Sentry Page Protection
Please Wait...
MMI Scenario 16
You are the pharmacist working in a GP Practice. Your morning clinic consists of medication reviews. One patient, Jacqueline Shaw, 80 years old, has sensory impairment and suffers from poor sight owing to advanced cataracts in both eyes. She can see an outline from her eyes, but mentions she is unable to safely identify her medicines and has come in to see you this morning for discussion about this and to review her medicines. What are the important points to consider in this consultation? How can we support Jacqueline with her visual impairment in this situation?
Example Answer
Communication: It would be important to call Mrs Shaw from waiting room in person and help her identify me as the (pre-registration) pharmacist ‘Hello, my name is…’ and chaperone her into the consultation room, given her visual impairment.
Environment: It would be important to consider the room layout, and setup beforehand, i.e. space, chair location, lighting to ensure the room is conducive to the needs of a patient with visual impairment. Could we arrange a carer to accompany Mrs Shaw? Consider this before the appointment is made.
Shared agenda: Before commencing the consultation, and introducing myself, it would be a good idea to explore Jacqueline’s perception of her medicines, illness, and current lifestyle. It is important to determine what matters to her and what is the most important point she wishes to get out of the consultation, and this may help align our intentions as the clinician.
Explore patients LICEF: As part of person-centred care, it is important to consider Jacqueline’s perception of her condition, how does the medicines, or indeed eyesight affect her lifestyle? Is it impacting on her quality of life? How could we support her to improve this through medicines use? What are her ideas for solutions? As mentioned, what concerns her the most about her medicines, is it her sight or indeed a side effect of one of the tablets – use this to angle and guide conversation. What does she hope to achieve by the end of consultation? How can we do this by touching on her feelings.
Barriers to patient safety: If it is indeed her vision which acts as a barrier to safe medicines taking, it is important to consider a compliance aid, big labels, brail (if she can read this), large font/colour/bold label or administration charts, big tablets pictures printed to support Jacqueline in identifying her pills. Consider living circumstance, does Jacqueline get support at home? Can we involve them in her medicines administration and educate them on her tablets as an additional safety step?
Polypharmacy: Use this opportunity to align with Jacqueline’s perceptions and concerns, to perhaps reduce the complexity of her treatment plan, by reviewing ongoing needs and indications, deprescribing where appropriate, and devising a simpler system for her to identify and take her medicines. Less tablets reduces pill burden and alongside visual impairment improve her compliance.
Social support: Consider Jacqueline’s social welfare, how can we better support her more holistically other than medicines related optimisation. Does she live alone? Is there a carer involved? Does she struggle to look after herself, is there a potential safeguarding/welfare concern? How can we support her socially in order to meet the goals of her consultation. Can we refer her to a social worker/prescriber who may be able to signpost/guide Jacqueline onto further support groups aid her home life.
Signposting: Can we refer Jacqueline onto Citizens Advice Bureau, Age UK, specialist low-vision clinic liaison, registration with RNIB, community pharmacy to support with home delivery of medicines, large print labels and tailored medicines use review to go through the dosette box setup to ensure Jacqueline has confidence in safely taking her tablets. Support can be found via the visionary website which allows local postcode searches.
Environment: It would be important to consider the room layout, and setup beforehand, i.e. space, chair location, lighting to ensure the room is conducive to the needs of a patient with visual impairment. Could we arrange a carer to accompany Mrs Shaw? Consider this before the appointment is made.
Shared agenda: Before commencing the consultation, and introducing myself, it would be a good idea to explore Jacqueline’s perception of her medicines, illness, and current lifestyle. It is important to determine what matters to her and what is the most important point she wishes to get out of the consultation, and this may help align our intentions as the clinician.
Explore patients LICEF: As part of person-centred care, it is important to consider Jacqueline’s perception of her condition, how does the medicines, or indeed eyesight affect her lifestyle? Is it impacting on her quality of life? How could we support her to improve this through medicines use? What are her ideas for solutions? As mentioned, what concerns her the most about her medicines, is it her sight or indeed a side effect of one of the tablets – use this to angle and guide conversation. What does she hope to achieve by the end of consultation? How can we do this by touching on her feelings.
Barriers to patient safety: If it is indeed her vision which acts as a barrier to safe medicines taking, it is important to consider a compliance aid, big labels, brail (if she can read this), large font/colour/bold label or administration charts, big tablets pictures printed to support Jacqueline in identifying her pills. Consider living circumstance, does Jacqueline get support at home? Can we involve them in her medicines administration and educate them on her tablets as an additional safety step?
Polypharmacy: Use this opportunity to align with Jacqueline’s perceptions and concerns, to perhaps reduce the complexity of her treatment plan, by reviewing ongoing needs and indications, deprescribing where appropriate, and devising a simpler system for her to identify and take her medicines. Less tablets reduces pill burden and alongside visual impairment improve her compliance.
Social support: Consider Jacqueline’s social welfare, how can we better support her more holistically other than medicines related optimisation. Does she live alone? Is there a carer involved? Does she struggle to look after herself, is there a potential safeguarding/welfare concern? How can we support her socially in order to meet the goals of her consultation. Can we refer her to a social worker/prescriber who may be able to signpost/guide Jacqueline onto further support groups aid her home life.
Signposting: Can we refer Jacqueline onto Citizens Advice Bureau, Age UK, specialist low-vision clinic liaison, registration with RNIB, community pharmacy to support with home delivery of medicines, large print labels and tailored medicines use review to go through the dosette box setup to ensure Jacqueline has confidence in safely taking her tablets. Support can be found via the visionary website which allows local postcode searches.