Posted on March 15, 2018 in: Professional Practice
By Dana Staat, Pharm.D., clinical pharmacy lead, internal medicine, Specturm Health-Butterworth, Grand Rapids and Michigan Society of Health-System Pharmacists immediate past-president
It’s true. I have uttered those words: Give me more students!
How many times in the last year have you wished for more students on rotation? Or maybe you haven’t offered a rotation for students because of time constraints, lack of ideas for student projects or competing responsibilities?
As I was considering the 2018 Michigan Society of Health-System Pharmacists (MSHP) theme of “Demonstrating our Value,” I reflected on my own professional practice site, and the most striking thing I noticed were the numerous opportunities that pharmacy students have on my rotation to demonstrate the value of the pharmacy profession.
The health-system that I work at, Spectrum Health, hosts 16 P4 students through a direct pharmacy experience program called the Spectrum Health Advance Pharmacy Practice Experience (SHAPPE) program. The 16 students in the SHAPPE program rotate through all their APPE experiences at Spectrum Health facilities. I precept a six-week APPE internal medicine (IM) rotation for P4 students. My IM partner and I have two students on our joint rotation each month. Every student on the IM rotation works with two clinical pharmacists each day. Many of the projects and activities that are completed by the IM students have been designed specifically around the consistent presence of students and are described below.
Participation in Interdisciplinary Rounds/Completion of Clinical Tasks/Pharmacy Consults
Students round with pharmacists daily on three different interdisciplinary teams. Depending on their experience and ability, students may also be asked to round independently. This experience often occurs toward the end of their P4 year. Students are responsible for working up each patient on rounds, paying special attention to patient home medications and the medication reconciliation process. Students are also integral to therapeutic drug monitoring and starting pharmacy consults. Students complete initial pharmacokinetic consults including monitoring and assessment as well as other specialized drug monitoring for drugs like argatroban, dofetilide and u500 insulin. After initial assessment, students will follow-up with their assigned pharmacist to discuss recommendations and write consult and handoff notes thereby saving valuable pharmacist time and allowing the students to develop their clinical skills.
Nearly all IM patient medication counseling is completed by P4 pharmacy students. Students are alerted to patients who require counseling by automated tasks. Students complete counseling on all new warfarin and direct oral anticoagulants. Students have also enabled our health-system to teach breastfeeding patients about lactation-medication concerns and breastfeeding medication safety. Discharge counseling on new medications is also completed by students on rotation.
Pharmacy Education-Clinical Pearl
In every block, students are formally assigned a complex drug information question to research. The students are responsible to research the question, assess the data and present their findings in a short presentation format. They develop a handout and distribute it to the rounding pharmacists. Their handout is also placed on the internal Spectrum Health website which are searchable for pharmacists’ future use.
Projects/Data Collection/Medication Use Evaluations
Every student completes one “extra” project while on their six-week rotation. Often these projects are items on our clinical project list. The students commonly complete new drug monographs for additions to formulary and/or drug class reviews. Recent projects have included a urea drug monograph and a long-acting muscarinic antagonist/long-acting beta2-agonist (LAMA/LABA) drug class review. Students may also complete medication use evaluations, such as the evaluation of inpatient adalimumab (Humira). A prospective medication use evaluation is planned to look at insulin discharge orders and instructions. Many SHAPPE students also complete their doctoral projects within Spectrum Health. Recent projects include “Evaluation of diabetic ketoacidosis treatment in the emergency department” and “Scheduled vs. as-needed pain medication in post-partum patients.”
At Spectrum, students can be utilized in many ways. By taking more students on rotation and designing consistent services around them, they can extend pharmacist clinical services in the hospital and demonstrate the value of the pharmacy profession in numerous ways.