Skin Injury: A Case Study

The pharmacist must offer to discuss the unique drug therapy regimen of each Medicaid recipient when filling prescriptions for them. Each patient must be made an offer to be counseled by the pharmacist. The items to be addressed include, the name of the drug, intended use of expected action, common side effects and their avoidance, techniques for self-monitoring, proper storage, potential drug-drug or drug-food contraindications, refill

Per medical report dated 01/23/15, the patient reported of middle and lower back pain and bilateral leg pain with tingling. He was diagnosed with thoracic compression fracture and lumbar spondylolisthesis.

According to the patient, he has an appointment with Wheeler Clinic, referring to his prescriber Laura kennedy on 01/24/2017 to have his scripts refill. The patient says, he has to see his prescriber monthly because she, referring to the prescriber, does not place an order for refills because she wants her patient to see her for updates of their well-being. Addressing the Nexium DR, the patient is prescribed through his PCP. The patient says, " I bought in the medication

He was given a refill prescription for gabapentin 600 mg, 1 tablet orally, 3 times a day for 30 days, # 120 and hydrocodone/APAP tablet, 10/325 mg 1 tablet 4 times a day for 30 days #120. The patient continues on stable doses of medications in a responsible and compliant fashion.

There is pain with lumbar flexion and extension. There is no aberrant behavior. The patient feels that he can perform increased activities of daily living with his current medications.

DOI: 12/5/2013. The patient is a 57-year-old female precertification technician who sustained a work-related injury to her head, neck, lumbar spine, and right knee after slipping and falling on icy sidewalk. As per OMNI entry, she was diagnosed with head/scalp injury, status post concussion, cervical strain, headaches, and right knee medial meniscal tear status post surgery on 06/04/2014.

Per the medical report dated 03/29/2016 by Dr. Waghmarae, the patient believes that her left buttock pain has increased over the last month. She describes her pain as aching, throbbing and stabbing. She rates her pain symptoms as 8/10. Pain is relieved by medication, heat, ice and use of a Transcutaneous Electrical Nerve Stimulator (TENS) unit, and is increased by movement and standing for long periods of time. She states that her bilateral legs have also increased in pain severity over the last month. She believes because she is doing a lot of standing and trying to clean up her house. She states that pain is increasing in her left buttock. She is not involved in physical therapy, chiropractic, massage therapy or acupuncture. Palpation of the lumbosacral spine reveals abnormalities along the bilateral facet joints. There is pain in her axial lower back in all planes of lumbar motion that is

Patient has been previously certified with 4 Butrans Patches 10 mcg/hr on 04/12/16 ( Review 256727).

Regardless of what type of medication the patient is asking for, Jerry is still limited by his LPN and medical assistant scope of practice. If Dr. Williams does not prescribe the medication, Jerry can't call in a refill for the medication. Factors that may influence Jerry's decision to refill this medication include that the patient states he is a

Based on the medical report dated 03/25/16, the patient continues to have significant headaches and bilateral neck and shoulder pain. IW has numbness and tingling in both arms with neck pain.

D-The patient requested an increase on her dose as she reports that she is experiencing chills. When asked as to what alternatives has done to address the chills rather than using illicit drugs. The patient reports she's been taking each day at time and used relaxation techniques; however, at times the "chills" can be unbearable to the point the patient does not want to relapse because she's been drug free for over a year, at which this writer provided positive feedback for the patient recovery process. Furthermore, this writer and the patient discussed the suspension of the patient take home bottles as the patient reports that the reason why the bottles were suspended was due to her medication; however, the patient reports she provided the clinic with an updated letter from her psychiatrist and notification that she is no longer prescribed with Hydroxyzone and wants to apply for all of her take homes. This writer addressed with the patient about program policy about medication/take home bottles. Furthermore, two of the patient's medication needs an updated RX script before the patient request can be reviewed. Also, a letter from her psychiatrist once again about the patient compliance with treatment and medication management. The patient reports she can get the updated script by next as this writer will assist obtaining an updated letter from her psychiatrist about the patient's overall treatment. This writer completed the dose change request form to increase the patient's dose by 5mgs.

D- The patient reports she is stable at her current dose and haven't used any illicit drugs. This writer discussed about the 5th take home bottle application and informed the patient about when her 4th bottle was approved, which was on 03/9/2016. This writer informed the patient that she has to wait 30 days to apply for the next bottle, which will be completed on the patient next bi-weekly scheduled appointment. Furthermore, the patient informed this writer that she has to leave as she has to be at work at 8:30am and apologized for arriving late to her session.

Problem Description Medications (array of medications) Medication Name Medication Dosage How Often

Per the Request for Authorization form dated 09/23/16, IW was prescribed with trazodone 50 mg #30 1 tablet at bedtime with 4 refills and provided with a refill of Vicodin 5/300 mg #60 1 tablet twice daily and Miralax 527 grams twice daily with 4 refills. IW will discontinue Restoril.

Diabetic patients and those with poor circulation need to take extra care to prevent skin injury. Daily inspection of their feet will allow to recognize minor injury and early sign of infection before they get worse. Prevent peeling and cracking of the skin by regular use of lubricants of moisturizers. Protect feet and hands wearing appropriate footwear and gloves. Trim your fingernails and toenails carefully. Avoid spread of infection by taking proper precautions and treating infection promptly. Diabetic patients and those with poor circulation need to take extra cares to prevent skin injury. Daily inspection of their feet will allow to recognize minor injury and early sign of infection before they get worse. Prevent peeling and cracking