ASHP PAI Self Assessment in Action Kimber Boothe, PharmD, MHA System Director Pharmacy Marilin Castle, PharmD, BCPS PGY2-HSPA Resident March 23, 2019
CONFIDENTIAL – FOR INTERNAL USE ONLY Outline • PAI Strategy • PAI Self Assessment & Action Plan Process • PAI Activities & Projects 2
CONFIDENTIAL – FOR INTERNAL USE ONLY Journey to Justify Resources Strategic Planning Business Plans FTE Analysis ROI Approval Execution 3
CONFIDENTIAL – FOR INTERNAL USE ONLY YNHH PAI Metrics – Acute Care Threshold Target Max Measure 2016 2017 Patient (ADC): RPh Ratio - (Avg, ICU, Floor) 43:1 30:1 25:1 Weekday 35:1 25:1 18:1 50:1 35:1 30:1 Evening/Weekend Orders Verified/RPh/Hr Weekday 50 40 30 Evening/Weekend 60 50 40 Decentralized RPh Coverage % Units Covered 50% 75% 100% % Units Rounding/Team 25% 50% 75% ASHP PAI Metrics PAI Self Assessment Score 65% 75% 85% % RPh w/ Residency 25% 50% 75% 4 % RPh Board Certified TBD TBD TBD
CONFIDENTIAL – FOR INTERNAL USE ONLY Healthcare Provider Ratios – Acute Care Patient to Pharmacist Ratio is below best practice Patient : Healthcare Provider Ratio How We Will Get to Goal: • Decentralize pharmacists 4 Nurses • Optimize technician roles • Optimize pharmacy 10 Respiratory Therapist student roles 15-20 Physicians • Optimize technology • Expand pharmacy 30 Pharmacists Goal residency • Justify resources 75 Pharmacists Current 0 10 20 30 40 50 60 70 80 5
CONFIDENTIAL – FOR INTERNAL USE ONLY St. Elizabeth Healthcare • Northern Kentucky • 4 infusion centers • 1,100 licensed beds • 1 outpatient/specialty • 3 acute care hospitals / 1 critical pharmacy access hospital • 55,000 Inpatient Discharges • 2 ER/ambulatory facilities • 500 St. Elizabeth Physicians • 2 ambulatory surgery centers / 3 providers at 116 locations imaging centers
CONFIDENTIAL – FOR INTERNAL USE ONLY Systematic Approach 1. Complete hospital assessment 2. Review assessment result 3. Prioritize action items 4. Evaluate peer comparison 5. Formulate action plan 6. Implement change 7
CONFIDENTIAL – FOR INTERNAL USE ONLY Completing Assessment 1. Individual lead 2. Team feedback 3. Assess each site 4. Complete the official assessment 8
CONFIDENTIAL – FOR INTERNAL USE ONLY Self Assessment 9
CONFIDENTIAL – FOR INTERNAL USE ONLY 10
CONFIDENTIAL – FOR INTERNAL USE ONLY Action List Prioritization 11
CONFIDENTIAL – FOR INTERNAL USE ONLY Action Plan 12
CONFIDENTIAL – FOR INTERNAL USE ONLY Compare Report 13
CONFIDENTIAL – FOR INTERNAL USE ONLY Survey Result Summary Category Edgew ood Florence Ft. Thom as OVERALL 7 3 % 7 3 % 7 3 % OPTIMAL PHARMACY PRACTICE 83% 83% 84% CHARACTERISTICS - PART 1 OPTIMAL PHARMACY PRACTICE 62% 63% 63% CHARACTERISTICS - PART II ADVANCING THE APPLICATION OF INFORMATION TECHNOLOGY IN 92% 92% 92% THE MEDICATION USE PROCESS ADVANCING THE USE OF 41% 40% 41% PHARMACY TECHNICIANS SUCCESSFULL IMPLEMENTATION OF NEW PHARMACY PRACTICE 82% 80% 80% INITIATIVES 14
CONFIDENTIAL – FOR INTERNAL USE ONLY Data Comparison Report 15
CONFIDENTIAL – FOR INTERNAL USE ONLY Prioritizing Actionable Items High “Major Projects” “Quick Wins” High priority Medium-high priority Add to action plan Add to action plan Execute once feasible Impact “Thankless Tasks” “Fills Ins” Low priority Medium priority Do not add to action plan Add to action plan Low Low High Feasibility 16
CONFIDENTIAL – FOR INTERNAL USE ONLY Hospital Assessment – Priority Actionable Items Assessment Question Actionable Actionable Actionable Item - EDG Item - FLO Item - FTT Are pharmacists involved in development of a patient care plan? [B23a] X X Do pharmacists review medication orders before initial dose is X X X administered? [B23b] Are drug therapy management services prioritized for inpatients based on X X X patient medication complexity? [B8] Does the pharmacy department at your hospital identify problem-prone X X X (e.g. high-alert) and high-risk therapies using pre-established criteria? [B24k] Are medication preparation and distribution tasks assigned to pharmacy X X X technicians, to the extent possible, to allow redeployment of pharmacists’ time to drug therapy management activities at your hospital? [D2] 17
CONFIDENTIAL – FOR INTERNAL USE ONLY Hospital Assessment Assessment Question Actionable Actionable Actionable Item - EDG Item - FLO Item - FTT If permitted by law, is the accuracy of medication dispensing by pharmacy X X X technicians checked by other technicians (i.e. “tech-check-tech”) who have appropriate education and training at your hospital? [D3c] Are all distributive functions that do not require a pharmacist’s clinical X X X judgement assigned to pharmacy technicians at your hospital? [D9] Do pharmacists participate on your hospital’s rapid response teams? X [B23n] Do pharmacists provide discharge education to patients at your hospital? X X X [B23m] Is medication reconciliation performed by the pharmacy staff at your X X X hospital? [B23k] 18
CONFIDENTIAL – FOR INTERNAL USE ONLY Hospital Assessment Assessment Question Actionable Actionable Actionable Item - EDG Item - FLO Item - FTT Based on the genetic characteristics of the patient, do pharmacists have a X X X role in adjusting dosing or changing therapy of selective medications? [B23f] Are all patients’ medication profiles reviewed for appropriateness at least X X X daily by a pharmacists? [B23c] Do pharmacists facilitate medication-related continuity of care? [B20] X X X Does the pharmacy department at your hospital manage prospective X X X medication-use evaluation programs to improve prescribing? [B24i] Do automated systems at your hospital notify pharmacists when X X X medication serum concentrations or other clinically important laboratory values fall outside of a therapeutic or normal range? [C2i] 19
CONFIDENTIAL – FOR INTERNAL USE ONLY Hospital Assessment Assessment Question Actionable Actionable Actionable Item - EDG Item - FLO Item - FTT If you employ pharmacy student interns, are their duties different from X X X traditional pharmacy technician duties? [B24c] Does a lack of pharmacy staff impede development of an optimal X X X pharmacy practice model at your hospital? [B6c] Initiation of a medication reconciliation, including obtaining and X X X documenting patients’ medication information for pharmacists’ review, should be done at every transition of care in which new medications are ordered or existing orders are rewritten. [D3a] Is the management of controlled substance systems assigned to X X X pharmacy technicians who have appropriate education and training at your hospital? [D3j] Are components of quality improvement programs conducted by X X X pharmacy technicians who have appropriate education and training at your hospital? [D3l] 20
CONFIDENTIAL – FOR INTERNAL USE ONLY Hospital Assessment Assessment Question Actionable Actionable Actionable Item - EDG Item - FLO Item - FTT Have pharmacy technician responsibilities been expanded to the extent X possible based on education and training at your hospital? [E4e] Are pharmacists assigned/deployed to patient-care units at your hospital? X X [E4d] 21
CONFIDENTIAL – FOR INTERNAL USE ONLY Do pharmacists review medication orders before initial dose is administered? [B23b] EDG FLO FTT PEER 100 100 100 79.59 SELECTION (%) 18.37 2.04 EXISTS IN ALL AREAS EXISTS IN MOST AREAS EXISTS ONLY IN SOME DOES NOT EXIST (0%) (100%) (50-99%) AREAS (1-49%) ANSWER CHOICES Peer group: N=49; bed size 400-599; community hospital; all metropolitan statistical area; all regions; Yes – medical residency program; Yes – 22 pharmacy residency program; Yes – takes 6 or more pharmacy students per year
CONFIDENTIAL – FOR INTERNAL USE ONLY Is medication reconciliation performed by the pharmacy staff at your hospital? [B23k] EDG FLO FTT PEER 100 100 100 SELECTION (%) 34.69 32.65 28.57 4.08 THROUGHOUT ALL AREAS IN SOME AREAS PARTIALLY PERFORMED NOT PERFORMED BY IN SOME OR ALL AREAS PHARMACY STAFF ANSWER CHOICES Peer group: N=49; bed size 400-599; community hospital; all metropolitan statistical area; all regions; Yes – medical residency program; Yes – 23 pharmacy residency program; Yes – takes 6 or more pharmacy students per year
CONFIDENTIAL – FOR INTERNAL USE ONLY 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? [D3c] EDG FLO FTT PEER 100 100 100 SELECTION (%) 44.9 30.61 12.24 8.16 4.08 EXISTS IN ALL EXISTS IN MOST EXISTS IN ONLY DOES NOT EXIST NOT PERMITTED BY AREAS (100%) AREAS (50-99%) SOME AREAS (1- (0%) LAW 49%) ANSWER CHOICES Peer group: N=49; bed size 400-599; community hospital; all metropolitan statistical area; all regions; Yes – medical residency program; Yes – 24 pharmacy residency program; Yes – takes 6 or more pharmacy students per year
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