The patient remained stable throughout admission, lower GI bleed was excluded, and no evidence of ongoing PR bleed was found on examination. Whilst the Hb continued patient’s to be low, this was usual for the patient due to iron deficiency anaemia. The ferrous patient’s fumarate was also withheld prior to colonoscopy, as per policy. Ferrous fumarate was restarted following the completion of investigations, and the GP was asked to perform a full blood count after admission and review oral iron. If the patient had not been anticoagulated this admission may have been avoided, whilst it was likely that they may have experienced a small amount of PR bleeding from the haemorrhoids it may not have been extensive enough to have resulted in hospital admission. However, due to the co-morbidities anticoagulation was indicated. Their patient’s HASBLED score was calculated prior to restarting apixaban and was found to be 2, due to age and previous bleed. Therefore it was reasonable to continue with anticoagulation if the risk of clotting was considered significant. When I reviewed this patient the apixaban was already withheld. I ensured that the HASBLED score was calculated and considered by the doctors when deciding the plan. I completed the yellow card in a timely manner, and ensured the patient was aware that I was doing so for informal consent purposes. Given the black triangle status of apixaban, and the severity of the bleed (requiring hospital admission), I would yellow card this scenario again if it occurred RPS Foundation Framework Cluster 1 Patient Cluster 2 Cluster 3 Personal Cluster 4 and Pharmaceutical Professional Practice Management and Care Practice Organisation Patient Consultation Professionalism Gathering Clinical Governance Information Need for Medicine Organisation Service Provision Knowledge Provision of Effective Organisations Medicine Communication Analysing Budget and Skills Information Selection of Reimbursement Medicine Team Work Providing Procurement Information Medicine Specific Education and Staff Management Issues Training Follow Up Medicines Research and Information and Evaluation Patient Education Monitoring Medicine Therapy Evaluation of Outcomes Transfer of Care
The patient remained stable throughout admission, lower GI bleed was excluded, and no evidence of ongoing PR bleed was found on examination. Whilst the patient’s Hb continued to be low, this was usual for the patient due to iron deficiency anaemia. The patient’s ferrous fumarate was also withheld prior to colonoscopy, as per policy. Ferrous fumarate was restarted following the completion of investigations, and the GP was asked to perform a full blood count after admission and review oral iron. If the patient had not been anticoagulated this admission may have been avoided, whilst it was likely that they may have experienced a small amount of PR bleeding from the haemorrhoids it may not have been extensive enough to have resulted in hospital admission. However, due to the patient’s co-morbidities anticoagulation was indicated. Their HASBLED score was calculated prior to restarting apixaban and was found to be 2, due to age and previous bleed. Therefore it was reasonable to continue with anticoagulation if the risk of clotting was considered significant. When I reviewed this patient the apixaban was already withheld. I ensured that the HASBLED score was calculated and considered by the doctors when deciding the plan. I completed the yellow card in a timely manner, and ensured the patient was aware that I was doing so for informal consent purposes. Given the black triangle status of apixaban, and the severity of the bleed (requiring hospital admission), I would yellow card this scenario again if it occurred RPS Foundation Framework Cluster 1 Patient and Pharmaceutical Care Cluster 2 Professional Practice Cluster 3 Personal Practice Cluster 4 Management and Organisation Patient Consultation Need for Medicine Provision of Medicine Selection of Medicine Medicine Specific Issues Medicines Information and Patient Education Monitoring Medicine Therapy Evaluation of Outcomes Transfer of Care Professionalism Organisation Effective Communication Skills Team Work Education and Training Gathering Information Knowledge Analysing Information Providing Information Follow Up Research and Evaluation Clinical Governance Service Provision Organisations Budget and Reimbursement Procurement Staff Management
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