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Patient Counseling
• Whentoseekhelpiftheyarecausingproblems?
• Howlongtowaitbeforereportingnochangeinsymptoms?
• Howtostorethemedicine?
• Theexpirydate
• Thecostofthemedicine.
• Howtohaveyourprescriptionrefilled,ifnecessary?
• Necessitytocompletethecourse.
• Drug–druginteractionor/bothdrug–foodinteractions.
• Supplymedicationreminderchart.
Issues regarding Manner:
• Uselanguagethatthepatientunderstands.
• Useappropriatecounselingaids.
• Presentfactsandconceptsinsimplewordsandinlogicalorder.
• Useopenendedquestions.
3. Conclusion
1. Verifythepatientcompliancebymeansoffeedback.
2. Summarizebyemphasizingkeypoints.
3. Giveanopportunitytothepatienttoputforwardanyconcerns.
4. Help the patient to plan follow-up.
ROLE OF PHARMACIST IN PATIENT COUNSELING
The importance of Pharmacy is not new to healthcare system. The role of the pharmacist
is very vital in this regard. A pharmacist’s first job is to dispense the medication to
the patients and make sure that he/she takes absolute attention to give the dosage
instructions to the patient. The role goes well beyond dispensing—means “patient
counseling”.
Patient counseling improves the quality of life of the patients, who are suffering from
different or multiple ailments like diabetes, hypertension, hyperlipidemia, osteoporosis,
psychiatric disorders etc. A pharmacist is the first person for patients to give advice on
many common medical conditions that patients have. Be it simple headache, common
cold or cramps in the abdomen, a pharmacist is the first choice and it is economical too
for patients. Instead of paying a hefty fee to a doctor, people generally seek the advice
of a professional pharmacist. He should be trustworthy, compassionate, affordable
and available to be called a medical messiah. He should be a good judge to determine
as to when a patient having seemingly ordinary medical conditions should seek the
doctor’s advice. This is very vital to prevent the condition of the patient becoming
complicated.
Patients with multiple ailments have to take different types of medications at different
times during the day and sometimes the time of taking medicines fall concurrently. This
poses a real challenge or threat to a patient if not guided properly by the pharmacist.
This can prevent drug interaction. This interaction can cause the variation of the serum
level of these medicines leading to hazardous effect to the patients. For example,
barbiturates, antidepressants, are potent enzyme inducers, which mean that they
induce the liver enzyme activity and thus increase metabolism of the medicines taken
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Textbook of Pharmacy Practice
concurrently with them. The result is increased and rapid excretion of the concurrently
taken medicine from the patient’s body and hence reduced efficacy. In this case the
patient might need increased dose of such medications or their medical condition may
get uncontrolled. On the other hand, we have drugs that inhibit the metabolism of other
medications by inhibiting the liver enzymes. The result is slowed down metabolism
of such medicines and increased serum levels and hence, increased pharmacological
activity of the concurrently taken medicine and the resulting drug toxicity. Antifungal
drugs are a good example of enzyme inhibitors, which inhibit the metabolism of other
co-administered drug. Patient may need dose adjustment to counter such hazardous
effect. Such occurrences may go unnoticed and pharmacist counseling can close these
loopholes.
Elderly patients with multiple ailments, who are on multiple medications may also
be benefitted by pharmacist counseling. For diabetic patients a pharmacist can educate
the patients about the proper use of insulin and a glucometer. Pharmacist can take
the medical history of the patient and the details of the medicines taken by him. Then
guide the patient as to how to take the medicines correctly and whether any medicines
prescribed to him by the doctor are interacting with each other or whether the dosage
of any medicines taken by him need to be adjusted.
Diabetic patients suffer from oral thrush, skin dryness, and burning sensation
especially lower limbs. A pharmacist is in better position to guide the patient to take care
of the oral hygiene and impress the importance of maintaining a good oral hygiene. He
can suggest the patient to visit a dentist for better dental care to prevent complications.
The pharmacist can recommend some topical over the counter (OTC) applications to
combat dryness and burning sensation of the skin. These simple but important tips to
the patient prove to be of great relief.
Smoking certainly poses a risk to the patients since tobacco smoke interacts
with the active ingredients of certain medicines through pharmacodynamic or
pharmacokinetic mechanisms that may result in decreased therapeutic efficacy of
various medicines like oral contraceptives, benzodiazepines and some cardiovascular
drugs like beta blockers, etc. This is particularly important for those patients who
have existing medical history of cardiac problems like severe angina, congestive
heart failure, stroke, severe arrhythmias, uncontrolled hypertension, gastric ulcers,
and in pregnant women. A pharmacist can guide the patients through various non-
pharmacological methods along with some OTC products available in the pharmacies
to help them quit smoking. They can also encourage them to see some counseling
centers for smoking cessation.
To sum it up, patient counseling is a very important subject that needs to be
encouraged, organized and incorporated into the overall pharmacy practice for the
benefit of the people.
Communication Skills in Patient Counseling
Communication is the exchange of information, ideas, thoughts and feelings. It involves
not just the spoken words, but also what is conveyed through inflexion, vocal quality,
facial expression, body posture and other behavioral processes. Effective communication
with patients depends greatly on the degree of empathy demonstrated in the course
of conversation. Pharmacist should use proper verbal and non-verbal communication
skills during the counseling session. It has been observed that effective patient
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Patient Counseling
counseling significantly reduces patient non-adherence, treatment failure, and wasted
health resources. To be a good communicator, pharmacist must be in tune to the types
of questions asked, the manners in which questions are asked, and the avoidance of
repetition. The counseling pharmacist should be well dressed so that the patient feels
the pharmacist is a professional. The nature of the counseling should be tailored to the
patient population. A good counselor is one, who listens to the patient carefully and
shares the problems intimately so that the patient expresses the emotions underlying
the disease. During counseling pharmacist should be totally involved in the counseling
and should not be half minded. For example, even attending a telephone call during
counseling the patient can affect the quality of counseling. An effective counseling will
end up with several questions being asked by the patient. Throughout the counseling
process, the pharmacist should avoid jargons and slang expressions.
Patient Counseling: A Growing Need in Chronic Illness
Unlike acute illness, where the patient get himself treated at an ambulatory care centre
or admits himself for a short period in the hospital, the chronic illness require hospital
stay, self-monitoring, follow-up, lifelong drug therapy, non-pharmacological measures
and several lifestyle modifications.
It is well known that the most prevalent chronic illnesses are strongly linked to
specific behaviors such as smoking, diet, sedentary lifestyle, intravenous drug abuse,
etc. Prevention and effective treatment of these illnesses require patient counseling.
Some examples of commonly seen chronic illnesses where pharmacists can play an
active role through counseling are illustrated here.
Essential Components of Patient Counseling for Diabetes Treatment
Since diabetes is a chronic complication affecting the diabetic patient at various levels,
the counseling should focus on the nature of the disease, lifestyle modifications,
medications, and acute and chronic complications.
I.Counseling regarding the disease: Thediabeticpatientsshouldbeexplainedthat
thediseaseislifelong,progressiveandneedsnecessarymodificationsinthelifestyle
pattern.Theyshouldalsostressupontheimportanceofstrictcompliancewiththe
prescribedmedication.
II.Counseling regarding lifestyle modifications: Forcounselingregardingthelife-
stylemodifications,thepharmacistshouldfocusonthekeyareasincludingdiet,
exercise,smokingandalcoholintake.
A. Diet: Dietarycontrolisthemainstayoftreatmentintype2diabetesandanintegral
partintype1 diabetes.Amongthedietarycounseling,importance should be
givenforthedietarycontentincludingcarbohydrate,fatandfiberintake.
1. Carbohydrates:Thebloodglucoseleveliscloselyaffectedbythecarbohydrate
intake.Dailyintakeshouldbekeptfairlyconstantand the amount given
shouldbeappropriatetothelevelofphysicalactivity.Peoplewithdiabetes
shouldlimittheirsugarintake,buttotalexclusionofsugarfromthedietis
impracticalandunnecessary.
2. Fat: Since there is an increased risk of death from coronary artery disease
in diabetics, it is wise to restrict saturated fats and to substitute them with
unsaturated fats.
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3. Fibre: Dietary fiber has two useful properties. Firstly, it is physically bulky
and increases satiety. Secondly, fibre delays the digestion and absorption of
complex carbohydrates, thereby minimizing hyperglycemia.
B. Exercise and physical activity: Exercisecanhelptopromoteweightlossand
maintainidealbodyweightwhencombinedwithrestrictedcaloricintake.In
type2diabetes,thedesiredlevelofexerciseis50%to80%ofmaximaluptakeof
oxygenthreetofourtimesaweek.
C. Alcohol intake: Even if the blood glucose of the patient is well controlled, modest
amount of alcohol will significantly alter blood glucose levels. In general, the
same guidelines of alcohol use applicable to the general public is also applied
to patients with diabetes.
D. Smoking: People with diabetes, especially those over age 40 years, who smoke and
have high blood pressure and cholesterol, are at a higher risk for cardiovascular
problems. Smoking can also lead to serious complications like infections, ulcers,
gangrene, and even amputations. Pharmacist should counsel patients regarding
the evil effects of smoking and educate the patients regarding the various
strategies to stop smoking.
III.Counseling regarding medications: Though lifestyle modifications play an
importantroleindiabetesmanagement,itiswellestablishedbyscientificstudies
thatthechroniccomplicationscanbepreventedbystrictglycemiccontrol.Hence,
thepharmacistcanplayanimmenseroleincounselingdiabeticpatientstoroutinely
monitorthe blood glucose level. Counselingshould be emphasized for oral
hypoglycemicagentsaswellasforinsulin.
Essential Components of Patient Counseling for Hypertension Treatment
Though hypertension is not a disease, it is known to be an important risk factor for
several complications resulting in end organ damage. If uncontrolled, it can lead to
a huge adverse impact on quality of life. Hence, the pharmacist should counsel the
patient for the importance of adhering to the treatment plan chosen for the hypertensive
patient. The management of hypertension requires non-pharmacological as well as
pharmacological methods.
Non-pharmacological measures: Inmanyoccasions,non-pharmacologicaltreatment
alonemaysufficeinthemanagementofhypertension.Apharmacistcancounselthe
patientsregarding weight loss andregular exercise, sodium and calorie restriction,
restrictionof saturatedfats and increased intake of dietary fibers,restriction of
alcoholintake, smoking cessation, caution while using coldremedies containing
sympathomimetics,self-monitoringofbloodpressure,etc.
Pharmacological measures: Inamajority of patients,drugtherapyis required.The
patientsoftenunderestimatehypertensionasbyitself,itusuallydoesnotexhibitany
majorsymptoms.Thus,non-compliancebecomesverycommon.Addedtothisisthe
factthatmanyoftheantihypertensivedrugscausessideeffectsthatareveryserious
suchasAngiotensinConvertingEnzyme(ACE)inhibitorsinducedcough,betablockers
inducedbradycardiaetc.Insomecases,thedosemodulationofthedrugsisalsovery
essential.Someofthepharmacologicalmeasuresthatcanbetakenbythepharmacist
duringcounselingarelistedinTable13.1.
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Patient Counseling
Essential Components of Patient Counseling for Coronary Heart Disease Treatment
As with other chronic diseases, the aim of treatment is to reduce the mortality, morbidity
and associated impairment in the quality of life. A pharmacist can play an active role
in the management of this chronic illness in several ways.
Non-pharmacological measures: Itincludeseducationregardingdiet,smoking,andexercise
andencouragingthepatientstomaintainadiaryonanginalattacks,painsymptoms,etc.
Pharmacological measures: Educatingthepatientsontheuseofnitratesincaseofan
acuteanginalattackisoneoftheimportantrolesofpharmacists.Someoftheimportant
pharmacologicalmeasuresarelistedinTable13.2.
Essential Components of Patient Counseling for Asthma Treatment
Asthma is a chronic condition requiring lifelong drug therapy. Pharmacist can play an
active role in counseling the patient regarding self-monitoring of drug therapy, other
lifestyle modifications and usage of specialized dosage forms such as metered dose
inhalers, dry powder inhalers, spacers, etc.
Non-pharmacological measures: Safetymeasureswhiletraveling,prophylacticuseof
drugsbeforeexercise,avoidanceofallergens,stoppingcigarettesmoking,etc.
Pharmacological measures: Patientinvolvement inmanagement ofasthma is very
important. Specific counseling ondrug therapy should concentrate on three areas:
Table 13.1: Drug counseling points in hypertension
Drug category Pharmacist role in counseling
Diuretics Monitor for muscle weakness, confusion, dizziness.
Beta blockers Monitor for hypotension, dizziness, headache, and bradycardia. Educate regarding
possibility of nocturnal dreams, impotence and CNS problems. Explain the need
for dose tapering before stopping the drug.
ACE inhibitors Monitor for hypotension, dizziness, cough, taste disturbances and rash.
Calcium channel
blockers
Monitor for swollen gums, chest pain, swollen joints (with nifedipine), constipation,
dizziness, and light-headedness. Educate the patient to swallow the extended-
release tablets as a whole. Explain the patient how to monitor his heart rate by
measuring the pulse rate.
Alpha blockers Monitor for hypotension. Patients on gastrointestinal therapeutic system (GITS)
preparation should be told not to crush/chew the tablets.
Table 13.2: Drug counseling points in coronary heart disease
Drug category Pharmacist role in counseling
Beta-blockers Monitor for hypotension, dizziness, headache, and bradycardia. Educate the patient
regarding possibility of nocturnal dreams and CNS problems. Explain the need for
dose tapering before stopping the drug.
Nitrates Sublingual administration, sublingual tablets should not be chewed or crushed, use
of transdermal patches, do not stand up immediately while using this medication.
Monitor for bluish coloured lips, fingernails or palms.
Aspirin Encourage the patient to take drug with food. Monitor for abdominal pain, tarry stools,
fever, spitting of blood. In case of enteric-coated preparations, ask the patient not to
crush or chew the tablets.
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Drugsto relievesymptoms, drugsused toprevent asthma attack andthose drugs
whicharegivenonlyasreservetreatmentforsevereattacks. Trainingregardinguse
ofthemetereddoseinhalerisoneoftheimportantrolesofthecounselingpharmacist.
Useofthesespecializeddevicesisoneofthemajorcausesofnon-complianceinsome
asthmaticpatients.Often,thepatientsfailtotaketheinhaledsteroids,astheydonot
produceanyimmediateeffects.Someofthepharmacologicalmeasurestobeincluded
whilecounselingthesepatientsaresummarizedinTable13.3.
Essential Components of Patient Counseling for Epilepsy Treatment
Management of an epileptic patient depends upon the severity and pathogenesis of the
condition. Strict compliance with medication forms the cornerstone of the treatment.
Failure to comply with treatment regimens leads to increased seizure recurrence. Poorly
controlled seizures increase the likelihood of hospital admission, which raises healthcare
costs. Indirect costs associated with seizure recurrence include injuries inflicted on self
and others, loss of employment, and loss of health insurance benefits, as well as social
costs (e.g. lost workdays). A pharmacist can contribute significantly in this illness.
Non-pharmacological measures: Theyincluderegularfollow-up,avoidanceofsleep
deprivation,and avoidanceof (overthe counter)OTC medications,stress relieving
activities,psychosocialcounseling,etc.
Pharmacological measures: Sincethetherapeuticeffectofthedrugsisdirectlydependent
ontheserumconcentrationofthedrugs,itbecomesessentialthatthepatientshould
bestrictlycompliant.Ifthelevelcomesdown,abreakthroughseizurecanoccur.Some
ofthemeasuresthatcanbeundertakenbythepharmacistarementionedinTable13.4.
Table 13.3: Drug counseling points in asthma
Drug category Pharmacist role in counseling
Beta receptor
agonists
Short-acting drugs belonging to this category should be used mainly for symptomatic
relief. Patients on long-acting drugs should be told that the medication may take
some time period to show the action. Patient also needs monitoring for tremors
and muscle pain.
Theophylline Patients on sustained release preparations should be told not to crush/chew the
tablets.
Anticholinergics Monitor for dry throat, nausea, headache, blurred vision, and painful urination.
Corticosteroids Medications should be administered regularly. They should not be stopped abruptly.
It needs dose tapering before stopping. Emphasize gargling of mouth after use of
inhale medications.
Mast cell
stabilizers
Patient should be told that this medication is used to prevent the asthma attack and
it does not relieve bronchospasm that has already started.
Table 13.4: Drug counseling points in epilepsy
Drug category Pharmacist role in counseling
Barbiturates Explain the patient about the possibility of dependence. Explain the possibility of
drug interactions especially with oral contraceptives. Monitor for fever, skin rashes,
swelling of eyelids, mental depression.
(Contd.)
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Patient Counseling
EXERCISE
Multiple ChoiCe Questions
Tick mark the appropriate choices
1. What is the primary objective in patient counseling?
(a) To ensure that the patient gets good care.
(b) To meet the patient’s needs.
(c) To serve as an intermediary between the patient and their family.
(d) To get non-covered services reimbursed.
2. Which one of these is a heart of counseling?
(a) Preparing for session (c) Counseling content
(b) Opening the session (d) Closing the content
short Questions
3. Give the counseling points for asthmatic patients.
4. Give the counseling points for hypertensive patients.
5. Give the importance of communication skills in patient counseling.
long Questions
6. Discuss the various steps involved in patient’s counseling.
7. Discuss the essential components of counseling for diabetic patient.
8. Discuss the pharmacist’s role in patient counseling.
Answer to MCQs
1. (b) 2. (c)
Table 13.4: Drug counseling points in epilepsy (Contd.)
Drug category Pharmacist role in counseling
Benzodiazepines Monitor for behavior problems, mental depression, impaired memory, skin rash.
Explain to the patient regarding the drug interaction. Monitor for symptoms of
overdose.
Hydantoins
(Phenytoin)
The patient should be advised not to stop the medicine or take other medicine
without the doctor’s advice. Explain the patients the various symptoms of overdose.
Monitor for gum bleeding, bone malformations, headache, and joint pain, learning
problems in children. Patients should be explained regarding the drug interaction
potential of the drug.
Valproates Controlled release and sustained release preparations should not be chewed or
crushed. They should be swallowed whole.
Succinimides This should be taken with food or milk so as to reduce the stomach upset. Patients
should be advised to give their medication history before undergoing surgery as
this drug can potentiate the CNS effect of anesthetics.
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Chapter
Educational and Training
Programs in Hospital
Implementation of education and various types of training programs for providing
safety to patients by all staff/health professional is beneficial. For example, physician
or pharmacist can be helpful by guiding the caretaker for not doing the unnecessary
movement for safety of patient. Several programs related to handling of equipments for
the safety of patient, motivating the healthcare professional for providing patient care,
can be conducted in a hospital. Patient handling is a skilful activity, based on theoretical
knowledge and practical experience. Some of the key points are:
• Hospitaladministrationhavealegalresponsibilitytoprovideeducationaltraining
tostaffforsafepatienthandlingactivities.
• Personalriskisassociatedwithsafepatienthandling.Thereisriskofinjury,whenpatient
isprovidedassistanceortransferredfromoneplacetoanotherplacefordiagnostictests.
Hence,handlingprocedureortransfershouldbeonlydone,ifitisreallyrequired.
• Educationalguidanceshouldbegivenbethenursestohaveappropriatepostureand
positioningduringpatienthandlinginclinicalpractice.
• Alltherelatedstaffmembersshouldbegivenpropertrainingtousethepatientlift
equipments,meanttoliftandtransferpatientsfromoneplacetoanother(e.g.from
bedtotestinglab.,chairtostretcher).Inthiscase,caretakermaybeinvolved.
• Adviceortrainingshouldbegiventocaretakertocontroltheunnecessarymovement
ofpatienteverytime.
Practice,whichisgenerallyfollowedinthehospital,maybebasedon:
1. Use of different styles in training programs: Hospital administration should
developtraining programs, in differentstyles, based on the predictedlearning
abilitiesof staffmembers.Every individualvaries interms oflearning abilities.
Hence,sometraining program should bedoneto communicate theinformation
verbally,visually,oracombinationofboth.
2. Development of interactive programs: Instead oflong trainingsessions, which
decreasestheattention,elements,forencouragingtheinteractionshouldbeadded
inthetrainingprogram.Theseincludegroupexercises,quizzes,demonstrations,
groupdiscussion,whichpromotethecooperationamongtheparticipants.Donot
trustonthelecturealonetojudgetheunderstandingofparticipant.
3. Useofcomputer-basedlearningineducationalprogram.
4. Makeaprovisiontodisplaythebasicinformationasaposterinthehospital.
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Educational and Training Programs in Hospital
5. Ensuretoreflectthechangingskills.Trainingprogramshouldpredicttheparticipant
existingskillsandprovidetheeducationortrainingrelatedtotheirlackingareas.
6. Consideremployeedemandsbeyondtraining.Differenttypesofessentialactivities
areperformedbystaff/participantinhospital;hencetrainingshouldbedesigned
insuchawaythattheactivitiesarenothamperedtoaffectthehospital.
7.Analyse thetraining programeffectiveness.Amethod should be developedto
evaluatetheprogram’seffectivenessbecauseitiswastageoftimeandfunds,when
trainingprogramisnotsuccessfulinimprovingtheparticipantskill.
ROLE OF PHARMACIST IN EDUCATION AND TRAINING
Pharmacist can provide various types of services, which are as follows:
• Toprovidethe better patient careby educating the patientfor properuse ofall
prescribedmedicinesandOTCmedicine,ifany.
• Tomakeaware thepatient on prescribed medicines including pharmacokinetic
properties,ADRs,andinteractionwithco-administereddruganddietaryitems.
• TomonitortheOTCproductssolddirectlytothepublic.
• Toevaluatetheprescribingtrendsofregisteredpractitioners.
• Tohelpintheselection,andprocurementofdrugsinhospitals.
• Developmentofpolicyforregulatingdistribution,andsupplyofdrugs.
• Todelivereducation and training related to pharmacy profession to community
healthprofessional,whichdirectlyimprovepatientsafety.
TRAINING PROGRAMS IN HOSPITAL
The success of any hospital relies on the staff, who works for providing patient care. The
staff include the security guards, technicians in pathological and X-ray lab, pharmacists,
nurses, physicians, etc. The success of any hospital relies on the various types of staff
members, who work for providing patient care.
Hospital staff should receive necessary training to perform their task better, improve
their work-related skill set, increase knowledge, to make aware of their future roles and
responsibilities related to their task, etc. Various types of duties are assigned to each staff
member to carry out their work for the growth of the hospital and patient care. Hence,
training programs of diverse types must be conducted in the hospital to improve the
efficiency in the prompt way. Training program can enhance the existing knowledge, skills,
and attitudes of the health professionals. There should be a good support from the hospital
administration in developing required training courses for the staff. The nursing head,
head of the other related departments along with the head, quality control department,
should participate in the training process, conducted to improve the performance of
healthcare professionals in terms of quality, efficiency, and accuracy.
Objectives of Training Program
The objectives of the training and educational developmental program for the hospital
staff are as follows:
• Todeveloptalenttoworkwithfullenthusiasminhospital.
• Tocreatetalenttofeelresponsibilitiesabouttheirfuturerolesinpatientcare.
• Toencouragebetterrelationshipsinstaffmembersinhospital.
• Toestablishharmonization among different departmental units topromote the
professionalcollaborationwithinhospital.
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Textbook of Pharmacy Practice
Various types of training programs organized for the staff in hospital are classified
into two broad categories:
i. Internaltrainingprograms,and
ii. Externaltrainingprogramscalledoff-the-jobtrainingprograms.
i. Internal Training Programs
Internal training programs, also called on-the-job training programs are conducted
in hospitals, which are guided by some of the staff of hospital, who has expertise in
particular area. Hospital resources are used to give the specific type of training.
Induction: All the newlyrecruited staff member are given training, referredto as
inductiontraining at the time of joining in hospitalorganization. In this program,
introductionregardingtheestablishmentofhospital,policiestomaintainthequality
patientcare, futurescope, jobdescription and responsibilities, etc.are givento the
recruitedstaffmember.
On-the-job training: Thepurposeofon-the-jobtrainingprogramistomakethenewly
recruitedstaffmembersfamiliarwithworkingenvironmentinhospital,forexample,
approachinhandlingofthepatient,maintenanceofhospitalequipments,storageof
drugs,sterilization,etc.Suchtypeoftrainingprograms,conductedbydepartmentalhead
orexperiencedstaffmember,arebeneficialforthenewlyrecruitedpersontoperform
variousactivitiesintheirjobs.Duringthisprogram,thelearnersgettheopportunity
tolearn,whileearning.
In this type of training, hospital staff, e.g. nursing staff, OT/ICU staff, housekeeping
staff, pharmacist, laboratory technician, imaging dept. staff etc., are get trained on
various work duties such as infection control practices that include needle stick
injury, injection and infusion practices, patient handling, the practice of handwashing
and sanitization, use of appropriate personal protective equipments (PPEs), various
practices of the bio-medical waste management system, etc.
Training during transfer of staff: Itisessentialtogivethetrainingtostaffmembers,who
areoldbuttransferredtootherdepartmentsofthehospitaltotakenewresponsibilities.
The internal training program is the most cost-effective, that improve the existing
training methods as well as relationship among staff members. In this case, resource
person (expert) is from hospital set up, who is given assignment to conduct the training
program within hospital space, without the involvement of travel expenses and
educational materials, etc.
There may be issues related to internal training programs, which are:
i. Notconductedbycompetentstafforformallyconducted.
ii. Duetootherresponsibilitiesinhospitalsetting,sufficienttimeisnotgivenand
iii. Notattendedtakenseriouslybyenrolledparticipant.
All of the above, result in undesirable consequences on patient care services, causing
impact on reputation of the hospital.
ii. External Training Programs
In external training programs, also called off-the-job training, expert or resource person,
who conduct the program is from outside the hospital organisation. In this program,
teaching is done by the outside skilled professionals. The expert professional may
impart a new approach that has not considered earlier. In contrast to internal training