1. Reaching New Heights through Pharmacy Technician Advancement
Ross Thompson, M.S., R.Ph.
Director of Pharmacy Services
Melissa Ortega, M.S., Pharm.D.
Pharmacy Operations Manager

2. Objectives
Review ASHP Pharmacy Practice Model Initiative (PPMI)
Discuss methods for evaluating your practice setting
List PPMI recommendations on technician advancement
Highlight methodologies for facilitating practice change
Discuss ASHP and MSHP initiatives to facilitate change

3. PPMI Vision and Goals Vision of PPMI Goal of PPMI
To create passion, commitment, and action among hospital and health-system pharmacy practice leaders to advance the health and well being of patients by optimizing the role of pharmacists in providing direct patient care
Goal of PPMI
Implement the vision by support a futuristic practice model
Describe how resources are deployed to provide care.
How pharmacists practice and provide care to patients
How technicians are involved to support care
Use of automation and technology
Replace!!!!!!!!!!!!
AJHP 2010;67:542 3

4. Translating Recommendations Into Practice
ASHP Publications
Policy
Tools
Research

6. Categories of Self-Assessment Criteria
Hospital Demographics
Optimal Practice Model Characteristics (organization)
Optimal Practice Model Characteristics (employee/scope)
Advancing Information Technology
Advancing Pharmacy Technician Roles
Successful Implementation of New Practice model
Recommendations are organized within 6 categories

7. Benefits of Completing a Self-Assessment
Identifies gaps
Assists with prioritization
Generates an action plan
Links to resources supporting the recommendation
Tracks performance / conformity
Provides comparison with other hospitals

8. Optimal Pharmacy Practice Model Characteristics – Part I
Are pharmacists recognized for taking a lead role in providing drug therapy management services to patients at your hospital/health system?
12% Exists in all areas/situations (100%)
50% Exists in most areas/situations (50-99%)
38% Exists only in some areas/situations (1-49%)
0% Does not exist (0%)
0% Not applicable
Let’s review a few examples of questions that appear in the self-assessment
These results reflect the collective responses from Massachusetts hospitals that completed the assessment.
Will not review technician-specific recommendations in order to save those for your deeper dive into technician advancement
On this question, 62% of Massachusetts participants rated in the top 2 categories while the national responses showed 73% in the top 2
Definition: Drug Therapy Management is a multidisciplinary team process for selecting appropriate drug therapies, educating patients, monitoring patients, and continually assessing outcomes of therapy. Pharmacist activities in drug therapy management may include, but are not limited to: initiating, modifying ,and monitoring a patient’s drug therapy; ordering and performing laboratory and related tests; assessing patient response to therapy; counseling and educating a patient about medications; and administering medications.

9. Optimal Pharmacy Practice Model Characteristics – Part II
Is medication reconciliation performed by the pharmacy staff at your hospital/health system?
4% Medication reconciliation is performed by pharmacy staff throughout all areas
8% Medication reconciliation is performed by pharmacy staff in some areas
38% Medication reconciliation is partially performed by pharmacy staff in some or all areas
46% Medication reconciliation not performed by pharmacy staff
4% Not applicable
30% of the nation rated in the top 2 categories while only 12% of Massachusetts organizations rated in these top 2 categories
State and national data shows the majority of hospitals rating in the middle categories but the national results show more distribution in the top 2
50% of Massachusetts responses were in the bottom 2 categories while the national results showed 44%

10. Optimal Pharmacy Practice Model Characteristics – Part II
If you employ pharmacy student interns, are their duties different from traditional pharmacy technician duties?
50% Yes
38% No
12% Not applicable
National data … 53% yes; 32% no; 15% not applicable

11. Advancing the Application of IT in the Med Use Process
Has clinical decision support been integrated with computerized provider order entry at your hospital/health system?
23% Exists in all areas/situations (100%)
31% Exists in most areas/situations (50-99%)
27% Exists only in some areas/situations (1-49%)
15% Does not exist (0%)
4% Not applicable
54% of the participating Massachusetts hospitals fell in the top 2 categories.
This is an area where we are significantly higher than the nationally score of 44%
So what will we do with that additional efficiency that the rest of the nation currently lacks???

12. PPMI Results: Massachusetts
Total of 1,025 organizations have submitted data
Overall score of 52% compliance with recommendations
Northeast region has 171 organizations scoring at 50%
Includes 26 of approximately 100 Massachusetts facilities
Massachusetts facilities collectively scored 51%
Advancing technicians’ role is the nation’s lowest score at just 28% compliance with recommendations
How many members of the audience have seen your hospital’s results of the PPMI self-assessment?
If you do not know if your department has completed the PPMI self assessment … ask your Director of Pharmacy about them
If you are the Director of Pharmacy and have not shared your results with your department, please do so
If you are one of the 75 hospitals who have not yet completed the self-assessment … please participate

13. Initiating the Change Effort at Tufts MC
Involvement and engagement of staff
Align with hospital’s shared governance
State the goal while allowing staff to navigate the best path

14. Items Close to Completion: 22 Items Needing Completion: 39
What to Prioritize
Total Score: 54%
Optimal Pharmacy Practice Model Characteristics Part 1 and 2
70% and 48% (66% and 41% nationally)
Advancing the Application of IT in the Medication Use Process
45% (46%)
Advancing the Use of Pharmacy Technicians
44% (28%)
Successful Implementation of New Pharmacy Practice
52% (60%)
Items Completed: 37
Items Close to Completion: 22
Items Needing Completion: 39
******Total Score: 51%
Optimal Pharmacy Practice Model Characteristics Part 1 and 2
70% and 48% (66% and 41%)
Advancing the Application of Information Technology in the Medication Use Process
45% (46%)
Advancing the Use of Pharmacy Technicians
44% (28%)
Successful Implementation of New Pharmacy Practice
52% (60%)
Items Completed: 37
Items Close to Completion: 22
Items Needing Completion: 39
Northeast: 56%
National: 60%
Only 10 questions – 1 different – have you expanded your capacity for residency training where possible? – last year yes, this year no
() was our score last year – some things were mis-understood last year
Score is broken down by the questions were categorized into
Compared to hospitals with 300 beds, medical, and pharmacy residents, with 6 or more pharmacy students

15. Acute Care Pharmacy Practice Model
Integrated Practice Model via 5 Service Delivery Teams
Each service team will consist of 2 or 3 pharmacists, 1 resident, and 1 technician on day shift; then either 1 or 2 pharmacists on weekday evening and weekend day shifts
Each service team is responsible for providing our complement of services to a specific patient care area
Assisting medical staff with drug selection and monitoring
Assisting nursing staff in drug administration and distribution
Reviewing and improving / approving medication orders
Providing targeted drug monitoring of high risk medications
Providing education and adherence counseling for patients
Melissa Insertion of words -
On the Tuft’s Experience Slide (Old version)
Will spend a few minutes describing how Tufts Medical Center is advancing the practices of our pharmacy technicians
Provide an overview of our department and what we mobilized in response to the PPMI recommendations
Melissa will provide a description of how we are facilitating the advancement of the pharmacy technicians’ roles

16. How We Will Structure Our Acute Care Services
Team based practice model: specialist, generalists, technician, resident, and student
Pharmacist time devoted to clinical services
Pharmacy core services provided to every patient, every day
Targeted services for high risk or complex patients / therapies
Drug distribution facilitated by pharmacy technicians
Certain philosophical decisions will remain intact throughout our practice model redesign
Allows us to draw on our existing strengths while looking for innovative ways to advance
Based on healthcare finances, it is safe to assume we have what we will have … and what we have will be held to an increasing standard
We need to become more efficient / effective with the resources we have

17. Creating a Vision
Recognized the need to clearly define our vision if we wanted to mobilize a coordinated change effort

18. Vision Statement
Members of the Tufts Medical Center Department of Pharmacy Services are sought after for their expertise and are accountable for medication therapy outcomes; providing the best possible care for every patient, every time.

19. Pharmacy Practice Councils
Four Councils
Chaired by staff
Wrote Charter
Establish goals
Plan and make change
Four Councils:
Technician Advancement
Operational Improvements
Training and Development
Pharmacy Practice Advancement

20. Change Management Overview States and Phases
Change is a process
Themes can be categorized into
3 states
Desired
State
Transition
State
Current
State
Change is a process. Change is about working from the current state toward the desired state and through that journey we spend much of our time in transition.
3 states
4 main phases within states
Prepare for a climate for change
Formulating a plan
Implementing change
Communicating and sustaining change
There are two words on the slide that are important – PAIN and REMEDY. To move from the present state toward the transition state, there must be enough pain associated with staying in the current state. The risks of the status quo must be greater than the risks of doing something different or moving toward something different. The consequences of the status quo must be greater than the potential consequences of moving toward something different.
On the Dora Slide:
So at this point you should have an understanding
ASHP Pharmacy Practice Model Initiative (PPMI) and how it relates to technician advancement
And how we evaluated our practice setting at Tufts Medical Center and compared ourselves to peer organizations
What I am going to focus on is the methods that we used to facilitate practice change (synthesized all this information presented by Ross )
-I will highlight change management principles
-I will review the role, structure, and function of the technician advancement council
-Highlight examples of advanced technicians Roles documented in the literature ( situational Analysis  Understanding where we want to go)
-I will discuss Recent advancement of technicians at Tufts MC
Then I will explain what we have done to advance technician roles by applying change management tools
Remedy/Vision
Pain/Urgency

21. The status quo is not an option!
“If you don’t like change, you are really going to hate being irrelevant”
- Tom Peters
THE POINT: Our job is to help others see the remedy so they can endure the pain of moving from present state through transition and begin to experience the benefits of the desired state. In any change transition is necessary and the pain associated with making any change in inevitable – but we CAN make it easier and help employees move through it more productively and effectively.
Transition: Tools such as change models are available to aid in the process

22. Change Models Key Principles
Documented in the literature with success in various settings
Business
Non-profit associations
Healthcare organizations
Types of change models
8 steps of change management
Healthcare redesign and improvement models
Pharmacy specific
Details previously on the slide:
Documented in the literature with success in various settings ( mention (HBR papers)
Business
Non-profit associations
Health care organizations
Kotter’s 8 step change management steps
Sutevski 8 step change model
Institute for Healthcare Improvement (IHI)
Compliments other change model, focuses on an improvement acceleration model
Denver Health Hospital Authority (DHHA)
Toolkit structured around six redesign steps
Pharmacy specific change models
Patient Safety and Clinical Pharmacy Services (PSPC)
Change package with 5 strategies on change concepts
Vermeulen et al.
Strategic approach for establishing priorities for change in the medication use process
The paper referenced on the slide is a highly recommended paper and discusses all these change models in detail and even makes recommendation on how to adjust these models to fit practice model changes
Ray MD, Breland BL. Am J Health-Syst Pharm—2011;68: 22

23. Change Models help you think about…
The what, why, and how to make it work for technicians and pharmacists in a new world
Where to start?
What are the best practices in raising the bar for technician roles?
Who are the key stakeholders?
What are the barriers and challenges?
Inter professional relationships on the front lines-what works what doesn’t when roles change?
How to get buy-in?
Resources to build advanced technician workforce – where to go and how to use?
What are the one or two keys to your success?
What will you measure to demonstrate value?
So if you glance at this slide …lots of questions and very overwhelming
Prevents you from going in many directions
So why is it important to understand and utilize change models
Overwhelming …Grey hairs?????
Change models helps you organize your thoughts, questions, and put in a more step by step approach.
move through the 3 states of the change process more productively and effectively
Break it down step by step

24. 2. Form a Powerful Coalition 3. Create a Vision for Change
Kotter’s 8-Step Change Model
1. Create Urgency
2. Form a Powerful Coalition
3. Create a Vision for Change
4. Communicate the Change Vision
5. Remove Obstacles
6. Create Short-Term Wins
7. Build on the Change
8. Anchor the Changes
Leading Change, John P. Kotter, HBR, 1998

25. The 8 Step Approach to Leading Change Applied: Mobilizing Practice Change: Advancing the pharmacy practice model through a technician advancement council
Applying the 8 step model
You could use these slides with just about any new service
Leading Change, John P. Kotter, HBR, 1998
Kotter JP. Leading Change: Why Transformation Efforts Fail. Harv Bus Rev. 1995;59-67.

26. Step One: Create Urgency
Helping others see the need for change and the importance of acting quickly
Convince at least 75% of your people that the status quo is more dangerous than the unknown
Tufts Medical Center’s Actions:
Distribute appropriate background materials and highlight gaps
Examine the best practices & understand the literature
Establish structure around initiative
Potential Pitfalls:
Underestimating the difficulty of driving people from their comfort zones
Becoming paralyzed by risks

27. ASHP PPMI Tuft’s Action Plan
Identify Gaps
Recommendations
Tufts
Impact
Feasibility
Are all distributive functions that do not require a pharmacist's clinical judgment assigned to technicians at your hospital? D9 No
 
Have pharmacy technician responsibilities been expanded to the extent possible based on education and training at your hospital? E4e
  
Is the management of medication assistance programs assigned to pharmacy technicians who have appropriate education and training at your hospital? D3k
Is the supervision of other pharmacy technicians assigned to technicians who have appropriate education and training at your hospital? D3n
Some areas/ situations
Is the management of pharmacy department information technology systems, including routine database management and billing systems, assigned to pharmacy technicians who have appropriate education and training at your hospital? D3m
Some areas/ situations
Is initiation of medication reconciliation , including obtaining and documenting patient medication information for pharmacist review, assigned to pharmacy technicians who have appropriate education and training at your hospital? D3a
Some areas/ situation 
Points to Mention-
Distribute appropriate background materials and highlight gaps
Our action plan as it relates to Technician Advancement
Decision on Impact and feasibility
Transition-Literature ( Mentioned by Ross)
Neat thing about completing the action plan provided by ASHP is that it automatically links literature to the specific recommendations
High Impact:
High Feasibility:   

28. Areas of Opportunity for Technicians
Examine Best Practices and Literature
Survey Themes
Less than 50%
More than 75%
Maintenance of computer system software (40%)
Medication safety functions (37%)
Leadership roles (28%)
Supervising other technicians
Technician checking (tech-check-tech) (32%)
Conducting aspects of the quality improvement programs and/or quality assurance program (31%)
Initiation of medication reconciliation (18%)
Collection patient data (i.e., labs, insurance information, etc.) (18%)
Criteria based screening of medical records (18%)
Evaluating clinic-administered medication for reimbursement (11%)
Collect and summarize data for department dashboard (21%)
Purchasing/inventory management/contract/Drug shortage management (85%)
Maintenance of medication storage (satellites, unit med rooms, medication bins) (88%)
Audits (79%)
Sterile product and Non-sterile product compounding (99%)
Reaching new height-Areas of opportunity
UHC Practice Advancement Committee Survey* Areas of Opportunity for Technician Deployment (April 2012) * 57 respondents
In alignment of what is documented as advanced technician roles in the literature (<50%)
How many of these activates are essential and a pharmacists is completing them.
Highlight a few
Am J Health-Syst Pharm—Vol 68 Oct 1, 2011
UHC Practice Advancement Committee Survey*: Areas of Opportunity for Technician Deployment- Apr 2012 28

29. Pharmacy Councils Establish Structure Around Initiative
Technician Advancement
Utilize the current technician workforce to help manage the growing complexities of the medication use system
Reassign medication distribution tasks to pharmacy technicians  Redeploy pharmacists time to drug therapy management activities and direct patient care activities
Maintain a competent pharmacy technician workforce
Develop opportunities for technician specialization
Incorporate technicians within the team based practice model
Operations Improvements
To place an emphasis on optimizing coordination between central operations and procurement to gain efficiencies to realign resources for decentralization of technicians
Pharmacy Practice Advancement
To design and implement activities that allow pharmacists to extend their scope of practice and maximize their contributions to patient care. This will incorporate the progress made by a current workgroup that will now include representation from the Cancer and Pediatrics service teams.
Training and Development
Account for training needs as staff assume new responsibilities, formalize structured programs for new employee training as well as annual training to address needs across the department.
Transition council’s is a great platform not only to synthesize all of this information but also to ensure that this will occur and really allows staff to figure it out and trust in their knowledge, skills and ability
Transition: There are different types of management style that you have to be aware of when establishing structure

30. Change Management Style- Finding the Balance
Establish Structure Around Initiative
Tight
Loose
Participative and authoritarian
Delegative and participative
Blend of authoritarian and participative
Set goals tightly
Be articulate and comprehensive
Allow the team to figure it out and trust in their knowledge, skills and ability
Delegate appropriately
Measure results tightly
Ensure accountability
Throughout the change process when establishing structure it is important to use a blend of management styles
Point: Anchor your style in participative and use the others to help find balance in the process.

31. Technician Advancement Council
Establish Structure Around Initiative
Council’s Charter
Positions
Facilitator
Chair
Liaisons
Objectives
Deliverables
Outcomes
Guideline
Expectations
Minutes and agendas
Participation and attendance
Key all clearly defined
Facilitator
Integration team leader
Chair
Appointed member
Liaison
Links to other councils
Objectives
Deliverables
Outcomes
Guideline
Expectations
Minutes and agendas
Participation and attendance
–Expectations set

32. Step Two: Form a Powerful Coalition
Identify key stakeholders, educate them and build their interest and support
Tufts Medical Center’s Actions:
Assemble a group with shared commitment and enough power to lead the change effort
# technician members > # pharmacist members > # administrative members
Identify and meet with stakeholders
Potential Pitfalls:
No prior experience in teamwork at the top
Extra Information:
4 Key Characteristics of a Coalition:
Positional Power: Are there enough key players on board?
Expertise: Are the various points of view, relevant to the tasks at hand, adequately represented so that informed decisions can be made?
Credibility: Does the group have enough people, with good reputations?
Leadership: Does the group include enough proven leaders to be able to drive the change process?

33. Tufts Medical Center’s Experience
Examples of Advanced Technician Roles
Sterile Product Area Lead Technician
Coordinates training and annual validation/surveillance of aseptic technique
Manage responsibilities, training, and workflow
Projects: QA Program 2013 and IV workflow Fall 2013
Automation and Distribution Technician
Oversees support systems to maintain automated dispensing cabinets (ADC)
Understands and independently uses, oversees, and troubleshoots issues
Coordinates software upgrade or hardware exchange
Project: Hospital-Wide ADC upgrade 2012
Informatics Technician
Oversees and maintains databases
Compiles and analyzes workload statistics
Project : Carousel Automation and Split-Billing Software
Triage Lead Technician
Holds technician staff accountable for performance
Oversight of med room unit inspection and ensure continuous survey readiness
Coordinates and composes schedule
Project: Pharmacy One source Upgrade 2012
Realizing that we have some advance roles within Tuft’s some examples and key roles that they have played or will play within our department
Old Version :
Ross Notes
Will spend a few minutes describing how Tufts Medical Center is advancing the practices of our pharmacy technicians
Provide an overview of our department and what we mobilized in response to the PPMI recommendations
Melissa will provide a description of how we are facilitating the advancement of the pharmacy technicians’ roles

34. Council Membership and representation
Core Areas of Practice
Pharmacy Technicians
Sterile Product Area
Central
Procurement
Informatics
Pediatrics
Perioperative Services, Infusion Center, and Clinic
Transition in Care
Automation/ Technology
Council Membership and representation
12 members
Technicians (8)
Pharmacist (3)
Chair
Technician
Facilitator
Manager
Ad Hoc Nurses
Stakeholders
Pharmacists
Nurses
Technicians
Utilizing those individuals in advance roles to be part of the council

35. “Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.” – Margaret Mead

36. Create and Communicate a Vision for Change
Step Three & Four:
Create and Communicate a Vision for Change
Create a picture of the future & how it will be different from the past
Use every vehicle possible to constantly communicate the new vision & strategies
Tufts Medical Center’s Actions:
Establish the vision = Council’s Objective
Strategy for realizing the vision
Analyze and plan
Council work
Potential Pitfalls:
Presenting a vision that’s too complicated
Under-communicating the vision
Old Version Slide details:
Answers “What’s In It For Me?” and explains individual impact
Create a picture of the future & how it will be different from the past
Develop strategies for achieving that vision
Ensure everyone understands and accepts the vision
Use every vehicle possible to constantly communicate the new vision & strategies
Strategy for realizing the vision
Analyze and Plan
Council work: start with defining the technician roles
Communicate updates and successes to key stakeholders
Work to gain credibility and leverage this for future initiatives

37. Putting it all together…
Establish the Vision
Council’s Objectives
Expand the role of team based technicians
Create opportunity for pharmacy technician specialization
Maintain competent workforce to manage growing complexities of the med use system
“Vision without action is simply dreaming”
Putting it all together…

38. Strategies for Achieving the Vision Analyze and Plan
List expected changes within the next two years
Team based technicians
Tech-Check-Tech
Perform current state analysis
Define each technician’s role
Date Collection Log
Review internal results
Current state analysis vs pilot project
Council vision in alignment with department vision
Current state analysis vs conduct a pilot project
-Analyze current advanced position if already implements and think through how to expand

39. High Impact/Importance
Activities currently being performed
Example of activities
Valued Activities
Face to face interaction with nurses, doctors, and other medical professionals on a daily basis
Compound sterile and non sterile medications
Maintenance of automated dispensing cabinet (ADC) inventory (loading, unloading, refilling) and pulling expired medications
Assist nurses with missing doses and ADC trouble shooting
Deliver medications to clinical areas (routine meds and/or stat meds and/or high cost meds)
Vault / controlled substance retrieval and delivery
Clean-Up Run: med room organized, check census, return meds
Process missing meds, purchasing drugs and supplies
Unit dose packaging/maintenance/dispensing
Complete charging/crediting

40. Step Five: Remove Obstacles
Align information, systems and processes to the vision
Identify resistors and help them see what is needed
Tufts Medical Center’s Actions :
Encourage risk taking and non-traditional ideas, activities, and actions
Recognize current activities that add value
Identify boundaries, constraints, and assumptions
Recognize resource needs and availability
Create a plan to overcome obstacles
Potential Pitfalls:
Failing to remove obstacles
Details on slide:
Encourage risk taking and non-traditional ideas, activities, and actions
Recognize current activities that add value
Identify boundaries, constraints, and assumptions
What can change, what cannot change
Recognize resource needs and availability
Create a plan to overcome obstacles
Key elements for success
Potential Pitfalls:
Failing to remove obstacles

41. Identifying obstacles: Council Feedback
Questions to ask
What potential physical barriers in a pharmacy department should be considered?
What additional education and training will individual members need in order to implement the desired change?
What types of resistance or “push-back” might be anticipated from pharmacist , nurses, or others outside the pharmacy department?
Council’s Exercise
What can change?
What cannot change:
Staffing Allocation
Responsibilities of technicians that are not required and do not add value
Regulations that prevent technicians from assuming pharmacist responsibilities (may require us to apply for a Board exemption)
No new FTE positions-change in FTE must come from within existing resources
Technology resource allocation

42. Plan Overcoming Obstacles
Key elements for success
Advocate for technological resources to support safe, effective, and efficient medication use system and aid the role of pharmacy technician
Collaboration with other councils
Streamline operations and reallocate resources to allow for a decentralize technician model
Operations Improvement Council
Optimize decentralized pharmacy service
Pharmacy Advancement Council
Prepare, train, and educate technicians to take on new roles
Education and Training Council

43. Step Six: Create Short-term Wins
Plan for visible improvements in performance, or “wins”
Create short-term targets, not just one long-term goal
Tufts Medical Center’s Actions :
Separate initiatives to deliverables
High impact/high feasibility items
Prioritize “low hanging fruit”
Define and engineer visible performance improvements
Potential Pitfalls:
Leaving short-term successes up to chance
Old version notes :
Create clear, visible success stories early in the process
Plan for visible improvements in performance, or “wins”
Create short-term targets, not just one long-term goal
Visibly recognize & reward people who make the win possible
Tufts Medical Center’s Actions :
Build momentum
Separate initiatives to deliverables
High impact/high feasibility items
Prioritize “low hanging fruit”
Define and engineer visible performance improvements
Potential Pitfalls:
Leaving short-term successes up to chance
Failing to score successes early enough (no short term results)

44. High impact & High Feasibility Items
Activities NOT currently performed
Activities and recommendations
Impact
Feasibility
Be seen and utilized as the drug distribution expert –service based technicians
Communicate drug shortages or unusual utilization
Transfer meds with patient between units
Gather patient data (i.e., labs, insurance, etc.)
Assist with insurance / prior authorizations
Track med delivery from pharmacy to floor
Adjust inventory levels and locations in ADMs
Develop and use reports to prioritize workflow
Collect and summarize department quality data
  
Transition-Literature ( Mentioned by Ross)
High Impact (value-added activities):
High Feasibility:   

45. Prioritize “Low Hanging Fruit”
5. Initializing or receiving communication
Missing doses
Medication status
High utilization
Drug shortages
7. Discharge process- insurance and prior authorizations inquiries
6. Oversight when patient’s are transferred
4. Drip Rounds-Monitoring of continuous infusions
2. Daily monitoring of override reports
Collection of data from practice advancement council and TAC
3. Collection of and following up of written orders
1. Pulling and receiving narcotics
Low hanging fruit = All distributive functions that do not require clinical judgment currently completed by a pharmacist 45

46. Implement the Process: Create Short Term Wins
Incremental approach versus big bang
Used the Plan, Do, Check, Act (PDCA) model to guide implementation
High impact/high feasibility items
“Low hanging fruit”
A P
C D
Override Reports
Plan: report collected and reviewed by technician.
Do: Reallocate task - Follow up on discrepancies with Pharmacist and/or health care provider.
Check: Number of overrides reconciled accurately
Act: Continue with plan
Improvement Ramp

47. Step Seven and Step Eight: Build on the Change and Anchor the Changes
Consolidate improvements and produce more change
Leverage quick wins to build momentum for change
Communicate change, the impact and the value; provide ongoing documentation
Tufts Medical Center’s Actions:
Build momentum for change
Publish results (tell the story)
Demonstrate value
Potentials Pitfalls:
Declaring victory too soon
Old slides
Tufts Medical Center’s Actions:
Build momentum for change
Publish results (tell the story)- Tuft’s Experience
Recognize what is important and what matters to stakeholder
Demonstrate value
Recognize & reward new behavior to embed into new culture
Potentials Pitfalls:
Declaring victory too soon – with the first performance improvement

48. Tuft’s Experience Pharmacy Extenders- Team Based Technicians
Pediatric team based technician
Responsible for specific nursing units
Delivering IV run, oral syringes, pediatric pull, narcotics, refilling automated dispensing systems, finding missing doses, following up with stat doses
Available by pager
Available for assisting decentralized pharmacist with request
Metrics
Percentage decrease of pharmacist time on task of distributive functions
Increased level communication between inpatient pharmacy and the units
Increased communication about medication turn around time
PDCA (PDc)
Pediatric team based technician
Responsible for specific nursing units
Delivering IV run, oral syringes, pediatric pull, narcotics, refilling automated dispensing systems, finding missing doses, following up with stat doses
Available by pager
Available for assisting decentralized pharmacist with request
Lessons learned
Not everyone can be placed in roles where they need to interact with other health care providers
Amount of autonomy
Define responsibilities and medication distribution model clearly
Hourly delivery runs not occurring on a consistent base
Role turns into a runner
New tool developed
Pediatric performance indicator log

49. Tuft’s Experience Pharmacy Extenders- Team Based Technicians
Lessons learned
Not everyone can be placed in roles where they need to interact with other health care providers
Amount of autonomy
Define responsibilities and medication distribution model clearly
New tool developed
Pediatric performance indicator log
Recognized benefits
Potential to reduce readmission rates, prevent or mitigate medication errors
PDCA (A) \
Conclude with Tufts Next Steps ( Expands the role of team based technicians) and allow for Ross to define when as a department and council we will be success full
Ross to go over & Articulate the connections between new behavior & organizational success

50. Tuft’s Experience Measure the Impact
Recognize and reward new behavior to embed into new culture
****Most importantly***
Example of the stories we shared at the staff meeting and intangible benefits
Conclude with Tufts Next Steps ( Expands the role of team based technicians) and allow for Ross to define when as a department and council we will be success full
Ross to go over & Articulate the connections between new behavior & organizational success

51. When We Succeed … What Will We Have?
Technician Advancement Council:
Empowerment to provide drug distribution services
More engaged and productive pharmacy technician workforce
Greater accountability for customer service to team-based units
Department of Pharmacy
More engaged and productive pharmacist workforce
Ability to refocus time toward optimizing care or expanding scope
Tufts Medical Center
Improved patient satisfaction
Increased adherence and decreased readmissions
Conclude with Tufts Next Steps
Change management through Council structure
Expand the role of team based technicians
Define when as a department and council we will be successful

52. What Barriers are Standing in Our Way
What could get in the way of our success?
Allow audience to respond … offer ideas:
Organization-wide support
Departmental commitment
Laws
Training
Professionalism
Resource Constraints

53. We Have Met the Enemy and …
Famous quote from author Walt Kelly’s cartoon character named Pogo …

54. Who Has A Success Story to Share?
Innovative Role for a Technician
Exemption from the Board or the DPH

55. How Can MSHP Support Tech Advancement?
Open Discussion
Questions
questions along the lines of the most innovative role assigned to a technician
questions of what tasks seem inappropriately managed by pharmacists