Assessing the Impact of a Layered Learning Practice Model on the Delivery of Clinical Pharmacy Key Performance Indicators within an Oncology Unit of a Tertiary Care Centre.

Abstract

Background: The layered-learning practice model (LLPM), within which a pharmacist supervises both a pharmacy resident and student, mitigates the growing demand for clinical rotations accompanying the national expansion of Doctor of Pharmacy programs. A Canadian collaborative of hospital pharmacists established consensus on eight clinical pharmacy key performance indicators (cpKPIs), activities associated with improved patient outcomes. With increased implementation of the LLPM alongside cpKPI measurement across institutions, this offers opportunities to evaluate pharmaceutical care delivery in the LLPM compared to standard practice. Objective(s): To quantify clinical productivity, as measured by the proportions of eligible patients receiving cpKPIs and the absolute number of completed cpKPIs, across scenarios during which pharmacists work with or without pharmacy learners. Methods: In this retrospective observational study, pharmacy students, pharmacy residents and pharmacists recorded completion of 7 cpKPIs for oncology inpatients over a 6-month period. Clinical productivity was described across scenarios when the following pharmacy professionals were present: i) pharmacist(s) with student(s) and a resident (‘P-R-S’); ii) pharmacist(s) with student(s) (‘P-S’); iii) pharmacist(s) alone (‘P’). Results: During the study, there were 685 recorded admissions under the inpatient oncology service. Generally, scenarios with pharmacy learners present provided cpKPIs to similar proportions of patients compared to standard practice. Standardized to 20 pharmacist work days, the total number of cpKPIs 1,2,3,5,6,7 (‘P-S’=281; ‘P-R-S’=255; ‘P’=258) and resolved drug therapy problems (DTPs) (‘P-S’=180; ‘P-R-S’=153; ‘P’=149) were similar across the scenarios. Scenario ‘P’ had fewer admitted patients per pharmacist work day (3.2) compared to Scenarios ‘P-S’ (3.4) and ‘P-R-S’ (3.7), which potentially contributed to a trend towards greater proportions of patients receiving cpKPIs in Scenario ‘P’. Conclusions: Compared to standard practice, integration of pharmacy learners within an oncology unit does not appear to impair clinical productivity, as demonstrated by the comparable proportions of patients receiving cpKPIs and total number of completed cpKPIs.