georgetown hospital system georgetown memorial hospital waccamaw community hospital tech trekking
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GEORGETOWN HOSPITAL SYSTEMGEORGETOWN MEMORIAL HOSPITAL WACCAMAW COMMUNITY HOSPITAL
TECH TREKKING
PATIENT
PHYSICIAN
NURSECASE MANAGER
PHARMACIST
TEAM APPROACH
Pharmacist Job Duties Order Entry &/or Order Reviewing/Dosing Order Clarification Order & Patient Follow up Medication Dispensing IV Admixtures calculations & checks Clinical Interventions Medication Procurement Automation- Pyxis Control Unit Inspections Quality Assurance/ PI Communication- phone/ rounds/ face to face Med Reconciliation Supervision
Increase Knowledge Base
New procedures New equipment New research New drugs Continuing education
Increased Work Load
Increased Patient Numbers Automation New Medications Expanded Clinical Duties
Regulations CMS JCAHO Licensure DHEC DEA SIP Guidelines Hospital Policies 100,000 Lives LeapFrog Healthgrades ASHP 2015 USP 797 Standards
Pills
Multiple Tasks
Continuing Ed
Projects
Community Involvement
Medication Safety Facts Medication errors account for more
than 7000 deaths annually Approximately two out of every 100
patients admitted to the hospital will experience a preventable adverse drug event
Over 12% of patients experience an ADE within 2 weeks of discharge
Massachusetts Coalition for the Prevention of Medical Errors
US TF on HC Cost Control Med Errors 30% of Health Care Cost
Med Errors cost 10-15 % of hospital’s annual operating cost
Med Errors $23 billion national cost (more than 50% are preventable)
National Pharmacists Shortage
Increasing Knowledge BaseExpanded Duties Safety-preventable ADE/Drug Conc/Interventions
Quality-Core Measures/SCIP/HAI/VAP
Changing Roles-Dispensing vs Clinical Roles
Goal To utilize Pharmacists to provide evidence
based Best Practices using the most cost effective methods to support medication safety by providing a universally consistent process regarding medication therapy across the continuum of care.
.
PATIENT
PHYSICIAN
NURSECASE MANAGER
PHARMACIST
Pharmacy Tech
TEAM APPROACH
Expansion of Technician Role Techs must be registered with
SCBORX National Certification SC- State Certification June 2006- Grandfathered in or Must be a graduate of approved accredited program
Today: Tech Job Duties Order Entry &/or Order checking Medication preparation Tech check Tech Prepare IV Admixtures Calculations Procurement-ordering, receiving, stocking Inventory Control-Max/Min Automation- Pyxis Control Unit Inspections Quality Assurance/ PI Communication- phone/ rounds/ face to face Med Reconciliation
JOB DUTIES SHIFT
Medication Reconciliation
Tech Check Tech
Unit Inspections
Chemo Admixtures
The Dilemma
What to do ???
Development of Career Ladder Pharmacy Technicians Organizational Value Self Worth Recruitment/Retention Cutting Edge
Development of Career Ladder
Organizational Value:
Increasing education, knowledge, responsibilities of the tech gives the Pharmacists increase support with the daily routine technical functions, allowing them more time to spend on Clinical Issues, which will create a more efficient department, while saving the organization dollars.
Development of Career LadderSelf Worth: This gives the Tech an opportunity for
career growth and advancement by increasing their job responsibilities, accountability and their learning which, in turn, increases their self worth and the morale in the department.
Development of Career Ladder
Recruitment/Retention: Replacing a trained, seasoned employee is
very costly to the institution($ 48,378)The career ladder not only provided a method to increase income, it helps retain the employee by giving them extra incentives to work toward as they increase their longevity with the organization.
( Year prior to starting WCH lost 3 techs-CVS/Cosco/ExCr)
Development of Career LadderCutting Edge: To continue to hire the high caliber employee we desire
and keep them incentivized, we must be creative and look for ways to build self esteem, promote professionalism and add opportunity for growth to hire and retain them. Providing this creative advancement, not only gives the “self starter” goals to work toward, it also creates a “need to grow” in the department, so others are not left behind.
(Environment of friendly competitiveness with support)
Expanded Responsibilities USP 797 Compliance- IV Admixture Monthly Unit Inspections Medication Reconciliation Tech check Tech Quality Assurance Studies PI Review Pharmacy Projects Community Involvement
Pharmacy Tech LevelsPharmacy Trekking Pharmacy Tech Levels
Non-Certified Pharmacy Tech…….220……..$ (1 year)
Certified Pharmacy Tech I….…….245……..$$ Certified Pharmacy Tech II………275………$$$
Pharmacy Trekking Differential
Trek A…………$ 0.75 ($1560) Trek B…………$ 1.50 ($3120) Trek C…………$ 2.50 ($5200)
Pharmacy Tech LevelsNon-Certified Pharmacy Tech…….220……..$ No National or SC State Certification
Certified Pharmacy Tech I….…….245……..$$ National Certification
Certified Pharmacy Tech II………275………$$$ National & SC State Certified OR National Certified with at least 3 years hospital pharmacy experience
Qualification to begin Trekking process may not occur until employee has attain Certified Pharmacy Tech II Status
Pharmacy Trekking A Must be performing at a “meets” level or higher on all performance
appraisal standards Must have demonstrated cross training competency in all areas of
Pharmacy as documented on the Pharmacy skills checklist. Demonstrated and documented competency in preparation of all IV
admixtures and Chemo solutions Documented ability and evidence of conducting monthly unit
inspections Documented completion of Pyxis minimum and maximum inventory
standards on a quarterly basis. No evidence of written or suspension level corrective action over the
previous 12 months. Documented minimum of 20 preceptorship hours of training new
pharmacy staff.
Pharmacy Trekking B Compliant with all Competency Level I criteria AND: South Carolina State Certified Pharmacy Technician with SC BORx OR
3 years experience as a hospital pharmacy technician with overall “exceeds” rating on most recent performance review. (based on 2006/2007 set up this means a 3.0 or higher)
797 Compliant (Completed documented 797 skills checklist & passed media-filled testing)
Minimum of 40 documented hours of preceptor ship with Pharmacy Tech students during annual review period OR Participation in local career day event
Documented participation with and mentorship of applied Ed of Pharmacy Students of 8 hours during annual review period OR complete 1 approved
(in addition to those required for annual licensure)
Pharmacy Trekking B (continued) Participates in one documented department quality assurance
initiative during annual review period.
Participates in Departmental one documented process improvement (PI) activity during annual review period
Participates in Pharmacy Week project OR Participates in Poison Prevention Week project
Participates in one or more GHS Community Health Events
Pharmacy Trekking C
Compliant with all Competency Level I and II criteria AND: Must have been a Pharmacy Technician with GHS continuously for a minimum of five years
OR must have graduated from an accredited pharmacy technician program and must have been a Pharmacy Technician with GHS continuously for a minimum of three years.
Demonstrates and documents completion of medication reconciliation process for 2 months during annual review period
Identifies specific opportunities for internal departmental policy changes that results in improvement in safety or operational efficiency. Writes and/or revises drafts of policies for review.
Tech Check Tech as assigned documented by skills test and log sheets
Researched and identifies a minimum of one industry or otherwise external “Best Practice”/benchmark process improvement to be presented as a possible best practice for GHS to adopt.
In addition to the minimum required preceptor ship hours with Pharmacy Tech students, individual will participate in the design of the training plan.
Pharmacy Trekking C (continued) Identifies and leads a minimum of one department quality assurance
initiative.
Identifies and leads a minimum of one Departmental process improvement (PI) activity
Serves in the leadership role to develop Pharmacy Week project plans OR Serves in the leadership role to develop Poison Prevention Week
project plans Participates in one or more GHS Community Health Related Event
Completes 2 hours additional CEUs (in addition to those requires of annual licensure renewal) during annual review period
WCH Pharmacy Trekking Costs
PM……………C...........$5200 GW……………C……….$5200 VG…………….C……….$5200 GB…………….B……….$3120 BI……………..B……….$3120 LD………….…B……….$3120 AY…………….B……….$3120 SS………..…..B……….$3120 AJ…………….A……….$1560 KM……….…..A……….$1560 Total Costs……..…………………$34,320
GMH Pharmacy Trekking Costs
MHR………….B.........$3120 TF.……………B……….$3120 MLR.………….B……….$3120 RS…………….B……….$3120 Total Costs……..…………………$12,480
Medication Reconciliation (Trek Level C Criteria)
$59.09/hr Average RPh $14.21/hr Average Tech 5.5 mins/patient
WCH 2 EAST –July thru Dec 2007 1064 admissions 1064 X 5.5 mins=5852mins/60=97.5 hrs 97.5 X $59.09= $5761.28 97.5 X $14.21= $1385.48 $5761.28- $1385.48= $4375.80/ 6mon X 2=$8751.60/yr Annual Efficiency Savings = $8751.60 @ WCH 2 East
Medication Reconciliation (Trek Level C Criteria)
$59.09/hr Average RPh $14.21/hr Average Tech 5.5 mins/patient
WCH : July Thru December 2007 (3604 Admissions) 5.5 min X 3604=19,822/ 60 = 330.37 hours 330.37 X $59.09= $19,521.56 330.37 X $14.21= $ 4,694.56 $19,521.56-$4694.56=$14,827/ 6mon X 2=$29,654/yr Annual Efficiency Savings = $29,654 @ WCH
Tech check Tech (Trek Level C Criteria) .
Pyxis Refills & Narc Pulls $59.09/hr Average RPh $14.21/hr Average
Tech WCH: Done Monday thru Friday 1.5 hrs/day X 5days/week x 26 weeks = 195 hrs
195 X $59.09= $ 11,522.55 195 X $14.21= $ 2, 770.95 $11,522.55 - $ 2,770.95= $8751.60/ 6mon 8751.60X2=$17,503.20/yr
Annual Efficiency Savings = $ 17,503 @ WCH
Tech check Tech (Trek Level C Criteria) .
Medication Repackaging Verification $59.09/hr Average RPh $14.21/hr Average Tech Done Daily GMH: July-Dec 2007 = 1009 Repackaging Procedures 0.1 hours/procedure (6 min) 0.1 x 1009 = 100.9 hrs/6 months
100.9 X $59.09= $ 5,962.18 100.9 X $14.21= $ 1,433.79 $5,962.18 - $ 1,433.79= $ 4528.39/ 6 months 4528.39 X 2= $ 9,056.78/yr
Annual Efficiency Savings = $ 9,056.78 @ GMH
Unit Inspections (Trek Level A, B, & C Criteria)
$59.09/hr Average RPh $14.21/hr Average Tech WCH Done monthly: 9 units @ 1 hour/unit = 54 hours/6month 9 X $59.09 = $ 531.81/mon x 6 months = $3190.86 9 X $14.21 = $ 127.89/mon x 6 months = $ 767.34 $3190.86 - $767.34 = $2423.52/6mon X2= $4847.04/yr
Annual EfficiencySavings = $ 4847.04 @ WCH GMH Done monthly: 10 units @ 1 hour/unit = 60 hours/6month 10 X $59.09 = $ 590.90/mon x 6 months = $3545.40 10 X $14.21 = $ 142.10/mon x 6 months = $ 852.60 $3545.40 - $852.6 = $2692.80/6mon X2= $5385.60/yr
Annual Efficiency Savings = $ 5385.60 @ GMH
Chemo IV Admixture (Trek Level A, B, & C Criteria)
$59.09/hr Average RPh $14.21/hr Average Tech GMH : July Thru December 2007 # Admixtures per 6 Months = 76 # Hours per Admixture = 1 # Hours per 6 Months = 76 Hrs
76 X $59.09= $4490.84 /6 months 76 X $14.21= $1079.96 /6 months $4490.84-$1079.96= $3410.88 /6mon $3410.88 X2=$6821.76/yr
Annual Efficiency Savings = $ 6821.76 @ GMH
Financial Benefit
WCH Med Reconciliation………..….. $ 29,654.00 WCH Tech Check Tech……………... $ 17,503.00 WCH Unit Inspections……………….. $ 4,847.04
WCH Efficiency Savings…….$ 52,004.04
GMH Tech Check Tech………….……. $ 9,056.78
GMH Chemo Admixtures………….…. $ 6,821.76 GMH Unit Inspections…………………. $ 5,385.60
GMH Efficiency Savings……..$ 21,264.14
Safety Allergy Procedure ADR Procedure Med Scanning Procedure Order Checking Tylenol Dosing Checks
Quality
Metformin- SrCr Checks Tech check Tech Inventory –Max/Min Levels Anesthesia Gases- Flow Rates Charge Capture-OR/Endo/Anes Billing Log Checks-Doc/Over/Rejections Blood Derivative Log Documentation
Worth
Organization Recruitment, Retention, Cost Effectiveness,
Community
Department Morale, Competitiveness, Environment
Self Motivation, Attitude, Importance
Cost/Benefit Analysis Financial WCH
Costs……………………….. $ 34,320.00 WCH Savings……………………. $ 52,004.04 WCH Net Gain……..$ 17,684.04
GMH Costs……………………….. $ 12,480.00 GMH Savings……………………. $ 21,264.14 GMH Net Gain……..$ 8,784.14
Safety:ADR/Allergy/Scanning/Tylenol Quality:Tech Check/Inventory/Charge Capture Worth: Organization/Department/Self
Time Benefit
WCH: Med Rec…………….….195 Hours Tech check Tech….…390 Hours Unit Inspections……..108 Hours 693 Hours
GMH: Chemo Prep……….…..152 Hours Repackaging Checks..202 Hours Unit Inspections….…..120 Hours 474 Hours 693 + 474= 1167 Hours (0.6 FTE)
Benchmarks Financial Costs………..$17,684.04 WCH
Gain Financial Costs………..$ 8,784.14 GMH Gain Turnover……………..…O Trekking Techs have
Left
Shift In Duties…………Tech check Tech,
Unit Inspections, Med Reconciliation, Chemo Admixtures
Best Practices………Scanning/ADR/Allergy
Inventory Control/Med Rec
THE Future
Family Caring For Family 6 Key GHS Initiatives Shift of more duties Increase in Quality & Safety Promotion of Best Practices Leader in Pharmacy Practice