An efficient virtual patient image model: interview training in pharmacy

This paper presents the development of a virtual patient simulation by a 3D talking head and its use by pharmacy students as a training aid for patient consultation. The paper concentrates on the virtual patient modeling, its synthesis with a speech engine and facial expression interaction. The virtual patient model is developed in three stages: building a personalized 3D face model; animation of the face model; and speech driven face synthesis. The model is used in conjunction with a training artificial intelligence module that creates several scenarios in which the student oral interview ability is assessed. The final evaluation phase is a randomized controlled trial at three partner universities: The University of Newcastle, Monash University and Charles Stuart University. It shows the potential to revolutionize the way pharmacy students’ training is conducted

A theoretical exploration of hospital clinical pharmacists' perceptions, experiences and behavioural determinants in relation to provision of optimal and suboptimal pharmaceutical care.

Pharmaceutical care describes a range of patient-focused activities delivered by pharmacists. The activities aim to optimise medicines use for patients and to reduce harm from adverse events with medicines. This study was conducted in an NHS Scotland organisation, where the clinical pharmacy service has an established quality management system. It was evident that some gaps existed in the quality assurance parameters for clinical pharmacy services and pharmaceutical care, with there being no clearly defined route to report adverse events or near misses that arose from within the service. In quality management terms this meant it was difficult to determine whether optimal pharmaceutical care was being delivered, or to establish how accurate clinical pharmacists were in their pharmaceutical care activities. Additionally, this meant it was difficult to evidence areas for quality improvement. This study aimed to explore the perceptions, experiences and behavioural determinants of the hospital clinical pharmacists in relation to optimal and suboptimal pharmaceutical care within an NHS organisation in Scotland using a theoretical framework. The research used the concept of suboptimal pharmaceutical care to describe the gap between pharmaceutical care as intended and pharmaceutical care as delivered. This research used qualitative study design and a phenomenological approach, and was conducted in two phases with the first phase influencing the design of the second phase. In Phase 1, focus group methodology was used to determine perceptions of hospital clinical pharmacists to optimal and suboptimal pharmaceutical care. Study participants (n=20) were hospital clinical pharmacists recruited from hospitals across the NHS Scotland health board. A topic guide focused the discussions on the activities related to medicines reconciliation and Kardex/medicines review. Data generated from focus groups was in the form of written statements and audio-recorded narrative to describe participants' perceptions of barriers and enablers to providing optimal pharmaceutical care. The Theoretical Domains Framework (TDF), an integrative theoretical framework that describes behavioural determinants, was used to analyse the findings. Phase 2 used in-depth interviews to explore participants' (n=10) experiences of optimal and suboptimal pharmaceutical care. A semi-structured interview schedule was developed using TDF, to facilitate identification of behavioural determinants to the provision of optimal and suboptimal pharmaceutical care. Within Phase 1, participants perceived that there were barriers to the delivery of optimal pharmaceutical care, citing as contributory elements time factors, lack of policy and procedure, conflicting priorities (including uncertainty over efficiency versus thoroughness), poor underpinning knowledge of medicines by doctors, and inadequate skills in completing and documenting activities. In Phase 2, key determinants were elicited, including knowledge (of trainees), time, policy, procedure or guidance on suboptimal pharmaceutical care, and personal and professional barriers and enablers, including professional embarrassment and hierarchy. The study has allowed an exploration of an underacknowledged topic in clinical pharmacy practice and identified behaviours, including role uncertainty and embarrassment, that may contribute to lack of reporting on suboptimal pharmaceutical care. Recommendations have been made using behavioural change technique interventions and include educational interventions, skills training, modelling, enablement, persuasion, incentivisation, coercion, restriction and environmental restructuring. Implementation of these interventions and evaluation of their effectiveness will enable the organisation to have more robust quality assurance parameters within the clinical pharmacy service, and to ensure continued conformance with the quality management system. Across the wider clinical pharmacy community, lessons may be learned about perceptions and experiences relating to suboptimal pharmaceutical care, and consideration made to capturing the learning opportunities that can arise when considering suboptimal pharmaceutical care in practice

An investigation of healthcare professionals’ experiences of training and using electronic prescribing systems: four literature reviews and two qualitative studies undertaken in the UK hospital context

Electronic prescribing (ePrescribing) is the process of ordering medicines electronically for a patient and has been associated with reduced medication errors and improved patient safety. However, these systems have also been associated with unintended adverse consequences. There is a lack of published research about users’ experiences of these systems in UK hospitals. The aim of this research was therefore to firstly describe the literature pertaining to the recent developments and persisting issues with ePrescribing and clinical decision support systems (CDS) (chapter 2). Two further systematic literature reviews (chapters 3 and 4) were then conducted to understand the unintended consequences of ePrescribing and clinical decision support (CDS) systems across both adult and paediatric patients. These revealed a taxonomy of factors, which have contributed to errors during use of these systems e.g., the screen layout, default settings and inappropriate drug-dosage support. The researcher then conducted a qualitative study (chapters 7-10) to explore users’ experiences of using and being trained to use ePrescribing systems. This study involved conducting semi-structured interviews and observations, which revealed key challenges facing users, including issues with using the ‘Medication List’ and how information was presented. Users experienced benefits and challenges when customising the system, including the screen display; however, the process was sometimes overly complex. Users also described the benefits and challenges associated with different forms of interruptive and passive CDS. Order sets, for instance, encouraged more efficient prescribing, yet users often found them difficult to find within the system. A lack of training resulted in users failing to use all features of the ePrescribing system and left some healthcare staff feeling underprepared for using the system in their role. A further literature review (chapter 5) was then performed to complement emerging themes relating to how users were trained to use ePrescribing systems, which were generated as part of a qualitative study. This review revealed the range of approaches used to train users and the need for further research in this area. The literature review and qualitative study-based findings led to a follow-on study (chapter 10), whereby the researcher conducted semi-structured interviews to examine how users were trained to use ePrescribing systems across four NHS Hospital Trusts. A range of approaches were used to train users; tailored training, using clinically specific scenarios or matching the user’s profession to that of the trainer were preferred over lectures and e-learning may offer an efficient way of training large numbers of staff. However, further research is needed to investigate this and whether alternative approaches such as the use of students as trainers could be useful. This programme of work revealed the importance of human factors and user involvement in the design and ongoing development of ePrescribing systems. Training also played a role in users’ experiences of using the system and hospitals should carefully consider the training approaches used. This thesis provides recommendations gathered from the literature and primary data collection that can help inform organisations, system developers and further research in this area

Challenges of Digital Commons: A Qualitative Study of an Automated Dispensing Cabinet in a Paediatric Intensive Care Unit

Missed medication doses can affect patient safety in hospitals. The use of automated dispensing cabinets (ADC) in clinical areas may reduce the occurrence of medications being unavailable at the time of need by alerting pharmacy to replenish stock. However, workarounds in ADC use can affect this capability. We studied nurses' use of an ADC in a paediatric intensive care unit with  54 hours of observation, semi-structure interviews (19 nurses; 4 pharmacy/management staff) and review of reported incidents. We found running out of medication a recurrent problem despite the ADC. Contributing factors affecting data entry in the ADC, and therefore replenishment alerts to pharmacy, included: the organisation of medication activities in the ward, nurses' information needs, patients' medication needs, and ADC design. Running out of medications was a 'tragedy of the commons'. Effective solutions may require going beyond user training and directives for accurate data entry, to work process redesign

Virginia Commonwealth University Professional Bulletin

Professional programs bulletin for Virginia Commonwealth University for the academic year 2018-2019. It includes information on academic regulations, degree requirements, course offerings, faculty, academic calendar, and tuition and expenses for graduate programs

Design Strategy for a Scalable Virtual Pharmacy Patient

This paper reports on the completion of the first stage of research of a pilot study undertaken in collaboration by 3 Australian universities. The pilot involves the development of a virtual pharmacy patient (VPP) as a study of its effects on student learning when it is used as a formative assessment tool for pharmacy students in interviewing and diagnosing a patient. The design criteria that have been incorporated into the virtual patient system are described. The novelty of this system is in its ability to track and report on the style and appropriateness of student questioning of a virtual pharmacy patient. One of the main problems in this type of system is recognition of free-text student questions. An overview of the pragmatic solution to this and the systems potential as a tool to generate a lexicon for more complex question recognition is presented

Virtual patients as a tool for training pre-registration pharmacists and increasing their preparedness to practice: A qualitative study

Virtual patients are an active learning pedagogical tool which simulate clinical scenarios in a three-dimensional environment. Their use in pharmacy education is under-researched in comparison to other healthcare professions. In the United Kingdom, pre-registration training refers to a year of workplace based training which pharmacy graduates must complete prior to professional registration as pharmacists. This study aimed to evaluate pre-registration pharmacists’ perceptions on the integration, usefulness and enjoyment of completing virtual patient simulations or non-interactive case studies as part of their training. Pre-registration trainees completed three virtual patient simulations or three non-interactive case studies on the topics of: emergency hormonal contraception, renal function and childhood illnesses. Telephone interviews were conducted with twenty pre-registration pharmacists, exploring their perspectives on the use of the virtual patient or non-interactive case studies. Data was analysed using the five-stage framework approach. Four main themes emerged from the data: case study design; usefulness of the case studies as a training tool; support in pre-registration training; utility of the learning tools. Trainees also identified technical issues they had experienced while completing the virtual patient simulations, specifically with keyword recognition. Pre-registration trainees who used the virtual patients provided comments relating to the novelty, realism and enjoyment in completing them. Trainees in both groups reported developing knowledge and skills from completing the case studies; those who used the virtual patient commented on the development of communication skills and an increase in confidence for practice and those who used the non-interactive cases focused on knowledge acquisition and numeracy. Participants were enthusiastic about virtual patients as a novel training tool which provided an opportunity for learners to practice realistic scenarios in a safe environment. Virtual patients offer the potential to ‘bridge the gap’ in pharmacist pre-registration sector-related training variation, promote learning through reflection on doing and increase overall preparedness for practice

Student Nurse Perceptions of Effective Medication Administration Education

Nursing faculty strive to educate students in a manner that prevents errors, promoting quality, patient-centered care. This endeavor is dependent upon meaningful and effective education that incorporates educational experiences reflective of the service sector. Anecdotal reports from clinical faculty and student nurses suggest that academic medication administration education may not optimally prepare students for safe entry into clinical practice. The aim of this phenomenologic qualitative research is to understand student nurse perceptions regarding teaching strategies and learning activities that prepared them for safe medication administration in acute care clinical settings. Focus group interviews resulted in two broad themes that are identified as Effective Education and Gaps in Education. Within these broad themes, findings revealed that students value faculty demonstrations, peer-learning opportunities, and repetitive practice with timely feedback. Study findings also pointed to educational gaps. Students reported needing to learn communication and conflict resolution strategies that would help them manage real-world interruptions, distractions, and computer generated alerts. Study findings recommend implementing relevant decision-support technology within academic lab learning activities