Arkansas Administrative Code › Agency 007 - ARKANSAS DEPARTMENT OF HEALTH › Division 33 - Division of Health Related Boards and Commissions › Rule 007.33.21-010 - RULE 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 underutilization);
(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)