• The Wright Center for primary care targets patient

care outcomes and safety improvements through

the implementation of the principles of the Patient-

Centered Medical Home (PCMH) and Chronic Care

delivery models. The Jermyn, PA, clinic is a National

Committee for Quality Assurance (NCQA) Level-3

PCMH designation. The practice currently serves

over 6,500 patients.

• The Wright Center first started with PSPC 4.0 in

November 2011 through a partnership with Wilkes

University School of Pharmacy.

• The Wright Script integrated CPS within

interprofessional chronic patient medical visits using

medication reconciliation and medication

management principles.

• The Wright Script team identified monthly rapid

cycle processes or PDSA (Plan-Do-Study-Act)

cycles at weekly huddle meetings to enhance CPS

and patient care.

PSPC Innovation and Safety Improvement: The Wright Script Team Courtney B. Graham1, Brittny A. Rule1, Jennifer M. Malinowski

1Wilkes University, Wilkes-Barre, PA and 2The Wright Center for Primary Care, Jermyn, PA

The Wright Script Team

Future Directions

Accomplishments PSPC Visit Flow

Partnership

NURSE, CARE MANAGER OR PHARMACY TEAM

Close loop on plan, educate patient, review follow up strategy, phone calls to titrate insulin based on 3 day self-

reported glucose readings

PROVIDER

Review interprofessional team recommendations, evaluates patient, and recommends therapy.

PHARMACY STUDENT/PHARMACIST

Medication reconciliation (allergy clarification, prescription and over-the –counter medications, herbals, other provider),

attempts to meet patient assistance needs, patient counseling, identification and documentation of potential

(pADEs) and adverse events (ADEs) in electronic medical record. High priority issues discussed with provider.

PRE-VISIT/CHECK IN/MEDICAL ASSISTANT

Printed medication list provided at check in to make corrections (“Patients as Proofreaders” campaign.

Vitals, preventative screenings (mini mental status exam, vision/hearing screens, point-of-care HbA1c testing)

Successful PDSA’s

100% of the total 30 Wilkes University APPE students

agreed/strongly agreed that they would recommend

the site to other students (26/30 strongly agreed).

Interventions

TEAM MEMBERS

Participant PSPC Role

Jennifer Malinowski,

PharmD

PSPC Team Lead

Rinku Seghal, MD

Jumee Barooah, MD

Physician POF lead (Diabetes)

Physician POF lead (Dyslipidemia)

Brian Ebersole, BA VP, Mission Delivery,

Education/Community Relevance Leader

Jignesh Sheth, MD VP, Quality

Physician POF lead (Hypertension)

Alicia Coar, PA Midlevel provider Lead

Tiffany Elkins, BS Information Technology Lead

Kari Machelli, BS, RN Care Manager Lead

Jasmine Cloud Medical Assistant Lead

P4 Ambulatory Care

Pharmacy students

Medication reconciliation support

PARTNERSHIPS

Wilkes University School of Pharmacy and Nursing

Wright Center for Graduate Medical Education

•Application of lipid guidelines to high risk POFs

•Proactively identify PSPC patients on visit days

•Transition of care handoffs between inpatient and

outpatient student learners

•Continue expansion to asthma POF

• An average of 3.1 pADE/ADE (interventions) per

PSPC patient in 18 months by student

pharmacists supervised by a pharmacy faculty.

• Student pharmacists are present for 31 weeks

out of the academic school year .

• The number of interventions decline when

pharmacists and students are not present.

Populations of Focus PSPC 4 (Hypertension): 47 high risk patients > 75

years old with blood pressure greater than 140/90

mmHg on 2 consecutive occasions with 5 or more

chronic diagnoses

PSPC 5 (Diabetes): 45 high risk patients 18 to 65

years old with Hemoglobin A1c (Hb A1c) >9.0%

and 5 or more chronic diagnoses at baseline

Reaching for Gold: A1c %

0

15

22 22 20

34 36

28

33 35 35

39 39

48 48

45 47

49

57

0

10

20

30

40

50

60

HbA1c <9% September 2012- March 2014

2%

4% 1%

32%

4%

3% 2%

7%

10% 1%

1%

4% 1%

1%

15%

9% 3%

Percentage of Adverse Drug Events (ADE's) and Potential Adverse Drug Events (pADE's)

Identified by Pharmacy Students (n=136)

Abnormal lab result not addressed Allergy clarification

Creatinine clearance Dosing adjustment

Drug-disease interaction Serious drug-drug interaction

Duplicate therapy Improper med use by patient

Lab/test indicated, not ordered Contraindication

Therapy not cost effective Suboptimal therapy

Treatment without indication Drug-Drug interation

Patient education/Adherence evaluation Untreated medical problem

Adverse Drug Event

“The Wright Center has agreed to fund a new pharmacy faculty

position at our Scranton clinic to replicate pharmacy clinical

education integration into this medical home inter-professional

academic venue because of the value enhancement to our medical

education and patient care mission delivered with excellence by

The Wright Script Team.”

– Dr. Linda Thomas-Hemak, MD, President and CEO, The

Wright Center for Primary Care

• Pharmacy integration

into team-based visits

• Pharmacy-initiated

medication reconciliation

• PSPC health record

alert

• Evidenced-based

diabetes protocol

• Insulin protocol staff

education

• Generic usage prompts

• Telephonic insulin

adjustment

• Group visits with

diabetes educators

• Device and insulin

administration education

• Drop down intervention

menu that pulls into

EMR

• Point of care testing for

A1c and LDL

• World diabetes day

program

• Penn State University

Dining for Diabetes

program

• Home visits

• Developed evidenced-

based HTN protocol

• HTN POF (PSPC 4.0): 85% of patients are currently

at goal

• HTN POF (PSPC 5.0): 100% of the PSPC 4.0

uncontrolled HTN patients are now at goal.

• A1c POF: 57% achieved A1c <9% by the 18 month

diabetic care studied period. 82% of patients were

able to sustain A1c <9%, once achieved, in a

chosen 8-month interval

“Actively participating in the patient centered primary care inter-

professional collaboration can drive value-based outcomes and

revolutionize the profession of pharmacy.”

–Former APPE student

The pharmacy team (2 APPEs and 1 pharmacist)

collaborates with all team members to improve patient

safety. Since 2011, the site held 15 APPE rotations (5-

6 weeks each) and 1 research rotation (5 weeks). The

partnership expanded to an additional 50% funded

faculty member at another site within the

organization.