4/26/2013. Premier Health. Premier Health Pharmacy Services. Expanding Role of CPhT in a Five Hospital System. Objective

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1 Expanding Role of CPhT in a Five Hospital System Nathan Simmons, PharmD, MBA Director of Pharmacy, GSH Pam Fair, CPhT GSH Jessica Brock, CPhT GSH Allyson Ashford, CPhT -UVMC 1 2 Objective All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Arthur Schopenhauer ( ) Define medication reconciliation importance on critical processes in transitions of care Describe the emergence of the CPhT role in medication reconciliation process Define rationale for approval and implementation of CPhT in the medication management process Describe CPhT experiences in expanding roles 3 4 Premier Health Premier Health Pharmacy Services Dayton- Middletown-Troy 5 Hospitals (1665 beds) MVH MVHS (opened 2012) GSH AMC UVMC Pharmacy staff Approximately 200 FTE Pharmacy and Medication Reconciliation 3 hospitals utilize CPhT in ED and Critical Care 1 hospital utilizes PharmD in ED for Hospitalist coverage EHR = Epic CPOE (5 hospitals) Ambulatory ED Physician offices (175) Beaker, Radiant 5 6 1

2 The Sick Health Care System 1 in 6 Americans have no health insurance Health care spending is escalating Fee-for-service promotes unnecessary utilization of services (ED), tests, and procedures Medication errors are rampant Focus is on treatment, not prevention Care is fragmented The Medication Reconciliation Process 2005 Arch Intern Med 2005;165; % of IP admissions had 1 discrepancies between home meds and admission meds 39% had potential to cause moderate to severe harm 2005 TJC published NPSG 8 Medications should be accurately and completely reconciled across the continuum of care 2006 (Jan)- mandated full implementation % hospitals were non-compliant with requirement AJHP 78% hospitals report pharmacy involvement in med red; < 5% employ RPh/CPhT in admission drug histories 2010 (Dec) revised standard 7 8 Initiation - Expanding Role for CPhT SELF LONG-TERM Assess/Plan HOME Infusion Surveillance Surveillance Health Care System Infusion Center Services Formulary Management EMERGENCY EC ACUTE 2008 CPhT in Critical Care 2011 Pilot GSH CPhT in the ED 1/24/11-4/27/11 39% of reviewed medications required CPhT intervention 2012 Approval and Implementation GSH AMC UVMC MVH (Hospitalist driven) Post ACUTE Procedurebased care 9 10 Rationale for CPhT in the ED Improve the medication reconciliation process (implemented Epic CPOM ) Specifically home medication list Standardize process flow in the ED Improve quality benchmark and data collection Improve admitting physician satisfaction with the medication reconciliation process Comply with TJC and CMS standards Leverage pharmacist and emerging CPhT skills and experience HUGE Impact on Patient Safety Our Goals Make the Patients Safer Decrease Readmissions Decrease Length of Stay Decrease Medication Cost Wrong Medication = Ineffective Doses Too High or Too Low

3 256 Work Hour (32 shift) Sample in January to Feb of 2012 Average Time per Patient: 14 minutes per Med Rec 466 Med Histories 5902 Medications 2138 Interventions 36% of All Medications Checked Required an Intervention # Interventions Per Patient 4.6 Annualized 6644 Medication Histories 84,149 Medications 30,483 Interventions Interventions 561 Incomplete = 26% 426 Incorrect = 20% 941 Missing = 44% Intervention Type from 32 Shift Sample # incomplete: # incorrect: # missing: Results of Medication Reconciliation Trial Permanent Position Expanded Hours to 7 Days a Week, 10 hours per day UVMC Data 9 Months of Data 5231 Admissions from ED 1487 Home Lists (28.4% ) 8954 Changes 8 Clinically Significant Changes over the 3 Quarters (Subjective) Average of 6 Changes per Patient AMC Data 37 shifts of Data Average Time per Patient: 14 minutes per Med Rec 507 Med Histories 5819 Medications 2932 Interventions 50% of All Medications Checked Required an Intervention # Interventions Per Patient

4 AMC Annualized Data 5001 Med Histories Medications Interventions Incomplete 4854 Incorrect 3966 Missing 4666 AMC Data - Annualized Incomplete 492 Incorrect 402 Missing 473 Intervention Type AMC # incomplete: # incorrect: # missing: Good Samaritan Hospital ER Technician Jessica Brock CPhT Carries a designated Spectra Link Phone for Easy Access and Communication Stationed in the Emergency Department Partially Dispensing during downtime Good Samaritan Hospital ICU Technician Pamela Fair CPhT ICU Satellite Pharmacy Easy Access and Communication

5 Upper Valley Medical Center ER Technician Allyson Ashford CPhT ER Based for Easy Access and Communication