Interprofessional Education: Healthcare Collaborations That Work Joseph A. Barone, PharmD, FCCP Dean and Professor II Ernest Mario School of Pharmacy 3/17/14

Ernest Mario School of Pharmacy 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 21 st Century” –Health Professions Education –Redesign health professional education –Multidisciplinary environment Pharmacotherapy 2009;29:145e-164e

Ernest Mario School of Pharmacy 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 Pharmacotherapy 2009;29:145e-164e

Ernest Mario School of Pharmacy 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. Pharmacotherapy 2009;29:145e-164e

Ernest Mario School of Pharmacy Where IPE occurs Classrooms Laboratories Introductory practice experiences Advanced practice experiences Pharmacotherapy 2009;29:145e-164e AJPE 2006; 70 (3):1-6

Ernest Mario School of Pharmacy 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 Pharmacotherapy 2009;29:145e-164e

Ernest Mario School of Pharmacy 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

Ernest Mario School of Pharmacy 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 IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011

Ernest Mario School of Pharmacy Core Characteristics of IPE Model Educational environment –Classroom –Experiential setting –“Real-World” experiences –How much and how soon ? Pharmacotherapy 2009;29:145e-164e

Ernest Mario School of Pharmacy 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 Pharmacotherapy 2009;29:145e-164e

Ernest Mario School of Pharmacy 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 IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011

Ernest Mario School of Pharmacy 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. IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011

Ernest Mario School of Pharmacy 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 IPEC. Core Competencies for Interprofessional Collaborative Practice. May 2011

Ernest Mario School of Pharmacy 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 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 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 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 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 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 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

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 Pharmacotherapy 2009;29:145e-164e

Ernest Mario School of Pharmacy