The Pharmacy Practice Model Initiative (PPMI) and Rural Health: Advancing Patient Care Denise Fields, PharmD Clinical Program Manager Physician Engagement and Academic Detailing , Express Scripts Columbus, IN John B. Hertig, PharmD, MS, CPPS Dan D. Degnan, PharmD, MS, CPPS Associate Director Senior Project Manager Center for Medication Safety Advancement Center for Medication Safety Advancement Purdue University College of Pharmacy Purdue University College of Pharmacy Indianapolis, IN Indianapolis, IN Disclosure • The speakers have no conflicts of interest to disclose. Outline • Overview of Pharmacy Practice Model Initiative (PPMI) • Why is it important for rural hospitals? • Practice advancement in Indiana • Opportunities for rural hospitals • Getting involved! • Discussion and questions First Things First • Who is in the audience? • What practice types do you represent? • How many of you have heard of the ASHP Pharmacy Practice Model Initiative? Background – Why Change? • Professions must continually assess their practice to determine whether expertise is being maximized – Healthcare reform – Quality and safety – Social and economic influences • Pharmacy practice changes – Doctor of Pharmacy degree – Residency training Educational Factors Driving Change http://www.aacp.org/Docs/MainNavigation/InstitutionalData/8921_DegreesConferred.pdf Educational Factors Driving Change Why Change? • More patients, increased demand – Payment tied to performance – Move away from fee-for-service payments – Pressure to reduce costs, reward performance • Challenge to US health care system to improve quality and cost effective care – More quality, better reimbursement • Better Care! AJHP 2009;66:713 Factors Driving Practice Change • Drug therapy is becoming more complex with greater patient risk • Pharmacists recognized as: – drug therapy experts – medication use process experts • Patients are better served if pharmacists take an active role as part of the care team ASHP/ASHP Foundation Pharmacy Practice Model Objectives Pharmacists Technicians & Technology Pharmacists Assessment Question Which of the following is a factor driving pharmacy practice model change? A) Increasingly complex medication therapies B) Changes to the United States healthcare system (incl. healthcare reform) C) Pharmacy education and training D) All of the above Impact • All these factors have combined to drive critical discussions regarding change within the health-system pharmacy profession • But, where do we go from here? Pharmacy Practice Model Initiative (PPMI) • Launched and coordinated by ASHP and the ASHP Research and Education Foundation • The goal of this initiative is to significantly advance the health and well-being of patients – Develop and disseminate a futuristic practice model that supports the most effective use of pharmacists as direct patient care providers PPMI. Available at <www.ashp.org> PPMI = Practice Advancement The Purpose of the PPMI • Describes how pharmacy department resources are deployed to provide care • One size does not fit all • Does include: – How pharmacists practice and provide care to patients – How technicians are involved to support care – Use of automation/technology in the medication use system AJHP 2010;67:542 Major PPMI Themes • Move pharmacists closer to the patient – Multidisciplinary care • Responsibility for safe use of medications and ensuring quality • Well-developed technician workforce • Wide-spread use of technology Rural Hospital Practice Models AJHP 2010;67:542 AJHP 2010;67:542 Considerations for All of Us • “The capacity of 1” – How much can we do with limited resources? – Where do our priorities lie? • Ensuring we practice at “the top of our license” • Ensuring the best care across ALL practice settings – Hospital, ambulatory, long-term care, community, and so on… – Teamwork is essential! So…Where Are We Going? PPMI Taskforce • Indiana Pharmacy Practice Model Taskforce – Indiana Society for Health-System Pharmacists 12 members – Steering group for hospital practice model change • Focus on completion of Hospital Self-Assessment (HSA) – Provides current data for practice in Indiana What are your opportunities? Using the Hospital Self-Assessment in Creating a Road Map to Advancement ASHP’s PPMI Resource Page Indiana’s HSA Engagement • 32.75% of Indiana Hospitals have completed the self-assessment (57/174) • 41% of IRHA Member Hospitals have completed the self-assessment (16/39) • 41% of IRHA CAH Member Facilities have completed the self-assessment (12/29) • 45% of Indiana CAH Facilities have completed the self-assessment (16/35) HSA Participation Within IRHA THANK YOU IT’S NOT TOO LATE Community Hospital of Bremen Decatur County Memorial Hospital Greene County General Hospital IU Health IU Health Bedford Hospital IU Health Paoli Hospital Logansport Memorial Hospital Pulaski Memorial Hospital Putnam County Hospital Reid Hospital & Health Care Rush Memorial Hospital St. Vincent Clay Hospital St. Vincent Frankfort Hospital St. Vincent Mercy Hospital St. Vincent Randolph Hospital Union Hospital Adams Memorial Hospital Bloomington Meadows Hospital Cameron Memorial Community Hospital Daviess Community Hospital Fayette Regional Health System Gibson General Hospital Harrison County Hospital Henry County Hospital IU Health Blackford Hospital IU Health Starke Hospital IU Health Tipton Jasper County Hospital Jay County Hospital Margaret Mary Health Memorial Hospital & Health Care Parkview LaGrange Hospital Perry County Memorial Hospital Scott Memorial Hospital St. Vincent Dunn Hospital St. Vincent Salem Hospital Sullivan County Community Hospital Wabash County Hospital Woodlawn Hospital HSA - Getting Started Begin Assessment Sample Question Assessment Summary Self Assessment Report Creating Action Plan Individualized Prioritization Action Plan Provides Resources Indiana CAH Opportunities • Critical Access Hospitals accounts for approximately 26% of all Community Hospitals in US – 35 CAH facilities in Indiana – 29 of them are IRHA members • Key differences in medication distribution – Pharmacist service hours • 24 Hour On-Site Services • Limited On-Site Hours with After Hours Remote Services • Hours without Pharmacist Services (On-Site or Remote) – Use of Technology • ADM • Robots • Smart Pump (with and without EMR Integration) Strengths for CAH vs. All Hospitals • Pharmacists recognized as leaders • Strong leadership support for pharmacy models that maximize technicians and technology • Resistance to change impeding development of optimal pharmacy practice model • Pharmacists assist with continuity of care Opportunities for CAH Hospitals • Pharmacist review of medication order before initial dose is given • Pharmacist oversight for med distribution within all areas of hospital/health system • Pharmacist Credentialing and Privileging • Pharmacists Advanced Clinical Roles • Technician Advanced Roles Technician Advancement Technician Medication Reconciliation Archived Webinars Available Tech Check Tech Technician Data Analyst Quality Improvement Inventory Turns Medication Errors ADM Efficiency Physician Compliance Patient Risk Assessment Technician IV Room Supervisor • Creation of Admixture Instructional Templates (for Pharmacist review) • Participation in Policy and Procedure Development and Periodic Review • Supervision of Compliance to USP 797 – Completion of Required Documentation – Environmental Testing and Device Inspection • Supervision of Quality Assurance – Training and Periodic Competency Testing – Daily IV Rounding by Technicians – Error, Charging and Inventory Turns Review Opportunities within IRHA/InSRN • Collaboration – Remote Pharmacist Service Pricing • Education – Lunch and Learn Webinars • Advocacy – Policy Support (http://www.indianaruralhealth.org/irha-programs/advocacy-and-policy/) ASHP Resources ASHP Advocacy Provider Status for Pharmacists Online Advocacy Center Take Action Use Your Voice Individualize Your Message Your Turn • Open Forum • Questions to ponder… – What are our greatest challenges? – What opportunities do we have? – What components of a practice model are absolutely essential? – What are some ideas that most of us are forgetting to consider?