VALIDATION TOOL - RESPONDING TO SYMPTOMS

Transcription

1 #VT03-1 VALIDATION TOOL - RESPONDING TO SYMPTOMS Despte changes n the tradtonal role of pharmacsts, the nterventon of communty pharmacsts n respondng to clents wth mnor alments, contnues to be one of the major contrbutons by communty pharmacsts towards the mantenance of the best health possble for ther socety. General Informaton Tool ID Number Montor Date Tme Name of Pharmacy Localty Name of the Pharmacst on duty Age of the Pharmacst Detals of Pharmacst Pharmacy owned by a pharmacst Yes No Pharmacst present s Presentaton of symptom the owner the managng pharmacst employed full-tme employed part-tme a locum pharmacst Symptom(s) presented and Medcaton(s) dspensed: The tool s used when a patent presents a symptom or when a request for an OTC medcaton s made. Consder each request made by a patent as one transacton. Use one tool (one set of valdaton tool number 03) for each symptom or each OTC request. Base the assessment on observatons made durng the dspensng process. For each step choose the relevant statement(s) as approprate. When the assessment process s completed, enter the scores n the computer usng an Excel fle and work out the total score. Wrte the total score obtaned n the approprate box on page 26 or 28. Before proceedng any further refer to Defnton Sheet 03.

2 #VT ESTABLISHING PATIENT IDENTITY The pharmacst establshes the dentty of the patent 6 The pharmacst s famlar wth the characterstcs of the patent 4 2 ESTABLISHING PROFILE OF THE SYMPTOM(S) v The pharmacst asks the patent to descrbe the nature and severty of the symptom(s) 2 The pharmacst asks the patent about the onset and duraton of the symptom(s) 3 The pharmacst asks the patent whether he experences any accompanyng symptom(s) 2 The pharmacst asks the patent whether there s anythng whch makes the symptom(s) worse or better 3 3 ESTABLISHING A TREATMENT HISTORY The pharmacst asks whether self medcaton was attempted 3 v The pharmacst asks the patent whether a medcal doctor was consulted for ths symptom 2 The pharmacst asks the patent whether any medcaton was prescrbed or used for ths symptom n a prevous occurrence 2 The pharmacst checks whether the patent s takng any other medcaton 3

3 #VT ESTABLISHING THE EXISTENCE OF RISK FACTORS The pharmacst asks whether the patent suffers from chronc condtons 5 The pharmacst asks whether the patent suffers from any allerges 5 5 DETECTION OF SERIOUS SYMPTOMS The pharmacst attempts to detect symptoms suggestve of serous dsease 10 Serous Dsease Mnor Illness GO TO 25 GO TO Ankle swellng Darrhoea 6 Anorexa Constpaton 7 Blood loss from any orfce Nausea & Vomtng 8 Dffculty n swallowng Indgeston 9 Hstory of severe njury Cough and Colds 10 Increasng breathlessness Sore Throats and Colds 11 Loss of weght Headache 12 Menstrual abnormalty Panful, frequent and urgent 13 urnaton Persstent or recurrent pyrexa Abdomnal pan 14 Pan n chest, abdomen, head, or ears Musculoskeletal dsorders 15 Spontaneous brusng Eye Dsorders 16 Swellng or lumps of any sze Ear Dsorders 17 Tenderness over the blood vessels Skn Dsorders 18 Urnary symptoms Itchng around Vulva 19 Yellow or green dscharge from pens or vagna Itchng around Anus 20 Yellow or green sputum Foot Dsorders 21 Other: Oral and Dental Dsorders 22

4 #VT PRESENTING SYMPTOM IS DIARRHOEA v v The pharmacst asks the patent about the usual pattern of bowel frequency 2 The pharmacst asks the patent whether he has experenced a change n the frequency and consstency of bowel motons 2 The pharmacst enqures whether the patent has eaten anythng whch mght have caused the darrhoea or whether he has recently been abroad 2 The pharmacst asks the patent whether he s runnng a temperature 2 The pharmacst asks the patent whether he has recently lost weght for no apparent reason 2 6a ASSESSING SYMPTOMS Tck one Presence of accompanyng symptom Yes No severe abdomnal pan whch s not resolvng left sded pan or tenderness alternatng epsodes of darrhoea and constpaton sgnfcant weght loss over a few weeks blood and mucus n stools contnuous and recurrent darrhoea nocturnal darrhoea excludng a dgestve nsult medcaton sde effect other: The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27

5 #VT03-5 6b Tck one The pharmacst recommends electrolyte replacement salts wth or wthout medcatons to reduce darrhoea 10 The pharmacst recommends regular flud ntake 5 The pharmacst recommends medcatons to reduce darrhoea 4

6 #VT PRESENTING SYMPTOM IS CONSTIPATION The pharmacst asks the patent how often he normally goes to the tolet 3 The pharmacst asks the patent whether he suffers from bouts of darrhoea alternatng wth constpaton 2 The pharmacst asks the patent whether there were recent events and changes n lfestyle whch may have concded wth the onset of constpaton 3 v The pharmacst checks the hydraton status of the patent 2 7a ASSESSING SYMPTOMS Tck one Presence of accompanyng symptom Yes No blood n faeces acute dstenson of the abdomen severe pan mld to moderate pan for more than 48 hours nausea and vomtng unexplaned weght loss recurrent bouts of constpaton constpaton alternatng wth darrhoea medcaton sde effect other: The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27

7 #VT03-7 7b The pharmacst nforms the patent to ncrease flud and fbre ntake and reduce ntake of refned carbohydrates 5 The pharmacst explans to the patent the mportance of engagng n some form of exercse 3 The pharmacst supples a bulk formng laxatve and nforms the patent to drnk plenty of fluds 2 v The pharmacst supples a stmulant laxatve for 4 days 2 v The pharmacst supples glycerne suppostores 2

8 #VT PRESENTING SYMPTOM IS NAUSEA AND VOMITING The pharmacst asks the patent whether he can assocate the symptom wth food ntake 4 The pharmacst checks whether the patent was recently abroad 4 The pharmacst asks the patent whether any blood staned vomt occurred 2 8a ASSESSING SYMPTOMS Tck one Presence of accompanyng condton Yes No blood - staned vomt frequent vomtng for more than 24 hours sudden vomtng wthout nausea epsodc or chronc vomtng accompaned by weght loss recent traveller to hot countres medcaton sde effect other: The pharmacst does not detect any of the above accompanyng condtons and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng condtons and decdes to consder referral 10 Indcate accompanyng condton and GO TO 27 8b The pharmacst gves advce to the patent about whch food to avod such as mlk, heavy or fatty meals 4 The pharmacst gves advce to the patent what he could eat when hungry such as bread, toast or plan bscuts 4 The pharmacst recommends electrolyte replacement salts wth or wthout medcatons contanng anthstamnes and antmuscarncs 2

9 #VT03-9

10 #VT PRESENTING SYMPTOM IS INDIGESTION The pharmacst asks the patent whether he can pnpont exactly where the dscomfort s 3 The pharmacst asks the patent whether t s releved by food 2 v The pharmacst asks the patent whether he has eaten anythng whch may have caused the upset 2 The pharmacst asks f ths s the patent s frst experence of ndgeston 3 9a ASSESSING SYMPTOMS Presence of accompanyng symptom vomtng or constpaton tredness wth gastro-ntestnal blood loss n vomt or stool pan whch spreads to jaw, neck, shoulder, and arms severe, contnuous pan Other: Tck one Yes No The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27 9b The pharmacst recommends avodance of stress, smokng, coffee, and spcy meals 4 The pharmacst recommends small regular non-spcy meals and engagement n exercses to nduce weght reducton 4 The pharmacst recommends antacds wth or wthout H 2 antagonsts 2

11 #VT PRESENTING SYMPTOM IS COUGH AND COLD The pharmacst asks the patent whether he has nasal congeston, nasal dscharge and sore throat 2 The pharmacst asks the patent whether he has any cough and f so to descrbe the type of cough 2 The pharmacst asks the patent whether he s runnng a fever 3 v The pharmacst asks the patent whether he suffers shortness of breath or chest pan 3 10a ASSESSING SYMPTOMS Tck one Presence of accompanyng symptoms Yes No cough whch has not mproved over 2-3 weeks long-standng recurrent cough persstent blood staned sputum sore throat causng dffculty to swallow wheezng and shortness of breath pan on coughng unexplaned weght loss other: The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 10b The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27 The pharmacst gves advce to the patent about symptomatc treatment such as ncreasng flud ntake and performng steam nhalatons 5 The pharmacst recommends a sutable cough and cold preparaton 5

12 #VT PRESENTING SYMPTOM IS SORE THROAT AND COLDS The pharmacst examnes the patent s throat and tonsls 5 The pharmacst asks the patent whether he has any dffculty n swallowng 5 11a ASSESSING SYMPTOMS Tck one Presence of accompanyng symptom Yes No whte pus flled spots on tonsls persstent hoarseness dffculty n swallowng large tender lymph nodes n the neck earache persstent sore throat other: The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27 11b The pharmacst advses the patent to avod smoky or dusty atmospheres and stop or reduce smokng f he s a smoker 3 The pharmacst recommends hgh flud ntake 4 The pharmacst recommends sore throat lozenges, wth or wthout a cold medcne 3

13 #VT PRESENTING SYMPTOM IS HEADACHE v v The pharmacst asks the patent to pnpont where the headache s 2 The pharmacst asks the patent whether he has experenced smlar epsodes prevously 2 The pharmacst asks the patent whether the headache s mld and annoyng or severe and debltatng 2 The pharmacst asks the patent whether he has suffered any possble trauma or accdent 2 The pharmacst asks the patent whether he suffers from hypertenson 2 12a ASSESSING SYMPTOMS Tck one Presence of accompanyng condton Yes No patent s a chld frst tme epsode change n nature and pattern of headache early mornng headache whch subsdes durng the day and there s no evdence of snus and nasal congeston patent has a hstory of hypertenson ntense occptal headache accompaned by nausea and vomtng accompaned by nose bleeds accompaned by drowsness, muscle weakness accompaned by fever and neck stffness medcaton sde effect other: The pharmacst does not detect any of the above accompanyng condtons and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng condtons and decdes to consder referral 10 Indcate accompanyng condton and GO TO 27

14 #VT b The pharmacst pnponts possble causal factors and dscusses wth the patent how to avod further headache attacks 5 The pharmacst recommends an analgesc and advses the patent on the proper use of the analgesc 5

15 #VT PRESENTING SYMPTOM IS PAINFUL, FREQUENT AND URGENT URINATION v The pharmacst asks the patent whether there s any tchng or dscharge 2 The pharmacst asks the patent whether the urne appears normal 2 The pharmacst asks the patent whether he has to get up durng the nght to pass urne 3 The pharmacst asks the patent whether he feels very thrsty or s drnkng large volumes of flud 3 13a ASSESSING SYMPTOMS Tck one Presence of accompanyng condton Yes No male patent vomtng fever and rgors blood n urne lon pan vagnal dscharge chronc attack symptoms for more than 3 days Other: The pharmacst does not detect any of the above accompanyng condtons and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng condtons and decdes to consder referral 10 Indcate accompanyng condton and GO TO 27

16 #VT b The pharmacst gves advce to the patent to drnk large volumes of fluds 3 The pharmacst explans to the patent to try and elmnate the bactera by double mcturton 2 The pharmacst counsels the patent on personal hygene 2 v The pharmacst recommends medcatons whch alkalnse the urne 3

17 #VT PRESENTING SYMPTOM IS ABDOMINAL PAIN The pharmacst asks the patent whether he had gastrontestnal llness recently 3 The pharmacst asks the patent whether the pan s ntermttent or constant 3 The pharmacst asks the patent whether the pan spreads to other parts of the body 4 14a ASSESSING SYMPTOMS Tck one Presence of accompanyng condton Yes No pan s unbearable contnuous severe pan for more than 1 hour pan has been present epsodcally for more than 7 days persstent pan vomtng constpaton chronc back pan and occasonal fantng hstory of myocardal nfarcton aggravaton caused by exercse or cold patent s a chld Other: The pharmacst does not detect any of the above accompanyng condtons and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng condtons and decdes to consder referral 10 Indcate accompanyng condton and GO TO 27 14b The pharmacst recommends medcaton 5 The pharmacst gves advce to the patent on lfestyle measures whch the patent can take to have symptomatc relef such as drnkng a lot of fluds n muscular spasms 5

18 #VT PRESENTING SYMPTOM IS MUSCULOSKELETAL DISORDER The pharmacst asks the patent about the orgn of the pan 3 v The pharmacst asks the patent whether he s experencng stffness, tenderness, swellng, numbness or tnglng 3 The pharmacst asks the patent whether he has recently sustaned any njury 2 The pharmacst asks the patent whether he experenced these symptoms prevously 2 15a ASSESSING SYMPTOMS Tck one Presence of accompanyng symptom Yes No back pan wth bowel or bladder symptoms sudden onset of pan n jaws, neck, arms headache wth back pan and muscle weakness symptoms of fatgue, fever, general malase Other: The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27 15b The pharmacst gves advce to the patent on the symptomatc management of the condton 5 The pharmacst recommends a topcal or systemc preparaton contanng an analgesc 5

19 #VT PRESENTING SYMPTOM IS EYE DISORDER The pharmacst asks the patent whether hs vson has been affected 3 The pharmacst asks the patent whether hs eyes are waterng 1 v The pharmacst asks the patent whether the pan s wthn the eye or f the rrtaton or dscomfort s on the surface 3 The pharmacst asks the patent whether there has been any trauma to or around the eye 3 16a ASSESSING SYMPTOMS Tck one Presence of accompanyng condton Yes No pan wthn the eye vsual dsturbances (double vson, blurred vson) hazy pupls subconjunctval haemorrhage patent s a newborn baby patent s a dabetc Other: The pharmacst does not detect any of the above accompanyng condtons and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng condtons and decdes to consder referral 10 Indcate accompanyng condton and GO TO 27 16b The pharmacst suggests symptomatc non drug treatment such as bathng the eye wth warm water 5 The pharmacst recommends sutable medcaton 5

20 #VT PRESENTING SYMPTOM IS EAR DISORDER The pharmacst asks the patent whether hs hearng s affected 3 The pharmacst asks the patent whether he s feelng dzzy 3 v The pharmacst asks the patent whether he s hearng rngng or hummng noses 2 The pharmacst asks the patent whether he has suffered from recent trauma or njury 2 17a ASSESSING SYMPTOMS Tck one Presence of accompanyng symptom Yes No oedema n ear canal perforated ear drum otts externa pan dscharge bleedng Other: The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27 17b The pharmacst gves advce to the patent on ear hygene such as cleanng and dryng the canal and not usng ear plugs n case of otts externa 5 The pharmacst recommends approprate medcaton 5

21 #VT PRESENTING SYMPTOM IS SKIN DISORDER The pharmacst asks the patent whether he has had any contact wth nfected persons or chemcals that could have caused the leson 5 The pharmacst asks the patent whether he can assocate dsorder wth food ntake or wth medcatons 5 18a ASSESSING SYMPTOMS Presence of accompanyng symptom rash wth headache, fever and malase weepng, vescular rash psorass scalp rngworm drug eruptons spder naev acne-lke papules rash whch dd not resolve after 1 week ndvdual lesons whch are slow growng or changng n shape or colour severe pan wthout rash panful rash bleedng from skn leson yellow dscoloraton of the skn of the face Other: Tck one Yes No The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27

22 #VT b The pharmacst gves advce on the symptomatc management of the condton e.g. coolng for prurtus; daly washng and thorough dryng n tnea nfecton 5 The pharmacst recommends an approprate medcaton accordng to the dagnoss 5

23 #VT PRESENTING SYMPTOM IS ITCHING AROUND THE VULVA The pharmacst asks the patent whether she can dentfy precsely the locaton of the dscomfort 5 The pharmacst asks the patent whether she s experencng any dscharge 3 The pharmacst asks the patent whether she has suffered smlar symptoms prevously 2 19a ASSESSING SYMPTOMS Presence of accompanyng symptom rashes n gental area offensve smelly dscharge blood staned dscharge vagnal blsters recurrent wth menstruaton no mprovement after 1 week wth abdomnal pan, fever, vomtng and darrhoea dabetc patent Other: Tck one Yes No The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 19b The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27 The pharmacst gves advce to the patent on measures that can be taken to reduce symptoms such as not wearng tght fttng trousers 5 The pharmacst gves an approprate preparaton such as an ntravagnal mdazole 5

24 #VT PRESENTING SYMPTOM IS ITCHING AROUND ANUS The pharmacst asks the patent whether he can dentfy the precse locaton of the dscomfort 5 The pharmacst asks the patent whether he has any blood n stools 3 The pharmacst asks the patent whether he experences a burnng sensaton at nght 2 20a ASSESSING SYMPTOMS Tck one Presence of accompanyng condton Yes No blood mxed n stools recurrent attacks of prurtus pan Other: The pharmacst does not detect any of the above accompanyng condtons and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng condton and GO TO 27 20b The pharmacst gves advce to the patent on anal hygenc practce 5 The pharmacst recommends a medcaton for threadworm nfestaton, or for haemorrhods dependng on the dagnoss 5

25 #VT PRESENTING SYMPTOM IS FOOT DISORDER The pharmacst asks the patent whether he s experencng severe pan 5 The pharmacst asks the patent whether the condton s recurrent 5 21a ASSESSING SYMPTOMS Tck one Presence of accompanyng condton Yes No bunon fungal nfecton wth toe nal nvolvement gout ngrowng toe nal thromboss patent s a dabetc Other: The pharmacst does not detect any of the above accompanyng condtons and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng condtons and decdes to consder referral 10 Indcate accompanyng condton and GO TO 27 21b The pharmacst gves advce to the patent on symptomatc measures such as epderma-abrason for corns and calluses 5 The pharmacst recommends an approprate medcaton accordng to the dagnoss 5

26 #VT PRESENTING SYMPTOMS ARE ORAL AND DENTAL DISORDERS (excludng teethng) The pharmacst asks the patent whether he has any teeth restored 5 The pharmacst asks the patent whether he recently had a dental nterventon 5 22a ASSESSING SYMPTOMS Tck one Presence of accompanyng symptom Yes No lost fllng dental abscess toothache post extracton haemorrhage perodontal dsease gngvts mouth ulcers such as herpes other: The pharmacst does not detect any of the above accompanyng symptoms and decdes to proceed recommendng approprate acton 10 The pharmacst detects one of the above accompanyng symptoms and decdes to consder referral 10 Indcate accompanyng symptom and GO TO 27 22b The pharmacst gves advce to the patent on dental care 5 The pharmacst recommends a dental product or a sutable medcaton dependng on the dagnoss 5

27 #VT RECOMMENDATION OF A COURSE OF ACTION The pharmacst explans how to carry out home nursng and remedes only 10 The pharmacst supples a non prescrpton medcne and gves detals on acton of medcnes suppled 2 manner n whch t s taken 2 v duraton of treatment 2 v possble sde effects, contra-ndcatons and nteractons 2 v economc choce 2 24 FOLLOW UP The pharmacst provdes nformaton on the health condton 3 The pharmacst helps the patent to feel n control of, take responsblty for and manage the stuaton 2 The pharmacst nforms the patent to come agan or seek medcal advce f symptoms persst 5 TOTAL SCORE REMARKS

28 #VT COLLABORATIVE EVIDENCE OF DIAGNOSIS OF SERIOUS/MINOR SYMPTOM The pharmacst nvestgates symptom(s) as descrbed n defnton sheet 03 5 The pharmacst documents n some form the presented symptom(s) 5 26 RECOMMENDATION OF COURSE OF ACTION Tck one The pharmacst stresses to the patent the mportance of seekng medcal advce wthout delay 10 The pharmacst recognses devatons from normalty, ndcates that the symptom may be serous, and suggests the mportance of seekng medcal advce f such symptom(s) perssts for more than 24 hours 8 The pharmacst recommends medcaton untl the patent seeks medcal attenton 5 27 BEFORE REFERRING The pharmacst asks the patent whether he has a famly doctor 6 The pharmacst gves advce on how home nursng should be admnstered and whch actons should be avoded untl medcal advce s reached 4

29 #VT REFERRAL Tck one The pharmacst refers the patent to the patent s regular famly doctor 10 The pharmacst offers to phone and make an appontment for the patent wth a general practtoner 10 The pharmacst suggests a general practtoner and provdes patent wth hs detals (.e. telephone number, clnc tmes) 8 29 PROVISION OF GENERAL ADVICE The pharmacst offers addtonal nformaton on the symptom(s) presented 5 The pharmacst helps patent to feel n control of the stuaton 5 TOTAL SCORE REMARKS