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Patient Counseling

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Patient Counseling Powered By Docstoc
					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.

                                                4
Outline
   WHO should be counseled?
   WHY should counseling be
    performed?
   HOW should counseling be performed?




                                      5
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?



                                      7
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

                                                  8
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

                                                          9
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



                                                             10
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

                                              11
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.




                                                   13
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


                                                14
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?”
                                               15
Example: Warfarin Counseling
   DO                            DON’T
       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®




                                                        16
Example: Warfarin Counseling
   DO                             DON’T
       Explain that warfarin          Explain that warfarin
        is used to slow the             is an anticoagulant
        blood clotting                 Explain that warfarin
        process to prevent              works by inhibiting
        unwanted blood clots            the vitamin K
       Ask patients to call            dependent clotting
        their doctor if they            factors and that it is
        notice bleeding that            an emergency
        they don’t normally             situation if they see
        have                            any blood

                                                           17
Example: Warfarin Counseling
   DO                             DON’T
       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




                                                        18
Example: Warfarin Counseling
   DO                             DON’T
       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

                                                          19
Example: Warfarin Counseling
   DO                              DON’T
       Ask the patient to              Assume the patient
        tell all their doctor/           realizes the need to
        dentist etc. all the
                                         notify all health care
        medications they are
        taking including                 providers concerning
        nonprescription ones             all the medications
        (e.g., pain                      they are on; OTCs
        medications,                     are often not
        vitamins, herbal                 considered
        products)                        medications

                                                            20
Example: Warfarin Counseling
   DO                                DON’T
       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
        physician’s knowledge as
        well

                                                                21
Example: Warfarin Counseling
   DO                              DON’T
       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


                                                           22
Example: Warfarin Counseling
   DO                           DON’T
       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

                                                  23
Example: Warfarin Counseling
   DO                            DON’T
       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

                                                         24
Example: Warfarin Counseling
   DO                                  DON’T
       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
                                                             25
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

                                              26
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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