The Portal of Geriatrics Online Education

Pharmacology/Toxicology

Palliative Care of a Patient with End-Stage Liver Disease: An Unfolding Case Study

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
2
Abstract: 

This case study was developed for use in academic coursework and as a standalone training for health care providers (MDs, ARNP, Pharmacists, Social Workers, Nurses). This unfolding case study about the management of an adult in the midst of a health crisis. This case is a composite of many actual cases seen in clinical practice. During the course of this case study, learners are presented with information as the providers learn of the patient’s emergent and ongoing health concerns – from his Emergency Department admission through the development of his palliative care plan. Learners are asked to make decisions and use their best judgment about how to care for this patient and family.

Educational objectives: 

By the end of this case study, the learner will be better able to:

  1. Understand the natural history and disease management of end stage liver disease (ESLD).
  2. Use evidence-based practice to collaboratively develop and refine goals of care for patients with chronic, progressive conditions.
  3. Work interprofessionally to ensure the best quality of care for the patient and family.
Date posted: 
Fri, 09/14/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 08/15/2018
Contact Person/Corresponding Author:



Suggested Citation:
Palliative Care of a Patient with End-Stage Liver Disease: An Unfolding Case Study. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/223

Interprofessional Didactic on Medication Reconciliation for Medical and Pharmacy Students

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Introduction
Medical schools are now required to include interprofessional training in which students collaborate with other healthcare professionals. This interprofessional didactic session was created by a pharmacist and physicians to teach a group of medical and pharmacy students about medication reconciliation.
Methods
A physician and pharmacist collaborated to deliver this 50-minute PowerPoint didactic during second-year medical students’ clinical skills course. Participating students included second-year medical students at the author’s institution, plus all pharmacy students rotating at the institution on the day of the didactic, since the author’s institution does not have its own pharmacy school. The didactic consists of lecturing, interprofessional small group work on cases, and large group discussion. Students were surveyed after the didactic to assess their attitudes about the session.
Results
A total of 63 students (54 medical and 9 pharmacy students) attended this didactic. Survey response rate was 58/63 (92%). On a 5-point Likert scale (1=Strongly Disagree, 5=Strongly Agree), students generally agreed that the lecture was valuable (mean +/- SD 4.7 +/- 0.5), provided new information (4.4 +/- 0.7), and should be continued for future students (4.7 +/- 0.5). Students also agreed that their school should have more interprofessional didactics (4.6 +/- 0.6).
Discussion
This 50-minute interprofessional didactic for medical and pharmacy students was highly valued by students, and provides a valuable setting for interprofessional education. This interprofessional didactic can be replicated at other institutions, including medical schools that do not have an on-site pharmacy school.

Educational objectives: 

By the end of this activity, learners will be able to:
1. Appreciate the difficulties many patients have with taking medications appropriately.
2. Describe how to approach patients in a collaborative, nonthreatening manner about their medications.
3. Identify how to appropriately obtain and document a patient’s complete medication list.
4. Appreciate the importance of maintaining an accurate medication list during times of transitions of care.
5. Appreciate the value of interprofessional learning.

Date posted: 
Thu, 02/15/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 02/15/2018
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Didactic on Medication Reconciliation for Medical and Pharmacy Students. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/223

Hacking Geriatrics: The World 2 Challenge

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
0
Abstract: 

The World 2 Challenge is an innovative quality improvement competition designed by our Reynolds Next Steps team, based on the concept of a healthcare hackathon.  We partnered with institutional leadership in our health system, graduate medical education leadership, nursing, physical therapy, pharmacy, and other interprofessional representatives to design a platform to promote friendly competition led by specialty faculty, fellows, and residents to improve the quality of care for older adults. In the process, they learn key principles of geriatrics and how to apply them at a broader level across the institution. Our first competition in April 2016 focused on improving communication at transitions of care for older patients.  At a retreat, 9 QI project "pitches" were delivered to a broad interprofessional audience, 5 were chosen by a voting process and developed their ideas further through interprofessional team collaboration. Ultimately, 2 project ideas were selected to go forward, and the ultimate winner of the QI competition will be the project with the most successful implementation and the broadest impact for the care of older patients institution-wide. This has been an energizing initial effort, and we look forward to its continuing for years to come because of several unique aspects that promote its success. The most important are the interprofessional focus, teamwork, contextual learning, and alignment with institutional priorities to make actual change in the way that patients are cared for at our institution.  We provide a timeline that illustrates the key inputs and steps to promote such a QI competition to enhance geriatric education and care.  We also provide the event agenda, pitch template, judging template, list of pitch topics, and follow-up inhouse publicity from our institution to give our geriatrics colleagues at other institutions sample materials which could be adapted to their specific needs.

Educational objectives: 
  1. To demonstrate how geriatrics can lead and facilitate improvements in care across the broader institution through interprofessional focus, teamwork, contextual learning, and alignment with institutional priorities, grounded in geriatrics principles.
Date posted: 
Mon, 10/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Hacking Geriatrics: The World 2 Challenge. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/223

Interprofessional Geriatric Education and Training in Texas: Seniors Assisting in Geriatric Education - Interprofessional Team-Based Training, Assignments & Grading

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

The Seniors Assisting in Geriatric Education (SAGE) program consists of an educational curriculum and community based outreach program aimed at increasing student opportunities for early exposure to older adults and issues of geriatrics. The program strives to create meaningful relationships for the interprofessional teams of students while gaining knowledge about today’s senior population and their needs. The educational component involves health care profession students interacting with each other and their senior mentor through structured assignments delivered in the home environment.

Student teams are paired in groups of 3-4 healthcare profession students. The student teams are then matched with a community-dwelling senior who receives services from Meals on Wheels or a senior volunteer from the local community. The program includes 6 visits over a 2 year period providing students an opportunity to apply their classroom education in the context and care of an older adult. Students practice and demonstrate basic clinical skills; including taking histories, interviewing, conducting examinations and cognitive assessments, and advising clients on nutrition, home safety, community resources and advance care planning.     

Educational objectives: 
  • Health professions students will develop competency with older adults;
  • Strengthen health care students clinical applications of medical education through an Interprofessional team experience in the SAGE Program;
  • Health professions students learn from each other and appreciate each others professions.
Publications from, presentations from, and/or citations to this product: 

SAGE Presentations

Marquez-Hall, S. (2015). Interprofessional practice: Seniors assisting in geriatric education. A round table presentation at the Interprofessional Practice Symposium, University of North Texas Health Science Center in Fort Worth, TX.

Marquez-Hall, S. Lane, Y. (2014) seniors assisting in geriatric education (SAGE): Reynolds program address the lack of training in geriatrics and provides a model for interprofessional education. Jefferson Center for Interprofessional Education Annual Conference, Jefferson Medical College, Philadelphia, PA.

SAGE Poster Presentations:

Marquez-Hall, S., Pitts-Lane, Y. Knebl, J., (2015). Seniors assisting in geriatric education (SAGE): Reynolds program addresses the lack of training in geriatrics and provides a model for interprofessional education. Poster presentation at Research Appreciation Day, University of North Texas Health Science Center, Fort Worth, TX.

Marquez-Hall, S., Lane, Y., Smith, R. (2014) Survey of medical students in a geriatric training program. Poster presentation at the American Geriatric Society Annual Scientific Meeting, Baltimore, MD.

SAGE Awards:

2013 Mae Cora Peterson Senior Spirit Award in recognition of the Seniors Assisting in Geriatrics Education (SAGE) Program, Senior Citizens of Tarrant County, Texas.

2011 AACOM Excellence in Communications Award. Second Place - Best Community Service Program-Serving Fewer Than 1,000. SAGE Program; University of North Texas Health Science Center at Fort Worth, Texas College of Osteopathic Medicine.  

Date posted: 
Thu, 10/13/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/13/2016
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Geriatric Education and Training in Texas: Seniors Assisting in Geriatric Education - Interprofessional Team-Based Training, Assignments & Grading. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/223

Interdisciplinary Health Profession Module Videos

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Care teams often don't know how to effectively and efficiently collaborate when addressing a patient’s health. Depending on a patient’s needs, team leadership can shift at any given moment from one person to another. Because of this constant jockeying and adaptation, educating learners about their own interprofessional relationships is becoming incredibly important. These videos and the corresponding text supplements provide a context for interprofessional team members to discover more about what it takes to become a member of another profession. This knowledge, combined with their own experiences and clinical practice, will assist in preparing learners for the next-generation of team-based healthcare.

Educational objectives: 

After watching these short 2-3 minute videos, interprofessional teams will be able to contextualize their own relationship within the group dynamic, understand the educational requirements that go into other disciplines, and formulate an effective team-based learning approach for future activities.

Date posted: 
Tue, 09/27/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/27/2016
Contact Person/Corresponding Author:



Suggested Citation:
Interdisciplinary Health Profession Module Videos. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/223

IMPROVE Polypharmacy Clinic Resource Site

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
3
Abstract: 

Polypharmacy and inappropriate prescribing are common among older adults. Polypharmacy is associated with a variety of adverse outcomes in older adults including falls, adverse drug events, hospitalization, mortality, and measures of function and cognition. The Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE) is an interprofessional polypharmacy clinic within an academic patient-aligned care team at the VA Connecticut Center of Excellence in Primary Care Education. The clinic consists of a pre-clinic conference, shared medical appointment, individual visit, and team precepting. The team consist of a pharmacist, geriatrician, primary care provider, and health psychologist and involves medicine residents, nurse practitioner residents, pharmacy residents, and psychology residents. This website describes the clinic design and provides the resources and links helpful for starting an IMPROVE Polypharmacy Clinic including forms, short topic discussions in polypharmacy, and various other resources helpful for deprescribing.

Educational objectives: 

This website:

1.  Describes the IMPROVE Polypharmacy Clinic design

2.  Provides resources needed to implement an IMPROVE Polypharmacy Clinic

3.  Provides handouts for short topic discussions on various polypharmacy-related topics and deprescribing

Date posted: 
Thu, 10/13/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/13/2016
Contact Person/Corresponding Author:



Suggested Citation:
IMPROVE Polypharmacy Clinic Resource Site. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/223

VirginiaGeriatrics.Org

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
2
Abstract: 

The VirginiaGeriatrics.Org website consists of 6 primary resources and a secondary list of resources for further research. These primary resources include a video archive of the geriatric grand round lecture series, interactive pre-clinical basic science geriatric case studies for medical students, more advanced geriatric case studies for clinical residents, a quick consult guide for geriatric consults, an "ask the expert" discussion resource, and various educational materials related to the Virginia Geriatrics Society Conference. Additionally, spread through the website are external educational resources to complement the core material. Finally, there are some resources for patients and families that may be interested in contacting clinics and/or geriatricians.

Educational objectives: 

Listed through 6 primary education sections (Grand Rounds, Med Student Materials, Resident Materials, Quick Consults, Ask the Expert, etc)

Date posted: 
Thu, 09/22/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 09/22/2016
Contact Person/Corresponding Author:



Suggested Citation:
VirginiaGeriatrics.Org. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/223

Medication Review Worksheet 2015

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Polypharmacy is associated with a variety of adverse outcomes in older adults including falls, adverse drug events, hospitalization, mortality, and measures of function and cognition.1  Primary care providers seek tools to address polypharmacy.This medication review worksheet facilitates a targeted chart review, the development of an indication-matched medication list, and the use of available resources related to potentially inappropriate medications,3,4,5,6 common disease-specific guidelines,7,8,9,10 and helpful calculators11,12,13,14 to develop an evidence-based deprescribing plan for use in geriatric primary care patients.

1.  Fried, TR, O'Leary J, Towle V, et al.  Health outcomes assoicated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc, 62: 2261-2272, 2014.

2.  Anthierens S, Tansens A, Petrovic M, et al.  Qualitative insights into general practitioners views on polypharmacy.  BMC Family Practice, 11(65): 1-6, 2010.

3.  American Geriatrics Society 2015 Beers Criteria Update Expert Panel.  American Geriatrics Society 2015 Updated Beers criteria for potentially inappropriate medication use in older adults.  J Am Geriatr Soc, Epub ahead of print, 2015.

4.  Steinman MA, Beizer JL, DuBeau CE, et al.  How to use the American Geriatrics Society 2015 Beers criteria-a guide for patients, clinicians, health systems, and payors.  J Am Geriatr Soc, Epub ahead of print, 2015.

5.  Hanlon JT, Semla TP, Schmader KE. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures.  J Am Geriatr Soc, Epub ahead of print, 2015.

6.  O'Mahony D, O'Sullivan D, Byrne S, et al.  STOPP/START criteria for potentially inappropriate prescribing in odler people: version 2.  Age and Ageing, 0:1-6, 2014.

7.  James PA, Oparil S, Carter BL, et al.  2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eight Joint National Committee (JNC 8).  JAMA, 311(5): 507-20, 2014.

8.  Stone NJ, Robinson J, Lichtenstein AH, et al.  2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines.  Circulation, 129(25 Suppl 2):S1-45, 2014.

9.  American Geriatrics Society Expert Panel on the Care of Older Adults with Diabetes Mellitus.  Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update.  J Am Geriatr Soc, 61:2020-26, 2013.

10.  American Diabetes Association.  Standards of medical care in diabetes-2014.  Diabetes Care, 37(S1):14-80, 2014.

11.  Multiple creatinine clearance methods.  Global RPh.  Available http://www.globalrph.com/multiple_crcl_2012.htm

12.  Hwang C.  CHA2DS2-VASc score for atrial fibrillation stroke risk.  MD+Calc.  Available http://www.mdcalc.com/cha2ds2-vasc-score-for-atrial-fibrillation-stroke-risk/

13.  Andrade, J.  HAS-BLED Score.  QxMD.  Available http://www.qxmd.com/calculate-online/cardiology/has-bled-score-bleeding-in-atrial-fibrillation

14.  2013 Prevention Guidelines Tools: CV Risk Calculator.  American Heart Association and American College of Cardiology.  Available at http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp

Educational objectives: 

This medication review worksheet will help trainees to:

1.  Complete a targeted chart review

2.  Reconcile a patient's medications by indication

3.  Develop an evidence-based strategy for deprescribing potentially inappropriate medications

Contact Person/Corresponding Author:



Suggested Citation:
Medication Review Worksheet 2015. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/223

Geriatric Fast Facts Quizzes

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
0
Abstract: 

Geriatric Fast Facts (GFFs) [www.geriatricfastfacts.com] is a mobile enabled website which contains 1-2 page concise, peer-reviewed evidence-based educational summaries on key geriatrics topics to increase medical knowledge.

GFF Quizzes are quick, online assessment tools paired with GFF content, to be used by learners at the point of care to assess knowledge of geriatric content aligned with ACGME Milestones.  Design elements include quiz content searchable by topic, links to corresponding GFFs, MCQ/ short answer question formats and ability to include images. Learners enter brief demographic information to start (institution, email of self and up to 1 other) allowing annotated score results, displayed immediately after quiz completion, to be sent to themselves and one other individual (faculty, program director). These quick quizzes, available on hand held mobile devices at the point of care, linked to GFF content provide learners and program directors information of learner knowledge assessment linked to ACGME Milestones.

Educational objectives: 

The Geriatric Fast Fact (GFF) quizzes, available on hand held mobile devices at the point of care, linked to GFF content will provide learners and program directors information of learner knowledge assessment linked to ACGME Milestones.

Additional information/Special implementation requirements or guidelines: 

The Geriatric Fast Facts (GFF) and GFF Quizzes may be viewed and accessed by the URL address geriatricfastfacts.com. The site may be then saved to the home screen to allow functionality as an "app".

Publications from, presentations from, and/or citations to this product: 

Quick Quizzes:  Geriatrics Right in Your Hand & at the Point of Care.  Denson K, Simpson D, Padua K, and the GET Collaboratives at the Medical College of Wisconsin & Aurora Health Care, American Geriatrics Society Annual Meeting, Baltimore, MD, 05/2015

Date posted: 
Thu, 10/08/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/08/2015
Product Viewing Instructions: 
The Geriatric Fast Facts (GFF) and GFF Quizzes may be viewed by the URL address geriatricfastfacts.com. The site may be then saved to the home screen to allow functionality as an "app"
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Fast Facts Quizzes. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/223

"TMI"... (Too Many Interpretations): Mr. Moore's Medication Misadventures!

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

This two hour interprofessional curriculum brings together fourth year medical students and third year pharmacy students in a hands-on, interactive small group session. Learners are given a guide briefly describing the case and delineating five health care members and their roles and expertise in Mr. Moore's healthcare team (Mr. Moore's partner, the outpatient pharmacist, the inpatient intern, etc). A pair of interprofessional facilitators guide learners through the case, utilizing different healthcare team members' roles and expertise to explore methods of medication organization and systemic barriers to accurate and safe discharge medication reconciliation. Learners discover and discuss discrepancies in high-risk medications, gain an appreciation of systems hurdles for patients and healthcare providers during transitions of care, complete an exercise in writing discharge medication instructions, and brainstorm action items to personally employ to overcome systemic hurdles for safer discharge medication reconciliation.

Educational objectives: 

By the end of the two-hour session, learners will work collaboratively to:

  1. Describe the roles and expertise of three health professions that can collaborate to reconcile medications and enhance safety of medication orders at the time of hospital discharge. 
  2. List three potential communication barriers between health professionals involved in discharge planning that contribute to medication errors in vulnerable older adults.
  3. Identify key components of discharge medication lists and instructions to communicate information safely to patients, caregivers, primary care providers and others on the healthcare team.
Date posted: 
Tue, 08/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 08/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
"TMI"... (Too Many Interpretations): Mr. Moore's Medication Misadventures!. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/223

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