More encounters

Had a couple of interesting patient encounters this week:

• The gentleman who had been prescribed an acute course of diclofenac. While I was counselling him about how to take it and the possible side effects, he told me that he had had a stomach ulcer in the past.

I advised him to speak to the doctor again which he did there and then. He asked us to shred the prescription since the doctor had advised an alternative painkiller which he already had at home.

• The lady who came in with a script for a single 30g tube of permethrin cream for scabies. We always supply the PRODIGY PILs with conditions such as this (e.g. scabies, threadworms, headlice, etc) since they describe all the other important measures, apart from the drug treatment, that patients need to follow and patients often find it embarrassing to talk about these conditions (even in the private consultation area).

On running through the information in the leaflet the lady could see that she needed a second tube of cream for the second treatment 7 days later, plus treatments for the other members of her family so she went back to the surgery and came back with the relevant scripts.

Adverse reaction - from doctor!

I had an interesting discussion with one of our local GPs this week. We get scripts mainly from three GP practices, two of which we have a great relationship with and one (a dispensing practice) which we don’t.

The upshot of this is that if there is a problem with a script, we can readily sort it out for patients from the two non-dispensing practices, but if it’s a script from the dispensing practice we send the patient back (it’s just over the road) since this has proved in the past to be more effective than the pharmacists trying to ring to speak to the doctors.

Now I don’t like working this way since it’s not in the patient’s best interests, so when I got a script for a steroid nasal spray for a 4 year old which, on talking to the mother, I knew should have been a steroid inhaler I decided to ring the practice myself.

The doctor concerned had meant to prescribe an inhaler but was so unpleasant on the phone that I won’t be in a hurry to try that again.

I think it’s such a shame when all health care professionals can’t work well together to ultimately provide patients with a safe, quick and effective service.

Taking the plunge

I recently described a bag of patient-returned medicines which also contained some knitting needles and tea bags. Well we can now better this after having another bag of medicines returned to us which also contained a toilet plunger!

We do explain to patients that we will open the bag and sort through the medicines that have been returned to us, but it doesn’t seem to stop some rather curious items appearing from time-to-time…

Here are some of the recent interventions I have made:

• Telling numerous patients prescribed a short course of erythromycin to stop taking their simvastatin whilst taking the antibiotic.

• Getting a short course of trimethoprim changed to an alternative for a patient also taking methotrexate.

• Getting an ACE inhibitor removed from a repeat prescription which also contained a newly prescribed angiotensin II inhibitor.

Multiple advantages

One of the multiple pharmacies in the town has recently been bought out by another multiple and the change-over happened this week.

It has proved to very advantageous for us since we have started to see a significant number of new patients that have been unsettled by this change in ownership. This was particularly the case when the multiple closed down over a weekend to allow for the change-over to take place.

I hope that we can impress these new patients enough to encourage them to continue to use our pharmacy.

Very interesting!

We’ve had some interesting H. pylori eradication regimes prescribed recently. A one week course of a PPI, amoxicillin and clarithromycin is usually prescribed in our area and we have had a number of variations to the licensed combinations, for example:

• The correct dose of amoxicillin but not enough to last for a week.

• Too small a dose of PPI and the incorrect dosage of amoxicillin over a week.

• One lady who had had a flare up of a previous ulcer, had been for a blood test and then had been given a script for eradication therapy with no explanation as to why she was taking it. The dose of PPI was in excess of the licensed combination and the dose of amoxicillin was incorrect.

One of those days!

We've just had ‘one of those days’. We had a number of dispensary staff off sick and on holiday and so over lunch there were periods of time where there was only one pharmacist and one technician in the dispensary (very short staffed for us).

And of course it became extremely busy with prescriptions. Most of the patients who were waiting were regulars who are used to a prompt service so it didn’t help when they all started cheering every time we handed out a script!

Finding an answer

I’ve had quite a few interesting patient enquiries this week for which I’ve needed to contact the relevant pharmaceutical companies. Some of them are:

• Can you mix Movical sachets in warm water? Answer: The company is aware that this has been done but doesn’t have any stability data and so doesn’t recommend it.

• There is grapefruit flavouring in Idrolax sachets so will this interact with simvastatin? Answer: No.

• Can a person who has had a cataract operation two months previously start to use Opticrom eye drops again for an allergy? Answer: Yes.

• Can a patient with chromic urticaria increase the maximum licensed daily dose of 180mg Fexofenadine (on the advice of their GP)? Answer: The company has studies to show that doses far in excess of 180mg daily can be administered safely but a consistent clinical benefit has not been shown.

First, find some food

I felt sorry for an elderly lady yesterday. It was about 10am and I gave her some doxycycline which stated that the starting dose of two capsules should be taken that morning.

However, when I advised her that she should take this dose after food she said ‘Oh well, I’ll have to wait until I get home to take them because I’m off to visit my daughter-in-law now and she never feeds me.’