Academic Pharmacy Now: 2020 Issue 1

Academic Pharmacy

The News Magazine of the American Association of Colleges of Pharmacy

NOW

Volume 13 2020 Issue 1

DO NO HARM Pharmacy school curricula are prioritizing patient safety to prepare future pharmacists for their vital role in keeping patients safe. 18

Also in this issue:

A Closer Look at Prescription Labels 5 STEM Superheroes 13

Pharmacists Help People Live Healthier, Better Lives.

who we are @AACPharmacy

Academic Pharmacy The News Magazine of the American Association of Colleges of Pharmacy

Pharmacists Help People Live Healthier, Better Lives.

1400 Crystal Drive, Suite 300 P Arlington, VA 22202 703-739-2330 P www.aacp.org Founded in 1900, the American Association of Colleges of Pharmacy is the national organization representing the interests of pharmacy education. AACP comprises all accredited colleges and schools of pharmacy, including more than 6,600 faculty, approximately 63,800 students enrolled in professional programs and 4,800 individuals pursuing graduate study.

NOW

CEO & Publisher

Lucinda L. Maine Editorial Advisor

Lynette R. Bradley-Baker

Editorial Director

Maureen Thielemans Managing Editor

Letters to the Editor

Jane E. Rooney

We welcome your comments. Please submit all letters to the editor to communications@aacp.org.

About Academic Pharmacy Now

Academic Pharmacy Now highlights the work of AACP member pharmacy schools and faculty. The magazine is published as a membership service.

Change of Address

For address changes, contact LaToya Casteel, Member Services Coordinator, at lcasteel@aacp.org.

Advertising

For advertising information and rates, visit https://www.aacp-mediaplanner.org/ or contact Samantha Roesler, AACP Media & Event Sales, at samantha.roesler@mci-group.com

Editorial Assistant

Kyle R. Bagin

Communications Advisor

Stephanie Saunders Fouch

Art Director

Tricia Gordon Digital Designer

Sean Clark

©2020 by the American Association of Colleges of Pharmacy.

All rights reserved. Content may not be reprinted without prior written permission.

Freelance Writer

AACP’s Professional Supporter Program

Joseph Cantlupe

Freelance Writer

Emily Jacobs

Promotion Supporter Freelance Writer

Athena Ponushis

2

Academic Pharmacy NOW  2020 Issue 1

Volume 13 2020 Issue 1

@AACPharmacy a look inside

campus connection

5

Rethinking Prescription Labels

8

A collaborative project involving the University of Wisconsin–Madison School of Pharmacy is focused on redesigning prescription labels to improve patient adherence.

Frightful Fun in the Classroom Zombies? No problem. A course featuring some apocalyptic challenges prepared student pharmacists to face real-world emergency situations.

community impact

12

NEOMED Pharmacy Professor Receives $1 Million to Study Whether Exercise Is Neuroprotective

18

The Department of Defense grant supports a study that may help change the pathology of Parkinson’s disease and inform activities for those in VA systems.

13

Do No Harm Pharmacy school curricula are prioritizing patient safety to prepare future pharmacists for their vital role in keeping patients safe.

DO NO HARM

Inspiring Future STEM Superheroes Dr. Sylvie Garneau-Tsodikova, newly selected to be part of the AAAS IF/ THEN Ambassadors Program, is a medicinal chemist encouraging girls to become STEM Wonder Women.

@AACPharmacy

26

Gaining New INsight

27 28

February 8–11, 2020 Wyndham Grand Rio Mar Puerto Rico Golf & Beach Resort

Last Chance: Renew Your AACP Membership New Year, New Look for AJPE.org!

Academic Pharmacy NOW  2020 Issue 1

3

community note publisher’s impact

Dear Colleagues: Happy New Year! I have high hopes for the new year as we work together to transform pharmacy practice and education to ensure that the public receives exactly the right “dose” of pharmacy services, including preventive and public health services.

In mid-January, the five AACP standing committees and the Argus Commission met in the Washington metro area for their face-to-face work time. As a reminder, President Sorensen challenged all of us to embrace his “bold aim” for transforming our work. Reaching half the primary care medical practices over the next five years to help them integrate or expand the medication management services our faculty and our graduates can offer is the aim.

At the meeting, Todd reminded attendees of the diffusion of innovation curve, noting that “a tipping point” for innovation occurs when the early adopters have implemented the innovation. Based on his assessment of pharmacists’ practicing in partnership with primary care teams, he thinks we may be at approximately 20 percent of those practices today. Twenty percent is the tipping point! So now our collective efforts, combined with those of other state and national pharmacy associations, can focus on how to help the Early Majority welcome pharmacists into their team. Efforts like the ACT/CPESN Collaborative ACT (Academia-CPESN Transformation) that now has engaged almost 80 colleges and schools of Pharmacy Collaborative pharmacy are an important part of this work. Better care for individuals, healthier populations, lower cost AND increased clinician well-being will be the evidence-based results.

This will also be a special year for a unique reason: Miss Community Pharmacy Practice Transformation Initiative: Facilitating Partnerships between CPESN Networks and Schools of Pharmacy America 2020 is none other than Camille Schrier, a Virginia Commonwealth University Pharm.D. student! In keeping with this issue’s feature story, Camille’s impact focus is on appropriate medication use and patient safety. For the talent portions of the Miss Virginia and the Miss America 2.0 programs, she executed a science demonstration. She is a passionate advocate for women and STEM in addition to her focus on medication safety. She is just the high-visibility, articulate spokesperson for the profession that we have often been missing. ®

We invite you and your school/college of pharmacy to become an active member of the ACT Pharmacy Collaborative.

The ACT Pharmacy Collaborative is an operational learning and ACTing collaborative among schools/colleges of pharmacy and clinically integrated networks of community-based pharmacies. The ACT Pharmacy Collaborative goal is to support the transformation of community-based pharmacy practice from a product-based to a pharmacy care delivery model in neighborhoods nationwide.

The ACT Pharmacy Collaborative will:

Unite schools/colleges of pharmacy and pharmacist leaders nationwide with a common focus to transform communitybased pharmacy practice

Mobilize stakeholders and resources to support and facilitate implementation of community-based pharmacy care

Amplify the development and implementation of sustainable community-based pharmacy care delivery

How you and your school can get involved: ● Get committed! Our Dean’s Statement of Commitment, available at www.actforpharmacy.com, invites schools to commit to community pharmacy practice transformation

AACP leaders and staff look forward to seeing you throughout 2020 as we visit your campuses and see you at ours and other organizations’ meetings. We also are fielding surveys of members and nonmembers this quarter to inform the next AACP strategic planning process. I hope you will share your thoughts with us by responding when you receive your survey via email soon. ●

●

Identify an ACT Champion – Empower a colleague who will represent the school and facilitate partnerships with CPESN Networks and local community pharmacies as a part of the Dean’s Statement of Commitment Invite collegues to participate in an “activation year” – Join our year-long cadence of idea-and-action-share webinars, student initiatives, and research pop-up groups beginning August 2019 through July 2020

www.actforpharmacy.com

The ACT Pharmacy Collaborative is supported by grant funding to the University of Pittsburgh from the Community Pharmacy Foundation. ACT Pharmacy Collaborative partners include CPESN USA and AACP. The work of the Collaborative is guided by a task force of AACP Faculty Appointees and CPESN USA Luminary Appointees.

Sincerely,

Lucinda L. Maine, Ph.D., R.Ph. CEO and Publisher

4

Academic Pharmacy NOW  2020 Issue 1

campus connection

Rethinking Prescription Labels A collaborative project involving the University of Wisconsin–Madison School of Pharmacy is focused on redesigning prescription labels to improve patient adherence.

By Katie Gerhards

An older patient, who was beginning to experience dementia, also had perpetually restless legs, which would keep her from being able to fall asleep at night. The patient had a prescription for a medication to help quiet that disruptive feeling, but on the label— which read “take two tablets by mouth two to three hours before bed”—all she could see was the number “three.” The patient continually took three tablets.

After speaking with the patient and physician, Nicole Sandberg, a pharmacist at Ballweg Family Pharmacy, decided to rewrite her prescription label to make it clearer for the patient to understand: “Take two tablets by mouth two hours before bed.” With only one number present, the label was easier for the patient to digest, and she was able to manage her medications more easily.

Research shows that this experience is not uncommon, and patients themselves think it’s time for a change. A

recent survey of state residents by Wisconsin Health Literacy (WHL), a division of Wisconsin Literacy, Inc., found that 88 percent of respondents found current medication labels confusing, and 23 percent reported having taken a medication incorrectly because of confusing labeling.

Mary Smith

“We want to get as many pharmacy partners as possible to modify their3/19/2019 labels using our toolkit or implementation guide,” said Mott. So far, 20 pharmacies have joined to redesign their labels. The project, now in its third phase, has been in progress since 2014 and has already improved patient Use only on your metrics. skin.

The United States Pharmacopeia (USP) Gently rub a thin layer of cream onto the Warning: Do not Opportunity in 2013 affected releasedskin a set of standards for put in eyes. Do not to Improve at bedtime. swallow. patient-centered prescription medicaLabels Filled: 1/2/2018 tion labels, General Chapter 17 in USP’s During early focus groups with the Fluocinonide Cream USP, 0.1% Expires: formulary, which focus on readability public, “we 12/26/2019 frequently heard that there and clarity. To date, Utah is the only is just too much on the label for pastate toRefills: have3 formally adoptedFriendly the Pharmacy tients to understand, so they don’t even 608-555-5555 Qty: 30 grams RX 2315648913 Main St. Dr. James standards.

ButHill a project led by123 WisDistributor: Rebel Anytown, WI 22222 bother to look,” said Mott. “Because consin Health Literacy with a range of they aren’t looking, they don’t know collaborators, including University of how to take their medications, and Wisconsin–Madison School of Pharma- then a lot of times they just end up not cy Professor Dr. David Mott, is paving taking it at all.” the way to get all Wisconsin pharmaThe USP guidelines address a lot of cies on board by creating a framework 3/19/2019 that feedback by suggesting simplified for implementation, which can help language, in the patient’s preferred out-of-state pharmacies improve their language when possible; improved labels, too.

NOTE: This is a “non-compliant” label example

MARY SMITH 1000 Maple Street, Anytown, WI 22222

6/12/2018

608-222-2222 RX: 023156456

TAKE ONE TABLET BY MOUTH ONCE DAILY MFG: Teva USA

ATENOLOL 100 MG Tab Qty: 60 Refill (01) time until 12/25/2018 RPh: CS White round Dr. Olivia Van Beek Copay $13.97 Discard after 3/25/2019

MEDICATION SHOULD BE TAKEN WITH PLENTY OF WATER

NDC: 0254-0261-03

CAUTION: Federal law prohibits transfer of this drug to any person other than the patient for whom prescribed.

Friendly Pharmacy 608-555-5555 123 Main Street Anytown, WI 22222

Mary Smith Warning: It is very important that you take or use this exactly as directed.

Do not skip doses or discontinue unless directed by your doctor.

Call your doctor about side effects.

You may report side effects to FDA at 1-800-FDA-1088.

May cause dizziness

Take 2 puffs by mouth 10 minutes before exercise.

Ventolin HFA 90mcg Inhaler

Shake the inhaler well before each spray.

Rinse mouth with water after use.

Fill date: 5/6/2018 Expires: 4/29/2018

Qty: 200 metered inhalations; Dr. Mia Stephens Refills: 1

Friendly Pharmacy 608-555-5555 123 Main Street Anytown, WI 22222

inhalations Rx: 235604235

A redesigned label template created through a Wisconsin Health Literacy collaboration includes a cleaner layout with large font and white space.

Academic Pharmacy NOW  2020 Issue 1

5

campus connection

Now Playing on Smart Speakers: Medication Information for Older Adults

By Emily Jacobs Medication needs for older adults has become the focus of numerous projects across the United States. For example, the University of Illinois at Chicago (UIC) College of Pharmacy is conducting the Medication optimization using Smart Speakers in an Independent Living Community (MedSS-IL) study to help provide health information to residents of the Admiral at the Lake Continuing Care Retirement Community in Chicago.

Led by Dr. Jennie Jarrett, UIC assistant professor of pharmacy practice, and Dr. Robert DiDomenico, UIC associate professor of pharmacy practice, the MedSS-IL project is testing the use of Amazon’s Alexa-enabled Echo Dot smart speakers among Admiral residents. This project aims to provide medication education accessed through the facility’s own residence app, to help improve medication knowledge and adherence.

Early in the project, researchers completed two focus groups with Admiral residents to understand their health information needs. “Interestingly, our patients were less interested in the drugs and the disease states themselves and were more interested in access of healthcare information and utilization and how that affects their privacy, how it can help to improve provider relationships as well as how can they do it in a mobile fashion,” Jarrett said.

The MedSS-IL project is using the focus group responses to help shape the health content that will be available through the smart speakers. This year, users will be able to listen to a series of podcasts that focus on medication access, use and cost. As part of the project, pharmacists will be available in person at the Admiral to provide information and answer questions.

After the focus group sessions, the researchers were able to observe how older adults use the smart speakers. Interestingly in their observations and discussions, researchers determined residents at the Admiral had already begun to use the smart speakers for medication reminders. “The average was about seven medications [per resident] per day,” said DiDomenico. “It can get complicated very quickly. And so if they could simply say, ‘I take my medications at 8:00 a.m., set a reminder to take medications at 8:00 a.m.’…that could help keep them on target.”

Jarrett and DiDomenico are also considering other potential uses for smart speakers in improving health management for older adults. Additional research could reveal how smart speaker use can be expanded to improve health outcomes in other high-risk patient groups, such as those susceptible to hospital readmissions.

Emily Jacobs is a freelance writer based in Toledo, Ohio.

6

Academic Pharmacy NOW  2020 Issue 1

readability through using increased whitespace, contrast and sentence case; and giving explicit instructions, among other standards. Instead of saying “take twice daily,” which leaves a lot of ambiguity—two at once? 12 hours apart?—the labels should say “take one pill in the morning and one pill in the evening,” for example. “Even though the USP guidelines are out there, they haven’t really taken off because what we learned is that pharmacies don’t know how to make these changes,” Mott explained.

Before they jumped into redesigning the label, project leaders wanted to speak with various stakeholders—pharmacists, physicians, software vendors—to assess and account for the barriers. WHL saw that as an opportunity and applied for a grant from the UW–Madison School of Medicine and Public Health’s Wisconsin Partnership Program.

“A really cool part of this project is that a lot of the development and evaluation has actually been by patients,” said Mott. Surveys found that patients didn’t want to see addresses, confusing dates, all capital letters and other clutter, instead preferring a cleaner layout that prioritizes the most critical information at the top of the label and includes a large font, white space, the name of the medicine, what it’s for and the prescriber’s name.

In one focus group, participants had to create their own label out of the disassembled parts typically found on a prescription bottle. Using the USP standards and patient feedback, the participating pharmacies redesigned their labels and put them to the test. In a survey, the results were clear: Only 13 percent preferred the old design. Between the 67 participating sites in phase two, and the approximately 128 additional sites so far in phase three, at least

campus connection

“If these labels can improve medication adherence in groups with lower socioeconomic status and among older adults, who use more medications than any other group, this has the potential to be a game-changer for adherence as well as safety.”

— Dr. David Mott

3.5 million prescriptions already or will soon bear the new, easy-to-understand labels each year.

Evaluating the Redesign Using data from a Medicaid health plan and Hayat Pharmacies in Milwaukee, Mott and his colleagues evaluated the impact of the new labels on medication adherence by calculating the medication possession ratio, which measures the number of days of medication supply against the number of days in the medication use interval. “We knew when the labels were changed, so we could look at the period before and after they received the new label and found that their adherence changed quite a bit,” explained Mott. “It was statistically significant.”

He continued, “If these labels can improve medication adherence in groups with lower socioeconomic status and among older adults, who use more medications than any other group, this has the potential to be a game-changer for adherence as well as safety.” The incidence of patients calling the pharmacy for more instruction after returning home has dropped, too, indicating the new labels are providing what they’re intended to: clear information.

Expanding the Impact The three pharmacy systems in the trial each faced unique challenges that

have provided insight as the project moves forward. For example, some current pharmacy software has limitations in font size and style, meaning some pharmacies using their services can use only capital letters—in direct disagreement with USP standards. Other pharmacies, such as Ballweg, have joined the effort but need to use up an existing stock of labels before ordering a new design.

Several students who were also interns with WHL became directly involved in the project. In some cases, these interns participated in patient focus groups, allowing them to get in-person, real-world responses regarding patients’ pharmacy labeling needs. Mott noted that firsthand experience and interactions with patients can be “really impactful” for students, supplementing classroom or laboratory learning.

As the project evolves, the team is also working with Epic and some health systems in the state to pilot-test modifying the “sig,” which is the physician’s instructions to the pharmacist and patient about how the medication should be used. After that test, they will follow up with patients to see if they noticed the change and whether it helped them better understand their medication.

The experience has also been educational for Mott and his collaborators.

He pointed out that while the research itself is valuable, sharing it is equally important. “People need models, they need advice,” Mott said. “They need… pharmacists who have gone through this process, who can maybe serve as a coach or something like that, to get them started or to help them solve a problem. That’s a pretty powerful thing to do when you’re talking about implementing a major change like this.”

The study has also been influential for University of Wisconsin–Madison School of Pharmacy students. To start, it has given them an opportunity to increase their awareness of the USP standards and how they affect patients.

Student pharmacists also attended a colloquium with Mott, representatives from partner pharmacies and the WHL project director where they were able to get an overview of the projects and their phases and ask questions about pharmacy labeling changes.

The team aims to wrap up the project this year. But before they do, they want to have 25 percent of Wisconsin’s pharmacies using their implementation system to redesign prescription labels and improve that aspect of patient care. P Katie Gerhards is content marketing manager at the University of Wisconsin-Madison School of Pharmacy. Reprinted with permission. Additional reporting by Emily Jacobs.

Academic Pharmacy NOW  2020 Issue 1

7

campus connection

Frightful Fun in the Classroom Zombies? No problem. A course featuring some apocalyptic challenges prepared student pharmacists to face real-world emergency situations.

By Joseph A. Cantlupe

There’s the typical pharmacy course where student pharmacists explore lab results, learn about medications and consider patient needs. A course held at the Virginia Commonwealth University School of Pharmacy went with a unique approach, which included this outrageous combination of words: Zombie Apocalypse Lab. Yes. They’ve done it. They lived to tell.

For two years, the VCU School of Pharmacy has run electives for third-year students in advanced non-sterile compounding with a twist. Enter zombies. Spurred by this bit of horror fantasy, the professors turned a seemingly routine pharmacy course into an edge-of-your-seat experience. That’s because the real world offers those too: natural disasters, floods, power outages. So the professors put a method to the madness by enabling students to prepare pharmaceutical concoctions using the nearest herbs in a lab with no electricity, no running water and only the most antiquated equipment, making the experience as stressful as it could be without the reality of the danger. They pumped

dreary music in the background, installed dark garbage bags to block sunlight and assembled cardboard cutouts of “The Walking Dead.” And yes, a zombie or two walking around with streaks of “blood.”

Dr. Lauren Caldas, assistant professor, dreamed up the idea for the elective because she wanted to be innovative and do things a bit differently for the 30 students in the non-sterile compounding course. She recalled saying to her partner, Dr. Abigale T. Matulewicz, also an assistant professor, “Hey, why don’t we do this elective and tie it to Zombie Week?” Both fans of “The Walking Dead,” they jumped on the idea of creating the zombie theme that ran through the course, which allowed students to learn real-life pharmacy skills. The two-week course began with student pharmacists evaluating an herb natural to Virginia that had medical properties that they could develop and ended with a zombie-in-your-face moment where the students had to put together medications in a fake hurry-up scenario to comfort people in pain over tooth ailments, at least in time to flee the clutches of any zombies and get real care.

photo: Danny Tiet/VCU School of Pharmacy

“The beauty of this was how it teaches the same core concepts without having students reliving the actual traumatic event they’ve gone through,” Caldas said. “We have had students who have gone through a lot, these individual harrowing stories coming from war zones and everywhere.

It teaches the same impressive skills of problem solving and thinking on your feet in a more relaxed environment. We wanted to elevate the learning environment and encourage the faculty to get out of their silos.”

VCU School of Pharmacy professors transformed a classroom into a zombie apocalypse scenario.

8

Academic Pharmacy NOW  2020 Issue 1

campus connection

“I liked the idea of putting a constraint on compounding.

When you have all the tools available, that’s not the real world—you have supply and equipment constraints. It highlights that in a fun way, kind of a real-world application.

And there was the need to use spot-on critical thinking.” ­— Michael Ong, student pharmacist

“We wanted to have the flexibility to do this as a fun thing versus a first-year compounding course, which is contentheavy and doesn’t allow for a lot of creativity,” Matulewicz added. “With a smaller number of students it allows for more unique things that we could do. It was a great way for students to be engaged, and also fun for us to be outside of the traditional teaching setting.”

A Major Ingredient A key component in the zombie apocalypse course design was an herb that could be a pharmaceutical source with medicinal properties to be used in the event of a catastrophe. Caldas thought of yarrow—a flowering plant known as a hardy perennial that grows in Virginia, essentially in the school’s backyard. The herb was used by Native Americans in the colonial days and is known for having anti-inflammatory and antiseptic properties, Caldas said. It has been used for years for fever, the common cold and even has been chewed on to relieve toothache, which was the source of “pain” for the would-be patients.

The team evaluated the herb and analyzed active drug ingredients and what could be extracted from the plant. The aim was to “make it relevant to pharmacy students. This is something they heard about but did not do themselves,” Hindle said. “In turn, they would extract the active ingredient and successfully incorporate it into some compounding product.”

Preparing for the Worst In the final class, the student pharmacists had a few hours to put together a formula designed to deal with fictitious patients’ tooth ailments before they could get medical care in the face of the zombie apocalypse. Many students focused on making a formula for mouthwash.

“Yarrow grows easily here and it is regularly used as a natural remedy like chamomile,” Caldas said. “Students used this natural product to create their own products, similar to creating a baking recipe from scratch.” That fits perfectly with non-sterile compounding, which is meant for something ingested by the mouth or skin rather than injected.

The students had to put together medications with equipment that was less than ideal. They used plastic utensils, dosing cups and soda bottles without access to computers, printers, dispensing software or running water. They couldn’t turn off all the lights in the lab—building manager’s orders—but they didn’t use electricity. Walls and doors were covered with black bags. There were spooky banging noises and actors wearing masks and fake blood with jarring laughs that made some students jump from their chairs. ”The zombies will not touch you, please do not touch the zombies,” Caldas reminded the students, laughing later. The lab room was also decorated with zombie-themed props and imagery, thanks to Dr. Krista Donohoe, an associate professor.

Caldas, an expert in labeling and dispensing, reached out to the School of Pharmacy’s Dr. Michael Hindle, a professor and expert in pharmaceutical analysis, and one of his doctoral students to research the medicinal properties of yarrow. Hindle spent months evaluating the substance and how students could extract and analyze medication from dried yarrow. At the outset, “we basically started from scratch with hard groundwork reviewing the literature, and sometimes what they do in the literature doesn’t always go as smoothly as described in the paper,” Hindle said.

When it came time to prepare the concoction, “we told (the students) you are making something from scratch,” Matulewicz said. “We would have multiple versions of ingredients to ensure that all of the students were kind of progressing at the same pace and made it clear there wasn’t going to be a huge supply of everything,” she added. “I loved it when they went to the supply area and looked at what they needed and it wasn’t there. There were some panic moments, and they tried to figure out what they had, with bantering conversations, ‘I have this, can we have this?’”

Academic Pharmacy NOW  2020 Issue 1

9

campus connection

photo: Danny Tiet/VCU School of Pharmacy

A student pharmacist must employ quick thinking and work with limited resources as zombies hover.

The students had to use an old-school torsion balance for measurement, Caldas said, to achieve the goal of treating a “patient” in pain with a tooth infection or abscess. “They had to be ready with the formulation plan in mind.”

The student pharmacists gave the zombie apocalypsethemed study high marks. “The activity taught us all how to take the skills that we had been taught all semester and creatively apply it in a fun way,” said Hannah Davidson Keeney, a class of 2019 student pharmacist. “It’s relatively easy to follow written instructions on how to make a compound, but this activity put the ball in our court and we had to figure it all out on our own with the resources we were given. There wasn’t one single way to do it and that was the beauty of it.”

Ultimately, the student pharmacists created “unique mouthwash” formulas and the “random measuring tools made them think about what they were doing in a fun way, instead of just asking them in a multiple-choice test,” Caldas pointed out. “They had to create individual compounds with zombies walking around, with blood on them. They did an amazing Michael Ong, class of 2020, liked the challenge of being job with the concept and theme.” forced to work in an atmosphere where there were limited options. “I liked the idea of putting a constraint on comOne of the toughest tasks was dealing with labeling because pounding. When you have all the tools available, that’s not the labels had to be written by hand and that gave the stuthe real world—you have supply and equipment constraints,” dents the most problems. “The students were so focused on said Ong. “It highlights that in a fun way, kind of a real-world being prepared to make the product, but what they needed application. And there was the need to use spot-on critical to make the label made them realize how reliant they are thinking.” He thought more about it. “It was stressful fun.” on technology,” Matulewicz said. Caldas added, “When the software no longer auto-populates things for you, it’s difA Ghastly Idea With Appeal ficult to remember.”

VCU isn’t the only institution tapping into the zombie world for insight into dealing with urgent situations or emergencies. Several years ago, the Centers for Disease Control and

10

Academic Pharmacy NOW  2020 Issue 1

campus connection

photo: Danny Tiet/VCU School of Pharmacy

The zombie-themed lab strengthened student pharmacists’ emergency preparedness skills.

Prevention launched an initiative to improve public awareness about being prepared. Its efforts focused on zombies.

“Wonder why zombies, zombie apocalypse and zombie preparedness continue to live or walk dead on a CDC website?” the CDC said on its site. “As it turns out, what first began as a tongue-in-cheek campaign to engage new audiences with preparedness messages has proven to be a very effective platform. We continue to reach and engage a wide variety of audiences on all hazardous preparedness via ‘zombie preparedness,’” the CDC said.

Some other academic institutions also have tapped into zombies as learning aides. A few years ago, University of Rhode Island student pharmacists worked in a mock dispensing clinic and prevented a virus from causing zombies to attack. The University of Michigan School of Public Health used a zombie-themed bio preparedness drill to help spread the word about community disaster response.

After two years of zombie apocalypse, the VCU School of Pharmacy professors have decided to take a break from the activity and be “reflective” about what they have done, said Matulewicz. That doesn’t mean they are sitting pat. They are

evaluating and publishing data from the program, conducting a student survey and may seek to share results from other schools. One of their papers, submitted to Currents in Pharmacy Teaching and Learning, emphasized: “An immersive simulation improved students’ overall knowledge and confidence in compounding a natural non-sterile product.

Schools can utilize a similar approach to teach compounding skills for emergency preparedness.”

The School of Pharmacy may broaden the program to include first-year students, although no final determination has been made, Caldas said. Students loved the program and some were disappointed it was put on hiatus. Some pharmacy professors who initially were skeptical about the zombie apocalypse approach have come around to the idea. A colleague told Caldas he thought she was crazy to offer this course, she noted. “Then, he said, ‘our hospital lost power for eight hours and now I see the point.’”

Innovation is the key, she observed. “To the naysayers who say ‘this is not what we do,’ my argument is, why not?” P Joseph A. Cantlupe is a freelance writer based in Washington, D.C.

Academic Pharmacy NOW  2020 Issue 1

11

community impact

NEOMED Pharmacy Professor Receives $1 Million to Study Whether Exercise Is Neuroprotective The Department of Defense grant supports a study that may help change the pathology of Parkinson’s disease and inform activities for those in VA systems.

Dr. Sheila Fleming, an assistant professor of pharmaceutical sciences at Northeast Ohio Medical University, was recently awarded a three-year, $954,566 grant by the U.S. Army Medical Research Acquisition Activity for the project titled, “Exercise Effects on Synuclein Aggregation, Neuroinflammation, and Neurodegeneration.” Fleming’s research project will examine the effect of exercise in an optimized preclinical Parkinson’s disease model and mechanisms related to accumulation of the toxic protein alpha-synuclein, neuroinflammation and expression of substances in the brain called trophic factors.

Research suggests that Parkinson’s disease pathology progresses from the back of the brain to the front and that early non-motor symptoms such as anxiety, depression and cognitive impairments may be related to this pathology. Fleming will look at the impact of exercise on both motor and non-motor function and determine whether exercise can prevent or delay symptoms that show up early or when neurodegeneration has already started.

Results from this research could help individuals afflicted by Parkinson’s disease. If exercise is truly diseasemodifying then it would provide a much needed, non-invasive, non-

12

Academic Pharmacy NOW  2020 Issue 1

pharmacological, low-cost therapeutic strategy for Parkinson’s disease patients and at-risk populations, including military veterans. “Three of the major risks for Parkinson’s disease are exposure to environmental factors like pesticides, traumatic brain injury and aging,” Fleming said. “There are also inherited forms. And we’re discovering new ones all the time. But right now, they account for maybe 10-15 percent of the cases. The thought in the field is that it’s a combination of genetic susceptibility combined with these environmental factors. So, in the military, they’re exposed to these risk factors.”

Exercise therapy could be made readily available through hospitals and VA systems across the country. The

Department of Defense provided a similar grant to Dr. Caryl Sortwell, of Michigan State University. The unique Partnering PI grant allows Fleming and Sortwell—two longtime collaborators—to study the effects of exercise at different stages.

“It’s a major award for both of us,” said Fleming. “We had been working together for many years because our interest and work are very complementary.

Ultimately, it’s about a $2 million grant.

She gets half and I get half. We’re treated separately but she studies all of the pathological events and I work on the behavioral aspects.” P Reprinted from Northeast Ohio Medical University.

community impact

Inspiring Future STEM Superheroes Dr. Sylvie Garneau-Tsodikova, newly selected to be part of the AAAS IF/THEN Ambassadors Program, is a medicinal chemist encouraging girls to become STEM Wonder Women.

By Athena Ponushis Dr. Sylvie Garneau-Tsodikova grew up in Québec City, watching superheroes on television. There were many men and one woman. Garneau-Tsodikova wanted to be Wonder Woman. And she wanted to save the children she saw on commercials who needed humanitarian aid. Sitting in her high school chemistry class, she found her superpower: science. Through chemistry, she could create new molecules that could create new medicine that could help those children.

Garneau-Tsodikova became a medicinal chemist, earning her Ph.D. at the University of Alberta, where she taught her students chemistry and her students taught her English. As a postdoctoral fellow at Harvard Medical School, she studied mechanistic enzymology and biochemistry. She now works as a professor and assistant dean for research at the University of Kentucky College of Pharmacy. Her lab focuses on infectious diseases, where she seeks to understand resistance mechanisms in bacterial and fungal pathogens to combat resistance with chemicals.

Garneau-Tsodikova was selected to be an ambassador in the American Association for the Advancement of Science (AAAS) IF/THEN Ambassadors Program, which strives to inspire girls in middle school to consider STEM careers. Here, she opens up about how she hopes to help girls find their power and to inspire others in pharmacy to play a part in empowering the next generation, too.

Q: How does your story resonate with young girls, inspiring them to pursue STEM careers?

A: I come from a family that didn’t have much money—we ate a lot of pasta with butter—but I am from Canada so that did not affect me the way it would affect girls in the United States. In Canada, it does not matter if you are rich or poor, you go to the same school. When I came to the U.S., I watched a documentary called “Waiting for Superman” about the education system here, and I learned if you are from a poor family you don’t go to the same school as if you were from a rich family. I realized that if I grew up here, I would not have had access to everything I had access to when I was a girl, so I need to change that. I started the Sci

Cats (Science Cultivates Academically Talented Students) outreach program, where graduate students, Pharm.D. students and faculty go to K-12 schools to do hands-on experiments with children in schools around Lexington that don’t have much financial support for science. And IF/THEN gives me an opportunity to further this message: It doesn’t matter where you are from, it doesn’t matter what language you speak, your situation as a child should not dictate how impactful you are going to be in the future, that you can make an impact no matter where you come from.

I was excited to learn in my chemistry class that I could create new molecules and they could potentially help the children I was seeing on TV, so I became a medicinal chemist

Academic Pharmacy NOW  2020 Issue 1

13

community impact

because I found my superpower, I could be Wonder Woman.

Girls have to find their superpowers so they can change the world in their own way. I love art and I love chemistry. I found art in chemistry; instead of using notes to create music, you use atoms to create molecules, instead of movement to create choreography, you mix chemicals so they can dance together and partner up and make new molecules. I think it’s important for girls to realize they do not have to relinquish something they like to do something else that they like. They can do it all at once, they just have to find the right STEM career that combines all of their passions.

Q: How were you selected to be an ambassador?

A: I was a previous AAAS Leshner Public Engagement Fellow, so when AAAS partnered with Lyda Hill Philanthropies to create IF/THEN, helping girls find their talents and fall in love with STEM, I got an email from AAAS and I applied. I submitted a video about a science festival I organized with the help of colleagues and students called Everything Is Science, and that’s the same name, EIS, as the resistance enzyme I work with to try to combat tuberculosis, but the festival was all about explaining how science is all around us.

IF/THEN selected 125 women and I was extremely fortunate to be named an ambassador. One thing that was really amazing, at the summit for the IF/THEN program, we met the girls who looked at our applications and helped select the ambassadors with AAAS and Lyda Hill. It was great to meet the young girls who are excited about STEM and selected us.

We are all from different STEM careers, backgrounds and ethnicities, so it makes for a good group of women.

14

Academic Pharmacy NOW  2020 Issue 1

Q: What does your role as ambassador involve?

A: What I want to do with the ambassadorship is start two initiatives. One is so that girls can see women in STEM in Kentucky. When we were at the IF/THEN summit, they took a 3D model of all of us and they are going to make the largest exhibition of statues of all women, 125 life-size statues of women. Isn’t that amazing? AAAS and Lyda Hill realized there are not enough statues of women, so they decided to change that and why not women in STEM? We do not know where the exhibit will be, but girls in Kentucky might never be able to see it if they cannot travel to that place. What I want to do is have every woman in STEM at UK have an interactive display, online and in a museum, where young girls and boys can interact with the display and say, ‘I would like to hear more about this person. Let’s bring this physicist to my school. Let’s bring this geologist to my school,’ so that they can see, yes, you can do what you want to do.

The other project relates to my love of art and chemistry. For me it’s important to marry your passions. I know there are a lot of young students out there who love different things like sports and art and they also love science, but they often see those things as separate. So I would like to work with AAAS to organize a national SciArt contest and have students submit works that show their science with their art. They could bake a cake in the form of a spaceship, they could knit sharks, rap about artificial intelligence or choreograph a dance to show how infectious diseases spread. It can be whatever they like, so long as they see that science is not something that’s separate from the rest of their lives.

community impact

“I think it’s important for girls to realize they do not have to relinquish something they like to do something else that they like. They can do it all at once, they just have to find the right STEM career that combines all of their passions.” ­— Dr. Sylvie Garneau-Tsodikova

Q: What opportunities unique to pharmacy do you see for aspiring young scientists?

Q: What challenges or opportunities have you faced as a woman in the field?

A: In pharmacy, we are trying to improve human health, so there are many opportunities, from being at the forefront of the discovery process for new medicine to being with patients. Right now, there are a lot of people who are sick who need medicine, but everyone does not have access to medicine as easily as others, depending on where you live or how much money you have, so there are opportunities to be creative and find new ways to reach patients. There are opportunities to understand diseases, because if you want to cure a disease, you need to understand the disease and there are many we do not understand well at all. There are opportunities to understand how diseases spread and how we can prevent that. I am more focused on discovery and the development of new medicine, but there is a whole spectrum of career paths you can take, that’s one of the beauties of the pharmacy career. There’s a quote I really like…I was at a training session at the American Pharmacists Association and I was really touched by two statues that they have there.

One says, “From making medicine,” and the other says, “To making medicine work,” and to me that summarizes the opportunities in pharmacy, from the lab all the way to working with patients.

A: I am a chemist and there are not many women chemists but I see that as an opportunity to be a trailblazer. My challenges were not in terms of being a woman, they were much more in terms of, I need to learn a new language, I need to move away from my family. These were the things that were hard for me as a woman but they were not because I was a woman. I always believed because there was Wonder Woman, that even if there were more men, a woman was there. My mom told me, ‘If you work hard you can do whatever you want,’ so I was lucky as a young girl because she never let me doubt my potential. I have had this mentality since I was a child and I think that’s why it’s important to go to young girls and make them believe that they can do anything. There are a lot of women pharmacists, but on the basic science side of it, there are fewer women than men. That’s why we have this IF/THEN program to change that.

As far as opportunities, I have traveled to many countries with my career, which is one of the things I really like about it, because I get to see my science in the big picture. I have been to South Africa and seen how they approach tuberculosis there. I have been to China, Australia, Egypt, Israel and many other places and seen how people think about health differently. Health is a global thing, so it’s an amazing opportunity for those of us in pharmaceutical sciences to see, so when we are doing our work we are not just thinking about us but thinking about everybody on the planet.

Academic Pharmacy NOW  2020 Issue 1

15

community impact

Q: How do you see pharmacy as a promising, fulfilling career for young women?

Q: What do you want readers to know most about the work you are doing?

A: I don’t think there’s anything more fulfilling than helping another human being. That’s why this IF/THEN program is great, because you are helping young girls, but with the pharmacy career, you are helping society. You are making a difference for the patient and for their whole family and all the people who love them. If you can help someone’s health be better, you can help everyone around them be happier. I was on a panel on infectious diseases one day with the Department of Defense. There was one person missing a leg, one person missing an arm and one person who was not missing limbs but her husband was a severely wounded soldier. I asked them if I could take their picture. I had spent the whole study section with them, and I brought that picture back to my students and I said, ‘See, when you are working at your bench and you are not sure what you are working for, you are working for them, to help them so that more soldiers do not lose arms or legs because of infectious diseases.’ I still have that picture in my office. When you are working to save the lives of other human beings, there’s nothing more rewarding.

A: First, I must say I think it’s important for deans and department chairs to support faculty to do outreach, because we cannot enrich the pipeline if we don’t reach out to students when they are young. I think outreach and public engagement should be part of our evaluation criteria during our annual reviews. But on a more heartfelt matter, I believe everyone is given a superpower when they are born, but too often, people do not find their superpower and just go through life without really doing what they could do best.

That’s the message I think is most important for people to hear. If we help a girl find her superpower, then there are no limits to what she can create and discover. She can become the super-shero who creates the new medicine, or cures the disease, or finds a novel way to reach patients. I truly believe pharmacists pursue pharmacy to help people, so I think it’s important for all of us in pharmacy to take a look in the mirror and really ask ourselves, ‘What am I doing to help the next generation?’ P

16

Academic Pharmacy NOW  2020 Issue 1

Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.

community impact

ACT (Academia-CPESN Transformation) Pharmacy Collaborative ge s 79 colle ls of oo and sch have cy pharma ined!* jo already 01/ *(a s of

) 23 /2020

Community Pharmacy Practice Transformation Initiative: Facilitating Partnerships between CPESN Networks and Schools of Pharmacy ®

We invite you and your school/college of pharmacy to become an active member of the ACT Pharmacy Collaborative.

The ACT Pharmacy Collaborative is an operational learning and ACTing collaborative among schools/colleges of pharmacy and clinically integrated networks of community-based pharmacies. The ACT Pharmacy Collaborative goal is to support the transformation of community-based pharmacy practice from a product-based to a pharmacy care delivery model in neighborhoods nationwide.

The ACT Pharmacy Collaborative will:

Unite schools/colleges of pharmacy and pharmacist leaders nationwide with a common focus to transform communitybased pharmacy practice

Mobilize stakeholders and resources to support and facilitate implementation of community-based pharmacy care

Amplify the development and implementation of sustainable community-based pharmacy care delivery

How you and your school can get involved: ● Get committed! Our Dean’s Statement of Commitment, available at www.actforpharmacy.com, invites schools to commit to community pharmacy practice transformation ●

●

Identify an ACT Champion – Empower a colleague who will represent the school and facilitate partnerships with CPESN Networks and local community pharmacies as a part of the Dean’s Statement of Commitment Invite collegues to participate in an “activation year” – Join our year-long cadence of idea-and-action-share webinars, student initiatives, and research pop-up groups beginning August 2019 through July 2020

www.actforpharmacy.com

The ACT Pharmacy Collaborative is supported by grant funding to the University of Pittsburgh from the Community Pharmacy Foundation. ACT Pharmacy Collaborative partners include CPESN USA and AACP. The work of the Collaborative is guided by a task force of AACP Faculty Appointees and CPESN USA Luminary Appointees.

Academic Pharmacy NOW  2019 Issue 4

17

community impact

DO NO HARM 18

Academic Pharmacy NOW  2020 Issue 1

community impact

Pharmacy school curricula are prioritizing patient safety to prepare future pharmacists for their vital role in keeping patients safe.

By Jane E. Rooney

It’s something we often take for granted, because we assume health professionals are being vigilant and have been trained to consider crucial questions such as: Has the patient received the correct medication? Is the proper dose indicated on the prescription label? Will the medication have any harmful interactions with other prescriptions being taken? Patient safety is paramount, but most people probably don’t give it much consideration when the healthcare system is operating as it should.

Academic Pharmacy NOW  2020 Issue 1

19

community impact

The reality, however, according to World Health Organization (WHO) statistics, is that four out of every 10 patients are harmed in primary and ambulatory care settings. The most detrimental errors are related to diagnosis, prescription and the use of medicines.

WHO defines patient safety as the absence of preventable harm to a patient during the process of healthcare and reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. Guidance from the organization indicates that “clear policies, organizational leadership capacity, data to drive safety improvements, skilled healthcare professionals and effective involvement of patients in their care, are all needed to ensure sustainable and significant improvements in the safety of healthcare.”

Learn More: https://medicationsafety.org

Pharmacists clearly play a crucial role in keeping patients safe. The Alliance for Patient Medication Safety (APMS) is a federally listed Patient Safety Organization (PSO) that works with independent and regional chain pharmacists on patient safety initiatives. Its mission is to help community pharmacies implement and maintain continuous quality improvement programs to improve patient care. Their programs help pharmacies comply with health insurance and state and federal quality assurance requirements.

“We emphasize that every pharmacy put in place a learning environment instead of a punitive environment in order to build a safe, just culture,” explained Tara Modisett, executive director, Alliance for Patient Medication Safety. “When a strong safety culture exists where the staff feels empowered to say ‘hey, this is a workaround or a process that isn’t the safest practice,’ and their input is valued and respected, good conversations can result. Most community pharmacies already deliver the safest care they know how to but PSOs provide resources and help to take it to a higher level.”

Learn More: https://patientsafetymovement.org http://bit.ly/PSMFCurriculum

20

Academic Pharmacy NOW  2020 Issue 1

Last year, the Patient Safety Movement Foundation developed a core curriculum—available for free to all professional healthcare schools—to teach patient safety from the first professional year through residency.

Chapman University School of Pharmacy (CUSP) has committed to this curriculum, which will begin during the first year of school with the goal of creating entry-level practitioners with a broad knowledge base and skills that can be used to improve patient safety. “We know Adverse Drug Effects are the fourth leading cause of death in America. We also know pharmacists are in communities within five miles of every citizen,” said Dean Ronald P. Jordan. “CUSP faculty are fully committed to ensuring our students become expert sources of safety information. By adopting Leadership in Patient Safety Education as a pillar of our school’s strategic plan, we seek to lead pharmacy schools to teach students and other health professionals to think safety first.”

the fluid nature of domain inter-relationships.

community impact

Actionable Patient Safety Solution

s (APSS) #17:

Patient safety curriculum

Getting started ........................................ ..........................4 Executive summary ........................................ ...................6 Error science ........................................ ..............................9 System science ........................................ ....................... 16 Human factors ........................................ ........................ 23 Technology ........................................ ............................. 34 Teamwork and communication .................... ................ 43 Leadership and leading change .................................. 49 Culture of safety ........................................ ..................... 55 Patient oriented safe care .................... ......................... 64 Conflicts of interest disclosure .................... ................. 69 Workgroup ........................................ ............................. 69

© 2019 Patient Safety Movement APSS #17 | 1

Figure 1: Creating a culture of safety challenges the idea of a hierarchy in patient care and it is instead replaced with an integrative approach including the patients, family members, and healthcare professionals while combining technology, systems, and communication methods in order to achieve the most patient-centered care possible.

the CAPE Outcomes and the 2016 Accreditation Standards outline the topics student pharmacists must learn to optimize the safety and efficacy of medication use systems. “All pharmacy schools emphasize patient safety and talk about it in a broad sense,” said Dr. Mary Douglass Smith, Presbyterian College School of Pharmacy’s interim executive director of experiential education. “I think being able to share errors and dig into more specifics will help students be more prepared for what the profession will be like. There will be errors but this is how we mitigate them and solve them. These are practical ways to put safety at the forefront of practice.”

6 | APSSBoth #17

Steps Toward Better Communication Dr. Catherine Hatfield, director of interprofessional education and clinical associate professor, University of Houston College of Pharmacy, said the main thing pharmacists can do to ensure patient safety is learn to speak up. “When you see something that doesn’t sit right with you, you have to be able to speak up and be a team member if the dose isn’t right or the drug isn’t right,” she noted. “If you are too afraid to speak up about an error, you are a part of the problem.” Hatfield attained the Institute for Healthcare Improvement (IHI) Patient Safety Certification several years ago and decided the information she learned was important enough to pass along to student pharmacists. What began as an elective became a required course in Houston’s curriculum in 2019.

Learn More: https://www.aacp.org/resource/ cape-educational-outcomes

Patient Safety Essentials Toolkit • • • • • • • • •

Action Hierarchy (part of RCA2) Ask Me 3® Cause & Effect Diagram Developing Reliable Processes 5 Whys

Flowchart FMEA Huddles SBAR

IHI’s Patient Safety Essentials Toolkit is a helpful companion for you and your organization on the journey to delivering safe, reliable care every time, for every patient.

Each of the nine tools in the toolkit includes a short description, instructions, an example, and a blank template.

Copyright © 2019 Institute for Healthcare Improvement. All rights reserved.

Individuals may photocopy these materials the contents are not altered in any for educational, not-for-profit uses, way and that proper attribution is provided that given to IHI as the source of the content. for-profit use in any form or by any These materials may not be reproduced means, or republished under any for commercial, circumstances, without the written permission of the Institute for Healthcare Improvement.

Learn More: http://www.ihi.org/Topics/ PatientSafety

Academic Pharmacy NOW  2020 Issue 1

21

community impact

Framework and Competencies Team Competency Outcomes

Pocket Guide

Knowledge • Shared Mental Model Attitudes • Mutual Trust • Team Orientation

& Tools Team Strategies formance to Enhance Per ty and Patient Safe

Performance • Adaptability • Accuracy • Productivity • Efficiency • Safety TeamSTEPPS has five key principles. It is based on team structure and four teachable-learnable skills: Communication, Leadership, Situation Monitoring, and Another Mutual key part of the curriculum is TeamSTEPPS, a standardized Support. The arrows depict a two-way dynamic framework of communication to improve safety that originated interplay between the four skills andpatient the team-related Interaction between theResearch outcomesand andQuality. skills It is an with the outcomes. federal Agency for Healthcare is the basis of ateamwork team striving to deliver quality care evidence-based set of tools, aimed safe, at optimizing patient outand support quality improvement. Encircling the four comes by improving communication and teamwork skills among healthskills is the team structure of the patient care team, which care professionals.

“I’ve been it in our caregivers, curriculumbut since 2014. represents not only theteaching patient and direct It is something thatwho should taught torole all health professions,” also those play be a supportive within the health careshe said. system.

“It’s aboutdelivery learning how to communicate and speak up to reduce commu-

SBAR A technique for communicating critical information that requires immediate attention and action concerning a patient’s condition Situation – What is going on with the patient?

“I am calling about Mrs. Joseph in room 251. Chief complaint is shortness of breath of new onset.”

Background – What is the clinical background or context?

“Patient is a 62-year-old female postop day one from abdominal surgery.

No prior history of cardiac or lung disease.”

nication ...TeamSTEPPS errors, which is is one the biggest fixable patient to safety issues anofevidence-based framework optimize team performance in healthcare today.”

She believes weacross need tothe gethealth away care from training delivery system.in silos and that there should be a movement to healthcare professionals get TeamSTEPPS into every pharmacy school, which will ultimately lead 4 to improved patient safety.

Assessment – What do I think the problem is?

“Breath sounds are decreased on the right side with acknowledgment of pain. Would like to rule out pneumothorax.”

Recommendation and Request – What would I do to correct it?

“I feel strongly the patient should be assessed now. Can you come to room 251 now?”

Mutual Support

9

Communication CUS Assertive statements:

“Stop the Line”

Learn More: https://www.ahrq.gov/teamstepps

22

30 Academic Pharmacy NOW  2020 Issue 1

“There are tools within TeamSTEPPS that train everyone how to communicate,” she continued. “One is called the SBAR (situation, background, assessment, recommendation) model. If a pharmacist can learn to speak that way to a doctor or nurse and that other health professional has been trained in SBAR, they can communicate effectively. CUS (concerned, uncomfortable, safety issue) is another one. If you get frustrated or upset, you need to figure out a way to communicate with that individual and enter into a dialogue so you can come to an agreement to figure out what is best for the patient. You need to advocate for the patient. When you’re upset and feeling like you’re not being heard, this allows you to express why you’re concerned. The safety issue should stop everything and everyone should come to an agreement and decide if things are proceeding the way they should be.”

Another main focus in the curriculum is learning to recognize errors. “A lot of what patient safety involves is how do we fix system errors so they don’t happen again,” Hatfield said. “We’ve got electronic records so you don’t have transcription errors, but what can you do to prevent the onset

community impact

of errors? A lot of that is communication. The IHI modules and the patient safety IPE force students to practice speaking up and learn the roles within medicine, nursing and pharmacy and how they work together to improve things for patients.”

The second year IPE includes a progressive case discussion in which more information is gradually released and student pharmacists must decide on a course of action. The students walk through the case and figure out what could have been done better to prevent errors. A simulated IPE in the fourth year has students deciding how to handle a situation where an error occurred and considering what processes could have been in place to prevent it.

The curriculum at Presbyterian College School of Pharmacy similarly focuses on communication and preventing errors. “Our P1 students take an Introduction to Pharmacy and Patient Safety course so they see it right out of the gate,” said Smith. “They learn about the role that the pharmacist has in protecting patient safety. We do a whole lab dedicated to medication errors. They practice SBAR communication to help remedy these errors. When I introduce the lab I tell them stories of errors I’ve made.

Errors will happen—our job is to minimize the harm. A lot of things can go wrong on a shift but the main concern is that every prescription is right and safe.”

“A lot of what patient safety involves is how do we fix system errors so they don’t happen again…what can you do to prevent the onset of errors? A lot of that is communication.”

— Dr. Catherine Hatfield

The therapeutics courses have an associated lab where students are presented with case studies. “In each of those modules they have a killharm station. We are showing them that these decisions will come up in practice and what those decisions will look like,” Smith explained. “When they can see a specific case, it really helps them understand. On rotations, we have really seen an increase in APPEs that are transitions of care.

We’ve realized as a profession that during these times of handoff, these transitions really open up the possibility of errors, confusion or poor communication. Our students are actively involved in these transitions of care and ensuring that the patient understands the medications.”

Tools to Make Tweaks The Alliance for Patient Medication Safety began as a 501(c)(3) organization to provide quality improvement resources and tools to pharmacies but since 2008 provides PSO services. PSOs grew out of the Patient Safety and Quality Improvement Act of 2005 passed by Congress. The ACT indicates that the quality improvement work and patient safety activities conducted by providers who work with a PSO are legally protected and not subject to discovery. The protections are to encourage healthcare providers to collect and analyze quality data. “We provide an error reporting portal so that a pharmacy can collect near misses, unsafe conditions and errors that reach the patient in order to find workflow and process breakdowns, or areas for improvement,” Modisett said. “The reported data are displayed in charts, graphs and spreadsheet form so that pharmacy teams can easily identify trends in a format that works best for them. Pharmacies can use this data in their staff meetings and discuss ways to improve how they operate that would reduce the risk of patient harm.”

Academic Pharmacy NOW  2020 Issue 1

23

community impact

The APMS PSO receives data from participating pharmacies, analyzes the data for alerts and aggregate trends and creates newsletters and safe practice recommendations for the pharmacies. The changes needed to improve safety processes in pharmacies can range from retraining to changing the physical space to altering the workflow. “We do offer the program as a resource for pharmacy schools to use,” Modisett said. “Some schools use it in their practice labs or use our CQI PowerPoint or our materials in their QA curriculum.”

“Pharmacists should be at the table to help address quality and patient safety issues, not only those focusing on medication errors, in the institutional, ambulatory and community settings.

Pharmacists’ ready access to patients help us have a unique perspective on their role in improving the quality and safety of care they receive.”

— Dr. Veronica Young

She continued, “We encourage the pharmacy team to continuously evaluate their operations and fine-tune their workflow. Pharmacies are very busy and complex systems; there is a lot going on between receiving the prescription and when the patient leaves the pharmacy. Each patient has a profile that needs to be updated for allergies, medication changes, insurance changes and reviewed for appropriate or duplicate drug therapy.

We advocate that the staff works together as a team to evaluate what is and what isn’t working. The PSO shares lessons learned so that pharmacies learn from each other.”

Houston’s Hatfield pointed out that when a pharmacist knows all of the medications someone is on, understands the complete picture and can do medication therapy management, it can put a patient’s mind at ease. “One thing that happens is patients have so many different providers and by having all that information in multiple places, patients are doing a disservice to themselves,” she added. “Pharmacists can encourage them to get everything filled at one pharmacy. Finding a primary pharmacy for your filling spot so all of their information is coming through one provider/ pharmacist. It’s good to have everything filter through one individual who is looking over everything—that’s something a pharmacist can do and should be encouraging patients to do.”

Empowering Patients At The University of Texas at Austin College of Pharmacy, the journey to prepare student pharmacists to empower patients to seek quality care begins in year one. Medication safety is part of the core curriculum. Student pharmacists learn how and when to intervene and make recommendations to ensure that safe use of medications is being addressed. Patient safety in the broader context of quality improvement is integrated through the IPE curriculum. Concepts are introduced using active learning to first-year pharmacy students in interprofessional teams consisting of pharmacy, medicine, nursing and social work learners. “Our second-year student pharmacists are required to complete the IHI Basic Certificate in Quality and Safety with medical students and graduate nursing students,” said Dr. Veronica Young, director, Center for Health Interprofessional Practice and Education, and clinical professor, Pharmacy Practice Division, The University of Texas at Austin College of Pharmacy.

“Students from the three programs complete the IHI modules in the same sequence and timeline in preparation for a student-driven, online patient safety discussion forum in the fall and spring semesters,” she continued. “It

24

Academic Pharmacy NOW  2020 Issue 1

community impact

is built to address specific programmatic needs among the three programs.

In response to carefully crafted discussion prompts designed to encourage sharing of interprofessional perspectives, students dialogue in interprofessional teams to explore causes of healthcare errors and solutions.”

These earlier activities around patient safety and quality improvement prepare third-year student pharmacists to work on their required yearlong population health projects. “One key objective of this project experience is for students to gain real-world experience in addressing social determinants of health. Students learn the importance of reducing barriers to health,” Young noted. “Part of improving population health is to align it with community empowerment, specifically, engaging pharmacists to empower individuals and communities to have an active role in their own healthcare. This field-based experience prepares our future pharmacists with the skills, competence and confidence needed to truly be a part of this change to improve patient safety.”

In her research, Young works with community organizations to empower individuals to address patient safety. Working with the Louise H. Batz Patient Safety Foundation in collaboration with the City of San Antonio Head Start Program, “we find innovative ways to support families to be an active member of their own healthcare team to seek safe and quality care,” she said. “The other part of my research focuses on capacity building. I believe that while we can reach out to community members individually, it is more effective and sustainable to support capacity building efforts in response to needs identified by community organizations. Most of my work centers around building capacity of frontline staff such as community health workers to promote health and improve patient safety.”

“I really think all pharmacists serve as stewards of medications, and we help decide when the benefits outweigh the risks and how we can minimize patient harm.”

— Dr. Mary Douglass Smith

Learn More: https://www.louisebatz.org/ https://saheadstart.org/

She emphasized that student pharmacists should be trained in interprofessional teams to address patient safety including medication-related errors. “Pharmacists should be at the table to help address quality and patient safety issues, not only those focusing on medication errors, in the institutional, ambulatory and community settings,” she said. “Pharmacists’ ready access to patients help us have a unique perspective on their role in improving the quality and safety of care they receive.”

Presbyterian’s Smith echoed that sentiment. “Once you enter into our healthcare system it can be hard to navigate and it can be confusing,” she acknowledged. “I had one major health concern and even I felt lost as someone with high health literacy. Because pharmacists are so accessible, it’s really about taking the time to explain things to a patient and helping them understand the different steps. How do I get a referral to a specialist, prior approvals, things like that?”

While empathy and patience go a long way, Smith said it comes down to setting the highest possible standard for safety: “I really think all pharmacists serve as stewards of medications, and we help decide when the benefits outweigh the risks and how we can minimize patient harm.” P Jane E. Rooney is managing editor of Academic Pharmacy Now.

Academic Pharmacy NOW  2020 Issue 1

25

Gaining New INsight

February 8–11, 2020

Wyndham Grand Rio Mar Puerto Rico Golf & Beach Resort The 2020 AACP INterim Meeting will arrive in Puerto Rico, Feb. 8–11, to give emerging and future leaders new perspectives and proven tools to use in leading change at their institutions.

Colleagues from around the Academy will connect in an environment perfect for problem-solving and relationship-building, and leave feeling empowered to create change in pharmacy education and in the roles their graduates will play in the rapidly evolving healthcare system. www.aacp.org/INsight2020

Programming at INsight 2020 focuses on issues critical to you and your peers, including: •

Leading change in a change-adverse environment

•

Accelerating transformation in pharmacy practice from the national and federal perspective, and the new roles pharmacists can play within the disruption of the healthcare system and the profession

•

Identifying the impact schools and colleges can have in the rapidly changing community pharmacy practice setting through training, advocating and sharing successful patient care implementation strategies

•

Advancing and conducting research at your institution through faculty development and the formation of interdisciplinary, collaborative teams

•

Utilizing innovative strategies to develop interprofessional practice teams with physicians and other healthcare professions

•

Promoting students’ professional identity formation through learning experiences in the curriculum

We hope you join us at future INterim Meetings, where we aim to Inspire, Innovate and Invigorate.

AACP Annual Meeting The premier professional development meeting for pharmacy educators heads to Long Beach, Calif., July 18–22.

Registration for Pharmacy Education 2020 opens in April.

26

@AACPharmacy

AACP greatly appreciates the support from our meeting sponsors, whose contributions made this event possible:

Educational Day Sponsor

Silver Sponsor

Bronze Sponsors

l

Last Chance: Renew Your AACP Membership Act before Feb. 1 or lose access to the valuable resources available only to AACP members, including: •

AACP Connect: The exclusive online community to share ideas, discuss challenges, post questions and access valuable resources.

•

Submit 2020 Annual Meeting research and education poster abstracts—only available to members.

•

Learn from your peers who share your needs by collaborating with AACP’s Special Interest Groups (SIGs) and Sections.

•

Webinar programming and publications: Stay up-to-date on industry news and best practices. AACP has more than 20 Webinars scheduled this Spring, including those with CE credit.

•

Discounted registration rates to attend AACP’s flagship meetings, including Pharmacy Education 2020 and the Institutes.

•

Academic Leadership Fellows Program: Bolster your career by immersing yourself in a year-long leadership development experience for members only.

Renew by Feb. 1 to continue receiving all these benefits and more: http://bit.ly/AACPmembership Academic Pharmacy NOW  2020 Issue 1

27

Pharmacists Help People Live Healthier, Better Lives.

1400 Crystal Drive, Suite 300 P Arlington, VA 22202 703-739-2330 P www.aacp.org

New Year, New Look for AJPE.org!

The American Journal of Pharmaceutical Education has launched a new website with enhanced features that allow visitors to easily search for and read articles, engage with the Journal on social media, sign up to become a reviewer, access submission instructions and much more.

Enhanced website features also include: • Ability for readers to jump to a desired section within an article

Visit the new www.ajpe.org today!

•

Improved search functionality allowing readers to view results by type of article, such as a commentary, brief, review, research

•

Editor’s choice carousel featuring articles selected by the Journal’s editorial team

•

Curated list of recommended articles similar in topic to those you’ve viewed