Jeffrey Clark, PharmD '21, was in the second year of his Health System Pharmacy Administration and Leadership (HSPAL) residency at UW Health when he had his first opportunity to directly manage a team of technicians and pharmacists.
The managerial role was part of a longitudinal experience designed to provide residents with the skills needed to succeed as a pharmacy leader. While the experience was challenging, it helped prepared Clark for his current role as the pharmacy supervisor for oncology infusion services at Wellstar Cobb Infusion Center.
Infusion pharmacy is a specialized field within pharmacy that focuses on the preparation and administration of medications via intravenous (IV) routes. Both IVs and injections may be classified as infusion pharmacy.
While patients often encounter infusion pharmacy within a hospital setting, Clark’s work focuses on outpatient settings.
“Infusion pharmacy tends to refer to ambulatory sites where that is their primary business—dealing with infusions that are not done in a hospital,” Clark explained. “We deal primarily with patients who are stable enough to be released from the hospital but they are on some type of drug, or their disease is so advanced that oral drugs are not cutting it.”
The patient comes to the infusion center to have their medication administered by healthcare professionals. Infusion pharmacists often work closely with patients, explaining how the medications work, monitoring for adverse reactions, and adjusting therapies in collaboration with healthcare providers. Clark noted that this level of interaction is more intensive compared to traditional community pharmacy roles.
Medications administered at infusion centers are typically higher risk drugs designed to treat cancer, autoimmune disorders and infections. Often the drugs must be administered over an extended period of time.
“It’s a really big, growing field,” Clark said. “It used to be limited to antibiotics and cancer but now it has really grown to just about everything.”
In some cases, patients may be able to take advantage of home infusion services. For these patients, medications are delivered to the home and then either self-administered or administered by a caregiver.
A home infusion nurse will typically provide instructions, demonstrate how the medications are to be administered and then follow up with the patient periodically throughout the course of their treatment. The main methods of administration include administering the medication through a peripherally inserted central catheter (PICC) line with a syringe, an elastomeric pump or an IV bag. Home infusion pharmacists prepare the medications, provide clinical oversight of the patient and coordinate care with other members of the patient’s healthcare team.
While home infusion may offer more comfort and convenience, sometimes a patient or caregiver may decide medication administration is outside their area of comfort.
“I’ve had some patients that were home infusion patients who said ‘I cannot do this at home.’ So now they come to the infusion center to get their medication,” Clark said.
The demand for infusion services is high. The Centers for Disease Control estimates 129 million people in the United States have at least one major chronic illness. Many of those patients require medication that needs to be infused or injected. According to the National Home Infusion Association, a heightened emphasis on cost-effectiveness and the desire of patients to resume normal activities while coping with illness will continue to drive growth in the infusion therapy sector.
“We have so many patients that want to come to our site. No one wants to go to the hospital,” Clark said. “We’re at capacity each day.”
For those interested in pursuing a career as an infusion pharmacist, the path begins with a Doctor of Pharmacy (PharmD) degree. During pharmacy school, aspiring infusion pharmacists take the same classes as those pursuing other specialties. The main difference, Clark explained, is that infusion pharmacists must have a different level of mastery of certain subjects.
“You need more clinical knowledge,” he emphasized.
Infusion pharmacists must have a solid understanding of disease states, the ability to manage complex medication regimens and the skills to effectively interact with patients. Infusion pharmacists are also tasked with handling the regulatory requirements related to safe compounding, handling and storage. Additionally, they help determine the appropriate pharmacological therapy for the patient. This, Clark added, means infusion pharmacists are involved at multiple stages in a patient’s treatment.
“You have to understand a little bit more on our side because of where we fall in the care model,” he said. "I have pharmacists whose main role is to serve as a clinical medication expert and provide clinical resources for providers and mid-level providers (PA/NP) that help them decide care for the patient and select the right treatment."
These pharmacists, he added, tend to have board certification in disease states (oncology for example).
"We have pharmacists who serve in a hybrid clinical and operational role where they are the main pharmacist who are reviewing and verifying the right treatments are ordered and made appropriately," Clark explained. "This role requires advanced clinical knowledge and experience because they tend to work across multiple disease states."
For those interested in pursuing a career in infusion pharmacy, Clark recommends gaining a strong foundation in pharmacology, pharmacotherapy, and pharmacy law. Infusion pharmacists must also be prepared for the challenges of continuously educating oneself about new medications.
“There are so many,” Clark said. “The field keeps growing and that is one of the tough things to keep up with.”
He also suggests seeking out rotations and residency programs that offer specialized training in infusion pharmacy.
“To really understand it, you need to be in it,” he said. According to Clark, infusion pharmacists do a lot of the same work as hospital pharmacists, but the infusion space offers more autonomy. He believes it is important for aspiring pharmacists to understand the unique aspects of ambulatory care (which includes infusion pharmacy), acute care and community pharmacy.
“Get some type of experience in infusion pharmacy so that you can understand the difference,” he advised.
Clark chose PCOM School of Pharmacy because of its proximity to home, the welcoming environment and because he felt it offered him the best opportunity for success.
“Some of the bigger schools I thought I’d be more of a number,” he said.
During his time at PCOM, Clark became close with several faculty members. He credited them with helping him secure applicable rotation experiences as well as his first job in hospital pharmacy.
“I keep in contact with faculty all the time,” he said. “It’s really nice to have those bonds and relationships.”
Clark described his choice to attend PCOM School of Pharmacy as a “wise decision” and said the personal connections were a primary factor in that belief.
“It’s the people,” he said. “It’s the faculty, it’s my peers. That is my favorite part—hands down.”
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