In a novel rotation, pharmacy students directly impact quality improvement

Dr. Paul Morales and Katherine Vu in front of Vu's IMUS IPPE project presentation at a Minnesota Society of Health-System Pharmacists meeting.

Introductory Pharmacy Practice Experiences (IPPEs) aren’t unique in and of themselves, but the University of Minnesota College of Pharmacy’s approach to them is. 

Outside of the minimum required hours students spend dispensing medications in a community or hospital pharmacy setting, pharmacy schools can get creative with how they introduce real-world pharmacy practice to students, said Dr. Andrew Traynor, professor and associate program director of experiential education at the college. In addition to a rotation that focuses on direct patient care, the college offers an IMUS IPPE, which stands for “improving medication use systems.” 

“It's an IPPE rooted in quality improvement and project management,” Traynor said. “There aren't any other IPPEs around the country we know of that are solely focused on students engaging in projects that relate directly to improving quality in patient care.”

Over the course of a semester, students work 80 hours within a quality improvement initiative— a project that “actively moves the needle on improving quality related to patient care in that organization,” Traynor said. The host sites range across community, hospital, and ambulatory pharmacy settings. Students build off what they learn in a foundational course on teamwork, leadership, and continuous quality improvement in pharmacy. 

Katherine Vu, now a fourth-year pharmacy student, completed her IMUS IPPE at M Health Fairview with Dr. Paul Morales, an oncology pharmacist and pharmacy manager. Vu worked on a project analyzing the data and charts of patients receiving two kinds of chemotherapy agents, nivolumab and pembrolizumab, to determine whether the process could be more efficient. Because both agents are infusions of medication, patients had to wait for it to be prepped for administration and additionally wait after receiving the medication to monitor for any reactions. 

“Ultimately we found that if we gave the higher doses to all patients in our study, they would be saving over 300 hours every 6 weeks for pembrolizumab infusions and over 41 hours every 4 weeks for nivolumab infusions. They wouldn't have to keep coming back to these clinics over and over,” Vu said. “Not only did it take up their time, but also the health care team members’ time. There could be less waiting and more healing for all patients.”

Morales said he looks for projects that could have a big impact and that allow IMUS IPPE students to “understand how things flow through the system.” The hospital has used the results from projects of past students on the rotation (e.g., how often to screen for interstitial lung disease) to create new system standards. 

“I think this is a project that you could expect a frontline staff pharmacist to run…it just exposes students to a different mindset from a leadership perspective and there is a void in pharmacy leadership,” Morales said. “Students bring unique outside perspectives. I've been doing cancer care for 15 years, so I don't question things that [Katherine] will— sometimes that'll bring fresh perspectives and new ideas to the table.”

During her third-year IMUS rotation, which also took place at M Health Fairview, student Jenna Salay was assigned to a project with Dr. Diana Langworthy, a clinical pharmacist and associate professor at the college. Salay conducted a literature review of papers on Cystatin C (a protein often used to measure kidney function) that determined dosing guidelines for common, renally-dosed antibiotics.  

Langworthy said the rotation offers students the opportunity to understand how projects run and garners interest in the work of pharmacists, as well as the importance of quality improvement in health systems. Salay’s work on the project provided historical data on pharmacokinetic studies that will be used to present the case for implementing a new Cystatin C standard at the hospital.

“Seeing this side of pharmacy and the work behind the care that we're able to give— that's so valuable to experience as a part of our career and it not only advances what we're doing, but projects like this are what makes our care even better for our patients,” Salay said. “And I know that's not an experience we can get through other IPPEs, especially having this freedom. I think that's what really makes it valuable.”