RTS - Pharmacy First [Contains scripts for RTS and PE]

What are the key symptoms to assess for a urinary tract infection (UTI) in women aged 16-64?

1. Fever within 48 hours

2. Pain when urinating

3. Cloudy or bloody urine

4. Needing to pee at night

What questions should be asked to rule out other conditions in suspected UTI cases?

1. Any recent PRIOR nitrofurantoin use

2. Urinary tract surgeries

3. Catheter use

4. Recurrent UTI history

5. Kidney stone history / Pyelonephritis

6. Vaginal discharge

7. Partner infections

8. Sexual history

9. Pregnancy

10. Menopausal status

11. Fluid intake

What are the red flags for UTI requiring referral to A&E or a GP?

1. Sepsis signs (confusion, slurred speech, blotchy skin, non-fading rash, difficulty breathing)

2. Pyelonephritis symptoms [Kidney Infection] (nausea, vomiting, kidney pain),

3. Immunocompromised state

4. Pregnancy

5. Pain during/after sex

6. No improvement after 7 days of OTC treatment

What is the treatment for mild UTI in women aged 16-64?

1. Self-care such as (hydration, avoid alcohol and fizzy drinks which can irritate the Bladder)

2. Paracetamol (2 tablets every 4-6 hours as needed)

—

Return to pharmacy if no improvement in 48 hours

What is the treatment for moderate to severe UTI in women aged 16-64?

• Nitrofurantoin for 3 days,

• Symptoms should improve within 48 hours

• Complete full course

—

1. Prolonged Release = 100 mg twice daily for 3 days

2. Immediate Release = 50 mg 4 times a day for 3 days

What precautions should be taken while on nitrofurantoin for UTI?

Be aware of harmless yellow/greenish urine discoloration

Avoid certain medicines (refer to patient information leaflet)

What are the key symptoms of shingles in adults aged 18 and over?

• Unilateral Rash with tiny bumps

• Pain (moderate to severe)

• Patient history of chickenpox

• Symptoms within 72 hours

What are the red flags for shingles requiring referral?

• Suspected meningitis (neck stiffness, photophobia)

• Suspected encephalitis (disorientation)

• Facial involvement

• Symptoms lasting over 90 days

What treatments are used for shingles in adults aged 18 and over?

1) Aciclovir 800mg tablets 5x five times daily for 7 days

OR

2) Valaciclovir 1g 3x three times daily for 7 days → [Helpful for patients who cannot take tablets 5 times a day]

AND

3) Paracetamol or ibuprofen for pain relief

—

Offer valaciclovir if:

Immunosuppressed patients // Adherence risk: already taking 8 or more medicines a day or is assisted in taking their medicines

What hygiene measures should be advised for shingles to prevent spread?

1. Avoid contact with those who haven't had chickenpox (especially pregnant women, immunosuppressed individuals, babies under 1 month)

2. Avoid sharing clothes/towels

3. Avoid contact sports

4. Wash hands often

5. Wear loose-fitting clothes

6. Cover weeping lesions

What are the characteristics of non-bullous impetigo?

Thin-walled vesicles or pustules that rupture quickly

Forming a golden-brown crust

What hygiene measures help prevent the spread of impetigo?

• Stay away from school/work until 48 hours after treatment or lesions are dry/crusted

• Wash hands before/after applying cream

• Wash flannels/sheets/towels at high temperature

• Clean toys with detergent

What is the treatment for localized non-bullous impetigo (3 or fewer lesions)?

Hydrogen peroxide 1% cream for 5 days

or

Fusidic acid cream for 5 days

—

Fusidic acid cream can be offered 2nd line if:

• Hydrogen peroxide unsuitable, for example if impetigo is around eyes

• Hydrogen peroxide treatment has been ineffective and impetigo still remains localised

What is the treatment for widespread non-bullous impetigo (4 or more lesions)?

1) Flucloxacillin 500 mg four times a day for 5 days

OR

2) Clarithromycin 250 mg twice daily for 5 days (If penicillin-allergic)

SUBSEQUENTLY

3) Erythromycin 500 mg four times a day for 5 days (If pregnant)

What questions should be asked to assess infected insect bites in individuals aged 1 and over?

- Travel history

- Chemoprophylaxis for malaria prone countries?

- Do you have an idea of how it happened?

- Symptom duration?

- Are you pregnant?

- Immunocompromised?

- Fever - systemically unwell

- Any previous symptoms like this? Did you take antibiotics for it?

- Have you had a short course of steroids in the last month? - exclusion

What are the red flags for infected insect bites requiring immediate medical attention?

• Systemic unwellness

• Bullseye rash (Lyme disease)

• Worsening condition

• Signs of sepsis

What treatments are used for infected insect bites?

Initial OTC pain relief (paracetamol, ibuprofen)

Cold compress (flannel or cloth cooled with cold water) over the affected area

—

Antibiotics:

1) Flucloxacillin 500 mg four times a day for 5 days

OR

2) Clarithromycin 250 mg twice daily for 5 days (If penicillin-allergic)

SUBSEQUENTLY

3) Erythromycin 500 mg four times a day for 5 days (If pregnant)

—

If not infected but complaining about itchiness can recommend:

1) Off-label Oral Antihistamines (chlorphenamine)

OR

2) Topical corticosteroids (hydrocortisone 1%)

What hygiene measures are recommended for infected insect bites?

1. Avoid scratching to prevent further inflammation and decrease risk of infection

2. Keep fingernails clean/short

3. Wear cotton gloves if needed

4. Keep hands clean before/after touching skin

5. Remove stingers by scraping sideways

What are the red flags for acute sore throat in individuals aged 5 and over requiring urgent referral?

1. Dysphagia - difficulty swallowing

2. Dysphonia - abnormal voice

3. Drooling

4. Distress

5. Stridor

—

• Scarlet fever

• Glandular fever

• Immunosuppression

—

Medications causing agranulocytosis (e.g. methotrexate, sulfasalazine, carbimazole, propylthiouracil, cotrimoxazole, valganciclovir, clozapine, carbamazepine, all chemotherapy)

Suspected cancer (persistent mouth ulcers, unilateral swelling, bleeding/numbness, red/white patches, hoarseness >3 weeks in those over 45)

What treatments are used for acute sore throat when antibiotics are indicated?

1) Phenoxymethylpenicillin 500 mg four times a day for 5 days

OR

2) Clarithromycin 500 mg twice daily for 5 days (If penicillin-allergic)

SUBSEQUENTLY

3) Erythromycin 500 mg four times a day for 5 days (If pregnant)

—

Take phenoxymethylpenicillin on an empty stomach → This improves BIOAVAILABILITY

What is the treatment for acute sinusitis in individuals aged 12 and over?

1) Off Label High-dose nasal corticosteroids for 14 days

→ Fluticasone furoate 27.5 micrograms/dose nasal spray

Two actuations (27.5 micrograms/actuation) in EACH nostril twice daily (total dose 110 micrograms twice daily) for 14 days

—

1) Phenoxymethylpenicillin 500 mg four times a day for 5 days

OR

2) Clarithromycin 500 mg twice daily for 5 days (If penicillin-allergic)

IF SUITABLE

2.5) Doxycycline 200mg as a single dose on the first day and then 100mg once daily for 4 days [5 days total]

SUBSEQUENTLY

3) Erythromycin 500 mg four times a day for 5 days (If pregnant)

—

Take phenoxymethylpenicillin on an empty stomach → This improves BIOAVAILABILITY

—

4) Paracetamol or ibuprofen for pain relief

What are the red flags for acute sinusitis requiring immediate medical attention?

Sepsis

—

Intraorbital/periorbital complications such as:

Swelling / Cellulitis / Displaced eyeball / Double vision / Eye muscle weakness / Reduced vision

Intracranial complications such as:

Swelling over frontal bone / Meningitis signs / Severe frontal headache / Focal neurological signs

What exclusions apply for using steroids in acute sinusitis?

1. Current use of oral/inhaled/topical/parenteral corticosteroids [CANNOT DOUBLE UP ON STEROIDS!]

2. Pregnancy

3. Children under 12

What is the definition of acute otitis media (AOM)?

Inflammation in the middle ear with effusion

Rapid onset of symptoms

Caused by viruses or bacteria

Most common in children from birth to 4 years

What treatments are used for acute otitis media in children aged 1-17?

Phenazone with lidocaine ear drops for up to 7 days

→ Otigo (phenazone 40mg/lidocaine hydrochloride 10mg/g) ear drops, solution

Instil 4 drops up to 3x three times daily into the external auditory canal of the affected ear(s).

—

Antibiotics:

1) Amoxicillin:

→ Children 1–4 years: 250mg three times a day (every 8 hours) for 5 days

→ Children 5-17 years: 500mg three times a day (every 8 hours) for 5 days

OR

2) Clarithromycin: (If penicillin-allergic)

→ Children 1–11 years: [WEIGHT DEPENDANT ~ CHECK PGD FOR DOSE!]

→ Children 5-17 years: 500mg twice a day (every 8 hours) for 5 days

SUBSEQUENTLY

3) Erythromycin 500 mg four times a day for 5 days (If pregnant aged 16 - 17 yrs)

—

4) Paracetamol or ibuprofen for pain relief

What are the red flags for acute otitis media requiring immediate medical attention?

• Meningitis (neck stiffness, photophobia, mottled skin)

• Mastoiditis (pain, soreness, swelling, tenderness behind the affected ear(s))

• Brain abscess (severe headache, confusion or irritability, muscle weakness)

• Sinus thrombosis (headache behind or around the eyes)

• Facial nerve paralysis

What patient education points should be covered during a 10-minute pharmacy consultation?

• Confirm name/DOB

• Explain medication indication/dose/strength

• Provide patient information leaflet

• Discuss cautionary advice (e.g., food interactions, driving)

• Check allergies/conditions

• Explain treatment duration/benefits

• Outline side effects and management

• Advise on next steps if treatment fails

• Emphasize completing antibiotic courses and consuming on an empty stomach to improve bioavailability

• Mention monitoring requirements

• Provide missed dose advice

• Answer questions

• Summarize key points

Script for UTI:

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy. How may I help you?

Sure, before I continue may I confirm your name and date of birth?

Nice to meet you Bobette, would you like a consultation room to discuss these issues further just to keep you comfortable?

You mentioned problems with urinating. May we explore that further?

—

When you urinate, do you feel any burning or paining sensation? Describe the severity of this pain? Can you rate it on a scale of 1-10?

When did you first notice these symptoms?

Is your urine cloudy at all?

Do you tend to go to the toilet more often at night?

Have you noticed any fever or high temperatures recently?

—

ICE [Ideas / Concerns / Expectations] = Do you have any idea what has caused this? Is there anything you’re worried about?

—

Do you notice any blood in your urine?

Have you engaged in intercourse recently?

Have you experienced any pain during intercourse ?

Do you notice any discharge?

Do you notice any rashes?

Do you notice any nausea or kidney pain?

Have you suffered from any infections known as urinary tract infections in the past?

—

Before I continue gathering information, may I ask a few lifestyle questions?

• Do you drink or smoke?

• Have you consumed recreational drugs?

• How would you describe your diet?

• How would you describe your level of activity and fitness?

• Do you have any allergies?

• Are you pregnant or breastfeeding?

• Do you take any other medication? Any herbal or over-the-counter remedies?

—

• I believe you are suffering from a urinary tract infection as you display symptoms of pain during urination, more often at night. You mentioned you have cloudy urine which is indicated as a UTI.

• I will be providing you with Nitrofurantoin 100mg MR capsules TWICE a day for THREE DAYS.

• Do you manage your own medication? Are you able to swallow capsules or do you require a different formulation of dosage?

• It is important you take the full course of the antibiotic to ensure appropriate effectiveness of the medication. Furthermore, please take the medication with food or milk. This will help to avoid stomach upset and also to help the absorption.

• You may experience common side effects such as feeling sick (nausea) and headaches but please do not worry as they are common. If you do have any doubts or queries feel free to ring the pharmacy and ask us but in the meantime, you can refer to the Patient Information Leaflet for more information.

• Self care tips you can also follow includes good hydration / avoid alcohol and fizzy drinks which can irritate the Bladder.

• If you feel any pain discomfort, it is okay to take paracetamol.

• Do you have any questions for me? Do you have any problems with what I have said?

Script for Shingles:

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy. How may I help you?

Sure, before I continue may I confirm your name and date of birth?

Nice to meet you Bobette, would you like a consultation room to discuss these issues further just to keep you comfortable?

You mentioned problems regarding a rash. May I see the rash?

I can see the rash is located on ONE SIDE OF YOUR BODY.

I can see raised tiny bumps.

—

Do you feel any pain? Describe the severity of this pain? Any stabbing, itching, burning sensation? Can you rate it on a scale of 1-10?

When did you first notice the rash and the pain?

Have you ever experienced Chicken Pox? Maybe as a child?

—

ICE [Ideas / Concerns / Expectations] = Do you have any idea what has caused this? Is there anything you’re worried about?

—

Do you feel disoriented at all?

Do you have any issues with your neck?

—

Before I continue gathering information, may I ask a few lifestyle questions?

• Do you drink or smoke?

• Have you consumed recreational drugs?

• How would you describe your diet?

• How would you describe your level of activity and fitness?

• Do you have any allergies?

• Are you pregnant or breastfeeding?

• Do you take any other medication? Any herbal or over-the-counter remedies?

—

• I believe you are suffering from shingles as you display symptoms of pain from a rash on one side of your body. You mentioned you suffering from chicken pox as a child.

• Shingles is an infection that causes a painful rash caused by the same infection that causes Chicken Pox → Varicella zoster virus.

• It is important to note, it is best to avoid any form of contact with those who haven't had chickenpox (especially pregnant women, immunosuppressed individuals, babies under 1 month). This includes washing hands often and

  avoiding sharing clothes/towels or playing contact sports to prevent the spread of the infection.

• Wear loose-fitting clothes and cover weeping lesions where possible!

• Stress tends to exacerbate shingles so its best to manage your mental health appropriately.

• I will be providing you with Acyclovir 800mg tablets FIVE TIMES a day for SEVEN DAYS. Is this appropriate with your lifestyle regime or is it inconvenient to you?

• Do you manage your own medication? Are you able to swallow capsules or do you require a different formulation of dosage?

• It is important you take the full course of the antiviral medication to ensure appropriate effectiveness of the medication. If it helps, you can try to set reminders on your phone to not let you forget about your medicine. Furthermore, please take the medication with food or milk. This will help to avoid stomach upset and also to help the absorption.

• You may experience common side effects such as feeling sick (nausea) and headaches but please do not worry as they are common. If you do have any doubts or queries feel free to ring the pharmacy and ask us but in the meantime, you can refer to the Patient Information Leaflet for more information.

• If you feel any pain discomfort, it is okay to take paracetamol.

• Do you have any questions for me? Do you have any problems with what I have said?

Script for Impetigo:

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy. How may I help you?

Sure, before I continue may I confirm your name and date of birth?

Nice to meet you Bobette, would you like a consultation room to discuss these issues further just to keep you comfortable?

You mentioned problems regarding skin. May I see the skin?

—

I can see thin lesions and pustules which rupture easily.

I can see golden brown crusting of exudate.

—

≤3 lesions/clusters present = Localised non-bullous impetigo

→ Treatment options: Hydrogen peroxide 1% cream for 5 days OR Fusidic acid cream for 5 days (subject to inclusion/ exclusion criteria in PGD)

≥4 lesions/clusters present = Widespread non-bullous impetigo

→ Treatment options: Flucloxacillin 500 mg four times a day for 5 days OR Clarithromycin 250 mg twice daily for 5 days (If penicillin-allergic) SUBSEQUENTLY Erythromycin 500 mg four times a day for 5 days (If pregnant)

—

How long have you been experiencing these clusters?

Have they been spreading at all?

Do they feel painful? Do they break easily? Have you noticed any thicker, liquid filled clusters?

—

ICE [Ideas / Concerns / Expectations] = Do you have any idea what has caused this? Is there anything you’re worried about?

—

Before I continue gathering information, may I ask a few lifestyle questions?

• Do you drink or smoke?

• Have you consumed recreational drugs?

• How would you describe your diet?

• How would you describe your level of activity and fitness?

• Do you have any allergies? WHAT IS THE REACTION?

• Are you pregnant or breastfeeding?

• Do you take any other medication? Any herbal or over-the-counter remedies?

—

• I believe you are suffering from an Impetigo, a bacterial infection of the surface of the skin (Staphylococcus or Streptococcus).

• I will be providing you with Flucloxacillin 500 mg four times a day for 5 days

• Do you manage your own medication? Are you able to swallow capsules or do you require a different formulation of dosage?

• It is important you take the full course of the antibiotic to ensure appropriate effectiveness of the medication. Furthermore, please take the medication on an empty stomach. This will help to avoid stomach upset and also to help the absorption.

• You may experience common side effects such as stomach upset and diarrhoea but please do not worry as they are common. If you do have any doubts or queries feel free to ring the pharmacy and ask us but in the meantime, you can refer to the Patient Information Leaflet for more information.

• Self care tips you can also follow includes Stay away from school/work until 48 hours after treatment or lesions are dry/crusted. Wash hands before/after applying cream. Wash flannels/sheets/towels at high temperature [60 degrees Celsius min]. Clean toys with detergent

• Do you have any questions for me? Do you have any problems with what I have said?

Script for Infected Insect Bite:

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy. How may I help you?

Sure, before I continue may I confirm your name and date of birth?

Nice to meet you Bobette, would you like a consultation room to discuss these issues further just to keep you comfortable?

You mentioned problems regarding skin. May I see the bite?

—

I can see Redness and swelling of skin surrounding the bite is spreading.

I can see pustular discharge at site of bite/sting.

—

Where is the bite located?

How long have you had this bite for?

Does it feel itchy?

Is it red // painful or hot to touch // tenderness to the area // swelling

Any previous symptoms like this? Did you take antibiotics for it?

—

ICE [Ideas / Concerns / Expectations] = Do you have any idea what has caused this? Is there anything you’re worried about?

—

Did you travel anywhere when you were bitten? // Are you on any medication for malaria prone countries?

Has any doctor stated you have a weaker immune system?

Do you feel any symptoms of fever?

—

- Have you had a short course of steroids in the last month? - exclusion

—

For itching alone

→ Treatment options: oral antihistamine and/or topical steroids over the counter

For INFECTION:

→ Treatment options: Flucloxacillin 500 mg four times a day for 5 days OR Clarithromycin 250 mg twice daily for 5 days (If penicillin-allergic) SUBSEQUENTLY Erythromycin 500 mg four times a day for 5 days (If pregnant)

—

Before I continue gathering information, may I ask a few lifestyle questions?

• Do you drink or smoke?

• Have you consumed recreational drugs?

• How would you describe your diet?

• How would you describe your level of activity and fitness?

• Do you have any allergies?

• Are you pregnant or breastfeeding?

• Do you take any other medication? Any herbal or over-the-counter remedies?

—

• I believe you are suffering from an Infected Insect Bite, a bacterial infection caused as a result of the bite (Staphylococcus or Streptococcus).

• I will be providing you with Flucloxacillin 500 mg four times a day for 5 days

• Do you manage your own medication? Are you able to swallow capsules or do you require a different formulation of dosage?

• It is important you take the full course of the antibiotic to ensure appropriate effectiveness of the medication. Furthermore, please take the medication on an empty stomach. This will help to avoid stomach upset and also to help the absorption.

• You may experience common side effects such as stomach upset and diarrhoea but please do not worry as they are common. If you do have any doubts or queries feel free to ring the pharmacy and ask us but in the meantime, you can refer to the Patient Information Leaflet for more information.

• Self care tips you can also follow includes Avoid scratching to prevent further inflammation and decrease risk of infection. Keep fingernails clean/short. Wear cotton gloves if needed. Keep hands clean before/after touching skin. Remove stingers by scraping sideways

• Skin redness and itching are common and may last for up to 10 days

• Do you have any questions for me? Do you have any problems with what I have said?

Script for Acute Sore Throat:

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy. How may I help you?

Sure, before I continue may I confirm your name and date of birth?

Nice to meet you Bobette, would you like a consultation room to discuss these issues further just to keep you comfortable?

You mentioned problems regarding your throat. May I examine your mouth and throat?

—

Treatment Options:

1) Phenoxymethylpenicillin 500 mg four times a day for 5 days

OR

2) Clarithromycin 500 mg twice daily for 5 days (If penicillin-allergic)

SUBSEQUENTLY

3) Erythromycin 500 mg four times a day for 5 days (If pregnant)

Take phenoxymethylpenicillin on an empty stomach → This improves BIOAVAILABILITY

For any pain, take painkillers!

—

How long have you had this sore throat for?

Any presence of pus on the tonsils or in the throat?

Do you feel any symptoms of fever such as high temperature?

Are the tonsils inflamed?

No cough present?

—

ICE [Ideas / Concerns / Expectations] = Do you have any idea what has caused this? Is there anything you’re worried about?

—

Any rashes or swollen glands? [Scarlet fever concern]

—

Before I continue gathering information, may I ask a few lifestyle questions?

• Do you drink or smoke?

• Have you consumed recreational drugs?

• How would you describe your diet?

• How would you describe your level of activity and fitness?

• Do you have any allergies?

• Are you pregnant or breastfeeding?

• Do you take any other medication? Any herbal or over-the-counter remedies?

—

• I believe you are suffering from Acute Sore Throat, typically caused by a bacterial infection.

• I will be providing you with Phenoxymethylpenicillin 500 mg four times a day for 5 days

• Do you manage your own medication? Are you able to swallow capsules or do you require a different formulation of dosage?

• It is important you take the full course of the antibiotic to ensure appropriate effectiveness of the medication. Furthermore, please take the medication on an empty stomach. This will help to avoid stomach upset and also to help the absorption.

• You may experience common side effects such as stomach upset and diarrhoea but please do not worry as they are common. If you do have any doubts or queries feel free to ring the pharmacy and ask us but in the meantime, you can refer to the Patient Information Leaflet for more information.

• Self care tips you can also follow includes: Have plenty of rest. Drink enough fluids to avoid feeling thirsty. Use a tissue and wash your hands with soap to help prevent spread of your infection to your family, friends and others you meet.

• Do you have any questions for me? Do you have any problems with what I have said?

Script for Acute Sinusitis:

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy. How may I help you?

Sure, before I continue may I confirm your name and date of birth?

Nice to meet you Bobette, would you like a consultation room to discuss these issues further just to keep you comfortable?

You mentioned problems regarding your nose.

—

Treatment Options:

a) Off Label High-dose nasal corticosteroids for 14 days

→ Fluticasone furoate 27.5 micrograms/dose nasal spray

Two actuations (27.5 micrograms/actuation) in EACH nostril twice daily (total dose 110 micrograms twice daily) for 14 days

—

1) Phenoxymethylpenicillin 500 mg four times a day for 5 days

OR

2) Clarithromycin 500 mg twice daily for 5 days (If penicillin-allergic)

IF SUITABLE

2.5) Doxycycline 200mg as a single dose on the first day and then 100mg once daily for 4 days [5 days total]

SUBSEQUENTLY

3) Erythromycin 500 mg four times a day for 5 days (If pregnant)

Take phenoxymethylpenicillin on an empty stomach → This improves BIOAVAILABILITY

—

4) Paracetamol or ibuprofen for pain reliefs!

—

Can you breathe or smell from your nose at all?

Do you feel any blockage or congestion of your nose?

Do you notice any mucus coming out of your nose?

Do you cough at all?

Do you feel any pressure or pain of your face?

Do you experience any headaches?

—

ICE [Ideas / Concerns / Expectations] = Do you have any idea what has caused this? Is there anything you’re worried about?

—

How long have you had this runny nose for?

—

Do you feel any symptoms of swelling over the frontal bone // any reduced vision?

—

Before I continue gathering information, may I ask a few lifestyle questions?

• Do you drink or smoke?

• Have you consumed recreational drugs?

• How would you describe your diet?

• How would you describe your level of activity and fitness?

• Do you have any allergies?

• Are you pregnant or breastfeeding?

• Do you take any other medication? Any herbal or over-the-counter remedies?

—

• I believe you are suffering from Acute Sinusitis, typically caused by a viral infection but is bacterial in your case.

• I will be providing you with Phenoxymethylpenicillin 500 mg four times a day for 5 days

• Do you manage your own medication? Are you able to swallow capsules or do you require a different formulation of dosage?

• It is important you take the full course of the antibiotic to ensure appropriate effectiveness of the medication. Furthermore, please take the medication on an empty stomach. This will help to avoid stomach upset and also to help the absorption.

• You may experience common side effects such as stomach upset and diarrhoea but please do not worry as they are common. If you do have any doubts or queries feel free to ring the pharmacy and ask us but in the meantime, you can refer to the Patient Information Leaflet for more information.

• Self care tips you can also follow includes: Have plenty of rest. Drink enough fluids to avoid feeling thirsty. Use a tissue and wash your hands with soap to help prevent spread of your infection to your family, friends and others you meet.

• Do you have any questions for me? Do you have any problems with what I have said?

Script for Acute Otitis Media:

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy. How may I help you?

Sure, before I continue may I confirm your name and date of birth?

Nice to meet you Bobette, would you like a consultation room to discuss these issues further just to keep you comfortable?

You mentioned problems regarding your ear. May I examine your ear [otoscopic examination]?

I am looking for:

• A distinctly red, yellow, or cloudy tympanic membrane

• Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks and an airfluid level behind the tympanic membrane

• Perforation of the tympanic membrane and/or sticky discharge in the external auditory canal

—

Treatment Options:

a) Phenazone with lidocaine ear drops for up to 7 days

→ Otigo (phenazone 40mg/lidocaine hydrochloride 10mg/g) ear drops, solution

Instil 4 drops up to 3x three times daily into the external auditory canal of the affected ear(s).

—

Antibiotics:

1) Amoxicillin:

→ Children 1–4 years: 250mg three times a day (every 8 hours) for 5 days

→ Children 5-17 years: 500mg three times a day (every 8 hours) for 5 days

OR

2) Clarithromycin: (If penicillin-allergic)

→ Children 1–11 years: [WEIGHT DEPENDANT ~ CHECK PGD FOR DOSE!]

→ Children 5-17 years: 500mg twice a day (every 8 hours) for 5 days

SUBSEQUENTLY

3) Erythromycin 500 mg four times a day for 5 days (If pregnant aged 16 - 17 yrs)

—

4) Paracetamol or ibuprofen for pain relief

—

Do you experience any headaches? Can you describe them for me please?

Any feeling of holding, tugging, or rubbing of the ear?

Any symptoms such as fever, crying, poor feeding, restlessness, behavioural changes, cough, or runny nose?

—

ICE [Ideas / Concerns / Expectations] = Do you have any idea what has caused this? Is there anything you’re worried about?

—

Can you breathe or smell from your nose at all?

Do you feel any blockage or congestion of your nose?

Do you notice any mucus coming out of your nose?

Do you cough at all?

Do you feel any pressure or pain of your face?

Do you experience any headaches?

—

How long have you had this ear problems for?

Have you had any other health issues? [Systemically unwell]

—

Do you feel any symptoms of swelling // neck stiffness // severe headache, confusion or irritability?

—

Before I continue gathering information, may I ask a few lifestyle questions?

• Do you drink or smoke?

• Have you consumed recreational drugs?

• How would you describe your diet?

• How would you describe your level of activity and fitness?

• Do you have any allergies?

• Are you pregnant or breastfeeding?

• Do you take any other medication? Any herbal or over-the-counter remedies?

—

• I believe you are suffering from an ear infection known as Acute Otitis Media, typically caused by bacterial infection.

• I will be providing you with Flucloxacillin 500 mg four times a day for 5 days

• Do you manage your own medication? Are you able to swallow capsules or do you require a different formulation of dosage?

• It is important you take the full course of the antibiotic to ensure appropriate effectiveness of the medication. Furthermore, please take the medication on an empty stomach. This will help to avoid stomach upset and also to help the absorption.

• You may experience common side effects such as stomach upset and diarrhoea but please do not worry as they are common. If you do have any doubts or queries feel free to ring the pharmacy and ask us but in the meantime, you can refer to the Patient Information Leaflet for more information.

• Self care tips you can also follow includes using a warm compress on the ear twice a day. Acute otitis media lasts about 3 days but can last up to 1 week

• Offer regular doses of paracetamol or ibuprofen for pain

• Do you have any questions for me? Do you have any problems with what I have said?

Explain ICE [For RTS situations]

1. Ideas: Asking them whether they have any ideas about what could have caused the condition like do u rmr the impetigo one they gave in the mock the ideas for why they got it would be how other kids at school had it so could have been caught from that

2. Concerns: Asking them if they have any particular concerns regarding the condition - so for the impetigo one again the mother was concerned about the other child getting it as well so just advising them on how to prevent spread like not share towels try to distance the kids etc.

3. Expectations: What treatment you would give them like if they have any particular expectations towards how they would like to be treated e.g. preference for liquid/topicals if swallowing difficulties

Explain BRAN [For PE situations]

1. B = Benefits of the medication how it’s going to help them with their current condition, how effective it is etc.

2. R = Risks of taking the medication which is basically potential side effects.

3. A = alternatives - so what other options/meds are available for the patient as well as the one they have been given e.g., for blood pressure if they were given a CCB then other classes like ARBs etc would be the alternatives. You can just say like the most appropriate medication has been prescribed to treat ur current condition but there are always alternatives available in the case of it not benefitting you.

4. N = Nothing so just speak about the risks of doing nothing and not taking the medication and that can convince them more to take it particularly if it’s more of a long term medication for prevention.