WHO AM I?
In the clinic I see the following:
A type 2 diabetic (diagnosed 2 years ago) who refuses to go on medication as he believes he can change his diet and exercise regime and ‘cure’ his diabetes. His BMI is 35 and has been since diagnosis. His BP is 175/110 on 2 agents
2 patients who have had 24 ABPM and who need hypertension workup
An exacerbation of COPD
A child has been booked in (only slot available) with abdo pain and suspected UTI
Patient is taking her daughter to Ghana for holiday and wants to know about travel vaccinations. Records in notes indicate that nurse noted female circumcision in mother, when smear was done.
Call from gynae consultant about a patient that you referred to them with pelvic pain following USS
Several children with coughs and colds-general advice about viral infections
A lady with a long history of back pain (not first presentation) who really just needs someone to listen to her issues and wants answers/referrals
One of your lab links indicate that a patient has a potassium of 6.3 and another a HB of 88- Hb 120 a month ago.
A child you know well with asthma walks in with an acute episode unable to speak in full sentences and looking unwell.
WHO AM I?
In the clinic I see the following:
Follow up Blood pressure and blood tests following starting ACEI
Elderly lady made appointment, but not sure why. Seems confused
You get a call interrupting your clinic from a HV wanting to speak to you about a child whose imms need updating (child on child protection register)
Lady in her 50s. Twisted my wrist. Drank too much last night and cant really remember what happened. Seems to be happening a lot.
Poorly controlled diabetes, poor compliance and depressed
Hypertension, not taking meds
COPD patient, breathing getting worse, can’t come to surgery
I’d like to start the pill
Elderly lady keeps passing urine in the night
My child has a sticky eye
Depressed and overweight
Elderly man, had a fall and cut his leg
B12 injection
Smear
Travel clinic advice
WHO AM I?
In the clinic my typical day:
Managing repeat prescriptions and signing prescriptions-
Request from patient for methotrexate which is on acute but not prescribed yet. From notes it appears that patient started on methotrexate by rheumatologist about 3 months ago. Latest letter from rheumatologist says patient now stabilised on 7.5mg once weekly. GP to continue prescribing and bloods to be done by hospital every 2 months. Note on consultant’s letter says ‘last blood tests were normal’ but does not list any readings or say when taken! No shared care agreement in place.
A request for a repeat prescription from patient – review overdue, multiple reminders to come in for review. Last script issued for 7 days and patient still not booked in for review.
Dealing with prescription queries-
Patient requesting Movicol sachets on repeat as Macrogol
Patient with diabetes requesting insulin every month, from dosage should last at least 2 months
Liaising with other HCP-
Call to local pharmacy about patient who may require a dosette box.
Chase up referral for pulmonary rehabilitation clinic for a COPD patient.
Triaging where appropriate
Patient on oral contraceptives needs a review. Call to patient for telephone review and requested her to have BP measured at pharmacy (as working and cannot make it to surgery in time) and to request pharmacy to forward us the results
Face to Face clinics – long term conditions, clinical medicine reviews, home visits, spirometry,
Saw patient with acute exacerbation of asthma, patient has already had 3 courses of steroids this year and possibly more as husband is doctor and patient admits that he has prescribed for her as well. Inhaler tech not great and spent time on getting this right. Patient started sertraline about 1 year ago roughly same time as her asthma exacerbations. Started to explore any issues that maybe going on at home/work which may be contributing to these exacerbations. Uncommon side effect of sertraline is bronchospasm and dyspnoea. Not enough time to deal with all and booked pt in following week. Will also discuss with her usual GP before seeing her again.
Spirometry for patient who is an ex-smoker and diagnosed with asthma, however recently symptoms more consistent with COPD.
Appointment with patient on multiple medications for medication review but mainly to address compliance issues
Audits
Reviewing pathology results
WHO AM I?
At work I see the following:
A discharge summary for one of our patients. Notice that 5 of her usual medications (3 antihypertensive medications, a beta-blocker and a PPI) are not on the discharge summary no mention of them being stopped either
A patient requesting a BP measurement, this is his 3rd visit and his blood pressure has been elevated on the last 2 visits (average 159/98). His BMI is 28 and he is about 40 years old. He is not on any medication. He has lost about 2kg since his first visit about 3 weeks ago and we discuss how he can continue to lose weight by changing some of his eating habits and increasing his exercise. He seems quite motivated to make some lifestyle changes as he is really worried about getting diabetes.
A young 15-year-old girl requesting some emergency hormonal contraception.
A couple come in requesting some travel advice. They both needed hepatitis A, typhoid and malaria chemoprophylaxis. Vaccinations are administered and a prescription issued for Malarone. They also need yellow fever and have to signpost them to a yellow fever centre.
A young mother comes in with her 1-month old baby who woke up this morning with a ‘sticky eye’. On examination, eye looks little congested but baby well otherwise. Advised lid hygiene technique and gave her an information leaflet on this. Reassured mother that usually viral.
Call from district nurse to request some palliative medication for cancer patient.
Call from hospital pharmacist to confirm what medication a patient is on (patient being discharged soon). Advised us of changes to medication on discharge.
A patient comes in with some new inhalers he has been prescribed but he is having trouble using these. I check his technique which is not correct and demonstrate correct technique using a placebo inhaler. He is still having trouble using the metered dose inhalers and so I issue him with a spacer device. He can now use the inhalers correctly. Fax a note to prescriber requesting a prescription for a spacer.
Receive about 30 prescriptions via EPS
A methadone addict comes in for her daily supervised dose of methadone. She also has one zopiclone tablet prescribed daily, however, we have not receive a script via EPS today. Ring surgery and apparently the script was sent yesterday via EPS. From our end we cannot see the script on the EPS spine and we cannot track it either.
Prescription received for doxazosin MR, however this is out of stock.
2 weekly scripts issued for patient for past month but the quantity of insulin has not been reduced and so 3 boxes of Humalog are being prescribed every 2 weeks.
A customer returns medication for his recently deceased father- 6 boxes of unused Movicol, 5 boxes of paracetamol and 4 tubs of unopened cetamacrogol cream.
See a smoking cessation patient for his final appointment and will now need to request a prescription for additional NRT patches until he is read to stop the NRT
Call from local GP about a dosette box patient, GP concerned that patient may be on both doxazosin MR and doxazosin immediate release as both on repeat. Confirmed that patient only on immediate release as MR unavailable. Agreed that it would be safer to remove the MR from repeat (until available again)
A medicine use review highlights that patient not taking sitagliptin although ordering every month.
Delivery driver will be ready to deliver in next half hour – need to get all the red delivery baskets checked in time
WHO AM I?
People seen/tasks performed during a typical day:
Sorted out prescriptions for catheters and colostomy products before starting morning surgery.
Saw Mrs SJ for her blood pressure check and also preformed MMSE as she and her husband both concerned that her memory has deteriorated which is causing them both distress. Gave them contact details of AgeUk as possible source for some support.
Mr BA attended for his diabetic foot check, BP and weight. Had chat about diet as gained 2kg since last review – admitted to over-eating since being made redundant and subsequently having to move house. Mrs A wasn’t aware he’d gained weight and said she’d try to help him lose it. Offered to refer him to see the dietician but he declined. He’d also missed his retinopathy screening appointment (appointment went to old address) so asked secretaries to re-instate, proving details new address.
Mrs A also had her own appointment as concerned about her hearing – checked her ears and as no wax/healthy ears and no other symptoms so agreed to refer her to audiologist.
Reviewed Ms KH whose blood pressure has been difficult to control and who needs to lose weight. She agreed, at last, to attend local exercise on prescription scheme so did referral. Also increased her ramipril and arranged repeat U&Es plus gave her leaflet on vitamin D as last result borderline and needs to use OTC supplements.
Did mental health review for Mr FG. Checked his drug compliance and detailed his support network. BP and weight OK. Arranged annual bloods.
Advised Mrs WP that her cholesterol was raised despite her attempts at improving her diet and that it would be advisable for her to take a statin. Gave form for LFT and repeat lipid profile to be taken after taking statin for three months.
Mrs LP attended for her wound dressing (leg ulcer) –at last some progress. Appointment took longer though as her daughter has just been diagnosed with bowel cancer and she was distressed and needed to talk.
Caught up as Mr DE just needed his B12 injection. He is doing well regarding his drinking and has now not had anything to drink for over a year.
Contacted Mrs SW to book her coil fitting appointment (at the end of her current period) – informed her that her pre-fitting swabs were all clear and reminded her about bringing sanitary towel to appointment. Checked coil stock and as running short Mirena coil put in order for delivery.
Afternoon surgery – spirometry clinic. Spent longer with Mr KL as struggling with his inhaler technique so tried to help him improve this – also suggested he attend the respiratory clinic for a proper review.
Just as leaving Practice Manager called as Miss TW in waiting room and making a fuss as symptoms of a urine infection but no appointment available. Dipped her urine sample (dip +ve for leucocytes and nitrites) and clarified her history (dysuria and frequency for a few days). . Discussed simple measures such as drinking more fluids but in view of her symptoms arranged for a prescription to be sent to her chemist for a three day course antibiotics.
Mr BC had a BCC removed from ear 8 days ago with 13 sutures to be removed. Some areas of suture line became unstable so half removed and appointment booked a few days later to review and remove remaining sutures. Steristrips applied for stability.
WHO AM I?
At work I see the following:
A 66 year old lady who can’t breathe and wants her medication and has become anxious as no one has been to administer it.
An 87 year old lady who has had a fall, assisted from floor, witnessed by carer, patient slid to floor, no fall. Recent reduced mobility. Falls referral made.
A 28 year old man with breathing problems following a fall on a building site. The patient had a 4-5 minute seizure and fell from standing, there is a language barrier as patient’s English is poor and had to find someone to translate.
A 70 year old lady who has had a fall. Patient has right sided weakness post previous CVA. Today she was on the toilet and had diarrhoea and vomited then slipped off the toilet and pressed care line button. Assisted her to a chair and cleaned patient up. Patient then able to mobilise as normal.
A 21 year old man with dizziness and nausea. Woke up this morning feel sick and lethargic and complaining of palpations. His BM was low cannot find reason why given glucose gel.
A 61 year old man with pain in rectum (info given by NHS111). Patient had colon removed 30 years ago. Has been seeing GP regularly about pain, today the pain is worse than normal. His note state that he is at risk of self-neglect.
A 93 year old lady who has had a fall. Her carer was holding on to her when she lost her balance, so was a controlled lower to floor. Was assist up by a passer-by and able to mobilise as normal.
A 79 year old lady who had a skin graft last week, on shin and it has now started bleeding. Wound re-dressed.
A 43 year old man who states he has taken heroin and crack cocaine and felt like harming himself. Referred to his crisis team.
A 57 year old lady with breathing problems, he has a history of COPD and his normal sats on air 85-88% he has been staying with friends and felt slightly breathless on movement., he checked his own sats which remained low (75%).