DIAGNOSTICS
pharmacists are both aware of these, and know how to fully utilize them for the benefi t of the patient, and the health service as a whole. This article will discuss a number of these tests, however it should be noted that the list of procedures is not exhaustive. Pharmacists should make sure to use their normal channels of information and education to ensure that they have the most up to date information on the full gamut of services that can be offered.
APPLYING PRESSURE
Speaking of things that all pharmacists know and love, one of the staple offerings in terms of community pharmacy diagnostic testing is that of blood pressure monitoring. There are no surprises in the statement that hypertension contributes in a big way to some of the UK and Scotland’s biggest killers, including stroke, M.I. and coronary heart disease, and as a result, it’s prudent that patients be able to have their blood pressure monitored and interpreted by a professional without having to wait for an appointment – especially those
in at-risk groups.
According to our friends at NICE, hypertension is generally classifi ed as a blood pressure of 140/90 mmHg or higher (depending on pre-existing disease states), with the diagnosis of hypertension increasing in severity through to stage 2 and also severe hypertension as these values continue to increase4
. All these numbers mean
that the accurate measurement of blood pressure values is vital, both to allow for an accurate diagnosis, and also to allow for an appropriate therapeutic regimen to be selected at the prescribing stage to get things under control, whilst minimising any risks to the patient.
With regards to assessing a blood pressure reading, the days of auscultatory assessment with stethoscope and cuff seem to be over to a certain extent (although it’s still a good idea to have these skills!). The new kid in town is the automatic, digital blood pressure monitor, and these self-infl ating monitors will now be the norm in most, if not all, pharmacies. However, whilst the use
of the “old school” listening method had a number of pitfalls and quirks which must be completely mastered, the use of these automatic devices is not without a certain degree of skill. For example, the cuff fi tted to the monitor must be of the correct size, as this can lead to false occlusion of the artery. The cuff itself should be annotated with its size range, and this used to ensure correct cuff selection. In addition, while carrying out the testing, the patient should be sat at a table, so that they can rest their arm on it, and the cuff placed on the arm, level with the heart. The patient should also be told to be silent and still during the test, as this can affect the values. In addition to these points, the blood pressure monitor should be regularly validated and calibrated in line with the manufacturer’s guidance, to ensure that accurate readings are given. Further information on the use of specifi c blood pressure monitors will be found in the manufacturer’s documentation, and this should be consulted before the pharmacist undertakes blood pressure testing within the pharmacy.
SMOKE SIGNALS Another test which has probably become commonplace within your pharmacy is that of the carbon monoxide (CO) test. Overwhelmingly, this test is used as part of the Smoking Cessation programme, and is used as a “trip wire” to ensure that patients have stopped smoking whilst they are enrolled on the programme, as dictated by NHS Scotland. However, pharmacists should be encouraged to not only use this test as a check on their patient’s behavior, but also as an educational tool for patients who smoke and may not currently be at the right stage of the quit cycle, making them aware of the presence of high levels of CO within their circulatory and respiratory systems, in addition to education about the mal-effects of such high levels.
The test itself is cheap, quick and straightforward to carry out thanks to the use of modern CO monitors, whilst the non-invasive nature of the test makes it ideal for use within the consultation room of a community pharmacy. These monitors contain
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