The Yellow Book

[PHARMAC1ST]

Sometimes in a busy pharmacy it is not practical to ask each and every patient on warfarin if they have there yellow book, and what is their inr, do they have regular tests, etc. The directions on the label clearly should be stated take as directed as per INR. Is that not sufficient to cover our back if something did happen?

Also how do we go about the large number of patients that are on repeat medication of warfarin and get delivery? Do we knock on their door and ask them for their yellow book or else they are not getting their warfarin?

Obviously this checking of the yellow book is important but more significant in patients that are newly starting on warfarin or elderly patients that are prone to confusion. Once they get the idea of their dosage and how the warfarin works and the risk of INR getting too high, which i am sure many warfarin clinics explain really well (from what i have seen when working in warfarin clinic) then surely we should have a little faith in patients taking their medication correctly?

[hibernia]

then surely we should have a little faith in patients taking their medication correctly?

After many years of seeing all sorts of amazing interpretations of apparently simple instructions that's exactly what I have - a LITTLE faith.

Check and then check again and even then some of them will get it wrong.

[131131]

Firstly may I thank everyone for their contributions to my enquiry.
Obviously I failed to explain the situation here in the Salisbury area and mistakenly assumed that everyone nationally taking Warfarin would be managed in the same way that all of us here are cared for.
That is to say that our regular Blood Tests and our DOSES are controlled by the dedicated Anti- Coagulation Clinic at the Hospital, not by our GPs or their receptionists and not even by the Pharmacist issuing the prescription. That means that when our GPs authorise a repeat prescription they are not advising us of the actual doses to be taken but are simply permitting the issue of two months supply of either or both of the two strengths available.
It is obviously up to us to abide by the instructions and advice of the Clinic and I have to say I fail to see how anyone not present by my side when I take my medication can ensure that I do so correctly, whether or not they have seen my book and quizzed me each time on my understahding of the
consequences of not doing so.
Correspondent 'Hibernia' is exactly right when he says that many patients, and I am one of them, feel that there is enough checking in our lives these days, and certainly do not take kindly to any more. Not for the first time I feel that Nanny State should be put firmly in its place and told not to treat all of us as if we don't have two ha'porth of sense in our heads!
Surely there must be some way of recognising that that actually does apply to most of us and that this blanket procedure for all is in many cases un-necessary and a waste of everyone's time, not least the Phqarmacist's.
Or am I being hopelessly old-fashioned?

[Sir_Dispensalot]

Or am I being hopelessly old-fashioned?

Nope, not old fashioned - but the continued litiginous nature of healthcare seems to like to attach blame to those involved in the prescribing and supply of medication to patients. Somehow if a patient is too bloody stupid to take their tablets as instructed by the warfarin clinic and the pharmacist doesn't check doses with them, that pharmacist is then liable to prosecution and being sued for damages from said stupid person. So really most pharmacists will be concerned with two things when asking for your yellow book.

1. Is everything ok for the patient and are all the doses ok for them?

2. Can i get myself struck off/criminally prosecuted/sued for not doing this?

At least one of the two reasons will apply at all times. So even if (and i hope not!) the pharmacist doesn't give two hoots about what you do with your warfarin, they still want to see that yellow book so that come the investigation they can say "yes, i saw the yellow book and recorded their INR and checked their dose with them".

Nanny state or not it's us that cop it when something goes wrong.

[El-loco]

That means that when our GPs authorise a repeat prescription they are not advising us of the actual doses to be taken but are simply permitting the issue of two months supply of either or both of the two strengths available. ...

Not for the first time I feel that Nanny State should be put firmly in its place and told not to treat all of us as if we don't have two ha'porth of sense in our heads!

You shouldn't be so dismissive. There are FOUR strengths of warfarin and all are commonly used.

0.5mg is white
1 mg is brown
3 mg is blue
and 5mg is pink

They are ALWAYS these colours

[johnep]

Except for time when one manufacturer was using pink packaging on strengths other than 5mg.
johnep

[Batfink]

It's all about communication. If you're the regular pharmacist you know your patients (mostly) and will know which ones are clued up about warfarin and which are not. i.e. most just need a gentle reminder: "Have you had a test recently, any dose changes?" and some will need further questioning. I have never refused anybody's prescription but would always make a note on the PMR stating "yellow book not seen, asked to bring it next time" etc etc.

Incidentally when the guidelines were first issued we did have one practice which was doing INR tests but curiously had never issued any of its patients with a yellow book. Obviously this led to great confusion in a large proportion of our patients!