Professor, College of Pharmacy/ Department of Pharmacy Practice
Faculty Perceptions of Entrustable Professional Activities to Determine Pharmacy Student
Readiness for Advanced Practice Experiences
Co-Authors: David Bright, Lisa Meny, Mandy Seiferlein
Objective: To quantify pharmacy faculty members’ perceptions of the importance of
entrustable professional activities (EPAs) and the expected level of entrustment that
should be achieved to determine APPE readiness. Methods: Entrustable professional
activities define the core skills and tasks expected of new pharmacy graduates and
may serve as a logical framework for determining pharmacy student readiness to begin
advanced pharmacy practice experiences (APPEs). A five-question survey was distributed
to all faculty members, staff members, and administrators at Ferris State University
College of Pharmacy. Respondents were asked to rate 18 statements mapped to 12 EPAs
on the perceived importance of each statement and the expected level of entrustment
students should achieve to determine readiness for APPEs. Thresholds were used to
determine consensus for importance and level of entrustment for each statement. Results:
Of the 44 faculty members surveyed, 28 (63.6%) responded. A strong consensus was reached
on the level of importance for 16 of 18 statements (89%), while two statements demonstrated
moderate consensus (11%). No strong consensus was identified on levels of entrustment.
Seven (39%) of 18 statements demonstrated moderate entrustment consensus and 11 (61%)
statements demonstrated little consensus. Conclusion: Strong consensus was identified
regarding which EPAs are important to determine students’ APPE readiness; however,
no strong consensus was found when evaluating levels of entrustment. Lack of consensus
regarding entrustment raises several questions that require further study and clarification
as the implementation of EPAs continues throughout the Academy.
Evaluation of a Multifaceted Approach to Antimicrobial Stewardship Education Methods
for Medical Residents
Co-Authors: Katie Axford, Lisa Dumkow, Andrew Jameson
Objective: Medical residents are an important group for antimicrobial stewardship
programs (ASPs) to target with interventions aimed at improving antibiotic prescribing.
In this study, we compared antimicrobial prescribing practices of 2 academic medical
teams receiving different ASP training approaches along with a hospitalist control
group. Design: Retrospective cohort study comparing guideline-concordant antibiotic
prescribing for 3 common infections among a family medicine (FM) resident service,
an internal medicine (IM) resident service, and hospitalists. Setting: Community teaching
hospital. Participants: Adult patients admitted between July 1, 2016, and June 30,
2017, with a discharge diagnosis of pneumonia, cellulitis, and urinary tract infections
were reviewed. Methods: All 3 medical teams received identical baseline ASP education
and daily antibiotic prescribing audit with feedback via clinical pharmacists. The
FM resident service received an additional layer of targeted ASP intervention that
included biweekly stewardship-focused rounds with an ASP physician and clinical pharmacist
leadership. Guideline-concordant prescribing was assessed based on the institution’s
ASP guidelines. Results: Of 1,572 patients, 295 (18.8%) were eligible for inclusion
(FM, 96; IM, 69; hospitalist, 130). The percentage of patients receiving guideline-concordant
antibiotic selection empirically was similar between groups for all diagnoses (FM,
87.5%; IM, 87%; hospitalist, 83.8%; P = .702). No differences were observed in appropriate
definitive antibiotic selection among groups (FM, 92.4%; IM, 89.1%; hospitalist, 89.9%;
P = .746). The FM resident service was more likely to prescribe a guideline-concordant
duration of therapy across all diagnoses (FM, 74%; IM, 56.5%; hospitalist, 44.6%;
P < .001). Conclusions: Adding dedicated stewardship-focused rounds into the graduate
medical curriculum demonstrated increased guideline adherence specifically to duration
of therapy recommendations.
Evaluation of the Treatment of Asymptomatic Bacteriuria in Psychiatric Patients Discharged
from the Emergency Department
Co-Authors: Lisa Dumkow, Kamah Ellena, Lauren Wolf
Abnormal urinalysis (UA) results, such as pyuria or bacteriuria, increase the risk
for antibiotic treatment even in the absence of urinary symptoms. In the emergency
department (ED), patients presenting with psychiatric emergencies commonly undergo
a medical assessment which includes a UA. We hypothesized that the rate of inappropriate
antibiotic treatment for asymptomatic pyuria in the psychiatric medical population
would decrease following implementation of an antimicrobial stewardship program (ASP)
in the ED. This retrospective cohort study compared the treatment of adult patients
presenting to the ED for medical assessment during a psychiatric emergency with noted
pyuria between three time periods following implementation of an ASP: early ASP (2014),
established ASP (2016), and mature ASP (2018). The ASP provided education and routine
audit‐and‐feedback focused on reducing urine testing and eliminating treatment of
asymptomatic pyuria. The primary end point was to compare rates of inappropriate treatment
of asymptomatic pyuria between groups. Secondary end points included comparing appropriate
agent selection and duration for patients who were prescribed antibiotics, prescriber
documentation, and patient outcomes between groups. A total of 180 patients with pyuria
were included; 60 within each study group with 88.3% being asymptomatic. Inappropriate
prescribing of antibiotics for asymptomatic patients at ED discharge decreased over
time following ASP implementation (2014 = 40.4%, 2016 = 31.4%, 2018 = 17.6%; P = .036).
Additionally, documentation noting a positive UA requiring antibiotic treatment decreased
(2014 = 46.7%, 2016 = 40%, 2018 = 26.7%). Of the 62 patients treated with antibiotics,
selection of a first‐line agent increased with ASP maturity (2014 = 15.4%, 2016 =
26.1%, 2018 = 69.9%; P = .002). Conclusion Inappropriate treatment of asymptomatic
pyuria in patients presenting to the ED with psychiatric emergencies decreased significantly
over time following implementation of an ASP. EDs may benefit from ASP interventions
aimed at decreasing reliance on UA interpretation in this patient population.
An Initial Environmental Scan of APPE Readiness Assessment
Co-Authors: David Bright, Lisa Meny, Mandy Seiferlein
Standards 2016 require schools/colleges of pharmacy (s/cop) to assess students' readiness
to enter advanced pharmacy practice experiences (APPEs). However, literature describing
how schools are meeting this standard is limited. The purpose of this study was to
conduct an environmental scan to describe how s/cop assess student readiness to enter
APPEs. A web-based survey was distributed to assessment leads at United States s/cop,
regardless of accreditation status. Respondents answered questions related to their
current approach to assessing student APPE readiness, existence of intentional assessment
plans, competencies used, assessment methods, benchmarks, and remediation strategies.
Aggregate data were analyzed using descriptive statistics. Fifty-two S/COP (36.1%)
responded. The majority (90.1%) were fully accredited schools. Most respondents have
an intentional APPE readiness plan (73.5%), although the duration since implementation
varied. There was no consensus among schools on which competencies informed APPE readiness
with 67.3% listing Center for the Advancement of Pharmacy Education (CAPE) 2013 outcomes,
61.2% Guidance for Standards 2016 Appendix A, 53.1% pre- APPE domains (Standards 2007),
and 30.6% Entrustable Professional Activities. Twenty-eight S/COP (57.1%) reported
having individual student-level data to assess student APPE readiness. The most common
methods for validating student APPE readiness were preceptor (48.9%) and student (44.9%)
surveys. Conclusions: This environmental scan begins to identify trends in how S/COP
is approaching the assessment of student readiness to begin APPEs. Further research
is needed to identify best practices and practical methods to ensure compliance with
current accreditation standards.