Change Packages
Pilot Period Materials and Results
(click below to view/download)
Flip the Pharmacy Change Packages
A Change Package is an implementation guide, in which the FtP initiative aims to provide bite size chunks of best practices that pharmacies across the country have implemented and share those with all pharmacies in order to transform pharmacy practice from filling a prescription at a moment in time to caring for patients over time.
The Flip the Pharmacy Change Packages are updated on a monthly basis.
Opioid Progression Change Packages
Opioid Change Package: Domain 1 (June 2020)
June 2020 begins the launch of the Opioid Progression 2 Change Packages.
There are several significant reasons why you should focus on documenting care plans for patients receiving an opioid prescription. Within the Change Package listen in to hear from Joe Moose at Moose Pharmacy and Attorney Shawn Parker with CPESN® USA discuss best practices for opioid safety.
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The goal of this month is to identify patients within the Appointment-Based Model who are taking opioid medications and begin documenting the indication and MME. During July, these patients will be followed-up with to discuss naloxone.
FtP Best Practices Webinar: June 2020
Best Practices & Additional Resources
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Word document to print Avery labels, specifically Avery 5160 Peel Address Labels.
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The label can be put on the back of opiate prescription hard copies, so that throughout the filling process, technicians and pharmacists can document:
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who checked the pdmp
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what the calculated MMEs are
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if naloxone was offered to patient and if the patient accepted naloxone
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Posted 6/10/2020
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Develop roles for each of your staff members for the first opioid change package
Posted 6/11/2020
Program Materials and Results
(click below to view/download)
Opioid Change Package: Domain 2 (July 2020)
The goal of this month is to follow up with patients or identify newly eligible patients for candidates of naloxone. If the pharmacy has not implemented a naloxone program, a guide to help is located within the change package.
FtP Best Practices Webinar: July 2020
Best Practices & Additional Resources
Posted 6/26/2020
​Pharmacy Resources for Naloxone Program Implementation
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Kelley-Ross Pharmacy has created some great pharmacist and patient materials surrounding naloxone. Click the link to the left to view the website.
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For implementing a naloxone program, click here to view numerous resources, including an implementation checklist for pharmacists, a blank naloxone collaborative drug therapy agreement, and FAQs
​Create Naloxone Training Resources for Pharmacy Staff
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Moose Pharmacy created a staff training guide when the North Carolina Standing Order was signed in July 2016.
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Create something similar to help your pharmacy staff understand their role and talking points with patients.
Posted 6/26/2020
Posted 6/26/2020
Ideas for Naloxone Distribution for Patients who Cannot Afford the Copay
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Deborah Bowers at Yorkville Pharmacy in SC shared that many states have programs in place that you may not know about for patients to receive naloxone at no charge. She stated that in SC they also have grant funding for lock boxes and disposal bags.
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Contact Community Anti-Drug Coalitions of America (CADCA)​ at 1-800-54-CADCA (1-800-542-2322) and ask for your local contact person. Describe to them your efforts in the opioid epidemic and ask if they have any offerings for your pharmacy and your patients.
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Posted 7/6/2020
Dispensing Opioid Prescriptions in Bottles with Red Caps
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North Star Pharmacy in Wyoming is dispensing opioid prescriptions in bottles with red caps to distinguish it from other prescriptions. The red caps trigger pharmacy staff to take special care with these types of prescriptions and have a meaningful conversation with the patient, along with counseling on the opioid prescription.
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The red caps also signifies to pharmacy staff to offer Deterra bags so the patient ​can destroy any unused opioid medication.
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Wyoming does not require red caps for opioid prescriptions unlike other states (i.e., Arizona) that do require red caps to be on opioid prescription vials.
Posted 7/9/2020
Create a Decision Tree
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Jackson Center Pharmacy uses a Decision Tree for their Opioid Protocol. Click the "Decision Tree" button to view the one Alison Haas, PharmD created.
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The tool helps them ensure each patient gets some form of counseling and education when they are receiving an opioid prescription.
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Patients with 50 MME or more receive more intensive education and counseling with the offer of naloxone. Those patients with < 50 MME at minimum receives counseling and opioid education.
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Documents referenced within Decision Tree:
​Share a Naloxone Educational Video with Patients
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Pete Kreckel shows patients a video about how to properly use Narcan or naloxone prior to patients leaving the pharmacy
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The video seen in the "View Here" is a Narcan educational video that Pete shares with patients.
Posted 7/9/2020
Posted 7/27/2020
​Create a Pharmacy / eCare Plan Vendor Specific Protocol for Opioid eCare Plan Documentation and Offering of Naloxone
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Emma Leffler, PharmD used the first 2 opioid change packages to implement their pharmacy-specific protocol for handling Opioid prescriptions. The overview protocol can be accessed by clicking the button.
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Emma also created 2 step-by-step documents for pharmacy staff to follow in order to document eCare Plans for different opioid-related scenarios
​Create and Post a Naloxone Flyer
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Brooke Weber, pharmacist, created a naloxone flyer to increase patient awareness of Naloxone.
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Since posting this in the waiting area, they have had several patients inquire about naloxone. Brooke said it has been a great conversation starter
Posted 8/11/2020
Opioid Change Package: Domain 3 (August 2020)
The focus is providing each patient receiving an opioid prescription with an Opioid Pledge that outlines the commitment of the pharmacy and the patient for opioid medications.
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Additionally, enhancing non-pharmacist support staff roles within the pharmacy is the second workflow innovation, regardless of health condition focus in the change package. Examples below are documents pharmacies have used to outline the roles of staff.
FtP Best Practices Webinar: August 2020
Best Practices & Additional Resources
Posted 7/30/2020
Develop non-pharmacist support staff roles at the pharmacy - click on the underlined text below to download the accompanying documents
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Begin with outlining the basic pharmacy workflow (Excel spreadsheet-Surgoinsville Pharmacy suggestions)
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Step 1: Create a document that outlines your specific store's daily duties from Open to Close (Workflow example document)
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Step 2: Divide duties into station duties (input, packaging, check-out, etc) and assign technicians to each station daily (Restructuring workflow document)
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Step 3: Make a detailed workflow for each station based on the job description for each (use the restructuring workflow document).
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Step 4: After you have done these things, assess your need for a clinical technician based on what services that you offer. This technician can be responsible for administrative tasks, creating the service, billing requirements, special certification and training requirements, policies and procedures, and scheduling.
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Step 5: Once you have a good workflow structure, you can easily add on services and tweak the station duties to fit your needs.
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For example, if you wanted to offer BP monitoring, the input technician could identify patients based on their profile. This can be applied to any disease state that you want to monitor. Opioid identification can be vetted by the input technician as well, or whichever station works best in your specific store.
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Posted 7/30/2020
Develop non-pharmacist support staff roles at the pharmacy and place final documents at each workstation
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Step 1: Brain storm ideas that each station does and finalize with the person who usually does that position
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Step 2: Print out, laminate, and post the document at each work station
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Step 3: Have the staff member check off the items with a dry erase marker as the person completes the task (if a daily task)
Customize your Pharmacy's Opioid Pledge and Implement
Posted 8/11/2020
Opioid Change Package: Domain 4 & 5 (September 2020)
The focus is on implementing aspects from Domains 4 and 5 of the Opioid Progression. We have a combined change package due to our COVID-19 response.
Ideas reviewed in the change package of how you can continue transforming your pharmacy practice:
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Implement a workflow for opioids prescribed for acute conditions
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Engage with patients receiving an opioid prescription for chronic pain and discuss their goals of treatment
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Share your opioid efforts with prescribers and other healthcare team members
FtP Best Practices Webinar: Sept 2020
Opioid Change Package: Domain 6 (October 2020)
At this point, Flip the Pharmacy participating pharmacies should have or are creating a sustainable practice around opioid medications. The goal is to continue offering these workflow innovations as we move into the next progression.
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For pharmacies who are ready to take the opioid progression to the next level, we have partnered with our Subject Matter Experts to help you do just that.
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Focus on the patient in more ways than just their medications – Social Determinants of Health
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Opioid Tapering
FtP Best Practices Webinar: Oct 2020
Coming Soon
COVID-19 Change Packages
Change Package #1 (3/24/2020)
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Objective: Integral to community pharmacies currently is focusing on protecting pharmacy staff and patients. This requires new workflows (practice transformation). Simultaneously, pharmacies need to be communicating the changes to patients.
Change Package #3 (4/17/2020)
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Objective: Helps to guide community pharmacies in applying for a CLIA Waiver in a straight-forward guidance document. *A how-to video is provided to help you fill out the form.*
Change Package #2 (4/8/2020)
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Objective: This document is intended to provide a stepwise, workflow approach for triaging patients suspected of COVID-19 and to develop a care plan for those patients.
Change Package #4 (5/15/2020)
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Objective: As community-based pharmacies consider reopening, learn what you need to consider when preparing to reopen your pharmacy to the patients you serve in your community while keeping pharmacy staff safe and healthy.
Hypertension Progression Change Packages
Change Package 1: Domain 1, Progression 1 (October 2019)
The focus of October 2019 is "Leveraging the Appointment Based Model (i.e., medication synchronization). Subject Matter Experts have stated that a great medication synchronization process is instrumental and necessary to begin transforming practice and documenting the care provided. Additionally, having a baseline of the pharmacy's current pharmacy practice is valuable to know which areas to focus on inititially and to reflect on improvement. Therefore, a pharmacy self-assessment is included in the change package as a link and you can click here to access the "Practice Transformation On-site Readiness Assessment for Coaches." Practice Transformation Coaches can be an external or internal source that will guide practice transformation efforts at the pharmacy.
The focus of November 2019 is "Improving Patient Follow-up and Monitoring," in which pharmacies are encouraged to continue enrolling patients into medication synchronization and following up on patients who previously received a care plan and have hypertension. Leading pharmacists stated that in order to be successful in this project, pharmacies must focus on certain health conditions. Beginning this month, the focus will be patients with hypertension. Included in this month's change package is a hypertension assessment for pharmacy staff members to ask patients who have hypertension during the follow up encounter. Additionally, the American Heart Association Blood Pressure Monitoring Training link is included for non-pharmacist staff members to get comfortable/knowledgeable about measuring blood pressure by December 2019.
The focus of December 2019 is "Developing New Roles for Non-Pharmacist Support Staff" and continuing to following-up with patients who have hypertension. The goal is to document blood pressure readings within the care plan. Blood pressure measurements can be done by any member of the pharmacy staff (non-pharmacists are encouraged to complete the AHA blood pressure monitoring training). Hear from your peers by listening to the podcast within the change package. The podcast is entitled "Progressive Staffing Models in Community Pharmacy Practice." View and complete the pharmacy reflection activity. The individual leading the pharmacy practice transformation efforts at your pharmacy is ideal for completing the activity. This information is intended to better help you think through your current workflow roles. In future months, the change package will be focused on improving these roles.
The focus of January is continuing to document blood pressure readings for patients – we completely understand that it is the first of the year so we want to continue documenting care plan components that we have seen before. Also, included in the change package are ideas for communication tools created by our friends with the ACT Collaborative and you can hear from peers about maximizing technology tools to build a more efficient pharmacy operations or workflow.
The focus of February is to establish and foster your relationship with one of your top prescribers for your mutual patients. This is a great time introduce your capabilities to the provider for mutual patients with hypertension. As you begin to start communicating medication related problems with providers through your preferred method, you can document those interactions under the care coordination notes within the eCare Plan.
The focus of the March Change Package is to is to help you better understand how community-based pharmacy fits in to measures that impact prescribers. Knowing this information will help you accomplish the ultimate goal of this Domain, which is to better understand your patient data within the pharmacy in a way that you may not have thought about before. In turn, the data and additional materials within the change package will help prescribers understand your value as you do so much more for patients that only dispensing their medications.
Resource for Current Flip the Pharmacy Practice Transformation Teams -
Ask a Question of the Coordinating Center
If you are currently participating in Flip the Pharmacy as a coach or pharmacy, please take your question to the Lead of your Practice Transformation Team.
If you are a PTT team Lead and you have a question for the coordinating center, please use this form to submit it instead of using email.
This form will allow the Flip the Pharmacy Coordinating Center to more efficiently route your question to the appropriate team member, and you will either receive a direct response via email or a response via the FtP listserv, if the Coordinating Center believes your question is relevant to all participants.
Your question may also be addressed on an upcoming program webinar.