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 1 st Medical Brigade (TF1MED) FWD.

CPE Information and Disclosures [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.” The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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

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 CAS EV AC/ MEDEV AC First Aid/ Buddy Care/ Aid S tation Intra-Theater Airlift AELT (Assists w/ comm) Inter-Theater Airlift LRMC Landstuhl Regional Inter-Theater Airlift Medical Center

Theater Pharmacist – Roles + Responsibilities What do you bring to the fight?  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.

TEMC Pharmacist Landscape TF 1 st MED BDE CENTCOM Surgeon ARMY MEDCOM Command / Staff OTSG PHARM ARCENT Surgeon Consultant AFCENT Surgeon NAVCENT Surgeon Theater Enabling MARCENT Surgeon USFOR – A Surgeon Medical Command SOC – CENT Surgeon CJTF – OIR Surgeon (TEMC) Pharmacist ASG – QA Surgeon 20% ASG – KU Surgeon LOE 80% USAMMC – SWA LOE Class VIII Distro Role I – III Pharmacy Capabilities across CENTCOM AOR Note: LOE = Line of Effort

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

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.

Theater Pharm Responsibilities  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

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).

Controlled Substances Accountability TF MED Unit (Role II – III) Timeline Non TF MED Unit or Surgeon (DAYS) Cell (Role I) DIO Appointment Orders DIO Appointment Orders DIO Instructions DIO Instructions 1 – 10 DIO Inventory List DIO Inventory List Appointing Authority DIO Inventory Worksheet DIO Inventory Worksheet (Unit CDR or Surgeon) 15 Action Officer Action Officer Unit Level or Surgeon TF MED Pharmacist Cell POC Appointing Authority Appointing Authority 25 (Unit CDR or Surgeon) Pharmacist TEMC (TF MED Commander) TEMC TEMC 30 Pharmacist Pharmacist

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 ?

End State Mission: TF 1 st 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: 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. 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. Challenges: 1) Broad Geographic Distance across CJOA 2) Decentralized Operational structure (OSS /OFS / OIR / OTH) Legend: 1MB HQ (Qatar) Direct Support (AF/KU) Over the Horizon Support End State : TF 1 st MED and EAB AHS medical units are postured to provide world class care to Soldiers and coalition partners across the CJOA.

Closing Remarks MAJ (P) Steven Barr Pharm D BCPS