Simulation in Pharmacy Education

Simulation in Pharmacy Education Amy L. Seybert, PharmD, FASHP, FCCP, CHSE Chair and Associate Professor Department of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy None 1

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University of Pittsburgh School of Pharmacy University of Pittsburgh Medical Center (UPMC) 3

Outline the rationale, advantages and disadvantages of simulation use in pharmacy education Identify competencies of pharmacists that are ideally taught by means of simulation 1. A safe, realistic learning environment is one of the advantages of high fidelity human patient simulation? 2. Have all of the following are competencies been proven to be successfully taught and assessed with the high fidelity human patient simulation environment? A. Communication B. Medication dispensing, distribution, and administration C. Patient assessment D. Patient safety E. Pharmacotherapy 3. Is cost one of the disadvantages of high fidelity human patient simulation? 4

Center for the Advancement of Pharmacy Education (CAPE) Foundational Knowledge Learner Essentials for Practice and Care Caregiver, Manager, Promoter, Provider Approach to Practice and Care Problem Solver, Educator, Advocate, Collaborator, Includer, Communicator Personal and Professional Development Self-aware, Leader, Innovator, Professional ACPE Standards 2016 Educational Outcomes Foundational Knowledge Essentials for Practice and Care Patient Centered Care Approach to Practice and Care Problem Solving Interprofessional Collaboration Communication Personal and Professional Development http://www.aacp.org/resources/education/cape/open%20access%20documents/capeoutcomes2013.pdf https://www.acpe-accredit.org/pdf/standards2016final.pdf Simulated practice experiences may be used to mimic actual or realistic pharmacist-delivered patient care situations. 60 clock hours of the total 300 hour requirement-20% Interprofessional experiences can be simulations The school s physical facilities include access to educational simulation capabilities 5

High Fidelity Simulation University of Pittsburgh School of Pharmacy High Fidelity Human Patient Simulation Vital signs Hemodynamic monitoring Intubation Line placement Defibrillation Medication administration Voice commands Heart rhythms and sounds Lung and bowel sounds CPR/ACLS RFID tag med recognition Completely wireless Seizures Sweating Urination Bleeding Debriefing with video http://www.laerdal.com/simman3g 6

Realistic Safe High levels of learner satisfaction Enhances knowledge and performance vs other learning techniques Interactive practice Comprehensive Interprofessional opportunities Standardized learning Immediate feedback Debriefing video Certifications Singapore Cross training IP education PBL vs. SC VS. SIM Skills Assessment PBL vs. Simulation FUTURE 2014 2013 2012 2011 2010 2009 2008 2007 Debriefing China IP education PBL vs. SC vs. SIM Simulation AACP/ACPE Pharmacy Practice Res Family Medicine Res Pharmacy Management Res Problem Solving Skills Med Administration Errors Satisfaction/Confidence OSCEs 2006 2003 2002 2000 1999 Biochem Teach Me to Teach Continuing Education- School of Pharmacy Critical Care Specialty Res Cardiology Specialty Res APPE Pharmacotherapy of CV Critical Care Research 1994 - Human Patient Simulation Begins at University of Pittsburgh PK/PD programming for crisis team training course Teaching 7

Competencies of pharmacists that are ideally taught by means of simulation Patient-centered care Science Context Physical Assessment Communication Pharmaceutical Calculations/Med Administration Direct Patient Care/Clinical Decision Making Pharmacotherapy/Monitoring Medication Safety Medications use systems management Health and wellness Population-based care https://www.acpe-accredit.org/pdf/standards2016final.pdf Science Context 8

Acid-Base Disorders Henderson-Hasselbalch equation pka and ph Calculation of base deficit Practical application Lactic Acidosis due to Metformin overdose Debriefing Viewer Video of case scenario Physical Assessment 9

Assessment First Session Second Session Third Session Avg score from rubric 4.2 5.8 7.8 0.029 P Students obtaining accurate BP* 21.5% 65.6% 97.6% <0.05 *Accurate defined as reading within 5 mm Hg of programmed BP Difference between first and final session SBL to Teach Blood Pressure Assessment to Doctor of Pharmacy Students AJPE 2007;71(3):Article 48.14 Communication 10

Medication Administration Direct Patient Care/Clinical Decision Making 11

Final session: MI, ACS, NSTEMI, etc Hypertensive Crisis HF requiring inotrope HF volume overload Vtach +/- pulse Vfib Atrial Flutter Atrial Fibrillation Torsades de Pointe Stroke, PE, DVT Includes: Physical Assessment Chart interpretation Decision making skills Patient counseling Graded Assessment Points Allotted Average Score Introduction to Patient 5 4.38 Data Collection/Interpretation -Physical Assessment -Patient History -Medication History -Diagnosis 10 7.94 Problem List Development 10 9.94 Pharmacotherapy Plan Development 20 19.38 Monitoring Plan Development 10 9.56 Verbal Communication of Plan 15 15 Patient Counseling 15 15 Documentation 15 14.56 Total Score 100 95.76 Seybert AL, Kobulinsky LR, McKaveny TM. Human Patient Simulation in a Pharmacotherapy Course. Am J Pharm Educ, 2008, April 15 ;72(2): Article 37. 12

Acute Care Simulation Course Am J Pharm Educ. 2011 Apr 11;75(3):54 13

Grade Assessment Points Average Score Average Score Final Allotted Midterm (n=13) (n=13) Introduction to Patient 10 9.3 1.5 9.5 0.8 Data Collection/Interpretation* 18 15.7 1.3 17.8 0.4 Pharmacotherapy Plan and 34 23.3 7.0 27.5 4.7 Monitoring Verbal Communication of Plan 10 9.6 1.4 9.9 0.6 Am J Pharm Educ. 2011 Apr 11;75(3):54 *P<0.001 *p=<0.05 Am J Pharm Educ. 2011 Apr 11;75(3):54 14

Prospective, randomized, cross-over study 90 minute seizure disorder practica sessions Smithburger PL, et al. Simul Healthc. 2012 Jun;7(3):141-6. Methods 4-week time period, IP teams consisting of pharmacy, medical, nursing, social work, and physician assistant students Results Communication and Teamwork Skills (CATS) Assessment scores improved from the HFS sessions 1 to 2 (p = 0.01), 2 to 3 (p = 0.035), and overall from 1 to 4 (p = 0.001). Students perceived the HFS improved: Their ability to communicate with other professionals Confidence in patient care in an IP team Stimulated student interest in IP work Efficient use of student time Conclusion HFS improved student teamwork and communication Pharm Pract. 2013 Apr;11(2):61-5. Epub 2013 Jun 30. 15

Allows for immediate feedback Programmable for point totals, additional references, etc. Able to print to give to each group as soon as simulation is complete Puts real time value with each decision 16

Teaching technology Assessment development Practical teaching opportunities Course development Patient case scenarios ACLS/Crisis Training Research Types of Errors: Baseline Data Wrong Route 1% Drug Prepared Incorrectly 12% Expired Product 4% Improper Dose or Quantity 15% Mislabeling 4% Wrong Administration Technique 24% Unauthorized or Wrong Drug 1% Prescribing 7% Omission 32% Intens Care Med 2010;36:1526-1531. 17

Results: Comparison of Error Rates Observation Period Medical ICU (Traditional Lecture) # doses observed Error rate (%) Cardiac Care Unit (Simulation Based Training) # doses observed Baseline 159 20.8 156 30.8 Post-Intervention 1 172 22.7 149 4.0* Post-Intervention 2 147 36.7* 97 6.2* Error rate (%) *Comparison between post-intervention and baseline; p<0.05 Intens Care Med 2010;36:1526-1531. Lessons Learned Preparation of case based on learning objectives Groups of 6 students are optimal Build-in extra simulator set-up time prior to session For large group instruction, assistance with time management of each session is crucial Realism Combination with other learning technology 18

Disadvantages Cost Time to prepare case Programming expertise Mobility to learning site Time and expertise in moulage and props Advantages of high fidelity human patient simulation: Realistic, yet safe environment for practice Proven to be superior to lower fidelity learning approaches Highly preferred by learners Standardization of teaching and ease of faculty time Debriefing Interprofessional opportunities Competencies that have been proven to be successfully taught and assessed with the high fidelity human patient simulation environment: Communication Medication dispensing, distribution, and administration Patient assessment Patient safety Pharmacotherapy Disadvantages of high fidelity human patient simulation: Cost Simulation programming Time for moulage Mobility 19

1. A safe, realistic learning environment is one of the advantages of high fidelity human patient simulation? 2. Have all of the following are competencies been proven to be successfully taught and assessed with the high fidelity human patient simulation environment? A. Communication B. Medication dispensing, distribution, and administration C. Patient assessment D. Patient safety E. Pharmacotherapy 3. Is cost one of the disadvantages of high fidelity human patient simulation? 1. A safe, realistic learning environment is one of the advantages of high fidelity human patient simulation? YES 2. Have all of the following are competencies been proven to be successfully taught and assessed with the high fidelity human patient simulation environment? A. Communication B. Medication dispensing, distribution, and administration C. Patient assessment D. Patient safety E. Pharmacotherapy YES 3. Is cost one of the disadvantages of high fidelity human patient simulation? YES 20

Copyright University of Pittsburgh 2013 SEYBERTA@PITT.EDU 21