MUR case study – what would you do?
He has recently been diagnosed with early dementia. He is accompanied to the MUR by his wife, who has requested the review, as she really doesn't know what her husband's medicines are for. Mr Williams consents to Mrs Williams being present during his MUR.
Due to his declining cognitive function she is now responsible for giving his medicines. The following is an excerpt from his MUR form:
|
Current medicine |
Taken as directed |
Comments |
|
Lisinopril 10 mg tablets One daily |
Yes |
Taking before breakfast - no problems reported |
|
Bisoprolol 10mg tablets One daily |
yes |
Takes after breakfast - some cold hands and feet but not troublesome |
|
Rivastigmine 4.6mg/24 hours 9mg /5cmsq patch |
yes |
New medicine (started taking six weeks ago) – uses at lunchtime |
|
Atorvastatin 20mg One to be taken daily |
yes |
Taking at night but will sometimes forget |
|
Furosemide 20mg tablets One daily |
yes |
Takes mid-morning for ankle swelling which is well controlled. Causing profound diuresis |
|
GTN spray Use prn |
No – uses rarely |
Has started to get some chest pain now and again, especially when walking up hill – doesn't tend to use this spray, although it does relieve the pain |
|
Aspirin 75mg One daily |
Yes |
No problems – takes with lunch |
|
Canesten HC cream |
No |
Was using for rash caused by patches, but this has improved |
|
Ispaghula sachets orange SF Take one twice a day |
No |
Experienced problems |
|
Senna tablets 7.5 mg |
No |
Experienced problems |
|
Anusol ointment |
Yes |
OTC product |
Andrew discusses a number of matters with the Williams'. His greatest concern is the return of some chest pain for Mr Williams after many years of good control after the angioplasty. The other issue raised by the couple is Mr Williams' constipation. He has become increasingly constipated in recent months. When he saw a locum GP about this approximately three months ago, he was given a prescription for both Fybogel and senna. However, this resulted in Mr Williams experiencing an embarrassing and distressing bout of faecal incontinence and he stopped taking them straight away. This was not reported to the GP as Mr Williams decided he could put up with it. However he now has haemorrhoids and increasingly has to strain, often spending long periods of time on the toilet.
- What are the key action points from this MUR?
Andrew completes the action plan of the MUR form – his action points are:
|
Issue |
Recommendation |
For consideration by |
|
Mr Williams is experiencing increasing chest pain on exertion which is relieved by GTN spray, however he is using it minimally |
Mr Williams to use GTN as directed for chest pain – patient to be reviewed by GP asap |
GP – to see Mr Williams at earliest opportunity Pharmacist to follow this up Patient – to use GTN when needed |
|
Straining/constipation/piles |
Suggest start using Fybogel sachet (only) at dose of one a day (only) now and assess if these help |
Patient – try this and report back to pharmacist or GP (if being seen) after one week. You need to drink plenty (patient is not fluid restricted) |
|
Taking medicines separately throughout day as believed that they mustn't be taken at same time of day – this has been causing problems, especially night time medicine gets missed |
Discussed which medicines can be taken at same time of day and these were marked with a star on boxes and on patient copy of MUR form |
Patient/carer– change medicines so that all of them after breakfast as discussed – report back to pharmacist if this is causing any problems |
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