Transcript Slide 1

Taking Practice to the Next Level:
Where Do We Go after the
Practice Model Summit?
What is the Imperative for
Practice Model Change?
Daniel M. Ashby, R.Ph., M.S., FASHP
Sr. Director of Pharmacy
The Johns Hopkins Hospital
Goal of the ASHP / ASHP Foundation
Practice Model Initiative
• Develop and disseminate a futuristic practice
model that supports the effective use of
pharmacists as direct patient care providers.
What is a “Practice Model”?
• Describes how pharmacy department
resources are deployed to provide care
• One size doesn’t fit all
• Does include:
 How pharmacists practice and provide care to patients;
 How technicians are involved to support care; and
 Use of automation/technology in the medication use
system
AJHP 2010;67:542
Examples of Practice Models
• Drug-DistributionCentered Model
• Clinical PharmacistCentered Model
• Patient-Centered
Integrated Model
AJHP 2010;67:542
Vision for the
ASHP / ASHP Foundation PPMI
• The initiative and summit will create passion,
commitment, and action among hospital and healthsystem pharmacy practice leaders to significantly
advance the health and well being of patients by
optimizing the role of pharmacists in providing
direct patient care.
Objectives for the Pharmacy Practice
Model Initiative
• Describe optimal pharmacy practice models
that ensure safe, effective, efficient and
accountable medication-related care.
• Identify patient-care-related services.
• Foster understanding of and support for
optimal pharmacy practice models by key
groups.
Objectives for the Pharmacy Practice
Model Initiative (continued)
• Identify existing and future technologies
required to support optimal pharmacy
practice models in health-systems.
• Identify specific actions that pharmacists
should take to implement optimal models.
• Determine the tools and resources need to
implement optimal practice models.
Facilitating Practice Change:
Historical Perspectives
Consensus Conference Approach
• ASHP Hilton Head Conference, 1985
• Pharmacy in the 21st Century Conference, 1989
• Implementing Pharmaceutical Care, 1993
ASHP / ASHP Foundation Practice
Model Summit : November 7-9, 2010
• Two day invitational event with 150 participants
• Participant and member survey prior to the
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conference to assess areas of consensus
Briefings commissioned and distributed
Plenary presentations and work groups
Consensus process to develop a new practice model
Video webcast of plenary presentations and
consensus process
Factors Driving Practice Change
• Health care reform
– More patients, increased demand
– Payment tied to performance
– Move away from transactional payments
• Unit of visit vs. unit of procedure
– Pressure to reduce costs, reward performance
• Challenge to US health care system to
improve quality and cost effective care
AJHP 2009;66:713
Core Competencies under
Health Care Reform
Steps hospitals should take now to prepare for
the 10-year phase-in of health care reform
legislation
Core Competencies under
Health Care Reform
1. Sophisticated IT Systems
–
EHR: efficiency, quality, outcome measures
2. Physician Integration
–
Care delivery, leadership, compensation models
3. Care Management
–
Incentives for quality, cost effective care
4. Pricing Transparency
–
Public reporting; review of cost methodologies
Factors Driving Practice Change
(continued)
• Drug therapy is becoming more complex with
greater patient risk
• Pharmacists recognized as:
– drug therapy experts
– medication use process experts
• Patients will be better served if pharmacists
take control of shaping the future
Factors Driving Change
(continued)
First Professional Degrees Conferred 1980 - 2008
(projected)
Source: AACP Profile of Pharmacy Students
12000
10000
BS
PharmD
8000
6000
4000
2000
* 2004/05 - 2007/08 projections based on fall 2004 enrollments by expected graduation year
http://www.aacp.org/Docs/MainNavigation/InstitutionalData/8921_DegreesConferred.pdf
07-08
06-07
05-06
04-05
03-04
02-03
01-02
00-01
99-00
98-99
97-98
96-97
95-96
94-95
93-94
92-93
91-92
90-91
89-90
88-89
87-88
86-87
85-86
84-85
83-84
82-83
81-82
80-81
79-80
0
Factors Driving Change
(continued)
Residency Programs in ASHP Accreditation
Process (1964-2010) as of 9/27/10
1400
PGY2
1200
Specialized
1000
800
Clinical
PGY1
Pharmacy Practice
600
Hospital
400
200
0
Factors Driving Practice Change
(continued)
• The vision established in previous consensus
conferences have not been fully achieved
• Only a portion of eligible patients receive care
from the pharmacist
• A contributor to shortfalls is a lack of time
• Pharmacists, with a change in the model, can
fill a gap in health care provision
AJHP 2010;67:1624-1634
Historical Precedent for a Summit
Conference Approach
“ To bring about change within a diverse profession
such as pharmacy, one needs a large number of
people pulling in the same direction. Before one can
get folks pulling in the same direction, one needs
general agreement about the best direction in which
to move.”
… William A. Zellmer
“ If you don’t know where you are going, you won’t
know when you get there.”
… Yogi Bera
What were the KEY
recommendations of the
Summit participants?
Christopher R. Fortier, PharmD
Manager, Pharmacy Support & OR Services
Medical University of South Carolina
Clinical Assistant Professor
South Carolina College of Pharmacy
PPMI Survey
180
Initial Statements
27
Newly Recommended Items
Overarching Principles
Services
Technology
Technicians
Implementing Change and Responding to
Challenges
Pre-Summit Survey Results
• ≥ 80% = Automatic Recommendation
• 41% to 79% = Unresolved Recommendation
• ≤ 40% = Not Recommended
1.
OVERARCHING
PRINCIPLES
OVERARCHING
PRINCIPLES
Overarching Principles
• Essential elements of a pharmacy practice
model can be developed for use in ALL
pharmacy departments
• Financial pressure will force changes on how
resources are used
Overarching Principles
• Investments in technology will be required to
optimally deploy pharmacy resources
• For hospitals with ambulatory care services,
drug therapy management will be available
by a pharmacist for each outpatient
Overarching Principles
• Curricular changes are required in
schools/colleges of pharmacy to prepare
students for larger role in drug-therapy
management
SERVICES
2.
SPECIFIC
SERVICES
Envision
• A residency-trained and appropriately
credentialed and privileged pharmacist
workforce
Services
• Every department should identify drug
therapy management services provided
consistently by pharmacists
• All patients deserve the care of a pharmacist.
It is recognized that resources will be
allocated according to complexity of patients
and organizational needs
Services
Essential pharmacist-provided management:
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•
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•
•
•
•
Emergency department
Antimicrobial stewardship
Neonatal intensive care
Oncology
Critical care areas
Organ transplant
Antithrombotic/anticoagulation
Services
• As an essential member of the healthcare
team, pharmacists must have privileges to
write medication orders in the healthcare
setting
• Accountability for development and
documentation of the medication related
components of the patient care plan
3.
TECHNOLOGY
Envision
• Look at the current technology and how it is
incorporated into pharmacy workflow.
Efficiencies and improved coordination of
patient care should be accomplished with the
implementation of technology
Technology
• Enable pharmacists to better interact with
patients and caregivers if implemented into
workflow correctly
• Will allow for rapid access to patient
information and variables that will facilitate
pharmacist development of drug therapy
management plans for individual patients
Technology
Technology priorities:
• Electronic medical record systems
• Barcode medication administration technology
• Real-time monitoring systems that provide a work
queue of patients needing review and intervention
• Barcode technology during inventory,
preparation/compounding, dispensing processes
• Integration of intelligent infusion devices into a
closed loop medication-use process
Technology
• Hospitals and health systems, college and schools of
pharmacy should collaborate to ensure appropriate
pharmacy informatics principles are embedded in
the curriculum
• Sufficient pharmacy resources must be available to
develop, implement, and maintain technologyrelated medication-use safety standards
TECHNICIANS
4.
TECHNICIANS
Envision
• Technician workforce composed of
individuals who are graduates of accredited
technician training programs and certified by
PTCB
Technicians
• Technicians who have appropriate education,
training, and credentials should be used to
free pharmacists from drug distribution
activities
• Assigning medication distribution tasks to
technicians would make it possible to deploy
pharmacists to drug-therapy management
services
Technicians
• Uniform national standards should apply to
the education and training of technicians
• PTCB certification process requires
completion of an accredited training program
by 2015
• Technicians must be licensed by state boards
of pharmacy to support the optimal practice
model
CHANGE &
CHALLENGES
CHANGE &
CHALLENGES
5.
Change & Challenges
• Department of Pharmacy administrative
leadership
• Clinical pharmacy leadership
• Support from medical staff leadership
• Support from health care executives
Change & Challenges
• Resistance to change from current pharmacy staff
• Pharmacist electronic access to complete patientspecific data
• State laws and regulations that require direct
pharmacy supervision of medication distribution
• State laws that limit pharmacists’ scopes of practice
Major PPMI Themes
• Move pharmacists closer to the patient
• Responsibility for safe use of medications
and ensuring quality
• Well-developed technician workforce
• Wide-spread use of technology
Where Do We Go From Here?
Susan Goodin, Pharm.D., FCCP, BCOP
Director, Division of Pharmaceutical Sciences
Associate Director, Clinical Trials and Therapeutics
The Cancer Institute of New Jersey
Perspectives
1. Summit is one component of the Pharmacy
Practice Model Initiative
2. Measurable outcome: Every pharmacy
department in the country engaged in
examining how it deploys its resources
– Understand the imperatives for change
– Concentrate talents of pharmacists on making the
best use of medicines
– Use technicians and technology wisely
2010 Pharmacy Practice Model Initiative Summit
William A. Zellmer
American Society of Health System Pharmacists
Perspectives
3. Social marketing techniques
- Marketing principles applied to public health goals
- Leverage proceedings of the Summit
4. Let’s not underestimate the economic
imperative for practice model reform
– Unsustainability of U.S. health care delivery,
including the hospital industry
2010 Pharmacy Practice Model Initiative Summit
William A. Zellmer
American Society of Health System Pharmacists
Perspectives
5. A critical choice: Leading change that we
believe in vs. being forced to accept the
change of others
2010 Pharmacy Practice Model Initiative Summit
William A. Zellmer
American Society of Health System Pharmacists
Segment and disaggregate
Optimal Pharmacy
v
Practice Models
2010 Pharmacy Practice Model Initiative Summit
William A. Zellmer
American Society of Health System Pharmacists
Putting the pieces back together
Optimal
Pharmacy
Practice Models
2010 Pharmacy Practice Model Initiative Summit
William A. Zellmer
American Society of Health System Pharmacists
What bold new actions do we need?
• Clear, inspiring vision for practice
• An assertive program to pursue the vision
• Completion of accredited technician
training as requirement for PTCB
certification
• The aggressive agenda for HIT
• Exercising your role as ambassador, leader,
mentor
2010 Pharmacy Practice Model Initiative Summit
William A. Zellmer
American Society of Health System Pharmacists
ASHP: Activities and Partnerships
• Collaboration with ASHP state affiliates to
translate recommendations into practice
(Presidential Officer Retreats occurred
November 12 – 16th, 2010)
• The dissemination of webcast of the Summit:
(http://prestonevents.com/reg/ppmi/)
• A sample slide set is available for those who
are in the position to give a presentation on
the PPMI (Schools, hospitals, state affiliates,
etc.)
ASHP: Activities and Partnerships
• Summit Proceedings and Briefing papers to be
published in 1st quarter of 2011 in AJHP
• Proactive publishing and spotlighting of
hospital and health system successes in
actively assessing and implementing practice
model change
• Proliferation of PPMI outcomes optimizing
social media applications
ASHP: Activities and Partnerships
• Revision of the ASHP Vision to reflect the
PPMI Summit recommendations
• Renewal of ASHP 2015 Initiative to
incorporate PPMI Summit recommendations
• Development of tools to facilitate practice
evaluation and gap analysis benchmarked to
Summit outcomes
• Work closely with partner organizations to
help support goals and vision of PPMI
ASHP: Activities and Partnerships
• Identify best measures to determine
accomplishments of practitioners and
Initiative
• ASHP Foundation demonstration grants
facilitating adoption and evaluation of best
practices
Your Role: Activities and Partnerships
• Be a Champion!
• Present/discuss the outcomes of the summit to
your department/institution
• Address concerns
• Gap analysis
• Develop a vision for the department
• Set goals and timelines
• Do the simple stuff first
• Publish/Present on your experiences and
successes
Precedent for Adopting Change
“We choose to go to the moon in this decade
and do other things not because they are easy,
but because they are hard, because the goal
will serve to organize and measure the best of
our energies and skills, because that challenge
is one that we are willing to accept, one we
are unwilling to postpone, and one which we
intend to win”
John F. Kennedy
Address at Rice University on the nation’s space effort; Houston, Texas, September 12, 1962
Questions, Answers, and Discussion