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Development and implementation of a simulation programme of study aligned to experiential learning and the initial education and training of the student pharmacist

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European Statement

Education and Research

Author(s)

Sam Ingram, Sian Williams, Stewart Glaspole, Greg Scutt, Railton Scott, Safoora Azimi, Danny Bartlett, Claire May, Lisa Knox, Graham Davies

Why was it done?

The General Pharmaceutical Council in the UK released updated standards in 2021, detailing expected learning outcomes at the end of undergraduate and foundation year training. As many of these new standards explicitly link to pharmacist skills it was important that these were integrated into undergraduate course delivery.

What was done?

An evidence-based strategy was employed to develop a global skills framework which was used, alongside the course structure, to inform a simulation and experiential learning strategy for the initial education and training of undergraduate pharmacists.

How was it done?

An evidence review was conducted, examining established skills frameworks in pharmacy education and the wider healthcare arena, this was thematically analysed, and generation of a 16-skills framework constructed. This was used to guide a series of stakeholder workshops and working groups to structure a spiraled curriculum of simulated activity and assessment and an aligned experiential learning plan.

What has been achieved?

A recognition of the importance of clinical and professional skills development by establishing this at the core of the new degree structure. Through the programme a suite of clinical and professional skills (CAPS) modules focuses on an evidence-based set of core skills, values, attributes, and behaviours. Generation of a suite of simulation workshops which ensures a safe environment to learn and show competence before enhancing these skills on placement(s) supporting pharmacy services in a range of clinical settings.

What next?

The simulation and experiential learning strategy has been implemented into the 2023-24 academic year. Monitoring and feedback generation from students, academic staff, placement providers, and key stakeholders to determine if this new format for learning is generating more engaged and capable student pharmacists.

National competition for pharmacy students in Bulgaria “become a hospital pharmacist”

European Statement

Education and Research

Why was it done?

There are five accredited faculties of pharmacy in Bulgaria – two in Sofia, one in Plovdiv, one in Varna and one in Pleven. The training is only full-time with a duration of 5 years, with 26 compulsory courses in which hospital pharmacy is covered to a very small extent. Only one of the faculties in Sofia offers the opportunity to specialise in clinical pharmacy during the studies, which include 30 hours of lectures and 45 hours of exercises in hospital pharmacy. The disinterest of graduating students in pursuing a career in hospital pharmacy prompted the BAHP Board to organise this competition to bring attention to hospital pharmacy in a non-traditional way.

What was done?

The Bulgarian Association of Hospital Pharmacists /BAHP/ organises during its annual conference a National Competition for Pharmacy Students “Become a Hospital Pharmacist” – for the first time in 2021. Since then, it has been held annually with increasing interest from students.

How was it done?

The areas in which the students will compete – Pharmacology and Pharmacotherapy, Regulation of Hospital Pharmacy and Practical part, as well as the regulations of the competition were determined. An invitation with information was sent to all faculties. For the year 2021, teams from three faculties participated, for 2022 four faculties, and for 2023 all faculties will participate. Each team has a scientific supervisor and the costs of participation are covered by the university.

What has been achieved?

1.Strengthening the links between the BAHP and the faculties
2. Repeatedly increased student interest in hospital pharmacy.
3. Increased number of students wanting to do their pre-graduate internship in hospital pharmacy

What next?

Continuation of the annual competition and deepening the collaboration with the faculties. It is also possible to organise such an event between different countries.

Advancing regulatory sciences closer to the patient care setting: a course development approach

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European Statement

Education and Research

Author(s)

Anthony Serracino Inglott, Maria Mamo, Amar Abbas, Luana Mifsud Buhagiar

Why was it done?

Regulatory science is not some detached activity performed in secluded offices but is applied by pharmacists as an integral part of their daily work, whether thought of as regulatory intelligence or not. This initiative endeavored to offer educational intervention, for streamlining a patient-centric culture and addressing gaps, while waning concerns regarding potential conflicts arising from regulator-stakeholder interactions.

What was done?

The Malta Medicines Authority (MMA), through the MMA Academy for Patient Centred Excellence and Innovation in Regulatory Sciences, implemented a course intended for collaborative synergy with professionals in patient care settings. Strengthening regulatory intelligence may provide substantial return on investment for the ultimate benefit of patients.

How was it done?

In April 2023, the MMA Academy completed registration as a Further and Higher Educational Institution. An accredited 3-day course, leading to an Award in Basic Regulatory Sciences (Malta/European Qualifications Framework Level 4), was launched across stakeholders. Twenty-four experts were engaged to deliver sessions on legislation, ethics, quality, information sources, digitalization, pharmacovigilance, good practices, risk, and avoiding victims of the system. Registrations were initially slow, owing possibly to the holiday season, increasing to maximal venue capacity following reminder mails and media posts. The course was delivered in September and feedback collected through a Likert scale evaluation exercise.

What has been achieved?

Thirty participants (8 from public, 22 from private entities) completed the course successfully. All respondents to the course evaluation exercise (n=24) expressed satisfaction with course content and willingness to attend further courses. Promisingly, 92% of same respondents found the information presented relevant to their practice, anticipating performance improvement. Feedback included recommendations for future initiatives, particularly on regulatory oversight of aesthetic medicine services and integration of artificial intelligence in hospital pharmacy practices. A continuous educational needs exchange is encouraged for course development tailored to respective patient care settings.

What next?

Interest was expressed by the Health Department (Ministry for Health, Malta) to support eligible candidates for participation, auguring well for enhanced prospective engagement by clinical pharmacists and colleagues in the state hospitals. This may also serve as example to other competent authorities. Going forward, the MMA Academy intends to invest in online provision to reach a wider audience through a virtual environment.

AN OBSERVATIONAL MULTICENTRE STUDY TO PROMOTE INDEPENDENT CLINICAL RESEARCH AND EDUCATION TO YOUNG HOSPITAL PHARMACISTS: THE QOSMOS PROJECT (submitted in 2019)

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European Statement

Education and Research

Author(s)

Daniele Mengato, Federica Milani, Laura Agnoletto, Nicoletta Freddi, Roberta Rampazzo, Vera Damuzzo, Nicola Realdon

Why was it done?

Recently, the national monitoring of Hospital Pharmacy Students (SHP) highlighted a lack of education in clinical research and in designing of independent studies among students. To fill this gap, we established a collaboration between Scientific Associations and Student Organisations.

What was done?

In 2017 the Italian Society for Clinical Pharmacy and Therapeutics (SIFaCT) and the National Association of Hospital Pharmacy Students (ReNaSFO) established a join action to improve students’ research competencies. To this end, we designed the QOSMOS study: “Quality Of life (QoL) in Multiple Sclerosis (MS): a Multicentre Observational Study”.

How was it done?

The study has both educational and scientific objectives. Scientific objectives were to update data on QoL in MS and to correlate QoL to drug therapy. Regarding the educational challenge, every SHP participant received, by a panel of expert colleagues, the methodologic basis on observational studies and how to arrange teamwork activities. SHP could participate either as co-investigators or as members of teams which managed ethical approval, case report form (CRF), study monitor and data analysis. Investigators enrolled patients, collected clinical data and administrated a CRF, consisting of a questionnaire on QoL (MSQoL54).

What has been achieved?

22 SHP from 16 Italian centres, equally distributed from Southern to Northern Italy, joined the project. 20 SHP participated as co-investigators, one was included in the Scientific Committee of the study and 1 participated in the team dedicated to the Ethical Committee. We enrolled 341 patients with relapsing/remitting MS from May 2018 to June 2019 (median=20 per centre). The study achieved primary and secondary endpoints and pointed out a significant decrease in QoL related to physical health in patients treated with teriflunomide compared to other oral drugs (p=0.002).

What next?

Results will be presented in a scientific paper for submission to a peer-reviewed journal. This final aspect of the project has an educational goal once again, namely to bring young colleagues closer to writing and disseminating science. As QOSMOS gained good results, a new study investigating the role of clinical pharmacist in the Infectious Disease Department is starting with the goal to investigate optimisation strategies for treatment of HIV-positive patients.

IMPLEMENTATION OF A MEDICATION SAFETY AGENDA AT TWO HOSPITAL SITES IN RESPONSE TO WORLD HEALTH ORGANISATION (WHO) PATIENT SAFETY CHALLENGE ‘MEDICATION WITHOUT HARM’ (submitted in 2019)

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European Statement

Patient Safety and Quality Assurance

Author(s)

Meenal Patel, Sheena Patel, Peta Longstaff

Why was it done?

• Initiative introduced and on-going since 2017
• To increase and embed medication safety awareness
• To address under-reporting of medication-related incidents, with feedback
• To embed medication safety in education programmes and clinical practice

What was done?

A local medication safety agenda implemented across two hospital sites in response to World Health Organisation (WHO) patient safety challenge ‘Medication without Harm’.

How was it done?

• Medication safety group (MSG) introduced with local strategy, involving junior medical staff for frontline feedback • Medication safety metrics changed to allow benchmarking with peers as per NHS Improvement’s Model Hospital data • ‘Plan, Do, Study, Act’ model applied to improve transfer of care from hospital to rehabilitation unit following external incidents • Monthly analysis of incidents with harm, exploring reasons for under-reporting • Optimisation of incident reporting system to improve staff feedback following investigations • Near miss error log introduced in pharmacy with shared learning • Mitigation of medication-related risks e.g. medications safe storage action plan • Medication safety bulletins, patient safety newsletters and top tips guide introduced covering focal themes • ‘Safe prescribing’ mandatory induction training for junior doctors to support prescribing of high risk medicines and compliance to patient safety alerts • Hospital-wide education on lessons learnt from incidents • Medication safety resources for staff to access • Nursing quality round on medication safety • Electronic missed doses realtime report developed to tackle omitted/delayed critical medication doses • Medication safety awareness (MSA) week held to increase awareness on focal themes

What has been achieved?

• Multidisciplinary MSG with assurance on meeting WHO global challenge. • Monthly analysis of medication safety data to allow learning, collaboration and benchmarking against peers. • Positive staff feedback on bulletins/newsletters with staff involvement/engagement. • Training programmes embedded with safe prescribing education. • Improved hospital safety metrics: Following MSA week, a 5% and 21% increase in medication-related incident reporting occurred at each site which has been sustained. Reporting rates doubled at one site following success of MSA week. • In 2018-19, local target achieved for reported medication-related incidents per 100,000 finished consultant episodes and medication-related incidents with harm

What next?

• Collaborative multidisciplinary working raising the profile of pharmacists acting as medication safety officers
• Implementing medication safety measures from NHS Patient Safety Strategy 2019
• Initiatives for safer culture, safer systems and safer patients

SYSTEMATIC APPROACH FOR TRAINING HOSPITAL PHARMACISTS TO PRACTICE CLINICAL MEDICATION MANAGEMENT

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European Statement

Education and Research

Author(s)

S. Walk-Fritz, T. Hoppe-Tichy

Why was it done?

To improve drug safety, it is crucial to develop and maintain core competencies in a multidisciplinary medical team. Current clinical pharmacy education may provide some exposure to ward based clinical pharmacy, but so far there is no structured prerequisite training for pharmacists practising clinical medication management.

What was done?

A training framework for clinical pharmacists practising medication management was developed and implemented. The area of activity included medication reconciliation, participation in medical rounds, discharge counseling, etc. The novel curriculum was designed in order to (1) support junior hospital pharmacists in acquiring clinical pharmacy skills, communication skills and personal skills and (2) help senior clinical pharmacists to maintain and improve their skills.

How was it done?

Senior clinical pharmacists developed a training framework:

– Initial skill adaptation for junior hospital pharmacists (eg, observe an experienced clinical pharmacist participating in medical rounds, patient case presentation and evaluation, and participation in the drug information centre).

– Maintain and improve the skills of all clinical pharmacists performing patient centred care (eg, Jour Fixe (presentation and discussion of clinical treatment guidelines, patient case presentations), journal club, supervision discussion (patient case discussion with two senior clinical pharmacists) and supervision of participation in medical rounds by senior clinical pharmacists).

What has been achieved?

The training framework has been implemented successfully with a high general acceptance. Particularly, the Jour Fixe has allowed junior staff to acquire appraisal skills and senior staff to achieve continuing professional development. The supervision discussion of patient cases has also been well appreciated as a mean of acquiring additional skills. Parts of the training programme have been implemented in the training of pharmacy interns, such as performing medication reconciliation on admission.

What next?

The implemented training programme needs to be further expanded and adapted over time. A future aim is to establish a model with the German Association of Hospital Pharmacists (ADKA) for a national systematic training module (eg, for performing medication reconciliation).

INTRODUCTION OF A PATIENT CENTRED CLINICAL PHARMACY TRAINING SCHEME IN A LARGE UNIVERSITY HOSPITAL PHARMACY

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European Statement

Education and Research

Author(s)

E. Past, C. Hofer-Dueckelmann, U. Porsche, G. Fellhofer

Why was it done?

The increasing demand for clinical pharmacy services was combined with the will of the MI pharmacists to expand their roles and become advanced practitioners. There is no formal clinical pharmacy education in our country. Studying abroad is costly and often incompatible with private life. The head of our department promoted the introduction of the teaching bundle as a form of quality assurance for new clinical services.

What was done?

A clinical pharmacy training scheme was founded for and by pharmacists of the medicines information (MI) department. Over 1 year, four UK trained clinical pharmacists facilitated: 10 workshops on clinical topics focusing on pharmaceutical care planning; monthly discussions on patient cases collected in our hospital; and bedside teaching on two wards.

How was it done?

The main drivers were the pharmacists´ willpower to become more clinically orientated and the prospect of being able to offer new clinical services. The instructors incorporated the preparation of the educational activities into their routine workload. There were no monetary incentives. The workshops lasted 1 h with any further discussions held after work, a challenge for parents.

Instructors presented the newest insights of the respective clinical area, alternating with group activities. Continuous evaluation led to a stronger focus on real patient cases. This approach was continued during the monthly coffee break case studies. Incorporation of bedside teaching into the rota was a challenging task.

What has been achieved?

Two pharmacists set up a clinical service on an intensive care unit. Another pharmacist started to attend ward rounds on a neurosurgery ward. Medicines reconciliation will be introduced with pharmacy involvement in a pilot project.

What next?

This training scheme is transferable to any hospital setting. Prerequisites are idealistic and formally trained clinical pharmacists combined with highly motivated colleagues wishing to take on more responsibility and willing to learn from their peers. Workshops, a journal club and bedside teaching are ongoing.

IMMPACT: A THERAPEUTIC EDUCATION PROGRAM TO SUPPORT SEAMLESS CARE FOR PATIENTS LIVING WITH CANCER

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European Statement

Clinical Pharmacy Services

Author(s)

A. Decottignies, D. Bouchoucha, S. Lévêque, S. Barthier, J.F. Morere, A. Marfaing, A. Rieutord

Why was it done?

Cancer has become a chronic disease. However, the impact of the disease and related treatments on patients’ everyday life remain poorly addressed all along the patient clinical pathway. The objective was to customise support to the patient to be able to better understand and control the disease and treatment consequences.

What was done?

An integrated care model based on a therapeutic education programme (TEP) was designed to better support patients living with cancer in their everyday life. The hospital pharmacy led the project, launched in October 2013 and implemented for patients in March 2015. It is called IMMPACT (impact of illness and medication in patients undergoing chemotherapy). This TEP was accredited by the National Authority (ref No ETP 13/30 in August 2013).

How was it done?

A transprofessional working group was formed. Our concern was to propose a smooth and safe transition from hospital to home. To do so, the hospital set up a partnership with the health network to facilitate seamless care. A prospective survey was conducted in October 2013 including 41 ambulatory patients. Three priority themes were identified: tiredness, haematological problems and digestive disorders management. According to the results, educational sessions have been collaboratively designed and implemented.

What has been achieved?

The patients group workshops began in January 2014. To date, 31 group workshops have been run. These group workshops are facilitated by trained healthcare professionals using educational tools such as Barrows Cards, mosaic characters or metaplan. 83 patients have already experienced this programme. Patient global satisfaction is >92%.

What next?

Given the success of this programme and to fulfil the growing expectations of patients, new sequences are being designed about pain, chemotherapy related neurotoxicity, socio-aesthetics and lymphoedema management as well as developing a serious game for the patient. Finally, IMMPACT extension to community pharmacists is being considered to further sustain patients empowerment and continuity of care.

INNOVATING AND COLLABORATING – SYNERGY BETWEEN THE HOSPITAL PHARMACY AND THE UNIVERSITY

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