I WAS really flattered to be asked to write an article for this site.
“Write about anticoagulation, a health related specialty or personal interest”, Johnathan said.
That’s pretty broad and has given me plenty of time to consider what I would like to share. I’m sparing you (for now) my career path and the benefits of doing pharmacy senior manger posts on your journey to a consultant pharmacists post…if that’s what you want. I’m also going to convince you that sharing is caring. Sharing means more than sharing the packet of biscuits to prevent you getting fat (I need to do more of that type of sharing)!
We have all been blessed with a wealth of pharmaceutical knowledge. Have you ever thought what happens if we don’t share this? What if we prioritise checking of prescriptions over sharing our clinical knowledge with patients? What if we focus on medicines reconciliation in hospital and the process of discharge without keeping our patients fully informed?
Do we assume they will know? Are they anxious because they are unsure? Are they worried to ask us because they don’t want us to have extra work to do? What happens to a patient on anticoagulants if we don’t prioritise talking to them?
A tale of Sadness
This is a story we have talked about widely in our team and how we can evolve to make sure we are not faced with situations like this again. Mrs B was on a novel oral anticoagulant (NOAC) she came in to hospital, collapsed having had a huge melaena.
It’s an easy conclusion to assume that this is a normal side effect of anticoagulation and simply needs to be managed. However on review this is just not the case. The decision to start was made on a ward round and the new tablets were discussed. On the initial discharge the medicines were packaged up and she went home.
Over a month later (following on from a further supply from her GP and community pharmacy) she has a melaena and was admitted to hospital. Sadly, she had experienced 2 days of black tarry stools prior to the more serious bleed. She did not recognise this as bleeding, and did not take the anticipated action of stopping the medicines and seeking help. She has now recovered thankfully.
What special things should we have told her?
It’s essential for every patient on anticoagulation to know that they must stop the medicine and get help if they have any serious signs of bleeding. These are:
- Severe bruising
- Tea coloured urine
- Dark tarry stools
- Coughing up blood (coffee stained)
- Severe headache
- Prolonged bleeding.
These symptoms are as important as them knowing that they are being anticoagulated and why.
We all know it, but we need to ensure that we share our knowledge with our patients each time that they come to a pharmacy to visit. Repetition is part of our responsibility to ensure on-going compliance. C. Everett Koop (Former US Surgeon General) wrote: “Medicines don’t work in patients that don’t take them”.
I want to add to that: “and they do harm in those that take them incorrectly.”
As a pharmacist, I believe that I am ideally educated and placed to support patient in being satisfied with the information that they get on their medicines to support them practically in taking them correctly. Through sharing information I care about their welfare and support them on their journey. I feel privileged and fulfilled at work. It’s a great place to be.
How do you share and care?
Given the pressures within the NHS and the numerous activities we are all trying to complete on a daily basis, I understand that talking to patients can be practically difficult and sometimes emotionally challenging as well as time consuming. However, I guess, as part of our development as a profession and our inclusion of medicines optimisation, in all that we do, we must be mindful about the type of care we would want if we were the patient. We have the unique skills and abilities to deliver the level of care that we would wish to receive.
Sharron Gordon is a consultant pharmacist at Hampshire Hospitals NHS Foundation Trust
Follow Sharron @AnticoagPharma