Jim Motz, RPh

Pharmacy residency programs offer postgraduate training to launch pharmacists from their formal education into successful careers. These programs have significantly expanded in the past several decades from their humble beginning as internships in the 1930s, to prepare pharmacists for hospital management positions.

Accreditation standards were first implemented by the American Society of Health-System Pharmacists (ASHP) in 1962, which is when the nomenclature of postgraduate pharmacy training transitioned from internship to residency.

 While hospital pharmacy residencies have had a long history of training recent pharmacy graduates, it wasn’t until 1984 that accreditation standards were developed by ASHP for community pharmacy residency programs.

 The initial vision of community residencies was to “train the recent graduate in all aspects of community practice, including pharmacy management, community involvement, community health programs, clinical practice, teaching, and research.”

In addition to postgraduate year 1 (PGY1) pharmacy practice (hospital) residencies and PGY1 community residencies, there are PGY1 managed care residences, a wide variety of PGY2 residencies that focus on a certain specialty, and combined PGY1/PGY2 residencies in pharmacy administration, informatics, and other areas.

 In 2016, there were 2092 programs offering 4309 residency positions across all types of residencies.

 There were 5438 participants in the National Matching Service, which uses a computer algorithm to match candidates and programs.

Of the 4309 residency positions offered in 2016, only 228 were PGY1 community pharmacy residency positions.

 It is estimated that there are 10 or fewer specialty pharmacy—focused PGY1 community pharmacy residencies in the United States, according to the ASHP residency listing, or approximately 4% of all PGY1 community pharmacy residencies. Specialty pharmacy residency programs are recent developments, beginning within the past few years as the specialty pharmacy landscape rapidly expanded.

Rationale for Specialty Pharmacy Residencies

Specialty pharmacy revenue accounts for approximately 30% of all pharmacy revenue per year in the United States

 and is estimated to grow to 42% in the next 5 years.

 The increase in specialty medications approved by the FDA is an important reason why specialty pharmacy residency programs need to be developed. Certainly, the complexity and the high-risk nature of these medications require the competence and expertise of pharmacists to ensure safety and efficacy for patients. Residency programs provide the additional training necessary to ensure specialty pharmacists are competent and confident in their ability to provide care for patients using a specialty medication.

Besides the benefits provided by residency-trained pharmacists, specialty pharmacies will find value in offering residency programs for several other reasons. Inserting enthusiastic learners into the pharmacy provides precepting experiences for current specialty pharmacists. Many pharmacists not only enjoy precepting but also find that it motivates them to practice at a higher level in order to be a role model for their learner.

Residents also bring in fresh ideas about improving patient care and pharmacy workflow, providing energy and motivation to investigate, analyze, and complete valuable projects. The drive and passion of a new practicing pharmacist resident can be contagious and inspire others. By incorporating new ideas for patient care and completing a wide variety of projects, the specialty pharmacy can grow and improve its services.

The addition of a resident to a specialty pharmacy is a symbiotic relationship. It benefits both the pharmacy and the resident. First and foremost, the resident gains exposure to a new field of pharmacy and is able to become competent in providing specialty pharmacy services. The resident is also provided with an abundance of opportunities that would not otherwise be available, such as practicing in multiple settings through different rotations; learning management, leadership, and project management skills; improving presentation and public speaking abilities; and fine-tuning communication with a diverse group of patients and providers. Of course, this list is not all-inclusive and may vary among programs. It is, however, safe to say that pharmacy residents are provided a wealth of opportunities to advance their pharmacy practice that are not typically available through their formal education.

The rationale discussed here is a brief summary of why specialty pharmacy residency programs provide value and should be offered to graduating pharmacists, but there is unlimited potential for specialty pharmacies to initiate high-quality residency programs within their organizations.

For specialty pharmacies considering implementing a residency program, it is critical to understand that a great deal of work is required before the first resident even starts and on an ongoing basis thereafter. An excellent starting point of reference is at the ASHP website, where a number of publications are available, beginning with 

. Comprehensive information on factors to consider during the residency process is included in this and other publications.

Essentials to consider include budgeting for the resident salary, ensuring adequate workspace, determining a practice leader to serve as the residency director, and having a plan for the development of meaningful practice rotations that provide the resident with the ability to provide care to a diverse set of patients throughout the experience.

It is imperative to gain the support of pharmacy leadership before proceeding too far in the process. Of equal importance is gaining the strong support of those pharmacists who will become preceptors to the future resident. Pharmacists with past residency experience are invaluable in the planning process. All pharmacists participating in the program should be willing to sharpen their precepting skills and be prepared to share their time with the resident to provide direction and feedback.

ASHP provides resources to assist in the processes of recruitment, program design, and accreditation. Again, any pharmacy considering a residency will be well served to tap into these resources early in the process. Networking to learn best practices from other pharmacies and health systems with established residency programs provides another invaluable source of useful information.

Aurora Specialty Pharmacy Residency Program

Wisconsin’s largest nonprofit health care system, Aurora Health Care, has been training pharmacy residents for more than 20 years. The system will be training 35 residents across all pharmacy residency programs during the 2017-2018 year.

As part of Aurora Health Care, Aurora Specialty Pharmacy began a specialty pharmacy program in 2013. The program has since become accredited by URAC and the Accreditation Commission for Health Care. Aurora Specialty Pharmacy began offering its PGY1 Community-Based Specialty Pharmacy Residency program in 2016 with 1 resident.

The program is conducted through several rotations, typically longitudinal-style rotations lasting several months, although there are block-style rotations as well. During the first half of the year, each resident spends 2 days per week in the practice management rotation learning what it takes to manage a specialty pharmacy. This is altered to 1 day per week in the second half of the year to accommodate spending 1 day per week in an ambulatory care clinic rotation. The ambulatory care clinic was established during the first resident’s program year, within an outpatient neurology clinic. Also, throughout the year, each resident spends 3 days per week at the specialty pharmacy providing patient consultations, monitoring, and refilling assessments on specialty medications.

Two other rotations are completed in a block fashion in the middle of the year: drug policy and medication safety, and pharmacy logistics. During these, each resident completes a medication use evaluation and/or drug monograph, medication safety projects, and pharmacy logistics projects to gain exposure to drug acquisition channels, inventory management, reporting, and more.

Finally, each resident completes 3 additional rotations to meet the residency requirements, as well as staffing 3 shifts every third weekend at one of Aurora’s clinic-based community pharmacies. This enables the residents to be confident and well rounded in counseling on any medication, along with providing leadership development. They then provide an accredited 1-hour presentation for house staff, which gives the opportunity to become an expert in the chosen topic area and practice public speaking. Lastly, each resident completes a yearlong project with an emphasis on services provided to patients of a specialty pharmacy.

Pharmacy students and new graduates have expressed strong interest in specialty pharmacy residencies. Pharmacy leaders should investigate and take action to increase the availability of community pharmacy residencies, with a focus on specialty pharmacy practice. There is a real need to increase the number of specialty pharmacy residencies being offered, as these programs are beneficial to both graduating pharmacists and specialty pharmacies.

Marisa Goninen, PharmD, is the first graduate of the PGY1 community-based residency at Aurora Specialty Pharmacy in Menomonee Falls, Wisconsin. Jim Motz, RPh, is the manager of Aurora Specialty Pharmacy and the residency program director of the PGY1 community-based pharmacy residency at Aurora Specialty Pharmacy.

Stolpe SF, Adams AJ, Bradley-Baker LR, Burns AL, Owen JA. Historical development and emerging trends of community pharmacy residencies. 

. 2011;75(8):160. doi: 10.5688/ajpe758160.

Sasich LD. A proposal for a community pharmacy practice residency program. 

Groves RE. Community residency: a student perspective. 

Summary of programs and positions offered and filled in phase 1 of the 2016 match. National Matching Services Inc website. natmatch.com/ashprmp/stats/2016summpos1.html. Accessed March 8, 2017.

Summary results of the phase 1 match for positions beginning in 2016. National Matching Services Inc website. natmatch.com/ashprmp/stats/2016applstats1.html. Accessed March 8, 2017.

Koerner PH, Miller RT, Higginbotham S. Development of a community residency program with a focus on specialty pharmacy. 

. 2014;71(23):2067-2072. doi: 10.2146/ajhp130732.

ABD, UNE launch specialty pharmacy residency. 

. specialtypharmacytimes.com/market-news/abd-une-launch-specialty-pharmacy-residency. Published December 5, 2016. Accessed March 8, 2017.

Sederstrom J. Considering specialty pharmacy? Make your move. 

. drugtopics.modernmedicine.com/drug-topics/news/considering-specialty-pharmacy-make-your-move. Published February 16, 2017. Accessed March 15, 2017.

Articles

Pharmacy residency programs offer postgraduate training to launch pharmacists from their formal education into successful careers.

The Case for Establishing a Residency Program in Specialty Pharmacy

	Pharmacy residency programs offer postgraduate training to launch pharmacists from their formal education into successful careers. These programs have significantly expanded in the last several decades, from their humble beginning as internships in the 1930s, to prepare pharmacists for hospital management positions.

	Accreditation standards were first implemented by the American Society of Health-System Pharmacists (ASHP) in 1962, which is when the nomenclature of postgraduate pharmacy training transitioned from internship to residency.

	In addition to postgraduate year 1 (PGY1) pharmacy practice (hospital) residencies and PGY1 community residencies, there are PGY1 managed care residences, a wide variety of PGY2 residencies that focus on a certain specialty, and combined PGY1/PGY2 residencies in pharmacy administration, informatics, and others.4 In 2016, there were 2092 programs offering 4309 residency positions across all types of residencies.

	Of the 4309 residency positons offered in 2016, only 228 were PGY1 community pharmacy residency positions.

 It is estimated that there are 10 or fewer specialty pharmacy-focused PGY1 community pharmacy residencies in the United States, according to the ASHP residency listing, or approximately 4% of all PGY1 community pharmacy residencies. Specialty pharmacy residency programs are recent developments, beginning within the last few years as the specialty pharmacy landscape rapidly expanded.

	Specialty pharmacy revenue accounts for approximately 30% of all pharmacy revenue per year in the United States

 The increase in specialty medications approved by the FDA is an important reason why specialty pharmacy residency programs need to be developed. Certainly, the complexity and high-risk nature of these medications requires the competence and expertise of pharmacists to ensure safety and efficacy for patients. Residency programs provide the additional training necessary to ensure specialty pharmacists are competent and confident in their ability to provide care for patients using a specialty medication. 

	Besides the benefits provided by residency-trained pharmacists, specialty pharmacies will find value from offering residency programs for several other reasons. Inserting enthusiastic learners into the pharmacy provides precepting experiences for current specialty pharmacists. Many pharmacists not only enjoy precepting, but also find that it motivates them to practice at a higher level in order to be a role model for their learner.

	Residents also bring in fresh ideas about improving patient care and pharmacy workflow, providing energy and motivation to investigate, analyze, and complete valuable projects. The drive and passion of a new practicing pharmacist resident can be contagious and inspire others. By incorporating new ideas for patient care and completing a wide variety of projects, the specialty pharmacy can grow and improve their services. 

	The addition of a resident to a specialty pharmacy is a symbiotic relationship. It benefits both the pharmacy and the resident. First and foremost, the resident gains exposure to a new field of pharmacy and is able to become competent in providing specialty pharmacy services. The resident is also provided with an abundance of opportunities that would not otherwise be available, such as practicing in multiple settings through different rotations; learning management, leadership, and project management skills; improving presentation and public speaking abilities; and fine-tuning communication with a diverse group of patients and providers. Of course, this list is not all-inclusive and may vary between programs. It is, however, safe to say that pharmacy residents are provided a wealth of opportunities to advance their pharmacy practice that are not typically available through their formal education. 

	The rationale discussed here is a brief summary of why specialty pharmacy residency programs provide value and should be offered to graduating pharmacists, but is not all-inclusive. There is unlimited potential for specialty pharmacies to initiate high-quality residency programs within their organizations. 

	For specialty pharmacies considering implementing a residency program, it is critical to understand that a great deal of work is required before the first resident even starts and on an ongoing basis thereafter. An excellent starting point of reference is at the ASHP website where a number of publications are available, beginning with How to Start a Residency Program. Comprehensive information on factors to consider during the residency process is included in this and other publications.

	Essentials to consider include budgeting for the resident salary, ensuring adequate workspace, determining a practice leader to serve as the residency director, and having a plan for the development of meaningful practice rotations that provide the resident with the ability to provide care to a diverse set of patients throughout the experience. 

	It is imperative to gain the support of pharmacy leadership before proceeding too far in the process. Of equal importance is gaining the strong support of those pharmacists who will become preceptors to the future resident. Pharmacists with past residency experience are invaluable in the planning process. All pharmacists participating in the program should be willing to sharpen their precepting skills and be prepared to share their time with the resident to provide direction and feedback. 

	ASHP provides resources to assist in the processes of recruitment, program design, and accreditation. Again, any pharmacy considering a residency will be well served to tap into these resources early in the process. Networking to learn best practices from other pharmacies and health systems with established residency programs is another invaluable source of useful information. 

	Wisconsin’s largest not-for-profit health care system, Aurora Health Care, has been training pharmacy residents for more than 20 years. The system will be training 35 residents across all pharmacy residency programs during the 2017-2018 year.

	As part of Aurora Health Care, Aurora Specialty Pharmacy began a specialty pharmacy program in 2013. The program has since become accredited by URAC and the Accreditation Commission for Health Care. Aurora Specialty Pharmacy began offering its PGY1 Community-Based Specialty Pharmacy Residency program in 2016 with 1 resident. 

	The program is conducted through several rotations, typically longitudinal-style rotations lasting several months, although there are block-style rotations, as well. During the first half of the year, each resident spends 2 days per week in the practice management rotation learning what it takes to manage a specialty pharmacy. This is altered to 1 day per week in the second half of the year to accommodate spending 1 day per week in an ambulatory care clinic rotation. The ambulatory care clinic was established during the first resident’s program year, within an outpatient neurology clinic. Also, throughout the year, each resident spends 3 days per week at the specialty pharmacy providing patient consultations, monitoring, and refill assessments on specialty medications.

	Two other rotations are completed in a block fashion in the middle of the year: drug policy and medication safety, and pharmacy logistics. During these, each resident completes a medication use evaluation and/or drug monograph, medication safety projects, and pharmacy logistics projects to gain exposure to drug acquisition channels, inventory management, reporting, and more. 

	Finally, each resident completes 3 additional rotations to meet the residency requirements, as well as staffing 3 shifts every third weekend at one of Aurora’s clinic-based community pharmacies. This enables the residents to be confident and well-rounded in counseling on any medication, along with providing leadership development. They then provide a 1-hour ACPE-accredited presentation for house staff, which gives the opportunity to become an expert in the chosen topic area and practice public speaking. Lastly, each resident completes a year-long project with an emphasis on services provided to patients of a specialty pharmacy.

	Pharmacy students and new graduates have expressed strong interest in specialty pharmacy residencies. Pharmacy leaders should investigate and take action to increase the availability of community pharmacy residencies, with a focus on specialty pharmacy practice. There is a real need to increase the number of specialty pharmacy residencies being offered, as these programs are beneficial to both graduating pharmacists and specialty pharmacies. 

		Stolpe SF, Adams AJ, Bradley-Baker LR, Burns AL, Owen JA. Historical development and emerging trends of community pharmacy residencies. 

		Sasich LD. A proposal for a community pharmacy practice residency program. 

		Groves RE. Community residency: a student perspective. 

		Summary of programs and positions offered and filled in phase 1 of the 2016 match. National Matching Services Inc website. 

www.natmatch.com/ashprmp/stats/2016summpos1.html

		Summary results of the phase 1 match for positions beginning in 2016. National Matching Services Inc website. 

www.natmatch.com/ashprmp/stats/2016applstats1.html

		Koerner PH, Miller RT, Higginbotham S. Development of a community residency program with a focus on specialty pharmacy. 

		ABD, UNE launch specialty pharmacy residency. 

www.specialtypharmacytimes.com/market-news/abd-une-launch-specialty-pharmacy-residency

. Published December 5, 2016. Accessed March 8, 2017.

		Sederstrom J. Considering specialty pharmacy? Make your move. Drug Topics website

http://drugtopics.modernmedicine.com/drug-topics/news/considering-specialty-pharmacy-make-your-move

. Published February 16, 2017. Accessed March 15, 2017.

Pharmacy leaders should increase the availability of community pharmacy residencies, with a focus on specialty pharmacy practice.Â 

Due to their infrastructure advantages, health systems are well equipped to take on the challenges of specialty pharmacy.

Specialty pharmacy has attracted the attention of health-system pharmacy in a big way. A quick glance at the URAC list of specialty pharmacy—accredited companies provides confirmation of this assertion.

As of April 2015, URAC listed 12 health-system pharmacies with full accreditation for specialty pharmacy,

and more than twice that number are currently going through the process of specialty accreditation. At the recent 2015 Armada Specialty Pharmacy Summit, one observer blogged that health systems are now targeting specialty pharmacy for rapid growth.

Health systems’ interest in gaining entry to the specialty-pharmacy market should not be a surprise, considering that specialty drug sales are growing at rates reported to be approximately 19% per year. From a financial perspective, hospitals and health systems are averse to seeing these revenues leave their systems—and their bottom lines.

Furthermore, the 340B pricing program could offer substantial incentives to certain qualifying health systems when they retain specialty-pharmacy prescriptions. Add in the trend of health systems’ entry into risk-sharing contracts, the formation of accountable care organizations, and the consolidation and merging of specialist physician practices into the systems, and it becomes apparent that a focus on specialty pharmacy makes sense for health systems.

Health systems bring a number of advantages to the specialty marketplace that payers and manufacturers may soon recognize as significant. For example, full integration and availability of clinical information to multidisciplinary health care providers allows for a level of care coordination that is unlikely to be matched by unaffiliated pharmacies.

The accessibility of clinical data through the electronic medical record (EMR) affords advantages in processing authorization requests prior to service that should result in shortened approval turnaround time and faster initiation of treatment. The access to a full clinical data set through the EMR provides health-system pharmacies with broad advantages in their ability to produce the reporting necessary to demonstrate clinical outcomes and quality of care.

By virtue of an integrated approach, specialty pharmacies operating within the health system may be better able to leverage partnerships with specialist physicians and coordinate care. Patients will be able to recognize the greater ability of pharmacists working within the health system to connect and communicate patient concerns, adverse effects, and medication adherence to their health care team.

As a result, the integration of health-system specialty pharmacists with the patient’s health care team is expected to have positive effects on patient satisfaction. Certainly, health systems will face challenges in competing with established specialty pharmacies.

In some cases, health-system specialty pharmacies will need to provide evidence of their capabilities to pharmaceutical manufacturers in order to obtain desired access to certain limited-distribution medications. Using available data to prove outcomes through effective use of the EMR may prove to be persuasive in some cases.

Leveraging the influence of key physicians and adopting formulary principles to certain specialty therapeutic groups—an emerging trend&mdash;are additional tactics available to health systems that can be used to make the case for access to some limited-distribution medications. Health systems first need to develop expertise in optimizing payer contracts.

Payers will then begin to see value if integrated health systems can demonstrate positive clinical outcomes for their specialty patient populations, and therefore will elect to include accredited health-system specialty pharmacies within their specialty networks. A major challenge for health systems is the development of robust reporting capabilities and compelling outcomes data.

As mentioned previously, however, health-system pharmacies appear well positioned to do so. Which health systems should ultimately find success in the specialty pharmacy space?

A health system employing a forward-looking pharmacy director with the ability to articulate the importance of specialty pharmacy to system leadership and then acquire and mobilize the necessary resources within the pharmacy department will likely do well. Established outpatient or retail-pharmacy experience—including a full understanding of prescription claim processing, prescription benefit programs, and ability to obtain patient financial assistance&mdash;is a critical determinant of success.

Attention to payer contracting cannot be overlooked. If a health system does not possess each of these factors or does not wish to make the necessary commitment to build them, then that system might be receptive to partnership opportunities with an existing specialty within its service area.

Observers of the specialty space have taken notice of health systems’ interest in specialty pharmacy. Due to their infrastructure advantages, including the vast benefits of a fully integrated EMR, health systems seem to be well positioned to compete.

Despite some challenges, expect more systems to pursue entry into this highly competitive space and for health-system pharmacy to begin demonstrating the obvious advantages of specialty care integration. 

		URAC Accreditation Directory. www.urac.org/directory/DirectorySearch.aspx. Accessed May 29, 2015.

		Fein AJ. Specialty pharmacy’s bright but complex future: seven reflections on #Armada 15. Drug Channels website. www.drugchannels.net/2015/05/specialty-pharmacys-bright-but-complex.html. Accessed May 28, 2015.

, is manager of the specialty pharmacy program at Aurora Specialty Pharmacy in Elm Grove, Wisconsin.

Due to their infrastructure advantages, health systems are well equipped to take on the challenges of specialty pharmacy.  

Health Systems: Discovering Specialty Pharmacy

Numerous studies have documented the significant clinical and economic consequences related to adverse effects of medication administration. The prevention of adverse events (AEs) remains a significant challenge to the health care system. Medication safety is of major concern to specialty pharmacy as well. In fact, patients using specialty pharmaceuticals may be at increased risk of AEs due to a diverse set of factors, which may include but are not limited to polypharmacy, immune system suppression, use of multiple physicians, and concomitant illnesses.

The specialty pharmacy care team plays a key role in the prevention of adverse drug reactions and in contributing to successful treatment outcomes through vigilant monitoring, reporting, and communication with other health care professionals on the patient care team.

Specialty pharmacies adopt a range of strategies designed to assure the safety of drug treatment regimens and apply these consistently in patient care. For all new patients referred to a specialty pharmacy for drug therapy, specialty pharmacists will obtain a full patient health history and a medication history with particular attention to medication allergies and sensitivities, and assess for potential drug—drug interactions that will affect treatment. This is especially a concern for patients seeing multiple physicians. It is not uncommon for physicians to have incomplete or inaccurate medication records and consequently prescribe medication treatments with issues that will require attention before therapy is initiated. In the event that therapy issues are identified, specialty pharmacists routinely consult with prescribing physicians, provide therapy recommendations, and collaboratively work to adjust medication therapy to result in a safer regimen.

Two real-life case examples from our pharmacy’s medication event reporting files will help to illustrate ways in which Aurora specialty pharmacists, working within an integrated health care system, have used established medication safety procedures to reduce the possibility of AEs and contributed to successful treatment outcomes for patients.

Case #1: Oral Oncologic Medication Interactions

A new patient was referred to the pharmacy for treatment with an oral oncologic agent for treatment of renal cell carcinoma. Review of the patient’s full medication profile and concomitant illnesses revealed that the patient was also being treated with an antidepressant that had the potential to interact with the oncologic agent and result in prolongation of the patient’s QT interval. Knowing that the oncologic therapy had the potential to induce cardiac arrhythmia, a prolonged QT interval could result in treatment discontinuation and ultimately in treatment failure. In this case, the pharmacist consulted the patient’s primary physician and obtained approval for an alternative and safer antidepressant.

Case #2: Hepatitis C Regimen Dosage Adjustment 

The pharmacy received a new referral for a patient to be treated with antivirals for hepatitis C virus (HCV). Upon assessment and initial counseling of the patient, the pharmacist learned that the patient had markedly reduced renal function. The antiviral regimen prescribed for the patient was inappropriately dosed based on the patient’s renal status. Incorrectly dosed antiviral therapy has a high potential for significant AEs and, therefore, for potentially reduced treatment efficacy. Consultation with the prescribing physician resulted in a more appropriately dosed regimen. It should also be noted that although emerging treatment regimens for HCV require weight-based dosing, these regimens also may require adjustment for renal status.

An underappreciated way in which specialty pharmacists are expected to contribute to greater overall understanding of medication safety is by reporting AEs via the FDA’s MedWatch reporting system. Reporting can be done via the FDA’s online application or by submission of a written report to the agency. While reporting through the MedWatch system is considered voluntary, the FDA uses the data obtained for routine drug safety surveillance and communicates important new data to health care professionals. Since most specialty drugs are used by relatively small populations, reporting is a crucial way for new safety information to be made more widely known to the medical community.

It is also important to recognize how accreditors such as URAC hold specialty pharmacy accountable for the safety of the medication process through establishment of several safety and quality standards. Consistent attention to processes is an element of pharmacy practice that distinguishes a specialty pharmacy from other pharmacies, and this is made evident in accreditation standards that address drug intake, processing, and dispensing. Additionally, all specialty pharmacies will be expected by accreditors to develop, implement, and measure quality activities designed to address and improve the medication safety process. Accredited pharmacies will usually conduct 1 or more quality improvement projects that focus specifically on medication safety issues.

Specialty pharmacists may wish to investigate and utilize some of the tools developed by the Agency for Healthcare Research and Quality (AHRQ) to assess their pharmacy’s medication safety processes and use the data obtained to implement meaningful improvements. Aurora Specialty Pharmacy uses the AHRQ Pharmacy Survey on Patient Safety Culture to engage all staff members in the medication safety process and to help identify areas in need of improvement. It should be noted that the AHRQ tools aren’t specific to specialty pharmacy—medication safety processes in all pharmacy practices can benefit from implementation of AHRQ tools.

As discussed here, all specialty pharmacies have a responsibility to monitor and follow through on issues affecting the safety of medications dispensed to their patients. Aurora Specialty Pharmacy, working as part of an integrated health care system, is uniquely positioned to deliver on the promise of clinical outcomes while reducing the impact of AEs for patients using specialty drugs. A key advantage of the integrated system approach to specialty practice is the extensive availability of clinical data and a seamless health care provider communication channel through use of the systemwide electronic medical records. Leveraging the accessibility of clinical data and the ability to exchange information with physicians in a preferred and secure format allows for efficiencies not typically available to other pharmacies.

Strict attention to reducing adverse outcomes and improving medication safety efforts is a necessary focus for specialty pharmacies. With the ever-increasing cost of drug therapies and the degree to which all stakeholders expect value from specialty medications, attention to safety-related quality improvement activities will remain an area in which specialty pharmacists will demonstrate their importance to the health care system. 

 is the specialty pharmacy program manager for Aurora Health Care in Milwaukee. Aurora is an integrated health system and operates an Accountable Care Organization in Wisconsin.

Consistent attention to processes is vital to the practice of specialty pharmacy, with medication safety procedures playing a key role in the mitigation and reduction of adverse events.