The Pharmacists’ Patient Care Process as Sensemaking

By Kathryn J Smith, PharmD, BCACP

Imagine a small military unit sent on a mission in the Swiss Alps. They are not familiar with the terrain nor are they equipped to deal with the snowstorm they encounter. After two days of consistent snow, cold and hunger, panic begins to spread through the unit as they imagine what will become of them. All of a sudden, someone finds a map in the pocket of his uniform. Everyone crowds around the map trying to figure out where they are and possible paths they may take to safety. The soldiers regain their confidence, calm down and begin to formulate plans. With the use of the map, they are able to navigate out of the mountains. To reach their destination, they must seek help from villagers along the way and shift their path to continue to follow anticipated landmarks. Upon safely reaching base camp, it is discovered that the map used was actually a map of the Pyrenees and not the Alps. The map, albeit imperfect, serves as a source of confidence, hope and the means to move from anxiety to action.

Bringing this a little closer to home…
Imagine a pharmacy student on the first day of pharmacy school who is not familiar with the language or the landscape, perhaps even feeling lost and overwhelmed by new drug knowledge, kinetics, patient communication techniques, clinical skills, and more. How can we help the student make sense of all the new information? What sort of map can be offered?

What is Sensemaking?
Sensemaking is defined as the process of structuring the unknown by placing stimuli into a framework that enables us to comprehend, understand, explain, attribute, extrapolate and predict.1,2 It enables us to turn the complexity of the world into something we can comprehend. Sensemaking involves coming up with plausible understandings and meaning; testing these understandings with others via action; and then refining our understandings or abandoning these in favor of new meaning that better explain a shifting reality.1 As pharmacists, we have an accurate and clear “map” to help us make sense of the landscape of patient care: the Pharmacists’ Patient Care Process.3

PCPP as a Map
Think of it this way: when caring for a patient, pharmacists first collect information about the patient from the electronic medical record, other healthcare professionals, the patient or their caregiver. By understanding what the current status of the patient is, a sense of the medication related needs can be developed. Pharmacists then assess the information collected and develop list of problems the patient is experiencing. This relates to the explaining and attributing part of sensemaking, occurring within the context of the patient’s overall health goals. Which medications are working? Which are causing problems? Have new problems developed? Working with the patient, pharmacists and students can develop a plan to address the problems the patient is experiencing and to educate the patient on how to use devices or drugs they’ve been prescribed. Based on their expertise, pharmacists are equipped to predict how the patient might respond to the recommended changes once implemented. Medications may be started, stopped or continued, monitoring may be initiated or referrals may be placed. This sensemaking is not a one-and-done activity.1 Follow-up is key to understanding if the changes made that helped the patient reach their goals. If new information arises, it can be incorporated to make a new plan or “map” to positive outcomes.

As Kolar, Hager and Losinski so eloquently illustrated, the Patient Care Process (the “map”) works even better when used in combination with a Philosophy of Practice (a “compass”) and a practice management system (“landmarks”).4 Introducing the Pharmacists’ Patient Case Process to our students as a “map” may be a new method of helping them move from anxiety to action and give them more confidence when interacting with patients and developing as patient care providers. By organizing information about a patient in the framework of the Pharmacists’ Patient Care Process, pharmacists can also help their students make sense of a patient’s experience. When in unfamiliar territory, as with a complicated patient, this “map” serves as a starting point from which to get their bearings, make a plan and start moving in the direction of an intended target.

Students, have your faculty or preceptors introduced the PPCP in this way? Preceptors and faculty, what strategies would you recommend for teaching students how to use the PPCP as a map for their patient encounters?

Acknowledgements
The author would like to acknowledge Dr. Lindsey Childs-Kean for her help in reviewing this post before submission.

References
1. Ancona, D. L. (2011). Sensemaking: Framing and Acting in the Unknown. In Handbook of Leadership Education (pp. 3-20). Thousand Oaks, CA: Sage Publications, Inc.

2. Weick, K. E. (1995). Sensemaking in organizations. Thousand Oaks, Calif.: Sage.

3. Joint Commission of Pharmacy Practitioners. Pharmacists ’ Patient Care Process. 2014. https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf Accessed December 7, 2017.

4. Kolar C, Hager KD, Losinski V. Beyond the Pharmacists’ Patient Care Process: Cultivating Patient Care Practitioners by Utilizing the Pharmaceutical Care Framework. Inov Pharm. 2017;8(3): Article 7. http://pubs.lib.umn.edu/innovations/vol8/iss3/7. Accessed December 7, 2017.


Kathryn J. Smith is a Clinical Assistant Professor at the University of Florida College of Pharmacy. Educational scholarship interests include leadership, professionalism and the Pharmacists’ Patient Care Process. In her free time, Kate enjoys Chicago Cubs baseball and hanging out with her husband and their two-year old twins.


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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