Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 1
2017 Pharmacy Education Series
April 19, 2017Advancing the Practice of Pharmacy
Featured Speakers:
R. Anthony Davis, PharmDDrew Wiard, PharmD, MBA, BCPS
Michael Kleinschmidt, PharmD, BCPSClaudette Leiker, PharmD, RPh
Tony Back, PharmD
2
Submission of an online post‐test and evaluation is the only way to obtain CE credit for this webinar
Go to www.ProCE.com/CHSRx
Webinar attendees will also receive an email with a direct link to the web page
Print your CE statement of completion online
– Credit for live or enduring (not both)
Deadline: May 19, 2017
CPE Monitor (applicable to pharmacists and pharmacy technicians)
– CE credit automatically uploaded to NABP/CPE Monitor upon completion of post‐test and evaluation (user must complete the “claim credit” step)
Online Evaluation, Self-Assessmentand CE Credit
Attendance Code
Code will be provided at the end of today’s activity
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 2
How to Ask a Question
Locate menu bar on your computer desktop
Click orange arrow button to open menu box
Type question into question box
Click Send
Do not close menu box
– This will disconnect you
from the Webcast
Please submit questions throughout
presentation
Click No!
Click
Enter question
3
Accessing PDF Handout Click the hyperlink that is
located directly above the question box
Do not close menu box
– This will disconnect you
from the Webcast
No!
Clickhyperlink
4
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 3
2016 Pharmacy Education Series
5
It is the policy of ProCE, Inc. to ensure balance, independence, objectivity and scientific rigor in all of its continuing education activities. Faculty must disclose to participants the existence of any significant financial interest or any other relationship with the manufacturer of any commercial product(s) discussed in an educational presentation. None of the presenters have any relevant commercial and/or financial relationships to disclose
Please note: The opinions expressed in this activity should not be construed as those of the CME/CE provider. The information and views are those of the faculty through clinical practice and knowledge of the professional literature. Portions of this activity may include unlabeled indications. Use of drugs and devices outside of labeling should be considered experimental and participants are advised to consult prescribing information and professional literature.
April 19, 2017Advancing the Practice of Pharmacy
Featured Speakers:
R. Anthony Davis, PharmDDrew Wiard, PharmD, MBA, BCPS
Michael Kleinschmidt, PharmD, BCPSClaudette Leiker, PharmD, RPh
Tony Back, PharmD
CE Activity Information & Accreditation
ProCE, Inc. (Pharmacist and Pharmacy Technician CE)
– 2.0 contact hours
6
Funding:This activity is self‐funded through CHSPSC.
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 4
R. Anthony Davis, Pharm.D.
Carolinas Hospital System
Director, Pharmacy Services
7
“What did I just do?”
8
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 5
How do I find the time? What makes me the Expert?
Who am I to tell anyone about “Time Management”?
9
First: Accept Reality Time is finite
168 hours in a week
The same for: Donald Trump, Corporate CEO’s, “new baby mom’s”, and most of all, “ME”!
Can’t change time, can only change “PRIORITIES”.
10
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 6
Get up Off your “But” Not BUTT. Your “but”
Your excuses
We “ALL” find the time, when the priority is high enough.
11
The Question I was asked was…
“What do I do to find the time?”
Wasn’t what others say or do
It is for once, ALL ABOUT ME….
12
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 7
Keep a “To‐Do” List Contains everything I am working on at work in “small words”
Listed in categories
When finished with each item, cross it off an move it to the “DONE” section.
Share with my boss during monthly meetings
(If I need to).
13
Prioritize “To‐Do” List has priorities
Some require others (supervisors, colleagues, etc) help. Keep updated with DATES of when you asked for help or you met.
Plan before you leave work today, what you want to get done tomorrow.
14
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 8
Prioritize“Managers tell us all the time they have “a time management problem.” Their days, they say, are often hijacked by unplanned events, interruptions, crises — matters that can’t be ignored. They go to work planning to do certain things as a boss and at day’s end they realize they’ve done none of it.” –Harvard Business Review
That’s ok. Necessary Evil….
15
Taking on Too Much The bottom line is that by trying to take on everything at once we are ultimately setting ourselves up for a massive failure.
Taking on too much is a proverbial death sentence whether in our work, with our families or any other activity.
MULTITASKING = Poor work
16
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 9
Taking on Too Much When someone asks you to do something, What I do:
Repeat back the task
Ask when is it needed, in order to “Prioritize”
I will look into this, but it will happen on my time
Add it to the “To‐Do” List
Communicate
17
Why does my desk / office always look like this?
(Not officially my office)
Every time I clean it, in two days it is a mess again. ANSWER: Other people put stuff on my desk, and I have managed the distractions poorly.
18
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 10
Failing to Manage Distractions May loose as much as 2 hours a day from distractions
Distractions
Emails
Meetings
Phone calls
Employees
19
Failing to Manage Distractions
“Sometimes the best time to get work done is when no one else is in the office.”
My Favorite time to work (My Get Er Done Time):
Around the Holidays OR
Whenever my Boss is on vacation
Other times (when I have a project due):
Mornings (get up an hour earlier – usually not a popular choice)
Pretend I have left for the day, and close my door
20
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 11
Find “YOUR” Balance “When You Die, Your Inbox Will be Full”
21
Bon Appetite and don’t forget…”Stay thirsty my friends!”
22
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 12
Amy Hyduk‐Cardillo, PharmD, MBA, BCPS
Pharmacy Director, Lutheran Health Network, Fort Wayne, IN
Presented by Drew Wiard, PharmD, MBA, BCPS
23
Pharmacists: Identify ways to develop a thorough justification and opportunities to leverage resources for developing and expanding pharmacy services
Technicians: Identify technician practice advancement opportunities in a hospital pharmacy setting
Objectives
24
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 13
Lutheran Hospital—396 licensed beds
4 adult ICUs for total of 101 adult ICU beds
Pediatric ICU
Level III NICU
Transplant Center—Heart, kidney
Level II Trauma Center—Adults & Peds
Freestanding ED
Orthopedic Hospital—39 beds
Off‐site outpatient surgery center
Rehabilitation Hospital of Fort Wayne—36 beds
Network Pharmacy Services
Demographics
25
Inpatient Consults Anticoagulation, Kinetics, TPN, Pain Mgmt, ESAs Multiple required “Rx to Dose” & monitor items Renal Dosing Service IV to PO automatic interchanges Patient education
Anticoagulation Clinic AFib Clinic Adult CF Clinic, Pediatric CF Clinic Transplant Clinics Joint Camp Neurospine Camp Antimicrobial Stewardship Multidisciplinary Rounds
Clinical Pharmacy Services
26
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 14
Metric 2014 2016 Growth
Doses Billed (LH, TOH, RHFW combined)
3,674,866 3,719,718 ↑ 44,852 doses (↑~123 doses/day)
Clinical Consults Managed (Avg for LH, TOH & RHFW combined)
155/day 230/day ↑ 75/day (48%)
Documented Clinical Interventions (LH, TOH & RHFW combined)
55,860 73,597 ↑ 17,737 (32%)(Avg ↑ 49/day)
Pharmacy Services Growth
Clinical Services Expansion since 2014 AFib Clinic Multidisciplinary Rounds—Family Practice, Intensivist Service, Trauma Service, CV Service, Cardiology Service
ED Pharmacist, Family Practice Pharmacist Expansion of automatic renal dosing adjustments for 50+ drugs Expansion of clinical dosing & monitoring service to include mandatory “Rx to Dose” for DOACs, and vancomycin/AGly
Pharmacy‐initiated Factor Xa Level Protocol for dosing LMWH, HIT Protocol
27
Rapid detection & resistance testing—Gm + & Gm –
C. diff results review
RPh review of all culture reports
Clinical Coordinator/ID RPh—0.1 FTE able to devote to ASP prior to 2017 ASP Rounds 2‐3 days/week
Antibiogram publications & trending, working w/
students on epidemiology reports, follow‐ups on
rapid organism detection results & interventions,
Infection Control Mtgs, implementation of room
sterilization/fogger technology, etc.
Antimicrobial Stewardship Expansion
28
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 15
Outlined the CMS Standards & new TJC ASP Standards
Outlined literature supporting ASP Pharmacist
Outlined accomplishments in ASP program w/0.1 FTE RPh resource
Outlined deficiencies in meeting new standards (GAP Analysis)
Documented actual hard‐dollar and soft‐dollar cost‐savings for interventions w/0.1 FTE RPh resource
Calculated projected hard‐dollar cost‐savings for interventions if 1.0 FTE RPh resource allocated
SBAR able to demonstrate projected cost‐savings that would be more than double a 1.0 FTE RPh (salary & benefits) allocation to ASP
Antimicrobial Stewardship Position Justification
29
Rounding w/Peds Intensivists
Monitoring vanco and AGly levels for neonates
Medication History intake
Concurrent patient profile reviews
Special peds projects for PI, committee work,
peds‐focused med safety initiatives, etc.
Pediatrics Service Line Expansion
30
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 16
Residency 1‐month trial in Peds/PICU/NICU
Highlighting safety wins/errors caught
Highlighting safety issues
Significant physician support
Pediatric Pharmacist Justification
31
Automation Technicians
ED Medication History Technician
Technician Supervisor Trial
Pharmacy Technician Advancement
32
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 17
Success story Med History Tech presented with bag of home meds by a patient who had presented to the ED for HTN w/CP and was subsequently being admitted. While taking the patient’s med hx, Med Hx Tech physically reviewed each med individually with her and asked for indication on each one as entering into EMR. Med Hx Tech pulled out a bottle labeled “hydroxyzine” and asked the patient what she takes hydroxyzine for. Patient indicated she doesn’t take hydroxyzine but takes one with a similar sounding name for blood pressure. Med Hx Tech didn’t find that medication in the bag so proceeded to call the Rx that filled the bottle 35 days prior. The pharmacy that filled that prescription for the patient pulled up the prescription and determined that they had misfilled hydralazine with hydroxyzine. ED RPh & MD both notified. Patient later called ED RPh to extend her gratitude to Med Hx Tech for catching the error.
Pharmacy Technician Advancement
33
Technician Supervisor
Expand Medication History Techs in ED 24/7
Expand Medication History Techs across hospital
Advanced Practice Technician Job Description
Incorporate Med History Techs, Automation Techs, Purchaser and other future advanced tech position into one job description
Lead Oncology Tech?
Controlled Substance Tech?
Tech Check Tech Program
Pharmacy Technician Advancement—Next Steps
34
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 18
Leverage involvement of students
Leverage use of technology to free up pharmacists to perform clinical functions
Pharmacy school co‐funded faculty opportunities
Residency Program
Leverage resources across hospitals if feasible
Share FTEs w/revenue‐generating offices/clinics
Clinical Service Expansion Resource Opportunities
35
Enlist support of Medical Staff & Nursing Leadership
Develop a solid business plan and indicate how you will measure success of a new/expanded program or position
Capture and continue to present your metrics
Highlight at P&T, clinical service line committees, MEC, Admin meetings
Demonstrate changes to regulatory requirements that have impacted/will impact workload
Trend Reports
GAP Analysis
SBAR
Key To‐Do’s
36
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 19
Doses Dispensed/Billed
Clinical Interventions
Clinical Consults
Outcome Metrics (Core Measures, HCAHPs, etc.)
Cost‐Savings
Example Trending Reports/Snapshots
Fishburne, T. Marketoonist.com Accessed 3 Apr 2017.
37
Example Documented Intervention Detail Collected
38
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 20
Example Trending Reports/Snapshots
39
Example Trending Reports/Snapshots
40
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 21
Example Trending Reports/Snapshots
Inventory, ++ Orientees
++ Orientees, No floating of preceptor
hours, carousel prep
Open Ops Mgrposition,
++ Orientee
s
++ Orientees, No floating of
preceptor hours
41
Example Trending Reports/Snapshots
42
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 22
Ambulatory/Physician Office Clinics
Lipid Clinic
CHF Clinic
PAH Clinic
ED Pharmacist Service Expansion—5‐7 days/week
Incorporating clinical metric into productivity measure
Keeping Future Opportunities in Sight
43
44
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 23
45
46
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 24
47
48
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 25
• Pharmacy profession consistently evolving
• Degree Progression• Residencies• Fellowships
• Specialized Career Paths
• Shifts in Technology• Electronic Medical Records• “Pharmacovigilance” Software
• Sentri7™
49
• 168 Bed Facility • 35 miles West of Philadelphia
2014 Department Statistics
Staff FTE Per Diem
Pharmacists 8 1
Technicians 5 1
50
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 26
• Create a sense of identity
• Clear shift from previous ideology and output
• “Well this is how we’ve always done it”
• Communication
• Education
• Attitude
51
September October November December
2014
Clinical Pharmacist Handbook written
Surveyed Nursing, Administration, and
Pharmacy
Began “Operation UBCP”
RX to dose Vanco/ AG/ Warfarin
Open House Blitz
Modified Pharmacist Scheduling
Pharmacists Decentralized
to Units
52
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 27
January February March April May June July August September October November December
2015
Education Seminars
Cerner, Sentri7, Patient Counseling
Vancomycin, Anticoagulation
Adenosine MPI Case Reports Written/
Distributed
March Madness
Hired Clinical Coordinator
Began Pharmacy Student Program
Expanded ED Pharmacy Coverage
Electronic Heparin Protocols
Pharmacy Driven Staff In‐Services
Standardized Pharmacy/Nursing
Orientation
53
January February March April May June July August September October November December
2016
Pharmacist driven
HCAHPS pilot16% increase in
communication about medication metrics (Q1
2015 vs Q1 2016)
March Madness
Streamlined Inventory/ Formulary
CHS
Infusions Article
Pharmacy Pearls
Meds to Beds Program
Mission Side Effect
Creation of staff generated bi‐annual
competencies
Behavioral Health RX In‐Services
54
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 28
January February March April May June July August September October November December
2017
Medication History
Technicians Implemented
Pharmacists Immunization
Certified
March Madness
BLS and ACLS becoming position
requirements
Proposal to be submitted for ASHP Residency Program
USP 800 Cleanroom conversion
2017 Department Statistics
Staff FTE Per Diem
Pharmacists 10 (+2) 3 (+2)
Technicians 7 (+2) 1
55
• Electronic Medical Records
• “Pharmacovigilance” Software• Sentri7™• Micromedex™
• Standardized Interventions• Vancomycin/AG Nomogram• Warfarin training
56
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 29
• Medication History Technicians
• Patient Education with tablets
• Pharmacy to provide flu vaccine
• Overnight Pharmacy
• Residency Program
• Outpatient Wellness Clinic
57
58
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 30
59
Thank You
60
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 31
ADVANCING THE PRACTICE OF PHARMACY: INTEGRATING
PHARMACISTS IN THE HEALTHCARE TEAM
Claudette Leiker, Pharm D 61
OBJECTIVE:AT THE CONCLUSION OF THIS
PRESENTATION, PARTICIPANTS WILL BE ABLE TO LIST ACTIVITIES FOR WHICH
PHARMACISTS CAN PROVIDE MEDICATION MANAGEMENT EXPERTISE.
62
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 32
63
Daily Workflow: Census Review and Sentri-7 Dashboard
64
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 33
Daily Workflow: Renewal/expiring orders review
Anticoagulation Medications Review
65
Daily Workflow: Antibiotic Timeouts Review
66
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 34
Daily Workflow: Interdisciplinary Team Meeting
67
Daily Workflow:
Discharge Counselling
68
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 35
Daily Workflow: Response Teams
- code blue
- heart alert
- rapid response
- trauma alert
69
Daily Workflow: Dispensing activities
70
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 36
Thank you for all you do!
71
Tony Back, PharmD
Bayfront Health Port Charlotte
72
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 37
Objectives At the conclusion of the presentation, participants will be able to identify some key steps to increasing pharmacy interventions through Sentri7 and clinical rounding.
At the conclusion of the presentation, participants will be able to discuss how Sentri7 can be utilized to identify how many patients are on key medications.
73
Facility 254 beds
Level II NICU
Large CV population
Cath labs/ Open Heart.
Five ID physicians
One of the highest median ages in the US.
Geriatric / Polypharmacy!
74
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 38
75
Staff 8 staff pharmacist
Not open 24 hours
Centralized
All kinetics/ Warfarin/TPN management handled out of the central pharmacy
Automatic Renal Dosing Policy
Automatic Interchange Policy
76
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 39
Documentation Sentri7
Began in early 2016
Utilized front line pharmacist and DOP for interventions.
Difficulty meeting intervention goals.
77
Challenges to Clinical Documentation Time required to document.
Too busy with order volume.
Have to be logged into multiple systems.
Distractions/ forgetfulness.
“I didn’t get to it.”
78
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 40
Sentri7 Usage
79
Additional Uses of Sentri7 Sentri7 can also be used to easily see how many patients are on specialty medications
Technicians can use this to determine medication needs.
Also useful for buyers.
80
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 41
Opportunity There was a physician push for daily team rounding on critical care patients.
AMS requirements.
Pharmacist retired, opening up an FTE.
Converted this FTE to a dedicated Clinical /AMS position.
Began full time in December 2016.
81
Clinical Pharmacist Rounds Daily on CVR/ CVSD/ ICU.
Discharge Counseling.
AMS monitoring in Sentri7.
Monitors Staff Pharmacists activities.
Accountable to get documentation done.
82
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 42
Impact of Having a Dedicated Clinical Pharmacist
83
Targeting Interventions AMS activities first.
ABX length of therapy.
Correct ABX.
Renal Dosing.
Staff documentation of kinetics etc.
Rounding – document in Sentri7.
Customized tabs for work flow efficiency.
84
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 43
Standardize Event Section of the Rules Preload the medication if a drug specific rule.
Preload most common responses / notes.
“Additional Columns” – all needed information.
Create tabs to make workflow efficient.
Pharmacy dosing
Rounds
85
Keys to Improving Financial Impact of Interventions While ALL clinical interventions are valuable…Some interventions are worth more.
Review the “Top Interventions” tab under facility reports. Sentri7 > Admin tab >Top Interventions
Determine the hard cost value /hr .
Some quick easy interventions have higher payoff.
C‐Suite likes Hard Cost Savings.
86
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 44
87
Financial Results
88
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 45
89
91
Jerry H. Reed, MS, RPh, FASCP, FASHP
Senior Director, Pharmacy Services
Community Health Systems
Update on Current Pharmacy Initiatives and Strategies
Advancing the Practice of PharmacyCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 46
92