Patient Counseling

Kuliah ke 4

Rahmawati Syukur

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Goals and Objectives Goal: To review with the

pharmacist the steps and importance of effective patient counseling

Objective: To obtain actual practice in counseling patients in order for the pharmacist to become a more effective counselor

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Outline

WHO should be counseled?

WHY should counseling be performed?

HOW should counseling be performed?

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WHO to Counsel Patients with polypharmacy and taking

antibiotics or warfarin (Coumadin®), etc.

Other patient medication counseling could include patients with solid-organ transplant, asthma, COPD, new onset diabetes mellitus, CHF, the elderly, discharge medications for any patient, or if requested by physician.

Patients OTC

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Outline WHO should be counseled? WHY should counseling be performed?

HOW should counseling be performed?

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WHY Counsel? To promote adherence

to medications and avoid treatment failure and future hospital admissions

Helps patients cope with their disease and any medication side effects that might occur

Important to avoid potential drug interactions with OTC, herbal, and prescription medications

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Outline WHO should be counseled? WHY should counseling be

performed? HOW should counseling be performed?

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HOW to Counsel Be aware of barriers to counseling

Disease state: dementia, stroke Language: verify primary language Hearing/vision problems Environmental: noise, lack of privacy Educational level (reading ability) Patient motivation: disinterest in

learning Lack of pharmacist training/time

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Minimize Barriers:Effective Communication Skills Proper environment

Private, quiet Free of distractions, e.g., patient should

have pain controlled, ask patient to lower volume on the TV etc.

Introduce yourself Greet the patient Explain your purpose Ask the patient’s permission to counsel

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Minimize Barriers:Effective Communication Skills Know your audience

Educational level: tailor talk for understanding

Use appropriate language Religious or ethnic beliefs

e.g. need to avoid blood products or specific foods

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Minimize Barriers:Effective Communication Skills Be specific

Name of medication (brand/generic), dose, dosage form, schedule

List precautions: e.g., use sunscreen, avoid milk

How to administer (Sub-Q, PO, IM etc.) Special directions and precautions Necessary lab tests

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Minimize Barriers: Effective Communication Skills Be selective

Cover major / common side effects Cover major / common drug interactions Cover patient specific indication Emphasize benefits of medication What to do if dose(s) missed Duration of therapy Provide written information Summarize key points

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Minimize Barriers: Effective Communication Skills Be sensitive/empathetic

Listen to the patient Speak distinctly and clearly Return later if patient indisposed, not

alert, distracted, has visitors etc.

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Minimize Barriers: Effective Communication Skills Elicit feedback to assess

understanding Improves coping if side effects occur Increases adherence to improve

health Verifies patient’s comprehension

Ask open ended questions Ask if any final questions

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Assess Patient’s Understanding “Just to make sure I did not leave

anything out, could you tell me…[examples]

What is the medication used for?” When are you going to take the

medication?” What side effects might you

experience?” What will you do if that occurs?” What will you do if you miss a dose?”

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Example: Warfarin Counseling DO

Address patients formally

Ask what the patient knows about warfarin or Coumadin®

DON’T Address patients

by their first names

Assume the patient knows all or nothing about the drug

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Example: Warfarin Counseling DO

Explain that warfarin is used to slow the blood clotting process to prevent unwanted blood clots

Ask patients to call their doctor if they notice bleeding that they don’t normally have

DON’T Explain that warfarin

is an anticoagulant Explain that warfarin

works by inhibiting the vitamin K dependent clotting factors and that it is an emergency situation if they see any blood

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Example: Warfarin Counseling DO

Identify the specific reason the patient is taking it and how long they might be expected to take it

DON’T List every reason

anyone might be on warfarin

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Example: Warfarin Counseling DO

Explain the signs and symptoms of bleeding such as bloody nose, blood in the urine, a stool that changes color or darkens, bruises that never go away or increase in size

DON’T Give the patient

the impression that they are going to bleed to death

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Example: Warfarin Counseling DO

Ask the patient to tell all their doctor/ dentist etc. all the medications they are taking including nonprescription ones (e.g., pain medications, vitamins, herbal products)

DON’T Assume the patient

realizes the need to notify all health care providers concerning all the medications they are on; OTCs are often not considered medications

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Example: Warfarin Counseling DO

Ask the patient to avoid taking OTC pain medications such as aspirin, Aleve®, Motrin®, or Advil® unless they have discussed it first with their physician

Recommend Tylenol® as the OTC pain reliever of choice with their physician’s knowledge as well

DON’T Indicate that the only

good pain medications are those found on prescription

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Example: Warfarin Counseling DO

Tell the patient what to do if he or she forgets a dose

Ask the patient to inform their physician or anticoagulation clinic if a dose is missed

DON’T Tell the patient to

double up on their next dose if they miss one

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Example: Warfarin Counseling DO

Stress the need for follow-up appointments and blood draws

Indicate that it is normal for doses to change from time to time

DON’T Minimize the

importance of follow-up by an anticoagulation clinic or a physician

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Example: Warfarin Counseling DO

Ask the patient to eat a constant and moderate diet where they eat vegetables and salads in a consistent manner and neither over do nor stop eating what they normally eat

DON’T Limit or forbid the

patient to eat salads or vegetables, though a renal diet used by an ESRD patient may include some restrictions

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Example: Warfarin Counseling DO

Summarize key points covered

Ask if the patient has any other questions

Ascertain that the patient understands the information

Thank the patient and leave written information

Ask them to view the in-house educational TV program if available

Document as required

DON’T Assume the

patient has no final questions

Assume the patient has understood all you have discussed

Forget to leave a note in the chart

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Warfarin CounselingSummary Reason for being on anticoagulation Side Effects ( major and minor with

expected frequency) Signs of major bleeding Anticipated duration of therapy Adding or discontinuing medications Dietary considerations Arrangements for future blood draws

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Documentation of Counseling Session When counseling is completed

Write note or use counseling sticker in progress note.

Include assessment of patient and/or care giver understanding.

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Summary Prepare prior to counseling Introduce yourself and your topic Use language the patient understands Present information in logical order Summarize key points Verify patients’ understanding Allow final questions from patient Give written information to patient Place a note in the chart