counseling tips

[pharmasaur]

Hi guys, so I'm an intern at CVS and the pharmacist always asks me to counsel so she can focus on verifying. Anytime someone comes to the consultation window she makes me go there and see what they want. If it's a very specific question I can't answer I'll ask her but otherwise I need to do it. Honestly I'm only a second year student and I've barely learned about any drugs yet (besides brand-generic for top 200 and main indications) sooo, other than reading the sig on the bottle to them I don't know what else to say.

If they're getting an antibiotic I just tell them it's important to finish the bottle to avoid rebound infection or if they're getting vicodin for the first time I tell them it might make them drowsy/avoid driving.

Are there any other very general things I can say that would be helpful?? Just tryin to the best I can with limited knowledge...

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[clarkbar]

Particularly, what kind of "gotcha" questions can a retail pharmacist ask a studnet. Some preceptors like that sort of thing. A list of those would help.

 

[EBT12]

You will become more familiar with the medications with practice. Is it possible to review the new medications prior to them being dispensed to the patient? For example, the pharmacist could tell you when s/he is verifying the new prescription? Then, you would have a chance to look up the information before talking to the patient.

Also, if you are uncomfortable with counseling about medications, talk with the pharmacist. The pharmacist may not know what you have/ have not learned in school.

 

[owlegrad]

Are there any other very general things I can say that would be helpful?? Just tryin to the best I can with limited knowledge...

Well, adherence is important and general enough to use for almost any situation.

I can tell you what I did. I learned general things about the major drug classes and just used that as my talking points for any given med. I would discuss common and/or major side effects and what to do if they occur, how to take the medication, and talk about the importance of their medication. E.G., for a statin I would advise them to take it before bed to help lower cholesterol and if they had music pain to stop taking it and talk to the doctor. If it was a hypertension med I would advise them to watch for signs of dizziness (low blood pressure) and explain the importance of preventing hypertension. For diabetes medications I might discuss the importance of controlling blood sugar and talk about hypoglycemia, among other things.

Don't be afraid to let people know you have to look something up.

I hope you understand that no one here can just give you all the answers for counseling?

 

[owlegrad]

Particularly, what kind of "gotcha" questions can a retail pharmacist ask a studnet. Some preceptors like that sort of thing. A list of those would help.

Haha, there are so many possibilities that a list wouldn't be very helpful IMO. I mean they can ask anything so...just know everything I suppose?

I guess just hope you don't get any of "those" preceptors? I didn't at least.

 

[clarkbar]

Yes, but is there a book or source where one can study up on common retail otc and behind the counter drugs? Im particularly interested in the odd ball questions stickler preceptors ask.

 

[clarkbar]

edit

 

[SoylentGreen]

Try the Handbook of Nonprescription Drugs. Also when you're counseling Vicodin you should mention the possibility of APAP overdose if combining with tylenol, which is also in many cold meds. Check out the patient infomation in facts and comparisons or whatever resource you have available, it will include most of what you need to tell the patient.

It's good that you can feel uncomfortable and clueless now, not in 2 years when you are on your own.

 

[pharmasaur]

Try the Handbook of Nonprescription Drugs. Also when you're counseling Vicodin you should mention the possibility of APAP overdose if combining with tylenol, which is also in many cold meds. Check out the patient infomation in facts and comparisons or whatever resource you have available, it will include most of what you need to tell the patient.

It's good that you can feel uncomfortable and clueless now, not in 2 years when you are on your own.

ohhh yes thanks that's a good point i will bring that up!

 

[pharmasaur]

You will become more familiar with the medications with practice. Is it possible to review the new medications prior to them being dispensed to the patient? For example, the pharmacist could tell you when s/he is verifying the new prescription? Then, you would have a chance to look up the information before talking to the patient.

Also, if you are uncomfortable with counseling about medications, talk with the pharmacist. The pharmacist may not know what you have/ have not learned in school.

I really wish I had time, I got hired for a very busy 24 hour store and I don't have time to do ANYTHING. I don't even talk to the pharmacist more than a "hi" when I walk in because she is constantly on the phone. If I spend >1 min with a patient at pickup, a line of 6-7 people will form....not kidding....

I come across drugs I have never heard of before and I always want to write them down and look them up later, nope no time for that either LOL

 

[pharmasaur]

Well, adherence is important and general enough to use for almost any situation.

I can tell you what I did. I learned general things about the major drug classes and just used that as my talking points for any given med. I would discuss common and/or major side effects and what to do if they occur, how to take the medication, and talk about the importance of their medication. E.G., for a statin I would advise them to take it before bed to help lower cholesterol and if they had music pain to stop taking it and talk to the doctor. If it was a hypertension med I would advise them to watch for signs of dizziness (low blood pressure) and explain the importance of preventing hypertension. For diabetes medications I might discuss the importance of controlling blood sugar and talk about hypoglycemia, among other things.

Don't be afraid to let people know you have to look something up.

I hope you understand that no one here can just give you all the answers for counseling?

I don't counsel on any refills and most ppl on statins/htn meds have been taking it for a long time. But ya, if I get a new person taking those I'll bring those points up. Yeah I'm not looking for all the answers just some quick and easy tips

 

[Digsbe]

I always discuss the dosage instructions, major side effects, and anything to watch out for. I'm just a P2 as well so I'm still learning about drugs, but there are a few I'm comfortable with. Read the sitckers on the bottle if you have time before counselling someone and look up info you need. Repetition in practice is, in my opinion, the best way to learn. The way I remembered things was looking them up before counselling (if I had time) and asking the pharmacist questions I didn't know. If it's their first time getting a bp med or a diabetes med I'll discuss importance of adherance, their disease state, and ask if they have any questions about their disease in general. After a few times of asking the same questions about drugs from the pharmacist or looking it up in databases myself the repetition drills it into my head and I knew it well. At the end of each counselling session I always ask if they have questions or if there is anything I need to clarify. The worst thing you can do though is BS information when you don't know the answer.

 

[Dr Wario]

Just learn the location of the bathroom and where they hide the q-tips and you will be all set.

 

[PharmdA07]

I don't know about your preceptor, but here is what I would do:
-Talk to her to see if she can back you up when people ask you something you don't know. Back in my days, I remembered counseling people and my preceptor stood behind me verifying in front of the computer and if I was stuck with something I'd raise my voice a bit to signal him and he chime in immediately. That was during my schooling intern period; at my paid intern job my preceptor also stood behind me (in close proximity cause his computer is not that far from the counseling windows) and chime in whenever I asked for help. And they taught me to call for them, too in a subtle way such as "you should not eat blue cheese right before taking Levaquin, right David? (raise voice at the end toward David-the preceptor)" and he would chime in
-If it's a 24h store and people are too busy to even answer a nature call, go through the basics only with pt: dosing and frequency, what to take with (food, water, coke, etc.), when to take (qhs, qam-diuretics, etc.), and how to take (avoid what food, can you break/ crush the tabs, mix the liquid with something for peds, etc.) and ADRs (list 1 or 2 majors ones). That's it. I know in school they taught the three questions approach, but that will not be applicable to a busy store. If they ask you things at the end that you don't know, kindly say "I am not really quite sure about that, let me doublecheck with my pharmacist preceptor really quick" and approach your preceptor nicely.
-If you receive no help at all, talk to your preceptor at the end of the work day: kindly ask her for 15 mins and explain your situation and says that you know you need to learn and are doing so studiously but you need some help along the way as you're still not comfortable with everything due to you being P2
-If that doesn't work out, talk to your intern coordinator or school officials.
My two cents

 

[Unchained]

Pharmasaur you must be aware of the nature of the beast at CVS. They are a company which pushes their employees to extreme lengths. If you are not able to reach their metrics they threaten you with termination. Their employees as a result cheat, push the gray area and break the law to meet these metrics. I was witness to this kind of behavior over and over again. If something doesn't feel right then don't do it. Let this pharmacist know you are not comfortable performing these functions yet. If they are a good pharmacist they will understand. If they don't then they are not. Make a stand now. You don't want to end up like them.

 

[BeLikeBueller]

Honestly I'm only a second year student and I've barely learned about any drugs yet (besides brand-generic for top 200 and main indications) sooo, other than reading the sig on the bottle to them I don't know what else to say.

If they're getting an antibiotic I just tell them it's important to finish the bottle to avoid rebound infection or if they're getting vicodin for the first time I tell them it might make them drowsy/avoid driving.

Unfortunately, things probably won't change much until your fourth year. My best advice is, if you have the bottle handy when you counsel, tell them the side effects listed on the auxiliary labels on the bottle and/or the patient leaflet. You can rest assured that if it's important enough to go on the bottle, it's important for you to tell them.

 

[nextyearrx]

I have a question guys,

What would you recommend as a nasal decongestant for patients with hypertension? I know that psedoephedrine containing products are not recommended, so what should I tell them if they are asking for a decongestant?

Should I just tell them nothing is available ??

 

[zelman]

I have a question guys,

What would you recommend as a nasal decongestant for patients with hypertension? I know that psedoephedrine containing products are not recommended, so what should I tell them if they are asking for a decongestant?

Should I just tell them nothing is available ??

Nasacort OTC

 

[vinny808]

I have a question guys,

What would you recommend as a nasal decongestant for patients with hypertension? I know that psedoephedrine containing products are not recommended, so what should I tell them if they are asking for a decongestant?

Should I just tell them nothing is available ??

If their HTN is well controlled and managed, taking 1 or 2 days worth of sudafed should be fine. Depends on the pharmacist though, some pharmacist arent comfortable recommending it. And don't worry, counseling comes with experience. You're starting early as P2. You'll be a pro in no time.

 

[extra07extra]

Not worry. My expereince I just read to them bottle instruction is enough, can save your time.

 

[sosoo]

as ur preceptor had mentioned, if its something u dont know ask her. so if that something means everything, then ask the pharmacist each and every time a customer has a question. your best way to learn is to relay those counseling questions to the pharmacist, and standby to listen to the response.

 

[sunakuma]

I was about to create a new thread asking for tips and advices on how to approach counseling in retail, especially busy ones, and I found this tread.

My question is:
I am P4 and still have difficulty in counseling patient in retail despite of my work experience (often act as a cash clerk at the drive through). My preceptor now try to let me counsel each new medication to patient, regardless of refill or not. I am just not sure how to tell patient that I need to look up information before I talk to them about their medication, wouldn't that make them lost trust on you (Patient think: what? you don't know this medications and have to look up stuff before talk to me about them?).

At work my computer is right in front of the register and I can look up stuff before I ring them up (patients won't know what I am checking...) But on rotation now it is a different setting, the computer is not really right there in front of the register, and if I need to look up stuff I will have to step aside, which I need to tell patients why...isn't this weird?

How long should one spend the time on looking up information to counsel on a Rx? For REMS med, for some less common medicine, or medicine you have not heard of, how do you approach looking things up? (Say the Rx is already filled before you got there, patient just picking them up now and you have no chance of learning it ahead of the encounter).

I am also confused about what is too much to tell patient. I have preceptors told me they don't talk about suicidal thoughts when counseling SSRI, but also have preceptor say it out straight " there is a risk of having suicidal thoughts for this class of medication on adolescent and young adult".

Also another example is cipro. Black box warning of tendonitis. A preceptor of mine said he won't mention this as it may scare patient, only mention if patient is elderly, and warm them not to over exercise while taking it and call dr if any sore/weakness and pain of tendon/joint.

I have patient picking up about 10-15 new Rx, and it is crazy...I don't want to rush through each one, but also don't want to overwhelm the patient. I doubt the patient remember half of what I told him. Even myself lost track on what I had told him. I just tell pt at the end " I know it's a lot of information to take, but those information are in the papers, make sure to read them over when you got a chance and call us if have any questions." How should we approach situation like this? Do you go easier (more brief) on each Rx, or keep it the same length? I think pt always give me the blank stare if I go in a bit lengthy when there are >3 Rx.

My preceptor is always nearby and chim in whenever he feel appropriate or when I ask for help. But I feel very incompetent always have to step aside and look up or ask for help.

Sorry for the long and unorganized post, tired from a long work day.

 

[zelman]

I was about to create a new thread asking for tips and advices on how to approach counseling in retail, especially busy ones, and I found this tread.

My question is:
I am P4 and still have difficulty in counseling patient in retail despite of my work experience (often act as a cash clerk at the drive through). My preceptor now try to let me counsel each new medication to patient, regardless of refill or not. I am just not sure how to tell patient that I need to look up information before I talk to them about their medication, wouldn't that make them lost trust on you (Patient think: what? you don't know this medications and have to look up stuff before talk to me about them?).

At work my computer is right in front of the register and I can look up stuff before I ring them up (patients won't know what I am checking...) But on rotation now it is a different setting, the computer is not really right there in front of the register, and if I need to look up stuff I will have to step aside, which I need to tell patients why...isn't this weird?

How long should one spend the time on looking up information to counsel on a Rx? For REMS med, for some less common medicine, or medicine you have not heard of, how do you approach looking things up? (Say the Rx is already filled before you got there, patient just picking them up now and you have no chance of learning it ahead of the encounter).

I am also confused about what is too much to tell patient. I have preceptors told me they don't talk about suicidal thoughts when counseling SSRI, but also have preceptor say it out straight " there is a risk of having suicidal thoughts for this class of medication on adolescent and young adult".

Also another example is cipro. Black box warning of tendonitis. A preceptor of mine said he won't mention this as it may scare patient, only mention if patient is elderly, and warm them not to over exercise while taking it and call dr if any sore/weakness and pain of tendon/joint.

I have patient picking up about 10-15 new Rx, and it is crazy...I don't want to rush through each one, but also don't want to overwhelm the patient. I doubt the patient remember half of what I told him. Even myself lost track on what I had told him. I just tell pt at the end " I know it's a lot of information to take, but those information are in the papers, make sure to read them over when you got a chance and call us if have any questions." How should we approach situation like this? Do you go easier (more brief) on each Rx, or keep it the same length? I think pt always give me the blank stare if I go in a bit lengthy when there are >3 Rx.

My preceptor is always nearby and chim in whenever he feel appropriate or when I ask for help. But I feel very incompetent always have to step aside and look up or ask for help.

Sorry for the long and unorganized post, tired from a long work day.

In a rush, just go over the SIG on the label and explain the auxiliary warnings to make sure they can understand what is printed on the bottle. If you have more time, add in what to expect, how severely and in what time frame (both ADR and benefits). That will cover most on-the-spot counseling. If someone really wants to have an in-depth conversation you can add more and have them repeat key things back to you, but that will be a rarity in retail.

Also, don't mention things that the patient can't do anything about. If you tell everyone with a 3 day cipro Rx for a UTI that it can cause torsades, you are doing them a disservice.

 

[Twentytwelve2]

By law you are only required to counsel 4 things:
1. how to take it
2. importance of compliance
3. common severe side effects
4. how to store the med

anything else is extra

 

[Wickett]

Hi guys, so I'm an intern at CVS and the pharmacist always asks me to counsel so she can focus on verifying. Anytime someone comes to the consultation window she makes me go there and see what they want. If it's a very specific question I can't answer I'll ask her but otherwise I need to do it. Honestly I'm only a second year student and I've barely learned about any drugs yet (besides brand-generic for top 200 and main indications) sooo, other than reading the sig on the bottle to them I don't know what else to say.

If they're getting an antibiotic I just tell them it's important to finish the bottle to avoid rebound infection or if they're getting vicodin for the first time I tell them it might make them drowsy/avoid driving.

Are there any other very general things I can say that would be helpful?? Just tryin to the best I can with limited knowledge...

If you study the top 200 drug cards and note the patterns/major counseling points for those, you're ahead of the game. For less common meds, look at the leaflet and/or take a quick look at lexicomp before walking up to counsel. It's OK not to know everything, esp as a P2. I am a practicing PIC and I still have to pause and review meds from time to time before talking about them to a patient.

 

[lord999]

Hi guys, so I'm an intern at CVS and the pharmacist always asks me to counsel so she can focus on verifying. Anytime someone comes to the consultation window she makes me go there and see what they want. If it's a very specific question I can't answer I'll ask her but otherwise I need to do it. Honestly I'm only a second year student and I've barely learned about any drugs yet (besides brand-generic for top 200 and main indications) sooo, other than reading the sig on the bottle to them I don't know what else to say.

If they're getting an antibiotic I just tell them it's important to finish the bottle to avoid rebound infection or if they're getting vicodin for the first time I tell them it might make them drowsy/avoid driving.

Are there any other very general things I can say that would be helpful?? Just tryin to the best I can with limited knowledge...

I take the attitude that they're (the patient or the caretaker is picking it up) sick, they're tired, they wanna go home, and you're the one preventing them from doing so. Pick one to at most three really critical points about each drug dispensed. The judgment that you focus on is based on your read of patients:

Example - Metronidazole
1. "Don't drink EtOH with this, you'll probably be vomiting afterwards."

Patient you know is getting birth control:
2. "This is probably going to make your birth control worthless this cycle, use other protection."

Yes, this is patient profiling, but against what the IHS counseling techniques are, you have to really give a targeted message in order for the patient/caretaker to remember anything at all. The patient insert is for them to read. Long spiels are just purged like pharmacology lectures.

I would normally target around 20 seconds per drug (short elevator conversation mentality). But, use your read of patients and judgment to figure out what needs to be said and what needs to be left alone. There is a such a thing as too much information. The repeated matter that I have to chew out new residents and clinical pharmacists about is overdocumenting such that no one reads your note (and I can tell through our metrics). Getting better in patient communication should build the patient confidence that they can ask you questions while communicating the absolute "do not screw up" essentials to them. That's not easy, and it'll take some practice .

 

[CetiAlphaFive]

Hi guys, so I'm an intern at CVS and the pharmacist always asks me to counsel so she can focus on verifying. Anytime someone comes to the consultation window she makes me go there and see what they want. If it's a very specific question I can't answer I'll ask her but otherwise I need to do it. Honestly I'm only a second year student and I've barely learned about any drugs yet (besides brand-generic for top 200 and main indications) sooo, other than reading the sig on the bottle to them I don't know what else to say.
If they're getting an antibiotic I just tell them it's important to finish the bottle to avoid rebound infection or if they're getting vicodin for the first time I tell them it might make them drowsy/avoid driving.

Are there any other very general things I can say that would be helpful?? Just tryin to the best I can with limited knowledge...

Honestly, the single most important piece of advice I can give you is to develop your listening skills.
And don't just listen with your ears.

I've caught pyelonephritis that urgent care missed, and a buddy of mine sent someone to the ER from his counsel window with appendicitis.

It's scary, but you're likely doing a good job.

Learn to think of meds by class, and that's a good start.

 

[CetiAlphaFive]

I was about to create a new thread asking for tips and advices on how to approach counseling in retail, especially busy ones, and I found this tread.

My question is:
I am P4 and still have difficulty in counseling patient in retail despite of my work experience (often act as a cash clerk at the drive through). My preceptor now try to let me counsel each new medication to patient, regardless of refill or not. I am just not sure how to tell patient that I need to look up information before I talk to them about their medication, wouldn't that make them lost trust on you (Patient think: what? you don't know this medications and have to look up stuff before talk to me about them?).

At work my computer is right in front of the register and I can look up stuff before I ring them up (patients won't know what I am checking...) But on rotation now it is a different setting, the computer is not really right there in front of the register, and if I need to look up stuff I will have to step aside, which I need to tell patients why...isn't this weird?

How long should one spend the time on looking up information to counsel on a Rx? For REMS med, for some less common medicine, or medicine you have not heard of, how do you approach looking things up? (Say the Rx is already filled before you got there, patient just picking them up now and you have no chance of learning it ahead of the encounter).

I am also confused about what is too much to tell patient. I have preceptors told me they don't talk about suicidal thoughts when counseling SSRI, but also have preceptor say it out straight " there is a risk of having suicidal thoughts for this class of medication on adolescent and young adult".

Also another example is cipro. Black box warning of tendonitis. A preceptor of mine said he won't mention this as it may scare patient, only mention if patient is elderly, and warm them not to over exercise while taking it and call dr if any sore/weakness and pain of tendon/joint.

I have patient picking up about 10-15 new Rx, and it is crazy...I don't want to rush through each one, but also don't want to overwhelm the patient. I doubt the patient remember half of what I told him. Even myself lost track on what I had told him. I just tell pt at the end " I know it's a lot of information to take, but those information are in the papers, make sure to read them over when you got a chance and call us if have any questions." How should we approach situation like this? Do you go easier (more brief) on each Rx, or keep it the same length? I think pt always give me the blank stare if I go in a bit lengthy when there are >3 Rx.

My preceptor is always nearby and chim in whenever he feel appropriate or when I ask for help. But I feel very incompetent always have to step aside and look up or ask for help.

Sorry for the long and unorganized post, tired from a long work day.

I hate to be rude, but it sounds like you have a pretty large knowledge deficit.

Your 4th year is for learning, so it's time to kick it into high gear.

Your preceptors are flat out wrong about a couple things:

1.)
"Scaring" the patient is not a reason to ignore or omit important information.
While we won't get dinged by the board for failing informed consent, I can't imagine not doing it.
There is more than one way to communicate.

"Your Achilles tendon may rot off and explode while you're on this ____oxacin"
Vs.
"If you develop any unusual pain in your ankles or wrists while taking this, or get any numbness or tingling, hold off on the next dose and call me or the doctor"

2.) Anti depressants do not cause spontaneous suicidal ideation.
There is no reason or any literature that supports this misconception.

Counsel them that a patient with a history of suicidal thoughts is at risk.


Anyway, like I said, that's what P4 is for.

Take advantage of these two semesters.