Cleveland Clinic pharmacists: Cristal Exline, Walter Chavers, and Meredith Frey

Recognized as the nation's 4th best hospital overall and ranked number 1 for the 13th consecutive year for cardiac care by U.S. News & World Report, the Cleveland Clinic offers pharmacists the opportunity to practice pharmacy in a variety of professional practice models supported by a state-of-the-art facility.

The Ohio-based Cleveland Clinic was founded in 1921 by 4 physicians. It is a not-for-profit, multispecialty academic medical center that integrates clinical and hospital care with research and education.

The health system recognizes that the role of the pharmacist is changing and the practice of pharmacy is becoming more technology advanced. "The role of the hospital pharmacists is evolving from a mostly order-entry and drug–productdispensing role to one that views the pharmacist as the medication expert. The advent of automated systems for drug distribution will allow a more proactive role in the care of patients," commented Sam Calabrese, RPh, MBA, director of inpatient pharmacy operations.

In fact, the Cleveland Clinic Department of Pharmacy has a newly remodeled and expanded facility with high-tech automated systems including a USP 797-compliant clean room, carousel bar-coded dispensing systems, bar-coded packaging systems, and Pyxis direct unit-dose distribution.

Pharmacists working in the hospital have access to a broad spectrum of opportunities with more than 30 different functional work areas, work assignments, and positions within the pharmacy department. The pharmacist practice environments now range from central and specialty satellite locations to inpatient nursing units and outpatient clinics to home-based professional practice models.

In addition, 9 ambulatory pharmacies managed by the Cleveland Clinic are located throughout northeast Ohio and Florida. "These pharmacies collaborate with physicians and nurses to provide convenient and quality care to sick patients leaving the physician's office or one of our many hospitals on discharge," said Mike Wascovich, RPh, MBA, director of outpatient operations. The pharmacies also provide care for a large number of the center's employees and their families.

Most new pharmacist graduates are initially oriented and trained in the central pharmacy area. During this period, they also are introduced to practice areas such as sterile products and specialty satellites. After time in the central area, as pharmacists show interest or proficiency in a particular area of practice, qualified pharmacists may receive additional training in an area of interest including nursing unit–based practice, drug information, and informatics.

"Many new graduates are interested in the more clinical aspects of pharmacy practice. Although there is always a significant clinical component to processing or verifying physician orders, pharmacists practicing directly on the nursing unit provide additional visibility, direct access to medical and nursing personnel, and facilitate problem resolution and program implementation," said Mort Goldman, PharmD, director of pharmacotherapy services.

Therefore, the Cleveland Clinic Department of Pharmacy is implementing an expanded nursing unit–based pharmacist (NUBP) practice model. The objectives of the NUBP model are to:

• Provide pharmaceutical care services directly to patients
• Minimize the risks and maximize medication safety
• Enhance the efficacy and improve the outcomes associated with drug therapy
• Expand cost containment programs at the patient care level
• Enhance pharmacy services to medical, nursing, and other health care professionals

NUBPs go through an extensive core curriculum of training that involves an introduction to the medical record, patient monitoring, and documentation; patient education and counseling; clearing organ function monitoring; adverse drug reaction identification and monitoring; and adverse drug event reporting. The NUBP also spends time with a clinical specialist mentor and undergoes competency assessment. In some cases, additional educational programs and competencies may be required, depending on the area of practice.

Pharmacists interested in practicing as clinical pharmacy specialists have specialty residencies and are usually board-certified pharmacotherapy specialists, or have related board certifications. "Typically recruited for high-risk, high-expense, or high-volume clinical practices, the specialists are responsible for direct patient care with a significant education and research component," said Dr. Goldman.

This pharmacy practice group is vital in creating and implementing medication-use guidelines under the auspices of the Pharmacy and Therapeutics Committee and through the Drug Information Center. The clinical specialists provide more than 300 educational programs annually to health care professionals with more than half provided for physicians or physicians in training. Furthermore, the group developed and presently conducts the pharmacology curriculum for the Cleveland Clinic Lerner College of Medicine.

The Cleveland Clinic also offers 8 distinct residency programs. The goal of the PGY1 program is to prepare pharmacists for specialty residency training or to work as a high-level NUBP. In the PGY2 programs, residents are trained to pursue careers as clinical specialists in the hospital setting or clinical faculty at a college of pharmacy.

Nontraditional pharmacy roles also are available with the Cleveland Clinic. One of the more unique opportunities is the work-at-home program where pharmacists perform order review, clarification, and entry functions from home. The pharmacists are provided with a computer and a cell phone that has a Cleveland Clinic number. The work-at-home pharmacists cover 2 distinct orderprocessing areas 24 hours per day, 7 days per week.

Pharmacists looking to move up the ranks at the Cleveland Clinic need to demonstrate leadership skills. The Department of Pharmacy has a variety of internal committees, task forces, or working groups that provide opportunities for pharmacists to demonstrate their skills and commitment to the department.

Many contributing factors make a pharmacy career path at the Cleveland Clinic appealing. "Working at the Cleveland Clinic provides opportunities for pharmacists to apply their education, skills, and experience working alongside some of the most talented nurses, doctors, and health care specialists anywhere. They are a diverse and dynamic group, dedicated to delivering superior care to their patients," concluded Damita Freeman- Jones, regional pharmacy recruitment manager.