Clinical Interventions

[admin]

Hi Everyone

I thought it might be a good idea if we put up some of our clinical interventions. We can all learn from them, and share our experiences.

I thought we could put up a seperate thread for each one if we get a few, so if anyone else has seen a similiar one they can add to the thread. For now I'll start it off with one or two and of it grows put it in a separate forum.

If this is getting boring let me know and I'll stop, as I have loads of these. These are the simple ones (easy to type) so if you want more details, again let me know.

[admin]

Itraconazole Overdose

A prescription was presented for Itraconazole 400mg once a day for seven days. The normal dose for this drug is 100mg increasing to 200mg daily in Aids patients. I phoned the GP with my concerns.

The GP admitted he had copied a letter from a hospital consultant incorrectly and altered the dose to 100mg daily.

He had also copied the drug name wrong, but that was just a spelling mistake.

Result: Patient stopped being given incorrect dose of Itraconazole.

[admin]

Promethazine Overdose

A presription was presented for a 1 year old child for Promethazine elixir 5mg/5mls. The dose was 10mls at night.

The drug is not recommended for a child under 2 years old, and the patient information leaflet states if a child under that age ingests any, they should be sent to accident and emergency for treatment.

I phoned the GP and explained no safety data was available from the company in a child under 2 years old, and I was concerned at the drug and dose. The drug was changed.

[admin]

Sodium Chloride Eye Drops 5%

I received a prescription for Sodium Chloride Eye Drops 5% and was concerned that 5% was very strong for eye drops.

After contacting the GP I was told it was an error and should have been 0.9% and the prescription was changed.

[admin]

Oestradiol Gel 0.06% for internal use

I received a script for a 48 year old woman for internal vaginal dryness.

I phoned the drug info department of the company, and was told there was: -

1. No data available for internal use
2. The product was not licenced for this use

The prescription was changed.

[admin]

Diclofenac Overdose

I have received several scripts for diclofenac overdoses ranging from 100mg BD to 100mg TDS.

The maximum stated BNF dose is 150mg daily in divided doses via any route.

I have always got the doses changed by contacting the GP.

[admin]

Citalopram and Escitalopram Together

A prescrition was presented for a man who had previously been taking 40mg Citalopram daily, for Citalopram 10mg and Escitalopram 10mg together daily.

After contacting the GP the escitalopram only was prescribed, and the citalopram was accidently put on the prescription.

[Zoggite]

I have actually come across several scipts for NaCl 5% eye preparations- Moorfields eye Hospital make them, you can order them direct from them; I think the idea is to use the hyperosmolality to reduce intra-ocular pressure?
have you tried googling it?

[Zoggite]

The BNF does list Itraconazole 200mg BD for 7 days as a licensed use for treatment of onychomycosis, tinea pedis and tinea manuum.
I'm only standing up for Sporanox because it was originally developed in Belgium!

[admin]

I have actually come across several scipts for NaCl 5% eye preparations- Moorfields eye Hospital make them, you can order them direct from them; I think the idea is to use the hyperosmolality to reduce intra-ocular pressure?
have you tried googling it?

I know that they can be ordered from Moorfields, but I was suspicious after talking to the customer. They didn't have glaucoma or any serious eye problem, so that's what prompted me to ring the Dr. It turned out to be a mistake as he had typed in the wrong product on his computer.

I'm not saying that you can never use 5% NaCl eye drops, just what happened in the example. Sorry, by the time I got to writing the ones at the end I was tired and they tend to be a bit short! I'll put less ones on, and more detail in future.

[admin]

The BNF does list Itraconazole 200mg BD for 7 days as a licensed use for treatment of onychomycosis, tinea pedis and tinea manuum.
I'm only standing up for Sporanox because it was originally developed in Belgium!

Sorry I was writing from a note I made at the time. Again it's just what happened in this case. I can't remember what the patient had, but it wasn't anything that I felt would need such a large dose, so I phoned the Dr and he admitted he had copied the letter incorrectly.

I'm just putting down things that caused me to be suspicious at the time, and the result of me contacting the GP's involved. I guess I could have left it and assumed that the dose was correct, but after speaking to the customer it aroused my suspicious nature, and I called the GP. The script was written for 400mg take 1 daily, so that also made me feel it could be wrong at the time.

Would you have dispensed it at that dose of 400mg take 1 daily? Do you think I'm being too pickey? I only call GP's if I feel there may be a problem, not for the fun of it.

[Zoggite]

here's one I'd like to pick your collective brains about: has anyone ever come across "Zomig 2.5mg 30 tabs, Take one daily"?
Guess what: the surgery receptionist told me at 2.45pm today that "the doctor's on the 'phone at the moment, I'll get him to call you back"... Of course, I'm still waiting.
Is that a pig looking for a runway?

[Steve G]

Here's one: warfarin 10mg bd for two days. Contacted another GP at the surgery who very quickly agreed to change it.

[Steve G]

And another: one of the nomad patients I'm looking after during my pre-reg almost had her fluoxetine (60mg a day) stopped by a psychiatrist because he didn't look at all of the backing sheet and she did'nt tell him she was still taking it.

[Steve G]

And also numerous times GPs have inadvertently changed patients from propaderm 10% in WSP to propaderm alone... and then still write the script wrongly after you've told them exacty how to write it!