Patient Counseling Presentation

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Patient Counselling

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Group Member’s

Syed Muhammad Umar farooqi.

Muhammad Muneeb Afzal.Zaheer Abbas.

Presented to Sir Syed Zeshan Ali

The term counselling is widely used in pharmaceutical literature but the definition of term is less rapidly available. The British association of counselling (BAC) describes counselling as a

“Giving clients the opportunity to explore, discover, and clarify ways of living more resourcefully and towards greater well being.”

COUNSELLING

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In another words:

“Counselling is the sympathetic interaction between pharmacist and patient, which may go beyond, convince of straight forward information about the medicine and when to use it.”

The British national formulation explain counselling as:

“Counselling needs to be related to the age experience, background and understanding of the individual patient”

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The need for counselling

The purpose of counselling is to:

Ensure that patients are adequately informed about their medication.

Identify any problems which might cause loss of efficacy of the drug or be detrimental to the health of the patient.

Some time patients feel uncomfortable about prolonging the time and many may leave the consulting room with many questions unasked. In many cases the Prescriber will give excellent and comprehensive information but, because of the stressfulness of the situation, the patient may not take in all the information or retain it.

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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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http://www.aparx.org/images/pharmacist.jpg

Aids of counselling

Patient information leaflets: The NPA (Newspaper publishers’ association) is a useful source of information leaflets and warning cards. Leaflets on how to use ear drops, eye ointments, pessaries, suppositories, a nebulizer, and malaria tablets and head louse lotions are available.

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Warning cards:warning cards for anticoagulant therapy, lithium, MAOI and steroids should be available in all pharmacies, hospitals and any other area where counselling of the patient on drug therapy takes place.

Placebo devices: Placebo devices can be used to demonstrate a particular technique and also to check a patient’s ability to use a device.

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Telepharmacy

A “telepharmacy system” means a system that monitors the dispensing of prescription drugs and provides for related drug use review and patient counseling services by an electronic method, including the use of these technologies Audio and video Still image capture Store and forward

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Stages in the counselling process

1. Recognizing the need: It is important to ensure that all patients who require counselling receive it.

2. Assessing and prioritizing the need: Different patients and different medication and appliances need different types and levels of counselling and advice.

3. Specifying assessment methods: It can not be assumed that because counselling and advice have been given, the patient understands the advice or is able to adhere to it. It is therefore important that, before embarking on any counselling and advice process, the pharmacist has an idea of how the success of the process can be measured.

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4. Implementation: This involves giving the necessary information to the patient in an appropriate manner.

5. Assessment: Having given the information it is then of major importance to check how successful the interview has been. What does the patient understand, can he use this device, and does he have any problems? This ideal, where possible, is to assess compliance through follow-up.

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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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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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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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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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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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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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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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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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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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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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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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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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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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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

Ethical Principles

Beneficence Acting in the patients best interest

Past models doctor made decision Current thinking is to involve patient letting

the patient determine what is in their best interest

Autonomy Letting the patient have the final decision,

even if it is not in their best interest – i.e. refusing treatment, surgery, etc.

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Ethical Principles

Honesty The patient has the right to the truth

Medical condition, course of the disease Treatments

Code of ethics states: A pharmacist: “has the duty to tell the truth

and to act with conviction of conscience” Rapport is built on trust, which is based

on honesty

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Ethical Principles

Informed consent Requires honesty and autonomy to exist Patients have the right to full

information of all relevant facts and must give explicit consent before treatment

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Ethical Principles

Confidentiality From the patients perspective this is

“self-disclosure” and they should be the ones making this decision.

Patients are expected to divulge information to practitioners, the only choice is which one

Trust in confidentiality becomes very important

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Ethical Principles

Fidelity The right of patients to have

practitioners provide services that are in the patients best interest

Infidelity from an Rx’er could be: Recommending vitamins patients don’t need Failing to confront a doctor with an

inappropriate prescription out of fear that the doctor will direct his/her patients elsewhere

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Documents

Patient Counseling Presentation