Welcome!

Integrating Learners into the Pharmacists’ Patient Care Process (PPCP)

9/25/16Brian Barnes, PharmD, MS

Ashley Crowl, PharmD, BCACP

Crystal Burkhardt, PharmD, MBA, BCPA

University of Kansas, School of Pharmacy

2016 Annual Meeting and Trade Show“Advancing as Providers | Reimaging the Present”

Wichita Marriott Hotel

Wichita, Kansas

Disclosures

• List any disclosures you may have. Some are listed below:

• No financial interest in KPhA

• Provide insurance coverage for some KPhAmembers

• Provided with honoraria from KPhA for this presentation

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Program Summary

• Health Care Delivery system evolving to achieve “The Triple Aim”

• Pharmacist and education must adapt

• Practice-Ready and Team-Ready Graduates

• Use the Joint Commission of Pharmacy Practitioners’ (JCPP) Pharmacists’ Patient Care Process (PPCP) to bridge

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Learning Objectives

• Recognize the factors driving change in pharmacy education at the state and national level

• Describe the Pharmacists’ Patient Care Process (PPCP)

• Recognize how KU School of Pharmacy is incorporating the PPCP into the curriculum

• Discuss ways to utilize the PCPP to integrate students into your practice

• Apply the PPCP to patient cases in the community pharmacy setting

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How can you help students transition from student to practitioner utilizing the PPCP?

A. Create expectation that the PPCP will be utilized in your practice

B. Demonstrate the PPCP when meeting with patients

C. Have student demonstrate the PPCP

D. Provide feedback to student on utilization of the PPCP

E. All of the above

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Pre-Test

What are the 5 steps, in order, to the Pharmacist Patient Care Process?

A. Assess, Implement, Collect, Plan, Monitor

B. Monitor, Collect, Plan, Implement, Assess

C. Plan, Assess, Implement, Monitor, Collect

D. Collect, Assess, Plan, Implement, Monitor

7

Pre-Test

Why is it important to have a consistent practice model for the profession of pharmacy?

A. For uniformed payment for service

B. Shared expectation from other professions

C. Evaluate care provided

D. All the above

8

Pre-Test

How do you use the PPCP in your practice?

A. I don’t use it currently

B. I use aspects of the theory but in its entirety

C. I consistently go through all steps

D. I don’t know what the PPCP is

9

Pre-Test

What perspectives are considered when looking at curricular change at University of Kansas School of Pharmacy?

A. National Organizations

B. Alumni

C. Current Students

D. Faculty

E. All the above

10

Pre-Test

Drivers of curricular change

• Assessment data– Trends in pharmacy practice in KS and US– Internal (student and faculty)– Advisors (alumni, preceptors, advisory panels)– Comparison to peer institutions

• Content and science/practice proportions

• Curricular mapping to– CAPE outcomes (2013)– NAPLEX blueprint (2015)– ACPE accreditation standards (2016)– IPEC competencies (2011)– PPCP (2015)– EPAs (2017?)

Goals of curricular change

• Improve sequencing, reiteration, and relevance

• Address curricular content gaps

• Relax elective course requirements

• Expand opportunities to apply knowledge

• Improve patient communication skills

• Enhance clinical skills

• Expanded content in targeted areas

• Raise minimum passing standards

Summary of curricular change• 5 credit hours shifted from science to practice

• Revision of foundational coursework to improve sequencing and reduce reiteration

• Expanded pharmacy skills lab to 6 semesters

• Revised physical assessment course to emphasize MTM, IPE, and patient interviewing

• Expanded content related to PCT, health-systems, informatics, patient safety, public health/policy, cultural awareness, and pharmacoepidemiology

• Reallocation of standardized patient resources into skills lab and end of year OSCEs

Summary of curricular change• Drug information training throughout curriculum

• Enhanced content in research design and biostatistics

• PCOA during P3 year

• Established a co-curriculum that involves:– IPE training, cultural awareness, self-awareness,

professionalism, leadership, innovation/entrepreneurship

• Expanded PCT sequence from 3 to 5 semesters

• Patient case discussion sections added to PCT courses – Clinical documentation (SOAP), EHRs, lab value

interpretation, self-directed learning, cultural/ethical cases, drug information assignments, SBAR presentations

• Integration of the PPCP through the PharmDcurriculum

Pharmacists’ Patient Care Process

Pharmacists’ patient care process. JCPP. 2014.

Pharmacists’ Patient Care

Process

• Medication related problems:

– Indication

– Effectiveness

– Safety

– Convenience

Medication Related Problems

Indication

• Unnecessary med

• Needs additional med

Efficacy

• Dose too low

• Ineffective

• Lab

Safety

• Dose too high

• ADR

• Drug interaction

• Lab

Convenience

• Unable to take medication as intended

• Current

– Introduced in P1 year during Thursday Seminar

– Initial application in Pharmacotherapy 1 –OTC

– Mirrored with SOAP documentation

• Future

– Integrated throughout curriculum

• Basic Science

• Social & administrative Science

• Pharmacy Practice

• Experiential Education

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Teaching PPCP in the Classroom

Page 1 of 1

Patient Care Process Table – PHPR 661 Spring 2016

Instructions: Fill out the table with case-specific information. Use bulletpoints to organize your

information. Recommend copy/pasting the entire document into Google doc and sharing with the team.

Submit final plan to Blackboard (1 per team).

Case Application #____ Date:________

Team#:_____ Team Members (type first and last name):

COLLECT:

Demographics/ Background

Symptoms

Characteristics

History

Onset

Location

Aggravating factors

Remitting factors

Medications

Allergies

Conditions

Self-Care Exclusion concerns

Patient Preferences

ASSESS:

Health Problem(s) Diagnosis

Medication-Related Problem(s)

Candidate for self-care?

PLAN: If NOT candidate for self-care, determine urgency of referral and if appropriate, include non-

pharmacologic and/or pharmacologic treatment patient may utilize prior to seeing the physician

Referral Plan (if applicable)

Non-Pharmacologic Treatment(s)

Pharmacologic Treatment(s)

(include product, ingredients,

dose, duration) - Provide brief rationale

- If NOT recommending product the

patient is asking for, explain why

IMPLEMENT/FOLLOW-UP: MONITOR AND EVALUATE

Counseling points to tell patient

(write as if you are speaking to the

patient) - What to expect from treatment

- Side effects to monitor

- When to seek medical care

Follow-up (if applicable)

- When to talk to the patient again?

- What will you monitor?

• PCT 1 - OTC

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PPCP in the

Classroom

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PPCP in the

Classroom

• PCT 2-5

• OSCE

• Clinical Assessment

Name:________________________________Date:____________

Updated8/2016

KUSchoolofPharmacy:SOAPTemplateInstructions:FillintheSOAPtemplatewithcase-specificmaterial.Italicizedphrasesareprovidedforguidanceonly.Deletethe

italicizedwordsandunusedbulletpointsbeforecompletingtheSOAPnote.

Collect

S: · CC:(patient’sownwordstowhyhe/shepresentsforcare)

· HPI(pertinentpositivesandnegatives):Ptisa[75yoAAM]…o Mayinclude:

§ Symptoms(location,quality,severity,timing,setting,remitting/exacerbatingfactors,associatedsymptoms)

§ Illness/diseasehistory§ Homereadings(BP/bloodglucose)

· Adherence(pertinentpositivesandnegatives):

· PMH(pertinentpositivesandnegatives):

· SH(pertinentpositivesandnegatives):

· FH(pertinentpositivesandnegatives):

O: · Medications-Rx,OTC,Herbals:(citesource;includedose,route,frequency;quantifyprnuseifavailable)

· Allergies:(includingreaction)

· Immunizations(pertinentpositivesandnegatives):

· VS:(BP,HR,ht,wt,BMI,temp,etc.)

· Labs(pertinentpositivesandnegatives):

· PE(pertinentpositivesandnegatives):

· Diagnostictests(pertinentpositivesandnegatives):

Assess

A: ForEACHofyourassessments,numberedinorderofpriority,identifyyour:

· Diagnosis[e.g.1.Depression,2.Diabetes]o Goals:[ifapplicable:e.g.A1c<7%]o Currentstatus:[e.g.wellcontrolled,poorlycontrolled,stable,worsening,improving].o MedicationRelatedProblems:[e.g.Untreatedindication,Medicationusewithoutindication,Improper

drugselection,Subtherapeuticdosage,AdverseDrugreaction,Overdose,Druginteraction,Failuretoreceivemedication]

Plan,Implement,&Follow-up:Monitoran

dEvaluate

P: ForEACHofyourassessments,numberedinorderofpriority,identifyyour:

· PharmacologicTreatmentplano Recommendationsrelatedtocurrenttherapy(continue/discontinue/modify)o Recommendationsfornewdrugtherapy(mustincludedrug,dose,route,frequency;anticipated

duration,asappropriate)o Briefjustification/rationaleforproposedplan[e.g.SSRIsarefirstlinetreatment;perJNC8guidelines;or

patientspecificcircumstances]

o Monitortoassesssafety:drug-specificparameterstoassesstoxicities,adverseeffects,druginteractionsandtolerability[e.g.weeklyCBC;recheckK+andScrin1week]

o Monitortoassesseffectiveness:drug-specificparameterstoassessresponse[e.g.reassessdepressionsymptomsin2-4weeks;BPcheckin2weeks;recheckA1cin3months]

· Non-pharmacologicTreatmentplano RecommendationsforNON-drugtherapy(e.g.,nutrition/lifestylemodifications)o Briefjustification/rationaleforproposedplan[e.g.ECTduetomultiplefailedtherapies;DASHdiet

accordingtoJNC8guidelines]

· Monitoringandfollow-upplano Monitortoassesssafety:additionalproblem-specificparameterstoassesstoxicities,adverseeffects,

druginteractionsandtolerability[e.g.weeklyCBC;recheckK+andScrin1week]o Monitortoassesseffectiveness:additionalproblem-specificparameterstoassessresponse[e.g.reassess

depressionsymptomsin2-4weeks;BPcheckin2weeks;recheckA1cin3months]o Establishplanforfollow-upcare;bespecificwithregardtotypeandtimeframe[e.g.f/uvisittopractice

sitein1month,phonecallin1week,etc.]o Indicateneedforreferral,ifapplicable[e.g.referforCBT;referraltoOTforwalkingaidtoreducefallrisk;

refertonutritionist]

PPCP in Practice

Is not...

• Policy and procedure

• A list of resources or services provided

• At its core, different at different pharmacies

Is...

• A clear explanation of how the profession functions

• Allows for flexibility as a profession changes

• Connects the profession to its mission, vision and values

What do these jobs all have in common?

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PPCP in Practice

• Ambulatory Care

• Institutional

• Community

• Other Settings…

PPCP- Student to practitioner

• Preceptor needs to demonstrate process

– Review with students at beginning of rotation

– Conduct comprehensive medication reviews

– Show student process start to finish

• Don’t forget scheduling follow up

• Switch roles, let student lead patient visit

– Highlight when utilizing PPCP

PPCP- Ambulatory Care

• JM 58 yo female who is referred to your services for Diabetes Management & Education

– Dx 5 years ago

– Tolerating meds well, but still having elevated BS

– Working long hours and eating fast food more

– She saw her PCP 1 month ago

PPCP- Ambulatory CareCollect -Metformin 1000 mg BID, Glipizide 10 mg XL Qday, Empagliflozin 10 mg Qday

(started 3 mo ago), Lisinopril 20 mg Qday, Atorvastatin 40 mg Qday, Aspirin 81 mg Qday

-No missed doses of meds, no side effects, no hypo/hyperglycemia sx

-A1C-9.5% (8/20/16); K+=4.0, SCr=1.24, eGFR=56 ml/min, UACR= nml, AST/ALT=WNL, LDL=95 (03/15/16). ASCVD=13.2%. Immunization UTD. BP: 132/74 mmHg

-AVG blood sugar= 226, Fasting= 180-280, 2HPP= <180- Eating fast food 4x/wk (↑ from 1), not going on daily walks as she was 3 months ago

AssessDM: A1c not at goal (<7% per ADA), more effective medication available. Consider starting basal insulin at 0.2u/kg. Pt would benefit from lifestyle changes. HTN: at goal (<140/90 per JNC8), continue current medicationHLD: controlled, on high-intensity statin per AHA/ACC

PPCP- Ambulatory Care

Implement 1. Sent RX to her pharmacy to be filled2. Showed patient how to inject Lantus3. Provided patient with nutrition handout

-patient set goal to only eat fast food once a week-patient will start walking daily

4. Scheduled next visit

Follow-up 1. 2 weeks to review blood sugars2. A1c in November3. BP check at each visit4. Annual labs due in March (BMP, FLP, UACR)

Plan 1. Discontinue glipizide2. Initiate Lantus 20 units daily3. Continue other medications4. Educate patient on plate method, limiting fast food intake, and exercise

30 min daily most days

PPCP – Community

• A 35 year old male presents to your pharmacy with a request to refill his albuterol inhaler. Insurance rejects the refill as it is 10 days since his last fill.

PPCP – Community Collect List the necessary subjective & objective information you need to collect

Assess Analyze the information in the context of the patient’s overall health goals, and identify and prioritize the problems

PPCP - Community

Plan Develop an indvidualized patient-centered care plan that is both evidence based and cost effective.

Implement Execute the care plan in collaboration with other health care professsionalsand the patient or caregiver.

Follow-up List monitoring & evaluation parameters

Discussion & Application

Post-Test

How can you help students transition from student to practitioner utilizing the PPCP?

A. Create expectation that the PPCP will be utilized in your practice

B. Demonstrate the PPCP when meeting with patients

C. Have student demonstrate the PPCP

D. Provide feedback to student on utilization of the PPCP

E. All of the above

What are the 5 steps, in order, to the Pharmacist Patient Care Process?

A. Assess, Implement, Collect, Plan, Monitor

B. Monitor, Collect, Plan, Implement, Assess

C. Plan, Assess, Implement, Monitor, Collect

D. Collect, Assess, Plan, Implement, Monitor

33

Post-Test

Why is it important to have a consistent practice model for the profession of pharmacy?

A. For uniformed payment for service

B. Shared expectation from other professions

C. Evaluate care provided

D. All the above

34

Post-Test

How do you use the PPCP in your practice?

A. I don’t use it currently

B. I use aspects of the theory but in its entirety

C. I consistently go through all steps

D. I don’t know what the PPCP is

35

Post-Test

What perspectives are considered when looking at curricular change at University of Kansas School of Pharmacy?

A. National Organizations

B. Alumni

C. Current Students

D. Faculty

E. All the above

36

Post-Test

Questions?