Patient Counseling is defined as delivering the medication information to the patients or their representatives either orally or in written form regarding how to use the medicine, instruction on possible side effects, precautionary measures, storage conditions, consumption of diet, and modification of lifestyle if any requires.
Review the Patient’s Record:
A proper patient record review is essential for the better-quality service and care of the patient. Patient records contain information regarding the details of the diagnosis of the patients, medication given, social and earlier medical history, laboratory testing, and evaluation done by medical and clinical staff.
The availability of a complete, efficient, and proper medical record can be essential for the successful generation of outcomes in the patients. There require sufficient planning and use of correct data sources for obtaining correct medical records on a certain aspect of the patients. There are the following three fundamental aspects/principles to gather the correct information for the completion of procedure for the patient records:
- Quality Measurement: In this aspect, there is capturing of the patient medical document. While this document may still require clarification, validation, patient care, and reporting.
- Compliant Coding: In this aspect, there are highlighted the present status of the patient which includes; the diagnoses report, patient conditions, and key findings that may require further clarification for perception, specificity, validation, support in accessing the final approval of entering the oded data. During this aspect, healthcare specialists should be entirely aware of the rules and regulations of the organization.
- Proper Compensation: This aspect comes from the review of severity, clinical validation, coding accuracy, medical requirement, and the quality outcome associated with the conduct of the review.
Typically, reviews can start after 24 to 48 hours of patient admission or completion of initial assessments. A good rule of thumb says review can proceed when there is enough information such as; after completion of history and physical checkup and/or after completion of initial diagnostic testing so there may generate enough queries for review. Following are general steps for reviewing of patient’s record.
- The first step of patient review is to introduce yourself and explain the purpose of counseling.
- Obtain the initial vital signs because this information provides a baseline of medical need, clinical support, and present status and indication of disease processes.
- Obtain information from the patient or family regarding the potential and condition of the disease. This will provide the information on confusion or behavioral disturbances/ status of a patient.
- Obtain detailed information on nutritional status such as; food intake, fluid intake, and any weight loss or gain observed over time.
- Obtain the diagnosis validation through assessing the clinical finding report that supports the patient condition and status.
- Obtain the relevant past medical history before hospital admission. As well as review the past medication and corresponding diagnosis. For example, if the patient presented on antibiotics treatment then check if there is documentation on any other infection such as; pneumonia, urinary tract infection, or any other. Collect the information such as; allergies, use of herbals or any other, etc.
- Obtain concise information of the patient’s history and diagnosis at the time of hospital admission. Assess the patient’s understanding of the reasons for therapy. Summaries all issues that provoked the admission.
- Review the report of all diagnostics, treatment given and trend results all together to save time. These provide a timeline comparison for both normal as well as abnormal results which may be relevant and important.
- Obtain drug-related information such as; allergies, use of herbals or any other, etc.
Steps During Patient Counseling
Patient counseling is a two-way communication method, in which interaction between the pharmacist and patient is essential for effective counseling. The following are the four major steps to be used during patient counseling:
- Preparing for the session.
- Opening of the session.
- Counseling content.
- Closing the session.
1. Preparing for the Session: The knowledge and skill of the counselor is an important key for the success of counseling. The counselor is nothing but the pharmacist. Before proceeding to counsel, the pharmacists should establish a caring relationship with a patient in the stage of patient health care management. First of all, the pharmacist should introduce himself, explain the purpose of counseling and the expected length of the session. Pharmacists should be able to understand the patient primary spoken language and if possible he should stick to that language only. The pharmacist should know about the possible treatments of the patient in detail. If the pharmacist does not know about medicines that are received by a patient, then the pharmacist should consult drug information references before commenting on counseling.
2. Opening the Session: In the first phase of counseling, there should be a gathering of information. After completion of the introduction and the pharmacist should respond to him by name. The pharmacist should use a title such as; Ms., Mr., Mrs. and then shift over to the first name. For example, “Hello Mr. Rahul, I am Sachin, your Counselor/Pharmacist. I would like to state your medication details. Do you have a few minutes to spend with me?” Pharmacists should know the condition of the patient, he may be worried and upset due to their illness, so a few caring words will establish sympathy and the patient may support in the process of counseling. Pharmacists should assess the knowledge of patients about his/her health problems and medications, physical and mental health, attitude, health problems, and medication. Pharmacists should ask open-ended questions about the purpose of each medication and their expectations of medications. Pharmacists should ask about any problems or hesitations are experiencing with prescribed medications. During this counseling session, the pharmacist should avoid the following:
- Do not ask the question directly or in the way of distressing.
- Do not show excessive curiosity.
- Do not discuss the patient’s problems.
- Do not pass moral judgments.
- Do not interrupt when the patient is speaking.
- Do not make premature explanations.
- Do not argue with the patient.
3. Counseling Content: The content of counseling is considered to be the heart of the counseling session. So, during this stage, the pharmacist should provide the information orally and use visual aids or demonstration to fill the patient’s gap in knowledge and through on medication and treatment regimen which are prescribed to him/her. In this session, the pharmacist can provide information on medications such as oral solid by showing the color, size, shape, and marking on tablet/capsules. Oral liquid and injectable can be shown by showing the measuring mark on the device of the dosage form. Should demonstrate the use of administration devices such as oral and nasal inhalers. There should be face-to-face oral communication, show them a written handout so it can be helpful to recall the information. In this session the topic which is mostly covered are:
- Name and strength of the medication.
- The reason why it has been prescribed.
- How the medication will work.
- How to administer the medication.
- Expected duration of the treatment.
- Expected duration required to show therapeutic benefit.
- Expected benefits of the treatment.
- Possible adverse effects of medication.
- Possible drug or dietary interactions if consume with medication.
- What to do in case of a dose is missed.
- Special monitoring requirements, for example, blood tests.
Pharmacists should remember that the information which is given should be tolerated by patients. It is important to note that, in some situations, pharmacists should not directly jump to the conclusion regarding why such medication has been prescribed. For example, tricyclic anti-depressants are mostly prescribed in depression conditions and often used in other conditions such as; neuropathic pain and incontinence. So, in such situations, the pharmacist should ask the questions like what has the doctor told you about his medications? This type of question in this situation can help to avoid misunderstanding.
4. Closing the Session: It is essential to check the patient’s knowledge and understanding of medication use before the closing of the counseling session. In this closing session, the patient knowledge and understanding can be assessed by following feedback questions by asking:
- Can you remember what this medication is for?
- How long should you need to take this medicine?
- Can you show me how you will use this medicine?
- How you will identify the effects of medicine?
During this discussion, the patient may have some new questions or doubts. So, before the closing of this session, summarize the main point in logical order. If there is a need and requirement, the pharmacist can give their phone number and encourage them to make contact if they need any advice or any other information.
Precautionary Care/ Features of Effective Patient Counseling
1. Establish Trust: Pharmacists are the top most accessible and reliable health care professionals who can give them sufficient time with the patient and patients feel more comfortable with pharmacists compared to other health professionals. The pharmacist asks the questions more comfortably with the patient about the patient medication and the patient also replies to them comfortably.
2. Communicate Verbally: Pharmacists can inspire the patient to discuss by asking questions verbally. Pharmacists should first examine the patient to whether and what the patient knows about his therapy.
3. Communicate Non-verbally: The pharmacist needs to be aware of nonverbal communication such as; maintaining eye contact with the patient in addition to verbal communication.
4. Listen: During counseling sessions on the patient medication, the pharmacist needs to listen to the questions and needs of the patients.
5. Ask Questions: When the pharmacist asks any questions to the patient, the pharmacist should take care and also tell the reason for asking the certain type of questions so the patient gets not upset while answering.
6. Remain Clinically Objective: It is important to note that during interaction with the patient, pharmacists should not have ethical or religious attitudes. Otherwise, it will affect the patient’s ability to counsel.
7. During interacting with a patient, the pharmacist should show care and sympathy as well as encouragement. Such types of interactions result in patients may feel more comfortable while discussing on his/her medical conditions.
8. Arrangement of Special Counseling Area: While discussing or interacting with the patient, the pharmacist should take care of the privacy and confidentiality of the patient’s information. Thus, there should be an arrangement of special counseling areas or rooms to discuss on privacy and confidentiality issues of patients.
9. Shape Counseling to Meet Patient Needs: To obtain appropriate information from the patient, the pharmacist should take care to shape the counseling so the patients get motivated for effective counseling. For example, when the pharmacist counsels a patient with diabetes there is a need to provide additional teaching about the medications.
Special Cases Require for The Pharmacist
Following are some special cases/situations that there require the pharmacist to play a major role:
1. Patient Care: There is a significant and positive impact of pharmacists on patient care and therapeutic outcome through effective patient counseling.
2. Understanding of the Therapy: Pharmacists can provide better information and effectively understand the patient on the drug therapy.
3. Proper use and Management of Adverse Effects of the Medication: Pharmacist has more information and knowledge about the proper uses and adverse effects of the medicine. So, he can provide information effectively to the patients.
4. Improving patient adherence and motivating to take an active role in health: Pharmacist has a great role in the improvement of patient adherence. He plays an active role in health education. During the dispensing of the drug, the pharmacist provides behavior and emotional support. Sometimes pharmacist also collaborates with patients to incorporate the medication regimen in their daily schedule particularly when there is a complex therapeutic regimen and in elderly patients.
Outcomes of Patient Counseling:
- There may be better patient sympathy for their illness and the role of medication in its treatment.
- There is enhancing in the professional relationship between the patient and pharmacist.
- There is improved medication compliance.
- There is more effective drug treatment.
- There is a reduction in the incidence of medication errors, unnecessary medical costs.
- There are better managing approaches to the adverse effects of medication.
- There is improved in the quality of life of patients.
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