Advancing the Practice of Pharmacy in Iowa: Developing a Plan for Action

1. Advancing the Practice of Pharmacy in Iowa: Developing a Plan for Action Iowa Pharmacy Practice Model Initiative (PPMI) State Affiliate Workshop Tom Thielke RPh, MS, FASHP, FFIP Stacy Livingston, PharmD

2. Overview • Introduction and workshop overview • PPMI overview, the Wisconsin experience, Iowa opportunities • Advancing pharmacy practice in Iowa (large group discussion) • Brainstorming activity around priorities (small group breakout) • Break • Small group report out • Tying it all together and next steps

3. Objectives • Describe one state’s success in using the PPMI to leverage practice transformation • Identify opportunities for practice advancement in Iowa • Generate sustained interest, support and tactics for accomplishing practice advancement • Tools to help achieve short and long term vision • Communicate a state affiliate strategic plan for advancing pharmacy practice

4. PPMI Summit • Held in November 2010 • 150 participating pharmacists • Plenary session topics • Imperative for practice model change • External drivers for practice model change • Ideal practice model change • Strategies for success in implementing practice model change

5. PPMI Categories of Focus

6. Ground Rule… = Practice Advancement!!!

7. An Affiliated State Chapter’s Pharmacy Practice Advancement through PPMI

8. Getting Started: Using the PPMI ASHP Foundation State Toolkit

9. Engage and Create a PPMI State Leadership Team • Members of the Leadership Team • Attendees at the PPMI Summit • Key hospital pharmacy leaders in the state • Past ASHP Board members and presidential officers • Leaders from large and small hospitals • Pharmacy residents • Announce the creation of a leadership team to all state affiliate members

10. Prepare Leadership Team Members • Read background material on PPMI • Review PPMI Hospital Self-Assessment (HSA) questions • Complete HSA for their hospital • Create an action plan

11. Convene First Meeting of State PPMI Leadership Team • Solicit agenda items from the PPMI Leadership Team • Send out the agenda with attachments two weeks prior to the meeting • Create a brainstorming session to develop ideas on how to advance PPMI in all state hospitals • Develop a state affiliate strategic plan for implementation of PPMI • Set a schedule for regular leadership team meetings • Approximately three times per year

12. Develop an HSA Dissemination Plan and Completion Goal • Obtain a list of hospital pharmacy directors contact information from ASHP • Set a deadline and goal for completion of the HSA for all hospitals (80%) • Email the HSA link to all hospital pharmacy directors through an email blast • Explain what’s in it for them • Email HSA link as a follow up 4-6 weeks after as a reminder

13. HSA Continued • Obtain data from ASHP as to which hospitals have completed the HSA and action plan • Send an email to those who have not completed the HSA • To enhance the completion rate, have leadership team members and pharmacy residents call pharmacy directors • Set up computer stations at the next state affiliate meeting to help truant directors complete the survey

14. Plan and Conduct a PPMI Forum at an Upcoming State Affiliate Conference • Announce forum to all members and encourage attendance at this very important meeting • Use list from ASHP to personally invite all hospital pharmacy directors and leaders to attend the meeting • Have members of the leadership team present the strategic plan at the forum • Have hospital directors present that have completed the HSA and have developed their own strategic plan • Make the leadership forum part of every state affiliate meeting (3-4 hours)

15. PSW Leadership Forums Share your story

16. Development of Phase 2 of your PPMI Strategic Plan

17. Analysis of Data from Statewide HSA Completion • Once you have at least 40-50% response rate begin to analyze data • Download into Microsoft Access database • Use of “techy” residents • Identify area of practice where deficiencies exist in the state • Identify areas of practice where hospitals are successful in deficient areas • Use this data to focus education programs for affiliate chapter meetings

18. Reorganization of State Affiliate Educational Programming • Utilize the forum to keep focus on PPMI • Presentation of toolkits to help members improve hospital deficiencies • Invite speakers from ASHP to help promote PPMI • Involve residents across the state of Wisconsin • Spotlight presentations on ten categories by best practice hospitals – small and large • Facilitated roundtable discussions by leaders and residents in the state

19. Spotlight Sessions Pharmacotherapy Clinic Emergency Department Pharmacist Emergency Department Technicians and Medication Histories Technicians in EMT roles Accredited Technician Training Program in a Health-System Tech-Check-Tech

20. Spotlight Sessions Pharmacist Medication Histories and Reconciliation Remove Verification of IV Products Telepharmacy Technology Utilization of Students and Interns in Drug Therapy Management Developing a New Residency Program Discharge Pharmacist Program and Transition to Home

21. Round Table Sessions Implementing Tech Check Tech Implementing Telepharmacy Programs Centralized Order Processing in a Health-System Using Systems Redesign to Advance PPMI Developing Strategic Plans Managing Your Residency Program Director Impact of Regulations on Practice Advancement Developing an Ambulatory Practice

22. Round Table Sessions Leveraging the EMR to Advance Practice Medication Reconciliation Upon Admission Residency Program Forum: Initiating, Expanding and Improving Transitional Care Pharmacy Specialist Technician Environmental Trends Shaping Pharmacy Technician Training Programs Pharmacists at the Bedside Surgical Antibiotic Prophylaxis

23. Utilization of Residents • Formation of a project team • Administrative residents across the state of Wisconsin • Rotating PPMI Leadership Team member • Choose a statewide initiative • Divide into teams and conquer different sections • Conference calls every 2 weeks • Each team reports progress on conference calls

24. Utilization of Residents • 15 pharmacy administrative residents in Wisconsin • Assisted ASHP in the development of the HSA • Helped ASHP in the identification of literature citations supporting each PPMI statement • Development of toolkits for members to reference while implementing practices to improve deficiencies

25. Toolkit Example: Tech-Check-Tech • Why TCT? • Literature search – best practice • Divide up into teams for toolkit preparation • Business case • Regulatory – obtain PEB variance • Operations • Novel Expansion • Implementation consultants

26. Toolkit Example: Tech-Check-Tech • TCT Manual • Available on PSW website under professional resources • Development and implementation checklist • Information Provided • Literature summary • Obtaining a variance • Sample policies and procedures • Training materials • Competency assessment and validation • Quality assurance

27. Toolkit Example: Transitions in Care • Project Goal • Advance pharmacy transitions in care with the singular purpose of improving the lives of our patients • Phase 1 • Develop the resources to enable institutions to improve transitions of care and assist five institutions in advancing pharmacy practice regarding discharge, follow up, and hand off • Phase 2 • Progress the achievements of the previous year and improve inpatient and outpatient communication

28. Toolkit Example: Transitions in Care • Develop a best practice guideline • Discharge, follow-up and hand-off • Perform a statewide survey to establish a baseline for future comparison • Minimum response rate of 30% • Creation of a toolkit • Business case examples • Discharge resources: counseling scripts, checklists, ideal follow-up recommendations

29. Expansion of Forum Activities Keynote address at each forum held Progress report on what has been accomplished Case studies presented by small and large hospitals Feature hospital success stories Use of practice advancement round table sessions Phone trees for calls to action Frequent journal publications and news stories

30. Assist in Overcoming Barriers to Pharmacy Practice in Wisconsin • Key committees established to identify barriers and develop plans to eliminate • Pharmacy technician task force • Pharmacy practice review committee • Subcommittees – review • Pharmacy practice statutes • Pharmacy Examining Board rules • Other state’s practice laws

31. Hospital Pharmacy Leadership Enhancement Strategic plan development training Webinars Development of business plans Communication with the “c-suite” Presentation skills

32. Around the Clock Communication about PPMI Hospital leadership newsletter PSW journal articles Best practice toolkits Webinars Use of prime time on PSW website

33. Summary of Wisconsin Strategy • Established a sense of urgency • Engagement by PSW staff and leaders in the state • Created a vision • Practice advancement determined a priority • Develop a plan to promote the vision • Implement the plan • Took action based on mutual needs • Manage the process • Maintain the defined plan

34. Keys for Success and Things to Consider

35. Keys to Our Success • Determine steering group • Engagement of state executive and staff • Role of pharmacy residents • Horse power • Networking • Relationship and skill building • Created a sense of ownership at a local level • Practical, set the bar high • Local leaders must provide purpose, hope, trust, and results

36. Keys to Our Success It’s a plan, not an event Created short term wins Plan to manage data Good facilitators Communicate often

37. Things to consider… • What do patients and payers most need from their pharmacist? • Optimized quality care, lower cost, improved efficiency, better access, improved patient experience • How can we move from 18% of pharmacists responding that they are patient care providers to a much higher number? • Optimizing our value equation centers around: • Training, credentialing and competency • Roles of pharmacists and technicians • Accountability for services we commit to

38. What are Iowa’s Opportunities? Advancing technician roles Leveraging students, interns, residents Training and credentialing Expanding scope of pharmacist patient care services Legislative influence Using bi-annual meetings and steering committee to drive engagement and results

39. Questions?

40. It’s your turn!