OBJECTIVES Implementation of • Describe various hospital pharmacy Clinical Services at quality improvement initiatives • List components of the framework Various Institutions necessary for expanding clinical services • Describe methods of utilizing pharmacist- Niki Carver, Pharm.D., UAMS Medical Center extenders in providing clinical services Shannon Hays, Pharm.D., White Co Medical • Discuss the development and Melanie Claborn, Pharm.D., Veterans implementation of clinical pharmacy Healthcare System of the Ozarks/UAMS NW services in primary care at a federal facility Disclosure This presenter has no conflicts of interest to Increasing Possibilities for Health- disclose. Systems Pharmacists Involvement Niki Carver, Pharm.D. Assistant Director for Medication Safety University of Arkansas for Medical Sciences 4 Objectives Definitions • Describe various hospital pharmacy ASHP – American Society of Health-System quality improvement initiatives Pharmacists CMS – Center of Medicare & Medicaid Services 1 Health-Systems Pharmacists’ ASHP 2015 INITIATIVE Possibilities • This Initiative is a program to help make medication use in health systems more effective, Readmissions scientific, and safe. There are six key goals and 31 specific objectives to be accomplished by the year 2015. NPSG, Core • The 2015 Initiative is a tool to help health- Measures system pharmacy practitioners achieve the ideals identified in the vision statement. Pharmacokinetic Dosing, • ASHP dedicates itself to achieving a vision for Therapeutic Drug Monitoring, pharmacy practice in hospitals and health systems in IV to PO, Therapeutic which pharmacists Substitution 7 www.ashp.org/menu/practicepolicy/initiative/2015Initiative.aspx Goal/Objectives Goal 1 Increase the extent to which pharmacists help individual hospital Goal/Objectives inpatients achieve the best use of medications. Goal 2 Increase the extent to which health-system pharmacists help individual Objective Pharmacists will be involved in managing the acquisition, upon admission, of non-hospitalized patients achieve the best use of medications. 1.1 medication histories for a majority of hospital inpatients with complex and high-risk medication regimens* in 75% of hospitals. Objective In 70% of health systems providing clinic care, pharmacists will manage 2.1 medication therapy for clinic patients with complex and high-risk medication Objective The medication therapy of a majority of hospital inpatients with complex and regimens*, in collaboration with other members of the health-care team. 1.2 high-risk medication regimens will be monitored* by a pharmacist in 100% of hospitals. Objective In 95% of health systems providing clinic care, pharmacists routinely Objective In 90% of hospitals, pharmacists will manage medication therapy for 2.2 counsel clinic patients with complex and high-risk medication regimens. 1.3 inpatients with complex and high-risk medication regimens*, in collaboration with other members of the health-care team. Objective In 90% of home care services, pharmacists will manage medication therapy Objective Hospital inpatients discharged with complex and high-risk medication 2.3 for patients with complex and high-risk medication regimens*, in 1.4 regimens* will receive discharge medication counseling managed by a collaboration with other members of the health-care team. pharmacist in 75% of hospitals. Objective 50% of recently hospitalized patients (or their caregivers*) will recall Objective In 90% of long term care facilities, pharmacists will manage medication 1.5 speaking with a pharmacist while in the hospital. 2.4 therapy for patients with complex and high-risk medication regimens*, in collaboration with other members of the health-care team. Objective In 90% of hospitals, pharmacists will ensure that effective medication 1.6 reconciliation* occurs during transitions across the continuum of care. Goal/Objectives Goal/Objectives Goal 3 Increase the extent to which health-system pharmacists actively apply Goal 4 Increase the extent to which pharmacists help individual hospital inpatients achieve the best use of medications. evidence-based methods to the improvement of medication therapy. Objective 90% of health systems will have an organizational program, with appropriate pharmacy Objective In 90% of hospitals, pharmacists will be actively involved in providing care to 4.1 involvement, to achieve significant annual, documented improvement in the safety of all steps in 3.1 individual patients that is based on evidence, such as the use of quality drug medication use. information resources, published clinical studies or guidelines, and expert Objective 80% of pharmacies in health systems will conduct an annual assessment of the processes used consensus advice. 4.2 throughout the health system for compounding sterile medications, consistent with established standards and best practices. Objective In 90% of hospitals, pharmacists will be actively involved in the development Objective 80% of hospitals have at least 95% of routine medication orders reviewed for appropriateness by a 3.2 and implementation of evidence-based drug therapy protocols and/or order 4.3 pharmacist before administration of the first dose. (*Not including doses required in the context of sets. emergencies or immediate procedures such as surgeries, labor and delivery, cardiac catheterization, etc.) Objective In 90% of hospitals, pharmacy departments will actively participate in Objective 90% of hospital pharmacies will participate in ensuring that patients receiving antibiotics as 3.3 hospital-wide efforts to ensure that patients receive evidence-based 4.4 prophylaxis for surgical infections will have their prophylactic antibiotic therapy discontinued within 24 hours after the surgery end time. medication therapies required by the CMS hospital quality initiative, Joint Commission Core Measures, and/or state-based quality improvement and Objective 85% of pharmacy technicians in health systems will be certified by the Pharmacy Technician public reporting efforts. 4.5 Certification Board. Objective In 70% of hospitals, pharmacists will actively be involved in medication- and Objective 50% of new pharmacy technicians entering hospital and health system practice will have 4.6 completed an ASHP-accredited pharmacy technician training program*. 3.4 vaccination-related infection control programs. Objective 90% of new pharmacists entering hospital and health-system practice will have completed 4.7 an ASHP-accredited residency. 2 Goal/Objectives Goal/Objectives Goal 5 Increase the extent to which health systems apply technology effectively to improve the safety of medication use. Goal 6 Increase the extent to which pharmacy departments in health systems engage in public health initiatives on behalf of their communities. Objective 75% of hospitals will use machine-readable coding to verify medications 5.1 before dispensing. Objective 60% of pharmacies in health systems will have specific ongoing initiatives 6.1 that target community health. Objective 75% of hospitals will use machine-readable coding to verify all medications 5.2 before administration to a patient. Objective 50% of pharmacy departments in health systems will be directly involved in Objective For routine medication prescribing for inpatients, 70% of hospitals will use 6.2 ongoing immunization initiatives in their communities. 5.3 computerized prescriber order entry systems that include clinical decision support. Objective 85% of hospital pharmacies will participate in ensuring that eligible patients 6.3 in health systems receive vaccinations for influenza and pneumococcus. Objective In 65% of health systems, pharmacists will use medication-relevant portions 5.4 of patients' electronic medical records for managing patients' medication Objective 80% of hospital pharmacies will participate in ensuring that hospitalized therapy.* 6.4 patients who smoke receive smoking-cessation counseling. Objective In 70% of health systems, pharmacists will be able to access pertinent Objective 90% of pharmacy departments in health systems will have formal, up-to- 5.5 patient information and communicate across settings of care to ensure 6.5 date emergency preparedness programs integrated with their health continuity of pharmaceutical care for patients with complex and high-risk systems' and their communities' preparedness and response programs. medication regimens. CMS Core Measures AMI • Acute Myocardial Infarction (AMI) • Order set development and maintenance • Heart Failure (HF) • Identify patients • Interventions • Pneumonia (PNE) • Timely administration of ASA on arrival • Stroke • ACE/ARB at discharge for decreased LVF • ASA/Beta-blocker at discharge • Counsel patients about ASA at discharge ** Many measures are medication-related** • Statin (or HMG CoA reductase inhibitors) prescribed at discharge • Insures nurse is contacted/appropriate documentation occurs Heart Failure PNEUMOCOCCAL/INFLUENZA • Order set development and maintenance • Patients Assessed and Given Pneumococcal • Concurrent inpatient review Vaccination • Pharmacist screening/ordering • Interventions • Standing orders approved by Medical Staff • Discharge instruction • Nurse vaccinates within 24 hours of admission • ACE/ARB at discharge if decreased • Pneumonia Patients Whose Initial Emergency LVF Room Blood Culture Was Performed Prior To • Smoking cessation advice/counseling The Administration Of The First Hospital Dose Of Antibiotics • Insures appropriate documentation occurs • Pneumonia Patients Given Smoking