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Pelatihan Patient Counseling - Dr. Fita Rahmawati, SPFRS, Apt
Pelatihan Patient Counseling - Dr. Fita Rahmawati, SPFRS, Apt
Pelatihan Patient Counseling - Dr. Fita Rahmawati, SPFRS, Apt
Email : malihahanun@yahoo.com
INTRODUCTION
Safe and effective drug therapy depends
on patients being well informed about
their medication.
GOOD DRUGS
can be
BADLY USED
To Chew or not to Chew
Pasien 83 thn, mendapat resep :
• kejadian berulang.
• Pasien meninggal 3 minggu kemudian.
What pharmacist could be done to
prevent the event?
Kalau saja…..
• Farmasis menyempatkan mereview
resep, dan konseling
–Ukuran kapsul yang besar
–Konseling : jangan dibelah, dikunyah
PHARMACEUTICAL CARE
ASSESSMENT
PROCESS
DRP
PHYCICIAN COUNSELING
DIAGRAM LANGKAH KONSELING
VERIFIKASI AKHIR
Pharmacological Non-
approaches pharmacological
approaches
• The information is usually given verbally, but may be
supplemented with written materials .
29
Counselling Content
1. The medication’s trade name, generic name, common synonym, or
other descriptive name(s) and, when appropriate, its therapeutic class and
efficacy.
2. The medication’s use and expected benefits and action. This may
include whether the medication is intended to cure a disease, eliminate or
reduce symptoms, arrest or slow the disease process, or prevent the
disease or a symptom.
3. The medication’s expected onset of action and what to do if the action
does not occur.
4. The medication’s route, dosage form, dosage, and administration
schedule (including duration of therapy).
5. Directions for preparing and using or administering the medication.
This may include adaptation to fit patients’ lifestyles or work environments.
6. Action to be taken in case of a missed dose.
33
COMMUNICATION
• PHYSICAL,
Environmental barriers such as a lack of
privacy, noise, furniture,
• PSYCHOLOGICAL,
Semantics, effective patient communication
requires the use of words that are carefully
chosen.
Perception
Negative attitude
Environment
• Education and counseling are most effective when
conducted in a room or space that ensures privacy and
opportunity to engage in confidential communication.
• If such an isolated space is not available, a common area
can be restructured to maximize visual and auditory
privacy from other patients or staff.
• Patients, should have easy access and seating.
• The design and placement of desks and counters should
minimize barriers to communication.
• The environment should be equipped with appropriate
learning aids, e.g., graphics, anatomical models,
medication administration devices, memory aids, written
material, and audiovisual resources.
BARRIERS TO EFFECTIVE COMMUNICATION
• ADMINISTRATIVE
Administrative barriers such as management may view
the lack of money compensated for communication as a
reason not to communicate.
• TIME CONFLICT.
Time limits are very common when it comes to
pharmacists and patients. Time restraints are often
excuses not to counsel, though it often does not take
very long.
Other barriers to counseling:
– Disease state: dementia, stroke
– Language: verify primary language
– Hearing/vision problems
– Educational level (reading ability)
– Patient motivation: disinterest in learning
– Lack of pharmacist training
38
Minimize Barriers:
Effective Communication Skills
• Be specific
– Name of medication (brand/generic), dose, dosage
form, schedule
– List precautions: e.g., use sunscreen, avoid milk
– How to administer (Sub-Q, PO, IM etc.)
– Special directions and precautions
• Be selective
– Cover major / common side effects, drug interactions
– Cover patient specific indication
– Emphasize benefits of medication
– Duration of therapy
– Provide written information
39
Minimize Barriers: Effective
Communication Skills
• Be sensitive/empathetic
– Listen to the patient
– Speak distinctly and clearly
– Return later if patient indisposed, not alert,
distracted, has visitors etc.
40
Example: Warfarin Counseling
• DON’T
DO
– Address patients by
formally
their first names
– Assume
Ask whatthe
thepatient
patientknows
knowsall about
or nothing
warfarin
about
or
Coumadin®
the drug
41
Example: Warfarin Counseling
• DON’T
DO
– Explain that warfarin is an used
anticoagulant
to slow the blood
– clotting
Explain process to prevent
that warfarin unwanted
works by blood
inhibiting the
clots
vitamin K dependent clotting factors and that
– itAsk
is an
patients
emergency
to call situation
their doctor
if they
if they
seenotice
any
bleeding that they don’t normally have
blood
42
Example: Warfarin Counseling
• DON’T
DO
– List
Identify
every
thereason
specific
anyone
reasonmight
the patient
be on is
taking it and how long they might be expected
warfarin
to take it
43
Example: Warfarin Counseling
• DON’T
DO
– Give
Explain
thethe
patient
signsthe
and
impression
symptomsthatof bleeding
they are
such as
going to bloody
bleed tonose,
deathblood in the urine, a
stool that changes color or darkens, bruises
that never go away or increase in size
44
Example: Warfarin Counseling
• DO
DON’T
– Ask
– the patient
Assume to tellrealizes
the patient all theirthe
doctor/
needdentist
to notify
etc. all thecare
all health medications
providersthey are taking
concerning all the
including nonprescription ones (e.g., pain
medications they are on; OTCs are often not
medications, vitamins, herbal products)
considered medications
45
Example: Warfarin Counseling
• DO
DON’T
– Ask
– the patient
Indicate that thetoonly
avoid taking
good painOTC pain medications
medications are thosesuch
foundason
aspirin, unless they have discussed it first with their physician
prescription
– Recommend Tylenol® as the OTC pain reliever of choice with
their physician’s knowledge as well
46
Example: Warfarin Counseling
• DON’T
DO
– Tell the patient to
what
double
to doupif he
on or
their
shenext
forgets
dose
ifa they
dosemiss one
– Ask the patient to inform their physician or
anticoagulation clinic if a dose is missed
47
Example: Warfarin Counseling
• DO
DON’T
– Stress
– Minimizethethe
need for follow-up
importance appointments
of follow-up by an
and blood drawsclinic or a physician
anticoagulation
– Indicate that it is normal for doses to change
from time to time
48
Example: Warfarin Counseling
• DON’T
DO
– Limit
Ask the
or forbid
patientthe
to patient
eat a constant
to eat salads
and or
moderate diet where they eat vegetables and
vegetables.
salads in a consistent manner and neither
over do nor stop eating what they normally
eat
49
Example: Warfarin Counseling
•• DO
–
DON’T
Summarize key points covered
–
– Assume the has
Ask if the patient patient hasquestions
any other no final questions
– Ascertain that the patient understands the information
–
– Assume the patient has understood all you
Thank the patient and leave written information
– have
Document discussed
as required
– Forget to leave a note in the chart
50
Who and When to counsel
• Ideally, the pharmacist counsels patients on all new and
refill prescriptions.
• If the pharmacist cannot counsel to this extent, it should
be defined which patient types, or which medications
pharmacists will routinely counsel patients.
• This will vary depending on the pharmacy clientele, Exp:
- Patients receiving more than a specified number of medications
- Patients known to have visual, hearing or literacy problems
- Paediatric patients
- - Patients on anticoagulants
Modified Morisky Scale (MMS)
THANK YOU