DIAGNOSTICS


The monitoring of blood is an activity which might


strike fear into your heart, due to the potential problems which may arise from taking a patient’s blood, even though the quantity required for tests appropriate to pharmacy is miniscule.


an electrochemical gas sensor, much like a smoke alarm or home carbon monoxide detector, and on detection of the patient’s breath, the monitor will display the CO levels on a LCD monitor, typically with the accompaniment of a traffic light style colour-coded indication of the levels within the patient’s breath. CO monitors will normally provide levels in the format of a parts per million (ppm) reading, which can be used to assist the pharmacist in detailing the effects which such levels of the chemical will have on the patient’s body. A level of 1-2 ppm in a non-smoker can be expected, attributed to natural levels within the body, in addition to the inhalation of traffic fumes, etc. In a smoker, levels from around 10-50 ppm can be expected, depending on the severity of their habit, and leading to a number of bells and whistles coming from you monitor (brand dependent).


In terms of the effects of CO on the body, it should be explained to the patient in simple terms – the CO molecule binds to the haemoglobin in red blood cells around 200 times more effectively than O2 does. This results in a lessened amount of oxygen reaching vital organs, etc., putting stress on the heart and lungs to make sure that these organs can function effectively and get the oxygen they need. Such effects can thus lead to exacerbation of pre-existing conditions, such as angina, COPD and asthma, to name a few5


. As mentioned previously, the CO test is quick and easy to carry out, requiring a small sample of the patient’s breath, administered via a tube connected to the machine. As always, the manufacturer’s instructions should be followed to allow accurate readings to be taken, including


42 - SCOTTISH PHARMACIST


adherence to the calibration and servicing requirements of the device, to ensure that you’re giving your patients the right information.


THICKER THAN WATER The monitoring of blood is an activity which might strike fear into your heart, due to the potential problems which may arise from taking a patient’s blood, even though the quantity required for tests appropriate to pharmacy is miniscule. Whilst in some cases this is understandable, all pharmacists should at least be aware of how to interpret the results of such tests, and how to provide appropriate advice depending on the outcome. Pharmacists who do wish to carry out such tests, should consult with the appropriate sources to ensure that they inform the patient of any associated risks, whilst also protecting themselves via obtaining written consent, etc.


If you are going to be carrying out any blood tests in the Pharmacy, one of the most common ones will be blood glucose testing. Such a test might be carried out in a number of situations, including as part of a routine health check, and also in situations where the patient may have already had their diabetes diagnosed, and require constant monitoring. Such a test commonly involves the pricking of a finger with a lancet, and the application of a small drop of blood to a strip, which is “plugged” into an electronic monitor device. This electronic monitor is a simple reflectance photometer, which can detect glucose levels in the blood via its interaction with light. Target levels of blood glucose can vary, dependent on the patient’s pre-existing


conditions, but there are general “normal” levels which can be used as a starting point. For example, a level of 3.5-5.5 mmol/L before eating is regarded as normal, whilst a reading of less than 8 mmol/L would be a standard level when testing is carried out two hours after a meal6


.


Of course, these target levels, and the number of tests needed per day will vary from patient to patient, especially in a diabetic, and these factors should be considered by the pharmacist carrying out the testing. Another factor which a pharmacist should focus on when considering blood glucose testing, is the wide range of monitors which are currently on the market. These machines, and their operation, can be confusing, particularly to a patient who has recently been diagnosed with diabetes or who is susceptible to confusion, for example, the elderly. Pharmacists are urged to familiarise themselves with the various machines and reagent strips available for blood glucose testing so that they can advise patients effectively should they require assistance.


If you’re really feeling adventurous, another blood test which is gaining popularity within community pharmacy, due to its simplicity, speed and importance, is blood cholesterol testing. Of course, the role of cholesterol within various conditions such as heart disease are well known, particularly to pharmacists, suggesting that testing for levels of this substance in the blood should become a core activity of the practicing community pharmacist. These cholesterol monitors function in a similar fashion to aforementioned blood glucose monitors, involving the addition of a tiny drop of the patient’s blood (again obtained from a finger prick) to a reagent strip inserted into a machine. The machine then either measures the reflectance or absorbance of a particular wavelength of light when exposed to the sample, transforming this data into a cholesterol value. It should be noted that whilst these machines produce quick and (mostly) accurate results, most of the machines available provide total cholesterol values only, and thus the patient should be referred if you suspect that a more in-depth investigation is required. With regards to total cholesterol, current recommendations are that blood levels should be below 5 mmol/L for healthy adults, and below 4 mmol/L for those at high risk


of various cardiovascular conditions. These results may be used in concert with appropriate questioning and other testing (e.g, BMI, percentage body fat) to reinforce the importance of a healthy lifestyle to the patient. As with all of the tests identified, the receipt of a test value outside of stated guidelines, or other concerning factors will warrant a referral to another healthcare professional for further investigation.


THE LITMUS TEST This article hopefully reinforces the importance, and the wealth, of diagnostic testing that can be carried out within the community pharmacy to the benefit of the patient and the health service. In addition to those discussed, pharmacists may perform, facilitate, or provide advice on tests for various allergies, sexually transmitted infections, pregnancy and various urine markers, including ketones and various proteins, which can indicate various problems, including conditions of the renal system, amongst many others. Due to the constantly evolving nature of medical science, pharmacists must work to keep themselves fully abreast of the latest advances, know how they work, and ensure that they integrate them within their practice, where applicable. Such activities will further cement the vital role of pharmacy within the healthcare sector, and will go even further to promote the skills and usefulness of pharmacy as an underutilised profession. •


REFERENCES


(1) NHS Monitor. Closing the NHS funding gap: how to get better value health care for patients. 2013; Available at:


https://www.gov.uk/government/ uploads/system/uploads/attachment_ data/file/284044/ClosingTheGap091013. pdf. Accessed 02/09, 2015.


(2) Community Pharmacy Scotland. Minor Ailment Service. 2015; Available at: www.communitypharmacyscotland. org.uk/nhs-care-services/services/minor- ailment-service/. Accessed 09/14, 2015.


(3) NHS Scotland. Minor Ailment Service (MAS). 2015; Available at: www. communitypharmacy.scot.nhs.uk/core_ services/mas.html. Accessed 09/14, 2015.


(4) NICE. Hypertension: Clinical management of primary hypertension in adults. 2011; Available at: www. nice.org.uk/guidance/cg127/chapter/1- guidance. Accessed 09/02, 2015.


(5) Healthline. Carbon Monoxide in Cigarette Smoke. 2008; Available at: www.healthline.com/health-blogs/ freedom-smoking/carbon-monoxide- cigarette-smoke. Accessed 09/02, 2015.


(6) Diabetes UK. Testing. 2014; Available at: www.diabetes.org.uk/Guide-to- diabetes/Monitoring/Testing/. Accessed 09/02, 2015


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