Appropriate Clinical Staffing
Standards For Pharmacist Activities
Thomas Emmendorfer, PharmD
VHA PBM – VA MedSAFE
Objectives
Overview VA Pharmacy Cost Workgroup findings
 Define goal of hero group survey
 Review selected results of survey
 Develop clinical staffing model to define standards
 Develop business plan for select clinics

Pharmacy Cost Workgroup: Findings


VISNs with fewer than average number of clinical
pharmacists and higher than average pharmacy
costs should increase the number of clinical
pharmacists to reach the benchmark
VISNs with higher than average number of
clinical pharmacists and high costs should
evaluate manner in which those pharmacists are
utilized
Partial Listing of Findings
Goals of Survey
Define clinical activities
 Quantify clinical activities across the VA
 Determine best approach of developing
staffing model

Clinical Pharmacy Activities

Definition used for survey
– Those functions that are conducted by a
licensed pharmacist in the support of direct
patient care and/or through administrative
activities
Clinical Pharmacy Activities

Do NOT include:
– Verification, processing, or dispensing
medication orders/prescriptions that were
entered by a provider, or other functions related
to product distribution; unless this is a
function/duty incorporated into the clinical role
Survey Results
Clinical Pharmacist FTEE Per 10,000 Pharmacy
Patient Uniques (FY 2006)
100
90
80
Facilities#)
70
60
50
40
30
20
10
0
0 to 3.79
3.8 to 4.9
Clinical RPh/10,000 Rx Uniques
> 4.9
Clinical Pharmacy Services

19 Different Categories to distribute FTEE
– Examples:
» Primary Care
» Urology
» HBPC

At least 1 facility reported FTEE dedicated
to each of the 19 categories
Clinical Pharmacy Staffing Standard
Clinical Pharmacy Staffing Standard

Barriers to individualized standards
– Wide range of clinical pharmacy services
– Different services provided with similar clinic names

Solution
– Establish workgroups for commonly established clinics
– Clinical Pharmacy Staffing Standard Model
– Develop business plans for requesting clinical
pharmacy FTEE for select clinics
Staffing Model: Pharmacy Clinic for
Face-to-Face Visit (Specialty Clinic)
Parameters
Numerics
Enter number of clinical Pharmacist FTEE to staff clinic
1
Enter average number of hours per week clinic will operate
35
Enter 80 if the clinic will not be open on Federal Holidays. Enter 0 if it will be open on Federal Holidays
80
Enter estimated number of hours per year the clinic will not be open because of vacation/sick leave.
Enter 0 if none
0
Note 1
Time (hours) allotted for each clinic visit for established patients (e.g. 15 min = .25 hour)
0.33
Note 2
Time (hours) allotted for each clinic visit for new patients (e.g. 15 min = .25 hour)
0.5
Estimated number of new patients per week
10
Note 3
Estimated number of no-show appointments per week
5
Note 4
Projected annual clinic visits available: established patients
4485
Calculated
Field
Projected annual clinic visits available: new patients
520
Calculated
Field
Average Number of visits in 12 months for each established patient?
12
Note 5
Average Number of visits in 12 months for each new patient?
16
Recommended Panel Size Based on Numerics Entered
387
Staffing Model: Pharmacy Clinic for
Face-to-Face Visit (Primary Care)
Parameters
Numerics
Enter number of Primary Care Teams
6
Enter average number of hours per week the primary care teams operate (Do not exceed 40 hours)
35
Enter average number of hours per week primary care PHARMACY clinic will operate
35
Enter 80 if the clinic will not be open on Federal Holidays. Enter 0 if it will be open on Federal Holidays
80
Enter estimated number of hours per year the clinic will not be open because of vacation/sick leave.
Enter 0 if none
0
Note 1
Time (hours) alloted for each clinic visit for established patients (e.g. 15 min = .25 hour)
0.33
Note 2
Time (hours) allotted for each clinic visit for patients requiring time intensive visit (e.g. 15 min = .25
hour)
0.50
Note 3
Estimated number of patients per week requiring intensive visit
10
Estimated number of no-show appointments per week
5
Projected number of clinical Pharmacist FTEE to staff teams
6
Projected annual clinic visits available for clinical pharmacist FTEEE: established patients
26,779
Projected annual clinic visits available for clinical pharmacist FTEEE: intensive visit required for
patient
2,990
Note 4

Business Plans for Requesting
Clinical Pharmacy FTEE
Diabetes
– Sumita Biswas (Group Leader—
Atlanta)
– Melissa Atwood (Minneapolis)
– Carrie Thomas (Durham)
– Kim Ho (El Paso)
– Hasmig Chilingirian (Long Beach)
– Kimberly R. Watson (Little Rock)
– Molly Kurpius (Jesse Brown—Chicago)

Primary Care
– Donna Leslie (Group Leader—Jesse
Brown—Chicago)
– Jon Folstad (Cleveland)
– Kevin Burns (Minneapolis)
– Robert Henault (Boston)
– Hilary Davis (Phoenix)
– Dana Frank (Jesse Brown—Chicago)

Lipids
– Giselle Rivera (Group Leader—San Juan)
– Ana Vazquez (Bay Pines)

Anticoagulation
–
–
–
–
Maurice Jones (Cleveland)
Jeffrey Sayers (GLAHS)
Lisa Longo (PBM)
Keith Trettin (NCPS)
Building Consensus

Staffing Standard Model
– Reviewed by work groups
– Distributed to those who completed original
survey for feedback

Business Plans
– Reviewed by work groups
– Distributed to those who completed original
survey for feedback
Future Direction
Implement staffing model and assess for
outcomes
 Recommend creating a SharePoint site to
post staffing model and business plans
 Consider a process to identify resources
posted to the site as best practices
 Encourage sites to post related resources to
SharePoint site

Questions?