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MODULE 33: Decoding Hospital Order Sets: A Comprehensive Guide
Section 33.7: The Communication Masterclass: From Intervention to Collaboration
This concluding section provides scripts and strategies for effectively communicating with providers about order set-related issues.
SECTION 33.7
The Communication Masterclass
Transforming Your Clinical Knowledge into Collaborative Action.
33.7.1 The “Why”: Beyond Clinical Knowledge
We have spent this entire module engaged in a deep, comprehensive dive into the architecture and clinical intent of hospital order sets. You have learned to deconstruct admission plans, navigate the perioperative journey, and manage the urgency of critical care protocols. But all of this technical knowledge is meaningless if you cannot effectively communicate your findings and recommendations to the rest of the healthcare team. The most brilliant clinical insight, if delivered poorly, can be ignored, dismissed, or, worse, create animosity that damages future collaboration.
This final section is dedicated to the single most important “soft skill” in hospital pharmacy practice: communication. Specifically, we will focus on mastering a crucial paradigm shift—moving from a mindset of **intervention** to one of **collaboration**. In the retail world, a clarification call is often an intervention; you are an external checkpoint correcting an error before it reaches the patient. In the hospital, you are not an external entity. You are an embedded, integrated member of the patient care team. Your communication must reflect this reality. The goal is not to “correct a mistake” but to “partner with a colleague to optimize patient care.”
Adopting a collaborative approach transforms you from a perceived roadblock into a valued clinical resource. It builds trust, fosters respect, and ultimately leads to better, safer patient outcomes. When physicians and nurses see you as a knowledgeable partner who is there to help them navigate complexity and prevent harm, they will not only be receptive to your recommendations but will begin to seek you out proactively for your expertise. This section will provide the frameworks, strategies, and exact scripts to help you become that trusted, collaborative partner.
33.7.2 The Foundations of Collaborative Communication
Effective communication isn’t just about what you say, but how you structure your thoughts and present your case. In the high-stakes, time-crunched hospital environment, your communication must be structured, concise, and clinically relevant. The most widely accepted framework for this is SBAR.
SBAR: The Universal Language of Clinical Communication
SBAR is a structured communication technique designed to convey critical information clearly and briefly. It is the lingua franca of hospitals, used by nurses, physicians, respiratory therapists, and pharmacists alike. Adopting this framework immediately signals your competence and respect for the other person’s time.
- S – Situation: A concise statement of the problem. Who are you, and what patient are you calling about?
- B – Background: Brief, relevant clinical information related to the situation. What is the context?
- A – Assessment: Your professional conclusion or analysis of the situation. What do you think is going on?
- R – Recommendation: A clear, actionable suggestion to resolve the problem. What do you need from them?
The Psychology of the “Ask”: Tone, Timing, and Turf
Beyond the SBAR framework, the psychology of your interaction is critical. How you are perceived will directly impact how your recommendation is received.
| Element | The Collaborative Approach | Common Pitfalls to Avoid |
|---|---|---|
| Tone of Voice | Your tone should be calm, confident, and collegial. Assume good intent. Start with the premise that the provider is smart, capable, and simply missed a piece of information that you are now providing. Frame yourself as a helpful colleague. | Avoid tones that sound accusatory (“Why did you order this?”), uncertain (“Um, I think this might be wrong…”), condescending, or frustrated. Never let the stress of a busy shift translate into a sharp tone. |
| Timing of the Call | Triage your calls. If the issue is a genuine emergency (e.g., a massive overdose, a critical contraindication to tPA), call immediately. For non-urgent issues (e.g., a therapeutic interchange, a missing bowel regimen), consider batching your calls to a provider or sending a secure electronic message to be addressed when they have a moment. Respect their workflow. | Calling a surgeon about a missing stool softener while they are in the middle of a procedure is a fast way to damage a relationship. Calling a busy intern with a non-urgent question during morning rounds is equally inefficient. Context is everything. |
| “Turf” & Phrasing | Respect the provider’s role as the final decision-maker. Use collaborative and respectful phrasing. You are making a recommendation, not giving a command. This empowers the provider to agree with you and maintains a collegial dynamic.
Key Phrases:
|
Avoid phrases that sound like directives or accusations. This immediately puts the other person on the defensive and makes them less likely to accept your clinical reasoning, even if it’s flawless.
Phrases to Avoid:
|
Retail Pharmacist Analogy: The Trusted Colleague vs. The “Insurance Problem” Caller
You already live the difference between interventional and collaborative communication every day. Think about the two distinct ways you can communicate with a prescriber’s office about a rejected prescription.
The Interventional (and Ineffective) Approach: “Hi, this is the pharmacy. Dr. Smith’s script for Ozempic for patient Jane Doe was rejected. Her insurance wants a prior authorization. You need to call them and do a PA. The number is on the back of the card. Thanks.” This approach is transactional, places the entire burden of work on the other party, and does nothing to solve the underlying problem. It communicates “this is your problem, not mine.”
The Collaborative (and Effective) Approach: “Hi Carol, it’s John from the pharmacy on Main Street. Hope you’re having a good day. I’ve got Mrs. Jane Doe’s new prescription for Ozempic. I just ran it, and it looks like her new insurance plan for this year prefers either Trulicity or Victoza. I was just looking at Mrs. Doe’s profile and I don’t see a record of her having tried either of those yet. To save you the hassle of a PA and save Mrs. Doe the higher co-pay, would Dr. Smith be open to trying Trulicity first? If so, you can just send a new script over electronically and I’ll take care of the rest.”
The second approach is a masterclass in collaboration. It:
- Starts with a collegial tone.
- Identifies the core problem (formulary preference, not just “a PA”).
- Does the background research (checks preferred alternatives).
- Proposes a clear, actionable solution that benefits everyone (the office, the patient, the pharmacy).
- Frames the request respectfully (“Would Dr. Smith be open to…”).
33.7.3 The Script Library: Mastering Common Order Set Scenarios
The best way to master collaborative communication is to practice. The following scenarios provide detailed scripts for common order set-related issues you will encounter daily. Internalize the structure and the phrasing, and adapt them to your own style.
Scenario 1: The Missing Prophylactic Order
The Situation: You are verifying an admission order set for a 75-year-old patient admitted for pneumonia. You notice the pre-checked box for VTE prophylaxis (enoxaparin) has been manually unchecked by the provider, but there is no documented reason.
Ineffective (Interventional) Script
“Hi, Dr. Chen? You forgot to order VTE prophylaxis on your patient in 601.”
Why it fails: This is accusatory (“you forgot”). It doesn’t provide any context or demonstrate that you’ve done any clinical work. It forces the provider into a defensive posture.
Effective (Collaborative SBAR) Script
“(S) Hi Dr. Chen, this is the pharmacist calling about your new admission, Mr. Wei in room 601.
(B) I’m reviewing his admission order set and I saw that the order for VTE prophylaxis was opted out of. I took a look through his chart, and his platelets and renal function look good, and I don’t see any mention of active bleeding.
(A) My assessment is that with his age and acute infectious illness, he’s at high risk for a VTE and should be on prophylaxis per our hospital’s policy.
(R) I’m recommending we add the standard order for enoxaparin 40mg daily. Can I go ahead and add that for you?”
Scenario 2: The Incorrect Dose (Renal Adjustment)
The Situation: You receive an order set for a patient with a DVT. The provider has correctly chosen the VTE treatment dose of enoxaparin (1 mg/kg q12h). However, your review of the labs shows the patient’s serum creatinine is 2.8 mg/dL, giving them a calculated CrCl of 22 mL/min.
Ineffective (Interventional) Script
“Hi Dr. Smith, you ordered the wrong dose of Lovenox for Jane Doe. You need to change it.”
Why it fails: This is blunt, disrespectful, and gives a command (“you need to change it”). It provides no clinical rationale and undermines any chance of a collaborative relationship.
Effective (Collaborative SBAR) Script
“(S) Hi Dr. Smith, this is the pharmacist calling about Jane Doe in the ED, the patient with the new DVT.
(B) I’m verifying the enoxaparin order. The order is for the standard 1 mg/kg every 12 hours. I just saw her labs resulted, and her creatinine is 2.8, which gives her a calculated CrCl of about 22 mL/min.
(A) My assessment is that for a patient with a CrCl less than 30, the every-12-hour dosing will lead to drug accumulation and a very high risk of bleeding.
(R) The manufacturer and our hospital protocol recommend switching to once-daily dosing of 1 mg/kg in this situation. I’m recommending we change the order to 90mg subcutaneously once daily. Would you like me to make that adjustment?”
Scenario 3: Questioning a Clinical Choice (Patient Safety Concern)
The Situation: You are verifying a post-operative order set for an 82-year-old female who is post-hip replacement. She has no home opioid use. The order set includes a PCA with hydromorphone, and the provider has ordered a basal (continuous) infusion rate of 0.2 mg/hr in addition to the patient-controlled doses.
Ineffective (Interventional) Script
“I’m not comfortable with this PCA order. You shouldn’t use a basal rate on an opioid-naive patient.”
Why it fails: While your clinical concern is valid, this phrasing makes it about your personal “comfort” rather than objective patient safety. It sounds judgmental and uncooperative.
Effective (Collaborative SBAR, Focused on Safety) Script
“(S) Hi Dr. Wilson, this is the pharmacist. I’m calling to verify the post-operative PCA order for your patient, Mrs. Adams in room 812.
(B) I see the order includes both patient-controlled doses and a continuous basal infusion of hydromorphone at 0.2 mg per hour. I’ve reviewed her medication history, and it appears she is opioid-naive.
(A) My primary concern is for patient safety. National guidelines from ISMP and the Anesthesia Patient Safety Foundation strongly caution against using basal rates in elderly, opioid-naive patients due to a significantly increased risk of over-sedation and respiratory depression.
(R) To maximize her safety, I am strongly recommending that we remove the basal rate and manage her pain with the patient-controlled demand doses only. We can always re-evaluate if her pain is not well-controlled. Would you be open to making that change?”
