2018 Award for Excellence in Educational Design

By Rosalyn P. Vellurattil, PharmD, CHCP; Jill R. Wilson, MEd; and Scott T. Benken, PharmD, BCPS-AQ Cardiology, FCCM, University of Illinois at Chicago College of Pharmacy

The Chicagoland Critical Care Conference (C4) is a one-day, regional conference held at the University of Illinois at Chicago College of Pharmacy. It was created to fulfill a need for programming dedicated toward critical care practitioners. With its inception in 2016 as a conference designed for pharmacists, C4 has since expanded to include an interprofessional (IPE) audience alongside nurses. Together, the Office of Continuing Education and Meeting Services (OCEMS), the University of Illinois Hospital & Health Sciences System (UI Health), C4 program chair and C4 planning committee worked to design this valuable IPE continuing education initiative.

Educational Design and OCEMS Process

The role of the critical care clinical pharmacist, ICU nurse and acute care nurse practitioner (ACNP) has evolved tremendously over the past 30 years. These are essential team members to any critical care team.1 Inheriting this essential role on a critical care team creates the responsibility of remaining up-to-date on the most current and cutting-edge practices in the field. As it has been noted, didactic based continuing education programs can improve clinical decisions and reduce the costs of quality care.2 Further, it has been shown that pharmacist-driven educational projects share this similar impact.3

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Although national meetings exist having few dedicated lectures intended for critical care pharmacists and nurses, the rapidly evolving discipline of critical care warranted an annual meeting focused on emerging topics. The goals of C4-2017 were twofold: 1) to maintain or advance knowledge and/or competency in critical care; and 2) to enhance professional teamwork.

The C4 planning committee performed an extensive literature review, linking gaps in practice to the professional needs of the audience. Professional domains for clinical pharmacists and practitioner competencies for advanced practice nurses were identified as target subject areas for the conference.4-6 By doing so, educational sessions were created to focus on specific domains and competencies (Table 1). Subsequently, each session was then mapped to an IPE competency defined by the Interprofessional Education Collaborative.7

Table 1: Clinical Pharmacy Domains and Advanced Nurse Practitioner Practice Competencies

Clinical Pharmacy Domains

  • Antimicrobial Therapy
  • Reducing Adverse Drug Events (in complex patients)
  • Emergency/urgency Response

 

 

Advanced Nurse Practitioner Practice Competencies

  • Independently manages complex acute, critical and chronically ill patients at risk for urgent/emergent conditions
  • Promotes health/protection from disease and environmental factors by assessing risks associated with care of acute, critical and complex chronically ill patients.
  • Identifies the presence of comorbidities and the potential for rapid physiologic and mental health deterioration or life-threatening instability and the risk for iatrogenesis.
  • Diagnoses common behavioral and mental health and substance use or addictive disorder/disease, in the context of complex acute, critical, and chronic illness.
  • Prioritizes diagnoses during rapid physiologic and mental health deterioration or life threatening instability.
  • Collaborates with intraprofessional and IPE team and informal caregivers to achieve optimal patient outcomes during acute, critical and/or complex chronic illness.
  • Employs interventions to support the patient to regain and maintain age-specific physiologic and psychological stability consistent with the patient’s goals of care.
  • Performs diagnostic and therapeutic interventions including, but not limited to:
    • Interpretation of EKG and imaging studies
    • Respiratory support
    • Hemodynamic monitoring, line and tube insertion
    • Lumbar puncture
  • Employs treatments and therapeutic devices as indicated, including, not limited to:
    • Oxygen
    • Noninvasive and invasive mechanical ventilation
    • Prosthetics
    • Splints
    • Pacers
    • Circulatory support Adaptive equipment
  • Evaluates the effect of therapies including but not limited to:
    • Physical therapy
    • Occupational therapy
    • Speech therapy
    • Home healthcare
    • Palliative care
    • Nutritional therapy
  • Implements interventions to support the patient with a rapidly deteriorating physiologic condition based on advanced cardiac life support and fundamentals of critical care support
  • Prescribes medications maintaining awareness of and monitoring for adverse drug outcomes and complex medical regimens, especially in high-risk and vulnerable populations.
  • Uses pharmacologic and nonpharmacologic management strategies to ameliorate physical and behavioral symptoms in individuals who have mental health and substance misuse disorders.
  • Applies principles of crisis and stress management in assisting the patient and family experiencing complex acute, critical, and chronic physical and mental illness during changes in status.
  • Coordinates comprehensive care in and across care settings for patients who have acute and chronic illness needs.
  • Practices within the national, state, and institutional credentialing and scope of practice for AG ACNPs based upon education, certification and licensure criteria.

All this information was communicated to speakers via the program chair and the OCEMS. Speakers then completed additional educational needs assessments on their individual educational sessions using further literature evidence to link practice gaps and competencies directly with learning objectives, teaching interventions, and evaluation methods for learning and impact.

Speakers were provided with detailed guidelines regarding the creation of learning objectives, active learning techniques and learning assessment methods. Template slide decks, audience response system tutorials and guidance modules were provided for live and/or enduring content to tailor strategies used for the intended learner. Speakers were requested to submit disclosure forms and activity planning worksheets (highlighting needs assessment, gap analysis, learning objectives, and proposed activity learning strategies and learner assessment/feedback) for each session. The activity planning worksheets helped speakers stay organized and focused on content while allowing for an avenue for OCEMS staff to provide further guidance, in addition to serving as documentation on strategies planned for content delivery.

The OCEMS’ Continuing Education Advisory Committee (CEAC) consisting of six college of pharmacy faculty members performed educational session reviews. When an audience other than pharmacists is included in programming, a member from that discipline also participates with the committee to obtain appropriate perspective and ensure content relevancy to that profession. The CEAC is provided with a standardized activity proposal checklist to help guide their review. This standardized peer-review process informs the CEAC of details associated with each activity and helps the OCEMS manage all information necessary to implement an activity. Once the CEAC reviews and approves activity materials, an announcement for the event is created. All announcements are accompanied with a standardized checklist and has two OCEMS reviewers; one by staff and one by the continuing education administrator to further ensure compliance and accuracy of information provided. Interventions to manage and resolve issues related to content validity and integrity occur through a formal review process for resolution of speaker conflicts of interest.

Outcomes Assessment

C4 attendees were asked to complete an overall conference evaluation that included session evaluations, reflections, and pre/post-tests for each activity. The conference evaluation and post-tests measured the overall impact of the program in achieving its goals. Outcomes reporting summarized program outcomes based on Moore’s outcome levels.8

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Key Findings and Data Analysis

C4-2017 was effective in achieving its overall goals to advance knowledge/competency in critical care and enhance professional teamwork. Evaluations were critical in securing feedback to allow improvements to the program to be made. Specifically, reflections aided in motivating participants to develop plans to further their continuing professional development and teamwork in critical care. Learners will continue to be empowered to identify their own professional practice gaps and IPE barriers through self-assessments, reflections and evaluations.

Lessons Learned

C4-2017 was OCEMS’ first IPE program, having approximately a 7:3 pharmacist to nurse ratio in attendance. Although anticipated audience numbers were not met, participation was similar in 2016, and overall impact was consistently positive. It was found most pharmacists were previous attendees at the inaugural C4. Thus, word of mouth and prior participation is expected for 2018, hopefully increasing future nurse participation. Additionally, promotions and marketing to the nursing audience occurred later with our external stakeholder, UI Health. OCEMS is planning to increase marketing to nurses through our college social media platforms.

Opportunities for the future include integrating physicians into the target audience to engage with and enhance team learning. Additionally, utilizing distance technology equipment, broadcasting to an international audience will be attempted. This allows further showcasing of faculty expertise and strives to contribute to the college’s overall mission.

Implications and Conclusions

The OCEMS evaluated outcomes both following the delivery of C4 and in aggregate to determine if educational intervention outcomes and overall program mission/goals were being met. A formal assessment plan to document outcomes, targets and quality improvement is discussed at year end with OCEMS staff and the CEAC. The program mission and outcome goals of the continuing education program are shared in a dashboard format internally with faculty and administrative officers and externally with preceptors and alumni.

Planning for conference programming occurs one year in advance, and guidance is provided from OCEMS all throughout the process. Implementing systematic, quality, educational design processes in day-to-day operations is key in forming a foundation for excellence. C4 is just one example where standardized tools, policies and procedures, and planning documents (e.g., worksheets, templates, checklists and speaker guidance) implemented in the OCEMS facilitated consistency, quality improvement and sustainability since program inception. All who are involved in a continuing education offering from chair to speaker, staff, administrator and review committee partakes in the process in order to achieve the shared goal of continuing education: advancing professional knowledge, competence and performance that will positively impact patients’ lives.

Acknowledgements

The authors gratefully acknowledge the following individuals for their contributions on this valuable interprofessional continuing education initiative: Nicole Ozturk, Kate O’Brien (OCEMS); Ishaq Lat, PharmD, FCCM, FCCP; Megan A. Rech, PharmD, BCPS; Craig J. Cooper, BS Pharm, PharmD, BCCCP, BCPS; Sean P. Kane, PharmD, BCPS; Ruth Kleinpell, PhD, RN, FAAN, FCCM (C4 Planning Committee); Alexia Hieber Johnson, MS, RN, CCNS, CCRN, RN-BC (UI Health).

References

  1. Horn E and Jacobi J. The critical care clinical pharmacist: Evolution of an essential team member. Crit Care Med. 2006; 34[Suppl.]:S46–S51.
  2. Vukovic M, Gvozdenovic BS, Rankovic M, et al. Can didactic continuing education improve clinical decision making and reduce cost of quality? Evidence from a case study. J of Cont Ed Health Prof. 2015. 35(2):109–118.
  3. Nguyen HT, Pham HT, Vo DK, et al. The effect of a clinical pharmacist-led training program on intravenous medication errors: a controlled before and after study. BMJ Qual Saf. 2014; 23: 319-324.
  4. American College of Clinical Pharmacy. Standards of Practice for Clinical Pharmacists. Pharmacotherapy. 2014;34(8):794–797. Available from http://www.accp.com/docs/positions/guidelines/StndrsPracClinPharm_Pharmaco8-14.pdf.
  5. American Association of Colleges of Nursing & National Organization of Nurse Practitioner Faculties, 2016. Adult Gerontology Acute Care and Primary Care NP Competencies. http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/files/np_competencies_2.pdf
  6. Peslask CR, Lat I, MacLaren R, et al. Pharmacist contributions as members of the multidisciplinary team. Chest. 2013; 144(5) 1687-1695.
  7. Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Interprofessional Education Collaborative.
  8. Moore DE Jr, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. J Contin Educ Health Prof. 2009;29(1):1-15.
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