How can I integrate students into my professional practice? Megan E. - PDF document

How can I integrate students into my professional practice? Megan E. Thompson, PharmD Director of Experiential Programs Eric H. Gilliam, PharmD, BCPS Assistant Director of Experiential Programs Skaggs School of Pharmacy and Pharmaceutical Sciences University of Colorado Anschutz Medical Campus 2 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Objectives 1. Recommend strategies for integration of IPPE and APPE students into various practice settings. 2. Compare and contrast sites with continuous student involvement vs. intermittent student integration. 3. Provide examples of best practices of student integration from hospital-based settings. 4. Discuss Entrustable Professional Activities (EPAs) and provide examples of such activities. 1

3 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Reflection Are students valuable to my practice? How? 4 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Integrating APPE students into your practice model can: § Alleviate time pressures of the preceptor of such tasks like obtaining medication histories, answering drug information questions, etc. § Provide valuable patient care services (immunizations, point of care testing, patient education, etc.) § Help improve patient satisfaction scores § Improve patient outcomes § Help you implement services such as MTM, travel vaccine, or others § Provide valuable education to staff/other providers/students § Improve workflow/efficiency § Help you and your staff remain up-to-date with current guidelines or best practices § Expand healthcare resources in specialty/underserved/rural populations § “Create time” (per fellow preceptor) Kennerly, J., Weber RJ. Role of Pharmacy Education in Growing the Pharmacy Practice Model. Hosp Pharm. 2013 Apr; 48(4): 338-342. 2

5 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Health-Systems Extend Practice Model Through Student Pharmacists Article Topic Outcomes Delgado et al Cleveland Clinic Florida • Improved HCAHPS AJHP 2014;71:187 Layered Learning Model: Students • 55% increase in pharmacist interventions per patient as Pharmacists-Extenders in • Increase bedside medication reconciliation Community Hospital Setting • Increase in target disease state counseling Shepler BM; AJPE Purdue University APPE Study • Est. $8.5m saved over 4 years 2014;78(4) 4-year capture of student clinical • Average costs savings per student: $14,800 Article 71 activities and associated cost • Takes 8 student interventions to pay for 20 hours of savings weekly preceptor instruction Stevenson TL et al Auburn University School Wide • Est. $4.6m saved over 3.5 years AJPE 2011;75(5) Clinical Intervention Documentation • Mean cost avoidance per student range: $2,700 – Article Study $7,500 annually • 68% of interventions took place in IP setting 6 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS APPE Activities – New Requirements § ACPE 2016 Standards for APPEs § Entrustable Professional Activities (EPAs) 3

7 Required Elements for Core CU Rotations Direct Patient Care Medication Interprofessional Systems Team Work Management 8 Required Elements for Core CU Rotations • Assessing patient care needs and problems • Developing, monitoring, and • Applying institutional policies adjusting care plans and procedures when Direct Patient Care developing care plans • Anticipating care plan pitfalls based on medication resources • Appling systems approach to patient medication safety Medication Interprofessional Systems Team Work Management • Communicating within interprofessional teams • Developing plans in context to the teams’ goals • Referring to IP team members when appropriate 4

9 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Entrustable Professional Activities (EPAs) § “a way of making decisions about readiness for independent practice or progression to the next level of training.” § Tasks or responsibilities that can be entrusted to a student § Progression from supervised to unsupervised activities § Not an alternative to competencies (or ABOs); a means to translate competencies into clinical practice Ten Cate, O. Nuts and Bolts of Entrustable Professional Activities. J Grad Med Educ. 2013 Mar; 5(1): 157–158. 10 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Complex / Infrequent Simple / Daily EPA Development Over Time Responsibilities: Responsibilities: (Managing Code Cart) (Unit Monitoring) Observation only (student takes no action) First few days of Days 1 - 3 rotation Student takes action but with direct, proactive Weeks 1-2 Days 3 - 5 supervision Student takes action with reactive supervision (i.e., on Weeks 2-4 Week 2 request and preceptor is quickly available) Supervision is only at a Weeks 4-6 Weeks 3-6 distance Supervision is provided Week 6 (if there is If applicable by student to others opportunity to do so) Ten Cate, O. Nuts and Bolts of Entrustable Professional Activities. J Grad Med Educ. 2013 Mar; 5(1): 157–158. 5

11 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS How do I use EPAs to integrate my student? § Students need flexible, individual pathways § Ask yourself: Can I trust this student to execute this activity in my practice setting? (supervised or unsupervised?) » Counsel patients? » Provide vaccinations? » Perform a calculation for a pediatric patient? » Make therapeutic recommendations for a critically ill patient? » Work professionally with other members of your healthcare team? 12 Integration of APPE Students Think-Pair-Share Activity 6

13 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Reflect again… 1. What activities do I trust students to do in my practice? 2. What activities don’t I trust students to do in my practice? 3. Reasons: Why or why not? 4. How do I integrate IPPE students currently? (if applicable) 5. How do I integrate APPE students currently? 6. How could I integrate all students into my practice? 14 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Patient Care Responsibilities of a Pharmacy Student (IPPE vs. APPE) P1-3 Years • Obtain med history by applying motivational interviewing skills • Provide patient discharge medication education • Participate in quality assurance data collection and pharmacy operational activities P4 Year • Participate in pharmacokinetic or anticoagulation monitoring • Design a therapeutic regimen based on PK parameters and laboratory results • Perform antimicrobial stewardship activities • Review a list of monitored medications; apply evidence-based guidelines for dosing renally or hepatically impaired patients • Review patient profiles for proper drug and be able to recommend any changes Kennerly, J., Weber RJ. Role of Pharmacy Education in Growing the Pharmacy Practice Model. Hosp Pharm. 2013 Apr; 48(4): 338-342. 7

15 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS What might intermittent use of an APPE student look like? 16 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Goal Intermittent Integration Full Integration of of Student Student Continuous contribution of Assign student a single Assign student a long-term students (i.e., throughout project project and divvy up the year) pieces to APPE students throughout the year Increased integration of Obtain a medication Obtain a medication student contributions history history, assess current therapy, identify medication-related problems, make recommendation Increased value of student Provide resources to Support healthcare team contributions answer a drug information in meeting on-going drug question information needs 8

17 Student Integration in Acute Care / Health System Practice Settings 18 NEW MEXICO SOCIETY OF HEALTH-SYSTEM PHARMACISTS Health-System Settings § Goals for Consistent Student Integration: § Integrate student into practice § Shift work to the student suitable to the student’s practice level CREATE TIME BY PRECEPITNG PHARMACIST-EXTENDERS § BARRIERS SOLUTIONS Orientation • Create consistent goals, review policies, procedures, and workflow • Connect workflow with outcome TRUST • Teach & Test Triage Skills Define your “ red flag warnings ” • Dependency • Make the student first-line • Increase autonomy purposefully 9