Expanding Roles In Pharmacy: Whiteriver Service Unit’s .

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Alaska Pharmacist Association54th Annual Convention“Pharmacy Wellness and Well-Being”Expanding Roles in Pharmacy:Whiteriver Service Unit’sApproach toPracticing at the PinnacleGreg Sarchet and Weston Thompson

Financial DisclosuresGreg Sarchet: Declare(s) no conflicts of interest, real or apparent, and no financial interests in anycompany, product, or service mentioned in this program, including grants, employment, gifts, stockholdings, and honoraria.Weston Thompson: Declare(s) no conflicts of interest, real or apparent, and no financial interests inany company, product, or service mentioned in this program, including grants, employment, gifts,stock holdings, and honoraria.The American Pharmacist Association is accredited by the Accreditation Council for PharmacyEducation as a provider of continuing pharmacy education.

Learning Objectives Discuss the new “Expanding Technician Roles” policy adopted by the 2019 APhAHouse of Delegates. Discuss pharmacy practice opportunities in the Indian Health Service. Discuss pharmacist credentialing and Professional Practice Evaluation. Discuss the components involved in training pharmacy technicians to administerimmunizations. Discuss creating the peak collaboration environment. Describe leadership actions required to implement technician immunization delivery. Developing pharmacist buy-in with extreme ownership.

Self-AssessmentIn the state of Idaho, pharmacy technicians are able to:a. Prescribe immunizationsb. Counsel on immunizationsc. Answer clinical questions about immunizationsd. Administer immunizations

Self-AssessmentWhich of the following is a component of the WSU TechnicianImmunization Training Program?a. How to administer CPR to an unconscious patientb. Corporate policies and procedures about vaccinationc. Proper administration techniques for subcutaneous andintramuscular injectionsd. How to order vaccine from a warehouse or supplier

Self-AssessmentAs a result of pharmacy technician administration Whiteriver ServiceUnit has seen:a. An increase in vaccine associated adverse eventsb. An expansion of advance pharmacy practice servicesc. A decrease in immunization ratesd. A increase in pharmacy wait times

Self-AssessmentWhich of the following are benefits of pharmacy technician vaccineadministration?a. Pharmacy technician job satisfactionb. Increasing patient access to vaccinesc. Decreasing time burden on the pharmacistsd. All of the above

Self-AssessmentWhich of the following is not a quality improvement tool leadershipcan take advantage of to implement change?a. Scarcity Pieb. Lean 8 wastesc. Matrix Diagramd. De Bono’s Thinking Hats

2019 APhA policy submitted by the Federal Caucus APhA encouragesstate boards of pharmacy to develop regulationsallowing expanded pharmacy technician roles that allow bothtechnicians and pharmacists to practice at the top of their trainingand license or certification. APhA supportsstate board of pharmacy regulations thatstandardize and set minimum didactic and experiential standardsfor technicians to allow for functioning in expanded roles.

Rocky VIUnicorn. Clip Art image. 13 October 2019 s.html

Peak of LicensureLean – 8 wastes Defects Over Production Waiting Non-Utilized talents Transportation Inventory Motion Extra Processing

Whiteriver Service UnitIndian Health Service. The Federal Health Program for American Indians and Alaska Natives. Availableonline: https://www.ihs.gov/aboutihs/ (accessed 3 September 2019).

Pharmacist Peak of Licensure CriticalCare Pharmacy Prescribing through collaborative practice agreements Prescribing through credentialing and privileging Performing limited physical assessment Ordering and interpreting labs/cultures PCMH Seeing Patients Comprehensively

Technician Peak of Licensure Administeringimmunizations Completing medication reconciliations Calling patients for transitions of care Pre-Visit Planning Performing QI/QA Performing POC tests Tech check Tech

WRSU GPRANationalWRSUBoard of Governors of the Federal Reserve System. Government Performance and Results Act (GPRA) Reports. Available /gpra.htm (accessed 26 September 2019).

2017-New Law in IdahoRule 330.03 Delegation of Administration An immunizing pharmacist may delegate the technical task ofadministering a immunization to a student pharmacist or acertified technician under their supervision who; Holds a current certification in basic life support for healthcareproviders Has successfully completed an ACPE-accredited orcomparable course on immunizationsSarchet, G.; Helm, E.; McKeirnan, K. Pharmacy Technicians and their Impact on Immunization Delivery. Proceedings of the Federal Pharmacists Forum, AmericanPharmacists Association Annual Meeting 2019, Seattle, WA. March 22, 2019.

WSU Pharmacy Technician ImmunizationAdministration Training Program2-hour self-study Brief immunization overview Vaccination preparation (supplies,technique, reconstitution) Vaccination administration (routes, sites,needle selection)Common vaccines specifics(live/inactivated, spacing, dose) Documentation, storage, and handling Emergency, ADR managementSarchet, G.; Helm, E.; McKeirnan, K. Pharmacy Technicians and their Impact onImmunization Delivery. Proceedings of the Federal Pharmacists Forum, AmericanPharmacists Association Annual Meeting 2019, Seattle, WA. March 22, 2019.4-hour live training and assessment Needle safety Choosing correct needles and syringes Safety devices Drawing up vaccinations Finding the site of injection Discussion of proper technique Practice injection into training aid (handson) Brief intradermal and intranasaldemonstration Epinephrine demonstration and practice Discussion of ADR and emergencymanagement Competency check off with pharmacist

Scarcity Pie FromStephen Covey’s Seven Habits of Highly Effective People Theoryof one pie Abundancementality

Gaining Momentum Whatis our vision? Communication Leadingof visionthrough change Implementation

Pharmacy Expanding Vaccine Access (PEVA) Nationalworkgroup whose initiative is to decrease the prevalenceof vaccine preventable diseases Primary focus of PEVA is to increase access to and demand forimmunization services Subject matter experts to advise, educate and implement improvedimmunization practices to the public health service field Members include pharmacist from (26) IHS, (3) CDC, (1) BOP, (9)FDA, (2) ICECommissioned Corps of the U.S. Public Health Service Pharmacist Professional Advisory Committee, Pharmacists Expanding Vaccination Access (PEVA). Availableonline: https://dcp.psc.gov/OSG/pharmacy/pevahomepage.aspx (accessed 27 September 2019).

Standards for Adult Immunization Practice ASSESSimmunization status of all your patients at every clinicalencounter StronglyRECOMMEND vaccines that patients need ADMINISTERneeded vaccines or REFER your patients to avaccination provider DOCUMENTvaccines received by your patientsCommissioned Corps of the U.S. Public Health Service Pharmacist Professional Advisory Committee, Pharmacists Expanding Vaccination Access (PEVA). Availableonline: https://dcp.psc.gov/OSG/pharmacy/pevahomepage.aspx (accessed 27 September 2019).

PEVA 2017 3.2%51.8%35.5%AssessRecommendAdministerRefer* DocumentCommissioned Corps of the U.S. Public Health Service Pharmacist Professional Advisory Committee, Pharmacists Expanding Vaccination Access (PEVA). Availableonline: https://dcp.psc.gov/OSG/pharmacy/pevahomepage.aspx (accessed 27 September 2019).

Barriers to Administering VaccinesCommissioned Corps of the U.S. Public Health Service Pharmacist Professional Advisory Committee, Pharmacists ExpandingVaccination Access (PEVA). Available online: https://dcp.psc.gov/OSG/pharmacy/pevahomepage.aspx (accessed 27September 2019).

Technician Practice Regulation at Federal SitesNo Federal Law that addresses scope of practice of pharmacytechnicians Typically,the states are the ones that define scope of practice ofvarious healthcare professionals and pharmacy technicians Localpolicy/protocol that usually should be approved throughmedical staff and sometimes governing board depending on howlocal approval structure looks

Training Whiteriver Indian Hospital Technicians 3Whiteriver IndianHospital Technicians 1Whiteriver IndianHospital Pharmacist(Train the Trainer)Sarchet, Greg. “WRSU Pharmacy Techs” 2018 JPEG file.

Whiteriver Indian HospitalPharmacy Vaccine ServicesOffered : Walk-in pharmacyimmunization clinic Screen vaccine status forevery patient at pharmacyvisit Pharmacy led outreachvaccination programVaccination Rates Then: GPRA standards for children 1yoa 89% FY18 Flu 60% (6083) 65 PNA 92% HPV (2 doses by age 13–15years) 93%

If it’s not broke why fix it?2 FTE Pharmacy Positions allocated toWhiteriver Indian Hospital PharmacyChronic Disease Management Clinic(CDTM): Diabetes Lipid Hypertension Rheumatology Pain Mental Health Heart Failure3 FTE Pharmacy Positions allocated tovaccination efforts on the reservationDid you know. Clip Art image. 13 October 2019 http://clipartmag.com/you-did-it-clipart

Whiteriver Indian Hospital Process of VaccineAdministrationCredentialed pharmacistduties: Reviews screeningquestionnaire Reviews chart forvaccine(s) indicated, Reviews vaccinespulled fromfridge/freezer Counter-signs note inmedical recordCredentialed Technicianduties: Offers VIS Prepares andadministers vaccine(s) Documents vaccinationand note in medicalrecord

Whiteriver Indian Hospital ImpactVaccination Rates Now: GPRA standards forchildren 1yoa 90% FY19 Flu 60% (7946) 65 PNA 94% HPV 93%Sarchet, Greg. “Jacoby Vaccine Administration” 2018 JPEG file.

Whiteriver Indian Hospital ImpactPre Tech VaccineAdministration: 6 CDTM Pharmacists 80 hours delegated toCDTM clinic per weekPost Tech VaccineAdministration: 13 CDTM Pharmacists 144 hours delegated toCDTM clinic per week Outreach CDTMservicesPCMH Implementation

Training IHS Pharmacy Technicians NationwideSarchet, Greg. “SWIPHTT” 2018 JPEG file.

National ImpactIndian Health Service. The Federal Health Program for American Indians and Alaska Natives. Available online:https://www.ihs.gov/aboutihs/ (accessed 25 September 2019).

Practicing at Your Peak ”I love having 2 technicians on staff who are immunization certified, it allows me to focus ontasks that require a pharmacist and has decreased our wait times”-Pharmacist Tuba City AZ ”My job satisfaction has definitely increased, I love having patient interaction and working at thetop of my scope is amazing”-Pharmacy Technician Taos NM ”Patient’s often request having it done from a technician rather than the pharmacist”-PharmacyTechnician Albuquerque, NM “Being certified has helped out the workflow positively and greatly. The pharmacists are able touse their time for other complicated patients and administrative matters. I love having thepatient interaction and working at the top of my job scope it amazing”-Pharmacy TechnicianLaChee Pharmacy

WRSU Childhood Immunization RatesBoard of Governors of the Federal Reserve System. Government Performance and Results Act (GPRA) Reports. Available /gpra.htm (accessed 26 September 2019).

Future The future is now Empowering health care professionals improving patient care What else can we do? Pharmacists Technicians How can we increase pay for increased responsibilitiesWhat needs certification/What needs training IHS PTCB VA DoD

Advanced Pharmacy Technician in VeteransAffairsShift in Roles and Responsibility: VA Pharmacy is clinically focused where more VA pharmacists arefunctioning as practitioners. As the role of pharmacists evolved along withthe health care needs of our nation’s veterans, so have the roles andresponsibilities. More VA Pharmacies are shifting the non-clinicalpharmacist duties and day-to-day responsibilities to Pharmacy TechniciansRole of Veterans Affairs Administration (VHA)Advanced Pharmacy Technician (APT) The VHA/APT works with the pharmacist as a team to support optimumpatient care outcomes. VHA trained and specialized technicians will beequipped to support and assists pharmacist to enable them to performmore patient care activities, such as medication management, counseling,and preventive care screenings to name a fewWhat are we doing to produce qualityAdvanced Pharmacy Technician to efficientlywork with Pharmacist as a team? Standardized Training Standardize Competencies Standardize Roles

VHA Pharmacy Standardized TrainingDeveloped Training in theFollowing Areas: Diabetes Medication ManagementTraining Anticoagulation Training Infectious Disease Training Behavioral Health Training Pain Management Training Tech-Check-Tech Training Immunizations

Example of Developed Training

Medical Reconciliations in the ER WRSU Usingpharmacy technicians and telepharmacy to obtain medicationhistories in the emergency department. JAPhA. 2019. epub SatisfactionWith Medication Reconciliation Completed byPharmacy Technicians in an Emergency Department. P T. 2018Jul;43(7):423-428.

Pharmacy Technicians Roles in PharmacyChronic Disease Therapy Management Clinics Pre-Visit PainHealth ScreeningClinic Questionnaires Transitionof Care PharmacyTechnician Run Warfarin Clinic?

Pharmacy Technician Roles in Anticoagulation Proportionof work appropriate for pharmacy technicians inanticoagulation clinics. Am J Health Syst Pharm. 2016 Mar1;73(5):322-7. PharmacyTechnician Management of Stable, In-Range INRs Withina Clinical Pharmacy Anticoagulation Service. J Manag Care SpecPharm. 2018 Nov;24(11):1130-1137.

Tech Check TechGeorge, R. (2018). DoD Tech-Check-Tech Program. JFPS, Kansas City, MO.

Family PicturesMeme Generator. Available online: memegenerat