These are some funny and obscure reasons i found whilst surfing the web:
After talking about bananas on twitter i thought i would look up the medical properties of bananas. (it was being discussed if peeling a banana from the top is the correct way to peel it, or should you peel from the bottom)
Please note: im not sure how true the statements below are, it’s a collection of claims from the web…
Dont you just hate it when customers cannot wait for their medicines to be dispensed? They are told “it will be 5-10 minutes or so” and ive had people say…”what that long?” Obviously i don’t mean a one item prescription will take 10 minutes but you know the type im talking about. The 5 scripts, 6 item per prescription with dressings one.
Hello all
It’s been a pleasure blogging as Mrs Pharmacist but unfortunately I will no longer be blogging.
The page will remain open but no new blogs will be posted.
Bye Bye
Mrs Pharmacist
Dont you just hate it when customers cannot wait for their medicines to be dispensed? They are told “it will be 5-10 minutes or so” and ive had people say…”what that long?” Obviously i don’t mean a one item prescription will take 10 minutes but you know the type im talking about. The 5 scripts, 6 item per prescription with dressings one.
I don’t think im a “slow pharmacist” but when it’s just you in the dispensary, answering the telephone, labelling, dispensing and checking, things are obviously delayed.
I think it’s the culture and norm these days to expect everything at a “fast food” level. Things are needed yesterday. But where is the patience with our customers?
I for one will not rush a prescription for anybody. More haste, less speed….if i make a mistake, it will take longer to rectify and worse still cause harm to the individual.
So is there and average time to dispense an item? ( see poll below). I’m guessing approx 2 minutes per item. what are your thoughts?
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Well its been a while since i’ve blogged. The big news is that come June i will no longer be a Hospital Pharmacist. Im going to the “other side”….community pharmacy.
Why???? i hear you scream. Well the simple fact is that i get to spend more time with my children. Its less hours, no on calls and best of all i will have no childcare costs and my children have me all to themselves.
Its going to a big change. I will miss working as a hospital pharmacist. But who says community pharmacists cant be clinical too? I for one intend to provide my customers with a brilliant clinical service.
Im not selling my soul to the big mutilples. I will be working for an independent pharmacy.
So join me in my new journey……community pharmacy, here i come.
Image via Wikipedia
A few weeks back, a drug rep came to see us to provide more information on a new drug just added to the hospital formulary. This drug was dabigatran (Pradaxa ® 
), a direct thrombin inhibitor licensed for the prophylaxis of venous thromboembolism in adults after total hip replacement or total knee replacement surgery. This talk made me think… ” will warfarin still be used in 10 years time?”
Warfarin has been around since the 1950′s . It is licensed for the prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation; prophylaxis after insertion of prosthetic heart valve; prophylaxis and treatment of venous thrombosis and pulmonary embolism and transient ischaemic attacks (BNF 60).
Although the two newer oral anticoagulants dabigatran and rivaroxaban (Xarelto® ) available in the UK are not licensed for use in AF or treatment of venous thrombosis, pulmonary embolism and in valve patients, its only a matter of time before they are licensed for these indications once trial data is available.
Dabigatran as mentioned above is a direct thrombin inhibitor and rivaroxaban is a direct inhibitor of activated factor X. They are given orally but unlike warfarin do not require dose adjustments, and therapeutic drug monitoring (INR testing). They also do not have a narrow therapeutic range or have the same long list of drug and food interactions.
| from http://www.australianprescriber.com/magazine/33/2/38/41/#t1 | |||
| Comparison of oral anticoagulants | |||
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| Property | Warfarin | Rivaroxaban | Dabigatran etexilate |
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| Anticoagulant action | Reduced synthesis of functional clotting factors II, VII, IX and X | Direct competitive reversible inhibition of activated factor X | Direct competitive reversible inhibition of thrombin |
| Prodrug | No | No | Yes |
| Bioavailability | Almost 100% | 80% | 6.5% |
| Onset of anticoagulant action | 36–72 hours | Within 30 minutes Tmax 2.5–4 hours |
Within 30 minutes Tmax 0.5–2 hours |
| Duration of anticoagulant action | 48–96 hours | 24 hours | 24–36 hours |
| Elimination half-life (anticoagulant activity) | 20–60 hours | 5–9 hours in young adults 11–13 hours in older adults |
7–9 hours in young adults 12–14 hours in older adults |
| Predictable pharmacokinetics | No | Yes | Yes |
| Interactions with diet or alcohol | Yes, clinically significant | Low potential | Low potential |
| Drug interactions | Numerous clinically significant interactions | Potent cytochrome P450 3A4 and P-glycoprotein inhibitors augment anticoagulant effect (e.g. ketoconazole, clarithromycin, ritonavir) | Proton pump inhibitors reduce absorption Possible interactions with P-glycoprotein inhibitors and inducers |
| Dosing and dose adjustments | Dose individualised for each patient, requires frequent INR monitoring and adjustment | Fixed according to clinical indication | Fixed according to clinical indication |
| Monitoring | INR every 1–2 weeks | No routine monitoring required | No routine monitoring required |
| Use in liver failure | Contraindicated or caution advised | Contraindicated as hepatic metabolism | Possibly safe as no hepatic metabolism but caution advised |
| Use in severe renal impairment | No dose adjustment required | Increased drug exposure and elimination half-life in renal impairment Safety and dosing not yet established Contraindicated in severe renal impairment |
Increased drug exposure and elimination half-life in renal impairment Safety and dosing not yet established Contraindicated in severe renal impairment |
| Use in pregnancy | Category D Teratogenic in first trimester |
Contraindicated as safety not established (excluded from clinical trials) | Contraindicated as safety not established (excluded from clinical trials) |
| Reversibility after cessation | Several days, requires synthesis of clotting factors | 24 hours, dependent on plasma concentration and elimination half-life | 24–36 hours, dependent on plasma concentration and elimination half-life |
| Antidote | Immediate reversal with plasma or factor concentrate Reversal within hours with vitamin K |
None available | None available |
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| INR international normalised ratio
Tmax time to maximum concentration |
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So will they replace warfarin? Although the dosing regimens are simpler it can be argued that since intensive monitoring is not required, compliance may become an issue if they replace warfarin . I think until the costs of these new anticoagulants decrease and their safety and efficacy is proven in AF and the treatment of PEs and DVTs and heart valve patients, warfarin (and the other vitamin K antagonists, acenocoumarol and phenindione) will be around for a good few years yet.
see also
So what’s exactly happening with the on call situation? Anyone confused.com? Hmmm….yup i think we need to look at the current situation.
The current on call arrangements are due to end on 31/3/2011. The NHS staff council invited responses to its draft principles to harmonised on call arrangements and closed on 10th September 2010.
The NHS Staff Council have now signed off the final principles and these will be published soon along with guidelines for local implementation of the principles. This means the end of the emergency duty commitment payment that is currently paid for providing on call services, along with any local arrangements that have previously been protected. In its place will be whatever is agreed locally as from 1st April 2011. The principles can be found at http://www.sor.org/news/files/images/principles_final_2.pdf
Once they have been published, local partnerships (Staff and management side) should come together to develop harmonised terms and conditions for on call. But what is meant by local? This could mean individual Trusts, a group of Trusts, or SHA’s. The process that follows should involve trade union representatives and management side representatives (HR, Directors etc) getting together to negotiate new terms and conditions for on call that follow the principles agreed by the NHS Staff Council.
The important thing to note is the principles provide a framework for local partnerships and it is the partnership that decides the level of remuneration in line with the principles.
The Guild of Healthcare Pharmacists (GHP) have voiced concern that in some SHAs, the management side appear to be taking the view that from the 1st April the interim arrangements currently within Section 2, part 2 of the Agenda for Change handbook will come into place and there will be no pay protection arrangements. This could result in a large loss of earnings for pharmacists delivering on call. Based on a 1 in 12 rota, a band 6 pharmacist would be paid as little as £17 per night (£510 per year) to be on call and provide advice over the telephone.
Whilst this can be imposed upon staff with the appropriate period of notification, it is not in line with the principles that will be published by the NHS Staff Council. Any members that are issued with such notification should contact their union representatives as soon as possible (this would include local Unite rep, Trust staff side lead and regional officer) to allow this position, which is not in the spirit of the Agenda for Change principles, to be challenged.
Be under no illusion, this will happen. Some of us will have a reduced income because of this. Just make sure anything that is proposed is challenged so as to make it fair for all pharmacists.
So my advice:
1. Read and be familiar with the principles from the NHS council
2. Read and be familiar with the Agenda for change handbook
3. Join a Union – GHP/Amicus
4. DO NOT accept the current arrangements in section 2 of the Agenda for change handbook
5. and most importantly.. be involved with the process. Don’t just sit back then complain about it. DO something and help make a change that is fair to all
Links
1. GHP http://www.ghp.org.uk/home
2. Agenda for change handbook http://www.nhsemployers.org/SiteCollectionDocuments/AfC_tc_of_service_handbook_fb.pdf
After waiting 90 minutes for me and my 2 year old son to be seen by the GP for an emergency appointment (and register as a temporary resident whilst away from home) we visited the pharmacy next door to have my sons prescription dispensed.My son had an acute exacerbation of asthma, most likely viral.
The chemist was an independently owned one. We walked in to find one dispenser playing cards and the other playing with her mobile phone! Ok, I know they were not busy, but playing cards! There must have been something else they could have been doing. Theres always something to do at a pharmacy, clean up, date check, tidy shelves, put stock away, I could go on.
I handed the pharmacist the prescription, he barely acknowledged me. Within 5 minutes it was ready. Now where i work at a hospital pharmacy our standard operating procedure (SOP) states that we should counsel the patients on their medication when handing it out.
This pharmacist just handed it to me and that was that. Judging by his registration number on his Responsible Pharmacist certificate he had been qualified for the same length of time as me, so not a newbie although that’s no excuse. Why didn’t he ask me if i knew how to use the inhaler and spacer for my son? Why didn’t he tell me about the possible side effects of the steroid tablets? I know why, he had a game of cards to get back to!
To top it all off, he didn’t even put a patient information leaflet in with the steroid tablets! Very bad indeed.
It is a requirement of the Medicines for Human Use Regulations 1994, as amended (in accordance with the related European Directive) that a Patient information leaflet (PIL) is provided on each occasion medicinal product is supplied. Pharmacists must therefore ensure that a PIL is supplied with every dispensed medicinal product.
If pharmacists can’t even be bothered to tell their customers/patients about their medication, then who will? A GP doesn’t always have time, they assume the pharmacist will do it.
Maybe im naively thinking this was a one off, not all community pharmacies are like this, surely?
In case some of us have forgotten, here are the principles of our Code of Ethics:
1. Make the care of patients your first concern
2. Exercise your professional judgement in the interests of patients and the public
3. Show respect for others
4. Encourage patients to participate in decisions about their care
5. Develop your professional knowledge and competence
6. Be honest and trustworthy
7. Take responsibility for your working practices
I think some pharmacists need to re-evaluate how they work.
Calpol or paracetamol suspension is NOT a cure all! It’s lovely pink liquid and possible strawberry taste is loved by millions of children worldwide.
But It’s for pain relief and reducing a fever. It is not a magic cure all. I’ve heard people say, ” oh he has got a cough, give him Calpol” or she looks ill let’s give her Calpol. It won’t cure a cough and it won’t make your child look well!
How many parents are giving their children Calpol for random reasons? People, it’s a drug. Just because it looks and tastes nice does not mean it’s without it’s consequences especially on overdose.
So the next time you sell a bottle pharmacists, take that extra time to re-educate your customers/patients.
That is all.
