Banner img
Banner img

Patient Counseling Rubric

Part 1 – Introduction and Patient History

Not completed

Completed

Comments

1.Greets patient (hi, hello, handshake, etc.)

0

0.5

 

2.Introduces self (name)

0

0.5

 

3.States title (i.e., student pharmacist)

0

0.5

 

4.Explains purpose of counseling session (best benefits/safety)

0

0.5

 

5.Asks permission

0

0.5

 

6.Confirms patient name

0

0.5

 

7.Confirms date of birth

0

0.5

 

8.Verifies phone number

0

0.5

 

9.Verifies address

0

0.5

 

10.Collects past medical history (medical conditions)

0

0.5

 

11.Verifies patient allergies (drug/environmental/food and reaction)

0

0.5

 

12.Verifies Rx medications

0

0.5

 

13.Verifies OTC medications

0

0.5

 

14.Vitamin use

0

0.5

 

15.Herbal supplement use

0

0.5

 

16.Sample medication use

0

0.5

 

 

Part 2 – Basic Counseling Points

Not completed

Completed

Comments

17.Provides medication name

0

1

 

18.Brand or generic medication

0

1

 

19.Assesses prior knowledge – what did doctor tell you this was for?

0

1

 

20.Provides indication for medication

0

1

 

21.Assesses prior knowledge – how did doctor tell you to take this?

0

1

 

22.Provides dose of medication

0

1

 

23.Addresses dosage form concerns

0

1

 

24.Provides regimen for medication (tailored to patient schedule)

0

1

 

25.Explains anticipated duration of therapy

0

1

 

26.Refill information

0

1

 

27.Assesses prior knowledge – what did doctor tell you to expect about… (side effects/expected results, etc)?

0

1

 

28.Efficacy – What results to expect

0

1

 

29.Efficacy – When to expect results

0

1

 

30.Provides adherence tip

0

1

 

31.Describes missed dose instructions

0

1

 

32.Gives specific time frame for missed doses

0

1

 

33.Common ADRs (provide at least 3)

0    1    2   3

 

34.Severe ADRs

0

1

 

35.Management of ADRs (common & severe ADRs mentioned)

0

1

 

36.Discusses warnings and precautions (pregnancy, alcohol, etc when applicable)

0    1    2    3

 

37.Discusses drug-drug interactions (need to verbalize if none)

0

1

 

38.Other drug interactions (disease/food interactions; skip if none)

0

1

 

39.Where do you store your medications? (give suggestions)

0

1

 

40.Store away from kids/pets

0

1

 

41.Beneficial non-drug activities (diet, exercise, keep appts, etc)

0

1

 

Part 3 – Counseling Session and Communication

Not completed

Completed

Comments

42.Checks for patient understanding (corrects, reinforces)

0

1

 

43.Summarizes key points (at least 3)

0

1

 

44.Probes for questions

0

1

 

45.Identifies/addresses any real or anticipated concerns (anytime)

0

1

 

46.Offers follow-up

0

1

 

47.Uses open ended questions throughout session

0   1   2

 

48.Logical and sequential order used

0

1

 

49.Patient friendly language used (no jargon)

0

1

 

50.Appropriate non-verbal behavior (eye contact, body language)

0

1

 

51.Maintains control and direction of counseling session

0

1

 

52.Professionalism (dress, attitude, communication)

0

1

 

53.Overall presentation style

0

1

 

 

Part 4 – Special Instructions (OPTIONAL SECTION)

Points Awarded

Comments

54.Special Instructions addressed (ex. Eye drops, inhalers, etc)

NOTE: 2 extra minutes will be provided for device counseling

0-10

 

×