Pharmacy during an admission

This is what you can expect from the specialist CF pharmacist during your admission.

You will be seen by a pharmacist or a pharmacy technician within 24 hours of admission. The pharmacist will ensure that you have all the medication that you need and will order up anything that may not be on the ward. This pharmacist/technician may not be a specialist CF pharmacist, but they will still be able to ensure that the correct medication is prescribed and available to you.

At admission we will:

• Complete a medicines reconciliation of your treatment. This involves obtaining an accurate list of all the medications that you were taking at home. For this we will use sources such as

• Your GP repeats
• Clinic letters
• Your own medicines that you brought from home
• Taking a history from you or your carer
• CF medication lists provided by the CF pharmacist
• Ensure that the ward has a supply of all the medication that you need
• Ensure that the correct medication, time, and frequency are prescribed for you on the ward
• Ensure that there are no interactions within the medications prescribed

At admission, during your stay and at the end of your stay

A pharmacist will continue to revise your medication at least twice a week. This could be done electronically, so they may not necessarily come to your room, but your medication will be consistently reviewed for any monitoring and changes required. If you are started on any new medication and require counselling the pharmacist will discuss your new treatment and answer any questions that you may have. If there are any particular issues that you would like to speak to the pharmacist about, please let the nurses know.

Before you go home, a pharmacist will:

• Check your discharge medication and ensure that it is correctly prescribed
• Check the medication that you have in your room, and order up anything that you may be running out of
• Check to ensure that you are taking your medication as prescribed
• Check to ensure that any homecare prescriptions are updated,
• Check that your pharmacy receives an updated list of your medication if you have it in a blister pack
• Answer any questions that you may have regarding your medication or changes in treatment

Physiotherapy during an admission

This is what you can expect from the specialist CF physiotherapists during your admission.

We will see you within twenty-four hours of your arrival in hospital. This is usually the same day as you arrive but may be the next day if you arrive on the ward in the late afternoon. If you are very unwell then we will see you as soon as possible and the on call physiotherapists may see you if you are very unwell and admitted out of usual working hours.

At admission we will go through a full assessment with you. This may include:

• Talking with you about why you have been admitted to the ward.
• Completing clinical tests like lung function, taking sputum samples and listening to your chest.
• Checking your physiotherapy routine to clear your chest and any exercise that you are doing.
• Checking your inhaled/nebulised medications including any devices and your technique using them.
• Talking with you about your routine at home and any things that are going well or problems with your routine.
• Asking you questions about any joint or stress incontinence issues you may have (which are common in people with CF).
• Discussing with you what you want to get out of the admission and planning your treatment with you.
• Discussing our assessment with the CF team so that they know about any problems that have been identified.

At admission, during your stay and at the end of your stay

We will aim to see you twice a day although some of these physiotherapy visits will be with the ward respiratory physiotherapists rather than the CF physio team. There may be times where you or we feel that twice a day visits aren’t needed. 

During your stay we can:

• Check and, if needed, change your physiotherapy for your chest and let you know about any new treatments/devices available.
• Help you with carrying out your chest physiotherapy (if needed).
• Offer you the chance to have exercise equipment in your room.
• Check your nebuliser and inhaler medications and equipment, make sure that you can use them without any problems and let you know about any new treatments/devices available.
• If required, test any new inhaled medications with you to make sure that they are okay for you to take and that they are useful for you to take.
• Refer you to a specialist physio if you need treatment for any joint, muscle, posture or continence problem.
• Regularly assess and reassess how treatments are going and work with the rest of the team and you to adjust accordingly and make sure that you get the best treatment possible.

We will make sure that you are seen before you go home and will:

• Talk with you about your routine at home & any changes that have been made.
• Provide you with a treatment chart detailing your home routine if you think that this would be useful for you.
• Carry out repeat clinical tests like lung function, taking sputum samples and listening to your chest to check how well you have responded to the treatment.
• Check the physiotherapy techniques to help clear your chest and exercise that you are planning to continue with at home.

Nursing during an admission 

This is what you can expect from the CF nurses during your admission. 

We will see you within twenty-four hours of your arrival to hospital. This is usually the same day as you arrive but may be the next day if you arrive on the ward in the late afternoon.  

On Admission and during your stay 

• We will discuss with you what the plan is for your admission and what treatment you will be receiving. We will also discuss with you whether you plan on having part of your treatment at home if you are feeling well enough, and it’s appropriate to do so. We will ensure you have everything you need to make sure your stay is as comfortable as possible. 
• If you are having intravenous (IV) antibiotics we will discuss this with you in more detail and arrange venous access. This may be accessing your port-a-cath, if you have one, or organising for a midline to be sited. Occasionally you may need to have a cannula fitted if there is going to be a delay in getting a midline. We will discuss with you what antibiotics you have been prescribed and any monitoring that may be required. For example, if you are prescribed Tobramycin we will need to do blood tests to monitor the level of this drug in your blood stream to make sure you are not getting too high a dose. 
• We will take your bloods, or arrange for your blood tests to be done, prior to starting IV antibiotics so we can see what your infection markers are, and to check your liver and kidney function; as some antibiotics may affect this. We would also arrange for your bloods to be taken half way through your treatment to ensure us that you are getting the right treatment and are improving. We will also ensure any other tests that are required are carried out, for example a chest x-ray or ultrasound scan. We will ensure you have had your observations checked, including oxygen saturations, blood pressure, weight etc. 
• Whilst you are an in-patient we will visit you daily and make sure everything is going well with your treatment. If you have any issues with your treatment or are having any side effects we can look at how this can be resolved. 
• We would ensure referrals are carried out where appropriate, for example to the diabetes specialist team. 

Home IVs 

If having your IV antibiotics at home is something you wish to consider we would discuss this in more detail with you and ensure you get the training you need to make sure you feel comfortable and confident to do so. This would include a period of supervised practice and assessing you to make sure you can manage them safely. 

We would ensure you receive everything required to manage your treatment safely at home, including contact numbers for the CF team, the ward and the company that deliver the IV medication.  

Discharge 

We would ensure that when you are discharged from hospital that you have everything you need, including any new medication. You may need visits from the homecare nurse to take your bloods or change your dressing, this will be arranged in advance for you. We will also arrange an appointment with you for your next review.