NUR 7069 Module 5 Interprofessional Practice Paper: The IPEC Competencies in a Diabetes Team Example

Five Professions, One Patient: Rebuilding a Diabetes Team Around the IPEC Competencies in Perth Amboy

Student Name

M.S. in Nursing, Family and Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University

NUR-7069: Professional Identity Development for Nurse Practitioners

Mentor Name

Month Day, Year

Five Professions, One Patient: Rebuilding a Diabetes Team Around the IPEC Competencies in Perth Amboy

A Team in Name Only

The health center and team in this paper are invented. The center in Perth Amboy serves about 14,000 patients, a third of whom speak Spanish at home, and about 1,800 have type 2 diabetes. Two years ago it formed a diabetes team: two nurse practitioners, a clinical pharmacist, a registered dietitian, a community health worker and a behavioral health consultant. On paper, the team meets monthly and shares patients. In practice, the meetings were canceled more often than held, referrals went into separate queues and the proportion of patients above an A1c of 9 percent stayed where it was. The medical director asked me, one of the nurse practitioners, to lead a fresh start.

I began by interviewing each member. The pharmacist said she had authority to adjust medicines under a collaborative practice agreement but rarely received referrals. The dietitian said patients arrived without knowing why they had been sent. The community health worker said she learned about patients' housing and food problems but did not know whom to tell. The behavioral health consultant said nobody asked him about depression screening results. Everyone was busy, and everyone was working alone.

The IPEC Competencies

Four domains of competency for working across professions were set out by the Interprofessional Education Collaborative (2016), known as IPEC. Values and ethics ask members to respect one another and keep the patient's interests first. Roles and responsibilities ask each member to understand their own role and those of others and to divide the work accordingly. Communication across professions asks members to speak and listen in ways that keep the whole team informed and accountable. Teams and teamwork ask members to apply principles of team dynamics to plan, deliver and evaluate care that is safe, timely, efficient, effective and equitable.

The Evidence on Collaboration

Reeves et al. (2017) reviewed randomized trials of practice-based interventions to improve collaboration among health professionals, such as interprofessional meetings, checklists and audits. They included nine studies. The evidence was of low certainty, mainly because the studies were few and varied, but it pointed toward small possible gains in a few areas, including patients' functional status, how closely clinicians followed recommended practice and how resources were used. The authors called for better studies.

Carter et al. (2009) offered a more specific example. In a cluster randomized trial in six community clinics, clinical pharmacists working with physicians made recommendations for patients with uncontrolled hypertension. At nine months, blood pressure control was substantially higher in the intervention clinics than in the control clinics. The model worked because the pharmacist's role was clear and connected to the physician's decisions, not because of collaboration in general.

Together, the sources suggest that collaboration helps most when roles and processes are specific. That fits the team's problem: its members respected each other but had no shared process.

The Redesign

The team agreed on one goal: cut by a third, within a year, the number of registry patients whose A1c is over 9 percent. We then rewrote roles so that each member's work fit a step in the patient's care. Every patient with an A1c above 9 percent goes on a shared registry. The pharmacist adjusts medicines under the collaborative agreement for patients on stable regimens, freeing nurse practitioner visits for new or complex problems. The dietitian receives referrals with a stated question, such as carbohydrate counting for a patient starting insulin. The community health worker screens for food, housing and transport needs and enters what she finds on the registry. The behavioral health consultant reviews every positive depression screen. My role is to lead the huddle, make the medical decisions that exceed the pharmacist's agreement and keep the team focused on the goal.

Each Tuesday morning, the team spends thirty minutes reviewing the ten registry patients with the highest A1c or the longest time since contact. Each member speaks to what they know, and we agree on the next step for each patient and who owns it.

Communication Tools

The team adopted two simple tools. Every referral now includes a one-line question, so the receiving member knows what is being asked. Every huddle ends with a read-back of each patient's next step and owner, which the community health worker records on the registry. Spanish-speaking patients have their plans explained by a bilingual team member rather than by an interpreter line whenever possible, because the team found that patients asked more questions in those conversations. The tools are modest, but they address the communication domain directly and cost nothing.

My Role as an NP

Nurse practitioners are often the team members with the broadest prescribing authority, which can tempt us to make every decision. Collaborative practice asks me instead to make sure the right person makes each decision. In the first month, I caught myself changing a patient's insulin when the pharmacist had already planned a change. We agreed that medication changes for registry patients would go through her first unless I saw the patient for another reason.

What We Will Count

The team will count registry patients with an A1c over 9 percent, time from referral to first visit for each service, social needs identified and resolved, depression screens followed up and team members' ratings of collaboration every six months.

Limits

The evidence for collaboration in general is weak, and the pharmacist trial was for hypertension, not diabetes. The registry and huddle take time from clinical visits. The improvement may also reflect attention from leadership rather than the redesign itself.

Conclusion

The team had respect but no process. The IPEC domains showed where it fell short, the Cochrane review tempered expectations and the pharmacist trial showed the value of clear roles. A shared goal, a registry and a weekly huddle turned five professions into a team, with the nurse practitioner leading rather than doing everything.

References

Carter, B. L., Ardery, G., Dawson, J. D., James, P. A., Bergus, G. R., Doucette, W. R., Chrischilles, E. A., Franciscus, C. L., & Xu, Y. (2009). Physician and pharmacist collaboration to improve blood pressure control. Archives of Internal Medicine, 169(21), 1996-2002. https://doi.org/10.1001/archinternmed.2009.358

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Interprofessional Education Collaborative.

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6), Article CD000072. https://doi.org/10.1002/14651858.CD000072.pub3