Chasing the White Light

How nice it is to actually have a day off, in the middle of the week, with absolutely nothing planned.  Free time!  My wife and I decided to catch a late afternoon matinee.  The not-to-be-mentioned movie we were planning to see was foretold by our daughter to have an extremely long line.  She even went so far as to say that if it were here going to the movies, she would stop by the theatre early in the day and buy tickets ahead of time, because you don't want to wait in line all afternoon only to be turned away at the gate when it is your turn to purchase the tickets.

Being the risk takers that we are, we chose to take a chance and just show up, knowing full well that if the movie was sold out we would have just as great a time walking around town.  Upon arrival at the Cineplex parking lot, 45 minutes before movie start time, we realized that our sleepy town perhaps wasn't as up on this particular movie as much as the rest of the country.  We purchased our tickets, retrieved a large bag of popcorn, and proceeded to be the FIRST to arrive for the 3:45 viewing of this movie.

After 45 minutes of chatting and joking with my wife of nearly 25 years (it still amuses me that after many years of dating and 25 years of marriage we can sit in a theatre and entertain each other for 45 minutes while waiting for a movie to start) the previews began to roll.  During one of these block buster previews there were some statue lions that came to life and were beginning to look as if they were about to attack.  The fast thinking night watchman turned on his flashlight and began making circles on the ground and immediately the ferocious looking lions became ultra playful attempting to catch the white light as it circled around under their feet.

Later, during the middle of the feature presentation, there was this dramatic scene where the electrical power to the lighting was temporarily cut off and many people promptly turned on their flashlights.  The characters are tense and nervous; however, they notice the token cat following one of the flashlight beams.  They then begin playing with the cat, circling the light from the wall to the floor, temporarily averting their attention from the crisis at hand, watching the cat chase the elusive white light.

The white light is elusive, distracting, and unobtainable. The suggestion is that it doesn't matter what the cat may be doing, it can't help it, it needs to stop everything else and chase the light.  I would like to think that eventually, if the light kept moving, the cat would cease and give up.  I would also like to think that if the light stopped and then started again, the cat would recognize that it was a useless effort and not chase the light again.  This I don't know; however, I am sure, with a little research, one could find the answer from an almighty search engine.

Perhaps the white light is the beauty in the advertising pages of a fitness magazine.  We are looking for the elusive and unobtainable figure we want to see when we look in the mirror.  We spend money on health clubs, diet plans, trainers, garments and perhaps even surgery.  If we are fortunate, at some point along the path we may realize that no matter how we see ourselves in the mirror, this is the body we are meant to live in.

Maybe the white light we chase is the perfect job.  The one we read about in the trade journal with the fantastic pay and the title we know we deserve.  Yes, we have chased different jobs in the past; however, this time it is different.  We are sure that if we are able to move into this new position, all will be right.  We are good at what we do, we get the job, and after 8-12 months we find we are again looking at the job search engine. 

Yes, our job involves our skills and our ability to perform in our field; however, it also involves our ability to communicate and relate to our employees, peers and supervisors.  Job satisfaction comes from committing to be part of the team, assisting others in their efforts and receiving recognition for our efforts.  No matter what job we take, in absolutely any location in the world, it will still be you standing in your shoes performing the work. 

White lights exist around us, all day every day.  What about the perfect relationship.  You know, the one that doesn't require any compromise or effort to make work.  The one that after three months is dumped because it has become difficult, and besides, there is a white light that just flashed in front of me that caught my eye.  Perhaps drugs or alcohol has worked their way into your life as a white light.  The elusive and unobtainable emotional feeling you thought you experienced once, and now, against all better judgment and reason, you seek to find that experience at all cost.

I have chased all of these white lights at one point or another in my life.  Fortunately, through strong relationships, therapy, and commitment, I became aware of the white lights and began to recognize their existence.  The lights still flash and circle; however, I am now able to recognize that they are just a white light and I don't need to chase them.

Don't get me wrong, I realize more white lights exist and I most likely follow them without even recognizing what I am doing.  One that comes to mind this morning is the impulse to check social media while I am writing my blog.  I am never 100% in control; however, today I am not chasing the white light of the unobtainable physique, the elusive job, a relationship that requires no work, or a non-existent drug induced emotion.

Thanks
Steve


Copyright AudibleRx (TM), all rights reserved.

AudibleRx Company Description

"Consumer Medication Information, provided in audible format, with the intent of educating consumers to better understand their pharmaceutical care, increase adherence and decrease adverse events.  AudibleRxTM objectively bridges the medication-education-gap between the patient, their pharmacist and their doctor."


Vision
Provision of an easy to use web and app based program where consumers LISTEN to a pharmacist explain all of the important Consumer Medication Information associated with a specific medication.  This education will help an individual identify what they do and don’t know about the medication so they may take educated questions back to their own pharmacist or doctor.  The vision will be achieved through implementation of the Goal, Mission and Method.

Goal
Increase medication adherence, decrease medication related adverse events, and improve an individual's overall outcome of their pharmaceutical therapy.  This goal will be achieved through our mission.

Mission
Educate and motivate individuals to participate in their pharmaceutical care.  This mission will be achieved through the following method.

Method
Provide Medication Specific Counseling SessionsTM, (Consumer Medication Information) in accordance with current practice standards, in audible format, through an easy to navigate website or tablet/phone app.


Problem Defined
Patients rarely receive the complete counseling and education they need to fully understand:
  1. Their medication regimen,
  2. The importance of adherence to their medications,
  3. The consequences of not taking their medications.

Without discussing all of the adherence statistics in this Company Description, it is agreed that prescription non-adherence is a leading cause of hospital admissions, re-admissions and emergency room visits.  The top five reasons consumers are non-adherent to their medication therapy include:
  • Don’t understand the need for medication.
  • Can’t afford medication.
  • Forget to take medication.
  • Personal beliefs against taking medication.
  • Don’t understand how to take medication.

Daily, patients pick up prescriptions from busy pharmacy counters or receive prescriptions in the mail.   Current barriers to effective medication counseling do not regularly allow for the pharmacist to sit with the patient and discuss their medications for 10-15 minutes at the counter. 

Pharmacists are under tremendous pressure to meet their performance metrics and will regularly cover the counseling points of three or four medications with a patient in fewer than two minutes.   Patients are then sent home from the pharmacy (or discharged from a hospital) with stacks of informational paperwork that is cumbersome to read. 

Furthermore, many patients are challenged with literacy or visual impairment and are unable to read the Consumer Medication Information leaflets they are sent home with.

Problem Solved
Of the top five reasons individuals are non-adherent to their medication therapy, three of them are related to education, sometimes called Health Literacy.  When a patient understands how their medication works, why they are taking it, and importantly, the consequence of not taking their medication, they will be much more likely to participate in their pharmaceutical care.

AudibleRxTM provides audible Consumer Medication Information (CMI) as an alternative to the paper handouts patients receive with each prescription at the pharmacy.  Each Medication Specific Counseling SessionTM lasts between 4-6 minutes and is available through a web or app based platform.  

Briefly, and in a simple to understand format, the session will describe how the medication works and what the consumer needs to know about taking that particular medication; while also highlighting all of the important required pharmacist counseling information associated with that specific prescription.  After listening to a CMI session, a patient or caregiver will have a clear idea of what they do and don't know about their medication and be in a better position to take educated questions back to their own health care providers.

Please understand, our goal at AudibleRxTM is not to replace the important face-to-face counseling sessions that a patient will have with their own Community Pharmacist; rather, to help educate patients and caregivers so they will be in a better position to engage their own health care practitioner in an educated discussion about their medication therapy.

Access to AudibleRxTM is free to the consumer; however, licensing agreements are necessary in order for Health Care Providers to promote AudibleRxTM as a patient education tool.  Health care providers are offered a FREE Six Month Trial in order to realize the value in audible CMI as applied to patient education. 

Specific Consumer Medication Information sessions are easy to locate on the web and app based program because they are categorized both alphabetically (by generic and trade name) and also by disease state.

AudibleRxTM is not affiliated with any drug manufacturer and offers no advertising.  Every effort is made to keep the recordings provide by AudibleRxTM completely objective and unbiased.  The AudibleRx website complies with the HONcode standard for trustworthy health information on the internet.

Counseling information is organized in a fashion that is in concert with the Omnibus Reconciliation Act of 1990, the American Society of Health-System Pharmacists guidelines on pharmacist-conducted patient education and counseling, and the FDA guidelines on Useful Written Consumer Medication Information. 
  • Scientifically accurate. 
  • Unbiased in content and tone. 
  • Sufficiently specific and comprehensive 
  • Presented in an understandable format that is readily comprehensible to consumers. 
  • Timely and up-to-date. 
  • Useful.

We currently have over 270 completely different medication sessions available. If we count all of the different dosage forms of specific medications, including both generic and trade name, that number is well over 1800. If we count different package sizes and different generic manufacturers, that number is well over 5000.

Customers
AudibleRxTM may be utilized as a consumer medication education tool in a variety of settings such as:
  • Community Pharmacy as an alternative to the paper CMI handouts.
  • Mail Order Pharmacy as an alternative to the paper CMI handouts.
  • Medication Therapy Management business.
  • Hospital Discharge medication education tailored to the learning needs of individual patients.
  • Medical Clinic or Medical Concierge service added value benefit.
  • Nursing Home or Skilled Nursing Facility patient medication education.
  • Employee Wellness Benefit.
  • Medication Counseling Education for pharmacy, nursing or medical students at your Institution.
  • Insurance Company provision of audible CMI to its clients.
  • Tele-Medicine as a value added benefit.
  • Any situation where consumers would benefit from non-biased medication education.

Whether it be someone who is challenged with literacy, visual impairment, or just one of the many individuals that learn better by listening, everyone deserve access to Consumer Medication Information.  Make a commitment to provide Accessible Medication Education to your customers, clients and patients; information tailored to meet the needs of those that learn better by listening.  Please visit www.AudibleRx.com, watch the short video, listen to a couple sessions, evaluate the Provider, Partner and Sources pages, and let us know how we may work together.

Sincerely,
Steve Leuck, Pharm.D.

Copyright AudibleRx, all rights reserved.

"PART II" Out-Patient Pharmacist / In-Patient Rounds

Great thought must be put into the planning and implementation of any new service; for once it is begun, it must be regularly continued, monitored and evaluated if it is to succeed.

For those of you that haven't been following, five weeks ago we implemented a new program at the community hospital that I work at.  This program's implementation is described in detail in a previous post titled, "Out-Patient Pharmacist, In-Patient Rounds"; however, it involves a pharmacist from our out-patient clinic pharmacy briefly reviewing 50-70 charts every morning, looking specifically for potential medication discharge issues that would benefit from having a pharmacist help coordinate the process.  During rounds, the case managers, Rn's or MD's will refer at least one patient to the pharmacist who might benefit from a Bedside Medication Therapy Management visit.  This visit is then performed after rounds, before the pharmacist heads back to the out-patient pharmacy for the rest of their shift. 


I am not sure about everyone else; but I find this incredibly interesting stuff.  Us pharmacists have been working for the almighty line item productivity metric for EVER!  Here is an opportunity to break out of the fish bowl, have a positive impact on patient outcome and also help decrease readmission rates.  As the data unfolds, I will continue to take some time to put it into words.  As always, I appreciate feedback on similar programs others have implemented. 

Out-Patient Pharmacist, In-Patient Rounds
Five Week Evaluation

Out-patient pharmacist involvement in the Daily Rounds and Bedside MTM service at our community hospital began five weeks ago.  Subjectively, the service has been a success and is well received by both the rounds team and the patients who have been visited.  Objectively, the data collected from pharmacist involvement is significantly positive; however, the program has not been continuing long enough to gain any significant insight into whether it is making an impact on the 30 day readmission process.

This document will describe the successes and shortcomings of the program thus far. 

Data for first five weeks:
·         32 Bedside MTM consults were received during Rounds Huddle.
o   27 Bedside MTM consults were completed, charted and enrolled in follow up phone call program.
o   5 were not completed because patients were either discharged, sleeping, not in room, in an acute state, or in isolation.
·         40 Appropriate recommendations were made to help coordinate care regarding a medication that may be difficult to fill upon discharge. 
·         31 Verbal orders totaling 50 separate medications to be re-labeled so they may be taken home with the patient when they are discharged from the hospital. 
·         6 Clinical or Med Reconciliation issues were noted by pharmacist during chart review or during huddle and discussed.

Rounds Participation:
Importantly, the pharmacist has been well received on the rounds team.  Comments and suggestions regarding medication discharge planning are well received and definitely fill a gap in the rounding process. 

The efforts regarding coordination of "difficult to fill" discharge medications and the "re-labeling" of inhalers and eye drops makes a significant impact.  These are functions that do not need a pharmacist; however, they were not being done without a pharmacist.   
·         The 40 coordinated prescription interventions for "difficult to fill" medications has been limited to only 10 medications, with 3 medications taking more than 50% of the interventions.
·         The 50 re-labeled inhalers and eye drops was fully coordinated by the pharmacist; obtaining a verbal order from the physician during rounds, obtaining the medication from the unit med cart, taking it to the out-patient pharmacy and labeling it appropriately, then returning it to the appropriate med cart.
In my opinion, these two items alone justify pharmacist participation.  These two processes do not require the presence of a pharmacist in order to complete; however, as seen by the data, there is certainly an opportunity for pharmacist intervention.  Eventually, with some training, it is possible that these items might be performed without the presence of a pharmacist.

Bedside Medication Therapy Management:
Interestingly, the Bedside MTM visits are very well received by patients.  Our goal is to help educate patients about the management of their medications so they may be more prepared to manage their own medications when they return home.  As stated, during the first five weeks of the program, 27 Bedside MTM visits have been completed and all of them enrolled in 3 and 21 day follow up phone call service from the pharmacist.

It is too early for the objective data; however, subjectively, patients very much appreciate the opportunity to discuss medication management with a pharmacist at their bedside.  I believe this process will not only decrease the potential for readmission, it will also increase our patient satisfaction scores.

As a pharmacist, the difficulty we face is that we realistically only have time to visit one patient per day.  Rounds are complete at 11:30, at which time we need to return to the pharmacy office in order to print and review the med list for the patient we will see that day.  After our 20 minute Bedside MTM visit with a patient, we then need to document our visit in the patients electronic health record while also documenting our participation in rounds for the day.  Our time is complete at 12:30, at which time lunch begins, so we may be back at our out-patient post by 13:00.

Analysis:
Five weeks ago, this position didn't exist.  Today, there is more work than we are able to complete in our 3.5 hour shift.  The process of coordination of discharge prescriptions and re-labeling of bulk items has been a success.  The implementation of Bedside MTM visits is even more of a success.

Over the next few months I believe we will see that the greatest value comes from providing Bedside MTM visits to patients.  This is specifically a pharmacist driven process; coordinated and implemented by pharmacists.  Ideally, our daily flow will need to be evaluated so that we are able to see more than one patient/day.

Initially, we could potentially increase our participation time by 30 minutes so that we have until 13:00 (an even 4 hours) to complete our daily process.  Presumably, this would allow us time to see two patients each day which would significantly increase our presence.

Secondarily, in the future, we may look at training the case managers to recognize which meds will require special discharge coordination so they may follow up on these at least a day prior to discharge.  We may also be able to develop a process where charge nurses or respiratory therapists take  verbal order to re-label inhalers which may then be forwarded to the out-patient pharmacy for appropriate discharge labeling.  This may free up the pharmacist to see many more patients.

Conclusion:
The pharmacist involvement in Daily Rounds and Bedside MTM program has been received well and is a functioning program thus far.  Over the next two - three months we will be training a couple more pharmacists who will be available to cover this shift.  Time will tell if the provision of these services eventually leads to a decrease in 30 day readmissions as an objectively driven, outcome oriented, pharmacist delivered program.

Thanks
Steve
Copyright AudibleRx (TM), all rights reserved.

What Makes a Great Community Pharmacy

Recently, within the past 2 months, our community pharmacy created a relationship with the discharge navigator of a local hospital.  Our effort was directed at resolving a specific issue that had developed with patients being discharged after a specific orthopedic surgery.  Each one of these patients is discharged on six medications that are part of a specific protocol for this particular surgery.  The issue is, two of these medications quite frequently require a prior authorization with the patient’s prescription insurance company.

Regularly, these patients receive their surgery on Wednesday and then are scheduled for discharge by Friday afternoon.  Upon discharge, the orders would be sent to their pharmacy and the patients would be sent home.  Later that day, their family would go to the pharmacy to pick up their meds and one or two of them would not be ready because they are not covered by the insurance.  Unfortunately, both of these medications are only available as a brand name product, one costs $300+ and the other costs $500+ for a 30 day supply.

Physicians were frustrated because the hospital was discharging patients without their medications that are necessary for their particular protocol and the patients were frustrated because they could not get their medication.  After a few weeks of this scenario, the discharge navigator contacted us in the out-patient pharmacy.  After a few discussions, we set up a plan for the orders to be sent to our pharmacy, with the patients approval, at least 24 hours prior to discharge. 

In an ideal world, 24 hours should be enough time to obtain a prior authorization for these two medications through normal channels.  As we know, quite often, hospital discharges and medical staff availability do not always function in ideal world scenarios.  For the most part, this system has worked well.  We receive the orders in the out-patient community pharmacy, receive a face sheet with the patient demographic information, and begin the process of medication authorization with the prescription insurance company with the help of the physician’s office staff.

Three weeks ago we processed one of these particular discharge order sets.  As fate would have it, the ideal world scenario did not deploy as expected.  The patient’s wife came to our pharmacy Friday afternoon and all of the medications were ready; however, one of them had not yet been authorized by the insurance company.  The cost of this particular medication was a little over $525 for the 30 day supply.

Although the spouse was not too pleased, after a discussion of insurance companies, authorizations and medication protocols, she understood and went ahead and paid for the medication.  We agreed that if the authorization was approved, we would be happy to reprocess the claim and refund her the difference.  Over the next two weeks I talked with this particular spouse on the phone many times.  She had contacted the physician’s office multiple times and had followed up with both the hospital and her insurance company.  Her due diligence concluded with a letter of authorization from the insurance company stating that this medication was now covered.

She was very pleased as she came into the store with her insurance authorization letter; however, I attempted to process the prescription and it still was not covered.  I had a suspicion that the authorization had not been done retrospective, back to the day the prescription had been filled.  I wear a telephone headset at work so it is no big deal for me to get on hold with an insurance company while I continue to process prescriptions and such.  I offered to call the insurance company and see what I could figure out.

After 15 minutes on hold, I let the spouse know that I would be glad to continue the process and would give her a call when we figured it out.  I finally got through to someone, explained the situation and that we needed to change the date on the authorization so we could submit the claim and get a refund for THEIR CLIENT, and the young lady on the other line kindly explained to me that it was not her department, she could not authorize the change and she would gladly get someone on the phone for me who could help me.  This process went on for 70 minutes and 4 different transfers before the issue was resolved.

The catch is, by resolving this issue with excellent customer service and patient satisfaction; we decrease our reimbursement by 15% in order to accept assignment.  On the other side of the coin, the spouse brought us a wonderful box of chocolates and was more grateful for our efforts than words can describe!

So I ask again, “What makes a great community pharmacy”?

Is it the availability of the pharmacists, their willingness to work with you, the different services they offer, that they know your name every time you walk in the door, or one of many other factors we use when we are choosing which community pharmacy we frequent.

As a community pharmacist myself, I would like to think it is a combination of all of these items; however, I believe Customer Service is the number one factor. 

Thanks
Steve

Copyright AudibleRx (TM), all rights reserved.