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Creation of a pedagogical tool to optimise the validation of chemotherapies related to rhabdomyosarcoma

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European Statement

Education and Research

Author(s)

Franco Perna, Maria Elisabetta Uda, Maxime Annereau, Hail Aboudagga , André Rieutord, My Lan Vo

Why was it done?

The process of pharmaceutical validation of chemotherapy involves several steps, and the hospital pharmacist must rely on multiple therapy protocols. In addition, pharmacists who have just finished university do not have the appropriate training for pharmaceutical validation. Thus, we decided to develop a tool to support the validation of chemotherapy, in which pharmacists can learn therapy protocols.

What was done?

The hospital pharmacy has developed a pedagogical tool to support pharmaceutical validation in the context of rhabdomyosarcoma (RMS).

How was it done?

We initially carried out a systematic review, following the PRISMA 2020 Statement, to find if there were any educational methods or tools exist to facilitate pharmaceutical validation in paediatric oncology.
Then, we contacted several pharmacists, currently employed in French hospitals and abroad, to understand how they train new pharmacists and resident students about chemotherapies validation. After this first stage, we focused our research on the content of our future educational tool. We created an easy-to-fill questionnaire to obtain information and meet from clinical pharmacists inside our department to understand which information was needed for the tool and what could be the most suitable format for them.

What has been achieved?

Regarding the systematic review, only two studies were identified, in which tools for pharmacists were developed, but none of these concerned the pharmaceutical validation of paediatric chemotherapy. The hospital centres contacted did not develop pedagogical tools, but some of them support the training with standard operating procedures (SOPs).
The questionnaire, in which 15 pharmacists (27% students) were interviewed, revealed that most preferred a tool in pdf (48%) and paper format (22%), containing information on pathophysiology (48%) and epidemiology (22%) of rhabdomyosarcoma, on chemotherapy protocols (32%) and dosage regimens (19%). For this reason, a pedagogical tool has been developed in pdf format and in the form of a paper booklet with the required information.

What next?

This tool could be the first presented regarding the validation of paediatric chemotherapy.
The future prospect would be to develop other tools to support pharmaceutical validation so that we can invest more and more and provide more and more quality training to new hospital pharmacists.

Implementation of a simple continuing training programme for retraining operators in a clean room production

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European Statement

Education and Research

Author(s)

Maria Agerboe Sondrup, Anette Sand Østergaard

Why was it done?

Training of operators has previously been performed, however there was no consistent programme for continuing training in the department to secure optimal training of operators. Equally the effectivity and durability of the training was not evaluated. The aim was to establish a thorough system for continuing training focusing on ongoing confirmation of proper training as well as adaptation and optimization throughout.

What was done?

A programme for continuing training of operators was designed and implemented in a clean room production department by GMP-responsible operators and academics.

How was it done?

A template was designed for the programme. One module takes up to 3 months.
The template is the following:
Observation:
– Trainers observe operators in a clean room
– Current technique is observed and if necessary corrected
Training material:
– Developing educational material based on SOPs
– Short videos, PowerPoint presentations etc.
Individual training:
– Operators answer handed out multiple choice questionnaire (MCQ) by themselves
Group training:
– The correct answers to the MCQ are presented by the trainers at a plenary session
– All answers are discussed
Observation:
– Trainers observe operators in a clean room
– Current technique is observed and if necessary corrected
Evaluation:
– Trainers evaluate the training in terms of improvement from the first to the second observation
– Trainers write a report that is presented to the operators

What has been achieved?

A systematic and relatively simple training programme has been implemented. This streamlines the training of operators, thereby making it easier for the trainers to introduce new subjects and ensures that all new operators are trained the same as the experienced operators. The programme also makes the training system recognizable for the operators, which gives a higher compliance.

What next?

The program has only been implemented on processes related to production in clean room, but the training method can easily be applied to subjects outside of the clean room or in other healthcare settings. To involve the operators in the process, the second observation could be delegated to other operators and not just the trainers.

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.

Patient with accidental exposition to blood or other body fluids interviews: Training for pharmacy resident through health simulation

European Statement

Education and Research

Author(s)

Mathieu Fournel, Herve Trout , Jean Eudes Fontan , Marie Cabagnols

Why was it done?

At night, our Pharmacy residents are alone to lead the patient interview, which can be stressful and complex. They currently receive a theoretical course as training, which is insufficient and lead us to reinforce their training by organizing this simulation program.

What was done?

In our hospital, treatments for accidental exposition to blood or other body fluids (AEB) are prescribed by the emergency unit doctors and are delivered by our pharmacy residents who also give associated advices. In order to improve the quality of this procedure and train our pharmacy residents, we created and tested simulation case-scenarios of pharmaceutical interview of AEB’s victims with role-playing game.

How was it done?

We based our training program on the French Health Authority guidelines. Scenarios are based on our real-life experiences and potential clinically relevant situations.

What has been achieved?

First, we evaluated pharmacy residents’ theoretical knowledge and their self-confidence about AEB interview with anonymous questionnaires.
We created five different scenarios and tested them during six role-playing game sessions in two weeks with six pharmacy residents.
Every session lasted approximatively one hour, each resident played one scenario as a resident and one as a patient. Sessions started with briefing and ended with a detailed debriefing. All our scenarios are efficient, and debriefings were interactive and interesting. Evaluation of the sessions by pharmacy residents showed great satisfaction. They evaluated our scenarios as relevant and rated simulation training higher than lecture-based courses. Moreover, informal feedbacks are very positive.

What next?

Our next step is to film a simulated pharmaceutical interview of AEB’s patient for new pharmacy resident as an example before their first interview. Simulation will be part of the training of every new pharmacy resident in our hospital. Furthermore, we would like to extend simulation training to other types of patient’s pharmaceutical interviews.

INCLUSION OF PHARMACY STUDENTS IN AN INTERPROFESSIONAL TRAINING WARD PLACEMENT FOR HEALTHCARE STUDENTS IN SWEDEN (submitted in 2019)

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European Statement

Education and Research

Author(s)

Matts Balgård, Maria Swartling, Srebrenka Dobrić, Lena Klarén, Lina Karlsson

Why was it done?

ITWP for healthcare students is established at various teaching hospitals. However, to our knowledge, no such programme in Scandinavia has included pharmacy students. Clinical pharmacy is a growing profession in Sweden and other healthcare students will in the future work alongside clinical pharmacists. Therefore we set out to add pharmacy students to the ITWP team, believing that it would be a valuable experience for them to collaborate and share knowledge with students from other healthcare professions. Equally important, it is a way to promote the pharmacist’s competence and contribution to the multiprofessional healthcare team, prior to graduation.

What was done?

Final year undergraduate pharmacy students, specialising clinical pharmacy, were given the opportunity to spend two weeks of their six months pharmacy practice to participate in an interprofessional training ward placement (ITWP) together with medical, nursing and physiotherapy students. During this two-week clinical placement, the students were collaboratively responsible for managing the care of geriatric inpatients while under supervision of licensed practitioners.

How was it done?

A working group was formed consisting of teachers from the faculty of pharmacy, a student representative and a working clinical pharmacist. The group developed the initiative, including among other things, prerequisites, an evaluation plan, a workflow tool for clinical rounds, and suggested tasks for pharmacy students during the placement.

What has been achieved?

The programme has been running for three semesters and 6–8 pharmacy students have participated in the ITWP each semester. The initiative has been evaluated using surveys. Participating pharmacy students expressed gaining new knowledge and better insight into nursing care and the roles of the other professions. Nursing students appreciated the support in medication management and medical students found the pharmacy students to be valuable discussion partners that could challenge their drug-related decisions. Tutors expressed that the pharmacy students brought a beneficial dynamic to the ITWP team.

What next?

The opportunity for students from different professions to work together with a common objective in a real-life setting gives them valuable insight into each other’s professional roles early in their careers. This good practice initiative could be used in other interprofessional training ward placements wishing to involve pharmacy students.

INVOLVING PATIENTS IN A WORKSHOP FOCUSED ON COMMUNICATION SKILLS: A PROOF OF CONCEPT OF EXPERIENTIAL TRAINING FOR RESIDENTS IN HOSPITAL PHARMACY

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European Statement

Education and Research

Author(s)

Caroline Hache, Stéphane Honoré, Guillaume Hache

Why was it done?

The development of clinical pharmacy allows pharmacists to take patient-centered roles and responsibilities. However, patient-centered care requires a specific set of skills and training, such as patient-focused communication and conducting structured interviews. Thus, improvement of pharmacist-patient communication may lead to better clinical outcomes.

What was done?

We developed a workshop involving patients within the training programme of residents in hospital pharmacy. The workshop focused on communication skills needed to improve the quality and effectiveness of a pharmaceutical interview.

How was it done?

The workshop was developed jointly by two senior clinical pharmacists and a lecturer in education and communication science. The learning process integrated: working on participants’ perception of pharmacists-patient communication, didactic learning, training activities and evaluation. The assessment of the learning effect was performed by self-, peers-, and patient-scored charts. Patients’ feedback during the training activities and assessments was highlighted as the cornerstone of the learning process.

What has been achieved?

First, we built a competency chart on communication skills needed to perform a structured pharmaceutical interview. This tool has been validated by the patients and well accepted by the learners. It was used to assess the learning effect of the workshop, and may serve as a guide for the continuous development of junior practitioners. Secondly, the workshop has actually been implemented, with both the learners and patients expressing a high general acceptance and satisfaction. Finally, preliminary results show a learning effect assessed by both peers and patients.

What next?

The involvement of patients needs to be further expanded to the training programmes of undergraduate students, residents and clinical pharmacists. A future action planned is to develop a model with the French Society of Clinical Pharmacy (SFPC) for a national systematic training module: “Improving pharmaceutical interviews’ performance through effective communication”, involving patients.

THE EFFECT OF A PRESCRIBER TRAINING INTERVENTION ON THE PREVALENCE OF PRESCRIBING ERRORS FOUND IN A ELECTRONIC PRESCRIBING SYSTEM

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European Statement

Education and Research

Author(s)

Fionnuala Nevin, Gail Melanophy, Aisling Collins, Miriam Moriarty, Grainne Courtney, Tamasine Grimes, Gaye Stephens

Why was it done?

The available literature strongly advocates the importance of training for users of electronic prescribing systems to ensure their safe and effective use. However, there is a lack of evidence to demonstrate the effect that ongoing training has on the use and impact of these systems. This study was carried out to strengthen the case for staff training resources for electronic prescribing systems.

What was done?

A study was carried out to investigate the effect of a training intervention on the prevalence of prescribing errors found in an outpatient electronic prescribing system currently in use. Audit and feedback methods were used. Prescription audits were carried out before and after the delivery of a classroom-based training intervention. The audits were used to measure and analyse the effect of the intervention on prescribing errors found in the electronic prescribing system. A questionnaire and clinician observations were carried out with prescribers. The pre-intervention audit results, questionnaire, and clinician observations were used to inform the prescriber training intervention.

How was it done?

Key stakeholders were recruited and assisted in the planning and delivery of the study methods. This was to ensure participate buy-in and study success. The audit tools and questionnaire were initially piloted to test their design, and allow adjustments to be made based on feedback received.

What has been achieved?

The prevalence of prescribing errors was significantly reduced, following the delivery of the training intervention. Statistically significantly more medications prescribed during the pre-intervention audit contained one or more errors when compared with the post-intervention audit (28.6% versus 9.2%, p < 0.05). Most errors found were deemed to be system-related errors.

What next?

The study demonstrates the positive impact that ongoing training can have on users’ interactions with an electronic prescribing system. Electronic prescribing systems are being increasingly considered and implemented in healthcare settings internationally. The results of this study could be used to inform the planning for training interventions to be delivered as part of ongoing system maintenance. The study stands to inform those managing electronic prescribing projects that, despite initial training, errors can still occur and must be addressed. This study supports the need to provide adequate training resources for users of electronic prescribing systems.

NATIONAL CONSENSUS ON CORE COMPETENCIES FOR CLINICAL PHARMACISTS IN NORWAY

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European Statement

Clinical Pharmacy Services

Author(s)

Eliln Trapnes, Nina Carstens, Merethe Nilsen, Solveig Vist, Margareth Wiik, Janne Kutschera Sund

Why was it done?

In 2012 all the regional hospital pharmacy trusts in Norway decided to implement the IMM-model as a national method for clinical pharmacy practice in hospital settings. Although an extensive amount of training and education has been provided locally and regionally, there was a lack of defined core competencies for clinical pharmacists in Norway. Furthermore, a complete post graduate education program for clinical pharmacists did not exist. Based on this, the managements of the regional hospital pharmacy trusts requested defined skills sets and identification of relevant educational needs and opportunities.

What was done?

A joint national overview of core competencies for clinical pharmacists working in Norwegian hospitals has been compiled. Learning objectives have been defined for each of the steps in the Integrated Medicines Management (IMM)-model (Medication Reconciliation, Medication Review, Patient Counseling and Discharge Service). Relevant education opportunities were identified and recommendations on courses, practical training and other educational activities were described.

How was it done?

A group of six experienced clinical pharmacists representing all the hospital pharmacy trusts in Norway agreed upon core competencies needed to perform the main steps in the Integrated Medicines Management (IMM)-model (Medication Reconciliation, Medication Review, Patient Counseling and Discharge Service) in Norwegian hospitals. Existing education opportunities were compared to the defined learning objectives and a recommended time schedule for the training was made.

What has been achieved?

A national consensus on core competencies in clinical pharmacy services has been reached among all hospital pharmacies in Norway. The consensus, including the evaluation and recommendation of educational activities, makes it easier for leaders of clinical pharmacists to decide on which educational activities to prioritize, and for the Universities to know what educational areas they should cover.

What next?

The report with the identified core competencies will be adjusted according to local requirements and implemented in all Norwegian hospital pharmacies. Hopefully, our work will encourage further cooperation on educational activities between regions. An initiative has already started towards Norwegian Universities to try to integrate relevant competencies into the curricula of pharmacists, and this will continue.

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.

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