1. Pharmacy Practice Model Initiative
Empowering Students to Become
Agents of Change
This presentation is to introduce pharmacy students to the Pharmacy Practice Model Initiative and highlight ways to get involved

2. Shhhhhhh…
For event updates:
#ashpmidyear

3. Session Agenda PPMI Overview Practitioners Prospective
Interactive Session
Important Resources

4. Develop and disseminate a futuristic practice model
Goal:
Develop and disseminate a futuristic practice model
that supports the effective use of pharmacists as
direct patient care providers
What is the PPMI? We know we all like abbreviations in pharmacy (joke). It is a movement towards change in the way pharmacists practice in hospitals and health systems today.
Currently, there doesn’t exist one standard model with patient care-related services that are consistently provided by all the departments of pharmacy in hospitals and health-systems.
The goal of PPMI, Led by ASHP and the ASHP Foundation, is to positively impact patient care by developing and disseminating a futuristic practice model that can be used in all hospitals and health systems that supports the effective use of pharmacists as direct patient care providers.
Before we discuss more about PPMI and where our profession is headed in the furture, It is important to take a moment to recognize the progress our profession has made over the years

5. Pharmacy Has Come a Long way…
Unit Dose
1990
Surfactant
1993
Pharmaceutical
Care
20022008
1.5%  21.5%
Bedside Barcode
20032008
5.9%  11.4%
CPOE
with CDS
Ask Jen for clarification on surfactant and CPOE
Add in pharmaceutical care concept – 1993 conference?
PPMI is not the first time that pharmacists have come together to gain consensus on the future of practice

6. Historical Perspective
ASHP Hilton Head Conference, 1985
“ To bring about change within a diverse profession such as pharmacy, one needs a large number of people pulling in the same direction. Before one can get folks pulling in the same direction, one needs general agreement about the best direction in which to move.”
-William A. Zellmer
Has anyone here heard of the Hilton Head conference? Does anyone here
know why all pharmacy students get the PharmD now? Well, it all started
with the Hilton Head confernece in 1985!
The Hilton Head conference brought together a group of visionary pharmacists who helped establish the concept that the practice of pharmacy is a clinical profession and that the role of pharmacists in health-systems should be focused on the direct care of patients as part of multidisciplinary care teams.
The PPMI will build on the landmark work of the Hilton Head Conference and continue to expand on its vision of pharmacy as a clinical profession.
Here is a quote by Dr. William Zellmer, an influential thought-leader and recipient of the Donald E. Francke award in 2009, for his signficant contributions to international pharmacy practice.
“ To bring about change within a diverse profession such as pharmacy, one needs a large number of people pulling in the same direction. Before one can get folks pulling in the same direction, one needs general agreement about the best direction in which to move.”
Dr. Zellmer also provided very inspirational words as he delivered the closing remarks for the PPMI summit, I will share some of those words a bit later when I talk about the summit itself

7. Vision
The initiative and summit will create passion, commitment, and action among hospital and health-system pharmacy practice leaders to significantly advance the health and well being of patients by optimizing the role of pharmacists in providing direct patient care.
"So what does the Hilton Head conference have to do with the PPMI? Well, this
initiative is intended to have a tremendous impact on the profession
similar to the impact that resulted from HH and the change in pharmacy education standards .
The vision of PPMI can be embodied in three components...“  passion, commitment and action. ASHP president, Diane Ginsberg, summed up the vision very well in her opening remarks at the summit by charging all of the attendees to be “bold” in their thinking and proposals during their time at the summit.
Being bold means asking ourselves important questions about what the future holds for pharmacy:
· What if pharmacists could prescribe?
· What if pharmacists were reimbursed for cognitive services, not just dispensing?
· What if every pharmacist who provides direct patient care was residency trained?
· What if pharmacy technicians were licensed?
· What if every patient demanded pharmacist-provided care during every hospital stay?
As you can see, furthering the invovlement of the pharmacists in direct patient care is also central to the vision of the summit. This is important because By describing patient care services and activities that support the safe and effective use of medications, corresponding models can be adopted that optimize the full potential of pharmacist, technician, and technology resources.

8. Initiative and Summit Invitational Summit Social Marketing Campaign
Raise awareness
Stimulate discussion
Disseminate the findings
Initiative Grants
In just a few minutes I am going to speak about the proceedings of the actual PPMI summit, held in Dallas, TX in the beginning of November, however it is important to know that the summit was just the beginning of the overall initiative
The other two key components of the pharmacy practice model initiative are the social marketing campaign and the demonstration project grants
The social marketing campaign will promote change by first raising awareness of current issues and getting people excited about the initiative. This serves to stimulate discussions among thought leaders about models that optimize the role of the pharmacist. Following the summit, the findings will be disseminated as recommendations for practice throughout the profession.
And finally, grants sponsored by the ASHP Education and Research Foundation will be utilized to develop various demonstration projects that evaluate the impact of the practice model change in a variety of settings.

9. 5 PPMI Focus Areas Create a Framework Determine Services
Identify Emerging Technologies
Develop a Template
Implement Change
Within the three components of PPMI there are five focus areas of the PPMI which were identified by the PPMI advisory committee. This committee consisted of several pharmacy leaders who came together to guide the creation of the initiative:
1. The first is to create a framework for a pharmacy practice model that ensures the provision of safe, effective, efficient, accountable, and evidence-based care for all hospital and health system patients.
2. Determine patient care-related services that should be consistently provided by all departments of pharmacy in hospitals and health systems
3. Identify the available and emerging technologies that will support the implementation of the practice model
Now lets discuss the actual PPMI summit
4. Develop a template model that will support the optimal utilization and deployment of hospital and health-system pharmacy resources which is operational, practical, and measurable
5. And finally, to identify specific actions pharmacy leaders and staff should take to implement change within their own practice areas.

10. PPMI Summit, Dallas, Texas November 7 – 9, 2010
Two-day invitational event that included approximately 150 pharmacist participants
Issue Briefings commissioned
Plenary presentations and work groups followed by a consensus process to address key outcomes to develop a new pharmacy practice model
The first component of the initiative, the invitational summit, was held in November of The purpose of this summit was to bring together pharmacy leaders from diverse practice settings to fully develop the vision of the PPMI and address the five focus areas which I just mentioned. There were over 100 pharmacy leaders who made up the voting members of the summit and over 20 observers who witnessed the proceedings of the summit. In addition to that there was a live webcast of the summit which allowed many of you to view the proceedings of the summit as well.
5 briefing papers prepared pre-summit that addressed several different topics including optimal pharmacy practice models and strategies to initiate change. These were required pre-reading for all summit attendees
Attendees were also given prospective from several plenary presentations that were given at the summit. These presentations addressed a variety of topics as well, including introducing various successful practice models that are currently in place at different types of institutions such as a community hospital vs. an academic medical center
I’d now like to introduce the process by which concensus was achieved on the summit recommendations

11. PPMI Pre-Summit Survey Results
Divided into Sections: 1. Overarching Principles 2. Services 3. Technology 4. Technicians 5. Implementing Change and Responding to Challenges
Many ASHP members (including students!) were an integral part of preparations for the Summit.
In advance of the event, ASHP surveyed members about their perspectives on each of the practice elements that were discussed at the Summit. Results from the survey were used by Summit participants as part of the consensus process. The survey focused on 5 main areas: Overarching Principles, Specific Services, Technology, Technicians, and Implementing Change
164-question survey of 107 Voting Participants, Observers and ASHP Membership-at-Large
Voting Participants – 95% return rate
Members-at-Large - >1,300 participated
The survey results served as the basis for recommendations made at the summit, and guided the small and large group discussions. Summit participants were also able to propose new recommendations that were not a part of the original survey.
Now let’s talk about those recommendations upon which consensus was reached. I will try to focus on the key recommendations that came out of the summit and also those that directly relate to students

12. Section 1: Overarching Principles
Consensus on the following principles:
Opportunity to advance the health and well being of patients by changing the practice model
Financial pressures will force changes in how resources are used
Every pharmacy department should identify drug-therapy management services provided consistently by pharmacists
In the coming years, there will be increasing demand among new pharmacy graduates for residency training
Advancing health and well being of patients: it was recognized that pharmacists have the ability to have an even larger impact on patient care than we already do and changes in the practice model will be necessary for this to occur
With the ever changing economy it was recognized that financial pressures will have a greater impact on how pharmacy departments use their resources. As students who will graduate into this type of economy, it is important to keep this in the forefront of our minds
Consistency of pharmacists provided services was an important item upon which consensus was reached. In some institutions these services may involve pharmacy student-provided services
There was almost unanimous agreement among voting members that there will be an increasing demand for residency training. ASHP is already hard at work on the residency capacity issue and will be convening a residency stakeholders conference in early 2011 in an effort to address this issue

13. Section 2: Services Essential services should include:
Tracking and trending pharmacist interventions
Medication reconciliation at transitions in care
All patients deserve the care of a pharmacist. It is recognized that resources will need to be allocated according to the complexity of patients and organizational needs.
This should include pharmacy student interventions as well. Many of us might already be required to do this for some of our rotations. Even if it is not a requirement, it is a great idea to track your interventions so you can see what type of impact you are making as a student. The list will also come in handy when you have to speak about interventions during residency interviews!
Med rec is a great example of services that we can provide as pharmacy students. Ensuring complete and safe transitions in care was also something that was talked about a lot at the summit. Discharge counseling is an important aspect of this and another service that we can help provide as students
When discussing specific services that pharmacists should provide, the summit attendees felt strongly that every patient should come into contact with a pharmacists during their hospital stay. To make sure that pharmacy is prioritizing those patients who need pharmacists services the most, it was decided that pharmacists should be allocating services based on the acuity of patients

14. Section 3: Technology Technology priority order of importance:
Electronic medical record systems
Use of barcode technology during medication administration
Real-time monitoring systems that provide a work queue of patients needing review and possible intervention
Pharmacy residency programs should provide informatics training
- It may be hard for many of us to remember a time when we didn’t use technology and computers as part of our learning process. As students our level of comfort with technology will come in handy as we hope to further incorporate technology into pharmacy workflow and patient care

15. Section 4: Technicians
Pharmacy technicians who have appropriate education, training, and credentials should be used to free pharmacists from drug distribution activities
Assigning medication distribution tasks to technicians would make it possible to deploy pharmacists to drug-therapy management services
Uniform national standards should apply to the education and training of pharmacy technicians
To support optimal pharmacy practice models, technicians must be licensed by state boards of pharmacy
- As pharmacy students, many of us gain experience in the hospital and health system world by working as technicians during our time in pharmacy school. These recommendations regarding the use of technicians may impact our role in these positions during our time in school

16. Section 5: Implementing Change
Further support for the requirement of residency training
Support from health care executives, pharmacy department and clinical pharmacy leadership
The ASHP 2020 vision that all pharmacists that provide direct patient care be residency trained was further enforced at the summit. In order to implement optimal pharmacy practice models it was again agreed upon that residency training is necessary prepartion for pharmacists in these settings
We will look forward to the exact wording once the final recommendations are published
A big part of implementing change is also responding to challenges that might present themselves as new plans are implemented that is why ensuring that we have the support of health care executives, pharmacy administration and clinical pharmacy leadership is critical in comforting those challenges
As students we can play a role in this process by forming good relationships with our health professional colleuges during our time on rotations and talking to our preceptors about their vision for the practice model at their institution
This was just a preview of the many practice changing recommendations that were agreed upon at the summit. I hope that hearing these recommendations ignighted a passion for pharmacy advancement within all of you. If you are anxious to learn about more of the recommendations, the proceedings of the summit will be published in AJHP in spring 2011
We are going to switch gears now and hear about PPMI from a practitioners prospective. I would like to invite Dr. Jennifer Tryon to share with us how PPMI will effect her practice

17. Practitioners Prospective
Influencing others to buy into change…

18. Implementing the futuristic practice model will require incremental changes
Embracing change, not resisting change
Change management requires careful planning
Addressing the conceptual, psychosocial, and methodological aspects to change
Examples of change in pharmacy

19. Experience with influencing others to buy into change Department
Organizational
State
National
How you will implement the outcomes of the summit in your own practice
Hold your own summit
Debate the hot topics
Residency training
Mentoring
Max Ray’s briefing paper
Scott Kanours slides
- I’d now like to turn it over to Joe Dikun, the vice chair of the pharmacy student forum executive committee, to introduce the interactive portion of our session… 19

20. How are you going to be an agent of change?
PPMI Case Roundtables
How are you going to be an agent of change?

21. Timeline of Session 10 minute brainstorming session
5 PPMI cases to discuss
3 groups will be chosen to present their case
Wrap-up and closing at 3:55 PM

22. PPMI Case Roundtables Case #1 Case #2 Case #3 Case #4 Case #5
Create a Framework
Case #2
Determine Services
Case #3
Identify Emerging Technologies
Case #4
Develop a Template
Case #5
Implement Change

23. Resources to Facilitate Involvement
Arming you with tools to help advance practice

24. How can YOU get involved?
Emily has already shown them this screen shot, but it will provide a good basic starting point for you to talk off of.
As the future pharmacy workforce in training, it is important that students get involved in the initiative!
Utilize social media tools to join in on the discussion about the PPMI with fellow students and pharmacy leaders. The ASHP Connect Discussion Board is a great place to voice your opinions and have them heard. The ASHP Facebook page will be updating information throughout the initiative to keep you informed. You can even tweet with Emily Dotter, your student representative, during the PPMI Summit at #PPMI. And finally, stay connected to all of the PPMI participants by joining the PPMI subgroup on LinkedIn.
Look for opportunities to participate in PPMI related SSHP projects, which can be used to meet the requirements of ASHP recognition. The ASHP website has many tools and resources that you can use to start up a project at your school. There is a new section dedicated specifically to professional development projects.
Become agents of change at the local level by supporting the initiative’s goals and raising awareness about the PPMI to others. One way to get involved is to start advocacy projects at the local level. An advocacy toolkit is available on the ASHP website to help you start a legislative day and be an active voice for the profession of pharmacy.
The ASHP Pharmacy Student Forum will be developing additional ways students can contribute to the initiative.
As Dr. Zellmer reminded summit participants, all of the participants in the summit showed that they were taking the steps to leading change that we believe in versus being forced to accept the change of others

25. Virtual Participants Tweeted Group Pictures of their Sites
John Hopkins Hospital Pharmacy
University of Cincinnati SSHP
Harding College of Pharmacy
Henry Ford Pharmacy

26. Summit Materials
The ability to see the slide decks and review what was reviewed at the summit.
IDEA: Host a mini school event as a student society and see if your recommendations are the same as the summit

27. Perspectives and Resources
This is really interesting because it provides them with a lot of the same background documents that were used for the conference. Emily talks a little about the historical aspects, but those documents are also listed here. These are very interesting and important for us as students to understand how we got to where we are now and why we need to be actively involved in the current practice changes.

28. Pharmacy Spotlight
What is this page for? What more is to come for this page? Why is this important for PPMI?

29. Summit Webcast Archives http://prestonevents.com/reg/ppmi/
Did you miss the webcasts? Archives are available now. Talk about which sessions were recorded and which were not and why.

30. What’s Next? Consensus Statements Resources Demonstration Grants
Summit Proceedings (Spring 2011)
Briefing Documents (Spring 2011)
Self Assessments/Practice Based Tools
Demonstration Grants
SSHP Recognition Projects
Upcoming Meetings
Summer Meeting 2011 and MCM 2011
I would now like to turn it over to Emily to tell you how you can get involved and provide us with some closing remarks

31. Major Themes Moving the pharmacist closer to the patient
Greatly expanding the role of a qualified technician workforce and the use of technology
Ensuring that pharmacy departments are accountable for the development and implementation of medication use policy to ensure safe and effective use of medications
Working to assure pharmacists are accountable for patient outcomes.
To sum everything up I’d like to review the four major themes or outcomes of the summit:
Moving the pharmacists closer to the patient
Expanding technician workforce/advancing use of technology
Making sure that pharmacy departments are accountable for the development of policies to ensure the safety and effectiveness of medications

32. Igniting your Passion for Change: 3 Take Home Points
Be Bold
Think Outside the Box
Hit the Ground Running
It was our goal to have you leave this session feeling inspired about the future of your practice
While you may have heard this several times before, there truly is no better time to be pursuing a career as a hospital and health-system pharmacists. We certainly have a bright professional future in front of us and it is up to us to keep the vision of PPMI strong and be the agents of change that will be necessary to move the profession forward.
To end, I’d like to again quote ASHP president, Diane Ginsburg:
As you walk out of the session please keep in mind these three take home points – be bold, think outside the box, and hit the ground running.
Thank you very much for your participation!

33. For more information: www.ashp.org/PPMI
Visit the PPMI website to learn more about PPMI. You can direct any questions you have to