Patient Counseling guidelines
Patient counseling may be defined as providing medication information orally or in written form to the patients or their representative or providing proper directions of use, advice on side effects, storage, diet and life style modifications. It involves a one-to-one interaction between a pharmacist and a patient and/or a care giver. It is interactive in nature. The effective counseling should encompass all the parameters to make the patient/party understand his/her disease, medications and life style modification required.
Contents of patient counseling
The Omnibus Budget Reconciliation Act (OBRA) 1990, guidelines specify that the pharmacist should discuss at least the following points while counseling the patients:
Name and description of the medication, the dosage form, route of administration, duration of therapy, special directions and precautions for preparation, administration and use of the prescribed drugs by the patient, common side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur, techniques of self monitoring of drug therapy, proper storage, prescription refill information, action to be taken in case of missed dose.
Techniques of counseling
Several techniques can be adopted for effective counseling. Some of them include providing written information to the patient and the use of audiovisual materials. The use of various compliance aids include labeling, medication calendars, drug reminder chart and providing special medication containers and caps can also be adopted.
The United States Pharmacopoeia (USP) medication counseling behavior guidelines divide medication counseling into the following four stages Stage I: Medication information transfer, during which there is a monologue by the pharmacist providing basic, brief information about the safe and proper use of medicine. Stage II: Medication information exchange, during which the pharmacist answers questions and provides detailed information adapted to the patients’ situation.
Stage III: Medication education, during which the pharmacist provides comprehensive information regarding the proper use of medicines in a collaborative, interactive learning experience.
Stage IV: Medication counseling, during which the pharmacist and patient have a detailed discussion intending to give the patient guidance that enhances problem-solving skills and assists with proper management of medical conditions and effective use of medication.
Medication Counseling Tips
· Establish relationship – show interest in patient (verbal & nonverbal)
· Verify patient's name and prescriber's name
· Why the patient is being prescribed the medication (if known) or the medication’s use, expected benefits and action
· Open the medication containers and show patient what the medication looks like, or demonstrate use
· How to take the medication
· When to take and how long to take the medication
· What to do if a dose is missed
· Any special precautions to follow
· Foods, alcoholic beverages or OTC’s to be avoided
· How the patient will know the medication is working
· How to store the medication
· If the prescription can be refilled, and if so, when
· Verify the patients’ knowledge and understanding
· Ask the patient if they have any questions
· Document the interaction
Patients who should always be counseled:
- Confused patients, and their caregivers
- Patients who are sight or hearing impaired
- Patients with poor literacy
- Patients whose profile shows a change in medications or dosing
- New patients, or those receiving a medication for the first time,
- Children, and parents receiving medication
- Patients receiving medication with special storage requirements, complicated directions, significant side effects
Patients who should be counseled at certain intervals:
- Asthmatic patients
- Diabetic patients
- Patients taking 4 or more prescribed medications
- Patients who are mentally ill
- Patients using appliances
- Epileptic patients
- Patients with skin complaints
- Patients misusing drugs
- Patients who are terminally ill
1. ASHP (1976). ASHP Guidelines on pharmacist- conducted patient counseling. Am.. J. Hosp. Pharm., 33: 644-645.
2. ASHP (1997). ASHP guidelines on pharmacist-conducted patient education and counseling. Am. J. Health-Sys. Pharm., 54: 431-434.
3. Beardsley, RS. Review of literature: oral patient counseling by pharmacists. Proceedings of the National Symposium on Oral Counseling by Pharmacists About Prescription Medicines. 1997 Sep 19-21; Lansdowne, Virginia
4. USP (1997). USP Medication Counseling Behavior Guidelines. USP Convention, Inc, Rockville MD, Feb 1997.