Existing medications

Mark, when your patient comes in to be triaged, a lot of them are probably going to be on existing medication. Can you explain to me the importance of the triage system with that existing medication and how we deal with that?

So when patients are on medication when you take medication, your body metabolises it. It has an effect on your body. A good example of that is if a patient has a condition that is stressing their body. However, they take beta-blockers, bisoprolol or medication like that. And that will artificially lower blood pressure and lower pulse, so it will not give you the picture of a body that is under stress, whereas their pulse should be round about 120 and their blood pressure quite high, they are under a lot of pain, the beta-blocker will lower that. So you will get an erroneous image.

Do you find that most patients know what medication they are on and actually what that medication is for, or do you find there is a bit of a mismatch there?

Yeah, there is a mismatch. It is quite common.

So patients quite often then will be on medication that they do not actually know what they are on it for, or how long they have been on it and this sort of the stuff, is that correct?

That is right, yeah. And they do not know what the name of the medication is, even.

Can that cause you some problems?

Yep. Yeah, because medication, it can be anything from paracetamol too, as I was saying, beta-blockers that would seriously affect your cardiac output. Also on that note, somebody who has got an injury or somebody who is in pain, it is always a good idea to check just how many paracetamol they have been taking, because a lot of the time people will take too many paracetamol or they will take paracetamol with co-codamol, so they are getting a double dose of paracetamol there. And it is not that common, but sometimes, you add it up and you realise that they have been having toxic doses of paracetamol for three or four days.

So what about over-the-counter? I mean, we talked about those, I mean, they are over-the-counter medications. Do you take that into consideration? Do you get a lot of people taking over-the-counter medications incorrectly, or too much, or not enough of? Does that create you any problems?

It does not really cause problems. However, as I was saying, that anything you put in your body is going to do something, there is going to be some form of reaction inside your body. So herbal remedies, alternative therapies, they need to be taken into account and particularly alternative remedies, that is linked to people's cultural beliefs and their own personal beliefs as well, so that needs to be taken into account as well. It is important not to insult somebody who is just trying to help themselves, really.

So that would be documented in there, in their records, I take it, in like a free-text area, would it?

That is right, there is a free-text area on the triage notes.

What about things like illegal drugs and CBDs and things like that? I mean, again, do people... Are these questions you ask, are they important? And do they tend to answer you honestly, or is it one of those that you have got to make a judgement yourself on?

Yeah, it is a risky... It is a risky area because somebody who is using illegal drugs, they will not tell you that they have been using illegal drugs. They have got a heart rate of 130 and they have been using a lot of amphetamines, cocaine or any drugs that will get them in trouble, really, they tend not to disclose those. And that is where the triage experience comes in because you can kind of sift out that kind of behaviour.

Again, is it documented, is it put down in the notes? Or is it something that you cannot put in because they have not actually disclosed that they are taking it?

That is right, you are dealing with facts, it is scientific if the patient says that they have not been taking, then they have not been taking.