Patient Counseling

DMC Pharmacy Department

Competency
Dale Tucker RPh, BCPS
Terry Dunn Pharm. D.
Albert Bajjoka Pharm. D., BCPS
July 2005
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
DMC has a Tier 2 policy (MED 112) requiring
pharmacists to counsel all patients taking
warfarin (Coumadin) and dieticians to
counsel all patients on MAOIs
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.

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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 6
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 patients 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 patients comprehension
Ask open ended questions
Ask if any final questions

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Assess Patients 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 DONT
Address patients Address patients by
formally their first names
Ask what the patient Assume the patient
knows about knows all or nothing
warfarin or about the drug
Coumadin

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Example: Warfarin Counseling
DO DONT
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 dont normally
have
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 DONT
Identify the specific List every reason
reason the patient is anyone might be on
taking it and how warfarin
long they might be
expected to take it

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Example: Warfarin Counseling
DO DONT
Explain the signs and Give the patient the
symptoms of impression that they
bleeding such as are going to bleed to
bloody nose, blood in death
the urine, a stool
that changes color or
darkens, bruises that
never go away or
increase in size

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Example: Warfarin Counseling
DO DONT
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)
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 DONT
Ask the patient to avoid Indicate that the only
taking OTC pain good pain medications
medications such as
are those found on
aspirin, Aleve,
Motrin, or Advil prescription
unless they have
discussed it first with
their physician
Recommend Tylenol as
the OTC pain reliever of
choice with their
physicians knowledge as
well

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Example: Warfarin Counseling
DO DONT
Tell the patient what Tell the patient to
to do if he or she double up on their
forgets a dose next dose if they
Ask the patient to miss one
inform their
physician or
anticoagulation clinic
if a dose is missed

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Example: Warfarin Counseling
DO DONT
Stress the need Minimize the
for follow-up importance of
appointments and follow-up by an
blood draws anticoagulation
Indicate that it is clinic or a
normal for doses physician
to change from
time to time

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Example: Warfarin Counseling
DO DONT
Ask the patient to Limit or forbid the
eat a constant and patient to eat salads
moderate diet where or vegetables,
they eat vegetables though a renal diet
and salads in a used by an ESRD
consistent manner patient may include
and neither over do some restrictions
nor stop eating what
they normally eat

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Example: Warfarin Counseling
DO DONT
Summarize key points
covered Assume the patient
Ask if the patient has any has no final
other questions questions
Ascertain that the patient

understands the
Assume the patient
information has understood all
Thank the patient and you have discussed
leave written information
Forget to leave a
Ask them to view the in-
house educational TV note in the chart
program if available
Document as required
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Warfarin Counseling
Summary
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
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