Impact of an Emergency Department Simulation on Pharmacy Students’ Interprofessional Team Skills and Attitudes

Objective:  To evaluate the impact of an emergency department simulation on pharmacy students’ interprofessional team skills and attitudes as measured by a novel mixed methods approach. Methods: A simulated emergency department encounter was executed by interprofessional teams consisting of pharmacy and medical students.  Two rounds of the same encounter were separated by a short debriefing session facilitated by pharmacy and medical faculty.  A full, comprehensive debriefing session occurred after conclusion of the second round.  Pharmacy faculty evaluated pharmacy students using a competency-based checklist after each round of the simulation.  Pharmacy students completed a baseline self-assessment of their interprofessional skills and attitudes pre-simulation, and again post-simulation.  Results: Pharmacy students demonstrated significant improvement in providing clear and concise verbal interprofessional communication and using shared decision making to develop a collaborative plan of care, based upon student self-assessment and faculty observational ratings.  Student self-assessments also showed significant perceived growth in contributing to the team’s plan of care, and demonstrating active listening skills within the interprofessional team.  Through qualitative analysis, pharmacy students noted perceived self-improvement in a variety of team-based skills and attitudes including confidence, critical thinking, role identification, communication, and self-awareness.  Conclusion:  This simulation provided a learning opportunity for pharmacy students to improve their skills related to teamwork and interprofessional collaboration.  Based upon a novel a mixed methods assessment, both student self-assessment and faculty observational ratings were associated with significant growth in interprofessional skills and attitudes. This simulation provides a template experience for colleges/schools to meet, at least in part, ACPE Standards related to interprofessional education in collaboration with medical students.  

Positioning psychiatric pharmacists to improve mental health care

Psychiatric pharmacy continues to grow and look to the future with a focus on helping individuals recover from mental health and substance use disorders. The American Association of Psychiatric Pharmacists (AAPP) considers Board Certified Psychiatric Pharmacist (BCPP) the gold standard credential that all psychiatric pharmacists should attain to demonstrate specialized knowledge and expertise in psychiatry. BCPPs are part of collaborative interprofessional teams and practice in hospitals, clinics, and diverse health systems. Two out of 3 BCPPs practicing in clinics have prescriptive authority. BCPPs improve access, safety, medication adherence, and therapeutic outcomes. Every person with a mental health and substance use disorder should have access to a BCPP providing comprehensive medication management (CMM) and psychotropic stewardship aimed at improving population health. BCPPs are in demand owing to their expertise. AAPP envisions growth and expansion of the BCPP role in many areas including coordinating psychiatric transitions of care and telehealth services, managing long-acting injectable medication clinics, providing pharmacogenomic consultation, conducting clozapine and lithium monitoring, managing medications for substance use disorders, leading medication groups, CNS drug development, research, and provider education. To prepare the workforce, colleges and schools of pharmacy should hire BCPPs for optimal curriculum development, and each student pharmacist should have an opportunity to develop a therapeutic alliance with a person recovering from psychiatric illness. Postgraduate year (PGY) 1 residencies should offer learning experiences in psychiatric pharmacy to prepare residents to enter an expanded number of PGY2 psychiatric pharmacy residencies, ultimately earning their BCPP and being well positioned to improve mental health care

Exploration of Learning during an International Health Elective Using Photovoice Methodology

Based on surveys and structured interviews, International Health Experiences (IHEs) improve cultural sensitivity, communication, and self-confidence among health professions students. However, open-ended methods to explore student learning during an IHE are not widely utilized. We sought to explore pharmacy student-identified learning during an IHE in an open-ended fashion using Photovoice methodology. Pharmacy students on an IHE in Guatemala were given disposable cameras and asked to photograph images that reflected their learning. Through the application of Photovoice methodology students captured, reflected upon, and presented photos to describe the learning they experienced. Themes were drawn from the reflective and focus group data collected. During three IHEs, six students captured seventy-seven photos. Four main learning themes emerged: culture/cultural competence, professional growth, shifting of attitudes, and meaningful/emotional experiences. Pharmacy students documented learning in expected (cultural competence, professional growth) and unexpected (emotional experiences) domains during an IHE. Photovoice may be an effective methodology for the exploration of learning, allowing students to capture their own learning including and beyond what is expected by their instructors

Disease Control Among Patients With Diabetes and Severe Depressive Symptoms

Objective: Major depressive disorder and type 2 diabetes commonly co-occur and disease control tends to be poorer when both conditions are present. However, little research has examined the disease characteristics of patients with diabetes and more severe depressive symptoms. Methods: We report a retrospective observational study of 517 patients with diabetes from 2 primary care centers. Patients with diabetes and moderately-severe/severe depression symptoms (Patient Health Questionnaire [PHQ-9] score >15) were compared with patients with diabetes without moderate or severe depression symptoms (PHQ-9 score <15; the comparison group) with regard to control of diabetes, blood pressure, and lipid parameters. Frequency of HbA1c and PHQ-9 testing were also examined. Results: Patients with diabetes and moderately severe/severe depressive symptoms had higher HbA1c (7.56% vs 7.09%), diastolic blood pressure (78.43 vs 75.67 mm Hg), and low-density lipoprotein cholesterol (109.12 vs 94.22 mg/dL) versus the comparison group. Patients with diabetes and moderately-severe/severe depression underwent HbA1c and PHQ-9 testing with similar frequency to the comparison group. Conclusions: The presence of moderately severe/severe depressive symptoms was associated with poorer glucose, lipid, and blood pressure control among patients with diabetes. Further research should prospectively examine whether a targeted depression treatment goal (PHQ-9 score <15) in patients with diabetes results in improved control of these important disease parameters

Implementation of a statewide program within community pharmacies to prevent opioid misuse and accidental overdose

Objective: To describe the implementation of a statewide pharmacy program called ONE Rx (Opioid and Naloxone Education) within community pharmacies.Setting: Thirty community pharmacies.Practice description: Community pharmacies throughout the state of North Dakota were invited to participate. Pharmacists in North Dakota can legally prescribe and dispense naloxone.Practice innovation: ONE Rx is a statewide program that provides pharmacists with the education and tools to screen every patient who was prescribed an opioid medication for the risk of opioid misuse and accidental overdose. The goal of ONE Rx is to prevent opioid misuse and accidental overdose through patient screening and individualized education and intervention within the community pharmacy.Evaluation: Outcomes to measure the implementation of ONE Rx included the number of pharmacists and technicians who participated in the training, the number of pharmacies who chose to implement ONE Rx, and the number of patients screened for the risk of opioid misuse and accidental overdose.Results: The ONE Rx training was completed by 240 pharmacists and 41 registered pharmacy technicians. Thirty community pharmacies implemented the program between October 2018 and May 2019, and more than 1700 patients were screened for the risk of opioid misuse and accidental overdose.Conclusion: A statewide program to screen for opioid misuse and accidental overdose was successfully implemented.North Dakota Department of Human ServicesBlue Cross Blue Shield of North Dakota Caring FoundationAlex Stern Foundatio