Diane Hadley

Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

Objective To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings. Methods TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications.[a sentence was deleted] Conclusion Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.

Role of Novel and Emerging Oral Anticoagulants for Secondary Prevention of Acute Coronary Syndromes

Dual antiplatelet therapy has become a mainstay of long‐term management of patients after an acute coronary syndrome (ACS). Mortality for these patients remains high despite current evidence‐based treatment strategies. The coagulation cascade plays a role in the pathophysiology of ACS, and trials with warfarin in combination with dual antiplatelet therapy have found decreased rates of ischemic events at the expense of increased bleeding risk. Novel oral anticoagulants (NOACs) in the direct factor Xa (FXa) inhibitor and direct thrombin inhibitor (DTI) categories have been evaluated in combination with standard post‐ACS therapy. Rivaroxaban, a FXa inhibitor, reduced the rates of ischemic events but increased major bleeding rates. Apixaban did not decrease the rates of ischemic events and also increased major bleeding rates. Other FXa inhibitors have not been studied in the long‐term management of ACS (e.g., otamixaban), are not currently being studied in ongoing phase III trials (e.g., TAK‐442), or have been discontinued by the manufacturer (e.g., darexaban). The DTI dabigatran had a 2‐ to 4‐fold increased risk of major bleeding with unclear benefit for reducing ischemic events. The factor IXa inhibitor pegnivacogin is an RNA‐based aptamer that has been studied in patients undergoing cardiac catheterization but has not been studied for long‐term post‐ACS management. The European Society of Cardiology Working Group on Thrombosis recommends the use of newer antiplatelet agents over addition of NOACs. Additional guidelines are available to guide management in patients requiring triple antithrombotic therapy but do not provide definitive recommendations on NOACs. Many questions remain about the place of NOACs for long‐term post‐ACS management. Recent trials have evaluated double versus triple antithrombotic therapy to balance efficacy and bleeding risk, but they did not include NOACs. It also remains unclear if NOACs hold a place in post‐ACS therapy in the era of more potent antiplatelet agents such as prasugrel and ticagrelor.

Interprofessional education and the new educator: Getting started with planning and implementation

The need for collaborative learning is now recognized and supported by the accrediting bodies that form standards for the education of various health professionals; however, the concept of interprofessional education (IPE) is addressed differently in each set of accreditation standards.[1][1]–[8][

A Simulation Center Geriatric Teaching Experience in Interprofessional Communication

To the Editor: Caring for older adults requires the involvement of interprofessional (IP) teams, but health professional students have limited opportunities to learn about geriatric medicine together. The World Health Organization defines IP education (IPE) as multiprofession collaborative learning focused on health outcome improvement. IPE delivery methods include didactics, practice-based interventions, simulations, and experiential strategies. Based on the lack of IP geriatric opportunities, faculty from the University of Pennsylvania (UPenn) and University of the Sciences (USciences) created a geriatrics focused IPE simulation-based workshop; results are reported from the 2014 workshop.

Faculty facilitators’ and standardized family members (SFMs) perceptions of student teamwork during an interprofessional education simulation workshop

ABSTRACT Standardized patients can be trained to portray standardized family members (SFMs) for interprofessional education (IPE) initiatives to maximize student learning. To date, studies of IPE often focus on student learning outcomes rather than on the feedback and perspectives of SFMs and faculty facilitators (FFs), The purpose of our study was to examine SFMs’ and FFs’ perspectives immediately after participating in an IPE workshop. SFMs and FFs completed a semi-structured questionnaire consisting of open-ended questions to identify positive and challenging aspects of interactions with health professions students during an IPE workshop. A directed content analysis approach was used to assess written feedback (N = 29) from SFMs and FFs. Study findings highlight many similar themes between SFMs and FFs as well as minor differences regarding recognition of emotion and communication transitions. SFMs and FFs both agreed, however, that these are areas for further development by students to improve communication. Our study adds insight into SFMs’ and FFs’ feedback immediately after an IPE workshop.

Evaluation of interprofessional health care team communication simulation in geriatric palliative care

ABSTRACT An interprofessional education (IPE) simulation-based geriatric palliative care training was developed to educate health professions students in team communication. In health care, interprofessional communication is critical to team collaboration and patient and family caregiver outcomes. Studies suggest that acquiring skills to work on health care teams and communicate with team members should occur during the early stage of professional education. The Interprofessional Education Collaborative (IPEC®) competency-based framework was used to inform the training. An evaluation examined attitudes toward health care teams, self-efficacy in communication skills, interprofessional collaboration, and participant satisfaction with the training experience. One-hundred and eleven participants completed pre- and post-training surveys. Overall, a majority of participants (97.3%) were satisfied with the training and reported more positive attitudes toward health care teams and greater self-efficacy in team communication skills. IPE participants had higher collaboration scores compared to observer learners. Further research is needed to explore long-term effects of IPE in clinical practice.

A pilot IPE workshop integrating OT, pharmacy, PT, and PA programs

BACKGROUND AND PURPOSE This article describes the development, implementation, and evaluation of an interprofessional education (IPE) experience. EDUCATIONAL ACTIVITY AND SETTING The IPE experience included 53 student learners from occupational therapy, pharmacy, physical therapy, and physician assistant programs at the University of the Sciences (USciences). This experience used an icebreaker activity and a stroke case-based activity as the activities within the workshop. The core faculty utilized the jigsaw technique to increase student confidence with uni-profession and interprofessional discussions of the patient case. Learners were asked to evaluate their perceptions of the IPE learning experience. FINDINGS Results from a summative quality improvement evaluation indicated that learners had positive perceptions of this curricular innovation. DISCUSSION This pilot IPE workshop illustrates the possibilities for collaboration among health professional programs at USciences, a private health sciences university without an affiliated medical center. SUMMARY Discussion of the process to create, implement, and evaluate this pilot IPE activity is imperative due to increased expectations within professional accrediting guidelines in regards to IPE.

Pharmacy students’ experience with a capstone project

Due to the growing needs within the healthcare system and the opportunity for more pharmacy involvement, it is essential that pharmacy curricula provide opportunities to develop students’ critical thinking skills as a way to address these needs. The Center for the Advancement of Pharmacy Education