ASHP InterSections ASHP InterSections

August 18, 2015

New Mexico Clinic Pharmacists Wield Extensive Prescribing Privileges

From left, PMG Pediatric Pharmacy Specialist Kari Bishop, Pharm.D., discusses improvements in the electronic health record system related to adult and pediatric heparin infusions with Pharmacy Anticoagulation Specialist Linda R. Kelly, Pharm.D., Ph.C., CACP.

From left, PMG Pediatric Pharmacy Specialist Kari Bishop, Pharm.D., discusses improvements in the EHR system related to adult and pediatric heparin infusions with Pharmacy Anticoagulation Specialist Linda R. Kelly, Pharm.D., PhC, CACP.

IF THEY TAKE A MOMENT to look, patients who fill prescriptions after visiting one of the ambulatory care clinics in Albuquerque’s Presbyterian Medical Group (PMG) will see that the name on the medication bottle belongs to a pharmacist.

“When I write a prescription, it’s not checked or approved by a physician because I’m recognized as a healthcare provider by my state and my health system,” said Robert Rangel, Pharm.D., BCPS, PhC, director of pharmacist clinicians and anticoagulation services with PMG, noting that state laws dictate the limits of collaborative practice.

“That changes the perception among patients and colleagues about pharmacists’ abilities to care for patients, and it means that we’re recognized as advanced practitioners.”

Independent Prescribing

Collaborative practice agreements (CPAs) under which pharmacists write prescriptions are no longer isolated experiments. But most require a physician or nurse practitioner to review and sign off on every order. That’s where PMG breaks new ground: Any of the 14 clinical pharmacists practicing in ambulatory care can independently prescribe any medication used in the scope of a primary care visit as well as manage a spectrum of common chronic disease states. Right now, that list includes diabetes, elevated lipid levels and cardiovascular disease, hypertension, asthma and COPD, and even psychiatric and thyroid conditions.

Robert Rangel, Pharm.D., BCPS, Ph.C.

Robert Rangel, Pharm.D., BCPS, Ph.C.

The current CPA emerged from an earlier version at PMG’s anti-coagulation clinic, where pharmacists had wide latitude to adjust warfarin regimens and counsel patients. Improved clinical outcomes, such as a reduction in thromboembolic events, opened the door to the current, far more expansive CPA. This new practice agreement covers 15 primary care clinics, two cardiology clinics in greater Albuquerque, and one rural clinic with plans to expand to other parts of New Mexico. All of the more than 100 PMG physicians participate in the agreement.

“We’ve seen again and again that when you put a pharmacist in a clinic, even if they’re doing something small to begin with, sooner or later they’ll be asked to do more,” said Dr. Rangel.

The effectiveness of PMG’s ambulatory care practice reveals what pharmacists could do for patients if they were granted healthcare provider status under Medicare Part B, according to Joseph M. Hill, ASHP director of federal legislative affairs.

“This story is so great because it reinforces our message that pharmacist-provided care expands patient access and is cost effective,” Hill said, noting that the collaborative nature of PMG’s CPA mirrors the evolution of new care delivery models.

Charting Improvements in Fundamental Quality Measures

Three years ago, PMG restructured its budget so that the medical group, not the pharmacy department, paid the salaries of the ambulatory care pharmacists. A year later, the chain of command shifted; now, PMG ambulatory care pharmacists report to the director of the medical group rather the pharmacy director. The impact was huge, recalled Dr. Rangel.

“We’d been working and living in the medical group’s clinic but following a different management hierarchy. We didn’t feel like we were really a part of the medical group, and they felt the same way about us. We were still outsiders,” said Dr. Rangel.

The administrative shake-up solidified the unit and led to a collegial, supportive environment. “It really sealed the deal,” said Dr. Rangel.

Pharmacists at PMG clinics help patients manage a variety of chronic conditions, including diabetes.

The CPA’s success resulted from a lot more than just managerial and financial reshuffling. Once clinical pharmacists entered the scene, across-the-board improvements in fundamental quality measures followed, such as tighter A1c control for diabetic patients and improved blood pressure and lipid levels for cardiovascular patients. “We see better numbers for all three of them when pharmacist clinicians work in ambulatory care,” said Dr. Rangel.

Though their colleagues are accustomed to the presence of pharmacists in the outpatient clinics, patients are still getting used to the idea. Many express surprise when a pharmacist walks into the exam room to chat. “The majority of patients still see pharmacists as just drug dispensers,” said Dr. Rangel. “We still have a long way to go to change that perception. However, we are getting the word out, and it is making a difference.”

Expanding Scopes of Practice for Hospital Pharmacists

Linda Kelly, Pharm.D., CACP, PhC, a pharmacy anticoagulation specialist, anticipates that a CPA will emerge on the inpatient side at PMG. “I practice to the limit of my professional license in the outpatient clinics because of the CPA, but we haven’t yet defined a comparable role for clinician pharmacists on the inpatient side,” she said.

Setting comparable scopes of practice for clinical pharmacists throughout the organization will blur the lines between inpatient and outpatient care and create a more patient-centered care model, Dr. Kelly asserts. It just makes sense, she explained, that patients receive the same level of care from pharmacists wherever they practice in the organization.

“I already conduct medication management and offer prescribing recommendations for inpatients, but I can’t write orders independently,” she said. “Expanding our role to include prescribing is a logical next step.”

Dr. Rangel cautions that pharmacists tread carefully – but confidently – when seeking to expand their roles within a health system. “We were fortunate because we had already established relationships and a solid track record in the anti-coagulation clinic,” he said. “If we had walked into a clinic and said, ‘We’re here to manage your patients with chronic diseases and write prescriptions,’ we’d have hit forceful push back.”

“It was a slow process. We used our experience in the anticoagulation clinic as our introduction, and that made the transition much easier.”

Dr. Rangel suggests starting small, finding a niche, and letting the momentum build naturally.

“If I were starting from scratch, I’d ask the medical group what they need and how we can help… maybe managing diabetic or hypertensive patients,” he said. “Often members of the care team welcome that kind of offer. And as trust builds, demand for your services will almost certainly grow.”

–By Steve Frandzel

July 16, 2015

IT Wizardry Streamlines Hospital Discharges, TOC

Wing Liu, Pharm.D.

Wing Liu, Pharm.D.

THE TRANSITION OF CARE (TOC) after hospital discharge remains perhaps the most vexing stage in the healthcare continuum. Lapses during patient hand-offs between the hospital and a patient’s home or a post-acute care facility often include incomplete information about key aspects of care. For pharmacy care, such breakdowns typically show up as multiple, conflicting, and erroneous medication lists.

At Vanderbilt University Medical Center (VUMC) in Nashville, Tenn., patient care during TOC has improved with the use of a new software program designed by Wing Liu, Pharm.D., product manager for the inpatient computerized physician order entry (CPOE) system, and his IT team.

“We asked ourselves, ‘How can we do a better job of coordinating all aspects of the transition to ensure patient care remains uninterrupted at a high level, regardless of where patients go?’” Dr. Liu said.

The Discharge Wizard app pulls together all elements of TOC into a single application.

The Discharge Wizard app pulls together all elements of TOC into a single application.

Rolled out in 2012, the Discharge Wizard application pulls together all elements of TOC into a single application, including the often daunting process of medication reconciliation.

The solution links directly to VUMC’s electronic health record (EHR), allowing clinicians to merge and exchange key information between the two IT platforms, such as patient demographics, follow-up appointments, patient core measures (e.g., congestive heart failure), healthcare team members, current medical status, bed location, and diet and exercise regimens.

The application even compels users to conduct medication reconciliation to complete the discharge process.

“It’s designed well and is easy to use,” said Amy Myers, Pharm.D., BCPS, a clinical pharmacist at VUMC.

“During the medication reconciliation process, the system allows you to choose, medication by medication, which to stop and which to continue. The result is a single, accurate medication list, which is also accessible through the EHR. That’s a huge benefit.”

Easy-to-Read Discharge Plan Streamlines Patient Handoffs

Ultimately, the system produces a discharge plan. All patients receive an easily readable discharge letter that includes medication schedules, follow-up appointments, additional care instructions, and educational material. For patients headed to a post-acute care facility, the plan is transmitted to the new healthcare providers via fax, email attachment, or with an accompanying paper record.

Nicole Callendar, R.N.

Nicole Callendar, R.N.

“One of the best features of this solution is the option to customize the discharge report based on the patient’s destination,” said Nicole Callender, R.N., staff nurse and support liaison for the application. “The orders tell the patient exactly what is needed for his or her care.”

To encourage rapid adoption of the Discharge Wizard application into the current discharge workflow, Dr. Liu wanted the app to be a model of simplicity. By all accounts, he succeeded.

Although the application is optional, biweekly utilization reports show that clinicians use it in about 95 percent of discharges. The most useful feedback about the system’s impact on workflow and patient care, he added, comes from anecdotal reports by users vs. quantitative measures.

Any member of the care team can easily launch the application through the CPOE, but only healthcare providers and select clinical pharmacists can save information. The software guides them through a sequence of fields to gather all of the relevant information needed for a discharge report. At any point, the process can be paused and restarted by another clinician, for example, in the case that a pharmacist needs to get involved in the medication reconciliation component.

Applicability to Post-Acute Care Facility Transfers

Originally, the Discharge Wizard applied only to patients discharged home. But a Centers for Medicare & Medicaid Services grant called “IMPACT: Improved Post-Acute Care Transitions” highlighted the need for an expanded role for the system to include patients transferred to post-acute care facilities. This is a patient group that is typically burdened by complex, mutable drug regimens.

Amy Myers, Pharm.D., BCPS

Amy Myers, Pharm.D., BCPS

“This is a very vulnerable population, especially for medication errors, yet it’s often excluded from TOC studies, which typically focus on patients going home,” Dr. Myers said. “It became apparent that we needed to improve our system for sending transfer orders to the new facility.” The more robust application went live in fall 2014.

Once VUMC nurses realized that using the software application meant they didn’t have to handwrite discharge orders anymore, and that patients could actually read the reports, they were sold, said Nicole Callender.

“Now, it’s part of the culture and widely embraced,” noted Callender. “It’s at the point where, if you’re a bedside nurse who doesn’t have a printed discharge letter from the Discharge Wizard to give to the patient, that nurse is going to call the provider to ask for it.”

Allie D. Woods, Pharm.D., director of ASHP’s Section of Pharmacy Informatics and Technology, said that hospitals and health systems across the country need apps and systems like the Discharge Wizard to help reduce errors and improve medication reconciliation.

“It’s critical that TOC information is shared with all healthcare providers in a single location. This system is definitely a step in the right direction for healthcare technologies,” she added.

From the perspective of pharmacy informatics, the project has been eye opening, added Dr. Liu.

“As a pharmacist, I’ve been involved in creating an application for which my role was envisioning what it should do and how to get there,” he said. “It’s taken a team of four full-time software engineers working on it to get this far, and it’s been very gratifying to see the difference that it’s made for patients and healthcare providers alike.”

–By Steve Frandzel

Editor’s Note: The project described in this article was supported by Grant Number #1C1CMS331006 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

June 17, 2015

At NMMC, Pharmacists Introduce Medical Residents to Comprehensive Care

From left, James L. Taylor, Pharm.D., talks to a patient about his medication regimen.

From left, James L. Taylor, Pharm.D., talks to a patient about his medication regimen.

PATIENT-CENTERED CARE is intrinsic to good outcomes and requires a multidisciplinary, team-based approach. At North Mississippi Medical Center’s (NMMC) Family Medicine Residency Center in Tupelo, a special program ensures that family practice residents have access to the medication knowledge and experience of pharmacists. And the results have been extraordinary.

J. Edward Hill, M.D., faculty member in the family medicine residency program and a past president of the American Medical Association, is a big fan of the program. “Having a pharmacist in a clinic like this, working side-by-side with residents every day, is the most exciting thing for patient care and resident education I’ve ever seen,” he said.

As part of the program, each class of eight first-year residents inherits a panel of patients from the graduating class before them. They then follow the patients throughout the three years of their residencies as the patients transition through clinic visits, hospital admissions and discharges, and extended care facilities.

Positively Impacting Residents’ Learning Process

James L. Taylor, Pharm.D., the primary care pharmacy manager at the Center, guides residents on medication management every step of the way.

“I serve as a source of information to residents and do one-on-one consults, both in chronic care services and on transitional care services,” Taylor said. “For example, if the residents want to start someone on insulin, they ask me to do the initial education as well as the follow-up and titration. When the residents go on rotation, I’m their back-up in talking to patients when they’re not available.”

Having access to a pharmacist who can provide this kind of oversight has dramatically changed patient care at NMMC, according to Dr. Hill.

“On a daily basis, James catches things that could turn out to be errors or safety issues. He has had a major impact on the residents’ learning cycle and dramatically improved the care they provide,” he said.

Ensuring Comprehensive Care

Taylor, who works alongside a licensed social worker and five fellow faculty members and clinicians, draws upon his work as a pharmacist to provide residents with practical pointers that will enhance care. For example, Taylor understands the various insurance plans that the clinic’s patients have based on his work getting prior authorizations for various treatments. This knowledge has made him cost-sensitive, which he stresses to the residents.

J. Edward Hill, M.D.

J. Edward Hill, M.D.

“If a patient can’t afford the medications they’re prescribed, we’ve done them no good. So, I like to impress upon the family practice residents that they should be aware of the formulary coverage issues and costs of drugs available to the patients,” Taylor said. “If we could do this in every clinic, we would cut down on call-backs to the clinic that retail pharmacists need to make if a prescription is not covered, and our patients would be better served.”

Taylor has worked extensively with teams of physicians and administrators in the NMMC system to determine the safest and best ways to discharge patients and transition them through the care continuum. Taylor’s efforts help reduce readmissions and increase clinic follow-up, and he builds upon this success by passing proven care strategies along to the residents.

“We’ll make follow-up calls within two business days of hospital discharge to make sure patients have follow-up appointments, and we counsel them on their concerns,” Taylor said. “Residents learn how to question patients to get the right information about whether they are taking their medications correctly, and if not, why not.”

Kristi M. Gholson, Pharm.D., FASHP, director of pharmacy for the family medicine residency program, emphasized the program’s forward-thinking approach. “The residents may end up practicing somewhere that doesn’t have access to pharmacists the way they have now. We won’t be there to do this [kind of work] for them, so we teach them our way of thinking.”

A Welcome Addition

Feedback from both current and former residents has been overwhelmingly positive, said Gholson. “Some of them have said that they would never want to work in a clinic that didn’t have a pharmacist.”

Indeed, several former residents still reach out to Taylor for advice. “Hopefully, I’ve given them some things to think about when they are out there on their own, practicing evidence-based medicine and balancing cost considerations, so they can make the right choices for their patients.”

We need someone who has a broad knowledge of all medications, and that’s what pharmacists bring to us and to our patients. — J. Edward Hill, M.D.

That Taylor still hears from former residents is testimony to the value of pharmacists’ training and expertise, said Gholson.

“It shows that there’s a need for our knowledge. As a profession, we have to continue to market ourselves. We need to differentiate our skills and expertise from those of other members of the healthcare team.”

Dr. Hill said that physicians should welcome pharmacists as integral members of the care team.

“We often know enormous amounts about the medications in our particular specialties, but we need someone who has a broad knowledge of all medications, and that’s what pharmacists bring to us and to our patients.”

—By Terri D’Arrigo

June 2, 2015

UI Hospitals and Clinics Smart Pumps Project Reduces Errors

Filed under: Clinical,Current Issue,Feature Stories,Innovation,Managers,Quality — Kathy Biesecker @ 12:47 pm
University of Iowa Hospitals and Clinics' new pump-EMR integration has resulted in a significant decrease in manual pump programming and increase in compliance.

University of Iowa Hospitals and Clinics’ new pump-EMR integration has resulted in a significant decrease in manual pump programming and increase in compliance.

IN FEBRUARY 2014, University of Iowa Hospitals and Clinics (UI Hospitals and Clinics) in Iowa City began electronically integrating its intravenous (IV) infusion pumps and electronic medical record (EMR).

The primary goal? Increase patient safety by preempting inaccurate manual keypad entries when programming infusions at the pump. Studies have shown that IV medication errors are associated with a high likelihood of patient harm compared with other routes of administration.[i]

A Huge Patient Safety Win

“Anytime you can automate a process, you remove the potential for human error,” said Jeff Killeen, Pharm.D., manager of pharmacy informatics with UI Hospitals and Clinics.

“Integrating our pumps with the EMR closes the gap between what happens after the prescriber orders a medication and what happens at the infusion pump,” he noted, adding that an additional goal was to prevent transcription errors that can occur when pumps are programmed manually. “Eliminating that source of mistakes is a huge patient safety win for any organization.”

Jeff Killeen, Pharm.D.

Jeff Killeen, Pharm.D.

Pharmacists still verify the IV medication orders after they are entered into the EMR but now, the order is confirmed by a nurse and sent wirelessly to the pump. The nurse then verifies the medication details on the pump and starts the infusion, which documents the entire process and updates the EMR. This completes the data loop.

“The process is safer for the patient. The fact that there is less manual programming of the pump means there are far fewer chances for errors,” said Pamela Kunert, MSN, RN-BC, nurse practice leader in nursing informatics at UI Hospitals and Clinics. She added that in cases of downtime, manual programming is still used.

Increasing Compliance, Reducing Workarounds

The 700+ bed academic medical center (which includes a 190-bed children’s hospital) has steadily rolled out the pump-EMR integration across the entire health system. By early June, the initiative will be complete, according to Chief Pharmacy Officer Mike Brownlee, Pharm.D., M.S., FASHP.

Dr. Brownlee has already documented a significant decrease in manual pump programming as well as a jump in compliance from 86 percent to 92 percent for staying within upper and lower pump “guardrail” limits.

“That doesn’t sound like a big increase, but when you’re making hospital-wide changes like this, even a one percent increase in compliance is difficult to achieve,” said Dr. Brownlee.

Because infusion pumps are usually operated in isolation and manual keypad entry remains an enduring source of miscues, uncertainty about which drug and what dose a patient actually receives has been a nagging concern, added Alison Woods, Pharm.D., director of ASHP’s Section of Pharmacy Informatics and Technology.

Often, in fact, the pharmacist doesn’t find out for quite some time that a nurse has keyed in order information incorrectly or overridden safety stop “guardrails” on a pump.

“Pump integration creates much-needed transparency for all healthcare providers in the loop because now everyone knows with confidence what’s being administered, at what dose, and at what rate of delivery,” she said.

“That transparency creates an environment that no longer relies on reacting to mistakes and fixing problems retroactively after a patient has been harmed. This use of smart technology creates an efficient and safer patient care environment.”

Improved Efficiency Leads to Fewer Errors

The new system’s impact on pharmacist workflow has been very positive, according to Dr. Killeen.

“Before we had pump integration, the pharmacist had to manually check on factors such as infusion rates, current dose, and duration of infusion. Often this meant they had to physically check the pump itself,” he said. “If anything, the change has made our pharmacy team’s work easier because all of that information is tracked and displayed automatically in nearly real time within our EMR.”

…Nurses don’t have to worry about keypad entry errors. So, when an alert on the pump does occur, they know it’s something they need to pay attention to.

Dr. Killeen also noted that pump integration has meant a substantial reduction in the number of safety alerts, which has led to a corresponding drop in manual workarounds on the nursing administration side.

“When the order parameters are properly set up through the EMR with corresponding configuration in your smart pump library and pump integration is used, nurses don’t have to worry about keypad entry errors,” he said. “So, when an alert on the pump does occur, they know it’s something they need to pay attention to.”

Gaining Buy-In from Stakeholders

The sizeable benefits created by the pump-EMR integration didn’t come easily, according to Dr. Killeen, who emphasized the enormous amount of resources and resolve required to plan and execute the project.

“This type of system-wide project isn’t something to approach lightly,” he said. “It’s not something you can lump in and implement with other day-to-day changes.

“For such a large project to succeed, you must determine well ahead of time the resources you’ll need to carry it out and make sure they will be available.”

It took several pharmacists and pharmacy technicians six to nine months of very time-intensive work throughout planning and roll out along with countless hours spent by nursing staff, he said.

Dr. Killeen also underscored the importance of support from institutional leadership and from every area affected by the project.

“I wouldn’t even think about doing this if we didn’t have backing from at the very least the chief nursing officer, the chief pharmacy officer, and the chief medical officer,” he said. “Take your time and do it right; once you do, it’s definitely worth it.”

–By Steve Frandzel

 

[i] Proceedings of a Summit on Preventing Patient Harm and Death from IV Medication Errors. American Journal of Health System Pharmacy, Dec 15, 2008;65:2367-2379.

March 20, 2015

Residency Match Day

Filed under: Current Issue,From the CEO,Managers,Residents — Tags: , , — Kathy Biesecker @ 4:48 pm
Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

ON BEHALF OF ASHP I would like to congratulate everyone who matched in today’s Pharmacy Residency Match Program. Your many years of hard work have paid off, and you are now on your way to the next phase of honing your skills as a patient care provider and a leader in our profession.

More than 3,600 pharmacy students and new practitioners matched with a residency position. This year, I am also happy to report that over 300 additional residency positions were added to the 2015 Match. Further, this year’s 8% rate of growth for PGY1 residency positions exceeded the 5% growth in demand from applicants. Things are clearly heading in the right direction, and ASHP looks forward to continuing to build further capacity in pharmacy residency training throughout the United States and around the world.

When ASHP leaders created the vision for pharmacy residency training over 50 years ago and started accrediting pharmacy residencies, there were only a handful of programs in existence. And, just in the past three years, the number of positions has increased by 1000 or 25%. This exponential growth and demand, along with the dramatic advancement of pharmacy practice, is amazing and you are part of that.

Today is also a good time for all of us in the profession to reflect on the purpose of residency training as we congratulate our new incoming residents. Residency training is first and foremost about our patients, and about helping them to achieve optimal health outcomes. I applaud all of you as incoming residents for your dedication to your patients, and for your desire to take your clinical and leadership skills to the next level. The year(s) ahead of you in your residency programs will be marked by many challenges; however, the rewards and satisfaction of seeing the difference you make in the lives of your patients, the enhanced confidence in your skills and abilities, and the relationships that you will obtain through your residency will live with you forever.

We want you to know that ASHP is your professional home as residents and future patient care leaders. Further, that ASHP will have the resources you need to be successful throughout your career in your practice, which might be a hospital, an ambulatory clinic, or many other sites throughout the continuum of patient care. To those of you that did not match there are still 270 PGY1 positions and 112 PGY2 positions remaining in the post-match process. Also, if you did not match, I hope you will consider reapplying next year, and using ASHP’s many resources located on ASHP’s Residency Resource Center to help prepare yourself.

In closing, ASHP is the organization for you as a patient care provider, and I encourage you to take advantage of the many benefits of ASHP membership, including our new AJHP Residents Edition, which is a quarterly online supplement to AJHP that provides a forum for pharmacists to publish the results of projects they completed during their residencies.

Again, congratulations to all of you, and best of luck in your residency and your journey throughout your career in the wonderful profession of pharmacy!

Sincerely,

Paul

February 25, 2015

CPPA Helping Ambulatory Care Pharmacies Demonstrate Value

Filed under: Ambulatory Care,Clinical,Current Issue,Feature Stories,Managers,Quality — Tags: , , — Kathy Biesecker @ 12:19 pm

Lynnae Mahaney, B.S.Pharm., M.B.A., FASHP

THE ISSUE OF PHARMACIST CREDENTIALING and privileging continues to grow in the national consciousness as pharmacists seek to differentiate their skill sets in a crowded workplace. But how can the more than 60,000 outpatient pharmacy practices in clinics, health systems, and community settings demonstrate their own excellence in patient care?

The new Center for Pharmacy Practice Accreditation (CPPA), a partnership among ASHP, the National Boards of Pharmacy (NABP), and the American Pharmacists Association (APhA), was created to address that need. CPPA accreditation, according to Center Executive Director and former ASHP President Lynnae Mahaney, B.S.Pharm., M.B.A., FASHP, offers a way for ambulatory care clinics and others to demonstrate their value to patients, payers, and other healthcare providers.

Mahaney recently sat down with ASHP InterSections to talk about how the CPPA’s work will transform pharmacy practice.

Why did you want to lead the Center for Pharmacy Practice Accreditation?

I’ve always been a passionate proponent of the need for credentialing for pharmacy practice. We have to be able to show our value in a predictable, measurable, and specific way, and that’s what credentials do. I also believe that accreditation is an important means of moving pharmacy practice forward. Accreditation standards for how care is delivered in pharmacy practices should originate from within our own profession. That’s critical because we are the medication experts. We know what best practice is. And because ASHP, APhA and NABP have collaborated to create the Center, we serve a real purpose and niche in the accreditation marketplace.

Didn’t the CPPA recently accredit its first pharmacies under its community pharmacy practice standards?

Yes. In 2014, we rolled out the community pharmacy practice accreditation program and subsequently accredited three pharmacy practices: The discharge pharmacy for outpatients at Johns Hopkins Hospital in Baltimore, the Goodrich Pharmacy near Minneapolis, and the Medicine Shoppe in Two Rivers Wisconsin. We also recently released the new CPPA standards for specialty pharmacy practice accreditation, which we’re very excited about.

What qualities does a pharmacy practice need to qualify for accreditation?

We’re recognizing pharmacy practices for their quality, their patient care services, and their approach to medication safety. A practice must demonstrate an advanced and consistent level of high-quality patient care services across a spectrum of pharmacy care.

How long does accreditation process take?

It takes six to nine months from time of application to accreditation. A good portion of that time is dependent on factors such as how quickly the practice is able to submit written documentation of their compliance with the standards and successful completion of an onsite survey.

What value does CPPA accreditation have for ambulatory care pharmacy practice?

It recognizes the practice for its high level of performance and high-value patient care. That value can also be demonstrated to patients and healthcare providers and payers. I spend a lot of time talking with the payer community about the value of accredited pharmacy practices—practices providing patient care services that are contributing to positive patient outcomes.

For example, in order to get accredited, a pharmacy practice has to provide, at a minimum, medication therapy management and patient education and counseling. In addition, it has to provide two more patient care services, such as medication management for chronic disease states, immunization services, adherence services, etc. We know that these areas of care help keep patients healthy and improve outcomes.

What plans are you working on now?

ASHP, NABP, and APhA were very purposeful about why they came together to form this organization, which is to develop accreditation programs for pharmacy practice across the continuum of medication use. As a result, we are now looking at accreditation programs for nondispensing practices, for patient safety practices around medication use, and for acute care pharmacy practices. In addition, one of our goals is to offer accreditation for pharmacy practice across the entire medication-use process, including clinical management services.

Is interest in accreditation growing?

Yes, definitely… particularly when you start talking about specialty pharmacy practice standards. We are seeing a lot more interest on the community side for accreditation as well as from health systems that have multiple outpatient pharmacies. As a result, we’ve put together a process for accrediting practices in multiple areas, also called bundling. We also have a mechanism to accredit multi-site practices (including chain drugstores) that includes a headquarters survey and a sampling of locations for onsite surveys. I predict that, in the not-too-distant future, accreditation of pharmacy practice in ambulatory care settings will be the norm rather than the exception. It’s a very exciting time!

–Interview by Steve Frandzel

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