Jessica E. Wilhoite

Survey of pharmacist-managed primary care clinics using healthcare failure mode and effect analysis

Objective The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement. Methods The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement. Results Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were “Told you the name of each of your medicines and what they are used for”, “Answered your questions fully,” and “Explained what your medicines do”. Conclusions Educational components provided during pharmacist-managed clinic appointments are aligned with patients’ needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists’ self-efficacy, which may further improve patient care.

Evaluating student-pharmacists’ perspectives in medication adherence before and after a pillbox simulation. [abstract]

Objective: The utilization of interprofessional education and collaborative practice delivers optimal health services and improves patient outcomes. Training future healthcare providers in an integrated environment promotes a “collaborative practice-ready” workforce. The aim of this study was to identify ongoing specific interprofessional collaborative projects and promote their awareness among faculty at the St. John Fisher College Wegmans School of Pharmacy. Methods: Faculty members were surveyed to identify the ongoing interprofessional collaborative initiatives among pharmacy faculty. Results: A total of four collaborative practices were identified among faculty: ambulatory care, assistedliving, didactic, and assessment. The ambulatory care setting at an osteoporosis clinic provides patientcentered care with a clinical component. Each patient with a new diagnosis or change in medication therapy receives education/counseling from a pharmacist, a registered nurse for medication administration and a physician for a physical exam. In the assisted-living setting, pharmacy and nursing students are paired to conduct a high-level health assessment in their respective disciplines. Didactic interprofessional efforts are being conducted to create a flexible and comprehensive pain education curriculum. Physicians, dentists, nurses, pharmacists, psychologists, chiropractors, and oriental medicine practitioners will develop the curriculum. The pain module will be adaptable for interprofessional education activities. Finally, recognizing the similarities in accreditation standards for communication and professionalism, the School of Pharmacy and the NY Chiropractic School are sharing strategies and rubrics for assessing these outcomes. Implications: The survey revealed a broader range of interprofessional collaborations than was originally suspected. The school will continue to foster and support interprofessional education and collaborative practice. Disciplines Pharmacy and Pharmaceutical Sciences Comments Poster presented at: • Annual meeting of the American Association of Colleges of Pharmacy in Orlando, Florida, July, 2012. • Faculty Scholarship Celebration at St. John Fisher College in Rochester, New York, October 25, 2012. Abstract is published in American Journal of Pharmaceutical Education 2012; 76 (5) Article 99. https://doi.org/10.5688/ajpe76599is published in American Journal of Pharmaceutical Education 2012; 76 (5) Article 99. https://doi.org/10.5688/ajpe76599 Authors David Hutchinson, Jane M. Souza, Jennifer Mathews, Anthony Corigliano, Katherine Juba, Jill Lavigne, Andrea Traina, Karen A. Bobak, Constance Baldwin, and O.J. Sahler This poster presentation is available at Fisher Digital Publications: https://fisherpub.sjfc.edu/pharmacy_facpub/20 THE CROSSROADS OF INTERPROFESSIONALISM: Four Avenues of Collaboration at the Wegmans School of Pharmacy at St. John Fisher College David Hutchinson, Pharm.D.; Jane Souza, Ph.D.; Jennifer Mathews, Ph.D.; Anthony Corigliano, R.Ph.; Katherine Juba, Pharm.D.; Jill Lavigne, Ph.D.; Andrea Traina, Pharm.D.; Karen A. Bobak D.C. Constance Baldwin, Ph.D.; O.J. Sahler, M.D.

Cerebrovascular Events and Use of NuvaRing

Objective: To report 2 cases, occurring within 1 month at a single institution, in which young women experienced a cerebrovascular event while using the hormonal contraceptive product NuvaRing (etonogestrel/ethinyl estradiol vaginal ring). Case Summary: The first patient presented to the emergency department (ED) with a 10-day history of right frontal headache. A computed tomography (CT) scan and magnetic resonance imaging showed evidence for right postcentral and cortical venous thrombosis. A hypercoagulable workup identified a heterozygous factor V Leiden mutation. The second patient presented to the ED with a same-day history of left frontotemporal headache extending into her left jaw and neck, numbness and clumsiness of right hand and right foot, and inability to make a comprehensible sentence. A CT angiogram showed occlusion of the internal and external carotid arteries. A hypercoagulable workup indicated no evidence of a thrombophilic disorder and a transesophageal echocardiogram indicated no cardioembolic source, resulting in a final diagnosis of a spontaneous carotid artery dissection. Both patients reported recent use of NuvaRing. The medication was discontinued during the hospital stay. Discussion: The use of hormonal agents for contraception carries a well-known risk of venous thrombosis; however, the impact this therapy has on the risk of arterial thrombosis and ischemic brain events is less understood. We found no previous reports of an ischemic brain event in association with NuvaRing use. The Naranjo probability scale indicated a possible relationship between the ischemic events and NuvaRing exposure in both patients. Conclusions: Risk factors should be evaluated appropriately prior to initiating any form of combined hormonal contraceptives, oral or vaginal, in young women.