Presentation on theme: "Patient Counseling DMC Pharmacy Department Competency July 2005"— Presentation transcript:
1Patient Counseling DMC Pharmacy Department Competency July 2005 Dale Tucker RPh, BCPSTerry Dunn Pharm. D.Albert Bajjoka Pharm. D., BCPSJuly 2005
2Goals and ObjectivesGoal: To review with the pharmacist the steps and importance of effective patient counselingObjective: To obtain actual practice in counseling patients in order for the pharmacist to become a more effective counselor
3Outline WHO should be counseled? WHY should counseling be performed? HOW should counseling be performed?
4WHO to CounselDMC has a Tier 2 policy (MED 112) requiring pharmacists to counsel all patients taking warfarin (Coumadin®) and dieticians to counsel all patients on MAOIsOther 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.
5Outline WHY should counseling be performed? WHO should be counseled? HOW should counseling be performed?
6WHY Counsel?To promote adherence to medications and avoid treatment failure and future hospital admissionsHelps patients cope with their disease and any medication side effects that might occurImportant to avoid potential drug interactions with OTC, herbal, and prescription medications
7Outline HOW should counseling be performed? WHO should be counseled? WHY should counseling be performed?HOW should counseling be performed?
8HOW to Counsel Be aware of barriers to counseling Disease state: dementia, strokeLanguage: verify primary languageHearing/vision problemsEnvironmental: noise, lack of privacyEducational level (reading ability)Patient motivation: disinterest in learningLack of pharmacist training/time
9Minimize Barriers: Effective Communication Skills Proper environmentPrivate, quietFree of distractions, e.g., patient should have pain controlled, ask patient to lower volume on the TV etc.Introduce yourselfGreet the patientExplain your purposeAsk the patient’s permission to counsel
10Minimize Barriers: Effective Communication Skills Know your audienceEducational level: tailor talk for understandingUse appropriate languageReligious or ethnic beliefse.g. need to avoid blood products or specific foods
11Minimize Barriers: Effective Communication Skills Be specificName of medication (brand/generic), dose, dosage form, scheduleList precautions: e.g., use sunscreen, avoid milkHow to administer (Sub-Q, PO, IM etc.)Special directions and precautionsNecessary lab tests
12Minimize Barriers: Effective Communication Skills Be selectiveCover major / common side effectsCover major / common drug interactionsCover patient specific indicationEmphasize benefits of medicationWhat to do if dose(s) missedDuration of therapyProvide written informationSummarize key points
13Minimize Barriers: Effective Communication Skills Be sensitive/empatheticListen to the patientSpeak distinctly and clearlyReturn later if patient indisposed, not alert, distracted, has visitors etc.
14Minimize Barriers: Effective Communication Skills Elicit feedback to assess understandingImproves coping if side effects occurIncreases adherence to improve healthVerifies patient’s comprehensionAsk open ended questionsAsk if any final questions
15Assess 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?”
16Example: Warfarin Counseling DOAddress patients formallyAsk what the patient knows about warfarin or Coumadin®DON’TAddress patients by their first namesAssume the patient knows all or nothing about the drug
17Example: Warfarin Counseling DOExplain that warfarin is used to slow the blood clotting process to prevent unwanted blood clotsAsk patients to call their doctor if they notice bleeding that they don’t normally haveDON’TExplain that warfarin is an anticoagulantExplain that warfarin works by inhibiting the vitamin K dependent clotting factors and that it is an emergency situation if they see any blood
18Example: Warfarin Counseling DOIdentify the specific reason the patient is taking it and how long they might be expected to take itDON’TList every reason anyone might be on warfarin
19Example: Warfarin Counseling DOExplain 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 sizeDON’TGive the patient the impression that they are going to bleed to death
20Example: Warfarin Counseling DOAsk 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’TAssume the patient realizes the need to notify all health care providers concerning all the medications they are on; OTCs are often not considered medications
21Example: Warfarin Counseling DOAsk the patient to avoid taking OTC pain medications such as aspirin, Aleve®, Motrin®, or Advil® unless they have discussed it first with their physicianRecommend Tylenol® as the OTC pain reliever of choice with their physician’s knowledge as wellDON’TIndicate that the only good pain medications are those found on prescription
22Example: Warfarin Counseling DOTell the patient what to do if he or she forgets a doseAsk the patient to inform their physician or anticoagulation clinic if a dose is missedDON’TTell the patient to double up on their next dose if they miss one
23Example: Warfarin Counseling DOStress the need for follow-up appointments and blood drawsIndicate that it is normal for doses to change from time to timeDON’TMinimize the importance of follow-up by an anticoagulation clinic or a physician
24Example: Warfarin Counseling DOAsk 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 eatDON’TLimit or forbid the patient to eat salads or vegetables, though a renal diet used by an ESRD patient may include some restrictions
25Example: Warfarin Counseling DOSummarize key points coveredAsk if the patient has any other questionsAscertain that the patient understands the informationThank the patient and leave written informationAsk them to view the in-house educational TV program if availableDocument as requiredDON’TAssume the patient has no final questionsAssume the patient has understood all you have discussedForget to leave a note in the chart
26Warfarin Counseling Summary Reason for being on anticoagulationSide Effects ( major and minor with expected frequency)Signs of major bleedingAnticipated duration of therapyAdding or discontinuing medicationsDietary considerationsArrangements for future blood draws
27Documentation of Counseling Session When counseling is completedWrite note or use counseling sticker in progress note.Include assessment of patient and/or care giver understanding.
28Summary Prepare prior to counseling Introduce yourself and your topic Use language the patient understandsPresent information in logical orderSummarize key pointsVerify patients’ understandingAllow final questions from patientGive written information to patientPlace a note in the chart