2013 Pharmacy Education Series

2013 Pharmacy Education Series May 23, 2013 Pharmacy Practice Model Initiative Featured Speaker: Featured Speaker: Christopher R. Fortier, PharmD, FASHP Manager, Pharmacy Support & OR Services Medical University of South Carolina Adjunct Associate Professor South Carolina College of Pharmacy

2013 Pharmacy Education Series May 23, 2013 Pharmacy Practice Model Initiative Featured Speaker: Christopher R. Fortier, PharmD, FASHP Manager, Pharmacy Support & OR Services Medical University of South Carolina Adjunct Associate Professor South Carolina College of Pharmacy 1 On-Line Evaluation, Self-Assessment and Statement of Credit Submission of an on-line evaluation is the only way to obtain CE credit for this webinar Go to www.proce.com/chsrx Webinar attendees will also receive an email with a direct link to the web page Print your CE certificate on-line Credit for live or enduring only Deadline: June 21, 2013 Event Code Code will be provided at the end of today s activity 2 On-Line Evaluation and Statement of Credit www.proce.com/chsrx CPE Monitor NABP e-profile ID Birthday (MMDD format) CE information automatically uploaded to ACPE 3 www.proce.com 1

How to Ask a Question Locate menu bar on your computer desktop Click orange arrow button Menu box will open Type question into question box Click Send Do not close menu box This will disconnect you from the Webcast Please submit questions throughout presentation Enter question Click Send Click No! 4 Accessing PDF Handout Click the hyperlink that is located directly above the question box Do not close menu box This will disconnect you from the Webcast Close other applications Click hyperlink No! 5 CE Activity Information Accreditation: 2.0 contact hours Funding: This activity is self-funded through CHSPSC. 7 www.proce.com 2

Full Steam Ahead: Moving Forward with the Adoption of the Future Pharmacy Practice Model Christopher R. Fortier, PharmD, FASHP http://www.ashpmedia.org/ppmi/ppmi_vid2/ppmi_vid2.ht ml 9 Today s Topics What is the Pharmacy Practice Model Initiative (PPMI) PPMI Consensus Recommendations National PPMI Dashboard Practical Approach 10 www.proce.com 3

What is the ppmi WHAT IS PPMI 11 QUESTION Have you ever heard of PPMI and what recommendations make up the initiative? 12 Goal of the ASHP/ASHP Foundation Practice Model Initiative Develop and disseminate a futuristic practice model that supports the effective use of pharmacists as direct patient care providers. 13 www.proce.com 4

Objectives of PPMI Describe optimal pharmacy practice models that ensure safe, effective, efficient and accountable medication-related care Identify patient-care-related related services Foster understanding of and support for optimal pharmacy practice models by key groups 14 Objectives of PPMI Identify existing and future technologies required to support optimal pharmacy practice models in health-systems Identify specific actions that pharmacists should take to implement optimal models Determine the tools and resources needed to implement optimal practice models 15 Leading change that we believe in versus being forced to accept the change of others 16 www.proce.com 5

Factors Driving Change Elevate practice/opportunity Healthcare reform Payment/reimbursement Quality of care Electronic health record 17 Factors Driving Change Nursing Postgraduate residency and internships Clinical ladder Education ranges from associate-level RN to graduate-level Nursing executives Nurse practitioners and physicians assistants Shortages of MD s and lower costs allow them to expand their roles Reimbursed for care Urgent care and wellness clinics 18 Recommendations PPMI RECOMMENDATIONS 19 www.proce.com 6

Overarching Principles Services Technology Technicians Implementing Change and Responding to Challenges 20 OVERARCHING PRINCIPLES OVERARCHING PRINCIPLES 21 Overarching Principles Essential elements of a pharmacy practice model can be developed for use in ALL pharmacy departments Financial pressure will force changes on how resources are used 22 www.proce.com 7

Overarching Principles Investments in technology will be required to optimally deploy pharmacy resources For hospitals with ambulatory care services, drug therapy management will be available by a pharmacist for each outpatient 23 SERVICES SPECIFIC SERVICES 24 Services Every department should identify drug therapy management services provided consistently by pharmacists All patients deserve the care of a pharmacist. It is recognized that resources will be allocated according to complexity of patients and organizational needs 25 www.proce.com 8

Services Essential pharmacist-provided management: Emergency department Antimicrobial stewardship Neonatal lintensive i care Oncology Critical care areas Organ transplant Antithrombotic/anticoagulation 26 TECHNOLOGY 27 Technology Enable pharmacists to better interact with patients and caregivers if implemented into workflow correctly Will allow for rapid access to patient information and variables that will facilitate pharmacist development of drug therapy management plans for individual patients 28 www.proce.com 9

Technology Technology priorities: Electronic medical record systems Barcode medication administration technology Real-time monitoring systems that provide a work queue of patients needing review and intervention Barcode technology during inventory, preparation/compounding, dispensing processes Integration of intelligent infusion devices into a closed loop medication-use process 29 TECHNICIANS TECHNICIANS 30 Technicians Technicians who have appropriate education, training, and credentials should be used to free pharmacists from drug distribution activities Assigning medication distribution tasks to technicians would make it possible to deploy pharmacists to drug-therapy management services 31 www.proce.com 10

Technicians Uniform national standards should apply to the education and training of technicians PTCB certification process requires completion of an accredited training program by 2015 Technicians must be licensed by state boards of pharmacy to support the optimal practice model 32 CHANGE & CHALLENGES CHANGE & CHALLENGES 33 Change & Challenges Department of Pharmacy administrative and clinical pharmacy leadership Support from medical staff leadership and healthcare executives Pharmacist electronic access to complete patient-specific data State laws and regulations that require direct pharmacy supervision of medication distribution 34 www.proce.com 11

Major PPMI Themes Move pharmacists closer to the patient Responsibility for safe use of medications and ensuring quality Well-developed technician workforce Wide-spread use of technology 35 QUESTION Do you agree with these highlighted recommendations? 36 Initial results INITIAL RESULTS 37 www.proce.com 12

38 Self Assessment - Common Strengths Pharmacy leaders engaged with hospital leadership about medication management performance Pharmacists use available evidence-based medicine Pharmacists involved in monitoring, reporting and tracking adverse drug events 39 Self Assessment - Common Strengths Pharmacy involvement in development of medication use policies Pharmacists accepting responsibility for clinical and distributive activities Inspection and replenishment of medication storage issues assigned to pharmacy technicians 40 www.proce.com 13

Self Assessment - Common Weaknesses Mechanism for pharmacist accountability Establishment of medical home model Amount of discharge education being provided d Prioritization of drug therapy management based on complexity Barcode technology used during preparation and compounding 41 Self Assessment - Common Weaknesses Pharmacist documentation in EHR to demonstrate outcome improvements Automated notification of abnormal lab values Integrated smart pumps Telepharmacy for patient interaction Technician involvement in medication reconciliation 42 QUESTION In your opinion where are the MAJORITY of PPMI gaps within your current practice model? 43 www.proce.com 14

What we have done at MUSC Integrated model Tech check tech DoseEdge PPMI steering committee MUSC PPMI 44 MUSC PATH TO PPMI Reviewed PPMI Materials, Solicited Feedback from Staff PMT Retreat, Developed MUSC Vision for PPMI PPMI Survey Developed Based on PPMI Self-Assessment, Administered, Analyzed, Presented at Town Hall PPMI Task Force Developed PPMI Advisory Group Developed to enact PPMI 45 MUSC PPMI Objective 1 Technicians Elevate the practice of our pharmacy technicians to support the medication distribution model Plan Create career ladder for technicians Assign duties to technicians previously assigned to pharmacists Status Complete In progress Recognize and reward high performing technicians In progress 46 www.proce.com 15

MUSC PPMI Objective 2 Integrative Practice and Technology Establish minimal pharmaceutical care standards for all patients at MUSC Plan Create service-based teams for pharmacist staff lead by clinical specialists Create minimal task list of all duties clinical pharmacists (CPs) must perform daily Integrate specialist model into duties previously thought of as clinical pharmacist duties Continue to explore notification systems for complex programs (eg, monitoring) Status Complete Complete In progress In progress Obtain and implement technology to support a mobile practice for pharmacists (laptops) Complete 47 MUSC PPMI Objective 3 Training/Education Plan Status Establish an ongoing staff development program for pharmacists and technicians to ensure satisfaction and comfort with the high level of service expected from our staff Ensure all pharmacists are proficient in using pharmacy info system On an ongoing basis offer modules to pharmacists to enhance skills in nutrition monitoring, PK monitoring, etc Complete In Progress Implement Tech-check- Tech competency program which will be ongoing Complete 48 MUSC PPMI Objective 4 New Practitioners/Training Grow resident training and education Plan Redevelop PGY1 residency program with the intention of growing the number of preceptors, rotations, and residents Status Complete Utilize residents within their knowledge, skills and abilities to provide direct patient care In progress 49 www.proce.com 16

Practice steps PRACTICAL STEPS 50 Changing What s Possible Live it Be a role model Identify the practice gaps Utilize CHS formal tools and resources Communicate with staff about PPMI and the justification Utilize change management principles Create FAQ document 51 Changing What s Possible Prioritize and focus on a couple of recommendations Set monthly, quarterly, annual goals Make part of formal strategic plan Clinical and distributive productivity Promote from top down and bottom up Communicate with key physicians/administration Work with staff to identify challenges and action plans to overcome 52 www.proce.com 17

Changing What s Possible How will you know if you are successful Collaborate and share experiences Stay in constant communication with team Celebrate successes large and small 53 54 QUESTION What impact can PPMI have on both you professionally, within your department and for your organization? 55 www.proce.com 18

ACCEPT THE CHALLENGE 56 To bring about change within a diverse profession such as pharmacy, one needs a large number of people pulling in the same direction. Before one can get folks pulling in the same direction, one needs general agreement about the best direction in which to move. William A. Zellmer 58 www.proce.com 19

GIT R DUN 59 CHS Pharmacy Practice Model Initiative Trent A. Beach, PharmD, MBA, MHA, BCPS, FASHP Director, Clinical Pharmacy CHS Professional Services Corporation 60 Objectives At the end of this educational session, the participant will be able to: Discuss the vision for pharmacy practice at CHS affiliated healthcare facilities. Design an organization-specific action plan that will lead the affiliate pharmacy program to achieve the vision for pharmacy practice. Lead transformational change within affiliate organization consistent with the initiative s goals. Access tools and resources developed by the CHS Pharmacy Practice Model Task Force to implement or enhance key pharmacy practice services. 61 www.proce.com 20

Our Iceberg Is Melting John Kotter 62 CHS PPMI Task Force Members Chair: Trent Beach, Director; Clinica al Pharmacy, CHSPSC Pharmacist Affiliate Facility Division I R. Anthony Davis, PharmD Carolinas Medical Center Pam Graham, PharmD Wesley Medical Center Marshall E. Robbins, PharmD Crestwood Medical Center Diana Willman, PharmD, BCPS Southside Regional Medical Center Division II Jo Ann Gibbs, PharmD, BCPS Byrd Regional Hospital ClaudetteLeiker Leiker, PharmD, RPh South Texas Regional Medical Center Division III Alan Chen, PharmD Memorial Hospital of Salem County Diana Gordon, RPh Pottstown Memorial Medical Center Lawrence D. Jones, RPh Phoenixville Hospital Division IV David M. Dirig, RPh, PhD Fallbrook Hospital Bryan Rowe, RPh Deaconess Medical Center (Spokane) Division V Kristin Brooks-Shrum, RPh, MBA Heartland Regional Medical Center Amy E. Hyduk, PharmD, MBA Lutheran Hospital of Indiana Kim Porter, PharmD, BCPS Northside Medical Center CHSPSC Richard Kent, RPh, MS CHSPSC Mike Farrell, Project Manager CHSPSC 63 Pharmacy Practice Model Initiative Areas of Primary Focus Anticoagulation Management (TJC NPSG) Antimicrobial Stewardship/IVto-PO conversion Initiative Focus Renal and Pharmacokinetic Dosing Patient Safety - ADR and AE Avoidance CMS Quality Measures 64 www.proce.com 21

Pharmacy Practice Model Initiative Primary Goals Direct Patient Care Expanded Leadership Pharmacists & Technicians 65 Pharmacy Practice Model Initiative Objectives (Continued) Provide guidance in developing facilityspecific strategy to encourage innovative pharmacy practice Improve pharmacist leadership in med use systems and accountability for med-related patient outcomes Develop resources for professional development, competence assessment and training Redefine pharmacy productivity toward patient outcomes and impact on hospital metrics (e.g., Hospital Acquired Conditions, HCAHP, core measures, etc.) Create and educate a new pharmacy performance metric based on normalized prescriber intervention data 66 Pharmacy Practice Model Initiative Objectives (Continued) End State macy Practice: CHS Model Pharm AMS Leadership Patient Unit Deployment 100% Coverage Chart Documentation Outcomes Accountability Technician Optimization Pharmacy takes a lead role in the routine review of hospital/health-system antibiotic resistance patterns, antimicrobial stewardship program, and prevention of hospitalacquired infections Pharmacists are involved in routine development of patient care plans in all areas/situations. When possible, based on resources, pharmacists are assigned/deployed to patient care units. This may include shared resources All patients' medication profiles are reviewed for appropriateness at least daily by a pharmacist. This is distinguished from patient medication review at time of new order entry or verification Pharmacists monitor all patients' throughout facility responses to medication therapy daily Pharmacists routinely document recommendations, assess progress and achievement of therapeutic goals, and make follow up notes in patients' permanent medical records throughout all patient care areas Pharmacists are held accountable for patients' medication related outcomes Medication preparation and distribution tasks are assigned to pharmacy technicians, to the fullest extent possible, maximizing pharmacists' time to drug therapy management activities 67 www.proce.com 22

Pharmacy Practice Model Initiative Project Pathway Self-Assessments 1 Administer facility specificself-assessments 2 Determine: Level of patient care involvement Degree of leadership in medication use systems Practice change needs to meet vision Potential risks to performance improvement Journey Placement (Baseline) 3 Score placement on the Action Plans Beach Pharmacy Practice Model lassessment Scale 4 Verify placement with the Regional Director 5 Segmentation by selfassessed maturity allows appropriate resource development comparative benchmarking action planning for model advancement 6 Coordinate gap analysis and creation of action plans at each facility Reliant on the selfassessment outcomes Dependent on current state circumstances to achieve practice changes To expand fellow healthcare professionals and leaders expectations 68 Pharmacy Practice Model Initiative Pharmacy Programmatic Maturity Scale Order Review Order Review Order Clarifications Non-Formulary Response Some Autosubstitutions Monitoring Lists List Practice Some Renal Dosing beyond Initial Order Some Anticoagulation Monitoring; Sufficient to Meet NPSG 3 Some Time Assigned to Review Specific Types of Patient Concerns General Systematic Pt. Review * Significant Monitoring Effort Beyond Initial Order Efforts Cover an Increasing Proportion of the CHS Clinical Programs (e.g., Modules) Systematic Pt. Review with Improvement* Monitoring Efforts Cover all Patients Identified in all CHS Modules Approach in Place to Review and Learn and Some Signs of Improvement Some signs of Innovation Resulting from Learning Innovation Unique Patient Monitoring and Activities in Addition to CHS Modules Significant and Systematic Approaches to Learning and Improvement Signs of Organizational Analysis and Innovation * Majority targets 69 Pharmacy Practice Model Initiative Practice Maturity by Affiliate Self-Assessment General Systematic Pt. Review * Systematic Pt. Review with Improvement* None Innovation None Order Review Order Review Vast Majority of CHS Affiliates Monitoring Lists List Practice Marion County MC (1) S. Texas RMC (2) E. New Mexico MC (4) Fallbrook Hospital (4) Mat-Su RMC (4) Northwest MC (4) Payson RMC (4) Lutheran Hospita (5)l Moberly RMC (5) Significant Monitoring Effort Beyond Initial Order Southern Virginia RMC (1) Cedar Park RMC (2) McKenzie-Willamette MC (4) * Majority targets 70 www.proce.com 23

Direct Drug Cost Savings Volume-Based Normalization Direct Drug Cost Savings Per 100 Adjusted Patient Days Division <X> - Month, Year $2,500.00 $2,000.00 Benchmark Group 1 $4,500.00 $4,000.00 $3,500.00 Benchmark Group 2 $ Per 100 APD $1,500.00 $1,000.00 $500.00 $ Per 100 APD $3,000.00 $2,500.00 $2,000.00 $1,500.00 $1,000.00 $500.00 $0.00 Hospital A Hospital B Hospital C Hospital D Hospital E $0.00 Hospital F Hospital G Hospital H $4,000.00 Benchmark Group 3 $3,000.00 Benchmark Group 4 $3,500.00 $3,000.00 $2,500.00 $ Per 100 APD $2,500.00 $2,000.00 $1,500.00 $1,000.00 $500.00 $ Per 100 APD $2,000.00 $1,500.00 $1,000.00 $500.00 $0.00 Hospital I Hospital J Hospital K Hospital L Hospital M Hospital N $0.00 Hospital O Hospital P Hospital Q Direct Drug Savings/ 100 APD Benchmark Group 90th %'tile Benchmark Group Average Target for Benchmark Group 71 Direct Drug Cost Savings Volume-Based Normalization Benchmark Group 1 $2,500.00 $2,000.00 $ Per 100 0 APD $1,500.00 $1,000.00 $500.00 $0.00 Hospital A Hospital B Hospital C Hospital D Hospital E Direct Drug Savings/ 100 APD Benchmark Group Average Benchmark Group 90th %'tile Target for Benchmark Group 72 Interventions Volume-Based Normalization 70.00 Interventions Per 100 Adjusted Patient Days 60.00 ons (Month) Total Interventio 50.00 40.00 30.00 20.00 10.00 0.00 Hospital A Hospital B Hospital C Hospital D Hospital E AVG/100 APD Target per 100 APD 90th Percentile # Int/100 APD 73 www.proce.com 24

Management Dashboard Reports Sentri7 Website 74 Resources & Training Training Modules (Task Force) C-Suite Resource / Talking Points Anticoagulation Training Target Drug Monitoring Training Antimicrobial Stewardship Training Pharmacy Technician Educational Series (11 Modules) Renal Dosing Training 75 Pharmacist Accountability for Clinical Outcomes Clinical Practice Informatics Support Standards Educational Role Mentoring Others Medication Use Systems Leadership 76 www.proce.com 25

Communication Approaches Pull Meetings with CHS Leadership and Divisional Leadership Collaboratives with affiliates to create initial wins Communication creating leadership understanding of the dichotomy of pharmacist functions Communication demonstrating ti impact of our clinician activities (Productivity Reports) Optimization of technician roles and responsibilities in support of the pharmacy clinician role Creation of a new productivity metric for clinician activities (Volume-based interventional productivity model) Communication demonstrating training extent with our current pharmacists and future recruiting criteria Push Meetings with Affiliate Leadership Communication creating leadership understanding of the dichotomy of functions of pharmacists Create small, early wins and build momentum by increasing interventions Communication demonstrating impact of affiliate-specific ifi clinician i i activities iti (Productivity Reports) Communication demonstrating performance compared to like hospitals within Division and outside Division (Capacity comparison) Optimization of technician roles and responsibilities in support of the pharmacy clinician role Creation of a new productivity metric for clinician activities (Volume-based interventional productivity model) Communication demonstrating training extent with our current pharmacists and future recruiting criteria 77 Gap Analysis 78 79 www.proce.com 26

Proof of Concept Concept SCALE Analysis Working models Functioning prototype services Feasibility studies Communication 80 81 82 www.proce.com 27

83 Update on Current Pharmacy Initiatives and Strategies Bob Fink, Pharm.D., M.B.A., FASHP, FACHE, BCNSP, BCPS Chief Pharmacy Executive Community Health Systems 85 86 www.proce.com 28