Safety netting case study

Hi, my name’s Olivia. I woke up this morning with quite a lot of pain in my knee, and I took ibuprofen, like usual. But I just noticed that when I woke up this morning, it was quite swollen. And I’ve noticed I’ve just been feeling unwell for the last few days. OK, hi, Olivia. Can I just start by confirming your full name and your date of birth, please? Sure, yes. Olivia Jones. And my date of birth is 10/26/1987. OK, brilliant. So just to introduce myself, my name is Amira I’m one of the prescribing pharmacists on call today. I’m covering the acute on-call line. Can I just confirm to ask your consent to ask you further questions? Yeah, that’s fine.

To start off with, can you first confirm for me, is it your left knee or your right knee? It’s my left knee. And does it look visibly swollen, so if you compare it to your right knee? Yeah, I think in comparison it looks quite a lot bigger. And can you confirm for me the exact location on the knee? Is it the top of the knee or on the sides or the back of the knee? It’s on the top of the knee.

And if you’re able to just gently touch your knee, how does that feel?

Yeah, it’s quite tender. And if you could give me a score from 1 to 10, with 1 being no pain at all and 10 being the worst pain you’ve ever felt, what number would you give yourself? Probably about a 6.

Is the pain there all the time or only when you’ve just touched your knee just now? I don’t know. I mean, it feels quite stiff today. Have you recently been to the gym, or do you play any regular sports at all? No, I’m not really into sports. Do you happen to have a thermometer at home? Yeah, I did actually check my temperature a couple of hours ago when I wasn’t feeling very well. And it was at 37. OK, well that’s great. That’s normally where we’d like your temperature to be. That’s not a fever. Is there any problems with your breathing at all? No. So we sometimes ask patients to take a pulse over the phone.

That just gives us an idea of how your heart rate is doing, OK? OK, how do I do that? So if you could just hold out one of your hands for me with your palm facing upwards, OK? OK. And then I’d like you to press your index finger, which is your first finger, and your middle finger– so the two first fingers– and place that on the inside of your wrist, so the place which is the closest to the base of your thumb. OK. Don’t use your thumb, just those two fingers because the thumb also has a pulse, and that might kind of confuse things.

So now I would like you to just gently press on your skin until you can feel your pulse. So you should start feeling the pressure. Can you find it? Yeah, yeah, I can find it. Now I want you to count the pulse rate for the next 30 seconds starting now.

OK, what number did you get? 45. OK, brilliant. So we usually multiply that by 2 to give us how many beats we’ve got in a minute, which gives us 90 beats, which is slightly higher. But that could be explained because of the pain that you’re feeling. Yeah, I’m a coward about pain. Any problems in opening your bowels or passing urine in the last couple of days? No, it’s all been normal. Any night sweats? No. Could you tell me a little bit more about your family medical history, so your parents or siblings? Yeah, my mum has rheumatoid arthritis. My dad is healthy. And I’m an only child.

And your current living situation, are you living on your own or do you have a partner? Yeah, I live alone. And is that in a flat or a house? It’s a flat. Do you have any issues with access, like climbing stairs, or do you have a lift? No, yeah, we have a lift. So yeah, that’s not an issue. Great. So I’ve just got a few more questions then. So have you travelled anywhere recently? No, I wish I could. OK, right. Do you smoke at all? No. And any alcohol intake? No, I don’t drink. Any illicit drugs? No. Good.

So with your knee, we usually like to check the joint above and the joint below, so– just to make sure that we’ve checked everything. So have you got any pain kind of in your– pain down to your knee or from your ankle to your knee on either side? No, it’s mainly my left knee. My right knee does feel a bit painful sometimes. But today, it’s mainly my left knee. So just going by what I can see on your records and on your notes, it’s saying that you have been diagnosed with rheumatoid arthritis. Do you think it’s just a flare-up of your arthritis at the moment? Yeah, I think so.

I mean, it’s the stiffness and the pain that I usually get with the arthritis. But I just don’t think that the painkillers are working anymore. So what I’ll do is I’ll give you some co-codamol, and we’ll send it off to the pharmacy. OK. If you just give it a few days to work, and then if it doesn’t work, then just give us a call back, and we can review. Just bear in mind that the painkiller can make you a bit drowsy. Yeah, that’s fine. OK, before I let you go, there’s just a few things to remember. So if your pain gets worse, let us know.

And if the pain relief, obviously, doesn’t work, then call us back, and then we can reassess. Is that all right? Yeah, that’s great. Thank you for your help. That’s OK. Thank you. Bye.