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March 13, 2013

CPPA’s Value to Pharmacy Practice

Filed under: From the CEO — Tags: , , , , , , , — jmilford @ 9:49 am


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

AS YOU MAY BE AWARE, ASHP recently joined the Center for Pharmacy Practice Accreditation (CPPA) as a governing member. We believe that the CPPA brings considerable value to pharmacy. Its voluntary accreditation standards will help drive improvements in patient care in and between all sites of care, and, thus, will advance the profession of pharmacy.

Accreditation now exists for residency and technician training, schools of pharmacy, hospitals, clinics, and many other components of healthcare, education and delivery. Applying consistent standards in all of these areas has resulted in marked improvements in quality.

Recognizing that the breadth and complexity of the medication-use process calls for a more detailed level of focus to ensure consistent quality outcomes, we believe there is a need for a single integrated accreditation body, with strong medication-use knowledge and experience to identify and sustain these improvements. This is why ASHP joined the CPPA.

As a full partner in the CPPA, ASHP envisions a patient-centered, comprehensive approach to accrediting the medication-use process in various health care settings. The organization’s first goal is to start with community pharmacies that are not presently accredited and later expand its efforts to accredit other practice sites to ensure a continuum of care that focuses on the patient’s complete therapy from start to finish.

Thus, we hope to close the gaps present today between sites of care wherever medications are prescribed, dispensed or administered. Joining the CPPA will also help to significantly convey to patients and stakeholders our commitment to better patient care.

Further, we are happy to report that on March 1, 2013, the CPPA released its Community Pharmacy Practice Accreditation Standards with interpretive narrative. Within the standards, the Center identified three domains that reflect the overarching purpose of community pharmacy practice accreditation: practice management, patient care services and quality improvement. We also expect that these standards and the future work of the CPPA will greatly help to ensure better, more effective transitions of care.

Structurally, the CPPA is managed by a board of directors that consists of nine voting members, including chief  executive officers from APhA, NABP and ASHP, and six appointed directors (two from each partner organization). ASHP’s two board members are ASHP Past-Presidents Roger W. Anderson, Dr.P.H., R.Ph., FASHP, and Daniel M. Ashby, M.S., FASHP.

ASHP Past-President Lynnae Mahaney, B.S. Pharm, M.B.A., FASHP, is the CPPA’s new executive director. She is responsible for overseeing the Center’s business and organizational affairs.

The CPPA also has two standing committees: a Standards Oversight Committee, which coordinates the development of consensus-based standards, and an Accreditation Process Oversight Committee, which coordinates the development and implementation of the accreditation process. Both committees will have equal representation from ASHP, APhA and NABP.

To learn more about the CPPA and its efforts, we encourage you to visit its website, where you will also find answers to frequently asked questions.

Our hope is that the CPPA will contribute to the improvement of patient care through voluntary accreditation of all facets of the continuum of the medication-use process. Our goal is to ensure quality and safety for every patient who takes medications, throughout their lives.

December 26, 2010

Innovating the Pharmacy Technician’s Role

Illustrated by Matt Sweitzer ©2010 ASHP

AS PHARMACISTS EXPAND THEIR ROLES and carve out new niches in an era of health care reform, they are counting more and more on highly skilled pharmacy technicians to take on added responsibility.

Pharmacy technicians in practice sites around the country are performing tasks that were once considered solely the domain of pharmacists, such as dispensing medication, taking prescriptions over the phone, and managing error-reduction efforts. The result is tandem evolution: When pharmacy techs handle these duties, it frees pharmacists up to counsel patients and grow as key members of multidisciplinary health teams.

“Highly trained, skilled technicians are critical elements in a high-functioning pharmacy team,” said ASHP President Diane Ginsburg, M.S., R.Ph., FASHP. “If pharmacists are to achieve their highest calling—direct patient care—we must be able to rely on our technician workforce as our support system.”

In order for technicians to shoulder more responsibility, they will need more training and education. The push is on nationwide for standardization and accreditation.

“With the advancing role of pharmacists, we need technicians who are properly trained,” said Lisa S. Lifshin, R.Ph., director of program services and coordinator of technician program development in ASHP’s Accreditation Services Division. “Consumers are more in tune with their own safety, and they want someone who is trained to handle their medications safely.”

Portable, High-Level Skills

Heather Stremick, a student in the North Dakota State College of Science Pharmacy Technician Program in Wahpeton, checks the stock for a medication

The requirements for ASHP-accredited programs are stringent. Students must complete at least 600 hours of training and education that combine didactic components such as lectures and textbook learning, hands-on experience through lab work, and actual experiential rotations in real pharmacy environments.

The result of such an intensive mix of education is a thoroughly prepared pharmacy technician. This new type of worker has skills that are portable not just from environment to environment but also from region to region as more and more states ratchet up their standards and require pharmacy technicians to register with boards of pharmacy.

“We are a mobile society, and when techs train under accredited programs, there is an assurance that they have the same broad knowledge and training,” said Barbara Lacher, assistant program director and associate professor at the North Dakota State College of Science (NDSCS) Pharmacy Technician Program in Wahpeton. “They are not trained just to be a retail technician or a hospital technician. They have across-the-board training, and you know that anyone you hire out of an accredited program has had experience with things that nonaccredited programs might not offer, like vaccines, sterile products, IV preparation, and stress management.”

ASHP is not the only organization advocating for the professionalism of the pharmacy technician workforce. The National Association of Boards of Pharmacy, which has several technician training task forces, is advocating that technicians complete an education and training program that meets minimum standardized guidelines. It also recommends the use of a single accrediting agency
and a program that is developed by an established pharmacy organization.

Innovations in Pharmacy Tech Education

As the demand for highly trained pharmacy technicians grows, educators are using local resources creatively to offer comprehensive instruction to students. In Florida, Orange County Public Schools (OCPS) offers accredited pharmacy technician programs through technical schools such as Westside Tech in Orlando and Winter Park Techin Winter Park, where students range in age from 16 to about 40.

A pharmacy technician at Wishard Health Services, Indianapolis, utilizes the pharmacy’s electronic inventory.

“One of the toughest things [about setting up a program] was finding a way to educate full-time adult students and part-time high school students,” said Lori DeVeau-Diem, CPhT, a pharmacy technician instructor at Westside. “We had to juggle the schedule to ensure that the part-time students would get all of the necessary instruction and the full-time students wouldn’t have stretches of unoccupied time.”

The answer was to craft a modular program in which students can proceed at the pace that works best with their schedules and allows for one-on-one time with instructors as well as interaction with other students.

The heterogeneity of the student population benefits all involved, said John Diem, CPhT, director of pharmacy technician programs for OCPS. “Our students work extremely well together. The high school students challenge the adults academically, and the adults give them an example of professionalism and maturity,” he said. “It prepares them for working in the real world, where they’ll be working alongside people of all ages.”

At Southeastern Technical College, which has three campuses in southeastern Georgia, the pharmacy technician program stresses hands-on experience indifferent environments.

“My students do a lot of community service,” said Karen Davis, CPhT, pharmacy technology instructor at the Vidalia campus and former president of the Pharmacy Technician Educators Council. “They will work in patient assistant programs, do paperwork, conduct inventory, request medications, type labels, and more.”

Students in Southeastern’s program can rotate through different facilities as interns, where they learn how to be part of a multidisciplinary health team. “What students get in the classroom and lab should be reinforced at the work site,” said Davis. “By the time they have to take their tests for certification, they know how to do everything from data entry to IVs to total parenteral nutrition. The ASHP requirements are designed not for us to teach but for students to do.”

Looking Ahead

The future for pharmacy technicians is a bright one. The Bureau of Labor Statistics predicts that employment of pharmacy technicians will increase 31 percent by 2018 compared with 2008 figures, not only because pharmacists are expanding into more clinical roles, but also because prescription drug use will increase overall as the population ages.

%%sidebar%%The projected growth of programs is not just in hospital systems and traditional academia, said ASHP’s Lifshin. “We are getting a lot of calls from community and chain pharmacy representatives about how they can start an accredited program,” she said. “Health care is always a good avenue for schools to explore, and accreditation is their way of becoming more competitive. The voice of accreditation is a lot louder than it was just a few years ago.”

Davis sees pharmacy technician education evolving as the role of pharmacy technicians evolves. “Lick, stick, and pour jobs are all but gone,” said Davis. “Now that techs are working in triage, diabetes clinics, veterans’ programs, and so on, I think that eventually we will need national minimum standards. I can see the technician’s role expanding to the point where it will require an associate’s degree.”

Davis also predicts different levels of practice for pharmacy technicians and eventually specialization. “Pharmacists are asking for it,” she said. “They want technicians to be able to do things like take scrips over the phone. I can see someone calling us to request a technician for job placement and asking for a Level 1 pharmacy technician for one level of care, a Level 2 tech for more involved care, and so on.”

She added that pharmacy technicians and their educators should stay abreast of legislative changes within their states and continue to push for standardization and accreditation.

December 18, 2009

Stamp of Approval: ASHP Residency Accreditation Assures Quality

AS PART OF THEIR QUEST for ASHP accreditation in 2007, pharmacy leaders at Deaconess Health System in Evansville, Indiana, decided they needed to do something bold and innovative. They sent residents to the poverty-stricken community of Annotto Bay, Jamaica, to work with a team of pharmacists, physicians, and others on an international mission that many pharmacists might never experience.

In turn, Society surveyors praised Deaconess for offering residents creative patient-care training that benefited a needy community. ASHP accredited the program in August 2007.

“The surveyors were impressed with the flexibility of our program and the fact that we are able to provide opportunities outside the scope of our hospital,” said Joyce Thomas, Pharm.D., CACP, Deaconess pharmacy director.

The experience in Annotto Bay taught then-resident Andrea Tuma, Pharm.D., the ways in which cultural barriers can affect medication counseling.

“Americans are so used to the idea of seeing a doctor and taking medications, but these patients didn’t have the same access,” Tuma said, recalling her initial struggles. “My experience drove home the point that counseling is a two-way interaction, and that you have to listen as much as you talk.”

Reaching a Milestone

Thomas’s work in enhancing her residency program is an example of how ASHP accreditation helps raise the bar in training pharmacists as they move from pharmacy school to careers in hospitals and health systems.

This year, ASHP will accredit the 1,000th residency program to undergo its rigorous accreditation process since the program’s start in 1963. This important milestone for ASHP—the only organization that accredits pharmacy residency program —reveals how broadly accreditation has spread. It also highlights the far-reaching program improvements that often accompany this process.

ASHP believes so deeply in the value of accredited residencies, in fact, that its House of Delegates passed a resolution on the issue in 2007. The resolution states that by 2020, all new pharmacy graduates who will be providing direct patient care should first complete an ASHP-accredited residency.

“I think ASHP members realize that accreditation has been a huge value for our profession,” said Janet Teeters, M.S., B.S.Pharm., director of ASHP accreditation services, adding that accredited residency programs exist in hospitals, clinics, home health care, community pharmacies, and ?managed care organizations. “Accreditation really pushes the profession forward, making these sites strive to improve their training and clinical pharmacy services.”

ASHP survey reports, for instance, may recommend more diverse pharmacy services to match a diverse patient population, leading health systems to create specialized clinics for anticoagulation, diabetes, heart failure, or asthma.

“We often see reports of people hiring more staff, implementing new clinical services, putting in automation, or redesigning their work areas as a result of our visits,” Teeters said. “The peer review findings or recommendations in the accreditation reports often help pharmacy directors gain the resources they need.”

Those reports start with surveyors like David Warner, Pharm.D., ASHP director of residency program development. Warner travels up to 140 days a year, surveying residency programs and conducting other related work across the U.S. and in Puerto Rico.

ASHP surveyors meet with pharmacy residents, pharmacists, technicians, physicians, nurses, hospital administrators, and many others during the program review. They critique a variety of elements, including the way that residents are trained and evaluated.

ASHP surveyors judge programs using a core set of seven principles, including determining if the program:

• Uses a systems-based approach to train residents,
• Has well-qualified preceptors and program directors,
• Offers comprehensive, safe, and effective pharmacy services, and
• Requires a commitment from its residents to achieve the program’s educational goals and objectives and support the organization’s missions and values.

Warner and other surveyors emphasize the importance of teaching and mentoring residents as well as teamwork within the setting. “We look for the relationship that the pharmacy has with other professions,” he said. “Do physicians and pharmacists collaborate in patient-care decisions?”

In 2008, ASHP conducted more than 230 on-site survey visits. More than 130 of those were new programs. Those figures show the continuous growth in accreditation since the Society bestowed its first accreditation certificate to the program at Jefferson Medical College in Philadelphia in 1963. By 1964, 33 programs had been accredited.

Attracting Future Residents

Thomas sought accreditation after a discussion with a colleague in which she learned that most potential residents are interested in accredited programs.

“When recruiting, I find that residents are looking for accredited programs because they are quality programs backed by ASHP,” she said, adding that the accreditation process led to other inventive learning opportunities. Thomas wanted her residents to teach at a university, so she collaborated with Butler University College of Pharmacy and Health Sciences in Indianapolis to make it happen.

Meredith Petty, Pharm.D., clinical supervisor and residency program director at Deaconess, agrees that accreditation makes all the difference in recruiting and retaining residents.

“If I were a resident and taking an extra year to learn and develop myself, I’d want to be in a program that’s accredited,” she said, pointing to the fact that accredited programs are held to a higher standard.

The accreditation process can be done in a year or it can take place across multiple years. This all depends on how fast organizations develop their programs. ASHP will only conduct accreditation site surveys for those programs that have been operating with a resident for at least nine months.

Chris Taylor, Pharm.D., BCPS, clinical pharmacist at the Phoenix VA Healthcare System, believes accreditation can be a boost for program visibility. His accredited post-graduate year two (PGY2) residency program in internal medicine benefits from being listed on the ASHP’s popular online Residency Directory.

“Only accredited programs are included in the directory, so recruitment can be much more difficult if you’re unaccredited,” Taylor said.

Like the program at Deaconess, new training opportunities came with Taylor’s pursuit of accreditation. Taking the advice of surveyors, Taylor now conducts workshops for resident preceptors, including one that is designed to teach preceptors how to complete quality resident evaluations.

ASHP provides preceptors with many resources, including its National Residency Preceptors Con?ference. Held every other year, the conference brings together preceptors, residency program directors, and residents who network and participate in educational sessions.

Searching for Accredited Residencies

After she graduated from The James L. Winkle College of Pharmacy at the University of Cincinnati in 2006, Danielle Patrick, Pharm.D., was only interested in residency programs that had successfully made it through ASHP’s rigorous accreditation process. Patrick graduated from her PGY2 residency in critical care at University Hospital in Cincinnati in 2008.

“The paperwork, reports and evaluations are all part of a continual process in which the program is trying to improve,” Patrick said. “The value of accreditation to me is that I know I’m getting a great education and that I’ll be well-qualified based on the fact that I finished an accredited program.”

Midway through her PGY2 residency in pharmacy administration at Aurora Health Care in Wisconsin, Ashley Feldt, Pharm.D., said she takes real comfort in knowing that her residency program is ASHP-accredited.

“It makes me feel real positive that surveyors are reviewing a program to make sure there are enough preceptors to train residents and that they are committed to the program,” she said. The surveyors also indicated that Aurora’s operations are cutting edge, a plus for Feldt.

“We are in the process of implementing computer prescription order entry and bar-coding, the best practice for patient safety,” she said.

In her exploration of 2010 PGY1 residency programs, Angela Bingham, a student at the South Carolina College of Pharmacy at the Medical University of South Carolina campus in Charleston, is mindful that health systems are on the lookout for future employees who complete accredited residencies.

“When entering the job market, employers want to be confident that new employees can provide direct patient care that comes from accredited residency training,” she said.

No accreditation? No funding, says VA

?If you want to start a pharmacy residency program at any U.S. Department of Veterans Affairs (VA) medical center, you better ensure that it is accredited by ASHP. That’s because the VA requires its residency programs to be accredited in order to receive federal funding.

“There has to be a guarantee that the funding is used correctly and within professional standards, and accreditation is key to ensuring that that will occur,” said Lori Golterman, Pharm.D, clinical specialist in pharmacy benefits management services at the VA Central Office in Washington, D.C. “ASHP has supported our programs a great deal and helped us grow the quality programs that we have.”

The VA has an estimated 120 accredited programs, and trains about 22 percent of all pharmacy residents in the U.S., she said. More than 430 residents were enrolled in VA residencies in 2008.

The VA is assessing its medical centers without pharmacy residency programs to determine how they can implement the programs at those centers, Golterman said. Pharmacy residencies are offered at 89 of the VA’s 155 centers.

All new VA pharmacy residency programs must submit their ASHP accreditation survey reports to Golterman’s office. Report results are shared with all program directors to ensure a continual improvement process.

Golterman’s office has requested VA funding for an additional 80 residency positions over the next five years. She attributes the need for more positions to a rise in both the number of pharmacy schools and actual graduates.

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