Transcript PSW Initiatives Help Shape the PPMI

Reviewing
Wisconsin’s “Gaps”
Justin Guthman PharmD
Pharmacy Operations Coordinator
Froedtert Hospital
Milwaukee Wisconsin
PPMI Timeline within
Wisconsin
November 2010 – PPMI Summit
February 2011- PPMI Consensus Statements
February 2011- Hospital Advisory Group Meeting
March 2011- PSW Gap Analysis Work Begins
May 2011- ASHP and PSW Pool Resources
August 2011- Wisconsin Demonstration Project
Results
 Future Direction
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Wisconsin Involvement at
the PPMI Summit
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Rick Berry
Erin Hendrick
Steve Rough
Tom Thielke
Tom Woller
Lynnae Mahaney
PPMI Timeline within
Wisconsin
November 2010 – PPMI Summit
February 2011- PPMI Consensus Statements
February 2011- Hospital Advisory Group Meeting
March 2011- PSW Gap Analysis Work Begins
May 2011- ASHP and PSW Pool Resources
August 2011- Wisconsin Demonstration Project
Results
 Future Direction
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PPMI Consensus Statements
http://www.ashp.org/ppmi
PPMI Timeline within
Wisconsin
 November 2010 – PPMI Summit
 February 2011- PPMI Consensus Statements
 February 2011- Hospital Advisory Group
Meeting
 March 2011- PSW Gap Analysis Work Begins
 May 2011- ASHP and PSW Pool Resources
 August 2011- Wisconsin Demonstration Project
Results
 Future Direction
Hospital Advisory Board
(February 2011)
 Brainstorming session among pharmacy leaders
 Agreement with PPMI recommendations
 Concerns
 Lack of prioritization
 Ability to implement recommendations across the
entire spectrum of institutions
 Proposal to address concerns:
 Develop a statewide PPMI survey
 Identify “Gaps” within practice
 Develop “Guiding Documents”
PPMI Timeline within
Wisconsin
November 2010 – PPMI Summit
February 2011- PPMI Consensus Statements
February 2011- Hospital Advisory Group Meeting
March 2011- PSW Gap Analysis Work Begins
May 2011- ASHP and PSW Pool Resources
August 2011- Wisconsin Demonstration Project
Results
 Future Direction
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PSW Gap Analysis Work
Begins
 Pooling Resources
 Involvement of PGY2 Administrative
Residents from Aurora, UW, and Froedtert
 Adopted PPMI Consensus Statements into a
survey questionnaire
 Started initial development of “GAP” Analysis tool
PPMI Timeline within
Wisconsin
November 2010 – PPMI Summit
February 2011- PPMI Consensus Statements
February 2011- Hospital Advisory Group Meeting
March 2011- PSW Gap Analysis Work Begins
May 2011- ASHP and PSW Pool Resources
August 2011- Wisconsin Pilot Validation Project
Results
 Future Direction
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ASHP and PSW Pool
Resources
 ASHP recognized PSW initiatives
 ASHP and PSW collaborate to develop Self
Assessment Tool (SAT)
 ASHP requests Wisconsin’s
involvement as a “Pilot Validation
Site”
PPMI Timeline within
Wisconsin
November 2010 – PPMI Summit
February 2011- PPMI Consensus Statements
February 2011- Hospital Advisory Group Meeting
March 2011- PSW Gap Analysis Work Begins
May 2011- ASHP and PSW Pool Resources
August 2011- Wisconsin Pilot Validation
Project Results
 Future Direction
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Self Assessment Tool (SAT)
Wisconsin SAT Results!
(Aug 18th 2011)
 106 Question Hospital Self Assessment
 70 of 108 Institutions Responded! (65%)
 Individualized Action Plan (optional)
 Completed by 19 of 70 Institution (27%)
 Assessment of the lowest 40 scores
 Requests feasibility (low, medium, high)
 Requests impact of implementing (low, medium, high)
 Individualized action plans were provided on top 20
recommendations
Demographic Data
Average FTEs per role in Institutions less
than 50 Beds (n=24)
Average FTEs
2.9
3
2.3
2.5
2
1.5
1
0
0.5
0
Pharmacists
Technicians
Employee Role
Residents
Demographic Data
Average FTEs per role in Institutions with
51-149 Beds (n=20)
Average FTEs
12
10.6
8.1
10
8
6
4
0.6
2
0
Pharmacists
Technicians
Employee Role
Residents
Demographic Data
Average FTEs per role in Institutions with
150-299 Beds (n=19)
19.2
20
Average FTEs
18
14.3
16
14
12
10
8
6
0.7
4
2
0
Pharmacists
Technicians
Employee Role
Residents
Demographic Data
Average FTEs per role in Institutions with
greater than 300 Beds (n=7)
59.4
52.4
60
Average FTEs
50
40
30
20
7.1
10
0
Pharmacists
Technicians
Employee Role
Residents
Demographic Data
Metropolitan Classes
61%
70%
Percent of all
Respondants
60%
50%
36%
40%
30%
20%
3%
10%
0%
Metropolitan (n=43)
Non-Metropolitan
(n=25)
Metropolitan Class
Undefined (n=2)
Practice Models in Wisconsin
Model 1
(Drug-distribution
centered model)
7%
Model 2
(Clinical pharmacist-centered
model)
0%
Model 3
(Patient-centered integrated model)
Model 4
(Comprehensive pharmacy services model)
74%
19%
Adopted from Pedersen CA, Schneider PJ, Scheckelhoff DJ. Survey of pharmacy practice in
hospital settings: Dispensing and administration-2008. Am J Health Syst Pharm. 2009;66:926-46.
Wisconsin Action Report
Open Discussion
 Technician training/roles
 Pharmacists roles
 Student involvement
 Residency training
 Use of technology
Technician Training/Roles
 If permitted by law, is the accuracy of medication
dispensing by pharmacy technicians checked by
other technicians (i.e., "tech-check-tech") who
have appropriate education and training at your
hospital/health system?
“Gaps” within Wisconsin
 70% of hospitals >300 Beds have implement
Tech Check Tech to some extent
 15% of hospitals <300 Beds have implement
Tech Check Tech to some extent
 Action Plan Results
 Avg feasibility 1.87
 Avg impact 1.73
Technician training/roles
 Concerns?
 Goals?
 How can PSW/ASHP Help?
Pharmacists Roles
 Do pharmacists provide discharge
education to patients at your
hospital/health system?
“Gaps” within Wisconsin
 <1% of Wisconsin Hospitals have pharmacist
provided discharge education to all patients
 27% of Wisconsin Hospitals have pharmacist
provide discharge education in some patient
care units (including high risk areas)
 Action Plan Results
 Avg feasibility 2.17
 Avg impact 2.5
Pharmacists roles
 Concerns?
 Goals?
 How can PSW/ASHP Help?
Student Involvement
 If you take pharmacy students on
rotation, has a plan been developed
to allocate pharmacy student time to
drug therapy management services?
“Gaps” within Wisconsin
 37% of Wisconsin Hospitals have a plan
developed to allocate pharmacy student
time to drug therapy management
services
 Action Plan Results
 Avg feasibility 1.67
 Avg impact 1.0
Student Involvement
 Concerns?
 Goals?
 How can PSW/ASHP Help?
Residency Training
 Are you offering residency training at
your hospital/health system?
“Gaps” within Wisconsin
 21% of Wisconsin Hospitals have pharmacy
residency programs
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87% of hospitals >300 beds
7% of hospitals 150-299 beds
6% of hospitals 51-149 beds
0% of hospitals <50 beds
 Action Plan Results
 Avg feasibility 1.42
 Avg impact 1.42
Residency Training
 Concerns?
 Goals?
 How can PSW/ASHP Help?
Use of Technology
 Do real-time monitoring systems provide
a work queue of patients needing review
and possible intervention at your
hospital/health system?
“Gaps” within Wisconsin
 14% of Wisconsin Hospitals have real-time
monitoring systems in all areas
 36% of Wisconsin Hospitals have partially
implemented real-time monitoring systems
 50% of Wisconsin Hospitals do not have realtime monitoring systems
 Action Plan Results
 Avg feasibility 2.0
 Avg impact 2.38
Use of Technology
 Concerns?
 Goals?
 How can PSW/ASHP Help?
PPMI Timeline within
Wisconsin
November 2010 – PPMI Summit
February 2011- PPMI Consensus Statements
February 2011- Hospital Advisory Group Meeting
March 2011- PSW Gap Analysis Work Begins
May 2011- ASHP and PSW Pool Resources
August 2011- Wisconsin Demonstration Project
Results
 Future Direction
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Future Direction
 Evaluation of Wisconsin PPMI data
 Hospital Advisory Group Meeting
 Develop toolkits for implementation of best
practice
 PrimeTime
 Webpage
 Expand focus into other areas of pharmacy
practice
 Engagement of members from all areas of
practice
Acknowledgements
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Todd Karpinski
Sarah Sorum
Stephanie Irek (DPH4 Pharmacy Student)
Ives Hot (DPH3 Pharmacy Student)
Questions
Additional Discussion
 Time permitting!
Technician Training/Roles
 Are opportunities for advanced, specialized
pharmacy technician roles available at your
hospital/health system (examples of advanced
pharmacy technician roles include: dispensing
medications with remote video supervision,
managing medication assistance programs,
initiation of medication reconciliation [obtaining
list], order entry for pharmacist's verification, and
technician supervising other technicians)?
 Avg feasibility 1.3
 Avg impact 1.4
Pharmacists Roles
 Does resistance to change among
pharmacy staff impede development of
an optimal pharmacy practice model at
your hospital/health system?
 Avg feasibility 1.29
 Avg impact 1.57
Student Involvement
 When on rotations at your hospital/health
system, are pharmacy students trained
on the roles of safety and quality in the
medication-use process?
 Avg feasibility 1.5
 Avg impact 2.0
Residency Training
 Have pharmacists providing drug therapy
management completed an ASHPaccredited residency or achieved
equivalent experience?
 Avg feasibility 1.57
 Avg impact 1.21
Use of Technology
 Have systems been implemented at your
hospital/health system to efficiently capture
and report pharmacy metrics, outcomes data,
and pharmacists' value?
 Avg feasibility 2.06
 Avg impact 2.41