ABSTRACT
BACKGROUND: The Accreditation Council for Pharmacy Education "Standards 2016" require that pharmacy student education include training in the management of patients "across the lifespan" (Standard 12). Standards 2016 also require that students are practice-ready to participate as a contributing member of an interprofessional (IP) team (Standard 11). Didactic and experiential education in palliative or end-of-life (EOL) care is limited. Palliative care represents unique patient and team challenges in providing patients with empathetic and holistic care. INTERPROFESSIONAL EDUCATION ACTIVITY: This study describes an IP, palliative care simulation that achieved both IP and "across the lifespan" educational standards. The goals of the activity included increasing communication skills, recognizing roles and responsibilities, and enhancing the value of various healthcare providers' perspectives and expertise when caring for patients at the EOL. Pharmacy, physical therapy, nursing, and counseling students participated in a low fidelity palliative care simulation. The event consisted of a presentation on anticipatory grief and active listening followed by a role-playing simulation and group debrief. The Interprofessional Socialization and Value Scale were administered to assess student perceptions of IP skills. DISCUSSION: Quantitative and qualitative data demonstrated achievement of the goals of the activity. Reflections revealed students felt the simulation improved teamwork and communication skills and that using humility and listening in team-based palliative care transformed wisdom for future practice. IMPLICATIONS: This activity used a cost-effective, low fidelity, role-play simulation to achieve IP education competencies and demonstrated the value of multiple professions in EOL care.
Subject(s)
Education, Pharmacy , Students, Pharmacy , Death , Health Personnel , Humans , Palliative CareABSTRACT
BACKGROUND: There is wide variation in the frequency of reported use of palliative sedation (PS) to control intractable and refractory symptoms in terminally ill patients. The aim of this study was to determine the frequency and outcomes of PS use and examine patterns of practice after establishment of a policy for the administration of midazolam for PS in our palliative care unit (PCU). MATERIALS AND METHODS: This retrospective study reviewed PCU admissions for 2004 and 2005 and pharmacy records to identify patients who received chlorpromazine, lorazepam, or midazolam for PS in the PCU. Data on indication for PS, drug used, and discharge outcome were assessed for each patient. RESULTS: During the period studied, there were 1,207 PCU admissions. Of these patients, 186 (15%) received PS; and 143 (41%) of the 352 patients who died in the PCU received PS. The median age of PS patients was 58 (range, 20-84) years, and 106 (57%) were male. The most common indications for PS were delirium, 153 cases (82%); dyspnea, 11 (6%); and multiple indications, 12 (6%). Midazolam was used in 18 PS cases (10%). Six (55%) of 11 patients with dyspnea received midazolam for PS, compared with 12 (7%) of 175 patients with other indications for PS (p < 0.001). Forty-three (23%) of 186 PS patients were discharged alive, compared with 812 (80%) of 1,021 patients who did not receive PS (p < 0.001). CONCLUSIONS: PS was required in 15% of PCU admissions, and 23% of PS patients were discharged alive. Our findings suggest a potential for significant underreporting of overall PS. If our institution's policy on midazolam use for PS were less restrictive, midazolam use might increase. More research is needed to define the optimal agent for inducing rapid, effective, and easily reversible PS.