Introduction
This placement handbook has been ready to assist your studying throughout your scientific placement for PY3060B Medical Pharmacy. It additionally acts as your diary/log ebook and ought to be accomplished and submitted for evaluation. Some sections are required to be signed by the pharmacist supervising you and the case presentation/affected person treatment overview presentation will likely be marked by the pharmacist.
The handbook ought to be learn together with the scholar handbook beforehand used through the scientific visits to Lewisham, Royal Marsden and St. George’s Hospital. In addition to offering steering on affected person administration plans, shows, and many others., it additionally accommodates the Requirements for Skilled Conduct which proceed to use, regardless of whether or not the scientific placement was organised by your self or by the College.
Placements will likely be two week placements in hospital, group or PCT pharmacy. Your placement supplier ought to verify your begin and finish date. The primary week ought to be used to gather knowledge for the location actions. It is advisable attend day-after-day from 9am – 5pm on the primary week of your placement. The subsequent week ought to be used to finish the handbook, be sure it’s signed and retrieve any lacking data. The interval throughout which the placements will happen is from Monday 29th March to Friday 16th April. Your placement supplier ought to verify your begin and finish date.
You must full the part for every exercise. There are 5 actions in all that you need to perform through the scientific placement. You need to not use the identical affected person and/or exercise for a couple of report. Every report should confer with a distinct affected person or exercise. Along with recording the data, it’s best to present proof of reflective studying. Reflection is an integral a part of the case presentation and Affected person Administration Plan (PMP) course of and is included within the proforma. For the opposite actions there’s a reflective studying sheet to finish. This ought to be acquainted to you as it’s much like the report on your PDP and much like the RPSGB preregistration data.
The handbook ought to be accomplished; the suitable sections signed by the supervising pharmacist. The finished affected person administration plan ought to be handed by Tuesday sixth April for college kids who began their placement on Monday 29th March and on Tuesday 13th April for college kids who began their placement on Tuesday sixth April and on Tuesday 20th April for college kids who began their placement on Monday 12th April. Different placement actions ought to be handed in on Friday ninth or Friday 16th April or Friday 23rd April relying in your begin date. Case shows will likely be assessed On Monday, Wednesday or Friday week starting 19th, 26th April or third Could.
You need to be certain that all of the actions are signed off by your supervisor or different member of workers. The supervisor might want to make feedback and there’s a house for these on every worksheet. The reflective studying sheets ought to be accomplished and these additionally require to be signed by a supervisor or member of workers. Failure to finish these will imply that no marks could be obtained for that exercise.
Spare copies of all types and worksheets can be found on StudySpace.
Studying Outcomes
This handbook will assist you in reaching the next studying outcomes
Display and apply data of the idea and implication of ADRs.
Define the traits of some drug-induced issues and the medication related to them.
Relate the collection of remedy to remedy tips/proof base, drug properties and the affected person
Perceive using generally used medical abbreviations. (Enhances data gained in Skilled Follow 5)
Use knowledge from generally requested biochemical and haematological laboratory assessments to observe drug remedy and illness development. (Enhances data gained in Skilled Follow 5)
Present acceptable pharmaceutical recommendation to potential sufferers to handle some minor situations encountered in group pharmacy.
Present acceptable pharmaceutical recommendation to potential sufferers and healthcare professionals on the administration of a lot of frequent illness states.
Produce a structured reflective diary of placement expertise
Follow actions to be accomplished through the placement
Actions to be undertaken in placement
Core
Neighborhood
Hospital
PCO
1. Put together a Affected person Administration Plan (PMP)
Three. Public Well being exercise, reminiscent of
Provision of smoking cessation recommendation/merchandise
Emergency hormonal contraception
Recommendation on cardiac well being
Provision of wholesome life-style recommendation
Three. Affected person Medicine Historical past
Three. Analyse prescribing knowledge and put together abstract report
2. Counsel a affected person on the right way to get hold of optimum profit from their medicines
Four. treatment use overview
Four. Discharge Plan
Four. Prescription overview
5. Presentation of treatment use overview and proposals to group pharmacist
5. Case presentation
5. Case presentation
6. Cope with a request for OTC medicines or minor ailment remedy
6. Shadow prescribing go to
1. Affected person Administration Plan: Web page 1
Affected person initials: J.W
Identify of Pharmacy: Sainsbury Pharmacy
Identify of GP: Dr Khan
Intercourse: M
Weight/Peak if accessible:108 kg /1.74m
Age:75
Date:ninth June 2010
Presenting Complain (PC): Affected person had a chilly and temperature and he was presently taking Sudafed. He got here within the pharmacy as a result of it was not working and needed to purchase one other OTC product. He additionally had muscle weak spot and felt dizzy.
Related Previous Medical Historical past (PMH)
Diabetes
Osteoporosis
Allergic reactions:nkda
Affected person earlier prescribed/OTC treatment from PMR
Indication on this affected person
How lengthy on it?
Affected person earlier prescribed/OTC treatment:
Indication on this affected person
How lengthy on it?
1.Sudafed
2.Gaviscon
Three.
Four.
5.
Nasal decongestants
Gastro-oesophageal reflux illness
7 days
6.
7.
eight.
9.
10.
Affected person present prescribed/OTC treatment
Drug and dosing particulars
1.Ramipril(10mg) capsules-take one capsule every day
2.Metformin (500mg) tablets-Take one pill with or after night meal
Three.Aspirin(75mg)
Dispersable tablets
Take one pill as soon as every day after meals
Four.Simvastatin(40mg)tablets-Take one pill at evening with meals.
5.Omeprazole
(20mg) capsules-Take one capsule every day
6.Alendronic acid (70mg)tablets-Take one pill every week
7.Cal D3 chewable tablets-take one pill twice every day
Indication
Hypertension
Sort 2 diabetes
Prevention of an atherosclerotic occasion
Reducing ldl cholesterol
Gastro-oesophageal reflux illness
Osteoporosis
Osteoporosis
Period
Abstract of monitoring parameters
Measure blood stress and liver operate assessments.
Measure blood sugar glucose stage and HB1ac.
Measure levels of cholesterol.
Affected person Administration Plan: Web page 2
Exams if accessible e.g. BP, glucose or ldl cholesterol (regular vary)
Date ninth June 2010
1.Blood stress (130/85 mmhg ) – 164/83 mmhg
2.Pulse price (60-80 beats p/min) – 67 beats p/min
Three.Whole ldl cholesterol (Three-5mmol/l) – eight.21mmol/l
Four.Ldl cholesterol (HDL)(>1mmol/l) – zero.eight mmol/l
5.Blood glucose (<7mmol/l) -11.2 mmol/l
6.
7.
eight.
9.
10.
11.
12.
Significance of outcomes exterior regular vary if accessible:
The blood stress could be very excessive, levels of cholesterol are excessive particularly the overall levels of cholesterol. The HDL ranges are barely low The glucose ranges are out of vary and are excessive.
Different concerns (social points, compliance);
The affected person could be very outdated and forgets to take his treatment often and has been suggested on the MUR to have a dossete field made for him and delivered which is able to guarantee he takes his treatment often.
Medical Issues
1.Diabetes
2.Hypertension
Three.Excessive ldl cholesterol
Four.Osteoporosis
Pharmaceutical downside listing prioritised (max Four issues)
1.Administration of diabetes
2.Administration of hypertension
Three.Administration of excessive ldl cholesterol
Four.Administration of osteoporosis
Affected person administration Plan: Web page Three
SOAP NOTES (max. 2 pages in font measurement 11 Arial line spacing 1.5)
PHARMACEUTICAL PROBLEM administration of diabetes
Subjective
Affected person is chubby
Goal
Blood sugar ranges have been measured within the MUR by the pharmacist utilizing the finger prick take a look at. The results of this take a look at was 11.2mmol/l.
Affected person weighed 108 kg and had a BMI of 30 kg/ m².
Blood stress was excessive: 164/83.
Pulse price: 68 beats per/minute
Evaluation
The affected person is chubby and that is indicated by his BMI of 30kg/m².The blood sugar ranges on examination confirmed to be very excessive. Regular blood glucose ranges vary from Four-8mmol/l all through the day, due to this fact his blood glucose stage of 11.2mmol/l is nicely out of the conventional vary. The affected person’s excessive blood sugar ranges can result in micro vascular issues e.g. nephropathy or macro vascular issues e.g. stroke and particularly since he has different cardio threat components e.g. he’s overweight and has hypertension.
NICE Tips recommends that if the individual is chubby (physique mass index larger then 25kg) oral anti-diabetic remedy ought to be began. If metformin will not be tolerated or is contraindicated, then think about beginning a sulfonylurea. NICE additionally recommends rechecking HbA1c inside 2-6months to reassess blood glucose management.
Presently this affected person is on monotherapy on metformin .His blood glucose ranges are nonetheless very excessive.
If blood glucose management will not be being achieved NICE tips recommends second drug could be added if the individual is already taking the optimum dose. If affected person is taking metformin one of many following choices could be thought of:
Add a sulfonylurea
If the individual has an erratic life-style add a speedy appearing insulin secretagogue(nateglinide or repiglinide)
If there may be important threat of hypoglycaemia (or its penalties) with sulfonylurea, or is sulfonylurea is contraindicated add a gliptin or glitazone.
The affected person has excessive levels of cholesterol and is presently taking simvastatin for this which can also be really useful by NICE as 1st line remedy for the administration of blood lipid ranges in individuals with kind two diabetes. The affected person is on a dose of 40mg taken as soon as day by day at evening. This might be elevated to the utmost dose of 80mg since his whole levels of cholesterol are excessive.
The affected person can also be on antihypertensive treatment and may preserve a blood stress under 140/80 mmhg since he’s diabetic. NICE recommends an ACE inhibitor ought to be first line remedy right here. His blood stress is presently 164/83mmhg which is above the goal blood stress an in accordance with CKS tips if the blood stress doesn’t meet the goal blood stress referral to a specialist possibly required.
Plan
The plan is firstly be sure the affected person is aware of the life-style interventions he can take to scale back all dangers of issues of his diabetes. This affected person is overweight and has a BMI of 30. He ought to be inspired to drop some weight and be given acceptable dietary recommendation, i.e. scale back fats consumption, eat extra fruits, greens and carbohydrates. Since he has a BMI of 30, he could also be referred to a dietician for weight reduction treatment. This weight administration recommendation will assist scale back his threat components for diabetic issues in addition to different cardiovascular issues he has a threat of. Presently he takes metformin to manage his blood glucose ranges. The dose of Metformin might be elevated regularly to the utmost dose of 2g.if this doesn’t management the blood glucose then Sulfonyureas ought to be added as a mix remedy in accordance with NICE tips since his blood glucose ranges . He also needs to be made conscious that he can take a look at his blood glucose ranges at house utilizing the finger prick take a look at to verify his blood glucose ranges are managed. Blood stress ought to be monitored not less than each 1-2 months till it reaches the goal blood stress and to make sure affected person doesn’t flip hypotensive.
Affected person administration Plan: Web page Three
SOAP NOTES (max. 2 pages in font measurement 11 Arial line spacing 1.5)
PHARMACEUTICAL PROBLEM administration of hypertension
Subjective
NIL
Goal
On examination blood stress was 164/83
Pulse :67 beats/min
Whole ldl cholesterol:eight.21
HDL:zero.eight
Glucose:11.2mmol/l
BMI:30kg/m
Evaluation
From examination the affected person’s blood stress has elevated from his earlier blood stress proven on the affected person treatment report which was 158/84.The affected person had a chilly and got here in for various decongestants to Sudafed which he was presently taking for his chilly signs that he was experiencing. Sudafed shouldn’t be taken since he’s a affected person on anti hypertensive treatment. All decongestants ought to be stopped. Affected person ought to be suggested of different regimes he can take to fight his chilly signs reminiscent of olbas oil inhaler, vick’s rub and paracetamol to decrease his temperature.
In response to NICE tips in hypertensive sufferers aged over 55 or black the first alternative for preliminary remedy ought to be calcium channel or thiazide diuretics.
Step 2 is including an ACE inhibitor if the preliminary remedy was a calcium channel blocker or thiazide diurectic.if preliminary remedy was an ACE inhibitor add a calcium channel blocker or diuretic.
Step three within the steering recommends utilizing mixture of three medication:
Use mixture of ACE inhibitor, calcium channel blocker and thiazide kind diuretics ought to be used.
Step 4 within the steering recommends including an alpha blocker, spironolactone or one other diuretic. If the blood stress stays uncontrolled on enough doses of 4 medication and knowledgeable recommendation has not been obtained this could now be sought. Presently the affected person is on the utmost dose of Ramipril which is 10mg for hypertension. His blood stress remains to be elevated and step 2 remedy could be important and if after common monitoring if the blood stress has not been lowered step Three might have to be put into the drug regime. Because the affected person can also be diabetic his goal blood stress must be for a diabetic affected person must be thought of and ought to be geared toward lower than 140/85.
Plan
The affected person must moved to step two of NICE tips and due to this fact be on a mix of an ACE inhibitor and calcium channel blocker or thiazide diurectis.If the mix of ACE inhibitor (Ramipril) and a thiazide diuretics(furosemide) is chosen then cautious monitoring of his electrolytes, urea and creatine ought to be performed.
The affected person’s blood stress ought to be monitored often i.e. – as soon as each 4 weeks to evaluate remedy response.
While on drug remedy affected person must be given life-style intervention recommendation to take alongside the drug remedy. The affected person must be suggested to have a low fats and low saturated fats food regimen which is able to assist scale back his weight since he has a excessive BMI of 30mg/m, scale back his salt food regimen consumption (much less 6g salt per day), improve fruit and vegetable consumption and scale back cardiovascular threat by stopping smoking and growing oily fish consumption. Dynamic Train would additionally assist the affected person as a part of his life-style intervention, though since he’s very outdated this isn’t preferrred for the affected person.His glycaemic management ought to be optimised as he’s a diabetic (HBA1c of lower than 7%) and common blood sugar ranges ought to be monitored.
2. Affected person Counselling
Affected person initials:
Intercourse: M / F
Age:
Location of Counselling (e.g. group pharmacy, counselling room, ward kind, out -patient)
Present medical downside(s) (if identified):
Affected person’s wants ( different concerns):
Present treatment (medication and doses)
1.
2.
Three.
Four.
5.
6.
7.
eight.
9.
10.
Predominant Counselling factors to cowl
Supervisor’s signature:
Scholar signature:
Date
2 Affected person Counselling: reflective studying
Date
Temporary abstract of the character of the exercise
What have been you making an attempt to realize?
What occurred / what was the end result?
What have you ever learnt because of this?
What would you like / have to study extra about?
Tutor/Supervisor Feedback
Tutor/Supervisor Identify
Tutor/Supervisor Signature
Date
Three. Public Well being Exercise:
Affected person ID (init)
DOB/age:
M/F
Present downside(s)
Related previous medical historical past:
Present Medicine (if identified)
(Drug, dose, frequency)
1.
2.
Three.
Four.
5.
Exercise:
Supply
Affected person
Pharmacist
Referred by GP
Different ……………..
Purpose
Describe exercise and the way the state of affairs was handled.
Recommendation/data offered
Product equipped or bought
Different points and feedback (affected person onerous of listening to, mobility, who manages medicines at house, and many others)
Additional motion if wanted and final result
Tutors Feedback
Signature
Date
Three. Public Well being Exercise: reflective studying
Date
Temporary abstract of the character of the exercise
What have been you making an attempt to realize?
What occurred / what was the end result?
What have you ever learnt because of this?
What would you like / have to study extra about?
Tutor/Supervisor Feedback
Tutor/Supervisor Identify
Tutor/Supervisor Signature
Date
Four. Affected person treatment use overview Web page 1
Affected person:
DoB
Circumstances/prognosis
MEDICINE
(embody dosage particulars)
MODE OF ACTION
INDICATION
(Appropriateness)
MONITORING (EFFICACY/SAFETY)
PARAMETERS
COUNSELLING POINTS
Four. Affected person treatment use overview Web page 2
Points and Suggestions
Points
Contribution/advice
Consequence
For the eye of…
1.
2.
Three.
Four.
Reflection on Important Occasions:
References Used:
Supervisor’s Feedback & signature:
Identify:
Date:
Four Affected person treatment use overview: reflective studying
Date
Temporary abstract of the character of the exercise
What have been you making an attempt to realize?
What occurred / what was the end result?
What have you ever learnt because of this?
What would you like / have to study extra about?
Tutor/Supervisor Feedback
Tutor/Supervisor Identify
Tutor/Supervisor Signature
Date
5. Affected person treatment overview presentation
Medical Pharmacy Module
PY3060B
Affected person Medicine Use Evaluate Presentation Suggestions
Identify of Presenter: Assessors:
Title: Date:
Presentation begin time: Presentation finish time:
Period:
Feedback
Mark
Presentation Type
Readability
Eye Contact
Use of Language
Rapport
20
Assets
High quality of slides
Amount of slides
Used nicely?
Acceptable
20
Content material
Introduction
Dialogue
Understanding
Explanations
Scientific
40
On questioning
Method
Angle
Data
Confidence
20
General Mark
100
Feedback
Tutor/Supervisor
Date
6. OTC request/remedy of a minor ailment
Affected person ID (init)
DOB/age:
M/F
Present downside(s)
Related previous medical historical past:
Present Medicine (if identified)
(Drug, dose, frequency)
1.
2.
Three.
Four.
5.
Request
Supply
Affected person
Pharmacist
Referred by GP
Different ……………..
Describe exercise and the way the state of affairs was handled.
Potential issues and the way solved
Product equipped or bought
Recommendation/data offered
Different points and feedback (affected person onerous of listening to, mobility, who manages medicines at house, and many others)
Additional motion if wanted and final result
Tutors Feedback
Signature
Date
6 OTC request/remedy of a minor ailment: reflective studying
Date
Temporary abstract of the character of the exercise
What have been you making an attempt to realize?
What occurred / what was the end result?
What have you ever learnt because of this?
What would you like / have to study extra about?
Tutor/Supervisor Feedback
Tutor/Supervisor Identify
Tutor/Supervisor Signature
Date
