Walk-in Clinical Services for Common Clinical Conditions Case Studies from a Community Pharmacy Setting Jonathan Burton MFRPSII FRPharmS MBE & Sophie Davidson MPharm ARPharmS Community Pharmacist and Pre-Registration Pharmacist, Right Medicine Pharmacy, University of Stirling Wax Blockage Scabies Inspection of the hands under a magnifying glass showed inflamed lesions that presented as scabies mite burrows (as seen in figure 2) over the top of the hand and in between the webs of fingers. Patient was particularly itchy at night; the itch spreading to the arms, legs and torso also. Permethrin 5% cream was prescribed by the pharmacist for 2 all over applications – 1 week apart. Cetirizine was also prescribed to help with the itch. Advise was given re: timescale, NHS choices and in case of a severe skin flare to come back in and discuss use of topical steroid cream. When examined by otoscope, right ear revealed partial blockage and left showed a total blockage (as pictured in figure 1) Olive oil drops were prescribed by the pharmacist for use in both ears twice daily for 1-2 weeks and patient asked to return for review in that time. Figure 2; scabie burrow Figure 1; total wax obstruction Mole Query Angular Cheilitis Patient described changes in mole colour (darkening) and the shape of the border. She also stated that it was itchy. Under inspection with a magnifier the edge of the mole was undefined (similar seen in figure 3). ABCDE criteria was used to reassure the patient but reinforce the importance of a full medical assessment of any changes. A written SBAR was provided and patient saw GP the following day. Examination with magnifier showed small cracks and inflammation in the corners of patients mouth (as shown in figure 4) Patient had no signs of oral thrush. From questioning, it appeared symptoms had been present for a few weeks Miconazole 2% was prescribed for twice daily application until 4-5 days after the lesions had cleared Figure 3; undefined border on mole Figure 4; example of angular cheilitis Tonsilitis? Figure 5; swollen tonsils with slight exudate Vitals taken were as follows; temperature; 36.7C, BP; 123/81, pulse; 61 bpm Tonsils appeared swollen and slight exudate and flecks (figure 5) There was no major lymph node swelling or tenderness and it wasn’t impacting eating, drinking or breathing Patient however was using Infliximab for Crohns disease so doctor was phoned and he wanted to see patient the same day or next for further assessment and bloods. GP issued a prescription for Penicillin V as a precaution Infected Eczema Patient showed flare ups of eczema on both palms and fingers. She had experienced flares here previously (figure 6) Some cracks were weeping and crusting – showing signs of infection Fucibet (Fusidic Acid/ Betamethasone) was prescribed by the pharmacist for one week, with Dermol for ongoing use Patient asked to come back in a week for review – which showed treatment was only partially successful. Referred on to GP who prescribed Flucloxacillin and Clobetasol Proprionate Cream. Figure 6; weeping eczema on fingers The above case studies were developed using actual cases seen in the walk-in common clinical conditions clinic run at our pharmacy. The information detailed above also gives insight into the content on written SBAR communications shared with GP practices using the online SBAR tool on the Pharmacy Care Record (PCR). I would like to personally thank the NES Pharmacy team, NHS Forth Valley and my colleagues at Right Medicine Pharmacy for enabling and supporting me to continue to develop this work. JB.