DISCHARGE

COUNSELLING

BY MARGRETTA ODAME ANTWI

AGCP, MPH, MPSGH, B. PHARM
WHAT IS DISCHARGE COUNSELLING?
•A system for providing medication counseling
to all patients discharged from a hospital.
•After the patient's discharge, regimen is
reviewed by the pharmacist, the prescriptions'
are filled, and the pharmacist counsels the
patient at the bedside.
Goals
•Help patients understand the role of medication in
their recovery process
•Medication adherence
•Maintenance of sustained illness remission
•Possible side effects and its management
•To achieve long term treatment success and positive
outcomes
A. Principles of patient counselling are
the same
•Hospital
•Community
•Not always possible to counsel every patient
•Prioritise patients
B. Counselling area | time
•Quiet place
•No distractions or interruptions
•Sufficient – time for all points to be made and,
•Questions answered
 C. Advantages of counselling in hospitals
•Access to the patient’s notes
•Doctor and nursing staff involved in their care available
•Indications for drugs are known
•Reasons for their selection
•Patient’s response to the drugs
•Avoiding duplication of unnecessary information
•Reinforce important points
•Repeated sessions can be organized
D. Plan for counselling
•Timing of patient counselling should be planned
•Starting well before the date of discharge
•Avoid the situation where patients are eager to
leave and no time to listen or think
•Obtain all medication prior to discharge
E. Patient counselling checklist
Check list of all the points you wish to make
Example,
1. Disease state; what brought patient to hospital.
2. Name and appearance of drug (s); generic | trade names, other
names more meaningful to the patient e.g. water tablet, colours,
appearance of different brands.
3. How to use; inhaler technique, cream and ointment, drops etc. You
may have a leaflet – use this to show the patient
4. When to use; relate times to daily routine. Explain what p.r.n means.
Counselling checklist. cont.
5. How long to use; antibiotics, long medications
6. Side effects; only mention common ones. How to deal with
them e.g. take NSAIDS with food or milk.
7. Anything to avoid; drinks (alcohol)
8. Missed doses; what to do if dose is missed whether dosage
can safely be altered without consulting doctor.
9. storage; any special instructions e.g. refrigerator, GTN
tablets
Patient counselling checklist. Cont.
•The most pressing problem
•The problem that brought patient into hospital
•Therapy geared to resolution of that problem
•Emphasize need for long term monitoring,
including labs,eg BUN creatinine
F. How much information
•Different ways of organizing information about
several drugs
•Grouping drugs according to indications, times of
administration, similar formulation together
•Most appropriate to discuss the most recently
prescribed drugs first
•Most important points selected and emphasised
G. Confirming understanding
•Use open questions
•Ask patient to explain how long they will take
their medication
•Give patient an opportunity to ask questions
•Discuss any problem they think they may
encounter
BENEFITS OF DISCHARGE COUNSELLING
•Findings suggest that the addition of these key points to medication discharge
counseling, coupled with providing the patient with filled prescriptions
immediately at discharge can decrease 30 day rapid readmission between 35%
and 50%.
•Encourage medication adherence in the initial acute phase of treatment
following hospitalization
•Give patients the opportunity to be treated in a less intrusive outpatient setting.
•Improve patient quality of life
•Increase hospital bed availability, leading to better stewardship of precious acute
care resources.
Conclusion
The pharmacist is frequently the last person to
see a patient before they leave hospital, so be
prepared for any type of question from “ when
do I have come back to clinic” to “which is the
way out”,etc
References
John R. Tomko (2013) Tips for patient discharge counseling from the
hospital setting: Improving adherence. Mental Health Clinician:
February 2013, Vol. 2, No. 8, pp. 240-242
http://www.lopioidrems.com/IwgUI/rems/pdf
/patient_counseling_document.pdf R
THANK YOU