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What is Counseling?British Association for counseling (BAC):giving client the opportunity to explore,discover and clarify ways of living moreresourcefully and towards greater well

being

Counseling needs to be related to the age,experience, background, and understanding of theindividual patient.The pharmacist should ensure the patient understandhow to take or use the medicine and how to follow thecorrect dosage schedule.Any effect of the medicine on driving or work, anyfoods or medicine to be avoided and what to do ifmissed dose should be explainedThe possibility of staining the clothes or skin andcolors urine by the administration of urine should bemention to the patient.

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The aims of counselingThe aim of patient counseling in additionto the advice from the pharmacist couldbe to:Encourage the patient to identify any problem theyperceive with the medicine and any solution toovercome the problems.Encourage the patient to develop their own action plan

for taking medicine correctly.Gain an understanding of patient perspective.Respect the patient beliefs and be non-judgemental oftheir use of the medicines.

What information to include incounseling?

How to take or use the medicineWhen to take or use the medicineHow much to take or useWhat to aspect (immediate relief, no effect for several

daysWhy the medicine is being taken or usedWhat to do if something goes wrong (missed dose)How to recognize side effect and minimizing theincidenceLifestyle changes which need to be madeDietary changes which need to be made

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Consideration of the MedicineA narrow therapeutic indexThe potential for interaction with another drugor foodThe potential to cause side effectsAny drug in BNF which has a recommendationthat counseling is advisedNew drug under intensive surveillance by thecommittee on Safety of MedicinesThe medicines which require special storagecondition

Some drugs cause side effects which can be minimized by goodmanagementDrug Side effect PrecautionNSAIDS GI disturbances Take with foodTamoxifen Nausea Take at bed time

Some drugs have side effects which require the patient to be warnedfor the information and benefitDrug Side effectCNS drugs DrowsinessCo-beneldopa Colors urine

Some drugs have side effect that need monitoringDrug Side effectPenicillamine Blood and urine testsChloroquine Ocular tests

Some drugs have side effect that require immediate reporting to theprescriberDrug Side effectGold therapy Sore throat, breathlessness, rashesAminosalicylates Bleeding, bruising

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Consideration of the patientWhat counseling has the patient previouslyreceived?What are the patient comprehension levels?The age of the patientIs the patient pregnant or breastfeeding?Does the patient have physical disabilities?Does the patient has mental disabilities?Known poor compliance

Aids to counseling

Patient information leafletsWarning cardsPlacebo device

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ReferencesPharmaceutical practice book byA.J.Winfield and R.M.E. Richard,

Communication is a two-way process.

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Key counseling pointsfor the following specific dosage forms:

ear drops and sprayseye dropseye ointmentsinhalersliquid oral dosage formsnasal dropsnasal sprays

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Obtaining patient information

WWHAM

Who is the medicine for?What are the symptoms?How long have you been ill?

Action taken so far?Medicines being taken at the moment?

Obtaining patient informationSIT DOWN SIR

Site or location?Intensity or severity?Type or nature?

Duration?Onset?With? (Other symptoms)N annoyed or aggravated by?Spread or radiation?Incidence or frequency pattern?Relieved by?

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ASMETHODA Age/appearanceS Self or someone elseM MedicationE Extra medicinesT Time persistingH HistoryO Other symptomsD Danger symptoms

ENCOREExploreNo medication?CareObserveReferExplain.

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key counselling points

for the following specific dosage forms (contd):

oral powderspatchespessaries and vaginal creamssuppositoriestablets and capsules

topical applications.

Problem Why is this a barrier to

communication? What are

the diificulties?

Method for overcoming the

barrier

1. Hearing

impairment

Risk that important information

will be lost

Local induction loop

Pen and paper

Speak slowly and clearly

Allow to be lip read

2. Lack of privacy Patient will be reluctant to

disclose delicate information

Move to a more discrete area of

the pharmacy, e.g. consultationroom

3. Non-native

language speaker

Product material often only in

English.

Wide diversity of staff.

4. Visual impairment Unable to read leaflets.

Unable to read package

information

Large print label.

Color coding

Compliance aid

5. Physical

impairment

Unable to physically access

the pharmacy

counter/pharmacy

Need to ensure that there is a

method for pat ient to gain

attention of staff

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How to use eye drops

How to use eye ointment

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Inhalers