Presentation on theme: "Anthony P. Morreale, Pharm. D"— Presentation transcript:
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 ResearchAnthony MorrealeNational Director, Clinical Pharmacy Program and Outcomes AssessmentHeather OurthNational Director, Clinical Pharmacy Policy and StandardsJulie GroppiClinical Pharmacy Management AnalystKim 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 StatesThis 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 2010The 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 nationMembership includes VISN Pharmacy Executives, Pharmacy Chiefs/Associate Chiefs, Clinical Pharmacy SpecialistsMeet bimonthly via teleconference
5 Clinical Pharmacy Advisory Group To date four national meetings have been heldMeetings 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 assessment2. Create a Standardized clinical pertinence review process3. Create PACT action plan requirement for Pharmacy (Request from Chiefs)4. Assure a smooth transition of CPS from anticoagulation into other clinical areas5. Create Standardized Competency Assessment documents for similar jobs6. Establish a baseline of clinical services through a survey and measurement process7. Establish priorities for educational programming for leaders to enhance program implementation8. Create uniform system of Scope of Practice which incorporates FFP9. Establish Tele-work Proposals and New Models of Care10. Explore expanded use of clinical pharmacy technicians to enhance CPS efficiency
6 Clinical Pharmacy Executive Board (CPEB) Chartered in 2012, first meeting in Jan 2012Key Physician-thought leaders and PBM pharmacy leadershipGoals:Create a transformational plan that will provide the basis for initiatives and the strategic plan for CPPOFully 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=SharedStarted populating with Medical Home now working on all other specialty areas like anticoagulation, oncology, nephrology etc. Content to includeBusiness plans / staffing justificationsPeer reviewCompetenciesScope of practiceLiterature sourcesFunctional statements and performance statementsResearch ideasStaffing calculatorsData collection sourcesContact peopleLinks to useful sites such as VACO library
8 Position Statements / Field Guidance ReleasedStatements on recommended PACT staffing of Clinical PharmacistsStatement on centralized AnticoagulationStatement on External Funding for TravelUnion involvement in performance standardsPosition Paper on use of RN’s protocols to Manage medications in chronic conditions within PACTPACT business rulesEquivalent experience as applied to Scope of PracticeDSS guidanceDC RX redesignScope of PracticeOPPE GuidanceIn ProgressFiscal Glide Path education for ChiefsTele-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 managerVACO provided funding for the Director to travel intensely to local, regional and national meetingsTremendous 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 GroupVPE’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 PharmacistsTo 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 PharmacistsTo 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 VHADevelopment of the first VHA Clinical Pharmacy HandbookRevisions 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 revisionDevelopment of a CPRS tool to document clinical pharmacy interventions that characterizes the role of the CPS in practicePharmacists Achieve Results with Medications Demonstration (PhARMD) ProjectData 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 careClinical 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 CarePACT Business Rules and development of Specialty Care Business Rules and Staffing ModelsEmphasis 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 PractitionerDevelopment of a Policy Documents that coincide with LIP practiceCollaboration with Professional Organizations and key stakeholdersDevelopment of a communication and marketing plan for clinical pharmacySystems Redesign of the Pharmacy Practice ModelStandardize the roles of Pharmacy technicians throughout the VHA to enhance the overall performance of the pharmacy servicesIdentify additional areas of unmet clinical need in both the ambulatory care and inpatient settingsWorkgroup 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 2012PharmD ProjectClinical Pharmacy Outcomes ResearchSystems Redesign of the Pharmacy Practice ModelTeleheathAdvancing Clinical Pharmacy Specialists as Licensed Independent PractitionersPBM Clinical Pharmacy Quality AssurancePBM Clinical Pharmacy Penetration metricsMarketing and Publication Plan for Project and InitiativesIdentify Measurable Gaps in CarePrioritize National Educational Programs to advance clinical practice in areas where gaps in care for medication managementAssessing and Improving Medication Renewal, Nutritional Supplement and Supply Item Processes in VHAWorkload and Billing from 2011
16 Clinical Pharmacy Program Office Collaborating Workgroups Collaborating GroupsIntravitreal Bevacizumab (AVASTIN)PBM-Hines; Pharmacy Field expertHepatitis C CREATEPublic Health-Population HealthMedication ReconciliationPBM – Med Rec; PBM – PRE/CIPrimary Care PolicyPC; PC-FAC; PC Field expertsOffice of Nursing PolicyONS; NS Field expertsNational Antimicrobial Stewardship Task ForceInfectious Disease Program OfficeNational PBM Education Advisory GroupPBM-HinesED/UCC Med Management/Med Recon Task ForcePBM – Med Rec; ED Field expertsAcademic Detailing PilotOffice of Mental Health
17 Clinical Pharmacy Program Office Goals and Timelines in FY12 Clinical Pharmacy Handbook concurrence by end of FY12PharmD project national roll-out by 4th Quarter FY12Communication and marketing plan by end of FY12Systems Redesign Tool for use by facilities by end of FY12Identify 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 CPABEstablishing top project opportunitiesCreating a network of volunteer pharmacists and facilities who are interested in pursuing clinical pharmacy health services researchDeveloping proposals for grants and VA research foundationsAdvisory 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 countryGoal to identifying best practices and sites that needs assistance and to establish some staffing and performance normsReport 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 ProgramsDevelopment and integration of Clinical Pharmacy Policy assists with standardization of roles and responsibilities as well as supporting transformation of practice throughout VHAEducational InitiativesClinical Pharmacy Advisory Board/Clinical Pharmacy Executive BoardClinical Pharmacy Health Services Research TeamImprove pharmacy operational efficiencies-Use of Pharmacists, technicians, automationSystems Redesign of the Pharmacy Practice Model supports the role of using pharmacists, technicians and automation to the highest potentialAllows 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 techniciansLeadership boot camp educational program proposal developed in conjunction with PRRO.Develop core responsibilities for technicians and realign rolesWard inspections, Checking dispensed orders (Tech Check Tech), assist Pharmacists in non-traditional roles (below)Expanding and Standardizing roles for Pharmacy TechnicianAreas 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 trackingAugment, Standardize, and Improve technician training (develop meaningful, engaging and stimulating training opportunities), competency assessment, and professionalismImprove 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 toolsContinued PACT development and expansionSCAN/ECHO development and expansionSpecialty 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 techniciansEnhanced CommunicationsClinical Pharmacy Penetration Metrics andquality tools to monitor field guidance, handbooks and to identify sites that need supportRN Medication ProtocolsDevelopment of Clinical Pharmacy infrastructure through development of a national Clinical Practice Council system.