LH Pharmacy Services Advancing Care 2021

Lee Health

Pharmacy Services
Advancing Care 2021

PHARMACY
MISSION

Optimizing
Patient Outcomes

Through
Interdisciplinary

Medication
Management

ULTURE RIGHT

RIGHT C
COST
CARE
RIGHT TIME
Our Vision

Our vision is to inspire
hope, and be a national
leader for the advancement
of health and healing.

& PLACE RIGHT

Table of Contents

Message from the System Director of Pharmacy.............................................................................. 2
Service Overview...............................................................................................................................................3
Acute Care Hospitals.......................................................................................................................................4

Cape Coral Hospital...................................................................................................................................5
Golisano Children’s Hospital of Southwest Florida.....................................................................6
Gulf Coast Medical Center......................................................................................................................8
HealthPark Medical Center................................................................................................................... 10
Lee Memorial Hospital.............................................................................................................................13
Population Health and Wellness.............................................................................................................. 14
Lee Pharmacy............................................................................................................................................. 14
Health Plan Pharmacy.............................................................................................................................17
Infusion Centers (Lee Memorial Hospital Complex Care Center,

Lee Health Home Infusion, Regional Cancer Center)................................................................... 18
Lee Health Specialty Pharmacy........................................................................................................20
Skilled Nursing Facilities and Units..........................................................................................................21
LeeSar Cooperative Services of Florida.............................................................................................. 23
Antimicrobial Stewardship......................................................................................................................... 24
Informatics and Automation..................................................................................................................... 26
Education and Training................................................................................................................................ 28
Pharmacy Technician Training Program....................................................................................... 29
Doctor of Pharmacy Training Program and Pharmacy Intern Program........................30
Pharmacy Residency Program............................................................................................................31
Performance and Quality Improvement.............................................................................................. 34
340B Program................................................................................................................................................. 39
Professional Recognition............................................................................................................................40

Pharmacy Report | 1

Message from
System Director of Pharmacy

Guiding Principles for Pharmacy
Leadership at Lee Health

• Creating an environment for individual excellence
and team success in Optimizing patient outcomes
through interdisciplinary medication management.

• Advance, expand and promote Lee Health Pharmacy
Services in which pharmacy is recognized as a
leader in the State of Florida, advancing practice and
care to patients where continuity of care from the
patient’s perspective is expected and delivered.

• Contribute to providing an environment and culture
for personal and professional growth for pharmacists
and pharmacy technicians through encouragement,
continuous professional development, recognition
and utilization of the skills, talents and strengths of
the individual and fostering teamwork to enhance
success. John A. Armitstead, M.S.,
R.Ph., FASHP

• Develop and expand pharmacy training programs for
pharmacy residents, pharmacy students and interns,
and pharmacy technician students demonstrating professionalism, competency
and excellence while developing highly trained pharmacy personnel for
Southwest Florida, Florida and beyond.

I am pleased to share the Lee Health Pharmacy Services Advancing Care 2021. Our
pharmacy team members are committed to the Lee Health Mission and Vision and
deliver on being Caring People, Inspiring Health.
Our pharmacists and pharmacy technicians are professionals dedicated to Optimizing
Patient Outcomes Through Interdisciplinary Medication Management.
Our acute care operations have served as strong foundation to build our professional
services to include a comprehensive inpatient, ambulatory pharmacy, long term care
and home care services to patients that reach into the community to address our
commitment to our patients.
New this year have been some exciting developments including extension of care
delivery services to our own Lee Health Skilled Nursing Facilities, the introduction of
Lee Health Specialty Pharmacy, the addition of Lee Health Home Infusion (Access
Infusion) and the substantial construction project at the renewed Gulf Coast Medical
Center.
As we continue to battle COVID-19 we are thankful for the health of our health care
team members and truly understand the aspect that we are battling disease and
fighting for the care of our patients. Thank you for the unique contributions this past
year of our pharmacy team members, health care team members and our community.

John A. Armitstead, M.S., R.Ph., FASHP
System Director of Pharmacy

2 | Lee Health

SERVICE OVERVIEW METRO PKWY1 2 3
PLANTATION RD7
Lee Health comprises 4 EXIT
a multitude of services METRO PKWY 5 136
across the Fort Myers PLANTATION RD 6
and Cape Coral area in EXIT
Florida that serve 1800 131
beds with approximately
300 pharmacy staff EXIT
members. The health 123
system includes four
adult acute care 8
facilities, all of which
contain a Lee Pharmacy 1 Cape Coral Hospital
(community retail 2 Lee Memorial Hospital
pharmacy), one pediatric 3 Regional Cancer Center
acute care facility, a 4 Page Field
Regional Cancer Center, 5 Lee Health Home Infusion
an Outpatient Infusion 6 Gulf Coast Medical Center
Center, two primary care 7 HealthPark Medical Center/Golisano
clinics, an Employee 8 Coconut Point
Health Plan Pharmacy,
a Specialty Pharmacy,
Skilled Nursing Facility
and Units, a Home
Infusion Service, and
two clinic-based retail
pharmacies.

In the acute care
setting, decentralized
pharmacists provide
comprehensive
clinical services to the
emergency department,
intensive care units,
and general medical/
surgical floors.
Decentralized services
include medication
reconciliation,
antimicrobial
stewardship,
anticoagulation services,
pharmacokinetic dosing,
patient education,
and 24/7 emergency
code response. In the
outpatient setting,
pharmacists are
embedded within clinic
practices and act as a
res3ource to providers
and nEXuITrsing, provide
4 patien136t education, and
5 facilitate the transition
of care process in order
to ensure a seamless
6 transiEt1X3iI1oT n to home.

LEE HEALTH | ACUTE CARE HOSPITALS
4 | Lee Health

CAPE CORAL HOSPITAL

Cape Coral Hospital (CCH) is a Cape Coral
Hospital
291-bed adult acute care facility
located on the west side of the Stephen M. Kessinger RPh, MS, MBA, CGP (Pharmacy Director) &
Caloosahatchee River in Lee Mariamo Oyebanjo, Pharm.D., BCPS (Pharmacy Manager)
County, Florida. The hospital
was established in 1977 as an
independent entity to serve the
growing city of Cape Coral and
subsequently joined the Lee Health
System in 1996.
As it is the only hospital in the
surrounding area, CCH serves as the
primary source for acute care by
providing obstetrics/gynecology,
general medical/surgery,
neurosurgery, orthopedics, cardiac,
pulmonary medicine, neurology,
intensive care, emergency medicine,
endoscopy, and general/vascular
surgery services to the Cape Coral
community.
CCH is the first community hospital
in Florida to receive the Governor’s
Sterling Award, a prestigious
honor that recognizes excellence
in leadership, strategic planning,
operations, and overall performance.
In addition, CCH earned a Leapfrog
Hospital Safety Grade rating of
“A” in 2020. CCH is also among
Healthgrades Top 100 Best
Hospitals in America as of 2021.
The CCH inpatient pharmacy
department is staffed by 44
employees and includes 21
pharmacists, 16 registered pharmacy
technicians, 2 clinical specialists
(internal medicine and critical care),
2 pharmacy interns, and 1 pharmacy
purchasing specialist. Pharmacists
are incorporated in decentralized
roles on patient care units as well
as the emergency department and
intensive care units.

Pharmacy Report | 5

GOLISANO CHILDREN’S HOSPITAL OF SOUTHWEST FLORIDA

Golisano Children’s Hospital of GCHSWF is
one of 170
Southwest Florida (GCHSWF) is a hospitals
standalone, state-of-the-art facility that nationwide
opened in 2017 on a mission to deliver that belong
vital and lifesaving care for children and to Children’s
their families throughout the Southwest Miracle Network.
Florida region. The hospital offers
GCHSWF provides specialized various community
pharmaceutical care to neonatal intensive outreach programs
care (NICU), cardiac, cystic fibrosis, and conference
neurology, and oncology patients. The to support its Kid
NICU is a Level III facility that has been Minds Matter mission. In Golisano
designated a Regional Perinatal Intensive addition, GCHSWF is part Children’s
Care Center by the Florida Department of solutions for patient Hospital of
of Children’s Medical Services, one of safety network (SPS) Southwest
only 11 such centers in the state and the and affiliates with Johns
only one in Southwest Florida region. In Florida
addition, the State of Florida Department
of Children’s Medical Services designated Hopkins All Children’s
the Hematology/Oncology program Hospital to Advance
as one of just nine centers in the state Pediatric Care in Southwest Florida. Due
for infants and children diagnosed with to the need of local specialized pediatric
cancer and blood disorders. providers, GCHSWF continues to grow
by the addition of specialized services in
From left to right: Ingrid Kelley, PharmD (Pharmacy Manager), cardiology, neurology, and ultimately a
Diana Elnemr, PharmD, CPh, DPLA (Pharmacy Director), and designation a pediatric trauma center.
Melanie Levy, RPhT, CPhT (Pharmacy Technician Supervisor)
The pharmacy department serves
133 beds, two oncology clinics, and a
cystic fibrosis clinic with a team of 18
pediatric trained pharmacists and 15
pharmacy technicians. Pharmacists
are integrated within the patient
care units and cystic fibrosis clinic to
provide interdisciplinary care, and act as
resources for pediatric consultations to
the adult acute care hospitals. GCHSWF
supports transitions of care services
through close collaboration with Lee
Pharmacy at Health Park Medical Center
by coordinating customized pediatric
formulations as patients transition from
the inpatient or clinic setting to home.
In addition, GCHSWF is committed to
providing excellent training experiences
through the PGY-2 Pediatric Residency
Program.

6 | Lee Health

Pharmacy Report | 7

GULF COAST MEDICAL CENTER

Gulf Coast Medical Center (GCMC), Gulf Coast
Medical
established in 2009, is a 356-bed facility Center
that is currently undergoing extensive
expansion of services. Expected growth support safe and effective medication
by Fall 2021 includes 536 acute care management for our inpatient,
beds, 88 intensive care unit beds, an outpatient, diagnostic care areas, and
84-bed emergency department, and a adjacent 75-bed skilled nursing facility.
broad range of outpatient diagnostic and Pharmacy team members are an
treatment departments. integral part of the interdisciplinary
As community needs continue to grow, team in patient care units. Many of our
GCMC offers a variety of services staff pharmacists have continued to
including: interventional cardiology, further their growth by attaining board
orthopedics, general and vascular certification. An additional innovation
surgery, colorectal surgery, oncology, has been the expansion of pharmacy
dialysis, neurology, and neuro-surgery. In technician workflow to support a
addition, GCMC supports the community decentralized model, as their presence
as the only Comprehensive Stroke Center in patient care units and the emergency
in Lee County with an active Neuro department has become fundamental to
Interventional Lab. patient care.
Robust service as a Comprehensive
Stroke Center has earned GCMC the
American Heart Association/American
Stroke Association “Get With The
Guidelines” Gold Plus Stroke Center
designation. GCMC also achieved a
Leapfrog Hospital Safety Grade rating of
“A” in 2020.
Pharmacy services are provided by an
outstanding team of 26 pharmacists and
24 pharmacy technicians and support
personnel. These dedicated individuals

From left to right: Farah Zuberi, MS, RPh,
BCPS, BCSCP (Pharmacy Manager);
Peter Duggan, RPh, CPh, DPLA (Pharmacy
Director); Jennifer Moenander, RPhT, CPhT
(Pharmacy Technician Supervisor)

8 | Lee Health

Pharmacy Report | 9

HEALTHPARK MEDICAL CENTER

Located in the heart of South Fort HealthPark
Medical
Myers, HealthPark Medical Center Center
(HPMC) has been serving the community
with a modern approach to health and HPMC is the recipient of several
wellness since 1991. HPMC is a 460-bed recognitions, such as being named
facility that provides a wide range of the Top 50 Cardiovascular Hospital in
inpatient and outpatient services. the nation by IBM Watson Health. The
HPMC services include cardiology, facility’s cardiac rehabilitation program
obstetrics and gynecology, rehabilitation, is certified by the American Association
radiology, a full-service 24/7 emergency of Cardiovascular and Pulmonary
care center and a 112-bed HealthPark Rehabilitation. In addition, HPMC is one
Care and Rehabilitation Center facility. of 11 hospitals in Florida certified as a
Since opening, HPMC has continued to Regional Perinatal Intensive Care Center.
expand in order to meet the needs of HPMC services include high-risk and low-
the surrounding community. HealthPark risk obstetrical care and is the 3rd busiest
Surgery Services’ growing volumes delivery facility in the state of Florida.
include a full-spectrum of cardiothoracic, HPMC earned an A grade for patient
urologic, pediatric (including safety by The Leapfrog Group, a leading
general, orthopedic, and oncology), healthcare nonprofit organization.
gynecological, and general/vascular HPMC pharmacy department consists of
specialties. 63 caregivers, including 31 pharmacists
The state-of-the-art facility within the and 32 pharmacy technicians. The
surgery department allows for minimally pharmacist team provide services
invasive vascular and specialized heart ranging from inpatient decentralized
procedures such as Endovascular pharmacy services, medication provision
Transcatheter Aortic Valve Replacement to our adjacent Skilled Nursing Facility
(TAVR). This is in addition to other with over 100 beds, as well as pharmacist
robotic procedures that cover several active participation in the outpatient
specialties (cardiothoracic, OB/GYN, support team in the heart failure
urology, and general) which are offered management clinic, rapid diuresis clinic,
at HPMC. and post cardiac catheterization care
management.

From left to right: Yanela Lozano, PharmD,
DPLA, MBA (Pharmacy Director);
Mohit Patel, PharmD, CPh (Pharmacy
Manager) and Jullian Parnell, RPhT, CPhT
(Pharmacy Technician Supervisor)

10 | Lee Health

Pharmacy Report | 11

12 | Lee Health

LEE MEMORIAL HOSPITAL

Lee Memorial Hospital (LMH) was Lee Memorial
Hospital
established in 1916 with ten beds
and repurposed lumber to serve the The Department of Pharmacy at
members of Lee County. As of 2021, LMH Lee Memorial Hospital offers 24/7
has grown from its humble beginnings interdisciplinary patient care services by
to a Level II trauma Center that a professional staff of 27 pharmacists, 27
encompasses 362 beds, those of which pharmacy technicians, and 2 pharmacy
include a Rehabilitation Hospital (60 interns. Pharmacists are integrated in
beds), a Skilled Nursing Unit (18 beds), internal medicine floors, emergency
and Complex Care Center (12 chairs) that medicine department, medical/surgical
are located within the hospital campus. intensive care units, and an outpatient
With exceptional trauma-trained staff, infusion center known as Complex Care
the response power of emergency Center.
medicine services provides 24/7 life- LMH serves as the primary training site
saving trauma care to the residential for the PGY-1 Pharmacy Residency and
communities surrounding Lee County. PGY-2 Critical Care Residency Programs.
LMH continues to provide remarkable The inpatient pharmacy also supports
patient care in Fort Myers for more ambulatory patient care services by
than 100 years with the expansion of coordinating drug distribution and
behavioral health, general surgery, supply of over 100 Lee Physician Group
imaging, infectious disease, family outpatient clinics.
medicine, and vascular surgery.
In 2020, LMH earned an A grade for
patient safety, the highest patient safety
rank, by The Leapfrog Group, a leading
health care nonprofit organization
committed to driving quality, safety, and
transparency in U.S. health systems. LMH
is also a designated Chest Pain Center,
fully accredited by the Society of Chest
Pain Centers. In addition, the Agency of
Health Care Administration designated
LMH as a Certified Primary Stroke Center.

From Left to right: Carla Reid, RPhT, CPhT
(Pharmacy Technician Supervisor), Nina

Farhoudi, PharmD, CPh (Pharmacy Director)
and Farima Fakheri Raof, PharmD, BCPS,

CPh, DPLA, 340B ACE (Pharmacy Manager)

Pharmacy Report | 13

POPULATION HEALTH AND WELLNESS

Prescription Volume Lee Pharmacy

250,000 Lee Pharmacy, established in
200,000 2012, began as two outpatient
150,000 community pharmacies with
100,000 8 employees and evolved into
6 pharmacies with 46 team
50,000 members. Over the span of
0 8 years, Lee Pharmacy has
FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20 experienced a steady growth
in prescription volume and
14 | Lee Health pharmacy services to the
46K Lee Health and Fort Myers
71,867 community. In 2020 alone,
95,640 Lee Pharmacies dispensed
145,002 over 240,000 prescriptions,
178,364 increasing their prescription
192,680 volume by over 10% from the
220,921 previous year.

243,619

There are four Lee Pharmacies Anson Phetteplace,
PharmD, CPh, DPLA
strategically embedded within the adult (Pharmacy Director)
acute care hospitals at Lee Memorial and Michelle Sadler,
Hospital, HealthPark Medical Center, PharmD, BCACP,
Gulf Coast Medical Center, and Cape CPh (Pharmacy
Coral Hospital. These locations focus Manager)
on optimizing transitions of care for
discharge patients from the hospitals residency preceptors this year and have
and emergency departments, as well been working directly with our two
as dispensing outpatient prescriptions pharmacy residents to optimize their
to employees and their dependents. By community pharmacy practice and
incorporating outpatient pharmacies residency experience. Our residents
into the acute care setting, Lee Health are immersed in direct patient care
supports patients further along in the providing counseling, immunizations, and
continuum of care with pharmacy removing barriers to transitions of care
ambulatory services such as medication while simultaneously learning through
education, prescription dispensing, interdisciplinary healthcare experiences.
medication compounding, and
immunizations. The Lee Pharmacy located at Lee Health
The acute care Lee Pharmacy locations Coconut Point is a unique hybrid of
offer a Prescription Bedside Delivery both inpatient and outpatient functions
Program, known as Meds to Beds, to support an emergency department,
which delivers prescriptions directly to a surgery center, and primary care offices.
patient’s room prior to discharge. Meds The outpatient pharmacy is open
to Beds provides the opportunity to for prescription dispensing Monday
proactively identify and resolve barriers through Friday. However, the emergency
in discharge medications. In addition, department provides 24/7 pharmacist
the program allows patients to start services who is crossed trained in both
therapy immediately upon discharge emergency medicine and prescription
and improves patient satisfaction dispensing. The combined services
by preventing an additional trip to a allow patients to get prescriptions filled
community pharmacy before going anytime they are discharged from the
home. emergency department, day or night.
The Lee Pharmacy at Page Field is
situated within a pediatric primary care COVID-19 presented several obstacles
office, adjacent to a convenient care and challenges to normal practice
and multiple specialty offices, allowing this past year. However, the Lee
for integrated pharmacy services during Pharmacy team successfully adapted
patients’ office visit. The pharmacy team to maintain pharmacy services for Lee
collaborates with providers to ensure Health patients. The Lee Pharmacy
patients and caregivers leave their visit team looks forward to 2021 and new
with their medication in hand. opportunities to optimize patient care
In 2020, Lee Pharmacy was excited through interdisciplinary medication
to deploy a PGY-1 Community Based management.
Residency Program. A considerable
number of our ambulatory pharmacists
at Lee Pharmacy have become

Pharmacy Report | 15

16 | Lee Health

Health Plan Pharmacy Synergistic efforts between the
employee health plan design
The Lee Health Plan Pharmacy opened in committee and Lee Health Plan
Pharmacy have resulted in year-
2004 as a mail order pharmacy option for over-year cost containment and
the health system’s self-insured health plan member satisfaction.
beneficiaries. The pharmacy has grown
from dispensing 100 prescriptions per • The per member per month
week to our current volume of over 1,600 (PMPM) prescription costs on
prescriptions weekly, amounting to over the employee health plan are
85,000 prescriptions annually. This volume nearly 12% below the national
accounts for over 50% of all pharmacy average, yielding an annual
claims for the health plan’s 21,000 covered savings of $2.9 million
lives.
In addition to safely and efficiently • The 2018 implementation of
filling maintenance prescriptions for our Epic Willow Ambulatory has
health plan beneficiaries, the pharmacy allowed for improved patient
team assists health plan members with care with access to patients’
formulary concerns, prior authorizations, integrated electronic medical
and claims processing at network records
pharmacies. The staff consisting of 6
pharmacists and 6 technicians at the • The turnaround time for
Lee Health Plan Pharmacy provides prescriptions has been reduced
personalized and superior customer from a high of 7 days to our
service to our colleagues and their covered current rate of 3 days
dependents. In addition, HPP is committed
to the education and training of future
pharmacists by providing a Managed Care
learning experience for PGY-1 Community-
Based pharmacy residents and PGY-2
Health-System Pharmacy Administration
and Leadership residents.

Diane Bush, RPh, CPh
(Pharmacy Manager)

Pharmacy Report | 17

Infusion Centers

Complex Care Center Michael Koleff (Director) and
Complex Care Center (CCC) is a hospital- Kathleen Dolan, RPh (Pharmacy Manager)
based outpatient clinic located in the
Medical Office Building adjacent to Lee Health Home Infusion
Lee Memorial Hospital. The CCC clinic Since 1995 Lee Health Home Infusion
provides a wide range of outpatient has provided medications, treatment
services including transition of care for management, nursing resources, and
post-hospital discharged patients at insurance support to patients requiring
high risk for readmission, wound care home infusion and nutrition support
management, pharmacist-run warfarin therapies. As the practice of home
clinic, and outpatient infusions. infusion therapy has become prominent
Pharmacy services is provided from CCC due to its cost effective benefits
satellite pharmacy located within the Lee Health Home Infusion utilizes
clinic, staffed with pharmacy technicians a 15-member team, which includes
and ambulatory care pharmacists. three pharmacists, two pharmacy
Pharmacists collaborate with providers technicians, three registered nurses,
in development and delivery of patient two dietitians, and distribution and
treatment plans, conduct patient visits billing personnel dedicated to working
for warfarin management, and dispense together to provide compassionate care
intravenous medication infusions. The and personalized service to Southwest
CCC clinic is at forefront of offering Florida residents. The team routinely
innovative patient care options including collaborates with other members of
rapid diuresis for congestive heart failure the Lee Health continuum of care and
and investigational COVID-19 antibody external home care entities to provide
infusions. the best patient experience possible
in the comfort of the patient’s home.
Lee Health Home Infusion is one of the
leading suppliers of nutrition support
in Southwest Florida and services both
the population’s geriatric and pediatric
components. Lee Health Home Infusion
is accredited by the Community Health
Accreditation Partner (CHAP) and has
CMS certification to deliver Medicare and
Medicaid reimbursed therapies in a home
care setting.

18 | Lee Health

Regional Cancer Center Christine Gegeckas, RPh, BCOP, FFSHP
Lee Health Oncology services started (Pharmacy Director)
as Lee Cancer Care in 1998 and evolved
into the Regional Cancer Center
(RCC) in 2008. RCC provides a wide
variety of infusion therapies for adult
outpatients, and until recently, also
prepared adult chemotherapy for
inpatients at all Lee Health facilities.
Infusions include chemotherapy,
immunotherapy, monoclonal antibodies,
as well as treatments for rheumatology,
gastrointestinal disease, and
immunodeficiency.
With over 21,000 infusion preparations
per year, the pharmacy staff of
13, including 3 Board Certified
Oncology Pharmacists (BCOP),
provide comprehensive, collaborative
pharmaceutical services to adult
oncology and other (disease state)
patients. The program has expanded
to add 4 hematologists/oncologists,
with continuous growth planned for
the next year. Pharmacists provide
clinical services to providers and
patients. The oncology program has also
developed a collaborative chemotherapy
stewardship committee to oversee the
appropriate use of patient resources, and
a pharmacist has begun collaborative
services in the physician clinic.
The pharmacy technician and oncology
financial navigator have expanded the
patient assistance program, with an
annual medication cost recovery of
almost $3 million. Recent developments
include the completion of the hazardous
drug mixing area expansion, as well as
the development of an investigational
drug service (IDS). Future goals of RCC
pharmacy are to re-expand patient
education in the infusion center and
clinic, as well as implement physical
expansion of the oncology program.

Pharmacy Report | 19

Lee Health Specialty Pharmacy

Lee Health Specialty Pharmacy, patients monthly. Due to the expertise
of pharmacy team members, Lee Health
based within Lee Health Coconut Specialty Pharmacy provided $9 million
Point, provides unique answers to the in savings to their patients. Pharmacy
challenges patients and healthcare team members provide exceptional
professionals face in providing high and compassionate care through their
cost, high touch therapy to those with coordination of refills, medication
complex disease states. The Lee Health delivery, and periodic assessments and
Specialty Pharmacy team includes interventions.
6 pharmacists and 10 pharmacy Lee Health Specialty Pharmacy
technicians and is currently expanding. also collaborates with inpatient and
Pharmacists are a dedicated resource outpatient pharmacy services to
within neurology, rheumatology, provide support in ordering high cost
pulmonology, and infectious disease medication therapy and serving as a
clinics and focus efforts in ensuring resource for clinical support on specialty
optimized and personalized medication medications. Lee Health Specialty
therapy for each patient. Pharmacy Pharmacy holds ACHC accreditation
technicians work steadily to facilitate and is expected to be dual accredited
prescription coverage, insurance with URAC the end of 2021.
approval, and timely delivery of
medications.
Since opening in February 2020, Lee
Health Specialty Pharmacy has grown
from serving 50 patients to over 3000

Jessica Maroti, RPhT (Pharmacy Liaison), Fredrick Campogni, PharmD, CSP, AAHIVP, 340B
ACE (Clinical Pharmacist), RJ Barker, CPhT (Pharmacy Liaison), Binoy Shah, PharmD, MBA,
CSP, AAHIVP (General Manager), Beth Watkins, RPhT (Pharmacy Liaison)

20 | Lee Health

Skilled Nursing Facilities and Units

Lee Health Pharmacy began servicing and is the pharmacy liaison to the
skilled nursing facilities and units. The
the Skilled Nursing Facility (SNF) and consultant pharmacist works closely
the two Skilled Nursing Units (SNU) in with the in-patient pharmacy team and
July 2020. Providing this new service has the skilled nursing team to improve
given the health system the opportunity patient care at every stage of continuum
to optimize the patient care continuum, including admissions, discharges,
provide a more seamless transition of formulary management, and policy
care to the skilled nursing setting, and development.
coordinate timely placement upon
discharge. The conversion of the three Melinda Garner,
facilities from an external pharmacy PharmD, BCPS and
provider to Lee Health pharmacy Joy Darnell, RPh, CPh
services created savings to fund the
implementation of the Epic LTC module.
HealthPark Care and Rehab Center
is a 112-bed free standing SNF on the
HealthPark Medical Center campus
featuring rehab and long term beds.
Gulf Coast SNU is a newly opened free
standing unit on the Gulf Coast Medical
Center campus consisting of 75 rehab
beds. Lee Memorial SNU is an 18-bed
rehabilitation unit located as a patient
floor within Lee Memorial Hospital’s
campus.
The skilled nursing facilities and units all
feature automated dispensing machines
with over 90% electronic management
and integrated computer services with
the hospital pharmacies. The inpatient
pharmacy manages drug distribution to
these sites. With an average verification
time around 12 minutes, the integration
with Lee Health pharmacy has improved
the availability and timeliness of
medication administration to the skilled
nursing residents. In addition, a safety
process for medication administration
and resident identification bar-code
scanning was an added feature that
was also implemented within the skilled
nursing facilities and units.
A designated full time consultant
pharmacist performs admission drug
reviews, monthly drug regimen reviews,
nursing education, clinical follow up

Pharmacy Report | 21

22 | Lee Health

LeeSar Cooperative Services of Florida

LeeSar is a regionally ranked supply the lowest costs possible. Together
these two companies optimize
chain service organization who financial savings, mitigate supply
provides medications, supplies, shortages, and provide high quality
and services to member healthcare safety services through the use of
organizations. Cooperative Services innovative technology. The pharmacy
of Florida (CSF) serves as the services include a central pharmacy
regional aggregation group in distribution center, a 503B sterile
partnership with Vizient to ensure to sterile compounding pharmacy
the medications supplied and for shortage medications, nuclear
purchased by members remain at pharmacy services, tray exchange
programs, and a first responder
division for the local community
served with Lee Health. The pharmacy
team responsibilities include
working with health system key
stockholders and provider leadership
as well as senior administration to
target collective initiatives, pursue
regional standardization, and
maximize purchasing power through
an established negotiation and
contracting process.

Jonathan Girnys, PharmD, MBA, BCPS
Vice President of Pharmacy Services

Pharmacy Report | 23

Antimicrobial Stewardship

The Lee Health Antimicrobial are conducted through Antimicrobial
Stewardship Subcommittees, which
Stewardship Program aims to optimize are co-chaired by the stewardship
clinical outcomes of antimicrobial pharmacists as well as physician
therapy, minimize unintended effects of champions specific to each setting.
antimicrobials (toxicity, adverse events, These subcommittees report to
selection of resistant pathogens), and Infection Prevention CCG, Pharmacy
provide cost-effective care. and Therapeutics (P&T), and other
The program includes two full- committees as applicable to individual
time infectious diseases clinical initiatives. The program staff and work
pharmacist specialists who oversee groups also collaborate and coordinate
antimicrobial stewardship at the four efforts with the Antimicrobial
adult acute care hospitals as well as Stewardship Program at Golisano
the Rehabilitation Hospital and the Children’s Hospital, which is led by a
Coconut Point Emergency Department clinical pharmacist and physician team.
and a physician champion. The
collaborative operations of the program

From left to right: Elisabeth Chandler, Pharm.D., BCIDP, Megan
Patch, MS, PharmD, BCPS, BCIDP, BCPPS and Ashley Cubillos,
Pharm.D., BCPS, BCIDP

24 | Lee Health

During calendar year 2020, key initiatives for the
Antimicrobial Stewardship Program included:

• Implementation and for acute care, skilled of IV doxycycline and 5%
continual update of internal nursing, and rehabilitation decrease in IV linezolid
COVID-19 antiviral and anti- facilities to the newest ACIP system-wide over 6 months
inflammatory treatment recommendations, resulting
guidelines during the initial in an estimated system cost • Continuation of community
months of the COVID-19 savings of $311,000 per year antimicrobial stewardship
pandemic initiatives, including
• Implementation/update fluoroquinolone use
• Implementation and of multiple guidelines reduction, with sustained
oversight of emergency and treatment pathways, ≥50% decrease in
use authorization, including institutional fluoroquinolone utilization
compassionate use, and antibiograms (including for urinary tract infection
off-label pharmacotherapies a combination anti- treatment at all outpatient
for COVID-19, including Pseudomonal antibiogram), clinic locations (urgent care,
remdesivir, tocilizumab, and pneumonia pathway primary care, and employee
monoclonal antibodies and order sets, renal health)
dosing, polymyxin use,
• Implementation of area pharmacokinetics, and • Reinstatement of the PGY2
under the curve (AUC)-based pediatric maximum antibiotic Infectious Diseases Pharmacy
vancomycin monitoring, dosing Residency Program
with the goal of improving
safety of vancomycin while • Implementation of education • Initiation and completion
maintaining positive clinical and data feedback of multiple research and
outcomes regarding pharmacist- medication use evaluation
driven intravenous-to-oral projects for optimization of
• Revision of pneumococcal conversion, resulting in a 10% antimicrobial use across the
vaccination recommendations decrease in administrations system

IV Doxycycline Administrations Antimicrobial Stewardship - IV to PO iVents

80% 300

70% 250

60% 200

% Administrations50% 150
# iVents
40% 100

30% 50

20% 0
Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20
10%

0% Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20
Apr-20 May-20 Jun-20

Cape Coral Hospital Gulf Coast Medical Center
HealthPark Medical Center Lee Memorial Hospital

Pharmacy Report | 25

Informatics and Automation

The Pharmacy Informatics (IT) Team provides comprehensive support to the Lee

Health Pharmacy personnel in all aspects of medication ordering, preparation,
dispensing, administration, charging, decision support, and reporting. The team
comprises a collaborative effort of 7 pharmacists, 7 pharmacy technicians, 1 registered
nurse, and 1 information systems analyst.
While the Pharmacy IT team is dedicated to maintaining and troubleshooting existing
systems, these responsibilities account for only roughly 25% of workflow. As Lee
Health continues to grow and expand patient care service lines, the Pharmacy IT
team’s primary goal is to facilitate change. As such, the majority of the IT work effort
is focused on implementing new projects across the health system. In the past year,
major projects included the implementation of Beacon Oncology, upgrade to Pyxis
ES, and provision of COVID-19 Vaccine support.

Primary Support Areas: Recent accomplishments:
■ PDMP integration into Epic
■ Inpatient and outpatient pharmacies, ■ Implementation of e-prescribing
Specialty pharmacy, Complex Care of controlled substances (EPCS)
Center, Regional Cancer Center ■ Meds to Beds program
implementation and support
■ Individualizing the ordering, ■ Supporting rapid turnaround and
administering, or prescribing solutions to meet patient care
medications based on employee needs relative to COVID-19
position ■ Implementation of the Epic
Long Term Care module and
■ Supported applications/activities: converting pharmacy services
from an external provider to
◆ Epic Willow Inpatient, Ambulatory, internal
and Inventory ■ Implementation of Smiths
Medical CADD Solis PCA/
◆ Epic Beacon Oncology Module (go- Epidural infusion pumps
live August 2021) ■ Implementation and support of
Specialty Pharmacy services in
◆ BD Pyxis ES (upgraded from Pyxis coordination with Trellis Rx
4000) and BD Remote Assist ■ Expanded pharmacy data models
within Epic Slicer/Dicer reporting
◆ Emporos MerchantSoft Point of Sale tool
system

◆ MacroHelix 340b Software
◆ Baxter Abacus TPN Compounding

software/EM 1200 and EM 2400 TPN
Compounders
◆ Baxter Care Everywhere Drug
Library software/Sigma Infusion
pumps
◆ Smiths Medical PharmGuard
software/Medfusion 4000 Syringe
pumps/CADD Solis PCA pumps
◆ Cardinal E-recovery patient
assistance program
◆ E-prescribing
◆ Diversion Surveillance

26 | Lee Health

Training and Education From left to right: Emily Lowande, RPhT, CPhT (PAT); Andy
■ Initial Epic training to all new Murrin, RPhT, CPhT, (PAT), Chris Scott, PharmD (Manager
inpatient pharmacy department Pharmacy Informatics) and Justin Soto, RPhT, CPhT (PAT)
employees, residents, and students PAT: Pharmacy Automation Technician
■ Pharmacy Informatics Learning
Experience elective to PGY1 and
PGY2 residents
■ Pharmacy Tips of the Week: weekly
newsletter that provides updated
changes to pharmacy staff

Lee Health | IS Hours by Category

36% Production Support, Maintenance & Upgrades
28% Administrative
13% New Work - Enhancements
1% IT Staff Training
13% New Work - Projects
1% Discovery Hours
8% IT Staff PTO

Pharmacy Report | 27

EDUCATION AND TRAINING

Lee Health Educational Focus
Continuing Education Hours Provided
Lee Health has been an ACPE
1,250 accredited Continuing Education
1,000 Provider since 2008. Our ACPE
educational mission is to provide
750 easily accessible, evidence-based,
500 and relevant educational offerings
250 based on the educational needs
of our health-system pharmacists
0 and technicians. Due to the
2016 2017 2018 2019 2020 diversity of pharmacist specialties
and technician responsibilities
Lee Health ACPE within our health system, we offer
a wide variety of educational
28 | Lee Health offering to meet the needs for
Hours education across the spectrum
532 of practice. Our Lee Health
534 Residents provide at least one
341 ACPE accredited program during
633 the residency year. In 2020
we have developed 47 unique
1,136 education programs and awarded
over 1000 hours of accredited
hours to our employees.

Pharmacy Technician Training Program

The Pharmacy Technician Training inpatient, ambulatory, and pediatric
inpatient pharmacy settings.
Program (PTTP) at Lee Health provides Following program completion,
essential skills needed to successfully instructors offer support in preparation
practice in the adult acute care and for the Pharmacy Technician Certification
outpatient pharmacy setting, as well as Exam. As of 2021, the program has
specialty areas such as pediatrics and achieved a 98% graduation rate, 98%
chemotherapy. As the only American Florida pharmacy technician registration
Society of Health-System Pharmacists rate, 73% Lee Health retention rate, and
(ASHP) and Accreditation Council for is on track to earn a 73% Pharmacy
Pharmacy Education (ACPE) accredited Technician Certification Board (PTCB)
pharmacy technician program serving certification rate.
Southwest Florida, the PTTP is designed The Lee Health PTTP offers a dynamic
to educate, train, and retain students as educational experience for pharmacy
employees after program completion. technician students while empowering
The 21-week program provides them to become high-achieving
experience in a multi-health system leaders in the pharmacy profession.
environment, including didactic, Overall, pharmacy technician students
simulation, and experiential training. will be able to cultivate relationships
Students dedicate 400 hours to didactic with patients and a multi-disciplinary
topics, such as pharmacology and healthcare team to provide optimal
mathematical calculations, as well as patient-centered care and meet
simulation training including aseptic our evolving healthcare system’s
technique, proper garbing, IV mixing, challenging needs.
reconstitution, and repackaging. In
addition, students gain a total of 220
hours in experiential training in the adult

Pharmacy Technician Training Class Spring 2021
Pharmacy Report | 29

Doctor of Pharmacy Training Program

Lee Health provides experiences for both pharmacy clinical services and complete
a medication use evaluation (MUE).
advanced and introductory pharmacy Many students present their MUE results
practice experiences in the acute care in a poster format at state or national
and community settings. Lee Health was meetings. Lee Health utilizes a layered
an innovator in the state of Florida with learning approach where our students
the implementation of our advanced work closely with both PGY1 and PGY2
pharmacy practice experience (APPE) residents. Residents precept students
Block Program in 2011. Over the last during core rotation activities as well
decade our program has ranged between as system-wide activities including
65-90 student months of rotations per weekly educational presentations, topic
year. Rotations are scheduled at different discussions and the Student-Resident
Lee Health campuses to allow for Forum which guides students through
exposure to a wide variety of preceptors the residency application process. APPE
and patient populations. We offer all Block Program students complete a
the core required rotations and more Grand Rounds presentation and are
than twelve different elective rotations. assigned a Lee Health Mentor to support
Students participate in pharmacy and them through their time at Lee Health
system level committee meetings, serve and beyond.
as pharmacy extenders in the provision of

Pharmacy Internship Program

Established in 2020, Lee Health’s exposed to clinical and operational
Pharmacy Intern Program was pharmacy processes as well as direct
created from our desire to further the patient care activities. Pharmacist
development of the next generation of interns are involved in medication
pharmacists. In addition to the Doctor reconciliation, patient education,
of Pharmacy Training Program, Lee medication distribution, sterile and
Health Pharmacy Services is invested in nonsterile compounding, and other
providing exceptional educational and supportive functions.
experiential opportunities to pharmacist We are excited that our robust program
interns to better prepare them as they allows us to retain pharmacist interns
enter the profession. into resident or staff positions post-
In its inaugural year, the program graduation. In the future, we expect
employed 11 pharmacist interns across to grow our program into additional
the health system, including acute care pharmacy practice areas and offer
and community pharmacy practice this educational and development
settings. Throughout the duration of opportunity to more Doctor of
the program, pharmacist interns are Pharmacy candidates.

30 | Lee Health

Pharmacy Residency Program

The pharmacy residency programs at had a total of 44 first-year resident
Lee Health are committed to providing graduates, of which 20 have pursued a
excellent training experiences that second-year in residency training. Eleven
support the resident’s clinical, academic, first-year residents have stayed at Lee
and professional interests. The programs Health to continue their PGY-2 training.
are dedicated to preparing future Second year residency program types
pharmacy clinicians and leaders by have included: Oncology, Infectious
promoting confidence, leadership and Diseases, Health System Pharmacy
professional skills. Administration and Leadership (HSPAL),
Since the start of our programs in Critical Care, Pediatrics, Emergency
2008, we have graduated a total of 51 Medicine, and Internal Medicine. Twenty
pharmacy residents from our Lee Health of our resident graduates are currently
PGY-1 and PGY-2 programs. We have working at Lee Health.

PGY-1 Pharmacy Residency for continuing education credit. The
Our PGY-1 Program provides unique Dose Newsletter rotates it’s focus each
opportunities focused on our department month with The Dose of Pediatrics,
strengths in research, leadership, writing The Dose of Critical Care and The Dose
and teaching. Infectious Diseases each providing an
In addition to their major research in-depth review of recent evidence-
project which is presented at the Florida based literature or recently published
Residency Conference each Spring, Lee guidelines.
Health residents conduct a medication Residents complete the Lee Health ACPE
utilization evaluation (MUE) in the fall Teaching Certificate which provides them
of the residency year with the results with formal training in the delivery of
presented as a poster at the American pharmacy education in order to prepare
Society of Health-System Pharmacists for their future role preceptors.
Midyear Meeting.
PGY-1 Residents participate in two PGY-1 Residents from left to right: Natilee Azzara, Julianna Hennig,
longitudinal learning experiences, Stephanie Ducas, Kelsey Smith, Ellen Volovich, Shelly Kearns and
Administration and Leadership Seminar, Erica Bergeron
which provide the residents with
exposure to key concepts in Medication
Use Process, Medication Safety, Quality/
Performance Improvement, Legal and
Regulatory Compliance, Leadership,
Human Resources, Transitions of Care,
Information Systems, and the Business of
Pharmacy. Each resident then chooses
an area of focus for a one-month learning
experience.
The Lee Health residents publish a
newsletter three times a month that is
accredited by both ACPE and ACCME

Pharmacy Report | 31

PGY-1 Community-Based PGY-2 Critical Care
Pharmacy Residency
The PGY-1 Community-Based Pharmacy The PGY-2 Critical Care Pharmacy Residency,
Residency Program, established in 2020, established in 2015, offers a robust training
provides exceptional training opportunities experience to advance the resident’s clinical
for pharmacists to optimize their skills in skills, knowledge base, and professional
community and ambulatory care settings. interests in critical care pharmacy.
PGY-1 Community-Based residents are exposed
to direct patient care activities in the adult The program incorporates training sites across
patient populations within interdisciplinary four adult acute care hospitals in areas such as
collaborative practices.
Education and community outreach are ■ HealthPark Medical Center Cardiology ICU
integrated into the residency year through and Surgical ICU
brown bag events, immunization clinics,
medication therapy management sessions, and ■ Lee Memorial Hospital Medical ICU
patient education services. In addition, PGY-1 ■ Lee Memorial Hospital Surgical/Trauma ICU
Community-Based residents publish The Dose ■ Lee Memorial Hospital Emergency Medicine
of Community Practice as a part of the routine ■ Infectious Disease Consult
resident newsletter publication series.
PGY-1 Community-Based residents also develop In addition, elective learning experiences within
project management skills as they implement the health system include
process improvements and service lines in the
community and ambulatory care setting. As of ■ Gulf Coast Medical Center Neurology ICUs
2020, the inaugural class of PGY-1 Community- ■ Nutrition Support
Based residents developed and implemented ■ Antimicrobial Stewardship
a Medication Therapy Management Service at ■ Inpatient Hematology/Oncology
Lee Health. ■ Preceptor of PGY1 on Medical ICU

PGY-2 Residents from left to right: Jeanette Alava (HSPAL), The PGY-2 Critical Care Pharmacy Resident
Ian Murphy (ID), Arielle Charles (Pediatrics) and Sahar also develops strong presentation, publication,
Matloub (Critical Care) and project management skills throughout
their training via the monthly publication
of The Dose of Critical Care Newsletter, the
presentation of two formal ACPE accredited
lectures, coordinating the Lee Health Code Blue
Competency class, and completing the bi-
annual review of the Lee Health Renal Dosing
Chart.

■ PGY-2 Critical Care resident alumni are

• Amy West – Critical Care Clinical Specialist
(Medical/Surgical/Emergency Medicine)
for Orlando Health Dr. P. Phillips Hospital,
Orange County, FL

• Paul Ahearn – Critical Care Clinical
Specialist (Medical/Cardiac ICU) for
Bridgeport Hospital, Bridgeport, CT

• Michelle Henninger – Critical Care Clinical
Pharmacist (Surgical ICU) for Cleveland
Clinic, Weston, FL

• Kelly Groover – Critical Care / Oncology
Pharmacist for Lee Health, Fort Myers, FL

32 | Lee Health

PGY-2 Health System Pharmacy Administration and Leadership

The PGY-2 Health System Pharmacy ■ Financial Management
Administration and Leadership In addition, elective learning experiences
residency program, established in 2014, within the health system can be focused
is designed to develop the resident’s on Pediatrics, Oncology, Education
skills, knowledge base, and professional and Training, etc. The PGY-2 HSPAL
interests in pharmacy practice leadership. Resident develops strong presentation
skills through chairing of system wide
The program incorporates learning committees such as Pharmacy and
experiences integrated in the entire Therapeutics, Pharmacy Director’s
health-system, which comprise various Meeting, and Medication Safety, as well
patient populations and pharmacy as leading process improvements and
service lines (i.e. adult and pediatric transactional changes.
population, acute care, ambulatory, and
community services). The PGY-2 HSPAL ■ PGY-2 HSPAL resident alumni are
resident completes overlapping learning • Jonathan Girnys – Vice President
experiences such as of Pharmaceutical Services,
LeeSar CSF, Fort Myers, FL
■ Human Resources • Farima Fakheri Raof – Pharmacy
■ Business Development Manager, Lee Memorial Hospital,
■ Clinical Practice Management Fort Myers, FL
■ Community Practice • Michelle Estevez – Clinical
■ Acute Care Pharmacist, Lee Health Coconut
■ Medication Safety and Quality Point, Estero, FL

PGY-2 Infectious Diseases ■ Elective learning experiences the
resident can be exposed to include:
■ The PGY-2 Infectious Disease • Emergency Medicine
Pharmacy Residency, started in 2011, • Inpatient HIV
is dedicated to developing infectious • Informatics
disease pharmacy clinicians through • Pediatric Antimicrobial
advancing knowledge, leadership Stewardship/Infectious Diseases
and professional skills. Consult

■ Core learning experiences across the ■ In addition, residents will be involved
health system include: in various longitudinal learning
• Microbiology experiences including a longitudinal
• Critical Care research or quality improvement
• Antimicrobial Stewardship project, PGY2 Newsletter (The Dose
(I and II) of Infectious Diseases), two ACPE
• Antimicrobial Stewardship programs, and pharmacy practice
Administration service.
• ID Consult (I and II)
• HIV Clinic

Pharmacy Report | 33

■ PGY-2 Infectious Diseases resident • Jonathan Cho – Assistant Professor,
alumni are University of Tyler, TX

• Mike Turk – Antimicrobial • Marylee Worley – Assistant Professor,
Stewardship Pharmacist, St. Elizabeth Nova Southeastern University College
Healthcare, Edgewood, Kentucky of Pharmacy, Ft. Lauderdale, FL

• Emily Weisz – Infectious Diseases • Aileen Martinez – Infectious Disease
Clinical Specialist, Bridgeport Specialist, Cleveland Clinic Martin
Hospital, CT Health, Stuart, FL

• Edgar Turner – Emergency Medicine • Lauren Tesh Hotaki – Antimicrobial
Pharmacist, Lee Health, Ft Myers, FL Drugs Advisory Committee/
Oncological Drugs Advisory
• Megan Patch – Pediatric Infectious Committee, Designated Federal
Diseases Clinical Specialist, Golisano Officer, CDER, OEP, FDA
Childrens’ Hospital of Southwest
Florida, Fort Myers, FL

PGY-2 Pediatrics includes Pediatric Medical/Surgical
■ The PGY-2 Pediatric Pharmacy Care, Pediatric Intensive Care I &II,
Neonatal Intensive Care, Pediatric
Residency, started in 2017, is Infectious Diseases and Antimicrobial
committed to providing excellent Stewardship, Pediatric Hematology/
training experiences to advance the Oncology, Pediatric Emergency
resident’s clinical skills, knowledge Medicine, and Scholarly Research.
base, and professional interests. The
program is dedicated to preparing ■ In addition to the core rotations,
future pediatric pharmacy clinicians residents will be involved in various
and leaders by promoting confidence, longitudinal learning experiences
leadership and professional skills. such as Project Management, PGY2
■ The training site at Golisano Newsletter (The Dose of Pediatrics),
Children’s Hospital of Southwest Clinical Practice Advancement,
Florida is a free-standing pediatric Medication Safety, Pharmacy Practice
hospital with 128 beds. Required core Leadership, Pharmacy Practice
rotations are four to six weeks and Experience (Service), Pediatric
Cystic Fibrosis Clinic, and a Teaching
Residency Program Directors from left to right: Suzanne Turner Certificate Program if not previously
(PGY-1), Mallory Fiorenza (PGY-2 Critical Care), Anson Phetteplace obtained. Current elective rotations
(PGY-1 Community-Based), John Armitstead (PGY-2 Health System include Neonatal Intensive Care and
Pharmacy Administration and Leadership), Ashley Cubillos (PGY-2 Obstetrics and Gynecology.
Infectious Disease), Julie Tremblay (PGY-2 Pediatrics)
■ PGY-2 Pediatrics resident alumni are
• Christina Schwarz – Pediatric Clinical

Pharmacy Manager for Driscoll
Children’s Hospital, Corpus Christi, TX
• Elizabeth Faville – Pediatric Clinical
Pharmacist for Sarasota Memorial
Hospital, Sarasota, FL
• Christopher Kennie-Richardson –
Pediatric Clinical Pharmacist for
Moses H. Cone Memorial Hospital,
Greensboro, NC

34 | Lee Health

Performance and Quality Improvement

RESEARCH Florida Residency Conference abstract, and final
Lee Health Pharmacy Services encourages research manuscript.
and development through the activities of the The IRC, also known as an Institutional Review
Research and Scholarly Subcommittee (RSS) and Board, is a group of individuals who review, monitor
Lee Health Institutional Review Committee (IRC). and approve or disapprove human subject research
RSS is a subgroup of the Residency Advisory at Lee Health. The IRC comprises non-scientific
Council that is responsible for the oversight, review, and scientific members who provide oversight
and approval of medication use evaluations (MUE) to roughly 150 protocols at any given time, with
and major research projects for PGY1 and PGY2 pharmacy contributing approximately 10 research
residents. The subcommittee prioritizes projects protocols annually.
based on the impact to the health system, time Over the past two years, pharmacy research has
needed for completion, appropriateness for included:
publication or presentation, and expected level
of research team expertise (i.e. student, resident, 2020-2021 Statistics
practitioner, specialist, management). All MUEs ■ Medication Use Evaluations: 11
and major research projects conducted within the ■ Resident Research Projects: 9
health-system are presented to RSS for approval
and feedback is provided on project design, 2019-2020 Statistics
data collection, and IRC submission proposal. ■ Medication Use Evaluations: 10
Furthermore, an RSS member is assigned to each ■ Resident Research Projects: 9
resident as a reviewer over the course of the year
for their major research project. The reviewer • Keenan C, Armitstead JA, Fakheri Raof, F.
provides feedback on the resident’s ASHP poster, Strengthen the Pharmacy Technician Pipeline.
Advisory Board Pharmacy Executive Forum
PLATFORM PRESENTATIONS National Webinar 2019.
2021
• Armitstead JA. Strategic Planning for Health • Moulton J. Turner S. Integrating CPD into
System Pharmacy in Turbulent Times. Premier/ Your CPE Program. ACPE Spring Education
Acurity Webinar 2021. Conference 2019.
2020
• Reed BN, Armitstead JA. Leading the Future • Roberson A. Dagam J. Turner S. Those Pesky
Workforce: Balancing Innovation with Policies: Developing Effective Residency
Resilience. American Society of Health System Policies American Society of Health-System
Pharmacists Virtual Conference for Pharmacy Pharmacists National Preceptor Conference
Leaders 2020. 2019.
2019
• Armitstead JA. Controlled Substances Part II • Von Waldner T. Turner S. Baumgartner J. CPD
Medication Assisted Treatment. Florida Society Across Pharmacy Education and Practice. CE
of Health System Pharmacists Annual Meeting Pearls: ACPE Spring Education Conference
2019. 2019.
• Cubillos A. Cavert W. Boeser K. Impact of an
Electronic Pharmacist Driven Antimicrobial 2018
Stewardship Tool on Carbapenem Utilization in • Armitstead JA. Building the Pharmacy
an Academic Medical Center. MAD ID Annual
Meeting 2019. Technician Pipeline. The Advisory Board,
• Dagam J. Turner S. Phillips B. Quality Counts: Advisory Board Pharmacy Executive Committee
Writing Meaningful References American Meeting 2018
Society of Health-System Pharmacists National • Armitstead, JA. Continuous Professional
Preceptor Conference 2019. Development, Succession Planning and
Interacting with the C-Suite. Acurity Annual
Meeting 2018.

Pharmacy Report | 35

• Elizabeth B. Hirsch, Delaney E. Hart, Ashley Practical Strategies for Overcoming the Hurdles
Piche, Ashley L. Cubillos, Kira R. Beaulac, et al. A of the Opioid Epidemic. American Society of
Multi Center Evaluation of Outcomes following Health-System Pharmacists Midyear Clinical
Treatment with Ceftolozane Tazobactam. Global Meeting 2018
Conference on Clinical Pharmacy 2018. • Turner S. Chang J. Purposeful Preceptor
Development Moving From Surviving to
• Fiorenza M. Critical Care Track: Management of Thriving. American Society of Health-System
Alcohol Withdrawal in the Critically Ill Patients. Pharmacists National Preceptor Conference
Florida Society of Health System Pharmacists 2018.
Annual Meeting 2018.
• Groover K, Henninger M, Fiorenza MA, Johnson
• Kirschling TE, Armitstead JA, Schaafsma K. CA, Hamel MG. Evaluation of the Effects of Pre-
hospital Administered Ketamine for Agitation or
POSTER PRESENTATIONS Procedural Sedation on Hospital Length of Stay
2019-2020 and Mechanical Ventilation Days Critical Care
• Alava JA. Armitstead JA. Lozano Y. Evaluation Congress 2020.
of Adult Acute Care Hospital Pharmacy
Productivity Metrics. American Society of • Henninger M, Fiorenza MA, Feroz AM. Lactated
Health-System Pharmacists Midyear Clinical Ringers versus Normal Saline in Critically Ill
Meeting 2020. Patients and the Incidence of Acute Kidney
• Bergeron E. Charles, A. Patch M, Masse, Injury. Critical Care Congress 2020.
H, Stovall, S. Antimicrobial Stewardship
Opportunities for IV to PO Conversion in • Kearns S. Matloub S, Fiorenza F, Taillon J, Pammi
Pediatric Patients with Intra-Abdominal S. Assessment of an Anticoagulation Protocol
Infections. American Society of Health-System for Coronavirus Disease 2019 Patients within a
Pharmacists Midyear Clinical Meeting 2020. Community Health-System. American Society
• Cader A, Newton E, Gilmartin E. Alert of Health-System Pharmacists Midyear Clinical
Fatigue Reduction Utilizing Ketorolac Meeting 2020.
Pharmacodynamics. American Society of Health-
System Pharmacists Midyear Clinical Meeting • Volovich E, Smith K, Acosta C, Gatskevich E,
2020. Chandler E. Assessing ceftaroline utilization
• Cubillos A, Chandler E, Patch M, Saunders M, within a multicenter community health-system.
Lynch L, Gieselman M, Calkins K. Antimicrobial American Society of Health-System Pharmacists
Stewardship Intervention Bundle Decreases Midyear Clinical Meeting 2020.
Fluoroquinolone Prescribing for Urinary Tract
Infection in Urgent Care and Primary Care • Ahearn P, Fiorenza MA, Taillon J. Adjunctive
Clinics. Poster Presentation at ID Week 2020 Dexmedetomidine with Benzodiazepines
• Ducas S, Murphy I, Chandler E, Saunders M, Compared to Benzodiazepines Alone in Critically
Cubillos A. Empiric utilization of antimicrobials Ill Patients with Alcohol Withdrawal Syndrome:
targeting multidrug-resistant organisms in Effect on Length of Stay. American Society of
the management of community-acquired Health-System Pharmacists Midyear Clinical
pneumonia at a multicenter community health Meeting 2019.
system. American Society of Health-System
Pharmacists Midyear Clinical Meeting 2020. • Chandler E, Palavevecino E, Johnson JW,
• Fiorenza MA, Barkes J, Naik SK. Adjunctive Oral Beardsley JR, OhiCA, Luther FP, Williamson JC.
Midodrine Treatment in Critically Ill Patients: Impact of Minimum Inhibitory Concentration
Effect on Weaning Intravenous Vasopressors. on Clinical Outcomes of Daptomycinfor VRE
Critical Care Congress 2020. Bacteremia among Neutropenic Oncology
• Groover K, Fiorenza MA, Kasiewicz J. High versus Patients. ID Week 2019.
Low Rate Continuous Hypertonic Saline Infusions
for Traumatic Brain Injury: Effects on Sodium • Cubillos A, Hart DE, Gallagher JC, Puzniak
Levels. Critical Care Congress 2020. LA, Hirsch EB; for the C/T Alliance to deliver
Real-World Evidence (CARE). Ceftolozane-
tazobactam(C/T) treatment outcomes in

36 | Lee Health

immunocompromised (IC) patients with • Quarterman K, Terry D, Hernandez A.
multidrug-resistant (MDR) Pseudomonas Implementation of a 4T score upon ordering
aeruginosa (PA) infections. ID Week 2019. a Heparin platelet factor 4-antibody and
• Estevez M, Phetteplace A, Armitstead JA, Kolson the influence on patient outcomes in a large
J, Pugh R. Readmission rate reduction of Bedside community health system. American Society
Prescription Delivery Service and Discharge of Health-System Pharmacists Midyear Clinical
Medication Reconciliation Approved by Meeting 2019.
Pharmacist Programs, Florida Society of Health
System Pharmacists Annual Meeting 2019. • Tabulov C, Estevez M, Fiorenza M, Shenoy G.
• Evans R, Kearns S, Tran T. An assessment of Impact of filter lifetimes on delivered effluent
haloperidol given on override status for acute rates in patient receiving citrate and non-citrate
agitation and delirium at Lee Health. American anticoagulation therapy during continuous
Society of Health-System Pharmacists Midyear renal replacement therapy. American Society
Clinical Meeting 2019. of Health-System Pharmacists Midyear Clinical
• Faville E, Tremblay J, Monge R. Comparison of Meeting 2019.
two sedation assessment scales on the dose and
duration of analgesia and sedation medications • Thorp E, Dungca A, Cubillos A, Saunders M.
in critically-ill ventilated pediatric patients. PPAG Utility of procalcitonin in the discontinuation
2019 of antibiotics for respiratory tract infections.
• Fiorenza M, Cader A, Parmeet S. Outcomes American Society of Health-System Pharmacists
Associated with High versus Low Dose Midyear Clinical Meeting 2019.
Corticosteroids in Mechanically Intubated
Patients with Acute Exacerbations of Chronic • Turner E, Cubillos A, Wilson S, Britt N. Cultures
Obstructive Pulmonary Disease. Critical Care Prior to Empiric Antimicrobial Administration in
Congress 2019. the Management of Bone and Joint Infections.
• Groover K, Hill K, Fiorenza M, Kole M. American Society of Health-System Pharmacists
Utilization of angiotensin II in a community Midyear Clinical Meeting 2019.
health system. American Society of Health-
System Pharmacists Midyear Clinical 2018-2019
Meeting 2019. • Bahr R, Tirb K, Fakheri Raof F, Duggan P.
• Guglielmo K, Oyebanjo M, Estevez M, Volovich
E. Assessing the appropriate use of injectable Evaluation of hospital inpatient naloxone use in
calcitonin within a multi-hospital health-system. a health-system. American Society of Health-
American Society of Health-System Pharmacists System Pharmacists Midyear Clinical Meeting
Midyear Clinical Meeting 2019. 2019
• Kastrati S, Cubillos A, Reynolds S. Management • Barkes J, Faville E, Patch M, Stovall S. Review of
of Aspiration Pneumonia in the ICU setting. Staphylococcus aureus colonization polymerase
American Society of Health-System Pharmacists chain reaction and chromagar plate screenings
Midyear Clinical Meeting 2019. on selection of or a change in antimicrobial
• Kennie-Richardson C, Thorp E, Patch M, Stovall therapy within a community pediatric hospital.
S. Attainment of Therapeutic Trough Levels American Society of Health-System Pharmacists
in Pediatric Patients Receiving Vancomycin. Midyear Clinical Meeting 2019
American Society of Health-System Pharmacists • Brubaker BK, Duggan PA, Kole M, Phetteplace
Midyear Clinical Meeting 2019. AL, Armitstead JA. Reducing COPD Patient
• Patel R, Wallace J, Slomer J. Impact of a Readmissions with Pharmacist Intervention.
collaborative transition of care center on Florida Society of Health System Pharmacists
preventing hospitalizations and reducing Annual Meeting 2018.
readmission rates. American Society of Health- • Estevez M, Rolfe M, Hire R, Peterson D.
System Pharmacists Midyear Clinical Meeting Evaluation of periprocedural use of cangrelor in
2019. patients with antiplatelet requirements within a
multi-hospital health system. American Society
of Health-System Pharmacists Midyear Clinical
Meeting 2019.
• Fakheri Raof F, Fiorenza M, Armitstead J,
Saunders M. Optimizing Patient Outcomes and

Pharmacy Report | 37

Reducing Cost by Managing Acid Suppressive hemorrhage. American Society of Health-System
Therapy Prescribing. American Society of Health- Pharmacists Midyear Clinical Meeting 2019.
System Pharmacists Leaders Conference 2018. • Raof F, Hire R. Evaluation of Risk Factors for
• Faville E, Turner S, Armitstead JA. Strength in Hemorrhagic Transformation after Alteplase
Numbers: Assessing the Use of Strengthsfinder for Ischemic Stroke in a Community Healthcare
in a Pharmacy Residency Program. Florida System. Florida Society of Health System
Society of Health System Pharmacists Annual Pharmacists Annual Meeting 2018.
Meeting 2018. • Thorp E, Duckworth K, Fakheri Raof F, Hsin-
• Groover K, Henninger M, Fiorenza M, Johnson Cheng D. Evaluation of Intranasal Midazolam
C, Harnel M. Evaluation of the effects of pre- Administration in Pediatric Emergency
hospital administered ketamine for agitation Department Patients for Pre-Procedural
or procedural sedation on hospital length of Anxiolysis. American Society of Health-System
stay and mechanical ventilation days. American Pharmacists Midyear Clinical Meeting 2019.
Society of Health-System Pharmacists Midyear • West M, Jenkins D, Duggan P, Fakheri Raof
Clinical Meeting 2019. F. Evaluation of medication errors identified
• Pinero B, Sheridan R, Nancarrow D, Hire R, by pharmacists during discharge medication
Khan J. Evaluation of the duration of epilepsy reconciliation. American Society of Health-System
prophylaxis in aneurysmal subarachnoid Pharmacists Midyear Clinical Meeting 2019.

PUBLICATIONS • Rolfe M, Gegeckas C, Turner S, Orr
JW. Predictive factors for carboplatin
• Armitstead JA, et al. Executive summary of hypersensitivity reactions in gynecologic
the meeting of the 2020 American Society of cancers: Effect of BRCA status. J Oncol
Health-System Pharmacists Commission on Pharm Pract. Published online October 25,
goals: preparing the healthcare workforce for 2020:107815522096798.
a digital future. American Journal of Health-
System Pharmacy. 2021;78(5):447-453. • Steve Rough, BSPharm, MS, FASHP, Rita
Shane, Pharm.D, FASHP, FCSHP, John A
• DiPiro JT, Armitstead JA, et al. American Armitstead, BSPharm, MS, FASHP, Sylvia M
Society of Health-System Pharmacists Belford, Pharm.D, MS, CPHIMS, FASHP, Philip W
foundation pharmacy forecast 2021: strategic Brummond, Pharm.D, MS, FASHP, David Chen,
planning advice for pharmacy departments in BSPharm, MBA, Christine M Collins, BSPharm,
hospitals and health systems. American Journal MBA, Heather Dalton, Pharm.D, Anna Legreid
of Health-System Pharmacy. 2021;78(6):472- Dopp, Pharm.D, Michelle M Estevez, Pharm.D,
497. DPLA, BCPS, David R Hager, Pharm.D, BCPS,
Brooke Halbach, Pharm.D, BCPS, Ryan Hays,
• Faville E, Turner S, Armitstead JA. Strengths in Pharm.D, BCPS, Scott Knoer, Pharm.D, MS,
numbers: Assessing the use of StrengthsFinder FASHP, Desi Kotis, Pharm.D, FASHP, Derek
2.0 in a pharmacy residency program. Montgomery, Pharm.D, MS, Brooks Plummer,
American Journal of Health-System Pharmacy. Pharm.D, Melissa R Riester, Pharm.D, Diana
2020;77(Supplement_3):S66-S70. J Schreier, Pharm.D, MBA, BCPS, Deborah
Simonson, Pharm.D, Mark H Siska, BSPharm,
• Horner D, Altshuler D, Droege C, Feih J, MBA, FASHP, Kelsey Waier, Pharm.D, Lee C
Ferguson K, Fiorenza MA, Greathouse K, Vermeulen, BSPharm, MS, FCCP, FFIP. The
Hamilton L, Pfaff C, Roller L, Stollings J, Wong high-value pharmacy enterprise framework:
A. Major publications in the critical care Advancing pharmacy practice in health systems
pharmacotherapy literature: January-December through a consensus-based, strategic approach.
2016. J Crit Care. Am J Health-Syst Pharm. 2021; 78(6):498-510.

• Lozano Y, Armitstead JA, et al. Letters from
Leaders in Pharmacy. American Journal of
Health-System Pharmacy. 2021.

38 | Lee Health

340B Program

340B Summary staff all possess advanced 340B certifications
and bring years of relevant experience to the
The 340B Drug Discount Program is a US program.

Federal Government program created in 1992 The in-house 340B auditor performs various
with the intent to “stretch federal resources as program self-audits on a monthly, quarterly, and
far as possible, reaching more eligible patients yearly basis as well as assisting with external
and providing more comprehensive services.” audit requests as needed. The auditor reviews
The program, enforced by the Health Resources more than 6000 claims annually for compliance
and Services Administration (HRSA), requires with eligibility requirements and the prevention
drug manufacturers participating in Medicaid of diversion, GPO prohibition, and duplicate
to provide outpatient drugs to eligible health discounts.
care organizations and “covered entities” at
significantly reduced prices. The 340B analyst works closely with pharmacy
teams throughout the health system to
Lee Health has participated in the 340B assist with inventory management and the
program since 2009 as a disproportionate share maintenance of each pharmacy’s billing and
hospital. Specifically, this means that Lee Health recording software. These efforts assure
is a not for profit health system which serves compliance and yield optimal benefits from
a high percentage of Medicare and Medicaid the 340B program. Purchasing reports are
covered patients. The scope of the 340B generated on a monthly basis to check for
program at Lee Health includes Lee Memorial possible inaccuracies as well as opportunities.
Hospital, Healthpark Medical Center, Golisano
Children’s Hospital, the Regional Cancer Center, Effective communication between the 340B
Coconut Point, certain hospital-owned retail Compliance Team and system pharmacy
pharmacies, numerous outpatient clinics, and leadership is assured via bi-monthly 340B
several contract pharmacy arrangements Compliance and Operations team meetings
as well as participation in system pharmacy
(i.e. Walgreens, CVS leadership meetings. This collaboration assures
Specialty, Walmart, that appropriate resources are dedicated where
Publix, etc.). Since its appropriate, that findings are appropriately
inception in 2009, communicated and acted upon, and that
the Lee Health 340B policies and procedures remain current and
program has grown effective.
from 9 registered
locations to its present In addition to audits from drug manufacturers
235 active registrations. and regulatory bodies (i.e. HRSA), Lee Health
undergoes an annual on-site audit conducted
From left to right: Monika In 2017, the complexity by an independent third party vendor. The
Bartsch, MBA, BSBM, CPhT, RPhT, and scope of the 340B findings and feedback generated by this annual
340B ACE(Pharmacy and 340B program at Lee Health review is then evaluated for possible areas of
Program Compliance Auditor), combined with the improvement.
Joseph Bitner, Pharm.D., CPh, growing regulatory
CHC, 340B ACE (Pharmacy requirements prompted The 340B program at Lee Health
and 340B Program Compliance the development of successfully completed its first ever HRSA
Officer) and Blake Whitney, CPhT, a 340B Compliance audit in 2020. Also in 2020, despite
RPhT, PRS, 340B ACE (Pharmacy Officer position. This the unprecedented challenges posed
and 340B Program Compliance was followed by the by COVID-19, over $26 million in cost
Analyst) addition of a program avoidance and revenue was retained by
auditor in 2019, and the system as a result of the program.
an analyst in 2020.
The 340B Compliance

Pharmacy Report | 39

Professional Recognition

AWARDS & LEADERSHIP ROLES • John A. Armitstead. Joby Kolsum DO, Raymond
• Amanda Teckenbrock. American Society of Pugh. Readmission Rate
Health-System Pharmacists Reduction of bedside
Florida Society of Health Distinguished Leadership prescription delivery service
System Pharmacists, Award Recipient 2020 and discharge medication
Pharmacy Technician of the reconciliation approved by
Year 2019 • John A. Armitstead. Florida a pharmacist programs.
• Doug Peterson. Florida Society of Health System Florida Society of Health
Society of Health System Pharmacists, Chair of House System Pharmacists Poster
Pharmacists Preceptor of of Delegates 2020. Award 2019
the Year 2019 • Rakhi Patel. University of
• Farima F. Raof. Florida • John A. Armitstead. Get The Florida Outpatient Preceptor
Society of Health-System Medication Right Institute, of the Year 2020
Pharmacists Educational Practice and Care Delivery • Suzanne Turner. Chair,
Affairs Council Member Transformation Workgroup American Society of
2018-2021 2020-2021 Health-System Pharmacists
• Jeanette A. Alava. Florida Commission of Credentialing
Society of Health-System • Lee Health Pharmacy 2020
Pharmacists, Educational Resident Publication “The • Tina Gegeckas. Florida
Affairs Council Member Dose”. Florida Society of Society of Health System
2020 Health System Pharmacists Pharmacists, Fellow Award
• John A. Armitstead. Institutional Newsletter of 2019
American Pharmacists the Year 2020
Association, Health System
Strategy Council 2020-2021 • Michelle Estevez PharmD,
Anson Phetteplace, PharmD,
John Armitstead, RPh.,

CERTIFICATIONS Farah Zuberi (dual) Mariam Oyebanjo
Farima Fakheri Raof Mary Lynn Skruck
BCPS (Pharmacotherapy) Gloria Hwang (dual) Megan Patch (three)
Ann Ghattas Jack Dean Melanie Rolfe
Arya Cader (dual) Jenny Butler Melinda Garner
Ashley Cubillos (dual) Joe Macpherson Michelle Claman
Beth Wells Julie Katz Michelle Estevez
Bradley Murnyack Kari Duckworth Myles Hersey
Catalina Acosta (dual) Kelly Groover Nicole Morrison
David Ball Kristen Crawford (dual) Rakhi Patel (dual)
Dawn Jelinek Kristin Quarterman Regina Evans (dual)
Doug Peterson Lexie Hoffman Ron Cabibihan
Edgar Turner (three) Mallory Fiorenza (dual) Ryan Hire (dual)
Erika Walters
Estelle Sanchez-Marrero (dual)

40 | Lee Health

Sarah Doyle Jesse Grojean BCPPS (Pediatric)
Scott Morrison Mallory Fiorenza Ashley Nebbia
Shannon Pierce Stephanie Tears Glen Kelton
Stephanie Tears (dual) Julie Tremblay
Steve Bromley BCCP (Cardiology) Megan Patch
Sunmi Park Ryan Hire Michael Barberio

BCACP (Ambulatory Care) BCIDP (Infectious Disease) BCSCP (Sterile
Arya Cader Ashley Cubillos Compounding)
Bryan Brubaker Edgar Turner
Elisa Whitney Liz Chandler Farah Zuberi
Michelle Sadler Megan Patch Gloria Hwang
Rakhi Patel Ivonne Reyes
Sarah Stull BCOP (Oncology)
Jeanine Ewing CCGP (Geriatric)
BCCCP (Critical Care) Kristen Crawford Gretchen Petrie
Catalina Acosta Tina Gegeckas Steve Kessinger
Edgar Turner
Estelle Sanchez-Marrero BCPP (Psychiatry) CNSC (Nutrition Support)
Regina Evans Ray Norman

DPLA (AMERICAN SOCIETY OF HEALTH-SYSTEM PHARMACISTS PHARMACY LEADERSHIP ACADEMY)

Anson Phetteplace Jeanette Alava Peter Duggan

Arya Cader Jonathan Girnys Shannon Previty

Diana Elnemr Mariamo Oyebanjo Stephen Kessinger

Farah Zuberi Michelle Estevez Suzanne Turner

Farima F. Raof Mohit Patel Yanela Lozano

ADVANCED 340B OPERATION CERTIFICATION – APEXUS

Blake Whitney Joseph Bitner

Farima F. Raof Monika Bartsch

PHARMACY TECHNICIAN CERTIFICATIONS

Danielle Santos, Billing Whitney Hummel, Medication
and Reimbursement History, Billing and
Certificate Reimbursement, Technician
Product Verification,
Compound Sterile
Preparation Technician

Pharmacy Report | 41

© Lee Health 2021 • Pharm 6/21