Patient counseling: How pharmacists can choose the most critical cases

September 4, 2009

The best technique for counseling patients is a combination of Show & Tell and the Indian Health Services questions. If pharmacists could quickly decide which prescriptions needed extended counseling, they could employ this approach when it is most necessary. Now there's an algorithm for that.

I am currently consulting with a board of pharmacy to determine whether and how counseling can be used to reduce medication errors. Because this board of pharmacy is several states away from where I live, I participate in most meetings by conference call. This is sometimes an advantage, because it allows me access to my library during meetings, and I can grab a book if something we are talking about sounds familiar. If I had attended a recent meeting in person, I never would have thought to bring the book Blink with me.

What connected the story of Goldman's Algorithm to questions involving counseling was the conversation between several of the pharmacists sitting at the table. One problem under discussion was, not surprisingly, "time." We also talked about which errors counseling was most likely to catch. Another topic was which medication errors required the greatest attention, as they would be most likely to result in harm if not caught and the medications were actually taken by the patient. Finally, we discussed what level of counseling might be required to catch certain errors.

Most pharmacists would agree that this combination of counseling techniques is ideal. The problem is that a pharmacist in a busy pharmacy cannot do this every time or even with every new prescription. Perhaps we need to look at the Cook County Hospital solution. Pharmacists could develop a simple decision tree that would allow them to instantly decide which prescriptions present the greatest danger and for which detailed counseling is most necessary. What we need might be a counseling algorithm.

If pharmacists could quickly decide which prescriptions needed extended counseling - which would usually amount to no more than an additional few minutes of counseling time - they would be more likely to use Show & Tell Plus for these few prescriptions dispensed during the day. To design a quick decision-tree algorithm, we need only look at information readily available: the drugs and the patient. The algorithm might suggest Show & Tell Plus counseling if:

If you try this algorithm, let me know how it worked and how you modified it, if you did. Perhaps we can then recommend a modified, tested algorithm for everyday use.

This article is not intended as legal advice; it is intended to promote thought about ways to reduce medication errors. For legal advice, consult your own attorney.

Ken Baker is a pharmacist, attorney, and consultant on risk management. Contact him at ken@kenbakerconsulting.com
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