PHARMACISTS THRIVE AT THE CLEVELAND CLINIC

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

Recognized as the nation's4th best hospital overall and rankednumber 1 for the 13th consecutiveyear for cardiac care by U.S. News &World Report, the Cleveland Clinicoffers pharmacists the opportunity topractice pharmacy in a variety ofprofessional practice models supportedby a state-of-the-art facility.

The Ohio-based Cleveland Clinicwas founded in 1921 by 4 physicians.It is a not-for-profit, multispecialtyacademic medical center that integratesclinical and hospital care withresearch and education.

The health system recognizes thatthe role of the pharmacist is changingand the practice of pharmacy isbecoming more technology advanced."The role of the hospitalpharmacists is evolving from a mostlyorder-entry and drug?productdispensingrole to one that views thepharmacist as the medication expert.The advent of automated systems fordrug distribution will allow a moreproactive role in the care of patients,"commented Sam Calabrese, RPh,MBA, director of inpatient pharmacyoperations.

In fact, the Cleveland Clinic Departmentof Pharmacy has a newlyremodeled and expanded facilitywith high-tech automated systemsincluding a USP 797-compliant cleanroom, carousel bar-coded dispensingsystems, bar-coded packaging systems,and Pyxis direct unit-dose distribution.

Pharmacists working in the hospitalhave access to a broad spectrum ofopportunities with more than 30 differentfunctional work areas, workassignments, and positions withinthe pharmacy department. The pharmacistpractice environments nowrange from central and specialtysatellite locations to inpatient nursingunits and outpatient clinics tohome-based professional practicemodels.

In addition, 9 ambulatory pharmaciesmanaged by the Cleveland Clinicare located throughout northeastOhio and Florida. "These pharmaciescollaborate with physicians and nursesto provide convenient and quality careto sick patients leaving the physician'soffice or one of our many hospitals ondischarge," said Mike Wascovich, RPh,MBA, director of outpatient operations.The pharmacies also providecare for a large number of the center'semployees and their families.

Most new pharmacist graduates areinitially oriented and trained in thecentral pharmacy area. During thisperiod, they also are introduced topractice areas such as sterile productsand specialty satellites. After time inthe central area, as pharmacists showinterest or proficiency in a particulararea of practice, qualified pharmacistsmay receive additional trainingin an area of interest including nursingunit?based practice, drug information,and informatics.

"Many new graduates are interestedin the more clinical aspects ofpharmacy practice. Although there isalways a significant clinical componentto processing or verifying physicianorders, pharmacists practicingdirectly on the nursing unit provideadditional visibility, direct access tomedical and nursing personnel, andfacilitate problem resolution andprogram implementation," said MortGoldman, PharmD, director of pharmacotherapyservices.

Therefore, the Cleveland ClinicDepartment of Pharmacy is implementingan expanded nursing unit?based pharmacist (NUBP) practicemodel. The objectives of the NUBPmodel are to:

• Provide pharmaceutical care servicesdirectly to patients
• Minimize the risks and maximizemedication safety
• Enhance the efficacy and improvethe outcomes associated withdrug therapy
• Expand cost containment programsat the patient care level
• Enhance pharmacy services tomedical, nursing, and otherhealth care professionals

NUBPs go through an extensivecore curriculum of training thatinvolves an introduction to the medicalrecord, patient monitoring, anddocumentation; patient educationand counseling; clearing organ functionmonitoring; adverse drug reactionidentification and monitoring;and adverse drug event reporting.The NUBP also spends time with aclinical specialist mentor and undergoescompetency assessment. Insome cases, additional educationalprograms and competencies may berequired, depending on the area ofpractice.

Pharmacists interested in practicingas clinical pharmacy specialistshave specialty residencies and areusually board-certified pharmacotherapyspecialists, or have relatedboard certifications. "Typically recruitedfor high-risk, high-expense,or high-volume clinical practices, thespecialists are responsible for directpatient care with a significant educationand research component," saidDr. Goldman.

This pharmacy practice group isvital in creating and implementingmedication-use guidelines under theauspices of the Pharmacy and TherapeuticsCommittee and through theDrug Information Center. The clinicalspecialists provide more than 300educational programs annually tohealth care professionals with morethan half provided for physicians orphysicians in training. Furthermore,the group developed and presentlyconducts the pharmacology curriculumfor the Cleveland Clinic LernerCollege of Medicine.

The Cleveland Clinic also offers 8distinct residency programs. The goalof the PGY1 program is to preparepharmacists for specialty residencytraining or to work as a high-levelNUBP. In the PGY2 programs, residentsare trained to pursue careers asclinical specialists in the hospital settingor clinical faculty at a college ofpharmacy.

Nontraditional pharmacy rolesalso are available with the ClevelandClinic. One of the more uniqueopportunities is the work-at-homeprogram where pharmacists performorder review, clarification, and entryfunctions from home. The pharmacistsare provided with a computerand a cell phone that has a ClevelandClinic number. The work-at-homepharmacists cover 2 distinct orderprocessingareas 24 hours per day, 7days per week.

Pharmacists looking to move upthe ranks at the Cleveland Clinicneed to demonstrate leadership skills.The Department of Pharmacy has avariety of internal committees, taskforces, or working groups that provideopportunities for pharmacists todemonstrate their skills and commitmentto the department.

Many contributing factors make apharmacy career path at the ClevelandClinic appealing. "Working atthe Cleveland Clinic provides opportunitiesfor pharmacists to apply theireducation, skills, and experienceworking alongside some of the mosttalented nurses, doctors, and healthcare specialists anywhere. They are adiverse and dynamic group, dedicatedto delivering superior care to theirpatients," concluded Damita Freeman-Jones, regional pharmacy recruitmentmanager.