What it is:The Pharmacists' Patient Care Process (PPCP) is the five-step thinking loop (Collect, Assess, Plan, Implement, Follow-up) that every patient encounter is built on. SOAP, SBAR, and the oral case presentation are not separate skills, they're the same underlying process poured into three different containersdepending on who's listening and how much time you have.
The core problem:Without a shared structure, two clinicians describing the same patient say different things in different orders, and the listener has to guess what's actually relevant. That's how doses get missed and critical labs get buried in paragraph three.
What you do about it:Learn the PPCP skeleton so well it's automatic, then recognize that a SOAP note is the PPCP written down for the chart, SBAR is the PPCP compressed to 60 seconds for a phone call, and an oral presentation is the PPCP spoken out loud on rounds. Same bones, different skin.
Every one of these formats separates what the patient/chart tells you (Subjective + Objective)from what you think about it (Assessment)from what you're going to do about it (Plan). If you remember nothing else, remember that data and interpretation never mix. New clinical facts should never appear for the first time in your Assessment, they should already be sitting in S or O.
This is the framework JCPP (Joint Commission of Pharmacy Practitioners) built and that OSU's curriculum is anchored to. It's patient-centered, done in collaboration with the rest of the care team, and it's cyclical, not linear. Follow-up feeds back into Collect for the next visit.
| Step | What you're actually doing |
|---|---|
| 1. Collect | Gather the subjective and objective information you need to understand this patient's medical and medication history and where they stand right now. |
| 2. Assess | Analyze what you collected, connect it to the patient's overall health goals, and figure out what's actually wrong and what's driving it. |
| 3. Plan | Build an individualized, evidence-based, cost-conscious care plan with the patient or caregiver and the rest of the team, not for them. |
| 4. Implement | Put the plan into action in collaboration with the team and the patient. |
| 5. Follow-up: Monitor and Evaluate | Check whether the plan is working and adjust it. This step closes the loop back into Collect. |
Collect → S and O.Assess → A.Plan, Implement, and Follow-up all live inside P.That's the single biggest structural thing to internalize: SOAP has four letters but the process has five steps, because Plan/Implement/Follow-up all get written into the same "P" section of the note. A good Plan section reads almost like three sub-steps stacked together: what you're starting, how you're educating the patient, and when you're checking back in.
Patient-centered doesn't mean "whatever the patient wants."It means the plan is built collaboratively and accounts for the patient's goals, preferences, and social context, but it still has to be evidence-based. A plan that ignores guidelines to make the patient happy in the moment isn't patient-centered, it's just non-evidence-based.
SOAP is the written artifact of the PPCP. Before any of the four letters, every note starts with identifying information: your name in the upper right header, and the patient's name, age, DOB, gender/pronouns, and allergies in the upper left, before the Subjective section even begins. Sign at the end with your title and the date.
What the patient (or caregiver) tells you.
What you or the chart can measure or verify.
Your prioritized problem list and clinical reasoning.
What actually happens next, for each problem.
OSU's own guide is explicit that this educationally-orientedSOAP note exists to let faculty see your thought process, and it is notnecessarily what you'll write on rotation. Site-specific expectations vary a lot, ask your preceptor early what format they actually want. Sections can also be legitimately dropped if they're not pertinent to the visit type, an annual med-therapy-management visit doesn't need the same ROS depth as an admission H&P.
Subjective information comes from an interview, it's what the patient or caregiver reports, not something you measured. Written to be complete, concise, accurate, well organized, and free of anything extraneous. That last part matters more than students think, dumping in irrelevant history costs you points just like leaving something out does.
A short summary of why the patient is here, ideally in their own words. "CC: 'I have a headache.'"is a real, acceptable CC. If you're a pharmacist seeing the patient for a service rather than a walk-in complaint, replace it with something like "AL was referred for medication management of her diabetes."
Written in full narrative sentences, usually chronological, built around why the patient sought care. Structure it using the eight attributes of a symptom so you don't forget a dimension mid-interview:
| Attribute | What you're asking |
|---|---|
| Location | Where exactly is it? |
| Timing/History | When did it start, how long does it last, does it come and go? |
| Quality | What does it feel like, sharp, dull, burning? |
| Modifying factors | What makes it better (palliating) or worse (provoking)? |
| Severity | How bad, often 1-10. |
| Associated symptoms | What else is happening alongside it? |
| Onset/setting | What was going on when it started? |
| Meaning to patient | Why are they worried about it, what do they think it is? |
A medication list can legitimately live in either S or Odepending on where it came from. If you're building the list from scratch by asking the patient, it belongs in Subjective. If there's an existing verified list from the chart that you're confirming, it belongs in Objective. Don't stress about which is "correct," know why the distinction exists so you can defend your choice.
Objective information is anything obtained by the clinician, the EMR, lab work, or diagnostics, not self-report. Same standard as S: complete, concise, accurate, organized.
| Component | What belongs here |
|---|---|
| Vital signs | BP, HR, RR, weight, height, BMI, temp, O2 sat. Include prior-visit values when trend matters. |
| Physical exam | Organized by body system, pertinent positives andnegatives. Avoid the word "normal," describe what you actually found. |
| Labs | Recent values, compared to prior when relevant, note whether they're in range. |
| Diagnostics | Only the ones relevant to diagnosing or monitoring this problem. Credit the source, "Per radiology..." |
| Verified med list | Drug, dose, route, frequency, start date, duration if applicable, plus adherence and any adverse effects if known. |
Both the physical exam and labs sections get docked hard for vague language. "Labs WNL" tells the reader nothing and hides a trend. Give the actual number, or the actual finding, every time.
This is where the PPCP's "Assess" step gets written down, and it's the section with the most rubric weight because it's where your clinical reasoning is visible. Two parts: the prioritized problem list, then a numbered assessmentfor each problem that justifies your thinking.
Worked shape (not a real patient, just the format):
1. Uncontrolled Hypertension
DRP: NSAID use is working against BP control
2. Chronic Low Back Pain
DRP: Scheduled NSAID contributing to problem #1
3. Prediabetes
DRP: Elevated A1C without lifestyle counseling or pharmacotherapy documented
Numbered to match the problem list, written in narrative, and covering three things for each problem:
| Component | What it needs |
|---|---|
| Initial assessment | Pull the specific S and O data that shows why this patient has this problem right now. Every fact you cite here should already be sitting in S or O, if it's brand new information, it belongs there first, not here. |
| Treatment goals | Short- and long-term, tied to a guideline. "BP <140/90 per current guideline" beats "get BP better." |
| Treatment options and justification | Mention 2-4 reasonable options (pharm and non-pharm), then justify why one wins using guideline recommendations, patient-specific factors, cost, or DRP resolution. "Antibiotics are needed" with nothing else is the textbook example of an unacceptable justification, it's vague and defends nothing. |
The Assessment introduces no new facts.If your reasoning depends on a lab value, symptom, or medication that isn't already documented in S or O, go back and add it there. Graders are explicitly instructed to dock notes that "introduce significant new information not mentioned in S or O."
The Plan is where PPCP's Plan, Implement, and Follow-up steps all get written down together. Numbered and titled to match the problem list, format is a mix of list (for the sig) and narrative (for the reasoning and counseling).
| Component | What it needs |
|---|---|
| Treatment plan | Every chosen intervention. Pharmacologic items need a complete sig: drug, dose (calculated if weight-based), route, frequency, titration instructions if any, quantity, and duration. Non-pharm items need enough specificity to be actionable, not just "diet and exercise." |
| Education & counseling | The key points you'd actually say to the patient about each treatment, pharm and non-pharm both. |
| Monitoring, follow-up, referrals | What you're tracking, the specific timeframe for rechecking it, and any referrals. If a problem genuinely needs none of these, say so explicitly rather than leaving it blank, a silent gap reads as an oversight. |
Worked shape (not a real patient, just the format):
1. Uncontrolled Hypertension
Discontinue naproxen
Start amlodipine 5 mg PO daily
Counsel on a low-sodium diet, target <2,300 mg/day, and 150 min/week of moderate exercise
Home BP/HR log; phone follow-up in 4-5 days; recheck CHEM-7 in 2 weeks for renal function and potassium
Clinical practice guidelines are the standard of careand should anchor your justification. If a guideline is outdated, fall back to primary literature. Tertiary references (UpToDate, DynaMed, Micromedex) are not acceptable as clinical justification, they're fine as a starting point to find the actual guideline, but citing them directly as your evidence is a point loss. Format references in AMA style.
SBAR (Situation, Background, Assessment, Recommendation) is the compressed, real-time version of the same process, built for verbal handoffs where you don't have the luxury of a written note: calling a physician, giving report, or escalating a concern. It originated in the U.S. Navy's nuclear submarine program and aviation before healthcare adopted it, because those industries also needed a fast, standardized way to transfer critical information without losing anything.
| Letter | Question it answers | Notes |
|---|---|---|
| S - Situation | What's happening right now? | Aim for 8-12 seconds. Identify yourself, your unit, the patient, and state the problem, when it started, and how severe. This is the hardest part to keep brief, practice it. |
| B - Background | What led up to this? | Sets context. Come prepared with relevant labs, vitals, and recent medications, don't make the listener ask. |
| A - Assessment | What do you think the problem is? | Be specific, this is your clinical opinion, not just a restatement of the situation. |
| R - Recommendation | What should be done? | Say what you think needs to happen or be ordered. If you're not sure, it's fine to ask the listener for their recommendation instead. |
It gives you "permission" to make a recommendation even when you're junior, because the structure itself signals you've thought it through. It also levels the hierarchy: a nurse or student using SBAR with a physician isn't interrupting, they're delivering exactly the information format the listener expects, which is why it saves time on both ends.
Not everything needs to be communicated, only what's pertinent to the immediate decision. And SBAR isn't one-directional: end every handoff with "What questions do you have for me?"and tell them how to reach you if something comes up later. Effective communication is two-way, even when the format is compressed.
This is the PPCP spoken out loud on rounds or in a case discussion, longer than SBAR but still compressed compared to a full written SOAP note. It's a real, developed skill, and it's also how students, residents, and trainees get assessed on clinical reasoning in real time. The goals: organize the information, inform the team, promote discussion, and demonstrate that you actually understand the assessment and plan, not just recite facts.
| Section | What goes in it |
|---|---|
| Opening statement | Demographics plus only the past medical history relevant to the chief complaint, kept brief. "Mr. Smith is a 55-year-old man with a history of COPD who presents with a chief complaint of fever and productive cough." |
| HPI | Chronological, why the patient sought care, timing relative to admission, symptom attributes, pertinent ROS, and relevant chronic PMH woven in narratively. |
| PMH | Ordered by importance, only what impacts the HPI or current care. Past surgeries/hospitalizations if relevant. |
| Medications | What's relevant to the illness and plan, dose/frequency if it matters to the discussion. Have the complete list ready if asked. Allergies with the actual reaction, not just the drug name. |
| Social & family history | Only what's relevant to the illness or to discharge/home care planning. |
| Vitals, exam, labs | Give a range if variable, not just one snapshot. Pertinent positives andnegatives on exam, avoid "normal." Actual lab values with trend, and credit the source ("per radiology..."). |
| Assessment & Plan | Each problem gets its own A&P. State the differential, the rationale for your chosen treatment, and be specific in the plan, "start antibiotics" without naming one and a duration is the exact kind of vagueness that gets called out. |
Before presenting: pull the problem list from the SOAP note, H&P, or progress notes, identify and assess each problem, and build a complete plan, including the specific drug/dose/route/frequency/duration and the monitoring and follow-up plan. Also compare the problem list against the medication list, is every med tied to an indication, is anything missing, suboptimal, or interacting? That comparison catches a huge share of real drug-related problems.
Be concise, don't mislead, and remember you're persuading the team toward your diagnosis and plan as much as reporting facts, this is sometimes described as "telling the story." Being consistent in structure and style every time matters too, it lets the team know what to expect and keeps you organized under pressure. Location and audience change the expectations (inpatient vs outpatient, medicine vs surgery, a cardiologist vs a social worker), so when in doubt, ask what your team prefers.
Word choice in a note or presentation isn't cosmetic, certain pairs of terms carry different clinical and legal weight. Preceptors watch for this.
| Say this | Not this | Why it matters |
|---|---|---|
| "Not at goal" | "Uncontrolled" | "Uncontrolled" can imply the regimen has failed or the patient hasn't tried; "not at goal" is a neutral, factual statement about where the numbers stand relative to target. |
| "Non-adherent"(with detail on why, if known) | "Adherent" used loosely | Adherence claims should be specific and evidenced, don't state either without something backing it up, like pill counts, refill history, or patient report. |
| "Declined" | "Refused" | "Refused" can carry a combative or noncompliant connotation. "Declined" documents the same fact, the patient chose not to proceed, without editorializing. |
| "Shared decision-making" | (unstated assumption of unilateral choice) | When a plan involves patient preference, especially between reasonable options, document that it was a joint decision. It shows patient-centered care actually happened, not just that a med was prescribed. |
None of this is about softening the truth, it's about documenting facts without unnecessary judgment. A chart is read by the patient, other clinicians, and sometimes lawyers. Precise, neutral language protects everyone, including the patient's therapeutic relationship with the team.
Pulled directly from the rubric categories that separate a "Competent" (2/2) note from "Needs Improvement" (1/2) or "Not Acceptable" (0/2). These are the same failure patterns across S, O, A, and P, just applied to different content.