New Chief Orientation Clinical Pharmacy Program Office (CPPO) Overview 2012

1. New Chief Orientation Clinical Pharmacy Program Office (CPPO) Overview 2012 Anthony P. Morreale, Pharm.D., MBA, BCPSAssistant Chief Consultant for Clinical Pharmacy Services and Healthcare Delivery Services ResearchPharmacy Benefits Management Services (119)Department of Veterans Affairs

2. Clinical Pharmacy Program Office Team Composition

3. Vision for Clinical Pharmacy Practice • The PBM has been tremendously successful in creating a supportive infrastructure to manage the formulary and improve medication safety. • It is our goal to use the lessons learned and successes of those programs to expand on our leadership role in clinical pharmacy practice in the United States • This task will be accomplished by organizing, standardizing, engaging and energizing the strong leadership and clinical pharmacy base we already have. • We plan on leveraging technology, technicians, policies and communication tools to achieve these results

4. Clinical Pharmacy Advisory Board (CPAB) • Chartered in 2010 • The PBM Clinical Pharmacy Advisory Board (CPAB) was formed to promote the expansion of clinical pharmacy practice within VA. • Key Pharmacy stakeholders from several sites throughout the nation • Membership includes VISN Pharmacy Executives, Pharmacy Chiefs/Associate Chiefs, Clinical Pharmacy Specialists • Meet bimonthly via teleconference

5. Clinical Pharmacy Advisory Group • To date four national meetings have been held • Meetings consisted primarily of work group activities in which topics were brainstormed and ideas flushed out. Opportunities, obstacles, priorities and timelines have been developed for implementation. The top 10 projects for implementation in 2010-2011 were: • 1. Create nationally implemented standardized workload assessment • 2. Create a Standardized clinical pertinence review process • 3. Create PACT action plan requirement for Pharmacy (Request from Chiefs) • 4. Assure a smooth transition of CPS from anticoagulation into other clinical areas • 5. Create Standardized Competency Assessment documents for similar jobs • 6. Establish a baseline of clinical services through a survey and measurement process • 7. Establish priorities for educational programming for leaders to enhance program implementation • 8. Create uniform system of Scope of Practice which incorporates FFP • 9. Establish Tele-work Proposals and New Models of Care • 10. Explore expanded use of clinical pharmacy technicians to enhance CPS efficiency

6. Clinical Pharmacy Executive Board (CPEB) • Chartered in 2012, first meeting in Jan 2012 • Key Physician-thought leaders and PBM pharmacy leadership • Goals: • Create a transformational plan that will provide the basis for initiatives and the strategic plan for CPPO • Fully integrate the CPS into primary and specialty care by leveraging their unique education and training to solve medication-related problems and gaps in care for our Veterans while improving medication safety and cost outcomes

7. National Clinical Pharmacy SharePoint Site • New Clinical Pharmacy SharePoint Site has finally been created http://vaww.infoshare.va.gov/sites/vapharmacyinformatics/ClinicalPharmacy/default.aspx?PageView=Shared • Started populating with Medical Home now working on all other specialty areas like anticoagulation, oncology, nephrology etc. Content to include • Business plans / staffing justifications • Peer review • Competencies • Scope of practice • Literature sources • Functional statements and performance statements • Research ideas • Staffing calculators • Data collection sources • Contact people • Links to useful sites such as VACO library

8. Position Statements / Field Guidance • Released • Statements on recommended PACT staffing of Clinical Pharmacists • Statement on centralized Anticoagulation • Statement on External Funding for Travel • Union involvement in performance standards • Position Paper on use of RN’s protocols to Manage medications in chronic conditions within PACT • PACT business rules • Equivalent experience as applied to Scope of Practice • DSS guidance • DC RX redesign • Scope of Practice • OPPE Guidance • In Progress • Fiscal Glide Path education for Chiefs • Tele-work guidance

9. Roles and responsibilities: VACO • VACO, through the creation of a Assistant Chief Consultant for Clinical Pharmacy Services position, made the initial commitment in May of 2010. • VACO also providing funding resources to hire a CP analyst, and to conduct two national Clinical Pharmacy Advisory Group meetings during FY10. • VACO Currently recruiting for a Clinical Pharmacy Program and policy manager • VACO provided funding for the Director to travel intensely to local, regional and national meetings • Tremendous commitment to support large regional boot camps. • Instrumental in establishing national standards, priorities, and policies in concert with various offices within central office. • Ultimately Hired 3 more staff to manage programs

10. Roles and responsibilities: VPE’s • Several VPE’s have been very active members of the National Clinical Pharmacy Advisory Group • VPE’s must help drive and support of expanded clinical pharmacy practices through changes in policies, creation of performance goals, and standardization of practice goals. • To lead their VISN’s in espousing our core concepts & principles and promote the cost effective use of Clinical Pharmacists • To assure that Clinical Pharmacy Practice issues are treated with equal importance to the operational, formulary and medication safety issues in each VISN. • Responsibility to communicate up-line to VACO so that we can work on their behalf. It will be important that clear feedback to VACO about what is working, what is not and what issues exist at their facilities. • Assure that all Pharmacy and non-Pharmacy leaders within their VISN's are engaged and understand the issues, mission and vision so that as leaders they can lead the charge.

11. Roles and Responsibilities: Chiefs • Support of expanded clinical pharmacy practices through changes in policies, creation of performance goals, and standardization of practice goals. • To lead their facilities in espousing our core concepts & principles and promote the cost effective use of Clinical Pharmacists • To assure that Clinical Pharmacy Practice issues are treated with equal importance to the operational, formulary and medication safety issues in each VISN. This may require a designated Clinical Pharmacy lead at each facility. • Responsibility to communicate up-line to VPE’s and VACO so that we can work on their behalf. It will be important that clear feedback to VACO about what is working, what is not and what issues exist at their facilities. • Assure that all Pharmacy and non-Pharmacy leaders within their VISN's are engaged and understand the issues, mission and vision so that as leaders they can lead the charge. • Assure that all pharmacists, no matter who they work for, have Pharmacy service oversight for scope of practice, clinical and operational competency, formulary management, and medication safety. • Assure that all their staff are engaged and understand the issues, mission and vision so that as leaders they can lead the charge.

12. Clinical Pharmacy Program OfficeStrategic Goals for FY12 • Develop Policy to define, clarify, and standardize clinical pharmacy practice throughout VHA • Development of the first VHA Clinical Pharmacy Handbook • Revisions of key handbooks, directives, and templates to incorporate clinical pharmacy practice transformation, ensure continuity of roles and responsibilities of CPS, and changing role of pharmacists and technicians. Examples include: Coordinated Care Directive, OP Handbook, IP Pharmacy Handbook, CBOC Template revision • Development of a CPRS tool to document clinical pharmacy interventions that characterizes the role of the CPS in practice • Pharmacists Achieve Results with Medications Demonstration (PhARMD) Project • Data Extractions from CDW and National Database capabilities

13. Clinical Pharmacy Program OfficeStrategic Goals for FY12 • Refine Quality Assurance and Outcomes research capability to take on more groundbreaking, publishable assessments of the CPS role in primary and specialty care • Clinical Pharmacy Health Services Research Team formed to seek to organize, standardize, engage and energize the strong leadership and clinical pharmacy base currently in place and to lead the profession of pharmacy through fostering research opportunities. • Further expansion of role of CPS in PACT and Specialty Care • PACT Business Rules and development of Specialty Care Business Rules and Staffing Models • Emphasis on CPS role in antimicrobial stewardship, Hepatitis C, Pain Management

14. Clinical Pharmacy Program OfficeStrategic Goals for FY12 • Supporting the movement of the CPS as an Licensed Independent Practitioner • Development of a Policy Documents that coincide with LIP practice • Collaboration with Professional Organizations and key stakeholders • Development of a communication and marketing plan for clinical pharmacy • Systems Redesign of the Pharmacy Practice Model • Standardize the roles of Pharmacy technicians throughout the VHA to enhance the overall performance of the pharmacy services • Identify additional areas of unmet clinical need in both the ambulatory care and inpatient settings • Workgroup chartered to identify measurable gaps in care related to complex medication management and safety

15. Clinical Pharmacy Program OfficeStrategic Goals for FY12

16. Clinical Pharmacy Program OfficeCollaborating Workgroups

17. Clinical Pharmacy Program OfficeGoals and Timelines in FY12 • Clinical Pharmacy Handbook concurrence by end of FY12 • PharmD project national roll-out by 4th Quarter FY12 • Communication and marketing plan by end of FY12 • Systems Redesign Tool for use by facilities by end of FY12 • Identify additional areas of unmet clinical need in both the ambulatory care and inpatient settings. Initial plan to be completed by April 30, 2012.

18. Clinical Pharmacy Program OfficeGoals and Timelines in FY12 • Developed Team Charter for group charged with recommending health services research priorities for evaluation by the CPAB • Establishing top project opportunities • Creating a network of volunteer pharmacists and facilities who are interested in pursuing clinical pharmacy health services research • Developing proposals for grants and VA research foundations • Advisory group developed by March 2012 with recommendations to the CPAB by September 2012. • Develop metrics to better describe clinical pharmacy penetration at facilities across the country • Goal to identifying best practices and sites that needs assistance and to establish some staffing and performance norms • Report on initial metrics by February 2012 to CPAB and CPEB. Field release of metrics through VPEs by May 2012.

19. Clinical Pharmacy Program Office Priority Areas and Activities • Enhancement of Clinical Pharmacy Programs • Development and integration of Clinical Pharmacy Policy assists with standardization of roles and responsibilities as well as supporting transformation of practice throughout VHA • Educational Initiatives • Clinical Pharmacy Advisory Board/Clinical Pharmacy Executive Board • Clinical Pharmacy Health Services Research Team • Improve pharmacy operational efficiencies-Use of Pharmacists, technicians, automation • Systems Redesign of the Pharmacy Practice Model supports the role of using pharmacists, technicians and automation to the highest potential • Allows for movement of pharmacists away from operational functions and duties and towards more direct patient care activities

20. Clinical Pharmacy Program Office Priority Areas and Activities • Improve management and advancement of pharmacy technicians • Leadership boot camp educational program proposal developed in conjunction with PRRO. • Develop core responsibilities for technicians and realign roles • Ward inspections, Checking dispensed orders (Tech Check Tech), assist Pharmacists in non-traditional roles (below) • Expanding and Standardizing roles for Pharmacy Technician • Areas such as Medication Reconciliation, Anticoagulation, Tele-Health, Poly-Pharmacy, Formulary Management, Prior Authorization review, Quality Assurance, Controlled Substance Management, OR Responsibilities, Automation Oversight and Implementation, USP 797 Oversight and Implementation (IV Room Operations), Adverse Drug Reaction Tracking, Drug Accountability, Drug Use Evaluation tracking, Safety Bulletin implementation and tracking • Augment, Standardize, and Improve technician training (develop meaningful, engaging and stimulating training opportunities), competency assessment, and professionalism • Improve communications with National Technician Groups/Forums

21. Questions & AnswersAnthony P. Morreale, Pharm.D., MBA, BCPS, FASHPAssistant Chief Consultant for Clinical Pharmacy Services and Healthcare Services Researchanthony.morreale@va.gov

22. AREAS OF ACTIVE FOCUS • Clinical Pharmacy Handbook • Coding, Billing and workload assessment tools • Continued PACT development and expansion • SCAN/ECHO development and expansion • Specialty Care development and expansion especially in areas of intense VA expansion or those that have high medication related needs – these include HCV, ASP, ED, High Risk Medication assessment, Pain. • Pharmacy Education - Boot Camps and Live Meetings

23. AREAS OF ACTIVE FOCUS • Systems redesign • Expanding the use of technicians • Enhanced Communications • Clinical Pharmacy Penetration Metrics and • quality tools to monitor field guidance, handbooks and to identify sites that need support • RN Medication Protocols • Development of Clinical Pharmacy infrastructure through development of a national Clinical Practice Council system.