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In this encounter, Patient Smith Jr., a 67-year-old male is seeing Pharmacist Cody, RPh after his recent discharge from the hospital for an acute exacerbation of his heart failure.  Pharmacist Cody reviews the pharmacy’s records and interviews Mr. Smith about his medication use and finds that Mr. Smith had been prescribed three new medications (spironolactone 12.5 mg qday, carvedilol 3.125 mg qday and lisinopril 5 mg qday) on discharge from the hospital, but had failed to pick up his medications from the pharmacy.  He lists these medications as currently inactive on Mr. Smith’s active medication list and notes that the carvedilol should be taken twice daily but has been prescribed as once daily by Mr. Smith’s cardiologist. 

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Pharmacist Cody weighs Mr. Smith in the pharmacy and notes that Mr. Smith has gained five pounds compared to his self-reported weight upon discharge from the hospital.  He is also displaying some edema around the ankles.  When questioned about his goals for his personal health, Mr. Smith reports that his condition has prevented him from living the active lifestyle to which he is accustomed and he would like to feel well enough to continue to manage his home, garden and rental properties.

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Pharmacist Cody counsels Mr. Smith about the importance of adhering to his medication regimen for controlling his symptoms and preventing the need for further hospitalization.  He recommends that Mr. Smith see his cardiologist on an outpatient basis as soon as possible to address his weight gain and edema and contacts the cardiologist to address the discrepancy in the dose of Mr. Smith’s prescription for carvedilol.  Pharmacist Cody also identifies the need for Mr. Smith to be vaccinated against pneumococcal disease and performs the vaccination during the encounter.