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Beware the illusion of communication

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Although communication is a key skill for pharmacists, the truth is that little attention is paid to keeping other healthcare practitioners in the loop on transfer of care

Ray Fitzpatrick

Consultant Editor
HPE

Once again, HPE covers the spectrum of medication-related issues and implications for pharmacy. The oncology-related articles describe therapies for hard-to-treat cancers, such as hepatocellular cancer, head and neck cancer and soft-tissue sarcomas, involving newer, more complex medicines with their own pharmaceutical care issues. Complex medicines also emerge as a theme in the article by Roger Tredree and the ASHP report. Here, the importance of bio­pharmaceuticals cannot be overstated: these are overtaking traditional chemical-based drugs in the new-medicines marketplace. Another key theme covered is medication safety, raised at the ASHP meeting, an IV medicines meeting and the UK Neonatal and Paediatric Pharmacist Group symposium.

In contrast, there are clinical review articles on treating arthritides by Annelies Boonen, on Crohn’s disease by Silvio Danese and Erika Angelucci, on healthcare-acquired infections by Dilip Nathwani, on orphan drugs by Ilaria Uomo and colleagues, as well as practice-related material on intravenous delivery by Janet Watkinson, and iron dextran by Kirsten Smith and Aileen Currie.

Communication is a key skill for pharmacists: we must be able to listen, to question and to explain effectively to patients, and we need influencing and negotiating skills in dealing with other professionals. However, little attention is paid to communicating between ourselves and other practitioners in relation to transfer of care.

Hospital pharmacists see patients at various stages of care. We see them on admission, where there is clear evidence that we are best placed to undertake a drug history – or as recent UK government guidance calls it, “medicines reconciliation”.[1] On admission, hospital pharmacists develop pharmaceutical care plans to optimise treatment. And on discharge hospital pharmacists help the patient prepare for medication self-management. At these stages different pharmacists may be involved, particularly when the patient moves into primary care. It is vital that we communicate effectively over what we know about a patient’s medicines on admission, what pharmaceutical needs have been identified and our plans to meet those needs.

Such communication is too important to be relegated to a corridor conversation or a note clipped to a prescription sheet. We need proper documentation that is part of the formalised medication record, since – as demonstrated in this issue of HPE – we work in a world of ever more complex medicines with ever more opportunities for things to go wrong. Also, written records are important as we move away from being a product-focused profession, where activities can be counted, to a patient-focused profession, where activities and work are less easily quantified.

Recording what we do is not relished by most pharmacists, as we are usually very busy handling many pharmaceutical problems daily. This was clearly illustrated to me in 2001 by my own findings that hospital pharmacists document only 30% of all interventions actually made.[2] Therefore, I argue that we need good written as well as oral communication skills, and formal systems for documenting pharmaceutical care issues. As George Bernard Shaw said: “The problem with communication is the illusion that it has happened.” ■

1. UK National Institute for Health and Clinical Excellence/National Patient Safety Agency. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. PSG 001. London: NICE; 2007.

2. Boardman H, Fitzpatrick RW. Self-reported clinical pharmacist interventions under-estimate their input to patient care. Pharmacy World & Sc 2001;23(2):55-9.



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