Authors: Elizabeth F. Englin, PharmD, BCPS and Heather Taylor, PharmD, BCPSClinical Assistant Professors - UMKC School of Pharmacy
Since the inception of the Hospital Readmission Reduction Program (HRRP) by the Centers for Medicare and Medicaid Services (CMS) in 2011, implementation and expansion of pharmacy – led transitions of care (TOC) services has become a focus for many institutions and clinics.1 The positive impact of pharmacy – led TOC services has been well documented in the literature through landmark trials such as the Medications at Transitions and Clinical Handoffs (MATCH) study and Project Re – Engineered Discharge (ProjectRED).2,3 Examples of pharmacy – led TOC services include medication history collection, medication reconciliation, comprehensive medication review, disease state education and medication counseling. One barrier to implementation of successful pharmacy – led TOC services is staffing resources.4 In order to implement or expand pharmacy – led TOC services, there is an increased need for additional pharmacy personnel or adjustment of current workflows.4 One method to overcome this barrier is the utilization of pharmacy residents and students to provide pharmacy – led TOC services.5 Involving pharmacy residents and students in performing TOC services provides valuable learning opportunities for them, while also benefitting the institution and improving patient care. Under appropriate supervision, pharmacy residents and students can help expand TOC services and reach more patients by serving as practice extenders at less or no additional cost to the institution.6 Data demonstrate student pharmacist involvement increased the number of patients receiving pharmacy-led TOC services from 10 patients per day to 15-20 patients per day.5
Incorporating pharmacy learners into TOC practices requires strong patient – centered care skills. Student pharmacists and pharmacy residents are equipped with the tools necessary to provide these services as they are instilled throughout their pharmacy school curricula. In 2014, the Joint Commission of Pharmacy Practitioners (JCPP) established the Pharmacists’ Patient Care Process (PPCP).7 The five step PPCP outlines a universal approach to patient - centered care with the underlying principles of collaboration, communication and documentation.7 The five steps of the PPCP are: collect, assess, plan, implement and follow – up including monitoring and evaluation.7 The ultimate goal of the PPCP is to provide a standardized approach to patient care for pharmacists to apply regardless of pharmacy setting or direct patient care activities.7 The Accreditation Council for Pharmacy Education (ACPE) incorporated the PPCP into the 2016 accreditation standards for pharmacy schools and colleges.8 Standard 10.8 states that schools and colleges of pharmacy should “prepare students to provide patient – centered collaborative care as described in the Pharmacists’ Patient Care Process model endorsed by the Joint Commission of Pharmacy Practitioners.”8 As a result, student pharmacists and new pharmacy graduates are equipped with the skills and knowledge to deliver patient – centered care according to the PPCP.
The American Pharmacists Association (APhA) recently published a guidance document titled: Applying the Pharmacists’ Patient Care Process to Care Transitions Services.9 In this document, they highlight the many components of TOC services and map them to the PPCP.9 Aligning TOC services with the PPCP allows institutions to adopt a standardized approach to the delivery of pharmacy-led TOC services. This also serves as a great method to train pharmacy residents and students to deliver TOC services. Medication management is a crucial component of TOC in which pharmacists in all practice settings play an important role. Studies show that the risk and incidence of medication errors increases during TOC and pharmacist involvement in the TOC process helps avoid preventable medication errors. Many services that pharmacists currently provide in a variety of practice settings are components of TOC. Recognizing these services as elements of TOC and involving pharmacy learners in advancing these services are great steps to providing optimal patient care. As pharmacists, we have an obligation to help safely and effectively manage our patient’s medications during TOC in every pharmacy practice setting, including hospital, community, ambulatory care, long-term care, along with many others. We have a great opportunity to collaborate with pharmacist colleagues in other practice settings to achieve this common goal.
If your institution has a residency program, a student intern program, or serves as a rotation site for Introductory/Advanced Pharmacy Practice Experience (IPPE/APPE) students, we encourage you to identify opportunities to involve them in developing or expanding pharmacy-led TOC services. Through delivering these services, pharmacy learners will increase their knowledge and skills by engaging in direct patient care while also adding a valuable contribution to the pharmacy department. Are you ready to reap the countless benefits of involving pharmacy learners in TOC today?