Anthony P. Morreale, Pharm.D., MBA, BCPS
Assistant Chief Consultant for Clinical Pharmacy Services
and Healthcare Delivery Services Research
Pharmacy Benefits Management Services (119)
Department of Veterans Affairs
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Assistant Chief Consultant for Clinical Pharmacy
Services & Healthcare Delivery Services Research
Anthony Morreale
National Director,
Clinical Pharmacy
Program and
Outcomes
Assessment
Heather Ourth
National Director,
Clinical Pharmacy
Policy and Standards
Julie Groppi
Clinical Pharmacy
Management Analyst
Kim Quicci-Roberts
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The PBM has been tremendously successful in creating a
supportive infrastructure to manage the formulary and
improve medication safety.
It is our goal to use the lessons learned and successes
of those programs to expand on our leadership role in
clinical pharmacy practice in the United States
This task will be accomplished by organizing,
standardizing, engaging and energizing the strong
leadership and clinical pharmacy base we already have.
We plan on leveraging technology, technicians, policies
and communication tools to achieve these results
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Chartered in 2010
The PBM Clinical Pharmacy Advisory Board (CPAB)
was formed to promote the expansion of clinical
pharmacy practice within VA.
Key Pharmacy stakeholders from several sites
throughout the nation
Membership includes VISN Pharmacy Executives,
Pharmacy Chiefs/Associate Chiefs, Clinical
Pharmacy Specialists
Meet bimonthly via teleconference
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To date four national meetings have been held
Meetings consisted primarily of work group activities in which topics were
brainstormed and ideas flushed out. Opportunities, obstacles, priorities and
timelines have been developed for implementation. The top 10 projects for
implementation in 2010-2011 were:
◦ 1. Create nationally implemented standardized workload assessment
◦ 2. Create a Standardized clinical pertinence review process
◦ 3. Create PACT action plan requirement for Pharmacy (Request from Chiefs)
◦ 4. Assure a smooth transition of CPS from anticoagulation into other clinical areas
◦ 5. Create Standardized Competency Assessment documents for similar jobs
◦ 6. Establish a baseline of clinical services through a survey and measurement process
◦ 7. Establish priorities for educational programming for leaders to enhance program
implementation
◦ 8. Create uniform system of Scope of Practice which incorporates FFP
◦ 9. Establish Tele-work Proposals and New Models of Care
◦ 10. Explore expanded use of clinical pharmacy technicians to enhance CPS efficiency
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Chartered in 2012, first meeting in Jan 2012
Key Physician-thought leaders and PBM pharmacy
leadership
Goals:
◦ Create a transformational plan that will provide the basis
for initiatives and the strategic plan for CPPO
◦ Fully integrate the CPS into primary and specialty care by
leveraging their unique education and training to solve
medication-related problems and gaps in care for our
Veterans while improving medication safety and cost
outcomes
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New Clinical Pharmacy SharePoint Site has finally been created
http://vaww.infoshare.va.gov/sites/vapharmacyinformatics/ClinicalP
harmacy/default.aspx?PageView=Shared
Started populating with Medical Home now working on all other
specialty areas like anticoagulation, oncology, nephrology etc.
Content to include
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Business plans / staffing justifications
Peer review
Competencies
Scope of practice
Literature sources
Functional statements and performance statements
Research ideas
Staffing calculators
Data collection sources
Contact people
Links to useful sites such as VACO library
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Released
◦ Statements on recommended PACT staffing of Clinical
Pharmacists
◦ Statement on centralized Anticoagulation
◦ Statement on External Funding for Travel
◦ Union involvement in performance standards
◦ Position Paper on use of RN’s protocols to Manage
medications in chronic conditions within PACT
◦ PACT business rules
◦ Equivalent experience as applied to Scope of Practice
◦ DSS guidance
◦ DC RX redesign
◦ Scope of Practice
◦ OPPE Guidance
 In Progress
◦ Fiscal Glide Path education for Chiefs
◦ Tele-work guidance
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VACO, through the creation of a Assistant Chief Consultant
for Clinical Pharmacy Services position, made the initial
commitment in May of 2010.
VACO also providing funding resources to hire a CP
analyst, and to conduct two national Clinical Pharmacy
Advisory Group meetings during FY10.
VACO Currently recruiting for a Clinical Pharmacy Program
and policy manager
VACO provided funding for the Director to travel intensely
to local, regional and national meetings
Tremendous commitment to support large regional boot
camps.
Instrumental in establishing national standards, priorities,
and policies in concert with various offices within central
office.
Ultimately Hired 3 more staff to manage programs
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Several VPE’s have been very active members of the National Clinical
Pharmacy Advisory Group
VPE’s must help drive and support of expanded clinical pharmacy
practices through changes in policies, creation of performance goals,
and standardization of practice goals.
To lead their VISN’s in espousing our core concepts & principles and
promote the cost effective use of Clinical Pharmacists
To assure that Clinical Pharmacy Practice issues are treated with
equal importance to the operational, formulary and medication
safety issues in each VISN.
Responsibility to communicate up-line to VACO so that we can work
on their behalf. It will be important that clear feedback to VACO
about what is working, what is not and what issues exist at their
facilities.
Assure that all Pharmacy and non-Pharmacy leaders within their
VISN's are engaged and understand the issues, mission and vision so
that as leaders they can lead the charge.
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Support of expanded clinical pharmacy practices through changes in policies,
creation of performance goals, and standardization of practice goals.
To lead their facilities in espousing our core concepts & principles and
promote the cost effective use of Clinical Pharmacists
To assure that Clinical Pharmacy Practice issues are treated with equal
importance to the operational, formulary and medication safety issues in
each VISN. This may require a designated Clinical Pharmacy lead at each
facility.
Responsibility to communicate up-line to VPE’s and VACO so that we can
work on their behalf. It will be important that clear feedback to VACO about
what is working, what is not and what issues exist at their facilities.
Assure that all Pharmacy and non-Pharmacy leaders within their VISN's are
engaged and understand the issues, mission and vision so that as leaders
they can lead the charge.
Assure that all pharmacists, no matter who they work for, have Pharmacy
service oversight for scope of practice, clinical and operational competency,
formulary management, and medication safety.
Assure that all their staff are engaged and understand the issues, mission
and vision so that as leaders they can lead the charge.
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Develop Policy to define, clarify, and standardize clinical
pharmacy practice throughout VHA
◦ Development of the first VHA Clinical Pharmacy Handbook
◦ Revisions of key handbooks, directives, and templates to
incorporate clinical pharmacy practice transformation, ensure
continuity of roles and responsibilities of CPS, and changing role
of pharmacists and technicians. Examples include: Coordinated
Care Directive, OP Handbook, IP Pharmacy Handbook, CBOC
Template revision
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Development of a CPRS tool to document clinical pharmacy
interventions that characterizes the role of the CPS in practice
◦ Pharmacists Achieve Results with Medications Demonstration
(PhARMD) Project
◦ Data Extractions from CDW and National Database capabilities
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Refine Quality Assurance and Outcomes research capability to
take on more groundbreaking, publishable assessments of
the CPS role in primary and specialty care
◦ Clinical Pharmacy Health Services Research Team formed to seek
to organize, standardize, engage and energize the strong
leadership and clinical pharmacy base currently in place and to
lead the profession of pharmacy through fostering research
opportunities.
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Further expansion of role of CPS in PACT and Specialty Care
◦ PACT Business Rules and development of Specialty Care Business
Rules and Staffing Models
◦ Emphasis on CPS role in antimicrobial stewardship, Hepatitis C,
Pain Management
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Supporting the movement of the CPS as an Licensed
Independent Practitioner
◦ Development of a Policy Documents that coincide with LIP practice
◦ Collaboration with Professional Organizations and key
stakeholders
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Development of a communication and marketing plan for
clinical pharmacy
Systems Redesign of the Pharmacy Practice Model
◦ Standardize the roles of Pharmacy technicians throughout the VHA
to enhance the overall performance of the pharmacy services
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Identify additional areas of unmet clinical need in both the
ambulatory care and inpatient settings
◦ Workgroup chartered to identify measurable gaps in care related
to complex medication management and safety
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Clinical Pharmacy Program Office Workgroups 2012
PharmD Project
Clinical Pharmacy Outcomes Research
Systems Redesign of the Pharmacy Practice Model
Teleheath
Advancing Clinical Pharmacy Specialists as Licensed Independent Practitioners
PBM Clinical Pharmacy Quality Assurance
PBM Clinical Pharmacy Penetration metrics
Marketing and Publication Plan for Project and Initiatives
Identify Measurable Gaps in Care
Prioritize National Educational Programs to advance clinical practice in areas where
gaps in care for medication management
Assessing and Improving Medication Renewal, Nutritional Supplement and Supply Item
Processes in VHA
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Workgroup
Collaborating Groups
Intravitreal Bevacizumab (AVASTIN) PBM-Hines; Pharmacy Field expert
Hepatitis C CREATE
Public Health-Population Health
Medication Reconciliation
PBM – Med Rec; PBM – PRE/CI
Primary Care Policy
PC; PC-FAC; PC Field experts
Office of Nursing Policy
ONS; NS Field experts
National Antimicrobial Stewardship Infectious Disease Program Office
Task Force
National PBM Education Advisory
Group
PBM-Hines
ED/UCC Med Management/Med
Recon Task Force
PBM – Med Rec; ED Field experts
Academic Detailing Pilot
Office of Mental Health
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Clinical Pharmacy Handbook concurrence by end of
FY12
PharmD project national roll-out by 4th Quarter
FY12
Communication and marketing plan by end of FY12
Systems Redesign Tool for use by facilities by end
of FY12
Identify additional areas of unmet clinical need in
both the ambulatory care and inpatient settings.
Initial plan to be completed by April 30, 2012.
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Developed Team Charter for group charged with
recommending health services research priorities for
evaluation by the CPAB
◦ Establishing top project opportunities
◦ Creating a network of volunteer pharmacists and facilities who are
interested in pursuing clinical pharmacy health services research
◦ Developing proposals for grants and VA research foundations
◦ Advisory group developed by March 2012 with recommendations
to the CPAB by September 2012.
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Develop metrics to better describe clinical pharmacy
penetration at facilities across the country
◦ Goal to identifying best practices and sites that needs assistance
and to establish some staffing and performance norms
◦ Report on initial metrics by February 2012 to CPAB and CPEB.
Field release of metrics through VPEs by May 2012.
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Enhancement of Clinical Pharmacy Programs
◦ Development and integration of Clinical Pharmacy Policy assists
with standardization of roles and responsibilities as well as
supporting transformation of practice throughout VHA
◦ Educational Initiatives
◦ Clinical Pharmacy Advisory Board/Clinical Pharmacy Executive
Board
◦ Clinical Pharmacy Health Services Research Team
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Improve pharmacy operational efficiencies-Use of
Pharmacists, technicians, automation
◦ Systems Redesign of the Pharmacy Practice Model supports the
role of using pharmacists, technicians and automation to the
highest potential
◦ Allows for movement of pharmacists away from operational
functions and duties and towards more direct patient care
activities
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Improve management and advancement of pharmacy technicians
◦Leadership boot camp educational program proposal developed in
conjunction with PRRO.
◦Develop core responsibilities for technicians and realign roles
Ward inspections, Checking dispensed orders (Tech Check Tech), assist
Pharmacists in non-traditional roles (below)
◦Expanding and Standardizing roles for Pharmacy Technician
Areas such as Medication Reconciliation, Anticoagulation, Tele-Health,
Poly-Pharmacy, Formulary Management, Prior Authorization review,
Quality Assurance, Controlled Substance Management, OR
Responsibilities, Automation Oversight and Implementation, USP 797
Oversight and Implementation (IV Room Operations), Adverse Drug
Reaction Tracking, Drug Accountability, Drug Use Evaluation tracking,
Safety Bulletin implementation and tracking
◦Augment, Standardize, and Improve technician training (develop
meaningful, engaging and stimulating training opportunities), competency
assessment, and professionalism
◦Improve communications with National Technician Groups/Forums
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Clinical Pharmacy Handbook
Coding, Billing and workload assessment tools
Continued PACT development and expansion
SCAN/ECHO development and expansion
Specialty Care development and expansion
especially in areas of intense VA expansion or
those that have high medication related needs –
these include HCV, ASP, ED, High Risk
Medication assessment, Pain.
Pharmacy Education - Boot Camps and Live
Meetings
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Systems redesign
Expanding the use of technicians
Enhanced Communications
Clinical Pharmacy Penetration Metrics and
quality tools to monitor field guidance,
handbooks and to identify sites that need
support
RN Medication Protocols
Development of Clinical Pharmacy infrastructure
through development of a national Clinical
Practice Council system.
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