Hospital Pharmacy

Lecture 5

Patient Counseling Checklist: Introduce yourself: It is important for patients to know they are speaking with the pharmacist. They may be reluctant to ask questions or express concerns if they believe they are speaking to a technician or clerk.

Identify to whom you are speaking: If you are talking to the patient directly, information is less likely to be confused or distorted than if you are talking to the patient's representative, who must pass the information on to the patient. In third party communication, written information becomes even more important than when directly communicating with the patient.

Explain the purpose/importance of the counseling session: People listen and learn more effectively when they are given reasons for what is being asked of them. For example, patients are less likely to take tetracycline with food or dairy products if they are told that decreased absorption and effectiveness of the drug may result. For new patients, it will be necessary to explain why the information being gathered is needed.

Ask the patient what physician told him/her about the drug and what condition it is treating: Find out what the patient knows or understands about his/her disease. There is no reason for the pharmacist to present information that the patient already has mastered. Generally speaking, in any effective counseling session, the patient should speak more than the healthcare provider.

The purpose of the session is to ensure that patients leave the hospital with knowledge about the proper use of the medication. It really does not matter whether the patient gets this information from the pharmacist or physician. Accurate information that the patient supplies should be supported and praised. Inaccurate information should be corrected, and information that is omitted should be added. Use any available patient profile information.

• Listen carefully and respond with appropriate empathy: These skills are absolutely essential to an effective counseling session. The relationship between the patient and practitioner is a key variable in predicting compliance with treatment regimens. Patients need to view health care providers as competent, trustworthy professionals who care about what happens to them. Listening and empathic responding are effective tools for communicating caring.

Tell the patient the name, indication, and route of administration of the medication: This and the steps that follow will generally be performed after determining the appropriateness of the medication and filling the prescription. Telling patients the name of the medication helps them get used to identifying it. This is especially important in case of an emergency (e.g., a child ingesting it, overdose). Stating the indication reinforces the diagnosis and creates confidence in the appropriateness of the therapy.

While the route of administration often seems obvious, pharmacists often encounter cases of patients taking a medication by the wrong route. It should not be assumed that printing this information on the label will cover these points. Many patients cannot read, and those who can read often do not.

Inform the patient of the dosage regimen: Patients should be told the dosage regimen in order to either reinforce what the doctor instructed or inform them for the first time. While a particular dosage regimen may seem straightforward or obvious, it may be interpreted incorrectly. For example, not everyone eats three meals a day. Patients with diabetes may eat six or seven mini-meals each day. Therefore, directions that state, "Take one tablet after meals and at bedtime," may prompt some patients to take their medications more than the intended four times per day.

Ask the patient if he/she will have a problem taking the medication as prescribed: This is an important question that is seldom asked by any healthcare provider. Yet, research shows that the complexity of the dosage regimen can greatly affect compliance. In fact, once-a-day dosing generally achieves rates of compliance of greater than 80% while four-times-a-day dosing reduces compliance to below 40%. Noncompliance as a consequence of complex dosage regimens may result in hospitalization of the patient. Pharmacists should attempt to resolve problems related to the dosage regimen, either through tailoring the regimen or working with the physician to change the medication to a less complicated dosing schedule.

Tailor the medication regimen to the patient's daily routine: Making a connection between taking a dose of medication and a regular daily task will enhance compliance. This could include identifying when the patient wakes up and goes to bed or which meals the patient eats. Pharmacists should not assume that patients follow a common routine (e.g., eating three meals a day). They should ask patients about their routines before suggesting a plan.

Tell the patient how long it will take for the drug to show an effect: If patients are not told when to expect onset of action, they may believe the medication is not working. Patients may cease taking a medication, or they may take too much because they believe one dose did not work.

Tell the patient how long he/she might be taking the medication: Patients need to have a reasonable expectation of how long they will need to take the medication. This helps them get into a "mind set" of compliance. Moreover, it gives patients a chance to express concerns about the length of treatment.

Thank you