Assessing students' knowledge regarding the roles and responsibilities of a pharmacist with focus on care transitions through simulation.

BACKGROUND AND PURPOSE: To evaluate the impact of a pharmacist-focused transitions of care (TOC) simulation on students' perceptions and knowledge of pharmacist roles in the healthcare continuum. Educational Activity and Setting: Two simulations, highlighting pharmacist roles in various practice settings, were conducted within the Pharmaceutical Skills courses in the third-year doctor of pharmacy curriculum. Patient cases were built utilizing electronic medical records (EMR). Students' knowledge was assessed before and after the simulations regarding pharmacist involvement in medication reconciliation, reduction in patient readmissions, reduction of inappropriate medication use, roles and communication on an interprofessional team, and involvement with health information technology (HIT) during care transitions. FINDINGS: Fifty-one third-year pharmacy students were anonymously evaluated prior to and following the simulation to assess changes in knowledge and perceptions during the fall semester. Thirty-two (62.7%) students completed the pre-simulation and 21 (41.2%) students completed the post-simulation assessments, respectively. In the spring semester, 40 (80%) students completed the pre-simulation and 23 (46%) students finished the post-simulation assessments. Students predominately had community pharmacy work experience (n=28, 55%). Overall, students enjoyed the variety of pharmacist-led encounters throughout the simulation and assessments demonstrated an increase in knowledge after the simulations. SUMMARY: TOC simulations enhance students' understanding of the significant impact that pharmacists have in ensuring continuity of care as members of an interdisciplinary team.

Anticholinergic burden: clinical implications for seniors and strategies for clinicians.

OBJECTIVE: To review the current literature assessing the risks associated with the use of anticholinergic (AC) medications in older adults and to provide recommendations for pharmacists to incorporate the evaluation of AC burden as a component of a medication therapy management program for older adults. DATA SOURCES: A MEDLINE/PubMed search was conducted from January 1990 to July 2011 using the terms anticholinergic, antimuscarinic, geriatric, aged, and elderly. References cited in studies and reviews identified in this search were also evaluated. Articles published in languages other than English or conducted in nonhuman species were not evaluated. STUDY SELECTION: Studies and reviews were included if they evaluated adverse events associated with the use of AC medications in the older adult population. DATA EXTRACTION: Data were extracted by the method of independent extraction by multiple observers based on their selection of sections. DATA SYNTHESIS: The review presents evidence that AC medications are associated with negative outcomes in older adults and the importance of health care provider interventions to avoid these consequences. CONCLUSION: AC burden is associated with adverse drug events and negative health outcomes in older adults. Health care providers should carefully assess the risks versus benefits of using medications with AC properties to minimize AC burden and prevent adverse outcomes in this vulnerable patient population. AC burden should be considered as acomponent of a medication therapy management program for seniors.

Alcohol, medications, and the older adult.

Late-onset alcoholism is a common occurrence in older adults and may be a consequence of life-changing events such as retirement, declining health, loss of independence, or loss of a loved one. Alcohol use and misuse often go unrecognized. Alcohol use can cause significant drug interactions and exacerbate underlying disease. Because of physiologic changes in older adults, alcohol pharmacokinetics and pharmacodynamics may be altered and contribute to adverse alcohol-induced clinical consequences. We report on an elderly man who may have had unrecognized alcohol-induced drug interactions, falling, and exacerbation of heart failure. Following a fall, he was admitted to the hospital. After discharge, the man and his wife relocated to an assisted living facility and he abstained from alcohol. Four months later the man received a prescription for a glass of wine or two with dinner; one week later after two glasses of wine, a dose of lorazepam was given. Later that evening the patient fell and suffered a subdural hematoma. The effects of alcohol in older adults are discussed.

Comparison of two drug-burden computational procedures applied to anticholinergic drugs.

Two computational procedures for estimating continuous drug-burden scores are compared, using a simulation study based on a sample of patients exposed to anticholinergic medications. Both procedures seek to quantify the medication burden to overcome the limitations of a binary classification of exposure. An artificial neural network procedure renders better statistical properties than a linear weighted score, even when both scores are correlated and are viable alternatives to binary classification.