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What information should we use? (David Gibson)

At school I was a keen historian and I lament the fact the subject never really fitted in with the scientific career I chose. One important learning point I took from my history lessons at school was the use of sources of information, in particular the use of primary and secondary sources. As a pharmacist, this has become especially pertinent since I have been given access to the national summary care record (SCR), and I have been reflecting upon how I obtain the information that I require to prescribe appropriately.

A 68-year-old woman was admitted with a seizure. She was treated in the emergency department with benzodiazepines and was then transferred to the admissions unit where I first saw her on the post-take ward round the following morning. The consultant and I reviewed her history and blood results and discovered that she was prescribed valproate, but her serum levels were low. We discussed the possibility of increasing the dose. Because the patient was still too drowsy from the benzodiazepine to speak to us, we did not know her current drug regimen. So I accessed the SCR in an attempt to ascertain what she was prescribed.  

I found that over the previous two months the patient’s valproate dose had been reduced gradually while her other antiepileptic medicines remained unchanged. This explained the low valproate levels and made me consider where best to get the information to justify the dose change. Her medical notes arrived on the ward; a letter from her neurologist explained it all. The patient had been told to stop the valproate and switch to carbamazepine — a far better drug to treat her post-stroke seizures. The neurologist had detailed a clear plan to switch the drugs and had explained the possibility of increased seizure frequency during the titration period. This completely changed our management plan and in a couple of hours the patient was on her way home, with no change to her medication and a neurology review booked for the following day.

For me, this is a good example of how the SCR should be used in conjunction with other sources of information, enabling me to provide the best care for my patients. A prescriber needs to interpret information — including its source — and evaluate the strengths and weaknesses, just as I did with the history resources at school.

Citation: Clinical Pharmacist URI: 11090878

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