Michelle T. Dalisay, RPh, MSc.

Case 1: The physician has prescribed 100 mg of drug X but the correct dose would be 10 mg. The pharmacist need to tell him that it has to be 10 mg and not 100 mg.

Pharmacist 1: Good Morning Dr. Jones, this is ___________, the pharmacistin-charge for today. I just want to clarify the dose given to Mr. Apostol which is 100 mg of Drug X, because as far as I know the correct dose of this drug is 10 mg. I have already verified it through MIMS.

Pharmacist 2: Good morning, this is _________ the attending pharmacist, I would just like to check and verify the dosage strength of Drug X that you have prescribed to Mr. Apostol. I would just like to ask if we can change the dosage strength since you have prescribed 100mg and according to______, the appropriate dosage strength would be 10 mg only. Mr. Apostol could suffer from toxic condition if 100 mg of Drug X would be given.

Pharmacist 3: Good morning Dr. Jones, I am ___ and Im here to ask about your patient Mr. Apostol medication. Im sorry for your time but I just need to confirm your order of 100 mg of drug, because I have looked over MIMS and the correct dose is 10 mg. I just want to confirm to you if there is an error in the prescription?

Pharmacist 4: Good Morning Dr. Jones, I am ______, the pharmacist in charge to out patient Mr. Apostol. I have here your prescription given to Mr. Apostol and I wanted to make clear if you have prescribed 100 mg of this drug. I just wanted to let you know that according to my reference the correct dose should be 10mg.

Pharmacist 5: Good Morning Dr. Jones, I am __ your pharmacist. Dr. Jones, may I just ask the dose you gave to Mr. Apostol? Is it 100 mg or 10 mg? Because according to my reference the recommended dose is 10 mg only. Pharmacist 6: Good Morning Dr. Jones, This is ____ your pharmacist. Sir , if you dont mind, Id like to verify the dosage of the said drug, so Id like to know if this is to be divided per 10mg tablet administration? Or if there had just been an error? If you would please care to verify it, our source calls for only 10mg for drug X.

Pharmacist 7: Good day Dr. Jones, this is _____ your pharmacist on duty. I would like to ontervene with the medications you prescribed to Mr. Apostol. It seems that youve prescribed him with Drug X which has a dosage strength of 100mg. According to my reference___, the correct dose that sholuld be 10mg only. I suggest that you lower the dose prescribed or alter his dosage regimen. Pharmacist 8: Good morning Dr. Jones, Can I have a moment with you please? My name is _______ and Im the pharmacist handling the medication of Mr. Apostol. I would like to check and clarify this medication with you, if you may? Ive seen on his medication you prescribed him 100mg of drug. But based on my knowledge and my collaboration with the other pharmacists the appropriate dosage strength is 10 mg. Pardon me with my intrusion but Dr. Jones I just wasnt to help with the care of our patient.

Always introduce yourself Do not apologize Do not put the physician on the spot Prepare your recommendation and keep current references in reserve Do not expect pat on the back

Pharmacist 1: Good Morning Dr. Jones, this is ___________, the pharmacistin-charge for today. I just want to clarify the dose given to Mr. Apostol which is 100 mg of Drug X, because as far as I know the correct dose of this drug is 10 mg. I have already verified it through MIMS.

Pharmacist 2: Good morning, this is _________ the attending pharmacist, I would just like to check and verify the dosage strength of Drug X that you have prescribed to Mr. Apostol. I would just like to ask if we can change the dosage strength since you have prescribed 100mg and according to______, the appropriate dosage strength would be 10 mg only. Mr. Apostol could suffer from toxic condition if 100 mg of Drug X would be given.

Pharmacist 3: Good morning Dr. Jones, I am ___ and Im here to ask about your patient Mr. Apostol medication. Im sorry for your time but I just need to confirm your order of 100 mg of drug, because I have looked over MIMS and the correct dose is 10 mg. I just want to confirm to you if there is an error in the prescription?

Pharmacist 4: Good Morning Dr. Jones, I am ______, the pharmacist in charge to out patient Mr. Apostol. I have here your prescription given to Mr. Apostol and I wanted to make clear if you have prescribed 100 mg of this drug. I just wanted to let you know that according to my reference the correct dose should be 10mg.

Pharmacist 5: Good Morning Dr. Jones, I am __ your pharmacist. Dr. Jones, may I just ask the dose you gave to Mr. Apostol? Is it 100 mg or 10 mg? Because according to my reference the recommended dose is 10 mg only. Pharmacist 6: Good Morning Dr. Jones, This is ____ your pharmacist. Sir , if you dont mind, Id like to verify the dosage of the said drug, so Id like to know if this is to be divided per 10mg tablet administration? Or if there had just been an error? If you would please care to verify it, our source calls for only 10mg for drug X.

Pharmacist 7: Good day Dr. Jones, this is _____ your pharmacist on duty. I would like to intervene with the medications you prescribed to Mr. Apostol. It seems that youve prescribed him with Drug X which has a dosage strength of 100mg. According to my reference___, the correct dose that should be 10mg only. I suggest that you lower the dose prescribed or alter his dosage regimen. Pharmacist 8: Good morning Dr. Jones, Can I have a moment with you please? My name is _______ and Im the pharmacist handling the medication of Mr. Apostol. I would like to check and clarify this medication with you, if you may? Ive seen on his medication you prescribed him 100mg of drug. But based on my knowledge and my collaboration with the other pharmacists the appropriate dosage strength is 10 mg. Pardon me with my intrusion but Dr. Jones I just wast to help with the care of our patient.

CASE 2: All the medications of Mr. Apostol are given orally except Ciprofloxacin IV. The pharmacist need to suggest to the physician to consider shifting the mentioned medication to oral since the biovailability of IV and oral preparation is nearly the same.

Pharmacist 1: Good morning, I am ___ , a pharmacist in this hospital. I just want to inform that I have reviewed Mr. Apostols drug profile and medication history. I have noticed that all his medication have been shifted to oral route except for one which is Ciprofloxacin given intravesnously. I would like to take your opinion sir in shifting this IV drug to oral medication of Ciprofloxacin. According to____ oral and IV bioavailability of ciprofloxacin is almost equal and the same. Pharmacist 2: Good morning, I am ___ . I noticed that all medications are given orally except for Ciprofloxacin IV. I can suggest for ease of administration, that you convert the ciprofloxacin IV into an orally administration. According to ____, it shows close biovailability , pharmacology ad pharmacokinetics. Pharmacist 3: Good morning, ___ I am, the pharmacist. I just have concern regarding Mr. Apostols medication. Ive learnedthat all of his medications are already given orally except for ciprofloxacin that is given IV. If you dont mind, I suggest that we change Ciprofloxacin IV into ciprofloxacin oral because those two have same biovailability and maybe it will be easier and convinient for the patient to take the ciprofloxacin orally.

Pharmacist 1: Good morning, I am ___ , a pharmacist in this hospital. I just want to inform that I have reviewed Mr. Apostols drug profile and medication history. I have noticed that all his medication have been shifted to oral route except for one which is Ciprofloxacin given intravesnously. I would like to take your opinion sir in shifting this IV drug to oral medication of Ciprofloxacin. According to____ oral and IV bioavailability of ciprofloxacin is almost equal and the same. Pharmacist 2: Good morning, I am ___ . I noticed that all medications are given orally except for Ciprofloxacin IV. I can suggest for ease of administration, that you convert the ciprofloxacin IV into an orally administration. According to ____, it shows close biovailability , pharmacology ad pharmacokinetics. Pharmacist 3: Good morning, ___ I am, the pharmacist. I just have concern regarding Mr. Apostols medication. Ive learned that all of his medications are already given orally except for ciprofloxacin that is given IV. If you dont mind, I suggest that we change Ciprofloxacin IV into ciprofloxacin oral because those two have same biovailability and maybe it will be easier and convinient for the patient to take the ciprofloxacin orally.

Pharmacist 4: Good Morning. Iam _____, the pharmacist. Not that I;m questioning your judgements and decisions, but if you are to take my opinionwe can remove his IV and give him his medication orally. I noticed that his only IV medications is Ciprofloxacin. I happen to read a cross something related to that saying theres already a ciprofloxacin tablet available. Maybe you may consider that. Pharmacist 5: Good Morning. Iam _____, the pharmacist. If I could have a moment of your time to talk to you about the medication of one your patient, Mr. Apostol. His chart indicates that you have prescribed him with oral medication except the ciprofloxacin IV. According to my references, the bioavailability between ciprofloxacin IV and oral are the same therefore giving similar optimal effects at similar rates. Since the patient is already taking oral medications would you consider changing ciprofloxacin IV to ciprofloxacin oral?

Pharmacist 4: Good Morning. I am _____, the pharmacist. Not that Im questioning your judgements and decisions, but if you are to take my opinion, we can remove his IV and give him his medication orally. I noticed that his only IV medications is Ciprofloxacin. I happen to read a cross something related to that saying theres already a ciprofloxacin tablet available. Maybe you may consider that. Pharmacist 5: Good Morning. Iam _____, the pharmacist. If I could have a moment of your time to talk to you about the medication of one your patient, Mr. Apostol. His chart indicates that you have prescribed him with oral medication except the ciprofloxacin IV. According to my references, the bioavailability between ciprofloxacin IV and oral are the same therefore giving similar optimal effects at similar rates. Since the patient is already taking oral medications would you consider changing ciprofloxacin IV to ciprofloxacin oral?

Pharmacist 6: Good morning Dr Jones, I am___ the pharmacist assigned to Mr. Apostol. All the medication of Mr. Apostol are administered orally except Ciprofloxacin IV. I would like to recommend that we shift Ciprofloxacin IV into oral. Ciprofloxacin IV and oral are almost the same based on bioavailability. Pharmacist 7: Good morning Dr. Jones, I am____ . About the medication of Mr. Apostol, May I just ask if ciprofloxacin is needed to be IV? Because of not so needed, you could give him an oral one for it has almost the same biovailability according to____. It was stated there that ciprofloxacin IV & oral dosage form has no significant change in its biovailability.

Pharmacist 6: Good morning Dr Jones, I am___ the pharmacist assigned to Mr. Apostol. All the medications of Mr. Apostol are administered orally except Ciprofloxacin IV. I would like to recommend that we shift Ciprofloxacin IV into oral. Ciprofloxacin IV and oral are almost the same based on bioavailability. Pharmacist 7: Good morning Dr. Jones, I am____ . About the medication of Mr. Apostol, May I just ask if ciprofloxacin is needed to be IV? Because of not so needed, you could give him an oral one for it has almost the same biovailability according to____. It was stated there that ciprofloxacin IV & oral dosage form has no significant change in its biovailability.

Pharmacist 7: Good morning Dr. Jones, I am____ . About the medication of Mr. Apostol, May I just ask if ciprofloxacin is needed to be IV? Because his other medications are given orally and Ciprofloxacin oral has nearly the same bioavailability with that of IV prep.

Assertive Body Language

1. Stand straight, steady, and directly face the people to whom you are speaking while maintaining eye contact. 2.Speak in a clear, steady voice - loud enough for the people to whom you are speaking to hear you. 3 Speak fluently, without hesitation, and with assurance and confidence.

Assignment
1. The patient X is admitted in room 212 due esophageal cancer and experiencing difficulty in swallowing. The physician has prescribed Esomeprazole (Nexium) 20mg PO OD and instructed the nurse to pulverize and crush the nexium before giving it to the patient. 2. The patient M has been prescribed with Cefuroxime (Rocephin) 500mg PO Q8 for 7 days.

Assignment
3. The patient W has been prescribed with Celecoxib (Celebrex) 500mg PO BID for arthritis. 4. The patient MN is admitted in surgical unit room 111 due to pain on upper left quardrant. The physician has prescribed Mefenamic acid (Ponstan) 500mg PO Q8. The following day, the physician ordered to give Etoricoxib (Arcoxia) 120mg PO OD.

Answer: Problem: Esomeprazole (nexium) tablet should not be pulverized or crushed Solution: It can be dissolved in half a glass of noncarbonated water and gently mix until it dissolves into little pellets Good morning Dr. Jones. I am Michelle Dalisay the pharmacist on duty . This is regarding Patient X admitted in room 212. I just want to confirm if you have instructed the nurse to pulverize and crush the nexium. According to ______ nexium should not be pulverized or crushed but it can be dissolved in half glass of water and gently mix until it dissolves into little pellets

Answer: Problem: Cefuroxime is not the generic name of Rocephin and no oral dosage form of Rocephin available in the market. Solution: Confirm with the physician if he/she refers to cefuroxime. Good morning Dr. Jones. I am Michelle Dalisay the pharmacist on duty . This is regarding Patient M. I just want to confirm if you prescribed Cefuroxime or Ceftriaxone? Because the generic name of Rocephin is Ceftriaxone and this is not available in tablet or capsule form.

Answer: Problem: There is no Celecoxib (Celebrex) 500mg Solution: Confirm the dose of celebrex Good morning Dr. Jones. I am Michelle Dalisay the pharmacist on duty . This is regarding Patient M. I just want to confirm if you prescribed him/her with Celecoxib (Celebrex) 500mg? Because Celebrex is only available in 50mg, 100 mg, 200mg and 400mg.

Answer: Problem: Both Mefenamic and Etoricoxib are NSAIDS. Solution: Suggest to discontinue either of the two Good morning Dr. Jones. I am Michelle Dalisay the pharmacist on duty . This is regarding Patient MN admitted in surgical unit room 111. I just want to confirm if Arcoxia is needed to be given right now? because the patient is currently on Mefenamic (Ponstan) 500mg and these two medications are both NSAIDS.