657—6.14 (155A) Patient counseling and instruction.
	 6.14(1) Counseling required. Upon receipt of a new prescription drug order and following a prospective drug use review pursuant to 657—8.21(155A), a pharmacist shall counsel each patient or patient’s caregiver. An offer to counsel shall not fulfill the requirements of this rule. Patient counseling shall be on matters which, in the pharmacist’s professional judgment, will enhance or optimize drug therapy. Appropriate elements of patient counseling may include:
	  a.   	 The name and description of the drug;
	  b.   	 The dosage form, dose, route of administration, and duration of drug therapy;
	  c.   	 Intended use of the drug, if known, and expected action;
	  d.   	 Special directions and precautions for preparation, administration, and use by the patient;
	  e.   	 Common severe side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur;
	  f.   	 Techniques for self-monitoring drug therapy;
	  g.   	 Proper storage;
	  h.   	 Prescription refill information;
	  i.   	 Action to be taken in the event of a missed dose;
	  j.   	 Pharmacist comments relevant to the individual’s drug therapy including any other information peculiar to the specific patient or drug.
	 6.14(2) Instruction. A pharmacist may instruct patients and demonstrate procedures for self-monitoring of medical conditions and for self-administration of drugs.
	 6.14(3) Counseling area. A pharmacy shall contain an area which is suitable for confidential patient counseling. Such area shall:
	  a.   	 Be easily accessible to both patient and pharmacists and not allow patient access to prescription drugs;
	  b.   	 Be designed to maintain the confidentiality and privacy of the pharmacist/patient communication.
	 6.14(4) Oral counseling not practicable. If in the pharmacist’s professional judgment oral counseling is not practicable, the pharmacist may use alternative forms of patient information. “Not practicable” refers to patient variables including, but not limited to, the absence of the patient or patient’s caregiver, the patient’s or caregiver’s hearing impairment, or a language barrier. “Not practicable” does not include pharmacy variables such as inadequate staffing, technology failure, or high prescription volume. Alternative forms of patient information may include written information leaflets, pictogram labels, video programs, or information generated by electronic data processing equipment. When used in place of oral counseling, alternative forms of patient information shall advise the patient or caregiver that the pharmacist may be contacted for consultation in person at the pharmacy by toll-free telephone or collect telephone call. A combination of oral counseling and alternative forms of counseling is encouraged.
	 6.14(5) Exception. Patient counseling, as described above, shall not be required for inpatients of an institution where other licensed health care professionals are authorized to administer the drugs.
	 6.14(6) Refusal of consultation. A pharmacist shall not be required to counsel a patient or caregiver when the patient or caregiver refuses such consultation. A patient’s or caregiver’s refusal of consultation shall be documented by the pharmacist. The absence of any record of a refusal of the pharmacist’s attempt to counsel shall be presumed to signify that the offer was accepted and that counseling was provided.