Orientation to the Interprofessional Teaching Clinic (IPTC)

Orientation to the Interprofessional Teaching Clinic (IPTC)

Orientation to the Geriatric Interprofessional Assessment Clinic (GIAC) 1 What is IPE? World Health Organization defines Interprofessional Education (IPE): When students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.1 World Health Organization (WHO). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization. 2010. 1

2 Interprofessional Collaborative Practice Competencies Values and Ethics Roles and Responsibilities Interprofessional Communication Teams and Teamwork Link to Competency Document IPEC Report 2011, Updated 2016 3

Pharmacy Occupational Therapy Social Work Physical Therapy Medicine Dietetics Silod Approach to Healthcare 4 Pharmacy

Occupational Therapy Physical Therapy Interprofessional Collaborative Practice Nursing Medicine Shared Leadership Team Huddles Alternative Presentation Styles Patient Partnership Transparency 5

We are a collaborating site with the National Center for Interprofessional Practice and Education 6 Geriatric Interprofessional Assessment Clinic is a unique interprofessional clinic in which you will be introduced to interprofessional team care of older adults. The clinic involves students from Schools of Medicine, Pharmacy, Social Welfare and Health Professions. 7 In the GIAC Students care for complex, older adult patients as an interprofessional team and are supervised by interprofessional faculty members.

Students build upon their own professional training to work and learn together as a team. Students gain an understanding of the roles of other health professions and how they can work collaboratively to optimize patient care. 8 GIAC Orientation The GIAC runs one half-day per week on Wednesday afternoons. In the Fall and Spring semesters we have: Medicine SW OT Pharmacy Dietetics and Nutrition In the Summer we have Medicine and PT.

9 Where is the clinic located? The clinic is located in the Landon Center on Aging - 3599 Rainbow. (NE corner of 36th and Rainbow) For your first clinic date, be in clinic by 12:30pm for orientation. After the first day, plan to be in the clinic by 12:45pm. 10 What should we wear? Please wear typical outpatient clinic attire. Please wear your name badge or name tag. 11

GIAC Orientation Faculty Medicine: Shelley Bhattacharya DO, MPH and Denise Zwahlen MD Physical Therapy: Laura Hughes Zahner PT Pharmacy: Crystal Burkhardt PharmD Dietetics and Nutrition: Nick Marchello MS, RD, LD Occupational Therapy: Jane Hughes OTD, OTR/L Social Work Myra Hyatt LSCSW, LCSW 12 GIAC Orientation Prior to coming to GIAC each week, please review Dr. Bhattacharyas and Dr. Zwahlens patient schedules for the session. The domain name for the GIAC is UKP-LCOA FAM MED. Not all students have familiarity with O2 , so

you may need to help guide them through the electronic chart. 13 GIAC Orientation There is a white board with patient names listed on it. Each student will sign up for 1-2 patients. Learners from other professions will also sign up to see these patients. Learner sign-ups should be based on the needs of the patients for that encounter. There will typically be no more than 3 learners in the room for each patient encounter. One of the learners needs to be a medical student, with the other learners chosen based on the patient needs. 14 GIAC Orientation

Prior to interviewing your patient visit, perform a 5 10 minute pre-huddle with the team. During your prehuddle, be specific as to who will do what part of the history and exam. There are dry erase boards hanging on the wall near the schedule for your use/convenience. You will have 30 minutes to see the patient including obtaining the history and review of systems, as well as performing a goal-directed physical exam. Please structure your interview so that the ideas and goals of the team are integrated together during your pre-huddle. 15 GIAC Orientation (cont.) At 30 minutes, you will hear a knock on the door. This signifies that you need to wrap up and move into post huddle. Please finish what you are doing and exit the room. If you havent begun the physical exam, go ahead and exit. The physical exam can be done with the faculty after your presentation to them.

Med students: for your review of systems, most of it should be gained from your history. So, you should not need to go through each system during that part of the interview. That can be a big time-saver! If you feel like you need orthostatic blood pressures, point of care tests (A1c, BS) or a urinalysis, as you identify this, inform nursing so that they can get started. You dont have to wait for the official order from us. This will save time. 16 GIAC Orientation (cont.) After coming out of the room, post-huddle with your team for a few minutes and decide how you are going to share the patient presentation with your preceptor team. If you have extra time, as when the Attending is not out of the previous patients room, consider needed testing such as TUG (Get Up and Go), GDS or SLUMS. After discussion with the preceptor team, Dr. Bhattacharya or Dr. Zwahlen and the learner team will enter the room

together, summarize the plan, answer questions and end visit. Total time per patient should take no more than 60 75 minutes. 17 Standardized Patient Encounter Evaluation Rubric (SPEER) Students may be observed via a live video-feed while in the patient room to allow reflective feedback of the teams patient and interprofessional interaction. This will help facilitate growth as interprofessional providers and ultimately provide better patient outcomes. Please watch video below to learn more: https://www.youtube.com/watch?v=YJbsWxYmukU&feature=youtu.be 18 IPTC Workflow General flow in

the GIAC IP Team Huddle IP Team Doc and Debrief IP Patient Encounter IP Patient Encounter IP Team Huddle Present to IP

Preceptor(s) 19 IPTC Workflow START HERE Form an IP team, and assign yourselves to a patient. IP Team Huddle IP Team Doc and Debrief

IP Patient Encounter IP Patient Encounter IP Team Huddle Present to IP Preceptor(s) 20 IPTC Workflow START HERE

Students form an IP team, and assign yourselves to a patient. Students review chart TOGETHER and determine roles/ responsibilities. IP Team Huddle IP Team Doc and Debrief IP Patient Encounter

IP Patient Encounter IP Team Huddle Present to IP Preceptor(s) 21 IPTC Workflow START HERE Form an IP team, and assign yourselves to a

patient. Review chart TOGETHER and determine roles/ responsibilities. IP Team Huddle IP Team Doc and Debrief IP Patient Encounter IP Patient Encounter

IP Team Huddle Communicate in a patient-centered manner as a team. Present to IP Preceptor(s) 22 Before the Patient Encounter All students will be given access to the patients charts in the electronic health record system (O2), for the purposes of GIAC only. Although you have access to the charts, it is important to

huddle with your IP team prior to seeing the patients, to define your contribution to the visit and to determine the teams plan when in the patient room. When reviewing the chart: Click on the patients name on the provider schedule and choose Review from the toolbar directly above the schedule The faculty or prior GIAC students will walk you through this on the first day of the clinic or beforehand 23 During the Patient Encounter Upon entering the patient room, the team should introduce themselves or designate one member to introduce the team members, their professions, and provide an elevator speech about the team-based approach. Elevator Speech example: Hello, Mr. Smith. Welcome to the Geriatric Interprofessional Assessment Clinic or the

GIAC. (Introduce yourselves and your profession.) Are you familiar with the GIAC ? We provide team-based care. Along with your input, each one of us is here to provide expertise and to come up with a care plan that suits you and your wellbeing. Ask patient to share reason for visit, limit to 3 problems for that visit; match to reason for appt. 24 IPTC Workflow START HERE Form an IP team, and assign yourselves to a patient. Review chart TOGETHER and

determine roles/ responsibilities. IP Team Huddle IP Team Doc and Debrief IP Patient Encounter IP Team Huddle IP Patient Encounter

Communicate in a patient-centered manner as a team. Develop Assessment and Plan as a team. Present to IP Preceptor(s) 25 IP Team Huddle These patients are coming in to see a geriatric physician but know they will be working with an IP team. Use the huddle time as a team to determine the plan for what each team member will do in the room as it seems appropriate

for the patient. There may be shared roles and responsibilities, and thats ok. Sometimes though, the plan changes or needs to adjust organically during the actual patient encounter. You will learn to adapt quickly. It is important to engage as fully as possible to provide the best patient care, and to benefit optimally from this opportunity. 26 IPTC Workflow START HERE Form an IP team, and assign yourselves to a patient. Review chart

TOGETHER and determine roles/ responsibilities. IP Team Huddle IP Team Doc and Debrief IP Patient Encounter IP Team Huddle IP Patient Encounter

Present to IP Preceptor(s) Communicate in a patient-centered manner as a team. Develop Assessment and Plan as a team. Involve all professions in the presentation, if possible. 27

Patient Presentation Use SBAR as your communication tool within your team in the post-huddle When you present to the faculty, present the recommendations first, supported by why your team chose this approach All team members should participate in the patient presentation, including those that dont identify any concerns from their professional stand point. 28 IPTC Workflow START HERE Form an IP team, and assign yourselves to a

patient. Review chart TOGETHER and determine roles/ responsibilities. IP Team Huddle IP Team Doc and Debrief Return to the patients room with team and preceptor(s)

IP Patient Encounter IP Team Huddle IP Patient Encounter Present to IP Preceptor(s) Communicate in a patient-centered manner as a team. Develop Assessment and Plan as a team.

Involve all professions in the presentation, if possible. 29 IPTC Workflow START HERE Form an IP team, and assign yourselves to a patient. Review chart TOGETHER and

determine roles/ responsibilities. IP Team Huddle Each profession should be represented in the patient note as is appropriate. Return to the patients room with team and preceptor(s) IP Team Doc and Debrief

Student or preceptorinitiated debriefing may take place at any point during the clinic. ALL students will debrief with the preceptors at the end of clinic every week. IP Patient Encounter IP Team Huddle IP Patient Encounter Present to IP Preceptor(s)

Communicate in a patient-centered manner as a team. Develop Assessment and Plan as a team. Involve all professions in the presentation, if possible. 30 Interprofessional Debriefing Expectations During the clinic day, there will be opportunities to dialogue intentionally about the interprofessional aspects of your GIAC experience. It is ideal to have these conversations with your interprofessional team.

You can initiate these conversations or they may be initiated by preceptors from any of the professions. Why? These conversations and related reflections help to make explicit what might be implicit, actualize the learning and assist with translation to future practice experiences. Students have found greater satisfaction with their GIAC experience when they participated in intentional debriefing around interprofessional concepts. We expect that students spend some time each day they are in the GIAC debriefing about concepts or experiences with interprofessional collaboration and/or teamwork. Again, this may be preceptor-initiated or student-initiated. 31 When to Debrief? Opportunities for these conversations in the clinic work Possible Debrief flow could include: After the IP Team Huddle IP Team

regarding a patient who has Doc and not yet been roomed. Debrief After the patient encounter and IP Team Huddle but before reporting out to preceptors. After the patient visit has ended during the Doc and IP Patient Debrief, but before you select a Encounter new patient. Whenever seems appropriate. All students will debrief together at the end of clinic. IP Team Huddle

Possible Debrief IP Patient Encounter IP Team Huddle Present to IP Preceptor(s) Possible Debrief 32 Interprofessional Collaborative Practice How did that feel? What went well?

What could be improved? Values and Ethics What were the benefits or challenges of working in an interprofessional team? How has working together influenced your respect for one another? What values related to patient care do you share with your interprofessional colleagues? Roles and Responsibilities What surprised you (or what did you learn) about the role of another team member today? What instances of role blurring or shared competency between professions have you observed? Interprofessional Communication How was the openness and inclusivity of the team to all professions and the patient/family voices? In what ways could communication have been improved during the visit? Teamwork What promoted or discouraged teamwork today? What TeamSTEPPS principles or tools were used or could have been helpful? (Situation Monitoring, Mutual Support, SBAR, CUS, Briefs, Huddles, etc.) What did you notice about leadership today? How did it influence interactions or outcomes? Summary How does what you are learning about interprofessional collaboration affect patient care? How are your perceptions of interprofessional collaboration changing or staying the same?

What is a take-home point that you can apply to your future interprofessional collaborations? 33 A team is a small number of people with complimentary skills who are committed to a common purpose, performance goals and approach for which they hold themselves mutually accountable. 34 What should we expect from your team?

Because these are Family Medicine patients, they come in for a variety of reasons. Common reasons for patient visits: Chronic Disease Management Emergency Room Follow-up Hospital follow-up Geriatric consult Establish care Many times, these patients face multiple health challenges (and often psychosocial challenges). Having an IP team can address more issues. Always consider what you and the other team members can recommend given each patients priorities and circumstances; their context is important. Learn about other professions roles and responsibilities related to patient care Learn about other individuals approaches to patient care and communication Actively engage throughout the visit, with your interprofessional peers, as a team

contributing through your professional lens. 35 Physical Therapy Student Expectations As a PT student in this clinic, Laura Hughes Zahner will schedule a meeting with you prior to the GIAC to: Answer any questions you might have after reviewing this Orientation Orient you to O2 (electronic health record) and ensure you have access Discuss Day One, more specifically relevant to you Many times, the PT student can perform parts of the Subjective exam (called history by medical students) and the Objective exam (or physical exam), as it seems appropriate for the patient, and is decided upon before going into the patients room with your IP colleagues. 36

Other PT roles These visits are a great opportunity to: Ask PT-related subjective exam questions, as is helpful for the team/patient Perform PT-related objective examination, as is helpful for the team/patient Educate patients as might be helpful to them Give simple tips and/or exercises as needed Determine whether or not a patient could benefit from a referral to PT (e.g. JaySTART program) or other related services Assist with documentation related to the PT component of the patients visit that day 37 Occupational Therapy Student Expectations As an Occupational Therapy Student in this clinic your role is to engage the patient in an occupational profile to determine if there is a disruption in their daily life as it pertains to the visit that day.

Review the EHR in O2 for each patient assigned to you and identify OT needs in preparation for meeting with your team and the patient. Provide onsite OT recommendations to the team which can range from referral for services, consultation or specific intervention recommendations. Medical Student Expectations As a Medical student in this clinic, you will be responsible for charting in the room while seeing the patient. Use the Notewriter template in O2. Talk to your IP team about anything they would like to add to the note. Dont expect to give the typical SOAP format presentation. It will change based on your team. Learn about other professions roles and responsibilities related to patient care. Its OK if another profession takes the lead. Learn about other individuals approaches to patient care and communication.

39 Dietetics Student Expectations As a Dietetics intern in this clinic, you should assess the patients EMR (prior to GIAC clinic) for PMH regarding aspects of medical nutrition therapy. Dietetic interns should actively participate in all interprofessional activities, including A) sharing info derived from prior EMR evaluation B) devising a plan with teammates for the interview C) asking pertinent questions during the interview process

D) actively contributing to the post-huddle plan development E) contributing to the physician debrief F) actively participating in the planned intervention G) actively contributing to the post-round debriefing session. 40 Social Work Student Expectations The Social Work student will call each patient prior to their visit to complete a social history TEAM: Please review their note prior to seeing each new patient Social Work student will complete or help you complete a GDS and SLUMS/MOCA when deemed necessary Social work student will identify resources 41 Pharmacy Student Expectations Serve as the medication expert for the team and patient

Prior to the visit, complete a comprehensive medication history through review of the patients chart and reconcile outside medication information During the visit they will Identify the medication management system in place Understand high risk medications used Identify medication-related problems and contribute to medication and non-medication treatment plan development Provide education to team and patient/caregiver on medications (starts, adjustment, discontinuation, etc.) Assist in documentation related to Pharmacy components of the visit (current medication & Patient Instructions) 42 GIAC Ground Rules for All Professions Faculty and students are responsible for creating A safe and supportive environment for learning A patient-centered environment whereby patients

are treated with respect inside and outside the patient room. A collegial environment within which we speak to one another with mutual respect and have the courage to resolve conflict. 43 GIAC Ground Rules for All Professions Wed like for every student to be able to Contribute to patient encounter as determined by pre-huddle discussion Present the patient to the team and preceptor(s) Receive feedback from interprofessional preceptors Participate in interprofessional debriefing opportunities 44

GIAC Ground Rules for All Professions We encourage every student team to Seek learning from all preceptors Check in with the interprofessional preceptors while formulating your plan Determine not only what your plan is, but how the plan will be communicated to the preceptor and patient 45 GIAC Survey You will receive a survey at the end of your time in GIAC about your Interprofessional experiences. Thank you in advance for taking the time to complete these surveys. Your feedback is greatly appreciated! 46

Questions? 47 Thank you for your attention! 48 References 1) Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. 2) TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety. Agency for Healthcare Research and Quality. U.S. Department of Health and Human Services.

http://www.ahrq.gov/professionals/education/curriculum-tools/tea mstepps/index.html 3) General Interprofessional Debriefing Questions Facilitator Guide. University of Kansas Medical Center. Josiah Macy Jr. Foundation. Interprofessional Learning in Practice: https://nexusipe.org/misc/preceptors-nexus/materials/General%20In terprofessional%20Debriefing%20Facilitator%20Guide%28Updated-O ct-16%29.pdf

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