Thoughts on the #PPMI Twitterchat

ASHP and the ASHP Foundation have undertaken an initiative to change the way pharmacists practice pharmacy. And that initiative is called The Pharmacy Practice Model Initiative (PPMI); go figure. It’s quite an aggressive goal and one that I hope results in some great ideas on how to get pharmacists to the bedside where they have been shown to improve patient care and save hospitals money. Of course I’m banking on judicious use of technology to help lead the way, but that’s just my bias speaking.

Part of the PPMI includes a consensus summit scheduled to take place November 7-9, 2010 in Dallas, Texas. The PPMI Summit is by invitation only and “will bring together thought leaders throughout hospital and health-system pharmacy to reach consensus on optimal practice models that are based on the effective use of pharmacists as direct patient care providers.” In other words a bunch of pharmacists are going to try to hammer out the future of pharmacy in three days. Now that’s entertainment.

In preparation for the PPMI Summit, ASHP hosted a Twitterchat on Pharmacy Practice Models on November 1 at about 11:30am PST. You can view the archived Twitterchat here or simply search Twitter using #PPMI. There were several great comments made during the Twitterchat, although I have to admit that the chatter was a bit confusing to me at times. It was like a bunch of people at the Thanksgiving table all trying to talk at the same time, i.e. bits and pieces of conversations intertwined. Regardless I found some things I thought were worth mentioning.

• Looking for a short and sweet definition of what the PPMI is? According to @gumprx ASHP and the ASHP foundation are hoping to use the PPMI “to create a framework that ensures provision of safe, effective, efficient, accountable, and evidence-based care in hospitals.” In addition @McKesson_HIT said that the “central goal of PPMI is positioning the pharmacist as a direct provider of patient care.”  Combining those two statements gives us a nice, simple working definition. Now the question becomes how do we get there and what will it take to get hospitals to adopt the PPMI recommendations? Hmm, those are the same questions pharmacists have been asking themselves for 20 years. Everyone knows we need a new practice model, and everyone has a vague idea of what that model should be, but how do we make it a reality. I’m hoping the smart folks at the PPMI Summit will have the answers.
• @BrandonRShank asked “What do you feel is going to be the greatest challenge of #PPMI?” – Challenges, i.e. barriers, are always an issue when it comes to change, and make no mistake, barriers to a pharmacy practice model change will be one of the biggest tasks undertaken by PPMI Summit participants. Healthcare is often slow to make significant changes, and this is especially true when it comes to pharmacy where we’ve been practicing the same way for a couple of decades. If it ain’t broke don’t fix it, right? Wrong. Constant development and improvement of any system is important.

No matter what decisions are made at the PPMI Summit, they won’t be worth a nickle if the recommendations aren’t disseminated to healthcare systems, discussed, processed and implemented. It will take a collective effort from all pharmacists involved from the grassroots level on up. In addition pharmacists will have to be ready for the change. Until you’re ready to get serious it’s not going to happen. Pharmacy Directors will play a key roll here as change typically starts at the top and slowly trickles down.

• This has to be my favorite comment from the chat: @poikonen: “Requiring pharmacists to check every order is a colossal waste of time where good technology can do it better”. – I couldn’t have said it better myself. Technology is a viable way to get pharmacists out of the physical pharmacy and to the patient bedside where they belong. Technology and automation are very good at repetitive tasks. Humans not so much. We make mistakes while machines typically do not. My thoughts and feelings on this matter are no secret, and I would encourage ASHP to push the State Boards of Pharmacy hard to accept technology and alternative strategies, i.e. tech-check-tech, to free up pharmacists time.

Just an FYI – I emailed CSHP on August 31, 2010 asking for their position on tech-check-tech in the acute care setting. They responded on September 16, 2010 with an email referring me to their vision statement. Their vision statement says nothing about using tech-check-tech so I sent a second email on September 27, 2010 asking for clarification. To date I haven’t received a response. If this is what we can expect from our pharmacy organizations then I think we’re in big trouble; really big trouble.

• I was bothered by a recent PPMI poll asking whether or not pharmacist felt that clinical specialists were required for an optimal pharmacy practice model. A screen shot of the poll results can be found here. During the Twitterchat I asked why clinical specialists were necessary. The answer came from @gumprx: “Clinical Specialists – Members in Favor based on #PPMI Survey p4 http://bit.ly/aPFx48” (the bit.ly link is to a PDF containing the results of several poll questions presented to pharmacists about pharmacy practice) – I find the results disturbing. The thought that clinical specialists are necessary – not desired, but required – to drive practice change in pharmacy scares me more than you can imagine. Nothing, and I mean nothing about a title, a set of letters after your name or the results of an exam makes you better, smarter or wiser than any other pharmacist. I’ve met clinical specialists with credentials up the wazoo that surprised me with their lack of logic and focus. On the other hand I’ve met pharmacists with the absolute bare minimum requirements needed to practice pharmacy surprise me with advanced knowledge and abilities to think outside the box. I for one have no credentials outside the bare minimum, i.e. I have a pharmacy degree and a license, nothing else. The lack of a title and additional letters after my name have excluded me from doing a great many things during the course of my career, and it continues to frustrate me when I see the inability of people to see beyond titles. We should be careful where we build our walls because at some point we may want to be on the other side. Then what? Seek the talent and drive, everything else will take care of itself.

I am looking forward to the PPMI and am very excited about what will take place in Dallas on November 7-9. The thought of all that brain power in one place at one time is awe inspiring. Let’s hope the PPMI attendees can accomplish what we all want; a better pharmacy practice model.

Even if you can’t be at the PPMI in person, I would encourage all pharmacists to participate virtually by signing up here. Good luck PPMI.

I welcome your thoughts and comments.