Journal of Nursing Education

Major Article 

A Synchronous Interprofessional Patient Safety Simulation Integrating Distance Health Professions Students

Kathleen Packard, PharmD, MS, BCPS, AACC; Lindsay Iverson, DNP, APRN, ACNP-BC; Ann Ryan-Haddad, PharmD; Robyn Teply, PharmD, MBA, BCACP; Alynne Wize, MS, Ed; Yongyue Qi, MS

Abstract

Background:

Increasing rates of medical errors necessitate incorporation of patient safety education for health professions students. Institutions must address the needs of both campus- and distance-based learners to meet interprofessional education (IPE) accreditation requirements. The purpose of this project was to evaluate a synchronous interprofessional patient safety simulation to train students on interprofessional teamwork and communication through recognition of patient safety and medical hazards.

Method:

Students from health care professions participated in a Haunted Hospital/Heartbreak Hospital patient hazard/medical error simulation. A total of 201 students in 41 teams, both campus and distance, participated over three semesters.

Results:

Mean Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) scores significantly improved from 44.81 ± 3.59 to 47.08 ± 3.31 (p < .0001). Qualitative responses indicated that students appreciated working with other health care students through collaborative practice and recognized the importance of discipline-specific expertise.

Conclusion:

This simulation provided campus and distance learners with a collaboration opportunity that improved their perceptions of IPE. [J Nurs Educ. 2019;58(10):577–582.]

Abstract

Background:

Increasing rates of medical errors necessitate incorporation of patient safety education for health professions students. Institutions must address the needs of both campus- and distance-based learners to meet interprofessional education (IPE) accreditation requirements. The purpose of this project was to evaluate a synchronous interprofessional patient safety simulation to train students on interprofessional teamwork and communication through recognition of patient safety and medical hazards.

Method:

Students from health care professions participated in a Haunted Hospital/Heartbreak Hospital patient hazard/medical error simulation. A total of 201 students in 41 teams, both campus and distance, participated over three semesters.

Results:

Mean Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) scores significantly improved from 44.81 ± 3.59 to 47.08 ± 3.31 (p < .0001). Qualitative responses indicated that students appreciated working with other health care students through collaborative practice and recognized the importance of discipline-specific expertise.

Conclusion:

This simulation provided campus and distance learners with a collaboration opportunity that improved their perceptions of IPE. [J Nurs Educ. 2019;58(10):577–582.]

Increasing rates of medical errors necessitate incorporation of patient safety education and development of interprofessional communication and teamwork for health professions students. It has been demonstrated that interprofessional collaborative practice can lead to a reduction in medical errors (Bishop, Phillips, Lee, Sicat, & Rybarczyk, 2015). Previous medical error simulation studies have also demonstrated that interprofessional student teams are able to identify significantly more errors than individuals (Clay et al., 2017). Therefore, accreditation guidelines emphasize the need for interprofessional education (IPE) opportunities for health professions students (Health Professions Accreditors Collaborative, 2019). Institutions must be innovative in addressing the needs of learners, both campus-and distance-based, to meet accreditation requirements.

There are many barriers to providing robust IPE opportunities for health professions students. Some schools have a limited number of professions at each site and may even have only one profession per campus. To provide IPE activities, such institutions must collaborate with outside entities, many times at a distance. IPE for distance-based learners can also be logistically challenging and many times the activities are conducted asynchronously only (McCutcheon, Alzghari, Lee, Long, & Marquez, 2017). Another major barrier to the implementation of IPE activities is the conflicting schedules for the various health professional students. For these reasons, distance IPE is an emerging approach. A recent literature review found that of 478 IPE articles published, only 15 included distance learners (McCutcheon et al., 2017). These methodologies included virtual towns, online learning communities, virtual interactive patients, and synchronous and asynchronous forums.

Creighton University has more than 900 health professions students in Dentistry, Emergency Medical Services, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy, and Public Health. There are distance Occupational Therapy cohorts in Anchorage, Alaska (n = 38), Denver, Colorado (n = 54), and the Greater Omaha area (n = 54), distance Pharmacy cohorts throughout the United States (n = 286), and distance graduate nursing students throughout the United States (n = 400). Thus, distance students account for most of our total health professional student body. The university is also opening a distance satellite in Phoenix, Arizona in 2018–2021 to include more than 200 students from all health professions.

In 2017, Creighton University commenced its IPE Passport curriculum, which requires all students to complete three experiential interprofessional activities prior to graduation. The framework and development of this program has been described previously (Packard, Doll, Beran-Shepler, Stewart, & Maio, 2018). Developing appropriate, authentic, and synchronous interprofessional activities with distance students has been challenging. The Heartbreak Hospital/Haunted Hospital medical error simulation is one of several IPE Passport activities with a synchronous distance education component. The purpose of this educational activity was to evaluate this synchronous interprofessional patient safety simulation to train students on interprofessional teamwork and communication through recognition of patient safety hazards and medical hazards.

Method

Prior to the initiation of data collection, the study was deemed exempt, and consent was obtained from the university's institutional review board. Student participation in the survey and reflection questions was voluntary. The activity was adapted from the original University of Chicago patient safety “Room of Horrors” developed for medical student and intern training (Farnan et al., 2016). An interprofessional adaptation was presented at the T3 Train-the-Trainer Interprofessional Faculty Development Program at the University of Missouri Columbia. At the same time, a group of students with an interest in the prevention and treatment of cardiovascular disease, the American Pharmacists Association–Academy of Student Pharmacists Operation Heart students, had inquired about collaborating with other professions with similar interests. Under the mentorship of an interprofessional team of faculty, the Heartbreak Hospital/Haunted Hospital Interprofessional Medical Error/Patient Safety Simulation was created.

At Creighton University, this activity is currently an embedded, mandatory IPE Passport experience for some professions, including nurse practitioner students and public health students, effective 2019. For others, it is an elective activity. In an effort to recruit a variety of professions at all levels, the Creighton Center for Interprofessional Practice, Education and Research (CIPER) sponsors monetary prizes to the top three teams that identify the most errors and hazards. Recruitment is primarily completed through the IPE Passport course site. The activity is listed as a menu IPE passport option for all health professions students. Activity organizers closely monitor activity enrollment as the sign-up deadline approaches. If sign up from any one profession is lacking, e-mail blasts are sent to those professions by faculty. We also ask for student representatives to announce the opportunity in various classes.

The simulation occurs twice per year: Heartbreak Hospital around Valentine's Day, and Haunted Hospital near Halloween. The simulation cases are centered around a patient with a primary cardiovascular illness. Scenarios are developed by the CIPER Curriculum Committee, which includes faculty representatives from all professions to ensure balance in the types of errors and hazards. Because the activity is open to all professions at all levels, faculty integrate basic safety hazards (e.g., blood on the floor) to more complex medical errors (e.g., incorrect dosing of anticoagulation).

The simulation is typically offered in the nursing simulation laboratories using a high-fidelity manikin. The simulation is conducted in two simulation rooms at the same time to accommodate more students. The day prior to the event, a multidisciplinary group of faculty not involved with the creation of the case run through the simulation for quality assurance. Students sign up for a 30-minute slot and are assigned to teams to optimize a balance between professional years in the curriculum. A balance between profession and year in the curriculum is attempted to prevent disadvantage to students earlier in their program or to teams that are missing professions. Up to 10 students are permitted per team due to space constraints. One student per team is from a distance cohort, and the other nine are from the campus. Students check in and complete a presurvey, the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instrument (Dominguez, Fike, MacLaughlin, & Zorek, 2015). The SPICE-R is a reliable and validated tool that has been modified by the original developers to be used for a range of health professions students (Dominguez et al., 2015). Demographics obtained include participants' profession, gender, learning pathway (campus or distance), and year in the curriculum. Students undergo a 10-minute prebrief led by a faculty member in a conference room. The distance student participates via Zoom video conferencing technology. Students introduce themselves to one another and discuss their profession, roles, and responsibilities, which is an Interprofessional Education Collaborative (IPEC) core competency (IPEC, 2016). They are then provided instructions and background information about the simulated patient. Students are instructed to identify a campus-based student as the scribe to document all medical errors and patient safety hazards identified during the simulation.

The campus students then proceed to the simulation room and have 8 minutes to identify as many medical errors or patient safety hazards as possible while the distance student is conferenced in via speakerphone. The distance student has online access to a one-time, time-limited videorecording of the simulation at the exact time that campus students enter the simulation room. Campus-based students may peruse the room, and distance students may stop, rewind, and zoom in on the video to find errors and hazards. Both campus and distance students are constantly communicating with one another during this time to identify, discuss, and document possible errors and hazards. This aligns with the Communication and Teamwork IPEC Core Competencies (IPEC, 2016).

After 8 minutes, students reconvene in a conference room with the distance student joining via Zoom. Students have 2 minutes to finalize and submit their answers online. A 10-minute debrief is then led by the faculty facilitator. All medical errors and patient safety hazards are revealed, and students are asked to reflect on the experience. Students are asked by the faculty facilitator “What did you learn about working together in a team?” and “What was the most challenging component of this exercise?” which again emphasizes the Teams and Communication IPEC Core Competencies (IPEC, 2016). A postsurvey is then completed including the SPICE-R, six additional Likert-scale questions, and reflection questions (Table A; available in the online version of this article). Student teams are assigned a score based on the percentage of medical errors and patient safety hazards identified. The top three teams to win the competition are announced the following day and awarded prize money, to be split between members.

Postsurvey

Table A:

Postsurvey

Data from the pre- and postsurveys were analyzed to determine the mean change between the SPICE-R scores using a paired student's t test. Two-way mixed ANOVA was also completed to assess the interaction between demographics and change in SPICE-R scores. Descriptive statistics were used to assess responses to Likert scale questions. Question response data were collected and compiled into a database for independent analysis by two researchers. The researchers identified key words or phrases that exemplified themes of the student's reflection, then discussed and converged the themes to develop the overall results. A summary describing prevalent reflection themes and demonstrated by selected student quotations was discussed with all investigators and consensus was reached.

Results

The first Heartbreak Hospital simulation was completed in February of 2017, followed by Haunted Hospital in October 2017 and the second Heartbreak Hospital in February 2018. The total number of possible patient safety hazards and medical errors were 49, 68, and 51, respectively, for the three events. A total of 201 unique health professions students in 41 teams, both campus and distance, participated in the event over three semesters. Forty-five (22%) of the students were male, and 43 (21%) of the students were distance-based learners. Figure 1 depicts the distribution of student year in their respective curriculum, and Figure 2 depicts the distribution of student profession. The majority of students (n = 153, 76%) were in their first year of studies. Pharmacy students (n = 65, 32%) and Occupational Therapy students (n = 64, 32%) had the highest participation rates for the activity. Teams ranged in number from two to 11 students and contained between two and five professions. As time passed and the popularity of the activity increased, both team size and the number of professions per team grew. The mean team size was 6.58 ± 3.06 and the mean number of professions was 3.08 ± 1.02.

Student year in the curriculum.

Figure 1.

Student year in the curriculum.

Student profession.

Figure 2.

Student profession.

Of 201 participants, 168 completed pre- and post-SPICE-R and 153 completed the Likert scale questions. Mean SPICE-R scores significantly improved from 44.81 ± 3.59 to 47.08 ± 3.31 (p < .0001). There was no effect of gender, year in school, profession, or pathway (campus versus distance) on SPICE-R scores (Table 1). Interestingly, smaller teams (two to four members) and teams with two professions were associated with greater improvement in SPICE-R scores (p = .007 and .004, respectively).

Changes of Estimated Marginal Mean Scores of Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) by Student Demographics (N = 168)

Table 1:

Changes of Estimated Marginal Mean Scores of Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) by Student Demographics (N = 168)

For the Likert scale questions, 84% of students agreed or strongly agreed that the activity was a valuable learning experience, 88% agreed or strongly agreed that interacting with other professions was a valuable learning experience, and 81% agreed or strongly agreed that they would use the skills gained on future rotations and in practice.

Qualitative responses indicated that students appreciated working with other health care students through collaborative practice and recognized the importance of discipline-specific expertise. A reflection analysis revealed three dominant themes:

  • Teamwork and Discipline-Specific Contribution.
  • Appreciation of One's Own Role and Respect for Other's Roles.
  • Application of IPE Activity to Future Practice.

Teamwork and Discipline-Specific Contribution

Students expressed working as a team can improve the quality of patient care. This was demonstrated through these example student comments:

  • This experience taught me how to work with other professions and utilize each other to problem solve.
  • Collaboration with interprofessional teams will allow us to work together to promote well-being to the patient and to optimize treatment plans.
  • It was helpful to have other professional students with me…. I enjoyed being able to relate on the similarities and compare some of the differences in our professions.
  • I learned more about how to effectively work in a multidisciplinary team.

Appreciation of One's Own Role and Respect for Other's Roles

Student comments demonstrated the value of other team members' roles and perspective:

  • This showed me how each member of the team brings specific knowledge that adds to the quality of health care…. We had a pharmacy student on our team who was able to identify types of medications that were wrong, we wouldn't have been able to identify this hazard if we did not have this pharmacy student on our team.
  • I wish that I could have worked on a team that had a student from each profession—this would have made it the most optimal interprofessional collaboration activity.
  • I thought it was helpful having other health professionals in the room to point out things that I necessarily would not have caught, such as medications. I think it'll help me be a better health professional not only for the safety of my patients, but also for myself and my colleagues.
  • Working with students from other disciplines is a nice way to meet others outside of my program and also provides an avenue to learn about their roles on a health care team.

Application of IPE Activity to Future Practice

Students commented that the activity improved observation and communication skills, ability to work under stress, and willingness to collaborate with other health care professionals in the future:

  • I learned how to work with individuals in a stressful environment. It was important to use good communication skills and have patience with others.
  • I will definitely look to my fellow health care professionals to consult on how to provide the best and safe quality care for the patient…. I need assistance of other health care professionals to address issues I am not qualified in. We need to work together to find treatment options that work well together to provide the best quality of care for the patient.
  • This activity helped me to improve my observation skills, encouraging me to think outside the scope of physical therapy, and realize it takes every health profession to keep a patient safe and make sure all their needs are met properly.
  • I learned that better collaboration produces better outcomes.

A separate analysis of scores was completed for the first cohort of students to complete the Heartbreak Hospital in February 2017. Thirty-six students in nine teams participated in this inaugural event (Table 2).

Team Scores for Spring 2017

Table 2:

Team Scores for Spring 2017

A statistical difference in scores based on the number of professions per team was not comparable because only one team had more than two professions represented. However, student teams of five had statistically significant higher scores than student teams of three or four (Table 3).

Comparison of Team Score by Number of Team Members, Spring 2017

Table 3:

Comparison of Team Score by Number of Team Members, Spring 2017

Discussion

Our project demonstrated that larger interprofessional teams are able to identify more medical errors and patient safety hazards. Our data indicated that students were only able to identify 33% to 57% of medical errors and patient safety hazards. A similar study completed with nursing and medical students also indicated that graduating students miss many errors, especially those in a critical care unit (Clay et al., 2017). Poor identification may be partially explained by the large proportion of first-year students participating early in their didactic curriculum. Some of the content incorporated into the cases was not taught to students until later in their respective curriculum. Most students participating also never received prior medical error training, either didactic or experiential. Wiest et al. (2016) demonstrated the value of hands-on medical error training in a study to assess the effect of prior safety training in the identification of safety hazards. In their study, students with prior safety training did not identify more hazards in this simulation than those without training. This suggests that health sciences students need multiple experiential patient safety training opportunities integrated and reinforced throughout their curriculum.

Even though students in larger teams identified more patient safety hazards and medical errors, their perceptions of IPE were greater in smaller teams. It should be noted that students completed their postactivity surveys prior to knowing how many errors their team identified, compared with other teams. Furthermore, studies have shown that in larger teams, individuals tend to exert less energy (Weiss, Tilin, & Morgan, 2018). Cohesion and intimacy decrease, and members perceive the experience as less satisfying (Weiss et al., 2018). Research from Wheelen (2009) has suggested that smaller teams of three to eight are more productive than those with nine or more members.

The majority of students found the activity to be a valuable learning experience. Student reflections identified that the activity was an excellent way to work with other professions. Comments from students expressed appreciation how other professions recognized different safety hazards. Overall, students voiced a desire for similar synchronous IPE activities in the future.

Lessons Learned

Each semester, feedback was reviewed and integrated into future offerings of the activity. For example, students requested clearer instructions stating exactly what they can and cannot do during the simulation, such as touch items in the room. We also increased the time of the prebrief so that students could formally introduce themselves and explain the role of their profession. We also added name tags for campus students and required the distance students to use their full name and profession when logging into Zoom.

For the distance cohort, although zooming in on certain errors, such as an expired medication, was necessary, it often provided the distance students with an unfair advantage. During the first offering of this activity, distance students were able to identify more medical errors than campus students. Therefore, we asked the videographer to zoom in on nonerror distractors, such as a crooked painting on the wall, to level the playing field. This corrected for the inequity in the balance of errors identified between campus and distance. Therefore, there were no observable differences in the number or types of errors that distance students identified, compared with campus students. One semester, a fish-eye camera was used to record the simulation for distance students so they could control the zooming. Feedback from the students that semester was negative. Many of them had trouble viewing the images from the fish eye camera or simply getting the recorded file to play.

During the debrief, it was found to be more efficient to have students first read the answer key and then enter the discussion, as opposed to a faculty member reading the answer key. Therefore, paper copies are provided to campus students and a Word® document is temporarily placed on a shared Zoom screen for the distance students to read. Finally, after the first offering of the activity, students requested 2 minutes before the debrief to collate their answers prior to submission.

Limitations and Future Directions

It is important to acknowledge the limitations of this project when interpreting the results. Despite our best efforts, due to scheduling barriers, the teams did not always represent a balanced mix of professions and year in curriculum. This may have led to innate team advantage and disadvantage based on team size and balance of professions. To remedy this, researchers would have to conduct the activity in the evening or lobby for protected IPE time built into all health professions' curricula, which Creighton University currently does not have. As previously stated, there was a larger proportion of first-year students who registered for the activity. This was because the activity coincided with the inaugural year of our IPE Passport, which requires students to earn three stamps prior to graduation (Packard et al., 2018). Thus, many of the more challenging medical errors, such as incorrect dosing of anticoagulation, for example, were not identified by most teams. It was also anecdotally witnessed by faculty mentors and reported by the students in their reflections that in larger teams, not everyone participated in the debriefing. Based on this and other results from the project, a future direction for this IPE activity is to increase the number of opportunities with a slightly reduced team size. We also would like to pilot leveled simulations with more challenging content reserved for students later in their respective curricula. In the coming years, this activity will become a mandatory, embedded IPE Passport stamp for other professions, such as physician assistant students. We are therefore considering integrating standardized live patients to replace the manikin in the near future. Students would then be able to interact with the patient.

Conclusion

This unique simulation provided health professions students with an interprofessional collaboration opportunity that significantly improved their perceptions of IPE. The results also suggest that for an early, one-time IPE event, smaller teams with fewer professions may be effective. Accreditation agencies for all health science programs require IPE and collaboration among health professions students. Institutions can implement this innovative method, which incorporates both campus and distance pathway students, to meet IPE requirements.

References

  • Bishop, S.E., Phillips, A., Lee, B.B., Sicat, B. & Rybarczyk, B. (2015). Internists, pharmacists, and psychologists on learning teams: An interprofessional team-based learning experience in graduate medical education. Journal of Interprofessional Education & Practice, 1(2), 43–47. doi:10.1016/j.xjep.2015.07.069 [CrossRef]
  • Clay, A.S., Chudgar, S.M., Turner, K.M., Vaughn, J., Knudsen, N.W., Farnan, J.M. & Molloy, M.A. (2017). How prepared are medical and nursing students to identify common hazards in the intensive care unit?Annals of the American Thoracic Society, 14, 543–549. doi:10.1513/AnnalsATS.201610-773OC [CrossRef]28157394
  • Dominguez, D.G., Fike, D.S., MacLaughlin, E.J. & Zorek, J.A. (2015). A comparison of the validity of two instruments assessing health professional student perceptions of interprofessional education and practice. Journal of Interprofessional Care, 29, 144–149. doi:10.3109/13561820.2014.947360 [CrossRef]
  • Farnan, J.M., Gaffney, S., Poston, J.T., Slawkinski, K., Cappaert, M., Kamin, B. & Arora, V.M. (2016). Patient safety room of horrors: A novel method to assess medical students and entering residents' ability to identify hazards of hospitalisation. BMJ Quality & Safety, 25, 153–158. doi:10.1136/bmjqs-2015-004621 [CrossRef]
  • Health Professions Accreditors Collaborative. (2019). Guidance on developing quality interprofessional education for the health professions. Chicago, IL: Author.
  • Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Author.
  • McCutcheon, L.R.M., Alzghari, S.K., Lee, Y.R., Long, W.G. & Marquez, R. (2017). Interprofessional education and distance education: A review and appraisal of the current literature. Currents in Pharmacy Teaching and Learning, 9, 729–736. doi:10.1016/j.cptl.2017.03.011 [CrossRef]29233450
  • Packard, K., Doll, J., Beran-Sheplar, K., Stewart, N.H. & Maio, A. (2018). Design and implementation of an interprofessional education passport curriculum in a multi-campus university with distance learners. Medical Science Educator, 28, 749–755. doi:10.1007/s40670-018-0589-3 [CrossRef]
  • Weiss, D., Tilin, F. & Morgan, M. (2018). The interprofessional health care team: Leadership and development (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
  • Wheelen, S.A. (2009). Group size, group development, and group productivity. Small Group Research, 40, 247–262. doi:10.1177/1046496408328703 [CrossRef]
  • Wiest, K., Farnan, J.M., Byrne, E., Matern, L., Cappaert, M., Hirsch, K. & Arora, V.M. (2016, May). Hospital horror story: Situational awareness to assess interns' recognition of safety and low-value hospital hazards. Poster presented at the University of Chicago Quality and Safety Symposium. , Chicago, Illinois. .

Changes of Estimated Marginal Mean Scores of Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) by Student Demographics (N = 168)

VariablePresurveyPostsurveyp-Value



EMMSEEMMSEWithin-SubjectBetween-SubjectInteraction
Gender< .001.110.743
  Male44.2000.55446.4250.534
  Female45.1920.30747.2460.296
Years in school< .001.213.870
  144.7880.30646.9020.294
  >145.5530.57047.5790.549
Pathway< .001.517.156
  Campus44.8480.28647.0530.276
  Distance45.8420.80747.0530.778
Profession< .001.235.721
  Pharmacy45.4600.49947.9400.475
  Occupational therapy44.8620.46346.7590.441
  Physical therapy44.3950.53846.4190.512
  Other45.2110.80947.0530.771
Number of team members< .001.007.574
  2 to 445.8380.42147.9560.399
  5 to 844.4790.50146.9170.475
  9 to 1144.2500.48146.0770.457
Number of professions< .001.004.380
  245.7930.45848.2590.427
  344.7380.43346.8620.403
  4 to 544.2000.52045.8670.485

Team Scores for Spring 2017

Team NameNo. of Team MembersNo. of ProfessionsPoint Totals (of 49; %)
CABG Patch Kids5226 (53%)
Lub Dub Club3221 (43%)
Pace Makers4219 (39%)
EK O-Gees5228 (57%)
The 4 Reps4225 (51%)
Train Wreck3220 (41%)
Heartbreakers4216 (33%)
The Upbeats4224 (49%)
Safe & Sound4319 (39%)

Comparison of Team Score by Number of Team Members, Spring 2017

No. of Group MembersNMean Competition ScoreSDSEM
3 to 4720.573.1011.172
5227.001.4141.000

Postsurvey

Likert Questions:

Overall, participating in this Interprofessional Education (IPE) Passport activity was a valuable learning experience.

□ strongly disagree□ disagree□ neutral□ agree□ strongly agree

Interacting with Interprofessional students and/or professionals was a valuable learning experience.

□ strongly disagree□ disagree□ neutral□ agree□ strongly agree

As a result of participating in this IPE Passport activity, I will use information/skills gained on future rotations and in practice.

□ strongly disagree□ disagree□ neutral□ agree□ strongly agree

Reflection Questions:

Please comment on how you will use the interprofessional collaboration information/skills gained in your future practice.

Please share any positive comments about your experience with this IPE Passport activity.

Please share any constructive feedback about your experience with this IPE Passport activity.

Authors

Dr. Packard is Professor of Pharmacy Practice, Dr. Ryan-Haddad is Professor of Pharmacy Practice, Dr. Teply is Associate Professor of Pharmacy Practice, Mr. Qi is Assistant Professor, School of Pharmacy and Health Professions, Dr. Iverson is Associate Professor, Graduate Nursing Program, and Ms. Wize is Senior Instructional Designer, Teaching and Learning Center, Creighton University, Omaha, Nebraska.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Lindsay Iverson, DNP, APRN, ACNP-BC, Associate Professor, College of Nursing, Creighton University, 2500 California Plaza, Omaha, NE 68178; e-mail: liverson@creighton.edu.

Received: September 28, 2018
Accepted: June 24, 2019

10.3928/01484834-20190923-04

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