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Pharmacists, prescribers or not, doing clinical assessments…is this a good idea?

INSPECTION (looking), palpation (feeling) and auscultation (listening) are clinical examination skills that generally don’t come naturally to pharmacists.

Until now that is…

Pharmacy in Scotland is moving forward rapidly. Like many others, I recently qualified as an independent prescriber and as such have been looking for training opportunities to support my future role. Clinical assessment is one such area that is helpful for non-prescribing pharmacists, but very important for those practicing as prescribers.

Prescribing decisions are often based upon findings of these core clinical assessment skills of inspection, palpation or auscultation.

We were discussing today how to possibly apply these skills in community pharmacy.

Like many areas of practice the input does not need to be complicated. For example, today I learned how to properly examine the ear safely and effectively. In community pharmacy we are presented with this complaint very often and the ability to reliably check for inflammation, wax or infection is in my view an excellent use of community pharmacists’ skills.

Currently, I have an interest in respiratory prescribing, so the respiratory examination and especially the simulated pre-recorded chest sounds were very useful. Discerning the sometimes subtle difference between a wheeze, a rhonchi or a crackle is very tricky and requires considerable practice, not to mention experience.

One interesting tip I got from one of the ‘real’ patients attending, was to examine side-to-side, so that you can compare as you go. For example if listening to the chest do so in a zig-zag fashion comparing sounds on each side as you go.

Most of the examination techniques were quite easy to do. However, without a doubt they must be very difficult to master. For example discerning the various heart or chest sounds to aid diagnosis I can only assume would take years of practice.

NHS education for Scotland is currently running an excellent course on clinical assessment for pharmacist prescribers, or those in training to become pharmacist prescribers.

The NES course is being run over two days and includes the following areas…

  1. General examination including hands, face, mouth and eyes.

2. Assessing and recording temperature, pulse, respiratory rate and blood pressure.

3. Examination of the chest and assessment of peak expiratory flow rate.

4. Examination of the eyes and ears.

5. Basic ECG assessment.

6. Understanding basic blood results.

As pharmacist prescribers we must start somewhere, and I was grateful for the opportunity and support from NHS Education for Scotland support to do that today!

Johnathan Laird is a community pharmacist independent prescriber with a special interest in asthma. He is based in based in Aberdeen.

Follow Johnathan @JohnathanLaird

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