Print Name Student Number

Further Information Required Source of Information

How long exactly have these symptoms been happening? patient

Have you had psychosocial interventions yet Patient
Have you had any thoughts about harming yourself Patient
Have you been drinking – related to INR Patient
General Pharmaceutical Needs/Problems Assessment Action Monitoring

Special Needs: (e.g. visual, learning, auditory disabilities or problems Yes Patient is forgetting to take his Give patient his medication in a Ask the patient if they think it
with dexterity)
No medication NOMAD tray could help
Problems: (e.g. practical supply problems)

Condition/ Aims Assessment A Action (including patient counselling points) Monitoring/

Problem P Follow up
N
depression Manage Aim not being met, A Patient needs to be offered CBT and physical activity normally see them after 2 weeks.
depression patient is starting programmes. His symptoms have been present for a while so See them regularly thereafter, for
according to sertraline, unclear sertraline is a suitable first line treatment, although it example at intervals of 2 to 4
guidance whether hes had CBT. interacts with warfarin, increasing bleeding risk. weeks in the first 3 months, and
Warfarin and sertraline then at longer intervals if response
interact NICE recommends patients on warfarin start taking is good.
mirtazapine – cautioned for use in elderly as increases risk of
falls, that this patient suffers with. There is a major Monitor closely for increased risk
advantage, mirtazapine can make patients sleepy, but this of falls
patient suffers from insomnia so taking mirtazapine will help
with that

A = actual problem, P = potential problem, N = no problem

 Not taking his Improve Aim not being met, A Consider giving patient NOMAD tray to improve adherence to Speak to patient next time after
medication/me patients patient is missing doses his medication. Discuss with the patient whether that’s giving NOMAD and see if
dicines adherence of his medication something they think would help adherence has improved
optimisation
Medicine optimisation can also help, the patient hasn’t been
taking his medications. Explore if the patient needs the senna
and oxybutynin, if he doesn’t need them, we can reduce pill
burden, as well as reducing antimuscarinic burden on the
patient, reducing the risk of falls.
Forgetting Manage Aim not being met, Y Patient must be investigated for dementia, as he has been Write to GP and ask for referral to
things patients patient isn’t on any forgetting things since his wifes fall three years ago AD services
symptoms medication
At the initial assessment take a history (including cognitive,
behavioural and psychological symptoms, and the impact
symptoms have on their daily life):
• from the person with suspected dementia and
• if possible, from someone who knows the person well (such as
a family member).
1.2.2 If dementia is still suspected after initial assessment:
• conduct a physical examination and
• undertake appropriate blood and urine tests to exclude
reversible causes of cognitive decline and
• use cognitive testing.
insomnia Help patient Aim not being met y Counsel patient on sleep hygiene Ask patient if sleep improves next
to sleep Offer people with depression advice on sleep hygiene if time he comes to pharmacy
better needed, including:
• establishing regular sleep and wake times
• avoiding excess eating, smoking or drinking alcohol before
sleep
• creating a proper environment for sleep
• taking regular physical exercise.

A = actual problem, P = potential problem, N = no problem

 Y Y Y
Legal Problems? Clinical Problems? Will you dispense prescription?
Clinical Check N N
of Prescription N N N
N
Comments Comments Comments
Mirtazapine may be a better option for this patient Discuss the option of switching to mirtazapine
with the prescriber

A = actual problem, P = potential problem, N = no problem