Loading in 2 Seconds...
Loading in 2 Seconds...
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
Ross Thompson, M.S., R.Ph.
Director of Pharmacy Services
Melissa Ortega, M.S., Pharm.D.
Pharmacy Operations Manager
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 changeObjectives
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
Optimal Practice Model Characteristics (organization)
Optimal Practice Model Characteristics (employee/scope)
Advancing Information Technology
Advancing Pharmacy Technician Roles
Successful Implementation of New Practice model
Assists with prioritization
Generates an action plan
Links to resources supporting the recommendation
Tracks performance / conformity
Provides comparison with other hospitals
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
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
If you employ pharmacy student interns, are their duties different from traditional pharmacy technician duties?
12% Not applicable
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
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 recommendationsPPMI Results: Massachusetts
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
Advancing the Use of Pharmacy Technicians
Successful Implementation of New Pharmacy Practice
Items Completed: 37
Items Close to Completion: 22
Items Needing Completion: 39
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 areaAcute Care Pharmacy Practice Model
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 techniciansHow We Will Structure Our Acute Care Services
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
Chaired by staff
Plan and make change
Change is a process
Themes can be categorized into
“If you don’t like change, you are really going to hate being irrelevant”
- Tom Peters
Documented in the literature with success in various settings
Types of change models
8 steps of change management
Healthcare redesign and improvement models
Ray MD, Breland BL. Am J Health-Syst Pharm—2011;68:1138-45
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?
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
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.
Helping others see the need for change and the importance of acting quickly
Step One: Create Urgency
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
Establish Structure Around Initiative
Minutes and agendas
Participation and attendance
Identify key stakeholders, educate them and build their interest and support
Step Two: Form a Powerful Coalition
Create and Communicate a Vision for Change
“Vision without action is simply dreaming”
Establish the Vision
List expected changes within the next two years
Team based technicians
Perform current state analysis
Define each technician’s role
Date Collection Log
Review internal results
Current state analysis vs pilot project
Activities currently being performed
Step Five: Remove Obstacles
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?
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
Step Six: Create Short-term Wins
Activities NOT currently performed
High Impact (value-added activities):
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
Step Seven and Step Eight:
Build on the Change and Anchor the Changes
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
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
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
Potential to reduce readmission rates, prevent or mitigate medication errors
Recognize and reward new behavior to embed into new culture
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 readmissionsWhen We Succeed … What Will We Have?
Innovative Role for a Technician
Exemption from the Board or the DPH