Quality improvement projects conducted by interprofessional teams of learners: Implementation and impact.

Students in their second year of the Vanderbilt Program of Interprofessional Learning (VPIL) complete team-based quality improvement (QI) projects in their assigned clinic as part of the core curriculum. This report describes the creation and implementation of the student teams' QI curriculum and investigates how clinical preceptors view the project impact. Between 2012-2019, the VPIL teams designed and implemented 69 improvement projects. Improvement projects fell primarily into three categories: improving clinic care delivery (n = 25, 36%), patient education and health coaching (n = 21, 30%), and quality measures such as screening tests/prophylaxis (n = 10, 14%). Clinic preceptors received a survey about the sustainability and effectiveness of the projects. Survey feedback was received from 44/69 (64%) preceptors. Many (70%) projects resulted in perceived improvements, and some projects (34%) had improvements that are still in use. Despite barriers and challenges, interprofessional student teams can successfully learn the basics of QI and work together to design and implement a project. These projects have the potential to make meaningful changes in clinic practices and are helpful to the clinic preceptors.

Automated Dispensing Cabinet Overrides-An Evaluation of Necessity in a Pediatric Emergency Department.

OBJECTIVE: Automated dispensing cabinets, or ADCs, are often used at health care facilities to aid in the medication-use process. Although ADCs minimize certain medication errors, they introduce a new type of error involving overrides. Although helpful when used appropriately in emergencies, overrides bypass pharmacist verification and increase potential for patient harm through drug-drug interactions, medication allergies, inappropriate dosing, and more. The purpose of this study was to evaluate automated dispensing cabinets override pulls in a pediatric hospital's emergency department. The authors sought to discover whether overridden medications were being administered before verification (indicating it was needed emergently, thus justifying override) or after verification (indicating the override did not result in quicker administration and/or the medication was not emergent). METHODS: This was a retrospective, observational study. Data were collected from electronic health record reports from a 343-bed pediatric hospital's emergency department from October 13, 2019, to December 22, 2019. RESULTS: A total of 445 override pulls were identified during this time, and after data analysis, 99 override pulls remained in the data set. Overall, time from input of prescription into the electronic medical record to medication override was approximately 4 minutes. Pharmacist verification also took a median of four minutes after prescription input. However, administration took twice as long, at 8 minutes. On average, pharmacist verification occurred 4 minutes before medication administration. CONCLUSION: This research from a pediatric emergency department suggests that most situations did not require an immediate administration, and perhaps an override was unnecessary and could have been avoided.

The Vanderbilt Program in Interprofessional Learning: Sustaining a Longitudinal, Clinical Experience That Aligns Practice With Education.

PROBLEM: Designing and sustaining a longitudinal, clinic-based interprofessional learning experience is logistically challenging, which has limited the educational opportunities available in health professions schools. The authors discuss the Vanderbilt Program in Interprofessional Learning (VPIL), which addresses some of the challenges facing clinic-based interprofessional experiences. APPROACH: VPIL places first- and second-year students from 4 professional degree programs (medicine, nursing, pharmacy, social work) in Nashville, Tennessee, on teams where they work and learn together in authentic clinical environments over a 2-year period. The program was implemented in 2010 and includes 3 components: a summer immersion experience, seminar-based classroom and simulation sessions, and a weekly clinical experience. Students also complete a capstone quality improvement project. VPIL administrators have set up structures at the institutional, clinic, faculty, and student levels that have contributed to the sustainability of the program. OUTCOMES: Between 2010 and 2019, VPIL admitted 398 students who participated on 91 clinical teams. In addition, 55 clinical preceptors and 12 core faculty trained students for future collaborative practice. The program has received consistently high ratings from students, who have produced 69 quality improvement projects at their clinics. These projects have addressed aspects of the care delivery process and produced durable materials, showing that the program has contributed to important innovations in the health system. NEXT STEPS: VPIL faculty continue to improve the curriculum and administrative structures and work to expand the program to reach a wider variety of health professions students. Going forward, lessons from the program could assist educators in creating opportunities for students to learn interprofessionally and deliver high value health care in increasingly complex delivery systems.

Establishment and evaluation of pharmacist-managed admission medication history and reconciliation process for pediatric patients.

OBJECTIVE: This was a single-center, prospective, pilot study aiming to evaluate the impact of pharmacist involvement in the admission medication history and reconciliation process and to quantify discrepancies found by pharmacists when compared to information collected by other health care providers at a pediatric institution. METHODS: A pharmacist completed a thorough medication history and reconciled discrepancies with the medical team. Discrepancies included incorrect medication, dose, route, frequency; omitted information; missing medications; or any other inconsistencies outside of these categories. Information was documented in the electronic medical record via a standardized template, and pertinent discrepancies were communicated with the medical team. RESULTS: Of the 100 medication histories included in the study, a total of 309 discrepancies were identified and corrected in the electronic medical record. The median length of time it took pharmacists to complete the medication history process was 15 minutes per patient (interquartile range, 10-20 minutes). Thirty discrepancies were determined as pertinent and were reported as intervened on and communicated to the medical team. CONCLUSION: This study provides evidence that pharmacist-obtained admission medication histories and reconciliation have the potential to prevent potentially significant adverse drug reactions and have a positive impact on patient care.Index terms admission, history, medication, pharmacist, reconciliation.