The Pharmacy Practice Model Initiative
(PPMI) and Rural Health:
Advancing Patient Care
Denise Fields, PharmD
Clinical Program Manager
Physician Engagement and Academic
Detailing , Express Scripts
Columbus, IN
John B. Hertig, PharmD, MS, CPPS
Dan D. Degnan, PharmD, MS, CPPS
Associate Director
Senior Project Manager
Center for Medication Safety Advancement
Center for Medication Safety Advancement
Purdue University College of Pharmacy
Purdue University College of Pharmacy
Indianapolis, IN
Indianapolis, IN
Disclosure
• The speakers have no conflicts of interest to
disclose.
Outline
• Overview of Pharmacy Practice Model
Initiative (PPMI)
• Why is it important for rural hospitals?
• Practice advancement in Indiana
• Opportunities for rural hospitals
• Getting involved!
• Discussion and questions
First Things First
• Who is in the audience?
• What practice types do
you represent?
• How many of you have
heard of the ASHP
Pharmacy Practice Model
Initiative?
Background – Why Change?
• Professions must continually assess their
practice to determine whether expertise is
being maximized
– Healthcare reform
– Quality and safety
– Social and economic influences
• Pharmacy practice changes
– Doctor of Pharmacy degree
– Residency training
Educational Factors Driving Change
http://www.aacp.org/Docs/MainNavigation/InstitutionalData/8921_DegreesConferred.pdf
Educational Factors Driving Change
Why Change?
• More patients, increased demand
– Payment tied to performance
– Move away from fee-for-service payments
– Pressure to reduce costs, reward performance
• Challenge to US health care system to
improve quality and cost effective care
– More quality, better reimbursement
• Better Care!
AJHP 2009;66:713
Factors Driving Practice Change
• Drug therapy is becoming more complex
with greater patient risk
• Pharmacists recognized as:
– drug therapy experts
– medication use process experts
• Patients are better served if pharmacists take
an active role as part of the care team
ASHP/ASHP Foundation
Pharmacy Practice Model Objectives
Pharmacists
Technicians & Technology
Pharmacists
Assessment Question
Which of the following is a factor driving
pharmacy practice model change?
A) Increasingly complex medication therapies
B) Changes to the United States healthcare
system (incl. healthcare reform)
C) Pharmacy education and training
D) All of the above
Impact
• All these factors have combined to drive
critical discussions regarding change within
the health-system pharmacy profession
• But, where do we go from here?
Pharmacy Practice Model Initiative
(PPMI)
• Launched and coordinated by ASHP and the
ASHP Research and Education Foundation
• The goal of this initiative is to significantly
advance the health and well-being of
patients
– Develop and disseminate a futuristic practice
model that supports the most effective use of
pharmacists as direct patient care providers
PPMI. Available at <www.ashp.org>
PPMI =
Practice Advancement
The Purpose of the PPMI
• Describes how pharmacy department
resources are deployed to provide care
• One size does not fit all
• Does include:
– How pharmacists practice and provide care to patients
– How technicians are involved to support care
– Use of automation/technology in the medication use
system
AJHP 2010;67:542
Major PPMI Themes
• Move pharmacists closer to the patient
– Multidisciplinary care
• Responsibility for safe use of medications
and ensuring quality
• Well-developed technician workforce
• Wide-spread use of technology
Rural Hospital Practice Models
AJHP 2010;67:542
AJHP 2010;67:542
Considerations for All of Us
• “The capacity of 1”
– How much can we do with limited resources?
– Where do our priorities lie?
• Ensuring we practice at “the top of our license”
• Ensuring the best care across ALL practice
settings
– Hospital, ambulatory, long-term care, community,
and so on…
– Teamwork is essential!
So…Where Are We Going?
PPMI Taskforce
• Indiana Pharmacy Practice Model Taskforce
– Indiana Society for Health-System
Pharmacists 12 members
– Steering group for hospital practice
model change
• Focus on completion of Hospital
Self-Assessment (HSA)
– Provides current data for practice in Indiana
What are your opportunities?
Using the Hospital Self-Assessment in
Creating a Road Map to Advancement
ASHP’s PPMI Resource Page
Indiana’s HSA Engagement
• 32.75% of Indiana Hospitals have completed
the self-assessment (57/174)
• 41% of IRHA Member Hospitals have
completed the self-assessment (16/39)
• 41% of IRHA CAH Member Facilities have
completed the self-assessment (12/29)
• 45% of Indiana CAH Facilities have completed
the self-assessment (16/35)
HSA Participation Within IRHA
THANK YOU
IT’S NOT TOO LATE
Community Hospital of Bremen
Decatur County Memorial Hospital
Greene County General Hospital
IU Health
IU Health Bedford Hospital
IU Health Paoli Hospital
Logansport Memorial Hospital
Pulaski Memorial Hospital
Putnam County Hospital
Reid Hospital & Health Care
Rush Memorial Hospital
St. Vincent Clay Hospital
St. Vincent Frankfort Hospital
St. Vincent Mercy Hospital
St. Vincent Randolph Hospital
Union Hospital
Adams Memorial Hospital
Bloomington Meadows Hospital
Cameron Memorial Community Hospital
Daviess Community Hospital
Fayette Regional Health System
Gibson General Hospital
Harrison County Hospital
Henry County Hospital
IU Health Blackford Hospital
IU Health Starke Hospital
IU Health Tipton
Jasper County Hospital
Jay County Hospital
Margaret Mary Health
Memorial Hospital & Health Care
Parkview LaGrange Hospital
Perry County Memorial Hospital
Scott Memorial Hospital
St. Vincent Dunn Hospital
St. Vincent Salem Hospital
Sullivan County Community Hospital
Wabash County Hospital
Woodlawn Hospital
HSA - Getting Started
Begin Assessment
Sample Question
Assessment Summary
Self Assessment Report
Creating Action Plan
Individualized Prioritization
Action Plan Provides Resources
Indiana CAH Opportunities
• Critical Access Hospitals accounts for approximately 26% of
all Community Hospitals in US
– 35 CAH facilities in Indiana
– 29 of them are IRHA members
• Key differences in medication distribution
– Pharmacist service hours
• 24 Hour On-Site Services
• Limited On-Site Hours with After Hours Remote Services
• Hours without Pharmacist Services (On-Site or Remote)
– Use of Technology
• ADM
• Robots
• Smart Pump (with and without EMR Integration)
Strengths for CAH vs. All Hospitals
• Pharmacists recognized as leaders
• Strong leadership support for pharmacy
models that maximize technicians and
technology
• Resistance to change impeding development
of optimal pharmacy practice model
• Pharmacists assist with continuity of care
Opportunities for CAH Hospitals
• Pharmacist review of medication order
before initial dose is given
• Pharmacist oversight for med distribution
within all areas of hospital/health system
• Pharmacist Credentialing and Privileging
• Pharmacists Advanced Clinical Roles
• Technician Advanced Roles
Technician Advancement
Technician Medication Reconciliation
Archived Webinars Available
Tech Check Tech
Technician Data Analyst
Quality Improvement
Inventory Turns
Medication Errors
ADM Efficiency
Physician Compliance
Patient Risk Assessment
Technician IV Room Supervisor
• Creation of Admixture Instructional Templates (for
Pharmacist review)
• Participation in Policy and Procedure Development
and Periodic Review
• Supervision of Compliance to USP 797
– Completion of Required Documentation
– Environmental Testing and Device Inspection
• Supervision of Quality Assurance
– Training and Periodic Competency Testing
– Daily IV Rounding by Technicians
– Error, Charging and Inventory Turns Review
Opportunities within IRHA/InSRN
• Collaboration
– Remote Pharmacist Service Pricing
• Education
– Lunch and Learn Webinars
• Advocacy
– Policy Support
(http://www.indianaruralhealth.org/irha-programs/advocacy-and-policy/)
ASHP Resources
ASHP Advocacy
Provider Status for Pharmacists
Online Advocacy Center
Take Action
Use Your Voice
Individualize Your Message
Your Turn
• Open Forum
• Questions to ponder…
– What are our greatest challenges?
– What opportunities do we have?
– What components of a practice model are
absolutely essential?
– What are some ideas that most of us are
forgetting to consider?