Magazine article Drug Topics

Determining When Counsel Is Most Appropriate

Magazine article Drug Topics

Determining When Counsel Is Most Appropriate

Article excerpt

In his book Blink: The Power of Think- ing Without Thinking, Malcolm Gladwell tells how Cook County Hospital in Chicago solved the problem of de- termining which patients with chest pain were really hav- ing a heart attack and which were not and needed only minimum observation. After two years of studying pa- tients with chest pain, the physicians discov- ered that a relatively simple "decision-tree" formula, termed Gold- man's Algorithm after the cardiologist who designed it, was 70 to 95 percent more ac- curate than the standard diagnosis system used by almost every hospital in the United States. It saved time and money, and it got the right patients to ICU more quickly.

I am currently consulting with a board of pharmacy to determine whether and how counseling can be used to reduce medication errors. Because this board of pharmacy is several states away from where I live, I participate in most meetings by conference call. This is sometimes an advantage, because it allows me access to my library during meetings, and I can grab a book if something we are talking about sounds familiar. If I had attended a recent meeting in person, I never would have thought to bring the book Blink with me.

What connected the story of Gold- man's Algorithm to questions involv- ing counseling was the conversation between several of the pharmacists sit- ting at the table. One problem under discussion was, noi surprisingly, "time." We also talked about which errors counsel- ing was most likely to catch. Another topic was which medication errors required the greatest attention, as they would be most likely to result in harm if not caught and the medications were actually taken by the patient. Finally, we discussed what level of counseling might be required to catch certain errors.

The Pharmacists Mutual Claims Study tells us that more than 80 percent of the claims against pharmacies involve cither the wrong dnig or the wrong directions. It was agreed that if counseling could catch this 80 percent of errors serious enough to result in a claim for injury, it was worth figuring out how to make such counseling doable. If time forces us to choose when to counsel, how do we make that decision? The group agreed that the counseling that is most effective for catching most errors is a combination of Show &· Tell and the Indian Health Service counseling techniques, using openended questions to determine what the patient already knows, so the pharmacist can fill in the blanks. …

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