COLLEGE OF NURSING AND PHARMACY

C-PPD1 – DISPENSING 1 (DISPENSING PROCESS, READING &

INTERPRETING THE PRESCRIPTION AND OTHER MEDICINE ORDERS)
First Semester | AY 2021-2022

Module 6: Patient Counselling

Time Frame: Week 11 & 12 (8hours)
Schedule of synchronous sessions:

Mapped Learning Outcomes and Course Content for C-PPD1 Dispensing 1, Module 6
Target Learning Outcomes Content and Activities
Hour (At the close of the period allotted, Online Session Offline Session
students should have :)
8 hours • Defining patient Interactive lecture: Assignment: Review in advance and
counseling. Patient Counselling prepare for recitation
• Providing Information to
the patient. Written Report#3: Sound Alike and
Look Alike Drugs

1. Content / Discussion / Learning Resources / Link

Patient Counselling

What is Patient counselling?

• Patient counseling is defined as providing medication information orally or in written form to the
patients or their representatives on directions of use, advice on side effects, precautions, storage, diet
and life style modifications.

Importance of Patient Counselling

• It is important in order to ensure that the patient receives and understands important information
such as the name of the drug and the purpose of the medication.
• Patient counselling also provides a key opportunity to identify potential dispensing errors.

WHY Counsel?

× To promote adherence to medications and avoid treatment failure and future hospital admissions
× Helps patients cope with their disease and any medication side effects that might occur
× Important to avoid potential drug interactions with OTC, herbal, and prescription medications

An elderly patient presented the following, along with a number of other prescriptions, to his regular
community pharmacy for processing:

Faculty: Jethro M. Ocampo, RPh Page 1 of 8

 COLLEGE OF NURSING AND PHARMACY
C-PPD1 – DISPENSING 1 (DISPENSING PROCESS, READING &
INTERPRETING THE PRESCRIPTION AND OTHER MEDICINE ORDERS)
First Semester | AY 2021-2022

Facing a lengthy wait, the patient asked that the medications be delivered. During the dispensing process, the
pharmacy technician incorrectly interpreted and entered the prescription into the computer as prednisone
instead of the Prandase that had been prescribed. The pharmacist checked the prescription, but did not
detect the error.

The incorrect medication was delivered to the patient later that day. The pharmacist did not call the patient
to provide counselling.

What do you think would happen?

Good communication skills for pharmacists

George Raymond, a 59-year-old man with moderate hypertension, enters your pharmacy holding an unlit
cigar. You know George because you attend the same church. He is a high school principal, has a wife
who works, and has four children. He has been told to quit smoking and go on a diet. He also has a long
history of not taking his medications correctly. He comes to pick up a new prescription—an antibiotic for
a urinary tract infection.

Although he knows you personally, he is somewhat hesitant as he approaches the prescription area. He
looks down at the ground and mumbles, “The doctor called in a new prescription for me, and can I also
have a refill of my heart medication?”

Components of the Interpersonal Communication Model

THE SENDER
• transmits a message to another person
THE MESSAGE
• is the element that is transmitted from one person to another.
THE RECEIVER
• receives the message from the sender
FEEDBACK
• is the process whereby receivers communicate back to senders their understanding of the senders’
message

Faculty: Jethro M. Ocampo, RPh Page 2 of 8

 COLLEGE OF NURSING AND PHARMACY
C-PPD1 – DISPENSING 1 (DISPENSING PROCESS, READING &
INTERPRETING THE PRESCRIPTION AND OTHER MEDICINE ORDERS)
First Semester | AY 2021-2022

What do you think is your personal responsibility in the communication model?

Barriers to Counseling
• Disease state: dementia, stroke
• Language: verify primary language
• Hearing/vision problems
• Environmental: noise, lack of privacy
• Educational level (reading ability)
• Patient motivation: disinterest in learning
• Lack of pharmacist training/time

Minimize Barriers: Effective Communication Skills

× Proper environment
× Private, quiet
× Free of distractions, e.g., patient should have pain controlled, ask patient to lower
volume on the TV etc.
× Introduce yourself
× Greet the patient
× Explain your purpose
× Ask the patient’s permission to counsel

× Know your audience

× Educational level: tailor talk for understanding
× Use appropriate language
× Religious or ethnic beliefs
× e.g. need to avoid blood products or specific foods
× 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
× Necessary lab tests

× Be selective
× Cover major / common side effects
× Cover major / common drug interactions
× Cover patient specific indication
× Emphasize benefits of medication
× What to do if dose(s) missed
× Duration of therapy
× Provide written information
× Summarize key points

× Be sensitive/empathetic
× Listen to the patient
× Speak distinctly and clearly
Faculty: Jethro M. Ocampo, RPh Page 3 of 8
 COLLEGE OF NURSING AND PHARMACY
C-PPD1 – DISPENSING 1 (DISPENSING PROCESS, READING &
INTERPRETING THE PRESCRIPTION AND OTHER MEDICINE ORDERS)
First Semester | AY 2021-2022

× Return later if patient indisposed, not alert, distracted, has visitors etc.

× Elicit feedback to assess understanding

× Improves coping if side effects occur
× Increases adherence to improve health
× Verifies patient’s comprehension

× Ask open ended questions

× Ask if any final questions

Assess Patient’s Understanding

× “Just to make sure I did not leave anything out, could you tell me…[examples]
× What is the medication used for?”
× When are you going to take the medication?”
× What side effects might you experience?”
× What will you do if that occurs?”
× What will you do if you miss a dose?”

Documentation of Counseling Session

× When counseling is completed

× Write note or use counseling sticker in progress note.
× Include assessment of patient and/or care giver understanding.

Summary

× Prepare prior to counseling

× Introduce yourself and your topic
× Use language the patient understands
× Present information in logical order
× Summarize key points
× Verify patients’ understanding
× Allow final questions from patient
× Give written information to patient
× Place a note in the chart

Faculty: Jethro M. Ocampo, RPh Page 4 of 8

 COLLEGE OF NURSING AND PHARMACY
C-PPD1 – DISPENSING 1 (DISPENSING PROCESS, READING &
INTERPRETING THE PRESCRIPTION AND OTHER MEDICINE ORDERS)
First Semester | AY 2021-2022

Patient Consultation Template

Patient Counselling Tools

MOBILE APPS

Epocrates
· Reviews prescription drug and safety information
· Runs drug-drug interactions
· Scans health care insurance formularies for medication coverage
· Calculates body mass index
· Identifies medications by physical characteristics or imprint
· Available for Android and iOS devices

MPR
· Provides detailed drug information
· Checks drug-drug interactions
· Offers up-to-date, concise prescription and OTC drug monographs
· Distributes daily drug news and warnings
· Contains personalized bookmarks for frequently accessed contents
· Accommodates more than 120 different clinical tools, such as calculators
· Available for Android and iOS devices

Micromedex

• Adult and pediatric dosage

• Adverse effects (separated into “common” and “serious”)
• Drug interactions
• Administration
• Black box warnings
Faculty: Jethro M. Ocampo, RPh Page 5 of 8
 COLLEGE OF NURSING AND PHARMACY
C-PPD1 – DISPENSING 1 (DISPENSING PROCESS, READING &
INTERPRETING THE PRESCRIPTION AND OTHER MEDICINE ORDERS)
First Semester | AY 2021-2022

• Breast feeding
• Common trade names
• Contraindications
• Dose adjustments
• Generic names, including selected combination products
• How supplied
• Indications (differentiated as “FDA labeled” and “non-FDA labeled”)
• Mechanism of action
• Monitoring
• Precautions
• Pregnancy category
• Therapeutic class

What are the other tools/ apps that you can find?

LABORATORY WORKSHEET

WRITTEN REPORT NO. 3

SOUND ALIKE AND LOOK ALIKE DRUGS

OBJECTIVES
• Contribute to the effective operation of the Pharmacy
• Minimize practice errors
• Contribute to the system for providing products and quality services

Sound alike and Look alike Drugs increase the risk of error at all steps of the medications use process.

The medication safety team must examine all medications on the formulary for potential look-alike or sound-
alike problems in dispensing drugs.

Dispensing errors due to “look-alike or sound-alike” medication names are reported. Recent ones include:
• Diazepam dispensed instead of Ditropan
• Pilocarpine dispensed instead of Atropine Eye Drops
• Clonidine dispensed instead of Clonazepam
• Chlorpromazine dispensed instead of Chlorpropamide
• Albuterol dispensed instead of Atenolol

CASE STUDY

GOAL: To minimize the potential errors associated with medication names that look or sound alike, using
PLAN, DO, CHECK and ACT (PDCA) Cycle.
The PDCA Model is an efficient tool in decreasing the time that might be spent on committing errors and
applying corrective action to prevent future errors.

Faculty: Jethro M. Ocampo, RPh Page 6 of 8

 COLLEGE OF NURSING AND PHARMACY
C-PPD1 – DISPENSING 1 (DISPENSING PROCESS, READING &
INTERPRETING THE PRESCRIPTION AND OTHER MEDICINE ORDERS)
First Semester | AY 2021-2022

PLAN

• Drugs whose names look or sound alike increase the risk error for all steps of the medication use
process.
• Therefore, the medication safety team should examine all medications on the formulary for potential
look – alike or sound – alike problems

Team members identified the following opportunities for implementing safeguards:

• Encourage prescribers, through education, to include the purpose for which a medication prescribed
• Enter formulating notes in both the online formulary and pharmacy computer system to alert
providers when a look – alike and sound – alike threat is present

Team members identified the following opportunities for implementing safeguards:

• Use “TALL MAN” lettering (i.e. DOBUtamine, DOPamine) on storage bin labels and automated
medication dispensing machine formulary lists to help differentiate products. Retrospective baseline
data were collected to determine the number of actual and potential errors involving look – alike or
sound – alike drugs.

DO

• Because of the number of drug pairs indentified, the team elected to implement and test safeguards
for only a limited number of drugs that were considered to be high – alert (i.e. products known to
have a high potential for causing harm when used occurrence reports to determine the number of
events involving look – alike or sound – alike drugs.

CHECK

• The team used pie charts to analyze before and after data. They found a decrease in number of
occurrences involving high – alert look – alike drugs. The aggregate number of occurrences involving
other look – alike or sound – alike drugs remained relatively stable.
• Staff provided positive feedback related to the benefit of the safeguard.
• No patients were harmed by the high – alert drugs that had look – like drug names.

ACT

• The expectations for error reduction were met. The team decided to implement the safeguards for
the remaining look – alike and sound – alike drugs of the formulary.
• A suggestion was made to develop a plan for proactive risk assessment of formulary addition
requests for look – alike and sound – alike name problems to allow for safeguards to be continually
implemented as formulary additions were made.

Faculty: Jethro M. Ocampo, RPh Page 7 of 8

 COLLEGE OF NURSING AND PHARMACY
C-PPD1 – DISPENSING 1 (DISPENSING PROCESS, READING &
INTERPRETING THE PRESCRIPTION AND OTHER MEDICINE ORDERS)
First Semester | AY 2021-2022

Questions:
1. Make a table list of 5 examples each of Sound Alike and Look Alike medicines.
2. What are some drug pairs which are look – alike or sound – alike drugs and are a potential source of error
in interpreting the prescription?
3. What visual warning may be used for “look – alike and sound – alike” drug to prevent medication error in
dispensing?
4. When taking prescription from a patients what “measures” can you take to prevent medication errors due
to “look – and sound – alike” name errors?
5. Have you encountered any “look – alike and sound – alike” drugs whose brand names are changed after
several months? Cite example.

2. Evaluation of Learning

For the evaluation of learning for Module 6, a scheduled quiz will be assigned in the Google Classroom and
will be taken before the start of the next Module during the Synchronous Class.

References

Adams, C.H. and Jones, P.D. Therapeutic communication for health professionals (2011/latest edition)

Blenkinsopp, A. and Panton, R. Health promotion for pharmacists (1991/latest edition)

Gupta, GD, NK Jain, Modern Dispensing Pharmacy (2011)

Pharmacists talking with patients: a guide to patient counseling / Melanie J. Rantucci. (2012)

Congratulations for having completed this C-PPD1 Module 6! See you in the next Module

Faculty: Jethro M. Ocampo, RPh Page 8 of 8