Secret agency?

Had an interesting phone call in the pharmacy this week, from a recruitment agency working on behalf on an unnamed multiple. They asked for me by name which I found curious since I haven’t worked here that long and haven’t really started to circulate locally yet.

I was offered all sorts of enticements such as a good salary and lots of development opportunities, which I politely declined. I have since heard that other pharmacists in the area have received similar approaches.

I know that the large multiples are always looking to recruit staff but I’m not sure how I feel about receiving such a direct approach from them at work!

Sticking to our guns

You know that we recently barred a patient from using the pharmacy (see Taking a Tough Line).

This patient has since tried to use the pharmacy twice. The first time, the patient came into the pharmacy full of surprise that they had been barred, and the second time a friend was sent in with a script while the barred patient waited outside the door!

But we are sticking to our guns and have refused to provide our pharmaceutical services on both occasions.

This is definitely the right thing to do in my opinion, but I live out of town and I know that some of the counter staff who live in the town do feel rather uncomfortable about the whole thing.

So this does become a very difficult balancing act. What do you think? Click on the comments link below - you can choose the "anonymous" option if you wish.

Now screening

We have recently started participating in the PCT’s Chlamydia screening campaign.

There seem to be various ways in which community pharmacies are getting involved in these schemes around the country, from just handing out testing kits through to advising patients on their results and offering treatment to patients who test positive under a PGD.

Our local scheme just involves us handing out the testing kits, which we do for free since the PCT is of the opinion that no patient counselling is needed about how to use the kit.

This is a shame because after we looked at all the information that the patient needs to take on board, we came to the decision that some additional counselling on what to do is definitely needed.

Therefore when patients request this kit one of the counter staff takes them into the counselling room to run through it.

Where pharmacy scores

Following my last blog on receptionists dispensing, here’s a sample of patient interventions that we have made recently:

The patient issued a new script for carbimazole and on questioning, knew to look out for ‘problems with his white blood cells’. However, when I asked what actual symptoms he needed to look out for (e.g. sore throat, etc) he had no idea. Therefore I filled him in on the rest.

The patient discharged from hospital after being initiated on zonisamide. The drug dose was being built up slowly on a weekly basis, therefore the patient had clear written instructions from the hospital on how to build up the dose over a 4 week period, and had four boxes containing the corresponding doses. Trouble is that she got rather confused and started taking all four boxes at the same time! Hence, after a discussion with the GP, we are now issuing her with weekly supplies.

The mum who had a little 3 year old with a repeat script of paracetamol suspension 120mg/5ml at a dose of 2.5ml QDS. On questioning her she said that the prescription had been repeated because the painkiller didn’t seem to be working so, in the absence of any thing else, I suggested that she may want to use the usual dose for a 3 year old of 5-10ml QDS.

Dispensing receptionists

Had a bit of an emergency with my baby daughter during the week when I needed to get her in to see a GP because of an ongoing high temperature that we were finding hard to control.

Since there are two pharmacists in the shop it was great to be able to leave at a moments notice!

The GP we got in to see gave me a script after discovering an ear infection and said that antibiotics were reasonable at this point since the symptoms had been present for 3 days and were not improving.

The interesting thing is to now be a patient at a dispensing doctors practice. The script that was handed to me wasn’t signed and when I queried this I was told that the GP would sign it when the dispenser had brought the medicines back to be checked (patient choice eh? – good job I do actually live miles from the nearest pharmacy!).

I didn’t mind too much since it was late and I needed the antibiotics, but it was fascinating to watch the receptionist dispense the antibiotic from the ‘dispensary’ in the corner of the room from where she was booking patients in, etc.

I’m obviously on my soap box about this issue being a pharmacist, but with the amount of patient interventions I regularly make, I just can’t see how similar problems are picked up in a dispensing practice.

Bitter PILs

We have been really disappointed with our local health promotion campaigns recently.

We know that the local PCTs are in uproar with all the reconfigurations and that PCT staff must generally feel pretty fed up with the whole thing, however we do feel that they have been paying us lip service recently when it comes to the six annual health promotion campaigns.

The reason for this is that we received our latest two monthly ‘campaign’ from the PCT which consisted of a signposting document and a grand total of 2-3 PILs for each subject.

So I rang them to say that we needed substantially more PILs in order to run a successful campaign, but none ever arrived. Therefore, we haven’t run this campaign since we simply haven’t got enough patient information to do so.

I hope things improve once the new PCT has settled down.

Raspberries?

It’s sometimes a real disadvantage for me being the ‘new girl’ in the pharmacy. For example, we regularly receive small gifts from our regular customers by way of thanks (for example, one elderly lady that we deliver to regularly bakes us a fruit loaf which is rather delicious).

I was talking to a patient about a recent eye infection I had treated on the minor ailments scheme. At the end of the conversation I asked him if he had any further questions to which he replied ‘Oh yes, raspberries or tomatoes?’

Well that completely threw me until another staff member shouted over ‘Raspberries please Tom’ and explained that Tom regularly gives the pharmacy staff a choice of which vegetables and fruit we would like from his allotment!

Taking a tough line

We are in the process of barring a patient from using the pharmacy. Apparently, it’s not the first time this has been done.

As does every pharmacy, we have our known ‘trouble makers’ who come into the pharmacy generally looking to curse the staff and steal the stock. We have CCTV and the counter staff ring a bell when these patients come into the shop so that as many staff as possible cover the shop floor.

This generally seems to work, but we have had one patient who has been particularly abusive to the staff and so we have sent that patient a letter by recorded delivery stating the reasons why he/she is no longer welcome in the pharmacy and that the staff have clear instructions to call the police should he/she enter the premises again.

This seems a sensible and fair way of dealing with this situation so we will wait and see! How do you deal with this sort of problem? Click on the "Comments" link at the end of this post and let me know.

Not in the script!

Here’s just a few examples of interventions I have made with patients this week (who ever said that community pharmacy is only about counting tablets and selling hairsprays – we continue to be a vital part of patient care!):

1. The patient who came in with a script for his existing antidepressant therapy, plus a new script for fluoxetine. I was expecting to either have a conversation with him about stopping the existing antidepressant and starting the fluoxetine, or about taking them both together (this happens a lot round here). What I wasn’t expecting was the patient to ask if his new ‘antihistamine’ was a good one and to have no idea about a change to his antidepressant therapy. So rather than try and sort this one out over the phone the patient went back to see the GP, and came back with another script for an antihistamine and with the knowledge that the GP did want him to take the two antidepressants together.

2. The carer who came in with a hospital script for a new client with schizophrenia. The antipsychotic was to be labelled ‘1 TDS for signs of anxiety’, and the procyclidine was to be labelled ‘1 TDS prn for extra pyramidal side effects’. So we wondered if the carer would know what these side effects were, and she didn’t. She also didn’t know that these side effects would be caused by the antipsychotic hence the need to take the two drugs together should these side effects arise. So we settled on labelling the procyclidine ‘1 TDS prn for side effects due to antipsychotic’ and explained exactly what EPSE were.

3. The patient prescribed the recently launched drug for obesity and had only been told by the GP that it was ‘very expensive’. So I filled her in on the rest!

My first 'event'

Made my first mistake since coming back into practice! I dispensed insulin pens against a script for cartridges this week. The patient who brought them back is a regular and was fine about the whole thing, but it didn’t make me feel any better about it.

As part of clinical governance we recorded it as a ‘significant event’ (we are only using a paper based system at the moment, rather than logging these directly with the NPSA).

I also reflected on how I could stop this happening in the future, but the all the pens and cartridges are already on separate shelves in the fridge, so it’s down to me to check, check and recheck again!