Patient Counseling
Kuliah ke 4
Rahmawati Syukur
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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 Patients with polypharmacy and taking
antibiotics or warfarin (Coumadin®), etc.
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.
Patients OTC
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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
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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 patient’s 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 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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Example: Warfarin Counseling 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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Example: Warfarin Counseling 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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Example: Warfarin Counseling 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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Example: Warfarin Counseling 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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Example: Warfarin Counseling 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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Example: Warfarin Counseling 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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Example: Warfarin Counseling 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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Example: Warfarin Counseling 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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Example: Warfarin Counseling 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