Whilst some pharmacies have some success with their consulting rooms, for many these rooms end up being storage areas. There are many reasons for this including

1. Poor design of the area: Where is it located? How is it designed? What will it be used for?

2. Lack of time: Pharmacist does not have time to meet with customers or patients

3. Lack of consulting skills: Dispensing skills is different from consulting

4. Lack of interest by the consumer: Does the consumer know or understand what you offering?

In the first part of this series, we will explore design considerations. For many, the consulting room becomes an "add-on" space with a grand title of "consulting room" or "advice area". If this type of investment is essential to the future of pharmacy in Ireland, we need to understand;

- Why have we included a consulting room in the retail layout?

- What will we use the room for?

- Who will use the room?

- How will we interact with consumers during the service?

- How will the area be designed?

- What will consumers expect from the area?

- How will the area be private and secure for the patient and the pharmacist?

Waiting area

These are all essential questions to ask ourselves before installing a consultation area. In the UK, consultation rooms are necessary in order to provide advanced services under the pharmacy contract. One multiple group stated that the best consultation areas will be those where there has been forethought in planning. The key issues are: 

-Providing adequate space from the beginning

-Meeting the needs of pharmacists and customers

-Future-proofing for new services or technology

-Compensating for any lost retail sales space (1)

They also noted that in general, customers prefer the consultation area to be close to the front of the store. This location also tends to be the one that has the smallest impact on retail sales space. However, pharmacy employees do not like the area to be away from the medicines counter or the dispensary, which are seen as the more professional end of the pharmacy. In addition, especially in smaller pharmacies, locating consultation areas near to the front windows reduces the natural light entering the store. But the busiest part of any pharmacy is normally between the medicines counter and the dispensary, with most staff passing through this area frequently. Anything that restricts the flow of people at this point will cause problems (1). In Australia, specifications for the consultation area within community pharmacies include: have a separate room or screened area (distinct from the general public area of the pharmacy) that:  

1. Allows for confidential sit down consultations between the pharmacist and patient;

2. Allows the pharmacist and patient to talk at normal speaking volumes without being overheard by other visitors or pharmacy staff; and

3. Allows the consultation to proceed in accordance with quality control standards (e.g. infection control). 

Pharmacies must meet these specifications if they intend to provide services funded under the Diabetes, Asthma and Medication Profiling programs in Australia. In the UK, the Green Light pharmacy model is comprised of five different types of consultation zones including private consulting rooms and seminar rooms for patient groups and university students. Furthermore, many services have been adapted to cater for ethnic minority groups with translation services available and cultural variations considered (2).

A consultation area therefore can range from a semi-private area to a fully enclosed room. There is controversy over the necessity and effectiveness of private rooms over semi-private counselling areas. Use of semi-private/open consultation booths addresses the concerns that patients may have about being summoned into walled rooms that may seem inconvenient and create embarrassment at being singled out.

Other practitioners support the need for a private room, but disagree on visibility: Some prefer a relatively soundproofed separate room with lots of clear glass so that other customers can see that a private consultation is taking place. Whilst others feel that patients seem to prefer a separate room without windows (i.e. GPs examining rooms do not have windows). To some, this may raise the risk of patient harassment charges - but the pharmacy can be structured in such as way as to offer privacy without the inherent risks associated with seclusion.

Waiting area

The "Forward Pharmacy" is a concept in Australia, whereby a semi-private area is located beside the dispensing area and the patient is counselled prior to dispensing, that is at the start of the dispensing process.

A closed consultation room can take many forms

- Glass panelled office- frosted, semi-transparent, double glazing, use of blinds for privacy

- Solid Wall closed- with glass door (frosted or semi-transparent, with or without blinds)

- A mixture of solid and glass walls and solid/glass doors

There are many design options including semi-circular walls and straight floor to ceiling walls. The problem with introducing circular walls, it that it can inevitably create storage problems and could contribute to increased costs. Whatever design you choose, you must make sure there is adequate space and it is designed professionally. A shabby consultation room will create a negative perception of your service on offer.

Whilst there are actually no strict specifications for consultation areas in Ireland, before you include one in your pharmacy, you need to consider future-proofing your investment in the space. Consider for example, you may need space for

- Technology: Pcs, Health Information Portals, Screens for Educational Programmes etc

- Equipment: BMI, blood pressure, cholesterol etc

- Clean area: Benches, sinks etc

- Storage: Cupboards, waste disposal area, private storage for any patient information

- Accessories: This will depend on services offered

- Furniture: Table, chairs, sofas, coat hangers- consider design

- Leaflet holders

- Poster areas

- Clinical/medical texts

- Other people: The consumer may want a friend or family member to accompany them or you may need a member of staff to accompany you

- Electrical points

- Telephone points

You should also consider how will an individual in a wheelchair or a mother and pram access the room. Failing to design these in from the beginning could be a false economy. It may lead to an expensive refurbishment in the future. The requirements of the DDA must also be borne in mind. For example, even if a wheelchair can fit into the consultation area, can it easily be turned around? Avoid any kind of step or trip hazard around the entrance.

Some pharmacies include softer accessories such as framed pictures of local scenery and small plants to provide calm and remove the sterile feel.  Artwork can inspire and nuture the human spirit (3). The room needs to be well lit, have comfortable chairs, adequately ventilated and be at an appropriate temperature. Avoid using mobile heaters; they are just uncomfortable, especially in small-enclosed areas.

You may be tempted to simply use magnolia in a consultation room. Its simple and easy but it is not great for enhancing a calm environment. Use colours such as blue, green and purple. Bright colours such as red, yellow and orange are regarded as stimulating and are not good choices for a consultation zone. It is essential that you resist the temptation to store items in the area unrelated to a consultation room such as employee personal goods (handbags etc). You could consider including a small drinking water unit within the room for patients. The latter are really quite inexpensive and you can pick them up from many online retailers.

Of course the design of the consultation room should follow on from your plans for its use. If for example you offer a cholesterol testing service, you should consider how would you manage a patient if the faint. Maybe it would be better to also have a reclining sofa and obviously this has implications for the space allocated to the room. You must really consider how you will use the room -will you rent the space to an allied healthcare professionals e.g. chiropodists? - Consider what space they will need.

Think about the investment- how much will the room cost?  For example if it costs €10k, with an average gross margin of 25%, you will need to sell €40k of product or service to cover the investment. At the moment in Ireland, there are no department led services, and hence no fee reimbursed health services. However, many pharmacists are of the view that you need to include semi-private or private areas to deliver the core professional aspects of the pharmacist's job that is educating and facilitating patients. And of course, many are operating well being clinics which patients will pay for to include a blood pressure check, cholesterol test, glucose test and a Body mass index result.

An effective way to assess whether your practice offers the necessary degree of privacy to your patients is to ask yourself if you would feel comfortable discussing your own personal health issues in your practice; would you feel your privacy was adequately respected and protected? You should also consider different types of consulting areas, semi-private and private.

Throughout this article we refer to the area as a "consultation room" but this does not mean you need to label for instance a private area as a consultation room.  You could use other labels such as

- Advice area

- Pharmacist

- Information

In some cases, you may choose not to label the room- why? You must consider the impact on the patient when they are asked to go into this room. Equally a well-designed closed room could also double as an office, provided that it remains uncluttered and pristine.

Before we leave the design of the consultation area, we should make a special note about security. In October 2003, a pharmacist appeared before the Royal Pharmaceutical Society's Statutory Committee, having been convicted of indecent conduct against a female. He had been sentenced to 15 months imprisonment, and ordered to be added to the sex offender's register for 10 years. 

The offences were alleged to have been committed in a consulting room in the pharmacy.  The pharmacist maintained he was innocent, but the Statutory Committee insisted they had to rely on the convictions.  The pharmacist was struck off (4). Whilst, we cannot make a comment on this case, we must alert the pharmacist that they have a responsibility to ensure the security for themselves and the patient.

One suggestion that arose from this case was to offer all patients a chaperone. If a patient wants a chaperone and no one suitable is available, it would be better to reschedule an appointment, and the patient should always have the opportunity to decline a particular person.  If a patient is offered and does not want a chaperone, it is important to make a written record in the PMR or something similar that the offer was made and declined.  If the offer is declined, the pharmacist may nevertheless exercise discretion to insist on the presence of a chaperone and decline to proceed if the patient objects to the presence of a chaperone.

It was also suggested that a patient should sign a consent form, if they agree to a service provided by the pharmacy. For further information see www.cr-law.co.uk.

We certainly do not want to end this article on a scary note regarding security but it would be negligent of any pharmacist not to pay attention to this issue. When designing your consultation spaces, whether semi-private or private, it is essential that you consider it from the patient's perspective. Ask yourself would you want your mum, dad or partner to use the area? If not, then you need to reconsider the space!

In the next part of this series, we will consider services that could be offered in a consultation area and challenges facing the pharmacist in delivering such services in Ireland.

References 

1. How to make space for a consultation room in your community pharmacy. www.pjonline.com

2. Greenlight Pharmacy www.greenlightpharmacy.com

3. Pharmacists Talking With Patients: Melanie J Rantucci 2nd Edition).

4. www.cr-law.co.uk