Letters
Letters Advancing the pharmacy practice model through statewide resident collaboration
I
n 2011, ASHP and the ASHP Research and Education Foundation published recommendations from the Pharmacy Practice Model Initiative (PPMI).1 The recommendations set ambitious goals for national pharmacy practice advancement and individual pharmacy departments. For the past two years, the Pharmacy Society of Wisconsin (PSW) has partnered with program directors of Wisconsin administrative pharmacy residencies and their residents to form the PSW PPMI leadership team and systematically advance the goals of PPMI across the state. In the inaugural 2010 initiative, the ASHP Research and Education Foundation collaborated with the PSW PPMI leadership team to develop a gap-analysis tool that was ultimately refined and distributed as the PPMI hospital selfassessment tool. Notably, the initiative demonstrated the potential value of a pharmacy resident partnership with state affiliate leadership in driving pharmacy practice advancement. In 2011, the residents again partnered with PSW and ASHP to develop evidence-based resources supporting the creation of a state affiliate toolkit. Priorities shifted in 2012, and the PSW PPMI leadership team turned its
attention to prioritizing and advancing practice at hospitals throughout Wisconsin by focusing on advancing the role of the pharmacy technician. PPMI recommendations state that all distributive functions not requiring clinical judgment should be assigned to pharmacy technicians.1 The goal of such a program is to use these well-trained technicians to perform a portion of the daily dispensing functions that do not require the clinical judgment of a pharmacist. By expanding the role of the technician—to include, for example, “tech-check-tech” (TCT) functions— pharmacists’ expertise may be deployed to areas that require the clinical skills and knowledge of a pharmacist. Before TCT implementation, Wisconsin law requires a variance be obtained from the Pharmacy Examining Board (PEB). The resident group developed a toolkit to facilitate this variance process, specifically for TCT of cart-fill doses. In addition, the toolkit outlines recommended components for implementing TCT for automated dispensing cabinets (ADCs) in a safe and effective manner, though a variance for ADC restock is not required in Wisconsin. Ultimately, the toolkit was created to allow pharmacy leaders to learn the key benefits of TCT, understand the
The Letters column is a forum for rapid exchange of ideas among readers of AJHP. Liberal criteria are applied in the review of submissions to encourage contributions to this column. The Letters column includes the following types of contributions: (1) comments, addenda, and minor updates on previously published work, (2) alerts on potential problems in practice, (3) observations or comments on trends in drug use, (4) opinions on apparent trends or controversies in drug therapy or clinical research, (5) opinions on public health issues of interest to pharmacists in health systems, (6) comments on ASHP activities, and (7) human interest items about life as a pharmacist. Reports of adverse drug reactions must present a reasonably clear description of causality.
612
Am J Health-Syst Pharm—Vol 71 Apr 15, 2014
requirements for implementing a TCT program, and provide a turnkey toolkit for creating a TCT program and submitting a variance to the PEB. The TCT toolkit contains four domains: business case, regulatory compliance, operations, and novel areas of expansion. Each domain was developed by a core working group composed of a lead resident, program director, and resident members charged with coordinating the creation of tools and resources for their specific domain’s objectives. The business case domain group conducted a thorough literature review and developed a value proposition for implementing a TCT program. The regulatory domain group developed educational materials on regulatory statutes, resources for obtaining variance requests, and strategies for complying with record and quality-assurance measures set by the state. The operations domain developed technician training modules, quality assessments, and customizable policy and procedure templates. Finally, the novel areas of expansion domain completed a strengths, weaknesses, opportunities, and threats analysis, which explored new areas for advancing the scope of TCT (e.g., dispensing first doses, medication packaging, sterile products). With assistance from key members of PSW, domain materials were compiled into a comprehensive toolkit. Continued on page 614
Short papers on practice innovations and other original work are included in the Notes section rather than in Letters. Letters commenting on an AJHP article must be received within three months of the article’s publication. Letters should be submitted electronically through http://ajhp.msubmit.net. The following conditions must be adhered to: (1) the body of the letter must be no longer than two typewritten pages, (2) the use of references and tables should be minimized, and (3) the entire letter (including references, tables, and authors’ names) must be typed double-spaced. After acceptance of a letter, the authors are required to sign an exclusive publication statement and a copyright transferal form. All letters are subject to revision by the editors.
Letters Continued from page 612
The first portion of the toolkit is a nine-page document that provides an overview of TCT, details on how to apply for a variance from the Wisconsin PEB, and an overview of a typical TCT program structure. The second portion of the toolkit consists of 22 appendices. As a whole, the appendices meet one of three required needs: a component of the submitted variance request, support for ongoing reporting to the Wisconsin PEB, and assistance in operationalizing and implementing TCT, such as sample institutional policies and procedures. The appendices were designed to be applicable for a range of hospitals, from small critical access hospitals to large academic medical centers. Only minimal modifications are necessary before these documents can be submitted to the PEB and further utilized at the institution to implement TCT programs. Resident members of the PSW PPMI leadership team served as site liaisons for the five initial sites that requested and obtained a variance. In March 2013, the toolkit was posted on the PSW website and is now available for public access. The TCT toolkit and associated appendices can be downloaded from the PSW webpage (www.pswi.org). 1. The consensus of the Pharmacy Practice Model Summit. Am J Health-Syst Pharm. 2011; 68:1148-52.
Meghann Voegeli, Pharm.D., M.S., Pharmacy Manager University of Wisconsin Hospital and Clinics Madison, WI Matthew Wolf, Pharm.D., Postgraduate Year 2 Health-System Pharmacy Administration Resident University of Wisconsin Hospital and Clinics [email protected] Theresa Crnic Smith, Pharm.D., BCPS, Pharmacy Manager Aurora Health Care Milwaukee, WI Erick Sokn, Pharm.D., M.S., Pharmacy Manager, Transitions of Care Cleveland Clinic Cleveland, OH Heather Schrant, Pharm.D., Postgraduate Year 2 Health-System Pharmacy Administration Resident University of Wisconsin Hospital and Clinics
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp130400
614
Am J Health-Syst Pharm—Vol 71 Apr 15, 2014
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letters Advancing the pharmacy practice model through statewide resident collaboration
I
n 2011, ASHP and the ASHP Research and Education Foundation published recommendations from the Pharmacy Practice Model Initiative (PPMI).1 The recommendations set ambitious goals for national pharmacy practice advancement and individual pharmacy departments. For the past two years, the Pharmacy Society of Wisconsin (PSW) has partnered with program directors of Wisconsin administrative pharmacy residencies and their residents to form the PSW PPMI leadership team and systematically advance the goals of PPMI across the state. In the inaugural 2010 initiative, the ASHP Research and Education Foundation collaborated with the PSW PPMI leadership team to develop a gap-analysis tool that was ultimately refined and distributed as the PPMI hospital selfassessment tool. Notably, the initiative demonstrated the potential value of a pharmacy resident partnership with state affiliate leadership in driving pharmacy practice advancement. In 2011, the residents again partnered with PSW and ASHP to develop evidence-based resources supporting the creation of a state affiliate toolkit. Priorities shifted in 2012, and the PSW PPMI leadership team turned its
attention to prioritizing and advancing practice at hospitals throughout Wisconsin by focusing on advancing the role of the pharmacy technician. PPMI recommendations state that all distributive functions not requiring clinical judgment should be assigned to pharmacy technicians.1 The goal of such a program is to use these well-trained technicians to perform a portion of the daily dispensing functions that do not require the clinical judgment of a pharmacist. By expanding the role of the technician—to include, for example, “tech-check-tech” (TCT) functions— pharmacists’ expertise may be deployed to areas that require the clinical skills and knowledge of a pharmacist. Before TCT implementation, Wisconsin law requires a variance be obtained from the Pharmacy Examining Board (PEB). The resident group developed a toolkit to facilitate this variance process, specifically for TCT of cart-fill doses. In addition, the toolkit outlines recommended components for implementing TCT for automated dispensing cabinets (ADCs) in a safe and effective manner, though a variance for ADC restock is not required in Wisconsin. Ultimately, the toolkit was created to allow pharmacy leaders to learn the key benefits of TCT, understand the
The Letters column is a forum for rapid exchange of ideas among readers of AJHP. Liberal criteria are applied in the review of submissions to encourage contributions to this column. The Letters column includes the following types of contributions: (1) comments, addenda, and minor updates on previously published work, (2) alerts on potential problems in practice, (3) observations or comments on trends in drug use, (4) opinions on apparent trends or controversies in drug therapy or clinical research, (5) opinions on public health issues of interest to pharmacists in health systems, (6) comments on ASHP activities, and (7) human interest items about life as a pharmacist. Reports of adverse drug reactions must present a reasonably clear description of causality.
612
Am J Health-Syst Pharm—Vol 71 Apr 15, 2014
requirements for implementing a TCT program, and provide a turnkey toolkit for creating a TCT program and submitting a variance to the PEB. The TCT toolkit contains four domains: business case, regulatory compliance, operations, and novel areas of expansion. Each domain was developed by a core working group composed of a lead resident, program director, and resident members charged with coordinating the creation of tools and resources for their specific domain’s objectives. The business case domain group conducted a thorough literature review and developed a value proposition for implementing a TCT program. The regulatory domain group developed educational materials on regulatory statutes, resources for obtaining variance requests, and strategies for complying with record and quality-assurance measures set by the state. The operations domain developed technician training modules, quality assessments, and customizable policy and procedure templates. Finally, the novel areas of expansion domain completed a strengths, weaknesses, opportunities, and threats analysis, which explored new areas for advancing the scope of TCT (e.g., dispensing first doses, medication packaging, sterile products). With assistance from key members of PSW, domain materials were compiled into a comprehensive toolkit. Continued on page 614
Short papers on practice innovations and other original work are included in the Notes section rather than in Letters. Letters commenting on an AJHP article must be received within three months of the article’s publication. Letters should be submitted electronically through http://ajhp.msubmit.net. The following conditions must be adhered to: (1) the body of the letter must be no longer than two typewritten pages, (2) the use of references and tables should be minimized, and (3) the entire letter (including references, tables, and authors’ names) must be typed double-spaced. After acceptance of a letter, the authors are required to sign an exclusive publication statement and a copyright transferal form. All letters are subject to revision by the editors.
Letters Continued from page 612
The first portion of the toolkit is a nine-page document that provides an overview of TCT, details on how to apply for a variance from the Wisconsin PEB, and an overview of a typical TCT program structure. The second portion of the toolkit consists of 22 appendices. As a whole, the appendices meet one of three required needs: a component of the submitted variance request, support for ongoing reporting to the Wisconsin PEB, and assistance in operationalizing and implementing TCT, such as sample institutional policies and procedures. The appendices were designed to be applicable for a range of hospitals, from small critical access hospitals to large academic medical centers. Only minimal modifications are necessary before these documents can be submitted to the PEB and further utilized at the institution to implement TCT programs. Resident members of the PSW PPMI leadership team served as site liaisons for the five initial sites that requested and obtained a variance. In March 2013, the toolkit was posted on the PSW website and is now available for public access. The TCT toolkit and associated appendices can be downloaded from the PSW webpage (www.pswi.org). 1. The consensus of the Pharmacy Practice Model Summit. Am J Health-Syst Pharm. 2011; 68:1148-52.
Meghann Voegeli, Pharm.D., M.S., Pharmacy Manager University of Wisconsin Hospital and Clinics Madison, WI Matthew Wolf, Pharm.D., Postgraduate Year 2 Health-System Pharmacy Administration Resident University of Wisconsin Hospital and Clinics [email protected] Theresa Crnic Smith, Pharm.D., BCPS, Pharmacy Manager Aurora Health Care Milwaukee, WI Erick Sokn, Pharm.D., M.S., Pharmacy Manager, Transitions of Care Cleveland Clinic Cleveland, OH Heather Schrant, Pharm.D., Postgraduate Year 2 Health-System Pharmacy Administration Resident University of Wisconsin Hospital and Clinics
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp130400
614
Am J Health-Syst Pharm—Vol 71 Apr 15, 2014
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
