The public at large naturally expects to be counseled when obtaining medications at the pharmacy department’s pick-up counter. Sadly, this is often not the case. Many, if not all pharmacies, have an opt out signature pad which, when signed, permits the medications to be dispensed without any patient education or further pharmacist involvement.
The television show 20/20 aired a segment in 2007 depicting how often patients received counseling. This show revealed that routinely patient education was not performed. A different study at pharmacies in eight states revealed that with 63 percent of patients, only one of the following topics was discussed: name of the medication, drug type, or directions. In only 48 percent of the cases did the pharmacist assess the patient’s understanding of the medication and its use.
Legally Pharmacists are compelled to educate patients on their medications. The federal law, the Omnibus Budget Reconciliation Act of 1990 (OBRA-90), established a minimum for patient education. In order to participate in the state-sponsored Medicaid programs which are partially federally funded, states are required to adhere to the OBRA-90 pharmacy practice standards. This law was enacted in response to the public demand for information on their medications.
Counseling Should Include:
Depending on the situation, the pharmacist may choose to discuss the following with the patient:
– The name and description of the medication and its indication;
– Dosage form, dosage, route of administration and duration of drug therapy;
– Special directions and any precautions for preparation, administration and use by the patient;
– Common severe side or adverse effects or interactions and therapeutic contraindications that may be expected, including the means of avoidance, and the action to be taken if they occur;
– Techniques for self-monitoring drug therapy;
– Proper storage;
– Prescription refill information; what to do in the event of a missed dose.
The American Society of Health-System Pharmacists (ASHP) recommends a four step process in order to make patient education more effective.
The first step is for the pharmacist to establish a caring relationship with the patient. This begins with the pharmacist introducing themselves, explaining the purpose of the patient education, and obtaining patient consent. This can enable the pharmacist to determine if any communication barriers are present.
The second step is for the pharmacist to assess the patients understanding about their own health problems and medications. Is the patient mentally and physically able to appropriately use the medications? The patient should be able to verbalize how they will use the medications. This applies to refill medications also. The patient should be able to recount how they used their previous supply. Any problems or concerns regarding their usage should be explained.
The third step is to use both oral and visual aids filling in any deficits in the patients understanding. Tablets and capsules should be shown to the patient that they may see the size, shape and color of their medications. For liquids and injectable medications, the patient should be shown the measurement marks for the doses to be administered. Demonstrate assembly of any mechanical devices the patient will use. Hard copy paper handouts further foster retention. Problems the patient may have with their medication regimen should be assessed and the prescriber notified.
The fourth step is verification and demonstration of the patients understanding of the use of their medications. The patient must be able to verbalize how they will use their medications and how they will determine if it is effective.