From Pagers to Collaborative Practice Agreements: The impact of BCNSPs in my pharmacy journey
by Johanna D. Bezjak, PharmD, BCNSP
Council Member, BPS Nutrition Support Pharmacy Specialty Council
My first introduction to the Board-Certified Nutrition Support Pharmacist (BCNSP) credential offered by the Board of Pharmacy Specialties (BPS) was in my third year of pharmacy school. We had an esteemed professor, Dr. K, whose therapeutics lectures spanned from pediatrics to geriatrics and laid the foundation for our understanding of parenteral and enteral nutrition. Dr. K laid the groundwork that to this day, I use with my students. Outside the classroom, he was the nutrition support pharmacist at an academic, acute-care hospital adjacent to campus. Dr. K’s pager would routinely alarm during class, prompting him to announce the consult with pride and excitement: Who was it this time? The burn unit? The NICU? He had an aura of enthusiasm that was contagious and inspiring.
Fast forward to my PGY1 residency where nutrition support was a core rotation led by Dr. K. I struggled with the 5:00 am start time, as did my co-residents (one of them shaved their head leading up to rotation to minimize the time it took to get ready in the morning). We were taught how early mornings facilitated review of lab trends, pump rate checks, and chart review with minimal interruption. Dr. K’s scope of practice also involved management of home parenteral nutrition (HPN) patients following hospital discharge. It was his hybrid role that led me to another niche of pharmacy: home infusion.
Post-residency, I took a position at a health-system-based home infusion pharmacy. The population I supported was largely comprised of complex cases from the area’s 900-bed flagship academic center, including a large census of short bowel and abdominal transplant patients. I developed a rapport with the various inpatient and clinic-based teams. Our collaborations extended well beyond processing orders for intravenous therapies; we were working together to triage acute care needs in the home, minimize hospital readmissions, and optimize care management. These hospital-based teams did not routinely have a pharmacist involved with HPN management, so my pursuit of BCNSP was an organic step forward. I was eager to serve as a resource for colleagues, follow in Dr. K’s footsteps, and proudly display my BPS credential, which reflects my specialized qualifications and commitment to nutrition support. Since earning the BCNSP designation, I am honored to have been selected to participate in BPS nutrition support pharmacy job analyses, item writing, and Specialty Council activities.
Just as Dr. K catalyzed my interest in nutrition support, I am excited to mentor and advance the future of clinicians who practice in nutrition support and home infusion. In Spring 2019, one of our hospital-based nutrition teams identified a need for expanded clinical support of their HPN census. I was fortunate to pilot a role as their first clinic-embedded nutrition support pharmacist. The success of this pilot evolved into a permanent position; a role now shared by two BCNSP home infusion pharmacists in partnership with the hospital team. One of my proudest moments was in 2022, when a Collaborative Practice Agreement (CPA) was enacted between the hospital and home infusion pharmacy, authorizing our BCNSP clinical pharmacy specialists to lead drug therapy management for HPN patients. It is a privilege to witness these advances at our practice site, collaborate with talented clinicians, and provide services that holistically benefit our patients.
In celebration of Women’s History Month, I would like to acknowledge the women on our team that embody the knowledge, professionalism, and dedication of a BPS board-certified pharmacist:
Kayla Szabo, PharmD, BCNSP & Rebecca Tokarski, PharmD, BCNSP: Kayla and Rebecca practice under a CPA for drug therapy management of a large HPN population. The collaboration and care they bring to the nutrition support team and HPN population is truly remarkable. Beyond clinical duties, they lead parental nutrition-focused experiential activities for student pharmacists, pharmacy residents, and dietetics students.
Leita Frey, PharmD, BCPS: Leita is expanding learning experiences for our PGY1 residents and experiential students to demonstrate the growing scope of practice within infusion and specialty pharmacy. She also supports the development and implementation of home infusion clinical programs for health systems across the United States.
Claire Meredith, PharmD: Claire is our current PGY1 resident. She successfully completed her nutrition support learning experience which involved both inpatient and outpatient responsibilities. She recently served as a guest lecturer, teaching parenteral nutrition to student pharmacists at the University of Pittsburgh. Her dedication to learning and collaboration will support her success in whatever practice area and certification she pursues.