1. Modified Systematic Approach to Answering Questions Ch.#2

2. In 1975, A systematic approach for responding to DI requests was developed, which comprised of 5 steps: 1.Classification of the request. 2.Obtaining back ground information. 3.Systematic search 4.Response 5.Reclassification

3. In 1987, the systematic approach was modified into 7 steps and used for: 1.Quality Assurance 2.Student Evaluation 3.DI clerkships 4.As the basis for responding to DI inquiries 5.Applied in any area while practicing pharmacy ( Not limited to DIC use)

4. Modified Systematic Approach (1987): 1)Secure demographics of requester. 2)Obtain background information. 3)Determine and categorize ultimate question. 4)Develop strategy and conduct search. 5)Perform evaluation, analysis, & synthesis. 6)Formulate and provide response. 7)Conduct follow-up and documentation.

5. 1)Requester Demographics: **Accept the initial question & secure requester demographics (i.e. position, training, anticipated knowledge. **Identification of the enquirer The pharmacist receiving the query is to obtain the caller’s name, address, phone number and profession. **For example: the reference used, the approach, & the final response may be different when answering a request about the availability of investigational drug to an elderly pt. or a cardiovascular specialist. **The mechanism for delivery of response is also important to know ( verbal, written, e-mail,…)

6. ** Assign priority to the request according to the urgency of the problem or query. **Cases may be clinically urgent & the physician may have a patient waiting. **To enhance the credibility of the unit, it is essential that the caller be provided with some sort of time frame within which they can expect an answer. **It is important to maintain contact with the caller & follow up if agreed upon deadline cannot be met.

7. 2 ) Background Questions: **To develop a more complete picture of question & to provide an efficient response. **Must be sufficiently comprehensive. **Must be appropriate for the circumstances. **General questions obtained for patient specific or academic requests. **Other background questions should be specific for the nature of request.

8. **Obtain the necessary background information. If the request is patient specific, obtain the patient's: i. name, age, weight and sex. ii. medical history (including allergies). iii. Major organ function (cardiac, liver, kidney). iv. Drug history (name, dose, regimen, duration and indication).

9. **Use a dialogue. ** Establish whether the caller has consulted any references. **Ask which resources were used to avoid duplication & to determine the baseline sophistication of requester. **Responder may need to double check the used resources to verify the information. **When dealing with intermediaries, either: *work with them & educate them about information needed and why it is needed. or *bypass them & interact with the end-user directly. (see table 2-3 & Appendix 2-3)

10. 3) Ultimate Question/ Categorization of Question: ** Clarify the request if not clear. If it is clear go ahead. ** 85% of ultimate questions are significantly different from the original questions. Therefore, the final response would not have agreed with the initial question. ** The ultimate question may be the same as the original, esp. if not patient specific. ** It is important to confirm the ultimate question (through a discussion between the requester & the responder to determine the common goal) prior to categorization & development of search strategy.

11. **Once the ultimate question is determined, it is categorized. ** Classification of the request. Notice that there may be more than one classification. **Categorization is useful for: 1. Initial development of search strategy. 2. The determination of resources & staff training to be maintained. **Once the question is categorized, search strategy is initiated.

12. 4) Search Strategy: **Systematic search **Search the available reference. **Categorization prompts resource selection process. **Once resources are selected, they are prioritized based on the probability of their containing the information or data desired, NOT on the ease of access or degree of comfort.

13. 5) Data Evaluation, Analysis, and Synthesis: **Evaluate and interpret the information that has been sourced **Retrieved information must be objectively critiqued using techniques & skills for literature evaluation. **Analysis & Synthesis must be performed with consideration of background information for the response to be pertinent & useful to the requester.

14. 6) Formulation & Provision of Response: ** It is unethical to misrepresent results of the analysis & synthesis of literature evaluated. **If literature includes conflicting data, that must be presented to the requester using a logical argument. **If only one side of the conflict is presented: 1.The requester may NOT benefit from the complete picture. or 2.The requester may mistrust the responder if knows about the other side of the conflict later on.

15. Formulated response must be: -Succinct yet adequately comprehensive -Provided in a timely manner -Delivered at an appropriate sophistication level -Delivered using good communication skills from confident delivery to correct pronunciation. -Responder must be prepared for additional questions.

16. *All statements made should be traceable to the literature. *Statements where you think the answer is correct (but are not sure) are dangerous and must NOT be made. *Always check with at least two reference sources. *Select only the information that is pertinent to the request.

17. 7)Follow-up, Follow-through,& Documentation: a. Follow-up: * A process that verifies appropriateness, correctness, & completeness of a response following the communication. *Presents a professional approach to consultative assistance. *Enhances the perception of service delivery & the quality of the complete response. *Used for patient-specific requests, especially if judgmental, or when therapeutic decision is dependent on assumptions.

18. b. Follow-through: *The process of readdressing a request based on: - - the availability of new data or - the change in the situation or circumstances that were decisive factors in the synthesis of a response (e.g. patient developing renal failure)

19. c. Documentation: Essential for reducing the liability & promoting the development of a continual service. Could be done in a simple form or as an extensive review & summation of all processes completed. The documentation of improved patient outcome subsequent to a response would be an optimal method for justification of practices.

20. At minimum, documentation should include: 1.The ultimate question.(as verified by the requester) 2. The materials searched. 3.The response. 4.Follow-up. ( or follow-through, if applicable )