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Interprofessional Education: Healthcare Collaborations That Work Joseph A. Barone, PharmD, FCCP Dean 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy Pharmacotherapy 2009;29:145e-164e 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. Ernest Mario School of Pharmacy Pharmacotherapy 2009;29:145e-164e Where IPE occurs • • • • Classrooms Laboratories Introductory practice experiences Advanced practice experiences Ernest Mario School of Pharmacy Pharmacotherapy 2009;29:145e-164e AJPE 2006; 70 (3):1-6 Statements About IPE • Institute of Medicine – All health professionals should be educated to deliver patientcentered 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 Ernest Mario School of Pharmacy Pharmacotherapy 2009;29:145e-164e 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011 Core Characteristics of IPE Model • Educational environment – – – – Classroom Experiential setting “Real-World” experiences How much and how soon ? Ernest Mario School of Pharmacy Pharmacotherapy 2009;29:145e-164e 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 Ernest Mario School of Pharmacy Pharmacotherapy 2009;29:145e-164e 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 Ernest Mario School of Pharmacy IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011 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. Ernest Mario School of Pharmacy IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011 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 Ernest Mario School of Pharmacy IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011 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 Ernest Mario School of Pharmacy Examples of IPE at Rutgers and other institutions Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy Interdisciplinary Teams @ Rutgers/RWJUH • Emergency Medicine – Role of the pharmacists: • In-patient – – – – Rounding/recommendations with team Pharmacotherapy advice Medication reconciliation Education Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy Interdisciplinary Teams @ Rutgers/RWJUH • Oncology – Role of the pharmacists: • In-patient – 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 Ernest Mario School of Pharmacy Interdisciplinary Teams @ Rutgers/RWJUH • Cardiology – Role of the pharmacists: • In-patient – 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 Ernest Mario School of Pharmacy Memorial University • Health Canada funded 2005 program: – Interprofessional Education for Collaborative PatientCentred 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy Many examples of IPE • Interdisciplinary programs involve faculty and students – – – – – – Nursing Pharmacy Medical Occupational/physical Social Work Physicians Assistant Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy 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 Ernest Mario School of Pharmacy Pharmacotherapy 2009;29:145e-164e Ernest Mario School of Pharmacy