1. HRSA PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE
OVERVIEW
Safere Diawara, MPH
Quality Management Coordinator

2. WHY THE PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE?

3. Why are we doing this work?
Increase in multiple chronic conditions
Alignment with HRSA Core Measures
ADEs leading cause of death and injury – IOM Report
Aging population - polypharmacy
Lack of integration of clinical pharmacy services
Increasing 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 grow
In alignment with HRSA Core Measures, specifically in Diabetes, Cardiovascular, and HIV screening
ADEs are leading cause of death and injury in the US costing billions
Aging population, more medications - polypharmacy
IOM: To Err is Human
Literature 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 Reports
Collaboration with external and internal stakeholders
Major pharmacy organizations, 340B Coalition members and others
Contract with Mathmatica Policy Inc.
FY 2008 Senate Appropriations Committee Report
Program 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 Common
Injure 1.5 Million People Annually
Cost 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 services
Improve Patient Safety
Fewer errors, fewer injuries, less harm
Increase High Quality, Cost-Effective Pharmacy Services
Maximizing and enhancing medication use management

8. Emerging Aims Clinical Pharmacy Services and Patient Safety
More clinical pharmacy for complex patients
More management of high risk medications
Fewer drug-drug interactions
Fewer potentially inappropriate medications
Medication reconciliation for 100% of patients
Healthcare organizations develop and sustain a culture of medication safety
Drug-Drug Interaction: effects of one drug are altered by the administration of another drug
Potentially 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 Proposition
Organizations 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 outcomes
Provided by an inter-disciplinary healthcare team through individualized patient assessment and management
Services 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 Inpatient
Patient
Multiple Conditions
Hospital ED
Primary 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 Inpatient
Patient
Multiple Conditions
Hospital ED
Primary Care Home(s)
What are the constants? why are these conditions for a disaster?
Pharmacy
Services
Specialist
Conditions For A Disaster

15. Care Transitions and Handoffs
Patient
Multiple Conditions
Hospital Inpatient
Patient Self-
Management
Hospital ED
a 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)
Pharmacy
Services
Clinical Pharmacy
Services
Specialist

16. Patient Safety Pharmacy Collaborative
Optimum Health Outcomes
Integrated Patient Care
So 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 Outcomes
AND
Chronic Disease serves as a marker for detecting improvement in the system
Clinical Pharmacy Services
No Adverse Events

17. Learning Collaborative Engine
Enroll Participants
Select Topic
Prework
Identify Change Concepts
Planning Group
LS1
AP1
LS2
AP2
LS3
AP3
LS 4
LS4
PDSA=Plan, Do, Study, Act
LS= Learning Session
AP=Action Period
Supports
Listserv Site Visits & Filming
Conference Calls Rapid Sharing
Team Reporting Web site
Leadership Coordinating Council
Adapted from IHI Breakthrough Series Collaboratives IHI.org 4 4 4

18. Patient Safety & Clinical Pharmacy Collaborative – Next Steps
Share the information with potential partners
Engage with community partners
Engage senior leaders in the vision
Secure support for participation
Review participation package on:
Submit Team Participation Package

19. Patient Safety & Clinical Pharmacy Collaborative (PSPC)
Participation Requirements 19 19

20. State Based Organization Partners
State Primary Care Associations
State Primary Care Offices
State Offices of Rural Health
State Hospital Associations
State Pharmacy Associations
State AIDS Directors
Quality Improvement Organizations
Foundations
Institute for Healthcare Improvement (IHI) Campaign Nodes
Health Center Network Leaders
Area Health Education Centers
Others 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 Centers
Rural Health Clinics
Critical Access Hospitals
Disproportionate Share Hospitals
HIV AIDS Clinics
Others (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 Serve
Safer
More, Better Pharmacy Services
Improved Health Outcomes
Reduces/Manages Risk – and Risk is Increasing
Builds on and Takes Prior Experience to a New Level
Integrated
Takes HRSA Collaborative Experiences to the Next Power

23. 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
Commit to the overarching Aims of the Collaborative
Commit time and effort to testing and adapting changes
Attend all 4 Learning Sessions (some may be State or Regional) and pay for their travel
Measure and track progress and share activities and results with their senior leaders and other teams
Bring all organizations on a given team in alignment and action around continuity of care
Bring their organizations’ senior leader(s) to a designated Learning Session

24. THANKS

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, Virginia
Team Name:
Eastern Virginia Medical School Patient Safety & Clinical Pharmacy Services Collaborative
Motto:
Communication, Collaboration and Commitment
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.

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 Delivery
Safe Medication Use System
Patient Centered Care

29. PDSA-Worksheet for Testing Change
Aim: (overall goal you wish to achieve)
Every goal will require multiple smaller tests of change
Plan
List the tasks needed to set up this test of change: Person responsible, When to be done, Where to be done
Predict what will happen when the test is carried out
Measures to determine if prediction succeeds Do
Describe what actually happened when you ran the test
Study
Describe the measured results and how they compared to the predictions
Act
Describe what modifications to the plan will be made for the next cycle from what you learned

30. EVMS Change Package

31. Clinical Pharmacy Services
The following are core elements of CPS which patients are
currently receiving at the Gloucester County care site:
Patient counseling
Preventive 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 D
and
RN Educator
Pharmacy
Access
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
EVMS
Urgent HIV
Care
at Norfolk
Social
Case Mgt. and Ancillary Support
Patient’s
P.C.P. or
Specialty
Site
Local Hospitals
for Diagnostics and Treatment
Sites of Clinical Pharmacy Services
Local Service Providers
Non-medical Sites

33. An example in improvements in health outcomes
Cohort: Entire Population of Focus
Safety 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 involvement
Developing 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.

34. EVMS PSPSC: WE’RE GROWING AND WE’RE 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.
Dr. Virginia Walker
Contract Pharm D
Janet Hall
Consumer, Ryan White Part B
MOST OF OUR HAPPY FAMILY
Pierre Diaz
Consumer, Ryan White Part A
Rick Hall , Health Counselor
Three Rivers Health Dept.