Manish Khullar Richard Slavik Sean Gorman Nicole Bruchet Sarah Murray Brett Hamilton Dawn Dalen

1. Contribution of Hospital Pharmacy Residents to Resolution of Drug Therapy Problems for Patients: RES-DTP Study Manish Khullar Richard Slavik Sean Gorman Nicole Bruchet Sarah Murray Brett Hamilton Dawn Dalen

2. Background • Clinical pharmacists resolving drug therapy problems (DTPs) for patients improve clinical and health economic outcomes • A Canadian National Working Group has recommended 8 clinical pharmacy key performance indicators (cpKPI) to advance pharmacy practice and improve patient care Makowsky MK, et al. Med Care 2009;47:642-650. Gillespie U, et al. Arch Intern Med 2009;169:894-900.

3. Background • Performing admission medication reconciliation • Participating in inter-professional patient care rounds • Initiating a pharmaceutical care plan • Resolving drug therapy problems (DTPs) • Providing in-person disease and medication education • Providing discharge medication education/counseling • Performing discharge medication reconciliation • Providing bundled, proactive patient care Fernandes O, et al. Pharmacotherapy 2013; 33(10):e208.

4. Background Total DTP • Any DTP resolved by a pharmacist DSEM-DTP • DTP resolved for a condition covered in priority disease state education modules (DSEMs) DSEM-KPI • A key pharmacist intervention proven to reduce morbidity, mortality, or health resource utilization for that disease

5. Background • Pharmacist-resolved DTP is a key clinical performance indicator for IH Pharmacy Interior Health DTP Tracker Data (Jan 1 – Dec 31, 2013)

6. Rationale • Resolving impactful DTPs for priority patients is a major professional development goal for the IH Pharmacy Practice Residency Program • Limited data suggest that U.S. entry to practice PharmD students and residents may contribute to clinical care during experiential rotations Mersfelder TL, et al. Pharmacotherapy 2012; 46:541-548. Taylor CT, et al. Ann Pharmacother2000; 34:843-846.

7. Rationale • There are no data on the contribution of Canadian pharmacy practice residents to resolved DTPs during experiential rotations • A recently completed IH study identified discordance on the perception of IH resident contributions to DTP resolution

8. Objectives • To describe the contribution of IH pharmacy practice residents to clinical pharmacy care using resident-resolved DTPs • To describe resident satisfaction with tracking their resolved DTPs

9. Methods Design • Prospective, observational, one group study Setting • Kelowna General Hospital (KGH), Royal Inland Hospital (RIH), Penticton Regional Hospital (PRH), East Kootenay Regional Hospital (EKH) and Kootenay Lake Hospital from Sept 2, 2013 to Jun 13, 2014

10. Methods Inclusion Criteria • DTP Tracker data collated from 4 IH pharmacy practice residents after completion of the first 4-week patient care rotation (i.e. Internal Medicine) Exclusion Criteria • DTP Tracker data that is uninterpretable or incomplete

11. Methods Primary Outcome • Number of resident-resolved DTPs Secondary Outcomes • Number of resident-resolved DSEM-DTPs • Number of resident-resolved DSEM-KPIs • Progression of resident-resolved DTPs, DSEM-DTPs, and DSEM-KPIs over time • Survey feedback on resident satisfaction with training, usability, efficiency, and time of DTP tracking

12. Results *Interim analysis of 12 clinical rotations (50%) for 4 residents: Internal Medicine, community medicine, rural medicine (2), ambulatory care (2), nephrology (2), cardiology (3), critical care

13. Results Monthly Counts #4 #5 #1 #2 #3 #6 Rotation

14. Results DTP Tracker Satisfaction Survey Satisfaction Ratings Training Usability Efficiency Time Survey Domains

15. Conclusions • IH Pharmacy practice residents are resolving DTPs, DSEM-DTPs, and DSEM-KPIs • Resident interventions have increased over time throughout the residency year • Resident interventions would be expected to improve clinical and health economic outcomes for patients • DTP tracking by residents was well-accepted based on training, usability, efficiency, and time requirements