Content Owner(s): R/R

Practice Advancement Initiative

• Provide an overview of Hardin Memorial Health and its pharmacy practice model.

• Discuss the ASHP Practice Advancement Initiative and the importance of assessment.

• Share the initial HMH PAI Self-Assessment Summary Report (April 14, 2017).

• Share changes in HMH pharmacy vision and practice model advancements.

• Share updated HMH PAI Self-Assessment Summary Report (March 14, 2019).

Objectives

Hardin Memorial HealthEstablished in 1954

Hardin Memorial HealthStrong Today. Stronger Tomorrow.

Hardin Memorial Health• Located in central Hardin county Kentucky.• Serving 10 surrounding counties• Serving 400,000 Kentuckians• Nearly 67 owned / operated offsite locations• Strategic Plan:

– Recruit and retain physicians– Expand and enhance facilities– Identify and enhance key service lines– Population Health Management

Hardin Memorial Health

• 209 employed providers and 445 medical staff members– Provider base has increased 212% since 2011

• Emergency Department is 2nd busiest in KY, serving 73,000 patients in 2018

• HMH is 5th busiest in KY in Total Outpatient Volume and 14th busiest in Inpatient Volume

• S&P retained A- rating

HMH Pharmacy Leadership Structure

CEO

COO

Director of Outpatient/Ambulatory

Retail Manager

CNO

Director of Inpatient/Acute Care

Inpatient Manager

Clinical Coordinator

HMH Inpatient Pharmacy• Staff

– 43.22 “accessible” FTEs– 49 department employees (RPhs & CPhTs)

• ~ $25 Million medication budget FY19• Pharmacy open 24/7/365

– Mixed dayshift staffing model between clinical and distributive

• 4 “decentralized” clinical RPhs• 3 central, distributive clinical RPhs

– Evening and night shift staffing model primarily centralized

HMH Inpatient PharmacyClinical Pharmacy Service Lines

• M-F Multidisciplinary Critical Care Rounds• Pharmacokinetic dosing service (Vanco, AGs)• TPN consultation (adult & NICU)• Renal dosing consultation• Anticoagulant monitoring

– Warfarin education (new and unstable pts)• C&S review• IV to PO conversion• AMS – bug vs drug; dosing; duplicative therapy; BCID

evaluation (rapid blood diagnostic)• Skilled Nursing Facility – chart reviews

ASHP PAI – HMH Assessment – 4/14/17• Optimal Pharmacy Practice Characteristics – Part I -

Overall Score: 55%• Optimal Pharmacy Practice Characteristics – Part II -

Overall Score: 34%• Advancing the Application of Information Technology

in the Medication Use Process – Overall Score: 30%• Advancing the Use of Pharmacy Technicians – Overall

Score: 36%• Successful Implementation of New Pharmacy Practice

Initiatives – Overall Score: 36%

Overall Average Score = 38%

Action Planning

Action Planning

• PAI Action Plan for HMH– Distributed to Director of Pharmacy, Pharmacy

Manager, and Pharmacy Clinical Coordinator.– Leaders completed independent feasibility and

impact assessment on each action plan item identified by PAI.

– Scores were recorded and averaged to identify and prioritize opportunities.

Action Planning

• Overall Feasibility: 1.77 out of 3• Overall Impact: 2.16 out of 3

Examples of Changes• Focus on technology:

– Data mining software– Cleanroom electronic log software– Voalte

• Expansion of inpatient RPh FTE x 2• Implementation of proactive med safety processes

– Samsca®– hypertonic saline– AMS

Examples of Changes (cont.)

• Development of protocol for RPh ordering of pertinent lab and culture data off consult

• Expansion of CPhT roles– Practice Committee– CAP Development– Tech-check-tech– Medication History Technician Program Expansion

• Pushing toward full decentralization• Creation of ED RPh position – Q3 2019

ASHP PAI – HMH Assessment – 3/14/19• Optimal Pharmacy Practice Characteristics – Part I -

Overall Score: 66% (55%)• Optimal Pharmacy Practice Characteristics – Part II -

Overall Score: 49% (34%)• Advancing the Application of Information Technology in

the Medication Use Process – Overall Score: 34% (30%)• Advancing the Use of Pharmacy Technicians – Overall

Score: 38% (36%)• Successful Implementation of New Pharmacy Practice

Initiatives – Overall Score: 58% (36%)

Overall Average Score = 49% (38%)

Action Plan (Updated)

• Overall Feasibility: 1.96 out of 3 (1.77)• Overall Impact: 2.44 out of 3 (2.16)

Why did the PAI scores improve?

• Changes in pharmacy leadership• Addition of technology to support the actions• Continued support from senior leadership

which encourages the vision• Intentional recruiting of staff members• Momentum following positive changes

A Renewed Focus• Continued implementation of IT resources

– Clinical data mining– Cleanroom electronic log solution/remote RPh

verification– Diversion monitoring software

• Advancing the practice of CPhTs• Decentralized clinical pharmacy services• Creation of specialized practitioner roles (ED)• Residency program development (2021)

Content Owner(s): R/R