When we do a patient service, such as a medicine use review (MUR), we expect minor issues to be raised during the consultation, but every now and again something stops you in your tracks...it happened to me the other day. 

I was doing a MUR on a gentleman and we began discussing his medication...when we got onto his pain relief medicines and reached paracetamol I though he was going to say "yes, I take them as prescribed - Two, up to Four times a day when necessary" but he didn't...He said "I often take Four tablets Four times a day when in pain - sometimes more - I know it's an overdose!" I was shocked...such a toxic overdose is potentially lethal.

 The maximum dose is on all products and labels. I had a stern conversation about overuse of paracetamol and the toxicity of it. He admitted that he obtains extra supplies from corner shops and from family members...We discussed liver toxicity and the risk of paracetamol poisoning, and death, with overdose... I've referred him to his doctor urgently.

 I hope the patient takes my advice, cuts down on the paracetamol and gets his pain control reviewed; or else I fear for the consequences... and, I guess, this just goes to show the benefit of the MUR service - even on what might be thought of as trivial medication...

Last Friday was "Fruity Friday."

This is a great opportunity to get positive health care messages out to the public, whilst allowing them to sample unusual fruits - and perhaps changing  the way they view fruit for the better. I was working from home; but I popped in to see how it was going... The staff had put pictures of fruit around the pharmacy, done a brilliant window display and had chopped up fruit on the counter for the public to sample.

Patients loved it!

One customer JT said "this is a great idea, I've sampled fruit I haven't had in years and it's made me think about my diet"

Something to be repeated next year...

The LPC Executive team attended a very useful "joint" Regional Meeting in York yesterday with colleagues from LPCs in the Northern Region and Yorkshire Region. We heard a number of excellent presentations on a wide variety of subjects. Time after time we were told that contractors must deliver the services we have, or it will be difficult to negotiate new ones in the future...it's no use sitting back moaning about the lack of new services if you don't do the ones we have!    Perhaps the most sobering thoughts came from the presentation we had about simplification of the Drug Tariff to improve transparency and reduce endorsing. The LPC will issue an article about the  changes in the pink bulletin soon - and will have the presentation available on the website shortly. We are entering a very different world in July; so please examine the changes carefully and let us know your thoughts!

Community Pharmacy locally got some stick last week from the Head of Medicines Management, Janette Stephenson...This was because the palliative care pain relief drug Diamorphine has been switched over throughout the region to Morphine - and a couple of complaints had been received at the PCT from district nurses about difficulties obtaining supplies from pharmacy.

I caught up with Janette at a local clinical update meeting organised by the North East Pharmacy Forum last week and we had a chat about it.  We both agreed that it's hard to believe contractors could be unaware of the switch as letters had gone out from the PCT and the "LPC pink bulletin" ran a story about it well in advance. Janette was grateful to the LPC about the e-reminder that we'd sent around. For reasons of patient care, pharmacists carrying no stock should signpost patients to other pharmacies stocking the drug; but Janette couldn't reason why contractors didn't stock it... 

I reminded Janette that contractors weren't in the habit of taking medicines into stock on a "just in case basis" especially not controlled drugs for palliative care as the majority of pharmacies happily only deal with end-of-life dispensing on a rare basis...and perhaps there was a role for the district nurses and surgeries to alert pharmacies to the potential need for these drugs before they are prescribed?