Patient Counseling, Labeling, and Pharmaceutical Care Obligations
Counseling and labeling
Federal law (OBRA '90) and Minnesota requirements create a duty to offer counseling to outpatients receiving new prescriptions, and to counsel when necessary for refills. Counseling should cover drug name, purpose, directions, storage, precautions, interactions, and what to do about missed doses or adverse effects. The patient may decline; document the offer and any refusal. Labels must include pharmacy and patient information, drug name and strength, directions, quantity, date, prescriber, refills, and required auxiliary warnings. Supplement with oral instructions and written information when appropriate.
Pharmaceutical care
Pharmaceutical care includes prospective drug review, medication therapy management, monitoring, and documentation. Pharmacists should identify and resolve duplicate therapy, interactions, contraindications, and adherence problems. Patient records must be accurate and accessible, and protected health information must be handled under HIPAA and state law. Pharmacists have corresponding responsibility to question prescriptions that appear unsafe or illegitimate.
Traps
Questions test whether counseling is mandatory or may be declined, whether refill counseling is required, and whether auxiliary labels are optional. Another trap is assuming that a signed waiver eliminates the duty to counsel when the pharmacist identifies a problem. Also watch for labels missing the pharmacy phone number or directions.
Worked example
A patient receives a new inhaler and says, "I already know how to use it." Offer counseling, document the offer and the patient's decision, and provide written instructions. Rule of thumb: the offer is mandatory; acceptance is the patient's choice.