Clinical Pharmaceutical Reasoning in Hospital Pharmacy Practice using the DRIP framework: a New Approach for a Perfectionist Profession.

Clinical pharmacists are responsible for safe medication use in hospitals. Most clinical pharmacists are perfectionists. However, in their decision-making process, they have to embrace uncertainty, while interpreting available data, and integrating knowledge and clinical experience. In clinical practice, how to teach and master clinical pharmaceutical reasoning is unclear. We developed the DRIP framework including different aspects on drug, indication and patient and a stepwise approach to support clinical pharmaceutical reasoning by students, residents in hospital pharmacy and clinical pharmacists. The DRIP framework was first introduced during the daily report with residents and faculty of the clinical pharmacy. The framework was implemented in daily clinical practice to handle drug safety alerts, and to optimise drug therapy during ward rounds, multidisciplinary consultations, and in entrustmentbased discussions with residents. Pharmacists using the DRIP framework felt more confident that relevant aspects of a complex pharmaceutical problem had been considered, they learned to anticipate on the issues behind an apparently simple pharmaceutical question, and to explain their reasoning. Several CANMEDS roles can be simultaneously trained by using our approach. We are developing a course for residents in clinical pharmacy and pharmacology to teach the competency of clinical pharmaceutical reasoning using the DRIP framework.