Components of Clinical Pharmacy

Patient Communication/Counseling.

Good Reads:
Gennaro AR Remington
Roger Walker.
 Communication
• sharing of information/ideas/thought/feelings.
• pharmacist-patient relationships begin/develop with effective
communication, both verbal and nonverbal.
• Ineffective communication reduce the accuracy of the medical diagnosis.
• patient should understand
– the reasons for the therapy
– how it is to be used.
THE– COMMUNICATION PROCESS-Receiver/Medium/Sender.
the outcomes of the therapy.
• Goal of all communication…………………………………………………….understanding.

• Effective communication …….the meaning of a message is held in common by both

the participants.

• The medium…………………………………………..…….oral, nonverbal, or electronic.

• If the receiver responds to the message…………………………………….…feedback.

 Non Verbal Communication.
• For example, through facial expressions, gestures,
vocal quality.

• These nonverbal signs may modify the intended

meaning of a message.
Information gathering and Patient
Empowerment
 Benefits of Counseling
For the Patient For the Pharmacist
Improved therapeutic outcomes. Enhanced professional status.
Decreased adverse effects. Enhanced job satisfaction.
Improved patient adherence. Fulfillment of legal responsibility.
Decreased medication errors/misuse. Revenue generation.
Enhanced patient self-management.
Decreased health care costs due to appropriate use of
medications.

Guidelines
The Ad Hoc Panel on Medication Counseling Behavior Guidelines of the USP

The patient should:

• Recognize why a prescribed medication is helpful…………….(self awareness).

• Develop ability to make medication-related decisions concerning compliance.

• Improve coping strategies to deal with medication side effects/drug interactions.

( self management).

• Show motivation toward taking medications.(adherence).

PREPARING FOR THE COUNSELING SESSION
• Two way sharing of knowledge.

• Spend few moments mentally preparing for the interaction

about to occur.

• know as much as possible about the patient.

• Review the prescription as well as the patient’s medication

record.

• Another important issue to consider is the physical state of

the patient.
STEPS TO A SUCCESSFUL COUNSELING SESSION
1) Introduce yourself and 2) Explain the purpose the counseling 3) Update the patient
identify the patient. in terms of the benefits. medication profile.
Allergy and disease state.
Greet the patient. Ask patients concerns regarding
Provide your name as well as medication. New or discontinued
your position in the pharmacy Answering that question first will prescription drugs.
relieve the patient’s Mind. Changes to lifestyle history.

4) Assess what the patient 5) Assess whether the patient knows 6) Assess the patient’s
already knows about the how to take the medication. understanding of what to expect
newly prescribed drug. from the medication
patient must know the name,
strength and purpose of the
medication

7) any additional information 8) Ask the patient if he or she has any 9) Check patient understanding of
that the patient requires. concerns or questions. the information discussed
Potential interactions.
Monitoring information
Refill /Storage information
Life-style changes

10) Closing the session.

Provide written counseling information.
Tell the patient how to reach you if other questions arise.
TECHNIQUES TO USE DURING A COUNSELING SESSION
1. Non-verbal Eye Contact.. frequent and attentive eye contact, avoiding blank stares. “I’m
cues. listening.”
Mannerisms…Gestures, vocal qualities, body movement, clothing, hygiene.
leaning forward at a slight angle, which is a sign of attentiveness.
If the patient is seated or lying down, the interviewer should sit.
Excessive writing is distracting to patients.
Voice clarity is important.
assess patient’s language and hearing abilities.

2. Touch handshake by a pharmacist.

display sympathy, empathy, concern.
patient’s cultural background should be used as a guide to know when to use touch.
not everyone is comfortable being touched.
3. Listening. allow the patient to speak without interruption and concentrate on the words.
ask clarifying questions where appropriate, avoid jumping to conclusions .

4. Use pharmacist reframes what the patient has said in his own words.
paraphrasing This tells the patient that the pharmacist has listened and allows the patient to correct
any misinformation.

5. Avoid technical increase patient anxiety.

jargon. Latin or Greek prefixes used in health communication are particularly confusing.

Maintain control bring the conversation back to the topic when the patient strays too far from the
of the session. purpose of the session.
Use written use the prescription vial as a source of written communication.
information. pharmacist can refer to the directions on the label as well as any ancillary information
contained in auxiliary labels.
Open-ended open-ended question is one that cannot be answered with a yes or no.
questions. start with who, what, where, when, why, or how.
Avoid leading/restrictive questions.
leading question usually supplies a hint to the patient about the answer the pharmacist is
expecting.
The open question allows the patient the freedom to tell, in her own words, exactly why
she visited the doctor today.
Post-consultation questions
Do I know more now about the patient? Was I curious?
Did I really listen? Was I friendly?
Did I explore their beliefs and expectations?
Did I identify the patient's main medication-related problems?
Did I share the treatment options with them?
Did I help my patient to reach a decision?
Did I check that they understood what I said?
Did we agree?
COUNSELING PATIENTS WHO PRESENT
BARRIERS
fall into two categories
functional or emotional

Observation of the patient, patient medication profile

and the patient’s behavior during the counseling
session will usually reveal the presence of a barrier.
 Functional Barriers
• patient has difficulty receiving/understanding the
communication.
• Examples low illiteracy, hearing or visual impairment, and
non-English speaking patients.
1. Sensory Visually-Impaired Patient…….Use Large type labels, bold print, Braille label.
abnormalities Shape, size, and smell of medication and container to distinguish medicines.
Hearing-Impaired Patient….Face the patient and speak slowly and distinctly.
Quiet area for counseling. Sign language, Facial expressions.
2. Language Low Literacy Patient….careful verbal instructions.
barriers Video instructions, Use of numbers, colors and shapes to distinguish meds.
Complicated medical or technical words should be replaced.
Have Patience, kindness, speak slowly and face patient
Ask for feedback from patient to assess level of understanding
Use demonstrations when appropriate. include caregiver or family member in
conversation.
Comprehension Difficulties
caused by a psychiatric illness or mental retardation.
Include caregiver or family member in conversation when possible.
 2) Emotional Barriers
occurs when the patient is experiencing strong emotions that may interfere with
patient’s thought processes.

prevent her from listening to communications

responding appropriately.

Examples would be anger, frustration, sadness, worry, or embarrassment

Empathic responses truly listens to what the patient is saying, both in words and
reflective responding. nonverbal communication.

A reflective response is the pharmacist’s way of communicating to the

patient his or her understanding of the patient’s feelings.

acknowledges the patient’s feelings and usually has a calming effect on

the patient
sympathy pharmacist feels sorry for the patient.
Empathy neutral process in which the pharmacist identifies with the
feelings of the patient.
Putting yourself into the other person’s shoes,understand how the
patient feels.
Pharmacist BARRIERS TO COMMUNICATION
inappropriate nonverbal behaviors Control distractions
Lean toward patient
lack of confidence Open body posture.
Eye contact 50–75% of the time
Relax
lack of knowledge.

lack of time. relieve pharmacists from dispensing

economic considerations. functions and allowing the pharmacist to spend time with
patients

poor communication skills. appropriate choice of continuing professional education

opportunities to improve knowledge and skills

patient’s failure to value the counseling advertising the service provided.

session. brief description of the importance of this process in
improving patient medication therapy.
uncomfortable interacting with patients. little training in patient interaction.
CULTURE AS A BARRIER
Discover patient’s cultural perspective. Cultural Factors by Galanti
Patient-HCP relationship might be Verbal and Nonverbal Idioms, Same Word, Different
disrupted due to different Communication Meaning, Eye Contact, Touching
beliefs/values/language.
•patient’s viewpoint is based on his or Religion & Spirituality
her own cultural perspective.
Folk Medicine
 Counseling Children and Adolescents
• When children are old enough to understand, speak directly with them about their medicines.
• should be taught how to ask questions of health care providers, parents, and other caregivers.
• Children should receive information about medicines and their proper use as a part of school
health education.
• Information about the general use and misuse of medicines.
• Talk to parents and children about how to protect young children from accidental poisoning
and what to do if it occurs.
Ten Guiding Principles for Teaching Children and Adolescents About Medicines.Ad Hoc Advisory
Panel on Children and Medicines
Counseling the Elderly Patient
• Vision and hearing are often impaired, have low literacy skills.
• chronic conditions and the number of medications prescribed increase.
• Additional time may be required to address the needs of the patient.
• Written information and compliance reminder aids are particularly
helpful with large numbers of prescription products.
• provide small pieces of specific information coupled with a reminder aid
and verbal reinforcement.
Patient Medication Interview-Steps
1. Greeting and purpose purpose of the session and the benefits to the patient should be
of the interview outlined.
2. Gathering of basic name, address, phone number, birth date, all regular health care providers,
information occupation should be gathered.
3. Patient’s health current and past medical conditions.
history symptoms experienced and the duration of the illness.
Female patients, if they are pregnant or breastfeeding. Allergies.
4. Prescription medications in current use including the name/strength of the
medication use drug/prescriber/dosage form/route of administration/dosing schedule.
how the patient adheres to the prescribed regimen,
adverse effects that the patient has experienced.
all past medications used, and the reasons why was discontinued.
5. Nonprescription use of all products purchased without a prescription.
medication use typical over the- counter products as well as dietary supplements and herbal
products.
6. Life-style issues life-style issues such as use of tobacco products and alcohol as well as
recreational drugs.
explain that use of these products may affect drug therapy.
Remind the patient that this information is strictly confidential.
7. Closing the interview offer the patient the opportunity to add any additional information.
The pharmacist ensures that all information will be held in confidence unless
needed to discuss with another health care provider.
Pharmacist’s Professional Communications
• Pharmacists-HCP’s communications.

responding to a physician’s question during patient

care rounds.
providing an educational program to nursing staff.
publishing results of a research project.
question concerning compatibility of IV medications
from a nurse.
drug dosing question from a physician.
request about the ADR’s from a patient.
RESPONDING TO DRUG THERAPY QUESTIONS
• Pharmacist promote the profession of pharmacy by
being recognized as valuable members of the health
care team.
• Displaying confidence.
If the pharmacist does not appear confident, the
requester may certainly have reservations about the
information provided.

• Professional terminology should be used

when communicating with a patient, terminology that
a layperson should be used.
 DRUG ALERT NOTIFICATIONS
• situations that require the pharmacy department to alert the
medical/nursing staff of an important medication-related
issue.
• should include critical
drug product shortages.
change in pharmacy procedures.
withdrawal of a drug from the market.
one-page communication that clearly states the problem and
provides a recommendation.
Provide contact information for potential questions or concerns
 Written Professional Communication
ELECTRONIC Professional e-communication should be utilized where face-to-face/direct
MAIL communication would not effectively communicate
Close attention should be paid to content and format.
The subject line should clarify the intent of the message.
refrain from including confidential or controversial information.
It is most appropriate to respond within the same business day
MEMORANDA communicate drug information, policy changes, or in the evaluation/discipline of
(MEMOS) employees.
Memos should be formal in format and should be addressed to a specific individual or
group of individuals
COVER should accompany applications for employment.
LETTERS cover letters should be addressed to a specific individual
should include the purpose for writing the letter.
pharmacist’s background and training and his or her current position
summary of the key strengths
RESUME one-page summary or snapshot of individual’s education and work experience.
designed to highlight professional accomplishments
CURRICULUM intended to be a comprehensive chronology of the education, training, and work
VITAE experience.
inclusive of all types of professional activities