Exam 2 Flashcards
1
Q
Sixth Man on the Team
A
Patient, Family & Caregivers
very valuable and contributing partners
2
Q
What is SBAR?
A
communicating critical information that requires immediate attention and action concerning a patient’s condition
follows logical order to aid in clear and concise communication
3
Q
Key to strengthening health systems:
A
moving them from fragmentation to collaborating to improve outcomes for pts
4
Q
What does SBAR acronym stand for?
A
Situation – what is going on?
Background – What is the clinical background?
Assessment – What do you think the problem is?
Recommendation – What would you do?
5
Q
inform team of critical information simultaneously
A
call out
6
Q
Situational Awareness includes:
A
situation monitoring
cross monitoring
7
Q
What is TeamSTEPPS designed to do
A
improve pt safety
increase quality and efficiency of care
improve communication and teamwork skills among healthcare professionals
8
Q
Essential Elements
A
team structure strong leadership situational awareness mutual support shared mental model communication "sixth man on the team"
9
Q
Communication
A
call out check back handoff briefs huddles debriefs
10
Q
Communication Techniques
A
simple language
handing out printed materials
speak slow
read aloud instructions
write out instructions
present 2 or 3 concepts at a time & check for understand
asking pt how they will follow instructions at home
11
Q
Task Assistance is part of _______ and means ______
A
A part of mutual support and it is the protection from work overload
assistance will be actively sought and offered
12
Q
initial plan and establish goals
A
briefs
13
Q
Situational monitoring
A
active process
ask question, listen, notice
14
Q
TEAM STEPPS stands for:
A
TEAM Strategies and Tools to Enhance Performance and Patient Safety
15
Q
Effective Team Leaders:
A
organize
articulate clear goals
make decisions –through collective input of members
empower members–to speak up and challenge
actively promote, facilitate good teamwork
skillful conflict resolution
16
Q
Feedback is apart of ______ and it means
A
mutual support;
information provided to a team members for purpose of improving team performance
should be: timely, respectful, specific, directed, considerate
17
Q
All health professionals should be educated to deliver _______
A
patient-centered care as members of an interprofessional team
emphasizing evidence-based practice
quality improvement approaches
informatics
18
Q
Shared Mental Model is
A
Teams knowing what to expect –can regroup as needed
Optimal communication–everyone clear about the big picture
Helps team to predict and plan better
Team effort for the collective goals
Help to avoid errors
19
Q
closed loop communication
verifies accuracy of conveyed information
A
check back
20
Q
we expect patients to calculate
A
a measure doses
count pills
track amount of meds left & refill as necessary
use clocks and calendars to set time/day
21
Q
I’m Safe Checklist
A
I = Illness M = Medication
S = Safe A = Alcohol and Drugs F = Fatigue E = Eating and Elimination
22
Q
List Communication Techniques
A
SBAR Call-Out Check-Back Handoff Briefs/Debriefs Huddles
23
Q
Mutual Support means
A
Take Assistance
Two Challenge Rule
24
Q
process improvement after an event
A
debriefs
25
Two challenge rule is a part of _______ and it means _________
assertively voice a concern at least 2 times to ensure it has been heard
team members acknowledge the concern
26
What is the Team Structure
```
Types
Clear roles
Shared vision + mental models
Strong leadership
Collective trust + confidence
Regular feedback
```
27
Cross monitoring
error reduction strategy
| monitoring actions of other team members "watch each other's backs"
28
problem solving, identify critical issues or concerns
huddles
29
CUS Words are a part of ________ and it stands for
Mutual Support
C = I am Concerned!
U = I am Uncomfortable!
S = This is a Safety issue
30
transfer of information or responsibility
handoff
31
2 Types of Teams
Core
| Contingency
32
Proficient (green)
define medical term from complex document; calculate share of employee's health insurance costs
33
the ability to understand and share the feelings of another
empathy
34
What health literacy evaluation is more reliable to identify those at risk of low/inadequate health literacy compared with confirming those with adequate health literacy
Single Item Literacy Screener SILS
35
we expect patients to read:
labels & inserts
names of medicines
dosage instructions
read between the lines (BID, TID, QID)
36
SILS has a STRONGER correlation with
s-TOFHLA and REALM
37
universal precaution is
the idea that you should treat all patients as if they have low health literacy until you can prove otherwise
38
A shorter version of TOFHLA is and it includes:
s-TOFHLA
| 36 reading questions & takes 7 minutes
39
what percent understood take with plenty of water?
59%--10th/11th/12th grade level
| --more complex message limited comprehension
40
we expect patients to track experiences:
watch for side effects and seek appropriate help as needed
| take action for. missed doses when needed
41
Health Literacy Risk Factors
```
elderly
minorities
limited english proficiency (LEP) patients
low income
homelessness
prisoners
persons with limited education
```
42
list how health literacy affects people's ability
navigate the health care system, filling out forms and locating providers and services;
share personal information, such as health history with providers;
engage in self-care and chronic disease management
understand mathematical concepts such as probability and risk
43
Approx. ______ of high school graduates have limited health literacy
45%
44
patients and pharmacists work together in relationship that is realistic, collaborative, based on respect and trust, committed to the work of treatment
Therapeutic Alliance
45
Difference between literacy and health level
Health info can overwhelm each person with advanced literacy skills;
although a pt read at high levels--doesn't mean high health literacy level
46
Literacy vs Health Literacy
people who read well and are comfortable using numbers can face health literacy issues
47
types of appropriate response
```
empathy
reassurance
probing
advising
generalizing or comparing
assertiveness
aggressiveness
nonassertiveness
judging
```
48
scientific domain
ability to understand basic scientific, concepts
| ex: organs, medical text, risk statistics
49
REALM
Rapid Estimate of Adult Literacy in Medicine
50
bacteria
germs or bugs
51
supportive communications consists of
sadness, fear/anxiety, shame/embarrassment, guilt, anger
52
NAAL stands for
National Assessment of Adult Literacy
53
nonverbal behaviors
```
head nodding
forward lean
direct body orientation
uncrossed legs and arms
arm symmetry
```
54
In REALM patients are asked to do what
pronounce a list of 66 common words related to anatomy or illness
55
SILS response scale
```
1-5
1= never
2= rarely
3= sometimes
4= often
5= always
```
56
what is the shorter version of REALM and what do patients have to do
REALM-R and they have to pronounce a list of 8 common words related to anatomy or illness
57
civic domain
applying health info to make decisions regarding general public policy
ex: school board members making decisions on nutritious diet for school lunch; voters deciding whether tobacco should be banned in public
58
REALM has been highly correlated with
reading comprehension (reading-grade level) but does not directly measure comprehension of health information
59
dose
amount
60
the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions
health literacy
61
abstinence
not having sex
62
what percent understood do not take dairy, antacids, iron repair within one hour of medicine
8% --12th/13th grade level
--unfamiliar, multi-step instructions rarely understood
63
Tools to Improve Health Literacy
CMS 11-part toolkit
Federal Plain Language Guidelines
CDC Clear Communication Index
NIH "Pink Book" - Making Health Comm. Programs Work
Clear Communication - NIH Health Literacy Initiative
64
Basic or Below Basic level cannot do what on the National Assessment of Adult Literacy:
use a bus schedule or bar graph
explain the difference in 2 type of employee benefits
write a simple letter explaining an error on a bill
65
_____ literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services
low
66
TOFHLA is
includes 50 readings and 17 numeracy items and takes about 22 min to administer
67
access
able to get
68
Therapeutic Alliance
realistic
collaborative
based on respect and trust
committed to the work of treatment
69
List some of the examples of health literacy including numeracy skills
```
nderstanding cholesterol levels
interpreting blood sugar levels
measuring medications
comprehending nutrition labels
choosing between health plans or comparing prescription drug coverage--calculating premiums, copays & deductibles
```
70
SILS includes
asks one only one item on a 5 pt scale
71
we expect patients to talk to busy professionals
describe new feelings (side effects
present problems
ask questions
72
contaminated
dirty
73
NVS stands for
newest vital sign
74
screening
testing or checking
75
Adults with _____ health literacy were more likely to report their health as poor and ____ are more likely to lack health insurance than adults with _____ health literacy
Below Basic
42%
28%
Proficient
76
NVS correlates with
TOFHLA and s-TOFHLA
77
SILS stands for
Single Item Literacy Screener
78
handling patient emotions
respond to emotion with verbal and nonverbal cues
address emotions by reflecting back
encourage the pt to expand as appropriate
redirect the convo tactfully back to the goal of the encounter
often appropriate apologies, comfort, reassurance or support
maintain composure, use nonverbal cues and empathetic listening
79
fundamental domain
includes reading, writing, speaking and basic numeracy--what most people think of a general literacy
80
3 major problems associated with supportive communication
other person can decide to remain angry or uncooperative
defense resulting from certain situation or conditions can cause pts to displace a core emotion and replace it with anger or indifference at a time when they most need support
takes times, effort, and practice
81
How are results categorized for TOFHLA
inadequate
marginal
adequate
82
what percentage understood take with food
84%--1st grade level
| simple, familiar wording
83
communication skills and techniques
```
open discussion
gather info
understand pt perspective
share info
reach agreement on problems & plans
provide closure
```
84
cultural domain
incorporates beliefs, customs, and social identity into personal decision making
85
Four major health literacy domains
fundamental, scientific, cultural and civic domain
86
TOFHLA
Test of Functional Health Literacy in Adults
87
NAAL score on 4 levels
Proficient
Intermediate
Basic
Below Basic
88
NVS takes about and includes
brief tool 3 min
| includes 6 questions on interpreting a nutrition label
89
identification with affective experience of the other
imitation
affective communication
can be painful at times
doesn't mean giving in or giving up
one can be empathetic w/o responding empathetically
empathy
90
REALM takes about how many minutes?
3-6 minutes
91
Below Basic (red)
circle date on appointment slip; understand a simple pamphlet about pre-test instructions
92
Basic (orange)
Understand a simple patient education handout
93
patients and caregivers often present with emotions related to distress
supportive communication
94
Intermediate (yellow)
Determine healthy weight from BMI chart; interpret prescription and over-the-counter drug labels
95
Common medication related problems:
```
Drug Interactions
Adverse Events
Excessive/Insufficient Dose
Excessive/Insufficient Duration
Cost Efficacy Concerns
Patient Overuse/Underuse
Needs Additional Therapy
Duplicate Therapy
```
96
Methods to detect medication related problems:
Drug-Utilization Review (DUR)
Opioid Monitoring System
Pharmacist Review
Patient Recognized Concern
97
Step 1: Method to resolve medication related problems:
Confirm it is a true medication related problem
98
Step 2: Method to resolve medication related problems:
Step Counsel patient
99
Step 3: Method to resolve medication related problems:
Consult prescriber
100
DUR
Drug-Utilization Review
101
During Drug-Utilization Review & it requires
prescription processing system will alert you to a potential problem
requires pharmacist acknowledgment and approval before continuing the dispensing process
102
What problems are usually identified during drug-utilization review (DUR)
```
drug-drug interaction
drug-age interaction
drug-gender interaction
therapeutic duplication
over/under utilization
dose too high
```
103
Opioid Monitoring System
the system vary by state
mixed utilization methods like every controlled fill, ever C2 controlled fill, if suspicious
NC Controlled Substances Reporting System (CSRS)
104
CSRS
NC Controlled Substances Reporting Systems used for monitoring opiniods
105
Pharmacist Review includes
everything the DUR is not programmed to catch like
dose/duration concern
disease interaction
cost efficacy alternatives
additional therapy that may be beneficial
106
Patient recognized concern
patients usually will ask question or raise concern about cost-efficacy or adverse events
107
During patient recognized concern they should be asked
about adverse events
other medical conditions for potential interactions or additional therapy
typical use to estimate overuse/underuse
efficacy of the medication regimen
108
During Step 1 of resolving
confirm it is a tru medication related problem and if it is not the pharmacist can override
ex: if allergic to penicillin and dispensed amoxicillin previously pharmacist can override because no reaction to amoxicillin
109
During Step 2 of resolving
counsel patient
may be able to resolve by talking directly with the patient
ex: overuse of albuterol; talking w/ pt discover not using asthma prevention medicine so explain diff b/t 2 medicines to decrease use of albuterol
110
During Step 3 of resolving
consult the prescriber
usually discuss w/ pt before consulting w/ prescriber
gather all necessary info
for non-urgent medication related problems--fax prescriber w/ recommendation
for urgent medication problems--call prescriber w/ recommendation/solution
111
ISMP
Institute for Safe Medication Practices
112
ISMP provides
error-prone abbrev
confused drug names
high alert medications in acute AND community settings
113
Prescriber communciation techniques
do homework before recommending
be clear, complete, concise, timely, professional & organized
develop rapport--watch terminology tone & body language
prepared to modify recommendation due to info or challenges from provider
combination of info exchange, assertiveness & effective listening
USE TEACH BACK & READ BACK METHOD
utilize standardized communication process such as SBAR
114
OBRA
Omnibus Budget Reconciliation Act of 1990
115
Why was OBRA developed?
Developed by federal govt to address the rising costs of Medicaid and Medicare programs
116
Primary aim of OBRA
to save taxpayers' money through better use of medicaitons
117
Before OBRA-90 federal statue applied to
only medicaid pts
after OBRA all patients were included
118
Impact of OBRA-90
state & federal govt prohibited from reducing Medicaid pharmacy reimbursement levels
pharmaceutical manufacturers required to give Medicaid programs "BEST" prices
119
Requirements of OBRA-90
each state had to establish drug use review programs
each program had to have: prospective drug utilization reviews
retrospective drug utilization reviews
on-going assessments of drug data
educational programs
120
Prospective Drug Review happens when
BEFORE each prescription is filled
121
Prospective Drug Review shall include screen for :
```
over/under utilization
therapeutic duplication
drug-disease contraindications
drug-drug interactions
incorrect dose or duration
drug-allergy interactions
clinical misuse/abuse
```
122
NC offer to counsel can be presented by
ancillary pharmacy personnel such as
technicians
cashiers
123
Who can counsel pts
```
Pharmacists
Pharmacists inters (WITH Pharmacist oversight/overseeing)
```
124
If a patient refuses counseling
The pharmacist is not required to counsel if the patient refuses
125
Acceptable ways to offer counseling:
Any way that poses the offer in an open-ended fashion AVOIDING yes and no
what questions do you have for the pharmacist
126
Patient Medication Record Retrieval
Reasonable effort must be made to obtain record and maintain:
name, address, phone number, date of birth (or age), and gender
disease states, allergies, comprehensive list of medications
pharmacist's comment on the individual's drug therapy where appropriate
127
Retrospective Drug Utilization Review happens when
AFTER each prescription is filled
128
Retrospective Drug Utilization Review includes
| Usually completed through drug claim processing and information retrieval systems
analyzing prescription claims data to identify patterns:
fraud or abuse
medication overuse
inappropriate or medically unnecessary drug therapy
129
OBRA-90 Regulations counseling points could include:
brand name, generic name, other descriptive info
intended use / expected action
route, dosage form, dosage, administration schedule
common side effects encountered (including their avoidance and the action required if they occur)
techniques for self-monitoring of drug therapy
proper storage
potential drug-drug or drug-food interactions or other therapeutic contraindications
prescription refill information
action to be taken in the event of a missed dose
130
Indian Health Service Model 3 Prime Questions to assess baseline knowledge
What did you prescriber tell you this medication is for?
How did your prescriber tell you to take this medication?
What did the prescriber tell you to expect from this medication?
131
Teach Back Method
verify pt is picking up what you are putting down
| lets pt verbalize their understanding
132
Use what kind of questions for counseling
open-ended
133
Did the doctor tell you what this medication is for?
| What kind of question is this? Should it be avoided or utilized during patient counseling
Closed-ended
AVOID
134
This medication hasn't caused you any problems has it?
| What kind of question is this? Should it be avoided or utilized during patient counseling
Leading question
AVOID
135
You are taking this twice a day right?
| What kind of question is this? Should it be avoided or utilized during patient counseling
Leading question
AVOID
136
What did your prescriber tell you about this medication?
| What kind of question is this? Should it be avoided or utilized during patient counseling
Assessing Baseline Knowledge
UTILIZE
137
How do you feel about taking this medication? What concerns/worries do you have?
What kind of question is this? Should it be avoided or utilized during patient counseling
Assessing Comfort Level
UTILIZE
138
How are you going to take this medication?
| What kind of question is this? Should it be avoided or utilized during patient counseling
Teach Back Method
UTILIZE
139
The extent to which patients to take medication as prescribed by their doctors
Medical Adherence
140
Medical Adherence involves multiple factors such as:
getting prescriptions filled
remembering to take medications on time
understanding the directions
141
Types of Communication Barriers
```
Language
Hearing
Vision
Low Health Literacy
Cultural
```
142
Language & communication problems may lead to:
patient dissatisfaction
poor comprehension
lower quality of care
143
Why is effective communication important?
Helps patients take charge of their care
Can help foster a good working relation b/t you and pt
Increase day-to-day operating efficiency
reduce chance of medical errors
in order to give fully informed consent, pt need information they can understand
144
All health care providers who receive Federal funds MUST ensure equal access to services
Civil Rights Act
145
All health care providers (regardless of funding) MUST provide effective communication, free of charge, to patients (and companions) with disabilities
Americans with Disabilities Act
146
Based on statute, regulation, and case law, the informed consent process requires explanations of the benefits and risks of treatment alternatives
Informed Consent
147
Tips for Effective Communication
be descriptive
address the person by name
actively listen
tailor your technique and approach to each patient
allow time for patients to process the information and ask questions--silence is okay
utilize open-ended questions and the teach back method
148
LEARN Model stands for
```
Listen
Explain
Acknowledge
Recommend Treatment(s)
Negotiate Treatment(s)
```
149
What does L mean in the LEARN Model
Listen with empathy and understanding to the patient's perception of the problem
150
What does E mean in the LEARN Model
Pharmacists should EXPLAIN their perception of the problem followed by...
151
What does A mean in the LEARN Model
Acknowledging the differences and similarities of both perceptions
152
What does R mean in the LEARN Model
The pharmacist then RECOMMENDS TREATMENT all while maintaing patient involvement
153
What does N mean in the LEARN Model
Negotiation of treatment occurs which should be a combination of ideas combing from both the pharmacist and patient
154
LEARN allows
pharmacists to build trust, open communication and negotiate treatment with patients
155
1 out of _ patients either do not speak English or speak English as a second language
4---
| this is apart of language barrier
156
Qualifiied Medical Interpreters could be
certified freelance interpreters
employees from language agencies
trained bilingual clinicians and staff
community-based medical interpreters from local colleges, faith-based organizations, social services programs, migrant health clinics and etc
157
What is the pharmacists role in language barrier patients?
culturally appropriate, translated materials written in plain language
visuals (pictures/graphs)
158
Immunization in different language can be retrieved from
immunize.org
Medline Plus
Healthy Roads Media
Health Information Translations
159
__ out of ___ are either deaf or hearing impaired
3 out of 100
hearing barriers
160
Hearing Barrier patients may have difficulty
understanding the different roles in pharmacy
reporting adverse events
understanding medication administration technique
161
What is the pharmacists role in hearing barrier patients?
```
printed material
written instructions
videos w/ captions
revised labeling to make clear warnings
highlighting the appropriate time and method to take the medicine
```
162
__ out of __ individuals are blind or have severe trouble seeing, even with glasses
2 out of 100
vision barriers
163
Vision Barrier patients may have difficulty
understanding administration techniques
viewing medication instructions
reading patient education materials
164
What is the pharmacists role in vision barrier patients?
speak in quiet area
print prescription label & handouts using braille, raised lettering, large letters, & visual aids
provide patient with magnifying glass
record pt info for them
educate pt about available technology
165
Technology Device Available for
audio recordings
screen reader software
video conferencing
talking prescription labels & glucose monitors
166
how to be sighted guide
```
offer assistance
offer arm by tapping pt palm
pt will grasp arm above elbow
walk at comfortable space--stay one step ahead
describe turns, doorways & chairs
tell person when leave room
ask to touch guide dog
```
167
The ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Health Literacy
168
Factors that can influence an individual's health literacy
```
living in poverty
education
race/ethnicity
age
disability
```
169
Patient Friendly Education Materials should be
```
max 1 page front and back
minimum 12 pt font
use of visual aids
communication should be 5th grade reading level
leave lots of white space
DONT use fancy/script lettering
```
170
Involves ensuring that the needs of diverse patients are met by health professionals based on valuing diversity and taking concrete steps to ensure efficacy in serving the minority
Cultural Competency
171
Cultural Competency affects
patient health beliefs, treatment choices, & Prevention strategies
172
Cultural Competency Framework
```
Awareness
Knowledge
Skill
Encounters
Desire
```
173
Examples of Cultural Competence
```
Health Beliefs
Religion
Family/Culture
Gender/Sexual Orientation
Attitude towards health care workers & health Care
```
174
Ones belief on the cause, treatment and prevention of an illness
health beliefs
ex: apple a day keep doctor away
175
impact one's choice of prevention and treatment of illnesses
religion
ex: catholics and contraceptives
176
Each ethnic group brings its own perspectives and values to the health care system
family/culture
177
identity differ from the gender/sex assigned at birth
transgender
ex: trans woman refers to a woman who was assigned male at birth
178
identify with the gender assigned at birth
cisgender
179
assignment of people as male or female based on external genitalia at birth
sex
180
person's physical or romantic attraction to others
sexual orientation
ex: heterosexual, gay, lesbian, queer
181
inability to afford health care causes distain and fear leading to
avoidance
182
2nd barrier to cross-cultural communication
nonverbal communication
183
up to 70% can be attributed to
nonverbal components of communication
184
SOLER is an
non-verbal communication--active listening model
185
What does the S in SOLER stand for?
square
face squarely by doing this it shows you are involved
186
What does the O in SOLER stand for?
open
keep an open posture this means not crossing arms/legs & it makes people feel engage and welcome
187
What does the L in SOLER stand for?
lean
by leaning forward when a person is talking to you it shows you're involved and listening to what they have to say
188
What does the E in SOLER stand for?
eye contact
use good eye contact--your gaze shows that you're listening and not distracted
except when pt belongs to group that considers eye contact rude/intimidating
189
What does the R in SOLER stand for?
relax
its important to stay calm and avoid fidgeting when a person is talking to show you are focused
190
providers spend approx. how much time explaining newly prescribed medications during a patient appointment
less than 1 minute
191
Months with 30 days
April, June, September & November
February has 28 unless leap year then it has 29
192
30 days supply should last how long
1 month
193
90 days supply should last how long
3 months
194
direct methods of measuring medication adherence
direct observed therapy
measurement of drug concentration in blood
measurement of the biological marker in the body
195
indirect methods of measuring medication adherence
```
patient self-report
pill counts
pharmacy fill data
electronic medication monitoring
assessment of patient's clinical response
```
196
2 Calculation Adherence Metrics
Medication Possession Ration (MPR)
Proportion of Days Covered (PDC)
197
MPR
medication possession ratio
198
PDC
proportion of days covered
199
MPR =
(# of fills x days supply for each Rx dispensed)
divided by
number of days in period
200
patient is considered adherent if the MPR is
greater than or equal to 80%
201
MPR measures what
measures the percentage of time a patient has access to a medication
202
when would MPR be skewed
when receiving automatic refill or when obtaining medications earlier than needed
--maybe greater than 100%
doesn't actually tell whether pt being adherent or not
203
PDC =
(# of tablets x refills)
divided by
number of days in period
204
PDC is considered adherent if the PDC is
greater than or equal to 80%
205
Why do some medications require greater level of adherence to avoid negative outcomes
to avoid risk of drug resistance
ex: HIV medications
206
use PDC when patients are on 3 medications so if 2 drugs are picked up
the PDC cannot be calculated
a day is considered "covered" when all 3 medications are available to patient
207
Limitations to MPR and PDC are
inhalers, nitroglycerin, liquids, eyedrops, patient awaiting administration technique, Incorrect estimation of adherence (directions have changed or medication set to auto-refill)
208
Barriers to Medication Allowance
```
Condition Related
Social/Economic
Healthcare System
Patient Related
Therapy Related
```
209
Condition Related medication adherence
lack of symptoms associated with conditions
disability
psychotic disorders
depression
severity of symptoms
rate of disease progression (5 days left ot live)
substance abuse
210
Social Economic medication adherence
lack of family or social support
unstable living conditions
limited English language or health literacy
beliefs about illness and treatment
lack of health insurance
medication costs
difficulty access pharmacy (transportation)
211
Healthcare Factors mediciation adherence
access to care
transitions of care
high drug costs
reading level of patient education materials
patient-provider relationship
provider communication skills
lack of positive reinforcement or empathy
ability to educate patients and provide follow up
212
Patient related medication adherence
physical factors -visual/hearing/mobility/swallowing
psychological factors - knowledge/motivation/perceived benefit--side effects/understand why need it
213
Therapy related medication adherence
medication regimen complexity
```
social stigma (other people knowing)
acute/perceived side effects
interference with lifestyle
```
214
adherence intervention SIMPLE stands for
```
Simplify Regimen
Impart Knowledge
Modify patient beliefs and behavior
Provide communication and trust
Leave the bias
Evaluate adherence
```
215
Simplifying Regimen of adherence intervention
adjust timing--take before TV shows
avoid medications with special directions
216
Impart Knowledge of adherence intervention
shared decision making
involve patient family
pt homeless so pharmacist talk to dr about oral medicine instead of insulin because no where to store it
217
Modify Patient Beliefs and Behavior of adherence intervention
educate patients on the risks of non-adherence AND benefits of taking their medications
address pt fears/concern like side effects
empower pt
218
Provide Communication and Trust of adherence intervention
improve interviewing skills
active listening
emotional support
put pt input into their treatment like giving them option of oral pill and if they take it correctly wont do insulin
219
Leave the Bias of adherence intervention
Address patient-provider dissonance
ex: I know you are taking this medication already. You have been taking it every AM on empty stomach right?
220
Evaluate adherence of adherence intervention
```
self-report
MPR
PDC
medication adherence scales
biochemical tests
review fill dates
```
221
Strategies for Patients
automatic refill programs
utilize pill box
setting phone reminders
90 day supply fills
222
Strategies for Pharmacists
```
identify cost-cutting strategies
sync medications to be picked up on day
engage the staff
help pt customize support tools
education pt what to expect
nurture relationships with patients
```
223
Personality tests are
trait measurement tools that measure and quantify human attributes
224
Examples of Trait Measurement Tools
Meyers Briggs
HEXACO Personality Inventory
Isenberg Entrepreneur Test
Clifton Strengths
225
Transition to the 2nd half of life
see yourself as you are
recognize needs & wants
move w/ purpose--take the next best step
226
4 Clifton Strengths Domains
Executing
Influencing
Relationship Building
Strategic Thinking
227
Executing
make it happen
work tirelessly
make it reality
228
Influencing
reach audience
strength to influence
sell an idea inside or outside the organization
229
Relationship Building
holds team together
230
Strategic Thinking
future
231
Native Genius
really good at it something you would do anywhere no matter if you got paid to do its because its your strength
232
the act or process of becoming the people we are called to become emotionally, socially, physically and professionally
self-leadership
233
first step toward effective interpersonal relationships and group dynamics
self knowledge
234
self knowledge consists of
cognitive (know)
affective (feel)
psychomotor (do)
235
cognitive
know
physical attributes
objective facts
knowledge and skills
236
affective
feel
feelings
emotional intelligence
social interaction
237
pscyhomotor
do
physical actions
professional behavior
238
theory of self knowledge
Johari Window
239
open area
something you know and others know
240
blind area
unknown to me but others know it about me
241
hidden area
i know about me but you dont know about me
242
unknown area
unknown to me and unknown to others
243
shared belief that the team is safe for risk taking
psychological safety
