[Original publication date 7/5/2024] Diversion management starts before a new staff member walks in the door. It is looking for red flags, even before any access to medications is given. It starts before any staff is hired and can be before an interview is offered. Most hiring managers assume that the human resources team is doing their due diligence to monitor for potential issues that may arise, but without asking questions and knowing the process, it is possible that expectations do not meet reality. In addition, we assume that licensing boards are also watching for possible risk factors, but many of us have not reviewed the business and professions code related to licensing and possible loss of license, which may not factor in every misdemeanor charge.

To start from the beginning means that the pharmacy diversion lead needs to meet with human resources to define a set guideline for onboarding any new employee. This information should be shared with your diversion committee or group, and guidelines should be created for screening new hires. This includes “deal breakers,” for example a Driving Under the Influence (DUI) or other charge related to alcohol, illegal, or dangerous drugs within the last 3 years, regardless of felony or misdemeanor status.

This may also mean training human resources staff on how to properly review a professional license, including any public documents and the charges to the applicant by the board. Knowing the issue and the timeline of events better allows the hiring manager to make an educated decision on hiring, and/or can allow the diversion team to better monitor those at a higher risk. For example, a recent hire had public documents about past diversion and substance abuse treatment at a prior facility. This was not discovered until possible diversion occurred at the current facility. The knowledge of the past diversion would have helped decrease the risk to the new institution, the staff member, and most importantly the patients he was treating.

If the decision is made to hire a licensed staff member, prior to giving them access to automated dispensing machine (ADM), the system access request should require the staff member to acknowledge their risk of diversion. This includes asking questions regarding past infractions, but also asking about any current or pending investigations at previous facilities and/or within other localities or states. It is also important to identify the system access request form as a legal document, so that should a new staff member choose to put inaccurate information on the form, termination can be considered.

The system access request form allows the diversion team and the pharmacy informatics team to capture individuals at high risk who may have not been identified by human resources. For example, an employee may have been hired but while waiting to be onboarded was arrested for a DUI, or an employee recently left an institution after being placed under investigation for diversion but with a licensing board that is only starting the investigation process.

In summary, diversion management is not just what is occurring within the walls of the institution. It starts when a person applies to your facility. It is critical to research all avenues for areas of concern, and to ask important questions and understand the current licensing and onboarding process. It is every member of the team’s responsibility to ensure that the staff, facility, and patients are at the lowest risk possible.

[Original publication date 9/3/2024] - Pharmacy technicians are the backbone of successful pharmacy operations. In health system inpatient pharmacies, they handle complex tasks such as sterile compounding, inventory management, controlled substance security, automation oversight, and handling of hazardous medications. They work tirelessly behind the scenes to ensure patients receive safe and quality pharmaceutical care. The ongoing shortage of qualified pharmacy technicians is a significant barrier to progress in an evolving healthcare landscape in the era of technological revolution.

Over the past decade, almost all states have introduced licensing and national certification requirements for pharmacy technicians. Despite these new requirements, salaries and benefits for these positions have not kept pace, leading to a significant industry lag. The shortage was further exacerbated by increased burnout during the COVID-19 pandemic and a growing workload due to an aging population, stricter regulations around sterile compounding, and increasing complexity of tasks.

In health system inpatient pharmacies, the technician shortage is a major challenge, second only to drug shortages. Recruiting, onboarding, and training technicians are time-consuming processes, and staffing gaps lead to stress, lower morale, and additional vacancies. To address this issue, consider implementing competitive pay and hiring incentives, a career ladder, flexible scheduling, awareness campaigns, and robust training programs.

Competitive Pay and Hiring Incentives: Pharmacy technicians earn between $30,000 and $50,000 annually, with advanced roles reaching $50,000 to $60,000. The Bureau of Labor Statistics projects a 6% increase in job outlook for pharmacy technicians over the next year. Health system pharmacies should partner with local HR teams to conduct a thorough market pay review and implement competitive salaries and benefits to attract candidates. Additional incentives, such as sign-on bonuses and tuition reimbursements, are also effective in drawing more candidates.

Career Ladder: Offering career advancement opportunities can attract high-caliber candidates. These types of candidates are the most productive and committed members at the core of pharmacy operations. Positions like operations coordinator, lead/supervisor, chemotherapy specialist, IT specialist, and quality/regulatory compliance lead are becoming more popular and can attract committed technicians.

Flexible Scheduling: For 24/7 health system inpatient pharmacies, creating schedule flexibility can be challenging. Leaders should review workflow plans to identify opportunities for flexible shift times and adjust schedules to attract candidates who cannot commit to rigid hours. Consider shifting repetitive tasks to more popular hours, such as 8 a.m. to 5 p.m.

Awareness Campaigns: The shortage is partly due to a lack of public awareness about the career prospects for pharmacy technicians. Use social media, local job fairs, and presentations at high schools and colleges to promote the role and attract interest from potential candidates.

Robust Training Programs: Collaborate with local academic institutions offering pharmacy technician programs. These students often struggle to find hospital sites for their externships, so creating opportunities for them can benefit both the candidates and the department to evaluate if it’s a good fit.

In summary, pharmacy technicians are crucial to running safe and efficient pharmacy operations. Addressing the shortage with these strategies can help ensure a steady supply of skilled professionals.

Pharmacy design is evolving, driven by advancements in technology, a deeper understanding of workflow optimization, and an increased focus on medication safety and staff well-being. The future of pharmacy design depends on a comprehensive approach that integrates state-of-the-art technology, ergonomic principles, and a patient-centered mindset. This article explores the trends and key considerations shaping the pharmacy of tomorrow, highlighting how strategic design improvements can enhance efficiency, ensure safety, and improve patient outcomes.

Embracing Technological Advancements

Integration of cutting-edge technology is paramount in modern pharmacy design. As pharmacy operations expand and grow in complexity, leveraging technology is critical to function. Automated dispensing systems, robotic medication management, and advanced inventory tracking should not be futuristic concepts, but indispensable components of an efficient pharmacy. These technologies streamline operations, reduce errors, and allow staff to focus on patient care.

Impact of Technology on Pharmacy Operations

• Reduced Medication Errors: One study reported a 63% decrease in potential adverse drug events and a 96% relative reduction in dispensing errors after implementation of barcode technology in a hospital pharmacy.¹
• Increased Efficiency: One hospital pharmacy achieved a 7-minute turnaround time and an average accuracy of 99.48% after implementation of an automated dispensing system.²
• Inventory Optimization: Upgrading dispensing technology and properly managing automated dispensing cabinets can decrease inventory stockouts and generate significant cost savings through enhanced inventory management.³

Prioritizing Ergonomics and Staff Well-Being

The physical design of a pharmacy must prioritize staff well-being, as studies show that employee satisfaction is linked to higher customer satisfaction.⁴ Ergonomically designed workstations analogous to airplane cockpits reduce physical strain and increase productivity. Poor working conditions have been shown to contribute to medication errors.⁵ Survey data found that pharmacy personnel who are at risk of experiencing high distress have a twofold risk of making a medication error.⁶ Intentional staff-centered design can mitigate these risks.

Designing for Medication Safety and Regulatory Compliance

Good workflows significantly impact medication and patient safety, so it should come as no surprise that safe medication practices should be at the forefront of pharmacy design. In a global systematic review, the World Health Organization reported a 5% prevalence of preventable medication-related harm.⁷ One study at an academic hospital observed that 21% of medication errors went undetected by pharmacists during verification.⁸ Designing workflows that emphasize safety, combined with a commitment to regulatory compliance, ensures patient protection.

Enhancing Collaboration and Communication

Effective communication and collaboration among pharmacy staff and other healthcare professionals are essential for delivering high-quality care. Convenient access to patient data improves medication management and reduces errors stemming from miscommunication. Pharmacy design should incorporate spaces and workstation lines of sight that facilitate teamwork and information sharing. Quiet workspaces that promote concentration and minimal interruptions are crucial for tasks that require high levels of focus. Distractions are linked to 45% of medication errors.⁹

Conclusion

Thoughtful pharmacy design has immense potential to transform healthcare and pharmacy operations. By embracing technology, prioritizing ergonomics, ensuring medication safety, and fostering collaboration, we can create efficient pharmacy environments that deliver high-quality patient care, ultimately improving patient outcomes.

References:

1. Poon EG, Cina JL, Churchill W, et al. Medication Dispensing Errors and Potential Adverse Drug Events before and after Implementing Bar Code Technology in the Pharmacy. Annals of Internal Medicine. 2006;145(6):426. doi:https://doi.org/10.7326/0003-4819-145-6-200609190-00006
2. Temple J, Ludwig B. Implementation and evaluation of carousel dispensing technology in a university medical center pharmacy. American Journal of Health-System Pharmacy. 2010;67(10):821-829. doi:https://doi.org/10.2146/ajhp090307
3. Labuhn J, Almeter P, McLaughlin C, Fields P, Turner B. Supply chain optimization at an academic medical center. American Journal of Health-System Pharmacy. 2017;74(15):1184-1190. doi:https://doi.org/10.2146/ajhp160774
4. Chamberlain A, Zhao D. The Key to Happy Customers? Happy Employees. Harvard Business Review. Published August 19, 2019. https://hbr.org/2019/08/the-key-to-happy-customers-happy-employees
5. Pharmacy Workplace and Well-Being Reporting (PWWR) PWWR Report X Second Quarter 2024. American Pharmacists Association; 2024:1-11. Accessed September 24, 2024. https://www.pharmacist.com/Advocacy/Well-Being-and-Resiliency/pwwr
6. Pharmacy Staff | Mental Health Resources | Rising Stress Levels. National Association of Boards of Pharmacy. https://nabp.pharmacy/initiatives/pharmacy-practice-safety/mental-healt…
7. World Health Organization. Global Burden of Preventable Medication-Related Harm in Health Care. World Health Organization; 2024.
8. Cina JL, Gandhi TK, Churchill W, et al. How Many Hospital Pharmacy Medication Dispensing Errors Go Undetected? The Joint Commission Journal on Quality and Patient Safety. 2006;32(2):73-80. doi:https://doi.org/10.1016/s1553-7250(06)32010-7‌
9. Cohen MR, Smetzer JL. Safe Practice Environment Chapter Proposed by United States Pharmacopeia; Sulfamethoxazole/Trimethoprim and Lisinopril Hyperkalemia. Hospital Pharmacy. 2009;44(3):210-213. doi:https://doi.org/10.1310/hpj4403-210

In hospital settings, medication reconciliation stands as a cornerstone in patient safety efforts, ensuring accurate medication histories and preventing adverse drug events. Pharmacy technicians play a pivotal role in this process, offering indispensable support to pharmacists and healthcare teams. As hospital pharmacy leaders and executives navigate the complexities of healthcare delivery, harnessing the full potential of pharmacy technicians in medication reconciliation becomes paramount for optimizing patient outcomes and operational efficiency.

The Role of Pharmacy Technicians in Medication Reconciliation

Pharmacy technicians are instrumental in ensuring comprehensive and accurate medication reconciliation processes within hospital environments. Their responsibilities include gathering medication histories from patients and caregivers, verifying medication lists, and documenting relevant information for pharmacists and clinicians. By meticulously reviewing discrepancies and collaborating with other healthcare providers, technicians help mitigate risks associated with medication errors and improve overall patient safety.

Moreover, pharmacy technicians are adept at utilizing technology-driven solutions for reconciling medications across transitions of care, such as admissions, transfers, and discharges. Their proficiency in pharmacy information systems and electronic health records enables them to streamline workflows and maintain up-to-date medication records, thereby supporting seamless transitions and continuity of care for patients.

Upson Regional Medical Center (URMC) streamlined their medication reconciliation processes in 2021 when they deployed a single pharmacy technician to the Emergency Department (ED) to assist nursing with obtaining medication histories. This initiative resulted after experiencing increased and continuous reports of medication errors related to medication reconciliation. One-year post implementation, their rate of medication errors related to inappropriate or inaccurate medication histories had reduced by 80%. To this date, URMC has added a second pharmacy technician to the ED, allowing seven-day coverage, and have achieved the Leapfrog standard for medication reconciliation. Heather Riggins, Director of Pharmacy at URMC, states that hiring competent pharmacy technicians and ensuring they are trained up to obtain the best possible medication history is critical.

Strategies for Hiring Qualified Pharmacy Technicians

To bolster medication reconciliation efforts, hospital pharmacy leaders should adopt strategic approaches for hiring qualified pharmacy technicians:

1. Competency-Based Recruitment: Implementing competency-based assessments during the hiring process ensures that candidates possess essential skills in medication reconciliation, attention to detail, and proficiency in pharmaceutical software systems. URMC administers a didactic exam that includes matching generic/trade names for the top 200 drugs, identifying appropriate indications for medications, and hypothetical case studies for critical thinking skills.

2. Collaborative Hiring Practices: Involving pharmacists and competent pharmacy technicians in the recruitment process facilitates the selection of candidates who align with the hospital’s patient safety goals and organizational culture. URMC utilizes peer interviews for all hiring candidates, which includes a tour of the pharmacy and hospital. This gives our entire department buy-in on potential new hires. During the tour, staff can observe how the interviewing candidate presents themselves, interacts with others in the organization, and communicates in a more laid-back setting versus at the head of table. Additionally, the peer interview team conducts a mock patient scenario for medication reconciliation to test the candidate’s attention to detail and communication skills.

3. Continued Professional Development: Emphasizing the importance of ongoing education and certification encourages pharmacy technicians to stay abreast of evolving practices in medication reconciliation and enhances their contribution to patient care. URMC candidates are encouraged to obtain specialized training and receive reimbursement for these efforts.

Developing a Strong Training Program

Creating a structured training program is integral to preparing pharmacy technicians for their role in medication reconciliation:

1. Comprehensive Orientation: Offering thorough orientation sessions familiarizes new hires with hospital protocols, medication reconciliation procedures, and the importance of patient safety standards. Society of Hospital Medicine Train the Trainer Materials provides an excellent supplemental guide for training.

2. Hands-On Experience: Providing opportunities for practical training under the supervision of experienced pharmacists and pharmacy technicians allows new hires to refine their skills in medication history taking, data entry accuracy, and effective communication with patients and healthcare teams.

3. Continuous Feedback and Evaluation: Implementing regular performance evaluations and feedback sessions enables technicians to identify areas for improvement and ensures adherence to quality standards in medication reconciliation practices.

4. Integration of Technology: Incorporating training modules on pharmacy information systems and electronic health records equips technicians with the necessary tools to facilitate efficient medication reconciliation processes.

By investing in the recruitment of skilled pharmacy technicians and cultivating a culture of continuous learning and development, hospital pharmacy leaders can strengthen medication reconciliation initiatives. Empowering pharmacy technicians with the knowledge, resources, and support they need fosters collaborative healthcare environments where patient safety remains the top priority.

The role of pharmacy technicians in medication reconciliation is indispensable for ensuring accurate medication histories and promoting patient safety in hospital settings. Through strategic recruitment practices and comprehensive training programs, pharmacy leaders can harness the full potential of technicians to optimize medication reconciliation processes and enhance overall healthcare outcomes. By prioritizing these efforts, hospitals can uphold the highest standards of care and improve the well-being of patients across transitions of care.

References:

https://www.hospitalmedicine.org/clinical-topics/medication-reconciliat…

Technological advancements in the world within the last 50 years have brought society to a place that one could only dream of some years back. The pharmacy field is no stranger to technology and has shown tremendous changes and progress in this area. Only fifteen years ago, many facilities still utilized faxing of paper orders and manual processes during central pharmacy dispensing. IV admixture did not include barcoding; a pull-back method (where a pharmacy technician would compound an admixture and simply fill used syringe barrel with an air, setting the plunger to the mark of supposedly used volume) was a daily practice.

Today, pharmacy operations rely heavily on automated processes. The main reason for this transition is safety, efficiency and reliability. It is a known fact that robotic machinery has a significantly lesser chance of error, as compared to manual fills in medication dispensing. It is also known that barcode scanning while dispensing a medication, or restocking automated a cabinet, significantly reduces chances of mislabeled medications leaving the pharmacy and reaching patients.

When evaluating a new automation system, it is important to consider how it will perform during downtime. Key questions to ask the vendor include:

• Will the equipment use Active Directory login, and if so, will network outages prevent end users from logging in?
• How easily accessible is the medication inventory during downtime?
• Will the equipment remember transactions during downtime, and can these transactions be reconciled later?
• How user-friendly is the system, and can an average technician or pharmacist service it without difficulty?
• How resilient is the equipment to cyber incidents, and will it continue to function during a ransomware attack?

Asking these questions helps build robust processes and ensure system reliability.

The above concept of emergency preparedness was put to the test during the recent CrowdStrike incident. A faulty software update resulted in a devastating downtime event, affecting not only the healthcare industry but also airlines, large and small businesses, and people around the world.

Many hospitals across the country had to delay or cancel their surgical procedures and business operations reverted to paper. This incident exposed the internal vulnerabilities of many automation systems in the pharmacy world, including automated medication dispensing cabinets. The importance of timely, yet controlled software updates come to mind. For the system to operate safely and reliably – scheduled software updates are needed. It is advisable to have those updates manually pushed to medication dispensing cabinets, on schedule, rather than allowed to be automatically loaded. Software feature enhancements should always be carefully reviewed by the designated end-users, prior to load. It is best to have automated updates on medication dispensing cabinets and other vital equipment (such as infusion pumps, robotics, carousels, anesthesia carts) applied manually, on schedule, in collaboration with the facility’s information technology department support.

In today’s pharmacy, automation is used every step of the way from purchasing, to receiving medications, to dispensing, packaging, processing, and administering. Ensuring procedures are in place to enhance patient safety, data integrity, and business continuity is a step that every facility should be working on daily.

In June of 2023, Techdow USA Inc., a division of the Hepalink Group, successfully launched Enoxaparin Sodium (Enoxaparin) in multiple strengths of pre-filled syringes. Techdow USA’s Enoxaparin is critically needed and will be used primarily in the outpatient setting to treat and prevent harmful deep vein thrombosis and pulmonary embolisms. Techdow USA’s parent company, the Hepalink Group, is a global leader in naturally extracted active pharmaceutical ingredients (API) and finished drugs that sources from an extremely diverse and robust supply chain network. 

Techdow USA sources materials from North America, Europe, and Asia. Additionally, Hepalink Group owns and operates Scientific Protein Laboratories (SPL), the largest producer of Heparin API in North America. SPL’s API business was created by Oscar Mayer in the 1970s and is a global leader in naturally extracted API production. The Hepalink Group has expanded their worldwide offerings to now include manufacturing and marketing of their high-quality and reliable finished drug products in the USA. 

Techdow USA launched Heparin Sodium injection in 2022 followed by their next launch of Enoxaparin Sodium injection. Both Enoxaparin and Heparin Sodium are a complement to the Hepalink Group’s sophisticated vertically integrated products supply chain that provides increased supply reliability, competitive pricing, and robust quality. 

The Hepalink Group, a global supplier to the market and trusted partner to the largest pharmaceutical companies, is delighted to provide our customers with the opportunity to directly access the market’s largest global supply of our finished drug products, Enoxaparin and Heparin. Techdow USA’s products provide patients and customers the supply reliability they demand and deserve

Techdow USA is a high-performance pharmaceutical company that is committed to quality and reliability to our patients and customers. We develop, manufacture, and sell critical FDA approved products such as Heparin and Enoxaparin Injection for use in hospital and clinical settings. We are vertically integrated in raw materials and can deliver hard to source products at a competitive price.

Techdow USA is among the fastest growing companies in our industry and are always looking for ways to improve and set a new high-performance standard. We are passionate about making a difference for patients and bringing effective medicines to market. 

The healthcare industry is undergoing rapid change, placing pharmacy operations at a critical juncture. As drug prices rise and reimbursement rates fluctuate, health systems are increasingly seeing the untapped potential of retail pharmacy services as a key tool for generating revenue and improving patient care. This shift calls for innovative strategies to maximize revenue in pharmacy settings while maintaining a careful balance between financial sustainability and high-quality patient care.

In recent years, the role of pharmacies within health systems has seen significant change. No longer viewed simply as a cost center, pharmacies are now recognized as potential profit drivers and essential parts of integrated care delivery networks. This shift, highlighted by a recent Premier survey of health system leaders, is not just about financial gains. It reflects a broader approach that addresses financial challenges while also supporting population health efforts and improving patient outcomes.

One of the most promising opportunities for increasing revenue is reducing hospital readmissions. With the annual cost of 30-day readmissions reaching $41.3 billion, or $13,800 per Medicare patient, the financial impact is considerable. Onsite retail pharmacies are in a strong position to address this issue by providing thorough medication counseling before discharge, which significantly reduces the chances of readmissions and emergency department visits.

The advantages of onsite retail pharmacies extend far beyond readmission reduction. Research indicates that nearly 30% of patients fail to fill their initial prescriptions within a week of discharge. The mere presence of an onsite pharmacy serves as a powerful visual catalyst, markedly increasing the probability of prescription fulfillment. It has been proven time and time again across the United States that pharmacists embedded within healthcare systems can offer immediate interventions that their external counterparts often cannot, recommending cost-effective alternatives, facilitating connections with financial assistance programs, and collaborating directly with inpatient care teams to address potentially hazardous prescriptions, thereby enhancing patient safety and care quality.

For eligible hospitals, the 340B Drug Pricing Program represents a significant avenue for revenue enhancement, with participating retail contract pharmacies reporting returns on investment as high as 15%. However, capitalizing on this opportunity demands meticulous record-keeping, regular price file updates, robust tracking systems, and a comprehensive understanding of the regulatory landscape.

Efficient inventory management emerges as another crucial factor in revenue maximization. The implementation of advanced inventory systems, coupled with data analytics for demand prediction and strategic negotiations with wholesalers, can substantially reduce costs and enhance cash flow. Regular evaluations of slow-moving items and consideration of alternative sourcing further optimize inventory operations.

Diversification of revenue streams through expanded clinical services offers yet another avenue for growth. Comprehensive medication therapy management programs, immunization services, and specialty pharmacy offerings for high-cost medications can significantly augment revenue while simultaneously improving patient care.

To truly flourish in this evolving landscape, health systems must think beyond their current operational paradigms. This may involve geographic expansion to high-traffic locations, forging partnerships with local employers to access new patient populations, or implementing mail-order services to enhance convenience, foster customer loyalty, and meeting the consumer where they are at by getting with the times of technology and delivery.

As many organizations continue to scale for success, it is imperative to understand that maximizing revenue capture in pharmacy operations demands a nuanced and multifaceted approach that harmoniously balances strategic expansion, operational efficiency, and an unwavering commitment to patient care. By conceptualizing their retail pharmacies as strategic assets capable of enhancing care delivery, mitigating readmissions, and generating substantial revenue, health systems can position themselves advantageously in the increasingly complex healthcare ecosystem.

As we navigate this transformative era, those who can adeptly maneuver through these intricacies and embrace this comprehensive approach will not only ensure the financial sustainability of their pharmacy operations but will also play a pivotal role in shaping the future trajectory of healthcare delivery. The pharmacy of tomorrow transcends its traditional role as a mere dispensary, emerging as a key player in the dual pursuit of superior health outcomes and financial stability for health systems nationwide.

References: Tarr, L. D., & Lupica, S. (2004). Workers\u27 Compensation. https://core.ac.uk/download/232791407.pdf

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I strongly believe that every medical center needs a dedicated medication safety leader. The American Society for Health-System Pharmacy (ASHP) published a position statement on the Role of the Medication Safety Leader that I highly encourage all pharmacy directors to read. Medication safety simply cannot be another hat one wears as a pharmacy manager or director who is also managing budgets, monitoring financial performance, implementing cost-saving measures, addressing regulatory concerns, maintaining a competent and engaged staff, and more! A medication safety leader sets the medication safety vision, identifies opportunities to improve the medication-use process, and leads efforts and initiatives to prevent medication errors. For those who have bought into this idea and secured the funding to hire a dedicated medication safety leader, wonderful and congratulations!  Here are some tips on what to look for in your future medication safety leader along with how to assess for these traits during the interview.  The same ASHP position statement referenced above lists 19 characteristics that medication safety leader should have which I agree with 100%.  I am going to add (or highlight) five (5) more.

1. Assertive, but not aggressive. “Appropriate assertiveness” is already listed as a desirable characteristic on the position statement (characteristic #15), but I want to call out the need for the appropriate assertiveness and why to avoid aggressiveness. Medication safety leaders are often put into the position of having to convince various levels of leadership of something- to heed the lessons of medication errors, to consider a new process, to implement safety technology, etc. Many of which are unpopular ideas from the start for a variety of reasons: cost, level of effort to implement, increased workload, or even normalcy bias (the concept that an outside error won’t happen here).  Appropriate assertiveness refers to advocating for safety to the right stakeholders, at the right forum, and at right time.  Being aggressive does not help to convince leadership. Instead, it turns them away.  During an interview, ask candidates about how they manage conflict or how they respond to criticism and look for non-verbal cues such as eye-contact and tone to assess for assertiveness.
2. Highly organized. At any given moment, medication safety leaders are juggling a multitude of projects and initiatives at various stages – some in flight, some they are still advocating or getting buy-in for, some nearing completion or in the monitoring phase. This is in addition to day-to-day medication error review, presentations, and meetings. It takes a highly organized individual to keep everything straight and moving forward. During the interview, ask candidates how they stay (or plan to stay) organized with multiple projects or ask them to walk you through how they managed a complex project.
3. Flexible. In my nine years in medication safety, I have come to realize the need to pivot multiple times with medication safety projects. At times we need to pivot within the project itself i.e. we were headed north, but now realize we need to head northeast (metaphorically speaking). In addition, we often need to pivot our attention, efforts, and energy from one project to another because of organizational priorities or momentum (sometimes when a new error happens it increases interest and speeds up a safety project).  During the interview, some of the same questions for assessing the ‘highly organized’ trait may be used to assess the candidate’s level of flexibility. You can also ask how they adjust to changes that they have no control over.
4. Collaborative. Nothing in medication safety can be done in a silo. A medication safety leader cannot develop a safer workflow without engaging front line workers and operational leaders.  In addition, more often than not, medication safety projects will be multidisciplinary in nature- involving any combination of physicians, nurses, respiratory therapy, central supply, bioengineering, pharmacy, healthcare risk, and others. During the interview, ask candidates to explain how they collaborated with others on a project.
5. Curious. Being curious helps to do so many things- develop rapport, learn about a workflow or system, think outside the box, draw connections, and so much more.  During the interview, ask candidates to tell you about a time where they had to complete a project but were not given all of the details. Look for how many questions they ask during the interview about the position and the organization as well as the quality of those questions. Routine questions asked by many candidates may not be reflective of natural curiosity, but thoughtful questions that perhaps reference something discussed earlier might point to a naturally curious individual!

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