Beyond Distribution

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Beyond Distribution

• Expanding The Scope To Include Clinical Practice

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Presentation Outline

• Alana Froese
• Clinical Pharmacy Technician Program Development
• Brenda Zacharuk
• Surgical Ward Pilot Project
• Yvonne Dresen
• Oncology Outpatient Clinic Pilot Project
• Tracy Todd
• Culture Clinical in Community
• Nicole Abrahamczik
• Clinical and Telepharmacy

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Area Scope
Smithers Terrace Prince George Hudsons
Hope Fort Nelson Prince Rupert Burns
Lake Vanderhoof
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Vision Statement

• To develop
• Clinical Pharmacy Technicians
• who will work with a pharmacist,
• either on site or remotely,
• to enhance the capacity to provide
• Pharmaceutical Care
• through clinical pharmacy services
• in Northern Health

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Purpose

• To provide high quality education and training
  for pharmacy technicians in the area of clinical
  pharmacy services

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Program Structure

• Foundation Module
• Introduces the concepts of clinical pharmacy and
  consists of seven sections
• Generalist Module
• Covers introductory concepts relating to drug and
  disease state management principles in 13
  specialty areas

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Foundation Module

• Section A Health Science Principles
• Medical Terminology
• Anatomy Physiology
• Pathophysiology
• Section B Clinical Pharmacy Concepts
• Pharmaceutical Care
• Pharmacology Pharmacotherapeutic Principles
• Pharmacokinetic  Pharmacodynamic Principles
• Drug Use Evaluation and Pharmacoeconomic
  Principles

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Foundation Module

• Section C Information Management
• Pharmanet Patient Profiles
• Information Resources
• Information Retrieval Strategies
• Types of Literature Available in Journals
• Drug Information Request Management
• Section D Communications
• Counseling Patient Education
• Pharmacy Workup of Drug Therapy (PWDT)
• Allergy Assessments
• Professional Writing Presentation Skills

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Foundation Module

• Section E Medication Management
• Medication Safety
• Incident Reporting
• Special Care Areas
• Special Patient Populations
• Clinical Policies
• Section F Ward Orientation
• Orientation to Health Care Professionals
  Services
• Patient Health Records
• Chart Documenting
• Infection Prevention Control
• Daily Clinical Activities

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Foundation Module

• Section G Administration
• Professional Business Communications
• Manual Maintenance
• PT Committee Management
• Clinical Reports Statistics

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Generalist Module

• Section 1 Renal
• Section 2 Neuropsychiatry
• Section 3 Cardiovascular
• Section 4 Hematology
• Section 5 Immunology
• Section 6 Infectious Disease

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Generalist Module

• Section 7 Oncology
• Section 8 Palliative/Pain/Musculoskeletal
• Section 9 Gastrointestinal/Hepatic
• Section 10 Respiratory/EENT
• Section 11 Endocrinology
• Section 12 Genetics/Reproduction
• Section 13 Dermatology

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Generalist Module

• In each section, the technician studies related
  material for each specialty
• Medical terminology
• Anatomy
• Physiology
• Pathophysiology
• Clinical pharmacology
• Diagnostic tests

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Clinical Tech Certification

• Certification requires
• Completion of section assignments
• Open-book, timed exams
• Practicum at end of Generalist module
• Upon successful completion of the certification
  program, the pharmacy technician is awarded a
• CERTIFICATE SERVICE PIN
• and the designation of

Certified Clinical Pharmacy Technician
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Clinical Practice Implications

• Developed to fill gaps in pharmacy services
  caused by the North American-wide pharmacist
  shortage
• Provides an opportunity for the pharmacist
  technician to work in a collaborative partnership
  
• Results in enhanced clinical pharmacy services
• It does not change the fact that the recruitment
  of pharmacists will continue to be difficult but
  establishes an environment that adapts to this
  fact

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Surgical WardClinical Pilot Project
Brenda Zacharuk
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Clinical Tech on Surgical Unit

• Original pilot 8 weeks in duration
• Goal To establish feasibility of extending
  clinical patient care to the full surgical ward
  (48 patients)
• 50 of ward currently staffed by a clinical
  pharmacist
• Pilot extended indefinitely

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Medication Reconciliation

• Review chart of new admissions to ward
• Identify the smoking patients
• Obtain Pharmanet
• Interview patient
• Report discrepancies

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Chart Review

• Orders/routes appropriate for clinical status of
  the patient
• Monitor stop dates for antibiotics and narcotics
• Drug levels and pending cultures
• Intervene for non-formulary orders written

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Multidisciplinary Rounds

• Pharmacy
• Nursing
• Clinical Dietary
• Physiotherapy
• Occupational Therapy
• Social Work

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NICC Program

• Certified Nicotine Counselor
• Counsel on smoking cessation
• Offer nicotine replacement therapy during
  admission
• Recommend dose to pharmacist for ordering
• Enroll patient in the program if requested

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Lab Results

• Monitor and record daily blood work
• Report abnormal values
• Track culture and sensitivity (C S) blood,
  urine, wound, etc.
• Alert pharmacist to positive results for timely
  treatment options

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Outpatient DVT Clinic

• DVT patients not requiring hospitalization
• Record INR results daily
• Organize scheduling of next INR
• Statistics

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Goals for the Future

• Warfarin counseling
• Discharge planning
• Device teaching
• Larger role in diabetes management
• IV to PO step down
• Mentor program graduates
• Continue to develop clinical skills through
  education initiatives

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Oncology Outpatient ClinicClinical Pilot
Project
Yvonne Dresen
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Clinical Tech in Oncology

• Goal to maximize clinical time for pharmacist
• Original project 8 weeks in duration
• Anemia Patient Management
• Financial assistance program registration for new
  patients and follow - up

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Clinical Tech in Oncology

• Medication history for new patients
• Nicotine Intervention Counseling (NICC)
• Oral cancer medication dispensing
• Process physician orders for oncology patients

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Clinical Tech in Oncology

• Double check of BSA, dose calculations, required
  blood work
• Preparing worksheets (ie formula cards or drug
  preparation sheets)
• Communication with CIVA room

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Oncology Pilot Statistics

• Pilot Project Statistics over 8 weeks
• Total tech hours 222
• Total Pharmacist hours 296
• Pharmacist hours without tech 73

Based on these figures, the pharmacists clinical
time was optimized by approximately 40
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Clinical Tech in Oncology

• Oncology patient history log management
• Connection between CIVA room and Cancer Unit
• Updating chemo worksheets / stability lists
• General troubleshooting

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Clinical Tech in Oncology

• Literature search for pharmacist
• Data management
• Liaison with other regional and provincial
  facilities
• and other related duties

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Goals for the Future

• Development of satellite pharmacy
• In house investigations of efficacy of
  supportive care, incidences of adverse effects,
  etc
• Completion of Clinical Pharmacy Technician
  Program and mentoring of other graduates of
  program

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Culture Clinical in a Community Setting
Tracy Todd
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Cultural Attitudes

• Clinical technician development is very exciting
• However
• One of the many challenges we face is
• Cultural Attitude

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Cultural Attitudes

• Many pharmacists physicians support the
  initiative
• Discovery of duties a technician can be assigned
  to enhance clinical services
• Still a strong resistance amongst others

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Cultural Attitudes

• The Clinical Tech program
• Provides opportunities to initiate cultural
  change in our profession
• Gives the technician the tools necessary to
  encourage change in our profession and patient
  care

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A Community Approach

• The Clinical Technicians participation
• Will provide hospital and community pharmacy
  better communication upon discharge
• Enhances the continuity of care by
• Following up on medications from hospital
  admission
• Assisting in consultations
• Providing a seamless transition

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Seamless Transitions

• Large need in community for continued care after
  discharge from hospital
• Small communities face challenges
• Patient access to specialists may be difficult
  due to financial, mobility or distance concerns
• Clinical pharmacy team would greatly benefit
  general physicians in remote areas

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Rural Community Pharmacy

• In Hudsons Hope
• A community population of 1000
• One physician
• Relies on technician to monitor continuance of
  dosing, early refills, etc.

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Goals for the Future

• Expand the scope of a technicians role
• Promote a collaborative effort to provide optimum
  care for all members of the rural community
• Provide training for graduates of the program
  working in similar areas

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Nicole Abrahamczik
Clinical and Telepharmacy
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• For improving
• Pharmaceutical Care
• with the new clinical technician

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Imagine

• A stand alone tech in a small remote facility
• The pharmacist is in another city, with limited
  access to charts, and virtually no access to
  patients
• How does the pharmacist provide clinical care?
• With the help of a clinical technician

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Is it Reasonable?

• How many times in pharmacy do we say it simply
  cant be done?
• How many times does someone ask
• Could some of it be done?
• Could we make it work with a little ingenuity?
• Sometimes we cant accomplish the whole job
  alone, but we can make a big difference in the
  details

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Why Not?

• So a new clinical technician?
• Why not?
• Watching over a clinical technician from another
  town?
• Why not?
• It can be accomplished and it can make a huge
  difference to all places big and small, urban and
  remote

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Telepharmacy

• A clinical technician in a remote location has
  the access to the charts and to the patients that
  their pharmacist may not
• They can perform the interviews with patients
  regarding current medications
• They can flag any discrepancies, monitor lab
  values, and do follow-ups

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The Tools

• So what tools would a remote clinical tech need?
• A fax machine
• A computer
• Video conferencing equipment
• Special forms

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Process

• The Clinical Tech
• Goes to ward
• Does med rec
• Gathers and analyzes labs for out of whack
  markers
• Fills in a report of findings highlighting or
  flagging most important items for follow up
• Faxes the report to the remote pharmacist

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Process

• The Pharmacist
• Analyzes the information
• Calls the ward/doctor if necessary for more
  clarification
• Forms an action plan
• Makes recommendations to the doctors regarding
  treatment
• Lays out the monitoring plan for future
• Faxes the information back to the technician

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The Follow Through

• The tech can now follow the action plan
• Monitor the labs
• Go to discharge planning meetings
• Follow up with community pharmacy upon discharge
• Prepare stats
• Can also conduct drug research and many other
  tasks

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The NHA in 2004/2005

• Covers 600,000 sq km
• Services over 300,000 people
• Has over 2 dozen acute care facilities
• In 2004/2005 over 110,000 outpatient visits were
  scheduled
• Over 900 residential care bed spaces
• Only 9 out of 26 sites have on-site pharmacists

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The Potential

• Approximately 1 acute care facility per 25,000 sq
  km
• With 17 sites that operate without a pharmacist
  on site, clinical services have been minimal
• With the use of telepharmacy, and
  tech-check-tech, we can fully cover all of these
  sites without straining any one site
• Not all services need to come from one site

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Scenario of Possibilities

• Terrace runs on weekends and with 1 stand alone
  technician
• I perform all clinical duties, fill in reports,
  data entry
• Pharmacist in Quesnel has time to check my data
  entry
• Pharmacist in Vanderhoof checks my clinical
  reports and forms plans
• Technician in Prince Rupert can check my filled
  meds via telepharmacy

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Scenario of Possibilities

• All these sites pull together and keep another
  facility going strong with little or no loss to
  services
• Enhanced clinical and dispensary capacity from
  the many people involved all with ideas and
  different ways of doing things
• Not only do we keep our services strong, but we
  learn from each other

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So Many Uses

• Lack of pharmacist on site
• Vacation coverage
• Someone calls in sick
• Hours of operation outside pharmacist hours
• Pharmacist/Pharmacy manager is in a meeting
• Just need some spare time to catch up on other
  work

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A Little Goes A Long Way

• Many facilities are willing to give a little but
  dont have the time to take on a lot
• By covering more sites, the patients have to
  travel less for services
• Better financially as the few sites with pharmacy
  coverage dont have the patients coming to them
• Clinical technicians via telepharmacy are more
  cost effective and easier to retain than
  pharmacists

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Goals for the Future

• To help establish a telepharmacy program
  coordinating pharmacies in need of services with
  pharmacists who have time to cover services
• To finish clinical program and mentor future
  clinical technicians
• To cover tech-check-tech services for remote sites

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A Future Full of Potential
QUESTIONS??