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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.

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taking practice to the next level pharmacy practice model initiative ppmi and practice model summit

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

profession s imperative to set our own course
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

environmental influencers
Environmental Influencers
  • Technology
  • Meaningful Use
  • EHR
  • Bar-coding
  • Tele-pharmacy
  • Dispensing automation
  • Quality and Outcomes
  • Pay for Performance
  • REMS
  • National Quality Forum
  • “no-pays”
  • Health Reform
  • Accountable Care Organizations
  • Medical Homes
  • MTM
  • Drug Commoditization
  • Rural Health Issues
ashp members seeking consensus on future
ASHP Members SeekingConsensus 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
Vision for the ASHP / ASHP Foundation PPMI
  • The initiative and summit will create passion, commitment, and action among hospital and health-system 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
Goal of the ASHP / ASHP FoundationPPMI

Develop and disseminate a futuristic practice model that supports the effective use of pharmacists as direct patient care providers.

what is a practice model
What is a “Practice Model”?

AJHP 2010;67:542

  • 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
ppmi objectives
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
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
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 cost-effective use of medications, help ensure compliance with quality-of-care standards.

goal segment and disaggregate
Goal: Segment and Disaggregate

v

Optimal Pharmacy Practice Models

2010 Pharmacy Practice Model Initiative Summit

William A. Zellmer

American Society of Health System Pharmacists

goal putting the pieces back together
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

Overview: PPMI Summit Consensus-Building Process

Daniel Cobaugh, Pharm.D., FAACT

Vice President, ASHP Foundation

consensus building process
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 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 continued1
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 continued2
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

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
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
State Society Implications (Continued)

Accomplished by:

  • State Law & Regulations
  • Changes in Mindsets & Relationships
  • Policies
  • Credentialing
technology
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
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
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
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
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 continued1
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 continued2
Pharmacy Practice (Continued)
  • Pharmacists must have privileges towrite 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 continued3
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
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
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 continued1
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
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
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 continued1
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

What comes after the PPMI Summit?

Daniel Cobaugh, Pharm.D., FAACT

Vice President, ASHP Foundation

implementation tools and resources
Implementation Tools and Resources

Deliverable Deliverable Date

Summit Recommendations Complete

Residency Conferences Complete

Summit Video 2/11

Web-Based Timeline 2/11

MCM 11 Programming 4/11

Publication of Proceedings 4/11 (Web)

6/11 (Print)

implementation tools and resources continued
Implementation Tools and Resources(Continued)

Deliverable Deliverable Date

SM 11Programming 6/11

ASHP Vision Statement 7/11

Junior Investigator Grant 7/11

Residency Grants 7/11

Demonstration Grants 7/11

Briefing Document Webinars 7/11 – 1/12

ASHP 2015 Revisions 12/11

implementation tools and resources continued1
Implementation Tools and Resources(Continued)

Deliverable Deliverable Date

Assessment Tool 12/11

Complexity Score Tool 12/11

Section/Forum Activities Ongoing

State Affiliate Engagement Ongoing

Change Workshops TBD

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