Vision for UW Health Pharmacy Patient Care Services

Background
 
On November 1, 2006, UW Health Pharmacy held a leadership retreat to develop a five-year vision for pharmacy clinical practice. Strategies for accomplishing the vision of maximizing the quality of pharmacist patient care services provided at UWHC were discussed. Attendees included representatives from hospital administration, pharmacy administration, clinical pharmacists from diverse practice settings, School of Pharmacy faculty members and pharmacy residents. Areas of discussion and strategic thinking focused on a vision for the health system of the future and opportunities for pharmacy practice in and between all care settings. Planning was based on ten assumptions about the future of the UW Health electronic health record.

Department Mission
 
The fourfold mission of UW Health Pharmacy is to provide safe, high-quality patient care; to educate the next generation of pharmacy and other healthcare professionals; to provide education and outreach services to the community; and to conduct research to discover new methods of treatment and prevention.

Department Vision
 
The vision of UW Health Pharmacy is to be the foremost provider of high-quality, patient-centered pharmacy services in the nation, serving as a statewide and national employer of choice for pharmacy leaders and practitioners dedicated to advancing patient care services.
 
Five-year Vision for UW Health Pharmacy Patient Care Services

Driven by its mission and the core values of the institution (compassionate care, active learning, respect for others, excellence and innovation) UW Health Pharmacy will provide outstanding pharmacist patient care services as follows:
  1. Pharmacists will be active members of the patient care team. They will be responsible for assuring optimal, safe, and cost-effective medication therapy, applying an evidence-based approach to improve overall patient care.
  2. A pharmacy practice model will be maintained in which pharmacist clinical and distributive roles are effectively integrated, and all pharmacists are expected to be responsible for total patient medication use needs. Advanced pharmacist expertise may be developed in designated clinical areas, and pharmacists’ roles will be primarily clinically focused. Pharmacists will continue to maintain accountability for the safety and accuracy of the entire medication use process. By making medication use systems more efficient through technology, information systems, and technical support personnel, pharmacists will maximize their focus on direct patient care activities.
  3. Pharmacists will maintain an active, significant role in interdisciplinary patient care rounds. The pharmacist should focus on interventions and educational efforts to optimize patient medication therapies and improve medication-prescribing patterns.
  4. The provision of pharmacist patient care services will be aligned with medical services and hospital service lines, as well as enterprise-wide research and quality improvement initiatives.
  5. Pharmacist oversight of the medication use process will be maximized by review of medication orders and influence over medication therapy decisions in the Emergency Department, Radiology, Catheterization Laboratory, and other patient care procedure areas where medications are used.
  6. Pharmacists will maintain accountability for medication reconciliation for all inpatient transitions of care (i.e.; admissions, transfers, discharges), and lead effective reconciliation procedures in all other areas of care. 
  7. Pharmacists will document medication histories and reconciliation activity, clinical interventions, patient care plans, and patient education in the integrated electronic health record (EHR).
  8. Pharmacist medication teaching will be provided for all inpatients and outpatients as appropriate. This education will include the advancement of pharmacist first dose medication teaching, medication therapy classes, discharge medication teaching and post-discharge follow-up education in collaboration with other patient care practitioners to ensure optimal patient health.
  9. Pharmacist collaborative drug therapy management (practice) agreements will be encouraged in all care areas, enabling pharmacists to monitor, initiate and/or adjust medication therapy for individual patients in collaboration with other providers.
  10. Pharmacists will provide advanced patient care services in UW Health ambulatory pharmacies and clinics. These services will be provided in an integrated fashion and incorporate standards of practice which enable payment for their provision. 
  11. Pharmacists will ensure the clinical appropriateness and efficient utilization of high-cost clinic administered injectable medications throughout UW Health by sufficiently managing prior authorization processes, the revenue cycle, and the medication use process in the Infusion Center and relevant clinics.
  12. Pharmacists shall provide leadership to ensure that the organization achieves its externally defined core quality performance metrics related to medication management.
  13. Pharmacists shall be actively engaged in the training and mentoring of pharmacy residents and students.
  14. Pharmacists will provide medication-related education for other health care providers.
  15. Pharmacists will strengthen professional relationships with clinicians and other health care providers through interdisciplinary collaboration, education, and patient care services. 
  16. Pharmacists will positively influence the use of other hospital resources including laboratory tests, blood product and constituents, contrast agents and parenteral nutrition services.
  17. The Department of Pharmacy will maintain a competent, certified pharmacy technician workforce qualified to help manage the growing challenges and complexities of the medication use system to optimize pharmacist participation in direct patient care services.
  18. The Department of Pharmacy will prefer entry-level pharmacists to have completed an ASHP-accredited first-year postgraduate pharmacy residency training program.
  19. The Department of Pharmacy will prefer the completion of an ASHP-accredited second-year postgraduate residency training program for pharmacists practicing in highly specialized areas and caring for complex patients.
  20. The Department of Pharmacy will encourage and reward pharmacist certification and credentialing in areas of specialty clinical practice when possible.
Appendix 1
 
UW Health Epic Electronic Health Record (EHR) of the Future – Impact on Pharmacy, Pharmacy Practice Vision Assumptions
  1. Smart decision support software will reduce pharmacist retrospective interventions
    • Clarification of “sloppy orders”, abbreviations, allergies, etc;
    • Maximization of order set utilization; 
    • Medication reconciliation at transition of care; 
    • Minimization of interventions required to enforce use of standard order forms (e.g.; antibiotic ordering form, etc)
  2. Discharge process will require less pharmacist busywork, thus more time for patient teaching activities.
  3. Prior medication histories will be available electronically and available to all providers. 
  4. There will be less duplication of documentation.
  5. Pharmacist clinical documentation will be integrated with documentation of other providers. 
  6. Pharmacist interventions will be documented electronically, real-time, at the time of the intervention. 
  7. Better clinical decision support to notify pharmacists of patients where their intervention is necessary. 
  8. Procedure area orders (ED, Cath Lab, Radiology) may be immediately and efficiently sent to a pharmacist to review prior to medication administration.
  9. Ambulatory clinic, inpatient, OR and procedure area medication administration documentation will be fully integrated and accessible in all sites of care.
  10. The efficiency of activities related to the current pharmacist role will increase following EHR implementation, providing additional time for other pharmacist activities (e.g.; patient education, collaborative medication therapy management, interdisciplinary patient care rounds participation, and pharmacy student and resident education).