WHY THE PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE?
Why are we doing this work? b Increase in multiple chronic conditions b Alignment with HRSA Core Measures b ADEs leading cause of death and injury – IOM Report b Aging population - polypharmacy b Lack of integration of clinical pharmacy services
Why a Patient Safety & Clinical Pharmacy Collaborative? The [Senate Appropriations] Committee further encourages HRSA to establish a pharmacy collaborative to identify and implement best practices, which may improve patient care by establishing the pharmacist as an integral part of a patient-centered, interprofessional health care team. 2007 & 2008 Senate Appropriations Committee Reports Encourage Pharmacy Collaborative.
Institute of Medicine Findings on Patient Safety and Errors b Medication Errors are Most Common b Injure 1.5 Million People Annually b Cost Billions Annually …for every dollar spent on ambulatory medications, another dollar is spent to treat new health problems caused by the medication.
GOALS AND AIMS OF THE PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE?
b Improve Health Outcomes by implementing effective patient safety principles and clinical pharmacy services b Improve Patient Safety Fewer errors, fewer injuries, less harmFewer errors, fewer injuries, less harm b Increase High Quality, Cost-Effective Pharmacy Services Maximizing and enhancing medication use managementMaximizing and enhancing medication use management Patient Safety & Clinical Pharmacy Collaborative Goals
Emerging Aims Clinical Pharmacy Services and Patient Safety b More clinical pharmacy for complex patients b More management of high risk medications b Fewer drug-drug interactions b Fewer potentially inappropriate medications b Medication reconciliation for 100% of patients b Healthcare organizations develop and sustain a culture of medication safety
Value Proposition Organizations can achieve better health outcomes for patients through safer, integrated clinical pharmacy services. Organizations can achieve better health outcomes for patients through safer, integrated clinical pharmacy services.
WHAT IS THE PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE?
What are clinical pharmacy services? b Patient-centered services that promote the appropriate selection and utilization of medications to optimize individualized therapeutic outcomes b Provided by an inter-disciplinary healthcare team through individualized patient assessment and management b Services best provided by a pharmacist or by another healthcare professional in collaboration with a pharmacist
What is the Patient Safety & Clinical Pharmacy Collaborative? b 18 month rapid learning model that creates a community of learning, bringing together interdisciplinary teams from multiple types of organizations focused on improving health outcomes by focusing on improved patient safety and clinical pharmacy services. b Collaborative learning is accomplished by using learning sessions, action periods, Web training and listservs to measure, report and track improvement. Led by an expert faculty poised to help test and implement successful practices.
Care Transitions and Handoffs Specialist Patient Multiple Conditions Primary Care Home(s) Hospital ED Hospital Inpatient
Pharmacy Services Specialist Care Transitions and Handoffs Patient Multiple Conditions Conditions For A Disaster Hospital Inpatient Primary Care Home(s) Hospital ED
Hospital Inpatient Hospital ED Primary Care Home(s) Specialist Patient Self- Management Care Transitions and Handoffs Pharmacy Services Clinical Pharmacy Services Patient Multiple Conditions
Clinical Pharmacy Services Integrated Patient Care Optimum Health Outcomes No Adverse Events Patient Patient Safety Pharmacy Collaborative
Learning Collaborative Engine D SA P D SA P Adapted from IHI Breakthrough Series Collaboratives IHI.org Select Topic Planning Group Identify Change Concepts Enroll Participants Prework LS1 LS3 LS2 Supports Listserv Site Visits & Filming Conference Calls Rapid Sharing Team Reporting Web site Leadership Coordinating Council LS 4 AP1AP3AP2 PDSA=Plan, Do, Study, Act LS= Learning Session AP=Action Period D SA P
Patient Safety & Clinical Pharmacy Collaborative – Next Steps b Share the information with potential partners b Engage with community partners b Engage senior leaders in the vision b Secure support for participation b Review participation package on: b Review participation package on: http://www.hrsa.gov/patientsafety http://www.hrsa.gov/patientsafety b Submit Team Participation Package
State Based Organization Partners b State Primary Care Associations b State Primary Care Offices b State Offices of Rural Health b State Hospital Associations b State Pharmacy Associations b State AIDS Directors b Quality Improvement Organizations b Foundations b Institute for Healthcare Improvement (IHI) Campaign Nodes b Health Center Network Leaders b Area Health Education Centers b Others Who Want to Help Enroll and Support Collaborative Teams
Teams of providers from multiple caregiver organizations in a community who want to improve the quality and safety of care for a defined patient population they together serve: Health Centers Rural Health Clinics Critical Access Hospitals Disproportionate Share Hospitals HIV AIDS Clinics Others (inclusivity is encouraged) Who will join?
Key Benefits of Participation in the PSPC b Its the Right Thing to Do for the Patients We Serve SaferSafer More, Better Pharmacy ServicesMore, Better Pharmacy Services Improved Health OutcomesImproved Health Outcomes b Reduces/Manages Risk – and Risk is Increasing b Builds on and Takes Prior Experience to a New Level IntegratedIntegrated Takes HRSA Collaborative Experiences to the Next PowerTakes HRSA Collaborative Experiences to the Next Power
What will the teams do? Commit to Collaborative aims Commit time and effort Designate consistent members to attend all 4 Learning Sessions and support travel Measure and track progress Share activities and results Align with team around continuity of care Bring their organizations senior leader(s) to Learning Sessions
EVMS PSPC TEAM Working together to improve Services, Safety and Quality of Care for all our consumers!
Basic Facts on the EVMS Patient Safety & Clinical Pharmacy Services Collaborative b Primary Health Care Home Organization: Eastern Virginia Medical School, Norfolk, Virginia b Team Name: Eastern Virginia Medical School Patient Safety & Clinical Pharmacy Services Collaborative b Motto: Communication, Collaboration and Commitment b Team Leader: Judy Wessell, Nurse Practitioner The collaborative is composed of staff from EVMS, peer educator consultants, the Gloucester County Health Dept, and an independent PharmD.
Thanks to VDH for the financial and technical assistance to the Easterns EVMS PSPC team.
HRSA Five Strategies b Leadership Commitment b Measurable Improvement b Integrated Care Delivery b Safe Medication Use System b Patient Centered Care
PDSA-Worksheet for Testing Change b Aim: (overall goal you wish to achieve) Every goal will require multiple smaller tests of change b Plan b List the tasks needed to set up this test of change: Person responsible, When to be done, Where to be done b Predict what will happen when the test is carried out b Measures to determine if prediction succeeds b Do b Describe what actually happened when you ran the test b Study b Describe the measured results and how they compared to the predictions b Act b Describe what modifications to the plan will be made for the next cycle from what you learned
EVMS Change Package
Clinical Pharmacy Services The following are core elements of CPS which patients are currently receiving at the Gloucester County care site: Patient counseling Patient counseling Preventive care programs (smoking cessation) Preventive care programs (smoking cessation) Retrospective Drug Utilization Review (ADE/ADR) Retrospective Drug Utilization Review (ADE/ADR) Medication Therapy Management (Med reconciliation, Triple HAART, hepatic/renal evaluation) Medication Therapy Management (Med reconciliation, Triple HAART, hepatic/renal evaluation) Disease State Management (Viral Load/CD4, Lipid/metabolic evaluation) Disease State Management (Viral Load/CD4, Lipid/metabolic evaluation) Prospective chart review (co-morbid disease) Prospective chart review (co-morbid disease)
Pharm D and RN Educator Pharm D and RN Educator Pharmacy Access Pharmacy Access Medical Case Management at Gloucester Health Department Medical Case Management at Gloucester Health Department Local P A T I E N T Mail Order ADAP EVMS HIV Treatment at Gloucester Health Department Oral Health Oral Health EVMS Urgent HIV Care at Norfolk EVMS Urgent HIV Care at Norfolk Social Case Mgt. and Ancillary Support Social Case Mgt. and Ancillary Support Patients P.C.P. or Specialty Care Site Patients P.C.P. or Specialty Care Site Local Hospitals for Diagnostics and Treatment Local Hospitals for Diagnostics and Treatment Sites of Clinical Pharmacy Services Local Service Providers Non-medical Sites EVMS PSPSC: Patient Flow Across Providers
An example in improvements in health outcomes b b Cohort:Entire Population of Focus b b Safety Measure: Establishment of, or collaborating with, a patient-centered health care home. Measure Improvement: The process of consultation with a patients PCP or other provider in order to do a medicine reconciliation establishes the need for, or number of, changes from baseline. Display: Electronic medical record medicine list from EVMS. Use: CPS will verify record at each encounter, thereby, Promoting patient health literacy and self care involvementPromoting patient health literacy and self care involvement Developing a protocol communication between participants in the healthcare processDeveloping a protocol communication between participants in the healthcare process Establishing and maintaining responsive linkages between local service providers and the delivery of patient care -- addressing the unique needs of an HIV+ population.Establishing and maintaining responsive linkages between local service providers and the delivery of patient care -- addressing the unique needs of an HIV+ population.
EVMS PSPSC: WERE GROWING AND WERE DIVERSE!! Cindy Lewis, EVMS RN Educator Judy Wessell, EVMS Nurse Practitioner Tanya Kearney, Dir. AIDS Resource Center Fred Casey, Project Off. Ryan White Part B Allison Gray, RN Clinical Quality Coord. Janet Hall Consumer, Ryan White Part B Pierre Diaz Consumer, Ryan White Part A Dr. Virginia Walker Contract Pharm D Rick Hall, Health Counselor Three Rivers Health Dept. MOST OF OUR HAPPY FAMILY