Q&A with Mary Burkhardt, MS, RPh, FASHP, FSMSO, Pharmacy Chief at the VA Ann Arbor Healthcare System
Mary Burkhardt is a pharmacist specializing in medication safety and pharmacy management. She has a BS in pharmacy, an MS in hospital pharmacy administration, and completed a hospital pharmacy administrative residency. Mary is also trained in patient safety through her work at the VA National Center for Patient Safety. This past May, Mary was named a Fellow of the American Society of Medication Safety Officers, one of six in the nation.
Q: What motivated you to enter the healthcare field?
A: I was motivated by my mother's mentoring. She was a nurse who encouraged me to pursue a career in healthcare and she always emphasized the importance of the bedside nurse. She died of a medication misadventure (prescribing error not caught) back in 2003 while she was in assisted living. I was already passionate about and working full-time in medication safety, but now it's my life mission.
Q: Can you describe the Veterans Affairs hospital where you work?
A: I work for a moderate size VA healthcare system. We serve approximately 57,000 veterans in Michigan and Northern Ohio. Our medical center is a specialty referral center for the Northern portion of our network. We offer primary care, mental health, surgical, cardiovascular, neurology and extended care services, among others.
I began working full-time in patient safety at the Department of Veterans Affairs National Center for Patient Safety. After leaving VA in 2006, I re-joined the VA at the Ann Arbor Healthcare System in late 2010 in the Chief of Pharmacy role where I am very involved with day-to-day operations and patient care.
Q: Typically, what are your day-to-day responsibilities?
A: I am professionally responsible for the pharmacy staff in the health system. I spend time with planning, automation and system design, and various administrative tasks. We are fortunate to have an active safety and learning culture here, so I am able to maintain my involvement in patient safety activities and the education of pharmacy students.
I pride myself on my ability to mentor pharmacy residents and others in healthcare to keep safety on the forefront of their thoughts at all times.
Q: What type of patients/diagnoses do you encounter most frequently?
A: I come from an acute care background, but I am one of the few people who have worked with ambulatory care and the pharmacy benefits management and mail order pharmacy safety issues. These are all applicable skills for my current position because VA is its own system providing all of these services to our patients. We see all clinical specialties typically managed by the VA except we don't do organ transplantation.
Q: Are there other areas of interest for you as a pharmacist, either clinically or educationally, that you plan to pursue?
A: I am extremely interested in Human Factors Engineering (HFE). I have done coursework at the University of Wisconsin and I am always reading in this area. I credit this interest to John Gosbee, a former co-worker, and Laura Lin Gosbee, my co-author in a chapter on "Human Factors" in Medication Safety.
Q: What are the greatest challenges you face in your job?
A: In my current position, it has been a challenge to keep up with the demands of our ever-growing patient population of veterans. The most difficult challenge facing many of us is dealing with drug shortages; it is definitely a public health hazard.
Thanks to early patient safety leadership by VA visionaries, the VA really espouses patient safety as a core value from leadership to the front line. However, in other environments, I have been faced with many people who confuse quality improvement with safety. If they have a Continuous Quality Improvement program or espouse Six Sigma, they think this is sufficient to keep the patients safe.
Q: What do you like most about your job? What do you like least?
A: I love problem solving and innovation. Because of my strong background in patient safety, I feel I can be even more helpful to the patient safety efforts locally and nationally by working with staff from the national safety center just five miles away.
I am most frustrated when I hear about organizations that have well-known safety issues but do not make changes. Other industries, such as mining, have been in the news for this.
Q: What projects are you currently involved in?
A: Given our proximity to learning organizations, we take students, including non-pharmacy majors, here. We have had two projects this past year: one was a project on unit dose cart fill and the other project was a code cart medication tray redesign project. We had a hypothesis and they tested it. It was a blast.
Q: Do you feel the role of pharmacists has changed over recent years?
A: Yes, pharmacists are more and more involved in drug therapy management, which is a terrific and continuing advancement. The VA is a stimulating practice environment for pharmacists because we typically practice at the top of our licenses. We are fortunate to have pharmacists working in a number of high-risk areas to improve medication use outcomes. Additionally, we have centralized functions that work for us nationally to do things more robustly such as formulary management (VA Pharmacy Benefits Management), population medication safety (VA MedSafe), and our award winning Consolidated Mail Outpatient Pharmacy (CMOP) system. It is a large, welcoming, and gracious family. I just wish I had joined the VA earlier in my career!
Q: What do you feel is of the greatest concern to your profession today?
A: Pharmacists being sent to jail for medication error, like in the Eric Cropp case. That one move set the medication safety movement way back. Healthcare practitioners don't go to work to hurt patients; this happens accidentally, so we have to help prevent this by improving the systems. I can say this as the daughter of someone who paid the ultimate cost for a medication event. I never ever thought the staff or the physician meant to hurt my mom.
Q: What is the most rewarding part of your job?
A: Getting positive feedback from patients and employees. It is also great to watch new professionals turn into seasoned practitioners, which is why I came back to work with pharmacy residents.
I am grateful to be able to practice in a position that relies on such a unique set of skills. We just had a site visit from the Joint Commission and we heard loud and clear about how evident our safety and learning environment was to them throughout the organization. It's a great place to practice, and it's getting better all the time.
Q: What advice do you have for others thinking of entering pharmacy?
A: Get a good base of experience before specializing in a particular practice area. Medication safety experience is a life-long professional skill, not a temporary assignment. Volunteer to do data analysis, sit on a patient safety team, go to training, and learn about HFE. These are often life changing and rewarding opportunities.
Q: How has working in medication safety allowed you to grow professionally?
A: Working in this area has taken me to places all over the US and the world. I have also had the privilege of serving veterans and their caregivers. You can't ask for a better combination of missions.
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