Letters Continued from page 906
and an ability to facilitate the required teaching opportunities for residents tend to be the most popular mentors sought by residents. This leads to many faculty members mentoring multiple residents and a reduced ability to provide residents with the desired amount of feedback. Although Wright et al.1 recommended that mentors be faculty members at a college of pharmacy, we find this not always feasible due to our large number of participants. Instead, the mentor qualifications we recommend to IPTeC participants include didactic teaching experience, significant teaching outside of the classroom, and previous completion of a teaching and learning curriculum, in addition to commitment to developing postgraduate pharmacist trainees, which more resemble those outlined previously by American College of Clinical Pharmacy.2 Inclusion of nonfaculty mentors is especially beneficial to participants more interested in experiential teaching roles. A final challenge lies in maintaining deadlines. Mentors are often provided insufficient time to review residents’ teaching material. In addition, as deadlines approach, mentors with multiple residents experience voluminous labor. Furthermore, mentors have expressed confusion as whether it is the mentor’s or resident’s role to hold residents accountable for these deadlines. We have found that striking the appropriate balance between available resources (i.e., mentors) and program expectations (e.g., feedback frequency) is crucial. IPTeC requires one midpoint and one final teaching portfolio review as opposed to the quarterly feedback suggested in recent guidelines.1 We agree with recent recommendations that mentor–mentee relationships serve as a key component of teaching and learning curricula.1,2 However, facilitating such relationships presents challenges. The IPTeC program has incorporated several strategies to manage these challenges, which may be beneficial to similar programs attempting to implement mentor–mentee relationships.
1. Wright EA, Brown B, Gettig J et al. Teaching and learning curriculum programs: recommendations for postgraduate pharmacy experiences in education. Am J Health-Syst Pharm. 2014; 71:1292-302. 2. Havrda DE, Engle JP, Anderson KC et al. Guidelines for resident teaching experiences. Pharmacotherapy. 2013; 33:e147-61. 3. Gonzalvo JD, Ramsey DC, Sheehan AH, Sprunger TL. Redesign of a statewide teaching certificate program for pharmacy residents. Am J Pharm Educ. 2013; 77:1-7.
Kirk E. Evoy, Pharm.D., Pharmacy Resident Saint Joseph Regional Medical Center Mishawaka, IN [email protected] Kendra M. Malone, Pharm.D., Pharmacy Resident Eskanazi Health Indianapolis, IN Jasmine D. Gonzalvo, Pharm.D., BCPS, BC-ADM, CDE, Clinical Associate Professor of Pharmacy Practice and Clinical Pharmacy Specialist, Primary Care
Purdue University College of Pharmacy Indianapolis, IN Darin C. Ramsey, Pharm.D., BCPS, BCACP, Associate Professor of Pharmacy Practice Butler University College of Pharmacy Indianapolis, IN Amy H. Sheehan, Pharm.D., BCPS, Assistant Professor of Pharmacy Practice Purdue University College of Pharmacy Indianapolis, IN Tracy L. Sprunger, Pharm.D., BCPS, Associate Professor of Pharmacy Practice Butler University College of Pharmacy
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140873
Incorporating the Pharmacy Practice Model Initiative into advanced pharmacy practice experience rotations
T
he Pharmacy Practice Model Initiative (PPMI) is a patient-centered model that aims to advance the practice of pharmacy by encouraging pharmacists to take a larger role in direct patient care.1 An expanded pharmacist role necessitates a redistribution of responsibilities through increasing the use of pharmacy staff at all levels of education and practice. The PPMI also proposes that pharmacy students and technicians perform distributive tasks, allowing pharmacists more time to focus on clinical aspects. By adopting cutting-edge technology to decentralize pharmacists, expanding the role of pharmacy technicians, allowing student pharmacists to make guided interventions, and promoting specialized knowledge acquisition through the completion of pharmacy residencies, institutions will allow pharmacists to have a more direct role in interprofessional patient care.
As the practice of pharmacy evolves, it is important to maintain and strengthen pharmacy department leadership, responsibility, accountability, and infrastructure. Key components of leadership include mentoring students who will soon become practitioners involved in expanding the patient care role of the pharmacist. Concurrently, pharmacists should incorporate students into the provision of pharmacy services while continuing to ensure medication safety. With proper guidance, students can advance the role of the pharmacist and positively affect patient outcomes. A recent study demonstrated that student pharmacists had a positive impact on several Hospital Consumer Assessment of Healthcare Providers and Systems scores in the “communication of medication” domain.2 The use of student pharmacists also decreased the load of patients per pharmacy staff member from 30:1 to 7:1.
Am J Health-Syst Pharm—Vol 72 Jun 1, 2015
909
Letters
Northwestern Memorial Hospital (NMH) is an 894-bed academic medical center in Chicago, Illinois. The pharmacy department currently accepts students from 10 colleges of pharmacy to its advanced pharmacy practice experience (APPE) rotation programs: Butler University, Chicago State University, Creighton University, Drake University, Midwestern University, Purdue University, Roosevelt University, Rosalind Franklin University, Southern Illinois University in Edwardsville, and University of Illinois at Chicago. This unique collaboration provides students and preceptors from different educational backgrounds and school affiliations with an opportunity to work together during the same rotation and care for patients, according to the PPMI, in a patient-centered model. Students often work together to evaluate patients and complete assigned projects. They also assemble for daily lunch meetings and interactive educational conferences where they have opportunities to network formally and informally. By incorporating student pharmacists and pharmacy residents into the interprofessional team and entrusting them to make knowledge-specific and skillspecific clinical decisions independently, NMH facilitates a strong educational environment for students in addition to providing pharmacists the flexibility to focus on more challenging clinical dilemmas. To evaluate the PPMI and multischool learning environment-related benefits of NMH’s APPE rotation, a 30-question survey was administered to student pharmacists and preceptors during a six-month period in 2013. Survey responses indicated that the diverse learning environment provided students with benefits that they would not normally receive from a rotation site affiliated with only one college of pharmacy. Results indicated that students were amenable to the added workload and responsibility that the PPMIbased rotation model required of them. Students were often willing to work with and report to more than one preceptor as well as work with preceptors from other colleges of pharmacy. This allowed
910
a student’s primary preceptor to have more flexibility and time to perform his or her clinical duties in accordance with the PPMI. The provision of a variety of engaging daily conferences and multischool interactions that students view as beneficial allows them to function and learn more effectively as well as make valuable networking connections. We believe that this model is an effective way to transition toward PPMIcentric student teaching and that additional research on the impact of the PPMI on students should be conducted. 1. Shane R. Critical requirements for healthsystem pharmacy practice models that achieve optimal use of medicines. Am J Health-Syst Pharm. 2011; 68:1101-11. 2. Delgado O, Kernan W, Knoer S. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Am J Health-Syst Pharm. 2014; 71:1871-6.
Jacob Bierman, Pharm.D., Postgraduate Year 1 Pharmacy Resident CVS/Caremark CVS Health Irving, TX [email protected] Rachel Ralph, Pharm.D., Postgraduate Year 1 Pharmacy Resident Department of Pharmacy Northwestern Memorial Hospital Chicago, IL
Allyson Greenberg, Pharm.D., Clinical Staff Pharmacist Pharmacy Department Advocate Illinois Masonic Medical Center Chicago, IL Michael Postelnick, B.S.Pharm, BCPS (AQ-ID), Clinical Manager Department of Pharmacy Northwestern Memorial Hospital Despina Kotis, Pharm.D., FASHP, Director Department of Pharmacy Northwestern Memorial Hospital Nancy Fjortoft, Ph.D., Dean Chicago College of Pharmacy Midwestern University Downers Grove, IL Miriam A. Mobley Smith, Pharm.D., FASHP, Dean and Professor College of Pharmacy Chicago State University Chicago, IL
When this communication was written, Drs. Bierman and Greenberg were pharmacy students at the Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, and Dr. Ralph was a pharmacy student at the College of Pharmacy, University of Illinois at Chicago, Chicago, IL. The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140399
Convulsions associated with moxifloxacin
F
luoroquinolones are generally well tolerated but can cause central nervous system (CNS) toxicities.1 We are unaware of published case reports of moxifloxacin causing new-onset convulsions, though one case associating the drug with seizures in a patient with a history of epilepsy has been reported.2 We report a case of new-onset convulsions associated with the use of moxifloxacin. A 45-year-old perimenopausal woman appeared at an occupational medicine clinic after completing a 14-day course of cephalexin for persistent sinus symptoms, which included sinus and ear pain,
Am J Health-Syst Pharm—Vol 72 Jun 1, 2015
congestion, and low-grade fever. The clinic visit revealed a purulent discharge from her left tympanic membrane on otoscopic examination, but the remainder of the physical examination, including neurologic testing, was normal. The patient had a history of treated hyperthyroidism and seasonal allergies. Moxifloxacin 400 mg orally once daily was prescribed. The patient returned to the same clinic the next day after taking one dose of moxifloxacin. She reported that within one hour of taking the dose, she felt nauseated, nervous, anxious, and agitated. She described feelContinued on page 912
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
and an ability to facilitate the required teaching opportunities for residents tend to be the most popular mentors sought by residents. This leads to many faculty members mentoring multiple residents and a reduced ability to provide residents with the desired amount of feedback. Although Wright et al.1 recommended that mentors be faculty members at a college of pharmacy, we find this not always feasible due to our large number of participants. Instead, the mentor qualifications we recommend to IPTeC participants include didactic teaching experience, significant teaching outside of the classroom, and previous completion of a teaching and learning curriculum, in addition to commitment to developing postgraduate pharmacist trainees, which more resemble those outlined previously by American College of Clinical Pharmacy.2 Inclusion of nonfaculty mentors is especially beneficial to participants more interested in experiential teaching roles. A final challenge lies in maintaining deadlines. Mentors are often provided insufficient time to review residents’ teaching material. In addition, as deadlines approach, mentors with multiple residents experience voluminous labor. Furthermore, mentors have expressed confusion as whether it is the mentor’s or resident’s role to hold residents accountable for these deadlines. We have found that striking the appropriate balance between available resources (i.e., mentors) and program expectations (e.g., feedback frequency) is crucial. IPTeC requires one midpoint and one final teaching portfolio review as opposed to the quarterly feedback suggested in recent guidelines.1 We agree with recent recommendations that mentor–mentee relationships serve as a key component of teaching and learning curricula.1,2 However, facilitating such relationships presents challenges. The IPTeC program has incorporated several strategies to manage these challenges, which may be beneficial to similar programs attempting to implement mentor–mentee relationships.
1. Wright EA, Brown B, Gettig J et al. Teaching and learning curriculum programs: recommendations for postgraduate pharmacy experiences in education. Am J Health-Syst Pharm. 2014; 71:1292-302. 2. Havrda DE, Engle JP, Anderson KC et al. Guidelines for resident teaching experiences. Pharmacotherapy. 2013; 33:e147-61. 3. Gonzalvo JD, Ramsey DC, Sheehan AH, Sprunger TL. Redesign of a statewide teaching certificate program for pharmacy residents. Am J Pharm Educ. 2013; 77:1-7.
Kirk E. Evoy, Pharm.D., Pharmacy Resident Saint Joseph Regional Medical Center Mishawaka, IN [email protected] Kendra M. Malone, Pharm.D., Pharmacy Resident Eskanazi Health Indianapolis, IN Jasmine D. Gonzalvo, Pharm.D., BCPS, BC-ADM, CDE, Clinical Associate Professor of Pharmacy Practice and Clinical Pharmacy Specialist, Primary Care
Purdue University College of Pharmacy Indianapolis, IN Darin C. Ramsey, Pharm.D., BCPS, BCACP, Associate Professor of Pharmacy Practice Butler University College of Pharmacy Indianapolis, IN Amy H. Sheehan, Pharm.D., BCPS, Assistant Professor of Pharmacy Practice Purdue University College of Pharmacy Indianapolis, IN Tracy L. Sprunger, Pharm.D., BCPS, Associate Professor of Pharmacy Practice Butler University College of Pharmacy
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140873
Incorporating the Pharmacy Practice Model Initiative into advanced pharmacy practice experience rotations
T
he Pharmacy Practice Model Initiative (PPMI) is a patient-centered model that aims to advance the practice of pharmacy by encouraging pharmacists to take a larger role in direct patient care.1 An expanded pharmacist role necessitates a redistribution of responsibilities through increasing the use of pharmacy staff at all levels of education and practice. The PPMI also proposes that pharmacy students and technicians perform distributive tasks, allowing pharmacists more time to focus on clinical aspects. By adopting cutting-edge technology to decentralize pharmacists, expanding the role of pharmacy technicians, allowing student pharmacists to make guided interventions, and promoting specialized knowledge acquisition through the completion of pharmacy residencies, institutions will allow pharmacists to have a more direct role in interprofessional patient care.
As the practice of pharmacy evolves, it is important to maintain and strengthen pharmacy department leadership, responsibility, accountability, and infrastructure. Key components of leadership include mentoring students who will soon become practitioners involved in expanding the patient care role of the pharmacist. Concurrently, pharmacists should incorporate students into the provision of pharmacy services while continuing to ensure medication safety. With proper guidance, students can advance the role of the pharmacist and positively affect patient outcomes. A recent study demonstrated that student pharmacists had a positive impact on several Hospital Consumer Assessment of Healthcare Providers and Systems scores in the “communication of medication” domain.2 The use of student pharmacists also decreased the load of patients per pharmacy staff member from 30:1 to 7:1.
Am J Health-Syst Pharm—Vol 72 Jun 1, 2015
909
Letters
Northwestern Memorial Hospital (NMH) is an 894-bed academic medical center in Chicago, Illinois. The pharmacy department currently accepts students from 10 colleges of pharmacy to its advanced pharmacy practice experience (APPE) rotation programs: Butler University, Chicago State University, Creighton University, Drake University, Midwestern University, Purdue University, Roosevelt University, Rosalind Franklin University, Southern Illinois University in Edwardsville, and University of Illinois at Chicago. This unique collaboration provides students and preceptors from different educational backgrounds and school affiliations with an opportunity to work together during the same rotation and care for patients, according to the PPMI, in a patient-centered model. Students often work together to evaluate patients and complete assigned projects. They also assemble for daily lunch meetings and interactive educational conferences where they have opportunities to network formally and informally. By incorporating student pharmacists and pharmacy residents into the interprofessional team and entrusting them to make knowledge-specific and skillspecific clinical decisions independently, NMH facilitates a strong educational environment for students in addition to providing pharmacists the flexibility to focus on more challenging clinical dilemmas. To evaluate the PPMI and multischool learning environment-related benefits of NMH’s APPE rotation, a 30-question survey was administered to student pharmacists and preceptors during a six-month period in 2013. Survey responses indicated that the diverse learning environment provided students with benefits that they would not normally receive from a rotation site affiliated with only one college of pharmacy. Results indicated that students were amenable to the added workload and responsibility that the PPMIbased rotation model required of them. Students were often willing to work with and report to more than one preceptor as well as work with preceptors from other colleges of pharmacy. This allowed
910
a student’s primary preceptor to have more flexibility and time to perform his or her clinical duties in accordance with the PPMI. The provision of a variety of engaging daily conferences and multischool interactions that students view as beneficial allows them to function and learn more effectively as well as make valuable networking connections. We believe that this model is an effective way to transition toward PPMIcentric student teaching and that additional research on the impact of the PPMI on students should be conducted. 1. Shane R. Critical requirements for healthsystem pharmacy practice models that achieve optimal use of medicines. Am J Health-Syst Pharm. 2011; 68:1101-11. 2. Delgado O, Kernan W, Knoer S. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Am J Health-Syst Pharm. 2014; 71:1871-6.
Jacob Bierman, Pharm.D., Postgraduate Year 1 Pharmacy Resident CVS/Caremark CVS Health Irving, TX [email protected] Rachel Ralph, Pharm.D., Postgraduate Year 1 Pharmacy Resident Department of Pharmacy Northwestern Memorial Hospital Chicago, IL
Allyson Greenberg, Pharm.D., Clinical Staff Pharmacist Pharmacy Department Advocate Illinois Masonic Medical Center Chicago, IL Michael Postelnick, B.S.Pharm, BCPS (AQ-ID), Clinical Manager Department of Pharmacy Northwestern Memorial Hospital Despina Kotis, Pharm.D., FASHP, Director Department of Pharmacy Northwestern Memorial Hospital Nancy Fjortoft, Ph.D., Dean Chicago College of Pharmacy Midwestern University Downers Grove, IL Miriam A. Mobley Smith, Pharm.D., FASHP, Dean and Professor College of Pharmacy Chicago State University Chicago, IL
When this communication was written, Drs. Bierman and Greenberg were pharmacy students at the Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, and Dr. Ralph was a pharmacy student at the College of Pharmacy, University of Illinois at Chicago, Chicago, IL. The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140399
Convulsions associated with moxifloxacin
F
luoroquinolones are generally well tolerated but can cause central nervous system (CNS) toxicities.1 We are unaware of published case reports of moxifloxacin causing new-onset convulsions, though one case associating the drug with seizures in a patient with a history of epilepsy has been reported.2 We report a case of new-onset convulsions associated with the use of moxifloxacin. A 45-year-old perimenopausal woman appeared at an occupational medicine clinic after completing a 14-day course of cephalexin for persistent sinus symptoms, which included sinus and ear pain,
Am J Health-Syst Pharm—Vol 72 Jun 1, 2015
congestion, and low-grade fever. The clinic visit revealed a purulent discharge from her left tympanic membrane on otoscopic examination, but the remainder of the physical examination, including neurologic testing, was normal. The patient had a history of treated hyperthyroidism and seasonal allergies. Moxifloxacin 400 mg orally once daily was prescribed. The patient returned to the same clinic the next day after taking one dose of moxifloxacin. She reported that within one hour of taking the dose, she felt nauseated, nervous, anxious, and agitated. She described feelContinued on page 912
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
