Pharmacy finds way to improve quality through improved student program

Pilot test showed improved quality, decreased costs

Hospital pharmacists increasingly are pressed for time, and the trick for pharmacy managers is to find ways to improve quality and safety while improving staff efficiency.

The pharmacy department at Tampa General Hospital in Tampa, FL, has developed a new program for pharmacy students, called the student clinical service program, that has accomplished those goals.1

"We started this project with an interest in figuring out how to use our resources to accomplish better ways of doing things," says Minh-Tri Duong, PharmD, a post-graduate year 1 residency program director in the department of pharmacy at Tampa General Hospital.

The pharmacy department typically had pharmacy students work with preceptors to learn a variety of daily tasks assigned to pharmacists.

"They had various responsibilities as a pharmacist in training, but there was no consistent service delegated to students," Duong says.

As the demands on staff pharmacists increased, Duong looked at the student program as a possible way to improve quality and staff efficiency.

After meeting with pharmacists and preceptors, the department decided to start a pilot project in which pharmacy students would focus on two areas of responsibility throughout the course of their traditional training.

The two tasks selected were to have the students provide admission assessments and management of the IV to PO formulary switch program — the evaluation of patients on IV medications to see if they met criteria to be switched over to oral drugs, Duong says.

"We were lucky because there was an IV to PO policy, and my role then was to really design how the students would carry it out and how we'd teach them to do it," says Lindsay Bock, PharmD, clinical pharmacist at Tampa General Hospital.

The outcomes from the pilot project were impressive: Prior to having students handle the IV to PO switch program, the service was not consistently done because no one was able to get to those patients in time, says Linda Linderbeck, BSPharm, BCOP, clinical pharmacist.

"Once we utilized the students, we were able to ensure that every patient who met criteria for switch was converted to PO meds," Linderbeck says.

This resulted in a cost savings for the department and ensured that patients were not on IV medications when they didn't need to be, Duong says.

"It decreased the number of days the patient needs to be on IV therapy by an average of five days," Duong says.

Also, the admission referrals' completion increased by 60% within a month of implementing the program, Bock says.

The students gave impressively positive feedback on the program, Linderbeck notes.

"They enjoyed doing these activities, and they felt it enhanced their time here," she says. "They learned a bunch of things they might not have."

For example, students learned about different drug therapies during the process of assessing patients, Linderbeck says.

"It gave them a lot more opportunity to have face-to-face interactions with patients," she adds. "Even though there are pharmacists in the hospital, a lot of times patients don't get to meet the pharmacist during their stay, so this meant there was more interaction between patients and the pharmacy department, and the students appreciated this."

The students also said they liked the feeling of responsibility and ownership of the tasks they were assigned, Bock says.

Final evidence of the program's success was that more preceptors were receptive to having their students involved after the pilot project, Bock says.

And the program has evolved with hospital changes and market forces.

"Our pharmacy now is responsible for medication reconciliation and no longer has the admission assessment referral," Bock explains.

This transition, which takes place this spring, will mean a number of changes, Duong says.

"It's a huge responsibility for the department, and we'll revise the student clinical service to incorporate students in doing medication reconciliation and IV to PO switch and, potentially, other clinical services as well," Duong says.

The key for hospital pharmacies is to create a student clinical service program that remains flexible. Duong, Bock, and Linderbeck offer these suggestions for how it can be done:

Brainstorm to decide which areas to target: Before starting the student clinical service program, Duong and Bock met with some of the preceptors and administrators to discuss the different roles and responsibilities of a pharmacist.

"Then we tried to narrow down these roles and responsibilities to the ones we felt would be most appropriate to delegate to a student," Duong says. "We looked at the defined criteria, and we set guidelines for students to follow."

Through this process, they decided that the admission assessment and the IV to PO switch program would be the best to assign to students because these had clear cut criteria and could be delegated entirely to students, Duong explains.

Create a manual: Bock then created the 8.5-inch by 11-inch, soft-cover manual. It has 50 pages, which cover both the admission assessment and IV to PO switch.

"I created a manual for both jobs and included examples of how the students would do the work, step by step," Bock says.

"We have a print shop in our hospital," she says.

Bock followed the IV to PO switch policy and criteria, writing the manual's point-by-point descriptions in a way that would be clear to students.

"It says, 'Here's what you need to do to complete this,'" she says.

The first page is a table of contents, and each section starts with why they will be doing the process in this way, Bock explains.

"We tested the manual on students and revised it throughout the whole process," she says. "Before we started collecting data on it, we had a couple of students try it out."

Once the manual was complete, Bock had 5-10 printed for distribution to new students.

"On the first day of the student's rotation in our facility, they're provided with this manual, and they're told to read it that night because training on it will start the next day," Bock adds.

Pilot test it for department buy-in: Duong found volunteers among the preceptors for pilot testing the student clinical service program.

"We have about 10 preceptors, and three of the 10 participated in this project," Duong says.

"Some of the other preceptors were concerned that students who were providing the service would have their time taken away from their focused training," Duong notes. The student rotations range from four to eight weeks, but can also go longer, she notes.

Once the pilot test results were in, they found that the program enhanced the students' learning experience because students could provide the clinical service activities as part of their rotation, Linderbeck says.

"Students were still able to do the admission referrals and the IV to PO switch without it negatively impacting their focused training," Linderbeck adds. "So it gave students a little better understanding of the things all the pharmacists were doing throughout the day."

Show hospital pharmacists and administrators the pilot test results: Once Bock presented the results of the study, the pharmacists were impressed, Duong says.

"Now many of the pharmacists are very much on board with developing a clinical student service program," Duong adds.

"Having the students do these tasks frees us up to get other things done, increases our clinical activity, and it clearly enhances the student program all around," she adds.

What the pilot test showed was that a student clinical service program could fulfill both clinical quality goals and hospital efficiency goals, Duong says.

"The main driver for this project was our looking at and understanding that the resources are scarce and demands for pharmacist time continue to increase," Duong says. "And we need to look and think outside of the box to finding other resources we can tap into for providing better patient care."

Reference

  1. Bock LM, Duong MT, Williams JS. Case study: Enhancing clinical services by using pharmacy students during advanced experiential rotations. Am J Health Syst Pharm 2008;65:566-569.