Transcript Compliant with all Competency Level I criteria AND

GEORGETOWN HOSPITAL SYSTEM
GEORGETOWN MEMORIAL HOSPITAL
WACCAMAW COMMUNITY HOSPITAL
TECH TREKKING
TEAM APPROACH
PHYSICIAN
CASE MANAGER
PATIENT
PHARMACIST
NURSE
Pharmacist Job Duties
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Order Entry &/or Order Reviewing/Dosing
Order Clarification
Order & Patient Follow up
Medication Dispensing
IV Admixtures calculations & checks
Clinical Interventions
Medication Procurement
Automation- Pyxis Control
Unit Inspections
Quality Assurance/ PI
Communication- phone/ rounds/ face to face
Med Reconciliation
Supervision
Increase Knowledge Base
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New procedures
New equipment
New research
New drugs
Continuing education
Increased Work Load
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Increased Patient Numbers
Automation
New Medications
Expanded Clinical Duties
Regulations
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CMS
JCAHO
Licensure
DHEC
DEA
SIP Guidelines
Hospital Policies
100,000 Lives
LeapFrog
Healthgrades
ASHP 2015
USP 797 Standards
Pills
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Multiple Tasks
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Continuing Ed
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Projects
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Community
Involvement
Medication Safety Facts
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Medication errors account for more than
7000 deaths annually
Approximately two out of every 100
patients admitted to the hospital will
experience a preventable adverse drug
event
Over 12% of patients experience an ADE
within 2 weeks of discharge
Massachusetts Coalition for the Prevention of Medical Errors
US TF on HC Cost Control
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Med Errors 30% of Health Care Cost
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Med Errors cost 10-15 % of hospital’s
annual operating cost
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Med Errors $23 billion national cost
(more than 50% are preventable)
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National Pharmacists Shortage
Increasing Knowledge Base
Expanded Duties
Safety-preventable ADE/Drug Conc/Interventions
Quality-Core Measures/SCIP/HAI/VAP
Changing Roles-Dispensing vs Clinical Roles
Goal
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To utilize Pharmacists to provide evidence based
Best Practices using the most cost effective
methods to support medication safety by
providing a universally consistent process
regarding medication therapy across the
continuum of care.
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TEAM APPROACH
PHYSICIAN
CASE MANAGER
PATIENT
PHARMACIST
Pharmacy Tech
NURSE
Expansion of Technician Role
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Techs must be registered with SCBORX
National Certification
SC- State Certification
June 2006- Grandfathered in or
Must be a graduate of approved
accredited program
Today: Tech Job Duties
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Order Entry &/or Order checking
Medication preparation
Tech check Tech
Prepare IV Admixtures
Calculations
Procurement-ordering, receiving, stocking
Inventory Control-Max/Min
Automation- Pyxis Control
Unit Inspections
Quality Assurance/ PI
Communication- phone/ rounds/ face to face
Med Reconciliation
JOB DUTIES SHIFT
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Medication Reconciliation
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Tech Check Tech
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Unit Inspections
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Chemo Admixtures
The Dilemma
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What to do ???
Development of Career Ladder
Pharmacy Technicians
Organizational Value
Self Worth
Recruitment/Retention
Cutting Edge
Development of Career Ladder
Organizational Value:
Increasing education, knowledge, responsibilities
of the tech gives the Pharmacists increase
support with the daily routine technical
functions, allowing them more time to spend on
Clinical Issues, which will create a more efficient
department, while saving the organization
dollars.
Development of Career Ladder
Self Worth:
This gives the Tech an opportunity for career
growth and advancement by increasing their job
responsibilities, accountability and their learning
which, in turn, increases their self worth and the
morale in the department.
Development of Career Ladder
Recruitment/Retention:
Replacing a trained, seasoned employee is very
costly to the institution($ 48,378)The career
ladder not only provided a method to increase
income, it helps retain the employee by giving
them extra incentives to work toward as they
increase their longevity with the organization.
( Year prior to starting WCH lost 3 techs-CVS/Cosco/ExCr)
Development of Career Ladder
Cutting Edge:
To continue to hire the high caliber employee we desire and
keep them incentivized, we must be creative and look for
ways to build self esteem, promote professionalism and
add opportunity for growth to hire and retain them.
Providing this creative advancement, not only gives the
“self starter” goals to work toward, it also creates a “need
to grow” in the department, so others are not left behind.
(Environment of friendly competitiveness with support)
Expanded Responsibilities
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USP 797 Compliance- IV Admixture
Monthly Unit Inspections
Medication Reconciliation
Tech check Tech
Quality Assurance Studies
PI Review
Pharmacy Projects
Community Involvement
Pharmacy Tech Levels
Pharmacy Trekking
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Pharmacy Tech Levels
Non-Certified Pharmacy Tech…….220……..$ (1 year)
Certified Pharmacy Tech I….…….245……..$$
Certified Pharmacy Tech II………275………$$$
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Pharmacy Trekking Differential
Trek A…………$ 0.75 ($1560)
Trek B…………$ 1.50 ($3120)
Trek C…………$ 2.50 ($5200)
Pharmacy Tech Levels
Non-Certified Pharmacy Tech…….220……..$
No National or SC State Certification
Certified Pharmacy Tech I….…….245……..$$
National Certification
Certified Pharmacy Tech II………275………$$$
National & SC State Certified OR
National Certified with at least 3 years
hospital pharmacy experience
Qualification to begin Trekking process may not occur until
employee has attain Certified Pharmacy Tech II Status
Pharmacy Trekking A
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Must be performing at a “meets” level or higher on all
performance appraisal standards
Must have demonstrated cross training competency in all
areas of Pharmacy as documented on the Pharmacy skills
checklist.
Demonstrated and documented competency in preparation
of all IV admixtures and Chemo solutions
Documented ability and evidence of conducting monthly
unit inspections
Documented completion of Pyxis minimum and maximum
inventory standards on a quarterly basis.
No evidence of written or suspension level corrective
action over the previous 12 months.
Documented minimum of 20 preceptorship hours of
training new pharmacy staff.
Pharmacy Trekking B
Compliant with all Competency Level I criteria AND:
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South Carolina State Certified Pharmacy Technician with SC BORx OR 3 years
experience as a hospital pharmacy technician with overall “exceeds” rating on
most recent performance review. (based on 2006/2007 set up this means a 3.0
or higher)
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797 Compliant (Completed documented 797 skills checklist & passed mediafilled testing)
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Minimum of 40 documented hours of preceptor ship with Pharmacy Tech
students during annual review period OR Participation in local career day event
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Documented participation with and mentorship of applied Ed of Pharmacy
Students of 8 hours during annual review period OR complete 1 approved
(in addition to those required for annual licensure)
Pharmacy Trekking B (continued)
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Participates in one documented department quality assurance initiative
during annual review period.
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Participates in Departmental one documented process improvement (PI)
activity during annual review period
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Participates in Pharmacy Week project OR Participates in Poison
Prevention Week project
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Participates in one or more GHS Community Health Events
Pharmacy Trekking C
Compliant with all Competency Level I and II criteria AND:
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Must have been a Pharmacy Technician with GHS continuously for a minimum of five years
OR must have graduated from an accredited pharmacy technician program and must have
been a Pharmacy Technician with GHS continuously for a minimum of three years.
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Demonstrates and documents completion of medication reconciliation process for 2 months
during annual review period
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Identifies specific opportunities for internal departmental policy changes that results in
improvement in safety or operational efficiency. Writes and/or revises drafts of policies for
review.
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Tech Check Tech as assigned documented by skills test and log sheets
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Researched and identifies a minimum of one industry or otherwise external “Best
Practice”/benchmark process improvement to be presented as a possible best practice for
GHS to adopt.
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In addition to the minimum required preceptor ship hours with Pharmacy Tech students,
individual will participate in the design of the training plan.
Pharmacy Trekking C (continued)
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Identifies and leads a minimum of one department quality assurance initiative.
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Identifies and leads a minimum of one Departmental process improvement (PI)
activity
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Serves in the leadership role to develop Pharmacy Week project plans
OR Serves in the leadership role to develop Poison Prevention Week project plans
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Participates in one or more GHS Community Health Related Event
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Completes 2 hours additional CEUs (in addition to those requires of annual
licensure renewal) during annual review period
WCH Pharmacy Trekking Costs
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PM……………C...........$5200
GW……………C……….$5200
VG…………….C……….$5200
GB…………….B……….$3120
BI……………..B……….$3120
LD………….…B……….$3120
AY…………….B……….$3120
SS………..…..B……….$3120
AJ…………….A……….$1560
KM……….…..A……….$1560
Total Costs……..…………………$34,320
GMH Pharmacy Trekking Costs
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MHR………….B.........$3120
TF.……………B……….$3120
MLR.………….B……….$3120
RS…………….B……….$3120
Total Costs……..…………………$12,480
Medication Reconciliation
(Trek Level C Criteria)
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$59.09/hr Average RPh
5.5 mins/patient
$14.21/hr Average Tech
WCH 2 EAST –July thru Dec 2007 1064 admissions
1064 X 5.5 mins=5852mins/60=97.5 hrs
97.5 X $59.09= $5761.28
97.5 X $14.21= $1385.48
$5761.28- $1385.48= $4375.80/ 6mon X 2=$8751.60/yr
Annual Efficiency Savings = $8751.60 @ WCH 2 East
Medication Reconciliation
(Trek Level C Criteria)
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$59.09/hr Average RPh
5.5 mins/patient
$14.21/hr Average Tech
WCH : July Thru December 2007
(3604 Admissions)
5.5 min X 3604=19,822/ 60 = 330.37 hours
330.37 X $59.09= $19,521.56
330.37 X $14.21= $ 4,694.56
$19,521.56-$4694.56=$14,827/ 6mon X 2=$29,654/yr
Annual Efficiency Savings = $29,654 @ WCH
Tech check Tech
(Trek Level C Criteria)
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Pyxis Refills & Narc Pulls
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$59.09/hr Average RPh
$14.21/hr Average Tech
WCH: Done Monday thru Friday
1.5 hrs/day X 5days/week x 26 weeks = 195 hrs
195 X $59.09= $ 11,522.55
195 X $14.21= $ 2, 770.95
$11,522.55 - $ 2,770.95= $8751.60/ 6mon
8751.60X2=$17,503.20/yr
Annual Efficiency Savings = $ 17,503 @ WCH
Tech check Tech
(Trek
Level C Criteria)
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Medication Repackaging Verification
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$59.09/hr Average RPh
$14.21/hr Average Tech
Done Daily
GMH: July-Dec 2007 = 1009 Repackaging Procedures
0.1 hours/procedure (6 min)
0.1 x 1009 = 100.9 hrs/6 months
100.9 X $59.09= $ 5,962.18
100.9 X $14.21= $ 1,433.79
$5,962.18 - $ 1,433.79= $ 4528.39/ 6 months
4528.39 X 2= $ 9,056.78/yr
Annual Efficiency Savings = $ 9,056.78 @ GMH
Unit Inspections
(Trek Level A, B, & C Criteria)
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$59.09/hr Average RPh
$14.21/hr Average Tech
WCH Done monthly: 9 units @ 1 hour/unit = 54 hours/6month
9 X $59.09 = $ 531.81/mon x 6 months = $3190.86
9 X $14.21 = $ 127.89/mon x 6 months = $ 767.34
$3190.86 - $767.34 = $2423.52/6mon X2= $4847.04/yr
Annual EfficiencySavings = $ 4847.04 @ WCH
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GMH Done monthly: 10 units @ 1 hour/unit = 60 hours/6month
10 X $59.09 = $ 590.90/mon x 6 months = $3545.40
10 X $14.21 = $ 142.10/mon x 6 months = $ 852.60
$3545.40 - $852.6 = $2692.80/6mon X2= $5385.60/yr
Annual Efficiency Savings = $ 5385.60 @ GMH
Chemo IV Admixture
(Trek Level A, B, & C Criteria)
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$59.09/hr Average RPh
$14.21/hr Average Tech
GMH : July Thru December 2007
# Admixtures per 6 Months = 76
# Hours per Admixture = 1
# Hours per 6 Months = 76 Hrs
76 X $59.09= $4490.84 /6 months
76 X $14.21= $1079.96 /6 months
$4490.84-$1079.96= $3410.88 /6mon
$3410.88 X2=$6821.76/yr
Annual Efficiency Savings = $ 6821.76 @ GMH
Financial Benefit
WCH Med Reconciliation………..….. $ 29,654.00
WCH Tech Check Tech……………... $ 17,503.00
WCH Unit Inspections……………….. $ 4,847.04
WCH Efficiency Savings…….$ 52,004.04
GMH Tech Check Tech………….……. $ 9,056.78
GMH Chemo Admixtures………….…. $ 6,821.76
GMH Unit Inspections…………………. $ 5,385.60
GMH Efficiency Savings……..$ 21,264.14
Safety
Allergy Procedure
ADR Procedure
Med Scanning Procedure
Order Checking
Tylenol Dosing Checks
Quality
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Metformin- SrCr Checks
Tech check Tech
Inventory –Max/Min Levels
Anesthesia Gases- Flow Rates
Charge Capture-OR/Endo/Anes
Billing Log Checks-Doc/Over/Rejections
Blood Derivative Log Documentation
Worth
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Organization
Recruitment, Retention, Cost Effectiveness, Community
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Department
Morale, Competitiveness, Environment
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Self
Motivation, Attitude, Importance
Cost/Benefit Analysis
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Financial
WCH Costs……………………….. $ 34,320.00
WCH Savings……………………. $ 52,004.04
WCH Net Gain……..$ 17,684.04
GMH Costs……………………….. $ 12,480.00
GMH Savings……………………. $ 21,264.14
GMH Net Gain……..$ 8,784.14
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Safety:ADR/Allergy/Scanning/Tylenol
Quality:Tech Check/Inventory/Charge Capture
Worth: Organization/Department/Self
Time Benefit
WCH:
GMH:
Med Rec…………….….195 Hours
Tech check Tech….…390 Hours
Unit Inspections……..108 Hours
693 Hours
Chemo Prep……….…..152 Hours
Repackaging Checks..202 Hours
Unit Inspections….…..120 Hours
474 Hours
693 + 474= 1167 Hours (0.6 FTE)
Benchmarks
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Financial Costs………..$17,684.04 WCH Gain
Financial Costs………..$ 8,784.14 GMH Gain
Turnover……………..…O Trekking Techs have Left
Shift In Duties…………Tech check Tech,
Unit Inspections, Med Reconciliation, Chemo Admixtures
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Best Practices………Scanning/ADR/Allergy
Inventory Control/Med Rec
THE Future
Family Caring For Family
 6 Key GHS Initiatives
 Shift of more duties
 Increase in Quality & Safety
 Promotion of Best Practices
 Leader in Pharmacy Practice
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