Thursday morning of last week Elise and I got a chance to watch one of the clinical pharmacists (Steve) in the diabetes clinic. He is certified as a non-medical prescriber so he is allowed to start medications within his scope of practice and adjust medication doses. This is pretty similar to what some pharmacists who work for the VA in the states have. I think it's an awesome idea and we should expand to a similar system that England has adopted with the non-medical prescribing certification. The clinic offers a great multi-disciplinary approach to patient treatment which I really appreciate.
I sat in on two patient sessions and talked with Steve about the process he takes prior to seeing a patient and then again during the actual interviewing component. One of the patients did not speak any english so a family member had to translate which always adds another added struggle in terms of optimizing therapy. The patient was beginning to have some pain in her legs and had been prescribed amitriptyline but the family member informed us that she was always so drowsy. There had also been a bit of a miscommunication with her GP in regards to increasing her metformin dose so it was the perfect place for a pharmacist to step in and make the necessary adjustments and sort out a solution for the pain in her legs.
My other patient was interesting because her blood glucose was very uncontrolled and yet she was completely aware of the implications and knew that this was due to her poor eating habits. She was so honest with herself and with us, quite refreshing! Even with the acknowledgement though, she still had not seemed to find the motivation to change her lifestyle habits so although we did not make any drug interventions we hopefully were able to help her realize the magnitude of her poor decisions and point her in the right direction to start that change. We counseled her on smaller portion sizes, cutting out the snacking during the day, and eating well balanced proper meals.
That afternoon Elise and I followed one of the antimicrobial pharmacists around as she worked with one of the doctors to sort out a few patient's drug therapies. Antimicrobial use is actually quite different here in the UK than it is back home. One interesting difference is in infection control. No lab coats, no painted fingernails, no sleeves past the elbows, no dangling necklaces, etc on the ward! We have not moved to that point in the states yet! Also, I think that there is a difference in regards to antimicrobial treatment options for various disease presentations between here and states. I think we are overall less inhibited in the states (which can be good and bad) in regards to drug therapy and we put more of an emphasis/weight on the use professional judgement in concordance with guidelines and recommendations when deciding on treatment.
It's been really neat being able to shadow different pharmacists in their element and compare/contrast to the way things are typically done back home. I'm so grateful for the opportunity I've had to come here and very grateful to our preceptor, Dr. Steinke, for providing us with such a diverse pharmacy experience.
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