Resource - Indiana Rural Health Association
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Transcript Resource - Indiana Rural Health Association
Lisa Anne Boothby, PharmD, BCPS
Director of Pharmacy, Dukes Memorial Hospital
Demonstrate the value of clinical pharmacy services
to decrease 30-day readmission rates
Outline the pharmacist’s role in reducing medical
waste
Detail ethical issues associated with drug shortage
management
Clinical pharmacy services
Inpatient and outpatient settings
Improve patient outcomes
Patient Accountability and Affordable Care
Act
Pharmacists are “other healthcare providers”
Social Security Act
Part B versus Part D
Three MTM billing codes
Private insurance reimbursement follows
Smock N. Affordable Care Act Regards Pharmacists as Health Care Providers, Not Just Prescription Dispensers.
Available at URL: http://www.pharmacytimes.com/publications/issue/2013/January2013/Affordable-Care-ActRegards-Pharmacists-as-Health-Care-Providers-Not-Just-Prescription-Dispensers
Capitated healthcare precede reimbursement
May decrease need for pharmacy billing
Share in savings once minimum achieved
Accountable care organizations
Not all hospitals have embraced
Pilot programs
Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
Providers accountable
Achieving quality
Reductions in rate of spending growth
Physician led with many payer arrangements
National Committee for Quality Assurance
Established ACO criteria
7 categories with 4 levels
Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
To reach critical mass
Incorporate multiple payers or multiple hospitals
Apply for a CMS wavier to include Medicaid
patients
Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
Patient centered medical homes
Led by physician
Include pharmacist, nurse and other health care
practitioners
Treat patient with chronic conditions
Prevent adverse events and optimize therapy
Team ensures all health care needs are met
Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
Improve medication management
Preventing hospital readmissions
Decreases revenue in a traditional hospital
budgetary model
Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
Keep patients healthy and out of the hospital
VA collaborative practice model
Prescribing privileges
More than 20 years of success
Pharmacist credentialed providers
Medication management
Preventing disease
Maintaining cardiovascular health
Preventing end organ damage
Medication compliance, adherence
Therapeutic drug monitoring
Supportive care
1 month study at Mission Hospital
735 bed community teaching hospital
Asheville, North Carolina
Pre-post design
2 weeks normal routine
2 weeks with clinical pharmacist
Simone A. Physician-Pharmacist Team Improves Hospital Care. Published June 20, 2013. Available at
http://www.pharmacytimes.com/news/Physician-Pharmacist-Team-Improves-Hospital-Care
Drug information
Discharge counseling
Medication interventions
Medication reconciliation
Filling discharge prescriptions
Submit discharge summaries
Simone A. Physician-Pharmacist Team Improves Hospital Care. Published June 20, 2013. Available at
http://www.pharmacytimes.com/news/Physician-Pharmacist-Team-Improves-Hospital-Care
15-day and 30-day readmission rates
Number of ED visits
Employee satisfaction surveys
Simone A. Physician-Pharmacist Team Improves Hospital Care. Published June 20, 2013. Available at
http://www.pharmacytimes.com/news/Physician-Pharmacist-Team-Improves-Hospital-Care
33% vs. 17% readmission within 30 days
11% vs. 2% readmission within 15 days
9% vs. 4% ED visits within 30 days
Simone A. Physician-Pharmacist Team Improves Hospital Care. Published June 20, 2013. Available at
http://www.pharmacytimes.com/news/Physician-Pharmacist-Team-Improves-Hospital-Care
Prospective cohort
729 patients over three months
Pharmacy medication reconciliation
30-day readmission rate
Polypharmacy and readmission rate
Pal A. , Babbott S, and Wilkinson T. Can the use of a discharge pharmacist significantly decrease 30-day
readmissions? Hospital Pharmacy 2013;48(5):380-388.
Pal A. , Babbott S, and Wilkinson T. Can the use of a discharge pharmacist significantly decrease 30-day
readmissions? Hospital Pharmacy 2013;48(5):380-388.
Med reconciliation and counseling
Decreased 30-day readmission rate
16.8% vs. 26%; p=0.006
Polypharmacy
More than 5 scheduled medications
Associated with increased readmission rates
Pal A. , Babbott S, and Wilkinson T. Can the use of a discharge pharmacist significantly decrease 30-day
readmissions? Hospital Pharmacy 2013;48(5):380-388.
Walgreens program
Reduces readmissions
Pharmacists oversee medication regimens
Transitions of care
Walgreens Program Employs Pharmacists to Reduce Hospital Readmissions. November 20, 2012.
http://www.pharmacytimes.com/news/Walgreens-Program-Employs-Pharmacists-to-Reduce-Hospital-Readmissions
Med review at admission and discharge
Bedside medication delivery
Counseling for patients and their caregivers
Regularly scheduled follow-up post discharge
24-7 support for discharged patients
Ensure follow up with physician
Ensure appropriate self care
Marian General and Lutheran Hospital
Walgreens Program Employs Pharmacists to Reduce Hospital Readmissions. November 20, 2012.
http://www.pharmacytimes.com/news/Walgreens-Program-Employs-Pharmacists-to-Reduce-Hospital-Readmissions
11 pharmacists
Vanderbilt University
Brigham and Women’s Hospital
Medication reconciliation
Time consuming
Most important contribution
Improving care transitions
Correct the admission medication history
Haynes KT, Oberne A, Kripalani S. Pharmacists’ recommendations to improve care transitions.
Ann Pharmacother 2012;46(9):1152-1159.
Translation to a rural critical access hospital
Minimal resources
Decreased ED visits decreases admissions
Decreased revenue with traditional models
Next steps?
TARGETING TRANSITIONS
Project BOOST: www.hospital-medicine.org
Project RED: www.projectred.org
STAAR initiative: www.ihi.org/STAAR
Medication reconciliation process
Physician and nurse driven
2 to 3 errors per each
Follow-up by pharmacy
Clarify and correct errors
Time intensive
Increased safety risk
Omissions
Delays and duplications
Develop criteria for consultation
Greater than 10 scheduled medications
High-alert medications
Anticoagulants
Core-measure disease states
•
SEWER
IV dextrose
Potassium
Saline
Sodium
Calcium
lactated
ringers
magnesium
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REGULAR TRASH
Outside packaging
Empty items that once contained medication
Shipping packaging
Recycle paper, glass, plastic
•
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•
•
•
•
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NONHAZARDOUS
RX WASTE
Antibiotics
Lidocaine
Pitocin
Heparin
HAZARDOUS
WASTE
• Insulin
• Some vitamins
and minerals
• Phenylephrine
P-LISTED
HAZARDOUS
WASTE
• Coumadin
plus
wrapper
• Nicotine
plus
wrapper
and peel
•
•
INCOMPATIBLE
HAZARDOUS
WASTE
Aerosols
• Inhalers
Oxidizers
• Silver nitrate
CHEMO
WASTE
SHARPS
Needles and broken ampoules
Empty syringes
Smith CA. Managing Pharmaceutical Waste. Journal of the Pharmaceutical Society of Wisconsin 2002;17-22.
Save money, prevent delays and omissions
Clinical pharmacists know formulary medications
Clinical pharmacists prevent non-formulary and
not-available medication orders at admission
Formulary management policies/procedures
Therapeutic interchange programs
Evaluate PAR levels for expired drugs
Outpatient prescribing practices
Polypharmacy
Lack of follow-up
Mail order pharmacies automatic renewals
Three month supplies
Compliance
Adherence
Persistence
Controlled substance regulation
Changes from DEA
Expected in future
Vendors
Stericycle, others …
Environmentally conscious disposal
Therapeutic interchange
Drug classes
Pharmacodynamics of medications
Superior therapeutic alternatives
Evidence based medicine
Avoid grey market distributers
Receive emails for information only
Plan ahead
Keep adequate inventory levels
Medications dispensed daily
Accept small loss with expired medications
To stock adequate levels
Prevent drug shortages from reaching patient
Aminophylline
Sincalade
Nalbuphine
Dextrose 25% and 50% syringes
Furosemide IV
Metoclopramide IV
Fentanyl IV
Potassium phosphate IV
Pharmacists vital part of the healthcare team
Pharmacotherapy experts
Explain how medications work in the body
Suggest therapeutic alternatives
Eliminate therapeutic duplications
Avoid polypharmacy
Teach common side effects
Action for severe side effects
Ethical stewardship
Medical and financial resources
PHARMACY COST
CENTER
Collaboration
Rural health hospitals
Payers
Obtain grant money
Research
New practice models
Demonstrate added value
Lisa Anne Boothby, PharmD, BCPS
Director of Pharmacy, Dukes Memorial Hospital