Post on 22-Nov-2014
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Patient Counselling
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Group Member’s
Syed Muhammad Umar farooqi.
Muhammad Muneeb Afzal.Zaheer Abbas.
Presented to Sir Syed Zeshan Ali
The term counselling is widely used in pharmaceutical literature but the definition of term is less rapidly available. The British association of counselling (BAC) describes counselling as a
“Giving clients the opportunity to explore, discover, and clarify ways of living more resourcefully and towards greater well being.”
COUNSELLING
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In another words:
“Counselling is the sympathetic interaction between pharmacist and patient, which may go beyond, convince of straight forward information about the medicine and when to use it.”
The British national formulation explain counselling as:
“Counselling needs to be related to the age experience, background and understanding of the individual patient”
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The need for counselling
The purpose of counselling is to:
Ensure that patients are adequately informed about their medication.
Identify any problems which might cause loss of efficacy of the drug or be detrimental to the health of the patient.
Some time patients feel uncomfortable about prolonging the time and many may leave the consulting room with many questions unasked. In many cases the Prescriber will give excellent and comprehensive information but, because of the stressfulness of the situation, the patient may not take in all the information or retain it.
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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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Aids of counselling
Patient information leaflets: The NPA (Newspaper publishers’ association) is a useful source of information leaflets and warning cards. Leaflets on how to use ear drops, eye ointments, pessaries, suppositories, a nebulizer, and malaria tablets and head louse lotions are available.
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Warning cards:warning cards for anticoagulant therapy, lithium, MAOI and steroids should be available in all pharmacies, hospitals and any other area where counselling of the patient on drug therapy takes place.
Placebo devices: Placebo devices can be used to demonstrate a particular technique and also to check a patient’s ability to use a device.
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Telepharmacy
A “telepharmacy system” means a system that monitors the dispensing of prescription drugs and provides for related drug use review and patient counseling services by an electronic method, including the use of these technologies Audio and video Still image capture Store and forward
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Stages in the counselling process
1. Recognizing the need: It is important to ensure that all patients who require counselling receive it.
2. Assessing and prioritizing the need: Different patients and different medication and appliances need different types and levels of counselling and advice.
3. Specifying assessment methods: It can not be assumed that because counselling and advice have been given, the patient understands the advice or is able to adhere to it. It is therefore important that, before embarking on any counselling and advice process, the pharmacist has an idea of how the success of the process can be measured.
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4. Implementation: This involves giving the necessary information to the patient in an appropriate manner.
5. Assessment: Having given the information it is then of major importance to check how successful the interview has been. What does the patient understand, can he use this device, and does he have any problems? This ideal, where possible, is to assess compliance through follow-up.
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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
Ethical Principles
Beneficence Acting in the patients best interest
Past models doctor made decision Current thinking is to involve patient letting
the patient determine what is in their best interest
Autonomy Letting the patient have the final decision,
even if it is not in their best interest – i.e. refusing treatment, surgery, etc.
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Ethical Principles
Honesty The patient has the right to the truth
Medical condition, course of the disease Treatments
Code of ethics states: A pharmacist: “has the duty to tell the truth
and to act with conviction of conscience” Rapport is built on trust, which is based
on honesty
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Ethical Principles
Informed consent Requires honesty and autonomy to exist Patients have the right to full
information of all relevant facts and must give explicit consent before treatment
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Ethical Principles
Confidentiality From the patients perspective this is
“self-disclosure” and they should be the ones making this decision.
Patients are expected to divulge information to practitioners, the only choice is which one
Trust in confidentiality becomes very important
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Ethical Principles
Fidelity The right of patients to have
practitioners provide services that are in the patients best interest
Infidelity from an Rx’er could be: Recommending vitamins patients don’t need Failing to confront a doctor with an
inappropriate prescription out of fear that the doctor will direct his/her patients elsewhere
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