Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations

The implementation, benefits, and outcomes of a layered learner model (LLM) using pharmacy students as pharmacist extenders are described.

In 2011, Cleveland Clinic Florida (CCF) implemented a pharmacy practice model change with the goal of providing all inpatients quality pharmaceutical care while still providing key specialty clinical pharmacy services. An LLM was initiated in which pharmacists supervise pharmacy residents and students in a team format in which students are used as pharmacist extenders. CCF partnered with local and regional colleges of pharmacy to increase the number of advanced pharmacy practice experience student rotations at CCF. Students are given accountability for a specific number of patient beds based on their rotation. They are required to perform medication histories, education on drug indication and adverse effects, discharge counseling, targeted disease counseling, and profile review for drug-related problems for their patients. After the implementation of this model, improvements were observed in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores (58% versus 70%, respectively), pharmacy interventions per patient per day (0.9 versus 1.4, respectively), and bedside medication delivery capture rate (48% versus 65%, respectively).

The implementation of an LLM and partnering with local colleges of pharmacy have improved pharmacy practice at CCF by allowing pharmacy students to work as pharmacist extenders in providing comprehensive pharmacy services to many patients who would not otherwise be reached. This approach has improved HCAHPS scores within the "communication of medication" domain, increased overall patient interventions, and allowed expansion of CCF's discharge prescription program.