Patient Counseling, Medication Safety, and Pharmacy Practice Standards
Counseling questions test the offer-to-counsel standard, drug utilization review, documentation, and high-alert practices.
Counseling
- Offer counseling to the patient or caregiver for new prescriptions and changes in therapy. Cover name, purpose, dose, administration, common side effects, serious warnings, interactions, storage, and refill instructions.
- The patient may refuse; document the offer and refusal. Do not condition dispensing on acceptance.
- Use an interpreter or translated materials when needed; confirm understanding with teach-back.
Medication safety
- Perform prospective drug utilization review and resolve alerts before dispensing. Do not override clinically significant alerts without documented rationale.
- Use auxiliary labels and clear directions; separate look-alike and sound-alike products.
- Report medication errors and near misses through the pharmacy’s quality program; disclose errors to the patient per policy and law.
- High-alert drugs include anticoagulants, insulin, opioids, and chemotherapy; use independent double checks.
Worked example
A patient receives a new warfarin prescription and says she already takes aspirin daily. The drug utilization review flags bleeding risk. Do not simply override. Contact the prescriber, document the interaction review, and counsel on bleeding signs. If the prescriber confirms, document the rationale and provide written warnings.
Traps
- Counseling only when the patient asks.
- Failing to document a refusal.
- Overriding alerts without rationale.
- Giving only side-effect information and omitting administration and storage.