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

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Presentation on theme: "Reaching New Heights through Pharmacy Technician Advancement Ross Thompson, M.S., R.Ph. Director of Pharmacy Services Melissa Ortega, M.S., Pharm.D. Pharmacy."— Presentation transcript:

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 1

2 Objectives 1.Review ASHP Pharmacy Practice Model Initiative (PPMI) 2.Discuss methods for evaluating your practice setting 3.List PPMI recommendations on technician advancement 4.Highlight methodologies for facilitating practice change 5.Discuss ASHP and MSHP initiatives to facilitate change 2

3 PPMI Vision and Goals Vision 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 AJHP 2010;67:542 3

4 Translating Recommendations Into Practice 106 Recommendations ASHP Publications Policy Tools Research 4

5 5

6 Categories of Self-Assessment Criteria I.Hospital Demographics II.Optimal Practice Model Characteristics (organization) III.Optimal Practice Model Characteristics (employee/scope) IV.Advancing Information Technology V.Advancing Pharmacy Technician Roles VI.Successful Implementation of New Practice model 6

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 7

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 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. 8

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 9

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 10

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 11

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 12

13 Initiating the Change Effort at Tufts MC 13

14 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 14

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 15

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 16

17 Creating a Vision 17

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. 18

19 Pharmacy Practice Councils Four Councils Chaired by staff Wrote Charter Establish goals Plan and make change 19

20 Change Management Overview States and Phases Change is a process Themes can be categorized into –3 states Current State Transition State Remedy/Vision Desired State Pain/Urgency 20

21 “If you don’t like change, you are really going to hate being irrelevant” - Tom Peters The status quo is not an option! 21

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 Ray MD, Breland BL. Am J Health-Syst Pharm—2011;68:

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? 23

24 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 Kotter’s 8-Step Change Model Leading Change, John P. Kotter, HBR,

25 The 8 Step Approach to Leading Change Applied: Mobilizing Practice Change: Advancing the pharmacy practice model through a technician advancement council Kotter JP. Leading Change: Why Transformation Efforts Fail. Harv Bus Rev. 1995; Leading Change, John P. Kotter, HBR,

26 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 Step One: Create Urgency 26

27 ASHP PPMI Tuft’s Action Plan RecommendationsTuftsImpactFeasibility 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 No Is the management of medication assistance programs assigned to pharmacy technicians who have appropriate education and training at your hospital? D3k No 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 High Impact: High Feasibility: Identify Gaps 27

28 Areas of Opportunity for Technicians Am J Health-Syst Pharm—Vol 68 Oct 1, 2011 UHC Practice Advancement Committee Survey*: Areas of Opportunity for Technician Deployment- Apr 2012 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%) 28

29 Pharmacy Councils 29 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. Establish Structure Around Initiative

30 Change Management Style- Finding the Balance Establish Structure Around Initiative TightLooseTight  Participative and authoritarian  Delegative and participative  Blend of authoritarian and participative I.Set goals tightly II.Be articulate and comprehensive I.Allow the team to figure it out and trust in their knowledge, skills and ability II.Delegate appropriately I.Measure results tightly II.Ensure accountability 30

31 Technician Advancement Council Council’s Charter 1.Positions  Facilitator  Chair  Liaisons 2.Objectives 3.Deliverables 4.Outcomes Guideline –Expectations Minutes and agendas Participation and attendance Establish Structure Around Initiative 31

32 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 Step Two: Form a Powerful Coalition 32

33 Tufts Medical Center’s Experience Coordinates training and annual validation/surveillance of aseptic technique Manage responsibilities, training, and workflow Projects: QA Program 2013 and IV workflow Fall 2013 Sterile Product Area Lead 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 Automation and Distribution Technician Oversees and maintains databases Compiles and analyzes workload statistics Project : Carousel Automation and Split-Billing Software Informatics 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 Triage Lead Technician 33 Examples of Advanced Technician Roles

34 Council Membership Council Membership and representation –12 members Technicians (8) Pharmacist (3) Chair –Technician Facilitator –Manager Ad Hoc Nurses –Stakeholders Pharmacists Nurses Technicians Pharmacy Technicians Core Areas of Practice Sterile Product Area CentralProcurementInformaticsPediatrics Perioperative Services, Infusion Center, and Clinic Transition in Care Automation/ Technology 34

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 35

36 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 Step Three & Four: Create and Communicate a Vision for Change 36

37 Putting it all together… “Vision without action is simply dreaming” 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 Establish the Vision 37

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 38

39 High Impact/Importance Example of activitiesValued Activities 1.Face to face interaction with nurses, doctors, and other medical professionals on a daily basis 2.Compound sterile and non sterile medications 3.Maintenance of automated dispensing cabinet (ADC) inventory (loading, unloading, refilling) and pulling expired medications 4.Assist nurses with missing doses and ADC trouble shooting 5.Deliver medications to clinical areas (routine meds and/or stat meds and/or high cost meds) 6. Vault / controlled substance retrieval and delivery 7. Clean-Up Run: med room organized, check census, return meds 8. Process missing meds, purchasing drugs and supplies 9. Unit dose packaging/maintenance/dispensing 10. Complete charging/crediting Activities currently being performed 39

40 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 Step Five: Remove Obstacles 40

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: 1.Staffing Allocation 2.Responsibilities of technicians that are not required and do not add value 3.Regulations that prevent technicians from assuming pharmacist responsibilities (may require us to apply for a Board exemption) 1.No new FTE positions-change in FTE must come from within existing resources 2.Technology resource allocation 41

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 42

43 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 Step Six: Create Short-term Wins 43

44 High impact & High Feasibility Items Activities and recommendationsImpactFeasibility 1. Be seen and utilized as the drug distribution expert –service based technicians 2. Communicate drug shortages or unusual utilization 3. Transfer meds with patient between units 4. Gather patient data (i.e., labs, insurance, etc.) 5. Assist with insurance / prior authorizations 6. Track med delivery from pharmacy to floor 7. Adjust inventory levels and locations in ADMs 8. Develop and use reports to prioritize workflow 9. Collect and summarize department quality data High Impact (value-added activities): High Feasibility: Activities NOT currently performed 44

45 Prioritize “Low Hanging Fruit” 2. Daily monitoring of override reports 3. Collection of and following up of written orders 6. Oversight when patient’s are transferred 1. Pulling and receiving narcotics 5. Initializing or receiving communication Missing doses Medication status High utilization Drug shortages 7. Discharge process- insurance and prior authorizations inquiries 4. Drip Rounds- Monitoring of continuous infusions 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 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 A P C D Incremental approach versus big bang Used the Plan, Do, Check, Act (PDCA) model to guide implementation High impact/high feasibility items “Low hanging fruit” 46

47 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 Step Seven and Step Eight: Build on the Change and Anchor the Changes 47

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 48

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 49

50 Tuft’s Experience Measure the Impact Recognize and reward new behavior to embed into new culture 50

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 51

52 What Barriers are Standing in Our Way 52

53 We Have Met the Enemy and … 53

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

55 How Can MSHP Support Tech Advancement? Open Discussion Questions 55


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