By Carole Goodine
In a recent blog, Simon Sinek shared a formula for innovation: Innovation = lack of time + lack of resources + optimism. This describes the situation at our local hospital, and I suspect at many others. There is no extra money in healthcare, so if we want to innovate pharmacy care, we need to think outside the box and design creative solutions. I believe pharmacy students can help.
I’d like all patients admitted to a family practice unit at our hospital to have access to a pharmacist. Today, our family practice pharmacists see about 20 per cent of admitted patients. There is good evidence that proactive pharmacist care improves patient health and economic outcomes, reduces medication adverse events, and reduces morbidity and mortality. Proactive pharmacist care consists of an intervention bundle: obtaining a medication history on admission, reconciling admission medications, participating in interprofessional patient care rounds, developing and initiating a pharmaceutical care plan, resolving drug therapy problems, educating patients during their hospital stay and at discharge, and reconciling medications at transfer and discharge.
Clearly, there are good reasons to expand pharmacists’ reach, and the influx of students expected from entry-level Pharm D programs may be an opportunity to grow our program. Yes, precepting students requires time and commitment. It also provides preceptors with a chance to re-evaluate their current practice using a different lens. Students bring a fresh enthusiasm to the workplace. They are eager to learn and share their knowledge, they see things differently, and their wages are significantly less than a staff pharmacist. Entry-level Pharm D programs will increase demand for clinical pharmacy practice placements. To reduce preceptor burden, we want to design programs that will allow students to make meaningful contributions to patient care without adding workload to hospital pharmacists.
With this vision in mind, our team reflected on ways pharmacy students could contribute to patient care. We considered our challenges and factors that prevented pharmacists from seeing patients. Then we identified activities that fell within the scope of students’ abilities and considered our workflow. We realized that students could screen patients through a chart review. Pharmacists were spending an hour or more each morning reviewing electronic records to identify patients they would like to target for a pharmacotherapy assessment. When pharmacists arrived on the family practice unit, priorities quickly changed as nurses and physicians started to ask questions and other drug-related issues were identified. Pharmacists were frustrated with a lack of control over workflow; they felt that much of the care they were providing was reactive and that they were missing opportunities to be proactive. Pharmacists wanted to work with patients to prevent drug-related problems, rather than putting out fires.
As a result, in 2019 we designed a site-specific Pharmacy Patient Screening Tool (PPST) with the goal of piloting a pharmacy student-led patient screening program. With training and orientation, we felt that a pharmacy student could review patient charts and collect information to help unit-based pharmacists identify patients at risk for drug-related problems. They could then prioritize patient care activities based on perceived need.
Once we secured a grant from the Dalhousie Pharmacy Endowment Fund, we hired a pharmacy student and were on our way discovering new ways of providing patient care! First, we oriented the student to the unit and filled in any knowledge gaps. The student learned about high-risk medications and common disease states encountered on the family practice unit. They also received training on how to locate information in electronic and paper charts. A clinical manager worked with the student to screen patients until they were deemed capable of working independently. In less than three weeks, the student was screening independently and supporting the unit-based pharmacists’ activities.
In our study, we found that the student-to-pharmacist discrepancy rate was only 1%. The student’s work brought tremendous benefits. The hands-on learning opportunity increased the student’s therapeutic knowledge, communication, and data collection skills. Meanwhile, pharmacists felt that the student utilizing the PPST helped their workflow and patient prioritization.
It certainly helped that the student who conducted this project was a highly motivated hard worker who was eager to learn and had great communication skills. These attributes are common to many pharmacy students, and we believe that structured activities combined with self-directed learning are the cornerstones to successful student rotations. When both the preceptor and the learner work together to meet the patient’s needs, everyone wins.
Carole Goodine is a Pharmacy Clinical Manager at Dr Everett Chalmers Regional Hospital, Horizon Health Network, New Brunswick.