1- whom will do the counseling?
all medication counselling at the adult and children hospital are done by a pharmacist, pharmacy interns and students can also do this under the supervision of a pharmacist.
2- whom will be eligible to be counseled? Any criteria?
Due to the chronic shortage of pharmacists in our hospitals, we tend to prioritize who gets counselling, by that i mean ideally the ward pharmacist is responsible for carrying out all discharge counselling, he or she will at their discretion determine who needs this service, if they are on leave or absent and their ward is covered by someone else (rarely happens as we don’t have the staff to do this), then the replacement pharmacist will do the counselling based on handover discussion.
Otherwise if pharmacist is absent or a ward is not covered, we tend to rely on the medical team or the nursing staff to flag those patients that require counselling. Having said that we do ensure that wards like renal, cardiology etc always have pharmacy cover. Again this also depends on the patient and their medical complexity, e.g. post renal transplant patient versus surgical post appendectomy patient. For renal and cardiac and to some degree respiratory and some infectious disease wards have a standard discharge template whereby a pharmacist needs to sign off that they have done medication counselling for some patients. In the pediatric setting, the process is more or less the same but with a less structured format (currently being reviewed).
3- when the physician write a discharge medications, do the clinical pharmacist review those medications before being dispensed by pharmacist.
Since we do not have the distinction between pharmacist and clinical pharmacist in Australia, yes all discharge medication scripts are screened and reviewed by a pharmacist to ensure they are correct (med rec wise, labs checked, supply etc). Scripts are subsequently entered/typed by a pharmacy technician and further checked by pharmacist (double check system), but the pharmacist checker does rely on the ward pharmacist to ensure all that the discharge script is clinically sound. Again this process is less defined in our paediatric hospital and is being reviewed.