Sarah Ward, PharmD, BCPP
Mental Health Clinical Pharmacy Specialist
Veterans Affairs Tennessee Valley Healthcare System – Community Based Outpatient Clinic
Chattanooga, TN

Dr. Sarah Ward earned her Doctorate of Pharmacy degree from the University of Pittsburgh in 2014. She completed her PGY1 pharmacy residency and PGY2 psychiatric pharmacy residency at the Chillicothe VAMC in 2015 and 2016, respectively. After residency she relocated to Chattanooga, TN to join the VA Tennessee Valley Healthcare System (TVHS) to work in outpatient mental health. At the Chattanooga Community Based Outpatient Clinic Dr. Ward provides psychiatric medication management services within the Behavioral Health Interdisciplinary Program and Primary Care Mental Health Integration clinic. She is a certified yoga instructor and conducts classes twice weekly for veterans at the Chattanooga clinic as part of the Whole Health program.

Starting A New Site: Getting Local Buy-In

Being the first psychiatric pharmacist at your site can be challenging for multiple reasons, but mostly because other disciplines may have never worked with a psychiatric pharmacist. This means they are not sure what to do with you or how you can help the patients, caregivers, and healthcare practitioners of their clinic.

The first big step is to get to know your new co-workers and their workflow within the clinic. It is important to form strong relationships with your team members and any support staff to make your services the most successful. Everyone needs a break at work, so take advantage of any lunch invitations or extend some of your own. Consider stopping by team members’ offices to see if they need help with anything clinical. It may be useful to talk with your local supervisor (or supervising psychiatrist) or the clinic coordinator about giving a brief presentation explaining your education, training, and skills to your team members. If this is not possible due to time constraints or other limitations, consider creating a shortened CV highlighting your training, work experience, the services you are able to provide as well as your schedule if it will fluctuate. Always leave your door open when you are available, both literally and figuratively! Every time someone sees you, it will trigger him or her to think about utilizing your services when needed. I have had multiple team members express their appreciation for me keeping my door open.

Consider shadowing other providers in the beginning and observe if there are gaps in care where your knowledge or services may benefit patients. This also allows you to see if you can “take anything off their plate.” For example, I took over management of tobacco cessation prescriptions when I first started since it was previously a psychiatrist duty. Most clinics have a shortage of psychiatric prescribers and therefore need help with access to care and timely appointments. Be familiar with others’ schedules and how far they are booked out. Talk with nurses, therapists, and other providers about how you can help them. Attend team meetings (if possible) to learn about challenging patient cases or other problems that team members are recognizing.

Bringing New Service Ideas to Fruition

Become familiar with any patient databases or other clinic information available to you (such as first available appointments for prescribers). These can help guide you when brainstorming new services. When thinking of possible new services, it is important to consider how this would affect others’ workload. As psychiatric pharmacists our main mission is to help improve patient outcomes and safety, but you want to do this in a way that does not add extra stress and work to your team members.

Knowing the organizational structure at your clinic and who needs to be involved in creating new services (e.g. psychiatric pharmacist supervisor, mental health supervisor, clinic coordinator) is critical. It can be helpful to talk with some co-workers to determine the feasibility of a service idea and to see if they have any input. You should also consider reaching out to your network of psychiatric pharmacists (thanks CPNP!) as someone may have already created a similar service and provide you with guidance or even pre-created note/consult templates and service set up. Once you have a new service line in mind you want to explain why you think this service could be beneficial; for example, below average compliance with antipsychotic metabolic monitoring leading to increased number of veterans with diabetes and associated cost of treatment. Once approved, it is important to educate and re-educate AND re-educate staff about the available services to ensure they are adequately utilized. Consider creating flyers or brochures to distribute to team members and attending provider meetings to remind them where your service can help.

Proving Your Worth

Know your workload and how patient interventions are tracked. Discuss this with your supervisor early on to get a sense of what is reasonable and expected in your position. With any new service you create, it is important to reflect on what is working and what is not. Continually assess barriers and strengths of your services to further improve them. Money talks, so it is always valuable to extrapolate any outcome into cost savings; for example, increased clozapine utilization and monitoring decreases costly psychiatric hospitalizations.

Most importantly, to prove your worth be a reliable and dependable team member. If you say you will complete chart reviews and electronic consults within 72 hours, be sure to adhere to that commitment. If you agree to research the literature for the incidence of tardive dyskinesia from a specific agent, be sure to do so in a timely manner. Always be willing to help with complicated patient cases, but also recognize your limits within your scope of practice. Psychiatric pharmacists have an extensive knowledge of medications that other disciplines do not have. Sharing this knowledge and these skills with your team will prove the worth of having psychiatric pharmacists on patient care teams in a variety of psychiatric settings.