SharedCare - Decentralized

Pharmacy Technician Model

Tufan Nardali - Pharmacy Regulatory Operations Manager

Alison Capalbo - Pharmacy Technician IV, Direct Patient Care

March 12, 2018

Disclosure

• Tufan Nardali and Alison Capalbo declare no

conflicts of interest, real or apparent, and no

financial interests in any company, product, or

service mentioned in this program, including

grants, employment, gifts, stock holdings, and

honoraria.

Objectives

• Describe "SharedCare"

• Discuss the role of a decentralized pharmacy

technician and how this differs from

traditional responsibilities

• Develop a decentralized pharmacy technician

model

• Review benefits and challenges of a

decentralized pharmacy technician model

SharedCare

• Model of care that began as a LEAN project involving multi-disciplinary team with the goal of providing the safest, most effective, and efficient patient care

– Nursing and nursing aides

– Case managers/social worker

– Physicians

– Pharmacy

– Administration

http://whsc.emory.edu/home/publications/medicine/emory-

medicine/fall2012/img/pg8_team.jpg

SharedCare

• SharedCare refers to systematic communication and

collaboration between the team with the following

goals:

– Exceptional quality of care

– Increase patient satisfaction

– Top of license practice for all clinicians

– Increasing clinician time at bedside

– Increasing communication between care providers

– Increasing staff satisfaction

SharedCare Technician

• Decentralized, unit based pharmacy technician model – Current model includes nine technicians in the tower and two

technicians in the emergency department (ED)

• Technician roles evolving from distributive/operational duties to direct patient care responsibilities – Obtaining/clarifying/updating home medication history from patients,

pharmacies, providers and treatment facilities

– Clarifying allergies

– Identifying medication access issues

– Assessing if patients would like to utilize our outpatient pharmacy at discharge

– Assisting with missing medication doses on the unit

– Performing automated dispensing cabinet (ADC) refills

– Assisting in resolving ADC issues

– Completing medication inspections for respective units

Planning and Implementation of

SharedCare Technicians

Existing technician workflow in the ED evaluated

Training curriculum for SharedCare Technicians developed

Training and implementation completed

Workflow analysis and optimization is ongoing

Implementation

• SharedCare Technician Training – Curriculum created by the SharedCare Steering

Committee • Decentralized pharmacists

• Lead direct patient care technician

• Pharmacy management team

– Training curriculum developed into three phase process

1. Revamping the current medication reconciliation training being used for the ED technicians

2. Providing relevant education to technicians

3. Utilizing skills and information learned from the first two phases to staff independently as a SharedCare Technician

Implementation

• SharedCare Technician Education

– Clinical Education

• Diabetes, asthma/COPD, hypertension, anticoagulant and antiplatelet therapy

• Identifying duplicate or omitted medications based on patie t’s edical history

– Comparison of inpatient orders vs. home medications continued

– Standardized documentation in the electronic medical record (EMR)

Implementation

• SharedCare Technician Education

– Patient interaction/interviewing using the

A.I.D.E.T® method

• Educating technicians to use open-ended questions

http://caplive/caplive/workfiles/serviceexcellence

/AIDETposterOL.pdf

SharedCare Training Curriculum

Week 1

• Reading Day

• Clinical education in a classroom setting

• Shadowing a technician completing medication histories

• Knowledge competency

• EMR – Epic training

• Patient interaction/interviewing education

• Non staffing day - training in the ED

• Patient Interaction Competency

Week 2

• Training with a technician in the ED while staffing

• Final Epic competency

SharedCare Technician Workflow

• Morning duties – majority of time spent with direct patient care duties – Deliver medication batches, loads and stock outs to assigned units

– Complete direct patient care duties • Assess new medication histories to be completed

• Follow up on incomplete medication list

– Address ADC issues, nursing questions and missing doses as needed

• Afternoon duties – operational and direct patient care duties – Deliver medication batches, loads and stock outs

– Finish direct patient care duties that are outstanding

– Credit medications, address ADC issues, nursing questions and missing doses as needed

– Assist main pharmacy with operational duties

Pharmacy Transitions of Care

Navigator

Pharmacy Transitions of Care

Navigator

SharedCare Technician

Evaluations

• Medication history audits

• Number of medication histories completed

per day

• ADC audits

• Completing departmental improvement

initiatives

• Contribution to organizational goals

Challenges along the way

• Lengthy implementation period

• Barriers to completing medication histories – Contacting providers, pharmacies and facilities

– Workflow adjusted to have technicians start direct patient care duties in the morning and follow up on issues in the afternoon

• Developing a training plan to incorporate the skill sets of the medication delivery technicians into the SharedCare model

• Technicians being able to complete the SharedCare training and competencies successfully

• Standardizing documentation in Epic

• Staffing issues in the event of a call-out

Benefits

• Expanded roles of pharmacy technicians allowing them to practice at the top of their licenses

• Time gained by pharmacists to provide additional direct patient care activities

• Improved communication between nursing and pharmacy

• Improved nursing satisfaction with pharmacy department

• Reduced medication discrepancies

• Patient barriers identified by pharmacy technicians

• Decrease in the number of missing medication doses

• Technicians contributing to reducing 30-day hospital readmission rates

Self Assessment Questions

• What are the main responsibilities of a

decentralized pharmacy technician?

A. Updating home medication histories, assisting with

ADC issues, and identifying medication access issues

B. Updating home medication histories, assisting with

medication dosing, clarifying allergies

C. Triaging phone calls in the main pharmacy,

delivering medications to units

D. Assisting with outpatient inventory, clarifying

allergies

Self Assessment Questions

• What should you consider when developing

an education curriculum/training for

decentralized pharmacy technician model?

A. Common disease states and medications

associated with them

B. Patient interviewing skills

C. Standardized documentation in the medical

record

D. All of the above

Self Assessment Questions

• What benefits have been shown with

implementation of SharedCare model

A. Decrease in medication inventory

B. Reduced medication discrepancies

C. Time gained by nurse aides

D. More time for pharmacist to relax

http://hofstetterlandscaping.com/wp-content/uploads/2012/09/questions.jpg