Pharmacy Practice Model Initiative and the PPMI National Dashboard

Pharmacy Practice Model Initiativeand the PPMI National Dashboard

Pharmacy Practice Model InitiativeImperative for a better defined practice model identified by members.Planning commences for summit: assumptions developed, ASHP members,thought leaders, and participants queried, briefing papers developed.Consensus summit held resulting in 147 recommendations to better definecharacteristics of the optimal practice model for the future.SummitProceedingspublished in AJHPBriefing documentwebinar seriesconductedPresentations at MCM,SM, ResidencyConferencesHospital Self-Assessment (HSA)developed, launchedDemonstration andresident researchgrants issuedPPMI Websitewith resources,links launchedNational dashboarddeveloped tomeasure progressComplexity tooldevelopedPolicy issues fromsummit addressed2

PPMI National DashboardGoal 1 Goal 2 Goal 3 Goal 4 Goal 5Pharmacistroles,practices, andactivities willimprovemedication useand optimizemedicationrelatedoutcomes.Pharmacytechnicians willprepare anddistributemedicationsand performother functionsthat do notrequire apharmacist'sprofessionaljudgment.Pharmacistsand pharmacytechnicians willhave appropriatetraining andcredentials forthe activitesperformed withintheir scope ofpractice.Pharmacydepartmentsutilize availableautomationandtechnology toimprove patientsafety andimproveefficiency.Pharmacistswill demonstrateleadership inexercising theirresponsibility formedication usesystems and willbe accountablefor medicationrelatedpatientoutcomes.

GOAL 1: Pharmacist roles, practices, and activities willimprove medication use and optimize medication relatedoutcomes. (1.1 ‐ 1.4)1.1. Percentage of hospitals/health systems that have pharmacist‐review of all medicationorders before the first dose is administered (either onsite or via telepharmacy except forprocedure areas and emergency situations). [B23b]12 1.2. Percentage of hospitals/health systems sstemsthatthat require that pharmacists document theirrecommendations* and follow‐up notes in the patients' permanent medical records. [B15,B16] *Level and type of recommendation as determined by hospital protocol.70.6%54.9%1.3. Percentage of hospitals/health systems where pharmacists have privileges to writemedication orders (modify or initiate therapy) in the health care setting. [B13] 88.1%1.4. Percentage of hospitals/health systems where pharmacists have the authority to orderserum medication concentrations and other clinically important laboratory tests. [B25h] 83.2%4

GOAL 1: Pharmacist roles, practices, and activities willimprove medication use and optimize medication relatedoutcomes. (1.5 – 18) 1.8)1.5. 15 Percentage of hospitals/health systems that have pharmacists routinely assigned topatient care units / specialty services to provide drug therapy management at least 8 hoursper day, 5 days a week for a majority of patients? [E4d]1.6. Percentage of hospitals/health systems where pharmacists provide drug therapymanagement to all outpatients who exceed the threshold h value on the patient medicationcomplexity index. (*to be measured in 2012/13 after index is available) [B9, B11]1.7. Percentage of hospitals/health systems where pharmacists provide drug therapymanagement to all inpatients who exceed the threshold value on the patient medicationcomplexity index. (*to be measured in 2012/13 after index is available) [B8, B11]1.8. Percentage of hospitals/health systems with pharmacists that routinely provide dischargecounseling and/or conduct follow‐up with at‐risk patients or their pharmacies after discharge.[B20, B22, B23m]34.2%N/S*N/S*20.3%Composite Score: 58.6%5

GOAL 3: Pharmacists and pharmacy technicians will haveappropriate training and credentials for the activitesperformed within their scope of practice.3.1. 31 Percentage of hospital pharmacists who are board certified by the Board of PharmacySpecialties. [B10] 8.8%3.2. Percentage of pharmacists that have completed ASHP‐accredited residency training.[B25p] 17.8%3.3. Percentage of hospitals/health systems who have a credentialing and privilegingprocess* beyond licensure that defines and authorizes pharmacists' scope of practice.[B23r]15.5%3.4. Percentage of pharmacy technicians working in hospitals/health systems who havecompleted ASHP‐accredited training. [B6d, D5] 11.1%3.5. Percentage of pharmacy technicians working in hospitals/health systems who arePTCB certified. [B6d, D6] 65.8%Composite Score: 23.8%7

GOAL 4: Pharmacy departments utilize availableautomation and technology to improve patient safety andimprove efficiency.i4.1. Percentage of hospitals/health systems using a computerized prescriber order entry(CPOE) system with clinical decision support for inpatient medication orders (e.g., rules thatintegrate order information, patient information, and clinical practice guidelines intocomputer system logic that provide feedback to prescribers). [C2b, C2d]4.2. Percentage of hospitals/health systems that routinely use machine readable coding (e.g.,bar coding technology with or without a robot) in the inpatient pharmacy to verify dosesduring dispensing. [C2j]34.2%33.9%4.3. Percentage of hospitals/health systems that use automated dispensing technologies (e.g.,automated dispensing cabinets, robotics). [C2k] 89.1%4.4. Percentage of hospitals/health systems who have smart infusion pumps that areintegrated into a closed loop medication‐use process (i.e., where CPOE/pharmacy informationsystem is integrated with pumps, and administration is documented on eMAR). [C2m]4.5. Percentage of hospitals/health systems that use machine‐readable coding (e.g., Bar‐CodeMedication Administration [BCMA] system) to verify the identity of the patient and theaccuracy of medication administration at the point‐of‐care. [C2l]12.2%50.2%Composite Score: 43.9%8

GOAL 5: Pharmacists will demonstrate leadership in exercisingtheir responsibility for medication use systems and will beaccountable for medication‐related patient outcomes.5.1. Percentage of hospitals/health systems whose pharmacists with drug therapymanagement responsibilities are held accountable through formal evaluation for clinical 30.0%0%outcomes of patients under their care. [B1, B7]5.2. Percentage of hospitals/health systems whose pharmacy executive is recognized andpositioned in the organization to influence decisions on strategic issues affecting68.4%medication use (e.g., pharmacy department reports to the CEO or COO). [B6a]5.3. Percentage of hospitals/health systems that regularly* conduct strategic planning todetermine their optimal scope and level of pharmacy services, use of automation andtechnology, assignment of technicians, and readiness of staff to serve their patient59.2%population. [E1]*Strategic planning has been conducted in the past 24 months.5.4. Percentage of hospitals/health systems that have used the PPMI Hospital Self‐Assessment Tool at least annually. (*to be surveyed in 2012) [E2]5.5. Percentage of hospitals/health systems that conduct proactive and ongoingassessments and mitigate risk of medication‐use systems (e.g., ISMP Medication Safety SelfAssessment). [B17, B24e]5.6. Percentage of hospitals/health systems that routinely provide training to pharmacystudents and/or residents. [E4o, B26]N/S*53.6%62.3%Composite Score: 54.7%9

PPMI National DashboardGoal 1Goal 2Goal 3Goal 4 Goal 5Pharmacistroles, practices,and activities willimprove medicationuse and optimizemedication relatedoutcomes.Pharmacy ytechnicians willprepare anddistributemedications andperform otherfunctions that t donot require apharmacist'sprofessionaljudgment. Pharmacistsand pharmacytechnicians willhave appropriatetraining andcredentials forthe activitesperformed withintheir scope ofpractice.Pharmacydepartments utilizeavailableautomation andtechnology toimprove patientsafety and improveefficiency.Pharmacists willdemonstrateleadership inexercising theirresponsibility formedication usesystems stems and will beaccountable formedication-relatedpatient outcomes.60 60 606040 80808040804040 40608020 10020 10020 10020 10020 1000000058.6%19.5% XX%23.8%43.9%54.7%