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

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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

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.

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Reflection

Are students valuable to my practice? How?

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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)

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Kennerly, J., Weber RJ. Role of Pharmacy Education in Growing the Pharmacy Practice

• Model. Hosp Pharm. 2013 Apr; 48(4): 338-342.

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Health-Systems Extend Practice Model Through Student Pharmacists

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Article Topic Outcomes

Delgado et al AJHP 2014;71:187 Cleveland Clinic Florida Layered Learning Model: Students as Pharmacists-Extenders in Community Hospital Setting

• Improved HCAHPS
• 55% increase in pharmacist interventions per patient
• Increase bedside medication reconciliation
• Increase in target disease state counseling

Shepler BM; AJPE 2014;78(4) Article 71 Purdue University APPE Study 4-year capture of student clinical activities and associated cost savings

• Est. $8.5m saved over 4 years
• Average costs savings per student: $14,800
• Takes 8 student interventions to pay for 20 hours of

weekly preceptor instruction Stevenson TL et al AJPE 2011;75(5) Article Auburn University School Wide Clinical Intervention Documentation Study

• Est. $4.6m saved over 3.5 years
• Mean cost avoidance per student range: $2,700 –

$7,500 annually

• 68% of interventions took place in IP setting

APPE Activities – New Requirements

§ ACPE 2016 Standards for APPEs § Entrustable Professional Activities (EPAs)

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Required Elements for Core CU Rotations

7 Direct Patient Care Interprofessional Team Work Medication Systems Management

Required Elements for Core CU Rotations

8 Direct Patient Care Interprofessional Team Work Medication Systems Management

• Assessing patient care needs

and problems

• Developing, monitoring, and

adjusting care plans

• Communicating within

interprofessional teams

• Developing plans in context to

the teams’ goals

• Referring to IP team members

when appropriate

• Applying institutional policies

and procedures when developing care plans

• Anticipating care plan pitfalls

based on medication resources

• Appling systems approach to

patient medication safety

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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

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Ten Cate, O. Nuts and Bolts of Entrustable Professional Activities. J Grad Med Educ. 2013 Mar; 5(1): 157–158.

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Observation only (student takes no action) Student takes action but with direct, proactive supervision

Student takes action with reactive supervision (i.e., on request and preceptor is quickly available)

Supervision is only at a distance Supervision is provided by student to others

EPA Development Over Time

Ten Cate, O. Nuts and Bolts of Entrustable Professional Activities. J Grad Med Educ. 2013 Mar; 5(1): 157–158.

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First few days of rotation Weeks 1-2 Weeks 4-6 Week 6 (if there is

• pportunity to do so)

Weeks 2-4

Complex / Infrequent Responsibilities:

(Managing Code Cart)

Simple / Daily Responsibilities:

(Unit Monitoring) Days 1 - 3 Days 3 - 5 Weeks 3-6 If applicable Week 2

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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?

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Integration of APPE Students Think-Pair-Share Activity

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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?

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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

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Kennerly, J., Weber RJ. Role of Pharmacy Education in Growing the Pharmacy Practice

• Model. Hosp Pharm. 2013 Apr; 48(4): 338-342.

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What might intermittent use of an APPE student look like?

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Goal Intermittent Integration

• f Student

Full Integration of Student Continuous contribution of students (i.e., throughout the year) Assign student a single project Assign student a long-term project and divvy up pieces to APPE students throughout the year Increased integration of student contributions Obtain a medication history Obtain a medication history, assess current therapy, identify medication-related problems, make recommendation Increased value of student contributions Provide resources to answer a drug information question Support healthcare team in meeting on-going drug information needs

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Student Integration in Acute Care / Health System Practice Settings

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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

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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

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Health-System Settings

§ Example: Remote daily monitoring of target medications within a care unit

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Day Plan Monitoring

Initial Orientation (Day 1)

• Demonstrate practice
• Provide resources
• Discuss why the practice is needed
• Establish standards
• Navigation of resources
• Navigation of workflow
• Documentation Process

Days 2 – 3

• Observe student attempt the practice
• Retention of above

Days 3 – 5

• Student and preceptor practice

independently

• Agreement between preceptor and

students’ actions Days 4 – 6

• Preceptor double checks after student

report

• Missed interventions

Intermittently

• Conduct in depth spot-checks
• Consistency and improvement

Beyond

• Preceptor increases demand
• Increase expectations
• Efficiency
• Complexity

Health-System Settings

Notable Examples

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Continuous Student Programs Intermittent Student Programs

Southwest Memorial Hospital Cortez, CO

• Employee TB Screening

program (PPD placement & readings) Denver Health Hospital Denver, Co

• QA / Patient Safety Projects
• Pt education materials
• Project presentations for

national meetings Craig Hospital Englewood, CO

• Medication Integration

Program (regular medication education for LTC patients) UCH / SSPPS

• Research projects
• Mentor IPPE students

Other ideas

• Multidisciplinary team

rounding

• Medication reconciliation
• Medication discharge
• HCAHPS

Other ideas

• MUEs / Formulary projects
• Unit inspections
• Provide staff in-services

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Conclusion

§ Students need flexible, individualized pathways to progress from supervised to unsupervised activities § Determine what entrustable activities you are willing to have your student(s) do § Develop strategies, both short and long term, that will help your student(s) produce the outcomes you want § Full integration of students into your practice site can “create time“ for you

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§ Megan E. Thompson, PharmD, Director of Experiential Programs, CU Skaggs School of Pharmacy, megan.thompson@ucdenver.edu, (303) 724-2655 § Eric Gilliam, Assistant Director of Experiential Programs, CU Skaggs School of Pharmacy, eric.gilliam@ucdenver.edu, (303) 724-8327

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