Nishaminy Kasbekar
Q&A with Nishaminy Kasbekar, PharmD, chief pharmacy officer at PPMC
Over the past few decades, the role of pharmacists has grown, from merely dispensing medications to serving as valued and active members of the health care team, both for individual patients and more widely on an organizational level. Nishaminy Kasbekar, PharmD, chief pharmacy officer at Penn Presbyterian Medical Center, has recently been elected to a new national leadership role and has seen this remarkable transition over the course of her whole career at Penn Medicine. She completed her PGY1 and PGY2 pharmacy residency at HUP 28 years ago and has been with the health system for 25 years. She sat down with System News to talk about the critical role hospital pharmacists play in patient care, using the health system’s COVID-19 response as one example.
Q: In broad terms, how has the role of hospital pharmacies evolved over the years?
When I started, pharmacy’s role was kind of transactional – we provided patients with medication and that was our primary role. Over the years, it has transitioned to a more patient-centered model, where pharmacists also get involved in education, research, med safety, and innovation. At Penn Medicine, our pharmacists round on patient care units. They’re in critical care areas like the Emergency Department, infectious disease, critical care medicine, and transplants. We’re also seeing a lot more pharmacists on the ambulatory side, in the Clinical Practices of the University of Pennsylvania (CPUP), and in practices, helping to manage specialty medications and working holistically with providers to make sure patients get the right medication in the safest manner.
Our pharmacists came together in the early days of COVID-19 as part of a large-scale, multidisciplinary response, and our team demonstrated a high level of agility and expertise. In many ways, we’ve been preparing for this for years, having to be versatile in the face of drug shortages and changing technology.
Q: How did you get involved in the COVID-19 response?
I’m trained in infectious diseases and was deeply involved in the state’s response to anthrax exposures after September 11, 2001, where I gained a lot of leadership experience and made many connections, including P.J. Brennan, MD, CMO and senior vice president, Penn Medicine. During the COVID-19 pandemic, he asked me to create and lead a team comprised of pharmacy representatives from each entity, working with other disciplines to establish eligibility, pathways, and workflows for new COVID-19 vaccines and drugs.
Q: Where did your team begin?
When the vaccine became available in late 2020, under Emergency Use Authorization (EUA), there were limited supplies. P.J. created different ‘swim lanes’ for distribution and worked with Pat Sullivan, chief quality officer, Penn Medicine, and Judy O’Donnell, director, Infection Control, PPMC, to prioritize our employee groups. We started with the most forward-facing: trauma surgeons, ICU staff, and so on. My team set up vaccine clinics across the system in partnership with Pharmacy, Occupational Medicine, CPUP, Emergency Management, and other entity disciplines. We standardized our approach to implementation and documentation, managed sub-zero storage requirements for Pfizer vaccines, and more.
Q: How did your team handle community vaccinations?
To manage vaccine shortages, we followed CDC recommendations for EUA, initially rolling out vaccines to immunocompromised patients. We worked with Danielle Werner, COO, executive director of CPUP, and her group to identify patients with priority needs and sent those patients emails with self-scheduling links. At our vaccine clinics, folks would show up at the end of the day in case there were leftover doses. We also had lists of people to call in those situations to ensure nothing was wasted.
Q: How have you handled distribution of COVID-19 drugs?
[At first, supplies of many of these] agents were limited as well. We had to create a lottery or prioritize patients by need. At that point, we rolled COVID-19 vaccines out to practices like Family Medicine, and focused on distributing treatments. For example, the infusion suite could give immunocompromised oncology patients preventive monoclonal antibodies like Evusheld. When the Paxlovid antiviral came out, there were a lot of drug interactions, so we created a pharmacy consult service to help primary care providers manage those.
Q: Any final thoughts about the importance of pharmacists in health care?
At a time when our country is experiencing primary care shortages, drug shortages, skyrocketing drug prices, health care disparities, opioid addiction, and more, pharmacists can be involved in novel ways and play an integral role as frontline workers.
Nishaminy Kasbekar, PharmD, recently became President-elect of the American Society of Health-System Pharmacists (ASHP). The organization, with more than 60,000 members, serves as the voice of pharmacists around the nation. She previously served on the ASHP’s Board of Directors and its Women in Pharmacy Leadership Steering Committee.