Thrush and worms

Here’s a couple really good clinical interventions for you all:
• A script for Canestan Solution written ‘to be used TDS’ for a 8 day old baby. On taking this out to mum I checked how she was going to use it and she had been told it was for oral thrush! So I quickly rang the GP who said he was having a ‘really hectic day’ and got it changed to nystatin suspension. Mum was fine when I explained that one of the pharmacist’s roles is to act as a ‘double-check’ in the system as we dispense the scripts.
• A script for a 3 year old for mebendazole, with a dose that reflected a roundworm infection. So before I gave this out I asked mum if the family had recently been abroad to an exotic location (to which the answer was no) and to then describe the symptoms (which sounded like threadworms to me). So I rang the GP and with his, and the patient’s, agreement I scrapped the script altogether and treated the whole family on the Care of the Chemist scheme for threadworms.

Audit going well

My multi-disciplinary methotrexate audit seems to be going down well. I’ve asked five patients so far; one refused point blank, two filled it in there and then whiles they were waiting for their scripts, and two took them away and have both returned them.

People seem happy to complete the questionnaire if I tell them that the point of it is to see how well they are being managed on their methotrexate and if there are any areas where the local ‘health authority’ can improve services.

So far, all the patients seem to be very well informed and very well looked after. One thing that doing this audit does, is make you really bone-up on all aspects of methotrexate treatment so that you can readily answer any questions (good for the CPD as well!).

Called to the bar

We are now trying our very best to scan every bar coded script that comes into the pharmacy (especially since I read that 25% of scripts are now bar coded but only 1% of scripts are actually being dispensed in this way).

We now have two GP surgeries who are issuing bar coded scripts.

Information either seems to be getting a bit quicker at coming down from the spine, or we are getting more used to changing our way of working to accommodate these scripts (i.e. scanning them as soon as they come in, so that the information is ready for us when we do get to that script).

I still find that whoever is running the script through (including me!) isn’t looking at the patient’s record as much as they should to pick up new medicines, changes in doses, etc; but instead is concentrating on altering all the dose information on the script to patient-friendly terms on the label.

But we’ll get there I’m sure.

Methotrexate survey

The PCT certainly seems to be busy at the moment. We have now just received the paperwork for our annual multi-disciplinary audit.

This one involves doing a small survey with all patients taking methotrexate tablets to see how much they understand about their therapy, how well they are being monitored, etc. The audit will run over two months.

In my opinion this is a great audit to do since we now have all the detailed information from the NPSA to give to patients about methotrexate therapy if they aren’t suitably informed.

Now that we have completed our annual patient survey, we will also have to start to think about our own internal annual audit.

Waste not

The PCT have just starting running a medicines waste campaign. They have sent everyone bag inserts, posters, stickers, etc to try to better inform patients.

The GP surgeries are busy supplying this information with every repeat prescription that they issue so we have decided to put all our information away for the moment and to start using it once the GP surgeries stop.

We feel that this prolonged approach will have more of an impact if first the GP surgeries and then we give the patients the same messages about only ordering the medicines they need.

This approach also fits in better with what we are doing at the moment since from the last blog entry you will know that we are busy stuffing bags ourselves with the information about our new repeat prescription service.

Relocation (repeat after me)

You may remember many moons ago that we developed a plan for boosting our business since it is likely that one of the pharmacies in the town is doing a ‘minor relocation’ into one of the local practices (the dispensing practice!).

Well we have now actioned our main goal which was to re-launch our repeat prescription and delivery service. This has taken some time and planning to e.g. produce all the advertising, bag stuffers, patient sign-up forms, etc; to write the SOPs and train the staff; and to get the GP practices on board with the new service (since the ‘new’ service primarily involves us requesting repeat scripts from the surgeries on patients’ behalves).

So we are currently busy signing up all our patients up for the service, and so far it is going very well (we started off just working with one surgery in order to iron out any problems). I feel that the timing of this launch is right since, of course, we have future-proofed our patient sign-up forms for EPS, etc and it gets patients used to requesting their repeat items from us in preparation for repeat dispensing (whenever that may be!).

Patient was three

Here’s an example of why pharmacists provide a rather valuable service to the public!

Had a script in today for trimethoprim 200mg BD for 3/7’ to a patient with no date of birth on the script. The patient turned out to be a 3 year old and on checking the dose of trimethoprim it was the maximum daily dose for this age and I could have dispensed a syrup since no form was indicated on the script.

But it did immediately go through my mind that the doctor had just signed this script (the patient had picked it up from reception) without realising it was for a child. It was, of course, from the dispensing practice that we don’t have a great relationship with but this one had to be checked out.

Well it turned out that my gut feeling was right and so I modified the dose for the patient and got a new script issued from the surgery.