Utilizing Trainee-Integrated Pharmacy Practice Model to Alleviate DTPs in Cardiology

The role of a pharmacist on an inter-professional health care team and their importance to preventing medication related issues in patients that results in hospital re-admissions has been widely studied and accepted as necessary among pharmacists and providers alike.  Despite this, many hospitals and clinics are unable to free up the personnel to include enough clinical pharmacists on teams due to the large time commitment associated with such a position.  A new study posted in the North Carolina Journal of Medicine attempted to test the feasibility of  a Trainee-Integrated Pharmacy Practice (TIPP) model that would utilize pharmacy residents in a cardiology clinic to perform comprehensive medication services under the supervision of a clinical pharmacist preceptor.

In the pilot study, a clinical pharmacist divided time between three teams comprised of pharmacy residents and technicians in critical, intermediate, and acute care cardiology units.  Each team was responsible for rounding with the existing care team at in the units, and would make care plan recommendations, verify medication orders, counseling on high-risk medications, and medication reconciliation with the guidance of their clinical pharmacist preceptor.  The study tracked the medication recommendations made by each team, as well as the time commitments made by each member of the team to compare the demands that would be place on individual clinical pharmacists.

The results of the study show that after 30 days, the residents and their preceptor managed to find 512 medication reconciliation issues including necessary drugs omitted, incorrect doses, wrong frequencies, duplicate medications, and discontinued medications still being taken.  They also increased the rates of patients receiving anti coagulation counseling by 70%, and recommended 762 clinical changes,an average of about 3.5 per patient, of which 720 were accepted by the care team.  These recommended alterations generally involved medication optimization, over a fourth of which were recognized by literature to improve general health outcomes and adverse cardiovascular events.  Also, the study found that the teams were active in the clinical care process for an average of 10-12 hours per day, with the assistance of medication history compiled by technicians and a staffed medical record specialist to cut down on time spent for patient profiles.  This suggests that the time investment necessary would far exceed one clinical pharmacists ability to provide the same services and speaks to the viability of the integrated trainee team.

 

This study may open doors on inter professional teams for pharmacy residents in patient care roles that currently are not the standard of practice.  The study indicates that utilization of trainee-preceptor teams could alleviate the deficit for pharmacy expertise in the clinical setting that most hospitals do not have the resources for.  Do these teams provide the depth of knowledge required for positive clinical changes, or should hospitals only be entrusting these issues to established clinical pharmacists? How do you feel about this?

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Reference:

Kalich B, Cicci J, et alFrom Pilot to Practice: A Trainee-Integrated Pharmacy Practice Model in Cardiology. N C Med J. 2016; 77: 45-51. doi:10.18043/ncm.77.1.45 

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