Patient Safety, Counseling, and Public Health Requirements
Counseling and drug utilization review
Federal OBRA '90 expectations, adopted through state rules, require that pharmacists offer counseling to each patient receiving a new prescription, with an exception for prescriber or patient refusal documented appropriately. Counseling covers the drug name and description, dosage form and directions, duration, special precautions, common adverse effects, interactions, and storage. Prospective drug utilization review screens for therapeutic duplication, drug-disease contraindication, drug-drug interaction, incorrect dosage or duration, drug-allergy interaction, and clinical abuse or misuse. Know that the pharmacist must take reasonable steps to resolve identified problems before dispensing.
Patient safety and public health duties
Know the duty to maintain an accurate patient profile, to report medication errors and adverse events through the pharmacy's quality improvement program, and to report impaired practitioners and certain serious events as required by law. Know Oklahoma's public health roles for pharmacists, including immunization administration, naloxone distribution under standing order or protocol, and participation in the prescription monitoring program. Understand confidentiality obligations under HIPAA and state law, and the limited circumstances in which information may be disclosed, such as to the prescriber, to the Board, or under valid legal process.
Traps
A common trap is treating the counseling offer as optional documentation; the offer must be made and any refusal documented. Another is confusing DUR, which happens before dispensing, with counseling, which happens at the point of delivery. Watch for questions implying a pharmacist may disclose patient information to a family member without consent, or that naloxone requires a patient-specific prescription.
Rule of thumb
Use a three-step habit for safety questions: screen (DUR and profile), resolve (contact the prescriber and document), and educate (offer counseling and document any refusal). When a question asks who is responsible for catching a therapy problem, the answer in pharmacy practice questions is the pharmacist.