About more than just the prescription (Margaret Hook)

Independent prescribing in a hospice is not all about writing the prescription. It involves teamwork and, often, lengthy consultations.

Recently I was asked to seek permission from a lung cancer patient to prescribe her discharge medicines. I find it helpful to try getting to know patients who need help understanding their medicines or require medicines for discharge. Therefore, I asked if she could tell me about her illness.

Her story focused on her early symptoms of cough and blood in her phlegm, together with breathlessness, and she told me that lung cancer had been diagnosed not long before her admission. We talked about how she was coping now that some of her medicines had changed and since learning new techniques to control breathlessness and night-time cough. She showed me her glasses case and said, with a twinkle in her eye: “I never go anywhere without it”. Inside were two paper bags folded neatly beside her glasses; she told me how the physiotherapist had encouraged her to breathe into a bag when anxious about her breathing.

When I asked if she was able to stand and get about, she said her legs were weak and felt like jelly. I explained that after several weeks of being too ill to get out of bed she would need some help and support. She chuckled and admitted that the physio had tried, but on one of her “off days”. The physio had led her across the room “too far” and she had got cross and refused to go any further. She felt she could not ask the physio again.

Part of my reason for this long discussion was to assess the patient’s mood. At first she did not make any eye contact and seemed quite disinterested. I began to wonder if she was depressed. However, after a few minutes (when my concern for her care became more apparent) she warmed to me and we ended up discussing her childhood in India. She also mentioned she had been lucky to have a hospice nurse visiting her at home but she had not seen her for a couple of weeks. I was now sure that she was having some low moments and was sad at her diagnosis, but that she was not permanently depressed.

I later crossed paths with the community nurse and mentioned that this particular patient was missing her. I also raised what had happened with the physio. The nurse suggested that, from previous experience, chocolate might be the key to forgiveness.

 

Margaret Hook is principal pharmacist for St Peter’s Hospice, Bristol