Volume 35, No. 3 August 2021 - North Dakota Pharmacists Association
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Journal
NoDak Pharmacy
Volume 35, No. 3 August 2021
NDPhA Board of Directors
NDPhA Board Chairman District 5 Officer NDPSC President
Ramona Sorenson Dan Duletski, PharmD Steve Boehning
Trinity Hospital Minot ND Pharmacy Linson Pharmacy
1 Burdick Expressway W Dickinson, ND 4717 11th St. W
Minot, ND 58701 (701) 225-4434 West Fargo, ND 58078
(701) 857-5000 Daniel.Duletski@gmail.com 701-541-5702
Goodspirit1202@gmail.com sboehning@ideaone.net
District 6 Officer
NDPhA President Pat Brunelle BOP Executive Director
Jeff Jacobson 7500 Moonstone Lane Mark Hardy
2301 34 ½ Ave S Bismarck, ND 58503 ND State Board of Pharmacy
Fargo, ND 58104 (701) 224-9521 1906 E Broadway Ave
Jeffdjacobson1@gmail.com Pat@gatewaypharmacy.com PO Box 1354
Bismarck ND 58501
NDPhA President Elect District 7 Officer (701) 328-9535
Randy Habeck John Fugleberg MHardy@ndboard.pharmacy
Hillsboro Drug The Medicine Shoppe Jamestown
(701) 636-5231 703 1st Ave S NDSU College of Health
Valley City, ND 58072 Professions
NDPhA Vice President (701) 252-3002 School of Pharmacy
Jamie Vander Vorste 0545@medicineshoppe.com Charles Peterson
3026 Montana Drive PO Box 6050 Dept 2650
Bismarck, ND 58503 District 8 Officer Fargo ND 58108-6050
701-720-1873 Elizabeth Skoy (701) 231-7609
jamievandervorste@gmail.com NDSU School of Pharmacy Charles.Peterson@ndsu.edu
Thrifty White
District 1 Officer Fargo ND NDSHP President
Chantal Helde (701) 231-5669 Brody Maack
5537 124th Ave Nw Elizabeth.Skoy@ndsu.edu (701) 306-9230
Epping, ND 58843 brodymaack@gmail.com
cvance9@hotmail.com NAPT President
Mandy Chase
District 2 Officer ajchase_75@hotmail.com
Carolyn Bodell
Trinity Hospital Pharmacy EXOFFICIOS
Minot ND 58701
(701) 838-2933 Executive Vice President
jbodell@min.midco.net Michael Schwab
NDPhA
District 3 Officer 1641 Capitol Way
Megan Hursman Bismarck ND 58501
805 3RD Street (701) 258-4968
Langdon, ND 58249 mschwab@nodakpharmacy.net
(701) 256-3330
Megan.J.Lutman@gmail.com NDSCS Pharmacy Tech Program
Melissa Krava – Assistant Director
District 4 Officer NDSCS Pharmacy Tech Department
Tim Carlson 800 N 6 St
3825 Clearview Cir Wahpeton ND 58076
Grand Forks, ND 58201 (701) 671-2114
(701) 795-3498 Melissa.krava@ndscs.edu
tcarlson@thriftywhite.com
2 A Voi c e f or Pharmac y S i nc e 1 8 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 2 • M a y 2 02 1
Table of Contents 2021 Calendar
NDPhA President’s Message . . . . . . . . . . . . 4 AUGUST
August 23-25th. . . . . . . NACDS Total Store Expo –
Virtual
NDPhA 67th Legislative Overview . . . . . . . . 6-8
SEPTEMBER
September 8th . . . . . . . NDPhA Sponsored
NAPT Message . . . . . . . . . . . . . . . . . . 9 Opportunities Night - 6:00 PM
It takes a
September 9th . . . . . . . NDSU College of Health
Druggist Professional Liability Professionals
(continued)
FargoDome
Career Fair –
NDSU School of Pharmacy . . . . . . . . . . . . 10
September 9th . . . . . . . NDSU Scholarship Recognition
Ceremony FargoDome
Discounts and More
local business
September 18th . . . . . . Pharmacy White Coar
Board of Pharmacy – DSCSA Article . . . . . . . . 12 Ceremony – Festival Concert
Cumulative Multi-Policy Discount Hall
If you place your other policies with Auto-Owners, you could receive a discount on your
NDSU School of Pharmacy . . . . Businessowners
. . . . Policy.
. . The14-21 OCTOBER
owner to
more policies you place with us, the higher the total discount.
And you can include your personal insurance when October
using the multi-policy discount
7-8th. . . . . . . . to “The Business of
NCPA
improve the value of your insurance program. Ask your independent agent aboutLong-Term
this Care” Workshop –
Charlotte, NC
NDPhA Membership Dues . . . . .discount
. .today!
. . . . . 23
October 7th -9th . . . . . NCPA Pharmacy Ownership
protect one.
Commercial Umbrella Workshop – Charlotte, NC
You can increase your general liability and automobile liability8-10th. . . . . . .
October coverage with a Commercial
NASPA Fall Meeting
Umbrella policy. Ask your agent for more details. October 9th -12th . . . . NCPA Annual Convention –
Life Insurance and Disability Income Charlotte, NC
Auto-Owners offers a wide variety of October 18-19th. . . . . . ASHP Conference for Pharmacy
products, including:
A SPECIAL THANK YOU • Key Person Insurance
Leaders – Chicago, IL
October 21-22nd. . . . . ASHP National Pharmacy
• Term Life, Whole Life, Universal Life Insurance
TOAuto-Owners?
Why OUR SPONSORS • Annuities
• Disability Insurance
As a small business owner in our Preceptors
community,Conference
Chicago, IL
I understand–what it
takes to protect your small business. Let me help you get insurance
for your business at a great value. Stop in or give me a call.
• Highest rating by national insurance company • Long Term Care Insurance
rating services such as A.M. Best, which All of these can be tailored to meet your specific needs. You can also get discounts on your
ranks Auto-Owners among the highest in the personal auto and homeowners policies when you buy life insurance from us. Ask your
agent for a proposal.
industry with an A++ (Superior) rating.
• A national consumer magazine ranks
Auto-Owners among the top companies for Terry M Richter CLU, Agent
201 N 19th Street 324 2nd Ave SW
handling claims. Bismarck, ND 58501 Jamestown, ND 58401
• Auto-Owners is among the largest insurance Bus: 701-223-8757
Fax: 701-223-7440
providers in the United States. terry.richter.gj27@statefarm.com
Mon-Fri 8:30AM to 5:00PM
• Auto-Owners is an industry leader in Evenings & Saturday by Appt
controlling expenses, resulting in savings to
State Farm Fire and Casualty Company, State Farm General Insurance Company, Bloomington, IL
our policyholders. 1706446
State Farm Florida Insurance Company, Winter Haven, Florida
State Farm Lloyds, Richardson, TX
Sheila Welle CIC® LUTCF® LTCP Jorin J. Johnson CFP®
sheila@superior.agency
NDPhA JOURNAL SUBMISSION POLICY jorin@superior.agency
NORTH DAKOTA PHARMACY JOURNAL
704.361.1067 701.356.3256
The ND Pharmacists Association is pleased to accept submissions for 1641 Capitol Way • 701-258-4968
the Journal. Submissions should be reasonable in length due to space www.nodakpharmacy.net • mschwab@nodakpharmacy.net
considerations. In order to ensure the quality of our publication, editing
Advertising Contact Information
for grammar, spelling, punctuation and content may occur. Articles,
Joe Sitter - jsitter@unitedprinting.com
photos, and advertising should be submitted in electronic form.
United
Note: The analysis of coverage is in general terms and is superseded in all respects Printing
by the Insuring • Endorsements,
Agreements, 701-223-0505 Exclusions, Terms
and Conditions of the Policy. Some of the coverage mentioned in this material may not be applicable in all states or may have to be modified to
To submit, please email NDPhA at: mschwab@nodakpharmacy.net
NDPhA Membership ..............
conform to applicable state law. Some coverages may have been eliminated or modified since the printing of this material. 1,276
The deadline for the Next Issue is: Journal Circulation .............. 1,300
AUGUST 13TH, 2021 Journal is published five times a year by United Printing. All rights reserved. Information contained
within may not be reprinted wholly or in part without the written consent of the publisher.
A Vo i ce for Pharmac y S i nc e 18 85 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 02 1 3NDPhA President’s Message
Hello My Friends,
Summer is here and I hope everyone is getting a chance to meeting times and dates starting in the next Journal.
enjoy the outdoors with friends and family. The pandemic
restrictions are easing, and it is good to see people out Finally, I wanted to share a new item brewing on the retail
again enjoying life. I know the pandemic is far from over, side of pharmacy. It is a shared position between NDSU and
but some normalcy is great to see. Southpointe Pharmacy. The position is a comprehensive
community/ambulatory pharmacy teaching program.
One goal I have over the course of this year is to try and Jayme Steig started recently and has hit the ground running.
increase the membership in our North Dakota Pharmacists In addition to his teaching and research requirements for
Association. The NDPhA is a great resource for all of us on NDSU, he will be focusing on MTM programs, remote
a multitude of issues, including legislative, pharmaceutical patient monitoring programs and any other projects that
care, new and innovative pharmacy delivery methods. It could be important for the future of pharmacy. The ultimate
provides a network of pharmacy professionals that have goal is to get a program of best practices in place that can
answers to questions many of us have had throughout our be duplicated in any pharmacy across the state with relative
careers. The Association supports scholarships and services ease. I must temper my own enthusiasm because I know
for NDSU pharmacy students. I know if you are reading this is not something that will be easy or quick, but I am
this Journal, you are already a member. But, if you know a extremely excited to see where this can take us. If you have
pharmacist who is not a member, please point them to the any suggestions on things to focus on, please let Jayme or I
Association website at nodakpharmacy.net, or have them know at 701-234-9912 or by email at
call the office at 701-258-4968 to get more information. It SPP@SouthpointePharmacy.com.
really is a bargain at only 41 cents per day.
Take Care,
Another goal of mine is to try to increase the involvement
of everyone in their district meetings. I need to do a better
job of being involved at the district level and hope to pull
a few more of you with me. I know my excuses are always
Jeff Jacobson
easy and convenient. But I also know the district 8 meetings Jeff Jacobson PharmD, RPh
I have been a part of have been extremely informative
and valuable. Please consider attending your next district
meeting. The more people who attend, the better the
meeting and sharing of ideas. I will be posting future District
4 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021you might not know
we have life, home,
auto and business
insurance. now you do.
simple human sense
Sheila Welle CIC® LUTCP® LTCP® Jorin J. Johnson CFP®
sheila@superior.agency jorin@superior.agency
701.361.1067 701.356.3256NDPhA 67th Legislative Overview
NDPhA 67th Legislative Overview
The 67th legislative session was one for the records books. We started the session with more money than anticipated
due to COVID-19 federal relief funds. There were plenty of critics on both sides of the aisle regarding how the money
should be spent or saved. The total state budget for the 2021-2023 biennium, for this little state, came in at $16.9
billion which is $3.2 billion more than the previous biennium. A large portion of the funds went to statewide priorities
such as flood control, revolving loan funds, infrastructure funds and agriculture innovations. It is also noteworthy to
mention, the Department of Human Services budget is the largest budget in the state and has been for a number of
years now.
There were dozens of bills that we tracked, monitored, testified on and worked hard to influence throughout the
legislative session.
HB 1012 - MEDICAID AND MEDICAID EXPANSION:
As many of you know, the prescription benefit for Medicaid Expansion moved in-house with the DHS Medicaid
Division January 1, 2021. The medical benefit for Medicaid Expansion continues to be administered privately as a
managed care contract. Starting next year, BC/BS of ND will be taking over the Medicaid Expansion managed care
contract for the medical side. The Department of Human Services just announced BC/BS of ND won the bid so there
will be a new carrier in the near future.
During the legislative session, decisions were made to include interpreter services, continuous glucose monitors,
metabolic supplements and community emergency medical services as covered services under traditional Medicaid.
Individuals aged 19 and 20 will be taken off Medicaid Expansion and served under traditional Medicaid. The automatic
sunset clause for Medicaid Expansion was also repealed this session. The funding for the substance use disorder
voucher program more than doubled for this upcoming biennium to $17 million.
COVID-19 LIABILITY RELIEF:
During this past session, the Greater ND Chamber and 30 associations supported an umbrella relief bill that passed.
The bill provides immunity for businesses with specific provisions to protect healthcare.
STATE DEPARTMENT OF HEALTH MERGES WITH ND DEPARTMENT OF HUMAN SERVICES:
The director for the ND Department of Human Services will be the lead of the combined agencies. The State Health
Officer for the Department of Health will continue to be a member of the Governor’s Cabinet and will be appointed by
the Governor.
VACCINES, VACCINES, VACCINES:
There were nine vaccine related bills this session. Each bill had its own twist and turn. We stayed actively engaged
in monitoring and testifying on the various vaccine related bills. The vast majority of the vaccine related bills were
defeated or heavily amended. The bills ranged from:
• Removing vaccine requirements.
• Liability requirements for medical products.
• Notice of risks associated with vaccines.
• Informed consent prior to any vaccination.
• Prohibit public accommodations from refusing services to an individual who has not been vaccinated.
• Supply manufacturer insert prior to any vaccination to the patient.
• Prohibit vaccinating pregnant women unless witness is present.
The vaccine related bills were either defeated or heavily amended which brings limited change. Towards the end of
the legislative session, a small group of legislators brought forward a House floor amendment dealing with vaccine
passports. The amendment was brought forward at the last minute and passed with exceptions.
6 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021• Prohibits any government entity or private business from requiring documentation of an individual’s vaccination
status, the presence of pathogens, antibodies or antigens or an individual’s post transmission status.
• Does not apply to healthcare workers including LTC providers.
• Only applies to EUA vaccination status.
• Does not apply to K-12 or higher education.
• Does not apply during a declared public health emergency.
FREEDOM OF CHOICE FOR HEALTH CARE SERVICES:
This bill was modeled after the “pharmacy freedom of choice” law that currently exists in Century Code. For those
of you who are not familiar with the pharmacy freedom of choice laws, please let our office know. The bill brought
forward this session was done in an attempt to allow other health care providers to join limited networks and to allow
a patient the right to choose their healthcare provider. This bill was turned into a study and will be studied during the
Interim legislative session. We will be closely monitoring the interim study. Depending on how the study goes, this
could have positive or negative implications for our current pharmacy freedom of choice laws.
MARIJUANA:
Two different recreational and edible marijuana bills failed. The bills passed the House but failed in the Senate. You can
all anticipate seeing another public initiated measure in the very near future to pass recreational marijuana in ND. More
to come on this front!
CHANGES TO GOVERNOR & STATE HEALTH OFFICER EMERGENCY POWERS THROUGH PASSED BILLS:
• Governor cannot limit sale of alcoholic beverages.
• State Health Officer has to be a MD or DO with public health experience.
• If the Governor declares an emergency and the legislature is not in session, ND Legislative Management may
request the Governor call a special session. If the Governor does not call a special session within in 7 days of the
request, the disaster or emergency is only limited to 30 days.
• Prohibit the Governor or State Health Officer from imposing a mask mandate.
BILLS PASSED DIRECTLY RELATED TO PHARMACY:
• Pharmacists can give vaccinations to person ages 3 and older.
• Pharmacy technicians can administer medications by adhering to the Board of Pharmacy rules. Rules are
currently drafted and out for public comment. Following the public comment period the draft rules will go
before the Legislative Rules Committee for final approval.
• State Board of Pharmacy may allow limited prescriptive authority for smoking cessation, immunizations and
other public health issues.
• Pharmacists can administer COVID-19 tests regardless of emergency or disaster declarations.
• 340B discrimination and rights legislation was passed to protect the covered entity and contracted pharmacy
from the overreaching arm of the PBMs.
• Prohibition on PBMs charging pharmacies transaction fees.
• Medication Optimization study bill passed requiring the Insurance Commissioner’s office and Interim Health
Care Committee to conduct a study on clinical pharmacist services. This interim study will begin in August. We
will be actively engaged in this study as well.
• ND State Auditor’s budget bill was amended to include an audit of NDPERS’s claims data and the PBM they use
(Optum Rx). The audit will look at 2019, 2020 and current year pharmacy claims.
DRUG TRANSPARENCY BILL (HB 1032):
This bill, which passed at the very end, requires certain information from drug manufacturers, PBM’s and health
insurance companies.
A Vo i ce for Pharmac y S i nc e 18 85 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 02 1 7NDPhA 67th Legislative Overview
• Drug manufacturers must disclose wholesale acquisition costs, justify price increases when certain thresholds are
reached, R&D costs, and report aggregated rebates paid out.
• PBMs must report certain information to the insurance commissioner such as price protection payments,
aggregated rebates paid to health plans, employers and patients. PBMs must also report revenue from drug
manufacturers.
• Health Insurance companies must report the 25 most frequently prescribed drugs across all plans, top 25 highest
dollar prescriptions, increase in premiums attributable to prescription drugs across all plans, percent of specialty
drugs with utilization management and premium reductions due to specialty drug utilization management.
There are other provisions but I think you get the picture! The information needs to be reported to the Insurance
Commissioner’s office and his office must publish the information.
PRESCRIPTION DRUG PRICING (SB 2212):
SB 2212 started out as a drug importation bill but was turned into a drug pricing study. The study will concentrate
on importation, reference rate pricing and the role of PBMs play in drug pricing. This study will pull together industry
experts on all the topics mentioned.
***We will be actively engaged during the Interim with a variety of studies taking place. We will actively be engaged in
the medication optimization study and drug pricing study. The interim committee hearings will begin in August and
continue leading up to the next legislation session. We will also be providing background and information as requested
by the State Auditor’s office as they prepare for an audit for the NDPERS commercial plan. More to come in the future!
Please let our office know if you have any questions.
Respectfully,
Mike Schwab
Mike Schwab – EVP NDPHA
8 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021NAPT Message
NAPT Chairperson’s Message
Greetings to you from the Northland Association of Pharmacy Technicians (NAPT)! The 2021-2022 NAPT
Executive board members have taken a jump start to the term and have developed some clear goals to
continue to serve in the best interest of our general members. We’d like to welcome Lillie Lambert to the board
as a member-at-large who was installed at our last NAPT Executive Board meeting.
2021 NAPT ANNUAL FALL CONFERENCE
The fall conference is scheduled for September 10th-11th, 2021 in Fargo, ND at Holiday Inn. This year’s theme
is “Behind the mask, the counter, the scene. The Pharmacy Technician is part of the Pharmacy Team”. CE
topics include legislative and ND Board of Pharmacy updates, immunization delivery, opioids, medication
reconciliation, mental health and wellbeing as well as the fan favorite patient story and pharmacy technician
panel. Be on the lookout for the registration form and we hope to see you all there!
NAPT GENERAL MEMBERSHIP MEETING
The next NAPT General Membership meeting will be held during the fall conference on Saturday, September
11th at 12:15-1:30pm. Please note that at every NAPT General Membership meeting, we offer time for our
members to bring any topic up that they’d like to discuss. The NAPT Executive Board is very interested in
hearing feedback from our members. This will be an important meeting to attend as we have several items
requiring action/motions from our general members.
Take care,
Lindsay Cizek-Cribb, RPhTech, CPhT
NAPT Chairperson
CURRENT 2021-2022 NAPT EXECUTIVE BOARD MEMBERS
Title Name Email
Chairperson Lindsay Cizek-Cribb lindsaycizek@hotmail.com
President Mandy Chase ajchase_75@hotmail.com
Vice President Adelle Casavant acasavant5@gmail.com
Secretary Amanda Olauson a.s.o.092291@gmail.com
Member-at-Large Lillie Lambert llambert@famhealthcare.org
A Vo i ce for Pharmac y S i nc e 18 85 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 02 1 9NDSU School of Pharmacy
ONERx Article
Authors: Alli Bushaw PharmD Candidate Class of 2024, Heidi Eukel, PharmD, Oliver Frenzel, PharmD, MPH, Elizabeth
Skoy, PharmD, Jayme Steig, PharmD, Mark Strand, PhD, Amy Werremeyer, PharmD
ONE RX: UPDATES AND IMPACTS
The ONE Rx program is excited to share some updates to the program and impacts of opioid risk screening across the
state. The pandemic has brought numerous challenges to pharmacies delivering patient care services and pharmacists
have effectively adapted their practices to serve the patients’ needs in the safest and most efficient manner during
these challenging circumstances. The ONE Rx program has also adjusted and this has allowed for new initiatives that
will enhance the impact and utilization of the ONE Rx program in North Dakota.
Opioid risk screening continues to be effective in the fight against adverse opioid events with over 8,000 screenings
documented in pharmacies across North Dakota since ONE Rx inception. The pharmacists who have utilized this
program have shown resilience in serving not only their patients, but their community as well.
IMPACT TO PATIENT-CENTERED-CARE:
• One out of every three ONE Rx patient screenings have received education about the availability & benefits of naloxone.
• Over 67% of patients that are at-risk for accidental opioid overdose have received education about the benefits of naloxone.
• National data from the CDC has indicated that patients at high-risk for accidental opioid overdose only receive
a naloxone prescription 1.5% of the time.1 Results from the ONE Rx pharmacies have demonstrated a naloxone
prescribing rate for at-risk overdose patients of 26%!
• Nearly 9 out of every 10 patients have been introduced to appropriate medication disposal opportunities
(i.e. Med Take Back)
• 80% of patients identified as at-risk for adverse opioid events have received education and interventions from the
pharmacist focusing on patient safety during prescription opioid use.
These noteworthy results indicate that ONE Rx pharmacists are focusing on public health with a priority in opioid harm
reduction!
DOCSTATION HAS PARTNERED WITH ONE RX AS THE DOCUMENTATION PLATFORM.
-What is DocStation? DocStation is a patient care management platform specifically designed for pharmacists.
-Why should I use DocStation? DocStation makes it easy to document and track clinical details and interventions in a
clean and succinct manner. The platform’s tools and task workflows are uniquely designed to help pharmacists do
what they love most and get paid for it. Plus, it’s free for ONE Rx partners!
-Why would it benefit my pharmacy or patients? Actively participating in programs on DocStation, like ONE Rx and ND
Medicaid MTM, enables you to better engage in your patients’ care, create impactful interactions with your patients,
and get paid for the services you provide.
For more details and information about the DocStation platform, please visit: https://docstation.co/
CONTINUING EDUCATION AND INCENTIVE PROGRAM:
ONERx is also excited to announce the launch of their new incentive program taking place from now until August
1st 2021. A $250 Visa gift card will be distributed to any ONE Rx pharmacy that completes and documents at least 40
screenings within the given time frame. In addition, all pharmacists have the opportunity to participate in a free one-
hour continuing education program discussing the impact of the pandemic on opioid misuse and overdose. (CE is
accessible at learn.ceimpact.com with code Opioid2021)
ONERx is proud of the impact pharmacies have made and is even more excited to see what the future holds. Thank
you for you dedication and quality that you deliver to your patients each day!
1 . Gery P. Guy J. Vital Signs: Pharmacy-Based Naloxone Dispensing — United States, 2012–2018. Morbidity and Mortality Weekly
Report. Centers for Disease Control and Prevention; 2019 Aug 9;68(31):679. PMID: 31393863
10 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021It takes a
local business
owner to
protect one.
As a small business owner in our community, I understand what it
takes to protect your small business. Let me help you get insurance
for your business at a great value. Stop in or give me a call.
Terry M Richter CLU, Agent
201 N 19th Street 324 2nd Ave SW
Bismarck, ND 58501 Jamestown, ND 58401
Bus: 701-223-8757
Fax: 701-223-7440
terry.richter.gj27@statefarm.com
Mon-Fri 8:30AM to 5:00PM
Evenings & Saturday by Appt
State Farm Fire and Casualty Company, State Farm General Insurance Company, Bloomington, IL
State Farm Florida Insurance Company, Winter Haven, Florida
1706446 State Farm Lloyds, Richardson, TXBoard of Pharmacy – DSCSA Article
Drug Supply Chain Security Act Updates
By Hannah Scheetz, PharmD Candidate 2022 - 8 July 2021
Changes are in the near future for drug traceability of prescription drugs. The FDA’s Drug Quality and Security Act was
enacted by Congress in 2013 and Title II contains the Drug Supply Chain Security Act (DSCSA). The goal of this act is
to have an electronic, interoperable system to identify and trace prescription drugs distributed at a package level and
establish national licensure standards for wholesaler distributors and third-party logistic providers by
November 27, 2023.
An electronic, interoperable system to trace prescriptions drugs will allow companies to know who has touched the
products and if there are any vulnerabilities or threats. This system will also use product identifiers to verify product
and have the ability to a fast response of any suspect or illegitimate products, improve efficiency of recalls, and allow
the FDA to track counterfeit, stolen, contaminated, or harmful drugs. Products that are covered under this act include
prescriptions drugs that are in finished dosage form for patient administration without further manufacturing. This
includes capsules, tablets, and lyophilized products before reconstitution.
Under the DSCSA, key requirements include having authorized trading partners, verification, product tracing, and
product identification. Trading partners include manufactures, repackagers, wholesale distributors, dispensers, and
third party logistic providers. For trading partners to be considered authorized, manufactures and repackagers need a
valid registration with the FDA, dispensers need a valid state license, and wholesale distributors and third party logistic
providers need valid state or federal license with reporting requirements to the FDA annually. Verification includes
quarantining and investigating suspect drugs. An investigation requires validating applicable transaction information
and transaction history along with verifying lot number and product identifiers, notify if a product is illegitimate to the
FDA and trading partners within 24 hours, respond to manufacturers about illegitimate drugs to avoid patient use, and
finally store records for 6 years
Current product tracing requirements include lot level tracing in paper or electronic formats, however by November
of 2023, tracing will be to the package level and in electronic formats. Product tracing requirements include receiving
drugs only if there is valid transaction information, transaction history, and transaction statements, providing tracing
information with all prescription drug transactions, responding to recalls or to investigate a suspect or illegitimate
product, storing tracing information for at least 6 years, and returning product to the trading partner you originally
bought the drug from. Pharmacies are required by law to confirm who they are doing business with. This includes
checking the licensing of wholesaler distributors, third
party logistics, and pharmacies, and the registration
of manufactures and repackagers on the Board of
Pharmacy’s website. The last requirement, product
identification, includes a national drug code, serial
number, lot number, and expiration date readable to
humans and also have a barcode for machines.
The FDA is currently developing regulations to enhance
drug distribution systems for an interoperable, electronic
tracing of a product at the package level and anticipates
the release of a draft this November and final guidance
on the necessary system attributes for secure tracing
is scheduled for November of 2022. This will allow
pharmacies to become compliant with the needed
technology by the November 27, 2023 date.
12 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021A TOUCH OF Blue
Because every little bit
of flying time counts.
Living life to its fullest is easier with coverage from
Blue Cross Blue Shield of North Dakota. As always,
we’re here with a personal touch, including the
right protection for you. Get the assistance you
expect, the options you need—and get back to
doing what you do best.
BCBSND.comNDSU School of Pharmacy
NDSU Preceptors and Teacher of the Year named
By Carol Renner, Office of the Dean, Marketing/Communication Coordinator, NDSU College of Health Professions
Dr. Ashlee Anderson (PharmD - 2013) and Dr. Amber Slevin (PharmD - 2012) were named 2021
Preceptors of the Year, and Dr. Sanku Mallik was named Teacher of the Year in the NDSU School of
Pharmacy.
Anderson, a pharmacist at Sanford Specialty Pharmacy, Fargo, North Dakota, was named 2021 Adjunct
Preceptor of the Year. Pharmacy students on clinical rotations nominate award recipients.
“Dr. Anderson designed topic discussions and case logs that challenged me to apply concepts from the
rotation to patient cases. I was also able to help answer clinical questions that providers were asking,”
said one student about their experience with Dr. Anderson.
Another student said Dr. Anderson provided professional expertise and mentoring.
“I noticed a major drug interaction that was not picked up by the system that we used and brought it to
Dr. Ashlee Anderson, her attention,” said the student. “She then approved my recommendations and trusted me to reach out to
the prescribing provider, as well as the patient to discontinue the offending medication and recommend
PharmD
an alternative.”
As Faculty Preceptor of the Year, Dr. Amber Slevin’s expertise includes ambulatory care pharmacy
practice, gastroenterology/hepatology, viral hepatitis, and health literacy. She is an assistant professor of
practice and clinical pharmacy specialist at Family HealthCare in Fargo.
According to one student nominator, “Dr. Slevin was always asking for my assessment and therapeutic
plans for patients, both before meeting with the patient and after the interview. She would ask additional
questions to make sure I had a strong understanding of disease stated and therapeutic options.”
Another student noted how Slevin adapted each rotation experience for effectiveness. “Dr. Slevin was
always available for discussion on clinical issues and for feedback on how the rotation was progressing….
She also allowed for strong independence for students in clinical rotations.”
“All faculty and adjunct preceptors help prepare future pharmacists,” said Charles D. Peterson, dean of
the School of Pharmacy and College of Health Professions at NDSU. “These preceptors provide students
Dr. Amber Slevin, professional experiences that will prepare them to become members of the healthcare team.”
PharmD
For more information on how to become a pharmacy preceptor, visit www.ndsu.edu/pharmacy/
outreach/experiential_ed/
In NDSU Pharmaceutical Sciences, Dr. Sanku Mallik was named Teacher of the Year. He serves as director
of the Center for Diagnostic and Therapeutic Strategies in Pancreatic Cancer.
Mallik provides opportunities for pharmaceutical sciences graduate students to be part of a team
conducting groundbreaking research regarding pancreatic cancer, breast cancer, systems that can
precisely target treatment of cancer tumors, and other research topics.
Recent graduate Matthew Confeld said he learned several things in Mallik’s lab.
“We designed a unique growing chamber to test dozens of chemotherapy drugs simultaneously,” said
Confeld, among the many research projects he has done through Mallik’s lab. Confeld also learned that
failure can lead to success; how to look at the big picture and the details; and how to collaborate in
Mallik’s lab.
Dr. Sanku Mallik,
PhD “His enthusiasm and love of science makes for an enjoyable learning experience and he encourages self-
fulfilled learning over just spewing out answers,” said Confeld, who notes that Mallik’s personal qualities
set him apart. Confeld will soon be serving as a clinical trial methodology fellow.
“Dr. Mallik’s expertise, years of experience, and commitment to outstanding research engages students
to become involved in projects that can help to define their future professional careers,” said Charles D.
Peterson, dean of the College of Health Professions and School of Pharmacy at NDSU.
14 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021NDSU School of Pharmacy
NDSU Pharmaceutical Sciences Graduate Students Receive
National Awards
By Carol Renner, Office of the Dean, Marketing/Communication Coordinator, NDSU College of Health Professions
Two graduate students in the NDSU Pharmaceutical Sciences Department in the School of Pharmacy have received
awards from the American Society for Pharmacology and Experimental Therapeutics.
Kishore Chittimalli received a first-place award for his oral presentation
in the ASPET Cardiovascular Pharmacology Trainee Showcase. His
research focuses on cardiovascular disease.
“Cardiovascular diseases are prevalent in a growing population of
elderly individuals. Pharmacological approaches that preserve vascular
function and regeneration are of great benefit for preventing ischemic
complications and for maintaining functional abilities among older
adults,” said Chittimalli.
His research focuses on determining the beneficial effects of a small
peptide Angiotensin-(1-7) in a mouse model of aging experiencing
critical limb ischemia. Chittimalli’s work showed that the peptide can
accelerate vascular regeneration following ischemic insult and rescue
Kishore Chittimalli, NDSU graduate student limbs from amputations in old mice.
“This protective effect appears to be mediated by reversing pro-
inflammatory stress associated with aging. This is very encouraging and strongly supports further development of this
approach for the treatment of vascular disease in older adults,” said
Chittimalli, who conducts research in the lab of Dr. Yagna Jarajapu in
NDSU Pharmaceutical Sciences.
NDSU graduate student Santo Kalathingal Anto received second place
in the ASPET Cardiovascular Pharmacology Trainee Showcase.
“Our research focuses on the understanding of blood pressure
regulation by the peptide apelin in coronary arteries under
hypertensive conditions,” said Anto.
“We anticipate that our research will help us to better understand the
safety profile of apelin-based therapies, as well as developing new
therapeutic strategies in cardiovascular diseases,” explained Anto,
who conducts research in the lab of Dr. Stephen O’Rourke in NDSU
Pharmaceutical Sciences. Santo Kalathingal Anto, NDSU graduate student
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A Vo i ce for Pharmac y S i nc e 18 85 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 02 1 15NDSU School of Pharmacy
Introducing First-Year Pharmacy Students To Over-The-
Counter Counseling To Prepare For Community Introductory
Pharmacy Practice Experiences
By Tori Rude, Lauren M. Caldas, Heidi N. Eukel
There are currently over 300,000 over-the-counter (OTC) nonprescription drugs available for purchase by consumers in the
United States.1 This increased number of easily accessible medications elevates the importance of pharmacist involvement
in selecting the most appropriate OTC medication and ensuring safe and effective use.2 Community pharmacists are often
underutilized for their role in OTC medication and self-care recommendations.2 The Accreditation Council for Pharmacy
Education (ACPE) states the importance of making over the counter recommendations and emphasizes that it should be
implemented in pharmacy practice experiences.3 Student pharmacists have been shown to be a valuable resource in patient
counseling by making interventions that are cost saving to the patient, prevent the purchase of an inappropriate treatment,
and increase the likelihood of a patient to seek OTC counseling in the future.2
The sequence of IPPE at NDSU has recently changed - students complete their community IPPE in the summer following
their first professional year (P1) and their institutional IPPE the summer following their second professional year (P2).
Classroom instruction on OTC topics occurs in the P2 year. With this change came an opportunity to provide P1 students an
introductory experience to OTC product selection and counseling to best prepare them for IPPE in the community setting.
Unless first-year professional students sought out pharmacy work experience prior to their first IPPE, it is unlikely that the
students have had OTC counseling experience.
In order to best prepare students and new graduates to maximize their role in OTC counseling and recommendations, we
must teach them how to effectively and efficiently ask the patient pertinent questions to determine the problem, the most
bothersome symptoms, other medical conditions, and medications being used”.4 A limited number of OTC counseling
resources are available for pharmacy students. Existing resources focus on information in the form of medication databases,
quick reference guides, and flashcards containing key points.5,6,7 By creating and identifying additional resources to
communicate to our students they may become more confident and knowledgeable, increasing their involvement while on
experiential rotations.
The P1 skills laboratory course (PHRM 351L) took to a new innovation to prepare students for IPPE and OTC topics. An
online pharmacy simulation environment called MyDispense was adopted into the curriculum. Each student receives an
independent login and password to the system so their work can be tracked and feedback can be provided. Faculty built
patients, cases and an OTC formulary within MyDispense. The software allows students to interact with the patient, ask him
or her questions, and choose the most appropriate OTC product from the pharmacy inventory. Students could also counsel
the virtual patient on the use of the product chosen.8 Students gained confidence and experience with common OTC topics
in this simulated, risk-free environment.. Students completed five patient cases covering allergies, cough and cold, upper
GI, pain and fever, and ophthalmic, otic, and oral products. Following completion of the five patient cases, students
were provided with short recordings that de-briefed the most appropriate recommendation for each case to ensure a robust
learning experience. To anonymously assess improvement in skills as a result of this software, students completed a survey
including questions that measured their level of knowledge and confidence. Average student scores on the knowledge
questions increased from 60.1% (pre-simulation) to 71.0% (post-simulation) and self-rated ability on a scale of 0 to 100
increased from 55.9 (pre) to 76.3 (post).
By introducing OTC medications and the components of effective patient interview and counseling, our hope is that
students will be more prepared to enter their IPPEs and better equipped to assist our precepting pharmacists. Entering
practice sites with more knowledge and confidence may lead to students being able to participate in more activities and get
a more in-depth experience.
Let us know what you see with your IPPE students this summer! To become a new preceptor, visit www.ndsu.edu/pharmacy/
experiential_ed/ and click on the Pharmacy Preceptor Information Page.
16 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021NDSU School of Pharmacy
Figure 1: Students
are presented with a
simulated environment
where they can interact
with virtual patients in
a way very similar to in
person consultations.
They can ask a variety of
questions to the patient
to gather information and
assess the scenario.
Figure 2: Students choose the most appropriate product from the pharmacy for the virtual patient and provide
education specific to the product. The OTC items in the NDSU MyDispense formulary are stocked in the OTC shelves
(green), under/behind the counter (red), and in the refrigerator (blue).
References
1. US Food and Drug Administration, US Department of Health and Human Services. Drug applications for over-the-counter (otc) drugs. https://
www.fda.gov/drugs/types-applications/drug-applications-over-counter-otc-drugs. Accessed 10 April 2021.
2. M
cConaha JL, Finoli LM, Heasley JE, Lunney PD. Assessing Student Pharmacist Impact on Patient Over-the-Counter Medication Selection.
Journal of Pharmacy Practice. 2013;26(3):280-287. doi:10.1177/0897190012465957
3. A
ccreditation Council for Pharmacy Education. Chicago, IL. ACPE. Accreditation standards and guidelines for the professional program in
pharmacy leading to the doctor of pharmacy degree; 2016. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf. Accessed 10 May 2021.
4. C
ommittee NMAS, Ambizas EM, Bastianelli KMS, et al. Evolution of Self-Care Education. AJPE. 2014;78(2). doi:10.5688/ajpe78228
5. K
olesar JM, Vermeulen LC. Top 100 Nonprescription Drug Cards. McGraw Hill; 2020. https://medicalflashcards-mhmedical-com Accessed 13
Jan 2021.
6. Kujawski, S. A Quick Guide to the Most Commonly Used OTC Meds. tl’dr pharmacy. 29 Nov 2019. https://www.tldrpharmacy.com/content/a-
quick-guide-to-the-most-commonly-used-otc-meds. Accessed 10 May 2021.
7. Therapeutic Research Center. Natural Medicines. 2021. https://naturalmedicines-therapeuticresearch-com.ezproxy.lib.ndsu.nodak.edu/. Accessed
10 May 2021.
8. McDowell J, Styles K, Sewell K, et al. A Simulated Learning Environment for Teaching Medicine Dispensing Skills. Am J Pharm Educ. 2016;80(1).
doi:10.5688/ajpe80111
9. American Association of Colleges of Pharmacy. Arlington, VA. AACP. Graduating Student Survey 2020 National Summary Report; July 2020.
https://www.aacp.org/sites/default/files/2020-07/2020-gss-national-summary-report.pdf
A Vo i ce for Pharmac y S i nc e 18 85 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 02 1 17NDSU School of Pharmacy
NDSU Pharmaceutical Sciences Chair Receives Nih Grant For
Alzheimer’s Research
By Carol Renner, Office of the Dean, Marketing/Communication Coordinator, NDSU College of Health Professions
Dr. Jagdish Singh, chair and professor in the Department of Pharmaceutical Sciences in the NDSU School of
Pharmacy, is receiving a federal grant of more than $1.4 million for three years and the potential for additional funding
from the National Institutes of Health for Alzheimer’s disease research. The grant from NIH funds research titled
“Enhanced APOE2 Expression into Brain for Therapeutic Strategy for Alzheimer’s Disease.”
Neurons carry information in the brain and communicate with each other at junctions called synapses. Think of it as
an information superhighway where packets of information traveling through your brain are directed through these
junctions to carry messages that control functions of the brain and of the body.
A protein called Apolipoprotein E (APOE) plays a critical role in maintaining the plasticity of the brain’s synapses, along
with maintaining neuronal function. Studies have shown that APOE2 is more prevalent in people aged 100 or more
and is associated with making them less susceptible to Alzheimer’s disease.
Additional research studies suggest that APOE2 is neuroprotective, meaning it could positively impact cognitive
functions in aging. It may be possible, according to Singh, to increase the APOE2 level in the brain as an effective
therapeutic strategy against Alzheimer’s disease.
One of the challenges in doing so, however, is what is called the blood-brain barrier. In addition to being complex,
certain aspects of the human body are also designed to protect us and prevent substances from crossing that blood-
brain barrier.
“Although gene therapy possesses immense potential of treating various neurodegenerative diseases including
Alzheimer’s disease, its clinical application is limited, mainly due to lack of safe and effective vectors that can efficiently
deliver the therapeutic gene across the blood-brain barrier,” explained Singh.
To breach the barrier safely to deliver such therapeutic agents to the
brain, Singh’s long-term research goal focuses on designing a gene
delivery carrier that can efficiently deliver plasmid DNA encoding
APOE2 to the brain to help prevent and treat Alzheimer’s disease.
“The research of Dr. Singh and his lab places the NDSU College of
Health Professions and its Pharmaceutical Sciences Department at
the forefront of adding to knowledge that may one day help find a
better treatment for debilitating mental health conditions such as
Alzheimer’s disease,” said Dr. Charles Peterson, dean of the School of
Pharmacy and the College of Health Professions at NDSU.
Singh serves as co-principal investigator of the NIH grant to NDSU to
conduct Alzheimer’s disease research. Takahisa Kanekiyo, M.D., Ph.D.,
at Mayo Clinic in Jacksonville, Florida, serves as co-investigator
for this research. Dr. Buddhadev Layek, assistant professor in Dr. Jagdish Singh, Pharmaceutical Sciences
Pharmaceutical Sciences at NDSU, serves as part of the faculty team. Chair, North Dakota State University
18 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021NDSU School of Pharmacy
Pharmacy Involvement In Transitions Of Care For The Elderly
Gabrielle Coudron, Pharm.D. Candidate 2022 and Mark Dewey, Pharm.D., BCGP, FASCP
Transitions of care can lead to medication errors and poor outcomes, especially within the elderly population. In
2018, the percent of North Dakota residents greater than 65 years old was 15.3% which can be a significant when
considering this population will experience the majority of transitions of care.1 The purpose of this review is to assess
the areas that pharmacists can improve transitions of care and to consider how your pharmacy practice may be able
to address potential barriers.
Medication errors resulting from transitions of care for the elderly are a major focus in health care due to the
subsequent adverse outcomes and increased health care costs. Studies have reported up to half of elderly discharged
patients will experience at least one post-discharge medication error or unintentional medication discrepancy.2
Pharmacist involvement with transitions of care has been cited as an important strategy to reduce medication
errors across all populations regardless of age.3 Communication is discussed as a major factor in medication errors;
pharmacist involvement in transitions of care with the intention of improving communication has shown to result
in improved accuracy of information upon discharge.3,4 The burden of medication errors associated with transitions
of care is a major concern to the public because these errors, though largely seen in the geriatric population, are
seen throughout all age groups and care settings. Because of this, focusing on our ability as pharmacists to improve
transitions of care and communication can have a positive impact on geriatric and public health in North Dakota.
Hospital admission carries the risk of medication discrepancies for all patients which can lead to readmissions, with
the most medication errors occurring within the first 2 days of admission.5 Due to this risk, multiple studies have
implemented medication reconciliations which are heavily led by pharmacists. A Belgian study comparing physician
and pharmacist medication reconciliation found a significantly higher rate of discrepancies in the physician conducted
medication reconciliations with geriatric patients, as compared to the clinical pharmacist, with the majority being
omitted medications. Omitted medications led to 278 discrepancies at discharge, with 165 resulting in a prescribing
error or no prescribing at discharge.6 As the medication experts on a medical care team, we are best equipped to
obtain and investigate medication discrepancies from patients and translate this information to the care team.
Hospital readmissions pose a significant risk to elderly patients as a result of a poor transition of care. When
considering risk of readmission to the hospital, a multidisciplinary approach utilizing inpatient pharmacist expertise was
found to have a positive impact on reducing readmission rates at one week and one month.7 The results from these
studies are supported on a larger scale with a meta-analysis focused on pharmacist-led medication reconciliation
programs and their effect on hospital transition outcomes. Overall, there was a significant improvement in readmission
rates, including readmissions associated with adverse drug effects.8 These results are not only limited to clinical
outcomes. Providing discharge counseling above the standard of care has been shown to improve cost savings, with
the largest benefit being seen in high-risk elderly patients.9 The literature supports our need to play a larger role when
transitioning into a hospital and to use a multidisciplinary approach in this population. As our role within hospital
transitions becomes more prominent, it opens new avenues for pharmacy intervention after hospital discharge to aid
in transitions for patients and provide enhanced care.
The role of community pharmacists in care transitions is often overlooked and underutilized. Although community
pharmacists will receive and dispense discharge orders for patients, for a variety of differing reasons, they are less
likely to take on a more clinical role in a patient’s transition of care. Studies focused on community pharmacist’s
involvement have found improved outcomes through services such as comprehensive medication review or
medication therapy management when offered for patients who have recently been discharged.10 One study
highlighted the benefit of community pharmacist involvement in transitions of care by implementing a telephone-
based consultation where a medication reconciliation, assessment of adherence, and consultation of medication
regimens were performed and compared to those without this intervention with the endpoint of 30-day readmission
rates. It found through the involvement of a community pharmacist there was improved readmission rates in the
intervention group.11 With our strong community pharmacy presence in North Dakota, especially in rural areas, our
impact on transitions of care in this setting can be significant and should be pursued to improve patient outcomes and
prevent costly readmissions.
A Vo i ce for Pharmac y S i nc e 18 85 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 02 1 19NDSU School of Pharmacy
Although the impact of community pharmacies could be significant in transitions of care, there are barriers to our
involvement. Some pharmacists involved in discharge medication use reviews were surveyed and found this type of
intervention to be more complicated than traditional medication use reviews and difficult to engage with patients.
However, the majority of pharmacists who responded to the survey felt these interventions would be helpful in
managing adherence issues and medication errors.12 Community pharmacists have an opportunity and incentive
to become an active participant in transitions of care in both the geriatric and general population. In response
to decreased prescription reimbursement rates, adding a billable service to aid in transitions of care is a valuable
incentive for community pharmacists.10 Two significant barriers associated with the lack of involvement in transitions
of care from community pharmacists are referral and utilization by providers. Other barriers include time or workflow
constraints associated with the adding of another service. Through pharmacy advocacy, locally and nationally, these
barriers can be reduced and allow for greater involvement from all areas of pharmacy.
Similar to community pharmacy practice, ambulatory care pharmacy practice is well equipped to aid in transitions of
care in an outpatient setting. Ensuring timely follow-up after hospitalization is a major barrier to proper continuation
of care and decreasing time to follow-up aids in transitioning. Utilization of clinical pharmacists in an ambulatory care
setting led to decreased time to post-hospital follow-up, reduction of readmission rates, cost savings, and improved
reimbursement for transition of care codes after hospital discharge.13 In a study with similar endpoints, a secondary
outcome found a 24% increase in the number of patients with heart failure with reduced ejection fraction on
appropriate therapy as a result of a second follow-up visit with a clinical pharmacist.14 Cost and clinical outcomes have
been positively impacted through pharmacist intervention in an ambulatory setting, however, lack of reimbursement
limits the use of these resources.15 Our involvement in an outpatient setting allows for enhanced follow-up to improve
the outcomes of transitions of care, ensure adherence to regimens, and provides more points of contact with a
healthcare professional.
Long term care and skilled nursing facilities (SNF) often work closely with pharmacies to facilitate transitions of
care. When transitioning to such facilities, similar medication discrepancies are seen as when patients are admitted
or discharged from the hospital, including, omission of as needed medications and mismatch of frequency or
dosage.16 The utilization of a clinical pharmacist during transitions from hospitalization to a SNF in one study
found a statistically significant reduction in 60-day hospital readmissions.17 This study supports the importance of
medication reconciliation and patient education during transitions of care to allow for the best possible outcomes.
However, the difficulty most pharmacies encounter in practice was discussed in a qualitative analysis of a study
focused on improving medication information transfer during transitions of care. The study reported disconnect in
communication between facilities that resulted in a delay of care. The inability to efficiently contact the discharging
provider led to the use of the primary care provider for clarifications or prescriptions for discharge medications.16 This
communication approach hinders our ability to make effective clinical decisions and interventions during transitions of
care and can lead to future harm for the patient.
The potential impact of pharmacists in transitions of care for the elderly is immense, but due to underutilization it has
not been fully realized. Pharmacy involvement in transitions of care should occur in both inpatient and outpatient
pharmacy settings. Involvement of pharmacists in hospital transitions, utilization of systems in place in community
pharmacies, and increased involvement of ambulatory care pharmacists are a few ways to improve geriatric patient
outcomes. With the knowledge of our impact when we are involved in transitions of care, the number of geriatric
patients in North Dakota, and the importance of our accessibility in rural areas, we can advocate for our profession to
take a larger role to see improved outcomes and better transitions of care for geriatric patients.
References
1. Which U.S. States Have the Oldest Populations? PRB. Accessed June 6, 2021. https://www.prb.org/resources/which-us-states-are-the-oldest/
2. A
lqenae FA, Steinke D, Keers RN. Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to
Community Settings: A Systematic Review. Drug Saf. 2020;43(6):517-537. doi:10.1007/s40264-020-00918-3
3. J
ohnson A, Guirguis E, Grace Y. Preventing medication errors in transitions of care: A patient case approach. Pharmacy Today. 2015;21(3):79-90.
doi:10.1016/S1042-0991(15)30478-3
4. O
oi CE, Rofe O, Vienet M, Elliott RA. Improving communication of medication changes using a pharmacist-prepared discharge medication
management summary. Int J Clin Pharm. 2017;39(2):394-402. doi:10.1007/s11096-017-0435-5
5. P
icone DM, Titler MG, Dochterman J, et al. Predictors of Medication Errors Among Elderly Hospitalized Patients. Am J Med Qual. 2008;23(2):115-
20 A Voi c e f or Pharmac y S i nc e 18 8 5 • N o d a k P h a r m a c y J o u r n a l • Vo l . 35, N o . 3 • A u g u s t 2 021You can also read
