2015 florida pharmacists · talking points & other information: currently, pharmacists can...

2

2015 Florida Pharmacists

Health Fair & Legislative Days

3

This booklet belongs to

_____________________________

2015 Health Fair & Legislative Day Resource Pocket Guide Editorial Team:

Laura Rhodes, PharmD Candidate, Class of 2015, Palm Beach Atlantic University

Christina Laird, PharmD Candidate, Class of 2015, Auburn University

Isis Simon, PharmD Candidate, Class of 2016, Nova Southeastern University

Angela S. Garcia, PharmD, MPH, CPh, Nova Southeastern University College of Osteopathic

Medicine, Public Health Program

Jeanette E. Connelly, PharmD, Target Pharmacy

Alexis Jurick, PharmD, CPh, Lee Memorial Health System

4

Table of Contents

Map of Tallahassee page 6

Schedule of Events page 7

Meeting with Legislators page 9

How an Idea Becomes a Law page 11

Pharmacy Legislation page 13

HB 555 - MAC Pricing

SB 860 - MAC Pricing

HB 279 – Pharmacist Immunization Services

SB 792 – Pharmacist Immunization Services

SB 614 - Drug Prescription by Advanced Registered Nurse Practitioners (ARNPs) and

Physician Assistants (PA-Cs)

HB 545 – Telehealth

HB 281 – Ordering Medications by Advanced Registered Nurse Practitioners (ARNPs) and


SB 532 – Ordering Medications by Advanced Registered Nurse Practitioners (ARNPs) and


HB 683 – Medical Use of Marijuana

SB 528 - Florida Medical Marijuana Act

HB 1049 / SB 1180 – Compounding for Office Use

HB 511 / SB 438 - Palliative Care and Quality of Life Interdisciplinary Task Force

SB 382 - Pharmacist Services in Assisted Living Facilities

HB 547 - Advanced Practice Registered Nurses

SB 784 – Right Medicine, Right Time Act

HB 863 – Health Insurance

HB 751 – Emergency Treatment for Opioid Overdose

Health Fair Guide page 22

Overview page 23

Glucose page 24

Body Mass Index (Walgreen’s Scales) page 26

Blood Pressure page 28

5

Cholesterol page 30

Spirometry page 33

Bone Density page 35

Poster Presentations page 36

Counseling/Wrap Up page 36

My Personal Events & Info page 37

Legislative Photo Scavenger Hunt page 38

6

Map of Tallahassee

7

Schedule of Events

Sunday, March 8, 2015

8:00 PM Pizza & Policy Night

2nd Floor, FAMU College of Pharmacy, 1415 S. Martin Luther King Jr.

Blvd, Tallahassee, Florida 32307

Monday, March 9, 2015

8:00 AM Set up for Health Fair

Second Floor Rotunda, Florida Capitol

8:00 AM Legislative Visits – Committee Meetings Continue

Florida Capitol

9:00 AM Health Fair Begins

Second Floor Rotunda – Florida Capitol

3:00 PM Health Fair Ends

3:00 – 4:00 PM Breakdown of Health Fair

5:30 – 7:00 PM Welcome Reception (Invitation Extended to Legislators)

Governors Club, 202 South Adams Street, Tallahassee, Florida

Tuesday, March 10, 2015

8:30 AM Registration and Check in

Room 103, FAMU College of Pharmacy, 1415 S. Martin Luther King Jr. Blvd,

Tallahassee, Florida 32307

9:00 – 9:15 AM Welcome and Introductions

Michael Thompson (host), Suzanne Kelley (FPA), Christine Gegekas (FSHP)

9:15 – 10:00 AM Legislative Briefing, Questions and Instructions

Claudia Davant, FPA, Lawrence Gonzalez, FSHP, Preston McDonald, FPA,

Heather Fuller, FSHP

Room 103, FAMU College of Pharmacy, 1415 S. Martin Luther King Jr.

Blvd, Tallahassee, Florida 32307

8

10:00 – 10:45 AM Student Presentations

UF, FAMU, PBA, NSU, LECOM, USF

10:45 – 11:15 AM Break and Transition to Florida Capitol

10:30 AM – 4:00 PM Legislative Visits, Committee Meetings, Tour of the Old Capitol Building

TBD Group Visit to Gallery of Legislative Chambers

Subject to Floor Schedule

5:30 – 7:30 PM Wrap Up Social

FPA Network Member, Faculty, Technicians, Students

9

Meeting with Legislators

Meeting with your Legislators

□ Wear business attire and bring business cards if available.

□ Be prompt and patient - Arrive a few minutes early and be flexible if interruptions occur

□ Speak on behalf of yourself and not the FPA/FSHP, etc. □ Be prepared

- Bring information or materials supporting your position to leave with the legislator or staff member at the end of the meeting

□ Use personal examples - Members and staff value real-life examples and can understand the issue better if you

relate to them using practical terms

□ Don’t argue

- Identify issues of concern or differences of opinion and respond based on your

knowledge and experience. Remember you are trying to build relationships. □ Be political

- Make a connection between what you are requesting and the interests of the Member’s constituency

□ Don’t be afraid to say that you do not know the answer to a question. - If you don’t know the answer to a question, respond with something like “That is a

great question. I will have to get back to you.”

□ Be Responsive

- Be prepared to answer questions or provide additional information, in the event the

member expresses interest or asks questions. - At the end of the meeting, ask what the Member’s position and/or level of

commitment is on the issue or bill. If the response is negative, ask what they would be willing to support.

□ Purses, Bags, etc., should be left in the car/at home. - This can come across as unprofessional and will slow you down going through security.

□ Make sure the Member and/or Staff is left with the impression that you welcome any future discussion and can be used as a resource on pharmacy issues.

□ Thank the Member and/or Staff before you leave for taking the time to speak with you.

10

Meeting with Legislators

Do’s and Don’ts of Meeting with Legislators

● Do:

o Identify yourself as a pharmacy intern (not a pharmacy s tudent)

o Clearly identify the subject of personal interest, including House and Senate Bill numbers, if you know them

o Explain any business connections relative to the issue, and the impact the issue will have on them

o Use personal experiences to support positions

o Restrict conversation to a single issue

o Communicate while legislation is under consideration in committee, conference, or on the floor

o Communicate more than once on the same issue if the legislation changes favorably, or unfavorably, and note how the changes will impact pharmacy practice

o Communicate specific information with committee and subcommittee chairs responsible for the legislation to will help them make a more informed judgment on

the issue

o Come up with a short “Elevator Pitch” of what you are advocating. Imagine you have 60 seconds to communicate your viewpoint to a legislator. Be clear, concise, and confident.

● Don’t:

– Be rude or confrontational – Pretend to have greater political influence than you have on an issue or with a group

of constituents

– Promise something that cannot be delivered – Be self-righteous or all-knowing

– Be vague about the issue (research the member’s position and present facts to support or refute)

11

Ho

w A

n I

dea B

eco

mes a

Law

13

Pharmacy Legislation

HB 555 - MAC Pricing Provides requirements for contracts between pharmacy benefit managers (PBMs) and contracted

pharmacies, the contact should include an appeal process; requires PBM to ensure that prescription drug has met certain requirements to be placed on maximum allowable cost pricing

list; requires PBM to disclose certain information to plan sponsor.

Position: Support

Talking Points & Other Information:

● Pharmacies will not know what they are going to be reimbursed until after the pharmacy has purchased the medication and the patient has brought in a prescription.

● Example: You buy the supplies for the project, you finish the project and then find out that you will only be reimbursed half of what you paid for the supplies.

● Pharmacies cannot pass on that increase to the PBM, the plan sponsor or the patient, all of whom are held harmless to market changes in the cost of prescription drugs. This can lead to pharmacies not carrying certain drugs making it difficult for patients to get the drug they need.

SB 860 - MAC Pricing Provides requirements for contracts between pharmacy benefit managers (PBMs) and contracted pharmacies; requires PBM to ensure that prescription drug has met certain requirements to be

placed on maximum allowable cost pricing list; requires PBM to disclose certain information to plan sponsor; requires contract between PBM and pharmacy to include appeal process.

Position: Support

Talking Points & Other Information: same as for HB 555

Notes:

14

HB 279 – Pharmacist Immunization Services This language authorizes registered pharmacist interns to administer specific vaccines to adults

under the supervision of a pharmacist. It also requires the registered intern to be certified and complete a minimum amount of coursework to administer specific vaccines. This bill revi ses

which vaccines may be administered by a pharmacist or a registered intern (under pharmacist supervision)

Position: Support

Talking Points & Other Information:

● Currently, pharmacists can administer the following vaccines: influenza, pneumococcal, meningococcal, and shingles vaccines.

● This language expands the number and kinds of immunizations to include all of the vaccines recommended by the CDC for adults, international travel, or in response to a public health emergency declared by the Governor.

● This language allows registered interns to administer the vaccines under the supervision of a pharmacist.

o Registered interns must complete at least 20 hours of coursework approved by the board.

● According to the APhA, currently 45 states allow pharmacists to administer any vaccine.

● There are over 56,000 community retail pharmacy outlets in the USA, allowing pharmacists to provide vaccines to provide vaccines at a greater convenience to patients.

SB 792 – Pharmacist Immunization Services This language authorizes a registered intern to administer specific vaccines to an adult under the

supervision of a pharmacist, and revises which vaccines may be administered by a pharmacist or a registered intern (under pharmacist supervision).

Position: Support

Talking Points & Other Information: same as with HB 279

Notes:

15

SB 614 - Drug Prescription by Advanced Registered Nurse Practitioners (ARNPs) and Physician

Assistants (PA-Cs) Expanding the categories of persons who may prescribe brand drugs under the prescription drug

program when medically necessary; requiring advanced registered nurse practitioners and physician assistants who prescribe controlled substances for certain pain to make a certain

designation, comply with registration requirements, and follow specified standards of practice; providing applicability.

Position: Monitoring

Notes:

HB 545 – Telehealth

Defines “telehealth” as the use of telecommunications technology to perform services that include patient assessment, diagnosis, consultation, treatment, monitoring, education, transfer of

medical data, public health services, and health care administration. Defines “telehealth

provider” as any person who provides health care related services using telehealth and who are licensed (pharmacists, doctors, physical therapy, psychologists, massage therapists,

chiropractors, midwives, etc). Provides for certain practice standards for telehealth providers. Authorizes telehealth providers to use telehealth for prescribing controlled substances. Provides

for maintenance and confidentiality of medical records.


Notes:

16

SB 478 - Telemedicine Services

Defines “telemedicine” as telecommunications technology to perform services including patient assessment, diagnosis, consultation, treatment, monitoring, transfer of medical data, and

education. A health care provider (includes same practitioners as house bill but includes naturopaths), emergency medical technician, or paramedic may provide these services to a

patient that is a resident of this state. These services shall be covered by Medicaid. Provides for certain practice standards for telehealth providers. Authorizes telehealth providers to use

telehealth for prescribing controlled substances. Provides for maintenance and confidentiality of medical records.


Notes:

HB 281 – Ordering Medications by Advanced Registered Nurse Practitioners (ARNPs) and Physician Assistants (PA-Cs)

This language authorizes licensed physician assistant acting under the direction of a supervising physician to order medication and controlled substances for administration to specified patients,

as well as authorizes ARNPs to order medication for administration to specified patients . It also revises the definition of the term “prescription” to exclude an order that is dispensed for

administration to a specific patient. Clarifies that “orders” are not considered a prescription. Attempts to allow ARNP’s to order controlled prescriptions for inpatients in hospitals or similar licensed facilities, but not for outpatient prescriptions.


Notes:

17

SB 532 – Ordering Medications by Advanced Registered Nurse Practitioners (ARNPs) and

Physician Assistants (PA-Cs) Revises the term “prescription” to include an order for drugs or medical supplies by a licensed

practitioner that is dispensed for certain administration. Revises the term “administer” to include the term “administration”. Authorizes a licensed physician assistant or ARNP to order medication,

including a controlled prescription, for administration to a specified patient.


Notes:

HB 683 – Medical Use of Marijuana Allows registered patients (specifies registration requirements) and designated caregivers

(specifies caregiver requirements) to purchase, acquire, and possess medical -grade marijuana subject to specified requirements. Allows cultivation and processing licensee, employee, or

contractor to acquire, cultivate, transport, and sell marijuana. Allows retail licensee to purchase, receive, possess, store, dispense, and deliver marijuana. Allows a licensed laboratory to receive

marijuana for certification. Prohibits certain actions regarding the acquisition, possession, transfer, use, and administration of marijuana. Clarifies that persons are prohibited from driving

under the influence of marijuana.


Notes:

18

SB 528 - Florida Medical Marijuana Act

The filed version of this bill does not include pharmacy. The bill also defines a qualified patient as one who has been certified by a physician and diagnosed as suffering from the following: cancer,

HIV+, AIDS, epilepsy, ALS, MS, Crohn’s, Parkinson’s, chronic conditions with cachex ia, wasting syndrome, severe/persistent pain, severe/persistent nausea, persistent seizures or muscle

spasms.


Notes:

HB 1049 / SB 1180 – Compounding for Office Use

Providing that the Florida Pharmacy Act does not prohibit the dispensing of a compounded drug by a veterinarian, defines office use of compounding in the case of veterinary drugs to include

dispensing to the owner or caretaker of the animal patient.


Notes:

19

HB 511 / SB 438 - Palliative Care and Quality of Life Interdisciplinary Task Force

Requires the Department of Health (DOH) to 1) Establish a palliative care consumer and professional information/education program 2) Publish certain educational information and

referral materials about palliative care on its website 3) Develop and implement service and education initiatives regarding palliative care 4) Create the Palliative Care and Quality of Life

Interdisciplinary Task Force and specifies its purpose 5) Consult with the Palliative Care and Quality of Life Interdisciplinary Task Force 6) Report to the Governor and Legislature by specified

deadlines. This task force will have 11 members of which 5 are to be appointed by the Governor, 3 by the Senate President and 3 appointed by the House Speaker. Membership in this task force shall include professionals who have expertise in medical, nursing, social work, pharmacy, spiritual and patient and family caregivers or their advocates.


Notes:

SB 382 - Pharmacist Services in Assisted Living Facilities

Revises definition of “assistance with self-administration of medication” in the Assisted Living Facilities act to include taking a dispensed/properly labeled container from where it is stored and

bringing it to the resident, removing the prescribed amount of medication from a container, placing dose in resident’s hand or lifting container to resident’s mouth. Medications include 1)

insulin syringes prefilled with proper dosage by a pharmacist or an insulin pen that is prefilled by the manufacturer 2) applying topical medications 3) pouring prescribed premeasured dose of unit

dose nebulizer solution into dispensing cup of the nebulizer 4) using glucometer to perform blood glucose checks 5) application and removal of anti-embolism stockings 6) application and removal of oxygen cannula 7) assisting with use of continuous positive airway pressure device. Requires assisted living staff to have 2 additional hours (6 hours total) of training for assistance with medication.


Notes:

20

HB 547 - Advanced Practice Registered Nurses

Redesignates ARNPs as advanced registered practice nurses (APRNs); revises APRN certification and authorizes APRNs to administer, dispense & prescribe medicinal drugs pursuant to protocol.


Notes:

SB 784 – Right Medicine, Right Time Act Creates the Clinical Practices Review Commission. Requires a managed care plan that establishes

a prescribed drug formulary or preferred drug list to provide a broad range of therapeutic options to the patient. Requires sufficient clinical evidence to support a proposed coverage limitation at

the point of service. Requires the commission to evaluate the sufficiency of the evidence and the Office of Insurance Regulation to approve coverage limitations on the basis of the commission’s

evaluation.


Notes:

21

HB 863 – Health Insurance

Designates act as "Florida Patient Protection Act". Revises prescription drug coverage requirements for managed care plans; provides for an appeal of certain health care coverage

decisions made by managed care plans, health insurers, and HMOs; authorizes Office of Insurance Regulation (OIR) to hold certain public hearings; requires OIR to issue certain reports

annually; prohibits discriminatory benefit plans; provides penalties for use of discriminatory treatment criteria; provides requirements for certain civil actions brought against insurer or

HMO; provides penalties and attorney fees.


Notes:

HB 751 – Emergency Treatment for Opioid Overdose Designates act as "Emergency Treatment & Recovery Act"; authorizes certain health care

practitioners to prescribe emergency opioid antagonist to patient or caregiver; authorizes storage, possession, and administration of emergency opioid antagonist by patient or caregiver and certain emergency responders; provides immunity from professional sanction or disciplinary

action for certain health care practitioners (includes pharmacists).


Notes:

22

Health Fair Guide

Overview

What to do if you don’t know what to do: – Track down the Health Fair Coordinators and your school liaisons so they can clarify any

information, provide guidance, and delegate specific tasks

– If you find yourself not assigned to a station or a visit, don’t fret. Take this time to perhaps

explore the capitol, see where different offices are located, mingle with legislators and

staff located nearby, or complete the Legislative scavenger hunt located in this book.

– Check on student pharmacists at different stations to determine if you can assist in any

way or if you need to provide coverage due to a legislative appointment. You can only fill

in if you have been trained and this has been cleared by the respective school liaison and

Health Fair Coordinators.

– If you are scheduled for Health Fair Setup or Breakdown, please be sure you are on time

and check in directly with the Health Fair Coordinators for your assigned tasks and

responsibilities. Setup is 8:00am in the Capitol Parking Garage bay area (security

screening) then on the Second Floor of the Capitol Rotunda. Breakdown will be at each

station and includes bringing supplies and equipment back to the Capitol Parking Garage

bay area to be loaded in the vehicles so everything can be taken to the FPA House.

– Remember why you are here – to learn AND to advocate. Take every opportunity to do

both. Plan to stay for the entire time if you can. Our voice is more powerful in numbers.

– Always be professional, polite, and courteous. You never know who might be watching

and you are representing your ENTIRE profession. A legislator is not going to distinguish

you for you; he/she will associate all you do with the entire profession of pharmacy.

Things to remember: – Show up for your station 10 minutes early

– All long hair must be pulled back in a pony tail

– All pharmacy interns must wear close-toed shoes

– Stay at your station 5 minutes late, this will allow for smooth transitions between shifts

– Avoid using any diagnostic terms or medical jargon - this was discussed at each Team

Training. If you hear your peer using these terms, remember to professional redirect and

switch the language to layperson friendly teams.

– Always communicate and engage with your participants. Don’t have that uncomfortable

moment where you are touching a participant and not talking! Make sure to walk the

participant through what you are doing, why and transition them to the counseling intern

to help expedite the screenings and reduce times standing in line or waiting.

23

– Those participating in the health fair are “Health Fair Participants” not patients.

– Refer a health fair participant to their local pharmacist for follow-up when appropriate as

well as their Primary Care Physician (remind them to bring their Passport Journal)

– The main goal of the Health Fair is Educating Legislators about the clinical services that

pharmacists and pharmacy interns provide that improve patient care outcomes, reduce

health care spending, and demonstrate the pharmacists’ and interns’ contributions as

members of the health care team. Let’s show our legislators what we can do and what we

know!

Health Fair Guide

Stations:

– Health Fair Navigators

– Registration

– Glucose Screening

– Body Mass Index (Walgreen’s Scales) Screening

– Manual Blood Pressure Screening

– Cholesterol Screening

– Spirometry/Lung Function Screening

– Bone Density/Fracture Risk Screening

– Outreach Project Poster Presentations

Registration/Navigation:

– Navigators:

• You will be providing a personal guided tour of the health fair, waiting with the

attendees as they participate in each station. You will help to answer questions,

direct them to the next station, and allow for a smooth and welcoming experience

throughout the event. Be courteous and polite. This is a great opportunity to

discuss the care pharmacists provide as well as our views on current legislative

bills. – Registration:

• You will be the first point of contact to greet the legislators and/or their office

staff. Be courteous and polite. Ensure everyone signs the consent form and

receives a Passport Journal. Explain what the Passport is for and open the Passport

to the center pages where the screenings are recorded. Provide them with any

necessary materials and give them an overview of what they can find at the health

fair. Help them to pair up with a navigator if they would like and invite them to talk

with any students/pharmacists about any questions they may have.

24

Glucose

Source(s): 2015 ADA Standards of Diabetes Care, AACE Diabetes Resource Center

Lab Values and Goals:

Normal Ranges: Adults Without Diabetes

Fasting

< 70 mg/dL Hypoglycemic

70 – 99 mg/dL Normal ≥ 100 mg/dL Hyperglycemic

Non-fasting < 70 mg/dl Hypoglycemic

70-139 mg/dL Normal ≥ 140 mg/dL Hyperglycemic

Goals for Patients with Diabetes

Fasting blood sugar 80 – 120 mg/dL Blood glucose after you have not eaten for ≥ 8 hours.

Non-fasting blood sugar < 180 mg/dL Blood glucose 1-2 hours after the beginning of a meal. Random blood sugar < 200 mg/dL

A1C < 7%*

A1C is a test that shows how a person’s blood glucose has been over a 2-3 month period.

Interpreting Lab Values: – Glucose is low (fasting or non-fasting: < 70 mg/dL)

o This number is a little lower than we would like to see. o Common symptoms of hypoglycemia include: palpitations, sweating, dizziness,

anxiety, irritability, headache. o Keep a snack (peanut butter crackers, granola bar, glucose tablets, milk, fruit juice,

etc.) nearby. – Glucose within normal range (fasting: 70-100 mg/dL, non-fasting: 70-139 mg/dL)

o This number looks great; this is what we’re looking for – Glucose is high (fasting: > 100 mg/dL non-fasting: > 140 mg/dL)

o This number is higher than we would like to see. o Common symptoms include: Frequent urination, frequent hunger, frequent thirst,

fatigue, blurry vision, dry skin, wounds that will not heal. o Depending on their number, they need to go see their doctor in the next month to

get it checked again.

25

Counseling Pearls: – Have you ever been tested before?

– Why did you want to get tested today?

– Does anyone in your family have diabetes?

Questions to ask before you begin: – When was the last time you ate? – What did you eat?

– Has anyone ever talked with you about diabetes?

– Do you know what your normal numbers are?

– How do you check your blood sugar at home?

– When was the last time you tested yourself?

– Are you currently taking any medications to control your blood sugar?

– What other medications are you taking?

– What herbals, supplements, or other OTC’s are you taking?

– Are you on any blood thinners (including aspirin)?

Screening/Testing Procedures: 1) Put on gloves 2) Wipe patient’s finger with alcohol swab

3) While it dries, remove a test strip and insert it into the machine. 4) When the picture of a blood drop comes up, the machine is ready. 5) Place the lancet on the side of the fingertip and press the lancet trigger. 6) The finger should bleed; wipe off the first drop (decreases risk of being contaminated with

alcohol). If more blood is needed, start from the base of the finger and squeeze towards the tip to draw more blood.

7) Place the strip at a 90 degree angle to the blood drop. The meter should count down and give you a result.

8) Give the patient a cotton ball and offer a bandage. Immediately dispose of the lancet and any items with the patient’s blood on them.

26

Body Mass Index (Walgreen’s Scales)

Sources: NIH/WHO, Omron Health Care

Body Fat Composition: Quick Facts Body Mass Index:

- Calculate using weight and height (BMI = kg/m^2)

- It is used to identify possible weight problems for adults

- Women usually have a greater BMI than men

- Athletes have higher BMI’s due to increased muscle mass

BMI Weight Status

Below 18.5 Underweight

18.5-24.9 Normal

24.9-29.9 Overweight

30 or higher Obese

Body Fat Percent

Gender Age Low (-) Normal (0) High (+) Very High (++)

Female 20-39 <21.0 21.0-32.9 33.0-38.9 >39.0

40-59 <23.0 23.0-33.9 34.0-39.9 >40.0

60-79 <24.0 24.0-35.9 36.0-41.9 >42.0

Male 20-39 <8.0 8.0-19.9 20.0-24.9 >25.0

40-59 <11.0 11.0-21.9 22.0-27.9 >28.0

60-79 <13.0 13.0-24.9 25.0-29.9 >30.0

Skeletal Muscle Percent

Gender Age Low (-) Normal (0) High (+) Very High (++)

Female 18-39 <24.3 24.3-30.3 30.4-35.3 >/= 35.4

40-59 <24.1 24.1-30.1 30.2-35.1 >/= 35.2

60-79 <23.9 23.9-29.9 30.0-34.9 >/= 35.0

Male 18-39 <33.3 33.3-39.9 39.1-44.0 >/= 44.1

40-59 <33.1 33.1-39.1 39.2-43.8 >/= 43.9

60-79 <32.9 32.9-38.9 39.0-43.6 >/= 43.7

Visceral Fat Levels:

Level </= 9 …… Normal 10</= Level </= 14……High Level >/= 15……Very High

27

How to use the scales:

1) Turn the scale on. Remember, everyone is a guest. Do not save their information.

2) Press the guest button. Set the persons age, gender, and height using the up and down

arrows and set/mode button.

3) Have the person step on the scale. Make sure they are barefoot and have the hold the

handles at a 90 degree angle with arms straight.

4) Once their results are displayed, go over their meanings. To erase the person’s information,

simply turn the machine off and on again.

28

Blood Pressure

Reference(s): Operation Heart, JNC 8

Vocabulary:

– Antecubital Fossa: Small triangular area of the ventral elbow (in the crease where the brachial artery passes through)

– Diastolic Blood Pressure: The force/pressure when the heart is relaxed; measures the force the heart exerts during relaxation and the point of relaxation of the heart is diastole.

– Hypertension (HTN): high blood pressure, current guidelines >140 systolic OR >90 diastolic (this is the guideline for most of the population under 60 years of age)

– Korotkoff sounds: The pulsing/beating sounds heard during manual evaluation of BP

– Sphygmomanometer: Blood Pressure Cuff – Stethoscope: Device used to hear Korotkoff sounds

– Systolic Blood Pressure: The force produced by heart contraction/pumping; the pressure in the brachial artery is caused by the force of blood ejected from the heart during contraction

(or systole). – White Coat syndrome: Anxiety/nervousness experienced when dealing with healthcare

workers can change some people’s vital signs such as pulse and BP. If the patient seems nervous or anxious try to engage in casual conversation prior to screening (while patient resting in the chair).

How to take a Blood Pressure:

1) Always introduce yourself and ask the patient if they would like to have their blood pressure taken. Have them sit and relax for a few moments before you begin. Uncross ankles and arms

while waiting and during reading. 2) BP can differ from arm to arm so if a patient typically uses one arm over the other when they

have their BP checked try to stay consistent. Ask the patient if they know their normal BP reading. Explain the steps that you will be taking while measuring the blood pressure and

find their brachial pulse. 3) The easiest way to have the patient flex their arm slightly, you will be able to feel their biceps

tendon and most people’s brachial artery pulse can be felt if you go just medial to their bicep

tendon. 4) Next, ask the patient to remain seated and place their arm on the table. The arm should be

able to rest at approximately heart level. Ensure that both feet are resting on the floor. Have the patient remove heavy jackets or sweaters, roll up their sleeve if not too tight, and smooth

out the fabric so there is no “bulk” where you will place the cuff. Place the blood pressure cuff around the upper arm, snug but not tight, so that the “arrow” on the cuff is pointing

toward the antecubital fossa/where you will be placing your stethoscope over the brachial artery.

5) The fit of the cuff is important; an ill-fitting BP cuff (too large or too small) can give false readings. Make sure the valve is shut by using your thumb/fingers to twist it tight and then begin pumping up the blood pressure cuff. You should notice an increase in pressure (by

29

watching the needle). Raise the pressure 20 mmHg above their normal BP, or if you do not

know their BP pump up the cuff until you reach 180 mmHg. 6) Once you have determined your inflation level, you can begin. Pump the cuff and have the

stethoscope placed firmly over the brachial artery, DO NOT USE YOUR THUMB on the stethoscope, your thumb has its own pulse and you may pick it up through the stethoscope.

7) Now slowly release the valve to allow the pressure in the cuff to releas e slowly (but not too slowly). You will hear a “pulse or heartbeat like sound”, when you first hear that sound look

at the needle on the stethoscope, this is the systolic (or top) number. Continue to let the air slowly release until you stop hearing the “beating” sound. The last sound/“pulse” then the fade to silence is your diastolic (bottom) number.

Blood Pressure Goals:

Patient subgroup Target SBP (mm Hg) Target DBP (mm Hg)

60 years or older < 150 < 90

59 years or less < 140 < 90

18 years or greater with CKD < 140 < 90

18 years or greater with DM < 140 < 90

CKD: chronic kidney disease, DBP: diastolic blood pressure, SBP: systolic BP, DM: diabetes mellitus

Per JNC 8: The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a

second. The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient.

Non-Pharmacotherapy Recommendations:

Modification Recommendation ~ SBP Reduction

Weight reduction Maintain normal body weight

(BMI 18.5-24.9 kg/m2)

5-20 mmHg/10kg

weight loss

Adopt DASH eating plan Consume diet rich in fruits, vegetables, LF dairy and reduced fat

8-14 mmHg

Dietary Sodium Reduction Reduce to 2.4 g sodium or less 2-8 mm Hg

Physical Activity Aerobic physical activity for 150 minutes a week 4-9 mm Hg

Moderate alcohol

consumption

2 drinks or less/day for men

1 drink or less/day for women

2-4 mm Hg

30

Cholesterol Source: ACC/AHA 2013 Cholesterol Guidelines

The Importance of Cholesterol: High blood cholesterol is a major risk factors for heart disease. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men in the United States. Each year, more than one million Americans have heart attacks, and about a half-million will die from heart disease.

Types of Cholesterol: Everyone age 20 and older should have their cholesterol measured at least once every 5 years. It is best to have a blood test called a “lipoprotein profile” to find out your cholesterol numbers. This blood test is done after a 9- to 12-hour fast and gives information about your:

● Total cholesterol ● LDL (bad) cholesterol – the main source of cholesterol buildup and blockage in the arteries

● HDL (good) cholesterol – helps keep cholesterol from building up in the arteries

● Triglycerides – another form of fat in your blood

Factors That Affect Cholesterol Levels: ● Diet: Saturated fat and cholesterol in the food you eat make your blood cholesterol levels

rise. Saturated fat is the main culprit, but cholesterol in food also matters. Reducing the

amount of saturated fat and cholesterol in your diet helps lower your blood cholesterol level.

● Weight: Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL and total cholesterol levels, as well as

raise your HDL and lower your triglyceride levels. ● Physical Activity: Not being physically active is a risk factor for heart disease. Regular

physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes

on most, if not all, days. ● Other Health Conditions: hypothyroidism, obesity, pregnancy, diabetes

Non-modifiable Risk Factors: ● Age and Gender: As women and men get older, their cholesterol levels rise. Before the

age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women’s LDL levels tend to rise.

● Heredity: Your genes partly determine how much cholesterol your body makes.

How to Measure Cholesterol:

31

Optics check should be performed daily before patient samples are tested. Once a daily check

has been performed proceed to load cassettes as follows: ● Press the RUN button. The display will say, “Load cassette and press RUN.”

● Take your new cassette with blood sample and load it into the Cholestech LDX machine, and press RUN.

● Once the machine has finished analyzing the sample it will open up automatically and will DISPLAY VALUES according to the type of cassette used.

● Take the used cassette and dispose of it as specified. ● Never test thumb, test on side of finger.

Set up in Teams of 2-3 students: ● One student should milk the arm – make sure to converse. Milk arm from top to bottom.

Don’t milk hand, this will bruise RBC’s and make it harder to take blood. ● Another student should collect the blood. Take it as quick as possible because once blood

coagulates in the tube, you will have to start over. ● The third student should run the machine – make sure to write with a sharpie, the health

fair participant’s number on the cartridge. You will only have 10-15 seconds to read the numbers once they show up- so make sure you are paying attention!

Principles of Cholesterol Management: 1) Lifestyle modifications (i.e. adhering to a heart healthy diet, regular exercise, avoidance of

tobacco products, and maintenance of a healthy body weight) remains a critical component of health promotion and ASCVD (atherosclerotic cardiovascular disease) risk reduction, both

prior to and in conjunction with the use of cholesterol lowering medications. 2) The most recent guidelines introduce the concept of “4 major statin benefit groups” for

whom ASCVD risk reduction clearly outweighs the risk of adverse events. This include individuals:

a. With clinical ASCVD, defined as acute coronary syndrome or a history of MI, stable or unstable angina, coronary or other revascularization, stroke, TIA, or peripheral arterial disease.

b. With primary elevation of LDL-C ≥ 190 mg/dL c. With diabetes aged 40 to 75 years with LDL-C 70 to 189 mg/dL and without clinical

ASCVD d. Without clinical ASCVD or diabetes with LDL-C 70 to 189 mg/dL and estimated 10-year

ASCVD risk ≥ 7.5% 3) Treatment for these groups are outlined in the algorithm on the following page.

a. Based upon the presence of clinical ASVCD or other risk factors that may classify a patient into a particular statin benefit group, a low-intensity, moderate-intensity, or

high-intensity statin drug should be selected. This is outlined in the statin potency table below.

4) The updated clinical guidelines make no recommendations for or against specific LDL-C or non-HDL-C targets for the primary or secondary prevention of ASCVD.

ACC/AHA Cholesterol Treatment Algorithm:

33

High-intensity Statin Therapy Moderate-intensity Statin Therapy Low-intensity Statin Therapy

↓ LDL-C ~ ≥ 50% ↓ LDL-C ~ 30% to < 50% ↓ LDL-C ~ < 30%

Atorvastatin 40-80 mg

Rosuvastatin 20-40 mg

Atorvastatin 10-20 mg,

Rosuvastatin 5-10 mg, Simvastatin 20-40 mg,

Pravastatin 40-80 mg, Lovastatin 40 mg,

Fluvastatin XL 80 mg Fluvastatin 40 mg BID, Pitavastatin 2-4 mg

Simvastatin 10 mg, Pravastatin

10-20 mg, Lovastatin 20 mg, Fluvastatin 20-40 mg,

Pitavastatin 1 mg

Spirometry/Lung Function Testing

SPIROMETRY

Spirometry is performed to measure the inspiratory and expiratory capacity and overall lung function. We utilize spirometry to define a baseline of lung function in order to monitor for changes that reflect decompensation, recovery, response to treatment, or changes due to

comorbidities or URTI.

Anyone can be screened to help them understand the difficulties of performing this test accurately

- it will help you educate on the importance of avoiding tobacco use (including second hand exposures) and build empathy and sympathy for people with lung disease that must undergo these screenings on a regular basis. In the clinical setting, we would perform screenings if patients

demonstrate problems with lung function, breathing, have a history of smoking or environmental/occupational exposures, referrals by primary care providers to monitor responses to

medications, etc.

The following is a list of characteristics that identify good candidates for spirometry services and screenings:

● Symptoms of coughing (with and without sputum), wheezing, and shortness of breath ● A history of smoking

● A history of exposure to environmental risk factors including secondhand smoking and occupational pollutants

● A family history of chronic lung disease

● Diagnosis of asthma, COPD or other lung diseases

THE “HOW TO” OF SPIROMETRY TESTING

1. Ask if they have an inhaler they were prescribed. Ask if they have their inhaler with them. take the opportunity to review the importance of always carrying their inhaler (if they need one).

2. Make sure the individual taking the test feels comfortable, sits with relaxed posture and has

34

been explained clearly the actions they are to perform (breathing and use of the mouthpieces)

3. Explain what information you need to gather and why (demographics for predicted performance levels) as well as their expectations for the inhalation breath, forced

expiration, and recover breath. They need to be very clear on how to breathe to ensure a good breath cycle and how to blow into the mouthpiece.

4. Reassure that this test is very difficult to perform, especially outside a traditional clinical

setting. Remind the participant this test does not diagnose any lung diseases and that if they do not meet their predicted values, that they should be concerned. This screening is used in

addition to a very good clinical history to determine lung function but we are not diagnosing anything at the event.

5. It is best for the individual to take the test while they’re seated and do not repeat the test

more than twice to avoid dizziness, SOB, etc. 6. The first breath in is without the mouthpiece. Inform the participant they need to keep their

lips sealed around the mouthpiece the entire time they blow out and during the recovery breath. Do not have the patient hold their breath for an extended period of time before the forced expiration. This is a smooth process of breathing in, breathing out (with force) and a

recovery breath. Clearly explain and demonstrate BEFORE having the patient try to perform the test. Ask if they feel okay to repeat the test if needed.

7. It is critical that the expiration is forced out and extended for as long as possible. Most participants will not meet the predicted values; be prepared to explain their scores versus predicted and do not forget to remind them the difficulty of the test.

INTERPRETING THE RESULTS

Spirometry will show the measurements of a Forced Expiratory Volume in the first second of theperson blowing into a spirometer (FEV1) and the Forced Vital Capacity (FVC) for the total 6 sec

onds of the blow. If the FEV1/FVC ratio is between 70% to 80%, the person’s lung health is normal. Below 70% may be an indication of some obstructio

n in the clinical setting. Results are influenced by technique and patient demographics including age, gender, height, weight, ethnicity, smoking history, and previous diagnosis.

35

Bone Density

Osteoporosis: Bone Mass Density Ultrasound Machine Quick Facts:

● The most accurate predictor of measuring bone fracture risk is bone mineral density (BMD).

● Uses sound waves to measure bone density

● Measurements of the patella or calcaneus, with ultrasonography, reflect fracture risk with s

ound transmission through the bone. This is related to bone density and skeletal strength. ● This device is portable, less expensive than other measuring methods, and requires no ra

diation exposure.

● Screening NOT Diagnostic

● Patients could benefit from further BMD testing (conformational diagnosis by DXA)

● However, we use a T-score here, since we would need more clinical information for a BMD score.

Interpretation of Bone Density Results:

● Measured using a T-Score which is the number of standard deviations above or below the mean of a healthy 20-

35 year old female

▪ +1 to 1.0 is normal bone density

▪ -1.0 to -2.5 low bone density/ (don’t say osteopenia) ▪ -2.5 or lower increased risk (don’t say osteoporosis)

- Note remind the patient this a SCREENING if the t score is of concern recommend the patient visit their primary care physician with the screening results

Steps:

1) Have patient step forward – notice the foot they step with first (their dominant foot).

Perform the screening on their non-dominant foot.

2) Don Gloves, you can also place a little bit of Vick’s Vapor Rub under your nose to deter

the smell (don’t let the participants see you do it).

3) Make sure the participant’s foot is bare (no socks, no nylons) and provide baby wipe so

participant can clean their foot.

4) Place sanitary paper in machine.

5) Place a pea size drop of gel on your fingers, gently tap your fingers together, and wipe on

the rubber contacts.

6) Have participant place their foot in the machine (be sure foot is all the way back). Align the

2nd and 3rd toe with line on machine. Place brace on every participant.

7) Have participant use their baby wipe to remove gel from ankle..

8) Wipe rubber contact with a kim wipe (not an alcohol swab).

9) Make sure to converse with health care participant during the process!!!

10) Provide the participant with their T-score

36

Poster Presentations

Topics may include:

– Immunizations

– Diabetes

– Generation Rx (Prescription Drug Abuse Prevention/Education)

– Self-Care (Self-Management of Chronic Disease or Safe OTC Use)

– Heart Disease (HTN, Stroke)

– EPA Safe Drug Disposal

– Women’s Health

– Men’s Health

– Smoking Cessation

Students assigned to these stations will be discuss the various patient care projects.

Each school will have a handful of posters on display.

Counseling/Wrap Up

Third and fourth year students at this station will be available to answer questions

as well as discuss the significance of the attendee’s health fair results.

37

My Personal Events & Info

Senator ___________________________________________________

Meeting Time ____________________________________

Representative ___________________________________________________

Meeting Time ____________________________________

Health Fair Station(s) ________________________________________________

___________________________________________________________________

Times ________________________________________

Health Fair Set Up [ ] Health Fair Take Down [ ]

Legislative Visits ___________________________________________________

38

Legislative Photo Scavenger Hunt

Get excited! This is an awesome opportunity to get better acquainted with all the Capital has to

offer. The first 3 teams (of 4 students) will be eligible for prizes…

Rules:

- Complete each of the tasks listed below during your time at the Health Fair & Legislative

Days events at the Florida State Capitol.

- Email your completed entry to [email protected] &

[email protected] by March 13th, 2014

- Emails must be in the form of a power point presentation with each activity listed on a

separate slide.

- Make sure to include the full names of your 4-person team!

- Funny, creative, and uniqueness gets bonus points!

1) Take a team photo with at least 2 other students from another school by the Capitol Seal (and

include their names).

2) Take a team photo with at least 3 other students in front of the capitol (and include their

names).

3) Take a team photo with a Legislator or their aide (and include their names).

4) Take a team photo next to something that says House of Representatives or Senate (Bonus

points for doing both and for creativity).

5) Find out where you can pick up a schedule of events for the House OR Senate and take a

photo holding the schedule (Bonus points for doing both).

6) Take a team picture of one of the members of the FPA Lobbyists (and include their name).

7) Take a team photo of you displaying your school’s mascot or theme somewhere creative.

8) Find your Senator’s or Representative's office (or name listed somewhere) and take a picture

next to their name. (Bonus points for doing both!)

9) Find a historical place in the Capitol and take a team photo (be sure to include in your

submission why it is historical).

10) Come up with your own creative and interesting team photo at the Capitol to submit. Make

sure it’s related to legislation and advocacy!

mailto:[email protected]

mailto:[email protected]

2015 florida pharmacists · talking points & other information: currently, pharmacists can...

Documents