Posted: May 1st, 2022

Clinical Pharmacy Placement

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Introduction

This placement handbook has been prepared to help your learning all through your scientific placement for PY3060B Medical Pharmacy. It moreover acts as your diary/log e-book and should be achieved and submitted for analysis. Some sections are required to be signed by the pharmacist supervising you and the case presentation/affected individual remedy overview presentation will doubtless be marked by the pharmacist.

The handbook should be be taught along with the scholar handbook beforehand used by way of the scientific visits to Lewisham, Royal Marsden and St. George’s Hospital. Along with providing steering on affected individual administration plans, reveals, and plenty of others., it moreover accommodates the Necessities for Expert Conduct which proceed to make use of, no matter whether or not or not the scientific placement was organised by your self or by the School.

Placements will doubtless be two week placements in hospital, group or PCT pharmacy. Your placement provider should confirm your start and end date. The first week ought for use to assemble information for the placement actions. It’s advisable attend day-after-day from 9am – 5pm on the first week of your placement. The following week ought for use to complete the handbook, make certain it is signed and retrieve any missing information. The interval all through which the placements will occur is from Monday 29th March to Friday 16th April. Your placement provider should confirm your start and end date.

You need to full the half for each train. There are 5 actions in all that you should carry out by way of the scientific placement. You want to not use the similar affected individual and/or train for a few report. Each report ought to consult with a definite affected individual or train. Together with recording the info, it is best to current proof of reflective learning. Reflection is an integral part of the case presentation and Affected individual Administration Plan (PMP) course of and is included inside the proforma. For the alternative actions there is a reflective learning sheet to complete. This should be acquainted to you because it’s very like the report in your PDP and very like the RPSGB preregistration information.

The handbook should be achieved; the acceptable sections signed by the supervising pharmacist. The completed affected individual administration plan should be handed by Tuesday sixth April for school youngsters who started their placement on Monday 29th March and on Tuesday 13th April for school youngsters who started their placement on Tuesday sixth April and on Tuesday 20th April for school youngsters who started their placement on Monday 12th April. Completely different placement actions should be handed in on Friday ninth or Friday 16th April or Friday 23rd April relying in your start date. Case reveals will doubtless be assessed On Monday, Wednesday or Friday week beginning 19th, 26th April or third May.

You want to make sure that all the actions are signed off by your supervisor or completely different member of employees. The supervisor may wish to make suggestions and there is a home for these on each worksheet. The reflective learning sheets should be achieved and these moreover require to be signed by a supervisor or member of employees. Failure to complete these will suggest that no marks may very well be obtained for that train.

Spare copies of all sorts and worksheets will be discovered on StudySpace.

Finding out Outcomes

This handbook will help you in reaching the subsequent learning outcomes

Show and apply information of the concept and implication of ADRs.

Outline the traits of some drug-induced points and the remedy associated to them.

Relate the gathering of treatment to treatment ideas/proof base, drug properties and the affected individual

Understand utilizing usually used medical abbreviations. (Enhances information gained in Expert Observe 5)

Use information from usually requested biochemical and haematological laboratory assessments to look at drug treatment and sickness growth. (Enhances information gained in Expert Observe 5)

Current acceptable pharmaceutical advice to potential victims to deal with some minor conditions encountered in group pharmacy.

Current acceptable pharmaceutical advice to potential victims and healthcare professionals on the administration of plenty of frequent sickness states.

Produce a structured reflective diary of placement experience

Observe actions to be achieved by way of the position

Actions to be undertaken in placement

Core

Neighborhood

Hospital

PCO

1. Put collectively a Affected individual Administration Plan (PMP)

Three. Public Effectively being train, paying homage to

Provision of smoking cessation advice/merchandise

Emergency hormonal contraception

Suggestion on cardiac effectively being

Provision of healthful life-style advice

Three. Affected individual Medication Historic previous

Three. Analyse prescribing information and put collectively summary report

2. Counsel a affected individual on the precise solution to pay money for optimum revenue from their medicines

4. remedy use overview

4. Discharge Plan

4. Prescription overview

5. Presentation of remedy use overview and proposals to group pharmacist

5. Case presentation

5. Case presentation

6. Deal with a request for OTC medicines or minor ailment treatment

6. Shadow prescribing go to

1. Affected individual Administration Plan: Internet web page 1

Affected individual initials: J.W

Establish of Pharmacy: Sainsbury Pharmacy

Establish of GP: Dr Khan

Intercourse: M

Weight/Peak if accessible:108 kg /1.74m

Age:75

Date:ninth June 2010

Presenting Complain (PC): Affected individual had a cold and temperature and he was presently taking Sudafed. He bought right here inside the pharmacy because of it was not working and wanted to buy one different OTC product. He moreover had muscle weak spot and felt dizzy.

Associated Earlier Medical Historic previous (PMH)

Diabetes

Osteoporosis

Allergic reactions:nkda

Affected individual earlier prescribed/OTC remedy from PMR

Indication on this affected individual

How prolonged on it?

Affected individual earlier prescribed/OTC remedy:

Indication on this affected individual

How prolonged on it?

1.Sudafed

2.Gaviscon

Three.

4.

5.

Nasal decongestants

Gastro-oesophageal reflux sickness

7 days

6.

7.

eight.

9.

10.

Affected individual current prescribed/OTC remedy

Drug and dosing particulars

1.Ramipril(10mg) capsules-take one capsule day by day

2.Metformin (500mg) tablets-Take one capsule with or after night time meal

Three.Aspirin(75mg)

Dispersable tablets

Take one capsule as quickly as day by day after meals

4.Simvastatin(40mg)tablets-Take one capsule at night with meals.

5.Omeprazole

(20mg) capsules-Take one capsule day by day

6.Alendronic acid (70mg)tablets-Take one capsule each week

7.Cal D3 chewable tablets-take one capsule twice day by day

Indication

Hypertension

Kind 2 diabetes

Prevention of an atherosclerotic event

Lowering ldl ldl cholesterol

Gastro-oesophageal reflux sickness

Osteoporosis

Osteoporosis

Interval

Summary of monitoring parameters

Measure blood stress and liver function assessments.

Measure blood sugar glucose stage and HB1ac.

Measure ranges of ldl cholesterol.

Affected individual Administration Plan: Internet web page 2

Exams if accessible e.g. BP, glucose or ldl ldl cholesterol (common fluctuate)

Date ninth June 2010

1.Blood stress (130/85 mmhg ) – 164/83 mmhg

2.Pulse value (60-80 beats p/min) – 67 beats p/min

Three.Complete ldl ldl cholesterol (Three-5mmol/l) – eight.21mmol/l

4.Ldl ldl cholesterol (HDL)(>1mmol/l) – zero.eight mmol/l

5.Blood glucose (<7mmol/l) -11.2 mmol/l

6.

7.

eight.

9.

10.

11.

12.

Significance of outcomes exterior common fluctuate if accessible:

The blood stress may very well be very extreme, ranges of ldl cholesterol are extreme notably the general ranges of ldl cholesterol. The HDL ranges are barely low The glucose ranges are out of fluctuate and are extreme.

Completely different considerations (social factors, compliance);

The affected individual may very well be very outdated and forgets to take his remedy usually and has been advised on the MUR to have a dossete area made for him and delivered which is ready to assure he takes his remedy usually.

Medical Points

1.Diabetes

2.Hypertension

Three.Extreme ldl ldl cholesterol

4.Osteoporosis

Pharmaceutical draw back itemizing prioritised (max 4 points)

1.Administration of diabetes

2.Administration of hypertension

Three.Administration of extreme ldl ldl cholesterol

4.Administration of osteoporosis

Affected individual administration Plan: Internet web page Three

SOAP NOTES (max. 2 pages in font measurement 11 Arial line spacing 1.5)

PHARMACEUTICAL PROBLEM administration of diabetes

Subjective

Affected individual is chubby

Objective

Blood sugar ranges have been measured inside the MUR by the pharmacist using the finger prick check out. The outcomes of this check out was 11.2mmol/l.

Affected individual weighed 108 kg and had a BMI of 30 kg/ m².

Blood stress was extreme: 164/83.

Pulse value: 68 beats per/minute

Analysis

The affected individual is chubby and that’s indicated by his BMI of 30kg/m².The blood sugar ranges on examination confirmed to be very extreme. Common blood glucose ranges fluctuate from 4-8mmol/l all by way of the day, as a result of this reality his blood glucose stage of 11.2mmol/l is properly out of the traditional fluctuate. The affected individual’s extreme blood sugar ranges can lead to micro vascular points e.g. nephropathy or macro vascular points e.g. stroke and notably since he has completely different cardio menace parts e.g. he is chubby and has hypertension.

NICE Suggestions recommends that if the person is chubby (physique mass index bigger then 25kg) oral anti-diabetic treatment should be started. If metformin is not going to be tolerated or is contraindicated, then take into consideration starting a sulfonylurea. NICE moreover recommends rechecking HbA1c inside 2-6months to reassess blood glucose administration.

Presently this affected individual is on monotherapy on metformin .His blood glucose ranges are nonetheless very extreme.

If blood glucose administration is not going to be being achieved NICE ideas recommends second drug may very well be added if the person is already taking the optimum dose. If affected individual is taking metformin certainly one of many following selections may very well be considered:

Add a sulfonylurea

If the person has an erratic life-style add a speedy showing insulin secretagogue(nateglinide or repiglinide)

If there could also be vital menace of hypoglycaemia (or its penalties) with sulfonylurea, or is sulfonylurea is contraindicated add a gliptin or glitazone.

The affected individual has extreme ranges of ldl cholesterol and is presently taking simvastatin for this which will also be actually helpful by NICE as 1st line treatment for the administration of blood lipid ranges in people with variety two diabetes. The affected individual is on a dose of 40mg taken as quickly as day-to-day at night. This could be elevated to the utmost dose of 80mg since his complete ranges of ldl cholesterol are extreme.

The affected individual will also be on antihypertensive remedy and will protect a blood stress underneath 140/80 mmhg since he is diabetic. NICE recommends an ACE inhibitor should be first line treatment proper right here. His blood stress is presently 164/83mmhg which is above the objective blood stress an in accordance with CKS ideas if the blood stress would not meet the objective blood stress referral to a specialist probably required.

Plan

The plan is firstly make certain the affected individual is conscious of the life-style interventions he can take to reduce all risks of problems with his diabetes. This affected individual is chubby and has a BMI of 30. He should be impressed to drop some weight and be given acceptable dietary advice, i.e. reduce fat consumption, eat further fruits, greens and carbohydrates. Since he has a BMI of 30, he is also referred to a dietician for weight discount remedy. This weight administration advice will help reduce his menace parts for diabetic points along with completely different cardiovascular points he has a menace of. Presently he takes metformin to handle his blood glucose ranges. The dose of Metformin could be elevated frequently to the utmost dose of 2g.if this does not administration the blood glucose then Sulfonyureas should be added as a combination treatment in accordance with NICE ideas since his blood glucose ranges . He additionally must be made acutely aware that he can check out his blood glucose ranges at home using the finger prick check out to confirm his blood glucose ranges are managed. Blood stress should be monitored not lower than every 1-2 months until it reaches the objective blood stress and to ensure affected individual would not flip hypotensive.

Affected individual administration Plan: Internet web page Three

SOAP NOTES (max. 2 pages in font measurement 11 Arial line spacing 1.5)

PHARMACEUTICAL PROBLEM administration of hypertension

Subjective

NIL

Objective

On examination blood stress was 164/83

Pulse :67 beats/min

Complete ldl ldl cholesterol:eight.21

HDL:zero.eight

Glucose:11.2mmol/l

BMI:30kg/m

Analysis

From examination the affected individual’s blood stress has elevated from his earlier blood stress confirmed on the affected individual remedy report which was 158/84.The affected individual had a cold and bought right here in for varied decongestants to Sudafed which he was presently taking for his chilly indicators that he was experiencing. Sudafed should not be taken since he is a affected individual on anti hypertensive remedy. All decongestants should be stopped. Affected individual should be advised of various regimes he can take to combat his chilly indicators paying homage to olbas oil inhaler, vick’s rub and paracetamol to lower his temperature.

In response to NICE ideas in hypertensive victims aged over 55 or black the primary different for preliminary treatment should be calcium channel or thiazide diuretics.

Step 2 is together with an ACE inhibitor if the preliminary treatment was a calcium channel blocker or thiazide diurectic.if preliminary treatment was an ACE inhibitor add a calcium channel blocker or diuretic.

Step three inside the steering recommends using combination of three remedy:

Use combination of ACE inhibitor, calcium channel blocker and thiazide variety diuretics ought for use.

Step four inside the steering recommends together with an alpha blocker, spironolactone or one different diuretic. If the blood stress stays uncontrolled on sufficient doses of four remedy and educated advice has not been obtained this might now be sought. Presently the affected individual is on the utmost dose of Ramipril which is 10mg for hypertension. His blood stress stays to be elevated and step 2 treatment may very well be vital and if after frequent monitoring if the blood stress has not been lowered step Three might need to be put into the drug regime. As a result of the affected individual will also be diabetic his objective blood stress have to be for a diabetic affected individual have to be considered and should be geared towards decrease than 140/85.

Plan

The affected individual should moved to step two of NICE ideas and as a result of this reality be on a mixture of an ACE inhibitor and calcium channel blocker or thiazide diurectis.If the combo of ACE inhibitor (Ramipril) and a thiazide diuretics(furosemide) is chosen then cautious monitoring of his electrolytes, urea and creatine should be carried out.

The affected individual’s blood stress should be monitored usually i.e. – as quickly as every four weeks to judge treatment response.

Whereas on drug treatment affected individual have to be given life-style intervention advice to take alongside the drug treatment. The affected individual have to be advised to have a low fat and low saturated fat meals routine which is ready to help reduce his weight since he has a extreme BMI of 30mg/m, reduce his salt meals routine consumption (a lot much less 6g salt per day), enhance fruit and vegetable consumption and reduce cardiovascular menace by stopping smoking and rising oily fish consumption. Dynamic Prepare would moreover help the affected individual as part of his life-style intervention, although since he is very outdated this is not preferrred for the affected individual.His glycaemic administration should be optimised as he is a diabetic (HBA1c of decrease than 7%) and customary blood sugar ranges should be monitored.

2. Affected individual Counselling

Affected individual initials:

Intercourse: M / F

Age:

Location of Counselling (e.g. group pharmacy, counselling room, ward variety, out -patient)

Current medical draw back(s) (if recognized):

Affected individual’s needs ( completely different considerations):

Current remedy (remedy and doses)

1.

2.

Three.

4.

5.

6.

7.

eight.

9.

10.

Predominant Counselling elements to cowl

Supervisor’s signature:

Scholar signature:

Date

2 Affected individual Counselling: reflective learning

Date

Short-term summary of the character of the train

What have been you attempting to appreciate?

What occurred / what was the top end result?

What have you ever ever learnt due to this?

What would you want / have to review further about?

Tutor/Supervisor Suggestions

Tutor/Supervisor Establish

Tutor/Supervisor Signature

Date

Three. Public Effectively being Train:

Affected individual ID (init)

DOB/age:

M/F

Current draw back(s)

Associated earlier medical historic previous:

Current Medication (if recognized)

(Drug, dose, frequency)

1.

2.

Three.

4.

5.

Train:

Provide

Affected individual

Pharmacist

Referred by GP

Completely different ……………..

Goal

Describe train and the way in which the state of affairs was dealt with.

Suggestion/information supplied

Product outfitted or purchased

Completely different factors and suggestions (affected individual onerous of listening to, mobility, who manages medicines at home, and plenty of others)

Further movement if needed and remaining end result

Tutors Suggestions

Signature

Date

Three. Public Effectively being Train: reflective learning

Date

Short-term summary of the character of the train

What have been you attempting to appreciate?

What occurred / what was the top end result?

What have you ever ever learnt due to this?

What would you want / have to review further about?

Tutor/Supervisor Suggestions

Tutor/Supervisor Establish

Tutor/Supervisor Signature

Date

4. Affected individual remedy use overview Internet web page 1

Affected individual:

DoB

Circumstances/prognosis

MEDICINE

(embody dosage particulars)

MODE OF ACTION

INDICATION

(Appropriateness)

MONITORING (EFFICACY/SAFETY)

PARAMETERS

COUNSELLING POINTS

4. Affected individual remedy use overview Internet web page 2

Factors and Options

Factors

Contribution/recommendation

Consequence

For the attention of…

1.

2.

Three.

4.

Reflection on Necessary Events:

References Used:

Supervisor’s Suggestions & signature:

Establish:

Date:

4 Affected individual remedy use overview: reflective learning

Date

Short-term summary of the character of the train

What have been you attempting to appreciate?

What occurred / what was the top end result?

What have you ever ever learnt due to this?

What would you want / have to review further about?

Tutor/Supervisor Suggestions

Tutor/Supervisor Establish

Tutor/Supervisor Signature

Date

5. Affected individual remedy overview presentation

Medical Pharmacy Module

PY3060B

Affected individual Medication Use Consider Presentation Options

Establish of Presenter: Assessors:

Title: Date:

Presentation start time: Presentation end time:

Interval:

Suggestions

Mark

Presentation Kind

Readability

Eye Contact

Use of Language

Rapport

20

Property

Prime quality of slides

Quantity of slides

Used properly?

Acceptable

20

Content material materials

Introduction

Dialogue

Understanding

Explanations

Scientific

40

On questioning

Technique

Angle

Knowledge

Confidence

20

Basic Mark

100

Suggestions

Tutor/Supervisor

Date

6. OTC request/treatment of a minor ailment

Affected individual ID (init)

DOB/age:

M/F

Current draw back(s)

Associated earlier medical historic previous:

Current Medication (if recognized)

(Drug, dose, frequency)

1.

2.

Three.

4.

5.

Request

Provide

Affected individual

Pharmacist

Referred by GP

Completely different ……………..

Describe train and the way in which the state of affairs was dealt with.

Potential points and the way in which solved

Product outfitted or purchased

Suggestion/information supplied

Completely different factors and suggestions (affected individual onerous of listening to, mobility, who manages medicines at home, and plenty of others)

Further movement if needed and remaining end result

Tutors Suggestions

Signature

Date

6 OTC request/treatment of a minor ailment: reflective learning

Date

Short-term summary of the character of the train

What have been you attempting to appreciate?

What occurred / what was the top end result?

What have you ever ever learnt due to this?

What would you want / have to review further about?

Tutor/Supervisor Suggestions

Tutor/Supervisor Establish

Tutor/Supervisor Signature

Date