Remington: The Science and Practice of Pharmacy (21st edition)

Dispensing 2

STEPS TO A SUCCESSFUL PATIENT

COUNSELING SESSION

The following steps represent a logical outline for counseling a patient on a new prescription
(Fig 97-1).

1. Introduce yourself and identify the patient. Greet the patient. Smile and offer your hand in
greeting if appropriate. Provide your name as well as your position in the pharmacy and identify the
person with whom you are speaking. If the person is not the patient, determine the relationship
between the patient and person picking up the prescription. A counseling session may not be
appropriate if the person picking up the prescription is merely a friend or neighbor rather than a
caregiver. In this case, arrangements should be made for phone consultation or provision of written
counseling materials.

Introduce yourself and identify the patient

Ask patient to talk with you about the medication and explain the
purpose of the session

Update the patient medication profile

Assess what the patient already knows about the newly

prescribed drug and the reason it was prescribed

Assess patient knowledge of how to take the medication

Assess patient understanding of what to expect from the

medication

Discuss additional information that the patient requires for a

particular medication

Ask the patient to share any concerns or questions that have not
been addressed

Check patient understanding of the information discussed in the

counseling session

Close the session

Figure 97-1. Steps in a patient counseling session

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2. Ask patient to talk with you about the medication. Explain the purpose and the importance of the
counseling session. Determine that the patient has sufficient time for a conversation. A distracted
patient will not listen to any information provided in the session. Explaining the purpose and
importance of the counseling session in terms of the benefits to the patient will increase the
effectiveness of the session. Many patients do not receive patient counseling regularly and are not
aware of the benefits to be gained. It is helpful to ask the patient if he or she has any concerns about
the new medication before you start through the counseling process. This allows you to deal with any
issues that are bothering the patient first so that the patient is not distracted by other concerns while
you are providing drug information to her. For example, the patient may be wondering if the drug
will be covered by her health plan or whether she will have to pay the full cost of the medicine.
Answering that question first will relieve the patient's mind and allow her to concentrate on what you
are saying to her.

3. Update the patient medication profile. Review with the patient any profile information relevant to
the new prescription. This ensures that the pharmacist knows about any recent changes that would
affect the patient's current therapy. This may include the following:
 Allergy and disease state status
 New or discontinued prescription drugs that may not be included in the patient record
 New or discontinued non-prescription drugs including dietary supplements and herbal
products that may not be included in the patient record
 Changes to social lifestyle history

4. Assess what the patient already knows about the newly prescribed drug and the reason it was
prescribed. Ask the patient why he or she saw the prescriber today and what the patient has already
been told about the new medication. This not only tells the pharmacist whether the patient was given
information about the new prescription, but it also reveals what information the patient actually
understood and remembered from the medical visit. Confirm any correct information provided by
the patient, correct any misconceptions and fill in any missing information. Be sure that the patient
knows the name, strength and purpose of the medication. This is an appropriate time to show the
medication to the patient so that he will make the connection between the appearance of the drug and
its proper use. This is particularly important for patients who take multiple medications and may
occasionally confuse their uses. This is also an appropriate time to review how the new medication
will benefit the patient.
5. Assess whether the patient knows how to take the medication. Ask the patient how she will take
the new medication. It is often necessary to follow up with a few specific questions to ensure that the
patient will adhere to the prescribed dosing regimen. Examples of appropriate follow-up questions
include:
 What times of day do you plan to take the medication?

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 How can you schedule the medication around your daily activities to help you remember to
take the medication regularly?
 How will you plan for doses that need to be taken during the day while you are at work?
 How can you store your medication while you are traveling?

Confirm any correct information provided by the patient, correct any misconceptions and fill
in any missing information. Be sure that the dosing regimen the patient agrees to use works well with
the patient's work schedule and life-style. Discuss ways to help patient adhere to the dosing regimen.

6. Assess the patient's understanding of what to expect from the medication including the expected
outcomes of the therapy as well as its potential adverse effects. The patient's response tells the
pharmacist what outcomes the patient expects from the medication as well as any potential adverse
effects the patient anticipates from the medication. Confirm any correct information provided by the
patient, correct any misconceptions and fill in any missing information. Be sure to discuss the
therapeutic benefits to be gained by taking the medication appropriately. The patient should have a
realistic expectation of any potential common or potentially serious adverse effects that the regimen
may produce. Patients are more likely to adhere to a drug regimen when they are aware of potential
problems and know what to do if those problems occur. The patient should know if the adverse effect
will resolve by itself and how long that may take, whether there are any steps a patient should take to
relieve or resolve adverse effects, or if an adverse effect should be reported to the prescriber or
pharmacist. Offering solutions to resolve drug-related problems relieves patient anxiety and
empowers the patient to deal with the problem directly. Patients who are not prepared to deal with
adverse effects often quit taking medication and do not report it to a health care provider.

7. Discuss any additional information that the patient requires for a particular medication.
Examples of additional information that the pharmacist may provide to the patient includes:
 Potential interactions with other drugs, foods or diseases
 Missed doses
 Monitoring information-how will the patient know the medication is working, any testing
that should be done to assess the therapy, follow-up appointments with health care
providers
 Refill information
 Storage information
 Lifestyle changes to implement-changes in diet, exercise, avoid sun, etc.
The pharmacist must use professional judgment in determining what information is essential to
provide to a particular patient in a given situation and when to stop talking so that "information
overload" does not become a problem.

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8. Ask the patient if he or she has any concerns or questions that have not been addressed in the
previous discussion. Patients usually do not bring up these concerns unless they are asked directly
by the pharmacist. The patient may be distracted by these concerns while the pharmacist is providing
information. It is best to address concerns as soon as they are identified. A follow-up question about
unresolved issues and problems ensures that the patient has had an opportunity to voice any concerns
that may be a barrier to medication use.

9. Check patient understanding of the information discussed in the counseling session. Perhaps the
most critical step in the process is to check patient understanding of the newly prescribed medication
and its use. This can be accomplished by putting the question in the context of checking the
pharmacist's success in communicating the information clearly to the patient. This avoids putting the
patient on the spot" or making him feel that he is being quizzed. An example question might be the
following: "Mrs. Jones, we've discussed a lot of information about your new prescription today. To be
sure that I did a good job explaining everything, would you recap for me what you learned today
about your new medication?" As the patient recaps her understanding of the information, the
pharmacist can assess the patient's knowledge and retention of the information. This provides the
opportunity to reinforce any critical information, correct any misinformation, and fill in any
information that the pharmacist may have omitted during the counseling session. This also gives the
pharmacist the opportunity to praise and encourage the patient.

10. Closing the session. To close the counseling session:

 Provide written counseling information you have used during the session.
 Tell the patient how to reach you if other questions or concerns arise.
 Confirm when you expect the patient to return for a refill or follow-up with health care
provider.
 Reinforce the value to the patient of appropriate medication use and the positive outcomes
possible for the patient.
 Thank the patient for spending the time to discuss the new medication with you.

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