Counsel Patients About the Harmful Effects of the Sun

Editor’s note: Case is not based on an actual patient

Brown bag consults can be essential educational and safety tools to measure and ensure quality care. By asking patients to bring in all their current medications, including OTC, mail-order, specialty, and herbal products, pharmacists can guarantee appropriate and up-to-date care.

Pharmacists are key providers in the continuum of care, consistently identifying potential problems and concerns that may require follow-up with prescribers or a medication therapy management session. It is essential that a pharmacist’s workflow allow for brown bag consults, which can do the following:

• Develop the pharmacist—patient relationship to help create better individualized service, forge patient loyalty and trust, and prevent medical errors
• Provide insight into a patient’s lifestyle and quality of care
• Show how well patients understand their conditions and medications

Offering to review medications one-on-one can give pharmacists the opportunity to connect with patients by serving as trusted medical professionals in the community. Brown bag sessions for patients living with chronic disease states do not have to be time-consuming scheduled events. They can be offered anytime a pharmacist thinks that a patient needs follow-up care after a typical counseling session.

LO is a 45-year-old woman and a regular customer who is picking up a new antibiotic prescription. She has a small basket of items, including sunscreen and travel-sized items, that she shopped for while she waited. Although you are reviewing LO’s medication profile and preparing to counsel her on her new antibiotic prescription, you also have some concerns about her fair skin and red hair. Based on the items she is buying, you ask whether she is planning on being in the sun or going on vacation. LO says that she and her family are going on a Disney cruise. You notice what may be an inappropriate sun protection factor on the sunscreen that she is purchasing. You ask whether LO has a few minutes to briefly go over her medications. You explain the concept of a brown bag session, and she hesitates. LO says she thought services like brown bag sessions were mostly for elderly patients or those taking tons of medications. You tell her that the sessions can be for any patient who is interested in talking to a pharmacist in detail about any medication or preventive medicine. LO agrees to come back to the pharmacy after she stops at home to pick up all her medications.

In preparation for her return, you print out her medication profile. Here is what you find:

• Atorvastatin, 10 mg, once daily at bedtime
• Augmentin, 875 mg/125 mg, every 12 hours for 7 days
• Escitalopram, 10 mg, once daily
• Hydrocortisone, 2.5% cream, as directed
• Lo Loestrin 24 Fe, once daily

LO returns and empties her medications from her bag, and you notice these additional medications: u Adult multivitamin with iron, once daily u OTC calcium carbonate, 1000 mg, twice daily u OTC omeprazole, 20 mg, once daily u OTC topical retinoid After you review the medications for accuracy, you tell LO that because of her coloring, you are concerned about her getting sun. You also mention that some of her medications may make her more sensitive to sunlight. You review some sun cancer prevention tips and remind LO to limit midday sun exposure, use sunscreen that protects her against UV-A and UV-B light, and reapply sunscreen every 2 to 3 hours or after sweating or swimming. You also encourage her to pack a hat along with protective clothing. You ask whether LO has seen a dermatologist or self-checked moles for signs of cancer. LO says no and says she goes to see only her family nurse practitioner and obstetrician/gynecologist annually unless there is a problem. You remind LO that analyzing freckles and moles for possible abnormalities is important and that she can always ask you for help in identifying anything worrisome. You explain that she does not need to stay out of the sun and that vitamin D has its benefits but that she does need to take appropriate preventive measures.

Can you offer additional sun safety tips?

Jill Drury, PharmD, is a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin