Formulating Effective Responses and Recommendations: A Structured Approach

1. Formulating Effective Responsesand Recommendations:A Structured Approach Ch.#3

2. The process of formulating responses remains constant even with different types of requesters, requests, or settings. • Pharmacists must extend their knowledge of drugs & therapeutics to the clinical management or for large populations to ensure that DI is appropriately interpreted and correctly applied.

3. Accepting Responsibility & Eliminating Barriers: * The pharmacist’s responsibilities include: 1. Provide answers to DI questions. 2. Assist in resolving therapeutic dilemma 3. Assist in managing patient medication regimens.

4. It is NOT common to find comprehensive answers in the literature that completely & effectively address specific situations or circumstances that clinicians face in their daily practices. • Responses & recommendations must be synthesized thoughtfully using: • information and knowledge gathered from diverse sources & • added skills & competence in problem solving & direct patient care to effectively manage the care of patients & resolve complex situations.

5. First, pharmacists must overcome impediments, i.e.: • False perception that most DI requests do not pertain to specific patients. 2. The false perception that “casual interactions” with requesters preclude the need for in-depth analysis& extensive involvement in patient management. 3. Pharmacists sometimes oversimplify their interactions with requesters & fail to identify the context or the significance of the question. 4. The absence of sufficient background information & pertinent patient data diminish the ability of the pharmacist to provide effective responses.

6. Identifying the Genuine Need: *Most queries the pharmacists receive often involve specific patients & involve unique circumstances. *However, the requesters are usually vague in verbalizing their needs & provide specific information only when asked which doesn’t obviate the need for such critical information or relive the pharmacist of the duty to collect it.

7. Therefore, it is the pharmacist’s responsibility to obtain the needed information completely & efficiently using questioning strategies. • Good communication skills in both listening & questioning are important for enabling the pharmacist to: 1. Gather relevant information. & 2. Understand the “real” question.

8. Without such information the pharmacist will: • Risk providing general responses (not pt. specific) • Provide information that can be misinterpreted or misapplied. • Compromise the pharmacist credibility. • Jeopardize patient care.

9. Therefore, the pharmacist should recognize that requesters needs often go beyond a superficial answer to a primary question. • The pharmacist should always anticipate additional questions or concerns, including those not directly asked by requester. • See cases.

10. Generally, the pharmacist must learn to rely on: • Patient care skills. • Problem solving skills. • Insight. • Common sense. in formulating answers or recommendations.

11. Formulating the Response: • The steps in formulating a response include: • Assembling & organizing a patient database. • Gathering information about disease states. • Collecting medication information. • Obtaining pertinent background information. • Identifying other relevant factors & special circumstances. (See Table 3-3)may not all be relevant

12. Developing a patient database requires collecting pertinent information from: -patient -caregiver -health-care provider -medical chart -other patient records * Comprehensive medication history may also be obtained by the pharmacist from different sources.

13. Once data are collected & carefully assembled, it must be critically analyzed & evaluated before final response &recommendation are synthesized. • Analysis & Synthesis: Assist in: • Forming opinions • Arriving at judgments • Ultimately, drawing conclusions

14. Analysis: • A critical assessment of the nature & significance of individual ideas, elements, or factors. • It involves separating the information into isolated parts so that each can be critically assessed. • Analysis requires: 1. Thoughtful review. 2. Evaluation of the weight of available evidence. 3. Consideration of pertinent positive & negative findings.

15. Once information is carefully analyzed, synthesis can begin. • Synthesis: • Is the careful, systematic, & orderly process of combining or blending varied elements, ideas, or factors into a coherent response through the use of logic & deductive reasoning. • Synthesis relies on: -type & quality of data gathered -how data is organized, viewed, & evaluated • It involves the careful integration of critical information about: the patient , the disease, the medication with the background information to arrive at a judgment or conclusion.

16. Response & Recommendation: • An effective response must : ANSWER the question. • Other desired characteristics of a response: - timely, current - accurate, complete - concise, well referenced - clear, logical - objective, balanced - free of bias or flaws - applicable for specific circumstances - answers important related questions - address specific patients or situations

17. The response should begin with an introduction to the topic & systematically present specific findings. • Conclusions & recommendations are also included in response with pertinent reference citations from literature. • In formulating a response, you should: -Disclose all available information relevant to question -Present all reasonable options with explanations & evaluations of each

18. Specific recommendation must be scientifically sound & clearly justified. • Follow-up: • Allows pharmacist to know if recommendation was accepted & properly implemented. • A hallmark of a true professional & demonstrates pharmacist’s commitment to patient care. • Required to re-evaluate recommendation & make modification. • Allows pharmacist to receive valuable feedback from other clinicians & to learn from experience.