Patient Counseling Checklist
1. Pharmacist introduces self.
2. Identifies patient or patient’s agent.
3. Asks if patient has time to discuss medication.
4. Explains purpose and importance of counseling session.
5. Asks patient what physician told him or her about medication and what it is treating. Asks what patient knows or understands about the disease. Uses any available patient profile information (including possible allergies).
6. Asks if patient has any concerns prior to information provision.
7. Responds with appropriate empathy, listening, and attention to concerns. Uses these skills throughout counseling session.
8. Tells patient the name, indication, and route of administration of the medication.
9. Tells patient the dosage regimen.
10. Asks patient if he or she will have a problem taking the medication as prescribed.
11. Tailors medication regimen to patient’s daily routine.
12. Tells patient how long it will take for the medication to show an effect.
13. Tells patient how long he or she might be on the medication.
14. Tells patient when to return for a refill (and number of refills).
15. Emphasizes benefits of the medication and supports its use before talking about side effects and barriers.
16. Discusses major side effects of the drug and whether they will go away in time. Discusses how to manage side effect and what to do if side effect does not go away and becomes intolerable.
17. Points out that additional rare (emphasizes this to patient) side effects are listed in the information sheet (to be given to patient at the end of counseling session). Encourages patient to call if he or she has any concerns about these.
18. Uses written information to support counseling where appropriate.
19. Discusses precautions (e.g., activities to avoid).
20. Discusses beneficial activities (e.g., exercise, decreased salt intake, diet, self-monitoring).
21. Discusses drug–drug, drug–food, and drug–disease interactions.
22. Discusses storage recommendations and ancillary instructions (e.g., shake well, refrigerate).
23. Explains to patient in precise terms what to do if he or she misses a dose.
24. Checks for understanding by asking patient to repeat back key information (e.g., drug name, side effects, what to do about missed doses).
25. Rechecks for any additional concerns or questions.
26. Advises patients to always check their medicine before they leave the pharmacy.
27. Uses appropriate language throughout counseling session.
28. Maintains control of counseling session.
29. Organizes information in an appropriate manner.
30. Follows up to determine how patient is doing.
POINT-BY-POINT DISCUSSION
1. Pharmacist introduces self.
It is important for patients to know they are talking to the pharmacist. They may be reluctant to ask questions or express concerns if they believe that the person they are talking to is a technician. Pharmacists should greet the patient, extend a hand, and state their name: “Hello, I’m James Smith, your pharmacist.” This begins the relationship.
2. Identifies patient or patient’s agent.
Pharmacists need to know to whom they are talking. When they are talking to the patient directly, information that is communicated is less likely to be confused or distorted than when the pharmacist is talking to the patient’s agent. In third-party communication, written information becomes even more important than in communication directly with the patient. Pharmacists may need to call patients if they believe the information truly needs to be communicated directly to them.
3. Asks if patient has time to discuss medicine.
If patients do not have time to listen to the information that needs to be provided, then the information will be ineffective. For a new patient, time will be needed to establish a database so that appropriate decisions can be made in the future. If the patient does not have time for this, written information needs to be used, the patient needs to be contacted at a more convenient time, or both.
4. Explains purpose and importance of counseling session.
People listen and learn more effectively when they are given reasons for what is being asked of them. For example, patients are less likely to take tetracycline with food or dairy products if they are given a reason why these items should be avoided (decreased absorption and thus decreased effectiveness of the drug). Tell patients why the counseling session will be important from their perspective—what’s in it for them. For new patients, explain why the information being gathered is necessary.
5. Asks patient what physician told him or her about the medication and what it is treating. Asks what patient knows or understands about the disease. Uses any available patient profile information (including possible allergies).
Generally speaking, in any effective counseling session, the patient should talk more than the health care provider. The purpose of the counseling session is to ensure that patients leave the pharmacy with knowledge about the proper use of the medication. It really doesn’t matter whether the patient gets this information from the pharmacist or the physician. Pharmacists should find out what the patient already knows about the medication and condition before providing the patient with a litany of information. There is no reason for the pharmacist to go over information the patient already has mastered. Accurate information that the patient supplies should be supported and praised. Inaccurate information needs to be corrected, and information that is omitted should be added. Make sure profile information is incorporated and possible allergies are addressed (both seasonal and drug allergies).
6. Asks if patient has any concerns prior to information provision.
Many patients have concerns about the medications they are about to take or the condition the physician is treating. Often, they will not vocalize these concerns unless they are asked. It is important to address these concerns immediately with as much understanding as possible. It is not appropriate or useful to tell the patient you will address the concern later in the counseling session. Until the concern is addressed, the patient will not hear other information provided. The pharmacist should make every effort to understand the concerns of the patient and treat the concerns with the attention they deserve. The patient would not have brought them up if they weren’t important to him or her. If the patient has a concern that is not addressed appropriately, any information that follows will not be internalized.
7. Responds with appropriate empathy, listening, and attention to concerns. Uses these skills throughout counseling session.
These skills are absolutely essential to an effective counseling session. The literature on patient compliance identifies the relationship between patient and practitioner as a key variable in predicting compliance with treatment regimens. Patients need to see that health care providers are competent and trustworthy and care about what happens to their patients. These skills are effective tools for communicating caring.
8. Tells patient the name, indication, and route of administration of the medication.
This and the steps that follow will generally be accomplished after the pharmacist has determined that the medication is appropriate and the prescription has been filled. Telling patients the name of the medication helps them to get used to identifying their medication. This is especially important in case of an emergency (e.g., overdosage, ingestion by a child). Stating the indication reinforces the diagnosis and promotes confidence in the appropriateness of the therapy. Although the route of administration often seems obvious, experienced pharmacists have numerous documented cases of patients taking a medication by the wrong route. It should not be assumed that printing this information on the label will cover these points. Many patients cannot read, and those who can read often don’t.
9. Tells patient the dosage regimen.
Again, many patients cannot read, so it is important that they be told the dosage regimen. Even patients who can read should be told, either to reinforce what the physician told them or to inform them for the first time. While a particular dosage regimen may seem straightforward or obvious, how many times a day will a patient take medication with directions to “take one tablet after meals and at bedtime”? Not everyone eats three meals a day. Patients with diabetes may eat six or seven small meals each day.
10. Asks patient if he or she will have a problem taking the medication as prescribed.
After telling the patient the dosage regimen, the pharmacist should assess whether the patient will have any problems taking the medication as prescribed. This is an important question that is seldom asked by any health care provider. Yet, research shows that the complexity of the dosage regimen can affect compliance and, hence, outcomes. Once-a-day dosing generally achieves rates of compliance of greater than 80%, compared with 40% or less for four-times-a-day dosing. This has important implications for the pharmacist. The total cost of care needs to be considered, not just the cost of the drug. Serious noncompliance as a consequence of more complex dosage regimens may result in hospitalization of the patient. Pharmacists should make every attempt to resolve problems related to the dosage regimen either through tailoring (see below) or by working with the physician to change to a less complicated dosing schedule.
11. Tailors medication regimen to patient’s daily routine.
Any way in which the pharmacist can help the patient connect taking a dose of medication with a daily routine will enhance compliance. This might include identifying when the patient wakes up and goes to bed or which meals the patient eats. It should not be assumed that patients eat three meals per day. To be most effective, pharmacists should ask patients about their daily routines, rather than suggesting routines that the patient may not be comfortable with.
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