Pharmacist Rounds: Making an Impact- Students Improving Patient Care

Since 2003, all accredited schools of pharmacy in the United States have been mandated to provide the Doctor of Pharmacy degree (PharmD) as a national standard. To meet PharmD requirements and obtain their licenses, students must engage in a range of direct pharmacy practice experiences. Although PharmD programs began in teaching hospitals,¹ many schools of pharmacy have expanded their rotation sites to include community hospitals.

Student pharmacists can positively impact patient care when trained appropriately by qualified and licensed pharmacists, and several studies have reported that pharmacy student participation in the activities of the health

system benefits patient care.^2-11 In one such study, pharmacy interventions performed by pharmacy students contributed to 29% of all interventions made by the pharmacy department.⁷ The literature shows that the acceptance rate for interventions initiated by pharmacy students has ranged between 79% and 95%.^6,10-12 Pharmacy student participation appears to show enhanced clinical services for patients^2,11 and a reduction

in prescribing errors.¹³

Cost Avoiding and Cost Saving

A study conducted at Indiana University Medical Center evaluated the cost impact of pharmacy students in a health system.⁸ Pharmacy students were asked to document all interventions made over a period of 10 months. After each month, the director of pharmacy conducted an assessment of impact on patient care and costs. Recommendations were categorized as either cost avoiding or cost saving. Examples of cost-avoidance included the prevention of an allergic drug reaction or clinically significant drug interaction. Cost-saving interventions included a change in frequency of administration or elimination of duplication in therapy. The students provided a total of 1217 pharmacy interventions over the study period. Of the 1217 interventions performed, 98% were accepted and implemented by physicians. This annualized cost benefit was estimated at $354,752, of which $99,332 was a result of cost avoidance and $255,420 a result of cost savings.⁸

In another study evaluating the impact of pharmacy students in a surgical intensive care unit, researchers found that over a 20-month period, 1023 recommendations were made, with an acceptance rate of 98% and cost savings

of $58,556.¹⁴ In the ambulatory care setting, Slaugher et al reported that involving pharmacy students may result in savings of $275 for each 30-day drug regimen that is ordered for patients.⁶

A preceptor must consider his or her own skill set in order to better prepare the student pharmacist for providing

direct patient care services in a community hospital. Critical thinking and communication skills are important traits for clinical practitioners. For the clinical pharmacist, this means increasing the focus on the ability to integrate patient-specific laboratory data, physical findings, and effects of medication use, and then assessing the patient's

response to therapy. The clinical pharmacist must communicate these needs to other health care providers to promote optimal drug therapy and patient outcomes.

When students participate in an acute care inpatient pharmacy practice rotation, they should be required to interact directly with patients on a daily basis. They should assess patients being managed under collaborative practice protocols approved by medical staff, in such areas as anticoagulation, aminoglycoside and vancomycin dosing, anemia management, total parenteral nutrition, and sepsis bundles, among others. Practicing these skills is very important during a student's clinical rotation. Important to the success of this skill set development is the presence of quality rolemodeling by the site preceptor(s). Preceptors need to be committed to providing an educational experience to all advanced pharmacy practice experience students on a daily basis.

As the shortage of pharmacists continues, the community hospital practitioner must be more

acutely aware of the competition for new graduates. The increasing applicant pool for postgraduate year-1 residency training, expansion of new career options for pharmacists, and the increasing need for pharmacists in community settings make a strong case for community hospital programs to create environments that will attract

future practitioners.