The week after Easter
In the run up to Easter normally sane people go a bit crazy, just because the GP surgery is going to be closed for four consecutive days. So it's fair to say that it's quite a busy week. Things normally calm down after easter - not for me though, this week has been even busier than last week.
Today has been interesting shall we say. Firstly I had to deal with a dispensing error made by one of the pharmacists who was covering me on my week off. Zispin 30mg had been given instead of 15mg, so the patient had been taking double the dose she should have been for about a week. Unsurprisingly she had been a bit drowsy, but I managed to sort things out for her. I then had a patient in with a subconjunctival haemorrhage. These look spectacular, but in most cases aren't anything to worry about. I've had one myself - I won't go into details but it involved contact lenses and alcohol.
I've also bent the rules a few times today. Firstly I did a medicines use review with the daughters of a patient. MURs are supposed to be done with the patient, but this patient was housebound and the daughters are in and out everyday anyway so are up to speed with what's going on. Next I dispensed some out of date medicines, intentionally. I had a prescription brought in for a lady who has not got too long left. It had diamorphine (heroin) and hyoscine on it. In terminally ill patients hyoscine is used to reduce respiratory secretions ('death rattle'). So it's something that is needed fairly quickly. I didn't have any in stock, but one of the other pharmacies near by did. The only problem was it went out of date a few days ago. Damn. I really didn't want to leave this lady overnight without the hyoscine. So I phoned the manufacturers who at least confirmed there were no toxic products produced when hyoscine degrades. Of course the manufacturer came out with their standard line of 'we don't recommend you use the product after the expiry date.' Well I know this, but I don't really have much choice at the moment do I?
Today has been interesting shall we say. Firstly I had to deal with a dispensing error made by one of the pharmacists who was covering me on my week off. Zispin 30mg had been given instead of 15mg, so the patient had been taking double the dose she should have been for about a week. Unsurprisingly she had been a bit drowsy, but I managed to sort things out for her. I then had a patient in with a subconjunctival haemorrhage. These look spectacular, but in most cases aren't anything to worry about. I've had one myself - I won't go into details but it involved contact lenses and alcohol.
I've also bent the rules a few times today. Firstly I did a medicines use review with the daughters of a patient. MURs are supposed to be done with the patient, but this patient was housebound and the daughters are in and out everyday anyway so are up to speed with what's going on. Next I dispensed some out of date medicines, intentionally. I had a prescription brought in for a lady who has not got too long left. It had diamorphine (heroin) and hyoscine on it. In terminally ill patients hyoscine is used to reduce respiratory secretions ('death rattle'). So it's something that is needed fairly quickly. I didn't have any in stock, but one of the other pharmacies near by did. The only problem was it went out of date a few days ago. Damn. I really didn't want to leave this lady overnight without the hyoscine. So I phoned the manufacturers who at least confirmed there were no toxic products produced when hyoscine degrades. Of course the manufacturer came out with their standard line of 'we don't recommend you use the product after the expiry date.' Well I know this, but I don't really have much choice at the moment do I?
posted by UK Community Pharmacist at 4/11/2007 10:07:00 pm
4 Comments:
Thank Goodness!
The art of courageous common sense is still alive at the sharp end.
Keep it up, but don't confess it publicly. Otherwise you will be hounded by the intelligently incompetent who have attained a position where they can do no harm to the patient and public only to their profession.
Great comment!
www.fastfoodpharmacy.blogspot.com
let me know your thoughts
xo
filet
You were right to dispense the hyoscine as you did; I assume the purpose was to help the woman die with dignity. Such palliative care has a very different logic than curative care; the normal rules don't apply in those extreme circumstances.
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