General:
• If something says as directed always clarify how much they are taking
• ALWAYS DOSE CHECK -> single and daily dose as well as the indication
• UNCLEAR DOSES ARE NOT CARE ISSUES AS TECHNICALLY THEY ARE NOT WRONG JUST VAGUE
• We don't just change medicines because of the guidelines we must also use clinical judgement
• DON'T FORGET -> qrisk3 score for elderly, HTN, T2D
• NEVER: advise pts to completly stop alcohol => not realistic
• Always consider what the clinical trade off is?
• REMEMBER -> CARE ISSUES are DRUG RELATED PROBLEMS
• When looking at a list of medical conditions...
◦Signs and Symptoms that can be measured
◦Decide if medication is appropriate and then look at DRPs
◦Starting a medicine: Name + Dose + Counselling + Monitoring + Frequency (no dont
◦cut my face) => Always check it is appropriate for age group, and dosing is right for the indication (BNF monograph as standard
but EMC gives more detail)
• Examples of DRPs: OVERDOSE, UNTREATED CONDITION, DRUG INTERACTION, UNCONTROLLED *, NON-ADHERENCE AS EVIDENCE BY...,
PATIENT UNFAMILIAR WITH SICK DAY RULES AS EVIDENCE BY PATIENT INTERVIEW
◦always say AS EVIDENCE BY.. to supplement the care issue identi ed
Care planning:
• Initially we have some general info about the patient -> age and weight and name and gender and maybe height
• Look at their age -> are they 65+ = elderly
• BMI (weight? -> health)
• Occupation? -> lorry driver or on their feet all day, what type of patient (exercise? + activity)
• PMH
• DRUG
• GUISE ->
• GROUP -> Dose CHECK (OVERDOSE/SUB-THERAPEUTIC, IS THE PATIENT TAKING THE MEDICINE THE RIGHT WAY), CHECK ALL
CONDITIONS are being treated
• UNTREATED/UNECESSARY
• INTERACTIONS
• SIDE EFFECTS
• EVIDENCE
• Many of these issues will require access to a BNF
DRPs:
ADR, SIDE EFFECTS, DRUG INTERACTIONS, SUB-THERAPEUTIC DOSE,
INCORRECT DOSING E.G. DUE TO THE PATIENT
NO CLEAR INDICATION -> UNNECESSARY MEDICINE
Marking guide for the care plan:
• 100 marks in total -> the 90 mark is prede ned and the last 10 marks are bonus marks (extra correct justi ed)
• Recommend or prescribe something
• Interactions -> act on it
• Uncontrolled condition ->
• Every time you recommend or prescribe
• Drug + dose and Frequency + monitoring + counselling
• Monitoring and safety netting -> when should this be done
• Any follow up that needs to be done for the pt
• E.g. statin -> LFTS initially after 3 months
• Counselling points as well: often missed out
• => 20 marks total for each of these chunks
• Bigger issues -> identify and resolve (the biggest of these is 10 marks)
• Smaller issues -> identi ed and resolved (5 marks)
• =>In total that will give you 90 marks
• ADVICE -> REVISE BY GOING BACK AND LOOKING AT PREVIOUS CARE PLANS TO REMIND YOURSELF WHAT MONITORING IS REQUIRED
AND THE MOST COMMON SIDE EFFECTS ETC. AND WHATS THE COUNSELLING POINT
• Prioritise, is it important? -> yes and no
• It can be very dif cult
• What’s a NO is having lifestyle at the top – de nitely not the priority in a patient with an uncontrolled condition -> not the
pharmacists business, referral to other hCP looks good here
• This will be the last thing you think about after addressing the issue
• The priority is not something you should be reminded about
• Lifestyle advice (10 marks -> MAX)
• Make sure it is relevant
- diet and exercise is not speci c enough -> 0 marks
• Two different lifestyle advice that needs to be addressed usually
• E.g. not smoking cessation for a patient that is a non-smoker
• BMI and diet is good -> don’t address it in lifestyle
• Easy marks to get but the most dif cult to get full marks for because often full details aren’t give
• E.g. exercise 3-4 30 minutes sessions a week
• If something says as directed always clarify how much they are taking
• ALWAYS DOSE CHECK -> single and daily dose as well as the indication
• UNCLEAR DOSES ARE NOT CARE ISSUES AS TECHNICALLY THEY ARE NOT WRONG JUST VAGUE
• We don't just change medicines because of the guidelines we must also use clinical judgement
• DON'T FORGET -> qrisk3 score for elderly, HTN, T2D
• NEVER: advise pts to completly stop alcohol => not realistic
• Always consider what the clinical trade off is?
• REMEMBER -> CARE ISSUES are DRUG RELATED PROBLEMS
• When looking at a list of medical conditions...
◦Signs and Symptoms that can be measured
◦Decide if medication is appropriate and then look at DRPs
◦Starting a medicine: Name + Dose + Counselling + Monitoring + Frequency (no dont
◦cut my face) => Always check it is appropriate for age group, and dosing is right for the indication (BNF monograph as standard
but EMC gives more detail)
• Examples of DRPs: OVERDOSE, UNTREATED CONDITION, DRUG INTERACTION, UNCONTROLLED *, NON-ADHERENCE AS EVIDENCE BY...,
PATIENT UNFAMILIAR WITH SICK DAY RULES AS EVIDENCE BY PATIENT INTERVIEW
◦always say AS EVIDENCE BY.. to supplement the care issue identi ed
Care planning:
• Initially we have some general info about the patient -> age and weight and name and gender and maybe height
• Look at their age -> are they 65+ = elderly
• BMI (weight? -> health)
• Occupation? -> lorry driver or on their feet all day, what type of patient (exercise? + activity)
• PMH
• DRUG
• GUISE ->
• GROUP -> Dose CHECK (OVERDOSE/SUB-THERAPEUTIC, IS THE PATIENT TAKING THE MEDICINE THE RIGHT WAY), CHECK ALL
CONDITIONS are being treated
• UNTREATED/UNECESSARY
• INTERACTIONS
• SIDE EFFECTS
• EVIDENCE
• Many of these issues will require access to a BNF
DRPs:
ADR, SIDE EFFECTS, DRUG INTERACTIONS, SUB-THERAPEUTIC DOSE,
INCORRECT DOSING E.G. DUE TO THE PATIENT
NO CLEAR INDICATION -> UNNECESSARY MEDICINE
Marking guide for the care plan:
• 100 marks in total -> the 90 mark is prede ned and the last 10 marks are bonus marks (extra correct justi ed)
• Recommend or prescribe something
• Interactions -> act on it
• Uncontrolled condition ->
• Every time you recommend or prescribe
• Drug + dose and Frequency + monitoring + counselling
• Monitoring and safety netting -> when should this be done
• Any follow up that needs to be done for the pt
• E.g. statin -> LFTS initially after 3 months
• Counselling points as well: often missed out
• => 20 marks total for each of these chunks
• Bigger issues -> identify and resolve (the biggest of these is 10 marks)
• Smaller issues -> identi ed and resolved (5 marks)
• =>In total that will give you 90 marks
• ADVICE -> REVISE BY GOING BACK AND LOOKING AT PREVIOUS CARE PLANS TO REMIND YOURSELF WHAT MONITORING IS REQUIRED
AND THE MOST COMMON SIDE EFFECTS ETC. AND WHATS THE COUNSELLING POINT
• Prioritise, is it important? -> yes and no
• It can be very dif cult
• What’s a NO is having lifestyle at the top – de nitely not the priority in a patient with an uncontrolled condition -> not the
pharmacists business, referral to other hCP looks good here
• This will be the last thing you think about after addressing the issue
• The priority is not something you should be reminded about
• Lifestyle advice (10 marks -> MAX)
• Make sure it is relevant
- diet and exercise is not speci c enough -> 0 marks
• Two different lifestyle advice that needs to be addressed usually
• E.g. not smoking cessation for a patient that is a non-smoker
• BMI and diet is good -> don’t address it in lifestyle
• Easy marks to get but the most dif cult to get full marks for because often full details aren’t give
• E.g. exercise 3-4 30 minutes sessions a week
