PATIENT COUNSELING

Elizabeth Yu Tan, RPh MS Pharm

Faculty, Department of Pharmacy
School of Health Care Professions
University of San Carlos, Cebu City, Philippines
PATIENT COUNSELING
Factors to consider prior to counseling

• Communication skills
Use verbal and non-verbal communication
Ask patient to repeat key messages to assess comprehension

• Things to avoid:
Using medical terminology
Switching between brand and generic drug names
Ignoring patient emotion

• The patient must be the focus.

Key Questions to Ask Yourself

• What information do we need to convey during patient counseling?

• What if patient is unavailable for counseling?
If patient is unavailable for counseling…….

• Reschedule during inpatient stay.

• Speak to carer/family members.
• Counsel at discharge.
• Prepare counseling aids for patient.
Roles of Clinical Pharmacist

• On admission:
Medication reconciliation

• In-patient:
Contribute to prescribing decisions
Therapeutic planning
Patient counseling

• On discharge
Medication reconciliation
Patient counseling
Continuum of care
Roles of Clinical Pharmacist

Purposes:

On discharge: process of
comparing the patients
medication chart with the
discharge script

Identify any discrepancies and

have action plan.
Roles of Clinical Pharmacist

• Dispense discharge medicines

• Counsel patient on medicines

Reinforce information provided during inpatient stay
Provide verbal and written information
Continuum of Care

• How is continuum of care achieved?

• communication between hospital and community health
professionals
discharge summary to GP
discharge script
medication list
contact nursing home
contact community pharmacy
 Continuum of Care
• How is continuum of care ensured?

Know when the patient is being transferred to:

1. own home
2. continued therapy under “hospital in the home”
3. hospice, rehabilitation centres, nursing homes
Know who will continue to treat the patient:
1. hospital doctor via outpatient clinic
2. community GP
3. specialist
 Discharge Process

• Inform community pharmacist if blister pack/dose administration

aid is required.
• Inform community nurse if administration is required.
• Information form that accompanies discharge (medication cards,
discharge plan)
Discharge Summary
• Timely transfer of written discharge
information to GP and other health
professional.
• Should be accurate as medication
history on admission.
• More than a current drug list, must
include:
changes made to treatment, and
reasons for changes
medications found ineffective
about medicines use (e.g. the
need to monitor for ADRs,
adherence)
Any issues needing follow-up
Activity on Discharge Summary and Discharge Counseling

• Prepare to counsel Ms. Blake on discharge.

• Discharge meds are Amoxicillin 1g by mouth 3x daily (20 caps) and
Paracetamol 500 mg tablet as needed.
• Prepare a medication list for the patient.
• Consider:
1. Drug name (brand name)
2. Dose, frequency, route of administration
3. Drug-drug or drug-food interactions
4. Adverse drug reactions
5. Adherence (what to do if doses are missed)
6. Duration of therapy
7. Monitoring requirements (e.g. screening, signs and symptoms to
contact Doctor)
References
SHPA Standards of Practice for Clinical Pharmacy

Clinical Skills for Pharmacists, A Patient-Focused Approach (Tietze, J,

ed3)

Pharmacy Practice Experiences – A Student’s Handbook (Setlak, P)

Hospital Pharmacy (Stephens, M ed2)

Medication Review: A Process Guide for Pharmacists (Chen, T et al,

ed2)

Australian Medicines Information Training Workbook (ed1)