um-sop preceptor conf attendee version€¦ · ipec core competencies ipec core competencies model...

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Integrating the LLM / JCPP-PPCP in Experiential Education

SeenaHaines,PharmD,BCACP,FASHP,FAPhA,BC-ADM,CDEChairandProfessorofPharmacyPractice

JennyA.VanAmburgh,PharmD,RPh,FAPhA,BCACP,CDEClinicalProfessor&AssistantDeanforAcademicAffairs

NortheasternUniversity– SchoolofPharmacy

Wednesday,AprilX,X-XAM

Session Objectives 1. SummarizetherelevanceoftheJCPPPCPPin

achievingaconsistentprocessinthedeliveringofpatientcareacrossthecontinuumofpractice

2. DesignopportunitiesforadoptingtheJCPPPCPPusingthelayeredlearningmodel(LLM)successfulpracticeexemplars,andexampleactivities

3. Developapersonal/institutionalactionplanforimplementationoftheJCPPPCPP

Educational

2013CAPEOutcomes

2011IPECCompetencies

2014/15PPCP

2016ACPEAccreditationStandards(10.8)

2015NAPLEXBlueprint

2017EPAs

Joint Commission of Pharmacy Practitioners (JCPP) Vision

Patientsachieveoptimalhealthandmedicationoutcomeswithpharmacistsasessentialandaccountableproviders

withinpatient-centered,team-basedhealthcare.

Pharmacists’ Patient Care Process (PPCP)

1. Promoteconsistencyacrosstheprofession2. Provideaframeworkfordeliveringpatientcare

acrosspracticesettings3. Comprehensiveapproachtopatient-centeredcare

incollaborationwithhealth-careteams4. Applytoavarietyofclinicalservices(MTM)

GOALS

PPCPFoundations

1. Establishapatient-pharmacistrelationship2. Engagementandeffectivecommunicationwith

patient,familyandcaregivers3. Collaborate,document,andcommunicatewith

physiciansandotherHCP4. Enhanceprocessesbyinteroperableinformation

technologysystems

ApprovedbyJCPPOrganizationsMay2014,Supportedby12NationalPharmacyOrganizations

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ACPERelevance

Standard10:CurriculumDesign,Delivery,andOversight

10.8“Pharmacists’PatientCareProcess”

Thecurriculumpreparesstudentstoprovidepatient-centeredcollaborativecareasdescribedinthe

Pharmacists’PatientCareProcessmodelendorsedbyJCPP

2013CAPEEducationalOutcomesDomain2- EssentialforPracticeandCare

2.1Patient-centeredcare(caregiver)

Providepatient-centeredcareasthemedicationexpert(collect,interpretevidence,prioritize,formulateassessmentsandrecommendations,implement,monitorandadjustplans,anddocumentactivities).

• 2.1.1Collect subjectiveandobjectiveevidencerelatedtopatient,medications,allergies/adversereactions,anddiseasebyperformingpatientassessmentfromchart/electronichealthrecords,andpatient/familyinterviews.

• 2.1.2Interpret evidenceandpatientdata.• 2.1.3Prioritizepatientneeds.• 2.1.4Formulate evidencedbasedcareplans,assessments,andrecommendations.• 2.1.5Implement patientcareplans.• 2.1.6Monitor thepatientandadjust careplanasneeded.• 2.1.7Document patientcarerelatedactivities.

InterprofessionalEducationCollaboration(IPEC)

IPECCoreCompetencies

IPECCoreCompetencies ModelofInterprofessionalPractice

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EducationalStrategies

MillerGE.TheAssessmentofclinicalskills/competence/performance.AcademicMedicine,1990.ShumwayJM.AMEEGuideNo.25:Theassessmentoflearningoutcomesforthecompetentandreflectivephysician.MedicalTeacher.2003

SeeHandout

Pharmacists’ Patient Care Process (PPCP)

1. PharmacyHITCollaborative– processframeworkfordocumentationinHER

2. ThePharmacyQualityAlliance(PQA)–developingqualitymeasures

3. TheAllianceforIntegratedMedicationManagement(AIMM)Collaborative,CenterforMedicareandMedicaidInnovationgranteesinEducationandTraining

NATIONALSTRATEGIES

LayeredLearningPracticeModel

AttendingPharmacist Resident(PGY2/PGY1) APPEStudent

IPPEStudent

PharmacyIntern

AJPE.2016;80(4):Article68

TeamSystemApproach

HighFunctioningTeams

• Holdsharedmentalmodels

• Haveclearrolesandresponsibilities

• Haveasharedvisionandvalues

• Strongleadershipteam

• Engageinregularfeedback

• Strongsenseofcollectivetrustandconfidence

• Createmechanismstocooperateandcoordinate

• Manageandoptimizeperformanceoutcomes

Salas,etal.,2004

TeamSTEPPSCommunication

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Pharmacists’PatientCareProcess

Collect• Subjectiveandobjectiveinformation•Understandmedicationandmedicalhistory

Assess•Analyzepatient’stherapyinmeetinggoals• Identifyandprioritizeproblems

Plan• Individualized,patient-centeredplan• Collaboration,evidence-based,cost-effective

Implement

• Initiate,modify,discontinueasneeded• Educationandcoordinationofcare

Follow-Up

• Clinicalendpoints• Safety,effectiveness,adherence Citation: JCPP Pharmacists’ Patient Care

Process. May 29, 2014. Available at: https://www.pharmacist.com/sites/default/files/files/PatientCareProcess.pdfSeeHandout

Pharmacists’PatientCareProcess• Standards2016emphasize

ensuringourgraduatesare“practice-ready”and“team-ready”

• Pre-APPEPerformanceDomainsandAbilities– Assessmentdatatodocument

studentachievement

BasicPatientAssessment

IdentificationAssessmentResolutionof

DRPEducationCommunicationDocumentation

Entrustable ProfessionalActivities(EPAs)

ReadinessforindependentpracticeAssesstrainingprogressionSetoftasks/responsibilities

TranslatecompetenciestoclinicalpracticeObservableandmeasurableinprocessandoutcome

• Patientcareprovider• Interprofessionalteammember• Populationhealth/careprovider• Practicemanager• Informationmaster• Self-developer

EPATaskDomains

EPAMilestonesinPharmDEducation LevelsofEPAs– MeansofAssessment

Level5=LLM?

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ColoringthePPCPPPCPStepsA-E

Pharmacists’PatientCareProcess,May29,2014

PPCPStepsA-E

Pharmacists’PatientCareProcess,May29,2014

PPCP– Assess

MedicationRelatedProblems

GapinCareTherapeuticDuplication

NonadherenceOpportunitytoreducecosts

UnnecessarymedicationtherapyDosagetoolow/highAdversedrugevent

PPCPStepsA-E

Pharmacists’PatientCareProcess,May29,2014

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PPCPStepsA-E

Pharmacists’PatientCareProcess,May29,2014

PPCPStepsA-E

Pharmacists’PatientCareProcess,May29,2014

IntegratingthePPCPonRotations

Reviewaspartofyourorientationactivities

Colleges / Schools• Integrationintothecurriculum

• Skills/simulationlabs• Didacticcoursework

• IntegrationintoIPPEs/APPEs• Variability• Buy-infrompreceptors

v ConsistentuseofPPCPinpracticebypharmacists

v EnhanceddeliveryofpatientcarethroughenhancedIPEcollaboration

Best Practices

• LLM• ClevelandClinicFlorida• UniversityHospitalsofGeaugaMedicalCenter

• PPCP• FairviewPharmacyServices• UniversityofPittsburghSOP

LLM-• Communityteachinghospital(partofthegreaterClevelandClinicHealthSystem)

• Pharmacyservices:40FTEs/3PGY1s/5clinicalspecialistswith1-2studentsperblock

• PPMIevaluation:Identifiedthatmedicationreconciliation/dischargecounselingwaslacking– Increaseutilizationofstudents– Integrate‘realworld’patientcareexperiencesintorotationlearning

ASHPNCPP2016.Constructingalayeredlearningmodel:considerationsandopportunities

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LLM-• 226-235students/annuallyfrom6institutions(1onsitefacultymembersfrom2differentinstitutions)

• Createdteams(LLM):1pharmacist,1resident,2-5APPEstudents,1IPPEstudent

• Developeddailystudentresponsibilitiesforpatients• Patientratios:

– Pharmacist:30-40patients&student:5-10patients– Residentwasextenderofpreceptor

ASHPNCPP2016.Constructingalayeredlearningmodel:considerationsandopportunities

LLM-• Preceptor/teachingmodelwithexpectationsoutlined– Standardizedstudentorientations(hospital/EPICorientations,PPMI/HCAHPS,counselingmethods)

– Model/coachingstudentsheavyinthe1st week

• ComparedLLMtotraditionalmodel(1montheach)• Numberofinterventionswasstat.signwhencomparingLLM(n=2913)toTM(n=106)

ASHPNCPP2016.Constructingalayeredlearningmodel:considerationsandopportunities

• Smallnon-teachingcommunityhospital• 3residentpositions:2PGY1,1PGY2• Team:hospitalist,clinicalspecialist,PGY1resident,3APPEstudents– Meaningfulinterprofessionalrotation– Delineatedresponsibilitiesforeachteammember– Back-upplanforwhennostudentsavailable

• Maximizestudentandresidentload

LLM-

ASHPNCPP2016.Constructingalayeredlearningmodel:considerationsandopportunities

• BenefitsLLM:– 5,301interventionsover2,622encounters– Increasedscholarlyopportunities– Improvedpatientsatisfaction– Improvedstudentsatisfaction– Improvedthetrustandrespectamongstteammembers

LLM-

ASHPNCPP2016.Constructingalayeredlearningmodel:considerationsandopportunities

• Sharedpros/consofLLM:– Pros:

• Encouragedapproachable/relatableteachers• Balancetolearningandteaching• Allowsforextensionsofpracticeservices

– Cons:• Requiresdevelopmentoftrainingplansforlearners• Structuremaybecumbersome• Ensuringconsistentschedulingtoallowconsistentprovisionsofservices

LLM-

ASHPNCPP2016.Constructingalayeredlearningmodel:considerationsandopportunities

• ProvideMTM=CMMservices• Sharedtheimportanceofconsistentpracticemodelwithemployees,healthcareteamcolleaguesandpayors

• 24pharmacistsin30TwinCitieslocations(2015data)– 5,304uniquepatientsseen– 11,978visits– 14.4meds&9.9medicalconditionsperpatient– 15,167DTPsidentified,91%resolved

• PreviousstudyconductedinMinnesota(2001-2002):totalhealthexpendituresdecreasedfrom~$12,000to$8,000perperson(JAmPharmAssoc.2008;48(2):203-11.)

PPCP-

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• IntegratedthePPCPintothecurriculum(P1throughP4)

• Wantedtointegrateinto‘REAL’pharmacies• PittCommunity:77communitypharmacies

– 4,571patients,110students• Empoweringstudents:

– 2013MillionHeartsCampaignNationalAward– 2014AdvocacyStateAward– 2015ScriptYourFutureNationalAward

PPCP- FusingAllStepsQUEST-SCHOLARApplication

Kleppinger EL,AuburnUniversity- SchoolofPharmacySeeHandout

NortheasternUniversity- SOP

SeeHandout

PBA-GSOPPBLCaseStudiesCourse

SeeHandout

DirectPatientCare– IPPEvs.APPE

• PriortoP4YearExperience– Medicationhistories– Patientdischargemedicationcounseling– Qualityassurancedatacollection

• P4YearExperience– EngageinPKoranticoagulationmonitoringservice– Designatherapeuticregimen– Antimicrobialstewardshipactivities– Renalandhepaticdosingchanges

EPAsinAPPEAssessment