HRSA PATIENT SAFETY AND CLINICAL PHARMACY SERVICES COLLABORATIVE

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

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.

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 AimsClinical 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

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) Specialist

14. Care Transitions and Handoffs Hospital Inpatient Patient Multiple Conditions Hospital ED Primary Care Home(s) Pharmacy Services Specialist Conditions For A Disaster

15. Care Transitions and Handoffs Patient Multiple Conditions Hospital Inpatient Patient Self- Management Hospital ED Primary Care Home(s) Pharmacy Services ClinicalPharmacy Services Specialist

16. Patient Safety Pharmacy Collaborative Patient Optimum Health Outcomes Integrated Patient Care Clinical Pharmacy Services No Adverse Events

17. Learning Collaborative Engine Enroll Participants Select Topic Prework Identify Change Concepts Planning Group LS 4 LS1 AP1 LS2 AP2 LS3 AP3 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

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: http://www.hrsa.gov/patientsafety • Submit Team Participation Package

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

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

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. Patient’s P.C.P. or Specialty Care Site P A T I E N T EVMS HIV Treatment at Gloucester Health Department Medical Case Management at Gloucester Health Department Pharm D and RN Educator Social Case Mgt. and Ancillary Support Local Hospitals for Diagnostics and Treatment EVMS Urgent HIV Care at Norfolk Oral Health Pharmacy Access Sites of Clinical Pharmacy Services Local Service Providers ADAP Local Mail Order Non-medical Sites EVMS PSPSC: Patient Flow Across Providers

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 Allison Gray, RN Clinical Quality Coord. Tanya Kearney, Dir. AIDS Resource Center Fred Casey, Project Off. Ryan White Part B Dr. Virginia Walker Contract Pharm D Janet Hall Consumer, Ryan White Part B MOST OF OUR HAPPY FAMILY Rick Hall , Health Counselor Three Rivers Health Dept. Pierre Diaz Consumer, Ryan White Part A