Basic Comm Skills for Class Pres 2010
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Transcript of 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
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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
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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
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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.
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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
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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
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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
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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.
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Basic Communication SkillsBasic Communication Skills
in Pharmacy Practicein Pharmacy Practice
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The Communication ModelThe Communication Model
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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.
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Barriers to communicationBarriers to communication
Pharmacy EnvironmentPharmacy Environment
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Barriers to communicationBarriers to communication
Pharmacy EnvironmentPharmacy Environment
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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
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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
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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
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Good body language?Good body language?
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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
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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?
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PerceptionsPerceptions
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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
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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
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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
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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«´
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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«´
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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)
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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
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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)
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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
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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