Deaconess Incident Reports Buyer Med Supply Coordinator Store Room Pyxis Delivery Inventory Control Receiving Deaconess Support Clinic Support Waste Mngt Shortage Mngt Packaging/BCMA CS Control / Monitor Crash Carts Disaster Prep Records Mngt BCMA IV /Warehouse Shortage Mngt Invoices/AP 340b Asst. Director, Operations Barrett Cancer Center Critical Care 7E CCR ER NICU OR Interns IPPE Students Medication Safety Coord Pharmacist Operations Manager Central and Decentral Pharmacist Personnel; Coordinate Decentralized Operations Central Operations Pharmacist Coord. Central Unit Dose Automation Robot Pyxis Talyst IV Room Procurement and Distribution Medication Control UCH VP Services Admin Secretary Operations Coordinator, Technicians Tech III Tech II Tech I Quality/ Training Volunteers Director Services Investigational Drug Service (IDS) Residency Program Directors Residents PGY1: 7 PGY2 Critical Care: 3 PGY2 Internal Medicine: 1 PGY2 Hem/Onc: 1 PGY2 Am Care: 1 TUH VP Professional Services Admin Assistant Asst. Director, Clinical Services & Research CLINICAL PHARMACY SPECIALISTS Critical Care 2.0 FTE MICU/SICU 1.0 FTE CVICU 1.0 FTE NSICU 1.0 FTE MICU/SICU/ED Cardiology 1.0 FTE Neuroscience 1.0 FTE Internal Medicine 2.5 FTE 0.5 FTE Diabetes Now Emergency Medicine 1.0 FTE 1 st Shift 2.0 FTE 2 nd Shift Infectious Disease 1.0 FTE Trauma/Ortho/Surgery 2.0 FTE Ambulatory Care Anticoagulation and Pharmacotherapy 3.64 FTE APPE Stdnts ADRs IRB Clinical Coordinator, Hematology and Oncology CLINICAL PHARMACY SPECIALISTS Solid Organ Oncology 1.0 Practitioner UCCP 2.0 FTE Hematology/BMT 1.0 FTE Decentral HemOnc Clinical Pharmacist Clinical Staff Pharmacist rotation, 2.0 FTE Solid Organ Transplant 1.0 FTE Barrett Center Leadership Management [] Asst. Director, Ambulatory Services OperationsCoord Tech III Tech II Tech I Holmes IPPE Stdnts Outpatient Pharmacists Ambulatory Clinics Anticoagulation Heart Failure Pharmacotherapy Ambulatory Services Coordinator Concierge Program MAP Coord Financial Counselors Case Study: Practice Model Initiative at an Academic Medical Center Ohio Society of Health-System Pharmacists 76 th Annual Meeting Katie Clark McKinney, PharmD, MS, BCPS Director, Services UC Health University of Cincinnati Medical Center kathryn.mckinney@uchealth.com 513-584-8802 Objectives Describe three types of practice models healthsystem pharmacies may adopt Describe the steps needed to complete the Hospital Self-Assessment (HSA), the data available upon completion, and action planning/follow-up Identify three practice changes implemented at UC Health University of Cincinnati Medical Center as a result of the PPMI HSA Discuss prioritization/planning to further PPMI at UC Health University of Cincinnati Medical Center UC Health University of Cincinnati Medical Center (UCMC) UC Health University of Cincinnati Medical Center (UCMC) Mission Provide life changing, patient centered medical care Drive innovation through groundbreaking research Educate and inspire the next generation of healthcare professionals Vision Our vision is to be the region s quality health care partner and a national leader in solving complex medical problems. UC Health: Services Mission Provide high-quality patient care by ensuring safe, effective, and efficient use. Achieve positive outcomes for our patients and community. Lead collaboration, education, research, and use of technology within pharmacy Vision Be the regional provider of choice for high quality patient-centered pharmacy care. Heighten pharmacist visibility to the patient and serve as an indispensable member of the medical team to achieve optimal therapeutic outcomes. Integrate state-of-the-art technology to optimize patient outcomes in a fiscally responsible manner from both patient and societal perspectives. Strategically expand access and capacity while incorporating innovation, diversity, and sharing of healthcare knowledge to empower patients and drive success. UNIVERSITY OF CINCINNATI MEDICAL CENTER DEPARTMENT OF PHARMACY SERVICES Organizational Chart v.3/2015 MED SUPPLY OPERATIONS / QUALITY ASSURANCE CLINICAL SERVICES / RESEARCH AMBULATORY 1
Complex System Consists of: Many diverse and autonomous but interrelated and interdependent components or parts Linked through many (dense) interconnections. Cannot be described by a single rule and their characteristics are not reducible to one level of description. Exhibit properties that emerge from the interaction of their parts and which cannot be predicted from the properties of the parts. Change Management The only thing constant is change. Change means movement; movement means friction. Framework for discussion and practice change Associate education Professional Resource American Society of Health-System Pharmacists We believe that the mission of pharmacists is to help people make the best use of medicines. Only national organization of hospital and health-system pharmacists Focus: Improving use Increasing patient safety http://www.businessdictionary.com/definition/complexsystem.html#ixzz2wzpzw4v3 http://www.ashp.org/aboutus/ What is PPMI? Practice Model Initiative Joint initiative American Society of Health-System Pharmacists (ASHP) ASHP Research & Education Foundation Practice model to utilize pharmacists as direct patient care providers Instill passion, commitment, and action among hospital and health-system practice leaders What Is PPMI? (Continued) Transforming how pharmacists care for patients Led by pharmacists Empowers fellow pharmacists Improve patient outcomes http://www.ashp.org/aboutus/ http://www.ashp.org/aboutus/ http://www.ashpmedia.org/ppmi/overview.html 2
Care Team Integration All patients should have the right to receive the care of a pharmacist. Key Recommendations Leveraging Technicians Every pharmacy department should develop a plan to reallocate its resources to devote significantly more pharmacist time to management services By 2015, the Technician Certification Board should require completion of an accredited training program before an individual can take the certification examination Pharmacist Credentialing and Training Pharmacists who provide drug therapy management should be certified through the most appropriate board of pharmacy specialties Technology Pharmacist-provided drug therapy management should be prioritized using a patient complexity index that includes factors such as severity of illness, number of s, and comorbidities Sufficient resources must be available to safely develop implement and maintain technologyrelated use safety standards Leadership in Medication Use Hospital and healthsystem pharmacists must be responsible and patients related outcomes. In optimal pharmacy practice models, individual pharmacists must accept responsibility for both the clinical and distributive activities of the pharmacy department Practice Models Definition: How pharmacy department resources are used to provide patient care services, including: 1. How pharmacists practice 2. What services are provided in the care of their patients 3. The role of pharmacy technicians in supporting patient care 4. Use of automation and technology in the -use process Practice Model A Drug Acquisition Control Medication and processing of orders Little proactive involvement of pharmacists in selection or monitoring Rare involvement with other members of the health care team Minimal need for advanced training/ credentials Recruitment of new practitioners Little accountability for patient care outcomes Practice Model B Central inpatient pharmacy with limited focus to drug + Clinical pharmacy specialists functioning independently Reluctant adoption of clinical practice by pharmacists May fear lack of support for their clinical decisionmaking Accountability for and ownership of -use problems not well defined Limitations to availability of clinical services Practice Model C Nearly all pharmacists have distributive and clinical responsibilities; large number of pharmacists can assume multiple clinical and operational roles Flexibility Adaptability Most widely used model Pharmacists involved as members of interdisciplinary teams, proactively assisting with evidence-based selection, quality improvement, and the development of therapeutic plans Need for well-trained, highly-functioning pharmacy technicians to manage logistics of PPMI in Practice From which pharmacy practice model would you build your framework? To vote, text a CODE to 37607 Code 295652 A 295653 B 295654 C Option https://www.polleverywhere.com/multiple_choice_polls/qrih9nwrw6dvcm 3
Practice Models A B C Drug-Distribution Centered Model Clinical-Specialist Centered Model Patient-Integrated Model Practice Model: Drug-Distribution Centered Drug Acquisition Control Medication and processing of orders Little proactive involvement of pharmacists in selection or monitoring Rare involvement with other members of the health care team Minimal need for advanced training/ credentials Recruitment of new practitioners Little accountability for patient care outcomes Practice Model: Drug-Distribution Centered Drug Acquisition Control Medication and processing of orders Little proactive involvement of pharmacists in selection or monitoring Rare involvement with other members of the health care team Minimal need for advanced training/ credentials Recruitment of new practitioners Little accountability for patient care outcomes Practice Model: Clinical-Specialist Centered Central inpatient pharmacy with limited focus to drug + Clinical pharmacy specialists functioning independently Reluctant adoption of clinical practice by pharmacists May fear lack of support for their clinical decisionmaking Accountability for and ownership of -use problems not well defined Limitations to availability of clinical services Practice Model: Patient-Integrated Model Nearly all pharmacists have distributive and clinical responsibilities; large number of pharmacists can assume multiple clinical and operational roles Flexibility Adaptability Most widely used model Pharmacists involved as members of interdisciplinary teams, proactively assisting with evidence-based selection, quality improvement, and the development of therapeutic plans Need for well-trained, highly-functioning pharmacy technicians to manage logistics of Practice Model: Patient-Integrated Model Nearly all pharmacists have distributive and clinical responsibilities; large number of pharmacists can assume multiple clinical and operational roles Flexibility Adaptability Most widely used model Pharmacists involved as members of interdisciplinary teams, proactively assisting with evidence-based selection, quality improvement, and the development of therapeutic plans Need for welltrained, highlyfunctioning pharmacy technicians to manage logistics of 4
Improving or Changing Models Identify current pharmacy practice model Dissect model to identify strengths and challenges Compare to PPMI pillars and goals Create action plan for improvements and changes How can we measure our success? PPMI Focus Areas 1. Create a Framework 2. Determine Services 3. Identify Emerging Technologies 4. Develop a Template 5. Implement Change PPMI Focus Areas 1. Create a Framework 2. Determine Services 3. Identify Emerging Technologies 4. Develop a Template 5. Implement Change Framework for Discussion and Practice Change ASHP PPMI Pharmacist roles, practices, and activities will improve use and optimize related outcomes. http://www.ashpmedia.org/ppmi/overview.html technicians will prepare and distribute s and perform other functions that do not require a pharmacist's professional Pharmacists and pharmacy technicians will have appropriate credentials for the activities performed within their scope of departments utilize available automation and technology to improve patient safety and improve efficiency. Pharmacists will demonstrate leadership in exercising their responsibility for use systems and will be accountable for related patient outcomes. Complete Hospital Self-Assessment Developed to assess an individual hospital s conformity with the recommendations from the PPMI Summit 106 questions assessing adoption of the PPMI recommendations at the hospital level ASHP recommends completion of the HSA on a quarterly to annual basis http://www.ppmiassessment.org/docs/assessment_que stions.pdf Hospital Self-Assessment: Content Self-Assessment Section Number of Questions Hospital Demographic Information 15 Optimal Practice Model Characteristics, Part I 30 Optimal Practice Model Characteristics, Part II 27 Advancing the Application of Information Technology in the Medication-Use Process Successful Implementation of New Practice Models 24 10 Total: Six Sections 106 Questions 5
Crosswalk: HSA Summary/PPMI Goals ASHP PPMI PPMI Dashboard PPMI Dashboard HSA Summary Report Optimal Practice Model Characteristics Part 1 Optimal Practice Model Characteristics Part 2 Advancing the Application of IT in the Medication Use Process Advancing the Use of Technicians Pharmacist roles, practices, and activities will improve use and optimize related outcomes. technicians will prepare and distribute s and perform other functions that do not require a pharmacist's professional Pharmacists and pharmacy technicians will have appropriate credentials for the activities performed within their scope of departments utilize available automation and technology to improve patient safety and improve efficiency. demonstrate leadership in exercising their responsibility for use related 2014 2013 2012 2011 Pharmacist roles, technicians Pharmacists and practices, and will prepare and pharmacy technicians departments utilize demonstrate activities will improve distribute s will have appropriate available automation leadership in use and and perform other and technology to exercising their optimize functions that do not credentials for the improve patient safety responsibility for related outcomes. require a pharmacist's activities performed and improve use professional within their scope of efficiency. related 64% 17% 27% 73% 48% 64.5% 18.3% 26.8% 60.5% 48.4% 60% 16.6% 25.9% 52.7% 46.7% 58.6% 17.4% 23.8% 43.9% 54.7% 2014 2013 2012 2011 Pharmacist roles, technicians Pharmacists and practices, and will prepare and pharmacy technicians departments utilize demonstrate activities will improve distribute s will have appropriate available automation leadership in use and and perform other and technology to exercising their optimize functions that do not credentials for the improve patient safety responsibility for related outcomes. require a pharmacist's activities performed and improve use professional within their scope of efficiency. related 64% 17% 27% 73% 48% 64.5% 18.3% 26.8% 60.5% 48.4% 60% 16.6% 25.9% 52.7% 46.7% 58.6% 17.4% 23.8% 43.9% 54.7% Successful Implementation of New Practice Models http://www.ashpmedia.org/ppmi/national-dashboard.html http://www.ashpmedia.org/ppmi/national-dashboard.html UCMC PPMI Dashboard Pharmacist roles, technicians Pharmacists and practices, and will prepare and pharmacy technicians departments utilize demonstrate activities will improve distribute s will have appropriate available automation leadership in use and and perform other and technology to exercising their optimize functions that do not credentials for the improve patient safety responsibility for related outcomes. require a pharmacist's activities performed and improve use professional within their scope of efficiency. related 2015 UCMC 82% 60% 55% 55% 77% 2014 UCMC 71% 58% 60% 66% 77% 2013 UCMC 74% 51% 59% 59% 67% 2012 UCMC 72% 56% 55% 44% 67% UCMC PPMI Dashboard Pharmacist roles, technicians Pharmacists and departments practices, and activities will prepare and pharmacy technicians utilize available demonstrate leadership will improve distribute s will have appropriate automation and in exercising their use and optimize and perform other credentials technology to improve responsibility for related functions that do not for the activities patient safety and use outcomes. require a pharmacist's performed within their improve efficiency. scope of professional related 2015 UCMC 82% 60% 55% 55% 77% 2014 UCMC 71% 58% 60% 66% 77% 2013 UCMC 74% 51% 59% 59% 67% 2012 UCMC 72% 56% 55% 44% 67% PPMI Comparison Dashboard Pharmacist roles, technicians Pharmacists and practices, and will prepare and pharmacy technicians departments utilize demonstrate activities will improve distribute s will have appropriate available automation leadership in use and and perform other and technology to exercising their optimize functions that do not credentials for the improve patient safety responsibility for related outcomes. require a pharmacist's activities performed and improve use professional within their scope of efficiency. related 2015 UCMC 82% 60% 55% 55% 77% 2015 2014 UCMC 71% 58% 60% 66% 77% 2014 64% 17% 27% 73% 48% 2013 UCMC 74% 51% 59% 59% 67% 2013 64.5% 18.3% 26.8% 60.5% 48.4% 2012 UCMC 72% 56% 55% 44% 67% 2012 60% 16.6% 25.9% 52.7% 46.7% 2011 58.6% 17.4% 23.8% 43.9% 54.7% http://www.ashpmedia.org/ppmi/national-dashboard.html 6
PPMI Comparison Dashboard Pharmacist roles, technicians Pharmacists and practices, and will prepare and pharmacy technicians departments utilize demonstrate activities will improve distribute s will have appropriate available automation leadership in use and and perform other and technology to exercising their optimize functions that do not credentials for the improve patient safety responsibility for related outcomes. require a pharmacist's activities performed and improve use professional within their scope of efficiency. related 2015 UCMC 82% 60% 55% 55% 77% 2015 2014 UCMC 71% 58% 60% 66% 77% 2014 64% 17% 27% 73% 48% 2013 UCMC 74% 51% 59% 59% 67% 2013 64.5% 18.3% 26.8% 60.5% 48.4% 2012 UCMC 72% 56% 55% 44% 67% 2012 60% 16.6% 25.9% 52.7% 46.7% 2011 58.6% 17.4% 23.8% 43.9% 54.7% Hospital Self-Assessment: Tools Available Upon Completion http://www.ppmiassessment.org/ Sites previous years responses available to review Following completion, the HSA tool will allow the user to develop an individualized list of priorities (an "Action List") Opportunity to generate reports comparing their data with aggregated data collected from similar hospitals within and across their state. HSA: Comparative Report Beds Type MSA Region Less than 50 Academic Medical Center International International 50-99 Community Hospital Metropolitan Midwest 100-199 Critical Access Hospital Nonmetropolitan 200-299 Long Term Acute Care Facility Urban Northeast East 300-399 Pediatric Hospital South 400-599 Rehabilitation Hospital West Greater than 600 Specialty Hospital VA Hospital Other PPMI Focus Areas 1. Create a Framework 2. Determine Services 3. Identify Emerging Technologies 4. Develop a Template 5. Implement Change UC Health: Services Mission Provide high-quality patient care by ensuring safe, effective, and efficient use. Achieve positive outcomes for our patients and community. Lead collaboration, education, research, and use of technology within pharmacy Vision Be the regional provider of choice for high quality patient-centered pharmacy care. Heighten pharmacist visibility to the patient and serve as an indispensable member of the medical team to achieve optimal therapeutic outcomes. Integrate state-of-the-art technology to optimize patient outcomes in a fiscally responsible manner from both patient and societal perspectives. Strategically expand access and capacity while incorporating innovation, diversity, and sharing of healthcare knowledge to empower patients and drive success. 7
PPMI Focus Areas 1. Create a Framework 2. Determine Services 3. Identify Emerging Technologies 4. Develop a Template 5. Implement Change PPMI Goal 4: departments utilize available automation and technology to improve patient safety and efficiency Bar-code technology +/- robotics Benefit to changing pharmacist practice Impact on technician practice Strategic planning Goal 4: departments utilize available automation and technology to improve patient safety and improve efficiency. Technology Smart Pump Implementation Library Maintenance Timeline 2008 Ongoing Improve Patient Safety DoseEdge 2010 Bar-Code Medication Administration (BCMA) Integrated Electronic Medical Record Implemented Optimization of Automated Dispensing Cabinets Robot Rx First Fill Dispensing (addition to cartfill) Carousel Inventory Management Smart Pump Strategic Initiative Proposal Robot Rx upgrade ADC Scan on Refill 2012 Improve Efficiency 2012 January-April 2014 April 2014 June-October 2014 November 2014 Ongoing February- March 2015 June-August 2015 Goal 4: departments utilize available automation and technology to improve patient safety and improve efficiency. Goal 4: departments utilize available automation and technology to improve patient safety and improve efficiency. PPMI Goal 3: Pharmacists and pharmacy technicians will have appropriate credentials for activities performed within their scope of practice Technician certification Requirements by State of Ohio Requirements of UC Health organization Future: BoP governed licensure Technician education as an accredited degree program Pharmacists: Residency training Board certification; interest, opportunity and support Future: Non-traditional residency training http://www.google.com/url?url=http://singularityhub.com/2012/06/03/meet-robot-rx-the-robot 8
PPMI Goal 2: technicians will prepare and distribute s and perform other functions that do not require a pharmacist s professional judgment Anticoagulation clinic Supervisory roles PPMI Goal 1: Pharmacist roles, practices and activities will improve use and optimize outcomes Decentralized hematology-oncology pharmacist role Supports transitions of care Ownership for use process 2014 Winner ASHP Best Practices Award PPMI Goal 5: demonstrate leadership in exercising their responsibility for use systems and will be related outcomes Off-shift clinical pharmacy coverage 24/7 attending model 2 nd shift 3 rd shift http://www.ashpadvantage.com/bestpractic es/award.htm Next steps: Alignment with system and service-line strategic plan(s) and planning process UC Health: Services Mission Provide high-quality patient care by ensuring safe, effective, and efficient use. Achieve positive outcomes for our patients and community. Lead collaboration, education, research, and use of technology within pharmacy Vision Be the regional provider of choice for high quality patient-centered pharmacy care. Heighten pharmacist visibility to the patient and serve as an indispensable member of the medical team to achieve optimal therapeutic outcomes. Integrate state-of-the-art technology to optimize patient outcomes in a fiscally responsible manner from both patient and societal perspectives. Strategically expand access and capacity while incorporating innovation, diversity, and sharing of healthcare knowledge to empower patients and drive success. Quality and Excellence Growth Resource Stewardship Image Partnerships 9
UC Health: Services Mission Provide high-quality patient care by ensuring safe, effective, and efficient use. Achieve positive outcomes for our patients and community. Lead collaboration, education, research, and use of technology within pharmacy Vision Be the regional provider of choice for high quality patient-centered pharmacy care. Heighten pharmacist visibility to the patient and serve as an indispensable member of the medical team to achieve optimal therapeutic outcomes. Integrate state-of-the-art technology to optimize patient outcomes in a fiscally responsible manner from both patient and societal perspectives. Strategically expand access and capacity while incorporating innovation, diversity, and sharing of healthcare knowledge to empower patients and drive success. Crosswalk: UC Health Strategic Plan/PPMI Goals ASHP PPMI UC Health Strategic Plan Provision of exceptional and consistent pharmacotherapy Pharmacist roles, practices, and activities will improve use and optimize related outcomes. technicians will prepare and distribute s and perform other functions that do not require a pharmacist's professional Pharmacists and pharmacy technicians will have appropriate credentials for the activities performed within their scope of departments utilize available automation and technology to improve patient safety and improve efficiency. demonstrate leadership in exercising their responsibility for use related Establish and grow role in Transitions of Care Growth of Investigational Drug Service Growth of Specialty Build University of Cincinnati Physicians relationship Establish College of and UC Health partnership with therapy management Demonstrate outcomes for pharmacy services Improve the quality of out-patient pharmacy services http://www.ashpmedia.org/ppmi/index.html Local, Regional and Organization Support Participation in PPMI Week HSA Initiative SSHP (Local) GCSHP (Local) Partnered with Greater Cincinnati Health Council Directors of Professional Affairs Division Assessed facilities identified OSHP (State/Regional) Communication to encourage completion ASHP () Awarded OSHP PPMI Grant Tools And Resources For more information, visit: http://www.ashp.org/ppmi What you ll find: More information about PPMI Tools and resources Dashboard for tracking PPMI progress Web-based hospital self-assessment 10
Case Study: Practice Model Initiative at an Academic Medical Center Ohio Society of Health-System Pharmacists 76 th Annual Meeting Katie Clark McKinney, PharmD, MS, BCPS Director, Services UC Health University of Cincinnati Medical Center kathryn.mckinney@uchealth.com 513-584-8802 11