PDHC EXAM 2

What is polypharmacy?

-Concurrent use of 5 or more medications by a single patient. -Taking medications that have no indication -Duplication of therapy -Concurrent usage of interacting medications -Inappropriate dosages

What does a pharmacist generally do inside of a nursing home facility?

-Document identification of irregularity -Report irregularity to attending physician or director of nursing

Importance of MTM

-Increased cost effective and efficacious prescribing - Improved adherence - Increased revenue for pharmacists

Why Teamwork?

-Reduce clinical errors -Improve patient outcomes -Improve process outcomes -Increase patient satisfaction -Increase staff satisfaction -Reduce malpractice claims

Method to quickly communicate a patient scenario

1) What is going on with the patient? 2) What is the clinical background or context? 3) what do I think the problem is? 4) What would I do to correct it?

Core Elements of MTM

1. Medication therapy review (MTR) aka Comprehensive Medication Review (CMR) 2. Personal medication list (PML) or record (PMR) 3. Medication-related action plan (MAP) 4. Intervention and/or referral 5. Documentation and follow-up

What are the components of MTM?

1. Medication therapy review (MTR) aka Comprehensive Medication Review (CMR) 2. Personal medication list (PML) or record (PMR) 3. Medication-related action plan (MAP) 4. Intervention and/or referral 5. Documentation and follow-up

Roles of hospital pharmacistantimicrobial stewardship lead

7 Core Elements Leadership Commitment Accountability Drug Expertise Actions to Support Optimal Antibiotic Use Tracking/Monitoring Antibiotic Prescribing, Use, and Resistance Reporting Information on Improving Antibiotic Use and Resistance Education of Clinicians/Patients/Families

Copay

A specified amount every time a service is received I pay the same amount every time I visit my doctor, and for each prescription drug I have filled.

Mutual Support

Ability to anticipate and support team members' needs through accurate knowledge about their responsibilities and workload

Leadership

Ability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources

What is antibiotic stewardship (or antimicrobial stewardship)?

Advocating for using antibiotics ONLY when needed and testing for resistance and sensitivity rather than using an empirical approach. Reduces the cases of antibiotic resistance.

What is AA?

Alcoholics Anonymous

What is Managed Care?

An organized health care delivery system with three major goals Improve quality and accessibility of health care Improve outcomes and overall quality of life for patients Contain medical costs

State Board of Pharmacy

Application for licensure as a pharmacist

Areas of NAPLEX

Area 1 Ensure Safe and Effective Pharmacotherapy and Health Outcomes (Approximately 67% of Test) Area 2 Safe and Accurate Preparation, Compounding, Dispensing, and Administration of Medications and Provision of Health Care Products (Approximately 33% of Test)

Debrief

At the end of the shift or after an event, discuss how to improve Review the team's performance

Progress Toward Goal

Call a Huddle! Goal of team Tasks that need to be completed Is the plan still appropriate?

Self-pay

Charge patient directly "Payment due upon services rendered"

Does health insurance result in quality health care?

Childhood vaccinations

What information needs to be recorded in the medication list?

Collect the following information about each medication: - What is the name, strength, and dosage form? - What is the indication? - Who prescribed it? - Since using the medication, how have signs/symptoms changed? - How do you use the medication? - How often do you miss doses of the medication? - Are you satisfied with your drug therapy?

What is impairment?

Condition of being unable to perform one's professional duties and responsibilities in a reasonable manner and consistent with professional standards.

Cost-consequense

Cost Dollar outcomes:Multiple

Cost minimization Analysis

Cost are in dollar and clinical outcomes are in determined to be equal outcome:Clinical measurement

Cost benefit Analysis

Cost are in dollar and outcomes are also in dollar

Cost Effectiveness Analysis

Cost are in dollar and outcomes are in clinical consequences outcome:Clinical measurement

Cost utility Analysis

Cost are in dollar and outcomes include patient preference outcomes: Quality-adjusted life years (QALYs)

Pharmacoeconomic Evaluations

Cost-minimization analysis (CMA) Cost-benefit analysis (CBA) Cost-effectiveness (CEA) Cost-utility analysis (CUA) Fifth approach, cost-consequence analysis (CCA)

What are risk factors for suicide?

Depression and other mental disorders; Substance abuse; or combination of the above. - More than 90% of completed suicides have these risk factors. *More likely to occur following a significant emotional loss.

What is the goal of situation monitoring?

Develop a Shared Mental Model

Reasons for polypharmacy

Direct-to-consumer advertising of medications and over-the-counter products Increased access to medications Enhanced therapeutic knowledge of treating chronic diseases

Huddle

Discuss concerns and make changes to solve problems as the occur Monitor and modify the plan

What is a closed door pharmacy?

Dispensing Services Pharmacy is most likely not on the premises Physician orders or prescriptions are faxed to the pharmacy A unit-doses 30 day supply is delivered to the home Specialty pharmacy

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What is meant by narrow therapeutic index drugs?

Drugs with narrow therapeutic index are drugs with small differences between therapeutic and toxic doses.

MPJE

Exam taken for a specific state. Apply to a state Board of Pharmacy for pharmacist licensure 120 Questions 100 count toward your score 20 are pre-test and do not count Must take a separate MPJE for each state if applying to more than one state Board of Pharmacy members in each state write questions Laws and regulations that must be followed in pharmacy practice Federal State Questions ask what pharmacists need to do in order to act in compliance with all the laws or regulations that relate to the action described

Environment

Facility information Administrative information Human resources Triage acuity Equipment

Managed care pharmacy

Focus is on drug therapy and pharmaceutical care

What is diversion?

Giving or taking regulated drugs without a prescription. Diversion investigations involve, but are not limited to, physicians who sell prescriptions to drug dealers or abusers; pharmacists who falsify records and subsequently sell the drugs; employees who steal from inventory and falsify orders to cover illicit sales; prescription forgers; and individuals who commit armed robbery of pharmacies and drug distributors."

How does PRN relate to the Department of Health and the Board of Pharmacy?

Health care professionals can seek assistance for impairment through the Department's Impaired Practitioner Programs - the Intervention Project for Nurses (IPN) or the Professionals Resource Network (PRN). Impairment may be as a result of misuse or abuse of alcohol or drugs, or both, or due to a mental or physical condition which could affect the licenseeâs ability to practice with skill and safety.

Status of the Patient

History Vitals Medications Physical Exam Plan of Care Psychosocial Condition

Team member check list

I = Illness M = Medication S = Stress A = Alcohol and Drugs F = Fatigue E = Eating and Elimination

Premium

I pay $100 per month, Regardless of whether I see the doctor or not.

Team Structure

Identification of the components of a multi-team system that must work together effectively to ensure patient safety

What signs indicate impairment?

Increased tardiness and/or absenteeism - Subtle changes in behavior and/or appearance - Mood swings or personality changes - Quality of work, job performance, and progress notes decrease or deteriorate. - Disproportionate overreactions in response to situations that were handled appropriately in the past.

Situation awareness

Individual outcomes

Situation monitoring

Individual skills used to understand what is going on

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What is Team STEPPS?

Is a very well done curriculum for training on teamwork and communication in collaboration with the Department of Defense (DOD) and the Agency for Healthcare Research and Quality (AHRQ), plus additional agencies.

What is a collaborative practice agreement?

Is used to create formal relationships between pharmacists and physicians or other providers that allow for expanded services the pharmacist can provide to patients and the healthcare team. Define certain patient care functions that a pharmacist can autonomously provide under specified situations and conditions.

What is the safety concern related to U-500 insulin?

It's has a higher concentration of insulin than regular insulin and some nurses may administer 0.9mL rather than 0.45mL

Hospitalization

Laboratory services

Billing insurance companies aka Third Party Payers

May pay uniform fee per client May pay fee per visit Ex:Community or Retail Pharmacy

Medicare Part C

Medicare Manage Care

Which government healthcare program funds MTM?

Medicare Part D

How does MTM relate to the PPCP?

Medication Action Plan (MAP) with is patient care document that empower the patient to take personal action and track the progress of self management. Is a process of collecting patient specific information assessing, medication therapy to identify medication related problems, developing a prioritize list of medication related problem and creating a plan to resolve them with the patient, care giver and prescriber.

MTM

Medication Therapy Management Medicare Part D

Problems Associated with polypharmacy

Nonadherence Over- or underdosage of medications Therapeutic duplication Adverse drug reactions Falls

Qualified Health Plan

Offered by an issuer that is licensed by the state

Coinsurance

Once the insurance company begins paying, they cover 80%. I still have to pay the other 20%

What are the companies that provide a platform for the delivery of MTM?

Outcomes MTM Mirixa MTM

Private insurance

Paid for existing patterns of health services

PPACA

Patient Protections and Affordable Care Act Plus amendment: Healthcare and Education Affordability Reconciliation Act of 2010

Deductible

Patient pays out-of-pocket up to a specified amount over a period of time (usually a year) before the plan kicks in. At the beginning of each year I have to pay the full price, until I reach $500, then my insurance company begins paying their part.

Gag clause

Patient's co-pay is $20 Pts prescription costs $8 Prohibits pharmacist from telling pt not to use insurance and just pay cash!

What types of patients do ambulatory care pharmacists take care of?

Patients with chronic diseases BP, Diabetes, HIV, Preventive Care "Coumadine" Clinis

What is included in MTM?

Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events Providing verbal education and training designed to enhance patient adherence to his/her therapeutic regimens

Who may deliver MTM?

Pharmacists Pharmacist Interns SCPTh

Indirect billing

Physician charges "incident-to" visit fees and pays Pharmacist under contract agreement Ex:Outpatient Clinic

Medicare Part B

Physicians and other providers

Medicare Part D

Prescription Drugbenefit

Ambulatory patient services

Prescription drugs

Maternity and new born care

Preventive and Wellness services and chronic diseases management

Medicare Part A

Primarily Hospital

Situation Monitoring

Process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning

What is PRN?

Professionals Resource Network

What is medication adherence?

Refers to whether patients take their medications as prescribed (eg, twice daily), as well as whether they continue to take a prescribed medication

Emergency Services

Rehabilitative and habilitative services

Communication: Check-Back

Sender initiates the message Receiver accepts the message and provides feedback Sender double-checks to ensure that the message was received correctly

Pearson Vue

Site for exam administration

Communication: SBAR

Situation What is going on with the patient? Background What is the clinical background or context? Assessment What do I think the problem is? Recommendation or Request What would I do to correct it?

Brief

Start off the work session with a clear understanding of the plan Share the plan

Essential Elements of Team STEPPS

Strong Leadership, Mutual Support, Situational Awareness, Shared Mental Model, Communication

Communication

Structured process by which information is clearly and accurately exchanged among team members

Indemnity insurance

Subscribers reimbursed 80% Patients collected receipts/completed forms Administrative costs to process Headache for all

MTR/CMR

Systematic process of collecting patientspecific information, assessing medication therapies, identifying medication problems, and creating a plan to resolve them -Medication adherence - Drug interactions - Missing therapy - Duplication of therapy - Cost savings - Inappropriate therapy

Share mental model

Team outcomes when everyone has situational awareness

Naplex

This exam is a national exam that can be used for all states 200 count toward the score 50 are pre-test questions (not scored) "Majority" of questions are asked in scenario-based format Patient profile Medical record Require scrolling, clicking tabs Fixed-form examination complies with: "Content specifications" "Blueprint" "Other statistical and psychometric targets" All questions must be answered in order, cannot skip Passing scaled score is 75, Minimum is 0, Max is 150 5 Types Multiple Choice Multiple Response Constructed Response Ordered Response Hot-Spot

What are ADC's (automated dispensing cabinets)?

Used by community pharmacies and hospitals to take workload off of pharmacists to focus more on MTM. The machines count and dispense fast moving drugs.

National Association of Boards of Pharmacy

Writer of the NAPLEX and MPJE exams

Actuarial analysis

a statistical analysis of the population served, and an estimate of the necessary income needed to cover the estimated expenses. Cost for each type of service; Utilization rate (number of each type of service); Administrative

Basic principles of insurance - SPECULATIVE

chance of gain as well as chance of loss Gambling is an example

Co-insurance

patient pays a specified fixed percentage of a service (usually 20%).

Compensation is goal

patient, insurance company, or some other entity has paid for the direct cost of the service plus the perceived value of that service

Reimbursement

payment for only the direct cost of the service without any payment above that

Basic principles of insurance - PURE

possibility of loss but NO gain Illness, fires, storms are examples

SOAP Notes

• Subjective • Objective • Assessment • Plan