Pete Kreckel, RPh, is a busy pharmacist, dividing his work week between 3 places: he is a professor at Saint Francis University, a clinical pharmacist at Empower3 Center for Health, and the pharmacist-in-charge at Thompson Pharmacy on Broad Avenue in Altoona, Pennsylvania. 
 
Bill Thompson, RPh, owner of Thompson Pharmacy, knew of Kreckel’s interest and passion in advancing the profession of pharmacy. He signed up for the Flip the Pharmacy initiative, a partnership between the Community Pharmacy Foundation and Community Pharmacy Enhanced Services Network
 
What is Flip the Pharmacy? Kreckel describes it as “a playbook for practicing the profession of pharmacy for the next 20 years.” Flip the Pharmacy, Kreckel explains, is a Change Package curriculum designed to improve the profession of pharmacy and enhance the way we do our jobs in patient care. 
 
Once a month, the pharmacy receives the new Change Package with a focused challenge. For example, one of Kreckel’s favorite challenges was to collaborate with a local physician practice.

“Think of the one where you’re the go-to-guy,” he suggests.

Once you identify the practice, contact them and show them how your pharmacy team can help their patients. An important part of the program is documentation of clinical services provided during patient care planning, via a vendor system that supports the eCare plan standard. Kreckel uses the STRAND platform
 
Recently, Kreckel wrote and distributed an educational leaflet to local physician’s offices on the topic of serotonin syndrome. An Empower-3 clinic patient had been taking escitalopram 20 mg daily, and started taking NyQuil for cough and cold symptoms. Kreckel saw her after she was discharged from the hospital.

She had full-blown seizures as a result of serotonin syndrome, which occurred from the dextromethorphan/SSRI combination. The patient was life-flighted to the hospital and made a full recovery. Kreckel reminds us that it is important to speak with patients about taking antidepressants with cough and cold medications, especially during cough and cold season.

“This is where prevention comes in,” he said. “We need to take the time to re-educate health care professionals and counsel patients.”

Shortly after speaking with this patient, Kreckel happened to talk to a patient on fluvoxamine who was coughing.

“I knew what I had to do,” he said. “You never know what you are preventing by providing patient care.” 
 
Local providers were very appreciative of the informative reminder, which contained information about the signs and symptoms of serotonin syndrome as well as a list of the drugs most likely to cause the condition.

“We have such a heavy knowledge base—it is important to share this with other professionals,” Kreckel said. 
 
Kreckel gives several other examples where using clinical knowledge was critical in helping his patients. A 73-year-old male was taking tamsulosin, and Kreckel realized the patient was not adhering to his regimen.

Kreckel reached out, and the patient told him that he was having pain with intercourse. The patient told Kreckel that he would rather deal with BPH than pain from intercourse. Kreckel consulted with the physician, and the patient was switched to alfuzosin (Uroxatral). Uroxatral was similarly priced, and the patient had no issues with adverse effects.

“Around Christmastime, he ran up to me, told me he never missed a dose of the new medication, and gave me a big hug,” Kreckel recalls.
 
Another patient was taking sacubitril/valsartan (Entresto) and was also prescribed lisinopril. The duplicate therapy went unnoticed by every health care provider until it was caught on a medication review. The patient had just been admitted to the hospital. His diagnosis was Almond Joy (candy bar) allergy; however, digging a little deeper, Kreckel realized duplicate ACE inhibitors were causing angioedema, and the problem was quickly resolved with a medication change.
 
Recently, the Pennsylvania Department of Welfare made formulary changes that affected many patients, and puzzled doctors. Kreckel decided to be proactive and created a cheat sheet of covered chronic obstructive pulmonary disease and diabetes drugs to distribute to the local physicians.

“Now they know what medications will be covered by insurance. It makes everyone’s lives easier,” he said. 
 
Kreckel emphasizes that the outreach to patients and physicians is very important.

“We have to promote ourselves and the services we can provide. We need to show patients and doctors what we are capable of accomplishing,” he said.
 
If you are thinking about participating in Flip the Pharmacy, but wonder what kind of support there is, Kreckel reassures pharmacists that there is plenty of it. Every pharmacy is assigned a coach to provide guidance throughout the process. Kreckel is grateful to have John DeJames as a coach, who is very experienced in clinical knowledge obtained from a previous position leading clinical services for a pharmacy supermarket chain.
 
Of course, there can be challenges, such as finding enough staffing to complete additional work, but Kreckel insists that the extra work is well worth it. “You may have some homework at first,” he says, “but the outcomes are worth it.”
 
“Every independent pharmacy should be stepping into this,” Kreckel said. His call to action: “Do Flip the Pharmacy and make sure you are practicing at the top of your license to provide excellent patient care. Our future depends on it.” 

Flip the Pharmacy change package materials are publicly available on the Flip the Pharmacy website.