Interprofessional Education: Healthcare Collaborations That Work Joseph A. Barone, PharmD, FCCP Dean...

Interprofessional Education:Healthcare Collaborations

That Work

Joseph A. Barone, PharmD, FCCPDean and Professor II

Ernest Mario School of Pharmacy

3/17/14


Outline

• Laying the ground work for interprofessional education• Current examples of interprofessional education • Learnings and takeaways from our interprofessional

education experiences• The opportunities at RBHS


Ground work

• Pew Commission Report “Critical Challenges: Revitalizing the Health Professions for the Twenty-first Century”– Restructuring current healthcare system– Coordination and integration of clinical care

• Institute of Medicine “Crossing the Quality Chasm: A New Health System for the 21st Century”– Health Professions Education– Redesign health professional education– Multidisciplinary environment

Pharmacotherapy 2009;29:145e-164e


Definitions

• Multidisciplinary– Different aspects of patient’s care handled

independently by appropriate experts from different professions

• Interdisciplinary/Interprofessional Care– Provision of care by providers from different professions

in a coordinated manner that addresses the needs of the patients

• Interdisciplinary/Interprofessional Education– Educational approach in which 2 or more disciplines

collaborate in the teaching-learning process with the goal of fostering interdisciplinary/interprofessional interactions that enhance the practice of each discipline



Supporting Evidence

• Hundreds of articles on IPE• Suggests that an interprofessional approach to health

care improves quality and decreases cost of care. • Practitioners should develop the knowledge, skills, and

attitudes to provide effective interprofessional care.



Where IPE occurs

• Classrooms• Laboratories• Introductory practice experiences• Advanced practice experiences

Pharmacotherapy 2009;29:145e-164eAJPE 2006; 70 (3):1-6


Statements About IPE

• Institute of Medicine– All health professionals should be educated to deliver patient-

centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.

• Accreditation Council for Graduate Medical Education– Expect medical residents to work in interprofessional teams to

enhance patient safety and improve patient and/or population based care.

• Accreditation Council for Pharmacy Education – Standards and Guidelines for Accreditation of the Doctor of

Pharmacy Degree – interprofessional teamwork is an area of emphasis



Interprofessional Education Collaborative (IPEC)• American Association of Colleges of Nursing• American Association of Colleges of Osteopathic

Medicine• American Association of Colleges of Pharmacy• American Dental Education Association• Association of American Medical Colleges• Association of Schools of Public Health

IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011


IPEC

• Goal of IPE – preparing all health professional students for deliberatively working together with the common goal of building a safer and better patient-centered and community/population oriented US health care system



Core Characteristics of IPE Model

• Educational environment– Classroom– Experiential setting– “Real-World” experiences– How much and how soon ?



Core Characteristics of IPE Model

• Student perspective– Identify “essential” disciplines for healthcare team– Medicine, Nursing, Pharmacy, Clinical Social Work,

Dietician/Nutrition, and others as the situation requires– Socialization – acquisition of knowledge, skills, values, roles

and attitudes associated with the practice of a particular professional.

– Balanced team

• Instructor perspective– Critical roles as mentors and role models– Actively engaged clinicians– Informal and active listening between disciplines that respect

one another as important as formal instruction



Competency Domains

• Values/Ethics for Interprofessional Practice– Work with individuals of other professions to maintain a

climate of mutual respect and shared values

• Roles/Responsibilities– Use the knowledge of one’s own role and those of other

professions to appropriately assess and address the health care needs of the patients and populations served



Competency Domains

• Interprofessional Communication– Communicate with patients, families, communities, and other

health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease.

• Teams and Teamwork– Apply relationship-building values and the principles of team

dynamics to perform effectively in different teams roles to plan and deliver patient-/population-centered care that is safe, timely, efficient, effective and equitable.



Potential challenges

• Institutional level challenges• Lack of institutional collaborators• Practical issues (scheduling)• Faculty development issues• Assessment issues• Lack of regulatory expectations• Support for meeting regulatory expectations



Potential challenges

• Differences between disciplines in history and culture• Academic schedules• Professional identity• Accountability and clinical responsibilities• Expectations of professional education• Availability of IPE educational materials

Am J Pharm Educ 2006;70(3):1-7


Examples of IPE at Rutgers and other institutions


Interdisciplinary Teams @ Rutgers/RWJUH• Emergency Medicine Program

– Teams of pharmacists, post-docs, physicians, and nurses

• Kidney and Pancreas Transplant Center– Team of pharmacists, surgeons, nephrologists, dieticians,

nurses, and social workers

• Rutgers Cancer Institute of New Jersey (CINJ)– Team of pharmacists, physicians, and nurse practitioners

• Rutgers Cardiology Clinic– Team of pharmacists, physicians, and nurses


Interdisciplinary Teams @ Rutgers/RWJUH

• Emergency Medicine – Role of the pharmacists:

• In-patient – Rounding/recommendations with team– Pharmacotherapy advice– Medication reconciliation– Education


Interdisciplinary Teams @ Rutgers/RWJUH• Transplant

– Role of the pharmacists:• In-patient

– Rounding/recommendations– Anti-rejection drug level monitoring and dose adjustments– Medication reconciliation

• Outpatient (Bi-weekly clinic )– Patient counseling and education sessions– Refill requests/compliance – Community pharmacy follow-up and third-party payer issues


Interdisciplinary Teams @ Rutgers/RWJUH• Oncology


– Aid in creation of patient’s chemotherapy schedule– Coordinate compounding of chemotherapy– Laboratory monitoring

• Outpatient (Weekly clinic)– Patient counseling and education sessions– Medication reconciliation– Research drug information questions


Interdisciplinary Teams @ Rutgers/RWJUH• Cardiology


– Medication reconciliation – Communication with cardiologist for outpatient follow-up

• Outpatient (Weekly clinic) – Patient counseling and education sessions– Aide with physical exam– Pharmacotherapy ∆ recommendations– Community pharmacy follow-up and third-party payer issues


Memorial University

• Health Canada funded 2005 program:– Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP)– Combined pre-licensure pharmacy, medicine, nursing, and social work

students– Required 9 modules with common learning experiences– Helped identify “optimal scopes of practice”– Fostered collaborative relationships between professions

Canadian Nurse March 2008; 22-26


Critical Care Pharmacotherapy Course at EMSOP

• Designed to develop critical thinking and clinical decision making

• Students learn to evaluate medication related issues and make recommendations to address them

• Full day simulation lab experience with Rutgers nursing students


Health Professionals United Initiative

• Organized by the Pharmacy Governing Council and current P3 class council

• Invites the School of Nursing, Physician Assistants, Social Work, and Medicine

• Conducts a multidisciplinary case centered on communication among the healthcare professions

• Provides a common space for students to meet each other and discuss current healthcare issues


Advanced Pharmacy Practice Experience Rotations (APPE)

• Clinical Rotations– Large team made up of pharmacy, medical, and nursing

students, residents, and attending physicians– Attending asks questions directed at both the pharmacy,

nursing, medical, and other students– Residents often ask pharmacy students for dosing and adverse

effect information– Student “teams” evolve


APPE Rotations

• Participation on inter-disciplinary rounds as would a pharmacy clinician

• Required to work up medication related recommendations and present them to the team– Ex. Antimicrobial stewardship/ adjustment of antibiotics

according to levels, and medication reconciliation


Many examples of IPE

• Interdisciplinary programs involve faculty and students– Nursing– Pharmacy– Medical– Occupational/physical– Social Work – Physicians Assistant


Other examples of IPE

• Pharmacy grand rounds– All departments invited

• Medicine, surgery, nursing

– Plethora of topics presented• Topic discussion, journal club, clinical pearls

– Guest pharmacy speakers invited periodically


Other Local Efforts

• Chandler Clinic• Vice Chancellor for IPE at RBHS align IPE efforts across

all schools• Curriculum renewal process at NJMS with a guiding

principle to incorporate IPE and IP collaborative practice throughout the 4 year curriculum

• EMSOP IPE committee to coordinate internally and externally

• Joining Forces• Pharm.D./M.D.• Pharmacy/Dentistry collaboration on oral health


Observations

• Share a common language• Understand the value of each health care profession• Learn to work effectively as a team• Promote the interprofessional delivery of health care

in all practice settings• Have skin in the game • Realize the enormous opportunity that exists at RBHS

to become a national leader in IPE


Interprofessional Education: Healthcare Collaborations That Work Joseph A. Barone, PharmD, FCCP Dean...

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