Emily Messing: Keeping medications safe for patients
When we spoke with Emily Messing, she was in the middle of a “go-live” — upgrading Epic software — in her role as clinical pharmacy manager for informatics at Montefiore Medical Center in New York City. The Epic electronic health record software is used by healthcare agencies to manage healthcare records of all kinds, and an upgrade can be a big deal, Messing said. “We use it to track all of our inventory throughout the hospital.”
Messing earned her bachelor’s degree in biology at Colgate University, where she was on the equestrian team. “Sometimes we would ride against Binghamton,” she said.
After earning her undergraduate degree, she took a year off. “I wanted to make sure pharmacy was what I really wanted to do as my next step,” she said, “so I worked at a pharmacy in my hometown, I traveled a lot, I rode my horse — I had a great gap year.”
She decided pharmacy was it, so went to Touro College of Pharmacy in New York City. “From there, I did my PGY-1 general pharmacy residency at Montefiore, and my PGY-2 in medication safety at Memorial Sloan Kettering Cancer Center, also in New York, and then I’ve been back at Montefiore ever since,” Messing said.
“I work with all of our pharmacy safety software. We have a workflow system that essentially manages the compounding of all of the medications,” she said. “The orders from Epic get sent to this workflow system and then the technicians and the pharmacists scan the products against it to make sure they have the right medication and the right concentration. Then the system gives them all the steps and takes pictures along the way to make sure that when we’re compounding these medications we’re doing it correctly and safely.”
Another software program Messing oversees is one for IV smart pumps. “That’s how the nurses infuse medications, so it controls how fast you can give medications and how high of a dose you can give,” she said. “I’m responsible for setting those limitations in the pumps to make sure that they’re being given safely.”
Like many students first going to pharmacy school, Messing thought she would end up working in retail because she had worked in an independent pharmacy all through high school, college and her gap year. “I just assumed that’s what I would do,” she said. “But I first got exposed to patient safety as an elective in pharmacy school. I tried it on a whim and my first day I was blown away by my professor, by the stories, by what she was telling us you could do as a medication safety pharmacist.”
Messing pursued some electives, one at Kingsbrook Jewish Medical Center in Brooklyn, N.Y., where she worked with their medication safety pharmacist, shadowing to see what it would be like in a day in the life. She also went to the Food and Drug Administration (FDA), working with the pharmacovigilance department there to get a sense of what safety looks like from a regularly standpoint.
Additionally, she completed a rotation at the Institute for Safe Medication Practices (ISMP) under its founder and president emeritus, Michael Cohen. “At ISMP, I had the opportunity to respond to medication error reports, write for its bi-weekly newsletter and attend site visits to the FDA and USP,” Messing said. “It was truly one of the most amazing and rewarding experiences of my residency training and helped shape me into the pharmacist that I am today.
“During my residency at Montefiore, we had a medication safety manager here and I got to shadow and was involved in a lot of medication safety projects,” Messing said. “It was something I just kept coming back to throughout all of my rotations. That was what I loved. I was interested in critical care for example, but the safety aspect is what I kept coming back to that was in common and I enjoyed throughout all of my rotations.”
But in terms of the technology and using the safety software, Messing said she truly had no idea until she got the call to interview for her current job.
“During my first residency I did take an informatics rotation. When had a rotation with the person who had my role before me,” Messing said. “She said, ‘just learn what you can because you’re never going to have to do this again’ and I really didn’t think that this is where I would be. Then I did my PGY-2, and I realized how, with all the technology we have available today, we have to take advantage of it and use it to our fullest potential in order to keep our patients safe from the medication standpoint.”
And now, of course, she precepts.
Like many students, Messing’s initial thought of going into retail pharmacy upon earning her PharmD was not an unusual one. Most students begin their training not knowing the many pharmacy career paths they have available to them.
“That’s why I love precepting students,” she said. “I feel like they aren’t really exposed to informatics in school. They imagine that they’ll be sitting here writing code on a computer, but to see them learning and exploring this new area, it’s so applicable to every single area of interest that all of my students have.
“Brian Kam (a Binghamton Class of 2022 graduate), for example, is very interested in pain management so I knew he wasn’t interested in informatics per se, but to be able to apply everything we were doing on the rotation to his interests was so rewarding,” Messing said. “He was interested in pain and palliative care and we were able to talk about the different order sets in Epic — choosing safe starting doses of opioids, having supportive meds available to guide safe practice. He did chart reviews to see if all of our policies and protocols were being followed in the system and what else could we put in place to make it safer and help guide practice.
“So, no matter what interests the students have, we’re really able to teach them a lot of new things, but also stay the course with their interests,” she added.
“The most rewarding for me is when they are able to achieve their short-term goals in front of me,” Messing said. “For example, if they’re pursuing a residency, we take the process from beginning to end. We’ll look at their CV, their letter of intent. I always do mock interviews with them and debrief after each interview, and then to come to Match Day and see that they match with the program that they’re so excited about.
“Honestly, it’s just the most rewarding thing for me, especially if they initially come in and they’re unsure if they can do it,” Messing said. “Such as during mock interviews when they’re second-guessing their abilities. To see that progress and see them match where they want to be is a really good feeling.”
Messing is also a proponent of work-life balance.
“Montefiore does a really good job of trying to enforce that balance and I’d say that it is something we try to give to our students and our residents,” she said. “I definitely do still horseback ride and Montefiore is kind of like a family; we go out together, we go to dinner, we go hiking and do a lot of non-work-related activities, and we have a deal with each other that when we’re out we don’t talk about work!”
But the biggest escape for me is getting out of the city, going horseback riding,” she added. “And I have a dog, so spending time with my dog, walking her. It helps me to know I have to leave work at the end of the day to go take care of her.”
Messing no longer owns a horse herself, but luckily a friend does.
“I ride in Westchester,” she said. “I grew up in Connecticut and do have a car so it’s easiest to drive to my parents’ house. And one of my closest friends from growing up has a horse, so I ride him and take lessons and train on him.
“I’m really lucky,” Messing added. “She’s an emergency room doctor so when she’s working on the weekends I’ll get a message from her and she’ll say ‘can you ride him this weekend?’ So it’s worked out really well for me. It works out for both of us.
And what does Messing enjoy about her job, which seems really to be more of a calling for her?
“Definitely working at a place like Montefiore where it has such a positive culture is helpful to have that kind of mentality, but I think it’s just feeling accomplished at the end of every day and feeling like we’re providing better care for our patients,” she said. “It’s really satisfying when I see the impact of a project that I’m working on. I do a lot of process improvement projects here and I’m in a fellowship program this year for it. To see how everyone is able to come together as a team and have a common goal and see those projects pan out is really rewarding.”