The Layered Learning Practice Model and the Pharmacy Practice Model Initiative

By Larry Buie posted 06-22-2012 14:39


The University of North Carolina (UNC) Eshelman School of Pharmacy and UNC Hospitals formed the Partnership in Patient Care, with a mission of enhancing patient care and providing new educational opportunities for student and resident learners.  From this partnership developed the layered learning practice model (LLPM), a model of pharmacy practice and education, mimicking the medical model of active learning.  The LLPM was created with a goal of becoming PPMI compliant and enhancing pharmacy services in a patient centered fashion.   This model has been piloted on the hematology/oncology services at UNC Hospitals.


The LLPM is a made up of multidisciplinary team members designed to enhance pharmaceutical care delivery to patients.  The attending pharmacist is ultimately responsible for all pharmacotherapy related outcomes and student/resident education.  In this model, the attending pharmacist meets every newly admitted patient, provides information about the pharmacy services offered, and asks if the patient has a question about their medication, establishing a pharmacist-patient relationship.  Learning is handled in a layered fashion from attending pharmacist to resident to student.  All services, including discharge and anticoagulation counseling are supported by decentral clinical generalist pharmacists.


The establishment of the LLPM has moved the UNC Oncology pharmacy program one step closer to PPMI compliance.  The LLPM has allowed for clinical service expansion, brought us closer to compliance with national patient safety goals, increased the visibility of pharmacists on rounds and guarantees the right of every patient to have a pharmacist.   UNC Hospitals is in the process of developing a credentialing and privileging process for these new pharmacy practice roles.  Pharmacists involved in the LLPM are documenting recommendations/counseling in the medical record and verifying that critical medication related information is relayed to the outpatient primary oncologist at discharge.  Ultimately, technicians will be deployed throughout the North Carolina Cancer Hospital, working in tandem with pharmacists to obtain medication admission histories and facilitating the medication reconciliation process. 



07-09-2012 11:10

Hi Samm, our residents and students are involved with anticoagulation counseling, as required by the joint commission. Pharmacy has stepped up to take a leadership role with this initiative and the LLPM provides a means of additional resources, as well as additional learning opportunities for both students and residents. The decentralized pharmacy staff (clinical generalists) are critical to the success of the LLPM, because they support many functions including anticoagulation counseling, order verification and discharge counseling. The approach to care is that of a team, with Attending Pharmacist oversight. There is perceived increased job satisfaction for them with the expansion of responsibilites, however, this has not been surveyed to date.

07-09-2012 10:37

Larry, I am extremely excited after reading your blog and very eager to introduce this model to my institution. I am interested to know how long ago did UNC implement the LLPM how much student involvment there is (vs residents).

07-06-2012 01:12

This is an interesting concept. Professors have spoken about this during my didactics; it nice to see an institution take charge and initiate a program such as this. Is there more information on LLPM aside from the UNC website hyperlink? Perhaps, the hospital's input? Does anyone else know of other programs that are similar to this program?

07-05-2012 09:13

Larry, thanks for the great post. This is very exciting stuff. I am curious to know if residents/students perform any of the front-line work such as anticoag education, etc?
Also, how is your team documenting interventions and communication to outpatient providers?
Have you run into any problems with both the decentralized pharmacists and the clinical pharmacy team interacting with the patient separately?