A multidisciplinary teamwork training program: the Triad for Optimal Patient Safety (TOPS) experience.

INTRODUCTION: Communication and teamwork failures are a common cause of adverse events. Residency programs, with a mandate to teach systems-based practice, are particularly challenged to address these important skills. AIM: To develop a multidisciplinary teamwork training program focused on teaching teamwork behaviors and communication skills. SETTING: Internal medicine residents, hospitalists, nurses, pharmacists, and all other staff on a designated inpatient medical unit at an academic medical center. PROGRAM DESCRIPTION: We developed a 4-h teamwork training program as part of the Triad for Optimal Patient Safety (TOPS) project. Teaching strategies combined didactic presentation, facilitated discussion using a safety trigger video, and small-group scenario-based exercises to practice effective communication skills and team behaviors. Development, planning, implementation, delivery, and evaluation of TOPS Training was conducted by a multidisciplinary team. PROGRAM EVALUATION: We received 203 evaluations with a mean overall rating for the training of 4.49 +/- 0.79 on a 1-5 scale. Participants rated the multidisciplinary educational setting highly at 4.59 +/- 0.68. DISCUSSION: We developed a multidisciplinary teamwork training program that was highly rated by all participating disciplines. The key was creating a shared forum to learn about and discuss interdisciplinary communication and teamwork.

Postdischarge follow-up visits for medical and pharmacy students on an inpatient medicine clerkship.

BACKGROUND: Teaching medical and pharmacy students to collaborate on discharge planning for chronically ill patients may facilitate their ability to provide quality care. OBJECTIVE: To determine whether a discharge curriculum would improve students' attitudes and self-assessed skills in interdisciplinary collaboration and transitional care for chronically ill patients. DESIGN: The discharge curriculum of an inpatient medicine clerkship focused on safe patient transitions after hospitalization. Curricular components included an interdisciplinary workshop, follow-up visits with discharged patients, a final group debriefing, and letters to patients' primary care providers. Preassigned medical and pharmacy student partners coordinated discharges and conducted postdischarge visits. The change in students' attitudes and skills in interdisciplinary collaboration and discharge planning was assessed using a 5-point Likert-scaled survey given before and after the curriculum, and students reported their satisfaction using additional Likert-scaled and open-ended questions. RESULTS: The program was completed by 97% of students (37 of 39 medical, 22 of 22 pharmacy). The postcurriculum survey response rates were 92% and 86%, respectively; matched response rates were 58% and 59%. The attitudes and self-assessed skills of both medical and pharmacy students significantly improved for most survey items after the curriculum. Students also reported that the curriculum had a favorable impact on their learning about interdisciplinary care (4.3, SD 0.72), humanism (4.3, SD 0.63), and discharge planning (4.4, SD 0.70). Ninety-three percent reported that the curriculum was valuable to their education. CONCLUSIONS: A clinically oriented curriculum with postdischarge visits improved students' attitudes and self-assessed skills in interdisciplinary collaboration and transitional care and fostered a patient-centered approach to care.

Gabapentin-induced neurologic toxicities.

Gabapentin is an antiepileptic drug approved for the treatment of postherpetic neuralgia and as adjunctive therapy for partial seizures. The drug has been shown to be safe and nontoxic. The current literature has limited reports of neurologic toxicity associated with gabapentin therapy in patients with or without renal dysfunction. We describe the case of a 75-year-old man with renal dysfunction who developed neurologic toxicity due to gabapentin accumulation. Future studies are warranted to confirm the neurologic adverse effects of gabapentin, including any additional risks in patients with renal dysfunction.

Content on end-of-life care in major pharmacy textbooks.

The quantity and quality of end-of-life-care (EOLC) information in commonly used pharmacy textbooks were studied. EOLC content in each of eight best-selling pharmacy textbooks was assigned to 1 of 13 domains; there were a total of 104 possible domains for all eight books. Every mention of EOLC was given a score of 2 for "helpful content present" or 1 for "minimal content present." The quantity of EOLC content was assessed by tabulating the raw number of entries. The average number of EOLC-related entries per book ranged from 1.0 (ethics) to 27.5 (natural history). Eighty-one domains (78%) had fewer than 10 entries, 66 (63%) had 5 or fewer entries, and 28 (27%) had 1 entry or none. The overall quality of content was low, especially in the domains of spiritual issues, ethics, and context of care. The results were consistent with findings for medicine and nursing textbooks. A review of eight commonly used pharmacy textbooks revealed inadequate coverage of EOLC.

The impact of follow-up telephone calls to patients after hospitalization.

We studied whether pharmacists involved in discharge planning can improve patient satisfaction and outcomes by providing telephone follow-up after hospital discharge. We conducted a randomized trial at the General Medical Service of an academic teaching hospital. We enrolled General Medical Service patients who received pharmacy-facilitated discharge from the hospital to home. The intervention consisted of a follow-up phone call by a pharmacist 2 days after discharge. During the phone call, pharmacists asked patients about their medications, including whether they obtained and understood how to take them. Two weeks after discharge, we mailed all patients a questionnaire to assess satisfaction with hospitalization and reviewed hospital records. Of the 1,958 patients discharged from the General Medical Service from August 1, 1998 to March 31, 1999, 221 patients consented to participate. We randomized 110 to the intervention group (phone call) and 111 to the control group (no phone call). Patients returned 145 (66%) surveys. More patients in the phone call than the no phone call group were satisfied with discharge medication instructions (86% vs. 61%, P = 0.007). The phone call allowed pharmacists to identify and resolve medication-related problems for 15 patients (19%). Twelve patients (15%) contacted by telephone reported new medical problems requiring referral to their inpatient team. Fewer patients from the phone call group returned to the emergency department within 30 days (10% phone call vs. 24% no phone call, P = 0.005). A follow-up phone call by a pharmacist involved in the hospital care of patients was associated with increased patient satisfaction, resolution of medication-related problems, and fewer return visits to the emergency department.