Letters
Need for pediatric antimicrobial stewardship
T
he primary goal of antimicrobial stewardship is to optimize clinical outcomes while reducing the consequences of unnecessary antimicrobial use. Despite the large body of evidence that supports antimicrobial stewardship programs and their effectiveness in reducing resistance rates and antimicrobial costs, most of these data focus on the improved use of antimicrobial agents in adults.1 While antimicrobial stewardship committees must include an infectious diseases (ID) physician and a clinical pharmacist with ID training as core members,1 most tend to lack an active pediatric ID physician or a pharmacist with adequate training in pediatric ID. The vast majority of current ID residency programs focus on the adult population, with very few institutions offering a pediatric ID residency for pharmacists, largely due to a lack of trained pharmacists in this area and a lack of funding resources. Flannery and colleagues2 conducted a survey at a pediatric tertiary care center and found that more than 80% of respondents considered recommendations from an ID pharmacist to be helpful. Tools such as a pediatric-specific antibiogram, didactic education, and clinical guidelines were also found to be useful. Such research clearly demonstrates that pharmacists with adequate training and experience can contribute to the interdisciplinary team that treats pediatric patients. The lack of resources, funding, and support from hospital administration for pediatric ID pharmacists can be addressed by tracking antimicrobial use among pediatric patients and the associated decrease in costs. For example, a four-month prospective observational study conducted by Metjian and colleagues3 found that having an ID pharmacist for the pediatric population not only improved the appropriate use of antimicrobial agents in children but saved $50,090 in drug acquisition costs alone. Offering more training in pediatric ID and obtaining the resources needed to hire pediatric ID pharmacists are war-
ranted in order to advance current antimicrobial stewardship programs. 1. Dellit TH, Owens RC, McGowan JE Jr et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007; 44:159-77. 2. Flannery DD, Swami S, Chan S, Eppes S. Prescriber perceptions of a pediatric antimicrobial stewardship program. Clin Pediatr. 2014; 53:747-50. 3. Metjian TA, Prasad PA, Kogon A et al. Evaluation of an antimicrobial steward-
ship program at a pediatric teaching hospital. Pediatr Infect Dis J. 2008; 27:106-11.
Jonathan C. Cho, Pharm.D., Postgraduate Year 2 Pharmacy Resident in Infectious Diseases [email protected] Stephanie H. Stovall, M.D., FAAP, Pediatric Infectious Diseases Physician Lee Memorial Health System Fort Myers, FL
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140844
Pharmacy students’ experience with a capstone project
D
ue to the growing needs within the healthcare system and the opportunity for more pharmacy involvement, it is essential that pharmacy curricula provide opportunities to develop students’ critical thinking skills as a way to address these needs. The Center for the Advancement of Pharmacy Education’s 2013 educational outcomes1 and the Accreditation Council for Pharmacy Education (ACPE) draft standards 20162 emphasize the need for higher-level thinking skills by recommending supplementary, applicationbased, and student-driven projects. Specifically, the ACPE draft standards 2016 highlight these higher-level projects as a way to encourage students to be selfdirected learners and innovative thinkers when addressing current issues affecting the healthcare system. A capstone project is a higher-level and culminating experience designed to promote the application of information to assist in developing effective communication skills, to allow students to apply knowledge in a creative manner, and to encourage team-building skills.3-5 Given their benefits and support by accrediting bodies, many pharmacy programs have started to incorporate capstone projects within the curricula as a way to promote
higher-level thinking.4,5 Capstone projects can be useful in developing these skills for students as they transition into advanced pharmacy practice experience (APPE) rotations and ultimately into members of the healthcare team. In fall 2013, 12 third-year doctor of pharmacy students from the Philadelphia College of Pharmacy at the University of the Sciences enrolled in an elective course focused on pharmacists’ roles within different levels of transitions of care (TOC). The course was delivered using mostly active learning techniques and handson activities. The course was designed to build on therapeutics knowledge, patient counseling, and communication skills. It also promoted the use of concepts about the TOC process, such as regulatory issues. Instead of a final examination, students were assigned a capstone project on which they worked together to create a TOC model and link the TOC process among a hospital, an ambulatory care clinic, and a community pharmacy. The course and the capstone project received an abundance of positive feedback from students. Aside from reinforcing therapeutics knowledge, the TOC capstone project provided students with the ability to continue to develop skills such as
Am J Health-Syst Pharm—Vol 72 Mar 1, 2015
347
Letters
leadership, critical thinking, and effective communication and teamwork. The capstone assignment was unlike anything the students had previously encountered. Given the complexity of the project, each student took the lead on an aspect of the assignment, which helped each student identify his or her leadership style, including coordinating project logistics, creating group assignments, and keeping the group focused. Having each student take the lead on certain parts of the project, instead of placing the burden on one student, made the experience more enjoyable for students. In addition, it also helped students to become more assertive and confident. The capstone project also helped students build on their critical-thinking skills. As is the case for many issues facing the healthcare system, students understood that there was no clear right or wrong solution that could be easily achieved. As students reflected on the assignment once it was completed, it provided evidence of the students’ ability to understand, apply, synthesize, and evaluate concepts presented throughout the course.6 This project empowered students to “think outside the box” and create an innovative TOC model that could be implemented within an existing healthcare setting. Lastly, the nature of the capstone project ensured that students worked together and communicated within their groups and with other groups. Students realized that while no one is an expert at everything, everyone has something valu-
348
able to contribute. By coordinating their talents and understanding the group’s dynamic, students gained an appreciation of the challenges that may arise from working in small or large groups. In addition, students realized the benefits of effective communication and teamwork. The outcome in this particular case was a well-developed TOC model that introduced fresh ideas and solutions, which was unlikely to be created or achieved by one person. While an assessment of knowledge often requires the use of traditional examinations, incorporating capstone projects within pharmacy curricula is becoming more common as accrediting bodies have started to incorporate them within their standards.1,2 The capstone project allowed students in this course to utilize and continue to develop certain skill sets in ways that are challenging to achieve through an examination. It also provided students the opportunity to work together to address a healthcare issue and create a solution. Incorporating capstone projects throughout the curriculum may help better prepare students for APPE rotations and becoming effective pharmacists. 1. American Association of Colleges of Pharmacy. Center for the Advancement of Pharmacy Education: educational outcomes 2013. www.aacp.org/resources/ education/cape/Open%20Access%20 Documents/CAPEoutcomes2013.pdf (accessed 2014 Jul 25). 2. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of
Am J Health-Syst Pharm—Vol 72 Mar 1, 2015
pharmacy degree (draft standards 2016). www.acpe-accredit.org/pdf/Standards 2016DRAFTv60FIRSTRELEASEVERSION. pdf (accessed 2014 Aug 6). 3. The Glossary of Education Reform. Capstone project. edglossary.org/capstoneproject/ (accessed 2014 Aug 6). 4. Wuller CA. A capstone advanced pharmacy practice experience in research. Am J Pharm Educ. 2010; 74:article 180. 5. Conway JM, Ahmed GF. A pharmacotherapy capstone course to advance pharmacy students’ clinical documentation skills. Am J Pharm Educ. 2012; 76:article 134. 6. Overbaugh RC. Bloom’s taxonomy. ww2. odu.edu/educ/roverbau/Bloom/blooms_ taxonomy.htm (accessed 2014 Aug 17).
Radha V. Patel, Pharm.D., BCACP, Assistant Professor Department of Pharmacotherapeutics and Clinical Research University of South Florida College of Pharmacy Tampa, FL [email protected] Diane Hadley, Pharm.D., BCACP, Assistant Professor of Clinical Pharmacy Chintan Shah, Pharm.D. student Shrina Patel, Pharm.D. student Sanchita Sen, Pharm.D., BCPS, Assistant Professor of Clinical Pharmacy Department of Pharmacy Practice and Pharmacy Administration Philadelphia College of Pharmacy University of the Sciences Philadelphia, PA
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140643
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.
Need for pediatric antimicrobial stewardship
T
he primary goal of antimicrobial stewardship is to optimize clinical outcomes while reducing the consequences of unnecessary antimicrobial use. Despite the large body of evidence that supports antimicrobial stewardship programs and their effectiveness in reducing resistance rates and antimicrobial costs, most of these data focus on the improved use of antimicrobial agents in adults.1 While antimicrobial stewardship committees must include an infectious diseases (ID) physician and a clinical pharmacist with ID training as core members,1 most tend to lack an active pediatric ID physician or a pharmacist with adequate training in pediatric ID. The vast majority of current ID residency programs focus on the adult population, with very few institutions offering a pediatric ID residency for pharmacists, largely due to a lack of trained pharmacists in this area and a lack of funding resources. Flannery and colleagues2 conducted a survey at a pediatric tertiary care center and found that more than 80% of respondents considered recommendations from an ID pharmacist to be helpful. Tools such as a pediatric-specific antibiogram, didactic education, and clinical guidelines were also found to be useful. Such research clearly demonstrates that pharmacists with adequate training and experience can contribute to the interdisciplinary team that treats pediatric patients. The lack of resources, funding, and support from hospital administration for pediatric ID pharmacists can be addressed by tracking antimicrobial use among pediatric patients and the associated decrease in costs. For example, a four-month prospective observational study conducted by Metjian and colleagues3 found that having an ID pharmacist for the pediatric population not only improved the appropriate use of antimicrobial agents in children but saved $50,090 in drug acquisition costs alone. Offering more training in pediatric ID and obtaining the resources needed to hire pediatric ID pharmacists are war-
ranted in order to advance current antimicrobial stewardship programs. 1. Dellit TH, Owens RC, McGowan JE Jr et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007; 44:159-77. 2. Flannery DD, Swami S, Chan S, Eppes S. Prescriber perceptions of a pediatric antimicrobial stewardship program. Clin Pediatr. 2014; 53:747-50. 3. Metjian TA, Prasad PA, Kogon A et al. Evaluation of an antimicrobial steward-
ship program at a pediatric teaching hospital. Pediatr Infect Dis J. 2008; 27:106-11.
Jonathan C. Cho, Pharm.D., Postgraduate Year 2 Pharmacy Resident in Infectious Diseases [email protected] Stephanie H. Stovall, M.D., FAAP, Pediatric Infectious Diseases Physician Lee Memorial Health System Fort Myers, FL
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140844
Pharmacy students’ experience with a capstone project
D
ue to the growing needs within the healthcare system and the opportunity for more pharmacy involvement, it is essential that pharmacy curricula provide opportunities to develop students’ critical thinking skills as a way to address these needs. The Center for the Advancement of Pharmacy Education’s 2013 educational outcomes1 and the Accreditation Council for Pharmacy Education (ACPE) draft standards 20162 emphasize the need for higher-level thinking skills by recommending supplementary, applicationbased, and student-driven projects. Specifically, the ACPE draft standards 2016 highlight these higher-level projects as a way to encourage students to be selfdirected learners and innovative thinkers when addressing current issues affecting the healthcare system. A capstone project is a higher-level and culminating experience designed to promote the application of information to assist in developing effective communication skills, to allow students to apply knowledge in a creative manner, and to encourage team-building skills.3-5 Given their benefits and support by accrediting bodies, many pharmacy programs have started to incorporate capstone projects within the curricula as a way to promote
higher-level thinking.4,5 Capstone projects can be useful in developing these skills for students as they transition into advanced pharmacy practice experience (APPE) rotations and ultimately into members of the healthcare team. In fall 2013, 12 third-year doctor of pharmacy students from the Philadelphia College of Pharmacy at the University of the Sciences enrolled in an elective course focused on pharmacists’ roles within different levels of transitions of care (TOC). The course was delivered using mostly active learning techniques and handson activities. The course was designed to build on therapeutics knowledge, patient counseling, and communication skills. It also promoted the use of concepts about the TOC process, such as regulatory issues. Instead of a final examination, students were assigned a capstone project on which they worked together to create a TOC model and link the TOC process among a hospital, an ambulatory care clinic, and a community pharmacy. The course and the capstone project received an abundance of positive feedback from students. Aside from reinforcing therapeutics knowledge, the TOC capstone project provided students with the ability to continue to develop skills such as
Am J Health-Syst Pharm—Vol 72 Mar 1, 2015
347
Letters
leadership, critical thinking, and effective communication and teamwork. The capstone assignment was unlike anything the students had previously encountered. Given the complexity of the project, each student took the lead on an aspect of the assignment, which helped each student identify his or her leadership style, including coordinating project logistics, creating group assignments, and keeping the group focused. Having each student take the lead on certain parts of the project, instead of placing the burden on one student, made the experience more enjoyable for students. In addition, it also helped students to become more assertive and confident. The capstone project also helped students build on their critical-thinking skills. As is the case for many issues facing the healthcare system, students understood that there was no clear right or wrong solution that could be easily achieved. As students reflected on the assignment once it was completed, it provided evidence of the students’ ability to understand, apply, synthesize, and evaluate concepts presented throughout the course.6 This project empowered students to “think outside the box” and create an innovative TOC model that could be implemented within an existing healthcare setting. Lastly, the nature of the capstone project ensured that students worked together and communicated within their groups and with other groups. Students realized that while no one is an expert at everything, everyone has something valu-
348
able to contribute. By coordinating their talents and understanding the group’s dynamic, students gained an appreciation of the challenges that may arise from working in small or large groups. In addition, students realized the benefits of effective communication and teamwork. The outcome in this particular case was a well-developed TOC model that introduced fresh ideas and solutions, which was unlikely to be created or achieved by one person. While an assessment of knowledge often requires the use of traditional examinations, incorporating capstone projects within pharmacy curricula is becoming more common as accrediting bodies have started to incorporate them within their standards.1,2 The capstone project allowed students in this course to utilize and continue to develop certain skill sets in ways that are challenging to achieve through an examination. It also provided students the opportunity to work together to address a healthcare issue and create a solution. Incorporating capstone projects throughout the curriculum may help better prepare students for APPE rotations and becoming effective pharmacists. 1. American Association of Colleges of Pharmacy. Center for the Advancement of Pharmacy Education: educational outcomes 2013. www.aacp.org/resources/ education/cape/Open%20Access%20 Documents/CAPEoutcomes2013.pdf (accessed 2014 Jul 25). 2. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of
Am J Health-Syst Pharm—Vol 72 Mar 1, 2015
pharmacy degree (draft standards 2016). www.acpe-accredit.org/pdf/Standards 2016DRAFTv60FIRSTRELEASEVERSION. pdf (accessed 2014 Aug 6). 3. The Glossary of Education Reform. Capstone project. edglossary.org/capstoneproject/ (accessed 2014 Aug 6). 4. Wuller CA. A capstone advanced pharmacy practice experience in research. Am J Pharm Educ. 2010; 74:article 180. 5. Conway JM, Ahmed GF. A pharmacotherapy capstone course to advance pharmacy students’ clinical documentation skills. Am J Pharm Educ. 2012; 76:article 134. 6. Overbaugh RC. Bloom’s taxonomy. ww2. odu.edu/educ/roverbau/Bloom/blooms_ taxonomy.htm (accessed 2014 Aug 17).
Radha V. Patel, Pharm.D., BCACP, Assistant Professor Department of Pharmacotherapeutics and Clinical Research University of South Florida College of Pharmacy Tampa, FL [email protected] Diane Hadley, Pharm.D., BCACP, Assistant Professor of Clinical Pharmacy Chintan Shah, Pharm.D. student Shrina Patel, Pharm.D. student Sanchita Sen, Pharm.D., BCPS, Assistant Professor of Clinical Pharmacy Department of Pharmacy Practice and Pharmacy Administration Philadelphia College of Pharmacy University of the Sciences Philadelphia, PA
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140643
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.
