Objective. To design an assessment of practice readiness using blended-simulation progress testing.
Design. A five-station, blended simulation assessment was developed to evaluate patient care ...outcomes in first- and third-year pharmacy (P1 and P3) students, as well as first-year postgraduate (PGY1) pharmacy residents. This assessment of practice readiness included knowledge and performance evaluations administered as a progress test.
Assessment. Eighteen PGY1 residents, 108 P3 students, and 106 P1 students completed the assessment. P3 students scored significantly higher than P1 students across all evaluations. Third-year pharmacy students scored significantly lower than PGY1 residents in interprofessional communications and attitudes of ownership in a standardized colleague/mannequin model station, and in patient communication in a standardized patient station.
Conclusion. Learners demonstrated evolving skills as they progressed through the curriculum. A blended simulation integrated progress test provides data for improvement of individual student clinical skills, informs curricular advancement, and aligns curricular content, process, and outcomes with accreditation standards.
Gender differences have been described for glycemic control and prevalence of diabetes related complications in the outpatient setting but have not been examined in the hospitalized population. To ...address this, we investigated gender differences in demographics, glycemic control and variability (GV), macrovascular and microvascular complications, and admission diagnosis in non-critically ill hospitalized patients with a secondary diagnosis of diabetes recruited for the Readmission and Comprehension of Diabetes Education at Discharge (ReCoDED) Study. To date, 111 men and 87 women have been recruited, with the majority having type 2 DM (86 vs. 79%). Participants age (men vs. women) was 60.6 ± 11.7 vs. 57.6 ± 11.8 years, BMI 32.2 ± 8.4 vs. 32.1 ± 10.6 kg/m2, systolic (SBP) 136 ± 26 vs. 127 ± 23 mmHg, diastolic (DBP) 77 ± 13 vs. 75 ± 14 mmHg, HbA1c 8.0 ± 2.3 vs. 8.3% ± 2.5%, and DM duration 14.5 ± 10.4 vs. 14.1 ± 11.6 years. Race, education, and employment were similar. Men had more retinopathy (23 vs. 16%) and nephropathy (40 vs. 28%), but not neuropathy (60 vs. 63%). Women had a lower prevalence of CAD (49 vs. 36%), but a similar prevalence of CHF (37 vs. 37%), stroke (15 vs. 18%), and PVD (18 vs. 17%). The most frequent admission diagnoses were CVD (37 vs. 22%) and infection (10 vs. 19%). Mean blood glucose (BG) (198 ± 51 vs. 200 ± 54 mg/dl), GV (177 ± 80 vs. 182 ± 112 mg/dl), frequency of hypoglycemia (BG < 70 mg/dl) and hyperglycemia (BG >250 mg/dl) were similar in the 48 hours prior to discharge. Length of stay was 7.8 ± 6.9 vs. 8.3 ± 7.4 days.
In summary, this gender-based description of glycemic control and prevalence of diabetes-related complications in an inpatient population demonstrates that hospitalized women with DM have fewer microvascular complications, a lower prevalence of CAD but a similar prevalence of CHF, stroke and PVD when compared to men, despite similar BMI and DM duration. These findings will be examined as a risk factor for hospital readmissions in this ongoing study.
Disclosure
N. Patel: None. D. Pinkhasova: None. A. Donihi: None. E. Karslioglu French: None. L.M. Siminerio: None. K. Delisi: None. D.S. Hlasnik: None. M.T. Korytkowski: None.
Hospitalized patients with DM are at high risk for early readmission. Improving inpatient education and discharge (DC) processes are proposed interventions for reducing this risk.
We examined the ...contribution of blood glucose (BG) 48 hr prior to DC (nadir, peak, STD, CV) and patient comprehension (PC) of instructions for home DM management following DC to risk for 30d readmission.
Insulin treated non-critically ill patients with DM (N=202) were recruited. Diabetes Early Readmission Risk Indicators (DERRI) were calculated for each participant, who were contacted within 48 hr of DC to complete a PC Questionnaire (PCQ).
Of 126 participants age mean (STD) 61(12) years, BMI 32.9 (9.6) kg/m2, A1c 8.0 (2.2%), 45% women, 22% black, 85% type 2DM who completed the PCQ, 42 (33%) required clarification of misunderstood DC instructions. PC scores were negatively correlated with BG STD (-0.17, 95% CI:-0.32,-0.02) and CV (-0.38, -0.7, -0.05).
There was no difference in median (25ile, 75ile) PC scores between patients with and without 30d readmission (79 (67, 93%) vs.83 (71,100%), p=0.19); however, there were more readmissions in those with PC scores <100% compared to scores of 100% (n = 34) (29% vs. 15%, OR=2.4, 95% CI: 0.83, 6.88).
Among all 202 participants, median DERRI scores were higher in the 25% with 30d readmission (27 (24, 30)) than those without (19 (20, 24), p = 0.002).
In summary, these results demonstrate deficiencies in the hospital DC process as demonstrated by the need for clarification of information in >30% of patients following DC. It is possible that this corrected information may have served as an intervention to reduce readmission risk. PC scores were negatively associated with glycemic variability preceding DC and scores <100% were associated with a higher risk for readmission. DERRI scores were strongly associated with risk for 30d readmissions, representing the first prospective external validation of this tool. These results support proposals to improve the DC process and post-DC follow-up of patients with DM.
Disclosure
D. Pinkhasova: None. J. Swami: None. N. Patel: None. A. Donihi: None. L.M. Siminerio: None. E. Karslioglu French: None. K. Delisi: None. D.S. Hlasnik: None. D.J. Rubin: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. M.T. Korytkowski: None.
Funding
National Institutes of Health (UL1-TR-001857)
The purpose of this prospective observational cohort study was to examine sex differences in glycemic measures, diabetes-related complications, and rates of postdischarge emergency room (ER) visits ...and hospital readmissions in non-critically ill, hospitalized patients with diabetes.
Demographic data including age, body mass index, race, blood pressure, reason for admission, diabetes medications at admission and discharge, diabetes-related complications, laboratory data (hematocrit, creatinine, hemoglobin A1c, point-of-care blood glucose measures), length of stay (LOS), and discharge disposition were collected. Patients were followed for 90 days following hospital discharge to obtain information regarding ER visits and readmissions.
120 men and 100 women consented to participate in this study. There were no sex differences in patient demographics, diabetes duration or complications, or LOS. No differences were observed in the percentage of men and women with an ER visit or hospital readmission within 30 (39% vs 33%, p=0.40) or 90 (60% vs 49%, p=0.12) days of hospital discharge. More men than women experienced hypoglycemia prior to discharge (18% vs 8%, p=0.026). More women were discharged to skilled nursing facilities (p=0.007).
This study demonstrates that men and women hospitalized with an underlying diagnosis of diabetes have similar preadmission glycemic measures, diabetes duration, and prevalence of diabetes complications. More men experienced hypoglycemia prior to discharge. Women were less likely to be discharged to home. Approximately 50% of men and women had ER visits or readmissions within 90 days of hospital discharge.
NCT03279627.
To design an assessment of practice readiness using blended-simulation progress testing. A five-station, blended simulation assessment was developed to evaluate patient care outcomes in first- and ...third-year pharmacy (P1 and P3) students, as well as first-year postgraduate (PGY1) pharmacy residents. This assessment of practice readiness included knowledge and performance evaluations administered as a progress test. Eighteen PGY1 residents, 108 P3 students, and 106 P1 students completed the assessment. P3 students scored significantly higher than P1 students across all evaluations. Third-year pharmacy students scored significantly lower than PGY1 residents in interprofessional communications and attitudes of ownership in a standardized colleague/mannequin model station, and in patient communication in a standardized patient station. Learners demonstrated evolving skills as they progressed through the curriculum. A blended simulation integrated progress test provides data for improvement of individual student clinical skills, informs curricular advancement, and aligns curricular content, process, and outcomes with accreditation standards.
To investigate the effectiveness of an Inpatient Diabetes Management Program (IDMP) on physician knowledge and inpatient glycemic control.
Residents assigned to General Internal Medicine inpatient ...services were randomized to receive the IDMP (IDMP group) or usual education only (non-IDMP group). Both groups received an overview of inpatient diabetes management in conjunction with reminders of existing order sets on the hospital Web site. The IDMP group received print copies of the program and access to an electronic version for a personal digital assistant (PDA). A Diabetes Knowledge Test (DKT) was administered at baseline and at the end of the 1-month rotation. The frequency of hyperglycemia among patients under surveillance by each group was compared by using capillary blood glucose values and a dispersion index of glycemic variability. IDMP users completed a questionnaire related to the program.
Twenty-two residents participated (11 in the IDMP group and 11 in the non-IDMP group). Overall Diabetes Knowledge Test scores improved in both groups (IDMP: 69% ± 1.7% versus 83% ± 2.1%, P = .003; non-IDMP: 76% ± 1.2% versus 84% ± 1.4%, P = .02). The percentage of correct responses for management of corticosteroid-associated hyperglycemia (P = .004) and preoperative glycemic management (P = .006) improved in only the IDMP group. The frequency of hyperglycemia (blood glucose level >180 mg/dL) and the dispersion index (5.3 ± 7.6 versus 3.7 ± 5.6; P = .2) were similar between the 2 groups.
An IDMP was effective at improving physician knowledge for managing hyperglycemia in hospitalized patients treated with corticosteroids or in preparation for surgical procedures. Educational programs directed at improving overall health care provider knowledge for inpatient glycemic management may be beneficial; however, improvements in knowledge do not necessarily result in improved glycemic outcomes.
Substantial observational data has linked hyperglycemia in hospitalized patients with poor patient outcomes. While early studies suggested improved clinical outcomes with interventions targeting near ...euglycemia, more recent studies have yielded inconsistent results, with the suggestion of harm with more severe hypoglycemia. The American Association of Clinical Endocrinologists and American Diabetes Association published a revised consensus statement on inpatient glycemic management that takes into account this recent evidence. This statement identifies reasonable, achievable, and safe glycemic targets and describes protocols, procedures, and system improvements necessary to achieve these effectively. These modified glycemic targets promote a rational approach to inpatient glycemic management that minimizes risks associated with uncontrolled hyperglycemia and hypoglycemia. Intravenous insulin infusions are recommended for critically ill patients who experience blood glucose (BG) levels above 140 mg/dl with a target of 140 to 180 mg/dl. Lower BG targets (i.e., 110-140 mg/dl) may be appropriate for patients following cardiac or vascular surgical procedures. In noncritically ill patients, scheduled subcutaneous basal:bolus insulin is the preferred therapy for achieving fasting and preprandial BG below 140 mg/dl and random BG values below 180 mg/dl, with consideration of more or less stringent targets based on a patient's clinical status. Prolonged use of correctional insulin as monotherapy is discouraged. Oral and injectable noninsulin glucose-lowering agents have a limited role for hospital use but may be appropriate for selected noncritically ill patients. Educating personnel about appropriate inpatient glycemic management practices, obtaining reliable and reproducible measures of BG, and careful implementation of standardized protocols can help to ensure patient safety.
To describe a unique advanced pharmacy practice experience (APPE) in which pharmacy students provided medication education to hospitalized patients.
Students were trained to independently assess ...patients' needs for education and identify drug-related problems. Students then provided medication education and performed medication therapy management under the supervision of clinical staff pharmacists. To assess the impact of the APPE, the number of hospitalized patients assessed and educated during the 3-month time period prior to student involvement was compared to the first 3 months of the APPE.
Student participation increased the number of patients receiving medication education and medication therapy management from the hospital pharmacy. At the end of the APPE, students reported that the experience positively affected their ability to impact patients' care and to critique their own learning and skills.
The inpatient medication education APPE provided students the opportunity to be responsible and accountable for the provision of direct patient care. In addition, the APPE benefitted the hospital, the school of pharmacy, and, most importantly, the patients.
Purpose
In a comprehensive medication-education program at the University of Pittsburgh Medical Center, pharmacists provide medication education for hospitalized patients at high risk for ...nonadherence. This study assessed whether patients' ability to recall medication information after hospital discharge was influenced by the timing of education.
Methods
Patients who received medication education from pharmacists during a 10-week period were included. Patients were called 2 to 3 days after discharge and were asked to recall the indication, name, dose, frequency, and side effects for 2 medications that were reviewed by the pharmacist. After grouping patients by number of days between education and discharge, recall accuracy was compared between the groups.
Results
Of 270 patients who received education, 100 patients met inclusion criteria and were available for telephone follow-up. The highest recall responses were for frequency of administration (88%), medication name (78%), indication (78%), and dose (75%). In contrast, side effects were accurately recalled by only 34% of the patients. No significant differences were seen between the percentage of patients accurately recalling medication information and the time that education occurred; however, patients educated on the day of discharge tended to recall medication information less accurately.
Conclusion
Patients educated on the day of discharge did not recall medication information better than those educated prior to the day of discharge. It may be advantageous for medication education to occur 2 to 3 days prior to hospital discharge. Side-effect information was poorly retained; different strategies must be employed to improve patient recall of side effects.
To describe a unique advanced pharmacy practice experience (APPE) in which pharmacy students provided medication education to hospitalized patients. Students were trained to independently assess ...patients' needs for education and identify drug-related problems. Students then provided medication education and performed medication therapy management under the supervision of clinical staff pharmacists. To assess the impact of the APPE, the number of hospitalized patients assessed and educated during the 3-month time period prior to student involvement was compared to the first 3 months of the APPE. Student participation increased the number of patients receiving medication education and medication therapy management from the hospital pharmacy. At the end of the APPE, students reported that the experience positively affected their ability to impact patients' care and to critique their own learning and skills. The inpatient medication education APPE provided students the opportunity to be responsible and accountable for the provision of direct patient care. In addition, the APPE benefitted the hospital, the school of pharmacy, and, most importantly, the patients.
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