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MMI Scenario 5
You are working as medicines optimisation pharmacist within a residential care home. A resident, John, aged 89, is having difficulty in taking his morning medicine. When you enquire further it is his omeprazole 20mg capsules, which he takes in the morning 30 minutes before breakfast. The nursing team are asking if you change this to omeprazole liquid as it is easier for John to swallow with his morning cup of tea. What issues do you need to consider in this scenario?
Informed decision making: Firstly it is important to be person centred and have a conversation with John himself to explore his ideas, concerns and feelings towards taking this medicine. Does the patient want to take his / her medicines? If not why not? Could it be time of day medicine is administered which we could optimise and work with John i.e. could taking it last thing at night be more suitable, align with John’s needs.
Capacity: Does John understand what omeprazole is for? Does he have problems/side effects form this medicine? Any sensory or cognitive impairment which is making swallowing difficult?
Polypharmacy: Does the John feel that they take too many medicines or feel overwhelmed with the number of medicines he takes? Could this be an opportunity for a clinical medication review with scope to deprescribe or review inappropriate polypharmacy.
Ethical considerations: Does the patient have issues with the formulation? Would a liquid/soluble format meet his requirements?
Indication: What is the need for omeprazole? Has its indication expired, could we consider withholding the drug and reviewing GI symptoms?
Unlicensed ‘specials’: Omeprazole liquid is unlicensed, and if a liquid/soluble format would aid compliance could a licensed format be used first, e.g. omeprazole MUPS tablets which could be mixed with yoghurt, or fruit purees to make it easier to swallow. Consider this would not be 30 mins before food but would support some dose intake vs none. Could a food thickener be used e.g. ‘thick&easy’ to support swallowing which would aid compliance.
Documentation: Decisions made to switch formulation should be rationalised in the aim of improving patient care and experience. Important conversations/decisions made documented on care notes/GP system and updated on medicines administration charts (MARR) and well as the patient file so that future errors/omissions are minimised.