Longitudinal 3 Exam 2: Units 3&4

what are some legal function of a pharmacist within the healthcare system (7)

dispense, distribute, and compound medications

counsel patients/caregivers

conduct health and wellness testing

manage chronic disease states

perform medication management

administer immunizations

work with health systems to reduce hospital readmissions

the ___ ___ ___ is a set of boundaries in which a healthcare provider can practice

scope of practice

the pharmacist's scope of practice was established by ___ but carried out by the ___

state legislators, state board of pharmacy

the board of pharmacy works closely with what departments to help make the scope of practice

state's department of health and other health professional boards

what laws define the scope of practice in alabama

practice of pharmacy act 205 title 34 chapter 23

ALBOP administrative code chapter 680-x-2

PPA or Administrative code: dispensing and compounding rules

PPA

PPA or Administrative code: patient counseling

Admin code

PPA or Administrative code: collaborative practice

Administrative code CP

what does the administrative code specify

training for preceptors, supervising pharmacist, emergency refills, private consultation areas, immunization training, compounding requirements

what does the administrative code define

institutional and nuclear pharmacy, parenteral sterile therapy, collaborative practice

CPA or Autonomous prescribing: patient and population specific

CPA

CPA or Autonomous prescribing: statewide protocol and unrestricted category-specific authority

Autonomous prescribing

CPA or Autonomous prescribing: which is the most restrictive and which is the least restrictive

CPA is most restrictive and Autonomous prescribing is the least restrictive

what are examples of dependent pharmacist prescribing

patient-specific CPA and population-specific CPA

what are examples of independent pharmacist prescribing

government protocol and standards of care

what are some examples of autonomous prescribing

hormonal contraceptives, immunizations, naloxone, tobacco cessation, travel medications, "test and treat"

why are CPAs important

show trust in judgement between collaborators, enhance relationships, help provide patients with continuity of care, increase efficiency, capitalize each provider's skills

what are some CPA functions

initiate, monitor, and modify a patient's drug therapy, order and interpret labs, deliver preventative services

what are some preventative services a pharmacist can do with a CPA

BP, cholesterol, DM screenings, diet counseling, immunizations, obesity management, tobacco screenings/interventions

in a CPA, what should be specified about the participants

which pharmacists and prescribers, trainings, which patients or populations

in a CPA, what should be specified about the authorized services

disease states, specific services, any protocols/guidelines, process of care

in a CPA, what should be specified about the requirements/restrictions

level of patient consent, timeframe for agreement, documentation and communication, liability insurance, CE

what is a CTDM

range of services...intended to optimize therapeutic outcomes....", patient, protocol, collaborating physician, and collaborating pharmacist, covering pharmacist, covering physician, formulary, "Joint Committee," licensed healthcare facility, patient care services, protocol, quality assurance, routine scope of practice and services, unrestricted

what are pharmacist requirements needed in order to enter a CDTM agreement

active pharmacist license, an Alabama controlled substance certificate, a proper pharmacy, and paid collaborative practice fees

what is included in a CDTM

limitations of the agreement, standards for pharmacists and physicians, approval by the board, terms of denial, ground of modification/restriction/termination of the agreement, reporting requirement

how often does a CPA have to be renewed

every 2 years

what are some laws that can impact the development of pharmacy services

provider status (ECAPS, pharmacy and medically underserved areas enhancement act, CMM)

what is the pharmacy and medically underserved areas enhancement act

allows pharmacists to participate in medicare part B

what is ECAPS

establishes medicare reimbursement for test and treat of COVID, flu, strep, as well as vaccinations for COVID, flu, pneumonia, and hep B

what is the CMM

comprehensive medication management, covers under Medicare part B that allows pharmacists to identify medication related problems, initiate and monitor drug therapy, and educate patients

what types of people can you collaborate with (in general, not for a CPA)

physicians, nurses, PAs, NPs, dieticians, social workers, and others

what is pharmacist liability insurance

insurance that protects you against covered claims arising from real or alleged errors or omissions, including negligence, in the course of your professional duties

what is covered in pharmacist liability insurance (dollar amounts)

1 million/claim for professional liability and 1 million aggregate for personal liability

what is advocacy

An activity by an individual or group to plead a case, support a cause, or to recommend a course of action related to political, economic, social, institutional or patient-care issues.

what are characteristics of an advocate

leader, compassion, trustworthy, knowledgeable, communication, tech-savvy, patient experience, embrace change

what are some state advocacy organizations

APA, ALHSP

what are some national pharmacy organizations

AMCP, AACP, APhA, AHSP, JCCP, NCPA, PPA

in what states (from class) are pharmacists allowed to have a CPA

Arkansas, illinois, kentucky, maryland, tennessee, west virginia, alabama

in what states (from class) are pharmacists allowed to prescribe tobacco cessation products

arkansas, illinois, kentucky, maryland, tennessee, west virginia, alabama (with a CPA)

what states (from class) are pharmacists allowed to test and treat

arkansas, illinois, kentucky, maryland, tennessee, west virginia, alabama (with a CPA) tt

in what states (from class) are pharmacists allowed to administer immunizations

arkansas, illinois, kentucky, maryland, tennessee, west virginia, alabama (IMM)

in what states (from class) are pharmacists allowed to administer the HPV vaccine

arkansas, illinois, kentucky, maryland, tennessee, west virginia, alabama (HPV)

in what states (from class) are pharmacists allowed to administer the recombinant zoster vaccine

arkansas, illinois, kentucky, maryland, tennessee, west virginia, alabama

in what states (from class) are pharmacists allowed to administer a monkeypox vaccine

arkansas, illinois, kentucky, tennessee, west virginia

** NOT ALABAMA OR MARYLAND

in what states (from class) are pharmacists allowed to dispense naloxone without a prescription or prescribe naloxone

arkansas, illinois, kentucky, maryland, tennessee, west virginia, alabama (NAL)

in what states (from class) are pharmacists allowed to prescribe hormonal contraception

arkansas, illinois, kentucky, maryland, west virginia,

*** NOT TENNESSEE

in what states (from class) are pharmacists allowed to prescribe PrEP and PEP

Arkansas (with training), Illinois, Maryland, Tennessee, West Virginia (with a CPA)

*** NOT KENTUCKY OR ALABAMA

what is ASHP's Practice Advancement Initiative (PAI) INITIALLY

intended to drive changes in the practice of pharmacy at a local level by integrating pharmacists into the healthcare team

what did the PPMI summit in 2010 focus on

reaching consensus on optimal pharmacy practice models in hospitals

what did the ambulatory care summit in 2014 focus on

ensuring pharmacists participate as members of a care team for ambulatory care patients

what is the PAI in 2030 going to focus on

try to use delivery models that optimize the pharmacist as a direct patient care provider

what are the PAI pillars

care team integration

leveraging pharmacy technicians

pharmacist credentialing and training

technology

leadership in medication use

what are the PAI 2030 domains

patient-centered care

pharmacist role, education, and training

technology and data science

pharmacy technician role, education, and training

leadership in medication use and safety

what is a credential

a documented evidence of professional qualifications

why is credentialing important

to ensure clinical pharmacists practicing in such roles have the knowledge and skills necessary to provide care in a team based environment

what is the typical credentialing process

Application: identify applicants

Verification: develop credentials file

Analysis: review and evaluate file

Decision: notify applicant

what is privileging

permission or authorization granted by a hospital or other health care institution or a facility to a health professional to render specific diagnostic, procedural, or therapeutic services

credentialing is ___ while privileging is ___

broad, specific

what is the privileging process for an initial request

initiated by individual, submit application, application is reviewed, recommendation is given

what is the privileging process for reappraisal

the process is similar to the original request

what has been identified as key to developing credentialing and privileging for pharmacists

work with others, identify collaborators, takes their time, well defined process/policies, aligns with existing processes

how many different board specialty certifications are there?

15 (and i'm not typing them out sorry)

what are advantages to being board certified

validates knowledge, helps employers identify who can perform a task, recognition and respect, confidence in competence, increased compensation

what is a certificate

a document issued to an individual after the successful achievement of a predetermined level of performance in education and/or training program

what are differences between a board certification and a certificate program

board is internationally recognized, program is local/national

board is practice/experience driven, program is knowledge driven

board requires passing an exam, program requires completion of training

the program accreditor for the BLS board is ___ while the program accreditor for a certificate is ___

NCCA, ACPE

a certificate program must include what 3 things

1. a didactic component (live seminar, home study materials, etc.)

2. a hands-on component (practice experience, simulation, etc.)

3. a formative and summative assessment for each program

a balance sheet is

a statement of financial position at a specific point in time

what is the basic accounting equation

Assets = Liabilities + Owner's Equity OR

Owner's equity = assets - liabilities

what are some types of assets found on a balance sheet

current assets, fixed assets, other assets

what are some types of liabilities found on a balance sheet

current and accrued liabilities, long term liabilities

what are current assets

resources that can easily be converted to cash or consumed within one year

what does someone's current assets include

cash, checks, accounts receivable (money owed to the pharmacy), inventory, prepaid expenses

what are fixed assets

Resources that have a useful life longer than one year; can't be sold (liquidated) without disrupting operation

what are examples of fixed assets

buildings/land, equipment, fixtures, vehicles

what are liabilities

claims of creditors for the assets acquired to operate the business (borrowed equity)

what are current liabilities

debts that must be paid in one year

what are long-term liabilities

debts that are due in >1 year

what are long term liability examples

notes, loans, mortgages

what is owner's equity or Net Worth

what is left after subtracting total liabilities from total assets

You decide to purchase an A1C point-of-care testing machine that costs $5,000. You have $30,000 in a capital account, but you purchase the machine from your wholesaler "on account" that you must pay in 30 days.

1.You start with $30,000 in your capital account.

2.You acquire the machine on account.

3. After using it for four weeks, you return it and get a cash refund but pay a $500 restocking fee.

4.You now pay the $5,000 account payable (just before the 30-day due date).

$25500

Your pharmacy needs to purchase inventory that will cost $60,000 to acquire. You have $45,000 in a capital account, but you purchase the inventory "on account" that you must pay in 30 days.

1.You start with $45,000 in your capital account.

2.You acquire the inventory on account.

3. Just before the end of the 30-day period, you have sold half the inventory for $45,000 and you still have the other half of the inventory on hand ($30,000 worth).

4.You now pay the $60,000 account payable (just before the 30-day due date).

$30k cash $30k inventory in assets

what is an income statement

Summarizes revenues, expenses, and net income/net profit or loss of a business across a specific accounting period or range of time

what is profitability

The ability to produce sufficient sales to cover expenses, pay the current liabilities, and produce an acceptable return on investment

what is the bottom line

net income

what are the components of an income statement in order

total sales

cost of goods sold

gross profit

operating expenses

net profit (or loss)

what is the COGS

the cost of acquiring inventory that was sold during the accounting period

what is the COGS equation

Beginning Inventory + Purchases - Ending Inventory = COGS

what is gross profit

After paying COGS, what is left from revenues/sales to pay other expenses and taxes, and contribute to net profit

what is the gross profit equation

total sales - COGS = gross profit

what are operating expenses

general cost of operating and administering the business outside of the direct cost of goods sold

what are some operating expenses examples

rent, insurance, interest, store supplies, postage, utilities, advertising

what are the 5 primary purposes of a budget

planning, facilitating communication and coordination, allocating resources, controlling profit and operations, evaluating performances and providing incentives

what are some things to consider when sales forecasting

past sales levels/trends, economic trends, politics, pricing policy, advertising, competitors, new services, market research

in SMART goals, what does SMART stand for

Specific, Measurable, Attainable, Relevant, Time Bound

what are direct costs

those that directly attribute to the service

what are indirect costs

costs that would occur even if the service was not delivered

what are fixed costs

sum of all costs required before you can produce the first unit (or session), they remain constant

what are examples of fixed costs

facilities, lease, utilities, trainings, equipment

what are variable costs

costs that vary directly with number of units (or sessions) produced