Fiscal Year 2013–2014 Annual Report - Deaconess Hospital · and efficiently provides quality...

Deaconess Health System Pharmacy Department

Fiscal Year 2013–2014

Annual Report

WELCOME from the DEPARTMENT OF PHARMACY

Carrie Morton, PharmD, MBAPharmacy Director

I am excited to serve in a new role on the pharmacy leadership team and in administration this year at Deaconess.

Shortly after I accepted the position of pharmacy director in April 2014, the department was reorganized to better align with the growing health system and focus on population health management.

As pharmacy director, it’s my pleasure to present the Deaconess Health System Pharmacy Department Annual Report for the fiscal year ending October 2014. Despite the pharmacy leadership changes this past year, we continued to provide high-quality care to the patients of Deaconess Health System.

This year we continued to expand our role in the ambulatory setting by expanding our Medication Assistance Program and adding additional protocols to the Medication Therapy Management Clinic.

We also supported multiple initiatives focused on improving chronic conditions within the organization to help us achieve the quality metrics we’re striving for with value-based purchasing and our accountable care organization. All of this was occurring while we continue to support the needs of our inpatients at Deaconess Hospital, Deaconess Gateway Hospital, Deaconess Cross Pointe, The Heart Hospital and The Women’s Hospital.

2013–2014 Annual Report | DEACONESS PHARMACY DEPARTMENT

Table of ContentsDeaconess Health System Mission, Vision and Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Pharmacy Organizational Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Highlights of 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Inpatient ServicesDeaconess Hospital, Deaconess Gateway Hospital, The Heart Hospital, Deaconess Cross Pointe

Inpatient Pharmacy Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Inpatient Clinical Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Pharmacy Surgical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Women’s Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Outpatient Services Deaconess Family Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Pharmacy Benefit Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Deaconess Medication Therapy Management Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Anticoagulation Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Outpatient Infusion Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Home Care Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Medication Assistance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

SupportPurchasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Information Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Education and TrainingDeaconess Health System Pharmacy Residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Deaconess Health System Pharmacy Student Rotations . . . . . . . . . . . . . . . . . . . . . . 28

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DEACONESS PHARMACY DEPARTMENT | 2013–2014 Annual Report

MISSION, VISION AND GOALS

2013–2014 Fiscal Year Goals by Deaconess FIRST Pillars

With our new leadership team in place and with the input from the employees in the pharmacy department in various forums

in September 2014, we redefined our mission and vision statement to better align the pharmacy department with the growth and direction of Deaconess Health System.

MissionThe Deaconess Pharmacy Department is an innovative team that safely and efficiently provides quality medication therapy and outcomes to the patients and communities we serve.

VisionTo be the regional leader in evidence-based medication therapy by providing safe, quality and cost-effective programs that ensure proper medication use, utilize the latest advances in technology, and improve the health of our employees, patients and community.

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• Increasing quality, resulting in growth

o Design and implement Alaris drug library and EPIC Willow for The Women’s Hospital

o Expand Deaconess Family Pharmacy services for The Women’s Hospital employees

o Successfully convert The Heart Hospital and The Women’s Hospital employees to the prescription drug plan

o Design and implement at least one population management strategy to improve patient outcomes for 30-day readmission rates, populations costs, and medication adherence

• Fantastic people, increasing quality and top financial performance

o Report at least two changes every 30 days to improve metrics for quality, patient safety, costs or employee engagement

• Top financial performance

o Report pharmacy savings or enhanced revenue through P&T, value analysis, revenue cycle or service line greater than or equal to $1.2 million.


PHARMACY ORGANIZATIONAL CHART

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FANTASTIC PEOPLEPharmacist Certifications and Designations• 39.4% of pharmacist have at least one advanced credential:

o Board-Certified Pharmacotherapy Specialist (BCPS)

o Certified Anticoagulation Care Provider (CACP)

o Advanced Cardiovascular Life Support (ACLS)

o Basic Life Support (BLS)

o Master of Business Administration (MBA)

o Master of Health Administration (MHA)

o Making a Difference in Infectious Disease Certification (MAD-ID)

Pharmacists with Advanced Credentials

Residency-Trained Pharmacists

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2014 Highlights by Deaconess FIRST Pillars


Pharmacy Department Nurse Degrees and Certifications• All nurses that staff in the Deaconess

Anticoagulation Clinic (DAC) have their advanced certification – Certified Anticoagulation Care Provider (CACP)

Percent of nursing degrees

Technician Certifications• All pharmacy technicians are required to

become certified pharmacy technicians (CPhT) within one year of hire

Awards• Lindsay Whisenant received the Great

Catch Award in September 2014

• Maitri Vyas received Technician of the Year

• Emily Hicks received Pharmacist of the Year

INCREASING QUALITYGrand Rounds Presentations• Antimicrobial Stewardship Strategies

Including Dosing and Regimens Presenter: Jeff Starkey, PharmD, BCPS, MAD-ID

• Diabetic Guidelines, New Diabetic Medications and Literature Update Presenter: Traci Fritschle, PharmD, BCPS

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• Pain Control Including Equianalgesic Dosing Presenter: Kelli Lovell, PharmD, CACP

• Ambulatory Care Clinical Practice Guidelines Update Presenter: Jessica Stansbury, PharmD

• Practical Approaches to Medication Safety by Maximizing Technology Presenter: Michelle Schymik, PharmD, BCPS

Additional Presentations• Federal Changes on Opioid Prescribing:

Deaconess Physicians Presenter: Anna Gibson, PharmD

• Cardiac Medications: Red Shoe Series Presenter: Allyson Murray, PharmD, BCPS

• Hyperthyroid and Hypothyroid Lecture: University of Southern Indiana Nurse Practitioner Course Presenter: Jessica Stansbury, PharmD

• Diabetes Lecture: University of Southern Indiana Nurse Practitioner Course Presenter: Jessica Stansbury, PharmD

• Integrated Perspectives on Leveraging Specialty Pharmacy to Achieve ACO Goals: Series of webinars hosted by Avalere, Armada and Specialty Pharmacy Association of America (SPAA) Presenter: Carrie Morton, PharmD, MBA

• Transitioning from Charge-on-Dispense to Charge-on-Administration: Epic’s Spring 2014 Pharmacy Advisory Council Presenters: Scott Fordyce, PharmD; Stacey Donovan; Debra Rorie, RPh


Health System Committees with Pharmacist Involvement• Anesthesia Committee• Anticoagulation Leadership Team• Cardiovascular Core Care Team• Chronic Disease Management Team• Critical Care Core Team• Community Benefit Committee• Care Integration Steering Committee• Drug Control Team• Emergency Management Committee• Falls Team• Health Plan Beneficiary Task Force• Health Plan Steering Team• Heart Hospital Executive Committee• Infection Control• Medicine Core Care Team• Medication Reconciliation Team

• Moderate Sedation Team• Nutrition Support Team• Oncology Committee• Patient Care Leadership• Patient Safety Coalition• Pediatric Core Care Team• Pharmacy and Therapeutics Committee• Physical Environment Committee• Pneumonia/Influenza Committee• Renal Services Team• Sepsis Team• Stewardship Team• Stroke Committee• Surgical Core Care Team• Vein Preservation Committee• Value Analysis Committee

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RESULTING IN GROWTHPublicationsGranko R, Morton C, Schassfsma K. Role of Executive Coaching in Pharmacy Management. Am J Health-Syst Pharm. 2013; 70:1883-1884

Theising K, Wu K, Scheehan AH. Impact of Peer Assessment on Student Pharmacists’ Behaviors and Self-Confidence. Currents in Pharmacy Teaching and Learning. 2014; 6(1): 10-14

Growth in pharmacy services• Pharmacist began working in Cystic Fibrosis Clinic

• MTM Clinic added asthma wellness plan for Deaconess health plan beneficiaries

SUPERIOR SERVICE• Deaconess Anticoagulation Clinic patient satisfaction fiscal year average was 96.2,

exceeding outpatient satisfaction target of 94.7

• Average turnaround time of a stat order exceeds Epic overall average of nine minutes

Average Stat Turnaround Time


SUPERIOR SERVICE (CONT.)• Medication Assistance Program (MAP) continues to serve patients in need of

prescription assistance.

Patients Served (Average) by MAP

TOP FINANCIAL PERFORMANCE• The pharmacy department reported approximately $600,000 in savings to value

analysis through purchasing, formulary, and operational initiatives to reduce costs.

• MAP continues to offset the costs of medications for patients and the health system by connecting patients with prescription assistance programs and foundations

MAP Value of Prescriptions

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‘05–’06 ‘06–’07 ‘07–’08 ‘08–’09 ‘09–’10 ‘10–’11 ‘11–’12 ‘12–’13 ‘13–’14


INPATIENT PHARMACY OPERATIONSPharmacy Locations• Deaconess Hospital Pharmacy • Deaconess Gateway Hospital Pharmacy

Serves patients of• Deaconess Hospital• Deaconess Cross Pointe• Deaconess Gateway Hospital• The Heart Hospital at Deaconess Gateway • The Women’s Hospital – after hours

Inpatient Services Deaconess Hospital, Gateway Hospital, The Heart Hospital, Cross Pointe

2013–2014 Accomplishments by Deaconess FIRST Pillars

Fantastic People• Lindsay Whisenant received

the Great Catch Award in September 2014

Increasing Quality• Numerous tweaks in Epic

and to P&P to improve medication safety

• Developed Beyond Use Date Reference Chart

• Created IV room training manual

Resulting in Growth• Piloted pharmacist medication

reconciliation at discharge and collected data on error rates and types of errors

Superior Service• Average turnaround time for

stat medication order to be verified was 3.97 minutes (Epic average: 9 minutes)

Top Financial Performance• Negotiated contract

to include a needed pharmaceutical refrigerator (cost avoidance)

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FY2013/14 (excludes TWH)Average Daily Census 314Annual Admissions 25,785Annual Drug Spend $32,138,389Annual Doses Dispensed 2,003,477


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INPATIENT CLINICAL QUALITY IMPROVEMENTS


Fantastic People• Deaconess Pharmacy and

Therapeutics Committee is composed of multiple physicians as well as nurses, pharmacists and ancillaries

• Dr. Matt Kolleck, Deaconess hospitalist, is chairman

Increasing Quality• Seven new medications added to

formulary

• Eight drug-use evaluations completed

• Five new therapeutic interchanges approved

• Five new protocol developments

Resulting in Growth• Alaris dataset build for The

Women’s Hospital

• Development of vein preservation protocol

• Ten pharmacist competency programs developed

Superior Service• Quarterly Pharmacy Department

newsletters

• Monthly P&T newsletters

Top Financial Performance• More than $125,000 annual savings

through P&T Committee review

Antimicrobial Stewardship• New dosing protocols

• Antimicrobial auto stop protocol

• Annual antibiogram review

• Sepsis pathways

• Surgical antimicrobial prophylaxis streamlining

Safety/Medication Maximization• Renal dosing protocols

• Dose rounding

• Drug-drug interactions

• ISMP review

• Best practice alerts

Patient Care• More than 29,000 consults

• More than 130,000 pharmacist interventions

• More than 22,000 medication reconciliations

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PHARMACY SURGICAL SERVICESSatellite Locations• Deaconess Hospital

• Deaconess Gateway Hospital

Satellite Hours• Weekdays: 0600–1600

Serves Patients of• Deaconess Hospital


• The Heart Hospital at Gateway

• Consultant pharmacist for Evansville Surgery Centers

Surgery Satellite Staff• Five trained pharmacists

• Five trained technicians

Population Served


Increasing Quality• Developed order set for ENT cases

Resulting in Growth• Implemented medication provision

for expansion of eye surgery cases

• Implemented medication provision for anesthesia service for the endoscopy product line

Top Financial Performance• Conversion to Thrombin 5000 Unit

Spray Kit, saving $7,500 annually

• Completed anesthesia gas drug use evaluation and education to providers to reduce drug expense and improve outcomes

Surgery location # of surgeries

Deaconess Hospital 7156Deaconess Gateway Hospital

6574

The Heart Hospital 1425


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The pharmacy located in The Women’s Hospital supports the pharmaceutical

needs of inpatient adults and NICU patients, the OB/GYN emergency department, inpatient and outpatient surgeries, Boston IVF and The Breast Center.

Lead PharmacistTom Petersen, PharmD

Hours of OperationWeekdays: 0600–1800

Weekends: 0700–1530

Women’s Hospital Staff• Eight trained technicians

• Eight trained pharmacists

o One residency-trained pharmacist

o Two BCPS-certified pharmacists

o Two CACP-certified pharmacists

o Four ACLS/PALS-trained pharmacists


Fantastic People• Eleven pharmacists presented

topics at the Deaconess Pediatrics Conference

Increasing Quality• Alaris “Smart Pump” database

build and implementation

• Venous Thromboembolism (VTE) Prophylaxis/Outcomes (see graph on next page)

• C-Section Antibiotic Prophylaxis/Outcomes (see graph on next page)

Resulting in Growth• Supported medication needs of:

o Boston IVF expansion

o TWH Breast Center opening

Superior Service• Drug shortage management

Top Financial Performance• Addition of Family Pharmacy for

TWH employee prescriptions

Inpatient Services

The Women’s Hospital

FY2014Births 3108Doses dispensed 216,275NICU TPNs 3043Drug spend $1,089,492


DEACONESS FAMILY PHARMACYLOCATIONSDeaconess HospitalMonday – Friday, 0700 to 1900Saturday, 0900 to 1400

Remote Point of Sale LocationsGateway Hours same as Deaconess Hospital location

The Women’s Hospital Monday – Friday, 0900 to 1400

DFP Staff• Four technicians – Three dedicated

to DFP and one rotates between inpatient and outpatient

• Four trained pharmacists, two dedicated to outpatient and two rotate between inpatient and outpatient

• One pharmacist with immunization training


Fantastic People• Carrie Morton invited as an expert

speaker on a series of webinars on Specialty Pharmacy and ACOs hosted by Avalere, Armada and Specialty Pharmacy Association of America

Increasing Quality• Installed the ScriptPro/2000 robot

• Assigned a designated person in the Family Pharmacy to review the discharge hospice list to remove patients from system thereby decreasing possibility of re-filling expired patients Rx’s

• Tweaked ordering system to better manage inventory of very expensive specialty medications

Resulting in Growth• Added TWH and THH beneficiary

groups

• Analyzed growth potential for adding second location

Superior Service• Piloted discharge prescriptions to

bedside service

Outpatient Services

FY2013/14 Prescription volume 91,886Discharge prescriptions (excluding case mgmt. prescriptions)

7,807

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2013–2014 Accomplishments by Deaconess FIRST PillarsIncreasing Quality• Developed program to address

adherence for new expensive hepatitis C treatments

• Redesigned health plan steering committee to include members from TWH and THH

• Quarterly review of opportunity assessment with the Advisory Board

Resulting in Growth• Added TWH and THH beneficiary

groups

Top Financial Performance• Adjusted copay structure to align

with national benchmarks

• Adjusted formulary by removing items, changing tiers, or requiring a prior authorization or step therapy

PHARMACY BENEFIT MANAGEMENT

The pharmacy team performs monthly analysis on drug cost, plan spend and

rebate information provided by our transparent pharmacy benefit manager, Envision RXOptions. The pharmacy department plays a role in guiding and developing changes to the employee health plan through the Health Plan Steering Committee.

The pharmacy team advises the Health Plan Steering Committee on matters of formulary management, benefit decisions and copay structure to ensure cost effective and quality medication choices.

Population Served• Health plan beneficiaries of:

o Deaconess Hospitalo The Women’s Hospitalo The Heart Hospital

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MEDICATION THERAPY MANAGEMENT CLINIC


In the Deaconess Medication Therapy Management Clinic (MTM), pharmacists meet

with patients with chronic diseases to ensure medication adherence and improve outcomes.

LocationsOperates in the Deaconess Anticoagulation Clinic with shared resources such as rooms and medical office assistants at DH, DGH and DC Downtown.

Population ServedFY2013/14 Number of visits 755

MTM P&T-Approved Protocols• Asthma • COPD• Diabetes• Heart Failure• Hepatitis C

• Hyperlipidemia• Hypertension• Medication

Therapy Review• Smoking Cessation

MTM staff• 100% pharmacists are board-certified

pharmacotherapy specialists

• Four of five pharmacists residency trained

• Dr. Fredrick Wallisch, MD–Medical Director

Types of MTM Interventions Completed

Referral Type

Increasing Quality• Average improvement

of diabetic patients’ hemoglobin A1C was 0.62

• For hypertensive patients, systolic blood pressure decreased by 12.2, and diastolic blood pressure decreased by 6.8 on average

• Review Humana risk shared contract beneficiary discharge list for recommendations to be sent to their physician

Resulting in Growth• Implemented asthma

wellness protocol for Deaconess health plan beneficiaries

• Developed process for TWH and THH health plan beneficiaries to meet with MTM when needed

• Developed hepatitis C protocol to improved adherence with expensive medication therapies

Superior Service• Offer late

appointments one day a week

• Adjusted location of appointments to meet patient demand

Top Financial Performance• Completed 284 cost-

focused interventions

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DEACONESS ANTICOAGULATION CLINICS

At the Deaconess Anticoagulation Clinic (DAC), patients on warfarin

are monitored via a fingerstick, series of questions and medication adjustment per P&T protocol to ensure they stay within appropriate range for their indication.

Locations• Deaconess Hospital• Deaconess Gateway Hospital• Deaconess Clinic Downtown• Deaconess Clinic North Park

Population ServedFY2013/14 Number of visits 31,692Number of new patients 565


DAC Staff• Dr. William Hardesty, MD—

Medical Director

• DAC clinicians with advanced credentials:

Increasing Quality• Maintained percentage of INRs in range

above national benchmark of 65% with year-end average of 72.5%

• Developed a process with lab to alert the DAC clinician for high INRs

• Improved reporting capabilities on elevated INR values to report higher values

• Begin review of INRs greater than six with staff education when opportunities for improvement are identified

• Infection control and HFAP review of cleaning procedures and staff education

• DAC bridge therapy protocol updated

• Updated the no show and termination policies

Resulting in Growth• Provided warfarin education

to the Deaconess Clinic nurse coaches

• Developed process to monitor DAC patients admitted to the hospital for post-discharge follow up

Superior Service• Deaconess Anticoagulation Clinic

patient satisfaction fiscal year average was 96.2, exceeding outpatient satisfaction target of 94.7

• Staff education by Patient Experience Officer to improve patient satisfaction scores

• Revised protocols for manage-ment of “snow bird” patients

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There is a dedicated pharmacy team experienced with high risk drugs

and oncology treatments serving the patients in the Deaconess infusion centers. Pharmacists work closely with the nurses and physicians in oncology and the infusion centers to ensure safe, effective treatment is delivered to these patients.

This team also works closely with the Medication Assistance Program and the pre-cert departments to ensure


DEACONESS OUTPATIENT INFUSION SERVICES

Outpatient Infusion Volume

medications are covered by their insurance and patients receive financial help when needed.

LocationsThe three infusion centers at Deaconess are primarily serviced by the pharmacy satellites located at:

• Chancellor Center for Oncology

• Deaconess Clinic Downtown

Increasing Quality• Revised infusion records for chemo

and non-chemo outpatient infusions to improve billing accuracy

• Conducted a ChemoGLO Wipe Study at the Chancellor Center and Deaconess Clinic Infusion Center to monitor environmental exposure with common antineoplastic agents

• Rituximab DUE and benchmarking

• Tysabri® certified infusion sites

Resulting in Growth• HIPEC and hazardous drugs in

operating room process developed

Top Financial Performance• Implemented review of all drug waste

and inclusion on bill (JW modifier, Medicare requirement)

• Completed audit of infusion center charts and requested 100% review of charges prior to billing

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DEACONESS HOME CARE PHARMACY SERVICES

There is a dedicated pharmacy team experienced with home care and

hospice that serves the patients of Deaconess Home Medical Equipment.

LocationsDeaconess Home Medical Equipment – Deaconess Hospital Campus

DHME Staff• Four trained pharmacists

• Two trained technicians


Increasing Quality• Average INR in range was 60.4%

Resulting in Growth• Worked to transition services to

Deaconess VNA Plus

Superior Service• Addressed 873 INR lab values to

ensure appropriate anticoagulation therapy

Top Financial Performance• Completed audit of medication

billing units

DHME Orders Dispensed

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The Mission of MAPMedication Assistance program (MAP) works through a variety of public and private services that can help patients get their medications at no cost or a reduced cost when help is needed.

Locations• Deaconess Hospital

• Deaconess Clinic Downtown

Population Served• Patients without prescription

insurance coverage

• Patients with low income based on government guidelines

• Patients underinsured with high copays or deductibles

• Patients must have a valid prescription and physician

MAP Representatives• Six pharmacy technicians working

under pharmacist supervision.


Fantastic People• Two new pharmacy technicians

trained in MAP

Increasing Quality• Updated MAP website to include

more medication assistance resources including links to $4 lists at outside pharmacies.

• Evaluated alternative software programs

Resulting in Growth• Ended the fiscal year with 1,737

active patients

Superior Service• Educated all new Deaconess Clinic

nurse coaches on MAP

Top Financial Performance• Coordinated $4,462,725 (average

wholesale price) worth of home medications for patients who received them free of charge.

• Coordinated $504,102 (Deaconess cost) worth of drug replaced to Deaconess mostly for outpatient infusions.

• Coordinated foundation assistance from multiple disease state foundations that equated to $227,553 that was applied toward medication bills.

MEDICATION ASSISTANCE PROGRAM

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Pharmacy Support for Deaconess Health System


Fantastic People• Three individuals completed

Novation training

Increasing Quality• Programmed Novation reports to

be reviewed monthly

Resulting in Growth• Evaluated and selected new

wholesaler

Superior Service• Minimized impact of drug

shortages by ordering direct, anticipating purchases, changing operational processes, and substitution of different formulations

Top Financial Performance• Negotiated flu vaccine contract

• Completed 5 bulk buy purchases

• Implemented multiple initiatives in conjunction with Midwest Purchasing Coalition

PURCHASINGServes patients of• Deaconess Hospital

• Deaconess Cross Pointe


• The Heart Hospital at Deaconess Gateway

• Deaconess Clinic

Formulary Additions• denosumab (Prolia®)

• valrubicin (Valstar®)

• tbo-filgrastim (Granix®)

• pertuzumab (Perjeta®)

• vortioxetine (Brintellix®)

DRUG SPENDING BY THERAPEUTIC CLASS

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DHS TOP 20 DRUG SPENDGeneric Name Brand Name Therapeutic Class

Infliximab Remicade Disease modifying antirheumatic agent

Rituximab Rituxan Antineoplastic

Pegfilgrastim Neulasta Hematopoetic

Bevacizumab Avastin Antineoplastic

Trastuzumab Herceptin Antineoplastic

Immune Globulin Gamma Privigen Immune Serum

Pemetrexed Disodium Alimta Antineoplastic agent

Pneumoc 13-val conj-dip

Prevnar 13 Vaccine

Denosumab Prolia/Xgeva Antineoplastic

Alteplase Activase/Cathflo Thrombolytic

Ertapenem sodium Invanz Antibiotic/Carbapenem

Daptomycin Cubicin Antibiotic

Bendamustine Hcl Treanda Antineoplastic agent

Regadenoson Lexiscan Adenosine Receptor Agonist

Enoxaparin sodium Lovenox Anticoagulant

Albumin human Buminate Blood modifier agent

Octreotide acetate Sandostatin Endocrine-Metabolic Agent

Bivalirudin Angiomax Direct Thombin Inhibitor

Darbepoetin alfa Aranesp Hematopoetic

Azacitidine Vidaza Antineoplastic agent

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PHARMACY INFORMATICS TEAM


Fantastic People• One pharmacist retired

• Presented at Epic User Group Meeting

Increasing Quality• Numerous updates to Epic to

improve safety of medications

• Negotiated and completed robot overhaul

• Completed EPIC build for ambulatory and emergency department preference list

• Meaningful use grouper validation

Resulting in Growth• Reviewed and began build for

Epic 2014 upgrade and TWH implementation

Superior Service• IT pharmacy support located in the

pharmacy department

Top Financial Performance• Completed investigation on two

RAC audits

The informatics team within the pharmacy department is responsible

for automation, database management and Willow, the medication management application of Epic.

Under the direction of the pharmacy implementation supervisor, all build, maintenance and validation to ensure proper ordering, charging and automated clinical decision making are completed across the system and multiple campuses.

Pharmacy Informatics Team:• Three pharmacists

• Two technical analysts

Automation Supported• Aesynt™ Robot-Rx®

• Aesynt™ Unit Dose Packager and Overwrapper

• Baxter ABACUS™ Calculation Software

• Baxter DoseEdge™ Pharmacy Workflow Manager

• Baxter EXACTAMIX™ Automated Compounder

• CareFusion Pharmogistics® Carousel and Inventory Management Software

• Omnicell® automated dispensing cabinets

• ScriptPro® SP 200 Robot

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2013–2014 Resident• Jessica Stansbury

o Graduated from Purdue Universityo Residency Project: Implementation of

a Pharmacist in a Physician’s Office

2014–2015 Resident• Morgan Labhart

o Graduated from Appalachian College of Pharmacy

o Residency Project: Preparation for URAC Specialty Pharmacy Accreditation – A Gap Analysis

Where are our residents now?• 4—Clinical

pharmacists at Deaconess

• 1—South Bend, IN• 3—St. Louis, MO• 1—Cleveland, OH

• 1—Indianapolis• 1—Springfield, IL• 1—Vincennes, IN• 1—Washington

State• 1—Arizona

• 1—South Dakota

DEACONESS PHARMACY RESIDENCY PROGRAMThe pharmacy residency was originally accredited by ASHP in 2006 and was renewed in 2013. The residency started in July 2006 and has successfully graduated a total of 15 residents who have met the goals of the program by working in academia or as clinical pharmacists in a variety of settings.

Education and Training

Residency PreceptorsNew Preceptors in 2014: 4

Total Residency Preceptors: 20

Preceptor Requirements:

• One year of experience following an ASHP-accredited residency program

• Three years of experience if a residency program was not completed

• Must be a model practitioner and contribute to pharmacy knowledge

Residency Rotations Offered• Administrative• Advanced

General Medicine• Anticoagulation

Clinic – longitudinal rotation

• Cardiology• Critical Care• Drug Information• Emergency Room• Family Medicine –

longitudinal rotation

• General Medicine• Geriatrics• Infectious Disease• Medication

Therapy Management – longitudinal rotation

• Nephrology• NICU• Nutrition• Oncology• Orientation/

staffing• Pediatrics• Surgery

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DEACONESS PHARMACY STUDENT PROGRAMEducation and TrainingDeaconess Health System provides training for pharmacy students on both IPPE and APPE rotations. During the 2013–2014 year, students from Butler University, Purdue University, St. Louis College of Pharmacy, Southern Illinois University–Edwardsville, and Creighton were taught by Deaconess pharmacists.

Pharmacy Rotations Offered • IPPE Rotation - Hospital Operations

• APPE Rotationso General

Medicineo Anticoagulationo Nutritiono Surgeryo Home Care/

Hospice

o Oncologyo Pediatricso Emergency

Medicineo Family

Medicine Clinic

Student PreceptorsNew Preceptors in 2013–2014: 2

Total Student Preceptors: 9

One pharmacist oversees the coordination of all students rotations and serves as the Butler University College of Pharmacy Regional Coordinator.

2013–2014 Students• Forty student rotations were completed

• Five schools were served

2013–2014 Student Projects• All pharmacy students help with

admission medication reconciliation

• Updating anticoagulation reference

• Clarifying admission medication reconciliation steps for all students

• Tube feedings for certain medications

Student rotations = great recruiting39.7% of current pharmacists completed pharmacy rotations at Deaconess as students

Paid Summer StudentsA limited number of students work as technicians during peak vacation season and gain experience. Summer students also work on projects and help with regulatory requirements. FY13/14 projects included:

• Analyzed pain data to help HCAHPS pain team and address narcotic adverse events

• Developed and implemented discharge-medications-to-bedside program

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