Pharmacy Lives up to Credo: Adapt, Overcome, Persevere

All Pharmacy staff went above and beyond in 2012. Above: Jennifer Vaughn Copeland, of the Investigational Drug Pharmacy, makes a bubble gum-flavored antibiotic formulation that is more palatable for patients.

Without a doubt, 2012 was the most challenging year for Pharmacy Services that Chief Bill Churchill, MS, RPh, has experienced in his 38 years at BWH. 

Existing drug shortages were worsened by drug recalls and alarming news about New England Compounding Center (NECC), as well as the subsequent precautionary recall of all products from Ameridose, another compounding pharmacy. 

But the challenges aren't what Churchill will remember when he looks back at 2012; rather, he'll recall the way his staff responded to them and lived up to BWH Pharmacy's credo of "Adapt, Overcome, Persevere."

"It was a Herculean effort on the part of all of our staff to come up with creative solutions," Churchill said. "We never had to shut down the operating rooms or suspend procedures; we were always able to find an alternative."

After sterile drugs produced by Framingham-based NECC were linked to a national outbreak of fungal meningitis, the Food and Drug Administration (FDA) recalled NECC products. BWH did not use the NECC products that were linked to meningitis, but did purchase other medications from NECC. On the heels of the NECC situation, Ameridose voluntarily recalled all of its products-many of which BWH used-as a precautionary measure to ensure patient safety. The resulting drug shortages were so widespread that almost every BWH patient could have been affected had it not been for Pharmacy's expert handling of the situation. 

All Pharmacy employees played an important role in the response, with Pharmacy Director Michael Cotugno, RPh, and Caryn Belisle, RPh, who manages the sterile products room, leading the team in addressing the shortages. 

They arranged for the BWH Pharmacy to produce, in-house, all of the critical mixtures of medications that the hospital previously purchased from compounding facilities. Many pharmacists volunteered to undergo competency training on mixing IV drugs, though the task is not typically performed by pharmacists. Staff voluntarily changed shifts, worked in different areas and picked up extra hours. Almost every member of the pharmacy staff offered to do anything that was needed to help provide critical medications to patients.

"It was the most unbelievable team-wide effort I've ever been involved in," Churchill said. "We increased our volume of in-house production with virtually no additional resources."

The Pharmacy team partnered with medical staff, nursing, Patient Care Services, Biomedical Engineering and other departments to ensure that front-line care providers were up-to-date and continuously informed about the new types of drugs and dosage formulations that replaced previous ones from the compounding pharmacies.

Chief Medical Officer Stan Ashley, MD, commended their efforts. "We are so fortunate to have such excellent leadership and devoted staff in the Pharmacy," he said. "Whether they work directly with patients or behind the scenes, all staff approached this potential crisis with a true focus on our patients and ensured we were able to continue delivering the world-class care for which we are known."

As the Pharmacy credo states, staff not only overcame the challenges, but continued to persevere and excel in a number of areas throughout the year. Just a few examples of Pharmacy highlights in 2012 are included here.

From Products to Patients

The role of pharmacists has continued to evolve over the last few years, with more direct patient interaction than ever before. Pharmacists round with other care providers during multi-disciplinary rounds, making crucial interventions to enhance care and assist in solving medication-related issues.

"The addition of clinical pharmacists to critical care teams in intensive care units has been associated with lower rates of adverse drug events and complications, lower ICU mortality rates and shorter length of patient stay," said David Morrow, MD, MPH. 

The Anticoagulation Management Service (AMS) in Pharmacy also plays an important role in working directly with patients on anticoagulation (blood-thinning) medications. BWH became the first hospital in the state to have its AMS pharmacists licensed and credentialed to manage anticoagulation protocols, as well as prescribe medication orders and interpret laboratory results. AMS pharmacists work directly with the service's 3,400 patients to ensure adherence to medications and address any issues that arise. This past year, the team's interventions helped 26 patients newly diagnosed with deep vein thrombosis avoid unnecessary hospital admissions. 

Excellence in Research and Education

Staff also maintained their focus on meeting the Brigham's research and education mission in 2012. They delivered 119 regional and national presentations and produced 42 publications and 10 textbook chapters published in peer-reviewed journals. They also continued training the next generation of pharmacists and precepted 249 candidates for doctoral degrees in pharmacy. 

Setting the Standard

It's not surprising, given BWH Pharmacy's longstanding tradition of excellence, that it is a world leader in the field. 2012 saw 11 visits from pharmacy leaders from eight countries, eager for a glimpse at how the Pharmacy operates. Additionally, Pharmacy established an exchange program with the Kingdom of Saudi Arabia, enabling Saudi Arabian pharmacy practice residents to visit Boston and complete BWH's rigorous post-graduate residency training program.