Impact of altered mental status on antibiotic prescribing and outcomes in hospitalized patients presenting with pyuria.

BACKGROUND: Pyuria is nonspecific and may result in over-treatment of asymptomatic bacteriuria (ASB). The Infectious Diseases Society of America recommends against antibiotic treatment of ASB for most patients including those presenting with altered mental status (AMS). Close observation is recommended over treatment to avoid missing alternative causes of AMS and overuse of antibiotics resulting in adverse events and resistance. OBJECTIVES: The purpose of this study was to evaluate patient outcomes associated with antibiotic treatment of pyuria in patients presenting with AMS at hospital admission without specific urinary tract infection (UTI) symptoms. The primary objective was to compare 30-day readmission rates of patients with pyuria and AMS treated with antibiotics (AMS+Tx) versus those who were not treated (AMS-NoTx). Secondary outcomes included identifying risk factors for antibiotic treatment, comparing alternative diagnoses for AMS, and comparing safety outcomes. METHODS: This retrospective cohort study evaluated adult patients with AMS and pyuria (10 WBC/hpf) admitted between February 1, 2020 and October 1, 2021, in a 350-bed community teaching hospital. Patients with documented urinary symptoms were excluded. Additional exclusion criteria included admission to critical care, history of renal transplant, urological surgery, coinfections, pregnancy, and neutropenia. RESULTS: Two-hundred patients were included (AMS+Tx, n = 162; AMS-NoTx, n=38). There was no difference in 30-day hospital readmission rate for AMS between groups (AMS+Tx 16.7% vs AMS-NoTx 23.7%, P = 0.311). An alternative diagnosis of AMS occurred more frequently when antibiotics were withheld (AMS+Tx 66% vs. AMS-NoTx 86.8%, P = 0.012). Urinalyses showing bacteria (odds ratio 2.52; 95% CI, 1.11-5.731) and positive urine culture (OR 3.36; 95% CI, 1.46-7.711) were associated with antibiotic prescribing. CONCLUSIONS: Inappropriate antibiotic use is common among hospitalized patients presenting with AMS and pyuria; however, treatment of asymptomatic pyuria did not decrease rates of subsequent readmission for AMS or retreatment of symptomatic UTI. Patients who were monitored off antibiotics had higher rates of alternative AMS diagnosis.

Comparison of diagnosis and prescribing practices between virtual visits and office visits for adults diagnosed with uncomplicated urinary tract infections within a primary care network.

OBJECTIVES: Telemedicine visits are an increasingly popular method of care for mild infectious complaints, including uncomplicated urinary tract infections (UTIs), and they are an important target for antimicrobial stewardship programs (ASPs) to evaluate quality of prescribing. In this study, we compared antimicrobial prescribing in a primary care network for uncomplicated UTIs treated through virtual visits and at in-office visits. DESIGN: Retrospective cohort study comparing guideline-concordant antibiotic prescribing for uncomplicated UTI between virtual visits and office visits. SETTING: Primary care network composed of 44 outpatient sites and a single virtual visit platform. PATIENTS: Adult female patients diagnosed with a UTI between January 1 and December 31, 2018. METHODS: Virtual visit prescribing was compared to office visit prescribing, including agent, duration, and patient outcomes. The health system ASP provides annual education to all outpatient providers regarding local antibiogram trends and prescribing guidelines. Guideline-concordant therapy was assessed based on the network's ASP guidelines. RESULTS: In total, 350 patients were included, with 175 per group. Patients treated for a UTI through a virtual visit were more likely to receive a first-line antibiotic agent (74.9% vs 59.4%; P = .002) and guideline-concordant duration (100% vs 53.1%; P < .001). Patients treated through virtual visits were also less likely to have a urinalysis (0% vs 97.1%; P < .001) or urine culture (0% vs 73.1%; P < .001) ordered and were less likely to revisit within 7 days (5.1% vs 18.9%; P < .001). CONCLUSIONS: UTI care through a virtual visit was associated with more appropriate antimicrobial prescribing compared to office visits and decreased utilization of diagnostic and follow-up resources.

Viability of Virtual Skills-based Assessments Focused on Communication.

Objective To evaluate faculty and student perceptions of and performance on virtual skills-based assessments focused on communication compared to in-person assessments.Methods In spring 2020, virtual skills-based assessments were conducted. After all assessments were completed, two 12-item questionnaires, one for students and one for the faculty members who conducted the assessment, were designed to assess perceptions of virtual skills-based assessments. The surveys were distributed via an online platform to second- and third-year (P2 and P3) pharmacy students and to faculty who had participated in a virtual skills-based assessment. Scores from the spring 2020 virtual skills-based assessment were compared to scores on the in-person skills-based assessment that took place in spring 2019.Results Of the 19 faculty and 279 students invited to participate, 18 (94.7%) faculty and 241 (86.4%) students responded. The majority of faculty (88.9%) and students (63.5%) perceived the virtual skills-based assessments to be effective at simulating an interaction. However, only 33.3% of faculty and 28.6% of students preferred the virtual environment. There was not a significant difference in student performance between in-person and virtual assessments for patient consultation and SOAP note skills.Conclusion Providing sufficient formative and summative feedback to pharmacy students is a challenge, particularly in the context of skills-based assessments. Students and faculty reported that the virtual assessment provided an opportunity for an appropriate assessment of student communication skills. However, a strong preference for using virtual skills-based assessments in the future was not observed.

An assessment of interprofessional education in schools/colleges of pharmacy in the United States.

INTRODUCTION: Pharmacy educational standards provide requirements for interprofessional education (IPE). However, there has not been a comparison of IPE structure between doctor of pharmacy programs in the United States (US). The purpose of this study was to gather information regarding current IPE programs and curricula in schools/colleges of pharmacy (S/COP) across the US. METHODS: A survey was developed and emailed to at least one faculty member or administrator from each S/COP responsible for IPE or experiential education. The survey gathered information on IPE status, structure, and oversight. It also explored mechanisms promoting IPE success, pieces of advice for starting or expanding IPE, and hurdles for IPE implementation. RESULTS: Eighty-five S/COP representing 59.9% of programs in the US responded to the survey. All respondents felt IPE was either very important or important to pharmacy education. Mechanisms that promoted IPE success included partnerships, faculty interest in IPE, having an IPE center, being located on an academic medical center, administrative support, and integrating IPE during curricular development. IPE hurdles included logistics, faculty buy-in, sustainability, distance from other programs, and differing accreditation standards across programs. Themes of advice for others were to be innovative/patient/flexible, collaborative, identify key initial partners, develop a director or coordinator of IPE position, and receive administrative support. CONCLUSIONS: IPE is a vital component to training the next generation of health professionals, but the process for can be daunting. Building on the successes of others and predicting barriers can assist S/COP in developing effective IPE.

Assessing the Validity and Reliability of the Pharmacist Interprofessional Competencies Tool.

Objective. To determine the validity and reliability of the Pharmacist Interprofessional Competencies Tool (PICT). Methods. Faculty members at Ferris State University, College of Pharmacy developed the PICT, which has five interprofessional criterion (collaboration, ownership, respect, engagement, and application) and four competency levels (unacceptable, novice, competent, and proficient) to assess the interprofessional competencies of pharmacy students. Fourteen pharmacy faculty members were trained in how to use the PICT and then used it to assess students' behaviors in four to six video-recorded interprofessional education (IPE) learning activities. A subset of these faculty members evaluated the video-recorded IPE learning activities using two other previously validated interprofessional assessment tools. Psychometric analysis of the PICT, including internal consistency and inter-rater reliability, was conducted, along with a correlation analysis and factor analysis, and the results were compared to those from the other validated assessment tools. Results. The overall rating of the internal consistency of the PICT was excellent and item-total correlations of the individual criterion were fair to good, with the exception of the respect criterion. The PICT demonstrated excellent overall inter-rater reliability, and individual criterion rated as fair to excellent with the exception of the respect criterion. Specific dimensions of the PICT showed high convergence with previously validated interprofessional assessment tools. Conclusion. The PICT exhibited overall validity and reliability as an assessment tool for measuring the interprofessional competencies of pharmacy students. In establishing the overall validity and reliability of the assessment tool, the respect criterion was not proved to be reliable or valid. Additional training and slight modifications to the PICT and associated IPE learning activities are planned to assist with longitudinal assessment of student performance across the curriculum.

Assessment of student pharmacist learning within an interprofessional simulation: A comparison of small group vs. large group debriefing.

BACKGROUND: Simulation debriefing is a critical component of interprofessional education (IPE). The purpose of this IPE report was to determine if there is a difference in a student pharmacist's ability to articulate areas for improvement and continued growth in interprofessional practice between those who participated in a large group debrief compared to a small group debrief after an interprofessional simulation. INTERPROFESSIONAL EDUCATION ACTIVITY: One hundred pharmacy students participated in an interprofessional standardized patient simulation. Other participants included medicine or physician assistant, nursing, and physical therapy students. Students were randomly assigned to large or small group debriefing. Students completed a reflection to determine their ability to articulate areas for improvement and continued growth. DISCUSSION: Forty-six students in the large group debrief and 49 students in the small group debrief completed a post-simulation reflection. Reflections were analyzed quantitatively and qualitatively. Quantitative analysis was based on a scoring rubric used to determine whether the student was able to successfully articulate areas for improvement or continued growth. Reflections were evaluated qualitatively to identify the areas for improvement. There was no difference in the ability to identify an area for improvement or continued growth between the large group debrief compared to the small group debrief. IMPLICATIONS: There was no difference in students' post-simulation reflections based on participation in small group or large group debriefing following an interprofessional simulation. Students were able to effectively articulate areas for improvement and continued growth in interprofessional practice.

Interprofessional education through a telehealth team based learning exercise focused on pharmacogenomics.

BACKGROUND: Traditional interprofessional educational (IPE) exercises are those where learning exists "about, from, and with" trainees in two or more professions in order to prepare health sciences professionals to work on interprofessional teams. One emerging difficulty with IPE is the paucity of health profession students at single institutions, and the geographic and financial constraints of multi-institutional collaboration. INTERPROFESSIONAL EDUCATION ACTIVITY: To circumvent these barriers, we developed a multi-institution telehealth team-based learning (TBL) event between medical and pharmacy students on the topic of pharmacogenomics (PGx). Using a validated pre-post survey design, student attitudes and perceptions were measured before and after an educational intervention designed to simulate interprofessional telehealth collaboration. The survey results showed significant improvement across all areas of student attitudes toward interprofessional collaboration. Also, medical student PGx confidence increased substantially during the exercise even though the only PGx instruction they received was from pharmacy students. DISCUSSION: These data demonstrate that learning exists "about, from, and with" trainees in other professions, even if they do not physically train in the same location. Free tools are available to create virtual interactions between students on different campuses, and telehealth exercises using these tools are a valid way to conduct IPE across different campuses. The instructional experience does not need to be identical for all participants in the IPE event; rather, tailoring the educational experience to each group of students provides opportunities for inter-student teaching.

From Introduction to Integration: Providing Community-Engaged Structure for Interprofessional Education.

BACKGROUND: Training future healthcare profession students using interprofessional education (IPE) is critical to improve quality of health care and patient safety. OBJECTIVE: The objective of this study was to implement an IPE program and determine student satisfaction with each session, including a clinical case requiring teams with members from each profession addressing clinical scenarios. SUBJECTS: The subjects of this study were students from Athletic Training, Medicine, Nursing, Pharmacy, Physical Therapy, Physician Assistant, Social Work, and Speech-Language Pathology. METHODS: Evaluations, administered to all participating students, consisted of Likert-style responses, rating agreement with a series of questions, and space for descriptive comments. Score differences for each question were compared using independent group t-tests with a P-value of 0.05 to determine statistical significance. RESULTS: There were statistically higher satisfaction ratings for the problem-based learning case when compared to less interactive sessions (P < 0.0001). CONCLUSION: Students perceived benefits of the IPE program. Perceptions improved when various students had the opportunity to work together on clinically relevant problems.