Consultation

How can you manage a consultation

• tell patient how long it will last

• tell the patient the structure

• start on time

• make notes

Why are models of consultation used

• provide structure and make sure nothing is missed

• achieve particular purpose

• system of questions

• toolkit to aid developing consultation skills

What is the MRCF

• medication related consultation framework

• developed to reflect and evaluate skills of pharmacy practitioners

Explain the MRCF

• set the scene

• collect data and identify problem

• actions and solutions

• closing

• consultation behaviours

What are the skills needed to consult effectively and where will you use them in the consultation

• rapport - throughout

• questioning skills - info gathering

• listening - info gathering and giving

• clarity of explanation - info giving

• structure - throughout

What is cultural competence

• ability to recognise importance of race, ethnicity, culture in health services

• people from other cultural groups don’t share same beliefs and practice or perceive, interpret or encounter similar experience in the same way

How does improving cultural competence define race

• social construct describing people w/ shared physical characteristics

How does improving cultural competence define ethnicity

• social identity + mutual belongingness defining group of people

• shared beliefs, common origins and culture

How does improving cultural competence define culture

• particular set of belief, norms and values

• influence idea about nature of relationships, the way people live their lives and how they organize their world

What is equality in healthcare

• identification of barriers and biases, and targeted action to overcome specific inequalities, discrimination and marginalisation

What is diversity in healthcare

• being aware of diverse patient pop.

• accommodating diversity into provision of care

What is inclusion in healthcare

• differences of people seen as benefit

• people = comfortable to share perspectives and differences

What is the equality act (2010)

• law protecting people from discrimination

• un fair treatment based on certain personal characteristics

What should you collect and record for a medication history

• current medication

• past medication (within 6 months) - reason for discontinuation

• who administers and if compliance aid used

• check if they are managing to take medicines

What do you need to know when taking a FULL history from a patient

• previous medical history

• social history → lifestyle factors, occupation etc

Describe community pharmacy PMR system

• recording of

  • allergies

  • medical conditions

  • patient notes

  • adverse/safety incidents

  • NMS

what do you need to check w/ repeat prescriptions as a secondary source of information

• check up to date

• ask about acute medicines (e.g. antibiotics) they will not be on their repeat

Describe patient notes/medical record as a secondary source of information - from GP/hospital

• continuous journal

• records patient treatment and progress

• biochem results recorded

• medical and medicine history

• presenting complain, working diagnosis recorded on admission to hospital

Describe GP referral letter as a secondary source of information

• not always complete

• medication list may not be up to date

• no OTC medicines, herbal medicines or family/friend’s medicines

• patient may not be taking medicines as prescribed

what to check from a previous discharge documents as a secondary source of information

• changes to patient’s medication

Describe care home records as a secondary source of information

• Medication administration record → from care home

• read carefully to check any new, old or refused medicines

Describe specialist clinics as a secondary source of information

• patient may receive medicines via specialist prescriber from clinic

• contact them to establish drug regime

• treatment may need to be co-ordinated w/ hospital

Describe NHS summary care record (SCR) as a secondary source of information

• electronic patient record w. key info derived from patient’s GP records

  • patient medication

  • allergies

  • ADRs

Describe Patient’s own drugs (POD) as a secondary source of information

• encouraged to bring medicines into hospital

• to improve medication history taking

• prevent missed dose

• reduce NHS expenditure

• using PODs reduces risk of harm on discharge