Never assume

Here’s a couple of interventions that I have made recently, just proving the point that even on repeat prescriptions you can never assume that the patient is taking them correctly.

The patient who had a dose increase on fluoxetine. To make sure, I checked that she knew to take it in the morning (since the script was labelled one daily). ‘Well I do now’ she said. ‘No-one told me when I first starting taking it, so I took it at night and didn’t sleep for a week!’

The parents of a baby girl who had recently been started on a small prophylactic dose of cefalexin suspension. On giving the bottle out, I asked if they knew that it expired in 14 days and to throw the remainder away and get a fresh supply. Yes they replied, they had eventually worked that out for themselves but thanked me very much for pointing it out straightaway.

Too minimalist

We’ve just had our usual monthly batch of returned scripts from the PPD. We do try our best to remember to add manufacturer details/prices to the more obscure scripts, but it’s so annoying when we get scripts returned for really common drugs when there is just one brand, or for the creams/lotions that have been prescribed generically and the computer system hasn’t endorsed the brand.

Apparently the computer software that we use has two endorsement settings – one which lists absolutely every detail, and one which lists the bare minimum.

We were actually asked to switch the program to the minimum endorsement setting but now it appears rather too minimum and if we keep getting these types of returned scripts back (yes I know about the rules that the PPD has to follow) then we’ll have to switch the endorsement program back again.

That age old problem

I made some real clangers last week by incorrectly guessing at people’s ages.

You know how it goes when you give a script out and you want to pass on some information but the person who collects it isn’t the patient. I usually ask if it’s for a relative, but on a couple of occasions I have assumed people’s ages and got it badly wrong.

The first script was for a 65 year old women – the lady who stood up to collect it looked around that age to me so I took her to the counselling area and started to explain a few things until she said, ‘But this is for my mother!’.

The second script was for a 55 year old women - and a gentleman stood up to collect it. Instead of saying my usual ‘Is this for a relative of yours?’ I looked at him and said ‘Is this for your mother?’. ‘No, it’s for my wife’ he said, and luckily for me, just smiled...

First select your nurse

We’ve been having fun with our nurse prescribing computer software this week. We couldn’t understand why when we selected a particular nurse’s name and purple prescription form that we always seemed to get the computer assuming it was for a community practitioner nurse prescribing from their restricted formulary (hence most items were coming up as blacklisted!).

Then we discovered under ‘precriber details’ on the computer that we had to select either independent prescriber, community practitioner nurse prescriber, or supplementary prescriber (we had assumed that the system would do this for us when we selected the correct precriber’s name).

I also discovered that the dispensary staff didn’t really appreciate the differences between the three categories of nurse prescriber so we killed two birds with one stone by finding out how to correctly enter a nurse prescriber onto the computer and ensuring that the staff really understood the differences between the types of nurse prescriber.

Top form

I’ve seen from the pharmacy press that the draft revised version of the MUR form is now in circulation (see draft form at www.psnc.org.uk/advanced - comments required by February 28).

We’ve been waiting for this revised version before we start to implement MURs since we didn’t see the point in getting all the local GPs on board with the service only to have to go through it all again once the new form came out.

I am accredited to do MURs, but not having actually done one yet, I’m not the best person to comment on the proposed new form. However I have to say that it does look a lot better since I would predict that all GPs will want to see is the pharmacist action plan following the MUR. So hopefully the powers that be will get the new form agreed and in use as soon as possible.

In the meantime we are getting the premises accredited and the other pharmacists are also planning to get their accreditations. I personally liked the CPPE online accreditation but I know that at least one of the other pharmacists intends to attend a local training day where you receive the accreditation at the end of the days training.

Inspectors and everything else

We’ve had a bit of an impromptu RPSGB inspectors visit this week. The inspector came to visit to check up on the premises (since the pharmacy has fairly recently relocated) and then started to go through everything else as well. Considering that we hadn’t prepared for the ‘everything else’ we didn’t do too badly.

We’ve collated all the points raised and drawn up an action plan that we will implement over time. The main points raised were around our (apparently) out of date SOPs for OTC sales and the general dispensing process (to add to the SOP for CDs) and how we analyse errors in order to stop them happening again.

We do keep a log of all near misses in the dispensary but we aren’t yet very good at spending the time analysing the log to see what the common errors are and how we can therefore improve the dispensing process. So this will keep us busy for a little while.

More interventions

Here is my usual slot on some of the recent interventions we have made:

• Two asthmatic patients issued with acute scripts for erythromycin who were also taking theophylline. On contacting the relevant GPs, one was happy to halve the theophylline dose whilst the patient was taking the erythromycin, and the other GP wanted no action taken since the patient had recently had her theophylline checked and was at the lower end of the therapeutic range.

• One patient who was newly prescribed acamprosate at a dose of ‘2 QDS’. Following our conversation with the GP practice this was reduced to the usual dosage of ‘2 TDS’.

• A patient who had recently had an attack of gout and was not aware of leaving a gap before starting allopurinol and that the allopurinol was likely to precipitate a further episode of gout.