2. Want to be a Farmer for New Pharmacy Technician Services? What “crops” do you prefer to plant, nurture and harvest? What “crops” do you prefer to plant, nurture and harvest? What are your facility’s identified needs that remain unmet? What are your facility’s identified needs that remain unmet? How can you position yourself in win/win situations? How can you position yourself in win/win situations? What “farming” opportunities are on the horizon What “farming” opportunities are on the horizon (e.g., VA Home Care Model)?

3. Factors to Consider Before Planting Seasonal Weather and Expected Forecasts Seasonal Weather and Expected Forecasts Political Culture & Fiscal Status at Your Facility Political Culture & Fiscal Status at Your Facility Anticipated Needs For Your Product and Suppliers Anticipated Needs For Your Product and Suppliers Resources Available & Stakeholders Involvement Resources Available & Stakeholders Involvement Amount of Attention Your Crop May Need To Thrive Amount of Attention Your Crop May Need To Thrive Time and Effort………….. Time and Effort………….. Profitability of The Yield Profitability of The Yield Tangible/Objective Outcome Measures Tangible/Objective Outcome Measures Mechanisms to Market Successes Mechanisms to Market Successes Drive and Desire to “toot your own horn” Drive and Desire to “toot your own horn”

4. Phoenix VA Pharmacy “Plantings” Clinical Technician Positions Approved (GS 7) – 1998 Clinical Technician Positions Approved (GS 7) – 1998 Pioneered the Classification and Hiring of This Position Within VHA Pioneered the Classification and Hiring of This Position Within VHA Initial Crop: (2 ACS & 2 ICS) Initial Crop: (2 ACS & 2 ICS) Two Additional in Both 2000 & 2002 Two Additional in Both 2000 & 2002

5. Phoenix VA Pharmacy “Plantings” Example Functions (ICS) Inpatient Care Support – Current Emphasis on Discharges Inpatient Care Support – Current Emphasis on Discharges Maintain Same Day/Anticipated Discharge Patient List(s) Maintain Same Day/Anticipated Discharge Patient List(s) Review/Evaluate Pertinent Provider Discharge Guidance Review/Evaluate Pertinent Provider Discharge Guidance Medicine/Hospitalist/Pharmacist Note(s) Plan etc. Medicine/Hospitalist/Pharmacist Note(s) Plan etc. EPRP Indicators (Example – CHF Indicator) EPRP Indicators (Example – CHF Indicator) Medication/Disease Specific Discharge Packets Medication/Disease Specific Discharge Packets Med/Disease Specific Care Notes etc. Med/Disease Specific Care Notes etc. Routes/Reviews Medications Filled For Discharge Routes/Reviews Medications Filled For Discharge Remote Data Comparison Where Applicable Remote Data Comparison Where Applicable Enters Discharge Med List Template (CPRS) – Pharmacist Cosigner Enters Discharge Med List Template (CPRS) – Pharmacist Cosigner Medication Reconciliation Processes Medication Reconciliation Processes Others as Opportunities/Needs Present Others as Opportunities/Needs Present

6. Phoenix VA Pharmacy “Plantings” E xample Functions (ACS) Ambulatory Care Clinic Support Ambulatory Care Clinic Support Disease Management Clinic Support (Ex. HTN Clinic) Disease Management Clinic Support (Ex. HTN Clinic) Zoladex® Clinic Medication Coordination Zoladex® Clinic Medication Coordination Medication Conversion Assistance (Ex. Too many to count!) Medication Conversion Assistance (Ex. Too many to count!) Medication Box Fill Clinic Medication Box Fill Clinic Triaging Resource (phone as well as in clinic) Triaging Resource (phone as well as in clinic) Others as Opportunities/Needs Arose Others as Opportunities/Needs Arose

7. Phoenix VA Pharmacy “Plantings” E xample Functions (ACS) - Cont’d Anticoagulation Clinic Support Anticoagulation Clinic Support Direct Patient Care/Provider Communication Direct Patient Care/Provider Communication Phone Interviewing Phone Interviewing Running/Reporting Laboratory Results Running/Reporting Laboratory Results Communicating Clinical Pharmacist Change Recommendation Communicating Clinical Pharmacist Change Recommendation Facilitate medication renewals and lab numbers Facilitate medication renewals and lab numbers Documents via CPRS Progress Notes Patient Interview Results/ Findings / Change Communications Documents via CPRS Progress Notes Patient Interview Results/ Findings / Change Communications (2 FTE Clinical Technicians) + (2FTE Clinical Pharmacists) (2 FTE Clinical Technicians) + (2FTE Clinical Pharmacists) Manages ~ 2400 patients Manages ~ 2400 patients (1 FTE Clinical Pharmacy Specialist Recently Approved) (1 FTE Clinical Pharmacy Specialist Recently Approved)

8. Profits of the Yield Team Committees Team Committees Pharmacy & Hospital-Wide Pharmacy & Hospital-Wide Regional Technician Board Regional Technician Board State-Wide & National Poster/Lecture Presentations State-Wide & National Poster/Lecture Presentations Publications Publications Weber EW, Cohn-Oswald L, Hepfinger C, et al. Weber EW, Cohn-Oswald L, Hepfinger C, et al. Clinical Pharmacy Technicians: A Valuable Resource Clinical Pharmacy Technicians: A Valuable Resource For Clinical Pharmacists. Fed Pract. 2004;21(11);22-32 For Clinical Pharmacists. Fed Pract. 2004;21(11);22-32 Individual Professional Growth / Satisfaction Individual Professional Growth / Satisfaction Individual Fiscal Growth Individual Fiscal Growth

9. Future Crops? VA Home Care Model? Current Staffing: Primary Care PharmacistFTE Clinical Pharmacists12.8 Anticoagulation Pharmacists2 14.8 Projected Staffing: PC Home ModelProjected FTE Clinical Pharmacists16.5 Anticoagulation Pharmacists11

10. What Are Your Facility Crop Needs? Medical Home Care Model Is there a role to Incorporate Clinical Pharmacy Technicians Into This Care Model? Medication Reconciliation (Both Inpatient/Ambulatory Care)? Triaging Support (In Clinic/House, Telephone Opportunities? Pharmacoeconomic Opportunities (Medication Conversions)? Direct Patient Care/Patient Focused Care Needs Overall Enhancing Operational Functions Which Would Optimize Clinical Functions/Interactions for Clinical Pharmacists ( MTM Services/Disease Specific Clinics)

11. VHA Technician’s Source: https:/vssc.med.va.gov 6% 27% 56% 10% 1%

12. Evaluate Seasonal Weather and Forecasts (Facility Needs/Priorities) Establish What Farming Equipment You Have (What Resources/Time/Staff Available to Utilize) Identify Stakeholders and Seek Buy In (What Crops are Likely to Yield Profits) Plant – Nurture/Mentor – Harvest Experience the Profitability of The Yield