Arkansas Administrative Code › Agency 070 - Board of Pharmacy › Rule 070.00.15-003 - Regulation 9 - Pharmaceutical Care/Patient Counseling

Current through Register Vol. 49, No. 6, June, 2024
09-00
: PATIENT COUNSELING
09-00-0001
- PATIENT INFORMATION, DRUG
		  USE EVALUATION, AND PATIENT COUNSELING
The intent of this regulation is to improve pharmaceutical care
			 by defining basic standards of care. Pharmacy care/pharmaceutical care is
			 defined as the responsible provision of drug therapy for the purpose of
			 achieving definite outcomes that improve a patient's quality of life. These
			 outcomes are:
(1) cure of
		  disease,
(2) elimination or
		  reduction of a patient's symptomatology,
(3) arresting or slowing a disease process,
		  or
(4) preventing a disease or
		  symptomatology.
Pharmaceutical care (clinical pharmacy) involves four major
			 functions on behalf of the patient:
(1) identifying potential and actual
		  drug-related problems,
(2)
		  resolving actual drug related problems,
(3) preventing potential drug-related problems,
		  and
(4) optimizing patient therapy
		  outcomes. It is recognized that the patient might be best served if medication
		  is not provided.
(a) Patient
		  information (profile)
In order to effectively counsel patients, the pharmacist must,
			 through communication with the patient or caregiver, make a reasonable effort
			 to obtain, record, and maintain the following information for each patient. It
			 is recognized that most of this can be obtained using pharmacy technicians and
			 designed forms, etc.
(1) Name,
		  address, telephone number;
(2) Date
		  of birth (age);
(3)
		  Gender;
(4) Medical history
(A) Significant patient health problems known
		  to the pharmacist;
(B) Prescription
		  drug reactions/prescription drug allergies;
(C) List of prescription medications and
		  legend drug administration devices known to the pharmacist.
(5) Transitory patients or
		  situations where the pharmacy will only provide medication one time
In obtaining patient information, if the pharmacist knows or is
			 informed by the patient that this is a one-time situation, the pharmacist may
			 forego the above requirement to record and maintain the information.
(6) Pharmacist comments
(b) Drug use evaluation for new
		  and refill prescriptions
Drug use evaluation or drug utilization review includes the
			 following activities:
(1) The
		  pharmacist shall evaluate the prescription or medication order for:
(A) Reasonable dose and route of
		  administration;
(B) Reasonable
		  directions for use.
(2)
		  The pharmacist shall evaluate medication orders and patient information for:
(A) Duplication of therapy - is the patient
		  taking the same or similar medication(s)?;
(B) Prescription drug-prescription drug
		  interactions;
(C) Proper
		  utilization (over or under utilization);
(D) Known drug allergies.
(3) Drug-drug contraindications as
		  defined by the Board. (Is this medication contraindicated with another
		  medication the patient is taking?)
(4) It is recognized that the ultimate
		  decision to use the medication or not use the medication rests with the
		  physician who has more complete patient information. It is the pharmacist's
		  responsibility to monitor the patient's medication therapy in the areas
		  addressed in this regulation and inform the physician of the suspected
		  problem.
(5) If a problem is
		  suspected and the physician is informed, the pharmacist shall document the
		  process.
(c) Patient
		  counseling.
(1) A pharmacist shall counsel
		  the patient or caregiver "face to face" if the patient or caregiver is in the
		  pharmacy. If not, a pharmacist shall make a reasonable effort to counsel the
		  patient or caregiver;
(2)
		  Alternative forms of patient information may be used to supplement, but not
		  replace face-to-face patient counseling;
(3) Patient counseling, as described herein,
		  shall also be required for outpatients of hospitals and institutions when
		  medications are dispensed on discharge from the hospital or
		  institution.
(4) Patient counseling
		  as described in this regulation shall not be required for inpatients of a
		  hospital or institution where a nurse or other licensed health care
		  professional is authorized to administer the medication. However, the
		  pharmacist shall provide drug therapy counseling it is when professionally
		  deemed to be appropriate and when medications are provided by the pharmacy, and
		  when a pharmacist is on duty and a patient is discharged from the hospital or
		  institution.
(5) The pharmacist
		  shall maintain and make available to all patients appropriate patient-oriented
		  reference materials USP-DI or
Facts and Comparisons Patient Drug
		  Facts
or an equivalent or better publication as determined by the
		  Board.
(6) It is recognized that
		  the ultimate decision to not provide patient counseling rests with the
		  physician. If the physician in specific instances (blanket requests not
		  accepted) requests that information NOT be provided to the patient and gives
		  reason, the pharmacist should honor that request in almost all
		  instances.
(d) "Patient
		  counseling" shall mean the effective communication by the pharmacist of
		  information, as defined in this act to the patient or caregiver, in order to
		  improve therapeutic outcome by encouraging proper use of prescription
		  medications and drug delivery devices.
(1)
		  For original prescription medication orders, (excluding renewed or updated
		  prescriptions the patient has been recently taking) and orders for legend
		  devices, specific areas of counseling shall include:
(A) Name and general description of the
		  medication dispensed, i.e. antibiotic, antihistamine, blood pressure medicine,
		  etc.
(B) Name, general description
		  and directions for use of drug delivery devices, i.e., insulin syringes,
		  morphine pump, etc.
(C) Explanation
		  of route of administration, dosage, times of administration, and continuity of
		  therapy;
(D) Special directions for
		  storage as deemed necessary by the pharmacist;
(E) If the drug has been determined to have a
		  significant side effect by the Board of Pharmacy, the patient shall be properly
		  counseled to the extent deemed necessary by the pharmacist.
(F) When the prescription drug dispensed has
		  a significant side effect, if taken with over-the-counter drugs, the pharmacist
		  should counsel the patient about that interaction. (Example: Coumadin with
		  aspirin)
(G) If the prescription
		  medication is significantly affected by food or diet, the pharmacist should so
		  advise the patient. (Example: tetracycline with milk or food)
(H) The pharmacist shall inform the patient
		  or caregiver that he/she is available to answer questions about medications or
		  general health information.
(2) Refills-On refills the pharmacist shall
		  present the opportunity for the patient or caregiver to ask questions. However,
		  counseling on refills is not required except when needed in the professional
		  judgment of the pharmacist.
(d) Drug interactions - significant side
		  effects
Recognizing that a pharmacist cannot be expected to recognize all
			 possible drug interactions and also recognizing that the pharmacist and the
			 patient do not have time to explain the numerous side effects of drugs, the
			 pharmacy shall maintain a computer program which will identify significant drug
			 interactions. (These are drugs with side effects which may be managed most
			 effectively if the patient is aware of the specific side effect and what to do
			 if it occurs.) The pharmacist in charge will be responsible for assuring that
			 the computer system adequately flags and warns the pharmacist of any occurrence
			 of significant drug interactions or significant side effects. (If a pharmacy
			 was in business before September 1, 1997, and at that time, did not have a
			 computer system, said pharmacy may substitute
Patient Drug
			 Facts
or other drug interaction manuals to reference drug interactions
			 and side effects for effective patient counseling. This method should only be
			 used until such time as the pharmacy acquires an adequate computer program as
			 described in this section.) The pharmacist will be responsible for counseling
			 the patient on these interactions with verbal and, where appropriate, written
			 information. (2/12/91, 2/10/98, 07/15/2004)