Pharmacist Skills

Question 1

Drug Information Request

Step 1: collect: identify the requestor

Answer 1

Consumer/patient vs. prescriber/health care professional
Directly determine requestor’s position, training, baseline knowledge.
–> Requestor’s name
–> Preferred method of contact
–> Frame of reference (title, profession, etc.)
–> Resources the requestor has already checked

Question 2

Drug Information Request

Step 2: Collect: obtain background information

Answer 2

Ask background questions to obtain information as appropriate to the
situation.
–> Whether the request is patient specific or academic
–> Relevant information about the patient (name, DOB, age, weight, allergies)
–> Urgency of the request (negotiate the time response)
Be mindful not to inundate the requester with unnecessary questions. Asking
inappropriate questions may make the pharmacist appear incompetent and
inefficient.

Question 3

DRUG INFORMATION REQUEST

Step 3: ASSESS: Determine and categorize the ultimate question

Answer 3

Restate question rephrased in your own words, incorporating new or
additional information gathered
Often, ultimate question is different from the original question
–> Use background info obtained to determine ultimate question being asked
Some questions can be classified by only one characteristic; others can be
classified by more than one

Question 4

DRUG INFORMATION REQUEST

Step 4: COLLECT: Develop strategy and conduct search

Answer 4

Once question has been categorized, select appropriate references based
on the likelihood that they will contain useful information
Easiest, most familiar resources not always the best
–> Start with tertiary resources, then use secondary sources to find additional tertiary and
primary articles (if necessary)
–> It is an excellent habit to record all resources used, and whether or not they contained useful
information (e.g., notation of +, ~, ­ or useful, somewhat, not useful)

Question 5

Search Strategy

Answer 5

Tertiary: Summary of existing medical literature (reviews, textbooks)

Secondary: Indexing/abstracting services (MEDLINE)

Primary: Original research (Clinical studies)

Question 6

Drug information Resources

Answer 6

Disease and Drug knowledge

• Lexi-Comp and Micromedex
• Natural Medicine
• DiPiro
• MD Calc
• PubMed
• UpToDate
• Medscape

Question 7

Drug Information Request

Step 5: Assess: Perform evaluation, analysis, and synthesis

Answer 7

Objectively critique the information retrieved
For tertiary references, consider the following questions to ensure source quality:
– >1. Is author(s) sufficiently experienced and credentialed to be writing on the topic?
–> 2. Is this the most recent edition of the reference? Is the info contained likely to be timely based on the publication date?
–> 3. Is info referenced? Ideally, all statements should be supported with accurate citations, but sometimes these are left out to save space.
–> 4. Is the resource likely to contain info relevant to your search? (i.e., it would be inappropriate to use a text of drug interactions to identify the active ingredient of a product)
–> 5. Is it free of obvious bias or errors?
–> 6. Is it clear, concise and easy to use?

Question 8

Drug Information Request

Step 6: PLAN: Formulate and provide response

Answer 8

As a professional, your duty to provide an unbiased, well informed answer
–> Summarize your findings in your own words
For controversial topics both sides of the controversy must be presented
Reference background info in the response and be prepared for additional
questions

Question 9

Drug Information Request

Step 7: Implement and follow up: conduct follow-up and documentation

Answer 9

Follow­up is an important element that may be easier to implement in an
institutional setting (discuss with requestor and/or check patient’s medical
record).
–> In community setting, call patient to assess outcome of recommendation.

Follow­up process can strengthen inter­-professional collaboration and
patient­ pharmacist relationships.

Remember: if it isn’t documented, it didn’t happen!

Question 10

Main reasons for documentation

Answer 10

Provide record of what practitioner does
–> Provide real time trail of patient care
Why things are being done
Outcomes achieved from any interventions

Question 11

Forces affecting clinical documentation

Answer 11

The need for enhanced communication among healthcare providers
(PCP, specialist, ER/hospital visits)

–> lower redundancy and potential for medical errors

The emergence of EMRs/EHR in healthcare

The need to maintain secure patient data while making this
information available to others

Question 12

Differences in documentation

Answer 12

Will differ depending on situation

• -> Setting (e.g. hospital vs. ambulatory care vs community)
• -> Institution (BIDMC vs. MGH vs BWH, etc)
• -> Type of interventions (e.g. patient education vs. pharmacokinetic calculation)
• -> Preferences of clinician
• -> Type of documentation
• -> Progress note vs. intervention form vs. other documentation type
• -> What documentation have you seen while on co­op?