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patient facing
prescriber clarification
theurpetic
adherence
medication
pharmacy phone calls are for:
- ______ (financial, allergies)
- _____ _______ (renal, duplicate, interactions)
- ________ monitoring
- ________ concerns
- complex _________ regimen
understanding, respectful
reading
communication best practices
- be __________ and _______
- give pt benefit of doubt
- cannot assume ______ level
- be polite, get trust, take time and respect cultural differences
NATO Phonetic Alphabet
"Alpha, Bravo, Charlie, Delta, Echo, Foxtrot, Golf, Hotel, India, Juliet, Kilo, Lima, Mike, November, Oscar, Papa, Quebec, Romeo, Sierra, Tango, Uniform, Victor, Whiskey, X-ray, Yankee, Zulu"
use when spelling out names
10 not 10.0
1/2 = 0.5 not .5
50 --> "five-zero"
15 --> "one-five"
Clarify this number again with who you are speaking to
- be very accurate with numbers
- To prevent misinformatIon when communicating detailed numbers
- give examples of how you would be:
10.0?
1/2?
how would you say 50 or 15?
orders
unapproved abbreviations, EMR
electronic prescribing benefits:
- complete _______
- ______ ______ eliminated (most solved by _____- electronic medical records)
unapproved abbreviations
what are these examples of?
- QD - everyday
- QOD - every other day
- U - units
- IU - international units
- MS, MSO4 - morphine
- MgSO4 - magnesium sulfate
introduce, professional
details
rationale
repeat
numbers
trust
patient first
ISBAR
voice, body
power
set yourself up for success when communicating issues:
- __________ yourself + be ______
- have _______ ready
- be able to explain ______
- _____ back and no rush
- clarify _______
- develop _______
- _______ ________
- use the ______ method
- tone of ____ and ____ language
- be aware of ______ struggle ( improve it by developing relationships and use high reliable principles)
I - introduction
S - situation
B - background
A - assessment
R - recommendation
communication technique ISBAR abbreviations?
introduction
name
who
polite
"I" in ISBAR: _____________
- _______ , role, location
- clarify ______ you are speaking too
- be ______ + patient ( on hold, stay in scope of practice)
Hi, this is Jennifer, the pharmacist at My independent pharmacy, Is this Dr cleary?
situation
patients
reason
"S" in ISBAR: ________
- ______ name, DOB
- ______ for calling
- avoid being vague
Regarding Mr.Freeman, DOB 7/10/1940, we received a Rx for clarithromycin
background
history, medications
summary
"B" in ISBAR: _________
- short ______, current ______
- brief ________ of what has been done
Mr. freeman is currently on simvastatin 40 mg at bedtime for hyperlipidemia
assessment
summary
concern
objective
"A" in ISBAR: ______
- ________ statement of what your _________ is
- _________ data: vitals, lab results, recent fill date
- If a drug is subtherapeutIc or if patient cannot afford prescribed medication
i'm concerned bc drug interaction between clarithromycin and simvastatin can increase myopathy
recommendation
suggestions
document conversation
"R" in ISBAR: ______
- be clear, concise
- _________ (alternative, discontinue, monitor)
- if prescriber disagrees : politely acknowledge + ask for clarification
**** ___________ __________******
I recommended we switch to alternative, like azithromycin to avoid interaction?
medication reconciliation
-- process of obtaining correct med list at given time
-- exactly what pt is on
-- occurs at each office visit, hospital + nursing home admission and discharge
Patient, EMR
actually
side effects, cost, ran out, incorrect
medication reconciliation:
- ____ list or _____ list
- key is to understand how pt is _______ taking med
- why is there a discrepancy?
-> stopped due to _____ _____/___/ ____ _____/ takes ______ amount
- check dispensing history in EMR report
- check controlled substances with CT PDMD website
* accuracy improved since pharmacy took charge of this process
people who use drugs
LGBTQIA+
homeless
those experiencing housing instability
recently incarcerated
sex workers
what are the key populations defined by the CHC?
- can evolve over time
key groups
health disparities
stigma
discrimination
CHC ensures access to integrated quality speciality + primary care while recognizing ________ _______ who experience ____________ ________ secondary to ____________ and ____________
- serves as a resources for PCP who want to integrate caring for key populations in their own practices
barriers
clinicians
other reasons for health disparities:
- _______ to accessing healthcare in traditional clinic based setting
- lack of __________ trained in unique healthcare needs
stigma
discrimination against identifiable group of people
- stem from inaccurate beliefs
(examples)
believe addiction is moral failing
LGBT fear of what is different
PTs with HIV can easily spread it
LGBTQIA+
pronouns, name
____________: many similarities but must keep in mind that they represent diverse communities with differing healthcare beliefs
- important to use correct _______ and _____
- there are higher _______ among community
addiction
alcohol use disorder
remission,recovery
substance use disorder
______________: must be mindful of terminology and use medically accurate terms
- NOT ALCOHOLIC but person with _____ ___ _____
- NOT CLEAN but in _______/_______
- NOT ADDICT but person with _____ ____ _____
medications for opioid use disorders
MOUD
Substance use health and MOUD
public health approach goal to reduce harm related to high risk behavior
- model that benefits patients, families, and communities
- research shows it does not encourage substance use
harm reduction
______ ______ includes:
- safe sex counseling, free condoms, narcan, MOUD
MOUD programs
- allow for convenient access to substance use disorder treatment + behavioral health care within community
- more privacy, less stigma when embedded in primary care clinic
SBIRT
(screening, brief intervention, referral to treatment)
what methods do pharmacists use to identify unhealthy substance use?
- risky use
- substance use disorder
unhealthy substance use includes:
- ____ ____ _____
- _______ ________
risky use
consumption of amounts that increases likelihood of health consequences
Accidents, injuries, falls, overdose
social problems
substance use disorders
interactions
chronic disease management
RISKY USE CONSEQUENCES:
- _______, _____, _____, _______
- ______ ______ (vulnerable, decreased alertness, being target of aggression or aggressive
- progression to ____ ____ ______
- medication ______
- adversely affecting ____ ____ _______
dispensing controlled substances
medication, effects
profiles
trust
unhealthy substance use relevance to pharmacist:
- frontline in _____ _____ _______ (opioids, benzodiazepines)
- specific ________ and adverse _____ expertise
- access to medication ______
- pts ______ pharmacists
Screening, Brief Intervention, Referral to Treatment (SBIRT)
- to identify + effectivity intervene with those who are moderate to high risk for healthcare of psychosocial problems related to their substance abuse
What does SBIRT stand for and what is the goal?
screening
universal, targeted
2-3 questions
picking
ASSIST-FC (frequency + Concern)
S in SBIRT: _________
- can be _______ (ask all pts you see) or _______ (pt doesn't pick up on time, potentia; drug interaction, or Rx controlled substance)
- ____________ to identify pts with unhealthy substance use
- while pts are waiting to __________ medications/meet with pharmacist, DOCUMENT in computer system
- use ____________
ASSIST-FC
asks about substances used in past 3 months that have been used differently or in other doses than prescribed
- as part of the Screening in SBIRT
- introduce screening for alcohol, smoking, substance involvement
- stress types of substances, reason, provide usage window
frequency
anyone, concern
often
5+, 4+
ASSIST-FC QUESTIONS:
1. ______ of use in past 3 months
- indicates most relevant substances, if "never", end interview
- In the past 3 months, how often have you used the following substances?
2. whether ______ has ever expressed ______ about patient use of substance + how recent it occured
- For the substances you have used in the past 3 months, has a friend or relatIve or anyone else expressed concern about your use of ____
3. binge drinking - how ______ patient has ____ (male) or _____ (female) drinks in 1 occasion
drug list
response card
when screening for SBIRT and using ASSIST-FC, use the ______ ____ and _____ _____
number
yes
responses for SBIRT ASSIST-FC 2 questions is given a ______ score
(example)
Question 1:
never- 0 pts
once or twice - 2 pts
monthly - 3 pts
weekly - 4 pts
daily - 6 pts
- binge drinking: if _____ then Brief intervention is necessary
Question 1 and Question 2
when scoring ASSIST-FC:
- add _______ and _______
- each substance gets its own score
binge drinking
consuming more than the recommended lower risk guidelines for drinking on any one occasion
- puts patients at increased risk of injuries, unintended sex, accidents, fights, violence, falls, downings
positive, brief intervention
negative, positive reinforcement
if scoring is 1+, it is a _____ result and requires a ____ _______
if scoring is 0, it is a ______ result and ____ _______ is suggested
low- positive reinforcement
moderate - brief intervention
high - brief intervention + further assessment
assessing risk level score for ASSIST-FC:
Alcohol 0-5, all other substances 0 : _____ risk of health problems (____________)
6-8, 2-6: _____ risk of health problems ( ____________)
9-12, 7-12: _____ risk of health problems (_________ and ________)
Brief intervention
feedback, advice
non confrontational, non judgemental
B in SBIRT: _________ _________
- conversation to motivate patients who screen positive to consider healthier decisions (cutting back, quitting, seeking further assessment)
- includes ______, _____ and negotiating a goal
- _____________ and __________, directive, enhances motivation to change substance use
feedback
permission
findings
pros + cons
potential
reaction
during Brief Intervention:
___________ : provide personalized based on screening results and state your concern
- ask ______ to share info
- discuss screening _______
- ask for pt ____ and ____ around substance use
- link unhealthy such use to any _______ risks
- ask for pt _____ to that link
advice
cut, low
stop
during Brief Intervention:
_________ : make nonjudgmental yet explicit recommendation for change in behavior
- if risky drinking without serious consequences : advise to ___ back to ____ risk levels
- if serious consequences, Rx misuse, worsen known medical condition, known med interactions, pregnant: advise to _______ use, further assessment and discussion with PCP
FRAMES
Feedback
personal Responsibility
Advise
Menu of change
elicit change talk by Empathy
support Self efficacy
this approach can be used in brief intervention of SBIRT and what does it stand for?
Feedback
permission
risk
risks
interactions
thoughts
F in FRAMES: ________
* given to an individual about personal risk of impairment
- ask __________ to share results
- Provide _____ level and meaning
- Describe _____ associated with use and educate patIent on potentIal harmful ______
-ask individual for their ________
promote personal responsibility
reduce, quit
R in FRAMES: ___________
* responsibility for change is placed on client
- advise to ______ or ____ use
advice with permission
permission
A in FRAMES: ________
* advice for change us given by provider
- ask _____ to share info about lower risk use
menu of options
patients
successes, self-efficacy
challenges
ideas, self-efficacy
M in FRAMES: __________
* alternative treatment options offered to client
- go thru options and let _____ choose
- draw on past _____ and support _____
- explore _______
- affirm _____ and support self-efficacy
enhance motivation and elicit change talk by EMPATHY
understanding
E in FRAMES: _________
- be _______ and relatable
support self-efficacy
pros, cons
change
positives , change
S in FRAMES: ___________
- ___________ of use
- ________ rulers (0-10 on confidence/importance/readiness to change)
- contrast with a lower number: why 5 and not 3 or 4?)
- reinforce ______ and help envision _____
referral to treatment
RT in SBIRT: _____________
* activity link patients to resources when needed
SBIRT
provides a feasible and evidence based approach that pharmacists can use to assess unhealthy substance use, engage in brief interventions and make appropriate referrals
discomfort
privacy
exist
time
knowledge
Barriers to SBIRT for pharmacists:
- __________ with SBIRT
- lack of _________ and confidentiality concerns
- systemic approaches to ensure universal/targeted screening + documentation don't ________
- lack of _______ and reimbursement
- inadequacy _____ of referral programs and insurance coverage
comfort
integrate
help
insurance
Facilitating SBIRT:
- training and practice of technique to increase _______
- _______ into current workflow
- engage others for ________
- work with local community and _____ programs to identify referral programs
group
3+ people whose behavior exert mutual + reciprocal influence on one another
goals
roles
communication
individual, feedback
objective
effective groups have:
- identify clear, shared, and motivational _______
- identity _______ and accountabilities clearly
- utilize effective _____________ system
- monitors _______ performance and provide ______
- assesses ______ and date to make decisions
climate
emotional tone of group
indication of how comfortable individuals are in communicating
supportive
defensive
_________ climate in which individuals work well together
_______ climate in which individuals do not work well together
roles
members of groups can hold many _______ simultaneously and over time
group task
maintenance
self-centered
ROLES in GROUP:
- ______ ________: keep groups on task (initiates, contributes, motivating)
- ___________: helps group resolve conflict + serves supportive function, compromiser
- ______ _______: interrupts group flow by only fulfilling their own agenda rather than consider group as a whole, aggressor, dominator
autocratic - dominant authority
democratic - share authority
laissez-faire - authority to group members
what are the 3 different leadership styles?
dominant, strong
lines, direction
decision
creativity
willingness
emergency situations
AUTOCRATIC:
- _______, _______ authority over group
- most common in healthcare
advantages:
- clear authority _____ and ______
- quick ______
disadvantages:
- hinders ______
- decrease _____ to abide by decisions
*BEST FOR _________ ________
share, input, consensus
participation
expertise
information
motivated
conflict
longer
cliques
complex, creativity
DEMOCRATIC:
- _______ authority appropriately with the group by eliciting _____ from all members and seaking _______
advantages:
- active ______
- sharing ______
- generation of a lot of _______
- members are ________
disadvantages:
- ______ with differing perspectives
- _______ decision making process
- formation of _____
* BEST FOR __________ SITUATIONS REQUIRING _________ (NON EMERGENCY)
group members
growth
creative
prepared
tasks
advantage
self help groups
LAISSEZ-FAIRE:
- delegate authority to _______ _______
advantages:
- encourages _______ and development of members
- fosters ________ decision making
disadvantages:
- group members not _____ to work on their own
- can't handle _______
- members take ______ of situation and flounder in performance
* BEST FOR ____ ___ _______ and CASELOADS ASSIGNED TO SOCIAL WORKERS
peer
leadership
conflict
info
decision making
effective leader:
- ______ skills
- _______ skills
- __________ resolution skills
- _______ processing skills
- _________ skills
- resource allocation
- entrepreneurial skills
- introspection skills
progress
problems
tension/anger
interaction/involvement
creativity
strengths
conflict in groups:
- stops ________
+ helps identify larger ______
+ allows release of ______
+ fosters ________
+ encourages ______
+ tests ________
group decision making
best for decisions that are
complex
impersonal
require multiple experts + tasks + time + energy
individual decision making
best for decision that are
simple
personal
require individual expertise
little time and responsibility
orientation
conflict
emergence
reinforcement
phases of decision making:
1. ___________ : members socialize/orient to issue
2. _________ : ideas are disputed + tested
3. ________ : ambiguity in group as efforts to arrive at best decisions
4. __________: unity of opinion persuades as courses of action are identified
similar
problem solving for groups is ______ for individuals
brainstorming
evaluate
exhausted
record
break
generate creative solution to a problem following these guidelines:
- anything goes
- don't ________ ideas as you go
- think of as many as possible until ideas are __________
- _______ ideas
- take a ________ between brainstorming and evaluating ideas
Groupthink
thinking people engage in when deeply involved in group
when members striving for unamity override motivation to appraise alternative courses of action
A Concurrence-Seeking Tendency
invulnerability
morality
unanimity
Symptoms of Groupthink:
- Illusion of _________
- Belief in inherent ________ of the group
- Collective rationalization
- Out-group stereotypes
- Self-Censorship
- Illusion of ________
- Direct pressure on dissenters
- Self-Appointed mindguards
level, type
sharing territory
equal, open
communicate
Guidelines for TEAM BUILDING:
- members should have the same _____ and ______ of knowledge of the problem
- _______ ________- held in mutual territory
- Stature of members need to be ______ as possible for open _____ of info (round tables)
- Opportunities to _________ needs to be equal (being near one another)
