On-call scenario 2: Resolution

Last updated: Tuesday, November 26, 2019

What an on-call pharmacist could advise...

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You need to quickly assess and prioritise the web sources of information and advice. The guidelines that you find online from other NHS Trusts vary in their quality: some lack references, others are missing authors and publication dates. Those that do include references often cite a paper published in the BMJ several years ago. The Parkinson’s UK website signposts you to a different tool called the OPTIMAL calculator. You decide to dismiss the opinions you find in several discussion forums as you can’t assess their accuracy. As practice may vary in different countries, you also decide not to review the protocols from outside the UK.

Using several different NHS Trust guidelines and the OPTIMAL calculator, you calculate the dose conversion and reassuringly most sources give you a similar answer. You relay this information to the doctor and suggest a possible starting point for a rotigotine patch dose, explaining the limitations of your advice.

Have a go at using the OPTIMAL calculator yourself to see what dose of rotigotine patch might be recommended in this scenario. Remember that our patient, Amy Steer, was taking co-beneldopa dispersible 25/100 QDS and ropinirole 2mg TDS.

If at any stage you had felt out of your depth with this question you could have phoned a more senior pharmacist for advice: maybe a neurology, elderly care, or MI pharmacist. If not confident about your answer, you might also ask Dr Kotecha if the answer could wait until the next working day for you to discuss with a colleague.

Follow up 

The next morning you document your recommendation of administering rotigotine 16mg/24 hours, and speak to the pharmacist looking after the patient. She has already seen the patient on the ward round this morning and actually advised that the team start with a slightly lower dose as the patient has dementia. They will titrate the dose as necessary according to the patient’s response.

Maybe this scenario makes you think you could do with a 'refresher' on solving these kind of problems. If so, then you might want to look at the Administration tutorial.