Patient Family Centered Care Competency
Integrated Basic Scenario Inpatient Pharmacist Discharge
Counseling Encounter
Employee Name: _____________________________
EMPLID: ____________________________________
Title: _______________________________________
Unit: _______________________________________
Date: _______________________________________
HOW COMPETENCY IS MEASURED
A. Simulation/Mock Event
B. Observation
Scenario: A 60 yr old male has been admitted with abdominal pain. He had a bowel resection with
complications during his stay. He is now scheduled to go home and will have home health visits to assist
with dressing changes. The Pharmacist is coming to his bedside to do discharge counseling on his
medications. (Please see attachment.)
Critical Elements Critical Elements
Validated
(Staff can self assess by checking boxes to the left of each element)
(how measured—dateinitials)
1. 
2 ACKNOWLEDGES the patient by smiling and calling out his name, giving good
. eye contact:




2.





3.


4.






Ask the patient for their PREFERRED NAME.
INTRODUCES self and manages up own skill set. Explains who they are, what
their position is, and why they are there.
USES HAND GEL OR WASHES HANDS says “I am using hand gel for your
safety and mine.
USES KEY WORDS AT KEY TIMES: I am closing the curtain or door for your
PRIVACY
CHECK AND CONFIRM PATIENT identification: Ask them to state their name
and birth date. Let patient know you are checking this for their SAFETY (Key
Word) to assure get the right information in the right patient’s record.
DURATIONS: Lets patient know how long the encounter will take and what will
be done with the information.
EXPLANATION: Explain what you will be doing.
LETS THE PATIENT ASK QUESTIONS: What questions do you have before
we get started?
MANAGES UP: (Physician, nursing staff, pharmacists, other care
providers, etc)
I am reviewing your medications for your SAFETY and to help you understand
what you are taking, why you are taking it, how often and how much you are
taking, when to take, and any side effects you should watch for.
COMPLETE THE MEDICATION COUNSELING ON DISCHARGE
MEDICATIONS. emphasize medications that are different from admission
medications
Ask if there is anything else he/she can do for them before ending the
interaction.
Encourage the patient to use the Questions for the doctor NOTEPAD in the
room to write down any questions that he/she has for his doctor, or other staff.
THANK YOU: Thank the patient for their time
Expresses appreciation to them for their cooperation and communication
ASKS: “Would you prefer I leave your door open or close it for your PRIVACY
(KEY WORD?”
USES HAND GEL OR WASHES HANDS
Employee Name: ___________________________EMPLID: ____________________________
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_______ COMPETENCY DEMONSTRATED
_______ ACTION PLAN REQUIRED
VALIDATOR_________________________________________________ DATE___________________________
VALIDATOR_________________________________________________ DATE___________________________
VALIDATOR_________________________________________________ DATE___________________________
VALIDATOR_________________________________________________ DATE___________________________
Comments:
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Additional Information for the Pharmacist Scenario
Allergies:
sulfa (itchy rash)
Weight:
110 kg
HbA1C on admission: 10.2%
SCr on admission 1.1 mg/dL, 1.3 mg/dL on day of discharge
PMH per medical record:
DM Type 2, onset 15 years ago – managed by primary care practitioner
Medications Patient was taking at home prior to admission:
Lisinopril 20 mg po daily
aspirin 325 mg po daily
ginko biloba, unknown dose
insulin 70/30, 40 units subcue with breakfast and 30 units subcue with supper
Medications on Discharge
Lisinopril 20 mg, 1 tab po daily
aspirin 325 mg, 1 tab po daily
Insulin glargine 35 units subcue qhs
Insulin aspart 15 units tid with meals
Amoxicillin/clavulanic acid 875mg/125mg, 1 tablet q12hrs x 10 days
Oxycodone / acetaminophen 5/325 mg, 1-2 tablets q 6 hours prn pain
Docusate sodium 100 mg, 1 tablet po bid until no longer taking pain pills
Bisacodyl 10 mg, 1 tablet by mouth daily until no longer taking pain pills
According to Resident Physician’s Discharge Orders and Instructions:
 follow up with general surgery clinic in two weeks
 scheduled for diabetes education class AND endocrine clinic appointment in three weeks
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