Basic Comm Skills for Class Pres 2010

8/7/2019 Basic Comm Skills for Class Pres 2010

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PHRM 3900:PHRM 3900:

Pharmacy CommunicationsPharmacy CommunicationsMatthew Perri, Ph.D., R.Ph.Matthew Perri, Ph.D., R.Ph.

Professor of PharmacyProfessor of Pharmacy

Clinical and Administrative PharmacyClinical and Administrative PharmacyRoom 250G Ph:542Room 250G Ph:542--53655365

[email protected]@mail.rx.uga.edu



Plan for today:Plan for today:

Course overview & introductionCourse overview & introduction ± ± ID CardsID Cards

Name, where you are from, any prior degrees, somethingName, where you are from, any prior degrees, somethingabout yourself that will help me remember youabout yourself that will help me remember you

± ± Web pageWeb pageCourse objectives, Grading, Lecture outlines, HandoutsCourse objectives, Grading, Lecture outlines, Handouts

Other interesting stuff Other interesting stuff

OBRA 90 and Pharmacy CareOBRA 90 and Pharmacy Care

Common communication mistakes healthCommon communication mistakes healthpractitioners makepractitioners make

Basic communication skillsBasic communication skills



The Pharmacy Care ProcessThe Pharmacy Care Process

Collect and use

patient information

Identify patients¶ drug

related problems

Develop solutions

to these problems

Select and recommend

therapies

Follow up to assess

patient outcomes



OBRA 90:OBRA 90:

Three parts:Three parts:

± ± Patient InformationPatient Information

± ± Prospective Drug Utilization ReviewProspective Drug Utilization Review ± ± Patient CounselingPatient Counseling

Public Law 101-508, S4401, 1927(g) (November 5, 1990) and OBRA 90

Regulations. Federal Register November 2, 1992;57FR(212):49397-49401.



Patient InformationPatient Information

Full nameFull name

Address and phone Address and phone

Date of birth (DOB) / ageDate of birth (DOB) / age

Gender Gender

Drug list (profile) including all OTC, Rx, herbalDrug list (profile) including all OTC, Rx, herbalsupplements, etc.supplements, etc.

Pharmacist commentsPharmacist comments

Chronic medical conditions (diagnoses)Chronic medical conditions (diagnoses)

Keep for 2 yearsKeep for 2 years



Prospective DURProspective DUR

Over / underutilizationOver / underutilization

Therapeutic duplicationsTherapeutic duplications

DrugDrug--disease interactionsdisease interactionsDrugDrug--drug interactionsdrug interactions

Incorrect dosage or duration of treatmentIncorrect dosage or duration of treatment

Drug allergy interactionsDrug allergy interactionsClinical abuseClinical abuse -- misusemisuse



Patient CounselingPatient CounselingName (generic)Name (generic)

Intended use and expected actionIntended use and expected action

Route, dosage form, dosage and administrationRoute, dosage form, dosage and administrationscheduleschedule

Special directions for preparation, storage or Special directions for preparation, storage or

administrationadministrationPrecautions to be observed while takingPrecautions to be observed while taking

Common side effects, how to avoid or action required if Common side effects, how to avoid or action required if they occur they occur

Techniques for self monitoring of drug therapyTechniques for self monitoring of drug therapy

Potential interactions or therapeutic contraindicationsPotential interactions or therapeutic contraindications

RefillsRefills

What to do if you miss a doseWhat to do if you miss a dose

Any other information THIS patient may need to ensure Any other information THIS patient may need to ensure

safe usesafe use



10 Communication Mistakes10 Communication Mistakes

Pharmacists MakePharmacists MakeFrom: ³Lessons from medicine and nursingFrom: ³Lessons from medicine and nursingfor pharmacistfor pharmacist--patient communication´, Ampatient communication´, Am

Jour of Health System Pharmacists, Vol. 53,Jour of Health System Pharmacists, Vol. 53,June 1996, pages 1306June 1996, pages 1306--14.14.



Basic Communication SkillsBasic Communication Skills

in Pharmacy Practicein Pharmacy Practice



The Communication ModelThe Communication Model



The communication model:The communication model:

Communication takes twoCommunication takes two

± ± sender and receiver sender and receiver

To optimize communication we mustTo optimize communication we mustconsider the ³channel´consider the ³channel´

Two way flow of informationTwo way flow of information

Potential for a breakdown to occur at anyPotential for a breakdown to occur at any

timetimeBarriers will existBarriers will exist ± ± minimize these whenminimize these whenyou canyou can

Communications Skills in Pharmacy Practice,T

indall, Beardsley and Kimberlin, third ed., 1994, Lea and Febiger,p 15.



Barriers to communicationBarriers to communication

Pharmacy EnvironmentPharmacy Environment



Barriers to communicationBarriers to communication

Pharmacy EnvironmentPharmacy Environment





Basic Counseling andBasic Counseling and

Communication SkillsCommunication SkillsCourtesy and rapport:Courtesy and rapport:

± ± Quite possibly the most critical skills you willQuite possibly the most critical skills you will

need to develop, and includes:need to develop, and includes:How to address patientsHow to address patients

Introducing yourself Introducing yourself

Learning patient namesLearning patient names

Being aware of your appearance, attitude, issuesBeing aware of your appearance, attitude, issuesRespecting patient privacy issuesRespecting patient privacy issues

Avoiding stereotypes Avoiding stereotypes

Using appropriate body languageUsing appropriate body language



Body LanguageBody Language

Message impact:Message impact:7% verbal7% verbal

38% vocal38% vocal

55% body movements55% body movements

Often more believable than wordsOften more believable than words

Composed of Composed of Body movementsBody movements

Facial expressionFacial expression

GesturesGestures

Posture and breathingPosture and breathing

SpaceSpace



Basic Counseling andBasic Counseling and

Communication SkillsCommunication SkillsBody languageBody language

± ± Facial expressionFacial expression ± ± smilesmile

± ± Eye contactEye contact ± ± Open postureOpen posture

± ± DistanceDistance

± ± Tone of voiceTone of voice

± ± Get CLOSERGet CLOSER ± ± Control distractions, lean in, open posture, smile, makeControl distractions, lean in, open posture, smile, make

good eye contact, relaxgood eye contact, relax



Good body language?Good body language?



StereotypesStereotypes

Everyone does this to some extentEveryone does this to some extent

± ± Biker at 8:55PM on Saturday«.Biker at 8:55PM on Saturday«.

± ± What is your favorite stereotype?What is your favorite stereotype?What is the impact of this on rapport?What is the impact of this on rapport?

Being aware of how you may stereotypeBeing aware of how you may stereotype

others is criticalothers is critical

Treat everyone as an individualTreat everyone as an individual



RapportRapport

Mutual consideration and respectMutual consideration and respect

± ± The ³warm fuzzy´ part of communicationThe ³warm fuzzy´ part of communication

Paves the way for good communicationPaves the way for good communicationTrust is criticalTrust is critical

± ± How do you build trust?How do you build trust?

± ± How do you keep it?How do you keep it? ± ± What happens when you break it?What happens when you break it?



PerceptionsPerceptions



FINISHED FILES ARE THE REFINISHED FILES ARE THE RE--

SULT OF YEARS OF SCIENTIFSULT OF YEARS OF SCIENTIF--IC STUDY COMBINED WITH THEIC STUDY COMBINED WITH THE

EXPERIENCE OF MANY YEARSEXPERIENCE OF MANY YEARS

OF EXPERTSOF EXPERTS





Basic Skills: ListeningBasic Skills: Listening

ListeningListening

± ± Perceptions (F test)Perceptions (F test)

± ± Being nonBeing non--judgmental judgmental

± ± Being an active listener Being an active listener

Summarizing, paraphrasing, clarifying, feedbackSummarizing, paraphrasing, clarifying, feedback

(immediate, honest and supportive)(immediate, honest and supportive)

± ± Use appropriate listening body languageUse appropriate listening body language

± ± Use silence where appropriateUse silence where appropriate

± ± Listening with empathyListening with empathy



Basic Skills: InformationBasic Skills: Information

When Communicating Information:When Communicating Information:

± ± Everything up to this point, such as:Everything up to this point, such as:

Developing rapport; active listening; having a calm,Developing rapport; active listening; having a calm,

attentive postureattentive posture ± ± P lus:P lus:

Inquire about what the patient needsInquire about what the patient needs

State your purposeState your purpose

Use markers for critical informationUse markers for critical informationTalk in lay terms, but don¶t oversimplifyTalk in lay terms, but don¶t oversimplify

Avoid technical jargon Avoid technical jargon

Avoid information overload Avoid information overload

± ± Keep it short and simple, to the pointKeep it short and simple, to the point



Basic Skills: GatheringBasic Skills: Gathering

InformationInformationWhen gathering informationWhen gathering information

± ± Ask open Ask open--ended questionsended questions

Much more information can be gainedMuch more information can be gained

Saves timeSaves time

Provides opportunities for patients to revealProvides opportunities for patients to reveal

information we might not be thinking aboutinformation we might not be thinking about

± ± ³ How are you supposed to be taking this«?³ How are you supposed to be taking this«?

± ± ³T ell me more about this«´ ³T ell me more about this«´



Basic Skills: AssessmentBasic Skills: Assessment

Did your patient learn?Did your patient learn?

Did the other person understand what you said,Did the other person understand what you said,

and meant?and meant?

± ± Summarize your teachingSummarize your teaching

± ± Verify what your patients knowVerify what your patients know

± ± ³I know you believe you understand what you think I³I know you believe you understand what you think I

said, but I am not sure you realized that what yousaid, but I am not sure you realized that what you

heard is not what I meant.´heard is not what I meant.´

± ± Reinforce patient understanding when you canReinforce patient understanding when you can

³T hat¶s right, this medication will make you sleepy«´ ³T hat¶s right, this medication will make you sleepy«´



Basic Skills: EmpathyBasic Skills: Empathy

Seek to understand what your patients feelSeek to understand what your patients feel

± ± Empathy is not sympathyEmpathy is not sympathy

± ± Realistically, may not be attainable becauseRealistically, may not be attainable becauseyou are not the other personyou are not the other person

± ± Empathy will help you shape your Empathy will help you shape your

communication so that others better communication so that others better

understand you!understand you!Listening and Responding Test: (p47Listening and Responding Test: (p47

TindallTindall Book)Book)



Basic Skills: QuestionsBasic Skills: Questions

Encourage patients to ask questionsEncourage patients to ask questions

± ± When your patients are comfortable asking When your patients are comfortable asking

you questions, you know you have rapport you questions, you know you have rapport and are doing a good job communicating and are doing a good job communicating



Basic Skills: Being AssertiveBasic Skills: Being Assertive

and Persuasiveand Persuasive Assertive not aggressive (we¶ll come back to this Assertive not aggressive (we¶ll come back to thislater)later)

Use persuasion where appropriate, for exampleUse persuasion where appropriate, for examplewith medication compliance issueswith medication compliance issues

Persuasion becomes manipulation when it servesPersuasion becomes manipulation when it servesthe purpose of the communicator (pharmacist)the purpose of the communicator (pharmacist)rather than the interests of the recipient (patient)rather than the interests of the recipient (patient)

For most patient care scenarios the pharmacyFor most patient care scenarios the pharmacyprofessional should be a ³giver not taker´professional should be a ³giver not taker´

SoSo ± ± be alert to your motivations andbe alert to your motivations andcommunication purposes. (we will talk about ethicscommunication purposes. (we will talk about ethicslater)later)



Counseling Methods We WillCounseling Methods We Will

Learn:Learn:Basic CounselingBasic Counseling

± ± Interactive patient counselingInteractive patient counselingThe Prime QuestionsThe Prime Questions

Counseling in challenging situationsCounseling in challenging situations ± ± The PAR techniqueThe PAR technique

Prepare, assess and respondPrepare, assess and respond

Counseling for complianceCounseling for compliance ± ± The RIM techniqueThe RIM techniqueRecognize, identify and manageRecognize, identify and manage



Face Reading: Art not ScienceFace Reading: Art not Science

LightLight

ForeheadForehead

Eyebrows: shape,Eyebrows: shape,

position, typeposition, type

Eyes: spacing, angle,Eyes: spacing, angle,bulging, size of iris, corner bulging, size of iris, corner

indents, pupil response,indents, pupil response,

showing stressshowing stress

EyelidsEyelids

EyelashesEyelashes

Eye PuffsEye PuffsNose: size, shape, ridge,Nose: size, shape, ridge,

width, nose tip angle,width, nose tip angle,

Nose tipNose tip

NostrilsNostrils

Ears: size, cups and ridges,Ears: size, cups and ridges,

angle to head, placementangle to head, placement

CheeksCheeks

Mouth: size, angleMouth: size, angle

Lips: size and shapeLips: size and shape

TeethTeeth

SmilesSmiles

ChinsChins

Combinations of featuresCombinations of features

(Chin/eyebrow(Chin/eyebrow))LinesLines

Facial hair Facial hair

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Basic Comm Skills for Class Pres 2010