1. 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.