Clinical Skills for Pharmacists a Patient Focused Approach
In the preface to the first edition of Clinical Skills for Pharmacists, I described how the book was developed, the organization, structure, and format of the book, as well as my hopes for the book. I ended the preface by stating that the book was a work in progress and that all suggestions for improvement were welcome. Although I thought the book was unique and hoped it would find a useful niche within the profession, I was unsure of its acceptance. I have been quite surprised by the overwhelmingly positive response the first two editions of the book have elicited. Although my students delight in pointing out the occasional typographical error or inconsistency, feedback regarding the style and content has been consistently positive. The book has found a niche as a unique compilation of skill-related topics and is complementary to clerkship manuals and physical assessment, pharmacotherapeutics, and ethics textbooks.
The third edition has been completely updated. The book is now in color and in a larger format. More than 100 images (figures, photographs, illustrations), most in color, were added to this edition. A list of chapter acro-nyms was added to the book, for easy reference. Also new to the third edition are chapter-specific application exercises. Located at the end of each chapter, the application exercises are best completed in small groups, though they can be completed individually.
Approximately one-third of the book content is new. Basic clinical pharmacy skills remain the focus of the book, but the skills have been expanded to facilitate longitudinal development throughout the pharmacy curriculum. Chapter 1, Introduction: The Practice of Clinical Pharmacy, was updated to reflect the current state of pharmacy practice, including medication therapy management, medication reconciliation, and pharmacy-based immunization. Cultural diversity and telecommunication were added to Chapter 2, Communication Skills for the Pharmacist. The immunization history as a component of the medication history, examples illustrating each component of the medication history, and a medication history checklist were added to Chapter 3, Taking Medication Histories. Chapter 4, Physical Assessment Skills, was expanded and reorganized to provide more contextual context for pharmacists, including checklists for assessing skills performance. A new biomarker section was added to Chapter 5, Review of Laboratory and Diagnostic Tests. Examples illustrating each component of the structured patient case were added to Chapter 6, The Patient Case Presentation. More examples and guidance were added to Chapter 7, Therapeutics Planning, and Chapter 8, Monitoring Drug Therapies. Chapter 9, Researching and Providing Drug Information, was completely updated and example drug information questions, including answers, sources, and comments were added. A discussion of contemporary pharmacy-related ethical issues, including conscientious objection, and issues related to confidentiality and research were added to Chapter 10, Ethics in Pharmacy and Health Care.
This book remains a work in progress. Comments and suggestions for improvement are always welcome.
Introduction: The Practice of Clinical Pharmacy
Pharmacy practice is moving toward a model that integrates patient-focused care (also known as patient-centered care) and drug distribution services. To be successful, pharmacists must understand and speak the language of the health care system and function in a system that to the uninitiated is foreign and excessively complex. The variety of providers, rapidly evolving types of health care delivery systems, and complexities of relationships among the various health care professionals working within the health care system add to the confusion. This chapter describes patient-focused pharmacy practice and the clinical environment in which patient-focused pharmacists function.
Communication Skills for the Pharmacist
The ability to communicate clearly and effectively with patients, family members, physicians, nurses, pharmacists, and other health care professionals is an important skill. Some pharmacists are skilled communicators, comfortable with all types of people; other pharmacists find it difficult to communicate with health care professionals in perceived or actual positions of authority (e.g., physicians) or with patients from different socioeconomic or cultural backgrounds. Fortunately, communication skills can be learned. One incentive for improving communication skills is that pharmacists with excellent communication skills are likely to have very satisfying and successful careers. Another incentive is that the inability to communicate effectively may harm patients. Poor communication between pharmacists and patients may result in an inaccurate patient medication history and inappropriate therapeutic decisions; may contribute to patient confusion, disinterest, and non-adherence; and may add to patients’ frustration with the health care system. Poor communication between pharmacists and physicians, pharmacists and nurses, and pharmacists and pharmacists may harm patients if important information is not exchanged in an appropriate and timely manner.
Taking Medication Histories
Historically, pharmacists relied on other health care professionals to obtain and document information regarding medications taken by patients. Many medications in the early twentieth century were relatively ineffective and had few known risks, so most health care professionals had little interest in or need for detailed medication histories. Pharmacists had limited direct patient care responsibility and did not need firsthand knowledge of patient medication use. Today, the medication history is the foundation for planning optimal patient-specific medication regimens. The medication history is the starting point for generating hypotheses regarding the patient’s understanding of the role of medications in the treatment of disease; the patient’s ability to comply with the medication regimen; the medication’s effectiveness; and the patient’s experiences with side effects, allergies, and adverse drug reactions. Pharmacists have a unique combination of drug-related expertise and experience; patients trust and respect pharmacists. Although other health care professionals inter-view patients regarding their use of medications, no other health care professional has the pharmacist’s depth and scope of knowledge regarding medications. Therefore it is important that pharmacists obtain and document patient medication histories and communicate this information to the rest of the health care team.
Medication histories obtained by health care professionals other than pharmacists often lack important information regarding medication allergies and sensitivities, prescription and nonprescription medication use, use of alternative remedies, immunizations, and reliability in
Physical Assessment Skills
Learning Objectives Name the four fundamental physical assessment techniques and describe how to perform each of the techniques. Identify the components of the stethoscope, ophthalmoscope, and otoscope and state how to use each instrument. Describe how to use a tuning fork and a reflex hammer. Describe how to assess each of the major organ systems. Define common physical assessment terms. Interpret common physical assessment abbreviations.
