PCT policies

[johnep]

Attended Clinical Governance meeting run by local PCT.

Topics were:

1) Chlamydia testing. we were asked to give out cards to as many under 25s as possible. I asked about giving when selling condoms and the speaker said that is what they wanted. I then pointed out that these would be sold away from pharmacy area and would need cooperation of store manager. July is chlamydia awareness month in Cambridgeshire.

2)Anticoagulation. Local nurses gave talk on need to check as per NPSA guide. Have been one or two pts who have never had INR tested after leaving hospital. Then several points re interactions. I was too afraid to show my ignorance re drugs which decrease effect of warfarin other than vit K. Are there any?

3) High dose steroid inhalers. This is set at 800mcgs/day. We were asked to check at MURs.

4) Prescription Switching campaign. This is cost reduction basically. I asked re prescribing of generic cfc free b/a steroids and fact that some PMRs came up with Qvar even for children. PCT said Drs should prescribe steroid inhalers by brand . This is actually in BNF. However, as I am an OOH locum, very difficult to contact prescriber.

I found it a very good evening but the speakers outnumbered the attendees as usual. Just what is it with pharmacists that they only want to work the hours and consider pharmacy as just a job and not a career or vocation.

I could never do something I did not enjoy enough to put as much into it as possible. When in export I often worked very odd hours and have never had a 9-5 mentality which is so common these days.

Pharmacy and scientific matters in general have been a lifelong interest.
johnep

[laurabuk]

2)Anticoagulation. Local nurses gave talk on need to check as per NPSA guide. Have been one or two pts who have never had INR tested after leaving hospital. Then several points re interactions. I was too afraid to show my ignorance re drugs which decrease effect of warfarin other than vit K. Are there any?

In our area, all warfarin/anti-coag patients started on treatment at hospital are dosed by the anti-coagulation team at the point of discharge and are invited to regular outpatients clinics for their tests. I sat in with them last month - it was good experience to watch them.

Not sure about drugs, but lots of food stuffs are a problem - obv the cranberries, but garlic q10 and ginseng too. I try and make a point of questioning people buying these types of supplements about it.

3) High dose steroid inhalers. This is set at 800mcgs/day. We were asked to check at MURs.

Do you give out steroid cards in the community for inhalers? I have worked in comm for 18 months and have never seen one given out but at the hosp its routine to do so for all steroid inhalers over 100mcg/dose?

I found it a very good evening but the speakers outnumbered the attendees as usual. Just what is it with pharmacists that they only want to work the hours and consider pharmacy as just a job and not a career or vocation.

I could never do something I did not enjoy enough to put as much into it as possible. When in export I often worked very odd hours and have never had a 9-5 mentality which is so common these days.

Pharmacy and scientific matters in general have been a lifelong interest.
johnep

I agree john. It really bugs me the amount of people who just want pharmacy to be 9-5, or are in it for the ££. I'm only a 3rd year but I think pharmacists should be passionate about their jobs (or maybe i'm a nerd lol)

[Steve G]

Chlamydia testing - just been to a meeting tonight to launch a chlamydia testing and treatment service, which looks well thought out. However, PCT also want us to give out condoms to people with a C-card, without paying contractors anything. The chair of the LPC was not impressed.

Warfarin - this demonstrates how successful the nurses have been at expanding their roles, and doing things that we should be doing. Monitoring INR is ideally suited for pharmacists - warfarin interacts with foods, vitamins, drugs and nurses don't really have the knowledge needed. INR monitoring can be done in community pharmacy, and patients love it when compared to their experience of hospital clinics. Enzyme inducers would be expected to decrease INR.

[Sir_Dispensalot]

Just what is it with pharmacists that they only want to work the hours and consider pharmacy as just a job and not a career or vocation.

I could never do something I did not enjoy enough to put as much into it as possible. When in export I often worked very odd hours and have never had a 9-5 mentality which is so common these days.

Pharmacy and scientific matters in general have been a lifelong interest.
johnep

i agree, lots of us see the job as a 9-5 (or more likely an 8.30-6.30 plus commute home of around an hour or in my case a 2pm-11pm) and when you've churned out 500+ items a day the last thing you want to do is go to a meeting where you get told a load of half-arsed crap that you have to sift through to find anything relevant or useful - and that's normally stuff you can find out after a few minutes googling. This is all assuming that you don't get to the meeting late (and suffer the scornful stare of some office-bound pct monkey) because they planned it for 6pm and all the local teleporters are out of commission for you to insta-warp to their venue. After the meeting, feeling somewhat like you've been taught how to suck eggs and feeling a little angry you go out to your car to find a clamp on it because of the poor choice of venue the pct used.

/rant over

sorry - just a bit of personal experience there...


on a lighter note, i went to renew my smartcard the other day when the pct smartcard co-ordinator collared me and wanted a few more details on "this EPS thingy and what all these releases were about"
eeek!

[Sir_Dispensalot]

Warfarin - this demonstrates how successful the nurses have been at expanding their roles, and doing things that we should be doing. Monitoring INR is ideally suited for pharmacists - warfarin interacts with foods, vitamins, drugs and nurses don't really have the knowledge needed. INR monitoring can be done in community pharmacy, and patients love it when compared to their experience of hospital clinics. Enzyme inducers would be expected to decrease INR.

roche do a nifty machine for INR readings called the coaguchek - if you ask them really nicely they'll send you a machine for free. I tried (unsuccessfully) to set up INR services in two pcts - be warned - some pcts and surgeries can be very unhelpful when you try to set up a pioneer service...
there was a good article in the pj in may i think (might have been early june) that gave an excellent list of drugs, otc stuff, herbs and foods that can potentially affect INR (although some of it was a little over-cautious).

[Steve G]

roche do a nifty machine for INR readings called the coaguchek - if you ask them really nicely they'll send you a machine for free. I tried (unsuccessfully) to set up INR services in two pcts - be warned - some pcts and surgeries can be very unhelpful when you try to set up a pioneer service...
there was a good article in the pj in may i think (might have been early june) that gave an excellent list of drugs, otc stuff, herbs and foods that can potentially affect INR (although some of it was a little over-cautious).

We run an INR clinic at present, just need to work out how to expand it as the GP surgery next door also runs one, though we are far more flexible with appointment times. We have another branch in Maidstone who pretty much look after all the warfarin patients in the town - none of the surgeries there do INR monitoring. We also have a pharmacy over in East Kent who have been running INR clinics for over 20 years. We got the PCT to fund a coagucheck, and they also pay up front for the consumables.

[happy_bunny]

I have been trying to learn some things that enhance/inhibit warfarin for the exam and these are the ones I have memorised so far:

Enhancers:
amiodarone
allopurinol
anabolic steroids
antibacterials (esp erythromycin, clarithromycin, not so much penicillins)
azoles
cimetidine
cranberry juice
clopidogrel
dipyridamole
ezetimibe
fluvastatin
fibrates
mirtazipine
NSAIDs
PPIs
Simvastatin
SSRIs
thyroid hormones
tramadol
venlafaxine

Inhibitors:
azathioprine
barbiturates
carbemazepine
phenytoin
rifampicin
griseofulvin
primidone
oestrogens
progestogens
St johns wort
vitamin k

Sorry I bet that is incredibly dull to read, was a good test of my memory tho

Which interactions do people think are clinically relevant (i.e would contact the prescriber)? Or would you just warn the patient?
As a pre-reg I am generally dispensing so I tend to print the interaction warnings that flag up (in general not just warfarin ones) but nobody seems to do anything about them - am I just being overly nit-picky?

[Fleegle]

Cool!..Almost perfect alphabetical order too..what pneumonic are you using?

[happy_bunny]

I don't have one - I tend to learn a list by writing it out, then covering it up and trying to write it from memory, then repeating it until I can get them all without too much effort (its the same way they used to teach us spelling at school lol). Then see if I can still remember it after an hour or a day or whatever. Its funny how I seem to remember them better if the original list is more-or-less alphabetical tho