Workflow Best Practices - About ?· conflict of interest was resolved by peer review of the slide...

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AshleyBranham,PharmD,BCACP

Bri Morris,PharmD

WorkflowBestPractices

AshleyBranhamisreceivinganhonorariumforthisprogram.Theconflictofinterestwasresolvedbypeerreviewoftheslidecontent. Bri Morrisdeclaresnoconflictofinterestorfinancialinterestinanyproductorservicementionedinthisprogram,includinggrants,employment,gifts,stockholdings,andhonoraria.

Disclosures

1. DiscusshowanABMprogramcanpositivelyaffectpharmacyoperations.

2. Outlinestaffing/workflowconsiderationsneededforenhancedservicedelivery.

3. Createjobdescriptionsforkeyrolesofpharmacyteaminare-engineeredpractice.

LearningObjectives

WhatistheABM?Appointment-BasedModel(ABM):Coordinatingallofapatientsprescriptionmedicationstobepickeduponthesamedateeachmonth,coupledwithcarecoordinationfromthepharmacy.

BestThingSinceSlicedBread Coordinatedrefillprogram Completestriadofcare Businessdifferentiator Win-win-winmodel Improvedpatientoutcomes Prescribersatisfaction Increasedbusinessefficienciesandmargins

Improved:

Communication

Patientadherence

Qualityofcare

Healthoutcomes

Workflow/efficiencies

Inventorymanagement

Businessmargins

PhysicianPharmacist

Patient

ABMImpactonWorkflow Reactive proactive Optimizesdispensingprocess Thewaywedobusinesshere

Scripts patients Areweoptimizingtherapy? Howsthepatientsadherence?

Facilitatesthepatientappointment Opportunityforrevenueeachmonth Additionaltimeformeaningfulpatientinteraction

Hello,Goodbye Whatyoucanexpect: Streamlinedworkflow Predictableworkload Decreaseddeliveryruns Betterinventorycontrol Healthierbottomline Moretimeforenhancedservices

Whatyouwontmiss: ManicMondays Frequentflyers Waitingforpatientstoremembertocallinarefill Last-minutecall-insonFridayafternoonsorbeforeholidays Takingcareofpatientswhorunoutofpills

Synchronization:HowItWorksAction Example1. Determine andlistthechronicmonthlyprescriptionsthepatientwillbetaking.

Lisinopril20mgdaily (due4th)Synthroid 137mcgdaily(due16th)Metformin 500mgBID(due22nd)

2.Themedicationwiththehighestcopayshouldbecometheanchorprescription.

Synthroid 137mcg(due16th)

3. Calculatethequantityneededforeachmedicationtosynchronizeitwiththeanchorprescription.

Lisinopril 20mg(12tablets)Metformin 500mg(50tablets)

Synchronization:HowItWorks4. Contactthepatientsprescriber,explainyourABMprogram,and

requesttwoprescriptionsforeachsynchronizedmedication: Oneforthequantityrequiredforsynchronization Asecondforthenormalmonthlyquantity

5. Short/longfilltheappropriateprescription(s)tosynchronizewiththeanchorprescription.Documentonthehardcopytheone-timeshortfillwasfortheadherenceprogram.

ProgramMechanics 7DaysPriortotheAppointment Callpatienttoreviewmedications Assessadherence

Haveyoubeentothedoctorinthelastmonth?

Haveyoubeeninthehospitalinthelastmonth?

Areyoutakinganynewprescriptionorover-the-countermedications?

Arethereanyotherchangesweneedtobeawareofatthistime?

3-7DaysPriortotheAppointment Initiaterefillrequests,PAs;contactprescribersasneeded Updatethepatientprofileinthepharmacymanagementsystem Pharmacistreviewsordersandresolvesanydrugtherapyproblemsidentifiedbytheprogrammanager

FinalFillProcedures 1-2DaysPrior Reviewinventory/orderproducts Dispenseproduct(s) Callandremindpatienttopickupprescriptions

AppointmentDate Patientpicksupmedications Pharmacistaddressesanyclinicalissues Areweoptimizingpatienttherapy? Howsthepatientsadherence?

ABMismorethansyncingmedicationstothesameday.Thekeyisleveragingthepatientappointmentforenhancedservicedelivery.

TipsfromtheExperts Designateatechniciantorunthedailyoperations Bestuseofstafftime Somethingforthemtoown Vestedinterestinsuccess

Leverageyoursoftware Identifynon-adherentpatients Grouppatientsbysyncdate Reportstohelpwithpatientcalls Robustsyncprograms

MedSyncPearls SubmissionclarificationcodesforMedicareDPatients Allowforproratedcopaysfor

FreeTools/Resources SimplifyMyMeds Operationsmanual,patientforms Marketingkit FreetoNCPAmembers(www.ncpanet.org/smm)

ImplementingMedSyncvideoseries

Technician(s) RealMVPsofthepharmacy Generalunderstandingofmedications Roleanevolvepastdispensing SMMprogrammanager Scheduler Technologygurupackagingmachine,PMSexpert,clinicaldashboards

StudentPharmacists BothpaidpharmacyinternsandAPPEstudents Pharmacistextenders Allowpharmacisttofocusonothertasks,serveadditionalpatients Trainedtodocument;useexpertise! MTM/CMRs,immunizations,documentationofdoctorchanges,biometricscreeningsforself-ensuredcompanies

ImmunizationWorkflow

PatientRequestsVaccine

Technician/Internhelpswithhealthbackgroundquestionnaire. Technician/InternretrievesandprintsoutinformationfromtheImmunizationRegistry.

PatientCompletes

Questionnaire

Technician/InternchecksforcompletenessandgivespatienttheVaccineInformationStatement. Technician/Internprocessvaccine.Pharmacistverifies.

PatientReceivesVaccine

Pharmacistgivesvaccine.Technician/InternprepareyellowImmunizationRecordandMDletterforpatient

PharmacistverifiesImmunizations.Recordandinitials. Technician/InternfaxesrecordtoMDandfilespaperswork

MTM,CMRorAppointmentBe

foreApp

ointmen

t Technician/Internsetsandconfirmsappointment,preparesmedicationlist,checksadherence,andretrievesimmunizationrecords. Du

ringAp

pointm

ent Technician/Internconfirmsallinformationwithpatient,Interncanperformserviceswithpharmacistsupervision, andwritedocumentingnotes. A

fterA

ppointmen

t Pharmacistreviewsnotesandbillsforservices.Technician/Internfollowupwithpatientandproviderasneeded.

DifferentApproachtoPaymentandDelivery

PopulationHealthManagement

FeeforService

FailingForward:OurGuidetoPrepareCommunityPharmacyforDeliveringValuevRethinkWorkflowOperations

vPopulationManagementStrategies

vShiftingthePatientsExpectationofthePharmacyExperience

ValueStreamforObservedPharmacyPharmacyD

Pharmacist

Adheren

ceTech

Adheren

cePackagingTech

BackTech

DeliveryDriver

ClinicalPharmacist

Cashier

FrontTech

Clinical

Pharmacist

Assistant

CallPatientandgoovermedlist

Arethereanyadheranceissues?

DiscussDTPwithPatient

MarkallrefillsinPioneer

Putanynotesinthe

comments

Updatefillandnextsync

dates

AdherencePackaging?

Filloutform Makepatientbasket

Printpackagingsummarysheet

Deliverbaskettoadherencepack

room

PrintLabels Deliverbaskettobacktech

Lookoverallrequestedrefills

AnyIssueswithrefills?

CallProvidersOffice

Aretherenewmeds? Arethescripts

inthesystem?

CallProvidersOffice

Graballmedicationsto

befilledDoanyneedtobecut?

Cutmedicationsindividually

Countmedications

Putmedicationsintrays

Closetrayandpackage Checkpackage AnyIssues?

Fixwithrazorandreclose

Foldandputinbox

IsitforMtPleasant?

DelivertoPharmacist

Setoutfordeliverydriver

Logallmedicationsfilled

Confirmpackageiscorrect

Foldandsealinbox

Aretheremedsoutside

box?

Returntoadherencetech

Isitfordelivery?

Givetocashierforpickup

Setoutfordeliverydriver

medicationsinmachine?

Scanfilledandlabeledbottles

Findmedications Fillandattachlabels

Usecountertoconfirmcountanddocument

Deliverbaskettopharmacistto

confirm

Confirmcorrect Areallmedsthere?

Returntoadherencetech

Isitfordelivery?

Givetocashierforpickup

SetoutfordeliverydriverScan

Yes

Yes

No

No

Yes

No

Yes

Pullmedicationsuponcomputer

No

Yes

No

NoNo

Yes

No

Yes

Yes

No

Yes

No

GetPharmacist

Yes

No

Yes

No No

Yes

Needtodiscusswithprovider?

CallProvidersOffice

Yes

NoLogDTPinSystem

Pickupfordelivery

Ispatientthere?

Returntostore

Askthemquestionsabouttheirmedication

Arethereissues? CallPharmacist

Goovermedicationswith

patient

Arethereanytheydontwant?

Collectunwantedmedications

No

Yes

No

Yes

No

Getpatientsignature

Returnnotestotech

Inputnotesintosystem

Printdailypatientlist

Didtheyanswer?

Yes

Leavemessage

No

PatientCalls

PatientArrives

IsRxready?

Stapleandbag

Questionsforpharmacist?

Checkpatientout

Notifypharmacist

Yes

No

Consultwithpatient

PatientLeaves

Yes

Notifytechand

pharmacist

No

PatientArrives

Ispatientnew?

Getpatientsnameand

dateofbirth

Takeinsurance

info

CreatepatientprofileinPioneer

IsRxnew?

Scanorder

Willpatientwait?

Yes

No

Yes

Notifytechandplaceinred

basket

PrintlabelNo

Yes

Placeinpinkbasket

Putorderintopioneer

AttributionListArrives

PrintAttribution

ListGiveListtoAssistant

WritespatientsDOBandlastCMRdate

PrintsoutPioneerreports

GivesreportstoClinicalPharmacist

CallspatientMakesnotesonPioneerReport

Returnstoassistant

Buildsmatrixandmedlistin