E. Kelly Hester, PharmD, BCPS, AAHIVP Associate Clinical Professor Department of Pharmacy Practice Auburn University Harrison School of Pharmacy September 13, 2015 Disclosure/Conflict of Interest I have no actual or potential conflicts of interest to disclose in relation to this program. Objectives Discuss performance outcomes of entry-level graduates related to interprofessional communication skills Recognize limitations in the level of IPPE and APPE student abilities Identify opportunities to engage pharmacy students in verbal and written communication with other healthcare professionals 1
Audience Activity Your Expectations: What should a pharmacy student training with you be able to do in communication with other healthcare professionals? How are these expectations different from a new pharmacy graduate? Guidance for Interprofessional Education: Standard 11 11d. Faculty involvement Faculty, including preceptors, should role model effective interprofessional communication and collaboration for students at every opportunity. 2
Guidance for Interprofessional Education: Standard 11 11e. Non-pharmacist preceptors Interprofessional practice-based educational experiences for pharmacy students should occur with a pharmacist preceptor as a member of the team. On occasion, high-quality interprofessional practice-based educational experiences may be available to pharmacy students that would need to be precepted by a non-pharmacist member of the healthcare team. Guidance for Interprofessional Education: Standard 11 11f. Interaction with prescribers Interprofessional education training must involve student pharmacist interaction with prescribers (and students training to be prescribers) in didactic and experiential education settings. This requirement is based on the fact that to have the greatest impact on direct patient care, pharmacists and student pharmacists must be able to interact effectively with prescribers. Prescribers include physicians, dentists, nurse practitioners, physician assistants, veterinarians, and their respective students in training. 11.1 Interprofessional team dynamics All students demonstrate competence in interprofessional team dynamics, including articulating the values and ethics that underpin interprofessional practice, engaging in effective interprofessional communication, including conflict resolution and documentation skills, and honoring interprofessional roles and responsibilities. Interprofessional team dynamics are introduced, reinforced, and practiced in the didactic and Introductory Pharmacy Practice Experience (IPPE) components of the curriculum, and competency is demonstrated in Advanced Pharmacy Practice Experience (APPE) practice settings. 3
11.2 Interprofessional team education To advance collaboration and quality of patient care, the didactic and experiential curricula include opportunities for students to learn about, from, and with other members of the interprofessional healthcare team. Through interprofessional education activities, students gain an understanding of the abilities, competencies, and scope of practice of team members. 11.3 Interprofessional team practice All students competently participate as a healthcare team member in providing direct patient care and engaging in shared therapeutic decision-making. They participate in experiential educational activities with prescribers/student prescribers and other student/professional healthcare team members, including face-to-face interactions that are designed to advance interprofessional team effectiveness Standard 13: Advanced Pharmacy Practice Experience (APPE) Curriculum 13.3. Interprofessional experiences In the aggregate, students gain in-depth experience in delivering direct patient care as part of an interprofessional team. 4
Audience Activity Pharmacy Student Activities: Share 2-3 ways you have provided opportunities for pharmacy students to practice communication with other healthcare professionals as a preceptor. Interprofessional communication Increasing pharmacy role in the provision of integrated, patient-centered care High level communication skills Insight into the roles of other healthcare providers and effective interactions Who do we talk to? Children Patients Low literacy Insurance Companies 5
Pharmacy student limitations Minimal pharmacy and workplace communication experience ( shadowing ) Patient counseling focus Simulated or case-based interprofessional experiences in didactic program Lack practice with face-to-face communication with non-pharmacy health-care professionals Lack assessment and feedback with interprofessional communication Daily Communication Opportunities Hospital Pharmacy Practice Prescribers Medication reconciliation (clarifying home medications) Medication or alterations (efficacy and safety) Drug information questions Written consult ID physicians and wound care team: antibiotic Anticoagulation management (heparin, etc.) Stroke guideline/core measure 6
Hospital Pharmacy Practice Nurses Medication administration Timing of drug levels (antibiotics) Drug information questions (IV compatibility, allergy cross-sensitivity) New protocols In-service education Interdisciplinary committees Presentations (formulary ; antibiogram) Social/case workers Discharge medications (formulary and cost effectiveness) Transitions of care Community Pharmacy Practice Prescribers/Nurses Addressing drug coverage problems/formulary Drug interactions Drug dosing Prescription clarification Allergies Drug information questions Ambulatory Care Pharmacy Practice Physician-pharmacy student teams Addressing drug-related problems (dosing adjustments, drug interactions) Medication and vaccine Formulary considerations (prior authorizations) Drug information questions Pharmacy Service Adjustments to drug therapy Appropriateness of referral Written Communication Progress notes for referred patients 7
Mentoring Role modeling for communicating and problem-solving Be informed: information to know before contacting the other healthcare professional Medication facts Patient facts Talk it out: discuss the Action Plan in advance The problem = the patient s copay is $100 for Rx Drug A interacts with Drug B Potential alternatives would be Building effective and professional communication skills This is how I would phrase it.. Student Feedback Provided as close to the observed performance as possible (well timed) Elicit student thoughts on the interaction Student reflection on the observed behavior Connect feedback to specific correctable behaviors Suggest how the communication could have been improved (or handled differently) Provide multiple opportunities to improve Student driven initiatives Equal Access Birmingham (EAB) HSOP student-run free clinic for the homeless and underinsured population of Birmingham UAB School of Medicine collaboration since 2012 15 th Place Wellness Clinic (Mobile) HSOP students medically evaluate homeless patients for healthcare needs USA Medical School collaboration since 2013 8
Tell me and I forget, Teach me and I may remember, Involve me and I learn. Benjamin Franklin 9