Theater Pharmacy Overview MAJ (P) Steven Barr Pharm D BCPS - - PowerPoint PPT Presentation

Theater Pharmacy Overview

MAJ (P) Steven Barr Pharm D BCPS Theater Enabling Medical Command (TEMC) Pharmacist TF 1st Medical Brigade (TF1MED) FWD.

The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. [MAJ (P) Steven BARR “declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.”

CPE Information and Disclosures

 Target Audience: Pharmacists and Pharmacist Technicians  ACPE#: 0202-0000-18-222-L04-P/T  Activity Type: Knowledge-based

CPE Information

Define CENTCOM AOR

Army Health System and Medical Evacuation

Figure 1-1. Army air and ground evacuation platforms provide connectivity to assure a seamless continuum of medical care ATP 4-02.2

Air Force Schematic for AERO MEDEVAC

First Aid/ Buddy Care/ Aid S tation

AELT (Assists w/ comm)

Inter-Theater Airlift

LRMC Landstuhl Regional Medical Center CAS EV AC/ MEDEV AC

Inter-Theater Airlift Intra-Theater Airlift

Theater Pharmacist – Roles + Responsibilities

 Two catchall phrases for non – medical personnel:  “Safe Medication Use”: Oversee Class VIII Distro / Formulary

Management / CENTCOM Regulations + SOP’s.

 “Controlled Substances Accountability”: Theater Controlled

Substances SOP / Dis -- Interested Officer Program. What do you bring to the fight?

Role I – III Pharmacy Capabilities across CENTCOM AOR AFCENT Surgeon TF 1st MED BDE Command / Staff ARCENT Surgeon CENTCOM Surgeon ARMY MEDCOM OTSG PHARM Consultant USFOR – A Surgeon CJTF – OIR Surgeon ASG – KU Surgeon MARCENT Surgeon NAVCENT Surgeon SOC – CENT Surgeon ASG – QA Surgeon USAMMC – SWA Class VIII Distro

80% LOE 20% LOE

Theater Enabling Medical Command (TEMC) Pharmacist

TEMC Pharmacist Landscape

Note: LOE = Line of Effort

Theater Pharmacist Role within Med Brigade

HISO MEDLOG LOG ASST TM (LAT) PM VET IND HYG NUC MED BEHAV PHARM BIOMED ENVIRO FHP DSOCI/CPS CH of SPT OPS & CLIN INTEG (CSOCI) HSS BDE CDR BDE CSM CH of Plans, OPS & TNG DCO/XO S1 – S6 Sections HHC ADJ SARC CJA EOA

Regulatory Tools for Success

 Theater level: CENTCOM Regulations / SOP / PTC.  Service Specific (Pharmacy): AFI 44 – 102 / AR 40 – 3 /

NAVMED P – 177.

 MEDLOG: AR 40 – 61 / SB 8 – 75 – 11 / USAMMC – SWA

Customer Handbook.

 Joint Commission: Medication Management Standards.

Theater Pharm Responsibilities

 CENTCOM Pharmacy SOP’s: Write, Promulgate, or Enforce.  Aligned / consistent with CENTCOM Regulations 40 -1 (Quality

Management Programs) and 40 – 7 (Clinical Operations).

 Includes: PTC Charter.

Medication Use SOP. Controlled Substances / DIO SOP. Anti Venom Use SOP.

 Recorder, CENTCOM PTC: (you essentially run the committee)  PTC includes: Quarterly CENTCOM Formulary review.

New Drug Requests (NDR). Non Formulary Drug Requests (NFDR). Patient Safety Reporting (ADR / Med events) Medication Recalls Medication Supply Issues (i.e. opioids) Anti Venom Use reporting

Theater Pharm Responsibilities

Formulary Manager / Monitor Class VIII Distro

 # 1200 line items Class VIII Pharmaceuticals  25 % Quarterly Review (100 % annual review)  New Drug Requests (NDR)  Non Formulary Drug Requests (NFDR)  Medication shortages (Formulary alternatives – opioid shortage).

TF MED Unit (Role II – III)

Pharmacist

Controlled Substances Accountability

Non TF MED Unit or Surgeon Cell (Role I)

Appointing Authority (Unit CDR or Surgeon) TEMC

Action Officer TF MED Pharmacist

Timeline

(DAYS)

1 – 10 15 25 30

Action Officer Unit Level or Surgeon Cell POC

DIO Appointment Orders DIO Instructions DIO Inventory List DIO Inventory Worksheet DIO Appointment Orders DIO Instructions DIO Inventory List DIO Inventory Worksheet TEMC Pharmacist Appointing Authority (TF MED Commander) TEMC Pharmacist Appointing Authority (Unit CDR or Surgeon)

MOD 13 / Mail Order Rx Issues

 US CENTCOM MOD 13 criteria: Exhaustive list of waiver-able

and non - waiverable medical conditions and medications.

 Applies to all categories: Active duty, GS Civilians, Contractors.  Issues include: Personnel arrive without waiver.

Personnel develop new condition (require waiver). Personnel arrive in theater without sufficient Rx.

Anti Venom Program

 Envenomation from Snakes / Scorpions local to

CENTCOM AOR.

RAZI POLYVALENT SNAKE SAUDI POLYVALENT SNAKE SAUDI POLYVALENT SCORPION

 Non FDA approved investigational medications  IAW AR 40 – 7 usage report submitted to USAMMDA.  Event Occurrence: 1 – 2 times Quarterly.

How does One Succeed ?

 Tact  Professionalism  Prioritize  Team-work and Cooperation  Understand from end user perspective  “How can I help you today?”  Bottom line – must stay relevant & value

value add, or become irrelevant in an un- an unregulated environment.

Opportunities / Challenges

 Manage Daily Battle Rhythm / Commo: across Services +

Theaters (multiple competing requirements).

 Theater Governance Board: CENTCOM Bi – Weekly PHARM

TEL – CON.

 Set the Theater: Manage Formulary / Class VIII distro and

uphold CENTCOM standards.

 Battlefield Circulation (BFC) “Train and Assist”: NOT an OIP or

SAV visit.

Questions ?

Legend: 1MB HQ (Qatar) Direct Support (AF/KU) Over the Horizon Support Challenges: 1) Broad Geographic Distance across CJOA 2) Decentralized Operational structure (OSS /OFS / OIR / OTH) Key Initiatives & Events: 1) Establish standards by developing ARCENT SOP for Disinterested Officer and Medication Use. 2) Conduct Site Assistance Visits (SAV) to assess compliance with Federal Law and service specific guidance. 3) Coordinate with USAMMCE-SWA Pharmacist to manage CENTCOM formulary. 4) Support Theater Level, Host Nation, and Partner Nation events. Key Tasks: 1) Uphold Command initiatives for HSS through safe medication use. 2) Provide Theater Pharmacy services across CJOA. 3) Support ARCENT Surgeon by coordinating CENTCOM Pharmacy Therapeutics Committee.

4) Set the stage for transition to future Consultant Pharmacist.

End State: TF 1st MED and EAB AHS medical units are postured to provide world class care to Soldiers and coalition partners across the CJOA. Mission: TF 1st MED is the USARCENT theater enabling command, providing HSS and FHP for EAB throughout the USARCENT AOR ISO of OSS, OFS, and contingency operations over the horizon. Vision:

End State

Closing Remarks

MAJ (P) Steven Barr Pharm D BCPS