Patient Counseling

Presented by Parag Joshi (1) Raju Tripathi (12) Snehal Mestry (23) Shital More (25) Juee Raut (4) Sangita Kumbhar (24)

PATIENT COUNSELING
DEFINITION: Patient counseling is defined as one on one interactive session designed to improve the patients knowledge & behavior
Also refers to the process whereby a pharmacist

listens to the patients concern about his/her drug therapy & offers education appropriate to the patients needs

GOAL

To provide information directed at to encourage

safe and appropriate use of medicine and thereby increases therapeutic outcomes

NEED FOR PATIENT COUNSELING

Better patient understanding of their illness the

role of medication in its treatment

More effective drug treatment Reduce adverse effects and unnecessary health

cost
Improved quality of life for patient
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Qualities of good patient counselor

Be a good

listener Be flexible Be empathetic Be non judgemental Be tolerant Communicatio n

WHO,WHY and How?

WHO should be counseled?

WHY should counseling be

performed?
HOW should counseling be performed?

WHO to Counsel
Patients receiving more than a specified

number of medications Patients known to have visual, hearing or literacy problems Paediatric patients Patients on anticoagulants 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.

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

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

Stages in counseling process:

Recognize the need for counseling
Accessing and prioritizing the needs Specifying the assessment method to be used Implementing Accessing the success of the process
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When Patient counseling is necessary?

During an ambulatory clinic visit

On admission beginning with medication history

interview
Counseling throughout inpatient stay Immediately prior to discharge or at discharge
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Role of clinical pharmacist

1. How to remove drug from package 3. Administration timing

2. How to administer

4. Duration of use

5. Storage conditions (eg. Photosensitive drugs; amber coloured bottle)

6. ADR (eg.Nephrotoxicity for aminoglycosides)

Contd..
7. DI (eg. Warfarinaspirin; Antagonist) 8. Food-drug interactione: Eg. MAO inhibittors & cheese Tetracycline & milk)

9.Prevention of polypharmacy

10. Genetic counseling

11. Refill information

12. Additional information

Genetic counseling
The process by which patients or relatives, at risk of an inherited disorder, are advised of the consequences and nature of the disorder, the probability of developing or transmitting it, and the options open to them in management and family planning. Diagnostic (the actual estimation of risk)

Supportive aspects

Prevention of genetic disease

Genetic counseling Genetic screening and testing Premarital counseling Pre-implantation genetic diagnosis Prenatal diagnosis and selective abortion Neonatal screening Treatment of genetic disease Education

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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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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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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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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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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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
Address

DONT
patients
Address

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formally Ask what the patient knows about warfarin or Coumadin 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

patients by their first names Assume the patient knows all or nothing about the drug 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

Example: Warfarin Counseling

DO
Identify

DONT
List

the specific reason the patient is taking it and how long they might be expected to take it

every reason anyone might be on warfarin

Explain the signs and

Give the patient the

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symptoms of bleeding such as bloody nose, blood in the urine, a stool that changes color or darkens, bruises that never go

impression that they are going to bleed to death

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) 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 DONT 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 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 Stress the need for follow-up appointments and blood draws Indicate that it is

DONT
Tell

the patient to double up on their next dose if they miss one Minimize the importance of followup by an anticoagulation clinic or a physician

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Example: Warfarin Counseling

DO
Ask the patient to eat a Limit

DONT
or forbid the patient to eat salads or vegetables the patient has no final questions

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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 Summarize key points covered Ask if the patient has any other questions

Assume

Example: Warfarin Counseling

DO Ascertain that the patient understands the information
Thank the patient and

DONT
Assume

the patient has understood all you have discussed

leave information

written

Forget to leave a note

in the chart

Ask them to view the

in-house educational TV program if available

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Document as required

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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Thank you!!!

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