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MODULE 24: SPEAKING HOSPITAL: COMMUNICATION, CULTURE & POLITICS
Section 24.2: Paging & Secure Chat Etiquette (with Templates)
Mastering the hospital’s central nervous system: a deep dive into the art of urgent and efficient digital communication.
SECTION 24.2
Paging & Secure Chat Etiquette
Learning the grammar, syntax, and social rules of the two most critical communication tools in your arsenal.
24.2.1 The “Why”: From Casual Conversation to Code Blue Communication
In community pharmacy, your communication tools are the telephone and the fax machine. A conversation with a prescriber’s office is almost always asynchronous and buffered by office staff. Urgency is measured in hours, not seconds. In the hospital, the entire communication infrastructure is built for speed and immediate intervention. Pagers and secure messaging platforms are not just conveniences; they are the hospital’s central nervous system, transmitting critical signals that can mean the difference between a routine recovery and a rapid decline.
Learning to use these tools effectively is not an optional “soft skill.” It is a core competency of a safe and respected hospital pharmacist. Every message you send is a reflection of your clinical judgment, your professionalism, and your respect for your colleagues’ time and attention. A poorly worded page can cause confusion and delay care. An unnecessary page can create alert fatigue and damage your credibility. A message that lacks clarity can lead to dangerous medication errors. Conversely, a perfectly crafted page—one that is concise, clear, and clinically justified—is a thing of beauty. It communicates your value, builds trust, and directly contributes to better patient outcomes.
This section will provide you with a rigorous framework for using these tools. We will move beyond the basics of “what button to press” and into the nuanced art of crafting the right message, for the right person, through the right channel, at the right time. We will provide you with templates that have been battle-tested in real clinical practice, giving you the confidence to communicate clearly and effectively from day one.
24.2.2 The Analogy: From Landline and Mail to Flare Gun and Walkie-Talkie
A Deep Dive into the Analogy
In your retail pharmacy, your communication tools are reliable and structured, like a landline telephone and the postal mail service.
- The Telephone Call: This is your primary tool for clarification. It’s interactive and direct, but it’s not instantaneous. You often leave a message with a gatekeeper (the front office staff) and await a callback. It’s effective for routine problem-solving.
- The Fax/E-Script: This is the postal mail. It’s asynchronous, reliable for transmitting official documents (prescriptions), but not intended for urgent, back-and-forth conversation.
In the hospital, you are in a dynamic, unpredictable environment, and your tools must match. You are equipped with a flare gun and a walkie-talkie.
- The Page: This is your Flare Gun. You only fire a flare gun when your ship is sinking, you’ve crashed on a deserted island, or you see another ship in imminent danger. It is a loud, bright, un-ignorable signal that means one thing: “I have an emergency, and I need help RIGHT NOW.” It is, by its very nature, an interruption. You would never fire a flare gun to ask for the time or to say hello. To use it for anything other than a true emergency is to waste a precious resource and ensure that the next time you fire it, no one will take it as seriously. This is the pager.
- Secure Chat: This is your Walkie-Talkie. A walkie-talkie is for rapid, operational, back-and-forth communication with your team on the ground. “Alpha team, what’s your status on objective one? Over.” “Status is green, proceeding to objective two. Over.” It’s for things that are important and need a quick response, but aren’t emergencies. It allows for coordination without pulling everyone away from their tasks. You wouldn’t use it to report that the ship is on fire (that’s the flare gun’s job), but you would use it to ask for a status update or to coordinate your team’s next move. This is secure chat.
Your entire career, you’ve used the phone and the fax. This module teaches you when to reach for the walkie-talkie, and, most importantly, when it is appropriate to fire the flare gun.
24.2.3 Masterclass Part 1: The Pager — Firing the Flare Gun with Precision
The pager is the hospital’s oldest and most powerful tool for urgent communication. Its legacy endures for one reason: it is brutally effective at interrupting a busy clinician. When you send a page, you are making a deliberate decision to pull a physician or another provider away from their current task. Therefore, the decision to page must be respected, and the page itself must be perfect. An effective page is one that allows the recipient to understand the urgency and the core issue in seconds, enabling them to prioritize their response.
The Anatomy of a Perfect Page
Every page you send, regardless of the system, should contain five core components. Omitting any of them creates ambiguity and forces the recipient to waste time hunting for information. The goal is to give them everything they need to call you back, immediately understand the context, and be prepared to make a decision.
- Your Callback Information: Your name and your direct phone number. Example: `(John Smith, RPh x51234)`
- Patient Identifiers: The patient’s full name and their location (Room Number or MRN). Example: `(RE: Jane Doe, Rm 602)`
- The Concise Problem Statement: A brief, one-line summary of the issue. This should be specific and data-driven. Example: `(INR is 8.2)`
- The Specific “Ask” or Need (if applicable): What you need from them. This could be an order, a clarification, or simply for them to be aware. Example: `(Pls advise on holding warfarin)`
- Urgency Indicator (Optional but helpful): Words like “URGENT” or “STAT” should be reserved for true emergencies.
Putting it all together, a perfect page looks like this:
John Smith, RPh x51234 RE: Jane Doe, Rm 602. URGENT: INR is 8.2. Last warfarin dose given last night. Pls advise on holding future doses and need for reversal.
The Paging Decision Tree: “Is This Flare-Gun-Worthy?”
Before your finger ever hits the “send” button, you must ask yourself one question: **”Does this issue represent a potential for significant, near-term patient harm if I do not get a response within the next 15-30 minutes?”** If the answer is yes, you page. If the answer is no, you use secure chat or a non-urgent message. The following table provides a guide to making this critical decision.
| Scenario | Urgency Level & Rationale | Action |
|---|---|---|
| A new STAT order is entered for an antibiotic, but the patient has a documented anaphylactic reaction to that class of drug. | EMERGENCY. This is a “stop the line” moment. Administering this drug could be fatal. This requires an immediate intervention before the nurse can act on the order. | PAGE IMMEDIATELY. Page the ordering provider (likely the intern) and call the patient’s nurse to ensure they do not pull the medication. |
| A critical lab value returns (e.g., potassium of 2.1, supratherapeutic vancomycin level, positive blood culture). | URGENT. These values indicate a high risk of immediate harm (arrhythmias, organ damage, sepsis) and require timely intervention, but the patient may be currently stable. | PAGE. This is a classic and appropriate use of the pager. The provider needs to be aware and make a decision about treatment. |
| A patient on a heparin infusion has a PTT result that is critically high, and the protocol requires the infusion to be held. | EMERGENCY. This is an active safety threat. The patient is at high risk for a major bleed. The infusion must be stopped immediately. | PAGE IMMEDIATELY & CALL THE NURSE. Your first action is to call the nurse and tell them to pause the infusion. Your second is to page the provider to get orders for the next steps. |
| You review a patient’s profile and recommend changing their IV antibiotic to an equivalent PO formulation. The patient is stable. | ROUTINE. This is a clinically important and valuable intervention, but it is not urgent. The patient is not in immediate danger if they get one more IV dose. | DO NOT PAGE. This is a perfect use case for secure chat or a non-urgent EHR message. Paging for this will damage your credibility. |
| An intern writes an order for “Tylenol 650 mg PRN.” | ROUTINE. The order is incomplete (it’s missing a frequency and indication), but it is not dangerous. The nurse cannot act on it until it is clarified. | DO NOT PAGE. Use secure chat to send a quick message: “Hi Dr. Smith, need a frequency and indication for the Tylenol order on Jane Doe. Thanks!” |
24.2.4 Masterclass Part 2: Paging Templates for High-Stakes Scenarios
The following templates are designed to be adapted for your institution’s specific paging system. The principles of clarity, brevity, and including the five core components remain universal. Practice formatting your pages this way until it becomes second nature.
Template 1: Critical Lab Value
Scenario: Your patient, John Appleseed in room 456, has a history of a mechanical heart valve and is on warfarin. His daily INR check comes back at 9.1 (therapeutic is 2.5-3.5). This is a critical value indicating a very high risk of bleeding.
[Your Name], RPh x[Your Ext] RE: John Appleseed, Rm 456. URGENT: INR is 9.1. Last warfarin dose 5mg given last night. Patient has mechanical valve. Pls advise on holding warfarin and need for Vitamin K reversal.
Why this works: It immediately states the critical value, provides the essential clinical context (mechanical valve), and presents a clear question about the next two logical steps (holding the drug and reversing its effect). The provider can formulate a plan before they even call you back.
Template 2: STAT Order Clarification / Safety Check
Scenario: You receive a STAT order for “Dilaudid 4 mg IV PUSH” for a 92-year-old, opioid-naive female who weighs 45 kg. This is a massive overdose that could cause fatal respiratory depression.
[Your Name], RPh x[Your Ext] RE: Mary Johnson, Rm 312. URGENT SAFETY CONCERN re: STAT order for Dilaudid 4mg IV. Patient is 92yo, 45kg, opioid naive. Please call back immediately to clarify dose before this is dispensed.
Why this works: It uses strong, direct language (“URGENT SAFETY CONCERN”) that cannot be ignored. It provides the three key data points that justify the concern (age, weight, opioid status). It creates a hard stop, clearly stating that the medication will not be dispensed until you receive a callback. This is a textbook example of a pharmacist safety intervention.
Template 3: Contradictory Orders / Active Danger
Scenario: A patient is on a continuous heparin infusion for a pulmonary embolism. You see a new order from a consulting service to start enoxaparin 80 mg subcutaneously twice daily. Having two anticoagulants active at once creates an extreme risk of a major hemorrhage.
[Your Name], RPh x[Your Ext] RE: David Chen, Rm 789. URGENT: Patient is on a heparin drip AND has a new order for therapeutic enoxaparin. Major bleed risk. Both orders are active. Pls advise which anticoagulant to continue and DC the other.
Why this works: It clearly states the therapeutic duplication and the resulting risk (“Major bleed risk”). It highlights the system problem (“Both orders are active”) and gives the provider a clear, forced choice to resolve the conflict. This is not just a recommendation; it’s a notification of an active danger.
24.2.5 Masterclass Part 3: Secure Chat — Wielding the Walkie-Talkie
Secure, HIPAA-compliant messaging platforms (like Epic Secure Chat, TigerConnect, etc.) have revolutionized hospital communication. They allow for rapid, quiet, efficient communication for the vast majority of clinical issues that are important but not emergencies. Mastering this tool means understanding that it is a conversation, not a monologue, and that brevity and clarity are paramount.
The Rules of Engagement for Secure Chat
Effective secure chat is about respecting the other person’s workflow. Unlike a page, it doesn’t demand an immediate response, but a reasonably quick one is expected. Following these rules will make you a valued and effective communicator.
| The Do’s | The Don’ts |
|---|---|
| Be concise. Get to the point in the first message. Lead with the patient and the problem. | Send “naked” hellos. Never start a chat with just “Hi” or “Do you have a second?” and then wait for a reply. This wastes time. |
| Provide a clear “ask.” Make it easy for them to know what you need. A question or a clear recommendation. | Use it for emergencies. If a patient is in danger, page them. Do not rely on chat for time-critical issues. |
| Close the loop. A simple “Thanks!” or “Got it” lets the other person know the conversation is over. | Have long, complex conversations. If your chat is going back and forth more than 3-4 times, it’s time to pick up the phone. |
24.2.6 Masterclass Part 4: Secure Chat Templates for Daily Operations
These templates are designed to be quick, clear, and actionable. They are the bread and butter of your daily digital interactions with the medical team.
Template 1: The IV to PO Switch Recommendation
Scenario: Your patient, Susan Miller in room 204, was admitted for cellulitis and is on IV levofloxacin. You see in the chart that her fever is gone, her white blood cell count is normal, and she is eating a regular diet. She is a perfect candidate to switch to the oral equivalent.
Good Example:
Hi Dr. Davis. Re: Susan Miller, Rm 204. She is afebrile, WBC normal, and eating. Recommend switching IV levofloxacin to PO equivalent to facilitate discharge. Is it okay if I make that change?
Bad Example:
Hey
Why the good example works: It is one, self-contained message. It identifies the patient, states the key clinical data supporting the recommendation, clearly states the recommendation (“switching IV… to PO”), provides the positive outcome (“facilitate discharge”), and ends with a simple, closed-ended question that allows for a “Yes” or “No” answer.
Template 2: The Non-Urgent Dose Adjustment
Scenario: Your patient, Robert Jones in room 501, is on enoxaparin 40 mg daily for VTE prophylaxis. His labs this morning show his creatinine has increased from 1.1 to 2.3, meaning he now requires a renal dose adjustment to 30 mg daily.
Good Example:
Morning Dr. Lee. Re: Robert Jones, Rm 501. His Cr jumped to 2.3 today. Recommend adjusting his enoxaparin to the renal dose of 30mg daily starting tonight. Please let me know if you agree. Thanks!
Bad Example:
The Cr for the patient in 501 is up. Let me know what you want to do about his lovenox.
Why the good example works: It provides all the necessary data (patient, lab value), states the specific problem and the exact dose change needed, and ends with a polite, clear request for confirmation. It solves the problem for the provider; it doesn’t create work for them.
Template 3: The Simple Order Clarification
Scenario: An intern writes an incomplete order for “Tylenol PRN” without a dose, route, frequency, or indication.
Good Example:
Hi Dr. Jones. Re: Jane Doe, Rm 123. The ‘Tylenol PRN’ order needs a dose, route, freq, and indication. Can we clarify to ‘acetaminophen 650mg PO Q6H PRN mild pain/fever’? I can pend it for you.
Bad Example:
Your Tylenol order is incomplete.
Why the good example works: It’s non-accusatory, identifies the missing components, and provides a complete, easy-to-accept solution. It helps the busy intern by doing the work for them.
Template 4: The Discharge Medication Handoff
Scenario: A patient is being discharged on a new, expensive anticoagulant (e.g., apixaban). You need to communicate proactively with the case manager.
Good Example:
Hi Sarah (Case Manager). Heads up for Mr. Smith in 605, who might be d/c’d tomorrow. The team is planning to start him on Eliquis. It’s often high-cost + needs a PA. Can we work together this morning to check his coverage and see if we need an alternative?
Bad Example:
Eliquis is expensive.
Why the good example works: It’s proactive, collaborative (“work together”), and identifies a potential barrier to discharge early. It shows you are an active partner in ensuring a smooth transition of care.
Final Word: The Goal is Clarity, Not Noise
Every digital message you send is an interruption. Your goal is to make each one count. Learn to distinguish between the **flare gun (the pager)**, reserved for true emergencies where immediate action is needed, and the **walkie-talkie (secure chat)**, used for the important but non-urgent operational communication that makes up most of your day.
Mastering these tools is not about technology; it’s about psychology. It’s about respecting your colleagues’ time, anticipating their needs, and building a reputation as a pharmacist who communicates with purpose and precision. A clear, concise, and well-timed message is one of the most powerful tools you have for building trust and protecting patients.
