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Patient notes

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Yesterday, as every other week, I went back home from University.  As well as going home to see my family, I also go home to work.  Before I started Uni, I worked as a pharmacy technician at an independent pharmacy and I still absolutely LOVE my job.  But this week, it suddenly hit me – how are community pharmacists expected to do a clinical check as efficiently and carefully as a hospital pharmacist? 


I was explaining to my boss that when I clinically check a prescription at University, I normally have a case file complete with the patients biochemistry results, including serum creatinine levels so that any renal impairment can be picked up.  The next prescription that came in was for nitrofurantoin capsules for an elderly lady with a UTI.  How was he expected to clinically check it with next to no information?  As you will all know, nitrofurantoin only reaches therapeutic levels when the patients creatinine clearance is over 60ml/min.  It is reasonable to assume that an otherwise healthy 86 year old lady may NOT have a creatinine clearance over 60ml/min as renal function decreases with age. There is therefore, a very real chance that the patient will not receive any benefit from the treatment and in the worst case, end up in hospital with an infection that has reached her kidneys and causes her to be acutely unwell.  Not only is this dangerous for the patient but it is extremely costly for the NHS and this scenario could be avoided if the pharmacist had access to the patient notes, especially at times when the surgery is closed and the information cannot even be gained by phoning the surgery and asking the receptionist to read out the last biochemistry results. 


I firmly believe that all community pharmacists should have access to patient notes and I’m surprised that it’s not standard practice.  It would enable them to do their job a lot better, instil more confidence in the profession and to be included in more clinical decisions rather than having to refer patients back to the GP or spend all day on the phone trying to check if a patients potassium levels are going to be monitored or ask what the patients last BP measurement was. 


Personally, I know that if community pharmacy went down this road and the job enabled me to look at patient notes, that career path would be a lot more enticing.  I have chosen hospital pharmacy for many reasons but one of them was because with the information contained in a patients notes, you can approach a patient knowing what their diagnosis is, their biochemistry results, when a drug was started, any complications and a wealth of other information.  This not only enables a pharmacist to do their job more safely, it also instils the PATIENT with confidence as you are not asking them all the above information and are more receptive as a result.


Why are community pharmacists not trusted with this information?  Let us do what we are trained to do and with all the relevant information.....pretty please?

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From: Tomorrow's pharmacist blog

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