Transcript Taking Practice to the Next Level:

Taking Practice to the Next Level:
Pharmacy Practice Model Initiative
(PPMI) and
Practice Model Summit
David Chen, R.Ph., M.B.A.
Director, ASHP Pharmacy Practice
Sections
What is the Imperative for
Practice Model Change?
Profession’s Imperative to
Set Our Own Course
• Need to integrate initiatives in light of current
health care environment
• Need to respond to members’ demand for
concerted evaluation of practice model
• Need to:
“ 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
Education and Professionalism
First Professional Degrees Conferred 1980 - 2008
(projected)
Source: AACP Profile of Pharmacy Students
12000
10000
BS
PharmD
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* 2004/05 - 2007/08 projections based on fall 2004 enrollments by expected graduation year
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Professional Milestones
and Road Maps
Environmental Influencers
Quality and Outcomes
•Pay for Performance
•REMS
•National Quality Forum
•“no-pays”
Technology
•Meaningful Use
•EHR
•Bar-coding
•Tele-pharmacy
•Dispensing automation
Health Reform
•Accountable Care Organizations
•Medical Homes
•MTM
•Drug Commoditization
•Rural Health Issues
ASHP Members Seeking
Consensus on Future
Key Discussions – identifying the issues
– Section of Pharmacy Practice Managers
– Section of Pharmacy Informatics and Technology
– ASHP April 2008 Strategic Planning Retreat
– Council Discussions
– Affiliate Leadership
– ASHP Task Force on Science
– Others (JCPP, UHC, Individuals)
Vision for the
ASHP / ASHP Foundation PPMI
• The initiative and summit will create passion,
commitment, and action among hospital and healthsystem pharmacy practice leaders to significantly
advance the health and well being of patients by
optimizing the role of pharmacists in providing
direct patient care.
Goal of the ASHP / ASHP Foundation
PPMI
Develop and disseminate a futuristic practice
model that supports the effective use of
pharmacists as direct patient care providers.
What is a “Practice Model”?
• Describes how pharmacy department
resources are deployed to provide care
• One size doesn’t fit all
• Does include:
 How pharmacists practice and provide care to patients;
 How technicians are involved to support care; and
 Use of automation/technology in the medication use
system
AJHP 2010;67:542
PPMI Objectives
• Describe optimal pharmacy practice models
that ensure safe, effective, efficient and
accountable medication-related care.
• Identify patient-care-related services.
• Foster understanding of and support for
optimal pharmacy practice models by key
groups.
PPMI Objectives (Continued)
• 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 need to
implement optimal practice models.
Goal: Identify “Universal”
Beliefs and Assumptions
• Example: There is opportunity to significantly
advance the health and wellbeing of patients in
hospitals and health systems by changing how
pharmacists, pharmacy technicians, and technology
resources are deployed
• Example: In the next 5-10 years, hospitals and health
systems will be under increasing pressure to cut
operating costs, be more efficient, help ensure costeffective use of medications, help ensure compliance
with quality-of-care standards.
Goal: Segment and Disaggregate
Optimal Pharmacy
v
Practice Models
2010 Pharmacy Practice Model Initiative Summit
William A. Zellmer
American Society of Health System Pharmacists
Goal: Putting the Pieces
Back Together
Optimal
Pharmacy
Practice Models
2010 Pharmacy Practice Model Initiative Summit
William A. Zellmer
American Society of Health System Pharmacists
Overview: PPMI Summit
Consensus-Building Process
Daniel Cobaugh, Pharm.D., FAACT
Vice President, ASHP Foundation
Consensus Building Process
• A 174-item survey was distributed to 107
previously appointed voting participants and
the ASHP membership-at-large.
• Questions were categorized under 5 domains:
Overarching Principles
Services
Technology
Technicians
Implementing Change and Responding to Challenges
Consensus Building Process
(Continued)
• Consensus on an item was defined as:
>80% (+/- 3%) of voting participants indicated in the
PPMI Survey that they agreed or strongly agreed
with an item (N= 85);
>40% (+/- 3%) of voting participants indicated in the
PPMI Survey that they disagreed or strongly
disagreed with the item (N = 7).
Consensus Building Process
(Continued)
• Remaining items were included
for small-group discussion at the
Summit. (N= 72)
• Participants were divided into 7
small groups and participated in
5 small group discussions.
• Items for which less than 6 of
the small groups agreed on their
inclusion were during large
group consensus-building. (N =
38)
Consensus Building Process
(Continued)
• New items identified during the small group
sessions or recommended by individual voting
participants during the large group consensus
session were also discussed and voted upon in
the large group sessions. (N = 27)
PPMI Implications from a
State Society Perspective
(Or, They Expect me to do
WHAT?!)
Paul F. Davis, R.Ph.
Executive Director,
Texas & New Mexico Societies of
Health-System Pharmacists
State Society Implications
PPMI = Changes in:
• Roles and responsibilities of health-system
pharmacists
• Medication Therapy Management Model
• CPE, undergraduate & residency education
• Roles and duties of technicians
State Society Implications
(Continued)
Accomplished by:
• State Law & Regulations
• Changes in Mindsets & Relationships
• Policies
• Credentialing
Technology
• Telepharmacy will enable remote supervision
and should be available for use in pharmacy
departments.
• No hospital should be exempted from
compliance with technology-related
medication-use safety standards.
– (Laws & regulations, rural vs. intra-facility vs.
community clinics)
Pharmacy Education
• Advanced training in pharmacy informatics
with residencies and post-graduate education
should be expanded .
• Curricular changes are required in colleges of
pharmacy to prepare students for a
significantly larger role in drug-therapy
management than is currently achieved in
most hospitals and health systems .
Pharmacy Education
(Continued)
• Colleges of pharmacy should be required to
provide informatics training for all pharmacy
students to ensure graduates’ success in
optimal pharmacy practice models .
– (Availability of sites, funding, expanded role vs.
limited opportunities?)
Pharmacy Practice
• All patients have a right to the care of a
pharmacist .
– (Summit participants recognized that resources
have to be allocated according to the complexity
of patients’ needs and organizational needs.)
• (Concept vs. budgets. Small & rural hospitals.)
Pharmacy Practice
(Continued)
• Hospital and health system pharmacists:
– Responsible and accountable for patients’
medication-related outcomes .
• (Are they ready? What will it take to give them the
authority?)
Pharmacy Practice
(Continued)
• Drug Therapy Management:
– Pharmacist s should be certified through BPS.
– Provided by a pharmacist for each hospital
inpatient and be available from a pharmacist for
each outpatient when outpatient services exist.
• (Basis in state law – all pharmacists, PhC, advanced
education, certification)
Pharmacy Practice
(Continued)
• Pharmacists must have privileges to write
medication orders in the health care setting .
– Through credentialing and privileging processes,
as part of the collaborative practice team .
– Pharmacists should be required to document and
sign recommendations and follow-up notes in the
patients' medical records .
– Pharmacists should be part of accountable care
organizations and medical homes .
• (Legislation, hospital policies, beyond the hospital)
Pharmacy Practice
(Continued)
• Hospital and health system pharmacists:
– Responsible and accountable for patients’
medication-related outcomes .
• (Are they ready? What will it take to give them the
authority?)
Medication Management Model
(Not your old counseling & drug interaction buggy!)
• Review of medication orders before the first
dose is administered .
• Monitoring of patient response to medication
therapy .
• Adjustment of medication doses based on
patient response, pharmacokinetic
characteristics of the medication , or genetic
characteristics of the patient.
Medication Management Model
(Continued)
• Monitoring of and authority to order
medication serum concentrations and other
laboratory analyses.
• Medication reconciliation in the emergency
department; upon admission, inter-hospital
transfer, and discharge ; and in the
ambulatory-care setting.
• Provision of discharge education to patients .
Medication Management Model
(Continued)
• Participation on rapid response teams .
• Participation on resuscitation teams .
• Completion of ASHP-accredited residency
training or achievement of equivalent
experience .
• Hospital- or health-system-level credentialing
and privileging processes .
– (Current models, community relationships,
certification)
Technicians
• ASHP should define a scope of practice,
including core competencies, for hospital and
health-system pharmacy technicians .
• Uniform national standards for education and
training of pharmacy technicians .
• Must be certified by the Pharmacy Technician
Certification Board .
Technicians
(Continued)
• PTCB should require completion of an
accredited training program before an
individual may take the certification
examination by 2015.
• Must be licensed by state boards of
pharmacy .
Technicians
(Continued)
• All distributive functions that do not require
clinical judgment should be assigned to
technicians .
• Technician specialization should be
developed .
– (Recognition of technicians, PTCB vs. State Exam,
community implications)
What comes after
the PPMI Summit?
Daniel Cobaugh, Pharm.D., FAACT
Vice President, ASHP Foundation
Implementation Tools and Resources
Deliverable
Summit Recommendations
Residency Conferences
Summit Video
Web-Based Timeline
MCM 11 Programming
Publication of Proceedings
Deliverable Date
Complete
Complete
2/11
2/11
4/11
4/11 (Web)
6/11 (Print)
Implementation Tools and Resources
(Continued)
Deliverable
SM 11Programming
ASHP Vision Statement
Junior Investigator Grant
Residency Grants
Demonstration Grants
Briefing Document Webinars
ASHP 2015 Revisions
Deliverable Date
6/11
7/11
7/11
7/11
7/11
7/11 – 1/12
12/11
Implementation Tools and Resources
(Continued)
Deliverable
Assessment Tool
Complexity Score Tool
Section/Forum Activities
State Affiliate Engagement
Change Workshops
Deliverable Date
12/11
12/11
Ongoing
Ongoing
TBD