Bringing pharmacist training back home’
Program orients pharmacists to home infusion
You realize that professional development and staff competency are critical, but are you making sure that all employees are evaluated regularly? Many agencies concentrate on nursing staff but overlook other professionals, such as home infusion pharmacists. But doing so is a mistake. First and foremost, it is necessary for the provision of quality care; in addition, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires evidence of initial and ongoing development and competency for professional staff. And don’t forget the competitive advantage a thorough educational program has when chasing those managed care contracts.
But how do you go about training new home infusion pharmacists when experienced preceptors are not always available? Where can you turn to evaluate your pharmacist’s home infusion skills?
Farmington Hills, MI-based Amicare Management Services, a management services provider to its own agencies and recently to external organizations, has developed an in-depth, competency-based program for training new home infusion pharmacists. This orientation program also provides a framework for assessing and maintaining ongoing competency.
"We have sites throughout Michigan and Iowa," notes Lynne Farkas, RN, BSN, clinical infusion specialist for Amicare. "The pharmacists who were providing clinical management for the infusion program came from diverse backgrounds, and there was not a consistent orientation process in place."
As is frequently the case with home infusion, pharmacists often come from backgrounds other than home care, such as retail or hospital pharmacies.
"Even though they were excellent pharmacists and proficient at drug therapies, compounding, and aseptic technique, many of them did not have a lot of experience with home infusion," says Farkas.
This, combined with the geographic spread of each location, presented a challenge for both the organization and the pharmacists.
Sally Maier, RPh, PharmD, a home infusion pharmacist for Amicare’s Mercy Health Center in Dubuque, IA, says the resulting problems were obvious.
"Each location had different expectations about the home infusion pharmacist’s role," she says. "There were varying levels of orientation, training, and skill.
"When most of us were in school, home infusion was fairly new, so there weren’t many programs that actually gave training or guidance in this," explains Maier. "It can be very high-risk, and baseline competencies are required before you can provide safe, efficient care."
For example, home infusion pharmacists are involved in multiple aspects of the client’s care from admission to discharge, a huge difference from their hospital-based peers.
Training is systematic
"In addition, the quality and consistency of training is often dependent on a preceptor," says Farkas. "Our program makes orientation a much more objective and measurable process. It eliminates the chance that a preceptor may not adequately cover a topic or will perhaps miss it altogether. The content, learning resources, and evaluation methods have all been detailed and provided." (See sample, inserted in this issue.)
Such a program provides Amicare and its pharmacists with obvious benefits.
"As a result of the competency based orientation program, new pharmacists receive a more complete and consistent orientation," says Maier. "There are written lists of the knowledge requirements and tools they can use to measure their competency and skills. Now all our home infusion locations have a standardized method for training and evaluating the competency of the new pharmacist."
Developing a competency-based orientation program requires a great deal of time and commitment. Amicare offers the following steps it took in developing its program:
p Form a committee of experts.
First, a task force of experienced home infusion staff from across the system was formed. This group included four home infusion pharmacists (including Maier), Amicare’s quality improvement/risk management specialist, the director of infusion services, and Farkas.
Because task force members were located throughout two states, much of the planning was done over the telephone using conference calls. Several day-long planning sessions were conducted in person.
p Identify competencies.
Next, the competencies required of a home infusion pharmacist must be determined.
"The task force identified what we wanted the professionals to know: the expected knowledge, behaviors, and skills we wanted them to have," says Farkas.
These areas were selected after a thorough review of the literature, standards of practice for the industry, as well as regulatory and accreditation requirements.
p Identify learning resources.
It was one thing to know what areas the pharmacists should be competent in but quite another to provide them with all the learning resources for each subject area. So the task force began an intensive search for materials that would provide the necessary education and training. Such resources ranged from current articles to CE offerings and videotapes.
"If we didn’t have a particular learning resource, we developed one," notes Farkas. "I would say we were able to acquire about 75% from outside sources." Many of the learning resources were acquired or developed using Joint Commission standards as well as standards from the American Society of Health-System Pharmacists (ASHP) and articles from American Journal of Health-System Pharmacy.
Other useful tools were Occupational Safety and Health Administration standards on the management of hazardous drugs as well as Amicare’s internal policies and job descriptions.
p Develop tools to evaluate understanding and competency.
Once the competencies and learning resources had been identified, the task force developed testing methods. However, not all areas were applicable to the same type of test.
Some areas only needed to be completed and initialed on a checklist, whereas others required written exams or skills observation (i.e., compounding, process simulations for aseptic technique). Chart audits were also used to evaluate documentation and clinical management skills.
While the above testing methods were developed for use in the initial orientation of pharmacists, an abbreviated version was also created for those who had already been on staff, to make sure competency in core areas of knowledge were assessed and maintained. Certain parts of the program are also now part of the yearly performance evaluation process. Pharmacists complete a different version of the written exam, a chart audit, and an abbreviated skills checklist.
Farkas notes the program is self directed.
"Although a time-line for completion should be established by the manager or supervisor, the pharmacists can complete the program at their own pace," she says.
Depending on the experience of the new hire, the entire program at this point in the development takes anywhere from two to four weeks to complete.
More to come
As complete and in-depth as all this may sound, Farkas says the program is evolving. Now that the operational side is in place, Amicare plans to add a therapy-specific section. Some of the targeted areas for development include antibiotics, parenteral nutrition, pain management, and chemotherapy.
Maier agrees this is an ongoing process. "I see it as something that is going to continue to grow and develop," she says. "I don’t think we’ll ever get to a point where we can say we’re finished because there will always be new home infusion standards or new therapies."
The orientation program is too new to note any quantifiable results, but so far Farkas judges the program a success. Average exam score results were 95%, and most of the pharmacists surveyed felt the orientation had significantly increased their knowledge of home infusion, says Farkas. Even those pharmacists who were already in the home infusion role felt the program helped "fill in some gaps."
Clinical quality generally improves when care is provided by trained and competent staff. Maier notes, however, that "we still need to collect data to help us validate improvements in care delivery and client outcomes."
Even though the program is still in its early stages, it has already been used as a selling point when bidding on managed care contracts.
While Amicare is using the program among its 10 infusion locations, an agency of any size can benefit.
"What you need to know to provide quality home infusion therapy isn’t necessarily determined by how many sites you have," Maier points out. "Many issues are the same if you have one site or 100 sites."
Additionally, the format can be adapted for use with disciplines other than pharmacy.
For more information on Amicare’s home infusion pharmacists competency based program, call Farkas at (248) 305-7713.
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