That sinking feeling

Today, I picked up on a prescription where I had made a mistake.

I hate that sinking feeling that you get when a patient rings up to query a medicine they have been given. This involved a lady who had been started on the brand Dilzem in hospital and had continued to be prescribed it on FP10.

The trouble was that the script was written generically with Dilzem in brackets at the end and I had the brand Adizem picked for me. I had obviously seen generic diltiazem on the script, missed the ‘Dilzem’ at the end, seen that Adizem had been picked and assumed that this was the brand that the patient had (I believe this is called ‘root cause analysis’!).

So when the lady rang to query the brand we realised the mistake, swapped it over and apologised to her.

At least this mistake will cause no harm to the patient but we have now tightened up on our dispensing procedure (especially me!) to make sure we triple check scripts for generic diltiazem modified release preparations.

I'm not waving

I’m starting to feel like I’m drowning this week. Like everyone else we’ve had a really busy Easter and so all the proactive work has been put on hold.

The trouble is that it all seems to keep piling up. I’ve made a start on our SOP for CDs but haven’t got very far, and all our action points from the RPSGB Inspectors visit aren’t yet complete.

On top of this we’ve got all the work to start on improving our business with all the multiple changeovers in the area (following a very quick refit we now have a Boots Local near us!), MURs to begin once we get the new form, and of course we now have the patient survey to think about before March next year.

I certainly won’t get bored over the summer.

Special information

One of our regular customers came in this morning to ask for some further information on a GTN ointment that had been specially made up by the hospital.

Because it was a ‘special’ she didn’t receive a PIL with it and wanted more information about the product. So I talked to her about it and gave her a PIL from an equivalent preparation which she was very pleased with.

It has never occurred to me before that when we supply these ‘special’ extemp preparations that there isn’t a PIL to go with them. Has anyone got round this problem?

Frustrating time

I’ve had a really frustrating time this week trying to get hold of some sheaths for a gentleman who was rapidly running out of them. We phoned our wholesaler to order it as a special line and were promised delivery in 2-3 days.

We checked this delivery date again 2 days later and were assured that they would arrive the next day. The ‘next day’ came and went, and on calling the wholesalers we were suddenly told that it now be a further 5-6 days!!

Now with only 3 days supply of his sheaths left, we rang the manufacturer, placed a direct order and were promised next day delivery (for a price). Again the ‘next day’ came and went and on calling the manufacturer we were told that our order hadn’t been put through as an overnight delivery, but it would be right away.

On ringing them the next day we were told the old old story that the courier ‘couldn’t find us’ and they would rearrange for delivery.

Well, by this time the poor man had run out completely and so we gave him a few more days supply of a sheath we already had in stock until his sheaths finally did arrive. It was so frustrating and time-consuming to have been messed around by both the wholesaler and the manufacturer.

Tramadol substitute

Had a phone call from a worried daughter this morning. Her father had been prescribed tramadol by the hospital but it was making him feel very sick. He was already taking paracetamol but that was only ‘taking the edge off the pain’.

She had rung the hospital and was told by one of the nurses that the community pharmacist could provide an equivalent painkiller.

I explained that of the painkillers available OTC, nothing was strong enough to match tramadol and that of the paracetamol and codeine combinations available to buy, the dose of codeine in these preparations was so small that it added no real benefit over paracetamol alone.

So I advised her to speak to her father’s GP and later that evening she came with a script for co-codamol 8:500 which, of course, I could have supplied myself! I don’t yet know if they did any good or not.

Fully prepared

This afternoon I handed out a course of metronidazole to a gentleman with my usual counselling of no alcohol, etc.

“Oh, don’t worry,” he said, “I’ve just finished a course of these and so I know all about avoiding alcohol. I had a skin full last night to keep me going until I finish this lot.” Nothing I could say to that really…

Great opportunity!

This morning I had yet another call from a pharmacy recruitment agency asking for me by name, and letting me know that there were now ‘great opportunities’ for me locally if I wanted to move from my current position (bit of a coincidence with the new multiple moving into town don’t you think?). So again I politely told them that I was very happy where I was.

Competitive edge

Recently I told you that there has been a change of ownership of a pharmacy in the town which has proved to be particularly advantageous for us in terms of swelling of new patient numbers.

The owner of the pharmacy where I work is naturally keen to encourage these patients to continue to use our service, but he is also aware that the new multiple is likely to be pretty aggressive in building its business back up so we have given a lot of thought to how we can really start to improve the business in order to combat this.

We have come up with a number of key strategies to do this which we aim to take forward over the coming months.

These include really pushing our collection service again; further developing the dosette box service and other services to support people who are struggling with their medicines; being 100% ready when the local GPs finally decide to implement repeat dispensing; starting to do MURs as soon as the new form is released; and improving the ongoing training of the counter staff. I’ll keep you informed of progress.

Simvastatin and antibiotics

An elderly lady rang me today to double-check that she had done the right thing by stopping her simvastatin whilst taking a course of cefalexin.

Her logic was that she had been told in the past to stop her simvastatin whilst on a ‘different antibiotic’ (i.e. erythromycin) and has assumed that this applied to all antibiotics.

I told her that it didn’t apply to all antibiotics, to re-start her simvastatin, and that I would always tell her if she needed to stop her cholesterol drug if she got a future course of antibiotics that did interact.

It just got me thinking if there are other patients out there with the same assumptions. I always counsel patients about taking simvastatin and erythromycin together, but I’ve never stressed to these patients that they should continue taking simvastatin when they are prescribed further courses of antibiotics that don’t interact.

Has anyone else come across this?