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June 14, 2011

New VTE Prevention Case Studies Available

Filed under: InfoCentral — Tags: , , , — jmilford @ 9:15 am

As a part of ASHP Advantage’s educational initiative “Quality Improvement in Managing Patients at Risk for Venous Thromboembolism: Interventional Strategies,” three new on-demand case studies are available. These one-hour CE activities focus on patient cases in VTE prevention in medically ill, surgical, and pediatric patients. The case studies are supported by an educational grant from Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC.

December 26, 2010

Mentorship Program Helps Pharmacists Improve VTE Prevention

The team at Sharp Grossmont Hospital in La Mesa, Calif., has put the suggestions of VTE Initiative faculty member Gregory A. Maynard, M.D., to good use.

DESPITE THE FACT that venous thromboembolism (VTE) is the most preventable cause of death in hospitalized patients, and that evidence-based guidelines for mechanical and pharmacological prophylaxis are widely available, VTE is still a significant cause of morbidity and mortality among patients at risk. Studies have shown that the incidence of VTE is about one in 1,000, with more than 250,000 patients hospitalized annually with the condition.1

Recognizing the great need for VTE interventions, ASHP Advantage recently developed the Institutional Impact VTE Mentored Quality Initiative.2 Through the program, physician-pharmacist faculty teams provide on-site evaluations of health systems’ VTE preventions practices and offer site-specific recommendations to help each system meet its quality-improvement goals.

Mentorship and Support

True to the initiative’s name, faculty members go beyond a consulting role and instead mentor each facility’s staff members, said Stuart T. Haines, Pharm.D., BCPS, BC-ADM, professor and pharmacotherapy specialist, University of Maryland School of Pharmacy, Baltimore, and clinical specialist, West Palm Beach VA Medical Center, West Palm Beach, Fla. “VTE prophylaxis is one of the bread-and-butter things pharmacists do, but this particular project is far more intensive for the selected sites,” he said. “We have regular contact with them, and although we analyze what they are doing and offer suggestions for how it can be better, we also support them as colleagues and help them communicate their efforts to peers.”

Indeed, faculty members for the initiative were chosen because of their collegial efforts and reputations, according to Kristi N. Hofer, Pharm.D., ASHP Advantage’s director of scientific projects. “In choosing mentors, we focused on their expertise,” she said. “These faculty have either been involved in VTE prophylaxis at their own hospitals, have experience with similar programs, or are known for sharing their knowledge.”

Tailored Partnerships

Each participating hospital has different needs, and the recommendations they receive vary as much as the hospitals themselves. At the suggestion of initiative faculty, the focus at Baylor Medical Center in Waxahachie, Tex., is shifting from a “two-bucket” system, in which a patient is considered either low or high risk, to a “three-bucket” system that includes moderate risk, said Donna Drain, Pharm.D., clinical pharmacist.

Initiative faculty also prompted Waxahachie’s staff to revisit its risk- assessment procedures.

“The mentors were intuitive about that,” said Drain. “For years, we concentrated risk assessment within a few hours of admission, but the mentors asked us how we reassess when a patient changes level of care, like from surgery to ICU. It was an ‘aha’ moment.”

A third suggestion was to home in on the quality of VTE prophylaxis, as opposed to the quantity.

“That hit home with me,” Drain said. “As clinical pharmacists, we can get caught up on numbers. We’ll say that we are providing prophylaxis 72, 80, or 90 percent of the time, but we aren’t stepping back and saying, ‘Are we caring for Mr. Green? Are we there for Mrs. Jones?’”

At West Virginia University Hospitals, mentor recommendations swung in the other direction.

“We’d been sharing our VTE efforts with nursing units, but trying to attribute outcomes back to different units was difficult,” said Frank Briggs, Pharm.D., CACP, director, Center for Quality Outcomes. “Now, rather than look at which unit did what, we look instead at the percentage of patients who receive pharmacological prophylaxis.”

The focus changed as a result of mentor review, Briggs added. “We saw that we were overrelying on mechanical prophylaxis,” he said. “[The mentors] really drilled down into that and got us to look at ways of improving pharmacologic prophylaxis. We found that if you want to drive pharmacologic prophylaxis, then you have to report its use.”

VTE Initiative faculty member Gregory A. Maynard, M.D., M.S., FHM, chief, Division of Hospital Medicine, University of California, San Diego

Identifying Communication Gaps

The team at Sharp Grossmont Hospital in La Mesa, Calif., is incorporating suggestions from initiative faculty members Gregory A. Maynard, M.D., M.S., FHM, chief, Division of Hospital Medicine, University of California, San Diego, and Zachary A. Stacy, Pharm.D., BCPS, associate professor of pharmacy practice, St. Louis College of Pharmacy, into efforts to revamp its ordering system.

“After meeting with Dr. Maynard and Dr. Stacy, we found that we may have undermined our efforts at VTE prevention by utilizing a complicated point-based system,” said Electa Stern, Pharm.D., pharmacy clinical supervisor. “We also failed to associate the list of risk factors with the preferred pharmacological options.”

Maynard also shared a real-time measurement tool that utilizes a color-coded dashboard: Patients who have no VTE prophylaxis are in the red zone, those with only mechanical prophylaxis are in the yellow zone, and those who have pharmacological prophylaxis are in the green zone.

%%sidebar%%Stern said that the first priority is to minimize the number of patients in the red zone. A standardized nursing procedure will allow nurses to start mechanical prophylaxis in at-risk patients found to be without any prophylaxis. The new tool consolidates risk into two pools, low versus moderate/high, as well as defines risk factors to help prescribers choose appropriate therapy.

Stern notes the practicality of the advice her team has received. “These are simple ideas” she said, “but that’s why they are so exciting: They should be easy
to implement.”

1. Goldhaber SZ. Pulmonary embolism.N Engl J Med. 1998;339:93–104.
2. An educational grant from Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC., allows hospitals to participate in the program for free.

A Time to “Be Bold And Be Urgent”

Diane Ginsburg, M.S., FASHP

I WRITE THIS COLUMN having just returned from an incredibly energizing, exciting Pharmacy Practice Model Initiative (PPMI) Summit in Dallas. Pharmacy thought leaders from across the country came together to reach consensus on how we, as hospital and health-system pharmacists, should be practicing our profession in the future.

Summit attendees looked at a number of overarching principles for future pharmacy practice models and came to an agreement on the following principles:

• We, as pharmacists, must move closer to the patient.
• The role of a qualified technician workforce and the use of technology must be greatly expanded.
• Pharmacy departments are accountable for the development and implementation of medication-use policy to ensure safe and effective use of medications.
• Pharmacists are accountable for patient outcomes.

As Billy Woodward urged, we need to “be bold and be urgent” in our work to enact practice change. We need to embrace our common commitment to our patients and be accountable for their positive outcomes.

Stay tuned in the months and years ahead as the Pharmacy Practice Model Initiative gains momentum. As a tangible outcome of the Summit, we envision that every pharmacy department in the country will be engaged in examining how it deploys its resources. It’s a truly exciting time to practice pharmacy!

InterSections is a great place to catch a glimpse of some of the most innovative practice models happening today. Our cover story (page 8), about the enhanced role for educated, trained, and certified pharmacy technicians, shows just how important this segment of the pharmacy workforce is. As pharmacists move into direct patient-care roles, we’ll need to rely more and more on our professional technician partners.

Also in this issue, you’ll find a story on exciting work being done in the prevention of venous thromboembolism (VTE). Pharmacists in five hospitals around the country are being mentored in cutting-edge VTE practices through an ASHP Advantage program called Stop VTE. This interprofessional initiative is designed to increase the rate of thromboprophylaxis in hospitalized patients and promote the safe use of anticoagulants.

As the country continues to struggle under the weight of an economic downturn, pharmacyschool graduates are beginning to feel the pinch. The story on page 12 focuses on the strategic choices that recent graduates and new practitioners are facing regarding how and where to practice pharmacy.

%%sidebar%%Finally, ASHP’s recent Drug Shortages Summit highlighted an unfortunate trend in medicine today. Drug shortages cause significant disruptions in patient care, including canceled or delayed medical treatments and procedures. They also lead to adverse events caused by medications that may have the potential for greater harm than the first-line therapy that is unavailable due to a shortage. In the story on page 14, read about how pharmacists are stepping into this gap, coming up with processes and approaches that minimize risks to the patient.

I hope you’ll be informed and inspired by what you find in this issue of ASHP InterSections!

Diane Ginsburg, M.S., FASHP

September 28, 2010

ASHP Advantage Initiatives Provide CPE and Resources for Members

Filed under: ASHP News,InfoCentral — Tags: , , , , , , , — editor @ 6:45 am

Want to know how to increase the rate of thromboprophylaxis in high-risk populations? ASHP Advantage is offering an educational series featuring online home study activities, live interactive webinars, and regional, full-day workshops. Activities are accredited for pharmacists, physicians, case managers, nurses, and nurse practitioners.

“Understanding Triple-Negative Breast Cancer and Emerging Targeted Therapies” is the title of a new series of online educational activities, accredited for pharmacists, nurses, and nurse practitioners. Visit this learning portal for timely CE, an online resource center with helpful links, and highlights from national oncology meetings.

April 9, 2010

Preventing DVT Helps Patients and Bottom Lines

PHARMACISTS LYNDA THOMAS, Pharm.D., CACP, and Michael Palladino, Pharm.D., are part of a new wave of clinical specialists who oversee patients’ anticoagulation therapy post surgery.

Michael Palladino, Pharm.D., inpatient anticoagulation coordinator of the Jefferson Center for Vascular Diseases, speaks with a patient about the importance of DVT prevention.

They help ensure that orthopedic surgery patients don’t develop deep vein thrombosis (DVT), a potentially dangerous and often preventable condition common among orthopedic surgery patients. The best defense against DVT, anticoagulant therapy also comes with inherent risks. Leaders at Thomas Jefferson University (TJU) Hospital in Philadelphia see pharmacists as best equipped to keep patients safe post surgery.

“Warfarin is one of the top 10 drugs for medical errors,” noted Thomson, inpatient anticoagulation coordinator of the Jefferson

Center for Vascular Diseases, Thomas Jefferson University (TJU) Hospital in Philadelphia. TJU Hospital performs some 3,000 joint surgeries each year.

A New Wave

The pharmacists at TJU help to ensure that a new wave of clinical specialists who oversee patients’ anticoagulation therapy post surgery and help to ensure patients discharged on warfarin and other blood thinners transition safely home. Preventing adverse events and readmissions are key parts of their jobs.

“It’s an excellent chance for pharmacists to demonstrate the value and the return on investment from implementing these clinical services,” said Cynthia Reilly, B.S. Pharm., director of ASHP’s Practice Development Division.

Pharmacists Key to Prevention

Palladino, who is coordinator of the center’s orthopedic anticoagulation program, and Thomson focus on patient and family education around high-risk medications such  as warfarin and other bloodthinners. Their efforts helped TJU meet recent Joint Commission requirements around patient education for anticoagulant therapy.

In working with patients directly, “we’re first asking questions of the patient to get important information,” Palladino said. He added that pharmacists are best positioned to spot possible risks for each patient and to determine the drug and dose to prescribe to avoid bleeding complications or other risks.

TJU Hospital has instituted a computerized physician-order entry system, with automatic order sets prompting prescribers to assess each surgical patient for bleeding complications before offering appropriate prophylaxis anticoagulant options based on the patient’s risk.

“It’s an educational tool, as well as an order set,” Palladino said.

The pharmacists then work with patients to help them understand their medicines, the importance of follow-up monitoring, adherence, and drug-food interactions, and the potential for adverse drug reactions and drug interactions. Time is also spent calling health plans to advocate for patient needs, such as coverage for certain drugs or equipment.

Pharmacists also oversee proper care transitions for patients, scheduling labs and arranging for home health services. For the latter, pharmacists call each patient twice a week for six weeks post discharge to answer questions and ensure that each patient’s recovery goes smoothly.

“We’re transitioning patients back to the primary care physician,” said Thomson, adding that surgeons appreciate the help.

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