Infectious diseases pharmacist Robbie Christian, PharmD, BCIDP, has several passions: teaching; antimicrobial stewardship; promoting diversity, equity, and inclusion (DEI) in the pharmacy profession; and being an active aunt and spending time with her dogs. She even has a favorite organism.
Bacteria fighter
“Pseudomonas,” said Christian, an ASHP member, noting she refers to the bacterium as a he. “He knows how to withstand any antibiotic, and he’s often difficult to treat, but we always get him. Due to its several resistance mechanisms, it causes the most heartache with people, but I think with some of the newer drugs that are being developed, we’ll handle him.”
Since late 2022, Christian has served as an infectious diseases clinical pharmacy specialist and PGY2-ID residency program director at the VA Northeast Ohio Healthcare System in Cleveland. She spends her days working with learners, rounding with ID consult teams, and serving as the outpatient parenteral antimicrobial therapy manager. In this role, she watches over all patients going offsite with IV antibiotics. In addition, she assists with seminars and projects, establishes protocols, and works on research.
Christian said she likes “the puzzle of figuring out the best thing for the patient and being a good steward over our antibiotics. Antimicrobial stewardship was just a buzzword when I was finishing [pharmacy] school. But now I really know the importance behind it. If we are not good stewards now, it will be a very, very grim future. We do our best to make sure that we are using antibiotics only as necessary, especially during cold and flu season.”
A layered learning approach
Precepting is one of the tasks that brings her joy. She loves answering questions from trainees about the pharmacokinetics and pharmacodynamics of drugs, and seeing things click in their minds. “I do a lot of whiteboard teaching,” she said. This is where she asks trainees to write down everything they know about a particular subject so she can push them a little further.
Christian also believes in layered learning, working with pharmacy students and residents simultaneously, and having residents help teach students. Her students are appreciative, as evidenced by two awards—one for the Most Supportive Preceptor in 2020, and one for Preceptor of the Year in 2021.
Patient-centered care
Christian said she enjoys the veteran patient population she serves. “Our veterans are a hilarious group of people,” she said. “They’re blunt, and they’ll tell you what they are going to do and what they are not going to do. It makes it a little bit more creative in how we address our veterans and use patient-centered care to develop a plan for them.”
As an added bonus, Christian said she is privileged to work with Robert Bonomo, MD, chief of the medical service at the Cleveland VA and a well-known ID expert. “It is great to be able to round with him and pick his brain on what his thoughts are with some of the things in the guidelines, and up-and-coming medications and antimicrobials,” she added.
One initiative Christian developed relates to monitoring for azole antifungal drugs. At her hospital, monitoring of azoles was only occurring in about 20% of patients, which could potentially lead to some patients receiving the medications longer than necessary or experiencing adverse effects. Under a protocol that started Feb. 1, any patient prescribed certain azole drugs for at least a week will have a therapeutic level obtained that will be assessed by the managing physician and a pharmacist. “I’m excited about this project and hopeful that it will lead to some positive effects for our patients,” she said.
Early career as a pharmacy technician
Christian began her career as a pharmacy technician with CVS. While she enjoyed the work, the pharmacists she worked with encouraged her to pursue pharmacy school. Once there, she fell in love with microbiology and the lab and went on to complete a pharmacy residency, doing her PGY2 year at the same VA hospital where she now supervises others.
Her first pharmacist job was at Our Lady of the Lake Regional Medical Center in Baton Rouge, a 1,000-bed hospital. She had been looking for a position as an ID consult pharmacist, and the day after her interview, they invited her to begin after residency. Christian quickly found herself participating in patient rounds and making therapeutic interventions.
“I really got my feet wet,” Christian said. “I had to create an aminoglycosides protocol, and a vancomycin area under the curve/minimum inhibitory concentration protocol. We had a lot of patients with HIV, so I created this initiative where every patient admitted to the hospital who had HIV was first reviewed by the ID consult team and then a pharmacist. I reviewed all of their medications to look for interactions and continuance of therapy. I was just blown away by how many times our patients were not started on the right type of tenofovir, for example.”
About four years later, in the fall of 2022, she had the chance to return to the Cleveland VA to become residency program director, a position she always wanted. “Residency program directors, as well as preceptors, can help guide you in the right direction and make or break your career,” she said, noting her own preceptors were “really positive people who are pushing you forward in a good way to a career that is satisfying for the learner.” Along the way, she credits ASHP with helping her find residency programs where she encountered mentors and for the guidance the organization provides for program directors so she can ensure her learners get everything they need.
Advancing DEI initiatives
Promoting DEI also has been of interest to Christian. She chaired the Society of Infectious Diseases Pharmacists’ DEI Committee. She worked on efforts such as establishing a 60-minute implicit bias training for leaders and establishing grant funding for pharmacists working on projects to positively impact communities of minoritized individuals. Christian also was just named executive director of the Student National Pharmaceutical Association, an educational service association of pharmacy students.
In the “two and a half minutes per day” that she has free, Christian joked, she spends time walking her three dogs and cheering on her 10-year-old nephew at his basketball and baseball games.
