Special order problem

I spent some time today making sure that a mum got hold of some heart medicines for her four year old daughter.

This morning she brought in a prescription for this drug and told me that she had completely run out and needed to get hold of further supplies today in order to give her daughter the required evening dose.

What hadn’t been explained to her was that her daughter’s medication was a ‘special order’ that wouldn’t be with us for at least 3-5 working days.

I rang the hospital pharmacy department (which was 25 miles away) to ask for their advice and they told me it was possible for the patient to obtain further supplies today if she contacted her consultant who could then instruct the pharmacy department to supply it.

The trouble was that the patient didn’t have any transport which I informed the hospital of, but they said that one way or the other they wouldn’t leave the patient with no medication.

So I let mum know and she went home to sort it out.

I rang her this afternoon to check everything had worked out OK and she told me that the hospital had arranged for a supply to be made that evening from a local hospital which was only 5 miles away.

It was great that everyone pulled together to ensure that this lady received the necessary medication on time, but none of this would have happened if she had been told how long it would take to obtain supplies of this medication in the community.

Loose ends tied

In our continuing efforts to tie up all the loose ends in terms of complying with everything in the pharmacy contract, I had a look at the NPA template patient information leaflet that is now available and put my order in.

It’s great to have this sort of support available (for a small fee of course)!

An extra dosette of fun

We’ve had great fun and games with our dosette box service this week.

First of all, a nursing home insisted that we hadn’t supplied the extra prn medication with two of their resident’s dosette boxes.

We are always very careful to ensure that these ‘extras’ are secured to the boxes and so asked the home to have a good look round.

Thankfully they did ring us back to say that they had found the ‘extras’ tucked away in the respective residents’ rooms.

We also have a growing issue around a lack of communication and understanding of the dosette box service when patients are discharged from hospital.

The bottom line is that we can’t make any changes to the dosette box without instructions from the GP practice. However on two occasions this week we’ve had patients’ relatives come into the pharmacy to say that the hospital had stopped some of the drugs and so could we remove them from the dosette box?

This then involved us following up on the discharge medication sheet and then ringing the GP practice to get the go-ahead.

We have also had one occasion this week where the hospital has contacted us directly and asked for medication in the dosette box to be changed.

Again we explained that we are unable to do anything without the say-so of the GP practice (much to the surprise of the hospital!) and so asked the hospital to fax us the relevant discharge information so that we could then contact the GP practice and the patient to take this forward.

As we all know this type of service takes up a great deal of our time and we simply couldn’t do it without the ever-contentious issue of weekly scripts.

Keep taking the medicine!

Had an interesting telephone conversation today with a lady who hadn’t been taking any of her angina medicines for the past month because she had been ‘too busy’ to re-order them on repeat.

She had started to get headaches and so went to get her BP checked by the practice nurse. Needless to say her BP was very high, but she hadn’t told the nurse that she had stopped her medicines and had just gone home and re-started them all.

She felt so ill after doing this that she had stopped them all again and rang me for advice.

I explained to her that because she had completely stopped them all for some time, that she would need to slowly titrate most of the doses back up again.

I also persuaded her to tell her doctor since he was the only one who could monitor her and advise her on how to correctly re-start all her medicines.

EHC PGD accreditation

I received my accreditation certificate from the EHC PGD evening today and so we are now busy setting up the service.

We’ve got a lockable cupboard in the consultation room for all the paperwork and the PILs, and we are busy making sure that we have all the contacts for social services (for the under 14s) and for signposting the service when we can’t provide it.

We are going to begin to advertise the service just to the local GP practices and depending on uptake, we will take it from there.

Badge of honour

Finally feel like I’m making a bit of progress with the NPA Interact training for the new staff. One of the staff members has recently qualified and wears her badge very proudly, and the other staff member is now half way through.

Once I have got this second staff member through her training I’m going to start doing some revision sessions with the more experienced staff members. All good fun!

Touching on surveys

Today we started to look at how we are going to run our patient survey (probably over the summer).

We will be using one of the NPA-endorsed companies to help us carry out the survey and we’ve been discussing whether we should go for the touch screen survey or the paper-based survey.

We decided that we will use the paper-based package since it will suit our patient population much better.

The main thing against the touch screen survey for us is that we can envisage all the children playing with it; and we feel that our high elderly population will be more comfortable with paper and pen rather than with a touch screen.

I also personally feel that the paper-based survey will encourage more useful patient feedback from the open question at the end of the survey (i.e. ‘Do you have any other comments?’).

Latest interventions

Here are a few of interventions I have made this week:

1. Checking with a GP that a dose increase of modified release ISMN should be taken as two in the morning rather than as one twice a day (which would mean a loss of the nitrate-free period).

2. Getting a low dose of newly-initiated acamprosate changed to the correct dose.

3. Getting EHC removed from the regular repeat medication of a 17 year old girl.

4. Counselling a mum all about a new prescription for Desmotabs for her son. She had received very little information about why her son should be taking them and the importance of fluid restriction, etc.

Tracking the counterfeits

Had a very busy week last week catching up after the bank holiday and dealing with the patient recalls on the parallel imported counterfeit medicines.

The local GP surgeries gave us excellent support by quickly ringing all the patients who could have been supplied with these medicines (we did have telephone numbers for some of the patients affected).

We also had to think about how to explain this to patients and decided on the terminology ‘faulty batches’ rather than ‘counterfeit medicines’.

One patient had actually been supplied with one of the batches of olanzapine that was being recalled.

We are now left with one patient who we can’t get hold of. The surgery has rung him, we have knocked on his door during our deliveries, and we have also sent him a letter in case he is currently away on holiday.