GEORGETOWN HOSPITAL SYSTEMGEORGETOWN MEMORIAL HOSPITAL WACCAMAW COMMUNITY HOSPITAL

TECH TREKKING

PATIENT

PHYSICIAN

NURSECASE MANAGER

PHARMACIST

TEAM APPROACH

Pharmacist Job Duties Order Entry &/or Order Reviewing/Dosing Order Clarification Order & Patient Follow up Medication Dispensing IV Admixtures calculations & checks Clinical Interventions Medication Procurement Automation- Pyxis Control Unit Inspections Quality Assurance/ PI Communication- phone/ rounds/ face to face Med Reconciliation Supervision

Increase Knowledge Base

New procedures New equipment New research New drugs Continuing education

Increased Work Load

Increased Patient Numbers Automation New Medications Expanded Clinical Duties

Regulations CMS JCAHO Licensure DHEC DEA SIP Guidelines Hospital Policies 100,000 Lives LeapFrog Healthgrades ASHP 2015 USP 797 Standards

Pills

Multiple Tasks

Continuing Ed

Projects

Community Involvement

Medication Safety Facts Medication errors account for more

than 7000 deaths annually Approximately two out of every 100

patients admitted to the hospital will experience a preventable adverse drug event

Over 12% of patients experience an ADE within 2 weeks of discharge

Massachusetts Coalition for the Prevention of Medical Errors

US TF on HC Cost Control Med Errors 30% of Health Care Cost

Med Errors cost 10-15 % of hospital’s annual operating cost

Med Errors $23 billion national cost (more than 50% are preventable)

National Pharmacists Shortage

Increasing Knowledge BaseExpanded Duties Safety-preventable ADE/Drug Conc/Interventions

Quality-Core Measures/SCIP/HAI/VAP

Changing Roles-Dispensing vs Clinical Roles

Goal To utilize Pharmacists to provide evidence

based Best Practices using the most cost effective methods to support medication safety by providing a universally consistent process regarding medication therapy across the continuum of care.

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PATIENT

PHYSICIAN

NURSECASE MANAGER

PHARMACIST

Pharmacy Tech

TEAM APPROACH

Expansion of Technician Role Techs must be registered with

SCBORX National Certification SC- State Certification June 2006- Grandfathered in or Must be a graduate of approved accredited program

Today: Tech Job Duties Order Entry &/or Order checking Medication preparation Tech check Tech Prepare IV Admixtures Calculations Procurement-ordering, receiving, stocking Inventory Control-Max/Min Automation- Pyxis Control Unit Inspections Quality Assurance/ PI Communication- phone/ rounds/ face to face Med Reconciliation

JOB DUTIES SHIFT

Medication Reconciliation

Tech Check Tech

Unit Inspections

Chemo Admixtures

The Dilemma

What to do ???

Development of Career Ladder Pharmacy Technicians Organizational Value Self Worth Recruitment/Retention Cutting Edge

Development of Career Ladder

Organizational Value:

Increasing education, knowledge, responsibilities of the tech gives the Pharmacists increase support with the daily routine technical functions, allowing them more time to spend on Clinical Issues, which will create a more efficient department, while saving the organization dollars.

Development of Career LadderSelf Worth: This gives the Tech an opportunity for

career growth and advancement by increasing their job responsibilities, accountability and their learning which, in turn, increases their self worth and the morale in the department.

Development of Career Ladder

Recruitment/Retention: Replacing a trained, seasoned employee is

very costly to the institution($ 48,378)The career ladder not only provided a method to increase income, it helps retain the employee by giving them extra incentives to work toward as they increase their longevity with the organization.

( Year prior to starting WCH lost 3 techs-CVS/Cosco/ExCr)

Development of Career LadderCutting Edge: To continue to hire the high caliber employee we desire

and keep them incentivized, we must be creative and look for ways to build self esteem, promote professionalism and add opportunity for growth to hire and retain them. Providing this creative advancement, not only gives the “self starter” goals to work toward, it also creates a “need to grow” in the department, so others are not left behind.

(Environment of friendly competitiveness with support)

Expanded Responsibilities USP 797 Compliance- IV Admixture Monthly Unit Inspections Medication Reconciliation Tech check Tech Quality Assurance Studies PI Review Pharmacy Projects Community Involvement

Pharmacy Tech LevelsPharmacy Trekking Pharmacy Tech Levels

Non-Certified Pharmacy Tech…….220……..$ (1 year)

Certified Pharmacy Tech I….…….245……..$$ Certified Pharmacy Tech II………275………$$$

Pharmacy Trekking Differential

Trek A…………$ 0.75 ($1560) Trek B…………$ 1.50 ($3120) Trek C…………$ 2.50 ($5200)

Pharmacy Tech LevelsNon-Certified Pharmacy Tech…….220……..$ No National or SC State Certification

Certified Pharmacy Tech I….…….245……..$$ National Certification

Certified Pharmacy Tech II………275………$$$ National & SC State Certified OR National Certified with at least 3 years hospital pharmacy experience

Qualification to begin Trekking process may not occur until employee has attain Certified Pharmacy Tech II Status

Pharmacy Trekking A Must be performing at a “meets” level or higher on all performance

appraisal standards Must have demonstrated cross training competency in all areas of

Pharmacy as documented on the Pharmacy skills checklist. Demonstrated and documented competency in preparation of all IV

admixtures and Chemo solutions Documented ability and evidence of conducting monthly unit

inspections Documented completion of Pyxis minimum and maximum inventory

standards on a quarterly basis. No evidence of written or suspension level corrective action over the

previous 12 months. Documented minimum of 20 preceptorship hours of training new

pharmacy staff.

Pharmacy Trekking B Compliant with all Competency Level I criteria AND: South Carolina State Certified Pharmacy Technician with SC BORx OR

3 years experience as a hospital pharmacy technician with overall “exceeds” rating on most recent performance review. (based on 2006/2007 set up this means a 3.0 or higher)

797 Compliant (Completed documented 797 skills checklist & passed media-filled testing)

Minimum of 40 documented hours of preceptor ship with Pharmacy Tech students during annual review period OR Participation in local career day event

Documented participation with and mentorship of applied Ed of Pharmacy Students of 8 hours during annual review period OR complete 1 approved

(in addition to those required for annual licensure)

Pharmacy Trekking B (continued) Participates in one documented department quality assurance

initiative during annual review period.

Participates in Departmental one documented process improvement (PI) activity during annual review period

Participates in Pharmacy Week project OR Participates in Poison Prevention Week project

Participates in one or more GHS Community Health Events

Pharmacy Trekking C

Compliant with all Competency Level I and II criteria AND: Must have been a Pharmacy Technician with GHS continuously for a minimum of five years

OR must have graduated from an accredited pharmacy technician program and must have been a Pharmacy Technician with GHS continuously for a minimum of three years.

Demonstrates and documents completion of medication reconciliation process for 2 months during annual review period

Identifies specific opportunities for internal departmental policy changes that results in improvement in safety or operational efficiency. Writes and/or revises drafts of policies for review.

Tech Check Tech as assigned documented by skills test and log sheets

Researched and identifies a minimum of one industry or otherwise external “Best Practice”/benchmark process improvement to be presented as a possible best practice for GHS to adopt.

In addition to the minimum required preceptor ship hours with Pharmacy Tech students, individual will participate in the design of the training plan.

Pharmacy Trekking C (continued) Identifies and leads a minimum of one department quality assurance

initiative.

Identifies and leads a minimum of one Departmental process improvement (PI) activity

Serves in the leadership role to develop Pharmacy Week project plans OR Serves in the leadership role to develop Poison Prevention Week

project plans Participates in one or more GHS Community Health Related Event

Completes 2 hours additional CEUs (in addition to those requires of annual licensure renewal) during annual review period

WCH Pharmacy Trekking Costs

PM……………C...........$5200 GW……………C……….$5200 VG…………….C……….$5200 GB…………….B……….$3120 BI……………..B……….$3120 LD………….…B……….$3120 AY…………….B……….$3120 SS………..…..B……….$3120 AJ…………….A……….$1560 KM……….…..A……….$1560 Total Costs……..…………………$34,320

GMH Pharmacy Trekking Costs

MHR………….B.........$3120 TF.……………B……….$3120 MLR.………….B……….$3120 RS…………….B……….$3120 Total Costs……..…………………$12,480

Medication Reconciliation (Trek Level C Criteria)

$59.09/hr Average RPh $14.21/hr Average Tech 5.5 mins/patient

WCH 2 EAST –July thru Dec 2007 1064 admissions 1064 X 5.5 mins=5852mins/60=97.5 hrs 97.5 X $59.09= $5761.28 97.5 X $14.21= $1385.48 $5761.28- $1385.48= $4375.80/ 6mon X 2=$8751.60/yr Annual Efficiency Savings = $8751.60 @ WCH 2 East

Medication Reconciliation (Trek Level C Criteria)

$59.09/hr Average RPh $14.21/hr Average Tech 5.5 mins/patient

WCH : July Thru December 2007 (3604 Admissions) 5.5 min X 3604=19,822/ 60 = 330.37 hours 330.37 X $59.09= $19,521.56 330.37 X $14.21= $ 4,694.56 $19,521.56-$4694.56=$14,827/ 6mon X 2=$29,654/yr Annual Efficiency Savings = $29,654 @ WCH

Tech check Tech (Trek Level C Criteria) .

Pyxis Refills & Narc Pulls $59.09/hr Average RPh $14.21/hr Average

Tech WCH: Done Monday thru Friday 1.5 hrs/day X 5days/week x 26 weeks = 195 hrs

195 X $59.09= $ 11,522.55 195 X $14.21= $ 2, 770.95 $11,522.55 - $ 2,770.95= $8751.60/ 6mon 8751.60X2=$17,503.20/yr

Annual Efficiency Savings = $ 17,503 @ WCH

Tech check Tech (Trek Level C Criteria) .

Medication Repackaging Verification $59.09/hr Average RPh $14.21/hr Average Tech Done Daily GMH: July-Dec 2007 = 1009 Repackaging Procedures 0.1 hours/procedure (6 min) 0.1 x 1009 = 100.9 hrs/6 months

100.9 X $59.09= $ 5,962.18 100.9 X $14.21= $ 1,433.79 $5,962.18 - $ 1,433.79= $ 4528.39/ 6 months 4528.39 X 2= $ 9,056.78/yr

Annual Efficiency Savings = $ 9,056.78 @ GMH

Unit Inspections (Trek Level A, B, & C Criteria)

$59.09/hr Average RPh $14.21/hr Average Tech WCH Done monthly: 9 units @ 1 hour/unit = 54 hours/6month 9 X $59.09 = $ 531.81/mon x 6 months = $3190.86 9 X $14.21 = $ 127.89/mon x 6 months = $ 767.34 $3190.86 - $767.34 = $2423.52/6mon X2= $4847.04/yr

Annual EfficiencySavings = $ 4847.04 @ WCH GMH Done monthly: 10 units @ 1 hour/unit = 60 hours/6month 10 X $59.09 = $ 590.90/mon x 6 months = $3545.40 10 X $14.21 = $ 142.10/mon x 6 months = $ 852.60 $3545.40 - $852.6 = $2692.80/6mon X2= $5385.60/yr

Annual Efficiency Savings = $ 5385.60 @ GMH

Chemo IV Admixture (Trek Level A, B, & C Criteria)

$59.09/hr Average RPh $14.21/hr Average Tech GMH : July Thru December 2007 # Admixtures per 6 Months = 76 # Hours per Admixture = 1 # Hours per 6 Months = 76 Hrs

76 X $59.09= $4490.84 /6 months 76 X $14.21= $1079.96 /6 months $4490.84-$1079.96= $3410.88 /6mon $3410.88 X2=$6821.76/yr

Annual Efficiency Savings = $ 6821.76 @ GMH

Financial Benefit

WCH Med Reconciliation………..….. $ 29,654.00 WCH Tech Check Tech……………... $ 17,503.00 WCH Unit Inspections……………….. $ 4,847.04

WCH Efficiency Savings…….$ 52,004.04

GMH Tech Check Tech………….……. $ 9,056.78

GMH Chemo Admixtures………….…. $ 6,821.76 GMH Unit Inspections…………………. $ 5,385.60

GMH Efficiency Savings……..$ 21,264.14

Safety Allergy Procedure ADR Procedure Med Scanning Procedure Order Checking Tylenol Dosing Checks

Quality

Metformin- SrCr Checks Tech check Tech Inventory –Max/Min Levels Anesthesia Gases- Flow Rates Charge Capture-OR/Endo/Anes Billing Log Checks-Doc/Over/Rejections Blood Derivative Log Documentation

Worth

Organization Recruitment, Retention, Cost Effectiveness,

Community

Department Morale, Competitiveness, Environment

Self Motivation, Attitude, Importance

Cost/Benefit Analysis Financial WCH

Costs……………………….. $ 34,320.00 WCH Savings……………………. $ 52,004.04 WCH Net Gain……..$ 17,684.04

GMH Costs……………………….. $ 12,480.00 GMH Savings……………………. $ 21,264.14 GMH Net Gain……..$ 8,784.14

Safety:ADR/Allergy/Scanning/Tylenol Quality:Tech Check/Inventory/Charge Capture Worth: Organization/Department/Self

Time Benefit

WCH: Med Rec…………….….195 Hours Tech check Tech….…390 Hours Unit Inspections……..108 Hours 693 Hours

GMH: Chemo Prep……….…..152 Hours Repackaging Checks..202 Hours Unit Inspections….…..120 Hours 474 Hours 693 + 474= 1167 Hours (0.6 FTE)

Benchmarks Financial Costs………..$17,684.04 WCH

Gain Financial Costs………..$ 8,784.14 GMH Gain Turnover……………..…O Trekking Techs have

Left

Shift In Duties…………Tech check Tech,

Unit Inspections, Med Reconciliation, Chemo Admixtures

Best Practices………Scanning/ADR/Allergy

Inventory Control/Med Rec

THE Future

Family Caring For Family 6 Key GHS Initiatives Shift of more duties Increase in Quality & Safety Promotion of Best Practices Leader in Pharmacy Practice