Shortages
Patient communication – Have I involved the patient in decisions?
- Does the patient know about the shortage? Explain why the medicine is unavailable, when it might become available again (if known), and what you propose to do. An explanation helps to encourage compliance with a new medicine and avoids confusion about the status of the original medicine. It also gives patients the opportunity to ask you questions.
- Tried other medicines for same indication? Ask the patient what they’ve tried before and/or check their history if available. Perhaps they have used an alternative successfully in the past. Don’t switch to a medicine that the patient has previously not responded to, or was unable to tolerate.
- Practical issues with switch? Avoid switching to a medicine that presents practical problems for the patient. Perhaps the new medicine doesn’t fit into a compliance aid (e.g. NOMAD), needs frequent dosing in someone who's forgetful, or requires manual dexterity in a patient with rheumatoid arthritis in their hands.
Sharing the plan – How can I best share this plan?
- Who will change the prescription? If you are not a prescriber you'll need to liaise with the most appropriate prescriber to make any changes and potentially offer advice to them on what to do. You may also have to ensure that the patient’s GP doesn't continue to prescribe a medicine that isn’t available on a repeat prescription.
- Any monitoring? Who will do it? Should the patient be monitoring themselves for effectiveness (e.g. blood glucose) or side effects (e.g. sedation)? What should the patient do if there is a problem? If a GP is expected to perform blood tests has this been discussed?
The headings above form an acronym that might help you remember this approach:
Timeframe, Risks, Alternatives, Patient communication, Sharing the plan = TRAPS
Timeframe, Risks, Alternatives, Patient communication, Sharing the plan = TRAPS
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