TY - JOUR
AU - Clark, John, S.
AB - Open in new tabDownload slide Open in new tabDownload slide The standards of the Accreditation Council for Pharmacy Education (ACPE) for doctor of pharmacy programs require pharmacy curricula to provide students with introductory pharmacy practice experiences (IPPEs), which are defined as “practice experiences offered in various practice environments during the early sequencing of the pharmacy curriculum for the purposes of providing transitional experiential activities and active learning.”1,2 According to the standards, IPPEs “must involve actual practice experiences in community and institutional settings and permit students, under appropriate supervision and as permitted by practice regulations, to assume direct patient care responsibilities,” and they should “continue in a progressive manner leading to entry into the advanced pharmacy practice experiences.” IPPEs must constitute at least 5% of a curriculum’s length (at least 300 hours); this is a substantial increase from previous experiential education requirements that has challenged schools of pharmacy to identify creative ways to meet the IPPE requirements with existing (and often strained) resources. A number of experiential programs involve shadowing experiences, service learning, vaccination programs, actual patient encounters in a variety of settings (e.g., inpatient venues, home care), and other innovative approaches.3–12 However, the need for IPPEs becomes greater as pharmacy school enrollments continue to increase, stretching the capacity of health systems to support these experiences.13 As the primary experiential teaching site for a college of pharmacy, we worked together to develop and implement an institutional direct patient care (DPC) IPPE to help the college meet the increased standard for experiential learning. We viewed the development of the DPC IPPE as an opportunity to engage students in meeting the institution’s needs to enhance medication reconciliation on admission, as required by the Joint Commission’s national patient safety goals, while achieving the predefined ability-based outcomes.14 This opportunity provided a learning experience for the students while enabling them to contribute meaningfully to the care of patients. ACPE guideline 14.4 states that IPPEs should allow students to assume DPC responsibilities under appropriate supervision.1 Available evidence suggests that pharmacy students can ably perform medication reconciliation at the time of hospital admission. Padiyara15 reported that students added value to the care pharmacists provide by evaluating medication histories and making interventions to improve medication documentation and patient-centered care. Mersfelder and Bickel16 demonstrated that admission medication reconciliation activities performed by students improved the completeness and accuracy of more than 67% of patient medication records. Both of those studies involved fourth-year pharmacy students; our DPC IPPE was designed for third-year students. We first sought to identify an appropriate patient population for targeting the DPC IPPE activities and to define the potential student workload. We identified a medical service staffed primarily by hospitalist physicians—the medicine faculty hospitalists (MFH) service—that was not currently covered by a clinical specialist. The physicians are at the attending level and typically do not have residents or trainees on their service. As our pharmacy department had worked with the MFH physicians on other initiatives, we identified this as a good opportunity for the DPC IPPE activities. We worked with the college of pharmacy to pilot test the activities with one part-time and two full-time pharmacy interns over the summer (May–August 2009) to (1) define the work processes, (2) better understand the potential workload for students and preceptors, (3) identify types of potential discrepancies and interventions likely to be encountered, and (4) develop training and orientation materials and data collection forms. The interns were third-year students (i.e., at the same academic level as the students who would perform the activities). We developed a schedule and a list of procedures for medication reconciliation, and we had daily meetings to discuss the process. Through this approach, which we believe was invaluable to the development and ultimate success of the IPPE, we were able to accomplish the following: Design and refine an appropriate and efficient work process for the students to identify patients and complete a medication reconciliation, including taking a medication history, documenting findings and discrepancies, discussing findings with a preceptor, and entering data into the electronic medical record. Design appropriate data collection sheets for medication reconciliation. Identify barriers and challenges students may face when taking medication histories. Estimate the workload for students and preceptors. Identify and develop resources for students and preceptors (e.g., computers, access to hospital computer systems, templates and instructions for entering data into the electronic medical record, a list of common drug interactions and preferred formulary agents and substitutions, standard language to facilitate communication of findings to prescribers by pager). Develop guidelines for students, orientation materials (also recorded and posted on the course website), and a schedule for preceptors. Based on the results of the pilot, we developed a final plan for the DPC IPPE. Students would be divided into groups, and each group would attend the DPC IPPE one day per week from Monday to Thursday. We estimated that we could accommodate approximately 6 students on each of the four days (24 students per week). We developed a plan to minimize the workload for any one preceptor and ensure appropriate supervision of the students; to achieve that, we involved almost every pharmacist in our department. All students are precepted by a pharmacist practicing in a DPC role (clinical specialists and generalists) or a management role, and the student:preceptor ratio is 1:1. Students are assigned to complete medication reconciliation for all patients within three days of admission to the MFH service. Each student is assigned to cover a specific patient care area and must complete medication reconciliation for all MFH patients meeting criteria in his or her assigned area; the six students are expected to work as a team to divide the workload fairly and ensure that all patients are covered. Each day, the students must maintain a list of patients for whom medication reconciliation was completed and communicate that information to the students scheduled for the next day (students working on Monday begin by reviewing data on patients admitted on the previous Friday). Students are required to complete the following medication reconciliation steps: Review the patient’s admission history, physical examination results, and other pertinent information. Review medications being taken prior to admission (as indicated by the admission history and physical examination results documented in the electronic medical record) and current inpatient medications. Go to the patient care unit, seek out and meet the patient’s nurse, address any questions (e.g., patient status, appropriateness of the timing of the interview), and determine if the patient is currently available. Conduct a patient interview and medication history. Identify potential discrepancies by comparing gathered information. Contact the preceptor to meet briefly and discuss patient cases and potential discrepancies; then create draft pharmacy notes in the electronic medical record. Forward the pharmacy notes to the preceptor for editing and approval before the notes become part of the permanent medical record. If potential discrepancies are identified, page the responsible physician to inform him or her that medication reconciliation has been completed and request that the physician review the pharmacy notes to address any discrepancies (if urgent issues are identified, the student and preceptor page the physician to request immediate action). Thus far we have compiled two semesters of experience with the DPC IPPE and assessed some data for one semester. Overall, the DPC IPPE seems to provide a valuable learning experience for third-year students. Self-assessment surveys were given to the students before and after the experience to assess attitudes toward the process and to gauge their understanding of and ability to perform medication reconciliation. Preliminary review of the survey responses indicates that students have a positive attitude toward the process and are aware of its importance. The survey results also indicate improvements in students’ understanding of medication reconciliation and the pharmacist’s role in the process, as well as their ability to collect and assess pertinent data, reconcile medications, and communicate discrepancies to other health care professionals. Written comments of students at the end of the first semester revealed that most believed it was a valuable learning experience. In particular, students reported gains in confidence during patient interactions, better familiarity with the inpatient environment, greater confidence in working with other health care professionals, and improved drug knowledge and drug therapy assessment skills. After the first semester, we also held “debriefing sessions” with preceptors, who provided valuable feedback on the students and the entire process. We have since revised our expectations, orientation materials, and the DPC IPPE process, and we are currently beginning data collection and analyses to further quantify the impact of this activity on patient care. The DPC IPPE is a valuable learning activity that not only meets the requirements of ACPE but also meets the needs of the college of pharmacy in providing an experience that gives students real patient care responsibility, thus providing better preparation for inpatient clinical rotations during their fourth-year advanced practice experiences. Furthermore, the students perform a needed service for the health system and patients, accomplishing meaningful work that would otherwise have to be done by others. In our parlance, IPPE has come to have an additional meaning: Improving Patient care and Pharmacy student Education. Footnotes The Management Consultation column gives readers an opportunity to obtain advice on common management problems from pharmacists practicing in health systems. The assistance of ASHP’s Section of Pharmacy Practice Managers and its Advisory Group on Communications and Publications in soliciting Management Consultation submissions is acknowledged. Unsolicited submissions are also welcome. Readers are invited to submit topics for this column to ajhp@ashp.org or ASHP c/o David Chen, Director, Pharmacy Practice Sections, 7272 Wisconsin Avenue, Bethesda, MD 20814 (dchen@ashp.org). The authors have declared no potential conflicts of interest. References 1 Accreditation Council for Pharmacy Education . Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree . www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf (accessed 2010 Aug 13). 2 Beck DE Thomas SG Janer AL . Introductory practice experiences: a conceptual framework . Am J Pharm Educ. 1996 ; 60 : 122 – 31 . WorldCat 3 Bucci KK Maddox RW Holmes TH et al. . Implementation and evaluation of a shadow program for PharmD students . Am J Pharm Educ. 1993 ; 57 : 44 – 9 . WorldCat 4 Chisholm MA McCall CY Francisco GE et al. . Student exposure to actual patients in the classroom . Am J Pharm Educ. 1997 ; 61 : 364 – 70 . WorldCat 5 Levin GM Kane MP Fortin L . Preclinical exposure in a baccalaureate program in pharmacy . Am J Pharm Educ. 1996 ; 60 : 179 – 82 . WorldCat 6 Chisholm MA Wade WE . Using actual patients in the classroom to develop positive student attitudes toward pharmaceutical care . Am J Pharm Educ. 1999 ; 63 : 296 . WorldCat 7 Turner CJ Jarvis C Altiere R et al. . A patient-focused and outcomes-based experiential course for first-year pharmacy students . Am J Pharm Educ. 2000 ; 64 : 312 – 9 . WorldCat 8 Chisholm MA DiPiro T Fagan SC . An innovative introductory pharmacy practice experience model . Am J Pharm Educ. 2003 ; 67 :article22. WorldCat 9 Turner CJ Altiere R Clark L et al. . An interdisciplinary introductory pharmacy practice experience course . Am J Pharm Educ. 2004 ; 68 :article 10. WorldCat 10 Jarvis C James VL Giles J et al. . Nutrition and nutrition: a service-learning nutrition pharmacy course . Am J Pharm Educ. 2004 ; 68 :article 43. WorldCat 11 Turner CJ Ellis S Giles J et al. . An introductory pharmacy practice experience emphasizing student administered vaccinations . Am J Pharm Educ. 2007 ; 71 : article 03. WorldCat 12 Wuller WR Luer MS . A sequence of introductory pharmacy practice experiences to address the new standards for experiential learning . Am J Pharm Educ. 2008 ; 72 :article 73. WorldCat 13 Capacity of hospitals to partner with academia to meet experiential education requirements for pharmacy students . Am J Health-Syst Pharm. 2008 ; e53 – 71 . WorldCat 14 The Joint Commission . 2010 national patient safety goal on reconciling medication information . www.jointcommission.org/npsg_reconciling_medication/ (accessed 2011 Jan 18). 15 Padiyara RS . Student pharmacists and medication reconciliation upon hospital admission: proposing a way to meet ASHP 2015 objective 1.1 . J Am Pharm Assoc. 2008 ; 48 : 701 . Google Scholar Crossref Search ADS WorldCat 16 Mersfelder TL Bickel RJ . Inpatient medication history verification by pharmacy students . Am J Health-Syst Pharm. 2008 ; 65 : 2273 – 5 . Google Scholar Crossref Search ADS PubMed WorldCat Copyright © 2011, American Society of Health-System Pharmacists, Inc. All rights reserved.
TI - Improving student education and patient care through an innovative introductory pharmacy practice experience
JO - American Journal of Health-System Pharmacy
DO - 10.2146/ajhp100490
DA - 2011-04-15
UR - https://www.deepdyve.com/lp/oxford-university-press/improving-student-education-and-patient-care-through-an-innovative-ICzCEFNsTH
SP - 655
VL - 68
IS - 8
DP - DeepDyve
ER -