The Pharmaceutical Journal
Vol 276 No 7382 p26
7 January 2006

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CPD diary: supermarket pharmacist rationalising prescriptions

Len Clay has held various jobs in community pharmacy, including being the superintendent of a pharmacy chain. Five years ago, he joined Asda superstore in Preston, Lancashire, where he and his wife job share to give them time to look after their five sons themselves. This uncommon arrangement was put under the spotlight in 2003 when Mr Clay was invited to meet Cherie Booth as an example of a flexible working parent. Mr Clay also is the professional executive committee pharmacist for Preston Primary Care Trust. He supports Liverpool Football Club.

Action Preston is near a cardiac surgery unit. Some months ago, I received a prescription for both aspirin and clopidogrel for a patient who had had a coronary artery bypass graft. I was unsure of the clinical basis of this regimen. I investigated by contacting the North West Medicines Information Centre in Liverpool and was emailed a copy of the guidelines for the management of coronary artery disease in Merseyside and Cheshire. In this case, aspirin and clopidogrel were being prescribed together as an unlicensed indication. Although there is no evidence for using the combined regimen after coronary artery bypass, trials have shown a reduction in cardiac events in acute coronary syndrome and this rationale has been extrapolated for post cardiac surgery patients. It is thought that dual therapy reduces the risk of early graft occlusion. In my area, this therapy is recommended for between six weeks and 12 months post surgery.

Evaluation Reading through the guidelines filled in gaps in my knowledge beyond my initial query. I think that I am now in a better position to help patients with prescriptions for cardiovascular drugs and those who are about to undergo a coronary artery bypass. Pharmacists should make more use of drug and therapeutics centres because they are a free and easily accessible tool for everyday practice.

More recently, I had to submit three case studies as part of my medicines use review training. I asked the patient who had bought in the original dual therapy prescription to take part. In doing so, I found out that he was still on the therapy 14 months after surgery. I spoke to the prescriber about this and this resulted in clinical and cost-effective changes.

Recording I know it is antiquated, but I prefer to keep my records using the paper form of “Plan and record”. I do this at home. I am intending to switch to the CPD website at some point.

Being a community pharmacist these days is a busy lot but I try to keep up to date with the rapidly changing face of pharmacy. The “Plan and record” system is good. It shows you where you need to improve and writing it all down reinforces what you have learnt.