Idaho's Lindsay Kaster Named TOP Pharmacist
The Oncology Pharmacist congratulates Lindsay Kaster, PharmD, for being chosen by more than 750 of her peers as this year’s T.O.P. Pharmacist award winner.
“The best part of the job,” says Kaster, a clinical oncology pharmacist at the Boise Veterans Affairs (VA) Medical Center in Idaho, “is that it just brings that team dynamic together.”
Kaster has won accolades from colleagues like Brenda S. Dunn, PharmD, MBA, a pharmacy executive with Veterans Integrated Service Network 20, for her commitment to cost-cutting. “Lindsay’s proactive approach includes cost-avoidance measures for the veterans as well as the pharmacy, a dose-rounding program to reduce drug wasting, a comprehensive error-prevention process, a thorough review of adverse drug reactions with education to providers on how to eliminate or decrease future occurrences, development of a stability chart for pharmacy and nursing use, appropriate premedication practices, and strategies to effectively work with medication backorders and national shortages.”
Kaster says that because she does not depend on reimbursements for her paycheck, she can focus all of her attention on cost and quality. With the increasing criticism of the fee-for-service reimbursement model dominating most of the healthcare industry, she is proud to say that she saves the government more money than she makes.
“I’ll say, ‘we can do this instead, because it will save $1000 and it has the same efficacy data,’” she tells The Oncology Pharmacist. “Instead of pounding out orders, I spend my days trying to optimize the medications my patients are taking. A big part of my job is decreasing costs to taxpayers.”
But Kaster’s attention to the bottom line does not come at the expense of patient care. Replacing costly medications with cheaper ones can save money without compromising value. And better yet, reducing the number of drugs a patient takes can improve his or her well-being.
“I love the patients because they’re so resilient,” she says. “I deal only with cancer patients. Some people think that’s depressing, but they’re so strong and courageous.”
Kaster sits in on physician clinics and consults with oncologists regularly on prescription decisions. Many VA patients take up to 10 medications, so Kaster must play a part in helping them with chronic care needs, such as hypertension and hyperlipidemia.
“I kind of stumbled into pharmacy,” Kaster says. “I wanted to go to medical school, and I shadowed a bunch of physicians and didn’t really like it too much. I was graduating from college with a degree in biology and didn’t really know what to do. My mom, who is a nurse, said she loved the pharmacists she worked with. So I applied.”
She needs to be motivated. The national back orders for a number of important chemotherapy drugs have forced Kaster to think up creative solutions, from getting a delivery just moments before a patient arrives to sharing drugs with VA facilities in other parts of the country.
“The whole pharmacy team has been really stretched thin because there have been so many shortages on drugs that we use on a daily basis. It can be really stressful not knowing one day to the next if we will be able to give a patient his life-saving medication.” This is especially important at the Boise clinic, where they have no physicians on staff. Doctors on contract come through once a week. But most of the time, she and the nurses run the show.
“I believe that an oncology pharmacist is invaluable in the care of heme/onc patients, and this role will only continue to expand in the future,” Kaster tells The Oncology Pharmacist. “Ninety-eight percent of supportive care decisions in our clinic are made by a team of a pharmacist, nurse practitioner, and primary nurse.”
Tim Santos, acting chief of pharmacy at the Boise VA, commends Kaster for her work implementing new inspection regulations from the VA’s Office of the Inspector General and The Joint Commission. Santos and Kaster worked together to get the facility compliant with new procedures governing the safe handling of hazardous drugs and chemotherapy transportation.
“She applied her considerable talent for the tenacious pursuit of a goal by completing the development of the necessary forms, educating staff, and participating in the evaluation of appropriateness of the competencies chosen by staff members.”
The Boise VA also serves a very particular population: Their patients are veterans, and most live in rural areas. Most have to travel 1 hour or more to visit the center. “We have to do things a little different here than you would do things at a bigger facility,” she says.
She says that the teamwork drew her to oncology, and that makes it “really different from any other healthcare field.”
Kaster is already a preceptor and mentor for PGY1 residents, and she visits pharmacy students at Idaho State University each year to make a pitch for oncology, where she employs a creative touch by grabbing students’ attention with a David Letterman–style Top Ten list. “I think a lot of people overlook oncology because they think it’s depressing, so my goal is to get students interested,” she says.
And her goals don’t stop there. She would like to do more research that will benefit Idahoans. “There’s a lot of research to get done, especially on the rural populations we have here.”
Dunn says that someone like Kaster, both kind and shrewd, is the perfect person for the VA. “The Boise VA Medical Center is proud to have Dr Kaster as part of our clinical team, and we are extremely fortunate to have someone as kind-hearted and clinically minded as Lindsay to serve our veterans.”