Faculty Bibliography

NEEDS AND OBJECTIVES: To address the need for sustainable, efficient interprofessional education and practice (IPEP) at the graduate level health professions education (GHPE), the NYU School of Medicine (SoM) and NYU RoryMeyers College of Nursing (NYUMeyers) designed IPEP, a mobile learning solution. We aimed to: * Provide learners with applicable interprofessional (IP) practice skills * Encourage reflection on IP care planning * Develop an accessible and sustainable IP geriatric education curriculum for GHPE * Collect residents' reflection on IP practice for future curriculum design SETTING AND PARTICIPANTS: IPEP was housed on the NYU SOM learning management system. Since 2014, about 3500 learners from Health Professions schools across the U.S. have completed the 6 I.E. modules. DESCRIPTION: Approach/Methods To overcome barriers (e.g. limited learning space, lack of faculty, heterogeneous curricula) NYU SoM and NYU Meyers developed a series of 10-min e-learning materials including didactic modules and virtual geriatric primary care patient (VP) cases. These are based on the undergraduate online IP modules, NYU3T: Teaching, Technology, and Teamwork. The modules address: * IP teams/responsibility * Effective healthcare teams * Teamwork skills * Communication skills Conflict resolution * IP care planning 4 VP cases include IP assessment and management of older adults with chronic conditions. Reflective questions are integrated into modules and VP cases to stimulate critical thinking and attitude shift. In order to facilitate use, online modules and VP cases are designed in bite-size 10-min modules without heavy multimedia components. Thus, residents, nurse practitioners, and other graduate level providers can complete the modules via phone, tablets, or computers. EVALUATION: Users rated modules very positively (4.2 out of 5). More than 80% of users responded the length of the modules were "just right"; about 90% agreed to "recommend the modules to others". About 500 learners completed four VP cases this last year. According to the validated questionnaire measuring attitudes toward IP teams, there was a significant change toward team value (p = .006) but no significant changes around team efficiency or physician's shared role on team. DISCUSSION/REFLECTION/LESSONS LEARNED: Scheduling of IP activities, with joint clinical experiences and OSCEs, takes time, effort, and coordination of multiple schedules. The IPEP e-modules help smoother dissemination of IPE knowledge and skills to busy trainees. IP learners have found these a valuable resource. More VP cases for different populations may increase the application of IPE skills

OBJECTIVES: To examine dosages of high-risk medications administered to elderly adults who fall in the hospital and to determine whether electronic default doses are appropriate for elderly adults. DESIGN: Retrospective. SETTING: Large urban academic hospital. PARTICIPANTS: Individuals aged 65 and older experiencing a fall. MEASUREMENTS: Prescribed daily dosages and use of high-risk medications (opiates, benzodiazepines, benzodiazepine-receptor agonists (BRAs), sleep medications, muscle relaxants, antipsychotics) administered within 24 hours before a fall were ascertained and compared with published recommended dosages for older adults and the hospital's electronic medical record (EMR) default doses for these drugs. RESULTS: Of 328 falls, 62% occurred in individuals administered at least one high-risk medication within the 24 hours before the fall, with 16% of the falls involving individuals receiving two, and another 16% in individuals receiving three or more. High-risk medications were often administered at higher-than-recommended geriatric daily doses, in particular benzodiazepines and BRAs, for which the dose was higher than recommended in 29 of 51 cases (57%). Hospital EMR default doses were higher than recommended for 41% (12/29) of medications examined. CONCLUSION: High-risk medications were administered to older fallers. Doses administered and EMR default doses were often higher than recommended. Decreasing EMR default doses for individuals aged 65 and older and warnings about the cumulative numbers of high-risk medications prescribed per person may be simple interventions that could decrease inpatient falls.

Interdisciplinary care teams are important in managing older patients. Geriatric patients with cardiovascular problems represent a unique paradigm for interdisciplinary teams, and patients benefit from the assistance of physicians, nurses, social workers, pharmacists, and therapists collaborating on treatment plans. Teams work on the inpatient and outpatient sides and at patients' homes to maximize function and prevent readmissions to the hospital.