Good service

The EHC service is going really well. In the first couple of weeks we must be averaging about one consultation per day, which isn’t bad for a newly launched service.

The practice manager at the local GP surgery rang today asking me to supply them with information about the service for the reception staff to hand over.

I would imagine that our consultation rate will start to increase nicely.

Beyond reason

Had one of those really frustrating encounters today when a patient is convinced they are right and I am wrong, and no amount of reason can persuade them otherwise.

It was an elderly couple who came in to see me with a pot of calcichew D3 forte with our label on it dated August 2006. The bottle was full of brown tablets, which definitely weren’t calcichew D3 forte.

They were convinced that this was the bottle we had dispensed to them that week and that we had made a mistake.

I tried to point out that this bottle had been dispensed to them nearly a year earlier and that they must have used the empty bottle to start storing these unknown tablets, but they wouldn’t have it since they had ‘no other bottles in the house’.

So I gave them an emergency supply of the tablets, asked them to please throw away the unknown ones, and told them that they would have to arrange a further prescription from the GP surgery.

Fevered activity

We received a PCT circular today asking us to take account of the recent NICE guidance on treating fever in children.

I’ve made sure that all thestaff are aware of the guidance regarding antipyretic medication and that we are all ‘singing from the same hymn sheet’ regardless of whether we are supplying medication on prescription, on Care at the Chemist, or over the counter.

It did turn out to be quite a useful exercise since there were discrepancies among the staff as to how they were advising parents to use paracetamol and ibuprofen.

However, it did make me smile slightly because I see all sorts of weird and wonderful doses coming through on prescriptions for antipyretics which I inevitably have to alter (after talking to the parents of course).

Double dosette

We had a second instance today where we have recently set up a dosette box for a patient only to be told a few weeks later that the patient doesn’t like using the box and can we please stop supplying it.

Now that’s no problem, but what doesn’t seem to be appreciated is the time we take to set the service up, organise things with the patients/carers, etc - let alone the time it then takes to dismantle the unwanted trays of medication that are left with us.

So, I am just going to monitor this situation for now. If it starts to happen more frequently then we will need to seriously consider setting up our own screening tool to check the suitability of patients for this service.

I’m not convinced that other local healthcare professionals are applying any sort of criteria before they ask us to set up the service.

Testing time

An elderly lady called today asking me what she could do about her fingers since they were getting really sore from finger prick testing.

On looking at her records I could see that she had Type 2 diabetes but wasn’t using insulin, so I asked her how often she was testing her blood glucose levels, to which she replied twice a day.

Not wishing to tread on any one’s toes at this point I said that I would discuss this with her practice nurse and get the nurse to give her a ring (since the local guidelines quite rightly recommend testing twice a week).

I explained this to the nurse and she told me that the lady was really well controlled with a recent HbA1c level of 7. Therefore the nurse agreed to ring her back to ask her reduce her frequency of testing.

Practice leaflet

We’ve had the first draft of our practice leaflet back from the NPA and it looks really good. We are now turning our attention to pushing our collection and delivery service again.

We have revamped our PIL and are going to try to get it to look the same as the practice leaflet. In the meantime, I’m trying to find the time to start our annual patient survey.

Methotrexate interventions

Made a couple of good interventions this week with methotrexate, and on both occasions I gave the patients copies of the recently published NPSA methotrexate PIL which is excellent in my opinion.

* The first patient had just been initiated on methotrexate from the hospital and had brought in his FP10(HP) to be dispensed. So I spent some time with him going through the NPSA PIL and making sure he already had his monitoring book, etc. He was really pleased when he left.

* The second patient had been prescribed a course of penicillin for a skin infection. Patients on methotrexate should usually be prescribed erythromycin for skin infections but that had been tried and had failed. But I contacted the GP anyway and we agreed to ask the patient to reduce his methotrexate dose for the next two weeks in order to try to avoid any toxicity.

I also gave him the NPSA PIL so that he could clearly see which side effects to look out for. Again, he was really pleased with the service.

EHC PDG OK

We launched our EHC PGD enhanced service this week. We have initially informed all the local GP practices and put posters up in the pharmacy (which I had to do myself since there is no advertising material available with the scheme!).

I also did my first consultation today which went well. I’ve decided to just talk to the patient first and then fill out all the paperwork with her second.

The paperwork is pretty cumbersome and I would spend more time looking at that than concentrating on talking to the patient, if I tried to do both at the same time.