PPMI Hospital Presentation

The Pharmacy Practice Model

Initiative

Rouzan H. Srour, PharmD. Candidate 2015APPE Hospital Rotation

Rush University Medical Center March 24, 2015

Objectives

1. List the components of the pharmacy practice model initiative

2. Identify possible issues and flaws within the pharmacy practice model initiative

3. Be able to list ways to bridge the gap of professionalism

• PPMI is a profession-led initiative that is empowering the pharmacy team to take responsibility for patient outcomes

• 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. By describing patient care services and activities that support the safe and effective use of medications, corresponding models can be adopted that optimize the full potential of pharmacist, technician, and technology resources.

The Pharmacy Practice Model Initiative

• “Through PPMI, ASHP and the ASHP Research and Education Foundation work to maximize the pharmacist’ role in patient care by improving health-care team integration, leveraging pharmacy technicians, promoting pharmacist credentialing and training, encouraging the appropriate use of technology, and taking leadership in medication use”

• “…aspires to transform how pharmacists care for patients by empowering the pharmacy team to take responsibility for medication-use outcomes”

Components of the PPMI

Care team Integration

Leveraging Pharmacy

Technicians

Pharmacist Credentiali

ng and Training

Technology

Leadership in

Medication Use

Care Team Integration

• Promotes pharmacy as a “team-based” approach

• Shifts the roles of pharmacists and technicians to allow pharmacists to optimize their time with patients

• Allows pharmacists to be providers thus enhancing their relationship with patients

Care Team Integration

• Promoting a team-based approach • Credibility • Integrity • Self-reflection

Care Team Integration: Promoting Credibility

Improved Patient Care

Work towards one common

goal

Advocate for staff’s

comfort

Communicate

proactively

Establish relationships

based on trust

Care Team Integration: Integrity

• Work with ethics and justice

• Do what is right for the staff and the patient

• Do not give in to pressure

• Be honest to yourself and to others

• Engage in active listening

Care Team Integration: Self Reflection

• Know yourself and enhance your self-esteem

• Reflect on your body language and the body language of others

• Identify strengths and weaknesses

• Identify actions to continue and actions to eliminate



Leveraging Pharmacy

Technicians


ng and Training

Technology

Leadership in

Medication Use

Leveraging pharmacy technicians

• One of the few jobs that require extensive background and training

• In 2008, only 25.6% of hospitals required that newly hired technicians have PTCB certification


• PPMI seeks to expand the role of pharmacy technicians beyond filling, dispensing, and preparing medication

• Expanding roles include:• Obtain and document patients’ medication history • Maintain patient records • Prepare quality-improvement reports • Screen EMRs to identify patients in need of

interventions • Review patient charts to identify allergies and clarify

orders • Manage medication assistance programs • Document medication adherence information

What could go wrong?


• Medication errors

• Issues with dispensing without pharmacists checking

• Pharmacists still need to influence the design and performance of medication distribution

• Achieving consistency in medication use is not possible

Leveraging Pharmacy Technicians: Possible Mistakes

• In 2001, a pharmacy technician working at a Florida retail pharmacy, who had failed a certification exam entered a dosage frequency for methadone as “as needed.” The patient died.

• In 2007, a child in a hospital in Ohio died of concentrated sodium chloride solution prepared by a technician. The pharmacist was arrested. • This caused the passing of Emily’s Law which requires

that all technicians pass an exam approved by state board before dispensing drug products

Leveraging Pharmacy Technicians: standardizing training and certification

• Standardized accredited training

• Certification requirements

• Establish minimum hiring standards

• Integrate formal quality assurance processes



Leveraging Pharmacy

Technicians


ng and Training

Technology

Leadership in

Medication Use

Pharmacist Credentialing and Training

• Put the pharmacist as a the patient care provider for medications

• Relieve pharmacists of work that can be done by non-pharmacists

• Enhance pharmacist training • Life long learning • Residency • Training on high-risk medication use


• Enhance the role of the pharmacist as a healthcare team member • Medication Reconciliation to target discrepancies • Discharge counseling to target HCAHPS score • Leading interdisciplinary and collaborative development of

medication use policies and procedures• Manage medication therapy on an individualistic level• Allow pharmacists to write medication orders • Hold the pharmacist accountable for the medication-

related component of a patient’s healthcare plan

• Recognize the pharmacist as drug therapy and medication use experts




Leveraging Pharmacy

Technicians


ng and Training

Technology

Leadership in

Medication Use

Technology

• Make the use of technology more efficient• “Do more with less”

• Allow the pharmacist feasible access to patient medical records and information to optimize the pharmacist’s role in delivering patient-centered care

• Use technology to improve patient safety, quality, and efficiency

• Consider new and emerging technology to improve practice

Technology

• Electronic medical record systems

• Barcode medication administration

• Monitoring systems that provide a work queue for patients needing review and intervention

• Intelligent infusion devices

Technology

• ASHP pushes for pharmacy informatics in pharmacy school curriculums

• Clinical and non-clinical pharmacists should understand how it all works

• Knowledgeable pharmacists should be available to make decisions and offer advice on technology

• Interoperability is key



Leveraging Pharmacy

Technicians


ng and Training

Technology

Leadership in

Medication Use

Leadership in Medication Use

• Empowering pharmacists to take responsibility for the outcomes of the patient’s health

• Redefines the role of the pharmacist on the health care team • Promote health and wellness • Optimize therapeutic outcomes • Prevent adverse medication events


• Part of the success of PPMI comes from• Pharmacy-initiated change • Not health-system initiated

• Pharmacy director has a strong vision for the necessity of change

• Pharmacy staff are early adopters of innovation

• Recognition of the significance of strong relationships with medical staff

• Changes occurred intermittently and are still ongoing

What are some key leadership skills?


• Vision

• Interpersonal skills

• Mentoring

• Seizing opportunities

• Perseverance

• Lifelong learning


• Hold pharmacist accountable for • Adjustment of medication dosage and

pharmacokinetic monitoring • Review of medication orders before first-dose

dispensing • Monitoring lab values and drug levels • Medication reconciliation • Consultation for drug therapy management • Availability around the clock


“…post discharge medication review and telephone follow-up by a pharmacist were

found to reduce the hospitalization rate and total health care costs”

“…a lower rate of preventable adverse drug events 30 days after discharge associated

with medication review, patient counseling, and telephone follow-up”


Continuity of Care

Adverse effects

and medication errors

Issues with PPMI

• Shortage of well-trained, board certified pharmacists • Oncology • Pediatrics • Transplant • Geriatrics • Informatics

• Ensuring competency by requiring lifelong learning

• Increasing need for highly trained and certified technicians

Issues with PPMI

• Difficulty of pharmacists achieving work-life balance

• Requirement of leadership role as part of healthcare team

• Financial constraints

• Pharmacists’ role is seen as production-oriented not patient-oriented

• The importance of professionalism

Part of the success of the PPMI model is

commitment to professionalism

PPMI and Professionalism

• Defining professionalism• Competence in a specialized body of

knowledge and skill • Acknowledging one’s specific duties and

responsibilities • One’s ability and willingness to train,

discipline, and reflect on one’s actions


• Prepare professional pharmacists • Various pharmacist associations • Schools of pharmacy • Pharmacy team members at work

How can pharmacy preceptors increase

professionalism in their students?


• Accepting personal responsibility

• Allowing students a favorable environment

• Guiding students with specific strategies

• Reflection on outcomes measures

Bridging the Gap to Professionalism

Student

Pharmacist

Bridging the Gap to Professionalism

• Gap between education and practice • Need more practice/training for students

• Modeling of preceptors and teachers to their students • Increases quality of professional students • Increases services by students

• Students must seize opportunities of leadership and lifelong learning as they advance through their careers

Works Cited 1. Executive Summary. Pharmacy practice model summit. Am J Health-Syst Pharm. 2011, June 15; 68:43-49.

2. Shane, Rita. Critical requirements for health-system pharmacy practice model that achieve optimal use of medicines. Am J Health-Syst Pharm. 2011, June 15; 68: 65-75.

3. Siska MH, TribbleDA. Opportunities and challenges related to technology in supporting optimal pharmacy practice models in hospital and health systems. Am J Health-Syst Pharm. 2011, June 15; 68: 80-90.

4. Meyrs C. Opportunities and challenges related to pharmacy technicians in supporting optimal pharmacy practice models in hospital and health systems. Am J Health-Syst Pharm. 2011, June 15; 68: 92-100.

5. Pharmacy practice model initiative. www.ashpmedia.org/ppmi/overview.html (accessed 10 March, 2015).

6. Ashby DM. What is the imperative for practice model change? (PowerPoint). New Orleans, Lousiana: ASHP Summer Meeting, 2011.

7. Ashby DM. Redefining the practice model: Where have we been, where do we go? (PowerPoint). Las Vegas, NV: ASHP Midyear Clinical Meeting and Exhibition, 2009.

8. Zilz DA, Woodward BW, Thielke TS, Shane RR, Scott B. Leadership skills for a high-performance pharmacy practice. Am J Health-Syst Pharm. 2004; 61:2562-74.

9. Tipton JA. Getting noticed: Establishing strategy and defining success. Houston, Tx: C-Suite Resources.

10. Sokn E. Providing quality patient care through profressive pharmacy practice. Cleavland, OH: C-Suite resources.

11. Zellmer WA. Porfessionalism – An essential component of the pharmacy practice model. (PowerPoint). Tampa, FL: ASHP 2010 Summer meeting and exhibition, 2010..

http://www.ashpmedia.org/ppmi/overview.html

The Pharmacy Practice Model

Initiative

Rouzan H. Srour, PharmD. Candidate 2015APPE Hospital Rotation

Rush University Medical Center March 19, 2015

Documents

PPMI Hospital Presentation