It’s Thursday.

I always look forward to Thursdays as I get an opportunity to use my skills and knowledge to support patients in managing their anticoagulant therapy. Thursday is also a clinic day where I get to see a number of patients to provide warfarin counselling.

I am one of 2 anticoagulant pharmacy technicians working in the pharmacy led anticoagulant clinic at the Bristol Royal Infirmary. I have been in post since 2004 where my line manager thought he would take a chance of me by allowing me to be the first pharmacy technician to work in the anticoagulant clinic (Thank you Kevin Gibbs!)

We are a postal service, our patients have their INRs taken at their GP surgery and the INR results are released into the computerised dosing software which is also our patient database.

I arrive at work very early! Part of this is due to my commitment to the role but if I’m honest a lot of this is down to an easier commute! I like the quietness of the office at 6.30am. It gives me time to quietly consolidate, review and prioritise the workload for the day (along with a large mug of coffee!)

My first job is to review a handover from yesterday. Good communication in the team is essential as most staff have other roles and are not in the team every day. I ensure that my documentation is robust and I definitely have an eye for detail in ensuring accurate and comprehensive patient records.

I notice a patient has an INR of 8.2 recorded for yesterday. It is vital that I find out what actions have been taken for this patient as it appears that this INR was reported after the clinic closed yesterday evening. I have an e-mail from the haematology registrar stating that the patient was contacted last night to omit his warfarin and the out of hours GP had been contacted to arrange a home visit to administer vitamin K. It is very satisfying to see that the process to ensure that these patients are followed up is effective. I make a mental note to contact the patient a bit later as I decide it’s too early to call the patient; he lives on his own and was probably visited by his GP late last night so I decide to let him rest a bit. Besides, I don’t want to risk a fall if this patient tries to answer the telephone, especially with an INR of 8. See, its thinking outside of the box that helps me keep patients safe.

I have a new patient to see in clinic at 9.20am. I need to review the referral to ensure that I can safely initiate warfarin in this patient. Have they had baseline bloods done? Do they have any conditions or medications that could make them more sensitive to warfarin?  I understand that as a pharmacy technician I need to work within my limitations and if I have concerns about loading this patient I can speak to one of the pharmacists in the team. The face to face appointment with the patient offers me the opportunity to fully counsel the patient and identify any issues likely to affect a patient’s ability to manage warfarin safely. Time spent with patients in the clinic really brings home the impact and effect I can have by providing truly patient centred care. The job satisfaction from having a patient leave my clinic happy, fully informed and thankful for my help is very rewarding. Today the patient shook my hand as he left the clinic. A small gesture that means a lot and leaves me in no doubt that I have done my job well.

The rest of my day comprises of numerous tasks. I answer the phone to patients who are going on holiday, have bruising to legs, have started antibiotics, are have a tooth extraction planned, have forgotten their warfarin last night, are passing blood in urine, are stopping warfarin for a knee replacement, have not seen a district nurse for their blood test, have lost their dosing letter, have taken a double dose by accident…..the list goes on. I need to know how to respond and advise in all of these situations and every day will bring me a new question. Today’s question is…can I have a tattoo on warfarin?

Every interaction with a patient offers me an opportunity for me to identify and resolve any problems that the patient may be having with their treatment.  My role offers me many opportunities to offer professional excellence for patient centred care and impart my knowledge and expertise to improve outcomes and reduce the risk that patients are exposed to by their therapy.

Mary Carter

Specialist Pharmacy Technician – Anticoagulant

University Hospitals Bristol NHS Foundation Trust

October 2017