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Hospital pharmacy work experience: hyoscine, doctors and warfarin

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I had the opportunity to shadow a hospital pharmacist who has been qualified for just two weeks. I noticed that she found it difficult to pass on messages to the doctors even when she had written the notes in multiple places and her suggestions were not always acted upon. Even writing in a doctor’s ‘to do’ book did not always work. She did, however, say that she understands that doctors are very busy and often have different priorities to pharmacists. She remarked that she doesn’t have the time to go to ward meetings with doctors, nurses, occupational therapists, physiotherapists and dieticians but she said it would be really beneficial if she could. From her I learnt that hyoscine can be used to dry up secretions, for example from some kinds of tumours. She also told me that there are two main ways to treat atrial fibrillation; restoring the rhythm and restoring the rate. Digoxin is normally used to restore the rhythm and this tends to be better than restoring the rate because a regular rhythm reduces the risk of blood clots developing.

I spent the rest of the morning with a medicines management technician who showed me a warfarin chart which records patients’ regular blood test results to monitor blood clotting. The INR (international normalised ratio) is measured. An average INR is between 0.8-1.2, however to reduce the chance of blood clotting a patient can take warfarin, which raises the INR to approximately 2.5. It is important to have regular blood tests to ensure the INR does not become too high as this can increase the chance of a patient suffering from a bleed. However, if too little warfarin is taken the INR can become too low which can increase the risk of blood clots. Patients who have mechanical heart valves are typically allowed to have a higher INR (between 3-3.5) than normal warfarin patients as blood clots are often more likely to form on mechanical values.

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