Patient Counseling, Medication Safety, and Error Reporting
The counseling standard
Virginia requires that patients receive counseling from the pharmacist on new prescriptions and on refills when the patient requests it. The pharmacist must offer counseling; a documented refusal satisfies the offer, silence does not. Counseling should occur where privacy is protected and should cover directions, storage, significant interactions, and the most important adverse effects.
Safety systems
Expect questions on drug utilization review (prospective review against the patient profile and pharmacist resolution of alerts), auxiliary labeling and MedGuides for products with mandated patient information, tall-man lettering and look-alike/sound-alike pairs, high-alert medications, and the pharmacy's continuous quality improvement program. Virginia expects a documented, ongoing process for detecting, analyzing, and preventing errors, and licensees have reporting duties - to the patient and prescriber, to DEA for controlled substance loss, and to the Board for specified events.
Traps
- Counseling delegated to a technician without pharmacist involvement.
- No documentation of a patient's refusal.
- Confusing the internal CQI file with mandatory regulatory reporting.
Worked example
A patient picking up a new warfarin prescription says, "I've taken this before, I'm fine." The pharmacist must still offer counseling and document the refusal; a technician's assurance that the patient declined is not enough. If that patient later reports a dosing error that caused hospitalization, the pharmacy reviews it through its CQI program, notifies the prescriber, and determines whether the event triggers a report to the Board or another agency - while any controlled substance discrepancy is reported through DEA channels.