Los Angeles Jewish Home

Since the day the doors of the Joyce Eisenberg-Keefer Medical Center (JEKMC) opened in 2007, the facility was equipped with an on-site pharmacy. At the time, Bob Shmaeff, director of pharmacy, commented how it was "uncommon to have a pharmacy in a nursing home." Its location made it possible to deliver medications for residents on a moment's notice.

Five years later, the Jewish Home has taken another huge step to better meet the needs of seniors: the pharmacy is one of only 1,500 sites nationwide accredited by the American Society of Health-System Pharmacists (ASHP) for post-graduate training. In Los Angeles alone, approximately 400 students become pharmacists each year, so opportunities for post-graduate work are limited. "This accreditation is major league," says Bob. "This is national recognition that we have the capacity to train and develop exceptional pharmacists."

Bob explains the history of this groundbreaking program. "Two years ago, the Los Angeles Jewish Home entered into an agreement with Western University of Health Sciences, College of Pharmacy (WesternU), to provide training opportunities for pharmacy residents," he says. "Dr. Janice Hoffman (associate professor of pharmacy services and administration at WesternU and liaison between the school and the Home) and I came up with the idea of starting a residency program here." We have had Dr. Hoffman as a faculty-in-residence at the Jewish Home for five years and have seen the value of training pharmacy students at the Home: it is a win-win for all involved. The first resident, Aida Oganesyan, PharmD) completed the PGY1 (Post-Graduate Year 1) program last year. Currently doing her residency at the Home is University of Southern California (USC) School of Pharmacology graduate Kimberly Appleby.

As a graduate, Kim passed the board exams and is a registered pharmacist in the state of California. The PGY1 program is an excellent opportunity to further her education in a variety of ways. "Through Western University, I'm earning a teaching certificate and am qualified to act as a preceptor for students as they rotate through the Home in their final year of pharmacy school," she says. Another focus of PGY1 is the development of leadership skills as well as preparing for a potential future career in academia. 

At the Home, Kim has become an integral part of a multidisciplinary team providing care for our residents and seniors from the community. Her responsibilities include working with the interdisciplinary teams of the Home's Brandman Centers for Senior Care (BCSC), a Program of All-inclusive Care for the Elderly (PACE) and the Auerbach Geriatric Psychiatry Unit (AGPU). In both programs, she attends team meetings and offers clinical recommendations to the medical staff.  "Our bodies change as we age, and these changes can make us more susceptible to medication side effects, such as dry mouth, constipation, confusion, drowsiness and higher risk of falls," she explains. In particular, antipsychotic and psychotropic drugs can have potentially dangerous side effects. As a pharmacist, I'm able to offer information about the medications and make sure our seniors are receiving the safest and most effective care at the lowest dose." 

In addition to her involvement in BCSC and AGPU, Kim regularly reviews patients' and participants' medication regimens and makes recommendations to the medical staff as needed.

While at the Home, Kim and the preceding resident pharmacist have been part of two research studies. One study focuses on the positive impact of having a pharmacist as part of the AGPU team, including the reduction of number of medications used, particularly antipsychotic and psychotropic meds. Another study is with the USC School of Gerontology. This study concentrate on polypharmacy, or the use of multiple medications, particularly by older patients. "With coordination of care, we hope to decrease the number of meds and the incidence of side effects," explains Kim. The study is focused on seniors in their first year of residence in a nursing home.

For Kim, the first four months of her year at the Home have provided an excellent foundation for the future. "To be integrated into an interdisciplinary team with multiple medical professionals, social workers, dietary, rehab…all under one roof…It's an experience that is not available in the community, the program has made a significant impact. "Before the advent of our relationships with both USC and Western, the pharmacy was primarily involved in dispensing medications," says Bob. "With the development of these partnerships, the opening of the PACE center, and the implementation of the PGY1 program, the pharmacy can now penetrate deeper into the clinical aspects of patient care. It has made a huge difference." He adds, "The role of the pharmacy is expanding beyond traditional dispensing roles, and that requires additional training. Our goal is to take that training and put it into greater perspective so our pharmacists can integrate their knowledge into their day-to-day practice."

Congratulations to the Jewish Home's pharmacy team and administration on receiving the prestigious ASHP accreditation.