CSHP 2015: Sharing Our Success

1. CSHP 2015: Sharing Our Success Douglas Doucette, PharmD, FCSHP on behalf of the CSHP 2015 Atlantic Collaborative CSHP-NL Branch Semi-Annual Meeting, May 1, 2008 THERE ARE NO HANDOUTS AVAILABLE AT PPC FOR THIS PRESENTATION THESE SLIDES WILL BE POSTED TO CSHP NATIONAL SITE FOR INTERESTED PERSONS TO VIEW OR DOWNLOADTHERE ARE NO HANDOUTS AVAILABLE AT PPC FOR THIS PRESENTATION THESE SLIDES WILL BE POSTED TO CSHP NATIONAL SITE FOR INTERESTED PERSONS TO VIEW OR DOWNLOAD

2. CSHP 2015: Sharing Our Success 2 Objectives To describe the Atlantic Collaborative and its early progress in implementing CSHP 2015 To familiarize with CSHP 2015 Self-Assessment Tool To leave you feeling encouraged that CSHP 2015 can be adopted using a variety of approaches

3. CSHP 2015: Sharing Our Success 3 Outline CSHP 2015: Have you heard? Sharing Our Success 2015, �Down East� Style The CSHP 2015 Atlantic Collaborative The Moncton Hospital Experience Building Momentum: Challenges & Opportunities

4. CSHP 2015: Sharing Our Success 4 Acknowledgments CSHP Educational Services Committee 2015 Atlantic Collaborative Co-Founders Catherine Dougherty, Jennifer Ryan, Moira Wilson SERHA Pharmacy Management Team & Staff Pharmacists Speaker�s Declaration Thank you to the CSHP National Education Services Cmtee for invitation to speak at PPC Acknowledge � Moira, Jen & Catherine as founding members of 2015 Atlantic Collaborative; Pharmacy Management Team and staff pharmacists in SERHA who completed the 2015 self-assessment tools as part of local site survey Declaration � Thank you to the CSHP National Education Services Cmtee for invitation to speak at PPC Acknowledge � Moira, Jen & Catherine as founding members of 2015 Atlantic Collaborative; Pharmacy Management Team and staff pharmacists in SERHA who completed the 2015 self-assessment tools as part of local site survey Declaration �

5. CSHP 2015: Sharing Our Success 5 CSHP 2015: Have you heard? CSHP 2015 is� 1 of 4 pillars of CSHP Vision 2010 Derived from the ASHP 2015 Initiative but adapted to the Canadian healthcare environment based on input from key stakeholders A strategic objective of CSHP: �Improve patient medication outcomes & safety by advancing practice excellence through CSHP 2015� Refer to Carolyn Bornstein (Past-Pres & Vision Liaison) & her 2015 presentations (PPC, AGM 2007) on national website Use this summary of 2015 to introduce how the Atlantic group started off then discuss our managers� survey & results presented at the June workshop in Brackley Beach, PEI (Lilly Hosp Pharm Mgmt Seminar 2007) Following the Lilly Seminar, the concept of a collaborative was explored & is in its early phases (developing structure, purpose & soon to recruit/invite Atlantic sites to join). Refer to Carolyn Bornstein (Past-Pres & Vision Liaison) & her 2015 presentations (PPC, AGM 2007) on national website Use this summary of 2015 to introduce how the Atlantic group started off then discuss our managers� survey & results presented at the June workshop in Brackley Beach, PEI (Lilly Hosp Pharm Mgmt Seminar 2007) Following the Lilly Seminar, the concept of a collaborative was explored & is in its early phases (developing structure, purpose & soon to recruit/invite Atlantic sites to join).

6. CSHP 2015: Sharing Our Success 6 CSHP 2015: Have you heard? CSHP 2015 is� A patient-centered tool with 6 goals to support effective, scientific (evidence-based) & safe medication use for our patients, and to engage in public health initiatives in our communities A quality initiative comprised of a series of goals & objectives for pharmacy practice in hospitals and healthcare settings to be achieved by 2015

7. CSHP 2015: Sharing Our Success 7 CSHP 2015: Have you heard? 2015 Objectives Support the Goals Aim to demonstrate positive contributions of Pharmacy team Apply to all patients, pharmacists & practice settings May change as best practice evolves

8. CSHP 2015: Sharing Our Success 8 CSHP 2015: Have you heard? Objectives � Not all will apply to every Pharmacy Dept or institution but there are many objectives relevant to all Baselines � to be determined Targets Viewed as challenges, not standards Where our profession will be in 2015 but targets may be revised before then

9. CSHP 2015: Sharing Our Success 9 CSHP 2015: Have you heard? CSHP National website contains detailed information about CSHP 2015: Goals and Objectives Self-Assessment Tool Presentations from PPC 2007 and AGM 2007 �CSHP 2015 � Can you hit the target?� CJHP editorial, Sep 2007 There is much more to come from CSHP National on the topic of 2015! Stay tuned!!

10. CSHP 2015: Sharing Our Success 10 Sharing Our Success: 2015 �Down East� Style Boldly proclaimed our project the �CSHP 2015 Atlantic Collaborative� Although the genesis of the Atlantic Collaborative was from a group of Maritime hospital pharmacy managers, we hope to encourage Nfld/Labrador hospital pharmacy managers & their staff to join us

11. CSHP 2015: Sharing Our Success 11 2015 Process � Down East Style In April 2007, following CSHP Midterm Council, a Regional Pharmacy Director invited pharmacy clinical coordinators from 3 major regional health authorities (Halifax, Saint John & Moncton) to discuss CSHP 2015 in our regions Meetings commenced via teleconference to prepare a presentation and workshop for attendees of the June 2007 Atlantic Provinces� Hospital Pharmacy Management Seminar (HPMS) sponsored by Lilly Canada Moira invited Jennifer (Saint John, NB Reg 2), Doug (Moncton, NB Reg 1SE) & Catherine (Halifax, NS CDHA)Moira invited Jennifer (Saint John, NB Reg 2), Doug (Moncton, NB Reg 1SE) & Catherine (Halifax, NS CDHA)

12. CSHP 2015: Sharing Our Success 12 2015 Process � Down East Style Our planning generated a series of questions: How do we prioritize the 2015 goals/objectives? What rationale do we use for prioritization? Have any of our sites made progress on these objectives? If so, how did we get there? Are there objectives representing �low-hanging fruit� for quick, easy success? Which objectives are feasible for both large & small hospitals? Which are feasible with minimal pharmacy resources (RPh, RPh/PhT or interdisciplinary teams)?

13. CSHP 2015: Sharing Our Success 13 2015 Process � Down East Style To avoid bias from the managers� limited scope of knowledge (i.e. our respective sites), we chose to survey Maritime hospital pharmacy managers using Survey Monkey The main survey questions were derived from 2015 objectives Site-specific demographic data was also collected: Hospital size (#beds <100, 100-250, 251-500, >500) Teaching vs non-teaching facility Current pharmacist vacancy rate

14. CSHP 2015: Sharing Our Success 14 2015 Process � Down East Style Respondents were asked to rate each objective by: Perceived importance (low, medium, high) and Implementation status (not started, in progress, fully implemented) Notice of the survey was communicated via email to all Maritime hospital pharmacy managers The survey remained open for 2 weeks (closing in early June)

15. CSHP 2015: Sharing Our Success 15 2015 Process � Down East Style Where Are We Going? �CSHP 2015 � How Will We Get There?� Part of education program at the HPMS held at a PEI resort on June 14-15, 2007 Background info on CSHP 2015 was given to attendees Results were reported by ranking the objectives first by the respondents� level of importance then by implementation status Status: Not started > In progress > Fully implemented

16. CSHP 2015: Sharing Our Success 16 2015 Process � Down East Style Survey Results � Sites reported by: 40.5% response rate 17 of 42 expected attendees to HPMS Hospital size by # beds (%): <100 = 18 100-250 = 29 251-500 =24 >500 = 29 Teaching status (%): Teaching = 41 vs. Non-teaching = 59

17. CSHP 2015: Sharing Our Success 17 2015 Process � Down East Style HPM Survey Results (our top 4) Objective 1.1: Pharmacists will be involved in managing the acquisition, upon admission, of medication histories for 75% of hospital inpatients with complex and high-risk medication regimens. Ranked as high importance = 100% Status: Not started = 35% In progress = 65% Fully implemented = 0% 1.1 � Med Rec at Admission to 75% of inpts with complex, hi risk regimens1.1 � Med Rec at Admission to 75% of inpts with complex, hi risk regimens

18. CSHP 2015: Sharing Our Success 18 2015 Process � Down East Style HPM Survey Results (our top 4) Objective 1.2: The medication therapy of 100% of hospital inpatients with complex and high-risk medication regimens will be monitored by a pharmacist Ranked as high importance = 88% Status: Not started = 35% In progress = 59% Fully implemented = 6% 1.2 � RPh to monitor rx tx to 100% of inpts on complex, hi risk regimens1.2 � RPh to monitor rx tx to 100% of inpts on complex, hi risk regimens

19. CSHP 2015: Sharing Our Success 19 2015 Process � Down East Style HPM Survey Results (our top 4) Objective 3.2: In 100% of hospitals and related health care settings, pharmacists will be actively involved in the development and implementation of all evidence-based therapeutic protocols involving medication use. Ranked as high importance = 88% Status: Not started = 25% In progress = 69% Fully implemented = 6% 3.2 � RPh actively involved in protocols containing medications in 100% of hospitals3.2 � RPh actively involved in protocols containing medications in 100% of hospitals

20. CSHP 2015: Sharing Our Success 20 2015 Process � Down East Style HPM Survey Results (our top 4) Objective 4.7: 75% of pharmacies in hospitals utilize a unit dose system for drug distribution for 90% or more of their total beds. Ranked as high importance = 88% Status: Not started = 19% In progress = 63% Fully implemented = 19% 4.7 � Medication use/safety � Unit dose distribution4.7 � Medication use/safety � Unit dose distribution

21. CSHP 2015: Sharing Our Success 21 2015 Process � Down East Style How Will We Get There? During a breakout session, 4 working groups tackled the top 8 ranked objectives (2 per group) 4 presenters served as group facilitators For each objective, group members were asked to: Clarify/define the objective�s meaning, Discuss the gap, i.e. What contributes to the gap between our ranking of level of importance and implementation status? Conduct a brief SWOT analysis

22. CSHP 2015: Sharing Our Success 22 2015 Process � Down East Style Group Discussion for each objective Clarify what the objective means to you The Gap � What contributes to the difference between importance & status Strengths Who is doing this well? Lessons learned? Weaknesses If partly or not implemented, ask why? Indicators? How to measure them?

23. CSHP 2015: Sharing Our Success 23 2015 Process � Down East Style Group Discussion (cont.) Opportunities How can we learn from others or ourselves? Align with CCHSA standards? Threats Internal? External? What are the next steps to achieve success?

24. CSHP 2015: Sharing Our Success 24 2015 Process � Down East Style How Will We Get There? (continued) Facilitators encouraged discussion, questions and sharing of ideas while keeping all within allotted time All groups returned into a single room where a reporter from each group presented their results to all gathered The formation of an Atlantic Collaborative was proposed

25. CSHP 2015: Sharing Our Success 25 CSHP 2015 Atlantic Collaborative Idea conceived during preparation for the 2007 HPMS Based on concept of collaborative groups that exist for Safer Healthcare Now! Feb 2008: Atlantic hospital pharmacies & CSHP Branch Presidents participated in teleconference: Reviewed Collaborative�s proposed aims & structure Determined level of interest & commitment to participate as members of Collaborative Participants agreed to conduct self-assessment of their respective sites prior to next meeting What do we want the CSHP 2015 Atlantic Collaborative to accomplish? (a few thoughts of mine�) Increase awareness of 2015 among pharmacy teams, facility leadership, co-workers & patients Build membership among Atlantic health authorities, hospitals and clinics Link with other regions of Canada and CSHP National to share information on 2015 ** Do we need to get permission from CPSI/SHN to borrow from their documents or can we simply reference their resources? ** Expectations? Enrolment campaign � initial push in 2008-2009 (evaluate in 2009 if need to extend enrolment period) Learning sessions (based on ICU Collaborative) � Events held every 1-2 years in conjunction with CSHP Branch meetings or stand-alone (rotating host provinces). Event activities include new knowledge, methods, sharing experiences & team building. Faculty may be from local sites or other areas of Canada or abroad. Action periods Support Communication strategy � email, teleconference, live meetings, newsletters? 2015 Site leader � may or may not be Pharmacy Director/Chief depending on situation but must have commitment of Pharmacy Director/Chief and Senior Administration Funding? For communications (teleconf fees, publications), education (conferences, tools, etc.), travel, etc. May be able to access funds from local auxiliaries, endowment funds, corporate sponsors Are there objectives that are common to many/all sites where gaps exist & are considered a priority to improve upon? If so, how can the Collaborative facilitate multiple sites to develop, implement & evaluate actions to improve in this area? Collaborative documents?? FAQ Pre-work checklist Enrolment form What do we want the CSHP 2015 Atlantic Collaborative to accomplish? (a few thoughts of mine�) Increase awareness of 2015 among pharmacy teams, facility leadership, co-workers & patients Build membership among Atlantic health authorities, hospitals and clinics Link with other regions of Canada and CSHP National to share information on 2015 ** Do we need to get permission from CPSI/SHN to borrow from their documents or can we simply reference their resources? ** Expectations? Enrolment campaign � initial push in 2008-2009 (evaluate in 2009 if need to extend enrolment period) Learning sessions (based on ICU Collaborative) � Events held every 1-2 years in conjunction with CSHP Branch meetings or stand-alone (rotating host provinces). Event activities include new knowledge, methods, sharing experiences & team building. Faculty may be from local sites or other areas of Canada or abroad. Action periods Support Communication strategy � email, teleconference, live meetings, newsletters? 2015 Site leader � may or may not be Pharmacy Director/Chief depending on situation but must have commitment of Pharmacy Director/Chief and Senior Administration Funding? For communications (teleconf fees, publications), education (conferences, tools, etc.), travel, etc. May be able to access funds from local auxiliaries, endowment funds, corporate sponsors Are there objectives that are common to many/all sites where gaps exist & are considered a priority to improve upon? If so, how can the Collaborative facilitate multiple sites to develop, implement & evaluate actions to improve in this area? Collaborative documents?? FAQ Pre-work checklist Enrolment form

26. CSHP 2015: Sharing Our Success 26 CSHP 2015 Atlantic Collaborative We anticipate variation in member sites�: Size (of institution in #beds, pharmacy team) Physical & financial resources Strategic direction of pharmacy dept & health authority Pharmacy services available Emphasis on different 2015 goals/objectives These differences can be viewed as challenges, opportunities or both! N.B. sites also challenged by recently released Health Act & pending amalgamation of 8 RHAs into 2 RHAs

27. CSHP 2015: Sharing Our Success 27 CSHP 2015 Atlantic Collaborative �CSHP 2015 has something for everyone!� First steps (proposed) � 2008/2009: Build interest / awareness of 2015 goals & objectives Gain commitment of pharmacies & their senior leadership to participate in 2015 Participating sites conduct self-assessment to establish baseline status Concurrently seek support from CSHP National and/or other regions for evolution of 2015 initiatives Expectations? Enrolment campaign � initial push in 2008-2009 (evaluate in 2009 if need to extend enrolment period) Learning sessions (based on ICU Collaborative) � Events held every 1-2 years in conjunction with CSHP Branch meetings or stand-alone (rotating host provinces). Event activities include new knowledge, methods, sharing experiences & team building. Faculty may be from local sites or other areas of Canada or abroad. Action periods Support Communication strategy � email, teleconference, live meetings, newsletters? 2015 Site leader � may or may not be Pharmacy Director/Chief depending on situation but must have commitment of Pharmacy Director/Chief and Senior Administration Funding? For communications (teleconf fees, publications), education (conferences, tools, etc.), travel, etc. May be able to access funds from local auxiliaries, endowment funds, corporate sponsors Are there objectives that are common to many/all sites where gaps exist & are considered a priority to improve upon? If so, how can the Collaborative facilitate multiple sites to develop, implement & evaluate actions to improve in this area? Collaborative documents?? FAQ Pre-work checklist Enrolment form Expectations? Enrolment campaign � initial push in 2008-2009 (evaluate in 2009 if need to extend enrolment period) Learning sessions (based on ICU Collaborative) � Events held every 1-2 years in conjunction with CSHP Branch meetings or stand-alone (rotating host provinces). Event activities include new knowledge, methods, sharing experiences & team building. Faculty may be from local sites or other areas of Canada or abroad. Action periods Support Communication strategy � email, teleconference, live meetings, newsletters? 2015 Site leader � may or may not be Pharmacy Director/Chief depending on situation but must have commitment of Pharmacy Director/Chief and Senior Administration Funding? For communications (teleconf fees, publications), education (conferences, tools, etc.), travel, etc. May be able to access funds from local auxiliaries, endowment funds, corporate sponsors Are there objectives that are common to many/all sites where gaps exist & are considered a priority to improve upon? If so, how can the Collaborative facilitate multiple sites to develop, implement & evaluate actions to improve in this area? Collaborative documents?? FAQ Pre-work checklist Enrolment form

28. CSHP 2015: Sharing Our Success 28 CSHP 2015 Atlantic Collaborative Next steps � 2009 and beyond: Emphasize �grass roots� involvement in hospital pharmacies & include 2015 topics in education program of CSHP Branch Meetings Engage hospital pharmacy leaders and managers by making 2015 a standing agenda item on their meetings & seminars to provide updates of challenging situations Solicit active participation of all pharmacy staff! Several objectives are at Dept level while others are specific to pharmacists

29. CSHP 2015: Sharing Our Success 29 CSHP 2015 Atlantic Collaborative Next steps (cont.) Share the work! Find 2015 objectives of common interest (squeaky wheels!) to increase weight of activity and likelihood of success Share the knowledge! To encourage varied approaches to finding solutions & successes at other sites (QI model) Share your successes & lessons learned with staff & other stakeholders, at meetings & seminars, via email & newsletters, etc.

30. CSHP 2015: Sharing Our Success 30 Sharing Our Success: The Moncton Hospital Experience In an effort to continue momentum with 2015 following the 2007 HPMS, the SERHA Pharmacy Senior Management Team discussed options to develop and implement 2015 into our region�s Pharmacy Strategic Plan for 2008-2010 Add brief notes about our hosp/region (hosp role, #beds, #visits, catchment area, etc.; pharm team in Moncton & Sackville; pic of hosp) How/where did we start? Reviewed PPC/AGM presentations & 2007 Lilly Seminar survey notes. Reviewed 2015 resources on CSHP site & ASHP site. Conducted internet �2015� search for other published info from Amer or Cdn sites who have developed tools, resources or success stories. Used CSHP 2015 self-assessment tool to increase awareness of our site�s staff to the initiatives� goals & objectives & conducted internal survey (to supplement mgmt view of our baseline), essentially a SWOT analysis Based on internal survey results developed more comprehensive baseline analysis (see UK ref) to define baseline status & targets for each obj esp those requiring action. In process of setting priorities for those obj where pharm team has defined area of largest gap. Note that sites may decide to implement in a diff manner than recommended on SA tool due to their local strategic goals & priorities, available resources, etc. For example, may choose to act on obj rated as B to move it to A status as this may be a �quick win� requiring less effort & time than an obj rated as C or D. May choose not to address some C/D items (e.g. involving ambulatory clinics) in 08-09 or later b/c site has no current involvement in these services nor do plans exist for implementing services in these areas for the foreseeable future. In other words, each site must decide where it can best utilize existing resources with aim to benefit patient care outcomes. Add brief notes about our hosp/region (hosp role, #beds, #visits, catchment area, etc.; pharm team in Moncton & Sackville; pic of hosp) How/where did we start? Reviewed PPC/AGM presentations & 2007 Lilly Seminar survey notes. Reviewed 2015 resources on CSHP site & ASHP site. Conducted internet �2015� search for other published info from Amer or Cdn sites who have developed tools, resources or success stories. Used CSHP 2015 self-assessment tool to increase awareness of our site�s staff to the initiatives� goals & objectives & conducted internal survey (to supplement mgmt view of our baseline), essentially a SWOT analysis Based on internal survey results developed more comprehensive baseline analysis (see UK ref) to define baseline status & targets for each obj esp those requiring action. In process of setting priorities for those obj where pharm team has defined area of largest gap. Note that sites may decide to implement in a diff manner than recommended on SA tool due to their local strategic goals & priorities, available resources, etc. For example, may choose to act on obj rated as B to move it to A status as this may be a �quick win� requiring less effort & time than an obj rated as C or D. May choose not to address some C/D items (e.g. involving ambulatory clinics) in 08-09 or later b/c site has no current involvement in these services nor do plans exist for implementing services in these areas for the foreseeable future. In other words, each site must decide where it can best utilize existing resources with aim to benefit patient care outcomes.

31. CSHP 2015: Sharing Our Success 31 Sharing Our Success: The Moncton Hospital Experience South-East Regional Health Authority (SERHA) provides a full range of health care and wellness services to southeastern N.B., P.E.I. and northern N.S.

32. CSHP 2015: Sharing Our Success 32 Sharing Our Success: The Moncton Hospital Experience The Moncton Hospital is a Level 2 regional health facility with 383 beds, approx 16,000 admissions, 14,000 clinic visits, and 70,000 ER/trauma visits each year Pharmacy Services are comprised of 29 FTE pharmacists (incl 3 managers) & 34 FTE pharmacy technicians & clerical staff.

33. CSHP 2015: Sharing Our Success 33 Sharing Our Success: The Moncton Hospital Experience Our process: Reviewed 2015 resources on CSHP & ASHP sites Conducted internet searches for related 2015 info, tools, resources or early success stories Conducted internal gap analysis of 2015 objectives How/where did we start? Reviewed PPC/AGM presentations & 2007 Lilly Seminar survey notes. Reviewed 2015 resources on CSHP site & ASHP site. Conducted internet �2015� search for other published info from Amer or Cdn sites who have developed tools, resources or success stories. Used CSHP 2015 self-assessment tool to increase awareness of our site�s staff to the initiatives� goals & objectives & conducted internal survey (to supplement mgmt view of our baseline), essentially a SWOT analysis Based on internal survey results developed more comprehensive baseline analysis (see UK ref) to define baseline status & targets for each obj esp those requiring action. In process of setting priorities for those obj where pharm team has defined area of largest gap. Note that sites may decide to implement in a diff manner than recommended on SA tool due to their local strategic goals & priorities, available resources, etc. For example, may choose to act on obj rated as B to move it to A status as this may be a �quick win� requiring less effort & time than an obj rated as C or D. May choose not to address some C/D items (e.g. involving ambulatory clinics) in 08-09 or later b/c site has no current involvement in these services nor do plans exist for implementing services in these areas for the foreseeable future. In other words, each site must decide where it can best utilize existing resources with aim to benefit patient care outcomes. How/where did we start? Reviewed PPC/AGM presentations & 2007 Lilly Seminar survey notes. Reviewed 2015 resources on CSHP site & ASHP site. Conducted internet �2015� search for other published info from Amer or Cdn sites who have developed tools, resources or success stories. Used CSHP 2015 self-assessment tool to increase awareness of our site�s staff to the initiatives� goals & objectives & conducted internal survey (to supplement mgmt view of our baseline), essentially a SWOT analysis Based on internal survey results developed more comprehensive baseline analysis (see UK ref) to define baseline status & targets for each obj esp those requiring action. In process of setting priorities for those obj where pharm team has defined area of largest gap. Note that sites may decide to implement in a diff manner than recommended on SA tool due to their local strategic goals & priorities, available resources, etc. For example, may choose to act on obj rated as B to move it to A status as this may be a �quick win� requiring less effort & time than an obj rated as C or D. May choose not to address some C/D items (e.g. involving ambulatory clinics) in 08-09 or later b/c site has no current involvement in these services nor do plans exist for implementing services in these areas for the foreseeable future. In other words, each site must decide where it can best utilize existing resources with aim to benefit patient care outcomes.

34. CSHP 2015: Sharing Our Success 34 Sharing Our Success: The Moncton Hospital Experience We conducted an internal gap analysis using the CSHP 2015 Self-Assessment Tool Approx 28% of staff completed the SA tool Collateral benefit of increased staff awareness of 2015 objectives Results were reviewed to identify discrepancies & satisfy ourselves with overall precision of pooled ratings Summary results were presented to TMH pharmacy staff for discussion

35. CSHP 2015: Sharing Our Success 35

36. CSHP 2015: Sharing Our Success 36 Note that objectives listed in SA tool do not contain targets found in list of objectives on CSHP website (we used the latter in survey of hosp pharm mgrs in Jun 2007)Note that objectives listed in SA tool do not contain targets found in list of objectives on CSHP website (we used the latter in survey of hosp pharm mgrs in Jun 2007)

37. CSHP 2015: Sharing Our Success 37

38. CSHP 2015: Sharing Our Success 38

39. CSHP 2015: Sharing Our Success 39 Sharing Our Success: The Moncton Hospital Experience Next steps for 2008-2009? Comprehensive analysis of each objective is in progress: Establish baseline status Select targets for 2008-2009 Incorporate action plan into our departmental strategic plan

40. CSHP 2015: Sharing Our Success 40 Sharing Our Success: The Moncton Hospital Experience Next steps for 2008-2009 (continued) Working with our pharmacy team at a small hospital in our region: Employ the SA tool to identify their 2015 ratings Do the ratings differ from the larger hospital? Where gaps exist, assist them in devising a site-specific 2015 action plan & support them in its implementation

41. CSHP 2015: Sharing Our Success 41 Building Momentum: Challenges & Opportunities Increase your knowledge of CSHP 2015 CSHP National Website Related info on ASHP website Other health systems pharmacies (e.g. U Kentucky) have completed early work � search & view their successes Determine your site�s level of commitment and assess baseline Incorporate your 2015 priorities into action plans as part of your QI or strategic planning process Refer to CSHP national site, ASHP site, Univ Kentucky, others for ideas See comment from previous section on how sites need to determine their own priorities which may differ from sites of similar size or structure b/c of existing strategic priorities, resources, etc. Lilly Survey � may be source of regional or national benchmarking for 2015 Links to accreditation standards � remember that 2015 goals/obj are NOT standards but many can be linked to CCHSA and/or CHPRB stds to increase efficiencies (i.e. if you need to implement, develop, maintain programs or services to meet existing stds & these overlap with 2015 then there may be increased emphasis on these areas to maintain accreditation) Sharing � for sites that may struggle with specific obj, others who have successful developed or implemented services or initiatives can share how they did this incl any P&P, forms, training programs, tools, etc. There will likely be opportunities to exchange info for obj you have no discussion or activity in (D rating) or improve your existing initiative (move a D to C, B or A rating) Measurement � likely to be a significant challenge for all will be how to measure baseline target, subsequent progress, how often to measure & can we do so to allow comparison in a meaningful way. Ideally, our targets and means of measuring will remain true to patient-centered focus on the overall 2015 project, i.e. if we�re not positively affecting patient care then we need to reconsider what & how we are working! Much of this data (targets) may be available thru current patient safety initiatives, e.g. SHN AMI for ASA, BB, ACEI, statin use at discharge; SHN Med Rec; Refer to CSHP national site, ASHP site, Univ Kentucky, others for ideas See comment from previous section on how sites need to determine their own priorities which may differ from sites of similar size or structure b/c of existing strategic priorities, resources, etc. Lilly Survey � may be source of regional or national benchmarking for 2015 Links to accreditation standards � remember that 2015 goals/obj are NOT standards but many can be linked to CCHSA and/or CHPRB stds to increase efficiencies (i.e. if you need to implement, develop, maintain programs or services to meet existing stds & these overlap with 2015 then there may be increased emphasis on these areas to maintain accreditation) Sharing � for sites that may struggle with specific obj, others who have successful developed or implemented services or initiatives can share how they did this incl any P&P, forms, training programs, tools, etc. There will likely be opportunities to exchange info for obj you have no discussion or activity in (D rating) or improve your existing initiative (move a D to C, B or A rating) Measurement � likely to be a significant challenge for all will be how to measure baseline target, subsequent progress, how often to measure & can we do so to allow comparison in a meaningful way. Ideally, our targets and means of measuring will remain true to patient-centered focus on the overall 2015 project, i.e. if we�re not positively affecting patient care then we need to reconsider what & how we are working! Much of this data (targets) may be available thru current patient safety initiatives, e.g. SHN AMI for ASA, BB, ACEI, statin use at discharge; SHN Med Rec;

42. CSHP 2015: Sharing Our Success 42 Building Momentum Challenge of measuring How to measure baseline target? When to evaluate progress? Are we measuring same indicators to allow comparison across sites & time? Much of this data (targets) may be available thru current patient safety initiatives, e.g. SHN AMI (medications at discharge); SHN Med Rec; etc. Ideally, our targets and methods of measuring will remain true to patient-centered focus on the overall 2015 project Benchmarking CSHP? Lilly Survey?

43. CSHP 2015: Sharing Our Success 43 Building Momentum Regularly communicate your progress To Pharmacy Team & other stakeholders (Senior Admin, other health disciplines, patients) Emphasize that 2015 initiatives are intended to improve medication use, medication safety and public health (supports other current initiatives in Canadian health care) Investigate which 2015 objectives may be linked with existing CCHSA standards These may be higher priority if not fully implemented Concept of �Crosswalk� from ASHP 2015 Initiative

44. CSHP 2015: Sharing Our Success 44 Building Momentum Details soon to be released from National! More to come from National & Branch levels! 2015 Project Coordinator Steering Committee Translation into French 2015 topics in future PPC/AGM programs Summer 2008: CSHP Past-President, Emily Musing will be guest editor of Lilly Survey incorporating CSHP 2015 objectives as a special section

45. CSHP 2015: Sharing Our Success 45 Examples of 2015 Success Stories From 2007 PPC & 2007 AGM: 1 - Evaluation of medication discrepancies at hospital discharge 1 - Development of a structured integrated medication reconciliation strategy from hospital admission to discharge 1, 4 - Medication incident reporting: is it a means to an end? 5 - Development of a Meditech�� software-based pharmacist clinical workload measurement system 6 - Smoking cessation counselling with Aboriginals in Northern Interior British Columbia

46. CSHP 2015: Sharing Our Success 46 More success stories� 2 - The impact of Cardiac EASE (Ensuring Access and Speedy Evaluation) Program (in cardiac outpatients) 3 � Successful implementation of a standardized subcutaneous insulin order set including basal, prandial and adjustment scales 3 � Impact of institutional order form on antimicrobial prescribing use

47. CSHP 2015: Sharing Our Success 47 Summary CSHP 2015 is a challenge & an opportunity for the profession! Look inward: Assess your site�s status (2015 objectives) Determine implementation status & baselines Some info on targets already exists in your dept or RHA for other purposes Decide what you do well & where you need to focus your resources & energies to improve

48. CSHP 2015: Sharing Our Success 48 Summary Look outward: Getting started doesn�t have to involve a single site or RHA Find partners & exchange ideas & information to help each other move forward Form a provincial or regional 2015 collaborative Solicit assistance on measurement techniques & indicators from your RHA Quality or Research offices

49. CSHP 2015: Sharing Our Success 49 Summary Incorporate objectives of higher priority for action into your departmental strategic planning cycle and/or QI Committee agenda PDSA cycle � Plan, Do, Study, Act If your initial assessment looks daunting (e.g. many D�s & C�s), don�t sweat it� You have 7 more years to achieve these goals! More support is coming from National!

50. CSHP 2015: Sharing Our Success 50 Thanks for your attention! References: CSHP 2015 www.cshp.ca/programs/cshp2015/index_e.asp Bornstein C. CSHP 2015 � Can you hit the target? Can J Hosp Pharm 2007 Sep;60:284 ASHP 2015 Initiative www.ashp.org Canadian ICU Collaborative Enrolment Package, July 2007 CAPHC-SHN Pediatric Medication Reconciliation Collaborative, Procedure Manual, Version 1 (25 Jan 2006) �vretveit J et al. Quality collaboratives: lessons from research. Qual Saf Health Care 2002;11:345-51 University of Kentucky HealthCare Pharmacy Services www.hosp.uky.edu/Pharmacy/pdf/UK_ASHP_2015.pdf