Procedure Logs

C3.2 R5: Reconcile a patient’s medications on DISCHARGE

ID: CL is a 1 y/o 4 mos male (=12 kg)

CC: cough

HPI: 4 day history of cough, blood emesis x 1, wheezy breath sounds x 2 days, and fever x 2 days (39.0)

Family Hx: viral illness (brother had cough + fever earlier), sister has history of reactive airway disease, and brother has history of eczema and reactive airway disease.

Patient’s family had pulmicort in the community however only used it in the morning prior to admission, this was a trigger that I needed to provide them with a very thorough explanation of the medication (inhalers) at discharge.

At discharge CL was given:

  • Fluticasone 125mcg i puff BID x 4 weeks
  • Salbutamol 100 mcg Q6H PRN

I counselled CL’s mom on the indication of the fluticasone and salbutamol, and emphasized the importance of fluticasone being a chronic medication used for prevention of asthma exacerbations. I taught how to use the spacer, cleaning instructions and how to space the fluticasone and salbutamol if they need to be used concurrently. With collaboration with the nursing team, we had CL’s mom practice the use herself on the last scheduled dose of salbutamol prior to discharge. CL’s mom was taught about the side effects and the importance of following up with CL’s pediatrician in the community.

This was a great opportunity to teach at discharge, because I was much more familiar with the inhalers (from my experience of community pharmacy) and I felt that the discharge counselling would be beneficial for CL and the family to prevent an unnecessary asthma hospitalization in the future. I was really pleased with how I counselled CL’s mom, and she seemed to understand all the instructions and was amenable to the discharge plan.

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