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ASHP PAI Self Assessment in ActionKimber Boothe, PharmD, MHA

System Director Pharmacy

Marilin Castle, PharmD, BCPS PGY2-HSPA Resident

March 23, 2019

CONFIDENTIAL – FOR INTERNAL USE ONLY

Outline

• PAI Strategy• PAI Self Assessment & Action Plan Process• PAI Activities & Projects

2


Journey to Justify Resources

3

Strategic Planning

Business Plans

FTE Analysis

ROI

Approval

Execution


YNHH PAI Metrics – Acute CareMeasure Threshold Target Max 2016 2017

Patient (ADC): RPh Ratio - (Avg, ICU, Floor)

Weekday43:135:150:1

30:125:1 35:1

25:118:1 30:1

Evening/WeekendOrders Verified/RPh/Hr

Weekday 50 40 30Evening/Weekend 60 50 40

Decentralized RPh Coverage% Units Covered 50% 75% 100%

% Units Rounding/Team 25% 50% 75%ASHP PAI Metrics

PAI Self Assessment Score 65% 75% 85%% RPh w/ Residency 25% 50% 75%

% RPh Board Certified TBD TBD TBD 4


Healthcare Provider Ratios – Acute Care

How We Will Get to Goal:• Decentralize pharmacists• Optimize technician roles• Optimize pharmacy

student roles• Optimize technology• Expand pharmacy

residency• Justify resources

5

Patient to Pharmacist Ratio is below best practice

75

30

15-20

10

4

0 10 20 30 40 50 60 70 80

Pharmacists Current

Pharmacists Goal

Physicians

Respiratory Therapist

Nurses

Patient : Healthcare Provider Ratio


St. Elizabeth Healthcare

• Northern Kentucky• 1,100 licensed beds • 3 acute care hospitals / 1 critical

access hospital • 2 ER/ambulatory facilities• 2 ambulatory surgery centers / 3

imaging centers

• 4 infusion centers• 1 outpatient/specialty

pharmacy• 55,000 Inpatient Discharges• 500 St. Elizabeth Physicians

providers at 116 locations


Systematic Approach

1. Complete hospital assessment2. Review assessment result3. Prioritize action items4. Evaluate peer comparison5. Formulate action plan6. Implement change

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Completing Assessment

1. Individual lead2. Team feedback3. Assess each site4. Complete the official assessment

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Self Assessment

9


10


Action List Prioritization

11


Action Plan

12


Compare Report

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Survey Result Summary

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Category Edgewood Florence Ft. Thomas

OVERALL 73% 73% 73%OPTIMAL PHARMACY PRACTICE

CHARACTERISTICS - PART 1 83% 83% 84%

OPTIMAL PHARMACY PRACTICE CHARACTERISTICS - PART II 62% 63% 63%

ADVANCING THE APPLICATION OF INFORMATION TECHNOLOGY IN THE MEDICATION USE PROCESS

92% 92% 92%

ADVANCING THE USE OF PHARMACY TECHNICIANS 41% 40% 41%

SUCCESSFULL IMPLEMENTATION OF NEW PHARMACY PRACTICE

INITIATIVES82% 80% 80%


Data Comparison Report

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Prioritizing Actionable Items

“Major Projects”High priority

Add to action planExecute once feasible

“Quick Wins”Medium-high priority

Add to action plan

“Thankless Tasks”Low priority

Do not add to action plan

“Fills Ins”Medium priorityAdd to action plan

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Impact

Feasibility

Low

High

Low High


Hospital Assessment – Priority Actionable Items

Assessment Question Actionable Item - EDG

Actionable Item - FLO

Actionable Item - FTT

Are pharmacists involved in development of a patient care plan? [B23a] X X

Do pharmacists review medication orders before initial dose is administered? [B23b]

X X X

Are drug therapy management services prioritized for inpatients based on patient medication complexity? [B8]

X X X

Does the pharmacy department at your hospital identify problem-prone (e.g. high-alert) and high-risk therapies using pre-established criteria? [B24k]

X X X

Are medication preparation and distribution tasks assigned to pharmacy technicians, to the extent possible, to allow redeployment of pharmacists’ time to drug therapy management activities at your hospital? [D2]

X X X

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Hospital AssessmentAssessment Question Actionable

Item - EDGActionable Item - FLO


If permitted by law, is the accuracy of medication dispensing by pharmacy technicians checked by other technicians (i.e. “tech-check-tech”) who have appropriate education and training at your hospital? [D3c]

X X X

Are all distributive functions that do not require a pharmacist’s clinical judgement assigned to pharmacy technicians at your hospital? [D9]

X X X

Do pharmacists participate on your hospital’s rapid response teams? [B23n]

X

Do pharmacists provide discharge education to patients at your hospital? [B23m]

X X X

Is medication reconciliation performed by the pharmacy staff at your hospital? [B23k]

X X X

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Based on the genetic characteristics of the patient, do pharmacists have a role in adjusting dosing or changing therapy of selective medications? [B23f]

X X X

Are all patients’ medication profiles reviewed for appropriateness at least daily by a pharmacists? [B23c]

X X X

Do pharmacists facilitate medication-related continuity of care? [B20] X X X

Does the pharmacy department at your hospital manage prospective medication-use evaluation programs to improve prescribing? [B24i]

X X X

Do automated systems at your hospital notify pharmacists when medication serum concentrations or other clinically important laboratory values fall outside of a therapeutic or normal range? [C2i]

X X X

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If you employ pharmacy student interns, are their duties different from traditional pharmacy technician duties? [B24c]

X X X

Does a lack of pharmacy staff impede development of an optimal pharmacy practice model at your hospital? [B6c]

X X X

Initiation of a medication reconciliation, including obtaining and documenting patients’ medication information for pharmacists’ review, should be done at every transition of care in which new medications are ordered or existing orders are rewritten. [D3a]

X X X

Is the management of controlled substance systems assigned to pharmacy technicians who have appropriate education and training at your hospital? [D3j]

X X X

Are components of quality improvement programs conducted by pharmacy technicians who have appropriate education and training at your hospital? [D3l]

X X X

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Have pharmacy technician responsibilities been expanded to the extent possible based on education and training at your hospital? [E4e]

X

Are pharmacists assigned/deployed to patient-care units at your hospital? [E4d]

X X

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Do pharmacists review medication orders before initial dose is administered? [B23b]

100

100

100

18.3

7

79.5

9

2.04

EX ISTS IN ALL AREAS (100%)

EXISTS IN MOST AREAS (50-99%)

EXISTS ONLY IN SOME AREAS (1-49%)

DOES NOT EXIST (0%)

SELE

CTI

ON

(%)

ANSWER CHOICES

EDG FLO FTT PEER

22Peer group: N=49; bed size 400-599; community hospital; all metropolitan statistical area; all regions; Yes – medical residency program; Yes –pharmacy residency program; Yes – takes 6 or more pharmacy students per year


Is medication reconciliation performed by the pharmacy staff at your hospital? [B23k]

100

100

100

4.08

28.5

7

32.6

5

34.6

9

THROUGHOUT ALL AREAS IN SOME AREAS PARTIALLY PERFORMED IN SOME OR ALL AREAS

NOT PERFORMED BY PHARMACY STAFF

SELE

CTI

ON

(%)

ANSWER CHOICES

EDG FLO FTT PEER


CONFIDENTIAL – FOR INTERNAL USE ONLYIf permitted by law, is the accuracy of medication dispensing by pharmacy technicians checked by other technicians (i.e. “tech-check-tech”) who have appropriate education and training at your hospital? [D3c]

100

100

100

8.16

4.08 12

.24 30

.61 44

.9

EX ISTS IN ALL AREAS (100%)

EXISTS IN MOST AREAS (50-99%)

EXISTS IN ONLY SOME AREAS (1-

49%)

DOES NOT EXIST (0%)

NOT PERMITTED BY LAW

SELE

CTI

ON

(%)

ANSWER CHOICES

EDG FLO FTT PEER



SEH PAI Objectives 2018-2019

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OBJECTIVES Tactics

Clinical Practice Standardization

• EPIC Workflow / Documentation Standardization• Acuity Scoring• Activity Prioritization• Scheduling/Shift Optimization

Service Line Support/Expansion

• Hospitalist Rounding • Oncology• Heart Failure/LVAD• Pulmonary/Adult ECMO• Emergency Departments• Primary Care & Specialty Clinics

Medication Reconciliation• Admission• Discharge• Ambulatory

Residency Expansion • PGY1 • PGY2

Students • Intern Program• APPE Student Optimization including Pend Function

Precision Medicine• Pharmacogenomic Testing w/ EHR Integration• Pharmacogenomic Clinic• Precision Oncology

Patient Experience • Quiet at Night• Medication Education

Operations PAI • Staffing Workflow & Tech Check Tech


Time & Motion Study

86%22%

16%12%12%

6%4%4%

3%2%

1%1%

0%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

All clinical tasksClinical review (exclude rounding)

Documentation of interventionOrder verification

Professional communicationMedication Review

WalkingRounding

Providing drug/health information to patients/caregiversMeetings

TechnologiesLooking for somethingDischarge dispensing

Time & Motion Study Result

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Front Line Pharmacist Involvement

1. Pre-work shop survey2. Conducted PAI work shop

i. Background on PAIii. Survey debriefiii. Breakout sessions

1) Work flow prioritization2) Practicing at the top of your license3) Practice model4) Scheduling

1. Epic Decision Support • Optimization of Current Acuity Scoring• ICU Acuity Scoring

2. Workflow Prioritization • Optimization of “My List”• Clinical activities and time spent on activities

3. Education • BPS Presentations• Residency Expansion• Student Standardization

4. Scheduling • Revised Shifts Reducing Pharmacist to Patient

Ratio• Block and weekend scheduling

PAI Workshop 2017 PAI Workshop 2018


Summary

• PAI Self Assessment can drive strategy and support justification of resources

• Team approach on the assessment is valuable• The prioritized action plan allows alignment of goals with

department strategy• Meaningful resident, student, and preceptor projects can be

identified

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Questions & Discussion

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