Faculty Highlight: Terri Warholak

Why did you choose to become a faculty member at the UA College of Pharmacy?
My personal mission is to improve the quality and safety of pharmacy practice so teaching and doing research at the University of Arizona College of Pharmacy fit my goals. 

What is your research or clinical area of expertise? 
From 1990 to 1997, I served as a Commissioned Officer in the United States Public Health Service were my clinical pharmacy experience spans from inpatient to community practice and included 5 years in the Indian Health Service and an assignment at the Food and Drug Administration (FDA).

Why did you choose to focus on this research or clinical area?
My first job as a pharmacist was as a Commissioned Officer in the United Health Public Health Service where I served in the Indian Health Service (IHS) at the Phoenix Indian Medical Center, a tertiary referral facility, which served over 60 tribes. As all of the pharmacists did, I split my time between inpatient and outpatient duties. For the first few years of clinical practice, I was pleased with my performance. I became a pharmacist because I wanted to help people and I felt that the IHS pharmacy practice allowed me to utilize my knowledge and skills to review charts, perform prospective drug utilization review, to make meaningful interventions in drug therapy and to counsel patients on how to get the most from their medication therapy.

One day a few years later, I was informed that I was involved in a medication error that caused a patient to be hospitalized (the patient ultimately recovered). When I heard the news, I was devastated. I determined that I was no longer helping patients but rather hurting them and that I should resign from my position. The Director of Pharmacy did not accept my resignation but instead challenged me to elucidate how the error had happened and how it could be prevented in the future. As I began to investigate the error, I discovered that thousands of pharmacists across the country had made the exact same error. This discovery led me to delve into the peer-reviewed literature and to learn about systems theory. I concluded that the health care system was flawed. However, I remained hopeful as I read more about how continuous quality improvement process and systems theory had been used to improve a wide variety of systems ranging from the aeronautical industry to health care. This spurred my interest in helping to be part of a positive change in health care and led me to graduate school where I received my Doctor of Philosophy degree with a focus on improving the quality and safety of health care.

My personal mission ever since my graduate school days has been to “improve the quality and safety of health care.”

My professional mission guides my teaching, research and service activities. I have drawn on my clinical experiences and the evidence-based literature to encourage my students to learn about quality and safety and to be part of a positive change in health care.

What is a professional accomplishment you are proud of, and why? 
I'm proud of the impact I've had on the education of quality and safety in the United States.

When I was given the opportunity to teach a quality and safety class at Midwestern University Chicago in 2001, I decided to make the showcase of education that would provide practical quality improvement experiences for all pharmacy students in real-world settings. I have taught that course annually since then, bringing it with me to the University of Arizona, using it as a learning lab and a way of changing pharmacy practice.

My quality and safety course is designed to: 1) give students experience designing a project in a real life setting; and 2) changing practice through their efforts. The class provides an opportunity for students to work in a team, identify issues, prioritize, strategize, and evaluate a practical solution. Students learn systems thinking and complex problem solving. Students undergo personal and professional development allowing them to identify their skills, strengths, weaknesses, etc. One of the main goals of this course is to push pharmacy students towards innovation and entrepreneurship by allowing them to engage in activities that require them to use critical thinking to envision better ways of accomplishing their professional and personal goals.

My efforts were recognized in 2003 when I was awarded the American Association of Colleges of Pharmacy Council of Faculties, Innovations in Teaching Award. The class led to a textbook “Warholak TL, Nau D (Eds). Quality & Safety in Pharmacy Practice. McGraw Hill Companies, Inc. 2010” so that other pharmacists and pharmacy students could learn about quality and safety. This then led to a grant from the Pharmacy Quality Alliance where my team (Drs. Holdford, West, Hincapie and Arya) and I adapted my quality improvement class into the Educating Pharmacists in Quality (EPIQ).

EPIQ was developed as a quality improvement education resource, for use by pharmacy faculty and other professionals, to teach student pharmacists, pharmacists, and other stakeholders about measuring, reporting, and improving quality in pharmacy practice. EPIQ has been integrated into more than 20 Doctor of Pharmacy curricula and has been used as part of employee training programs in several different companies. A team of individuals at pharmacy schools have developed the EPIQ program and made it available for free to pharmacists and educators. I am one of three individuals who developed the first draft of the program. A systematic review of the program is currently being conducted. This year, the innovation received a major curricular innovation award from AHI.

2015 Duncan Neuhauser Award for Curricular Innovation from the Academy for Healthcare Improvement for work by a team of educators in developing the Educating Pharmacists in Quality (EPIQ) Program. Other team members were David Holdford (Virginia Commonwealth University), Vibhuti Arya (St. John’s University & NYC Health Department), Ana Hincapie (University of Cincinnati), and Donna West (University of Mississippi). 

Are you working on any interesting projects, research, or initiatives? 
I'm working on many research projects but here is my current favorite: The creation and validation of pharmacy Star ratings (official title: Informing the Development of Patient - Centered Pharmacy Quality Ratings) 

In addition, here are some of my service activities that one might find interesting: I'm a member of the Food and Drug Administration (FDA), Drug Safety and Risk Management (DSaRM) Advisory Committee and the United States Pharmacopeial (USP) Convention Healthcare Quality Expert Committee.

Why did you choose to become a pharmacist or a researcher? 
I chose to become a teacher and researcher to help improve pharmacy quality and safety. 

What is something that most wouldn't know about you?
I like to paint.

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