Development of the entrustable professional activity 'medication reconciliation' for clinical pharmacy.

BACKGROUND: Entrustable professional activities (EPAs) are observable process descriptions of clinical work units. EPAs support learners and tutors in assessment within healthcare settings. For use amongst our pharmacy students as well as pre-registration pharmacists we wanted to develop and validate an EPA for use in a clinical pharmacy setting at LMU University Hospital. METHODS: The development of the clinical pharmacy EPA followed a set pathway. A rapid literature review informed the first draft, an interprofessional consensus group consisting of pharmacists, nurses, and medical doctors refined this draft. The refined version was then validated via online survey utilising clinical pharmacists from Germany. RESULTS: We designed, refined and validated an EPA regarding medication reconciliation for assessment of pharmacy students and trainees within the pharmacy department at LMU University Hospital in Munich. Along with the EPA description an associated checklist to support the entrustment decision was created. For validation an online survey with 27 clinical pharmacists from all over Germany was conducted. Quality testing with the EQual rubric showed a good EPA quality. CONCLUSIONS: We developed the first clinical pharmacy EPA for use in a German context. Medication reconciliation is a suitable EPA candidate as it describes a clinical activity performed by pharmacists in many clinical settings. The newly developed and validated EPA 'Medication Reconciliation' will be used to assess pharmacy students and trainees.

Which Adverse Events and Which Drugs Are Implicated in Drug-Related Hospital Admissions? A Systematic Review and Meta-Analysis.

Adverse drug events (ADEs) and adverse drug reactions (ADRs) are leading causes of iatrogenic injury, which can result in emergency department (ED) visits or admissions to inpatient wards. The aim of this systematic review and meta-analysis was to provide up-to-date estimates of the prevalence of (preventable) drug-related ED visits and hospital admissions, as well as the type and prevalence of implicated ADRs/ADEs and drugs. A literature search of studies published between January 2012 and December 2021 was performed in PubMed, Medline, EMBASE, Cochrane Library, and Web of Science. Retrospective and prospective observational studies investigating acute admissions to EDs or inpatient wards due to ADRs or ADEs in the general population were included. Meta-analyses of prevalence rates were conducted using generalized linear mixed models (GLMM) with the random-effect method. Seventeen studies reporting ADRs and/or ADEs were eligible for inclusion. The prevalence rates of ADR- and ADE-related admissions to EDs or inpatient wards were estimated at 8.3% ([95% CI, 6.4-10.7%]) and 13.9% ([95% CI, 8.1-22.8%]), respectively, of which almost half (ADRs: 44.7% [95% CI: 28.1; 62.4]) and more than two thirds (ADEs: 71.0% [95% CI, 65.9-75.6%]) had been classified as at least possibly preventable. The ADR categories most frequently implicated in ADR-related admissions were gastrointestinal disorders, electrolyte disturbances, bleeding events, and renal and urinary disorders. Nervous system drugs were found to be the most commonly implicated drug groups, followed by cardiovascular and antithrombotic agents. Our findings demonstrate that ADR-related admissions to EDs and inpatient wards still represent a major and often preventable health care problem. In comparison to previous systematic reviews, cardiovascular and antithrombotic drugs remain common causes of drug-related admissions, while nervous system drugs appear to have become more commonly implicated. These developments may be considered in future efforts to improve medication safety in primary care.

Interprofessional geriatric assessment in nursing home (IgAP): a curricular development in geriatrics.

The hallmark of medical action in geriatrics is the interprofessional treatment of the patient by a multi-professional team consisting of doctors, nurses and therapists with the aim of treating the patients primarily in a way that preserves their function and thereby enabling them to live as independently as possible. Therefore, at the beginning of every geriatric treatment, there is a multiprofessional geriatric assessment of functional abilities. With regard to successful medical action, this necessarily requires all health professions involved to understand geriatric patients and their limitations. Under ideal circumstances, their competencies overlap. From the point of view of the related disciplines, this means to teach working together with the other professions - interprofessionally - and learning from one another in order to effectively collaborate. After comparing the existing education in geriatrics within the Medical Curriculum Munich (MeCuM) with the European catalog of learning objectives for geriatricians (UEMS-GMS), a deficit with regard to geriatric assessment was recognized in the field of multi-professional training. Therefore, the existing geriatric curriculum of the Ludwig Maximilians University (LMU) in Munich should be expanded to include an interprofessional course on geriatric assessment. This project report aims to show the development and implementation of this course. For this purpose, the model for curriculum development according to Kern was used by the planners to establish an interprofessional briefing. Due to its innovative character, the course received public recognition and is the basis for the expansion of interprofessionalism in the sense of professional cooperation in geriatrics. Establishing interprofessionalism in other disciplines and locations is welcome.

Influence of a ward-based pharmacist on the medication quality of geriatric inpatients: a before-after study.

Background Despite several international studies demonstrating that ward-based pharmacists improve medication quality, ward pharmacists are not generally established in German hospitals. Aim We assessed the effect of a ward-based clinical pharmacist on the medication quality of geriatric inpatients in a German university hospital. Method The before-after study with a historic control group was conducted on the geriatric ward. During the control phase, patients received standard care without the involvement of a pharmacist. The intervention consisted of a clinical pharmacist providing pharmaceutical care from admission to discharge. Medication quality was measured on admission and discharge using the Medication Appropriateness Index (MAI). A linear regression analysis was conducted to calculate the influence of the intervention on the MAI. Results Patients in the intervention group (n = 152, mean 83 years) were older and took more drugs at admission compared to the control group (n = 159, 81 years). For both groups, the MAI per patient improved significantly from admission to discharge. Although the intervention did not influence the summated MAI score per patient, the intervention significantly reduced the MAI criteria Dosage (p = 0.006), Correct Directions (p = 0.016) and Practical Directions (p = 0.004) as well as the proportion of overall inappropriate MAI ratings (at least 1 of 9 criteria inappropriate) (p = 0.015). Conclusion Although medication quality was already high in the control group, a ward-based clinical pharmacist could contribute meaningfully to the medication quality on an acute geriatric ward.

Pharmacists' involvement in COVID-19 vaccination across Europe: a situational analysis of current practice and policy.

One year since the emergence of the COVID-19 pandemic, rapid response measures have been implemented internationally to mitigate the spread of the virus. Following rapid and successful pre-clinical and human trials, several vaccines have been authorised for use across Europe through the European Medicines Agency and national regulatory authorities. Clinical trials have shown promising results including important reductions in disease severity, hospitalisation and mortality. In order to maximise the public health benefit of available vaccines, there is a pressing need to vaccinate a large proportion of the population. Internationally, this has prompted coordination of existing services at enormous scale, and development and implementation of novel vaccination strategies to ensure maximum inoculation over the shortest possible timeframe. Pharmacists are being promoted as healthcare professionals that enhance roll-out of COVID-19 vaccination programmes. This paper aims to summarise current policy and practice in relation to pharmacists' involvement in COVID-19 vaccination in 13 countries across Europe.

Virtual bedside teaching for pharmacy students during their final term at LMU Munich.

At Ludwig-Maximilians-Universität (LMU) bedside teaching (BT) for pharmacy students has been in place since 2014. To continue offering BT during the contact restrictions imposed by the authorities in 2020, the course was digitalised, and virtual bedside teaching implemented. Using Moodle, the original concept was divided into smaller sections and presented, e.g. in the form of video sequences. All sections of the course were accessed asynchronously by the students. Tasks were individually processed and evaluated. Virtual awards were used to increase the students' motivation. Contact with each other was possible via posting in available forums or the weekly online chat consultation. A total of 70 students successfully completed the course. The evaluation of the course was very positive, with mainly technical difficulties that were criticized. The students' feedback will be implemented in the course concept for the winter term.

[Learning from Mistakes using a Case-based Curriculum in Medical Education for Health Systems/health Economics and Public Health Care]. / Lernen aus Fehlern anhand eines fallbasierten Curriculums im medizinischen Querschnittsbereich Gesundheitssysteme/Gesundheitsökonomie und öffentliche Gesundheitspflege.

AIM OF THE STUDY: There are hardly any concepts on how to impart knowledge about the own health system to students and to clarify the importance and practical relevance of the topic. The case-based approach and the errors described therein should highlight the relevance of the topic to the medical profession. METHODOLOGY: A course concept was developed with focus on the practical relevance of the content to students. This was based on a method mix of game-based learning, case-based and cooperative learning. The seminar describes the path of a cancer patient through health care, an issue which, due to a lack of agreements and other interface problems, is dealt with unsatisfactorily. RESULTS: Analyses showed that students (n=1162) had moderate interest in the topic of the seminar during both survey periods. However, they found the method of case-based learning to be good and rated the relevance of the topic as high. CONCLUSIONS: The relevance of the topic complex GGG for later professional activity was apparently recognized by the students. The low motivation of the students to engage with this topic could be reduced, as confirmed by reports of the lecturers.

Validity and reliability of an adapted German version of the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education Instrument, version 2 (SPICE-2D).

OBJECTIVES: Evaluation of an interprofessional education (IPE) course at a German university was complicated by the lack of validated German versions of IPE assessment instruments. The objectives of this study were to (1) translate version 2 of the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE-2) and (2) test its validity and reliability. METHODS: After translation, the SPICE-2D instrument was administered electronically to medical and pharmacy students at four universities in Germany using a convenience sampling design. Confirmatory factor analysis was performed to assess validity of the translated instrument. Goodness-of-fit assessment was conducted by evaluating the standardized root mean square residuals (SRMR), the comparative fit index (CFI) and the root mean square error of approximation (RMSEA). Overall and factor-specific reliabilities of SPICE-2D were assessed using Cronbach's alpha. KEY FINDINGS: Four German universities participated. Response rate was 19.8% (n = 312/1576), mean age of respondents was 25.1 years (SD 3.3), and the majority were female (69%, n = 215). The SRMR of the overall model showed a good fit (0.061). The measured CFI of 0.95 and RMSEA of 0.072 (95% CI 0.053-0.091) can be considered acceptable. Cronbach's alpha indicated overall instrument reliability and composite reliabilities; only the reliability of factor 2 (Roles/responsibilities for Collaborative Practice) was mediocre (α = 0.41). Medical students scored consistently higher across all factors than pharmacy students. CONCLUSIONS: The SPICE-2D instrument demonstrated acceptable reliability, with the exception of the roles/responsibilities factor. A robust evaluation of SPICE-2D's validity and reliability in the context of a more representative sample of German medical and pharmacy students is warranted.