The Basics for a Successful MTF P

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The Basics for a Successful MTF PT Meeting

• Prepared by the DoD Pharmacoeconomic Center

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Introduction

• LCDR Joseph B. Lawrence
• PEC Navy Pharmacist Consultant
• Purpose of discussion
• Basic tools and strategies for PT
• Mock agenda for a MTF PT

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Topics of Discussion

• Purpose of PT
• Organization and operation
• Functions and scope
• Assembling a quality meeting agenda
• Information resources for MTF specific data and
  research
• Medication use evaluation
• Drug class review.
• Reports
• JCAHO and other surveys

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Purposes

• Policy development
• Evaluation, selection and therapeutic use of
  drugs and related devices
• Education
• Programs for drug related matter for medical team
• Goal
• ensure medications are used safely and
  appropriately

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Organization and Operation

• Composition physicians, pharmacists, nurses,
  administrators, QA coordinators, others
• Physician chairperson
• Pharmacist recorder
• Meet regularly
• Invite ad hoc members and specialist as needed
• Sufficient time to review meeting materials
• Recommendation presented to medical staff
• Liaison with other organization committees
  concerned with drug use
• Actions routinely communicated
• Conflict of interest policy
• Attentive to ASHP, AHA, JCAHO, DOD, ect

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PT Committee

• Organization
• Chairperson
• Respected member of medical staff
• Familiar with and advocate for progressive
  pharmacy
• Effective ally for pharmacy with medical staff
  and hospital administration
• Secretary
• Director of Pharmacy
• Sets agenda with chairperson

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Functions and Scope

• Evaluative, education and advisory capacity to
  the med staff
• Develop a formulary of drugs for the organization
• Programs/procedures to help ensure the safe and
  effective drug therapy
• Programs/procedures to ensure cost-effective drug
  therapy
• Educational programs for medical team
• Participate in QA activities regarding medication
• Monitor/evaluate ADR
• DUE
• Advise pharmacy in effective drug distribution
  and control
• Disseminate information of actions to health-care
  staff

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PT Agenda

• Delivered via member preference (email, hard
  copy, etc)
• Delivered with adequate time to review before
  meeting (1 week)
• Informative enclosures
• Eg drug monographs, adverse drug reaction
  reports, and policy changes
• Date/time/location of the meeting
• Review of old business
• Medical staff notification
• Minute routing comments
• Pharmacy budget
• Standing issues
• New business
• Requests for change in formulary
• Drug/product complaint
• Drug recalls
• Narcotic overlap
• ADR
• Planning for next meeting

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PT Committee

• Organization
• Follow-up
• Actions should be conveyed to all health-care
  professionals
• Recommendations are to be passed on to the
  appropriate committee

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Formulary Management

• Formulary
• Definition a continually revised compilation of
  pharmaceuticals that reflects the clinical
  judgment of the medical staff

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Formulary Management

• Formulary system management
• Definition method where the medical staff
  working through the PT committee, evaluates,
  appraises, and selects from the numerous
  available drug products those considered most
  useful in patient care

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Formulary Management

• Formulary system management
• Theory a well designed formulary can guide
  physicians to prescribe the safest and most
  effective agents for treatment of a particular
  condition.

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Formulary Management

• Objectives
• Decrease drug cost
• Assure high quality care
• Provide information on drug products
• Provide information on organizational
  policies/procedures
• Development of institution specific
  guidelines/protocols

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Formulary Management

• Purpose for ongoing management
• Removal/addition of drugs from/to the market
• Changes in hospital policies/procedures
• New clinical information available
• Clinical trials
• Guidelines
• Safety

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Formulary Management

• Advantages
• Ensure quality and appropriateness of drug use
• Educational for staff regarding most effective
  agents
• Economic benefits

• Disadvantages
• Only reduces cost
• Compromises patient care
• Limits physician prescribing authority

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Formulary Management

• Principles
• Drug product selection
• Comparison of all aspects of an agent to that of
  similar medications.
• Should be based on scientific evidence
• Consider effectiveness, safety and cost

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Formulary Management

• Principles
• Formulary Maintenance
• Addition/deletion
• Newly approved agents
• New information available (i.e. safety, efficacy)
• Tracking use of nonformulary agents
• Single drug review
• Compare single drug to other drugs that are
  similar
• Focus is on a single drug
• Therapeutic class review
• Compares/contrasts all the agents in a single
  class
• Focus is not on a single drug

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Drug Product Selection

• Development of a drug monograph
• Purpose to evaluate various medications to
  ensure that patients receive drugs that are
  safe,therapeutically effective and cost effective

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Drug Product Selection

• Development of a drug monograph
• Preparation
• Identify drug to evaluate
• Determine if there are similar agents on
  formulary
• Obtain background information
• Clinical and safety information
• Indications
• Cost
• Clinical trials

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Drug Product Selection

• Development of a drug monograph
• Components
• Summary page
• Introduction
• Pharmacology
• Pharmacokinetics
• Clinical efficacy

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Drug Product Selection

• Development of a drug monograph
• Components (cont)
• Adverse effects
• Drug Interactions
• Cost and dosage
• Conclusion/Recommendations
• References

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Drug Product Selection

• Points to consider addition to formulary
• Clinical effectiveness, safety, and cost
• Comparison to similar agents
• Comparison to standard therapies
• Advantages/disadvantages
• Niche

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Drug Product Selection

• Therapeutic Interchange
• Definition interchange of various TE drug
  products by pharmacists under pre-defined
  arrangements with the prescriber

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Drug Product Selection

• Therapeutic interchange
• Elements for successful implementation
• PT approval
• Scientific/clinical evidence
• Medical staff education
• Mechanism to implement interchange
• Maintenance

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Drug Product Selection

• Therapeutic interchange process
• Substitute generic for brand
• Give individual agents in place of combination
  product
• Switch from intravenous to oral antibiotics
• Change to different agent in same class
• Interchange may be automatic or may require
  notification

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Therapeutic Interchange

• Advantages
• Reduced inventory
• MTF saves money
• Encourages compliance with formulary

• Disadvantages
• Confusing to patients
• Patients may think that drugs are NOT equally
  effective
• Preferred product may change based on contracts

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Information resources

• Local data
• CHCS
• CIS
• Pharmacy automation system (ScriptPro, Pyxis,
  ect)
• Prime Vendor
• PDTS
• DoD level data
• PDTS
• M2

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Utilizing CHCS data

• Obtaining CHCS data
• Capturing CHCS data in Kea
• Importing columnar reports into Excel
• Importing delimited reports into Excel
• Sorting data in Excel
• Using Access queries to clean up data
• Miscellaneous tactics to clean up data before
  exportation including Word and Monarch

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Obtaining CHCS data

• Do it yourself
• Canned reports (dur, cost)
• Ad hoc report
• Request from CHCS administration
• Delimited with
• Specify columns

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Capturing CHCS data in Kea

• Print report to spool
• Command policy (i.e., after 2200)
• Big report take longer
• Print spooled report (PSR)
• dont print yet!
• Set Kea to capture incoming data
• Select file location and name
• Set Kea to end capture

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Importing text reports into Excel

• Open Excel
• File, Open, (change file type to .txt)
• Import text wizard
• Columns
• Delimited

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Sorting data in Excel
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Cost Report
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Supervisory Functions Menu Select Pharmacy
System Menu Option KP KP Pharmacy Cost Reports
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Capture incoming data
Back
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File location
Back
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End capture jpg
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Excel open txt
Back
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Text import wizard step 1
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Text import wizard step 2
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Text import wizard step 3
Back
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Delimited file step 1
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Delimited file step 2
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Obtaining DoD level data

• PDTS
• PDTS request http//www.pec.ha.osd.mil
• PDTS training
• M2
• Command authorized user

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• Outline the steps in developing this process
  improvement using the FOCUS-PDCA model

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Example PT Process improvement

• Wanted to improve error reporting, including the
  reporting of near miss errors.
• MTF filled an average of 33,000 prescriptions per
  month between Oct 02 and Jul 03
• During this time period an average 4.1
  errors/month were documented.
• No near miss errors were documented

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Definition of a Medication Error
"A Medication Error is any preventable event that
may cause or lead to inappropriate medication use
or patient harm while the medication is in the
control of the health care professional, patient,
or consumer. Such events may be related to
professional practice, health care products,
procedures, and systems, including prescribing
order communications product labeling,
packaging, and nomenclature compounding
dispensing distribution administration
education monitoring and use."
Source The National Coordinating Council for
Medication Error Reporting and Prevention
(NCC MERP), 1995.
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Types of error
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PT Process

• Studied current process
• Identified areas of needless complexity or
  redundancy
• Looked at outcomes and the best way the process
  should work
• Considered factors such as cost restraints,
  expandability and maintainability

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PT Discoveries

• Current process for reporting errors was too time
  consuming
• All reports were documented on a written report
• Routed through chain of command
• Felt many people didnt document errors due to
  fear of repercussions from chain of command
  and/or didnt want to bother with the hassle of
  filling out a report

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PT Collaboration

• Team assembled from pharmacy personal, Risk
  Management, Performance Improvement and PIPA.
• Goal was to improve process for reporting errors
  by eliminating fear of reporting and making it
  easier to report errors.

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Plan the Process Improvement

• New process was instituted for reporting errors.
• Points of contacts identified at all pharmacies
  to facilite the reporting of errors into MedMarx
• New forms created
• Staff trained

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Do the Improvement, Collect Data, Analyze

• Med errors measured pre and post
• Pharmacy staff entered errors into MedMarx
• Problems encountered
• Required continuous awareness training
• Staff deployment and turnover

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New Process Implemented
Start of FOCUS PDCA
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MTF