Incorporation of Innovative Strategies for Patient Education in Pharmacist-Led Transition of Care Initiatives.

As patients transition between health care settings, they are at an increased risk of adverse events and medication errors as a result of medication changes and miscommunication. Pharmacists have traditionally provided transitions of care (TOC) services, including patient education, in a face-to-face manner with the goal of reducing medication errors and enhancing patient safety and understanding. However, changes in care delivery models, a burdened health care workforce, and diminishing resources necessitate innovative approaches for the provision of patient education within TOC. Pharmacists should consider novel approaches to expand scope, reduce barriers, and creatively use existing resources to optimize patient education in TOC.

A Scoping Review of Student Pharmacist-Led Transitions-of-Care Initiatives.

OBJECTIVES: To identify and evaluate the current literature pertaining to student pharmacist-led transitions-of-care (TOC) initiatives and to inform pharmacy educators regarding the current and future roles of pharmacy learners in TOC. FINDINGS: A total of 14 articles were identified describing student-led initiatives in care transitions to the inpatient setting and from the inpatient to the outpatient setting. In most studies, student pharmacists involved in delivering TOC services were completing either an advanced pharmacy practice experience or an introductory pharmacy practice experience and were most commonly performing services such as admission medication history and reconciliation. The studies evaluated the impact of student-led TOC services through the identification or resolution of medication-related problems, interventions, and/or discrepancies and included limited and conflicting results pertaining to patient care-based outcomes. SUMMARY: Student pharmacists are involved in delivering and leading a variety of TOC services in the inpatient setting and postdischarge period. These student-led TOC initiatives not only provide added value to patient care and the health system but also enhance students' preparation and readiness for pharmacy practice. Colleges and schools of pharmacy should incorporate learning experiences into the curriculum that equip students to contribute to TOC efforts and promote continuity of care across the health system.

Development of a script concordance test to assess clinical reasoning in a pharmacy curriculum.

INTRODUCTION: Clinical reasoning is a vital skill for student pharmacists in the provision of patient-centered care, but these skills are often difficult to assess in the didactic curriculum. A script concordance test (SCT) is an innovative assessment method that can be used to assess clinical reasoning skills. The objective of this study was to develop and refine an SCT to assess clinical reasoning skills of third year student pharmacists (P3s). METHODS: An SCT was written and administered to P3s. Pharmacy practice faculty members served as the expert group. The SCT was scored and Rasch analysis was performed. RESULTS: The SCT included 20 case vignettes and 60 questions. Test reliability was 0.34 with mean square values for all items between 0.7 and 1.3. Forty-two questions had a difficulty score between 0 and - 1 logits, indicating there were multiple questions with similar difficulty levels. Two case vignettes and 43.3% of questions (n = 26) were revised to enhance clarity and decrease ambiguity. CONCLUSIONS: The SCT is a tool to assess clinical reasoning in the didactic curriculum. Faculty can create the SCT and use statistical methods such as Rasch analysis to assess validity and reliability of the SCT.

Enhancing the "What" and "Why" of the Pharmacists' Patient Care Process With the "How" of Clinical Reasoning.

Objectives. Clinical reasoning is integral to the provision of patient-centered care as outlined in the Pharmacists' Patient Care Process (PPCP). However, the PPCP was not created to foster clinical reasoning in student pharmacists and cannot be the sole tool used to characterize or cultivate these skills. This article describes elements of clinical reasoning, the relationship between clinical reasoning and PPCP, and concepts from the clinical reasoning literature that should inform the teaching of clinical reasoning skills.Findings. Key elements of the PPCP were identified in clinical reasoning definitions, but differences emerged. The literature supports clinical reasoning as a bidirectional, fluid process that is highly collaborative. Effective clinical reasoning requires multiple types of "thinking," interaction with others and the environment, self-assessment, and a tolerance for nuance or ambiguity. Teaching strategies can be used in the didactic and experiential setting to target the cognitive and contextual factors associated with clinical reasoning.Summary. Educators should consult the literature to enhance our understanding of clinical reasoning in seeking to teach, model, and foster these skills in our students. Future scholarship should include the development of models to support clinical reasoning within the profession of pharmacy, adoption and experimentation with clinical reasoning teaching techniques, and valuation of the utility of various assessment tools and processes.

Use of Digital vs Printed Posters for Teaching and Learning in Pharmacy Education.

Objective. To characterize student pharmacists' perceptions of the use of posters as a learning tool and their preferences regarding digital posters compared to printed posters for presentation and review.Methods. Student pharmacists presented and peer-reviewed posters in a digital format using a tablet and an overhead monitor or in a printed format mounted on a poster board. The perceptions of two cohorts of pharmacy students were characterized by comparing their responses on pre- and post-activity surveys.Results. The pre- and post-activity surveys were completed by 543 students (95.3%) in the 2017-2018 academic year and 553 students (97%) in the 2018-2019 academic year, respectively. Over 95% of students perceived that the poster activity enhanced their poster creation, literature evaluation, and communication skills, while also improving their learning of pharmacy-related topics. There was a significant increase on the post-activity survey in the number of students who preferred the digital poster format, with students indicating that the digital format was straightforward (87.3%), enhanced their presentation (77.2%), and promoted learning (70.5%).Conclusion. Poster presentations provide a platform for the dissemination and discussion of topics and allow students to improve their presentation and communication skills. Digital posters represent a convenient, cost-effective, and preferred presentation method for pharmacy students compared to printed posters.

A Survey of Provider-Reported Use and Perceived Effectiveness of Medications for Symptom Management in Telemedicine and Outpatient Visits for Mild COVID-19.

INTRODUCTION: Many patients with mild coronavirus disease 2019 (COVID-19) have symptoms requiring acute and follow-up care. The aims of this study were to assess (1) provider-reported use of medications and their perceived effectiveness and (2) degree of difficulty managing specific symptoms at episodic COVID-19 care sites and in a longitudinal monitoring program. METHODS: We sent an online survey to physicians, advanced practice providers, and registered nurses redeployed to COVID-19 care sites at an academic medical center from March to May 2020. We asked about the use of medications and perceived effectiveness of medications to treat symptoms of COVID-19 and the perceived challenge of symptom management. Comparison was made by provider type (episodic or longitudinal site of care). RESULTS: Responses from 64 providers were included. The most frequently used medications were acetaminophen (87.1% of respondents), benzonatate (83.9%), and albuterol metered dose inhalers (MDI) (80.6%). Therapies for lower respiratory tract symptoms were reported as more commonly used by longitudinal follow-up providers compared to episodic providers including guaifenesin (90.6% vs 60.0%, p = 0.007), benzonatate (93.8% vs 73.3%, p = 0.04), nebulized albuterol for patients with asthma (75.0% vs 43.3%, p = 0.019), and albuterol MDIs for patients without asthma (90.6% vs 66.7%, p = 0.029). Medications found to have the highest perceived efficacy by respondents using the therapy (> 80% reporting "very efficacious") included albuterol, acetaminophen for fever, non-sedating antihistamines, nasal steroid spray, and non-steroidal anti-inflammatory drugs (NSAIDs) for myalgia, arthralgia, or headache. Lower respiratory symptoms and anxiety were rated as the most challenging symptoms to manage. CONCLUSIONS: Providers reported that clinical care of mild COVID-19 with medications in common use for other respiratory infections is effective, both at episodic care and longitudinal sites of care, but that specific symptoms are still challenging to manage.

Facilitation of a multisite student topic discussion series using web-based conferencing technology.

INTRODUCTION: While technology's use and impact in the classroom setting is well-documented in literature, use during experiential education is less defined. Our objectives were to assess the change in clinical knowledge and application skills following a multisite topic discussion (TD) series using web-based conferencing technology during ambulatory care advanced pharmacy practice experiences (APPEs) and to assess student perceptions of learning through use of this modality. METHODS: A multisite TD series was created using web-based conferencing technology for students assigned to a clinical faculty member's ambulatory care APPE. Five topic discussions were conducted during each five-week rotation block covering disease states integral to ambulatory care practice. Pre- and post-assessments were administered to assess student learning and a survey was administered to assess student perceptions of learning. RESULTS: A total of 151 students were invited to participate in the study with 114 (75.5%) included in the final analysis. Overall student performance improved significantly from 53.3 ± 12.7% on the pre-assessment to 65.8 ± 14.3% on the post-assessment, with student performance on the post-assessment improving significantly in all topic areas. Students perceived that the TD series enhanced their learning and ability to apply clinical information while creating an online learning community. CONCLUSIONS: The addition of a multisite TD series using web-based conferencing technology successfully enhanced student knowledge. Student perceptions of this new web-based learning community were positive overall, despite some technological limitations. The results of this study support the use of web-based conferencing technology to enhance student learning during APPEs.

Implementation and evaluation of problem-based video podcasts in an introductory pharmacokinetics course.

INTRODUCTION: The use of problem-based video podcasts in health sciences education is limited. Principles of Pharmacokinetics is an introductory course that establishes a foundation for understanding pharmacokinetic concepts. The primary objective was to determine the impact of problem-based video podcasts in an introductory pharmacokinetics course on student learning. METHODS: Problem-based video podcasts were implemented in an introductory pharmacokinetics course in spring 2015. Student pharmacists in the first professional year enrolled in the course during spring 2015, 2016, and 2017 were included in the study with students enrolled in the course in spring 2014 serving as the control group. The primary outcome was the impact of problem-based video podcasts on student learning as assessed by student performance on the final exam. Other outcomes included student utilization of the video podcasts, overall course grades, and student perceptions of learning using video podcasts. RESULTS: A total of 633 students in four academic years were included for analysis. Final exam scores were significantly higher in spring 2015 and 2016 compared to 2014. The 2017 final exam scores were similar to the final exam scores in 2014. Students perceived the problem-based video podcasts enhanced their ability to apply concepts to a patient case, reinforced concepts from lectures, and improved their understanding of clinical pharmacokinetics. CONCLUSION: The use of problem-based video podcasts is an innovative method to augment learning outside of the traditional class time and may enhance learning without replacing direct instructor-student contact. Students reported the video podcasts improved their understanding of clinical pharmacokinetics.

Professional development series in postgraduate pharmacy residency training: Experiences and opportunities.

INTRODUCTION: The American Society of Health-System Pharmacists (ASHP) identifies competency areas that categorize clinical and non-clinical skills to develop during postgraduate residency training. To address the competency areas related to non-clinical skills, some residencies have developed programs to focus on interpersonal, leadership, and other professional skills. There is limited guidance in the literature regarding the development or impact of these programs. PERSPECTIVE: Professional development series have been implemented at two academic institutions to support the development of non-clinical skills during postgraduate residency training. While these programs address many of the non-clinical skills described in the competency areas, barriers such as program support, logistics, and need for assessment may impede the creation, growth, and success of similar programs. IMPLICATIONS: With the continued increase in the number of residency programs and trainees, scalability and sustainability are vital components for the success of professional development programs. Assessment of the impact of current programs and further guidance from pharmacy organizations regarding important aspects of professional development would help standardize this process.

Primary prevention of atherosclerotic cardiovascular disease: controversies and clinical considerations.

A new guideline for the treatment of blood cholesterol was recently released by the American College of Cardiology (ACC) and the American Heart Association (AHA), serving as an update to the National Cholesterol Education Program's (NCEP) Adult Treatment Panel III cholesterol guideline first released in 2001. With significant changes to key definitions, treatment strategy, and therapy selection, the guideline has transformed the treatment of blood cholesterol and also created controversy within the health care community. This controversy is largely focused on appropriate identification and treatment of patients for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). Whereas statins play an integral role in the treatment and secondary prevention of ASCVD, their use for primary prevention is less clearly defined. It is imperative that health care providers are well versed in the concepts and controversies of the new guideline recommendations for primary prevention of ASCVD and can effectively assess the risks and benefits of statin therapy in this patient population.

Coagulation and complications of left ventricular assist device therapy: a primer for emergency nurses.

Implantation of left ventricular assist devices (LVADs) is becoming more common with the advancement of mechanical circulatory support technology and the continued insufficient number of organ donors available for heart transplantation. Modern LVADs provide a mechanically induced, nonpulsatile, continuous blood flow that drastically alters the hemodynamic and coagulation profile of patients using these devices. In addition to the risk of bleeding and thrombotic events, LVAD support can also lead to arrhythmias and infection. Although LVAD therapy can prolong life, the majority of patients will experience an adverse event following implantation and many of these complications can result in emergency department visits. By understanding the pathophysiology and management of LVAD complications, emergency nurses will be able to provide prompt and quality care for this unique patient population.