Intro to Pharmacy Quiz 6 + Interprofessional Communication

medication related problem (MRP)

the use (or non use) of a specific medication that results in a less than optimal clinical outcome for the patient

4 main areas of medication related problems

-indication (unnecessary medication, needs additional therapy)

-effectiveness (dosage/duration too low, need additional monitoring)

-safety (adverse events, drug interactions, dosage/duration too high, drug-disease interactions)

-adherence (adherence, cost concerns)

how are medication related problems identified

-pharmacist review

-software alerts

-information databases

-patient concerns

who is responsible for identifying all medication related problems

pharmacists

drug-utilization review (DUR)

ongoing review of prescribing, dispensing, and use of medications to achieve appropriate therapeutic decision-making and positive patient outcomes

-prospective, concurrent, retrospective

software identified MRP

prescription processing system will send alerts for:

-drug-drug interaction

-drug-age interaction

-drug-gender interaction

-duplicate therapy

-over/underutilization

-dose too high

information database identified MRP

-opioid monitoring database (NC Controlled Substance Reporting System)

-immunization information systems (NC Immunization Registry)

patient identified MRP

ask patient appropriate questions to further evaluate their concerns

-adverse events, medical conditions, therapy, adherence, efficacy, cost barriers

identifying medication related problems

pharmacist’s job is to ensure a patient’s medication regimen is safe, effective, being used for correct indication, and that patient can adhere to the therapy

steps to identifying MRPs

1) confirm the problem

2) counsel the patient

3) consult the prescriber (gather all necessary drug and patient info; call or message prescriber with recommendation, use SBAR)

Institute for Safe Medication Practices (ISMP)

-safety organization with the mission to educate the healthcare community on safe medication practices

-various guidance documents (lookalike drug names, error prone abbreviations, high alert meds)

pharmacist resolves MRP independently

-typed SIG or medication errors

-quantity or day supply calculation errors

-missing patient DOB or address

-patient/insurance requests brand name

MRP requiring prescriber contact

-drug allergy documented for the prescribed medication

-dose appears outside normal range

-therapeutic duplication

-drug interaction

-incomplete directions requiring clinical interpretation

list of confused drug names

-use both brand & generic

-include purpose/use of medication

-configure computer selections so do not appear consecutively

-draw attention to dissimilarities (tall man/mixed case letters)

error prone abbreviations

-should never be used

-includes best practices related to zeroes, SIG codes, other abbreviations

high alert medications

heightened risk of significant patient harm when used in error

-special safeguards (providing access to information, limiting employee access, auxiliary labels, automated alerts, standardize prescribing process, double checks)

strengths domains

executing, influencing, relationship building, strategic thinking

executing

know how to make things happen

influencing

know how to take charge, speak up, & make sure team is heard

relationship building

have the ability to build strong relationships that can hold a team together

strategic thinking

absorb & analyze information that can inform better decisions

open self

info about you that both you and others know

blind self

info about you that you don’t know but others do

-feedback can turn this to open self

hidden self

info about you that you know but others don’t

-self disclosure can turn this to open self

unknown self

info about you that neither you nor others know

-self discovery can turn this to hidden self

benefits of feedback

-opportunity to motivate

-improves group or individual performance

-fosters growth through self assessment

-develops self advocacy

-builds independence of group

TeamSTEPPS

-appreciative

-timely

-respectful

-specific

-directed towards improvement

-considerate

-patient focused

ask-tell-ask

ask question, tell if you agree or not, ask question

DESC script

-Describe situation/behavior with data

-Express how situation makes you feel/concerns

-Suggest other alternatives & seek agreement

-Consequences stated

-use “I” statements, be brief, avoid absolutes

intrapersonal conflict

conflict within oneself

interpersonal conflict

conflict with 2 or more individuals

organizational conflict

disagreements throughout team or large organization

fact-based source of conflict

disagreement over information that can be proven factually

values-based source of conflict

difference in beliefs or opinions about a topic

goal-based source of conflict

competing priorities

approach-based source of conflict

differences in how to achieve a common goal

conflict resolution

-avoiding

-accommodating

-competing

-compromising

-collaborating

accommodating

bending to desire of another while neglecting your own needs

competing

pursuing your own needs without taking needs of others into consideration

compromising

negotiating & cooperating to find a solution

collaborating

analyzing solutions & identifying shared goals and commitment

S-TLC

-Stop

-Think

-Listen

-Communicate

medical errors

3rd leading cause of death in US

interprofessional communication

all health professionals should be educated to deliver patient centered care as members of an interprofessional team, emphasizing evidence-based practice, quality improvement approaches, & informatics

key to strengthening health systems

moving from fragmentation to collaboration

TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety)

-evidence-based framework to optimize team performance across healthcare

-communication, leadership, situation monitoring, mutual support

SBAR

-excels in presenting critical information concisely

-Situation (what is going on - identify self, healthcare site, area, title, date, etc)

-Background (history of problem/issue, list of current medications/labs)

-Assessment (what do you think problem is)

-Recommendation (what would you do)

barriers to prescriber communication

-multiple prescribers

-relaying messages through receptionists

-lack of availability & opportunity to speak with prescribers

-lack of interprofessional training

prescriber communication techniques

-set expectations with your one-liner

-present a story (clear, complete, concise, organized)

-remember the end of the story (be prepared to modify recommendation in response to new info or challenges)

check back

closed loop communication

-verifies accuracy of conveyed information

teach back

verifies patient understanding

handoff

-used during transitions of error

-transfer of information (to both teams), authority, & responsibility

briefs

determine initial plan & establish goals & expectations

huddles

problem solving, identify critical issues/concerns, anticipate outcomes

debrief

process improvement after an event, review lessons learned, reinforces positive behaviors

situational monitoring

actively assessing situation to gain info or support team functioning

-use STAR: Stop, Think, Act, Review

shared mental model

ensures all team members are on the same page

mutual support

-voice a concern at least 2 times

-use CUS words (Concerned, Uncomfortable, Safety issue)

-use DESC tool (Describe, Express, Suggest, Consequences)