Tuesday, October 24, 2006

Clinical pharmacy

One of the problems with being a relief pharmacist is that it can be difficult to do good clinical work. Some examples from today:
1) a prescription from an extended formulary/ supplementary prescibing nurse for 56 voltarol rapid
2) a 5 day course of trimethoprim 200mg twice a day for an elderly gentleman with a urinary tract infection
3) a prescription with co-codamol 30/500 capsules, 1 four times a day and paracetamol capsules 1 four times a day.

Now none of these prescriptions is actually wrong, however there are problems with all of them. Firstly voltarol rapid (diclofenac potassium) is no more effective than standard diclofenac other than for the first few doses possibly, and is a lot more expensive. Secondly, a five day course is unlikely to cure a UTI in a male, which I told the patient. Now these are useful things to feed back to the prescriber, but not something you would phone up about during surgery and during a busy day in a pharmacy.

I did phone the doctor about the third prescription, due to the significant risk of the patient overdosing on paracetamol. It would be far more sensible, and safer, to prescribe paracetamol, 2 tablets four times a day, with codeine separately which would allow you to titrate the dose of codeine easily.When I suggested this to the GP he ignored the idea, as the patient was "happy with what he was doing." Fine, but if the same situation cropped up again I'd do the same, in the interests of patient safety.

It is far easier to feed issues back to doctors and nurses when you actually know them, and you know when is a good time to call the practice to discuss general issues. Looks like I might have to find somewhere to manage soon, so I can get more satisfaction from what I do.

2 Comments:

Blogger Nostrumdammit said...

See if the practice you're dealing with has a practice pharmacist, get their direct extension number and / or email address and speak with them directly. Of course, immediate queries may still need to be routed in via reception staff, but you'd find that the practice pharmacist should be preparing the ground for you from the inside.
As in all things, the trick is relationship, relationship, relationship.
It's establishing relationship that's the problem!

9:17 am  
Blogger UK Community Pharmacist said...

True, but its not the easiest thing to do when you're just at the pharmacy for the day, and have no idea when, if ever you'll be back.

10:04 pm  

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