Career-changing and life-saving! (Rachel Hall)

I remember clearly the day I wrote my first prescription. It was for ramipril 2.5mg capsules. It felt strange signing it and I double checked it several times before giving it to the patient.

Suddenly all those months of hard work had paid off: no longer would I have to stand outside the doctors’ rooms waiting for them to sign prescriptions for me. But, at the same time, the increased responsibility was dawning on me. Taking clinical responsibility for a patient’s treatment was not new to me, having spent seven years working in community pharmacy recommending over-the-counter medicines. However, this took the notion to a whole new level.

The most important principle of pharmacist prescribing, I believe, is that you work within clear boundaries and only prescribe in areas where you are competent. The prescribing course covers 87 competencies, so is quite thorough — and providing evidence to support these competencies was certainly a challenge, but definitely worthwhile. I’m lucky to work with a group of extremely supportive GPs who are only too happy to answer a query or see a patient for me if I am not sure about a diagnosis or treatment plan.

Gut feeling

One example of this, which sticks in my mind, was when I saw a 62-year-old woman to review her antihypertensive treatment. She had been taking felodipine 5mg daily for about three weeks and had been asked to come back to me for a blood pressure check and for further tweaking of her medication, if needed.

She presented with unilateral leg oedema, which I could have assumed was caused by the felodipine as it fitted with the timescales she gave me. However, after further questioning and examination of her calf, my gut feeling was that it could be a DVT — so I called one of the doctors in for his opinion. He agreed and sent her off to A&E where it was confirmed, and she was started on warfarin.

Unfortunately, she had to cancel a trip to Jersey, but she understood the reason and, despite this, was extremely grateful. It would have been easy for me to assume her symptoms were a side effect of the felodipine, which shows how important the history of symptoms she gave and the examination were in this case.

The skills I learned from the independent prescribing course have been enriched, I believe, by my experiences over the past three years, adding to my expertise and professionalism. I know I’ve come a long way and feel I’ve been accepted as a practitioner in my own right.

 

Rachel Hall is clinical pharmacist at The Old School Surgery, Bristol