Patient Pharmacist Interaction

Durdana Waseem, Lecturer RIPS

Areas for Patients-Pharmacist Interaction

1. Hospital 1. In pharmacy 2. In wards Community 1.

2.

Hospital

Community

Therapeutic Communication

A skill that helps people to overcome temporary stress, to get along with other people, to adjust to the unalterable, and to overcome psychological blocks which stand in the way of self-realization

Objectives of Interaction

to educate the patient about the drug therapy he/she is receiving and/or taking

to elicit necessary information from the patient to make your decisions

to negotiate the terms of the goals of therapy and the patient's role in achieving them

Ethical Principles
Concepts that describe the moral standards applied in patient care
Beneficence Nonmaleficence Veracity Justice Fidelity Autonomy Confidentiality

Do the very best you can for every patient Above all, do no harm Tell the patient the truth Fair, equitable and appropriate treatment regardless of ethnicity, class or gender

concept of faithfulness and the practice of keeping promises

Allow the patient to be the ultimate decision maker Always protect your patient's privacy

Parts of Interaction
Welcome to patient Initial questioning (patient history, medication use behavior, perceptions) Prescription handling/medicine assessment (written directions for use) Dispensing/medication compliance/ evaluation Counseling (language, patients understanding of instructions, disease, drugs and dosage schedule, encouragement to comply with regimen) Follow up

Decision making Principles in PatientPharmacist Interaction

Every patient has a right to
be treated according to his/her unique character

decide and act on his/her own values to fulfill individual life plans
expect complete objective information and the emotional support necessary to act effectively on that information control of his/her time and effort expect whatever benefit is possible in the health care setting and to expect no avoidable harm expect that agreements established with the health care professionals will be kept

What Patient can Expect

The patient will expect you to
1

Care About What They Want Put Their Needs First, before Your Own

Possess the Technical Knowledge and the Clinical Experience and Confidence It Takes to Apply that Knowledge to Their Individual Case
Receive the Appropriate Medication for Their Medical Problems, and They Expect the Medication to Work

Be Realistic and Honest About What They Can Expect from Their Medications
Be Accountable for the Decisions You Make and the Advice You Give

Know When to Refer Them to Someone with Different Expertise

Characteristics & Behaviors Associated with Interaction

Characteristics about yourself
1

Behaviors you manifest toward your patient

2

Honesty/authenticity/open communication Empathy/sensitivity Patience and understanding Competence Assuming responsibility for

Putting the patients needs first Offering reassurance Seeing the patient as a person Mutual respect/trust Cooperation Caring

interventions
Being held accountable for the decisions and recommendations made

Building confidence
Supporting the patient Paying attention to the patient's physical and emotional comfort

General behaviors that will always impact the impression you have on your patients
Attend to your appearance and be conscious of the impact it has on the patient Be conscious of the impact the appearance of your surroundings has on the patient The vocabulary and language that you use to greet the patient will set the tone of the meeting Listen and give attention to the patient, he/she will be expecting it

First understand the patient

What your patient wants to know What the patient already knows The best way to recognize this difference is to determine the preferred language of the patient determine the level of comprehension best suited to the patientthis will determine the vocabulary/terms that are familiar to the patient identify any cultural or religious issues that are relevant to

communicating with the patient

Patient Pharmacist Encounter

Assess patients drug related needs
The medication is appropriate
There is a clinical indication for each medication being taken. All of the patient's medical conditions that can benefit from drug therapy have been identified The medication is effective The most effective drug product is being used The dosage of the medication is sufficient to achieve the goals of therapy The medication is safe There are no adverse drug reactions being experienced There are no signs of toxicity The patient is compliant The patient is willing and able to take the medications as intended

Convey to the patient

Explain the following to the patient

The reason the patient is taking each medication Explain how the medication works Use pictures and diagrams whenever possible Provide patients with information and labeling to take home with them

Convey to the patient

The specific instructions of how to take the medication explained in a manner the patient can understand Use the same terms from one encounter to the next Use phrases that are familiar to the patient so they are not misunderstood (twice a day, dissolved in water, with food) Start from your patient's point of reference (when do they eat, what time do they go to bed)

Convey to the patient

A description of how the patient will know that the medication is working well
Describe how the patient's symptoms will change and when to expect these improvements Create an understandable system for complicated terms (clinical parameters or laboratory values) Include specific values that will serve as endpoints

Communicate how confident you are that the patient's pharmacotherapy

will be effective

Convey to the patient

Explain the undesirable effects that might be expected Be specific about when adverse reactions are most likely to occur. Be clear about what the patient should do if a dose of the medication is missed or if he/she takes an extra dose of the medication

Convey to the patient

Inform the patient of when and how you intend to follow-up to evaluate effectiveness and safety of the medication Provide the patient with clear instructions of what to do if any problems arise with the medication Provide the patient with a way to contact you if the medication is not

working within the timeframe you discussed

Workup of an Ethical Problem In

Patient Pharmacist Interaction

Workup of an Ethical Problem

1.

Recognize when a patient encounter raises an important ethical problem, and gather the relevant facts What are the clinical facts? What are the legal facts? What are the ethical facts?

2.

Work with the patient to describe the problem that has to be resolved What is the ethical dilemma?

What ethical principles are involved?

Workup of an Ethical Problem

3. Determine what each of you (practitioner and patient) consider to be an acceptable resolution to the problem 4. Generate reasonable alternatives to resolve the ethical problem, and

consider each option in relation to the fundamental ethical principles

and the patient's preferences What are the possible strategies to address the problem?

Workup of an Ethical Problem

Autonomy: What does the patient want? Paternalism: How am I affecting the patient? Beneficence: What good can be done for the patient? Nonmaleficence: Is harm to the patient being avoided? Justice: Is the patient receiving what is fair? Veracity: Is the patient being told the truth? Confidentiality: Is the patient's privacy being protected?

Workup of an Ethical Problem

5. 6.

Select the resolution that you and the patient will implement What should be done? What is the final decision that you plan to implement? Critically examine the decision that has been made, and justify it What makes this the best choice? What would make you change your mind?

7.

Do the right thingimplement it

How am I going to accomplish this? What is the best strategy to implement the solution? How will I know if my actions were appropriate or not? Follow-up with the patient

Assignment 1 Case

Mr. Z., age 63, has had two heart attacks in the past. He now has a prescription for a medication to prevent recurrences of heart attacks that must be taken regularly to be effective. He tells you that he does not think he will bother to take the new medication because he does not believe another heart attack will harm him. How would you approach his care?

Assignment 2

Prepare a set of principles that a pharmacist must follow to establish and run a community pharmacy.

THANK YOU!