The AACP Academic Affairs Committee's Final 2022 Curricular Outcomes and Entrustable Professional Activities (COEPA) for Pharmacy Graduates to Replace 2013 CAPE and 2016 EPAs.

The American Association of Colleges of Pharmacy (AACP) Academic Affairs Committee was charged with revising both the 2013 Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes (EOs) and the 2016 Entrustable Professional Activities (EPAs). The Committee changed the document name from the CAPE outcomes to COEPA, (Curricular Outcomes and Entrustable Professional Activities) since the EOs and EPAs would now be housed together. A draft of the COEPA EOs and EPAs was released at the AACP July 2022 Annual meeting. After receiving additional stakeholder feedback during and after the meeting, the Committee made additional revisions. The final COEPA document was submitted to and approved by the AACP Board of Directors in November 2022. This COEPA document contains the final version of the 2022 EOs and EPAs. The revised EOs have been reduced to 3 domains and 12 subdomains (from 4 domains and 15 subdomains previously in CAPE 2013) and the revised EPAs have been reduced from 15 to 13 activities.

Alignment of an interprofessional student learning experience with a hospital quality improvement initiative.

Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students' experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their reliability as teamwork-observers was a valuable learning experience and also yielded an opportunity to gather unique, and otherwise difficult to attain, data from a hospital unit for use by quality managers and administrators.

Evaluation of Interprofessional Team Disclosure of a Medical Error to a Simulated Patient.

Objective. To evaluate the impact of an Interprofessional Communication Skills Workshop on pharmacy student confidence and proficiency in disclosing medical errors to patients. Pharmacy student behavior was also compared to that of other health professions' students on the team. Design. Students from up to four different health professions participated in a simulation as part of an interprofessional team. Teams were evaluated with a validated rubric postsimulation on how well they handled the disclosure of an error to the patient. Individually, each student provided anonymous feedback and self-reflected on their abilities via a Likert-scale evaluation tool. A comparison of pharmacy students who completed the workshop (active group) vs all others who did not (control group) was completed and analyzed. Assessment. The majority of students felt they had adequate training related to communication issues that cause medication errors. However, fewer students believed that they knew how to report such an error to a patient or within a health system. Pharmacy students who completed the workshop were significantly more comfortable explicitly stating the error disclosure to a patient and/or caregiver and were more likely to apologize and respond to questions forthrightly (p<0.05). Conclusions. This data affirms the need to devote more time to training students on communicating with patients about the occurrence of medical errors and how to report these errors. Educators should be encouraged to incorporate such training within interprofessional education curricula.

Impact of an Advanced Cardiac Life Support Simulation Laboratory Experience on Pharmacy Student Confidence and Knowledge.

Objective. To assess the impact of an advanced cardiac life support (ACLS) simulation on pharmacy student confidence and knowledge. Design. Third-year pharmacy students participated in a simulation experience that consisted of team roles training, high-fidelity ACLS simulations, and debriefing. Students completed a pre/postsimulation confidence and knowledge assessment. Assessment. Overall, student knowledge assessment scores and student confidence scores improved significantly. Student confidence and knowledge changes from baseline were not significantly correlated. Conversely, a significant, weak positive correlation between presimulation studying and both presimulation confidence and presimulation knowledge was discovered. Conclusions. Overall, student confidence and knowledge assessment scores in ACLS significantly improved from baseline; however, student confidence and knowledge were not significantly correlated.

The need for PGY2-trained clinical pharmacy specialists.

The American College of Clinical Pharmacy and other stakeholder organizations seek to advance clinical pharmacist practitioners, educators, and researchers. Unfortunately, there remains an inadequate supply of residency-trained clinical specialists to meet the needs of our health care system, and nonspecialists often are called on to fill open specialist positions. The impact of clinical pharmacy specialists on pharmacotherapy outcomes in both acute care and primary care settings demonstrates the value of these specialists. This commentary articulates the need for postgraduate year two (PGY2)-trained clinical specialists within the health care system by discussing various clinical and policy rationales, interprofessional support, economic justifications, and their impact on quality of care and drug safety. The integrated practice model that has grown out of the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative (PPMI) could threaten the growth and development of future clinical specialists. Therefore, the ways in which PGY2-trained clinical pharmacist specialists are deployed in the PPMI require further consideration. PGY2 residencies provide education and training opportunities that cannot be achieved in traditional professional degree programs or postgraduate year one residencies. These specialists are needed to provide direct patient care to complex patient populations and to educate and train pharmacy students and postgraduate residents. Limitations to training and hiring PGY2-trained clinical pharmacy specialists include site capacity limitations and lack of funding. A gap analysis is needed to define the extent of the mismatch between the demand for specialists by health care systems and educational institutions versus the capacity to train clinical pharmacists at the specialty level.

Elevated liver enzymes associated with dronedarone for atrial fibrillation.

A 51-year-old male with documented atrial fibrillation who was taking dronedarone 400 mg twice daily for approximately 3 months returned to the cardiologist for an ablation procedure. Baseline liver enzymes were within normal range prior to starting the medication and increased after the 3 months of therapy. Aspartate aminotransferase increased from 31 IU/L to 98 IU/L, and alanine aminotransferase increased from 21 IU/L to 101 IU/L. Two and a half months after discontinuation of the medication, liver enzymes normalized (aspartate aminotransferase: 30 IU/L and alanine aminotransferase: 25 IU/L). The Food and Drug Administration has now alerted health-care professionals of the potential for liver injury based upon post-marketing surveillance. The chronological course of elevated liver enzymes noted in our patient is suggestive of a dronedarone-induced problem. Clinicians should have a heightened awareness of the potential for liver enzyme elevation and injury with dronedarone and should monitor enzymes periodically, especially within the first 6 months of use.

Elevated international normalized ratio with the consumption of grapefruit and use of warfarin.

A 65-year-old male with documented atrial flutter who was taking warfarin chronically returned to the anticoagulation clinic for follow-up, after having been on 10 mg daily for approximately 2 weeks. He had a previous sub-therapeutic international normalized ratio of 1.7 on a dose of 65 mg/week. The international normalized ratio at this visit was now 4.77 via venipuncture, after just an 8% increase in weekly dosing. He self-reported adherence to the new warfarin dosing but had begun eating grapefruit since last visit. The patient had no active bleeding and was told to decrease his dose to 8 mg daily. He also stopped eating the grapefruit. One week later, he returned to the clinic and the international normalized ratio was 2.1. He is currently back on warfarin 65 mg/week, and his international normalized ratio has been within therapeutic range for the past 4 months. Clinicians should have a heightened awareness of the potential for elevated international normalized ratio when grapefruit juice is consumed in a patient who is taking warfarin.

Updates in hormonal emergency contraception.

In recent years, there have been many updates in hormonal emergency contraception. Levonorgestrel emergency contraception has been available for several years to prevent pregnancy when used within 72 hours after unprotected intercourse or contraceptive failure, and it was recently approved for nonprescription status for patients aged 17 years or older. Current research suggests that the primary mechanism of action is delaying ovulation. Ulipristal is the newest emergency contraception, available by prescription only, approved for use up to 120 hours after unprotected intercourse or contraceptive failure. The primary mechanism of action is delaying ovulation. When compared with levonorgestrel emergency contraception, ulipristal was proven noninferior in preventing pregnancy. Evidence suggests that ulipristal does not lose efficacy from 72-120 hours; however, more studies are warranted to support this claim. Many misconceptions and controversies about hormonal emergency contraception still exist. Research does not support that increased access to emergency contraception increases sexual risk-taking behavior. Several studies suggest that health care providers, including pharmacists, could benefit from increased education about emergency contraception. It is important for pharmacists to remain up-to-date on the most recent hormonal emergency contraception products and information, as pharmacists remain a major point of access to emergency contraception.

Osteoporosis treatment: an evidence-based approach.

Osteoporosis is a disease that results in decreased bone mass and quality of bone, which may lead to fracture. Clinicians need to counsel individuals on appropriate intake of calcium and vitamin D, increasing weight-bearing exercise, limiting alcohol and caffeine, and avoiding smoking. A variety of nonhormonal pharmacological options are available for prevention and treatment of osteoporosis, including bisphosphonates, calcitonin (Miacalcin®), raloxifene (Evista®), teriparatide (Forteo®), and denosumab (Prolia®). The National Osteoporosis Foundation and the American Association of Clinical Endocrinologists have recently published new guidelines, and it is important for clinicians to be familiar with the evidence behind each of these treatment modalities. It is paramount for nurses to make evidence-based, cost-effective decisions about pharmacological therapy based on individual patient-specific factors.

Survey of colleges of pharmacy to assess preparation for and promotion of residency training.

OBJECTIVE: To assess the prevalence of curricular programs or other structured activities designed to prepare students for and to promote residency training. METHODS: An electronic survey instrument containing 12 questions regarding institutional demographics and activities related to pharmacy student preparation for residency training was sent to administrators of all US colleges and schools of pharmacy. RESULTS: Ninety-one survey instruments were e-mailed to US colleges and schools of pharmacy administrators, and an overall response rate of 78% was attained. Twenty-two percent of respondents identified a structured curricular program to prepare students for postgraduate training. In addition, informal programs or informational sessions varying in scope and content were offered by many colleges and schools to prepare students for residency training. CONCLUSION: Many of the US colleges and schools of pharmacy reported structured activities or programs that promote residency training to students. Ten programs had a designated clinical-track curriculum.

Evaluation of compliance with osteoporosis treatment guidelines after initiation of a pharmacist-run osteoporosis service at a family medicine clinic.

BACKGROUND: Osteoporosis affects more than 10 million Americans, and fracture complications are devastating to patients and society. Despite the availability of guidelines and performance measures, osteoporosis is not optimally managed. Pharmacists have been pivotal in management of other disease states, and a multidisciplinary approach to osteoporosis management may improve patient outcomes. OBJECTIVE: To establish a pharmacist-run osteoporosis service at a family medicine clinic and to evaluate short-term compliance with osteoporosis treatment guidelines before and after initiation of the service. METHODS: A pharmacist-run osteoporosis service was established in October 2008. Adults with the diagnosis of osteoporosis before initiation of the service were included in evaluation of short-term compliance with treatment guidelines, including appropriate dual-energy X-ray absorptiometry (DEXA) scan frequency, pharmacotherapy, calcium and vitamin D supplementation, and nonpharmacologic education. Of 42 referred patients, 22 were eligible for inclusion. A retrospective chart review was conducted, and patients served as their own controls, with data from before and after establishment of the service evaluated. RESULTS: Of the 22 patients evaluated, 8 (36%) received DEXA scans at the appropriate frequency before the service was established, versus 18 (82%) after the service was initiated. Seven (32%) patients were taking appropriate pharmacotherapy before the service, versus 17 (77%) after the service. Nine (41%) patients were taking calcium and vitamin D before the service, versus 22 (100%) after the service. Three (33%) of these patients were taking the appropriate dose and salt of calcium before the service, versus 20 (91%) after the service. Five (56%) of the 9 patients were taking the appropriate vitamin D dose before the service, versus 21 (95%) after the service. No patient had documented nonpharmacologic education prior to the service, compared with all patients after the service. All differences were significant (p < 0.05). CONCLUSIONS: A pharmacist-run osteoporosis service significantly improved short-term compliance with guidelines, including appropriate DEXA scan frequency, pharmacotherapy, calcium and vitamin D supplementation, and nonpharmacologic education.

A peer review process for classroom teaching.

OBJECTIVE: Describe the planning, implementation, and faculty perceptions of a classroom peer-review process, including an evaluation tool. DESIGN: A process for peer evaluation of classroom teaching and its evaluation tool were developed and implemented by a volunteer faculty committee within our department. At the end of the year, all faculty members were asked to complete an online anonymous survey to evaluate the experience. ASSESSMENT: The majority of faculty members either agreed or strongly agreed that the overall evaluation process was beneficial for both evaluators and for those being evaluated. Some areas of improvement related to the process and its evaluation tool also were identified. SUMMARY: The process of developing and implementing a peer-evaluation process for classroom teaching was found to be beneficial for faculty members, and the survey results affirmed the need and continuation of such a process.

A method for educating patients and documenting smoking status in an electronic medical record.

BACKGROUND: Published evidence demonstrates benefit from pharmacist smoking cessation interventions; however, there is limited research evaluating the impact of a template within an electronic medical record used at pharmacy disease state management visits. OBJECTIVE: To determine the rates of smoking cessation and movement along the transtheoretical model of change after implementation of a template into existing pharmacy-related progress notes within the electronic medical record. METHODS: Patients who were routinely followed by clinical pharmacists for anticoagulation and diabetes mellitus education at 3 clinics at the Medical University of South Carolina were included. At each visit, the pharmacist would document patient smoking information in a newly designed template within the existing progress note. In addition, pharmacists would educate patients on the benefits of smoking cessation and pharmacologic options that may be available to them. Data were collected between April 2007 and March 2008. Baseline demographic data and smoking cessation rates and products were compared using descriptive statistics. The McNemar chi(2) test was used to compare the groups of patients achieving smoking cessation pre- and postintervention. RESULTS: Of the 90 current smokers, 38 (42%) achieved smoking cessation postintervention. Movement along the transtheoretical model of change was also seen, with 52 (58%) patients progressing to at least the next stage. Thirty-four patients in the contemplation/preparation stage and 4 patients in the precontemplation stage moved to the action or maintenance stage by the end of the study period (p = 0.03). A variety of pharmacologic therapies were used in individuals who stopped smoking, although varenicline was most common. Thirty-nine percent of the patients used no medications to achieve cessation. CONCLUSIONS: Incorporating a smoking cessation template into existing progress notes and providing education during existing pharmacy referral visits is a simple and effective method to assist patients in achieving smoking cessation.

Compliance with osteoporosis treatment guidelines in postmenopausal women.

BACKGROUND: Osteoporosis continues to be poorly managed despite compelling statistics indicating increased morbidity and mortality associated with fractures. Guideline compliance in individual practices must be evaluated to implement improvements in the care of patients with this disease state. OBJECTIVE: To evaluate compliance with osteoporosis treatment guidelines by physicians and patients at 2 family medicine clinics affiliated with a large university teaching hospital. METHODS: Postmenopausal women 65 years of age or older with the ICD-9 diagnosis code 733.0 for osteoporosis during the study period between July 2006 and July 2007 were identified through the family medicine electronic medical record (EMR). Of 133 patients, 113 were eligible for inclusion. A retrospective chart review was conducted and prospective voluntary telephone surveys were administered. The EMR of each eligible patient was examined for presence of a baseline dual-energy X-ray absorptiometry (DXA) scan as well as appropriate follow-up DXA monitoring, appropriateness of osteoporosis pharmacotherapy, calcium and vitamin D supplementation, and fracture history. The telephone survey was used to assess the patients' calcium use, nonpharmacologic recommendations received, and fracture incidence after diagnosis of osteoporosis. RESULTS: Of 113 patients diagnosed with osteoporosis, 68 of 82 (82.9%) had appropriate baseline DXA scans; however, only 9 (13.2%) of these 68 patients had appropriate follow-up scans every 2 years thereafter. Sixty-five (57.5%) patients were on Food and Drug Administration-approved, guideline-endorsed pharmacotherapy for osteoporosis. Thirty-five (70%) of the 50 participants in the telephone survey reported taking calcium regularly, and 41 (82%) patients recalled receiving some nonpharmacologic advice. Thirteen (26%) patients reported a fracture after diagnosis. CONCLUSIONS: Osteoporosis care can be measurably improved at these clinics with use of baseline and appropriate follow-up DXA scans, increasing the number of patients who receive pharmacotherapy, and providing ongoing reinforcement of nonpharmacologic measures whereby bone health may be maintained.

The Presidential Scholars Program at the Medical University of South Carolina: an extracurricular approach to interprofessional education.

The Medical University of South Carolina (MUSC) developed a Presidential Scholars Program (PSP) in order to foster interprofessional collaboration among students from the different health professions on campus. Now in its seventh year, the program provides approximately 40 selected students each year from six different colleges with a two-semester interprofessional educational experience. Students work in small interprofessional teams on a project designed to address a broad-based health care issue; they also participate in other structured educational sessions throughout the year. As one means for assessing student impressions of the interprofessional collaborative experience, a survey was administered prior to and immediately after the experience. Additionally, a sample of non-scholar MUSC students was randomly selected for completion of the survey as a control group. Results indicate that PSP students have a significantly greater understanding of each other and deeper appreciation of the value of interprofessional collaboration at the end of the year. The Presidential Scholars Program at MUSC provides a unique and innovative opportunity for students to work with individuals within other health care disciplines, reduces stereotypes of the various professions and teaches important team skills. Future research would involve alumni follow-up in order to further evaluate the long-term impact of the program.

Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics.

UNLABELLED: Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. OBJECTIVE: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT) device versus venipuncture within ambulatory care clinics at our institution. METHODS: All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC) Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED) visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis. RESULTS: A total of 145 patients were included in the data collection from the two clinics. The majority (41%) of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 %) of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post-implementation of POCT device. CONCLUSION: The results of this study demonstrate improvement in patient satisfaction with POCT compared to venipuncture, with limited value in clinical outcomes.

Impact of a dual PharmD/MBA degree on graduates' academic performance, career opportunities, and earning potential.

OBJECTIVE: To evaluate the academic experience and satisfaction of students who completed a dual PharmD/MBA degree program and the program's long-term impact on the students' career choice and earning potential. METHODS: GPAs, job placement, and starting job salaries were compared between graduates who completed the dual PharmD/MBA program and those who completed only the PharmD program. A satisfaction survey instrument was administered to 17 students who completed the dual PharmD/MBA degree program in May 2007. Data from a standardized job placement and starting salary survey instrument completed by all PharmD graduates were also obtained, as well as all students' final grade point averages (GPAs). GPAs, job placement, and starting job salaries were compared between graduates who had completed the dual PharmD/MBA program and those who had completed only the PharmD program. RESULTS: The graduating GPAs of dual-degree students were higher than those of both pharmacy (3.52 vs 3.41, p > 0.10) and business (3.82 vs. 3.68, p = 0.018) students not enrolled in the dual-degree program. Dual-degree students were slightly less likely to enter a residency (17% vs. 27%, p = 0.44) than other pharmacy graduates. Among those who elected not to pursue a residency, both mean starting salaries ($111,090 vs. $101,965) and mean total first-year compensation ($127,290 vs. $110,388) were significantly higher for dual-degree graduates compared to the PharmD graduates. CONCLUSIONS: Students enrolled in the dual-degree program did slightly better academically than students who completed only the MBA or PharmD programs and indicated a high level of satisfaction with the program. Dual-degree graduates reported increased career opportunities and were slated to earn significantly more during their first year in the workforce. These results affirm continuation of our program and make the case for support of similar programs across the nation.

Developing a business-practice model for pharmacy services in ambulatory settings.

A business-practice model is a guide, or toolkit, to assist managers and clinical pharmacy practitioners in the exploration, proposal, development and implementation of new clinical pharmacy services and/or the enhancement of existing services. This document was developed by the American College of Clinical Pharmacy Task Force on Ambulatory Practice to assist clinical pharmacy practitioners and administrators in the development of business-practice models for new and existing clinical pharmacy services in ambulatory settings. This document provides detailed instructions, examples, and resources on conducting a market assessment and a needs assessment, types of clinical services, operations, legal and regulatory issues, marketing and promotion, service development and exit plan, evaluation of service outcomes, and financial considerations in the development of a clinical pharmacy service in the ambulatory environment. Available literature is summarized, and an appendix provides valuable citations and resources. As ambulatory care practices continue to evolve, there will be increased knowledge of how to initiate and expand the services. This document is intended to serve as an essential resource to assist in the growth and development of clinical pharmacy services in the ambulatory environment.