in Kalamazoo. Dennis Parker, Jr., Pharm.D. from Detroit Receiving Hospital will be giving a presentation on the Management of Intracerebral Hemorrhage. Due to space constraints, the meeting will be limited to the first 40 individuals who RSVP. Please be sure to select your dinner preference when you RSVP.

Help Wanted: WMSHP is seeking actively engaged members to run for a board position for 2008-2009. Openings include: president-elect, treasurer, board member (4 positions), and technician board member. Experience is not necessary. Mentoring will be provided. If you are interested in running or nominating another member to run, please contact Ryan Bickel at ryanbickel@borgess.com or (269) 226-6616 by October 11th. Elections will be held in late October/early November and the results will be announced at the November meeting.

Coming Soon: The next WMSHP meeting will be held in Grand Rapids on October 11th at Bar Divani. Dr. David Langholz will discuss hypertension and the role of Tekturna. Continuing education credits will not be offered at this meeting. Please RSVP at www.wmshp.net, if you would like to attend. Seating may be limited, so sign up now.

Announcement: The MSHP Annual Meeting will be held on Friday, November 2, 2007 at the Lansing Center. This event is open to both MSHP/MPA members and non-members. Students and residents are offered complimentary registration if they register by October 19th. To register, please visit the MPA website, http://www.michiganpharmacists.org, and go to the "Events Calendar" which is found at the "Pharmacy Professionals" link.

In this month's WMSHP Newsletter, Jeffery Tichenor Pharm.D. writes of the use of recombinant factor VII for massive hemorrhage due to traumatic injury.

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Exsanguination is a leading cause of mortality in severe trauma patients, accounting for approximately 40% of mortality.¹ This high incidence of mortality stems from the "lethal triad" of coagulopathy, hypothermia and acidosis associated with massive hemorrhage. Preventing transition to any aspect of the lethal triad is the goal of current treatment. The mainstays of massive hemorrhage management are: ligation, tamponading, or compression of the affected vessels. Other common interventions being: transfusion with fresh frozen plasma, cryoprecipitate, and/or platelet concentrates. The high mortality rate associated with massive hemorrhage bears witness to the fact that current therapeutic options often fall short of their goal in this patient population.

Recombinant activated factor VII (rFVIIa; Novoseven^®) currently has Food and Drug Administration approval for the treatment and prophylaxis of bleeding in patients with Factor VII deficiency, and those with hemophilia with inhibitors to Factors VIII and IX. Factor VII is a vitamin K dependent glycoprotein, structurally similar to human factor VII. Factor VII can exert activity via both the extrinsic and intrinsic pathways in the clotting cascade (see figure below). As predicted by these mechanisms of action, rFVIIa only induces clot formation where vascular injury is present. This ability to form clots only at sites of injury has lead to the investigation of rFVIIa for the management of massive hemorrhage secondary to traumatic injury. Other traits of rFVIIa which make it a potentially attractive agent for use in patients with massive hemorrhage are its short half life of approximately two hours, and its ability to be rapidly infused over 2-5 minutes. rFVIIa has been studied in both penetrating (gunshots and stabbings) and blunt (collisions and attacks) traumas.

The largest and best carried out of the trials using rFVIIa for the treatment of massive hemorrhage was performed by Boffard and colleagues in 8 countries and 32 hospitals.² This study included 301 patients with severe trauma. It was a parallel, randomized, placebo controlled, double-blind trial to evaluate the ability of rFVIIa to control bleeding in trauma patients experiencing extensive hemorrhage.² One arm evaluated the use of rFVIIa in patients with blunt trauma, while the other evaluated its use in patients with penetrating trauma. rFVIIa was administered in consecutive doses of 200, 100, and 100 mcg/kg as deemed necessary by the clinician. The first dose was given after transfusion of the eighth unit of red blood cells (RBCs); and subsequent doses were given after 1 and 3 hours respectively. The blunt trauma arm resulted in RBC transfusions being significantly reduced by 2.6 units (90% CI 0.7 - 4.6, p= 0.02) with rFVIIa compared to placebo.² The need for massive RBC transfusion, defined as > 20 units of RBC, was also significantly reduced from 33% in patients on placebo to 14% with rFVIIa (p= 0.03).² Similar trends were noted in the penetrating trauma group, though the results there were not statistically significant.²

Another well performed trial of rFVIIa for the management of massive hemorrhage was done by Dutton and colleagues. This was a compassionate use study performed on 81 coagulopathic patients.³ The decision to use rFVIIa went through 1 of 2 "gatekeepers" at the facility, dosing was done at 100 mcg/kg. Factor VII restored hemostasis in 75% of the patients (61 of 81), with an average of 1.23 doses.³ Despite this success, mortality at hospital discharge was still approximately 32%.³ This trial also showed that an acidic body pH tempers the effects of rFVIIa. Responders to rFVIIa (n=61) in this study had an average pH of 7.29 while non-responders (n=20) averaged 7.02 (p= 0.0016).³ The research also confirms that patients must have sufficient functional platelet counts at baseline in order for rFVIIa treatment to be effective (patients below 50,000/mcL did not form clots with rFVIIa).³ The researchers compiled a group comparable to their patients as a control (matched on: age, sex, mechanism of injury, abbreviated injury score, laboratory data, clinical outcome, and TRISS probability of survival) and were unable to associate rFVIIa with a long-term survival benefit in their patients.³

Both of these extensive studies concluded rFVIIa to be beneficial in restoring hemostasis to patients suffering traumatic massive hemorrhage, especially those due to blunt trauma. However, no overall mortality benefit was established with the use of rFVIIa in their patient populations. Though, use of rFVIIa may be beneficial in a select group of trauma patients with massive hemorrhage. Patients with the following characteristics appear to be the best served by rFVIIa therapy.

- Blunt trauma victim
- Current treatments exhausted
- Absence of negative prognosis (sepsis, major organ failure, penetrating head injury)
- pH >7.1
- Glasgow Coma Score >8
- Age >18 & <65 years
- No history of atherosclerosis or thrombosis

References

1. Sauaia A, Moore FA, Moore EE, et. al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38:185-193.
2. Boffard KD, Riou B, Warren B, et. al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double blind clinical trials. J Trauma 2005;59:8-18.
3. Dutton RP, McCunn M, Hyder M, et. al. Factor VIIa for correction of traumatic coagulopathy. J Trauma 2004;57:709-719.

The summer is drawing to an end. The kids are heading back to school. It is also time for WMSHP to return from its summer break. The next meeting will be held in Kalamazoo on Thursday, September 13th. Check out the website, www.wmshp.net, for more details and to RSVP.

While we were on our summer recess, ASHP held the House of Delegates meeting. One of the hottest topics at this year's meeting was should residency training be required for new pharmacy graduates to provide direct patient care. After much discussion, they resolved the following:

To support the position that by the year 2020, the completion of an ASHP-accredited postgraduate-year-one residency should be a requirement for all new college of pharmacy graduates who will be providing direct patient care.

I am sure that this resolution, as well as, other new professional policies will be discussed at MSHP's annual board retreat this September. I will keep you posted on highlights.

In addition to our upcoming meeting, I would like to remind you of some other important upcoming dates. First, National Pharmacy Week this year is October 21-27. Information and planning resources can be found at the MPA website, www.michiganpharmacists.org. MSHP's annual meeting is Friday, November 2nd, at the Lansing Center. Registration forms for this meeting will be available at our September and October meetings. Finally, ASHP's 42nd Midyear Clinical Meeting will convene December 2 - 6 in Las Vegas, NV. Reserve your hotel now.

Now that April is almost upon us, we are starting to see the first signs of spring. For WMSHP, this means that we are also nearing our annual meeting, which highlights some research projects done by Western Michigan pharmacy residents. After a close vote, the Board selected the following two projects to be presented at the April meeting: "Pharmacist Interventions to Improve Adherence Among Patients with HIV/AIDS Starting Antiretroviral Therapy" by Melanie Crain, Pharm.D., and "Evaluation of Microorganisms Responsible for Early versus Late-Onset Hospital-Acquired Pneumonia in Intensive Care Unit Patients" by Sarah-Ann Brown, Pharm.D. I would like to thank all of the area residents for submitting their projects and encourage you to come to the meeting and support Melanie and Sarah-Ann.

Another spring tradition is the WMSHP Spring Seminar. This year's seminar will be held on Thursday, May 10th, at the Grand Rapids Airport Hilton. It is an excellent opportunity to earn continuing education credits and network with colleagues. Our morning sessions will focus on toxicology and advancing the pharmacy profession, while the afternoon will be broken into two tracks, Administration and Therapeutics. The Administration track will touch upon innovative technician practices, pharmacy law, and the benefits of being a preceptor. Historically, technicians have found the Administration track useful, because it fulfills their law review requirement for certification. The Therapeutics track will provide updates on HIV therapy, women's health, and glycemic control in patients with infections. Reserve the date on your calendars and watch our website, www.wmshp.net, for more information and to register.

Greetings! I just returned from MPA's Annual Convention and Exposition in Dearborn. It was nice to see many of you out there. I would like to take this opportunity to share with you some highlights from the convention.

One of the main topics which the MPA focused on this year was getting their membership involved politically to strengthen the profession of pharmacy. They suggested identifying legislators (or potential legislators) in your district that you believe in and supporting them. Support can be as simple as sending them a $10 check to support their campaign or as involved as knocking on doors for them during the campaign season. If you are not comfortable supporting a legislator, please consider supporting MPA's Political Action Coalition (PAC).

Another highlight of the meeting was finding more preceptors and sites to become involved with training pharmacy students in their P-3 and P-4 years. WMSHP will be working closely with the Michigan Colleges of Pharmacy Experiential Programs (McPEP) group to assist them in identifying preceptors and sites in our region, as well as, supporting their current preceptors and sites. WMSHP has arranged for McPEP to give a presentation at our May 10th Spring Seminar in Grand Rapids. Please mark your calendars for this event.

Finally, I would like to inform you that Jesse Hogue, Fred Schmidt, and I served as your delegates to the MPA House of Delegates session. During the session, Laura Shaw, Chairman of Michigan's Board of Pharmacy, provided the House with a special report. She reminded us that Michigan's new continuing education (CE) standards (R 338.3041) were recently signed into law. For those of who are not aware of the new standards, starting July 1, 2007, pharmacists will be required to obtain 10 hours of live CE per renewal period, will be required complete one hour of CE in pain management, and will not be permitted to obtain more than 12 hours of CE per day. The new rules can be found at www.michigan.gov/healthlicense under the "Health Professional Administrative Rules" link.