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Independent prescribing

Tick those boxes

By Emma Graham-Clarke, MRPharmS

Like many people, I rely on “to-do” lists, although I find that the “to-do” items accumulate faster than I can tick the boxes to say that I’ve done them. There always seems to be something more urgent or more interesting to do that pushes the less exciting tasks down the list.

One afternoon in critical care, I was chatting to Sally, one of our patients. She had been admitted a few weeks earlier with a neurological problem that resulted in her being unable to sit unaided, let alone walk. I listened as she described how this condition had started and how it was currently affecting her and her family. I knew her condition had resulted in severe neuropathic pain and she described these unpleasant sensations, which particularly affected her feet and legs. We started discussing milestones and box-ticking, and the satisfaction of ticking off the items achieved. I confessed to her that I was currently struggling with a couple of pieces of work I needed to do but was having difficulty getting round to doing them.

Sally listed her milestones, which included sitting on the edge of the bed unaided and having a shower. I admired her determination and lack of self-pity. Many people in her situation would say “why me” and struggle to get beyond that stage. I’m sure Sally had those feelings on occasion, but they were overridden by her strong desire to get better and do whatever was necessary to achieve that. The physiotherapists had arranged for a piece of equipment for Sally that would enable her to get used to sitting again, and it was going to be used the following day for the first time.

At the end of our chat, Sally sent me off with the instruction: “Tick those boxes!” We agreed that we would compare our milestones the following day. I would write the standard operating procedure (SOP) that had been bugging me and Sally would have the experience of sitting in a chair.

I returned to my office full of admiration for her determination and inspired by her courage. It put all the petty issues I had to deal with into perspective and I sat down and completed the SOP. The following day I was able to report back that I had ticked the box and Sally told me that she had achieved her milestone as well and had been able to sit. For the rest of her stay on the unit, we regularly compared our milestones and our box ticking, as well as having discussions about the medicines she needed to dampen the neuropathic pain.

We take inspiration from all sorts of sources and I remain inspired by Sally. When I cannot get my thoughts in order and get the jobs done, I just have to remember her saying “tick those boxes” and the work gets done.

Now, that’s one box ticked, on to the next task.


Emma Graham-Clarke, MPhil, MRPharmS, FFRPS, is consultant pharmacist for critical care at Sandwell and West Birmingham Hospitals NHS Trust

Citation: Clinical Pharmacist DOI: 10.1211/CP.2014.20067222

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