Teaching: To involve or not to involve pharmacy
Teaching: To involve or not to involve pharmacy
Determining when a pharmacist's help is needed
It is often difficult to make medication teaching an interdisciplinary process. Pharmacy departments just don't have the staff to provide education for every patient. Yet when the Joint Commission comes to conduct its accreditation survey at your institution, the surveyors will want to know how pharmacy is incorporated into patient education.
There is no single method to involve pharmacy in teaching. Therefore, patient education managers at each health care facility must work with pharmacies to determine when it is necessary to involve a pharmacist directly in the teaching process.
Pharmacists at Homestead (FL) Hospital, for example, teach patients about new medications their physicians prescribe for them and step in when patients are admitted to the hospital because of noncompliance with their medication regimen. They also teach if the patient requests a pharmacist.
"We have interdisciplinary rounds each morning, and during that time, the nurse will tell the pharmacist present when a patient is on a new medication or is having problems with compliance," says Marie Ade, RPH, director of pharmacy at Homestead Hospital.
Other hospitals give nursing staff more authority. The nurse doing the teaching at St. Joseph's Hospital of Atlanta determines when pharmacists participate in the education. Pharmacists are usually called when a patient is on several medications or on a complicated regimen that requires the patient to take medications at varying times to avoid drug-drug or drug-food interactions, says Anthony Compton, PharmD, coordinator of clinical pharmacy services at St. Joseph's.
At other times, the nurse might call the pharmacist if the patient seems confused or does not understand the information. The nurse is the best person to make the decision because he or she develops a relationship with the patient, explains Compton. The nurse becomes familiar with the patient's level of understanding, education level, and stress factors at home. "When a nurse determines that a patient needs more precise, in-depth information, he or she can call the pharmacy and ask a pharmacist to teach," he says. (For information on the best teaching methods for medication education, see story, p. 76.)
Creating education materials
While pharmacists are rarely the primary teachers for medication education, they are invaluable in the development of patient education materials and teaching protocols.
At Deborah Heart & Lung Center in Browns Mills, NJ, pharmacists serve as content experts for materials that contain medication information, specific guidelines for teaching about medications, and policies on medication teaching.
"At Deborah, medication instruction is done mostly by the nurses for both inpatients and outpatients. It would be ideal if a pharmacist could see patients prior to discharge to explain their meds. However, we don't have pharmacists available to do this at our hospital," says Nell Kapeghian, MSN, RN, patient education coordinator at the institution.
Patients at Deborah Heart & Lung Center are taught about their medications when they are first administered. At that time, they also receive medication information cards and a wallet to hold them. The cards are produced by Identa-Drug System in Camp Hill, PA. (For more information on the cards, see source box, above right.)
In conjunction with nursing, the pharmacy department at South Miami (FL) Hospital identified 100 of the top drugs prescribed to patients and created a teaching sheet in lay terminology. Now, 25 sheets in each category are printed in tablet form by the hospital's graphics department and kept in alphabetical order in a box on every nursing unit. "Nurses can use the sheets as a teaching guide and also give the sheet to patients to review later," says Raysa Gutierrez, PharmD, director of pharmacy at the hospital.
Because of South Florida's large Hispanic community, one side of each sheet is printed in Spanish, the other side in English. Information on the sheet includes the purpose for taking the drug, basic side effects, drug-drug and drug-food interactions, and instructions on what a patient should do if a dose is missed.
When a nurse needs information on a drug that is not in the file, he or she calls the pharmacy, and the information is printed from the computer. "We have a pharmacy messenger, so we send the material via the messenger. That way, the nurse has a clean, crisp copy rather than a fax copy," says Gutierrez.
Computer assists nursing staff
A computer system at St. Joseph's generates information sheets on medication. Before a nurse administers a new medication, he or she prints a sheet for the patient and begins teaching about the drug. In addition to general information on the use of the drug, each sheet has prominent statements about the significant side effects and instructions on what to do based on the severity of the unwanted effect.
For example, if a patient has a mild rash, he or she would call their doctor when convenient; however, if the side effect were shortness of breath, the patient is instructed to call 911.
"The FDA approval process has been shortened; therefore, we may have situations where drugs are coming to market before they are used on a wide variety of patient populations, so it is very important for patients and other health care providers to really understand the importance of looking for side effects," says Compton.
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