Documenting Dialogue on Nonprescription Drugs

by Deanna Laws, B.Sc.Phm.

Pharmacy's role in the delivery of health care services has evolved greatly over the past decade, and so has the software that supports the pharmacist. As you know, the College implemented its new standards of practice for nonprescription drugs on January I of this year. They require you to be available to consult and interact with patients who are seeking information or require assistance when purchasing a nonprescription drug, and to document when you feel that the information pertaining to that sale may be necessary or useful for continuity of care.

The College has endeavoured to be responsive to your comments and concerns throughout the development and implementation of these standards of practice. We heard, at district meetings last fall, that most pharmacists agreed with the concept of documenting information pertaining to the sale of a nonprescription drug for continuity of care, but were adamant that documentation had to be easily incorporated into existing software programs in order to be both meaningful and retrievable.

To this end, the College held a meeting last fall with computer software vendors to ensure that they were aware of the standards of practice for nonprescription drugs and the expectations that would be placed on you, as their clients. In addition, we wanted to determine what each of the vendors had planned to assist you in meeting and maintaining these new standards, and we share the information that was available to us at the time of writing. We have included a short descriptive paragraph including samples of documentation forms and/ or screens (where made available). As per last year's article, vendors have been listed alphabetically.

Pharma Plus developed a manual, pocket-sized documentation form that could fit into the lab coat pockets of pharmacists, as shown in Figure 1. Pharmacists are encouraged to use these forms to document information (pertaining to the purchase of a nonprescription drug at the time of the sale) that they would deem important for later inclusion into the patient's profile. As of January 15, 1997 the software for all Pharma Plus stores was upgraded to allow electronic recording of documented information pertaining to sale of nonprescription drugs directly into patient profiles. In addition to this software upgrade, pharmacies were provided with a video that demonstrated how to access and complete the Pharmacy Care Record, and stressed the importance of documenting pharmacist-patient interactions for both prescription and nonprescription drugs.

For information on the Pharma Plus system, you can call Jackie Stroud at tel: (905) 672-0600.

FIGURE 1.

Date: ___________ Pharmacist: _______________

Patient: OR	Agent:

Patient's Name:  ___________________________________

____________________________________________________

In our system:	Yes: No:

Condition/Problem/Request:
_____________________________________________________

_____________________________________________________

_____________________________________________________

Recommendation: (Product/Referral)

_____________________________________________________

Drug/Strength/Quantity
_____________________________________________________

_____________________________________________________

Specific Comments:
_____________________________________________________

_____________________________________________________

_____________________________________________________

Follow-Up: Date & Time of Day

____/____/____:	_______/_________/_______ [_______]
YY   MM   DD    Morning/Afternoon/Evening  Time

ProPharm Ltd. has developed a computer-generated function to allow the documentation of nonprescription drug counseling. This function is separate and distinct from the standard menu where prescriptions are typically filled. Now pertinent information pertaining to the sale of a nonprescription drug may be recorded directly into the dispensary system, which will track:

• drug to drug allergies
• drug to medical conditions
• drug to drug interactions.

Within the patient profile, a record will be kept of any details of the dialogue that the pharmacist deems relevant, including the action taken by the pharmacist, and/or consultation details.

Another important feature of ProPharm's documentation solution is the system's ability to produce a consultation follow-up report that can be used in further consultations with the patient. Samples of the consultation details screen, and the patient profile are included in Figure 2.

For further information on the ProPharm system, you may call Freda Servinis at tel: (416) 750-4920.

Figure 2.

The KROLL system of documenting dialogue allows pharmacists to access all of its features, both for prescription and non prescription drugs, directly from the one prescription-filling computer screen allows the system to check for drug interactions and allergies in the same way it does when filling a prescription drug. Prescription and nonprescription drugs are entered into separate Rx and nonprescription profiles, which can be viewed either separately or simultaneously by the pharmacist. Non prescription drugs are stored in the system by the same method as that for unfilled prescriptions, so that they do not affect a pharmacy's prescription count or its dollar sales.

A pharmacist's dialogue with the patient and other pertinent information can be documented in several ways. One method is to use the "mandatory counselling screen" developed for initial prescriptions (Figure 3); another is to fill in the freeform comment screen attached to the "Patient Card" (Figure 4). In addition, KROLL has developed a computerized "Pharmacist Intervention Form" that can also be accessed directly from the prescription-filling screen. Here, all pertinent patient data, details of actions taken, follow-up information and results can be documented.

The KROLL system allows for a variety of reports by the pharmacist. These include a follow-up report from the mandatory counselling screen, listings of freeform comments for specified classifications, and a pharmacist intervention form. Another reporting option is a freeform reminder, either to call patients or to otherwise follow up, that is triggered on the required day.

Further information on the KROLL system can be obtained by calling Risa Kay at tel (416) 383-1010 or 1 (800) 263-5876.

(including former Big V stores)

Shoppers Drug Mart pharmacies are using the "Pharmacy Care" screen on the Healthwatch system. It was designed to capture various interventions that the pharmacist might perform. This screen uses codes to identify intervention types and also allows free-form text entry for the pharmacist's comments. The stores that were formerly Big V pharmacies are documenting these purchases in a separate database within the pharmacy system, which is accessible by looking up the patient. The screen captures the drug name, as well as comments in free-form text. Neither system compiles the nonprescription drug information with the rest of the patient's profile, in terms of display, or drug utilization review checks.

In addition, pharmacists have also been provided with pocket-sized pads printed with fields and layouts duplicating those on the "Pharmacy Care" screen, allowing the pharmacist to note required documentation at the time of the interaction. This information may then be entered into the computer system by an assistant at a later, more convenient time. An example of the "Pharmacy Care" documentation form, which mirrors the corresponding computer screen, is shown in Figure 3. Further information on the Shoppers Drug Mart system can be obtained from Brenda Gryfe-Becker at tel: (416) 493-1220.