The Logbook A Tutors Perspective

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The Logbook A Tutors Perspective

• Heather Walker
• 23rd February 2005

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Summary of Logbook Assignment
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What is an intervention?

• Any action taken with the aim of improving
  patient care

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Interventions

• Drug dispensed dose, form, side effects,
  interactions
• Supervised consumption
• Frequency of pick ups
• Missed doses
• New patients
• REFERRAL

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Pre-assessment

• Try and schedule the time to have a longer
  initial session with a patient when they are new
  to you.
• Find out who their key worker is and how to
  contact them
• If you get the chance to talk to the
  prescriber/keyworker ask for any relevant
  information.is there anything I need to know?

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Assessment

• Appearance
• Ask them how they are
• Do a history
• Is this the first treatment?
• Length of time on this or previous treatments
• Any other dugs, prescribed/OTC/other
• Previous experiences of treatment outcomes
• Previous experiences of community pharmacy
• What does patient know about the prescribed drug
  (dispel any myths)
• Ask what they would like/expect from you.

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Assessment contd.

• If patient approves can get information from GP
  and undertake basic health screen
• Diet/nutrition
• Dental health
• Needle exchange/safer injecting/citric acid
• Harm minimisation including safe sex
• Minor ailments
• Smoking cessation

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Care planning

• Plan discussions with the patient and tackle one
  subject at a time.
• Inform patient that you are part of the team
  and can help with communication if necessary.
• Make sure you are giving the same messages as the
  rest of the team.
• Keep in regular touch with the keyworkers and
  prescribers to inform the patients care.

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Choice of patients

• Ideally 10 patients with at least 2 from the
  group listed on p 82
• Variety
• Try to choose those where you have made a
  significant intervention
• Make up numbers with in depth profile of a lesser
  number

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Accreditation

• Maintenance improvement of clinical practice
• Risk management
• Communication with patients

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What the tutor will look for

• Safe practice
• Not necessarily a good outcome
• How you have dealt with a situation what you did
  well, less well and whether it could be done
  better next time.
• What you have learnt
• How you have put your knowledge into practice
• How you have improved your practice

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Pharmacist Logbook
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Examples from other years

• Pharmacist reported patient concerned he was
  going to be thrown off the scheme by the
  key-worker
• Pt buying needles, pharmacist directed to needle
  exchange service for disposal.
• Prescription without a start date
• Missed doses
• New patient not on supervised consumption

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•     CB - 24 yrs
• Supervised methadone
• Still seems to be unable to stop injecting. Bad
  abscess behind the knee, leftover antibiotics
  from last time - should she take them?
• Tried to determine Drs instructions previously.
  Seems as if last course not completed.
  Recommended going back to Dr.

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• DS 39 yrs
• On fortnightly pick ups
• On methadone, antidepressants and a benzo.
• Serial overdoser GP not aware
• Pharmacist highlighted the situation as
  dangerous.

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• SA - 32 yrs
• Would not take all the methadone on supervised
  consumption as he wanted to reduce the dose
• Pharmacist liaised with the key worker and they
  agreed to have a plan to gradually reduce the
  dose.