1 - Professional Communications and Motivational Interviewing / Historical Perspective and Technology in Pharmacy

What are the five principles of motivational interviewing?

1.) Express empathy through reflective listening

2.) Develop discrepancies between clients' goals or values and their current behavior

3.) Avoid argument and direct confrontation

4.) Adjust to client resistance rather than opposing it directly

5.) Support self-efficacy and optimism

You notice that your hospital pharmacy department does not devote clinical pharmacists to its outpatient clinic areas, but hospitals in healthcare systems like the VAH, Kaiser, HUP, and Geisinger do. Why?

1. Your hospital is not concerned about the health of their patients.

2. Your hospital can’t afford the manpower for enhanced out-patient care.

3. The VAH is a Health System responsible medically and financially for the longitudinal care of their patient population and Inpatient care is usually more expensive than outpatient care.

3. The VAH is a Health System responsible medically and financially for the longitudinal care of their patient population and Inpatient care is usually more expensive than outpatient care.

You’ve been discharged after a short hospital admission and receive a bill from the hospital which was sent to your insurance company. The bill includes multiple charges including room, supplies and multiple drug doses including aspirin ($10 per dose)

1. The hospital is making huge profits

2. These charges are necessary to cover the huge costs of running a hospital

3. Most payers reimburse the hospital based on only 80% of what is billed

4. Most payers reimburse the hospital based on something other than the hospital’s bill

4. Most payers reimburse the hospital based on something other than the hospital's bill

You work in a hospital and notice a significant effort is made so that intensive care patients don’t get leg clots or hospital acquired infections, and that heart failure patients are educated about diet and their medications prior to discharge.

1. The hospital is merely concerned about the health of their patients.

2. Government mandates, by law, the way that patients must be treated in hospitals for certain conditions.

3. Hospitals are eligible for better reimbursement if they show that they perform well in certain areas.

4. Hospitals will not be reimbursed for the care of conditions cause by the hospital

4. Hospitals will not be reimbursed for the care of conditions caused by the hospital

In the early 20th century, pharmacy had no credible standards or enforceable laws regarding the safety of therapeutic agents. The first major legislation was the Pure Food and Drug Act of 1906. It was not comprehensive, it had many loopholes and did not address the efficacy of drugs.

The ultimate turning point was the __________________________ of 1937, which led to the creation of the _______________________ of 1938. This act allowed the FDA at the time to: _______________________. Although drugs were not yet categorized into prescription and non-prescription.

"Elixir Sulfanilamide" scandal

Food, Drug, and Cosmetic Act

approve new drugs and establish safety standards

The __________________ were known as “The Era of Expansion,” since numerous laws and amendments were passed.

The ____________________ to the Food Drug and Cosmetic Act (1951) established three key things: ___________________________

1940s to 1960s

Durham-Humphrey Amendment

- Standardization of drug manufacturing

- Prescription vs. Non-prescription status

- FDA oversight into drug research for approval

During the 1960s into 1970s, the _____________________ (APhA) labeled pharmacists as “merchants” rather than healthcare providers. There was also curriculum expansion, in which more science courses were added (medicinal chemistry, pharmacokinetics).

During the 1970s-1980s, the Health Maintenance Organization Act (1973) led to managed care and HMOs. While the ________________________ (1975) identified gaps in management and communication skills. While ASHP’s “Mirror to Hospital Pharmacy” highlighted the need for clinical roles.

Dichter Report

Millis Commission Report

The Pharmacists’ Code of Ethics was established by _______________________

Titles XVIII and XIX amended the 1935 Social Security Act to create _______________________, respectively

Reagan’s TEFRA of 1980 called for the __________________________

APhA

Medicare and Medicaid

institution of DRGs (diagnosis-related groups)

Which two pharmacists played national leadership roles in defining contemporary pharmacy practice? __________________________

The Pharmaceutical Care Concept is the belief that pharmacists became responsible for managing ________________________

Charles Hepler and Linda Strand

medication therapy.

Which pharmacist practice is most related to the concept of “Pharmaceutical Care”? _________________________

The Future Vision Statement of Pharmacy Practice as stated by _________________________ of Pharmacy Practitioners is that: "Pharmacists will be the health care professionals responsible for providing patient care that ensure optimal medication therapy outcomes.

Medication Therapy Management

the Joint Commission

Examples of Medication Order Scanning Technology include: ______________________

_________________ is a computer system supporting the direct entry of medication orders into a patient’s profile by the prescriber. (usually with _______________________, which is an interfaced database identifying potential clinical and operational prescribing problems.

Fax machines and Pyxis Connect

Computerized Prescriber Order Entry (CPOE)

decision support

- Decreases delay in order completion

- Eliminates pharmacist transcription

– Reduces transcription errors

- Computerized decision support can check for errors

– Prospective advice/protocols

– Off-site order entry as well as in-hospital

– Eliminates abbreviation use

– Combined with dispensing technology, allows for pharmacist deployment

Pros of Computerized Prescriber Order Entry (CPOE)

- Physician to nurse communications can deteriorate?

– False sense of security

– Wrong patient or wrong drug errors (miss-picks from ordering screens)

– Physician work arounds and log-on security risks

Cons of Computerized Prescriber Order Entry (CPOE)

– Provides clinical warnings (e.g. Dosage, Interactions, Duplications)

– Interface with laboratory

– Reports

– Pre-set Protocols

Pros of Decision Support Technology

– Selectivity (Excessive insignificant warnings lead to “warning fatigue” and inappropriate “Over-riding”)

– False sense of security

Cons of Decision Support Technology

- Reduces pharmacy labor costs (+/-)

- Eliminates cart fill checking tasks of pharmacists (+/-)

- Improved medication dispensing accuracy

- Supports Bar Code Med Administration (Doses are bar coded)

Pros of Centralized Dispensing Robots

- Improved accuracy not proven to result in improved patient safety

- Doesn’t remove nurse error

- Expensive capital cost

- Requires bar coding if the medication doesn’t come from the manufacturer in bar-coded unit dose packaging

Cons of Centralized Dispensing Robots

- Unit-dose medications and bulk medications

- Real-time interface to computer system

- Reduces or eliminates manual cart-fill process

- Controlled substance accountability

Pros of Decentralized Point of Care Cabinets

- Incorrect medication choice from open matrix drawers

- Drugs stocked in the wrong pocket

- Expanded drug inventory

- Over-ride medications

- Nurses “pouring” entire day’s meds causing “queuing”

- Nurses returning meds to wrong pocket

Cons of Decentralized Point of Care Cabinets

A "three-point check" in Bar Code Medication Administration (BCMA) typically refers to scanning three barcodes to verify medication administration. These barcodes consist of the: _________________________

- Nurses badge

- Medication and dose

- Patient's ID band

The five "rights" of medication administration include the right:______________________

- Patient

- Medication

- Dose

- Time

- Route

What automation technology or combination of technologies would best suit the following needs?

– The need to speed up dispensing and improve turn-around time for medications to get to the patient

- Decentralized Point of care cabinets

- Computerized Prescriber Order Entry (CPOE)

What automation technology or combination of technologies would best suit the following needs?

– The need to expand drug distribution to ancillary areas such as radiology, catheterization lab, etc.

- Decentralized Point of care cabinets

- Computerized Prescriber Order Entry (CPOE)

What automation technology or combination of technologies would best suit the following needs?

– The need to support other technologies

- Centralized Dispensing Robots

- Bar Code Medication Administration (BCMA)

What automation technology or combination of technologies would best suit the following needs?

– The need to expand medication distribution to a multi-hospital health care system from a central location

Centralized Dispensing Robots

What automation technology or combination of technologies would best suit the following needs?

– The desire for deployment of pharmacists out of the pharmacy into clinical roles

- Decentralized Point of care cabinets

- Computerized Prescriber Order Entry (CPOE)