A mammoth undertaking

By Gillian

Last week, our main goal of the weekly hospital consultation was to sort out a better pain management regime.  In practice, that got usurped by Chris being neutropenic and hospitalised for four nights so we never got around to blogging about the original issue.

We had emailed our key worker over the Bank Holiday weekend to let her know that  we needed help with pain relief, and she had tried to set us up an appointment with the Palliative Care consultant, who had been extremely helpful previously in sorting out Chris’s nausea. But the consultant was on leave all that week, so rather than waiting for her to get back we were given an appointment with the palliative care registrar who works closely with the consultant.

We went over the symptoms with her in great detail, and she asked a lot of questions to fully understand Chris’s situation. He explained that the morphine was simply not touching his back pain, merely making him constipated and drowsy. The ibuprofen, on the other hand, worked really well for 18 hours per day, but just did not last long enough to keep him pain free for 24 hours.

Although in some cases it is possible to go above the recommended maximum dose of ibuprofen, the registrar was very unwilling to let Chris do so for fear of kidney damage. Instead she prescribed diclofenac, another Non-Steroidal Anti-Inflammatory. She also suggested moving from morphine onto a different but related opiate, oxycodone, as a top-up for break-through pain (i.e. in between the doses of diclofenac, to be taken as and when Chris requires it).

Chris and I have worked out a procedure for dealing with the hospital pharmacy. They are usually extremely busy between 11am and 2pm (invariably the time period that we want to use them) because as well as all the out-patients like us, they are also making up the prescriptions for all the in-patients following the doctors’ morning ward rounds. There is usually a wait of 25-35 minutes minimum, on extremely uncomfortable chairs. So I take Chris’s medical exemption certificate (giving him free prescriptions since he is a cancer patient) and go to the pharmacy with the prescription, leaving him upstairs in the oncology clinic waiting to have his arm dressed and bag changed. It saves time overall and means that he doesn’t have to risk his back on the pharmacy seats.

This time I went straight down to the pharmacy, and as I got there I recognised the palliative care registrar we had just been talking to. She said that she thought there might be a problem with the prescription as there are extra safeguards on controlled drugs, and she wanted to come to the pharmacy with me to make sure that things went smoothly.  I’ve spent hours sitting waiting in that pharmacy, and I’ve seen quite a few patients turned away due to problems with incorrectly filled in prescriptions.

I queued up to hand in my prescription, and when I did so the registrar piped up “Actually, I’m the doctor that prescribed this”. The issue was that the pharmacy will only dispense controlled drugs (e.g. opiates) on a hand-written prescription form, and in particular the name and address of the patient must be hand-written by the prescribing doctor. In this case she had automatically used one of the pre-printed labels that was in Chris’s case notes. A senior pharmacist was called over, who agreed that if the registrar signed across the label then that would be acceptable. There was also a potential issue that Chris has been prescribed above the normal maximum dose of one of the anti-emetics, and every time I go to pick up a repeat prescription the pharmacy question it. So the registrar signed against that item too, to show that she really meant it.

I thought it was really kind of her to anticipate a problem on the prescription form, and to meet me at the pharmacy to resolve it personally. We really do have a very caring medical team.