Professional Documents
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Kuliah ke 4
Rahmawati Syukur
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 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
Outline
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
Outline
HOW to Counsel
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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Proper environment
Private, quiet
Free of distractions, e.g., patient should have pain controlled, ask patient to lower volume on the TV etc. Greet the patient Explain your purpose Ask the patients permission to counsel
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Introduce yourself
Educational level: tailor talk for understanding Use appropriate language Religious or ethnic beliefs
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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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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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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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Improves coping if side effects occur Increases adherence to improve health Verifies patients comprehension
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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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DO
DONT
Address patients formally Ask what the patient knows about warfarin or Coumadin
Address patients by their first names Assume the patient knows all or nothing about the drug
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DO
DONT
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 dont normally have
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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DO
DONT
Identify the specific reason the patient is taking it and how long they might be expected to take it
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DO
DONT
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
Give the patient the impression that they are going to bleed to death
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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)
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
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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 physicians knowledge as well
DONT
Indicate that the only good pain medications are those found on prescription
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DO
DONT
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
Tell the patient to double up on their next dose if they miss one
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DO
Stress the need for follow-up appointments and blood draws Indicate that it is normal for doses to change from time to time
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DO
DONT
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
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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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 inhouse educational TV program if available Document as required
DONT
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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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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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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