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Staff in the Department of
Pharmaceutical Care employ numerous methods for teaching
patients about how to properly use their medications. Patient
instruction occurs with routine discharge counseling by a
pharmacist, with prescription services received through the
Ambulatory Care Pharmacies, with pharmacist consultation
received by patients in designated ambulatory care clinics,
through the provision of group or one-on-one patient education
classes in the inpatient setting, and through pharmacist
interactions which occur in the Anticoagulant Case Management
Service.
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Discharge Counseling.
Once
a patientŐs discharge prescriptions have been written, the
patient has the option to have medication counseling
performed by the pharmacist in his / her room at bedside.
Discharge counseling may be performed by either a
satellite-based or patient care unit- (PCU) based clinical
pharmacist. During the counseling session, the pharmacist
reviews with the patient what the medication is used for;
how to properly take the medication; and potential side
effects that may occur. This is performed through the use of
open-ended questioning. Each patient is also given
medication information brochures which describe the
medication, its use, and common potential side effects.
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Ambulatory Care Pharmacy.
Pharmacists
in the Ambulatory Care Pharmacies interact with all patients
who request prescription service in order to provide
education and informational services. Counseling is
interactive. Pharmacists ask open-ended questions to
evaluate the patientŐs understanding of his/her medications.
Verification processes test the patientŐs ability to
safely administer less commonly used dosage forms (e.g.,
oral or nasal inhaler devices). Information reviewed with
patients includes: name and strength of the medication,
description of the drug, the medicationŐs indication for
use, instructions for administration, expectations regarding
the specific therapy, potential adverse reactions, warnings
and precautions, and proper storage of the medication.
Counseling may be augmented with tools such as written
medication information, medication administration calendars,
and/or training devices or pictures.
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Formal Medication Instruction.
In addition to patient-specific
counseling provided by a pharmacist to patients who are
discharged from the hospital on home medication therapy, the
Department of Pharmaceutical Care also provides formalized
medication instruction to targeted patient populations who
require it. These groups are generally comprised of patients
with serious medical conditions that make appropriate
medication usage vital to their successful medical
treatment.
Patients may be instructed in
groups (in a traditional classroom setting), or they may
receive lengthy one-on-one training with a pharmacist who is
specialized in a particular area of drug therapy. In either
case, the instruction is intended to make the patient
extremely knowledgeable about his / her medication therapy
and reduce the incidence of future hospitalizations because
of medication misuse or noncompliance.
Specialized patient instruction is
provided to the following patient groups: Cancer
Chemotherapy, Medical Cardiology, Internal Medicine /
Geriatric / Digestive Diseases, Pediatric
Hematology-Oncology / Bone Marrow Transplantation, Adult
Bone Marrow Transplantation, Solid Organ Transplantation,
Psychiatric Disorder, and Pulmonary.
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Financial Counseling.
The Ambulatory Care
Pharmacies have a pharmacist financial counselor available on weekdays
from 8:00 a.m. until 5:00 p.m. to work with patients who may be having
difficulties paying for their medications. That pharmacist will help
patients understand what resources might be available to them to help
cover the cost of prescription medications. For example, the pharmacist
might suggest the patient be screened by social services to see if he or
she qualifies for any public aid. The pharmacist also communicates with
prescribers to suggest less expensive but equally effective medications,
or might also suggest one of several medication assistance programs available
for specific medications the patient is taking. The pharmacist financial
counselor is located in the Pomerantz Level 2 Ambulatory Care Pharmacy and
can be reached at 319-384-6907.
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Anticoagulation Case Management
Service (ACMS). The
Anticoagulation Case Management Service was developed to
maximize patient care for patients requiring anticoagulant
therapy. By monitoring clinical responses and providing
ongoing patient education, the program prevents unnecessary
adverse drug effects associated with warfarin therapy. The
goals of this service are threefold: 1) effectively manage
patientsŐ anticoagulation therapy, 2) reduce the
occurrence of adverse patient outcomes, and 3) lower total
healthcare expenses.
A major focus of the ACMS is to
carefully review all drug therapy with each patient in order
to prevent drug-drug interactions which can adversely affect
the patientŐs therapy and underlying condition. Several of
the interactions associated with warfarin include commonly
used drugs such as acetaminophen and cimetidine, which can
be purchased without a prescription, without the involvement
of a member of the health care team, and without the patient
education necessary to prevent an adverse effect from
occurring.
Patients referred to and followed
by the Anticoagulation Case Management Service at the University of Iowa Hospitals and Clinics receive
individualized comprehensive monitoring and management of
their anticoagulant therapy. The indication, duration, and
intensity of anticoagulation for each patient is initially
established with the patientŐs physician based on the
latest guidelines for antithrombotic therapy from the
American College of Chest Physicians. Following the initial
patient assessment, patients are then referred to the ACMS
and scheduled for follow-up visits as appropriate. During
each visit, patients are assessed for signs and symptoms of
thromboembolism and hemorrhage. Drug and diet therapies are
assessed to evaluate drug-drug, drug-food, and drug-disease
state interactions which may affect the patientŐs
anticoagulant therapy. When indicated, a lab test (i.e., INR)
is ordered to assess the patientŐs level of
anticoagulation. Based on the clinical pharmacistŐs
evaluation of drug and diet therapies, medical conditions,
and the level of anticoagulation, the patientŐs
anticoagulant therapy is adjusted to maintain the level of
anticoagulation in the optimal range.
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