Monthly Archives: November 2011

Dishonourable Discharge

The GP magazine Pulse reported on Friday 18th November that ‘GPs raise alarm over hospital discharge letter delays’. http://www.pulsetoday.co.uk

I am sure pharmacists would concur with that. It was estimated that up to 40% of hospital discharge notes never reach GPs. This may be due to the postman, hospital admin staff, those crazy GP receptionists who are too busy making clinical interventions (see ‘Can I take your order please’ post) or other factors.

Sometimes the hospital will give a weeks supply of medicines. This may be enough time to sort out a new prescription from the GP but generally it is not. Patients come to us to ask us to order their new medicines straight after discharge and we have to explain that we are not able to order it as the surgery will just ignore the request as the patient has not had it before.

It would be helpful if pharmacists got sent a copy of the discharge letter too with patients consent. This would act as a back up and keep us in the loop. On more than one occasion, I have to fax a copy of the patients discharge copy to the surgery as they had not got one.

When do you say no?

A patient brings in a 10 item prescription with 5mins to go before closing. You have been open for 10 hours.

Do you dispense it all and stay until after closing?

Ask them to call back in the morning?

Find out what they urgently need and dispense those items and ask them to call back in the morning for the rest?

Say no and send them to a 100 hour pharmacy? They have had all day to come in….

Can I take your order please?

On the 4th November, there was an article on the BBC NEWS website titled, ‘Receptionists ‘key’ to safe repeat prescription process’. This reported a study from the British Medical Journal.

Here are some quotes from it and my thoughts:

‘GP receptionists play a “hidden” role in ensuring patients get the correct treatments when they need them’

So do we!!!

‘Are receptionists the unsung heroes in general practice?’

NO

‘Many were adept at using a formulary to match brand names with generic equivalents; they often telephoned patients to clarify ambiguous requests, and many kept (individual or shared) notebooks containing knowledge they had gleaned on the job’

Maybe someone should invent a book that contains the names of drugs in it and bring it out twice a year? Or maybe they could send a similar one to surgeries every month!?!

‘Some receptionists, the study found were aware of having to make up for the failings of their doctors’

I do that too..

‘Receptionists in some practices expressed concern that doctors did not check prescriptions thoroughly before signing’

Concern? Its scares the crap out of me!

‘They believed that because of this they had a heavy responsibility to undertake safety checks themselves, although these were not recognised or remunerated’

Safety checks?!? Is that checking blood results? Checking for interactions and contra-indications?

GP receptionists get a basic wage but get a bonus payment for every time they stop a pharmacist from talking to a GP on the phone.

Every surgery should employ a pharmacist to help with the repeat prescription process.

(Please note that this post is not anti-BBC. The article was well written)

Inhaler use

I went to a LPF meeting on Asthma last night and really enjoyed it. What follows are some points that I either did not know, I knew but needed a gentle reminder or things that I think are interesting. It is NOT a comprehensive guide to inhaler use.

#Turbohalers are tasteless.

#One patient had 53 doses in 24 hours as they could not taste anything.

#Spiiva handihaler should be changed every 3-6 months.

#You can see the empty Spiriva capsule after use.

#The Turbohaler setting on the In-Check Dial is the same as Spiriva.

#The aerochamber plus makes a noise if you inhale too fast.

#Accuhalers have a sweet taste.

#Easyhalers have a 6 month shelf life once opened.

#Unused doses are collected in the clear window of the Easyhalers.

#Seretide Accuhalers are not licensed for COPD.

#The dose of Seretide Accuhalers should always be one puff BD.

#Always suck twice with a DPI inhaler to get all the dose. This is similar to hoovering over the same area twice.

#An Isle of Wight study showed that 94% of healthcare professionals were unable to demonstrate how to use an MDI correctly.

#At the LPF meeting 90% of pharmacists inhaled too quickly while using the In-Check Dial to mimic an MDI inhaler.

We all need to know how to use all inhalers so that we can show patients how to use them properly. If you have forgotten, then revise!