A more confident, and clinical, me

Residents Corner By Briana Cosca, PharmD

Following my graduation from the University of Montana in 2016, I moved to Portland, OR, to start my community pharmacy practice residency with Fred Meyer and Washington State University. My personal residency objectives were to learn how to successfully implement and grow clinical services and to develop myself as a pharmacy practice leader. While my residency year did fulfill these objectives, what I really learned was how the role of the community pharmacist is expanding, and how it is changing the overall practice of pharmacy. 

Pharmacist prescribing
There is always an adjustment period when starting a residency, including acclimating to the rapid pace of day-to-day tasks and perfecting to-do list strategies. However, my adjustment period included adapting my skillset to that of a pharmacist prescriber. Coming from a state with limited abilities for pharmacists to prescribe in the community setting, I was blown away by what Oregon and Washington pharmacists are able to do as part of the daily community pharmacy workflow.

In Washington, our practice sites prescribe medications under 19 different collaborative drug therapy agreements (CDTAs), including antibiotics for UTIs, travel medications, and diabetic testing supplies. In Oregon, all pharmacists are authorized to prescribe hormonal contraception and naloxone in accordance with state protocols. With these services established prior to the start of my residency, I had to learn policies and procedures quickly, as I was rapidly seeing patients who were requesting prescriptive clinical services.

At the start of my residency, I was not comfortable with my ability to accurately assess patients and identify indications for prescription medications. In this, and other areas as well, I lacked confidence in my knowledge and skills as a pharmacist. Fortunately, I had several patient and encouraging preceptors who guided me through the residency, my learning experiences, and the complex decision-making process necessary to prescribe. Each time I concluded a travel consultation with a prescription for malaria prophylaxis or documented a hormonal contraceptive visit, I gained confidence, not just in myself, but in the direction that the profession is heading.

Finding my voice
By the end of my residency year, I had not only written dozens of prescriptions as a community pharmacist in Oregon and Washington, but I had also assisted in implementing and modifying policies and procedures for several prescriptive clinical services and CDTAs. I have found my leadership voice through coaching pharmacy teams to follow best practices when prescribing medications, and found new and creative ways to raise public awareness of these clinical services.

My last few days of residency were spent making adjustments to policies and procedures from a Washington tobacco-cessation CDTA for implementation in Idaho, in response to a new statute authorizing Idaho pharmacists to prescribe all FDA-approved smoking cessation medications. I have grown from a fledgling pharmacist who was insecure in the role of prescriber to one who is confident and capable of driving the expansion of the role of community pharmacist into this new territory.

What comes next?
Moving on from the break-neck pace of residency will be a new challenge for me as I begin my role as a community pharmacist in southern Oregon. I am looking forward to taking what I have learned this past year and applying it to my new team to help drive our prescriptive clinical services even further. Residency has given me a voice and a desire to continue to push the limits of what pharmacy practice can be.

I am also excited about the next steps currently being taken to grow pharmacist prescriptive authority in Oregon. This past legislative session saw the approval of a state law to implement a pharmacist formulary of medications. I look forward to working on the implementation of this newest advancement in pharmacy practice in my new home state and the new opportunities it will bring.

Residency is a year of living firmly outside your comfort zone. My biggest take away this year is the knowledge that this has made me a stronger community pharmacist, leader, and person. I learned that the best learning experiences come from being open to what is new and uncomfortable for you. Do this, and your future self will thank you.

Good luck in whatever comes next!