Steve Abel

MentorVIEW With Steve Abel,
Head of Purdue University Department of Pharmacy Practice

Steve Abel has enjoyed a varied and decorated career in pharmacy. A Fellow of the American Society of Health System Pharmacy, he’s been involved with the Institute for Advancement of Community Pharmacy and NCPA, helping establish guidelines for pharmacy practice residency. Abel, who is also an author, has spent the past two decades focusing on what pharmacists can do to make a difference. He’s also enjoyed the good fortune of being able to practice in every area of pharmacy - community, hospital, sales, ambulatory care in a clinic and academia.


PNOW: You are currently working with the Indiana University School of Medicine and Purdue. How are you able to manage your schedule?

SA: I’m fortunate to work for Purdue University. Our home is based in West Lafayette. But my primary office and a major focus for our department are also in Indianapolis. The reason is because the Indiana University School of Medicine is housed here and we have an extremely strong collaborative working relationship on a number of venues with them, some of which relate to teaming for provision of improved patient care. The other very important venue is in the area of research and finding ways that we can mix our collaborative pharmacy and medical talents to the best advantage of patients here on the medical center campus. I actually have a couple of other outreach areas that I’m responsible for, one in Fort Wayne and the other in Evansville. So, I really try to be a good communicator. E-mail is the way I balance most of it. I have a much greater presence at the West Lafayette campus and in Indianapolis than I do in Fort Wayne and Evansville. If I visited all of the places on a routine basis, I would never have time to land in one place and get anything done. And the last reason I feel I’ve been at least reasonably successful is I have a marvelous group of faculty folks who work with me. I always have a couple of students or a student and a resident with me to keep me grounded in the realities of day to day, and also add four more hands to the pool.

PNOW: You’ve been involved in research with the collaborative medical talents to raise the standard of how medical care can best be provided. Can you tell us a little bit about some of the things you’re doing?

SA: When I was an assistant director of pharmacy for clinical and educational services at what is now Clarian Health Partners, I worked extremely closely with physicians and other health care professionals trying to define a role for all of us in the way care is provided for our patients. My specific focus was looking at where the pharmacist really needs to apply his or her expertise and how that can best be integrated with other health care disciplines to the positive benefit of patient care.

PNOW: Could you give us some examples of how this works?

SA: Specific examples include pharamacokinetic dosing, which involves applying math to the care of patients. We’ve done a lot with dosing of specific medications that could be potentially harmful to patients if they’re not appropriately monitored. We’ve shown some fairly dramatic impact of minimizing toxicity and optimizing therapy. I’ve done a lot of work with antimicrobial therapy, both assuring patients receive the appropriate therapy and, more importantly, that recommendations and changes we have made have served to minimize concern over resistant micro-organisms. We’ve made our environment, in many ways, much safer for our patients. We’ve done a lot to identify recommendations pharmacists make, what impact those recommendations have toward avoiding adverse drug events. Within the Clarian system, roughly 4,000 adverse events are avoided on an annual basis simply by the pharmacist reviewing medications that are ordered or received by patients and modifying their regimens based on specific information we know might make them more pre-disposed to an adverse event.

PNOW: Could you give us some insight on where the collaborative approach was twenty years ago?

SA: Twenty years ago, we were thinking of placing pharmacists on the units, getting them out of the main pharmacy in the basement and actually having them more accessible. We thought it would improve their utilization as a resource and also result in some safety nets. Our goal was to place pharmacists in more close proximity to the bedside. I remember phoning the physician and saying, ‘I’m going to start participating in rounds with you tomorrow and working with you. Where do I meet you and when?’ The physician said, “Don’t bother because I don’t really want this service and there’s no need for you to waste this time.” So I went to the person next lower in the chain of command and told him the same thing. I showed up and participated with their team in an active way for three months. My role was really to develop a role for those unit-based pharmacists who would follow me. I remember at the end of the three months contacting the physician that first told me no. I said, ‘I’m sure you’ve identified the benefit that you’ve received from having me around, so we’re sticking around. It’ll be these other folks now that will be assuming my responsibilities, but in advance thank you for your support.’ Thankfully it worked out OK. Suffice it to say the doors weren’t always open widely. But it’s nobody’s fault. Pharmacy is a profession that’s changing so dramatically that there wouldn’t have been necessarily the role model for that type of service yet. What we used to think was very risky has now become quite commonplace in terms of this team effort and partnership.

PNOW: You were a forerunner with collaboration in the Midwest. Did you have a mentor? Who were the people you were connecting with to aid you in this process?

SA: My professional mentor without question is Nick Popovich who is a professor of pharmacy practice at Purdue. I’m very blessed in my current position to work with him on a daily basis. He is certainly an integral part of the management of our department and has taught me many things when I first started to work with him as a student. He is one of those who taught me not to give up and make sure your work is your very best effort. That doesn’t mean it has to be perfect, but you must have given your best in doing it. I was very fortunate to work with another colleague at Purdue, Bruce Carlstedt, who is an individual I currently work with on a daily basis. I could watch Bruce, see what he had done to create an atmosphere of acceptance and, in some ways, pattern what I was doing after that. Also, I would be remiss if I did not mention my mom and dad who taught me an extremely strong work ethic, and I’m very appreciative of that, too.

PNOW: Where do you see pharmacy and pharmacists in 10 years?

SA: I think a lot depends on your practice site. But there is clearly going to be a significantly greater use of the cognitive skills of the pharmacist. I think the pharmacist will have a much greater role in terms of patient safety and in the actual management of disease states. That’s not to suggest that we expect to completely take away from any other discipline their role as far as prescribing or administration of drugs or the monitoring, but I think one can’t overlook the fact that the most accessible health care professional is the pharmacist. Given that, we really have an opportunity to have an impact on care. The other thing I think is terrific is that most of the physicians who are trained now have been trained in an environment where it isn’t really separate and distinct from the pharmacist. So the disciplines have a much better understanding of each other and a much better respect for what one can offer the other. Even if we don’t have input into the selection of a therapy for a patient, it certainly is our responsibility to be accountable for what that medication does for that patient. That’s a different role for us. When we identify what is happening either to the benefit of the patient or perhaps to the detriment, it’s our role as a team player to make sure it gets communicated back to the appropriate individuals that we work with and make sure that the outcomes are hopefully optimal no matter what the setting.

PNOW: Why do you believe pharmacists are the most accessible professionals?

SA: That’s simply based on data that shows how frequently consumers go into a pharmacy. All of the pharmacies that are springing up all over the country have pharmacists in them. When customers are in a store where a pharmacist is accessible to them, they can interact with that pharmacist. Think about it: There are a lot of little towns that don’t have doctors but have a little pharmacy.

PNOW: How do you see yourself as a mentor and what priority do you assign to that part of your professional experience?

SA: I would like to believe I’m a mentor and I think if you ask the students that they would probably say I might at least fulfill a part of that role. One of the things that I learned as a student - and it’s absolutely something that’s been incorporated into my life and academia for the last five years - is that when I really needed somebody, my face did not run into a closed door. People were always there to take the time. I’ve made that a priority for my academic life. If a student needs me and I can’t help them at that particular moment, I will certainly find a time that I can do it because I just cannot shut the door in that student’s face. I think that’s absolutely critical. A lot of times students don’t need anything more than a pat on the back or just a little bit of encouragement to be successful. Many individuals have run in and out of this door even before I worked for Purdue saying they can’t complete this rotation or are going to drop out of the Pharm D Program because they are not cut out for a more clinically oriented role. And I say, ‘Let’s sit down and chart a course for you. Just bear with me for a couple of weeks here and we’ll see if we can’t make it better. And I bet you that I will celebrate on your graduation day just as you do.’ It’s such a fulfilling feeling to have that opportunity.

PNOW: What are the students and the young pharmacists today going to need to possess that perhaps 20 years ago wasn’t as necessary?

SA: First they need the technical skills. I certainly think the importance of the technical skills is probably the same as it was 20 years ago. The difference is the technology that we are afforded has advanced so greatly. We are expected to understand not only the technology of years ago but also some of the new biotech products. Understanding those requires a really thorough understanding of science and, maybe more importantly, the commitment toward life-long learning to keep up with those advances so you can be the best pharmacist in whatever practice setting. Then, there is the interpersonal side. Pharmacists should be expected to speak with patients. They should be able to direct a conversation toward the baseline educational level of the individuals with whom they’re dealing. In some cases, they’ll be speaking to people who can’t write and really understand particularly sophisticated instructions; in others, they might be making a recommendation to the dean of the medical school. You just have to be able to cross all those lines and communicate effectively. I think the interpersonal skills piece is going to be really important because, as practitioners, we’re all figuring out that we really are part of a team.

PNOW: One of your major focuses now is identifying where pharmacists make a difference. Can you tell me some thumbnail points where you can clearly say pharmacists are making a difference?

SA: They clearly make a difference in helping patients understand their medications in any setting. That certainly avoids unnecessary physician visits, office calls, visits to the emergency department and, hopefully, hospitalization. Also, we know errors occur with high frequency in the prescribing, dispensing, administering and monitoring, but the majority of those errors occur with the prescribing and the administering. Pharmacists are doing a lot to appropriately educate those involved with the prescribing of medications by being more proactive in screening orders to be sure they’re accurate in terms of providing what we hope will be optimal therapy at minimized risk for patients. We are also working really hard with the administration end. Part of it is helping the patient understand how to administer their drugs and part of it is helping our colleagues within the various disciplines, particularly nurses, understand the implications of administration of certain drugs to make sure when that happens to our patients, it’s being done in the most efficient and safe manner.

PNOW: What advice do you have for people who are looking to advance their skills, either as a mentor or mentee?

SA: When you have the opportunity to teach somebody, teach. When you have opportunity to serve as a role model for students, take that opportunity and do your best to serve them.

More from MentoringNOW

Every segment of MentoringNOW is archived at Pharmacynow.org. We encourage you to e-mail our programs to your colleagues and peers and to send us your comments to paul@pharmacynow.org.