1. New Chief Orientation Clinical Pharmacy Program Office (CPPO) Overview 2012
Anthony P. Morreale, Pharm.D., MBA, BCPS Assistant Chief Consultant for Clinical Pharmacy Services  and Healthcare Delivery Services Research Pharmacy Benefits Management Services (119) Department of Veterans Affairs

2. Clinical Pharmacy Program Office Team Composition
Assistant Chief Consultant for Clinical Pharmacy Services & Healthcare Delivery Services Research
Anthony Morreale
National Director, Clinical Pharmacy Program and Outcomes Assessment
Heather Ourth
National Director, Clinical Pharmacy Policy and Standards
Julie Groppi
Clinical Pharmacy Management Analyst
Kim Quicci-Roberts

3. Vision for Clinical Pharmacy Practice
The PBM has been tremendously successful in creating a supportive infrastructure to manage the formulary and improve medication safety.
It is our goal to use the lessons learned and successes of those programs to expand on our leadership role in clinical pharmacy practice in the United States
This task will be accomplished by organizing, standardizing, engaging and energizing the strong leadership and clinical pharmacy base we already have.
We plan on leveraging technology, technicians, policies and communication tools to achieve these results

4. Clinical Pharmacy Advisory Board (CPAB)
Chartered in 2010
The PBM Clinical Pharmacy Advisory Board (CPAB) was formed to promote the expansion of clinical pharmacy practice within VA.
Key Pharmacy stakeholders from several sites throughout the nation
Membership includes VISN Pharmacy Executives, Pharmacy Chiefs/Associate Chiefs, Clinical Pharmacy Specialists
Meet bimonthly via teleconference

5. Clinical Pharmacy Advisory Group
To date four national meetings have been held
Meetings consisted primarily of work group activities in which topics were brainstormed and ideas flushed out. Opportunities, obstacles, priorities and timelines have been developed for implementation. The top 10 projects for implementation in were:
1. Create nationally implemented standardized workload assessment
2. Create a Standardized clinical pertinence review process
3. Create PACT action plan requirement for Pharmacy (Request from Chiefs)
4. Assure a smooth transition of CPS from anticoagulation into other clinical areas
5. Create Standardized Competency Assessment documents for similar jobs
6. Establish a baseline of clinical services through a survey and measurement process
7. Establish priorities for educational programming for leaders to enhance program implementation
8. Create uniform system of Scope of Practice which incorporates FFP
9. Establish Tele-work Proposals and New Models of Care
10. Explore expanded use of clinical pharmacy technicians to enhance CPS efficiency

6. Clinical Pharmacy Executive Board (CPEB)
Chartered in 2012, first meeting in Jan 2012
Key Physician-thought leaders and PBM pharmacy leadership
Goals:
Create a transformational plan that will provide the basis for initiatives and the strategic plan for CPPO
Fully integrate the CPS into primary and specialty care by leveraging their unique education and training to solve medication-related problems and gaps in care for our Veterans while improving medication safety and cost outcomes

7. National Clinical Pharmacy SharePoint Site
New Clinical Pharmacy SharePoint Site has finally been created harmacy/default.aspx?PageView=Shared
Started populating with Medical Home now working on all other specialty areas like anticoagulation, oncology, nephrology etc. Content to include
Business plans / staffing justifications
Peer review
Competencies
Scope of practice
Literature sources
Functional statements and performance statements
Research ideas
Staffing calculators
Data collection sources
Contact people
Links to useful sites such as VACO library

8. Position Statements / Field Guidance
Released
Statements on recommended PACT staffing of Clinical Pharmacists
Statement on centralized Anticoagulation
Statement on External Funding for Travel
Union involvement in performance standards
Position Paper on use of RN’s protocols to Manage medications in chronic conditions within PACT
PACT business rules
Equivalent experience as applied to Scope of Practice
DSS guidance
DC RX redesign
Scope of Practice
OPPE Guidance
In Progress
Fiscal Glide Path education for Chiefs
Tele-work guidance

9. Roles and responsibilities: VACO
VACO, through the creation of a Assistant Chief Consultant for Clinical Pharmacy Services position, made the initial commitment in May of 2010.
VACO also providing funding resources to hire a CP analyst, and to conduct two national Clinical Pharmacy Advisory Group meetings during FY10.
VACO Currently recruiting for a Clinical Pharmacy Program and policy manager
VACO provided funding for the Director to travel intensely to local, regional and national meetings
Tremendous commitment to support large regional boot camps.
Instrumental in establishing national standards, priorities, and policies in concert with various offices within central office.
Ultimately Hired 3 more staff to manage programs

10. Roles and responsibilities: VPE’s
Several VPE’s have been very active members of the National Clinical Pharmacy Advisory Group
VPE’s must help drive and support of expanded clinical pharmacy practices through changes in policies, creation of performance goals, and standardization of practice goals.
To lead their VISN’s in espousing our core concepts & principles and promote the cost effective use of Clinical Pharmacists
To assure that Clinical Pharmacy Practice issues are treated with equal importance to the operational, formulary and medication safety issues in each VISN.
Responsibility to communicate up-line to VACO so that we can work on their behalf. It will be important that clear feedback to VACO about what is working, what is not and what issues exist at their facilities.
Assure that all Pharmacy and non-Pharmacy leaders within their VISN's are engaged and understand the issues, mission and vision so that as leaders they can lead the charge.

11. Roles and Responsibilities: Chiefs
Support of expanded clinical pharmacy practices through changes in policies, creation of performance goals, and standardization of practice goals.
To lead their facilities in espousing our core concepts & principles and promote the cost effective use of Clinical Pharmacists
To assure that Clinical Pharmacy Practice issues are treated with equal importance to the operational, formulary and medication safety issues in each VISN. This may require a designated Clinical Pharmacy lead at each facility.
Responsibility to communicate up-line to VPE’s and VACO so that we can work on their behalf. It will be important that clear feedback to VACO about what is working, what is not and what issues exist at their facilities.
Assure that all Pharmacy and non-Pharmacy leaders within their VISN's are engaged and understand the issues, mission and vision so that as leaders they can lead the charge.
Assure that all pharmacists, no matter who they work for, have Pharmacy service oversight for scope of practice, clinical and operational competency, formulary management, and medication safety.
Assure that all their staff are engaged and understand the issues, mission and vision so that as leaders they can lead the charge.

12. Clinical Pharmacy Program Office Strategic Goals for FY12
Develop Policy to define, clarify, and standardize clinical pharmacy practice throughout VHA
Development of the first VHA Clinical Pharmacy Handbook
Revisions of key handbooks, directives, and templates to incorporate clinical pharmacy practice transformation, ensure continuity of roles and responsibilities of CPS, and changing role of pharmacists and technicians. Examples include: Coordinated Care Directive, OP Handbook, IP Pharmacy Handbook, CBOC Template revision
Development of a CPRS tool to document clinical pharmacy interventions that characterizes the role of the CPS in practice
Pharmacists Achieve Results with Medications Demonstration (PhARMD) Project
Data Extractions from CDW and National Database capabilities

13. Clinical Pharmacy Program Office Strategic Goals for FY12
Refine Quality Assurance and Outcomes research capability to take on more groundbreaking, publishable assessments of the CPS role in primary and specialty care
Clinical Pharmacy Health Services Research Team formed to seek to organize, standardize, engage and energize the strong leadership and clinical pharmacy base currently in place and to lead the profession of pharmacy through fostering research opportunities.
Further expansion of role of CPS in PACT and Specialty Care
PACT Business Rules and development of Specialty Care Business Rules and Staffing Models
Emphasis on CPS role in antimicrobial stewardship, Hepatitis C, Pain Management

14. Clinical Pharmacy Program Office Strategic Goals for FY12
Supporting the movement of the CPS as an Licensed Independent Practitioner
Development of a Policy Documents that coincide with LIP practice
Collaboration with Professional Organizations and key stakeholders
Development of a communication and marketing plan for clinical pharmacy
Systems Redesign of the Pharmacy Practice Model
Standardize the roles of Pharmacy technicians throughout the VHA to enhance the overall performance of the pharmacy services
Identify additional areas of unmet clinical need in both the ambulatory care and inpatient settings
Workgroup chartered to identify measurable gaps in care related to complex medication management and safety

15. Clinical Pharmacy Program Office Strategic Goals for FY12
Clinical Pharmacy Program Office Workgroups 2012
PharmD Project
Clinical Pharmacy Outcomes Research
Systems Redesign of the Pharmacy Practice Model
Teleheath
Advancing Clinical Pharmacy Specialists as Licensed Independent Practitioners
PBM Clinical Pharmacy Quality Assurance
PBM Clinical Pharmacy Penetration metrics
Marketing and Publication Plan for Project and Initiatives
Identify Measurable Gaps in Care
Prioritize National Educational Programs to advance clinical practice in areas where gaps in care for medication management
Assessing and Improving Medication Renewal, Nutritional Supplement and Supply Item Processes in VHA
Workload and Billing from 2011

16. Clinical Pharmacy Program Office Collaborating Workgroups
Collaborating Groups
Intravitreal Bevacizumab (AVASTIN)
PBM-Hines; Pharmacy Field expert
Hepatitis C CREATE
Public Health-Population Health
Medication Reconciliation
PBM – Med Rec; PBM – PRE/CI
Primary Care Policy
PC; PC-FAC; PC Field experts
Office of Nursing Policy
ONS; NS Field experts
National Antimicrobial Stewardship Task Force
Infectious Disease Program Office
National PBM Education Advisory Group
PBM-Hines
ED/UCC Med Management/Med Recon Task Force
PBM – Med Rec; ED Field experts
Academic Detailing Pilot
Office of Mental Health

17. Clinical Pharmacy Program Office Goals and Timelines in FY12
Clinical Pharmacy Handbook concurrence by end of FY12
PharmD project national roll-out by 4th Quarter FY12
Communication and marketing plan by end of FY12
Systems Redesign Tool for use by facilities by end of FY12
Identify additional areas of unmet clinical need in both the ambulatory care and inpatient settings. Initial plan to be completed by April 30, 2012.

18. Clinical Pharmacy Program Office Goals and Timelines in FY12
Developed Team Charter for group charged with recommending health services research priorities for evaluation by the CPAB
Establishing top project opportunities
Creating a network of volunteer pharmacists and facilities who are interested in pursuing clinical pharmacy health services research
Developing proposals for grants and VA research foundations
Advisory group developed by March 2012 with recommendations to the CPAB by September 2012.
Develop metrics to better describe clinical pharmacy penetration at facilities across the country
Goal to identifying best practices and sites that needs assistance and to establish some staffing and performance norms
Report on initial metrics by February 2012 to CPAB and CPEB. Field release of metrics through VPEs by May 2012.

19. Clinical Pharmacy Program Office Priority Areas and Activities
Enhancement of Clinical Pharmacy Programs
Development and integration of Clinical Pharmacy Policy assists with standardization of roles and responsibilities as well as supporting transformation of practice throughout VHA
Educational Initiatives
Clinical Pharmacy Advisory Board/Clinical Pharmacy Executive Board
Clinical Pharmacy Health Services Research Team
Improve pharmacy operational efficiencies-Use of Pharmacists, technicians, automation
Systems Redesign of the Pharmacy Practice Model supports the role of using pharmacists, technicians and automation to the highest potential
Allows for movement of pharmacists away from operational functions and duties and towards more direct patient care activities

20. Clinical Pharmacy Program Office Priority Areas and Activities
Improve management and advancement of pharmacy technicians
Leadership boot camp educational program proposal developed in conjunction with PRRO.
Develop core responsibilities for technicians and realign roles
Ward inspections, Checking dispensed orders (Tech Check Tech), assist Pharmacists in non-traditional roles (below)
Expanding and Standardizing roles for Pharmacy Technician
Areas such as Medication Reconciliation, Anticoagulation, Tele-Health, Poly-Pharmacy, Formulary Management, Prior Authorization review, Quality Assurance, Controlled Substance Management, OR Responsibilities, Automation Oversight and Implementation, USP 797 Oversight and Implementation (IV Room Operations), Adverse Drug Reaction Tracking, Drug Accountability, Drug Use Evaluation tracking, Safety Bulletin implementation and tracking
Augment, Standardize, and Improve technician training (develop meaningful, engaging and stimulating training opportunities), competency assessment, and professionalism
Improve communications with National Technician Groups/Forums

21. Questions & Answers Anthony P. Morreale, Pharm. D
Questions & Answers Anthony P. Morreale, Pharm.D., MBA, BCPS, FASHP Assistant Chief Consultant for Clinical Pharmacy Services and Healthcare Services Research

22. AREAS OF ACTIVE FOCUS Clinical Pharmacy Handbook
Coding, Billing and workload assessment tools
Continued PACT development and expansion
SCAN/ECHO development and expansion
Specialty Care development and expansion especially in areas of intense VA expansion or those that have high medication related needs – these include HCV, ASP, ED, High Risk Medication assessment, Pain.
Pharmacy Education - Boot Camps and Live Meetings

23. AREAS OF ACTIVE FOCUS Systems redesign
Expanding the use of technicians
Enhanced Communications
Clinical Pharmacy Penetration Metrics and
quality tools to monitor field guidance, handbooks and to identify sites that need support
RN Medication Protocols
Development of Clinical Pharmacy infrastructure through development of a national Clinical Practice Council system.