2017 Pharmacy Education - ProCEs3.proce.com/res/pdf/CHS2017Apr19Handout.pdf · Advancing the Practice of Pharmacy CHS Pharmacy Education Series ProCE, Inc. 3 2016 Pharmacy Education

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

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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



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2016 Pharmacy Education Series

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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

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Funding:This activity is self‐funded through CHSPSC.



R. Anthony Davis, Pharm.D.

Carolinas Hospital System

Director, Pharmacy Services

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“What did I just do?”

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How do I find the time? What makes me the Expert?

Who am I to tell anyone about “Time Management”?

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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”.

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Get up Off your “But” Not BUTT. Your “but”

Your excuses

We “ALL” find the time, when the priority is high enough.

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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….

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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).

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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.

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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….

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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

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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

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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.

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Failing to Manage Distractions May loose as much as 2 hours a day from distractions

Distractions

Emails

Meetings

Phone calls

Employees

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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

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Find “YOUR” Balance “When You Die, Your Inbox Will be Full”

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Bon Appetite and don’t forget…”Stay thirsty my friends!”

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Amy Hyduk‐Cardillo, PharmD, MBA, BCPS

Pharmacy Director, Lutheran Health Network, Fort Wayne, IN

Presented by Drew Wiard, PharmD, MBA, BCPS

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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

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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

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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

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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

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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

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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

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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

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Residency 1‐month trial in Peds/PICU/NICU

Highlighting safety wins/errors caught

Highlighting safety issues

Significant physician support

Pediatric Pharmacist Justification

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Automation Technicians

ED Medication History Technician

Technician Supervisor Trial

Pharmacy Technician Advancement

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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

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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

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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

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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

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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.

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Example Documented Intervention Detail Collected

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Inventory, ++ Orientees

++ Orientees, No floating of preceptor

hours, carousel prep

Open Ops Mgrposition,

++ Orientee

s

++ Orientees, No floating of

preceptor hours

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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

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• Pharmacy profession consistently evolving

• Degree Progression• Residencies• Fellowships

• Specialized Career Paths

• Shifts in Technology• Electronic Medical Records• “Pharmacovigilance” Software

• Sentri7™

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• 168 Bed Facility • 35 miles West of Philadelphia

2014 Department Statistics

Staff FTE Per Diem

Pharmacists 8 1

Technicians 5 1

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• Create a sense of identity

• Clear shift from previous ideology and output

• “Well this is how we’ve always done it”

• Communication

• Education

• Attitude

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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

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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

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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

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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

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• Electronic Medical Records

• “Pharmacovigilance” Software• Sentri7™• Micromedex™

• Standardized Interventions• Vancomycin/AG Nomogram• Warfarin training

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• Medication History Technicians

• Patient Education with tablets

• Pharmacy to provide flu vaccine

• Overnight Pharmacy

• Residency Program

• Outpatient Wellness Clinic

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Thank You

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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.

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Daily Workflow: Census Review and Sentri-7 Dashboard

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Daily Workflow: Renewal/expiring orders review

Anticoagulation Medications Review

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Daily Workflow: Antibiotic Timeouts Review

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Daily Workflow: Interdisciplinary Team Meeting

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Daily Workflow:

Discharge Counselling

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Daily Workflow: Response Teams

- code blue

- heart alert

- rapid response

- trauma alert

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Daily Workflow: Dispensing activities

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Thank you for all you do!

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Tony Back, PharmD

Bayfront Health Port Charlotte

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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.

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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!

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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

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Documentation Sentri7

Began in early 2016

Utilized front line pharmacist and DOP for interventions.

Difficulty meeting intervention goals.

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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.”

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Sentri7 Usage

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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.

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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.

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Clinical Pharmacist Rounds Daily on CVR/ CVSD/ ICU.

Discharge Counseling.

AMS monitoring in Sentri7.

Monitors Staff Pharmacists activities.

Accountable to get documentation done.

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Impact of Having a Dedicated Clinical Pharmacist

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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.

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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

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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.

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Financial Results

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Jerry H. Reed, MS, RPh, FASCP, FASHP

Senior Director, Pharmacy Services

Community Health Systems

Update on Current Pharmacy Initiatives and Strategies



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Documents

2017 Pharmacy Education - ProCEs3.proce.com/res/pdf/CHS2017Apr19Handout.pdf · Advancing the Practice of Pharmacy CHS Pharmacy Education Series ProCE, Inc. 3 2016 Pharmacy Education