title: From Pilot to Practice: A Trainee-Integrated Pharmacy Practice Model in Cardiology.
abstract: OBJECTIVE
  Problems related to medication use portend poor outcomes, but resources for expanding clinical pharmacy services are limited. We conducted a pilot study in the area of cardiology to determine the impact and feasibility of a trainee-integrated pharmacy practice (TIPP) model comprised of pharmacy residents and a clinical pharmacist.
  
  
  METHODS
  Coverage of 2 acute care and 1 intensive care team was distributed among 1 clinical pharmacist and 3 pharmacy residents. Patient care services included interdisciplinary rounds, order verification, medication reconciliation, counseling, clinical monitoring, and documentation. A pharmacy technician collected medication histories for newly admitted patients. Data related to medication reconciliation, clinical interventions, and time requirements were collected. Clinical services were compared to historical controls where data were available.
  
  
  RESULTS
  Over the 18-day pilot study, the mean daily census consisted of 33.4 ± 5.3 patients. Admission medication reconciliation was performed on 8.1 patients per day, resulting in the discovery of 3.5 discrepancies per patient. Of 18 patients receiving anticoagulant therapy, 9 were counseled prior to discharge. Compared to historical controls, the number of patients receiving medication reconciliation and discharge counseling improved by 81% and 70%, respectively (both P < .05). A total of 763 clinical interventions were recommended (42.4 per day), with many recognized in peer-reviewed literature as conferring improvements in clinical outcomes. Members of the model were active for a mean of 10-12 hours each day, with 6.3-7.2 hours corresponding to direct patient care.
  
  
  CONCLUSIONS
  This was a single-arm, observational pilot study.
  
  
  CONCLUSIONS
  Implementation of a TIPP model significantly expanded clinical pharmacy services on an acute care cardiology service, but it required significant time commitments.
authors.affiliation: assistant professor, Department of Pharmacy Practice, Feik School of Pharmacy, University of the Incarnate Word, San Antonio, Texas.
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Kalich
authors.affiliation: clinical pharmacy specialist, Department of Pharmacy, UNC Health Care, Chapel Hill, North Carolina.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Cicci
authors.affiliation: assistant director of pharmacy, Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
authors.forename: Shailly
authors.initials: S
authors.lastname: Shah
authors.affiliation: assistant professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland breed@rx.umaryland.edu.
authors.forename: Brent N
authors.initials: BN
authors.lastname: Reed
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000458:organization & administration; D009657:North Carolina; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010865:Pilot Projects
chemical_list: D002317:Cardiovascular Agents