1. Interprofessional Practice in the Ambulatory Care Arena
Chrystian Pereira, Pharm.D BCPS
Associate Professor
University of Minnesota College of Pharmacy
Smiley’s Family Medicine Clinic

2. Objectives
Explain how the Interprofessional Education Collaborative (IPEC) 2016 core competencies align with an ambulatory care practice experiences.
Identify potential opportunities and challenges that may arise when building an interprofessional practice (IPP).
Demonstrate approaches and strategies to incorporate learners involvement into an interprofessional collaborative practice.
Describe possible assessment criteria and approaches to use in practice settings

3. IPEC 2016
Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Interprofessional Education Collaborative.

4. IPEC 2016 IPE IPP Values and Ethics
Understanding where each other are coming from
Roles and Responsibilities
Know where each other is going
Communication
How to talk to each other
Teamwork
Understand how we support each other

5. Opportunities Each competency leads to an opportunity
Values: allow you to approach someone different to see if you could work together
Communication: Keeps the channels open for more discussion

6. Challenges Understanding boundaries and limitations
In Ambulatory Care, different members will be present in different sites
Realize that these will present themselves at a later time – even under best intentions

7. Learners Learners are part of the team
Sharing learners is a great way to begin to communicate
Teaching learners about others can serve as a bridge to improve a professional relationship

8. Assessment of IPE Yes/ No
FM Interperprofessional Team Meeting Evaluation
Leads care teams to consistently and appropriately manage patients with chronic conditions and co-morbidities
Understands the roles and responsibilities of oneself, patients, families, consultants, and interprofessional team members needed to optimize care, and accepts responsibility for coordination of care
Accepts responsibility for the coordination of care, and directs appropriate teams to optimize the health of patients
Communicates collaboratively with the health care team by listening attentively, sharing information, and giving and receiving constructive feedback

10. Interprofessional Practice in the Ambulatory Care Arena
Chrystian Pereira, Pharm.D BCPS
Associate Professor
University of Minnesota College of Pharmacy
Smiley’s Family Medicine Clinic

11. Implementing Interprofessional Collaboration in the Community Pharmacy Setting
Chelsea Phillips Renfro, PharmD
Assistant Professor and Coordinator for Simulation-based Education
Department of Clinical Pharmacy and Translational Science
University of Tennessee Health Science Center College of Pharmacy

12. Objectives
Explain how the Interprofessional Education Collaborative (IPEC) 2016 core competencies align with community pharmacy practice.
Describe a process for implementing an interprofessional practice (IPP) in the community pharmacy setting.
Identify potential opportunities and challenges that may arise when building an IPP.
Demonstrate approaches and strategies to incorporate learners in IPP in the community pharmacy setting.

13. Why is a Team Effort Important?

14. Interprofessional Collaboration Competency Domains

15. Opportunity for Collaboration

16. Identify the Need/Opportunity
Help me!!

17. Identification of Shared Goals

18. Identification of Shared Goals

19. Patient Identification

20. Development of Communication Strategy
Community Pharmacy
Health System
Electronic Health
Record

21. Potential Challenges Dedicated pharmacist time outside of dispensing
Technician support
Prescriber buy-in
Workflow

22. Incorporating Learners
Written and verbal communication with other members of healthcare team (i.e., nurses, prescribers)
Identification of potential opportunities
Identification of shared patients
Documentation

23. Implementing Interprofessional Collaboration in the Community Pharmacy Setting
Chelsea Phillips Renfro, PharmD
Assistant Professor and Coordinator for Simulation-based Education
Department of Clinical Pharmacy and Translational Science
University of Tennessee Health Science Center College of Pharmacy

24. Expanding pharmacist involvement in multidisciplinary management of pain, agitation and delirium in an intensive care unit
Patricia Louzon, PharmD, BCPS, BCCCP
Clinical Manager, Critical Care and Emergency Department
AdventHealth Orlando
Clinical Assistant Professor
University of Florida College of Pharmacy
15 min

25. Objectives
Explain how the Interprofessional Education Collaborative (IPEC) 2016 core competencies align with clinical pharmacy practice in an intensive care unit
Identify potential opportunities and challenges that may arise when building an interprofessional practice (IPP)
Demonstrate approaches and strategies to incorporate student involvement into an interprofessional collaborative practice in an intensive care unit
Describe possible assessment criteria and approaches to use when evaluating new intensive care unit services

26. Background AdventHealth Orlando Part of 7 hospital system 160 ICU beds
Community teaching hospital
27 pharmacy residents
Student 3 month block rotations
~100 APPE and ~30 IPPE rotations/year
40 interns
3 Colleges of Pharmacy

27. Background
Pharmacist collaboration on patient care protocols can improve outcomes
Awakening Breathing Coordination Delirium Early mobilization bundle recommended to coordinate ICU patient care
Pain, Agitation and Delirium management by pharmacists identified as a potential area of service expansion
Guldbrand P et al. Acta Anaesthesiol Scand 2004;48:
Devlin J et al. Crit Care Med 2008;36:626-8.
Barr J et al. Crit Care Med 2013;41:

28. Methods- Phase 1 Engage IPP team
Empower pharmacists to collaborate on sedation management
Mitigate oversedation
Improve delirium screening and treatment
Create weaning order set and pathway
Revise ABCDE Bundle Order set
Daily monitoring and implementation
Education
Louzon, P et al. Am J Health-Syst Pharm. 2017; 74:

29. Methods- Phase 2 Multispecialty “ABCDE Bundle Team” created
Expand to include hospital executives, physical therapists, respiratory therapists
Daily ABCDE bundle rounds with pharmacist sedation management
Expanded to 6 ICU’s at main campus followed by other 6 system ICU’s over 1 year
Louzon, P et al. Am J Health-Syst Pharm. 2017; 74:

30. Goals Improve LOS and ventilator days Reduce hospital expenditures
Advance pharmacist scope of practice
Integrate learners into IPP
Louzon, P et al. Am J Health-Syst Pharm. 2017; 74:

31. Role Delineation- Pharmacists
Preceptor
Identify champions from other disciplines
Develop and maintain content
Obtain approval from IRB and committees
Supervise learners
Educate and sustain
Pharmacy resident
Participation on rotations
Layered learning

32. Role Delineation- Students
Planning/research stages
Order set development
Data collection
Manuscript and poster development
Daily involvement on rotation
Patient screening
Sedation management recommendations to preceptor and multidisciplinary team
Education provider

33. Challenges with building IPP
Proof of concept needed
Potential need for increased resources
Other professional recognition of pharmacist expertise
Concern for infringement on other profession scope
Changing ingrained culture
Deep sedation and continuous infusions

34. Challenges with student involvement in IPP
Research inclusion in school agreements
IRB enrollment as an investigator
Length of rotation in comparison to project length
Time to develop provider relationships
Multiple student involvement

35. IPEC Competency alignment
Competency 1 (values/ethics for IP practice)
Relationship building with nursing, pharmacy and physician staff
Confidentiality and ethics in data collection
Competency 2 (roles/responsibilities)
Communicate student roles in research
Collaborate with different skillsets in direct patient care for sedation management
This initiative demonstrates agreement with IPEC competencies in the interprofessional domain
Competency 1- work with other professions in climate of mutual respect and shared values
This was demonstrated in relationship building with nursing pharmacy and physician staff, through a shared desire for DEFINED patient outcome improvements
The providers developed a trusting relationship in the ability of pharmacists to manage sedation
Confidentiality and ethics were practiced by students involved in data collection and reporting
Competency 2- use knowledge of role and other professions to advance health
Unique roles in research were defined
In depth medication knowledge positioned pharmacists in a role to make sedation management recommendations, while skills of other providers addressed other elements of the ABCDE Bundle such as nursing and physical therapy on mobility and respiratory therapy on breathing trials. By identifying each team member as a specialist in certain bundle elements, the team was able to capitalize on specialized skills of all parties. Without the interdependence of all team members, there was not have been a complete patient care bundle

36. IPEC Competency alignment
Competency 3 (IP communication)
Written and verbal communication
Group and individual settings
Competency 4 (teams and teamwork)
Planning stages, evidence-based design
Evaluation of patient profiles
Deliver real-time recommendations through different formats
Accountability for outcomes
Competency 3 is to communicate with professionals in a manner that supports a team approach to promotion and maintenance of health
-Involvement in this initiative enabled students to practice written communication through manuscript and poster development.
There were many opportunities for verbal communication in group setting such as on ICU rounds, individual settings with a provider or preceptor
Students had to identify the best time and setting for each recommendation, and the appropriate language to use so that all disciplines could understand assessment and recommendations
Listening was important to identify expert assessment of each bundle element that may impact sedation management such as patient performance on breathing trials and ability to participate in mobility sessions
Competency 4 is applying relationship building values and principles of team dynamics to perform effectively in different team roles
Students were involved in roles throughout the initiative, including planning and evidence-based design
Those involved long term were able to see the process of team development and changes as the initiative progressed
The team shared responsibility for overall impact on patient outcomes

37. Assessment criteria Value added (each team member) Sustainability
Short and long term outcomes
Data availability
Vent, ICU and hospital length of stay
Alignment with best practices
Sedation utilization tied to cost
Return on investment

38. Key components IPP collaboration
Nurses, physicians, leadership, educators
Integration of learners
Detailed and continued education
Analysis of data to report outcomes

39. Patient care improvements
Louzon, P et al. Am J Health-Syst Pharm. 2017; 74:

40. Other initiative outcomes
Continued clinical improvements in Phase 2
42.9% reduction in drug expenses ($183,216)
Student authorship at national venue
Integrated sedation management into daily ICU practice and learner roles
Expansion of pharmacy services
6.6 pharmacist FTE’s obtained
Increased APPE rotations
PGY-2 Critical Care residency

41. Expanding pharmacist involvement in multidisciplinary management of pain, agitation and delirium in an intensive care unit
Patricia Louzon, PharmD, BCPS, BCCCP
Clinical Manager, Critical Care and Emergency Department
AdventHealth Orlando
Clinical Assistant Professor
University of Florida College of Pharmacy
15 min