Counselling Session 4: Discharge Medicine Changes

1. Aim

To practise counselling 4 of 4 using an explicitly assumed teaching scenario or a supervised de-identified case. An actual patient session must be entered in the student record.

2. Requirements

Assumed teaching scenario or consented de-identified clinical record, verified medicine and laboratory sources, local policy, observation form, supervisor, and private setting. Actual patient details, medicine strengths, dose instructions, laboratory intervals, and software must be entered in the student record.

3. Theory

At discharge, additions, stops, and changed directions should be reconciled against the pre-admission and inpatient lists. The patient needs a clear current list and a chance to ask questions. Unresolved discrepancies require prescriber confirmation, not silent student edits.

4. Procedure

Confirm this session number, teaching or actual status, consent and privacy requirements, and supervisor.
List verified facts separately from assumed scenario details and missing information.
Perform the supervised reasoning or communication task: Review an assumed discharge list, classify each change, check reasons and follow-up, then rehearse a supervised patient explanation with teach-back.
Record exact source titles and dates, any limitation, and the supervisor feedback.
Do not give a patient-specific instruction from an assumed case; seek qualified clinical review before any recommendation.
Document the learning outcome and whether a real supervised encounter occurred.

5. Observation and calculation

Student record field	Entry
Case or product	Record here
Method	Record here
Observation	Record here
Inference	Record here
Supervisor check	Record here
Outcome	Record here

Assumed teaching scenario only: An assumed discharge list contains an assumed medicine absent from the earlier list. The discrepancy is invented and its resolution is specified in your college lab manual and instructor's method sheet. Every invented fact and observation is assumed. This is not a real patient encounter or clinical recommendation.

6. Output or final result

Submit a labelled discharge reconciliation flow and a supervisor-reviewed learning record. Actual session completion and patient outcome: Record here.

Teaching-lab safety: Protect patient confidentiality, use consent and local supervision, and escalate urgent or uncertain clinical questions through the responsible care team. Do not enter assumed details into a patient chart.

This page is a supervised-activity guide; it does not report a completed case.

7. Sources

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Theory notes: Pharm D Year 4, 4.3 Clinical Pharmacy