1. The Pharmacy Practice
Model Initiative
Rouzan H. Srour, PharmD. Candidate 2015
APPE Hospital Rotation
Rush University Medical Center
March 24, 2015

2. Objectives
1. List the components of the pharmacy practice
model initiative
2. Identify possible issues and flaws within the
pharmacy practice model initiative
3. Be able to list ways to bridge the gap of
professionalism

3. • PPMI is a profession-led initiative that is empowering
the pharmacy team to take responsibility for patient
outcomes
• The initiative and summit will create passion,
commitment, and action among hospital and health-
system pharmacy practice leaders to significantly
advance the health and well being of patients by
optimizing the role of pharmacists in providing direct
patient care. By describing patient care services and
activities that support the safe and effective use of
medications, corresponding models can be adopted that
optimize the full potential of pharmacist, technician, and

4. The Pharmacy Practice Model
Initiative
• “Through PPMI, ASHP and the ASHP Research and
Education Foundation work to maximize the pharmacist’
role in patient care by improving health-care team
integration, leveraging pharmacy technicians, promoting
pharmacist credentialing and training, encouraging the
appropriate use of technology, and taking leadership in
medication use”
• “…aspires to transform how pharmacists care for patients
by empowering the pharmacy team to take responsibility
for medication-use outcomes”

5. Components of the PPMI

6. Care Team Integration
• Promotes pharmacy as a “team-based” approach
• Shifts the roles of pharmacists and technicians to
allow pharmacists to optimize their time with
patients
• Allows pharmacists to be providers thus
enhancing their relationship with patients

7. Care Team Integration
• Promoting a team-based approach
• Credibility
• Integrity
• Self-reflection

8. Care Team Integration:
Promoting Credibility
Improved
Patient Care
Work towards
one common
goal
Advocate for
staff’s comfort
Communicate
proactively
Establish
relationships
based on trust

9. Care Team Integration:
Integrity
• Work with ethics and justice
• Do what is right for the staff and the patient
• Do not give in to pressure
• Be honest to yourself and to others
• Engage in active listening

10. Care Team Integration: Self
Reflection
• Know yourself and enhance your self-esteem
• Reflect on your body language and the body
language of others
• Identify strengths and weaknesses
• Identify actions to continue and actions to
eliminate

11. Components of the PPMI

12. Leveraging pharmacy
technicians
• One of the few jobs that require extensive
background and training
• In 2008, only 25.6% of hospitals required that
newly hired technicians have PTCB certification

13. Leveraging pharmacy
technicians
• PPMI seeks to expand the role of pharmacy technicians
beyond filling, dispensing, and preparing medication
• Expanding roles include:
• Obtain and document patients’ medication history
• Maintain patient records
• Prepare quality-improvement reports
• Screen EMRs to identify patients in need of interventions
• Review patient charts to identify allergies and clarify orders
• Manage medication assistance programs
• Document medication adherence information

15. Leveraging pharmacy
technicians
• Medication errors
• Issues with dispensing without pharmacists
checking
• Pharmacists still need to influence the design and
performance of medication distribution
• Achieving consistency in medication use is not
possible

16. Leveraging Pharmacy
Technicians: Possible
Mistakes
• In 2001, a pharmacy technician working at a Florida retail
pharmacy, who had failed a certification exam entered a
dosage frequency for methadone as “as needed.” The
patient died.
• In 2007, a child in a hospital in Ohio died of concentrated
sodium chloride solution prepared by a technician. The
pharmacist was arrested.
• This caused the passing of Emily’s Law which requires that
all technicians pass an exam approved by state board before
dispensing drug products

17. Leveraging Pharmacy Technicians:
standardizing training and
certification
• Standardized accredited training
• Certification requirements
• Establish minimum hiring standards
• Integrate formal quality assurance processes

18. Components of the PPMI

19. Pharmacist Credentialing and
Training
• Put the pharmacist as a the patient care provider for
medications
• Relieve pharmacists of work that can be done by non-
pharmacists
• Enhance pharmacist training
• Life long learning
• Residency
• Training on high-risk medication use

20. Pharmacist Credentialing and
Training
• Enhance the role of the pharmacist as a healthcare team
member
• Medication Reconciliation to target discrepancies
• Discharge counseling to target HCAHPS score
• Leading interdisciplinary and collaborative development of
medication use policies and procedures
• Manage medication therapy on an individualistic level
• Allow pharmacists to write medication orders
• Hold the pharmacist accountable for the medication-related
component of a patient’s healthcare plan
• Recognize the pharmacist as drug therapy and medication
use experts

21. Pharmacist Credentialing and
Training

22. Components of the PPMI

23. Technology
• Make the use of technology more efficient
• “Do more with less”
• Allow the pharmacist feasible access to patient medical
records and information to optimize the pharmacist’s role
in delivering patient-centered care
• Use technology to improve patient safety, quality, and
efficiency
• Consider new and emerging technology to improve
practice

24. Technology
• Electronic medical record systems
• Barcode medication administration
• Monitoring systems that provide a work queue for
patients needing review and intervention
• Intelligent infusion devices

25. Technology
• ASHP pushes for pharmacy informatics in pharmacy
school curriculums
• Clinical and non-clinical pharmacists should understand
how it all works
• Knowledgeable pharmacists should be available to make
decisions and offer advice on technology
• Interoperability is key

26. Components of the PPMI

27. Leadership in Medication
Use
• Empowering pharmacists to take responsibility for the
outcomes of the patient’s health
• Redefines the role of the pharmacist on the health care
team
• Promote health and wellness
• Optimize therapeutic outcomes
• Prevent adverse medication events

28. Leadership in Medication
Use
• Part of the success of PPMI comes from
• Pharmacy-initiated change
• Not health-system initiated
• Pharmacy director has a strong vision for the
necessity of change
• Pharmacy staff are early adopters of innovation
• Recognition of the significance of strong
relationships with medical staff
• Changes occurred intermittently and are still ongoing

29. What are some key
leadership skills?

30. Leadership in Medication
Use
• Vision
• Interpersonal skills
• Mentoring
• Seizing opportunities
• Perseverance
• Lifelong learning

31. Leadership in Medication
Use
• Hold pharmacist accountable for
• Adjustment of medication dosage and
pharmacokinetic monitoring
• Review of medication orders before first-dose
dispensing
• Monitoring lab values and drug levels
• Medication reconciliation
• Consultation for drug therapy management
• Availability around the clock

32. Leadership in Medication
Use
“…post discharge medication review and telephone
follow-up by a pharmacist were found to reduce the
hospitalization rate and total health care costs”
“…a lower rate of preventable adverse drug events
30 days after discharge associated with medication
review, patient counseling, and telephone follow-up”

33. Leadership in Medication
Use
Continuity
of Care
Adverse
effects and
medication
errors

34. Issues with PPMI
• Shortage of well-trained, board certified pharmacists
• Oncology
• Pediatrics
• Transplant
• Geriatrics
• Informatics
• Ensuring competency by requiring lifelong learning
• Increasing need for highly trained and certified
technicians

35. Issues with PPMI
• Difficulty of pharmacists achieving work-life balance
• Requirement of leadership role as part of healthcare
team
• Financial constraints
• Pharmacists’ role is seen as production-oriented not
patient-oriented
• The importance of professionalism

36. Part of the success of the
PPMI model is commitment
to professionalism

37. PPMI and Professionalism
• Defining professionalism
• Competence in a specialized body of knowledge and
skill
• Acknowledging one’s specific duties and
responsibilities
• One’s ability and willingness to train, discipline, and
reflect on one’s actions

38. PPMI and Professionalism
• Prepare professional pharmacists
• Various pharmacist associations
• Schools of pharmacy
• Pharmacy team members at work

39. How can pharmacy
preceptors increase
professionalism in their
students?

40. PPMI and Professionalism
• Accepting personal responsibility
• Allowing students a favorable environment
• Guiding students with specific strategies
• Reflection on outcomes measures

41. Bridging the Gap to
Professionalism

42. Bridging the Gap to
Professionalism
• Gap between education and practice
• Need more practice/training for students
• Modeling of preceptors and teachers to their
students
• Increases quality of professional students
• Increases services by students
• Students must seize opportunities of leadership and
lifelong learning as they advance through their
careers

43. Works Cited
1. Executive Summary. Pharmacy practice model summit. Am J Health-Syst Pharm. 2011, June 15; 68:43-49.
2. Shane, Rita. Critical requirements for health-system pharmacy practice model that achieve optimal use of medicines. Am J
Health-Syst Pharm. 2011, June 15; 68: 65-75.
3. Siska MH, TribbleDA. Opportunities and challenges related to technology in supporting optimal pharmacy practice models in
hospital and health systems. Am J Health-Syst Pharm. 2011, June 15; 68: 80-90.
4. Meyrs C. Opportunities and challenges related to pharmacy technicians in supporting optimal pharmacy practice models in
hospital and health systems. Am J Health-Syst Pharm. 2011, June 15; 68: 92-100.
5. Pharmacy practice model initiative. www.ashpmedia.org/ppmi/overview.html (accessed 10 March, 2015).
6. Ashby DM. What is the imperative for practice model change? (PowerPoint). New Orleans, Lousiana: ASHP Summer Meeting,
2011.
7. Ashby DM. Redefining the practice model: Where have we been, where do we go? (PowerPoint). Las Vegas, NV: ASHP Midyear
Clinical Meeting and Exhibition, 2009.
8. Zilz DA, Woodward BW, Thielke TS, Shane RR, Scott B. Leadership skills for a high-performance pharmacy practice. Am J
Health-Syst Pharm. 2004; 61:2562-74.
9. Tipton JA. Getting noticed: Establishing strategy and defining success. Houston, Tx: C-Suite Resources.
10. Sokn E. Providing quality patient care through profressive pharmacy practice. Cleavland, OH: C-Suite resources.
11. Zellmer WA. Porfessionalism – An essential component of the pharmacy practice model. (PowerPoint). Tampa, FL: ASHP 2010
Summer meeting and exhibition, 2010..

44. The Pharmacy Practice
Model Initiative
Rouzan H. Srour, PharmD. Candidate 2015
APPE Hospital Rotation
Rush University Medical Center
March 19, 2015