1. Reviewing Wisconsin’s “Gaps” Justin Guthman PharmD Pharmacy Operations Coordinator Froedtert Hospital Milwaukee Wisconsin

2. PPMI Timeline within Wisconsin  November 2010 – PPMI Summit  February 2011- PPMI Consensus Statements  February 2011- Hospital Advisory Group Meeting  March 2011- PSW Gap Analysis Work Begins  May 2011- ASHP and PSW Pool Resources  August 2011- Wisconsin Demonstration Project Results  Future Direction

3. Wisconsin Involvement at the PPMI Summit  Rick Berry  Erin Hendrick  Steve Rough  Tom Thielke  Tom Woller  Lynnae Mahaney

4. PPMI Timeline within Wisconsin  November 2010 – PPMI Summit  February 2011- PPMI Consensus Statements  February 2011- Hospital Advisory Group Meeting  March 2011- PSW Gap Analysis Work Begins  May 2011- ASHP and PSW Pool Resources  August 2011- Wisconsin Demonstration Project Results  Future Direction

5. PPMI Consensus Statements http://www.ashp.org/ppmi

6. PPMI Timeline within Wisconsin  November 2010 – PPMI Summit  February 2011- PPMI Consensus Statements  February 2011- Hospital Advisory Group Meeting  March 2011- PSW Gap Analysis Work Begins  May 2011- ASHP and PSW Pool Resources  August 2011- Wisconsin Demonstration Project Results  Future Direction

7. Hospital Advisory Board (February 2011)  Brainstorming session among pharmacy leaders  Agreement with PPMI recommendations  Concerns  Lack of prioritization  Ability to implement recommendations across the entire spectrum of institutions  Proposal to address concerns:  Develop a statewide PPMI survey  Identify “Gaps” within practice  Develop “Guiding Documents”

8. PPMI Timeline within Wisconsin  November 2010 – PPMI Summit  February 2011- PPMI Consensus Statements  February 2011- Hospital Advisory Group Meeting  March 2011- PSW Gap Analysis Work Begins  May 2011- ASHP and PSW Pool Resources  August 2011- Wisconsin Demonstration Project Results  Future Direction

9. PSW Gap Analysis Work Begins  Pooling Resources  Involvement of PGY2 Administrative Residents from Aurora, UW, and Froedtert  Adopted PPMI Consensus Statements into a survey questionnaire  Started initial development of “GAP” Analysis tool

10. PPMI Timeline within Wisconsin  November 2010 – PPMI Summit  February 2011- PPMI Consensus Statements  February 2011- Hospital Advisory Group Meeting  March 2011- PSW Gap Analysis Work Begins  May 2011- ASHP and PSW Pool Resources  August 2011- Wisconsin Pilot Validation Project Results  Future Direction

11. ASHP and PSW Pool Resources  ASHP recognized PSW initiatives  ASHP and PSW collaborate to develop Self Assessment Tool (SAT)  ASHP requests Wisconsin’s involvement as a “Pilot Validation Site”

12. PPMI Timeline within Wisconsin  November 2010 – PPMI Summit  February 2011- PPMI Consensus Statements  February 2011- Hospital Advisory Group Meeting  March 2011- PSW Gap Analysis Work Begins  May 2011- ASHP and PSW Pool Resources  August 2011- Wisconsin Pilot Validation Project Results  Future Direction

13. Self Assessment Tool (SAT)

14. Wisconsin SAT Results! (Aug 18 th 2011)  106 Question Hospital Self Assessment  70 of 108 Institutions Responded! (65%)  Individualized Action Plan (optional)  Completed by 19 of 70 Institution (27%)  Assessment of the lowest 40 scores  Requests feasibility (low, medium, high)  Requests impact of implementing (low, medium, high)  Individualized action plans were provided on top 20 recommendations

15. Demographic Data

20. Practice Models in Wisconsin Model 4 (Comprehensive pharmacy services model) Model 3 (Patient-centered integrated model) Model 2 (Clinical pharmacist-centered model) Model 1 (Drug-distribution centered model) Adopted from Pedersen CA, Schneider PJ, Scheckelhoff DJ. Survey of pharmacy practice in hospital settings: Dispensing and administration-2008. Am J Health Syst Pharm. 2009;66:926-46. 74% 7% 19% 0%

21. Wisconsin Action Report Open Discussion  Technician training/roles  Pharmacists roles  Student involvement  Residency training  Use of technology

22. Technician Training/Roles  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/health system?

23. “Gaps” within Wisconsin  70% of hospitals >300 Beds have implement Tech Check Tech to some extent  15% of hospitals <300 Beds have implement Tech Check Tech to some extent  Action Plan Results  Avg feasibility 1.87  Avg impact 1.73

24. Technician training/roles  Concerns?  Goals?  How can PSW/ASHP Help?

25. Pharmacists Roles  Do pharmacists provide discharge education to patients at your hospital/health system?

26. “Gaps” within Wisconsin  <1% of Wisconsin Hospitals have pharmacist provided discharge education to all patients  27% of Wisconsin Hospitals have pharmacist provide discharge education in some patient care units (including high risk areas)  Action Plan Results  Avg feasibility 2.17  Avg impact 2.5

27. Pharmacists roles  Concerns?  Goals?  How can PSW/ASHP Help?

28. Student Involvement  If you take pharmacy students on rotation, has a plan been developed to allocate pharmacy student time to drug therapy management services?

29. “Gaps” within Wisconsin  37% of Wisconsin Hospitals have a plan developed to allocate pharmacy student time to drug therapy management services  Action Plan Results  Avg feasibility 1.67  Avg impact 1.0

30. Student Involvement  Concerns?  Goals?  How can PSW/ASHP Help?

31. Residency Training  Are you offering residency training at your hospital/health system?

32. “Gaps” within Wisconsin  21% of Wisconsin Hospitals have pharmacy residency programs  87% of hospitals >300 beds  7% of hospitals 150-299 beds  6% of hospitals 51-149 beds  0% of hospitals <50 beds  Action Plan Results  Avg feasibility 1.42  Avg impact 1.42

33. Residency Training  Concerns?  Goals?  How can PSW/ASHP Help?

34. Use of Technology  Do real-time monitoring systems provide a work queue of patients needing review and possible intervention at your hospital/health system?

35. “Gaps” within Wisconsin  14% of Wisconsin Hospitals have real-time monitoring systems in all areas  36% of Wisconsin Hospitals have partially implemented real-time monitoring systems  50% of Wisconsin Hospitals do not have real- time monitoring systems  Action Plan Results  Avg feasibility 2.0  Avg impact 2.38

36. Use of Technology  Concerns?  Goals?  How can PSW/ASHP Help?

37. PPMI Timeline within Wisconsin  November 2010 – PPMI Summit  February 2011- PPMI Consensus Statements  February 2011- Hospital Advisory Group Meeting  March 2011- PSW Gap Analysis Work Begins  May 2011- ASHP and PSW Pool Resources  August 2011- Wisconsin Demonstration Project Results  Future Direction

38. Future Direction  Evaluation of Wisconsin PPMI data  Hospital Advisory Group Meeting  Develop toolkits for implementation of best practice  PrimeTime  Webpage  Expand focus into other areas of pharmacy practice  Engagement of members from all areas of practice

39. Acknowledgements  Todd Karpinski  Sarah Sorum  Stephanie Irek (DPH4 Pharmacy Student)  Ives Hot (DPH3 Pharmacy Student)

40. Questions

41. Additional Discussion  Time permitting!

42. Technician Training/Roles  Are opportunities for advanced, specialized pharmacy technician roles available at your hospital/health system (examples of advanced pharmacy technician roles include: dispensing medications with remote video supervision, managing medication assistance programs, initiation of medication reconciliation [obtaining list], order entry for pharmacist's verification, and technician supervising other technicians)?  Avg feasibility 1.3  Avg impact 1.4

43. Pharmacists Roles  Does resistance to change among pharmacy staff impede development of an optimal pharmacy practice model at your hospital/health system?  Avg feasibility 1.29  Avg impact 1.57

44. Student Involvement  When on rotations at your hospital/health system, are pharmacy students trained on the roles of safety and quality in the medication-use process?  Avg feasibility 1.5  Avg impact 2.0

45. Residency Training  Have pharmacists providing drug therapy management completed an ASHP- accredited residency or achieved equivalent experience?  Avg feasibility 1.57  Avg impact 1.21

46. Use of Technology  Have systems been implemented at your hospital/health system to efficiently capture and report pharmacy metrics, outcomes data, and pharmacists' value?  Avg feasibility 2.06  Avg impact 2.41