US Public Health Services and US Coast Guard Breakout: Pharmacy II. CDR Robert Boyle Clinical Pharmacist, USPHS Salt River Integrated Health Care

Transcription

1 US Public Health Services and US Coast Guard Breakout: Pharmacy II Pharmacist Collaboration in a Hemodialysis Setting CDR Robert Boyle Clinical Pharmacist, USPHS Salt River Integrated Health Care

2 CPE Information and Disclosures CDR Robert Boyle declares no conflicts of interest, real or apparent, and no financial interests in any 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 Pharmacy Education as a provider of continuing pharmacy education.

3 CPE Information Target Audience: Pharmacists ACPE#: L04-P Activity Type: Knowledge-based

4 Learning Objectives Objective: Discuss collaborative practices within pharmacy

5 Self-Assessment Questions Question 1 : What are the best tools available to you in your practice to be able to improve collaboration with fellow healthcare providers? Question 2: Name 3 pharmacological classes of medications that are regularly managed by pharmacists working in a dialysis setting?

6 Collaboration on Multiple Fronts

7 Collaboration on Multiple Fronts

8 Pharmacist Collaboration in Hemodialysis Problem: Hemodialysis patients spend an inordinate amount of time in a healthcare setting yet still have poor health outcomes. Solutions?:

9 Pharmacist Collaboration in Hemodialysis Salt River Integrated Health Care (SRIHC) system serves over 10,000 patients mostly Salt River Pima Maricopa Indian Community (SRPMIC) members. ~35% of SRPMIC adults have diabetes The dialysis center serves ~90 patients Dialysis patients spend at least 15 hours/week in healthcare settings

10 Collaborative Practice Agreement at SRIHC Key Points: Orders and monitors laboratory and other procedures to assess pharmacotherapy safety and efficacy Initiates, monitors, and adjusts medications based on approved disease state management protocols

11 Main Areas of Focus Participate in multidisciplinary rounds Medication reconciliation Immunization reconciliation Deliver medications to patients at chairside Appropriately prescribe and dose medications

12 Some Results of Collaboration Bone Mineral Numbers improved from 2015 to Hospital Readmission Rates initially decreased from 2015 to 2017 then stabilized in Patients spent roughly 1 hour less/month in healthcare settings 2 1: Based on Cerner EMR data search from Salt River Fresenius Hemodialysis Center 2: Based on patient survey and the Indian Health Service Appointment Manager

13 Some Results of Collaboration 85% POST % of HD patients with using a Renal Vitamin 1 PRE 1: Based on EHR RPMS Data

14 Some Results of Collaboration 73% POST % of HD patients with Vitamin D 25 Hydroxy at >30ng/mL 2 PRE PTS AT VIT D GOAL 2: Based on Cerner EMR data search from Salt River Fresenius Hemodialysis Center

15 Key Points Collaboration in the hemodialysis setting has lead to improved communication and improvement in some key indicators Working with teammates with diverse backgrounds and training helps us attack problems from multiple angles While dedicating around 30% of a pharmacists time to one specific team can bring benefits, it isn t always easy to implement the time away from the pharmacy Look for ways to collaborate in your practice

16 Answers To Self-Assessment Questions Question 1 : What are the best tools available to you in your practice to be able to improve collaboration with fellow healthcare providers? Answers: Credentialing on medical staff and/or collaborative practice agreements Question 2: Name 3 pharmacological classes of medications that are regularly managed by pharmacists working in a dialysis setting? Answers: Phosphate binders, vitamin supplementation, blood pressure medications, symptomatic medications for access site pain management, cramps and nerve pain

17 Closing Remarks CDR Robert Boyle USPHS Salt River Integrated Health Care Option 3