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Australian Journal of Pharmacy : April 2005
pharmacy educ counselling casebook Gathering information Demographic details and a summary of medical and surgical conditions are usually summarised by the ACH and can be obtained from the resident’s file. This will include date of birth, sex, weight, height, BP, adverse drug events/allergies, immuni- sation status, self-medicating or not, swallowing difficulties —medication crushed or not. Examination of care plans will identify mood, cognitive impairment, continence, skin integrity, mobility, diet, monitoring protocols and so on. Current medications taken are documented in the medication chart—checking short-term medications, start doses, regular medications, as necessary ‘prn’ medications and nurse-initiated medications (NIMs). Due to documentation it is an easy matter to establish use of common ‘prn’ medications such as paraceta- mol, laxatives, sedatives and so on. Drug usage needs to be writ- ten on the report to assist the GP in development of the medica- tion management plan. Much information can be collected from progress notes, care plans, pathology results, transfer letters, and other health professional assessments. The use of the compre- hensive medical assessment (CMA) and/or patient summary pro- vided by the GP when requesting Item 903 will assist pharma- cists in data collection. A CMA is available to all permanent residents of ACH. A GP can provide a CMA to new residents on admission to an ACH (recommended within first six weeks) and to existing residents on an as required basis. A CMA is a volun- tary service for residents of ACH and must include: • a detailed medical history; • a comprehensive medical examination; • developing a list of diagnosis and/or problems; and Scenario D ORIS has recently become a resident of the Happy Valley Hostel. She is 90 years old and has been living in a retirement village until three months ago. She has been admitted following a fall where she fractured her right humerus. Doris is fortunate as she has good cognitive skills, as expected is hard of hearing and wears glasses. Doris is mobile with the help of a walking stick only. You have been asked to prepare a RMMR. Her medications are as follows: Short-term medications: • Clotrimazole Cr (Canesten Cr) • Amoxycillin 500mg tds Regular medications: • Enalapril 20mg d • Indapamide 2.5mg d • Venlafaxine 37.5mg • Ergocalciferol (Ostelin) 1000iud • Calcium carbonate (Caltrate) 600mg • Temazepam 10mg I n • Paracetamol 500mg 2 bd 282 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 APRIL 2005 PRN orders: • Docusate sodium, sennosides a and b (Coloxyl & Senna)—2 bd • Paracetamol 2 prn • Temazepam I n prn Her main problems are a current chest infection, rash under her left breast, and pain in her knees. Her listed medical conditions are hypertension, osteoarthritis of the knee, peptic ulcer perforation, depression and vitamin D deficiency. Doris is a very elegant, well-dressed lady and delighted to have a chat. She tells you she was on Vioxx but her doctor stopped it last year. She is now troubled with the pain in her knees. She is very happy at Happy Valley, and likes the meals. Other information you have obtained from her notes and talking to the nursing staff. Issues Immunisation: Doris has annual influenza vaccinations and wishes to be revaccinated when she recovers from her current chest infection. • a written summary to aid the facility. The CMAcan provide the GP the basis to develop the resident’s care plan and can also complement the RMMR.15 A small percentage of residents in ACHs may be self-medicat- ing. These residents will require regular assessment of their ability to continue self-medication. An essential part of the information gathering is to ‘interview’ the resident. This will vary from a detailed interview plan similar to a home medicines review to a ‘Hello, nice day…’ if the person has severe cognitive impairment. Data collection and accurate documentation is aided by a number of good software packages available. Assessment Assessment by the pharmacist of the medication–related prob- lems requires a realistic holistic approach to the needs of the res- ident at this time in their life. Over zealous monitoring may often not be appropriate. Additional preventive medication treatment may be proposed for discussion by the GP. Aged care work highlights the need often for a multi-discipli- nary care approach rather than just medication particularly in conditions like OA. Report writing Pharmacists need to communicate with the GPs working in ACH to identify the format of reports that the GPs find useful to develop their medication management plan. In general, the preferred for- mat identified is: short reports, evidence-based, options if appro- priate, focus of resident medication management issues and pro- vide space for comments and action.