Course Name: Pharmacy Practice

Course Code: MPP-6106

Submission Date: 23 November, 2013

AssignmentOn

Challenges, Initiatives and Recommendation for Advancing

Pharmacy Practice Model

Submitted ToProf. A.Y. Sk. Feroz Uddin AhmedAdvisorDepartment of PharmacyPrimeasia University

Submitted ByNAME : Arfia ChowdhuryID:123-008-062Semester: Summer, 2013Master of Pharmacy ProgramDepartment of PharmacyPrimeasia University

Content Page No.

Introduction ……………………………………………………………………………………....... 3

Pharmacy Practice Models …………………………………………………………………..... 3

Advanced Pharmacy Practice Models ………………………………………………......... 3

Challenges to Advancing Pharmacy Practice Model ………………………………… 4

Pharmacy Practice Model Initiative ……………………………………………………….. 5

Recommendations of the Advancing Pharmacy Practice Model ………………. 5

Conclusion …………………………………………………………………………………………….. 9

Reference ……………………………………………………………………………………………… 9

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Challenges, Initiatives and Recommendation for Advancing Pharmacy Practice Model

Introduction

The mission of the profession of pharmacy is to improve public health through ensuring safe, effective, and appropriate use of medications. Contemporary pharmacy practice reflects an evolving paradigm from one in which the pharmacist primarily supervises medication distribution and counsels patients, to a more expanded and team-based clinical role providing patient-centered medication therapy management, health improvement, and disease prevention services (1).

The Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (NABP) define the practice of pharmacy as follows:

The “Practice of Pharmacy” means the interpretation, evaluation, and implementation of Medical Orders; the Dispensing of Prescription Drug Orders; participation in Drug and Device selection; Drug Administration; Drug Regimen Review; the Practice of Telepharmacy within and across state lines; Drug or Drug-related research; the provision of Patient Counseling; the provision of those acts or services necessary to provide Pharmacist Care in all areas of patient care, including Primary Care and Collaborative Pharmacy Practice; and the responsibility for Compounding and Labeling of Drugs and Devices (except Labeling by a Manufacturer, Repackager, or Distributor of Non-Prescription Drugs and commercially packaged Legend Drugs and Devices), proper and safe storage of Drugs and Devices, and maintenance of required records. The practice of pharmacy also includes continually optimizing patient safety and quality of services through effective use of emerging technologies and competency-based training (1).

Pharmacy Practice Models

In this discussion, pharmacy practice models refer to hospital/ health-system based practice models (2).

Advanced Pharmacy Practice Models

The definition of advanced practice adopted by the APPFSC (Advanced Pharmacy Practice Framework Steering Committee) and endorsed by all participating pharmacy organizations is presented below.

Advanced practice is practice that is so significantly different from that achieved at initial registration that it warrants recognition by professional peers and the public of the expertise of the practitioner and the education, training and experience from which that capability was derived.

Whatever the definition or criteria used to describe advanced pharmacy practice, the term should evoke the view of a practitioner who demonstrates higher levels of knowledge and skill over an extended period of practice, and the attitudes and behaviors reflective of a deep understanding of the nature of and need for professionalism in practice – that is, they are committed to the sustained pursuit of excellence.

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The above definition has guided the development of the APPF presented in this document. Since most international and national advanced pharmacy practice initiatives have focussed on areas of patient care the component parts of the APPF have been developed using ‘Patient Care’ as the example (3).

Challenges to Advancing Pharmacy Practice Model

The most significant challenges to Advancing Pharmacy Practice Model include the followings- Absence of Trust

Concerns about job stability Fear of conflict

Resultant complacency Lack of Commitment

Actions and words don’t always align Avoidance of Accountability

Set low standards with no real “teeth” Inattention to Results

Difficulty in agreeing to meaningful results Generational struggles Fiscal struggles Workflow (time to perform duties)

The following graphical presentation represents some other challenges (4) -

Fig: Challenges to Advancing Pharmacy Practice Model

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Challenges to Advancing

Practice

ResourcesCompensation

models

Skills

Time

Financial

Work forceStrategic

Cultural

Structural

Technical

Privacy and security issues

Pharmacy Practice Model Initiative

The Pharmacy Practice Model Initiative (PPMI) is sponsored by the American Society of Health-System Pharmacists (ASHP) and the ASHP Research and Education Foundation. The goal of this initiative is to significantly advance the health and well being of patients by supporting futuristic practice models that support the most effective use of pharmacists as direct patient care providers (5).

At this pivotal time, there is an urgent need to create a forward-thinking hospital and health-system pharmacy practice model. ASHP and the ASHP Foundation are sponsoring a Pharmacy Practice Model Initiative that includes -

A consensus summit, A robust social marketing campaign, and Program evaluations.

The goal of this initiative is to significantly advance the health and well-being of patients by developing and disseminating a futuristic practice model that supports the most effective use of pharmacists as direct patient care providers (6). 

Recommendations of the Advancing Pharmacy Practice Model

The recommendations of the Pharmacy Practice Model consensus about optimal pharmacy practice models in hospitals and health systems is categorized according to the major sections of the summit proceedings. The “recommendations” constitute summit participants’ consensus advice on how to create sustainable pharmacy practice models in the nation’s hospitals and health systems. In total, the consensus of the summit is a vision for what pharmacists need to do to “ensure the provision of safe, effective, efficient, and accountable medication-related care for hospital and health-system patients, taking into account the education and training of pharmacists, the prospect of enhancing the capacity of pharmacy technicians, and the current and future state of technology” (quoting from the first objective of the Pharmacy Practice Model Initiative). (2)

A. Recommendations of imperatives for new pharmacy practice models

1. All patients should have a right to the care of a pharmacist. (Summit participants recognized that resources have to be allocated according to the complexity of patients’ and organizational needs.)

B. Recommendations for optimal pharmacy practice models: Characteristics, requirements, and challenges

1. Hospital and health-system pharmacists must be responsible and accountable for patients’ medication-related outcomes.

2. Drug therapy management should be provided by a pharmacist for each hospital inpatient.

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3. For hospitals and health systems that provide ambulatory care services, drug therapy management should be available from a pharmacist for each outpatient.

4. Pharmacists who provide drug therapy management should be certified through the most appropriate Board of Pharmacy Specialties certification process.

5. Pharmacist-provided drug therapy management should be prioritized using a patient medication complexity index.

6. A patient medication complexity index should be developed that includes factors such as severity of illness, number of medications, and comorbidities.

7. As an essential member of the health care team, pharmacists must have privileges to write medication orders in the health care setting.

8. Through credentialing and privileging processes, pharmacists should include in their scope of practice prescribing as part of the collaborative practice team.

9. Pharmacists must be allowed to document recommendations and follow-up notes in patients’ medical records.

10. Pharmacists should be required to document and sign recommendations and follow-up notes in the patients’ medical records.

11. Pharmacists must be involved in identifying, developing, reviewing, and approving new medication order sets.

12. Pharmacists should actively monitor for and report potential and actual adverse drug events.

13. Pharmacists should use patient- specific data to be leaders in disease prevention and wellness.

14. Pharmacists should be part of accountable care organizations and medical homes.

The following characteristics or activities should be considered essential to pharmacist-provided drug-therapy management in optimal pharmacy practice models:

15. Accountability for the development and documentation of medication-related components of the patient care plan.

16. Review of medication orders before the first dose is administered.

17. Daily patient-specific medication review.

18. Monitoring of patient response to medication therapy.

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19. Adjustment of medication doses based on patient response or pharmacokinetic characteristics of the medication.

20. Adjustment of medication regimens based on genetic characteristics of the patient.

21. Monitoring of critically important serum medication concentrations and other clinically important laboratory analyses.

22. Authority to order serum medication concentrations and other clinically important laboratory analyses.

23. Authority to adjust dosage for selected medications.

24. Participation in antimicrobial stewardship.

25. Medication reconciliation in the emergency department; upon admission, interhospital transfer, and discharge; and in the ambulatory care setting.

26. Provision of at discharge education to patients.

27. Participation on rapid-response teams and resuscitation teams.

28. Pharmacist completion of ASHP-accredited residency training or achievement of equivalent experience.

29. Pharmacist expertise in literature evaluation.

Every pharmacy department should:

30. Identify drug therapy management services that should be provided consistently by its pharmacists.

31. Develop a plan to reallocate its resources to devote significantly more pharmacist time to drug therapy management services.

32. Develop a plan to allocate pharmacy student time to drug therapy management services.

33. Develop, maintain, and up- date medication-use policies.

34. Ensure institutional safe medication use.

35. Play a critical role in ensuring that the hospital or health system adheres to medication-related national quality indicators.

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36. Play a critical role in ensuring that the hospital or health system adheres to medication-related evidence- based practice guidelines.

37. Track and trend adverse drug events in the hospital or health system.

38. Manage prospective medication-use evaluation programs to improve prescribing.

39. Manage retrospective medication-use evaluation programs to improve prescribing.

40. Identify problem-prone and high-risk therapies using preestablished criteria.

41. Routinely review hospital or health-system antibiotic resistance patterns.

42. Track and trend pharmacist interventions.

C. Recommendations for advancing the application of information technology in the medication-use process

1. No hospital should be exempted from compliance with technology-related medication- use safety standards.

2. Sufficient pharmacy resources must be available to safely develop, implement, and maintain technology-related medication- use safety standards.

3. Telepharmacy technology, to en- able remote supervision, should be available for use in pharmacy departments.

4. Telepharmacy technology that allows pharmacists to interact with patients from a remote location should be available for use in pharmacy departments.

5. Electronic medical records must be designed to align pharmacists’ documentation outlining care provided as well as a method to trace and ensure the quality of care provided.

6. Human factors engineering principles should be employed to design and optimize safety, efficiency, and effectiveness of technology.

7. Technology in medication-use systems should be designed to demonstrate the impact of pharmacy services on patient outcomes.

8. Technology in medication-use systems should be designed to support pharmacy processes to improve patient outcomes.

9. Colleges of pharmacy should be required to provide informatics training for all pharmacy students to ensure graduates’ success in optimal pharmacy practice models.

10. Hospitals and health systems and colleges of pharmacy should collaborate to ensure that appropriate pharmacy informatics principles are embedded in the curriculum.

11. Pharmacy residency programs should provide informatics training to ensure residents’ success in optimal practice models.

12. Advanced training in pharmacy informatics with residencies and postgraduate education should be expanded.

D. Recommendations for advancing the use of pharmacy technicians

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1. ASHP should define a scope of practice, including core competencies, for hospital and health- system pharmacy technicians.

2. Uniform national standards should apply to the education and training of pharmacy technicians.3. To support optimal pharmacy practice models, technicians must be certified by the Pharmacy

Technician Certification Board.4. By 2015, the Pharmacy Technician Certification Board should require completion of an

accredited training program before an individual may take the certification examination. 5. To support optimal pharmacy practice models, technicians must be licensed by state boards of

pharmacy.6. All distributive functions that do not require clinical judgment should be assigned to technicians.7. Opportunities for technician specialization should be developed.

Conclusion

Existing pharmacy practice models can rapidly relieve some of the projected burden of access to quality care, reduce health disparities, and improve overall health care delivery. Pharmacists are integral to the provision of and access to quality patient care. Maximizing the expertise of the pharmacist, pharmacy profession, and each pharmacy practice is critical to advance our nation’s health.

In conclusion, it would seem that PPMI recommendations are in line with patient safety efforts. As pharmacists, we are fortunate to be evaluating our practice model at a time when legislation is requiring health care providers to make meaningful to care for patients in a safe and financially responsible way. It is encouraging that we have reached consensus in such an important time in a way that is supported by other best practice statements as well as legislative initiatives.

Reference

1. J Am Pharm; Scope of contemporary pharmacy practice: Roles, responsibilities, and functions of

pharmacists and pharmacy techniciansl; Assoc (2003) 2010;50:e35-e69.

doi:10.1331/JAPhA.2010.10510

2. http://www.ajhp.org/content/68/12/1148.full Accessed November 04, 2013.

3. http://www.shpa.org.au/lib/pdf/whatsnew/

Advanced_Pharmacy_Practice_Framework_nov2012.pdf Accessed November 10, 2013.

4. Mark H. Siska and Dennis A. Tribble; Opportunities and challenges related to technology in

supporting optimal pharmacy practice models in hospitals and health systems; Am J Health-Syst

Pharm. 2011; 68:e80-90

5. http://www.ashpmedia.org/ppmi/ Accessed November 04, 2013.

6. http://www.ashpfoundation.org/MainMenuCategories/PracticeTools/PPMI Accessed November

06, 2013.

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