Clinical tips: stroke


stroke

Jarrod McMaugh takes a look at the patient perspective regarding stroke… and how pharmacists can help

The pathophysiology of stroke is one that pharmacists are familiar with, and does not require further discussion in a clinical tips article. Instead, I wanted to focus on the patient experience and what it is like for a person who has experienced a stroke, and what they need from their interactions with pharmacists.

Special thanks to Sas Freeman for assistance in understanding this perspective.

Patience

People who have experienced a stroke or brain injury may have various ongoing symptoms that may affect communication.

One that is not well appreciated by others is the impact on stamina. Activities that you may find simple or trivial can be tiring. This can be experienced differently between individuals, and from day to day.

Patience is definitely a virtue in these situations, allowing an individual enough time to interact with you; at the same time, don’t allow the interaction to become patronising.

An example of these experiences can be found here – https://www.theglobeandmail.com/life/facts-and-arguments/the-lingering-symptoms-of-a-brain-injury-force-me-to-lead-a-double-life/article31454966/

Listening

Continuing on the need for patience without being patronising is the need to actually listen to the needs of the person in front of you. There are two parts to this – providing enough time to actually listen to what is being communicated to you, and heeding what is said without second-guessing or ‘correcting’ someone.

In both instances, people who have experienced a stroke or other brain injury encounter situations where they are not given enough time to deliver their request, and when they do, they may be told they aren’t asking for the right thing or that they are mistaken in wanted one thing when ‘something else may be better’

While every person we assist should be shown the courtesy of being listened to, this is especially important for a person who may find that the people they ask for help aren’t prepared to give them the time necessary to effectively communication their needs.

Sas Freeman describes this in her blog here – http://www.sasfreeman.com/listening-time/

Explaining

A person who has experienced a stroke may be starting multiple new medications at a time when their ability to communicate has been impacted and their stamina is stretched. Over time these medications may change, as well as the symptoms they are experiencing.

Patients have described being unsure about the importance of the medications they have been prescribed, what each one does, and which one is most important.

From a pharmacist’s point of view this may seem like obvious information, but for someone who’s life has been impacted by a sudden change in their health, it is easy to lose track of this information, especially if the pharmacist doesn’t take the appropriate amount of time and care in explaining them at each refill.

Maintaining supply

As with all medications, ensuring continuity of supply is an essential part of effective treatment.

For a person who has experienced a stroke, it can be very distressing to present to a pharmacy for their medication, only to find that it is unavailable due to poor stock management (either by the pharmacy, or by the manufacturer).

This can be a significant source of distress for someone who is relying on continuity of medication to prevent another instance of stroke.

Putting real-life situations ahead of the literature

There are situations that a pharmacist will encounter that require us to use our clinical knowledge and professionalism in a way that is not strictly supported by the literature. For instance, there are medications used in the prevention of stroke that do not have stability data when utilised in a Dose Administration Aid.

Pharmacists need to consider whether there are situations where packing a medicine in a DAA may still be appropriate, despite lack of stability data, or even warnings from the manufacturer that this may not be appropriate.

As discussed in the PSA Guidelines for pharmacists providing dose administration aid services (available from http://www.psa.org.au/wp-content/uploads/5366-PSA-Dose-Admin-Aid-guidelines-FINAL_WEB1.pdf), every individual situation of potential non-adherence to therapy should include a consideration of whether leaving a medication out of an adherence-aid may result in worse outcomes than exposing the medication to instability in a DAA.

A pharmacist must make an informed judgement as to the suitability of any medicine for inclusion in a DAA, taking into account guidance from current resources where available. The pharmacist should carefully assess a medicine’s stability in a DAA against the risks of non-adherence if that medicine is not packed, and discuss with the prescriber if required

In this situation, a pharmacist may assess whether the client will be able to manage their medication from the original packaging, whether packing in a DAA would be appropriate (balancing adherence against stability), or whether consultation with the prescriber for an alternative medication would be the best outcome.

Regardless of the direction taken, the client’s preference and safety should be  the guiding principle.

Jarrod McMaugh is a community pharmacy practitioner with Capital Chemist in the northern suburbs of Melbourne. He has extensive experience in developing and delivering professional services in the community pharmacy setting.

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