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Reaching New Heights through Pharmacy Technician Advancement. Ross Thompson, M.S., R.Ph . Director of Pharmacy Services Melissa Ortega, M.S., Pharm.D. Pharmacy Operations Manager. Review ASHP Pharmacy Practice Model Initiative (PPMI) Discuss methods for evaluating your practice setting

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reaching new heights through pharmacy technician advancement

Reaching New Heights through Pharmacy Technician Advancement

Ross Thompson, M.S., R.Ph.

Director of Pharmacy Services

Melissa Ortega, M.S., Pharm.D.

Pharmacy Operations Manager

objectives

Review ASHP Pharmacy Practice Model Initiative (PPMI)

Discuss methods for evaluating your practice setting

List PPMI recommendations on technician advancement

Highlight methodologies for facilitating practice change

Discuss ASHP and MSHP initiatives to facilitate change

Objectives
ppmi vision and goals
PPMI Vision and Goals

Vision of PPMI

To create passion, commitment, and action among hospital and health-system pharmacy practice leaders to advance the health and well being of patients by optimizing the role of pharmacists in providing direct patient care

Goal of PPMI

Implement the vision by support a futuristic practice model

Describe how resources are deployed to provide care.

How pharmacists practice and provide care to patients

How technicians are involved to support care

Use of automation and technology

AJHP 2010;67:542

translating recommendations into practice
Translating Recommendations Into Practice

106 Recommendations

ASHP Publications

Policy

Tools

Research

categories of self assessment criteria
Categories of Self-Assessment Criteria

Hospital Demographics

Optimal Practice Model Characteristics (organization)

Optimal Practice Model Characteristics (employee/scope)

Advancing Information Technology

Advancing Pharmacy Technician Roles

Successful Implementation of New Practice model

benefits of completing a self assessment
Benefits of Completing a Self-Assessment

Identifies gaps

Assists with prioritization

Generates an action plan

Links to resources supporting the recommendation

Tracks performance / conformity

Provides comparison with other hospitals

optimal pharmacy practice model characteristics part i
Optimal Pharmacy Practice Model Characteristics – Part I

Definition: Drug Therapy Management is a multidisciplinary team process for selecting appropriate drug therapies, educating patients, monitoring patients, and continually assessing outcomes of therapy. Pharmacist activities in drug therapy management may include, but are not limited to: initiating, modifying ,and monitoring a patient’s drug therapy; ordering and performing laboratory and related tests; assessing patient response to therapy; counseling and educating a patient about medications; and administering medications.

Are pharmacists recognized for taking a lead role in providing drug therapy management services to patients at your hospital/health system?

12% Exists in all areas/situations (100%)

50% Exists in most areas/situations (50-99%)

38% Exists only in some areas/situations (1-49%)

0% Does not exist (0%)

0% Not applicable

optimal pharmacy practice model characteristics part ii
Optimal Pharmacy Practice Model Characteristics – Part II

Is medication reconciliation performed by the pharmacy staff at your hospital/health system?

4% Medication reconciliation is performed by pharmacy staff throughout all areas

8% Medication reconciliation is performed by pharmacy staff in some areas

38% Medication reconciliation is partially performed by pharmacy staff in some or all areas

46% Medication reconciliation not performed by pharmacy staff

4% Not applicable

optimal pharmacy practice model characteristics part ii1
Optimal Pharmacy Practice Model Characteristics – Part II

If you employ pharmacy student interns, are their duties different from traditional pharmacy technician duties?

50% Yes

38% No

12% Not applicable

advancing the application of it in the med use process
Advancing the Application of IT in the Med Use Process

Has clinical decision support been integrated with computerized provider order entry at your hospital/health system?

23% Exists in all areas/situations (100%)

31% Exists in most areas/situations (50-99%)

27% Exists only in some areas/situations (1-49%)

15% Does not exist (0%)

4% Not applicable

ppmi results massachusetts

Total of 1,025 organizations have submitted data

Overall score of 52% compliance with recommendations

Northeast region has 171 organizations scoring at 50%

Includes 26 of approximately 100 Massachusetts facilities

Massachusetts facilities collectively scored 51%

Advancing technicians’ role is the nation’s lowest score at just 28% compliance with recommendations

PPMI Results: Massachusetts
what to prioritize
What to Prioritize

Total Score: 54%

Optimal Pharmacy Practice Model Characteristics Part 1 and 2

70% and 48% (66% and 41% nationally)

Advancing the Application of IT in the Medication Use Process

45% (46%)

Advancing the Use of Pharmacy Technicians

44% (28%)

Successful Implementation of New Pharmacy Practice

52% (60%)

Items Completed: 37

Items Close to Completion: 22

Items Needing Completion: 39

acute care pharmacy practice model

Integrated Practice Model via 5 Service Delivery Teams

Each service team will consist of 2 or 3 pharmacists, 1 resident, and 1 technician on day shift; then either 1 or 2 pharmacists on weekday evening and weekend day shifts

Each service team is responsible for providing our complement of services to a specific patient care area

Acute Care Pharmacy Practice Model
how we will structure our acute care services

Team based practice model: specialist, generalists, technician, resident, and student

Pharmacist time devoted to clinical services

Pharmacy core services provided to every patient, every day

Targeted services for high risk or complex patients / therapies

Drug distribution facilitated by pharmacy technicians

How We Will Structure Our Acute Care Services
vision statement

Members of the Tufts Medical Center Department of Pharmacy Services are sought after for their expertise and are accountable for medication therapy outcomes; providing the best possible care for every patient, every time.

Vision Statement
pharmacy practice councils
Pharmacy Practice Councils

Four Councils

Chaired by staff

Wrote Charter

Establish goals

Plan and make change

change management overview states and phases
Change Management Overview States and Phases

Desired

State

Transition

State

Current

State

Remedy/Vision

Pain/Urgency

Change is a process

Themes can be categorized into

3 states

slide21

The status quo is not an option!

“If you don’t like change, you are really going to hate being irrelevant”

- Tom Peters

change models key principles
Change Models Key Principles

Documented in the literature with success in various settings

Business

Non-profit associations

Healthcare organizations

Types of change models

8 steps of change management

Healthcare redesign and improvement models

Pharmacy specific

Ray MD, Breland BL. Am J Health-Syst Pharm—2011;68:1138-45

change models help you think about
Change Models help you think about…

The what, why, and how to make it work for technicians and pharmacists in a new world

Where to start?

What are the best practices in raising the bar for technician roles?

Who are the key stakeholders?

What are the barriers and challenges?

Inter professional relationships on the front lines-what works what doesn’t when roles change?

How to get buy-in?

Resources to build advanced technician workforce – where to go and how to use?

What are the one or two keys to your success?

What will you measure to demonstrate value?

slide24

Kotter’s 8-Step Change Model

1. Create Urgency

2. Form a Powerful Coalition

3. Create a Vision for Change

4. Communicate the Change Vision

5. Remove Obstacles

6. Create Short-Term Wins

7. Build on the Change

8. Anchor the Changes

Leading Change, John P. Kotter, HBR, 1998

slide25

The 8 Step Approach to Leading Change Applied:Mobilizing Practice Change:Advancing the pharmacy practice model through a technician advancement council

Leading Change, John P. Kotter, HBR, 1998

Kotter JP. Leading Change: Why Transformation Efforts Fail. Harv Bus Rev. 1995;59-67.

slide26

Helping others see the need for change and the importance of acting quickly

  • Convince at least 75% of your people that the status quo is more dangerous than the unknown

Step One: Create Urgency

  • Tufts Medical Center’s Actions:
  • Distribute appropriate background materials and highlight gaps
  • Examine the best practices & understand the literature
  • Establish structure around initiative
  • Potential Pitfalls:
  • Underestimating the difficulty of driving people from their comfort zones
  • Becoming paralyzed by risks
ashp ppmi tuft s action plan
ASHP PPMI Tuft’s Action Plan

Identify Gaps

High Impact:

High Feasibility:   

areas of opportunity for technicians
Areas of Opportunity for Technicians

Examine Best Practices and Literature

Am J Health-SystPharm—Vol 68 Oct 1, 2011

UHC Practice Advancement Committee Survey*: Areas of Opportunity for Technician Deployment- Apr 2012

technician advancement council
Technician Advancement Council

Establish Structure Around Initiative

Council’s Charter

Positions

Facilitator

Chair

Liaisons

Objectives

Deliverables

Outcomes

Guideline

Expectations

Minutes and agendas

Participation and attendance

slide32

Identify key stakeholders, educate them and build their interest and support

Step Two: Form a Powerful Coalition

  • Tufts Medical Center’s Actions:
  • Assemble a group with shared commitment and enough power to lead the change effort
    • # technician members > # pharmacist members > # administrative members
  • Identify and meet with stakeholders

Potential Pitfalls:

  • No prior experience in teamwork at the top
council membership

Council Membership and representation

12 members

Technicians (8)

Pharmacist (3)

Chair

Technician

Facilitator

Manager

Ad Hoc Nurses

Stakeholders

Pharmacists

Nurses

Technicians

Council Membership
slide35
“Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.” – Margaret Mead
slide36

Step Three & Four:

Create and Communicate a Vision for Change

  • Create a picture of the future & how it will be different from the past
  • Use every vehicle possible to constantly communicate the new vision & strategies
  • Tufts Medical Center’s Actions:
    • Establish the vision = Council’s Objective
    • Strategy for realizing the vision
      • Analyze and plan
      • Council work

Potential Pitfalls:

  • Presenting a vision that’s too complicated
  • Under-communicating the vision
putting it all together

Putting it all together…

“Vision without action is simply dreaming”

Establish the Vision

  • Council’s Objectives
    • Expand the role of team based technicians
    • Create opportunity for pharmacy technician specialization
    • Maintain competent workforce to manage growing complexities of the med use system
strategies for achieving the vision analyze and plan
Strategies for Achieving the Vision Analyze and Plan

List expected changes within the next two years

Team based technicians

Tech-Check-Tech

Perform current state analysis

Define each technician’s role

Date Collection Log

Review internal results

Current state analysis vs pilot project

high impact importance
High Impact/Importance

Activities currently being performed

slide40

Align information, systems and processes to the vision

  • Identify resistors and help them see what is needed

Step Five: Remove Obstacles

  • Tufts Medical Center’s Actions :
    • Encourage risk taking and non-traditional ideas, activities, and actions
      • Recognize current activities that add value
  • Identify boundaries, constraints, and assumptions
    • Recognize resource needs and availability
    • Create a plan to overcome obstacles
  • Potential Pitfalls:
  • Failing to remove obstacles
identifying obstacles council feedback
Identifying obstacles: Council Feedback

Questions to ask

What potential physical barriers in a pharmacy department should be considered?

What additional education and training will individual members need in order to implement the desired change?

What types of resistance or “push-back” might be anticipated from pharmacist , nurses, or others outside the pharmacy department?

plan overcoming obstacles
Plan Overcoming Obstacles

Key elements for success

Advocate for technological resources to support safe, effective, and efficient medication use system and aid the role of pharmacy technician

Collaboration with other councils

Streamline operations and reallocate resources to allow for a decentralize technician model

Operations Improvement Council

Optimize decentralized pharmacy service

Pharmacy Advancement Council

Prepare, train, and educate technicians to take on new roles

Education and Training Council

slide43

Plan for visible improvements in performance, or “wins”

  • Create short-term targets, not just one long-term goal

Step Six: Create Short-term Wins

  • Tufts Medical Center’s Actions :
  • Separate initiatives to deliverables
      • High impact/high feasibility items
      • Prioritize “low hanging fruit”
  • Define and engineer visible performance improvements

Potential Pitfalls:

  • Leaving short-term successes up to chance
high impact high feasibility items
High impact & High Feasibility Items

Activities NOT currently performed

High Impact (value-added activities):

High Feasibility:   

prioritize low hanging fruit
Prioritize “Low Hanging Fruit”
  • 5. Initializing or receiving communication
    • Missing doses
    • Medication status
    • High utilization
    • Drug shortages

7. Discharge process- insurance and prior authorizations inquiries

6. Oversight when patient’s are transferred

4. Drip Rounds-Monitoring of continuous infusions

2. Daily monitoring of override reports

3. Collection of and following up of written orders

1. Pulling and receiving narcotics

Low hanging fruit = All distributive functions that do not require clinical judgment currently completed by a pharmacist

implement the process create short term wins
Implement the Process: Create Short Term Wins
  • Incremental approach versus big bang
  • Used the Plan, Do, Check, Act (PDCA) model to guide implementation
    • High impact/high feasibility items
    • “Low hanging fruit”

Override Reports

  • A P
  • C D
  • Plan: report collected and reviewed by technician.
  • Do: Reallocate task - Follow up on discrepancies with Pharmacist and/or health care provider.
  • Check: Number of overrides reconciled accurately
  • Act: Continue with plan

Improvement Ramp

slide47

Consolidate improvements and produce more change

  • Leverage quick wins to build momentum for change
  • Communicate change, the impact and the value; provide ongoing documentation

Step Seven and Step Eight:

Build on the Change and Anchor the Changes

  • Tufts Medical Center’s Actions:
  • Build momentum for change
    • Publish results (tell the story)
  • Demonstrate value

Potentials Pitfalls:

  • Declaring victory too soon
tuft s experience pharmacy extenders team based technicians
Tuft’s Experience Pharmacy Extenders- Team Based Technicians

Pediatric team based technician

Responsible for specific nursing units

Delivering IV run, oral syringes, pediatric pull, narcotics, refilling automated dispensing systems, finding missing doses, following up with stat doses

Available by pager

Available for assisting decentralized pharmacist with request

Metrics

Percentage decrease of pharmacist time on task of distributive functions

Increased level communication between inpatient pharmacy and the units

Increased communication about medication turn around time

tuft s experience pharmacy extenders team based technicians1
Tuft’s Experience Pharmacy Extenders- Team Based Technicians

Lessons learned

Not everyone can be placed in roles where they need to interact with other health care providers

Amount of autonomy

Define responsibilities and medication distribution model clearly

New tool developed

Pediatric performance indicator log

Recognized benefits

Potential to reduce readmission rates, prevent or mitigate medication errors

tuft s experience measure the impact
Tuft’s Experience Measure the Impact

Recognize and reward new behavior to embed into new culture

when we succeed what will we have

Technician Advancement Council:

Empowerment to provide drug distribution services

More engaged and productive pharmacy technician workforce

Greater accountability for customer service to team-based units

Department of Pharmacy

More engaged and productive pharmacist workforce

Ability to refocus time toward optimizing care or expanding scope

Tufts Medical Center

Improved patient satisfaction

Increased adherence and decreased readmissions

When We Succeed … What Will We Have?
who has a success story to share
Who Has A Success Story to Share?

Innovative Role for a Technician

Exemption from the Board or the DPH