Chapter 2: Counselling
Once you understand the customer’s symptoms, decide whether the request can be managed within your role and your pharmacy’s procedures.
If there is a referral sign or any uncertainty, involve the pharmacist before discussing supply.
For a suitable customer, start with oral rehydration every time.
Start with oral rehydration salts
Oral rehydration salts are the first-line treatment for diarrhoea at every age. They replace the fluid and salts being lost and, for most people, are the only treatment needed.
What to say: “This is the important one. It puts back the fluid and salts you are losing.”
Explain how to prepare it correctly
This is one of the most important parts of the conversation. Tell the customer to:
use the measuring cup supplied
use plain, clean water
follow the amount of water on the pack exactly
not make the solution stronger or weaker
not add cordial, juice, sugar or any other sweetener
keep the prepared solution in the fridge
use it within 24 hours
Sip small amounts often
If the customer feels sick, small frequent sips are easier to keep down than a full glass.
Chilling the solution may improve the taste. Some products are also available as ice blocks, which can be easier for children.
Keep using oral rehydration until the diarrhoea stops, not just until the customer feels better.
When a medicine that slows the bowel may be considered
For an adult or child over 12, a medicine such as loperamide may be considered for a short time when getting to a toilet is genuinely difficult.
It should only be used when there are no referral signs. Oral rehydration is still needed alongside it.
Do not supply a bowel-slowing medicine if:
there is blood or mucus in the stool
there is a fever
the customer has recently taken antibiotics
the person is under 12 years
the customer is pregnant or breastfeeding
here is any sign of dehydration
If any of these apply, involve the pharmacist.
Pharmacist Only treatment
Diphenoxylate with atropine is a Pharmacist Only Medicine (Schedule 3).
Do not counsel on this product yourself.
You could say: “That one needs to come from our pharmacist. Let me get them for you.”
Provide simple food and lifestyle advice
Remind the customer to:
return to normal food when they can manage it
choose simple starchy foods if these are easier to tolerate
avoid fatty, sugary and very spicy foods for a few days
avoid sports drinks, soft drinks, cordial and fruit juice
use a barrier cream if the skin becomes sore
wash hands carefully and clean shared surfaces
When medical review may be needed
Some customers may need medical assessment. This includes customers with:
blood in the stool
diarrhoea after antibiotics
recent tropical or subtropical travel
symptoms lasting 14 days or more
a long-term change in bowel habit
