2 WHY THE PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE?
3 Why are we doing this work? Increase in multiple chronic conditionsAlignment with HRSA Core MeasuresADEs leading cause of death and injury – IOM ReportAging population - polypharmacyLack of integration of clinical pharmacy servicesIncreasing numbers of Americans with multiple chronic health conditions.Use of medications is the most common approach for the treatment of chronic conditions whose associated costs and human burden continue to growIn alignment with HRSA Core Measures, specifically in Diabetes, Cardiovascular, and HIV screeningADEs are leading cause of death and injury in the US costing billionsAging population, more medications - polypharmacyIOM: To Err is HumanLiterature supports use of clinical pharmacy services to improve health outcomes, enhance patient safety and create cost savings – current lack of integration
4 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.FY 2007 and FY 2008 Senate Appropriations Committee ReportsCollaboration with external and internal stakeholdersMajor pharmacy organizations, 340B Coalition members and othersContract with Mathmatica Policy Inc.FY 2008 Senate Appropriations Committee ReportProgram Management-…Committee commends HRSA for working with stakeholders to develop recommendations and implementt cost effective clinical pharmacy services to improve patient health outcomes as components of federally qualified health centers, rural hehospital programs, academic medical centers, Indian Health Service programs, Ryan White programs, and all HRSA supported programs in which medications play an integral part of patient care. The Committee looks forward to receiving a report of these activities. The Committee strongly encourages HRSA to continue to develop and implement cost effective clinical pharmacy programs in all aof the various safety net providers settings.The Committee further encourages HRSSA 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, interporfessional health care team.
5 Institute of Medicine Findings on Patient Safety and Errors Medication Errors are Most CommonInjure 1.5 Million People AnnuallyCost Billions Annually“…for every dollar spent on ambulatory medications, another dollar is spent to treat new health problems caused by the medication.”
6 GOALS AND AIMS OF THE PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE?
7 Patient Safety & Clinical Pharmacy Collaborative Goals Improve Health Outcomes by implementing effective patient safety principles and clinical pharmacy servicesImprove Patient SafetyFewer errors, fewer injuries, less harmIncrease High Quality, Cost-Effective Pharmacy ServicesMaximizing and enhancing medication use management
8 Emerging Aims Clinical Pharmacy Services and Patient Safety More clinical pharmacy for complex patientsMore management of high risk medicationsFewer drug-drug interactionsFewer potentially inappropriate medicationsMedication reconciliation for 100% of patientsHealthcare organizations develop and sustain a culture of medication safetyDrug-Drug Interaction: effects of one drug are altered by the administration of another drugPotentially Inappropriate Medications: example: especially drugs that are inappropriately prescribed to the elderly, like naproxen, amiodarone, long-acting benzodiazepines and anticholinergic antispasmodics which are some of the most common.
9 Value PropositionOrganizations can achieve better health outcomes for patients through safer, integrated clinical pharmacy services.
10 WHAT IS THE PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE?
11 What are clinical pharmacy services? Patient-centered services that promote the appropriate selection and utilization of medications to optimize individualized therapeutic outcomesProvided by an inter-disciplinary healthcare team through individualized patient assessment and managementServices best provided by a pharmacist or by another healthcare professional in collaboration with a pharmacist
12 What is the Patient Safety & Clinical Pharmacy Collaborative? 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.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.
13 Care Transitions and Handoffs Hospital InpatientPatientMultiple ConditionsHospital EDPrimary Care Home(s)What are the constants?one example of a flow for a patient ... with diabetes (walk them through the steps)Specialist
14 Care Transitions and Handoffs Hospital InpatientPatientMultiple ConditionsHospital EDPrimary Care Home(s)What are the constants? why are these conditions for a disaster?PharmacyServicesSpecialistConditions For A Disaster
15 Care Transitions and Handoffs PatientMultiple ConditionsHospital InpatientPatient Self-ManagementHospital EDa solution to the hand off reality could be .... self-management and clinical pharmacy services. This is only one of many ways you could map this out.Primary Care Home(s)PharmacyServicesClinical PharmacyServicesSpecialist
16 Patient Safety Pharmacy Collaborative Optimum Health OutcomesIntegrated Patient CareSo on the ground at the sites, this is what we want to see happen. A patient enters into the system where clinical pharmacy services are delivered as a major component of car. We will then measure the results and outcomes of that integrated care through optimization of health outcomes and limiting adverse events.So what is the value in this……System improvements in pharmacy services will improve outcomes and safety for your patients across a broad range of chronic conditions. …we’re ready to go beyond improvements one disease at a time!Integrated Clinical Pharmacy Services and Improved Patient Safety Lead to Better Patient Health OutcomesANDChronic Disease serves as a marker for detecting improvement in the systemClinical Pharmacy ServicesNo Adverse Events
17 Learning Collaborative Engine Enroll ParticipantsSelect TopicPreworkIdentify Change ConceptsPlanning GroupLS1AP1LS2AP2LS3AP3LS 4LS4PDSA=Plan, Do, Study, ActLS= Learning SessionAP=Action PeriodSupportsListserv Site Visits & FilmingConference Calls Rapid SharingTeam Reporting Web siteLeadership Coordinating CouncilAdapted from IHI Breakthrough Series Collaboratives IHI.org444
18 Patient Safety & Clinical Pharmacy Collaborative – Next Steps Share the information with potential partnersEngage with community partnersEngage senior leaders in the visionSecure support for participationReview participation package on:Submit Team Participation Package
20 State Based Organization Partners State Primary Care AssociationsState Primary Care OfficesState Offices of Rural HealthState Hospital AssociationsState Pharmacy AssociationsState AIDS DirectorsQuality Improvement OrganizationsFoundationsInstitute for Healthcare Improvement (IHI) Campaign NodesHealth Center Network LeadersArea Health Education CentersOthers Who Want to Help Enroll and Support Collaborative Teams
21 Who will join?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 CentersRural Health ClinicsCritical Access HospitalsDisproportionate Share HospitalsHIV AIDS ClinicsOthers (inclusivity is encouraged)Examples of other possible team members include outpatient ambulatory care clinicians and leaders, HIV and Women’s Health Organizations, state and local health departments, social services, mental health, home care and other non-physician staff who participate as part of an extended primary healthcare team.
22 Key Benefits of Participation in the PSPC It’s the Right Thing to Do for the Patients We ServeSaferMore, Better Pharmacy ServicesImproved Health OutcomesReduces/Manages Risk – and Risk is IncreasingBuilds on and Takes Prior Experience to a New LevelIntegratedTakes HRSA Collaborative Experiences to the Next Power
23 What will the teams do? Commit to Collaborative aims Commit time and effortDesignate consistent members to attend all 4 Learning Sessions and support travelMeasure and track progressShare activities and resultsAlign with team around continuity of careBring their organizations’ senior leader(s) to Learning SessionsCommit to the overarching Aims of the CollaborativeCommit time and effort to testing and adapting changesAttend all 4 Learning Sessions (some may be State or Regional) and pay for their travelMeasure and track progress and share activities and results with their senior leaders and other teamsBring all organizations on a given team in alignment and action around continuity of careBring their organizations’ senior leader(s) to a designated Learning Session
25 EVMS PSPC TEAM Working together to improve Services, Safety and Quality of Care for all our consumers!
26 Basic Facts on the EVMS Patient Safety & Clinical Pharmacy Services Collaborative Primary Health Care Home Organization:Eastern Virginia Medical School, Norfolk, VirginiaTeam Name:Eastern Virginia Medical School Patient Safety & Clinical Pharmacy Services CollaborativeMotto:Communication, Collaboration and CommitmentTeam Leader:Judy Wessell, Nurse PractitionerThe collaborative is composed of staff from EVMS, peer educator consultants, the Gloucester County Health Dept, and an independent PharmD.
27 Thanks to VDH for the financial and technical assistance to the Eastern’s EVMS PSPC team.
28 HRSA Five Strategies Leadership Commitment Measurable Improvement Integrated Care DeliverySafe Medication Use SystemPatient Centered Care
29 PDSA-Worksheet for Testing Change Aim: (overall goal you wish to achieve)Every goal will require multiple smaller tests of changePlanList the tasks needed to set up this test of change: Person responsible, When to be done, Where to be donePredict what will happen when the test is carried outMeasures to determine if prediction succeedsDoDescribe what actually happened when you ran the testStudyDescribe the measured results and how they compared to the predictionsActDescribe what modifications to the plan will be made for the next cycle from what you learned
31 Clinical Pharmacy Services The following are core elements of CPS which patients arecurrently receiving at the Gloucester County care site:Patient counselingPreventive care programs (smoking cessation)Retrospective Drug Utilization Review (ADE/ADR)Medication Therapy Management (Med reconciliation, Triple HAART, hepatic/renal evaluation)Disease State Management (Viral Load/CD4, Lipid/metabolic evaluation)Prospective chart review (co-morbid disease)
32 EVMS PSPSC: Patient Flow Across Providers Pharm DandRN EducatorPharmacyAccessMedicalCase Managementat GloucesterHealth DepartmentLocalP A T I E N TMail OrderADAPEVMS HIV Treatment at Gloucester Health DepartmentOralHealthEVMSUrgent HIVCareat NorfolkSocialCase Mgt. and Ancillary SupportPatient’sP.C.P.orSpecialtySiteLocal Hospitalsfor Diagnostics and TreatmentSites of Clinical Pharmacy ServicesLocal Service ProvidersNon-medical Sites
33 An example in improvements in health outcomes Cohort: Entire Population of FocusSafety Measure: Establishment of, or collaborating with, a patient-centered health care home.Measure Improvement:The process of consultation with a patient’s 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 involvementDeveloping a protocol communication between participants in the healthcare processEstablishing and maintaining responsive linkages between local service providers and the delivery of patient care -- addressing the unique needs of an HIV+ population.
34 EVMS PSPSC: WE’RE GROWING AND WE’RE DIVERSE!! Cindy Lewis, EVMSRN EducatorJudy Wessell, EVMSNurse PractitionerTanya Kearney, Dir.AIDS Resource CenterFred Casey, Project Off.Ryan White Part BAllison Gray, RNClinical Quality Coord.Dr. Virginia WalkerContract Pharm DJanet HallConsumer, Ryan White Part BMOST OF OUR HAPPY FAMILYPierre DiazConsumer, Ryan White Part ARick Hall , Health CounselorThree Rivers Health Dept.