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MODULE 23: CLINICAL PHARMACY ON THE FLOORS: MASTERING PATIENT CARE ROUNDS
Section 23.6: Scripts & Phrases That Land Well: Retail-to-Hospital Translations
A practical guide to translating your existing communication expertise into the specific dialect of multidisciplinary rounds.
SECTION 23.6
Scripts & Phrases That Land Well: A Deep Dive
This section is a practical, tactical playbook of specific language you can use to communicate your value effectively and confidently.
23.6.1 The “Why”: Learning the Local Dialect of Influence
You are already a skilled communicator. As an experienced retail pharmacist, you have spent years mastering a specific form of medical communication. You are fluent in the language of patient counseling—breaking down complex regimens into simple, actionable steps. You are an expert at the concise, fact-based dialect of prescriber clarification calls. You have developed a professional, empathetic tone for navigating difficult conversations about cost and insurance with patients. Your communication skills are not in question. This module is not about teaching you how to talk; it’s about teaching you a new professional dialect.
Every profession, and every sub-culture within a profession, has its own unique linguistic shorthand, its own unwritten rules of discourse. The fast-paced, hierarchical, team-based environment of inpatient rounds is no exception. The “language” that works perfectly when counseling a patient at the pharmacy counter can come across as slow or overly simplistic on rounds. The direct, almost transactional language of a clarification call can sound abrupt or confrontational in a group setting. The key to being heard is not just having the right information, but presenting that information using the accepted dialect of the environment.
This section is designed as a practical translation guide. We will take common scenarios and communication challenges you have already mastered in the retail setting and directly translate them into the phrases and scripts that “land well” with an inpatient medical team. By consciously adopting this new dialect, you are not being inauthentic; you are demonstrating your adaptability and your respect for the team’s culture and workflow. It is a subtle but powerful signal that you are not just a visitor on their service, but a fully integrated member of the clinical team, speaking the same language of patient-centered care.
Retail Pharmacist Analogy: Speaking “Insurance” vs. Speaking “Patient”
Think about how you instinctively code-switch your language dozens of time a day in the pharmacy. A patient comes to the counter, frustrated that their medication isn’t ready. You look at the screen and see a rejection: “Refill Too Soon – NDC Not Covered on Plan Formulary Tier 3.”
Do you say that to the patient? Of course not. That’s “insurance speak.” It’s accurate, but it’s confusing jargon to a layperson. Instead, you translate it.
Your translation to “Patient Speak”: “It looks like the insurance company is saying it’s a little too early to fill this one. They also have a preferred alternative to this medication that might be cheaper for you. Let me give your doctor’s office a quick call to see what they’d like to do.”
You have taken the same core information and translated it into a dialect the patient can understand and that focuses on a solution. When you then call the prescriber’s office, you will switch dialects again, likely using more clinical and logistical shorthand. This is a skill you have perfected.
This section is about learning one more dialect: “Rounds Speak.” It’s about taking the same brilliant clinical insights you have and framing them in the language that is most efficient, collaborative, and persuasive for the unique audience of a multidisciplinary team.
23.6.2 The Master Translation Guide: From Retail Scenarios to Rounds-Ready Scripts
This is the core of our practical guide. We will break down the four “bread and butter” scenarios from the previous section and provide a detailed tactical playbook of phrases. For each scenario, we will identify the core message you are trying to convey, analyze how you might communicate it in a retail setting, and then provide a series of “upgraded” phrases specifically tailored for rounds.
Playbook 1: Antimicrobial Stewardship Scripts
Your goal in these interactions is to be seen as the team’s antimicrobial expert and stewardship partner, not as the “antibiotic police.” Your language should be collaborative, evidence-based, and focused on patient safety and optimal outcomes.
Scenario A: De-escalating Therapy Based on Cultures
Core Message: “We can use a narrower, more targeted antibiotic now.”
| Communication Mode | Example Script & Analysis |
|---|---|
| Retail Analogy (Prescriber Call) | “Hi Dr. Smith, this is the pharmacist. I’m calling about Jane Doe’s prescription for Augmentin. Her culture from last week just came back sensitive to Keflex. Do you want to switch her?”
Analysis: Direct, transactional, and effective for a one-on-one call. It can feel a bit like you’re “telling” the prescriber what to do. |
| Rounds-Ready Script (Basic) | “The patient’s cultures are back and show we can de-escalate. I recommend we stop the vancomycin and cefepime and switch to ceftriaxone.”
Analysis: This is good. It’s clear and has a specific recommendation. It meets the basic requirements. |
| Rounds-Ready Script (Advanced/Collaborative) | “I have a great stewardship opportunity for Mr. Chen. His cultures finalized this morning and grew only *E. coli* that’s sensitive to ceftriaxone. My assessment is that we can safely discontinue the vancomycin and cefepime and narrow him to ceftriaxone. This will reduce his risk of C. diff and nephrotoxicity.”
Analysis: This is excellent. It frames the intervention positively (“stewardship opportunity”), includes the key data, states a clear assessment, provides a rationale (the “why”), and makes a specific recommendation. |
| Rounds-Ready Script (Framed as a Question) | “Now that we have final cultures showing *E. coli* sensitive to ceftriaxone, do we feel comfortable de-escalating the vancomycin and cefepime to ceftriaxone monotherapy?”
Analysis: A superb option for teaching rounds or with a new team. It invites discussion and allows the team to arrive at the correct conclusion with your guidance. |
Scenario B: Optimizing Duration of Therapy
Core Message: “This patient has received enough antibiotics and we should stop them.”
| Communication Mode | Example Script & Analysis |
|---|---|
| Retail Analogy (Patient Counseling) | “Make sure you finish all of this antibiotic, even if you start to feel better.”
Analysis: This is the classic, and often appropriate, retail message. In the hospital, our goal is often the exact opposite: to stop as soon as it’s safe. |
| Rounds-Ready Script (Proactive Planning) | (On Day 1 of therapy) “What is our anticipated duration for the antibiotics? For CAP, we can typically aim for a 5-day course.”
Analysis: This is a proactive, high-level move. It sets the expectation for a shorter, evidence-based course from the very beginning. |
| Rounds-Ready Script (Specific Recommendation) | “For Mrs. Miller’s pneumonia, today is day 5 of antibiotic therapy. She’s been afebrile for 48 hours and is clinically stable. Per guidelines, she has completed an adequate course. I recommend we discontinue her azithromycin and ceftriaxone today.”
Analysis: Perfect. It provides the day of therapy, the evidence of clinical stability, cites the standard of care (“per guidelines”), and makes a clear, actionable recommendation. |
| Rounds-Ready Script (Handling Pushback) | Attending: “Let’s just continue for a full 7 days to be safe.”
You: “I understand the concern. The most recent IDSA guidelines for CAP actually recommend a 5-day course for patients who have met stability criteria, noting that longer durations don’t improve outcomes but do increase the risk of side effects. I can send you the link to the guidelines if that would be helpful.” Analysis: Respectful, evidence-based, and non-confrontational. It reframes the decision around evidence, not opinion, and offers to provide the source material. |
Playbook 2: IV-to-PO Conversion Scripts
Your goal here is to be the champion of patient mobility, safety, and timely discharge. Your language should focus on these benefits, framing the switch not just as a drug change, but as a key step forward in the patient’s recovery.
| Communication Mode | Example Script & Analysis |
|---|---|
| Retail Analogy (Insurance Call) | “Hi, this is the pharmacist. The patient’s insurance won’t cover IV levofloxacin at home, but they will cover the oral tablet. Can we switch?”
Analysis: In retail, the trigger is often cost or logistics. In the hospital, the trigger must be clinical appropriateness first and foremost. |
| Rounds-Ready Script (The Classic) | “This patient meets criteria for an IV-to-PO switch. I recommend we change her from IV to oral levofloxacin.”
Analysis: Good and direct. It works well on a busy service. |
| Rounds-Ready Script (Benefit-Oriented) | “Ms. Jones is looking much better today. She’s afebrile, her white count is down, and she’s eating. I think she’s a perfect candidate to switch from IV to oral antibiotics. This would let us take out her IV and get her more mobile, which could help speed up her discharge.”
Analysis: Excellent. It frames the recommendation around the patient and system benefits (mobility, discharge), which strongly resonates with physicians and case managers. It shows you’re thinking about the big picture. |
| Rounds-Ready Script (Highlighting Bioavailability) | “Since levofloxacin has nearly 100% oral bioavailability, we can expect the exact same clinical efficacy from the oral tablet as the IV. I recommend we make that switch today to simplify her regimen.”
Analysis: This is a great teaching point, especially on an academic service. It provides the scientific rationale for why the switch is safe and effective, reinforcing your role as the drug expert. |
Playbook 3: Renal Dose Adjustment Scripts
Your goal is to be the team’s indispensable safety net. Your language must be clear, precise, and convey a sense of vigilance. This is one area where being direct and data-driven is almost always the best approach.
| Communication Mode | Example Script & Analysis |
|---|---|
| Retail Analogy (Prescriber Call) | “Hi, Dr. Evans, I’m calling about the gabapentin script for Mr. Smith. He’s 85 years old and I’m worried about the 600mg TID dose. Can we start lower?”
Analysis: In retail, you often don’t have lab values, so you rely on proxies like age. In the hospital, you have the data, and you must use it. |
| Rounds-Ready Script (The Direct Flag) | “Just a flag for Mr. Smith—his creatinine is up to 2.5 today, which gives him a creatinine clearance of 22. His current piperacillin-tazobactam dose needs to be adjusted.”
Analysis: Direct, efficient, and data-driven. It presents the objective numbers and the clear consequence. This is often all that’s needed. |
| Rounds-Ready Script (The Full SBAR) | “For Mr. Smith, I have an urgent dosing recommendation. His creatinine has jumped to 2.5, with a CrCl of 22. My assessment is that his current dose of piperacillin-tazobactam is too high and puts him at risk for neurotoxicity. I recommend we reduce the dose to 3.375 grams IV every 8 hours, per our institutional renal dosing protocol. I can pend that order.”
Analysis: The gold standard. It provides all the data, the specific risk, and the exact solution, including a reference to the hospital protocol (which adds authority). |
| Rounds-Ready Script (Proactive Monitoring) | “Given that we’re starting enoxaparin and his creatinine is borderline, I’ll be sure to calculate a daily creatinine clearance and monitor closely for any signs of accumulation or bleeding.”
Analysis: This is a high-level communication that builds incredible trust. It shows you are not just reacting to bad lab values, but you are proactively anticipating a potential problem. It tells the team you are their safety net. |
Playbook 4: Prophylaxis Stewardship Scripts
Your goal is to ensure every patient gets the prophylaxis they need, and no patient gets the prophylaxis they don’t. This requires a constant, gentle stewardship presence. Often, your role here is one of de-prescribing.
Scenario A: Questioning the Need for Stress Ulcer Prophylaxis (SUP)
| Communication Mode | Example Script & Analysis |
|---|---|
| Retail Analogy (Patient Question) | “You’re right, many people take pantoprazole. It’s used to reduce stomach acid.”
Analysis: In retail, you often affirm the use of common medications. In the hospital, your job is to constantly question if they are truly indicated. |
| Rounds-Ready Script (Gentle Questioning) | “I noticed we have pantoprazole ordered for SUP. Could you remind me of the specific indication for that?”
Analysis: A brilliant, non-confrontational opening. It forces the team to justify the order against the established criteria. Often, they will realize there is no good indication, and you can guide them to the conclusion to stop it. |
| Rounds-Ready Script (Direct Recommendation) | “For Mrs. Davis, I’m recommending we discontinue the pantoprazole. She was started on it in the ICU while on the ventilator, but she’s now extubated and on the floor. She no longer meets criteria for stress ulcer prophylaxis, and continuing it increases her risk for C. diff and pneumonia.”
Analysis: Clear, confident, and evidence-based. It identifies the reason for the initial order (correctly) and then explains why it’s no longer needed, including the risks of continuing therapy. |
Scenario B: Ensuring VTE Prophylaxis is in Place
| Communication Mode | Example Script & Analysis |
|---|---|
| Rounds-Ready Script (Collaborative Opening) | “What’s our plan for VTE prophylaxis for this patient?”
Analysis: Simple, open-ended, and collaborative. It puts the topic on the table and invites the team to weigh in. It’s a great phrase to have in your back pocket for every new admission. |
| Rounds-Ready Script (Highlighting a Contraindication) | “Just a safety flag on VTE prophylaxis: The patient’s platelets have dropped to 40 this morning. I recommend we hold the enoxaparin and place sequential compression devices (SCDs) for mechanical prophylaxis until her platelets recover.”
Analysis: Positions you as the safety expert. You identified a critical lab change, assessed the risk, and provided a safe alternative recommendation. This is a high-value intervention. |
23.6.3 Phrases for Navigating Difficult Conversations
Not every recommendation will be met with immediate agreement. There will be times when you need to handle disagreements, correct misinformation, or address a potential error. The language you use in these moments is critical for maintaining a positive and collaborative relationship with the team.
The Key Principle: Separate the Person from the Problem
Your language should always be directed at the clinical problem, not at the person who may have created it. Avoid any language that could be perceived as accusatory or personal. It’s never “The dose you ordered was wrong.” It’s always “The patient’s renal function has changed, which now requires a dose adjustment.”
Scripts for Correcting an Error
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To correct a simple mistake (e.g., wrong frequency):
“Just a quick clarification on the vancomycin, should we be dosing that every 12 hours instead of every 8 for this patient’s calculated clearance? Happy to write the order if you agree.”
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To point out a therapeutic duplication:
“I noticed we have both IV ketorolac and a standing order for oral ibuprofen. To minimize the risk of GI bleeding and nephrotoxicity from dual NSAID use, should we discontinue one of them? The ibuprofen is probably best to stop since he’s getting the IV ketorolac.”
Scripts for Disagreement or Pushback
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When you disagree with a plan:
“I understand the rationale for using ciprofloxacin here. I’m just a little concerned about the potential for QTc prolongation given her other medications. Would it be reasonable to consider an alternative like cefpodoxime to mitigate that specific risk?”
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When your recommendation is initially rejected:
“I appreciate that perspective. The main reason I’m recommending the switch is the new IDSA guideline that came out last year showing equal efficacy with the shorter course. I’m happy to pull up the study if it would be helpful for the team to see it.”
Module 23 Summary: Your Transformation into a Clinical Pharmacist
This module has been a deep dive into the art and science of performing on multidisciplinary rounds. The journey from an expert dispenser to an expert clinical advisor is challenging, but it is built on a set of learnable skills.
- Understand the Environment: Recognize the different cultures, paces, and expectations of teaching and non-teaching services.
- Prepare Meticulously: Use a systematic approach like the 5-Box system to work up your patients. Your credibility is built on the foundation of your preparation.
- Communicate Strategically: Master the art of timing, brevity, and impact. Use structured tools like SBAR to ensure your message is clear, concise, and persuasive.
- Master the Core Plays: Focus on becoming an undeniable expert in the “bread and butter” scenarios—stewardship, IV-to-PO, renal dosing, and prophylaxis. Excellence in these areas is how you build trust.
- Embrace Your New Role: You are the team’s medication expert, safety sentinel, and collaborative partner. Your existing knowledge is immense; this is your guide to applying it in a new, more powerful way.
This is a journey of continuous learning. Each day, each patient, and each interaction is an opportunity to refine your skills, demonstrate your value, and profoundly impact patient care.
