Dynamic Patient Counseling

INTRODUCTION	1. Introduces self (must say first name) AND role (pharmacist)	Pharmacist Name
	2. Confirms patient identity (must say first name, last name, and date of birth)	Patient First Name Patient Last Name Patient DOB / /
	3. Explain the purpose of the counseling session and estimate how long it will take
	4. Verify patient allergies to medications, foods, or other substances	Allergies
DRUG NAME	5. State the name, strength, and dosage form of the drug and whether generic substitution has occurred	Drug Name Drug Strength Drug Dosage Form Generic Substitution
OPEN-ENDED #1	6. “What did your prescriber tell you the medication is for?”
OPEN-ENDED #1	6A. Confirm intended use and describe benefits to taking medication	Drug Indication/Use Benefit(s) to Taking Drug
OPEN-ENDED #2	7. “How did your prescriber tell you to take the medication?”
	7A. Show medication and read patient the SIG on their prescription label	Complete SIG on Rx Label
	7B. Explain dosage regime giving specific recommendations regarding when during the day to take the medicine, minimum number hours between doses, maximum doses per day, etc.	# of doses each day # of hours between doses When during the day to take
	7C. Give administration advice including whether to take with food, empty stomach, avoid certain foods, do not crush or chew, etc.	Take with Food Status Additional Instructions Do Not Crush or Chew Warning
	7D. For any complicated dosage form (e.g. inhaler, injection, eye/ear drop, suppository, etc.): Describe and demonstrate proper administration Ask if they have questions or anticipate problems administering the medication Ask patient to teach back administration instructions	Complicated Dosage Form
	7E. Explain in precise terms what to do if they miss a dose.
	7F. Point out the day’s supply of medication provided and whether refills were authorized	Quantity Dispensed Days supply Refills Authorized
	7G. Discuss storage recommendations	Storage Temperature
OPEN-ENDED #3	8. “What did your prescriber tell you to expect from the medication?”
	8A. Tell when medicine will start to work and whether it will alleviate any symptoms (i.e. notice an effect)	How long before it starts working How long before full effect Will patient notice an effect If yes, what effects will the patient notice when it is working
	8B. Explain how long they can expect to be taking the medication	Treatment Length
	8C. Discuss common side effects of the medication	Common Side Effects
	8D. Warn about and describe symptoms of developing an allergic reaction to the medication	Symptoms of Allergic Reaction
	8E. Warn about rare but serious side effects of the medication	Additional Serious Side Effects Is a Med Guide Required
	8F. Discuss precautions (e.g., activities to avoid) and beneficial activities (e.g., exercise, decreased salt intake, diet, self-monitoring)	Activities to Avoid (warnings) Beneficial Activities
	8G. Tell patient about avoiding possible drug interactions
	8H. Point out that additional side effects and warnings are listed in the written drug information sheet provided
TEACH BACK	9. “Just to make sure I have not left anything out, can you tell me how you are going to take this medication?”
CONCLUSION	10. Provide closure (pay compliment, express thanks) and give follow-up instructions and contact information
COMPLETION CODE	Listen to complete counseling and view completion code