Practice Spotlight: Collaborative Patient Care

26 Nov

The stroke rehabilitation team at the Toronto Rehabil­itation Institute provides a multidisciplinary, team- based, patient-focused, collaborative approach to patient care. Barb Coulston, a pharmacist, and Cynthia White- head, a physician, have worked closely together for 6 years as part of this team.

The Neuro Rehabilitation Program, Stroke Service, is a 24-bed inpatient service providing high-tolerance, short-duration rehabilitation, with an average length of stay of 6 weeks. The team consists of a physician, a physiatrist, pharmacists, nurses, occupational therapists, physiotherapists, speech language pathologists, social workers, a dietician, a community resource worker, and a chaplain. The team’s approach to rehabilitation is based on the patient’s goals for therapy, with each team member striving to assist the patient in reaching his or her individual targets.
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Ms Coulston’s main goal (and that of other pharmacists working with the unit) is to reconcile any discrepancies in patients’ medication histories, as they first move from acute care to rehabilitation and then transition back to the community or to a long-term care facility. During the medication reconciliation process at the time of admission to the stroke unit, both Dr Whitehead and Ms Coulston perform their respective histories and assessments, sometimes interviewing the patient together. They write the admission orders together, which allows them to collaboratively resolve medication issues, prevent unintentional medication errors, proactively plan for any potential medication issues at the time of discharge, ensure that best practices for the secondary prevention of stroke are in place, and plan for any potentially emerging patient care issues and required follow-up.

Each day, the stroke service pharmacists and physician together review and assess patients’ monitor­ing parameters and the results of laboratory tests; they also liaise with other members of the patient’s stroke rehabilitation team and with the patient’s family or caregivers. In addition, the pharmacists’ daily work includes assessing and preventing drug-related problems; assisting patients to become more functional in taking their medications correctly, accurately, and safely; providing seamless care by partnering with community pharmacists and family physicians; providing drug information to the multidisciplinary team; and providing medication education to patients, families, and caregivers. kamagra jelly uk

Weekly medication review rounds allow the attending physician, physiatrist, and pharmacists to review each patient’s medication regimen. This joint review allows ongoing evaluation of patient outcomes, monitoring of therapeutic parameters, streamlining of regimens for patient self-medication and for discharge, resolution of potential postdischarge medication issues, and prepara­tion of prescriptions for discharge medications (i.e., medication reconciliation on discharge). Together, Dr Whitehead and Ms Coulston have created templates for “Dear Doctor” letters and other template memos for communication with family doctors and community pharmacists related to drug benefits covered by the Ontario Ministry of Health and Long-Term Care. Many of the individual “Dear Doctor” letters are written jointly to ensure that the transition back to the community is thorough and seamless.

Both Ms Coulston and Dr Whitehead have found that the Stroke Service team is one of the most success­ ful, effective teams with which they have collaborated. The team members, many of whom have worked together for a long time, represent a true community of practice with a wealth of experience. The team’s well-established structure and practices allow newer members to quickly learn what is expected of them. The team is a self-reflective one, and members of the team continually strive to improve their communication and collaboration skills with each other and to advance their practice for the benefit of their patients. Students from all health disciplines, including pharmacy students in the Structured Practical Experience Program (SPEP) and pharmacy interns, rotate through the Stroke Service, participating in unique interprofessional education programs and gaining valuable exposure to a collaborative physician-pharmacist relationship.
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Ms Coulston has found that working with the Stroke Service has enhanced her clinical and collaborative skills and given her insight into the physician’s approach to patient care while enhancing her own leadership, team-building, and teaching skills.
Dr Whitehead has been able to reflect upon her passion for facilitating and supporting well-developed, highly functioning patient health care teams. This has allowed her to engage in research and teaching related to interprofessional collaboration and education, with a focus on physician-related issues and barriers in this regard.

Ms Coulston and Dr Whitehead have used their shared clinical model of patient care in their work as cofacilitators for interprofessional teaching at the Faculty of Rehabilitation Medicine, where they serve as role models and teach future graduates the importance of collaborative practice. Throughout their years of working and reflecting on their practice together, they have come to realize the importance of sharing their experience with others. They are both confident that similar models of physician-pharmacist collaboration could be of value in many other clinical practice areas.
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