RPS Foundation Framework Cluster 1 Patient and Pharmaceutical Care Cluster 2 Professional Practice Cluster 3 Personal Practice Cluster 4 Management and Organisation Patient Consultation Need for Medicine Provision of Medicine Selection of Medicine Medicine Specific Issues Medicines Information and Patient Education Monitoring Medicine Therapy Evaluation of Outcomes Transfer of Care Professionalism Organisation Effective Communication Skills Team Work Education and Training Gathering Information Knowledge Analysing Information Providing Information Follow Up Research and Evaluation Clinical Governance Service Provision Organisations Budget and Reimbursement Procurement Staff Management EXAMPLE 3 This scored 8/15. Whilst on the ward I counselled a patient newly started on warfarin, the patient was a little bit agitated at the time and didn’t seem to be taking all of the information in. Therefore I decided to cut the warfarin counselling down to the key points about the variable dosing depending on his INR, to report signs of bleeding and bruising immediately, not to take NSAIDs, to keep diet stable and to inform all health care professionals that he is taking warfarin. I did not go into a lot of detail about each counselling point as I felt the patient wouldn’t be able to retain all of the information and wanted to make sure he understood the most important points. I gave him a yellow book and advised him to read it and ask any questions when he came for his clinic appointment. During the counselling I felt that the patient was comfortable speaking to me, although he kept going off topic and telling me about his past, which worried me as I was concerned that he wasn’t taking in the information. As he kept wanting to discuss other topics I kept having to bring the conversation back to warfarin, I think I achieved this without upsetting the
similar drugs which he may come across in future. By filling out an error report online he could personally reflect on his error while feeding this back to my pharmacy colleague was an ideal opportunity to avoid similar mistakes on a wider scale. RPS Foundation Framework Cluster 1 Patient and Pharmaceutical Care Cluster 2 Professional Practice Cluster 3 Personal Practice Cluster 4 Management and Organisation Patient Consultation Need for Medicine Provision of Medicine Selection of Medicine Medicine Specific Issues Medicines Information and Patient Education Monitoring Medicine Therapy Evaluation of Outcomes Transfer of Care Professionalism Organisation Effective Communication Skills Team Work Education and Training Gathering Information Knowledge Analysing Information Providing Information Follow Up Research and Evaluation Clinical Governance Service Provision Organisations Budget and Reimbursement Procurement Staff Management EXAMPLE 2 This scored 10/15. Patient age: 55 Gender: Female Medical history: N/A Social history: N/A My Role: Responsible Pharmacist Medicine history:
The patient remained stable throughout admission, lower GI bleed was excluded, and no evidence of ongoing PR bleed was found on examination. Whilst the patient’s Hb continued to be low, this was usual for the patient due to iron deficiency anaemia. The patient’s ferrous fumarate was also withheld prior to colonoscopy, as per policy. Ferrous fumarate was restarted following the completion of investigations, and the GP was asked to perform a full blood count after admission and review oral iron. If the patient had not been anticoagulated this admission may have been avoided, whilst it was likely that they may have experienced a small amount of PR bleeding from the haemorrhoids it may not have been extensive enough to have resulted in hospital admission. However, due to the patient’s co-morbidities anticoagulation was indicated. Their HASBLED score was calculated prior to restarting apixaban and was found to be 2, due to age and previous bleed. Therefore it was reasonable to continue with anticoagulation if the risk of clotting was considered significant. When I reviewed this patient the apixaban was already withheld. I ensured that the HASBLED score was calculated and considered by the doctors when deciding the plan. I completed the yellow card in a timely manner, and ensured the patient was aware that I was doing so for informal consent purposes. Given the black triangle status of apixaban, and the severity of the bleed (requiring hospital admission), I would yellow card this scenario again if it occurred RPS Foundation Framework Cluster 1 Patient and Pharmaceutical Care Cluster 2 Professional Practice Cluster 3 Personal Practice Cluster 4 Management and Organisation Patient Consultation Need for Medicine Provision of Medicine Selection of Medicine Medicine Specific Issues Medicines Information and Patient Education Monitoring Medicine Therapy Evaluation of Outcomes Transfer of Care Professionalism Organisation Effective Communication Skills Team Work Education and Training Gathering Information Knowledge Analysing Information Providing Information Follow Up Research and Evaluation Clinical Governance Service Provision Organisations Budget and Reimbursement Procurement Staff Management
Ciprofloxacin has no cross-sensitivity with penicillin group and therefore is a safe choice. The adverse reaction was documented in the Critical Medical Information Store (CMIS) system which can be assessed nationwide in Singapore by any doctors to alert them prior to prescribing drugs of similar class. Reflection: I felt that I have approached this matter appropriately as a pharmacist, any known drug allergy should be clearly documented to prevent any such adverse reaction from happening again and this will trigger prescribers to consider the risks of cross-sensitivity when using other classes of antibiotics. RPS Foundation Framework Cluster 1 Patient and Pharmaceutical Care Cluster 2 Professional Practice Cluster 3 Personal Practice Cluster 4 Management and Organisation Patient Consultation Need for Medicine Provision of Medicine Selection of Medicine Medicine Specific Issues Medicines Information and Patient Education Monitoring Medicine Therapy Evaluation of Outcomes Transfer of Care Professionalism Organisation Effective Communication Skills Team Work Education and Training Gathering Information Knowledge Analysing Information Providing Information Follow Up Research and Evaluation Clinical Governance Service Provision Organisations Budget and Reimbursement Procurement Staff Management