Interdisciplinary Health Care Teams Research Articles

The Mount Sinai Interdisciplinary Approach to Perioperative Care Improved the Patient Experience for Transgender Individuals.

Although medical care for transgender and gender nonbinary (TGNB) individuals is rapidly expanding, numerous gaps in the organization of quality care for TGNB individuals remain. In 2018, the Mount Sinai Center for Transgender Medicine and Surgery (CTMS) expanded its unified care approach to integrate services with an interdisciplinary inpatient team for surgical patients as part of the program. The inpatient team connected with the existing interdisciplinary ambulatory team with all pertinent medical and psychosocial information shared between the teams. The format enabled the hospital team to better prepare in advance of a patient's arrival and facilitated discharge planning as well. We sought to assess patient satisfaction with inpatient care after implementation of the interdisciplinary operation. The standard Press Ganey survey tool used by the Mount Sinai Health System to measure patient satisfaction with care was queried before and after implementation of the interdisciplinary inpatient care team. Patient ratings of inpatient care rose dramatically. Relative to other institutions nationally, Press Ganey scores rose into the 98th or 99th percentiles across all domains. The new scores represented a rise of 25% for communication with nurses, 3% for hospital environment, 25% for care transition, and 100% for willingness to recommend. The discharge information score represented a 30-fold improvement. An interdisciplinary inpatient health care team can significantly improve patient satisfaction for TGNB patients. Such an approach might be considered for other TGNB health care programs along with health care delivery in other areas of medicine.

300 - Increasing Complexity Awareness of Parkinson Disease Psychosis: Risk Factors, Symptoms, Diagnosing & Management

Background:After Alzheimer’s disease, Parkinson’ disease (PD) is the second most common age-related neurodegenerative disorder globally. Approximately 1 million individuals in the United States (US) have PD; every year 60,000 more Americans are diagnosed. PD is a movement disorder caused by dopamine insufficiency in the substantia nigra. The disease process is complicated by falls, constipation, dysphagia, insomnia, anxiety, depression, and behavioral/cognitive disorders. Upon diagnosis, evidence-based symptom management should include individualized nonpharmacologic and pharmacologic interventions along with lifestyle changes that will promote positive outcomes.More than 50% of persons diagnosed with PD develop psychotic symptoms. Parkinson’s disease psychosis (PDP) is a non-motor symptom and consists primarily of hallucinations and delusions. PDP is caused by neurotransmitter changes in the brain, some related to long-term use of parkinsonian medications. In many cases, PDP symptoms are mis-diagnosed as a chronic co-morbid condition, such as mild cognitive impairment or dementia.Symptoms run from benign to aggressive. Undiagnosed and untreated symptoms can accelerate. Delirium caused by medications or infections may contribute to psychosis. Rapid Eye Movement Sleep (REMS) Disorder associated with PD results in daytime sleepiness and acting out dreams. All symptoms profoundly impact formal and informal care partners. When underlying causes are identified by expert clinicians, symptoms may be reversible. There are many evidence-based paths to follow such as managing polypharmacy, appropriate prescribing patterns, and the effective use of nonpharmacologic interventions.Conclusion:During this symposium the complexities of the disease are addressed including the toll PDP can have on the person living with PD, their care partner(s) and the interdisciplinary health care team. It is imperative clinicians can simultaneously manage the overlapping motor symptoms and PDP to prevent physical and mental disabilities and improve quality of life. After attending this session, clinicians will be able to provide quality care to individuals living with PDP and their care partners.

Impact of Pharmacist Education on Incoming Medical Residents.

Introduction: The graduating medical student transitioning to the role of a first-year medical resident is expected to know the proper medications and dosages for routine patient conditions. Pharmacists on an interdisciplinary health care team can be effective teachers of medical residents. Given the small amount of pharmacy-based education included in medical school curricula, it is important that medical residents have a basic foundation of pharmacotherapeutic knowledge. The purpose of this study was to assess the effectiveness of a pharmacist-led education session in improving medical resident pharmacotherapy knowledge. Methods: During orientation in 2016 to 2019, first-year medical residents completed an 8-item pre-test assessing their choices of medications and dosages on 8 patient conditions. A post-test assessing these same items was taken after a 50-minute lecture from a pharmacist experienced in resident education. First-year medical residents at a separate institution within the university system completed the pre-test only. Results: Overall, 243 medical residents received the lecture and took both tests and 170 medical residents at the other institution completed the pre-test only (100% response rate). Using descriptive statistics, the 2 groups of medical residents were comparable in age, gender, and scores on the pre-test. Medical residents receiving the lecture showed an average 32% point change improvement in performance on the post-test. The pharmacist-led lecture consistently received the highest ratings (4.7 ± 0.5 out of 5) from residents of all the orientation topics presented. Conclusions: A pharmacist-led education session increased the pharmacotherapy knowledge of first-year medical residents at their resident orientation. Medical residents value reinforcement of basic pharmacotherapy knowledge to start their training.

The Effectiveness of Transition Care Interventions from Hospital to Home on Rehospitalization in Older Patients with Heart Failure: An Integrative Review

Heart failure (HF) is one of the common causes of rehospitalization in older people leading to an increase in the number of mortalities, disabilities, and readmission rates. However, there has been a lack of literature reviews on current evidence regarding the effects of transition care interventions (TCI) on rehospitalization before discharge from hospital to home. The current review aims to examine the effectiveness of transition care interventions on rehospitalization within 30-days for older patients with HF. The current review of international knowledge employs the PRISMA guidelines and includes primary studies published between 2011 and 2021 taken from PubMed, CINAHL, PsycINFO, Cochrane, and Scopus. Our review identified 15 relevant studies that together examined 10,701 patients with HF. We found that the effectiveness of TCIs could reduce rehospitalization rates and costs of care. The findings asserted that nurses, pharmacists, and multidisciplinary teams were predominantly provided transition care interventions. In principle, transition care intervention could inform policymakers to develop the current discharge planning practices in older HF patients. Therefore, interdisciplinary healthcare teams and caregivers should develop the transition care interventions with long-term periods before discharge from hospital to their home, particularly for older patients with HF in order to improve their capacity for self-care, quality of care, and promote continuing care.

Advancing team cohesion: Using an escape room as a novel approach

Objective An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p < .001; Wilks’ Λ = .725; partial η2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.

Declaring Uncertainty: Using Quality Improvement Methods to Change the Conversation of Diagnosis.

Diagnostic uncertainty may be a sign that a patient's working diagnosis is incorrect, but literature on proactively identifying diagnostic uncertainty is lacking. Using quality improvement methodologies, we aimed to create a process for identifying patients with uncertain diagnoses (UDs) on a pediatric inpatient unit and communicating about them with the interdisciplinary health care team. Plan-do-study-act cycles were focused on interdisciplinary communication, structured handoffs, and integration of diagnostic uncertainty into the electronic medical record. Our definition of UD was as follows: "you wouldn't be surprised if the patient had a different diagnosis that required a change in management." The primary measure, which was tracked on an annotated run chart, was percentage agreement between the charge nurse and primary clinician regarding which patients had a UD. Secondary measures included the percentage of patient days during which patients had UDs. Data were collected 3 times daily by text message polls. Over 13 months, the percentage agreement between the charge nurse and primary clinician about which patients had UDs increased from a baseline of 19% to a median of 84%. On average, patients had UDs during 11% of patient days. We created a novel and effective process to improve shared recognition of patients with diagnostic uncertainty among the interdisciplinary health care team, which is an important first step in improving care for these patients.

The Design of Voxe: An Electronic Patient-Reported Outcome Measure Platform to Capture Pediatric Transplant Patients’ Voices and Transform Care

Purpose Patient-reported outcome measures (PROMs) are vital to engage patients meaningfully and capture their varied experience. The objective of this research program is to transform care delivery and improve health outcomes for pediatric transplant patients by implementing PROMs into clinical practice. Informed by the results of previous research - Phases 1 (Systematic Review), 2 (Key Stakeholder Interviews), and 3 (Consensus Workshop) - the aim of this study (Phase 4) is to create an electronic PROM (ePROM) platform - Voxe - that will capture and integrate PROM data into clinical care. Methods The ‘user-centric’ approach, in which end-users (i.e., patients and healthcare providers) are central to the design process, has guided the development of Voxe. Study participants include 12 heart, kidney, liver, or lung transplant recipients between 10 - 17 years of age and 16 members of their interdisciplinary healthcare teams. A rapid and iterative testing methodology has been implemented to ‘test, learn and improve’ Voxe prior to coding and launch. The International Organization for Standardization (ISO) model is also being utilized. Results To ensure success, ISO performance indicators are being benchmarked and tracked. During each iteration objective and subjective standards with metrics of (1) effectiveness - accuracy and completeness with which users achieve specific goals; (2) efficiency - resources used in relation to results achieved; and (3) satisfaction - extent to which the users’ physical, cognitive, and emotional responses that result from the use of Voxe meet the users’ needs and expectations are being collected. Using a Desirability Index, patient participants described Voxe as “clear”, “friendly”, “helpful” and “creative” and healthcare providers noted the ease of use of Voxe and its ability to enable “a more patient-centered model of care”. Conclusion The ‘test, learn, and improve’ model enables objective and subjective metrics from patients and healthcare providers to directly influence how Voxe looks and operates to drive adoption and success. Future phases will include usability testing and an implementation effectiveness evaluation of the platform. Ultimately, Voxe leverages eHealth technology as an innovative approach to capture and integrate patients’ voices into their care experience.

Empowering Public Health Pharmacy Practice-Moving from Collaborative Practice Agreements to Provider Status in the U.S.

This article describes the history and evolution of pharmacist-physician collaborative practice agreements (CPAs) in the United States with future directions to support pharmacists’ provider status as the profession continues to evolve from product-oriented to patient-centered care and population health. The pharmacy profession has a long history of dispensing and compounding, with the addition of clinical roles in the late 20th century. These clinical roles have continued to expand into diverse arenas such as communicable and non-communicable diseases, antimicrobial stewardship, emergency preparedness and response, public health education and health promotion, and critical and emergency care. Pharmacists continue to serve as integral members of interprofessional and interdisciplinary healthcare teams. In this context, CPAs allow pharmacists to expand their roles in patient care and may be considered as a step towards securing provider status. Moving beyond CPAs to a provider status would enable pharmacists to be reimbursed for cognitive services and promote integrated public health delivery models.

Examining the hurdles in defining the practice of Nurse Navigators

BackgroundNurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. PurposeA critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. DiscussionNurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. ConclusionNurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.

Factors Associated with Good COVID-19 Preventive Behaviors Among Older Adults in Urban Communities in Thailand.

Introduction/Objectives:The coronavirus disease 2019 (COVID-19) pandemic has affected mobility and mortality entire age, especially older adults. The COVID-19 preventive behaviors among older adults during the pandemic should be determined. To our knowledge, little is known about the preventive behavior during the COVID-19 pandemic among older adults living in urban areas in Thailand and the factors predicted to their behavior. Hence, the present study aimed to assess COVID-19 preventive behaviors among older adults and to identify the associated factors.Methods:This cross-sectional study included 421 participants aged ≥60 years. Data were analyzed using descriptive statistics, binary and multiple logistic regression analysis.Results:We found that 321 (72.6%) of the participants had good COVID-19 preventive behaviors. Moreover, 83.4% of the participants had good family support and 58.2% had easy access to health information. Only sufficient income (odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.04-2.97), easy access to health services (OR: 3.66, 95% CI: 1.42-9.45) and protective material (OR: 1.98, 95% CI: 1.14-3.45), and good family support (OR: 2.05, 95% CI: 1.10-3.82) were associated with good COVID-19 preventive behaviors. In contrast, health literacy, access to health information, and neighbor and health personnel support were not associated with COVID-19 preventive behaviors.Conclusion:Based on the present results, interdisciplinary healthcare teams should consider social support, and access to healthcare when developing interventions for encouraging and promoting health outcomes in order to improve physical and psychological COVID-19 preventive behaviors, particularly among elderly people living in urban communities during the COVID-19 pandemic.

Does an encounter with the ambulatory clinical pharmacist in the transitional setting play a role in clinic attendance and patient engagement?

BackgroundPatient engagement is an important aspect in improving patient outcomes. However, there is a paucity of literature regarding patient engagement in a nonresearch health care setting and the impacts of ambulatory clinical pharmacist interventions. Patient engagement has several definitions making it challenging to assess, but attendance to initial primary care provider (PCP) visits is an important aspect of patient engagement. ObjectiveThe study objective was to assess if improved patient engagement, defined as attendance to an initial PCP visit, was associated with differences in services provided or pharmacist participation during postdischarge clinic appointments. Practice descriptionThe site of this study was the Johns Hopkins After Care Clinic (JHACC), an interdisciplinary postdischarge, safety net clinic in Baltimore, MD. Practice innovationThrough an interdisciplinary health care team including pharmacists, patients received comprehensive care to assist with postacute disease-state management and transitions of care. Evaluation methodsInitial PCP visit attendance after a postacute visit in a high-risk population was evaluated for differing service delivery factors between groups who attended and did not attend their initial PCP visit. Descriptive statistics and chi-square tests were used for analysis. ResultsPatients were statistically significantly more likely to engage in primary care when clinical pharmacy specialists participated in their JHACC appointment (P = 0.02). Medication education and disease-state counseling improved initial PCP visit attendance, both of which are key pharmacist activities. ConclusionThis study suggests ambulatory clinical pharmacy specialists’ roles in an interdisciplinary clinic model correlates with increased attendance to initial PCP visits, a surrogate for patient engagement. Disease-state education and medication education are both important activities in improving this measure; however, additional research is necessary to determine specific pharmacist interventions associated with patient engagement. As research in patient engagement continues, the positive effects of pharmacist involvement in this area could support their value in ambulatory care services.

Pharmacist impact on medication dosing and billable coding accuracy in outpatients with chronic kidney disease

BackgroundAmbulatory care pharmacists can enhance economic and clinical outcomes as part of interdisciplinary health care teams. Patients with chronic kidney disease (CKD) often have complex medication regimens, potentially resulting in dosing errors and drug interactions. ObjectiveTo demonstrate the impact that clinic-based pharmacists may have in populations comprising ambulatory patients with CKD. Practice descriptionCommunity-owned, not-for-profit health system with outpatient, primary, and specialty care clinics. Practice innovationThis quality-assurance, cohort, interventional study included patients aged at least 18 years with a CKD- or end-stage renal disease–associated diagnosis code seen by a clinic primary care provider at least once between January and June 2019. Primary outcomes included the number of medications requiring pharmacist intervention, pharmacist-initiated recommendations, and associated outcomes. Evaluation methodsPatients were randomly assigned to 2 cohorts. Providers of patients in the proactive pharmacist intervention group were notified of pharmacist recommendations immediately after initial data collection. Providers of patients in the group undergoing usual care (control group) were notified of identified medication recommendations after a 3-month period of usual care. Demographics were assessed using descriptive statistics. Differences in CKD staging, number of recommendations made, and provider responses were assessed using the chi-square, Fisher exact, and Mann-Whitney U tests. ResultsA total of 182 patients were eligible for inclusion. In the intervention group, 22.1% of patients were identified as having inappropriately dosed medications versus 19.5% in the control group. In the intervention group, 46 of the 95 patients (48.4%) had an inaccurate CKD stage documented compared with 48 of the 87 patients (55.2%) in the control group (P = 0.772). The rate of pharmacist recommendation rejection substantially decreased between the intervention and control groups’ provider responses (24% to 11.8%). ConclusionPharmacist-initiated recommendations resulted in the identification and resolution of medication-dosing errors and improved collaboration between providers and pharmacists.

Measuring health care quality: Implications, threats, and opportunities for clinical pharmacists

AbstractThe Patient Protection and Affordable Care Act of 2010 has helped usher in an era of focus on health care quality and quality improvement. Since then, a variety of programs has driven quality improvement throughout the health care system using a combination of incentives and penalties. Many studies have demonstrated the value of integrating clinical pharmacist services into interdisciplinary models of care for the purpose of moving the needle on performance measures. The implementation of quality‐linked reimbursement programs has the greatest potential to meaningfully improve quality of care and reduce costs. However, the benefits of quality measures are dependent on their implementation into measurement systems and their application into clinical practice. Common threats to quality measurement in pharmacy practice may arise due to misapplication of health plan‐related measures to evaluate pharmacy services. Additionally, the core concepts related to novel reimbursement models have not adequately percolated into the formal education of practicing pharmacists. Therefore, the goal of this article is to help educate and raise awareness about the current quality landscape and present opportunities and directions for pharmacists to demonstrate their value in interdisciplinary health care teams. This article is broadly divided into four sections—first, we provide an introduction to quality measurement and its application to clinical pharmacists. Second, we elaborate on the development and endorsement of quality measures and measurement systems. Third, we present clinical scenarios of patient care—set in inpatient, ambulatory care, and community practice settings—that engage pharmacists in the context of quality measurement and evaluate the implications, threats, and opportunities for clinical pharmacists in each of these scenarios. Finally, we present recommendations for future advocacy, measurement, and leadership for pharmacist involvement in the quality landscape.

Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes\u2014the INFORM cluster-randomized controlled trial

BackgroundEffective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on goal-setting theory on improving formal staff communication in NHs.MethodsThis pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (translating research in elder care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4641 care aides and 1693 nurses cared for 8766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on goal-setting theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up.ResultsBaseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p = 0.021) and enhanced groups ([0.01; 0.33], p = 0.035). We found no difference in this outcome between the two higher intensity groups.ConclusionsTheoretically informed feedback was superior to simple feedback in improving care aides’ involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested.Trial registrationClinicalTrials.gov (NCT02695836), registered on March 1, 2016

Conflict and interactions on interdisciplinary nursing student teams: The moderating effects of spontaneous communication

BackgroundRecently, empirical researchers have observed direct associations between conflict and interaction behaviors within organizational teams. However, research concerning indirect links between conflict and interaction behaviors on interdisciplinary teams in nursing school is scant, particularly in Taiwan. ObjectivesThe aim of this study was to explore the relationships among various types of conflict and interaction behaviors on interdisciplinary nursing education teams. Design, setting, and participantsThis study utilized a cross-sectional, quantitative, descriptive design. The authors collected survey data from 99 nursing students who participated in 18-week capstone courses of small interdisciplinary groups collaborating to design healthcare products in Taiwan during 2018 and 2019. MethodsQuestionnaires assessed the nursing students' perceptions about their teams' conflicts (of task, process, and relationship), and interaction behaviors (constructive controversy, helping behaviors, and spontaneous communication). The authors used descriptive statistics to compare demographics, conflict scores, and interaction behavior scores for collocated and distributed interdisciplinary teams. A Pearson's analysis identified correlations among the variables and their components, and the SPSS PROCESS macro showed moderating effects of spontaneous communication on the relationship between distributed team and conflict subscales. ResultsAfter confirming the distributed team experienced significantly more conflict than the collocated team, we found significant negative correlations between constructive controversy and both process conflict and relationship conflict on the distributed team. Another interaction behavior, spontaneous communication, had a moderating effect on the relationships between the distributed team and both task conflict and relationship conflict. ConclusionIn interdisciplinary educational settings for nursing students, spontaneous communication may moderate the types of conflict that distributed teams are more likely than collocated teams to experience. Constructive controversy may be especially effective at mitigating conflict on distributed teams. Nursing educators may refer to these insights to improve outcomes for educational interdisciplinary healthcare teams.

Reducing preventable patient transfers from long-term care facilities to emergency departments: a scoping review.

In Canada, there were over 60,000 long-term care facility patient transfers to emergency departments (EDs) in 2014, with up to a quarter of them being potentially preventable. Each preventable transfer exposes the patient to transport- and hospital-related complications, contributes to ED crowding, and adds significant costs to the health care system. There have been many proposed and studied interventions aimed at alleviating the issue, but few attempts to assess and evaluate different interventions across institutions. A systematic search of MEDLINE, CINAHL, and EMBASE for studies describing the impact of interventions aimed at reducing preventable transfers from long-term care facilities to EDs on ED transfer rate. Two independent reviewers screened the studies for inclusion and completed a quality assessment. A tabular and narrative synthesis was then completed. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. A total of 26 studies were included (Cohen's k = 0.68). One was of low quality (Cohen's k = 0.58). Studies were summarized into five themes based on intervention type: Telemedicine, Outreach Teams, Interdisciplinary Care, Integrated Approaches, and Other. Effective interventions reported reductions in ED transfer rates post intervention ranging from 10 to 70%. Interdisciplinary health care teams staffed within long-term care facilities were the most effective interventions. There are several promising interventions that have successfully reduced the number of preventable transfers from long-term care facilities to EDs in a variety of health care settings. Widespread implementation of these interventions has the potential to reduce ED crowding in Canada.

Role of pharmacists during the COVID-19 pandemic in China-Shanghai experiences.

The roles and contributions of pharmacists in Shanghai during the coronavirus disease 2019 (COVID‐19) pandemic are described in this report. Five pharmacists have been appointed as members of an expert interdisciplinary health care team tasked with taking care of all adult patients with COVID‐19 in Shanghai in a designated hospital, the Shanghai Public Health Clinical Center (SPHCC). They work with pharmacists at SPHCC, having responsibilities that include drug supplies, dispensing, pharmacy intravenous admixture services (PIVAS), prescription audits, medication reconciliations, pharmacotherapy, therapeutic drug monitoring, and patient education. Due to the pandemic, pharmacy operations in all hospitals are modified to adhere to guidelines for infection risk mitigation and personnel protection. Community pharmacies serve as the public access point to health care and medical supplies, providing services beyond dispensing and medication counselling. The establishment of internet hospitals (telehealth facilities) provide new opportunities for delivering pharmaceutical care and working with health care professionals. Pharmacists also participate in evaluating new treatments and keeping health care teams informed of new findings for potential treatment considerations. In response to the critical need for health care professionals in Wuhan, 68 pharmacists from different parts of the country went there to work with the local pharmacists. Through assuming new roles and adapting existing practice, pharmacists have acquired invaluable experiences for future practice advancement. In order to assume these responsibilities effectively, pharmacists need to be equipped with the necessary skills for meeting the evolving health care challenges.

Practitioners’ Awareness of Complementary and Alternative Medicine Practices within Interprofessional Healthcare Teams in Institutions

OBJECTIVE The purpose of this research was to explore practitioners’ awareness of Complementary and Alternative Medicine (CAM), broadly, and Music Therapy (MT) activity, specifically, within their healthcare institutions. The goal of this was to better evaluate their level of knowledge and understand their recommending practices of these modalities within their roles as interdisciplinary healthcare team (IDHT) members in those institutions for optimization of patient care decision-making. DESIGN A quantitative, descriptive, exploratory and cross-sectional research design was used to measure practitioners’ awareness of CAM and MT in their healthcare institution utilizing a principal investigator-created valid and reliable tool entitled the “Global Complementary/Alternative and Music Therapy Assessment (GCAMTA). SETTING/LOCATION Data were collected electronically using various social media platforms and from several professional healthcare associations. SUBJECTS A sample of 499 healthcare practitioners participated. RESULTS Solo/group practitioners of small, private practices revealed high awareness (82-94%) of institutional CAM being provided and recommended as opposed to practitioners in larger institutions. Almost half of practitioners (48%) in larger hospital institutions are unaware if CAM is being recommended to patients. Although practitioners have positive or neutral overall impressions of MT, 83% of practitioners do not recommend MT in their current practice. Results of the Chi-Square Analysis were significant; practitioners in smaller, private practices are more aware of their institutional CAM as opposed to practitioners in larger hospital settings (p

Development of an Interdisciplinary Healthcare Team for Pressure Injury Management: A Quality Improvement Project.

The purpose of this quality improvement project was to create an interdisciplinary healthcare team for the management of patients with stage 3, stage 4, and unstageable pressure injuries (PIs), improve the communication among the interdisciplinary healthcare team, test the educational level of the nursing staff regarding PI management, and conduct quarterly PI prevalence surveys to decrease the rate of the hospital-acquired pressure injuries (HAPIs). Patients with stage 3, stage 4, and unstageable PIs in medical adult inpatient units of a private tertiary hospital located in the eastern province of Saudi Arabia were included in the study. During the project period (February 21, 2017, to May 23, 2017), a healthcare team was formed consisting of a hospitalist, a plastic surgeon, a case manager, a dietitian, a physiotherapist, and wound and home health nurses. The team communication and staff adherence to the care plan were measured through an audit tool. Nurses' educational level was measured by pre- and posttest assessments. In addition, a quarterly PI survey day was conducted twice to monitor the occurrence of HAPIs and to reevaluate nursing staff knowledge of management of HAPIs. Results showed improvement in communication within the interdisciplinary team regarding care of patients with HAPIs, with 100% staff adherence to the plan of care. In addition, unit-based educational sessions conducted to measure staff knowledge showed a statistically significant increase (P < .000). Although small, the HAPI rate decreased from 5.9% to 5% during this short 3-month study.

A Pilot Study of Mindfulness-Based Cognitive Therapy to Improve Well-Being for Health Professionals Providing Chronic Disease Care

To assess the efficacy of mindfulness-based cognitive therapy delivered onsite during work hours in reducing stress and improving well-being in an interdisciplinary chronic care health care team. A longitudinal, mixed methods, observational pilot study using a survey created from validated assessment tools to measure effectiveness of training. Surveys were completed before training, and 1 and 15months after training. Twenty-four professionals in the cystic fibrosis Centers at Cincinnati Children's Hospital and the University of Cincinnati participated in 6 mindfulness-based cognitive therapy training sessions. Sessions incorporated mindfulness, cognitive therapy, and experiential exercises for processing feelings related to stress and burnout. The presurvey and 1-month postsurvey responses revealed statistically significant improvements for empathy, perceived stress, depersonalization, anxiety, perspective taking, resilience, and negative affect. Sustained effects were seen at 15months for empathy, perspective taking, and depressive symptoms. The 1-month post-training surveys reported a quarter of respondents (25%) practiced skills at least 5 times in between sessions; at 15months, 35% reported practicing at the same frequency. Participants reported using mindfulness skills for personal stressful events (74%), work-related general stress (65%), patient-related stress (30%), sleep or general relaxation (22%), and wellness (13%). Group mindfulness-based cognitive therapy training was feasible and effective in decreasing stress for interdisciplinary cystic fibrosis care team members who elected to participate. Further investigation is needed to determine optimal dose of training, durability of perceived benefits, and generalizability to health care professionals working with other chronic disorders.