Q&A with Associate Clinical Professor of Pharmacy Practice Christopher Giuliano and the Heart Failure Transition of Care rotation team
Last year, Ascension St. John Clinical Pharmacists Melvin Leonard, Samantha Scalia and Associate Clinical Professor of Pharmacy Practice Christopher Giuliano co-authored a paper titled, “Impact of Pharmacist Involvement in Heart Failure Transition of Care,” based on implementation of a Heart Failure Transition of Care Pharmacy Service.
The Transition of Care team is composed of pharmacy students, residents and pharmacists who optimize care for these patients, and this service demonstrated an impressive 42% reduction in the odds of a heart failure re-admission. WSU Applebaum's Transition of Care (TOC) rotation at Ascension St. John Hospital focuses on effective management of heart failure using a coordinated approach by multiple health care providers.
We asked Dr. Giuliano, rotation preceptors Dr. Leonard and Dr. Scalia, and P4 student Nicholas Panecaldo to walk us through a pharmacy student's experience during the TOC rotation.
Q: Tell us about the Heart Failure Transition of Care rotation.
Dr. Melvin Leonard: The Heart Failure Transition of Care program focuses on HF patients admitted to the cardiac medical floors. The program involves pharmacists, postgraduate year 1 residents, professional years 3 and 4 pharmacy students, and interns. All pharmacy students and interns receive a two-day training, followed by supervised training on the patient care unit under the direction of heart failure TOC clinical pharmacists. Three main interventions are done for all identified patients. These include (1) admission medication reconciliation, which is completed on admission through patient interview, and review of the patient’s refill record and outside medical records, if available; (2) discharge medication reconciliation, where medication discrepancies are addressed and discussed with physicians prior to the provision of patient discharge instructions; and (3) patient or caregiver counseling with a focus on heart failure medications through verbal and written education materials.
Q: What are some examples of issues that arise during TOC?
Dr. Samantha Scalia: The most common issues that occur are related to patients not being started or discharged on the correct medications. Additionally, many patients need more education on the medications they are currently taking.
Q: Why is this TOC training important?
Dr. Christopher Giuliano: We can take amazing care of patients in the hospital but if they are not discharged home on the correct medications and do not understand how to take them, they will not experience the long-term benefits of the medications. We have been able to keep more patients out of the hospital through this program and improve their quality of life.
Q: Tell us about your student experience.
P4 Nicholas Panecaldo: During the rotation, I learned a great deal about heart failure treatment, education techniques, working with a health care team and the movement of patients during their stay at the hospital. I found out early on that a proper medication history allowed for a smooth transition to discharge. Patients and the health care team responded very well with a pharmacy presence and found it very refreshing.
Q: What skills and insight did you gain?
Panecaldo: Performing an admission medication history allowed me to gain insight on patient regimens and identify possible drug-drug interactions or inappropriate drug therapy upon discharge. Many times I would catch duplication of therapies or dose changes that were unintentional, as other providers were not up to date on using the EMR [electronic medical record]. Additionally, I found that it was beneficial for me to practice my medication counseling during this rotation. Overall, I think that this rotation would be excellent for someone to learn about the flow of the hospital, practice medication counseling, better understand heart failure, availability of health care providers for questions and interventions, as well as understanding the impact that a pharmacist can have on patient care.
The Doctor of Pharmacy program at Wayne State University is a four-year curriculum in the heart of Detroit. Approximately 100 students are enrolled in each year of the program. WSU Applebaum information meetings for prospective students take place at 6 p.m. on the first Tuesday of each month. The application process for the Doctor of Pharmacy program begins in July.