Presentation on theme: "Lisa Anne Boothby, PharmD, BCPS Director of Pharmacy, Dukes Memorial Hospital."— Presentation transcript:
Lisa Anne Boothby, PharmD, BCPS Director of Pharmacy, Dukes Memorial Hospital
Demonstrate the value of clinical pharmacy services to decrease 30-day readmission rates Outline the pharmacist’s role in reducing medical waste Detail ethical issues associated with drug shortage management
Patient Accountability and Affordable Care Act Pharmacists are “other healthcare providers” Social Security Act Part B versus Part D Three MTM billing codes Private insurance reimbursement follows Smock N. Affordable Care Act Regards Pharmacists as Health Care Providers, Not Just Prescription Dispensers. Available at URL: Regards-Pharmacists-as-Health-Care-Providers-Not-Just-Prescription-Dispensershttp://www.pharmacytimes.com/publications/issue/2013/January2013/Affordable-Care-Act- Regards-Pharmacists-as-Health-Care-Providers-Not-Just-Prescription-Dispensers
Capitated healthcare precede reimbursement May decrease need for pharmacy billing Share in savings once minimum achieved Accountable care organizations Not all hospitals have embraced Pilot programs Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
Providers accountable Achieving quality Reductions in rate of spending growth Physician led with many payer arrangements National Committee for Quality Assurance Established ACO criteria 7 categories with 4 levels Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
To reach critical mass Incorporate multiple payers or multiple hospitals Apply for a CMS wavier to include Medicaid patients Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
Patient centered medical homes Led by physician Include pharmacist, nurse and other health care practitioners Treat patient with chronic conditions Prevent adverse events and optimize therapy Team ensures all health care needs are met Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
Improve medication management Preventing hospital readmissions Decreases revenue in a traditional hospital budgetary model Daigle L. Pharmacists Role in Accountable Care Organizations. ASHP Policy Analysis. ASHP, 2011.
Keep patients healthy and out of the hospital VA collaborative practice model Prescribing privileges More than 20 years of success Pharmacist credentialed providers
Medication management Preventing disease Maintaining cardiovascular health Preventing end organ damage Medication compliance, adherence Therapeutic drug monitoring Supportive care
1 month study at Mission Hospital 735 bed community teaching hospital Asheville, North Carolina Pre-post design 2 weeks normal routine 2 weeks with clinical pharmacist Simone A. Physician-Pharmacist Team Improves Hospital Care. Published June 20, Available at
Drug information Discharge counseling Medication interventions Medication reconciliation Filling discharge prescriptions Submit discharge summaries Simone A. Physician-Pharmacist Team Improves Hospital Care. Published June 20, Available at
15-day and 30-day readmission rates Number of ED visits Employee satisfaction surveys Simone A. Physician-Pharmacist Team Improves Hospital Care. Published June 20, Available at
33% vs. 17% readmission within 30 days 11% vs. 2% readmission within 15 days 9% vs. 4% ED visits within 30 days Simone A. Physician-Pharmacist Team Improves Hospital Care. Published June 20, Available at
Prospective cohort 729 patients over three months Pharmacy medication reconciliation 30-day readmission rate Polypharmacy and readmission rate Pal A., Babbott S, and Wilkinson T. Can the use of a discharge pharmacist significantly decrease 30-day readmissions? Hospital Pharmacy 2013;48(5):
Med reconciliation and counseling Decreased 30-day readmission rate 16.8% vs. 26%; p=0.006 Polypharmacy More than 5 scheduled medications Associated with increased readmission rates Pal A., Babbott S, and Wilkinson T. Can the use of a discharge pharmacist significantly decrease 30-day readmissions? Hospital Pharmacy 2013;48(5):
Walgreens program Reduces readmissions Pharmacists oversee medication regimens Transitions of care Walgreens Program Employs Pharmacists to Reduce Hospital Readmissions. November 20,
Med review at admission and discharge Bedside medication delivery Counseling for patients and their caregivers Regularly scheduled follow-up post discharge 24-7 support for discharged patients Ensure follow up with physician Ensure appropriate self care Marian General and Lutheran Hospital Walgreens Program Employs Pharmacists to Reduce Hospital Readmissions. November 20,
11 pharmacists Vanderbilt University Brigham and Women’s Hospital Medication reconciliation Time consuming Most important contribution Improving care transitions Correct the admission medication history Haynes KT, Oberne A, Kripalani S. Pharmacists’ recommendations to improve care transitions. Ann Pharmacother 2012;46(9):
Translation to a rural critical access hospital Minimal resources Decreased ED visits decreases admissions Decreased revenue with traditional models Next steps?
Medication reconciliation process Physician and nurse driven 2 to 3 errors per each Follow-up by pharmacy Clarify and correct errors Time intensive Increased safety risk Omissions Delays and duplications
Develop criteria for consultation Greater than 10 scheduled medications High-alert medications Anticoagulants Core-measure disease states
INCOMPATIBLE HAZARDOUS WASTE Aerosols Inhalers Oxidizers Silver nitrate REGULAR TRASH Outside packaging Empty items that once contained medication Shipping packaging Recycle paper, glass, plastic P-LISTED HAZARDOUS WASTE Coumadin plus wrapper Nicotine plus wrapper and peel HAZARDOUS WASTE Insulin Some vitamins and minerals Phenylephrine NON- HAZARDOUS RX WASTE Antibiotics Lidocaine Pitocin Heparin SHARPS Needles and broken ampoules Empty syringes SEWER IV dextrose Potassium Saline Sodium Calcium lactated ringers magnesium CHEMO WASTE Smith CA. Managing Pharmaceutical Waste. Journal of the Pharmaceutical Society of Wisconsin 2002;17-22.
Save money, prevent delays and omissions Clinical pharmacists know formulary medications Clinical pharmacists prevent non-formulary and not-available medication orders at admission Formulary management policies/procedures Therapeutic interchange programs Evaluate PAR levels for expired drugs
Outpatient prescribing practices Polypharmacy Lack of follow-up Mail order pharmacies automatic renewals Three month supplies Compliance Adherence Persistence
Controlled substance regulation Changes from DEA Expected in future Vendors Stericycle, others … Environmentally conscious disposal
Therapeutic interchange Drug classes Pharmacodynamics of medications Superior therapeutic alternatives Evidence based medicine Avoid grey market distributers
Receive s for information only Plan ahead Keep adequate inventory levels Medications dispensed daily Accept small loss with expired medications To stock adequate levels Prevent drug shortages from reaching patient
Aminophylline Sincalade Nalbuphine Dextrose 25% and 50% syringes Furosemide IV Metoclopramide IV Fentanyl IV Potassium phosphate IV
Pharmacists vital part of the healthcare team Pharmacotherapy experts Explain how medications work in the body Suggest therapeutic alternatives Eliminate therapeutic duplications
Avoid polypharmacy Teach common side effects Action for severe side effects Ethical stewardship Medical and financial resources
PHARMACY COST CENTER
Collaboration Rural health hospitals Payers Obtain grant money Research New practice models Demonstrate added value
Lisa Anne Boothby, PharmD, BCPS Director of Pharmacy, Dukes Memorial Hospital