Friday, October 27, 2006

Documenting interventions

Community pharmacists are supposed to record the interventions they make, at least the most significant ones. This is not always easy! On Thursday I was at a busy pharmacy with just myself and a trainee dispenser in the dispensary. We were non-stop all day, so I didn't really have time to stop and document the interventions I made. There were a few really good interventions I made, which demonstrate the value of community pharmacists:

1) An elderly gentleman attempting to purchase a bottle of gaviscon for heartburn he was getting. On further questioning he had not experienced this heartburn before, and was also taking etodolac (Lodine, a non-steroidal anti-inflamatory drug). There are several sinister conditions that can present as heartburn, particularly peptic ulcers (commonly caused by NSAIDs) and gastric cancer. So this gentleman set lots of alarmbells ringing. I referred him to his GP, who told him to stop the etodolac and gave him some omeprazole.

2) Another elderly gentleman, this time complaining of a cough. He wondered if it could be caused by the salbutamol he had recently started taking. Further questioning revealed he was also taking ramipril, an angiotensin-converting enzyme inhibitors. A persistent dry cough is a classical side effect of ACE inhibitors, so this gentleman was advised to make an appointment with his GP to change his antihypertensive medication.

3) A prescription that had so many problems its tough to know where to start. The sript was for:
- bendroflumethiazide 5mg 1 daily x56
- allopurinol 100mg 1 daily x84
- irbesartan 300mg 1 daily x56
- lansoprazole 15mg 1 daily x 56
- arthrotec 75mg 1 twice daily x 60

So this gentleman's medication was all out of synch, with one month of one, two of a few others and three months of another. Now bendroflumethiazide is effective at reducing blood pressure, and at a dose of 2.5mg per day has very few side effects. Increasing the dose to 5mg has no extra BP lowering effect, but does affect body chemistry, and in particular reduces the amount of uric acid excreted from the body. Gout is caused by high levels of uric acid, which then crystallizes in the joints. Allopurinol is used to prevent attacks of gout, so giving bendroflumethiazide 5mg to a patient with gout is not the best idea in the world.

Arthrotec is a combination product of diclofenac (another NSAID, the same group of drugs as ibuprofen) and misoprostol, a prostaglandin analogue which protects the stomach from the toxic effects of the diclofenac. Lansoprazole is also a drug which is used to protect the stomach from NSAIDs, so there is no reason to prescribe lansoprazole with arthrotec. These issues were not serious enough to warrant a call to the GP, but doing a medication use review would have been a useful way of drawing these problems to the GP's attention. As I didn't have time to spend 20 minutes or more with this gentleman and the regular pharmacist doesn't do MURs, I advised him to make an appointment with his GP for a full medication review and explained the issues to him.

Ideally I would have documented these interventions, possibly on the patients medication records. However I simply did not have the time to do so, and this is one of the major challenges facing community pharmacists today. By documenting our interventions we can show the value of our role, however there often simply isn't time to do so. This is only taking into account the major interventions, and not including all the counselling we do, such as advising patients using corticosteroid inhalers (such as Becotide) to rinse their mouth after using them, or advising patients on statins to see their GP urgently if they have any unexplained muscle pain or weakness. I think the future of community pharmacy lies in robotic dispensing, freeing up pharmacist time to speak to patients and document what they do.


Blogger vicoprofen said...

I´m totally agreed with you
This Information was so informative and precise
I hope to there were more pages like this one
and I like to invite you to visit my page...
We are online pharmacy...
If you need any information about medicines
medications,treatment against any disease, prescriptions or online prescriptions
contact us. We´ll be so glad to help you
and to help people does need any medication
We are here for your good.
Vicoprofen - Lortab- Tylenol
- zyban
All Major Medications are available right here at:

1:54 am  
Anonymous Anonymous said...

I have the pleasure to visiting your site. Its informative and helpful, you may want to read about obesity and overweight health problems, losing weight, calories and "How You Can Lower Your Health Risks" at phenterminefastinadipexionaminmeridiaxenical site.

7:20 pm  
Blogger Adi said...

Find Internet Marketing resource hare Online Marketing Strategy | Internet Marketing Tools | Online Marketing Campaign | Online Marketing Business | Online Marketing System | Online Business | Online Home Business | Online Business Tips | Internet Marketing Online

2:25 am  
Blogger Adi said...

Oes Tsetnoc one of the ways in which we can learn seo besides Mengembalikan Jati Diri Bangsa. By participating in the Oes Tsetnoc or Mengembalikan Jati Diri Bangsa we can improve our seo skills. To find more information about Oest Tsetnoc please visit my Oes Tsetnoc pages. And to find more information about Mengembalikan Jati Diri Bangsa please visit my Mengembalikan Jati Diri Bangsa pages. Thank you So much.
Oes Tsetnoc | Semangat Mengembalikan Jati Diri Bangsa

5:52 am  
Blogger Frank said...

at first I was hesitant about ordering from online pharmacies but I ordered from and I can tell you that I had a good experience, my mediciation was delivered, I was not scammed, and their medications are effective. no prescription required when ordering from F.S

12:44 pm  
Anonymous Anonymous said...

like gambling? love las vegas? assay the all left unaccustomed to [url=]casino[/url] las vegas at with all upwards 75 procedure sanction to adopt [url=]online casino[/url] games like slots, roulette, baccarat, craps and more and bottom-line a crushing in existent onset with our $400 cost-free bonus.
we from unbroken appreciation b wealthier games then the to pieces online [url=]casino[/url]! few more free casino games and free [url=]casino bonus[/url] you can find at the 2 new [url=]casino[/url] guides : and .

1:27 am  
Blogger hannah said...

I lost a lot of weight by taking Phentermine that I ordered from WWW.MEDSHEAVEN.COM i am very satisfied!

1:51 am  
Anonymous Anonymous said... had changed their website to WWW.MEDSHEAVEN.NET you can order all medications you are looking for from their new site , I highly recommend them.

9:39 am  
Anonymous Anonymous said...

how many cycles of clomid to get pregnant | where can you buy clomid - buy clomid no prescription, clomid steroid

5:36 pm  
Anonymous Anonymous said...

clomid success rate 2011 | clomid price walmart - buy clomid 50mg, clomid side effects after ovulation

4:44 pm  
Anonymous Anonymous said...

men clomid | buy clomid pct - buy cheap clomid, clomid days 3 7 when will i ovulate

2:10 pm  
Anonymous Anonymous said...

clomid ectopic pregnancy | - buy clomid online no prescription australia, when do you take clomid

10:29 pm  
Anonymous Anonymous said...

clomid effectiveness | [url=]clomid 50 mg[/url] - can you buy clomid over the counter, ggcw clomid and iui success stories

1:37 pm  

Post a Comment

Links to this post:

Create a Link

<< Home