Figure 1 [3] Geriatric bloodwork analysis stands as a fundamental component within the realm of pharmaceutical practice, especially when considering the various ailments that can happen concurrently in the elderly. During Term 1 that has just passed, I had the privilege of attending a hospital placement experience within the Care of Older People (COOP; or geriatrics) team at an NHS trust located in North London as part of a module coursework assignment. This experience offered invaluable insight into the critical role that pharmacists play in healthcare, especially in the senior population. Throughout this experience, I got to live life as a hospital pharmacist (albeit only for 2 weeks); screening prescriptions, looking for drug interactions, and establishing drug histories for newly admitted patients as part of the medicines reconciliation process. However, it is through performing these seemingly routine tasks where I was able to dive into the mindset of a hospital pharmacist, who places their patients’ healthcare as their priority. It is also during this placement that I recognised the importance of being detail-oriented, as minor alterations in blood tests can signal substantial underlying issues which demand a pharmacist’s meticulous attention. Unlike other specializations, COOP underscores the significance of polypharmacy, as many patients often have various ailments that require medical intervention simultaneously. For instance, an elderly patient with cancer may also have hypertension, hence it is not alarming to see cyclophosphamide on their drug chart with amlodipine right beneath it. Therefore, as a pharmacist, it is our job to ensure that all the drugs on the patient’s drug chart are safe, ie:
However, without providing any additional context, one might assume that a pharmacist would just sit at a patient’s bedside 24/7, eyes peeled and stuck onto the patient - because surely, that’s what monitoring means, right? Well, this is where the essence of this entry comes into play. Blood tests, or referred to bloodwork hereinafter, are essentially how pharmacists glue their eyes on their patient to pick up on any abnormalities, or signs that they need to stop or start a certain medication. Comprehending geriatric blood investigations involves the meticulous consideration of many biological markers, including haemoglobin count (Hb), red and white blood cell counts, platelet levels, coagulation factors such as INR, inflammatory markers such as CRP levels, as well as electrolyte concentrations such as sodium, potassium, and bicarbonate; to name a few. However, with that being said, the true challenge lies not merely in identifying these components, but rather the interpretation of their implications within the broader context of pharmaceutical care. This understanding of the bloodwork components must also come with fingertip clinical knowledge that is expected from the pharmacist, in order to produce the most effective patient care strategy. For example, a 79-year-old patient admitted for a chest infection, has been taking frusemide for the past 12 years, is said to have acute kidney injury (AKI). By looking at the patient’s bloodwork, their serum creatinine levels to be exact, will we be able to obtain a value to perform their creatinine clearance calculation, which is indicative of kidney function. Therefore, with this in mind, we will be determining if frusemide, the loop diuretic, is useful for them. Knowing that frusemide is cleared renally [2], the drug poses more harm for the patient than good, as processing the drug would burden the patient’s kidneys further and worsen their AKI. Therefore, this discussion can be brought up to the other healthcare professionals looking after the patient, to decide if frusemide can be temporarily taken off their drug chart until their creatinine clearance improves. Other than that, medications used for the patient’s presenting complaint (chest infection), should also be screened by the pharmacist to ensure that the patient will get treatment from their presenting complaint, whilst not worsening any of their already existing ailments. Therefore, by honing our skills in understanding and analysing these investigations, coupled with the clinical knowledge that the school is bequeathing to us, we equip ourselves with the tools necessary to provide informed and empathetic care to our senior patients. As we decode these results, it is imperative that we, as pharmacists, keep in mind that these aren’t just figures on a screen. These are our patients’ stories, and their cries for help. Every decision that we make has the potential to change not only our patients’ lives, but the lives of those they love as well. Let’s keep decoding and making a difference in geriatric care - one blood report at a time. References: 1. MedicinesComplete — BNF | Hyoscine Butylbromide | Contraindications [Internet]. www.medicinescomplete.com. 2023 [cited 2023 Dec 25]. Available from: https://www.medicinescomplete.com/#/content/bnf/_881463863?hspl=hyoscine%20butylbromide#content%2Fbnf%2F_881463863%23pot-contraindications 2. DrugBank Online. Furosemide [Internet]. go.drugbank.com. 2023 [cited 2023 Dec 25]. Available from: https://go.drugbank.com/drugs/DB00695 3. Sabah D. 10 tips for a healthy old age [Internet]. Daily Sabah. 2019 [cited 2023 Dec 31]. Available from: https://www.dailysabah.com/health/2019/04/22/10-tips-for-a-healthy-old-age Written by: Olivia Ho
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