a publication for pharmacy colleagues

Issue 22 July 2010

Online at qmonthly.cvscaremark.com

Industry News
Deficit panel eyes another bite at health care

Concern over rising U.S. debt could force lawmakers to take another crack at reining in health care costs long before any promised savings from President Barack Obamas sweeping overhaul are realized. The new health care law, signed by Obama in March, seeks to save the elderly about $500 billion through the Medicare government health care program for the elderly over the next decade without reducing basic benefits. But deficit hawks and even some supporters of the overhaul say more cuts are needed to improve the long-term U.S. budget outlook. The Democratic-controlled Congress is unlikely to rewrite the new law, but some experts believe more could be done to speed up Medicare payment reforms and expand other cost-saving measures in the new law. When it comes to reducing the deficit, Medicare and other government health care programs are bigticket items. The aging 78-million strong baby boom generation and rising medical costs will continue to put pressure on government spending.
Source: Smith, Donna; David Alexander and Paul Simao. Deficit panel eyes another bite at health care. Reuters online. 21 June 21, 2010.

New metrics give a glimpse into drive-thru best practices

With the launch of the new CVS/pharmacy drive-thru sensor technology in more than 3,000 stores, processes have been put in place to begin documenting, studying and reacting to the data it generates. Starting this month, field management teams will be able to view reports on a weekly basis that capture drive-thru traffic patterns as well as outline the drive-thru window behaviors, and will then be able to communicate these results to the Pharmacies in their Regions to further enhance the patient experience. With these new reports and metrics, the field management teams will be given a view into the drive-thru business that they havent had before, says Donna St. Jean, Manager, Pharmacy Operations. Because of the new sensors, we are able to capture and document how many patients use the drive-thru daily, the time of day they visit our stores, specific traffic patterns, average patient wait time at the window and even average amount of time a patient waits for the transaction to be completed, she says. The first pilot report included data from more than 2,800 stores and was delivered to field management teams in mid-June. The chain-level statistics from that report recorded the following data within a one-week period: Drive-thru saw more than 1.4 million vehicles Average greet time was 30 seconds Average transaction time was 2:59 minutes These numbers are helping to pave the way for enhanced patient service and a better patient experience when using the drive-thru. Our target greeting time needs to be consistent with our phone greeting time, which is 20 seconds or less, says St. Jean. It is only by shedding light on our drive-thru greet time that we are able to act on it. Here are some actions you can take to have an immediate impact on your Pharmacy drive-thru scores: Be sure to greet all drive-thru customers in a timely fashion, and prioritize the drive-thru over other non-customer-facing activities. Even if you cannot greet the customer faceto-face immediately, use the phone to let them know you will be right with them. Follow PSI principals to prevent issues at the time of pickup, including properly setting customer expectations at the time of drop-off, ensuring all customers are contacted when a problem arises and documenting that contact on an Action Note. We are thrilled to directly deliver on our mission to provide expert care and innovative solutions that are effective and easy for our patients, says St. Jean. This new view into the drive-thru business will provide the feedback our teams to need to make significant improvements in drive-thru patient service satisfaction.

Medicare helps low-income beneficiaries save big

Answering the call for help with New Script Pick-ups

More Medicare beneficiaries will qualify for Extra Help with their prescription drug costs, and be eligible to pay no more than $2.50 for generic drugs and $6.30 for each brand name drug thanks to changes to Medicares Low-Income Subsidy Program (also known as LIS or Extra Help) that takes effect this year. These changes make it easier than ever for people on Medicare with limited incomes to save on their drug costs. The Centers for Medicare & Medicaid Services estimate that Extra Help can save eligible Medicare beneficiaries as much as $3,900 per year. It is estimated that more than 1.8 million people with Medicare may be eligible for Extra Help, but are not currently enrolled to take advantage of these savings. To qualify, Medicare beneficiaries incomes must be less than $16,245 a year (or $21,855 for married couples) and have resources limited to $12,510 (or $25,010 for married couples).
Source: Medicare provides assistance to help low income beneficiaries get big savings on prescription drug costs. Centers for Medicare & Medicaid Services. 1 June 2010.

The current state of the economy has created additional barriers to medication adherence, and our Pharmacy Teams continue to do an outstanding job of encouraging our patients to stay adherent on their medications. However, as the economic environment remains challenged, the opportunity to influence patient behavior grows. It is our responsibility to help our patients stay adherent and keep them on their prescribed medications, and help them overcome every obstacle we possibly can, says Sid Sahni, Director of Retail Pharmacy Operations. Our patients rely on us to provide them with the best care possible, so our responsibility to help them is even greater at a time like this. In order to better influence a greater number of patients and complement Pharmacists existing adherence efforts, enhancements have been made to the Patient Care Initiative (PCI) program, including a renewed focus on New Script Pick-up calls. While the program remains the same, the Pharmacy Operations team has created daily voice message reminders to help Pharmacists remember to call
One CVS Drive Woonsocket, R.I. 02895 [email protected]

patients on the New Script Pick-up report each day. We recognize that, on any given day, our Pharmacists are incredibly busy serving our patients. They get increasingly busy during the late afternoon which also happens to be the optimum calling window and making New Script Pick-up calls may slip their mind, Sahni says. The new voice mail messages will be delivered every day between 4 p.m. and 6 p.m., and will serve as a friendly reminder for Pharmacists to make the calls. The New Script Pick-up program is an excellent opportunity for Pharmacists to interact with our most vulnerable patients and help them stay on track by having them pick up their medications and begin the appropriate therapy, Sahni says. It is incredibly important that these calls are made each day because our patients appreciate the reminder as well as the personalized counseling many of them receive as a result. Be sure to keep an ear out for these new reminder messages and act on them! This small outreach makes an enormous impact on our patients health.

A sneak peek at PCI Connect!

Starting next month, CVS Caremark will begin launching PCI Connect, an enhancement to PCI that includes new features to help manage PCI activities online in RxConnect. PCI Connect will help improve the efficiency with which PCI activities are performed, thereby allowing you to spend more time where it is most valued with your patients. Through PCI Connect, you will now have access to several exciting, new features to help manage PCI activities, including: A Patient Care Queue (PCQ) to help manage and schedule your PCI calls at the best times to reach patients Customized on-screen messages that support conversations during outreach calls An Open Action Items list that includes recent PCI outreach calls made from your store A label-receipt message for every prescription identified, real-time, for First-Fill Counseling In addition to streamlining current PCI activities, PCI Connect will establish the foundation for our future patient care programs. Approximately 40 percent of stores will receive PCI Connect in August, with the remaining 60 percent going live in October. In the coming months, be sure to keep an eye out for the training and implementation schedule for your store!

Customer Service Best Practices

It is my belief that you must first earn the respect of the patients and then be proactive in their treatment plan. It is also important to take the initiative to call the physician if the medications are not producing the desired result. I see smiles when my patients come in and they see that I am on duty that day, and this makes the extra effort worth it. We provide personal care, personal trust, and personal respect. As a result of our interventions, we can make a difference in peoples lives, and they are more apt to stay lifelong patients with us.
Roderick Deal, R.Ph. Store #7608, Nashville, Tenn.

Quality Corner
Ophthalmic and otic script preparations
Prescriptions written for ophthalmic and otic preparations can create challenges during the filling process. Contributors such as legibility issues, lookalike packaging, off-label uses and similar dosage forms require our Pharmacy Teams to pay special attention to seemingly minor details. For example, you will occasionally see a prescription for eye drops to be used in the ear but you should never use ear drops in the eye. When eardrops are mistakenly instilled in a patients eyes the patient will immediately complain of a stinging or burning sensation and the eyes will become red and irritated. Some best practices that should be followed to ensure that the correct product is dispensed are as follows: Data entry Always thoroughly examine any prescription at drop off that is written for an ophthalmic or otic preparation. Double-check the directions to make sure they make sense. Often times the abbreviations for eyes and ears can be misleading due to legibility issues. Pay special attention to sound or look-alike terms such as optic versus otic. Pay close attention to computer messaging regarding look-alike drug names and other error prone medications. Never try to guess. Clarify any questions, ask the patient or caregiver why the medication was prescribed, and contact the prescriber if necessary. Production

Company News
And the survey says Pharmacists weigh in on favorite RxConnect features
Last month the Pharmacy Operations team conducted the RxConnect Favorite Features survey in order to learn more about your favorite things about the new pharmacy computer system and how these features make your job easier at each workstation. More than 300 Pharmacists and Pharmacy Team members participated in the online survey. Here is what you said you love about RxConnect The hottest feature at Drop-off is Instant access to copays, via (F12), Adjudication Status Indicator. Many of you agreed with the person who said, Its so easy! You can quickly tell the patient what the copay is and be sure that the prescription has been successfully adjudicated before the patient leaves. Print Next Batch (P) at Production is making the workflow process quicker. You told us you love being able to choose P to print labels for the next 3 families (up to 10 labels) by just scanning your credentials once! Pharmacists agreed that, at Verification, the ability to View the Profile from both verification screens, (F5), is one of your favorite features. Check Fill Status (S) at Pick-up is great! If the patient or caregiver does not know how many prescriptions theyre picking up, its easy to find the prescriptions and the customer leaves with everything they need. Top five features we love Did you know? By just entering the queue name like QE, QP, etc. in the navigation bar, you can access any queue directly from Patient Profile or from any other queue. No need to exit to the Main Menu to access the queues, which saves key strokes. We love this time-saving feature: Use the View Pending (VP) option from the Navigation bar at Patient Profile to display prescriptions that are on hold, scheduled, or ReadyFill-enrolled and to view their fill dates. From Verification, you now have the ability to view the original hardcopy image of a chain transfer prescription, as long as it is from an RxConnect store into an RxConnect store. Simply enter (V) in the Navigation bar during the Data Entry Verification screen. Make your job easier! When authorizing a refill renewal request using the hardcopy fax, scan the barcode in the upper right hand corner to initiate the request from the QR queue or from the Main Menu. What else can RxConnect do? Use Previous Rx Image (P) to load the previous image at Drop-off when data entering multiple prescriptions written on one prescription blank. To view the rest of the RxConnect survey results, visit the RxConnect Support page on RxNet.

Clinical Pearls
Leaves of three let them be!
Poison ivy is the most common plant-based cause of allergic contact dermatitis in the United States. It features three leaves that are connected by a central stem and may exist as a climbing vine or shrub. Along with poison oak and sumac, poison ivy is a member of the Toxicodendron species, which is characterized by the production of the chemical Urushiol, which is responsible for the hypersensitivity reaction produced upon contact with these plants. Urushiol remains active even in dead plants and becomes airborne when its sources are burned. If a patient is exposed to poison ivy, he or she should wash the area with soap and water immediately. The area under the fingernails should also be thoroughly cleaned, as this is the most common way poison ivy is spread to other parts of the body. Patients may also choose to cleanse with Zanafel, an over-the-counter (OTC) wash that may bind and remove additional Urushiol. Despite these measures, 50 percent of those exposed will develop itching, redness, and warmth within two to 48 hours. The hallmark rash of poison ivy can last anywhere from one to three weeks. OTC treatment options include topical corticosteroids, oral antihistamines, and colloidal oatmeal. Hydrocortisone cream 1% can be applied two to four times daily as needed; areas treated with a topical corticosteroid should not be covered. To further assist with itching, recommend Benadryl (diphenhydramine) 25-50 mg by mouth every six to eight hours as needed. Diphenhydramine can cause drowsiness in patients, so caution should be taken when administering this medication to the elderly. Colloidal oatmeal baths, such as Aveeno, are also effective for widespread itching. Topical antihistamines should not be used because they may further irritate the dermatitis. Patients should call their health care provider when the rash is widespread, features pus-filled blisters, or involves the eyes, genitals, or mouth. The best way to prevent allergic contact dermatitis is to prevent exposure whenever possible; providing a visual example of the plant serves as a strong educational tool. Patients may apply IvyBlock (betoquatam), an organoclay lotion, prior to being near poison ivy, which creates a physical barrier and prevents the absorption of Urushiol into the skin. Pharmacists should also recommend that patients wear protective clothing and clean their belongings with soap and water when in endemic areas. Pets, recreational equipment and garden tools should also be cleaned after use or exposure to the plant. Contaminated clothing should be washed separately from other laundry.
Sarah Moran, Pharm.D. Community Practice Resident One CVS Drive Woonsocket, R.I. 02895 [email protected]

Never store eye drops and ear drops side-byside on the pharmacy shelf. Clearly separate and distinguish optic solution from otic suspension. Accurate product selection is supported with bar code scanning technology. Proper utilization of accuracy scan procedures will help prevent this type of error from occurring. Always attach the appropriate auxiliary label to the product that you are dispensing. Verification The Pharmacist should first interpret the scanned prescription image before reviewing data entry for accuracy. Pay close attention to computer messaging regarding look-alike drug names and other error prone medications. Mix-ups when dispensing ear drops and eye drops can be minimized by adhering to these best practices. Compliance with these simple steps can minimize the potential for human error and prevent this type of adverse drug effect.
Kevin Masci, Manager, Quality Assurance and Patient Safety