Pharmacy Automation and Funding Models

• These study notes cover key aspects of hospital pharmacy theory, including healthcare in Canada, managed care, automation in pharmacy, long-term care, and the functions of a hospital pharmacy department.

Healthcare in Canada - Canada Health Act (CHA)

• Enacted in 1984, the CHA ensures reasonable access to insured health services for eligible Canadian residents on a prepaid basis, without direct charges at the point of service.
• Provinces and territories must meet specific criteria and conditions defined by the CHA to receive full federal cash contributions under the Canada Health Transfer (CHT).

Five Criteria of the CHA

• Public Administration: The insurance plan must be administered and operated on a non-profit basis by a public authority accountable to the provincial government.
• Comprehensiveness: The plan must cover all medically necessary services, including hospitals and physicians, inpatient care, necessary drugs and supplies, diagnostic tests, and outpatient services after discharge.
• Universality: Insurance benefits must be provided on uniform terms and conditions to all insured residents.
• Accessibility: The plan must provide reasonable access to all services without exclusion or barriers, and prohibit discrimination based on income, age, or health status.
• Portability: Coverage must be granted when moving to another province, with limited coverage available outside of Canada.

Financing and Excluded Services

• Provinces and territories have autonomy in determining how to finance health insurance plans, including premiums, payroll taxes, sales taxes, and other revenues.
• Premiums are allowed as long as residents are not denied coverage for medically necessary services due to inability to pay; financial assistance is often available for low-income residents.
• Services not considered medically necessary, such as preferred hospital accommodation, private duty nursing, telephones, televisions, prescription renewals by telephone, medical certificates, and testimony in court are generally excluded.

Canadian Healthcare System

• The Federal Government assures quality of care through national standards guided by the CHA.
• Provinces and territories administer and manage healthcare based on need, which is not affected by job change.
• Public funding comes from federal and provincial/territorial governments, mainly through income taxes.
• Patients generally do not pay deductibles on basic healthcare but may pay for some services like ambulance or devices, with low co-payments for certain services and health premiums in some provinces like Ontario.

Coverage Types

• Universal coverage includes all hospital and emergency care.
• Physicians are typically billed directly to provincial insurance plans, with private insurance covering minimal parts, and specialists require a GP referral.
• Pharmaceuticals are variably covered, with provincial programs for seniors/social assistance/disability and programs like Trillium in Ontario for low-income individuals.
• Dental coverage is limited to emergency services in hospitals, and vision coverage is provided for children, seniors, and individuals with certain conditions like diabetes.

Responsibilities and Funding

• Federal Government: Sets and administers national standards, provides financial support to provinces, and delivers direct healthcare to specific groups, including veterans and First Nations.
• Provincial Government: Manages and delivers healthcare services, plans and finances hospital and physician care, manages drug prescription care, and utilizes federal and provincial taxes.
• 30% of healthcare is privately funded, covering non-insured or partially covered services like prescriptions, dental, and optometry.
• Public contributions come from benefactors, inheritance, and promotional programs.

Threats to the Healthcare System

• Increased costs result from inflation, demographics, scientific progression, population growth, shorter hospital stays, new outbreaks, and self-medication. Longer wait times, aging populations, shortage of healthcare providers, and emergency room overcrowding pose ongoing challenges.

Hospital Departments and Their Functions

• Key departments include Admitting (patient registration), Emergency Department (urgent care), Outpatient Clinics (routine medical check-ups), Nursing Units (inpatient care), and Radiology (imaging tests).
• Support departments include Pharmacy (medication dispensing), Central Supply Department (CSD) (equipment sterilization), and Cafeteria/Gift Shop (food and retail services).
• General hospitals, convalescent hospitals, chronic care facilities, psychiatric hospitals, addiction treatment centers, and rehabilitation hospitals represent different hospital classifications.

Hospital Roles and Medical Staff

• Hospital roles include emergency services, medical and surgical treatments, rehabilitation, and palliative care.
• Medical staff include active staff physicians (permanent, often specialists), courtesy staff (family physicians), residents (licensed physicians in training), and clinical clerks (medical students).
• The Medical Advisory Committee (MAC) regulates and supervises medical staff activities, addresses professional practice, and reports to the hospital board.

Hospital Mission, Vision, and Values

• Mission: Defines the hospital's purpose.
• Vision: Guides objectives.
• Values: Provides underlying principles.

Board of Directors

• Consists of the CEO/President and volunteers with experience in clinical, financial, legal, and technological areas.
• Responsibilities: include overseeing strategic plans, approving budgets, managing risk, and evaluating the CEO's performance.

Accreditation

• A quality improvement tool involving self and peer assessments by healthcare organizations to meet established standards.
• Accreditation Canada comprises 14 voluntary members including physicians and nurses.

Accreditation Process

• Each organization self-assesses against established standards, undergoes an on-site survey by an accreditation team, receives a report with recommendations, and develops an action plan.
• Accreditation is important for evaluating program quality, ensuring compliance with standards, instilling confidence, supporting the hospital's mission, and attracting qualified staff.

Managed Care in Canada

• Refers to the National Health Insurance System (NHS).
• Based on the Canada Health Act.
• This Act ensures uniform services, no point-of-service charges, and requires presentation of a health card for eligible services.
• Funded through income tax.

Managed Care and Pharmacy

• Includes provincial drug formularies, generic substitution, co-payments/deductibles, drug evaluation, evidence-based medicine, patient education, group purchasing, and third-party payors.

Automation and Technology in Pharmacy and Nursing

• Automation involves mechanical systems for packaging, dispensing, distribution, and transaction information.
• Important for expanding capabilities, improving efficiencies, accuracy, patient safety, and service quality. Pharmacy vs Nursing Technologies:

Pharmacy Technologies

• Robotic Pharmacy: Controlled storage, medication selection, returns, increased accuracy, reduced missing medications.
• PACMed: Automated packaging and dispensing including unit-dose packaging and cabinet replenishment.
• ΒΑΧΑ ΤΡΝ Compounder: Automates compounding of sterile ingredients, verifying with bar codes
• Helps reduce the need for manual additions by pumping volumes as low as 0.2 mL
• Can prepare a 3L patient-ready TPN bag in approximately four minutes.
• Provides detailed reporting on calibration activities, pumping accuracy and individual patient formulas.

Nursing Technologies

• Automated Dispensing Systems (Acudose/Pyxis/Omnicell): Offer varied drawer capacity and security.
• Acudose Product: Locks meds until selected; alerts if incorrect.
• Alaris Medication Administration Pumps: Administers fluids and medications
• Fluids can be delivered continuously (Primary) or intermittently (Secondary)
• Alaris Medication Administration Pumps: administer IV fluids,medications, blood and blood products.
• Information and Software Systems improves patient information organization in healthcare settings and leads to better care; includes eMar and CPOE.

Computerized Physician Order Entry (CPOE)

• Process of digitally entering orders eliminating handwritten or transcription errors
• Systems provide automatic reminders, dosage warnings, drug interaction alerts, and access to lab values.
• Bar Code Technology allows for accurate dispensing and administration, reduces errors by 97%, and improves efficiency and safety.

Other Pharmacy Technologies

• Robotic Couriers are used for secure, programmed transport of medications and samples throughout hospitals.
• Remote Dispensing Locations allow prescription acceptance via pharmacist review and counseling through video conferencing, with technology dispensing medications.

Pharmacy Technician's Role With Automation

• They handle computer information input, stock replenishment, expiry date checks, resolution of technical issues, and equipment maintenance.
• Expanded roles include "superusers" or "site administrators".

Common Challenges of Hospital Technology

• Includes complexity, design, maintenance, staff training, and downtime impacts.
• Focus is set on whether the technology will provide increasing efficiencies.

Long-Term Care (LTC)

• Provides 24/7 care for individuals unable to live independently.
• Short Stay: Up to 60 days, with expectation of return home.
• Respite Care provides relief to caregivers.
• Long Stay: For permanent residents requiring 24-hour care.
• Other types of care: Home care, Retirement home, Group Home, Hospice

Types of Homes

• Retirement Homes: Privately owned, regulated under the Retirement Homes Act.
• Group Homes: Supportive housing for disabled individuals, government-funded.
• Hospice: End-of-life facilities with majority privately funded.

Legislation for LTC

• Nursing Homes, Homes for the Aged and Charitable homes under one ministry
• Similar to other, but with Sections and regulations on Drugs, Pharmacy Service providers, Obtaining/keeping drugs
• Includes 2010 Act that defines provincial director roles, types of patients, care levels, facility layouts, and medication administration policies.

Ministry Standards applied to all provincial LTC Facilities

• This act covers changing of community needs, access and affordability, and HR

Pharmacy Services in LTC Facilities

• Ordering and dispensing, packaging, emergency medications, equipment control, med carts etc
• Clinical services
• Regular clinical reviews
• Patient medication hx collected on new admission

Types of Drug Distribution in LTC

• Individual, blister or UD.
• Advantages of Unit dose/multi-dose/blister pack:
• Reduced errors and more effiacy

Technician and Pharmacist roles in LTC

• Techs focus on order entry, generation of labels, packaging, record keeping, transportation arrangements, medication destruction, and physical facility visits.
• Pharmacists focus on MTM and clinical skills

Home Care

• Funding, benefits, types of patients, pharmacy services
• Aids those terminally ills, elderly
• Helps reduce healthcare costs
• Tech review drug, clinical support, assess
• Pharmacist can help with doctor orders, facilities and equipment.
• Non-Sterile Compounding, Compliance Packaging and Clinical Support Services
• Assessment And patient training (devices)
• Communicate with other healthcare professionals

Hospital Pharmacy Department

• Central Area (Core): Processes orders
• Sterial areas do what you expect
• Pharmacy Scope of Services is split into Admin, Tech, Clin

Types of Service Division

• Techs focus on med monitoring, etc
• Clinical do therapy monitoring, etc.
• It is a system/process by which health professionals in an institution evaluate and select drugs that are considered most useful in-patient care.

The Hospital Formulary

• List what med is to be stocked and how.
• organized by category
• Drugs are often added or deleted based on their clincial and drug safety

Differentiate Drug type for the board.

• Non means regularly provided
• Restricted drugs listed and have limited prescribers.
• For non formulary ones the drugs are not licensed and are rarely given due to cost or safety concerns.
• The form must be sent to the med board.

The process for Special Drug Access must be done by law, with certain saftey parameters kept.

Pharmaceutical Care

• Pharmaceutical care defines the need of drug adminsitration.
• Care requires for 9 steps relating to all pt data for treatment.

Explore the benefits of robotic pharmacy systems, automated dispensing systems, and medication packaging. Learn about features ensuring safe medication distribution. Differences between funding models for group homes and retirement homes in Ontario are discussed.