Site Archive

A complete index of all published Pharmshark articles.

Clinical Triage

Acute Appendicitis: Recognising the Pattern and Knowing When to Refer — A community pharmacy triage guide to recognising acute appendicitis, including the classic pain migration pattern, atypical presentations, key differentials, and when to call 999.
Acute Asthma Exacerbation vs Poor Control — How to assess asthma severity at the pharmacy counter, when to call 999, when to arrange emergency hospital assessment, and when emergency supply or PGD supply is appropriate.
Acute Chest Pain: Could This Be Acute Coronary Syndrome? — How to recognise possible acute coronary syndrome at the pharmacy counter, understand why ACS can mimic indigestion, identify atypical presentations, and know when to call 999, refer urgently, or advise self-care.
Acute Severe Headache: Migraine vs Red Flags — A triage guide for community pharmacists on distinguishing primary headache disorders from serious secondary causes requiring emergency or urgent referral.
Anaphylaxis Recognition in Pharmacy — How community pharmacists can rapidly recognise anaphylaxis, act on airway, breathing, and circulation signs, and escalate to 999 without delay.
Black Stools and Vomiting Blood: Recognising Upper Gastrointestinal Bleeding — A community pharmacy triage guide to recognising upper gastrointestinal bleeding, distinguishing melaena from iron-induced dark stools, and identifying who needs 999.
Carbon Monoxide Poisoning: The Silent Emergency — Why flu-like symptoms in winter may not be flu, and how to recognise when a patient presenting at the pharmacy counter could be suffering from carbon monoxide poisoning.
Cauda Equina Syndrome: Recognising a Spinal Emergency — How to screen for cauda equina syndrome at the pharmacy counter and refer appropriately when back pain or sciatica is accompanied by bladder, bowel, or saddle sensation changes.
Cellulitis, DVT, or Dependent Oedema? — How to distinguish cellulitis from deep vein thrombosis and dependent oedema, when to call 999 for necrotising fasciitis or pulmonary embolism, and why compression stockings must not be advised before DVT is excluded.
Dementia, Delirium, or a Medicine? Recognising Cognitive Decline at the Pharmacy Counter — A clinical triage guide for community pharmacists on distinguishing dementia from acute delirium, identifying medicine-induced cognitive impairment, and knowing when to refer urgently.
Diabetic Ketoacidosis: Recognising the Emergency — A community pharmacy triage guide to recognising diabetic ketoacidosis, including ketone thresholds, the SGLT2 inhibitor trap, sick day rules, and when to call 999.
Exertional Syncope and Palpitations: When to Refer Urgently — How to assess exertional syncope and palpitations at the pharmacy counter, recognise features requiring urgent cardiovascular assessment under NICE CG109, and identify medicine triggers and broader non-cardiac causes.
Fever in Children: Recognising the Seriously Ill Child — How to use the NICE NG143 traffic light system to distinguish a self-limiting viral illness from a potentially life-threatening infection in a febrile child, and when to call 999, refer urgently, or safely advise home care.
Head Injury in Patients on Anticoagulants — Why any head injury in a patient taking warfarin or a direct oral anticoagulant requires emergency department assessment, and how to identify features that require calling 999.
High Blood Pressure in the Pharmacy: When to Act and When to Reassure — What to do when a patient records a very high blood pressure reading on the pharmacy machine, and how to tell the difference between a hypertensive emergency and a reading that can wait.
Hot, Dry and Confused: Triaging Heat Exhaustion and Heat Stroke — A community pharmacy triage guide to distinguishing heat exhaustion from heat stroke, knowing when to call 999, and identifying patients whose medicines put them at greater risk in a heatwave.
Hypoglycaemia: Recognising and Responding to Low Blood Sugar — How community pharmacists can recognise hypoglycaemia, distinguish mild from severe episodes, treat safely in pharmacy, and know when to call 999.
Liver Disease in the Pharmacy: Recognising Risk and Knowing When to Refer — How to identify patients at risk of undiagnosed liver disease, which symptoms require urgent action, and how to navigate referral pathways for MASLD, cirrhosis, viral hepatitis, and drug-induced liver injury.
Measles: Recognition and Referral — How to recognise suspected measles at the pharmacy counter, when to isolate and refer, and your operational responsibilities as a pharmacist when a notifiable disease is suspected.
Meningitis and Meningococcal Sepsis: Recognising the Signs — A community pharmacy guide to recognising meningitis and meningococcal sepsis across all ages, with infant-specific features, the ALARM framework, and clear escalation guidance.
Oesophageal Cancer: Recognising the Warning Signs and Referring Appropriately — How to identify the red flag symptoms of oesophageal cancer at the pharmacy counter and refer using NICE NG12 criteria.
Opioid Overdose Recognition and Naloxone Use in Pharmacy — How to recognise an opioid overdose in or near the pharmacy, when and how to use naloxone, and the pharmacist's role in take-home naloxone supply and harm reduction.
Sepsis Recognition: The Unwell Patient with Infection — How to tell when a patient presenting with infection may be developing sepsis, and when to seek urgent medical help without delay.
Stroke and TIA: FAST Recognition and Urgent Referral — Recognise stroke symptoms, call 999 immediately, and never give aspirin before hospital assessment.
Sudden Sensorineural Hearing Loss: Recognising an ENT Emergency — A community pharmacy triage guide to recognising sudden sensorineural hearing loss, distinguishing it from wax or infection, and acting within the critical treatment window.
Testicular Torsion: Recognising a Surgical Emergency — How to recognise testicular torsion in the pharmacy and why sudden scrotal pain in a young male must always be treated as a surgical emergency until proven otherwise.
The Red Eye: Conjunctivitis or Something Serious? — How to distinguish benign conjunctivitis from sight-threatening acute glaucoma, uveitis, or keratitis, and when to refer patients urgently.
Tick Bites and Lyme Disease — How to advise on tick removal, recognise erythema migrans and early Lyme disease, and know when to refer to a GP or A&E.
UTI in Older Adults — How to recognise urinary tract infection in older adults, apply antimicrobial stewardship principles around asymptomatic bacteriuria and delirium, and know when to escalate.

Dispensing Checks

ACE Inhibitors: The Dispensing Safety Checklist — Renal and electrolyte monitoring, sick day rules, first-dose hypotension, angioedema recognition, and key drug interactions for ACE inhibitor dispensing in community pharmacy.
Anti-Seizure Medicines: The Dispensing Safety Checklist — Brand switching categories, valproate Pregnancy Prevention Programme, full-pack dispensing requirements, male valproate safety advice, and monitoring checks for anti-seizure medicines.
Anticoagulants: The Dispensing Safety Checklist — Point-of-dispense safety checks for warfarin and direct oral anticoagulants (DOACs): first dispense essentials, repeat dispense screen, and red flag bleeding symptoms.
Digoxin: The Dispensing Safety Checklist — Narrow therapeutic index, interaction-driven toxicity, electrolyte monitoring, blood sampling timing, and toxicity recognition for digoxin dispensing in community pharmacy.
Lithium: The Dispensing Safety Checklist — Monitoring requirements, brand safety, key drug interactions, and toxicity recognition for lithium dispensing in community pharmacy.
Methotrexate: The Dispensing Safety Checklist — Weekly dosing safety, day-of-week labelling, folic acid co-prescription, key drug interactions, and monitoring requirements for methotrexate dispensing in community pharmacy.
Statins: The Dispensing Safety Checklist — Point-of-dispense safety checks for statins: muscle toxicity risk, critical dose caps and interactions with simvastatin, monitoring requirements, and red flag symptoms.

Pharmacy Services

Blood Pressure Case Finding: The NHS Advanced Service Guide — Step-by-step delivery guide for the NHS Community Pharmacy Hypertension Case-Finding Advanced Service, including clinic readings, ABPM, referral thresholds, and submission requirements.
Cardiovascular Disease Modern Service Framework: The Community Pharmacy Readiness Guide — What the new national Cardiovascular Disease Modern Service Framework does and does not mean for community pharmacy, and the readiness steps pharmacy teams can take now within existing commissioned services.
Discharge Medicines Service: The Community Pharmacy Guide — A step-by-step guide to delivering the NHS Discharge Medicines Service, covering the three clinical stages, referral handling, timeframes, payment, and common pitfalls.
New Medicine Service: Delivering Effective Medicines Support — A practical guide to the NHS New Medicine Service, covering the three consultation stages, all eligible conditions including the October 2025 addition of depression, the consultation framework, claiming, and common pitfalls.
Pharmacy Contraception Service: Oral Contraception and Emergency Contraception — A practical guide to the NHS Pharmacy Contraception Service, covering eligibility, the POP vs COC decision, product selection, measurements, counselling, emergency contraception, and common pitfalls. Updated for the October 2025 service expansion.
Pharmacy First: A Guide to Accurate Clinical Documentation — What to record, when to record it, and why accurate PharmOutcomes documentation is the foundation of a safe and compliant Pharmacy First service.
Pharmacy First: Acute Otitis Media in Children — How to assess acute otitis media under the NHS Pharmacy First service, when antibiotics are actually indicated, when ear drops are appropriate, and why most children should receive watchful waiting with analgesia.
Pharmacy First: Acute Sinusitis — How to assess acute sinusitis under the NHS Pharmacy First service, when to supply antibiotics or a nasal corticosteroid under PGD, and the clinical features that distinguish bacterial from viral infection.
Pharmacy First: Acute Sore Throat — How to use the FeverPAIN scoring tool to assess sore throat under the NHS Pharmacy First service and decide when to supply antibiotics or advise self-care.
Pharmacy First: Impetigo — How to assess and treat impetigo under the NHS Pharmacy First service, including the topical-versus-oral decision, when to use hydrogen peroxide versus fusidic acid, when to refer, and essential contagion advice.
Pharmacy First: Infected Insect Bites — How to assess infected insect bites and stings under the NHS Pharmacy First service, when antibiotics are indicated, and the key exclusions including tick bites and signs of Lyme disease.
Pharmacy First: Shingles — How to assess and treat shingles under the NHS Pharmacy First service, including which patients qualify for aciclovir PGD 2a versus valaciclovir PGD 2b, treatment time windows, ophthalmic and head/neck red flags, and the v1.1 update excluding head and neck shingles.
Pharmacy First: UTI in Women — How to assess and treat uncomplicated lower urinary tract infections under the NHS Pharmacy First service, covering the UKHSA diagnostic triad, age limits, upper UTI exclusion, the nitrofurantoin dose, and the many exclusions pharmacists commonly miss.
Testosterone Replacement Therapy: Delivering the Private PGD Service Safely — A practical guide for community pharmacists delivering testosterone replacement therapy under a private Patient Group Direction, covering PGD governance, eligibility criteria, assessment, monitoring, and service pitfalls.

Professional Development

Master the Shift: Cognitive Offloading for Community Pharmacists — Practical strategies for reducing mental load on the shop floor: from brain-dump notebooks and hold markers to handover rituals and reduced-interruption checking areas.

Healthcare News

CPCF 2026/27: What the New England Contract Means for Your Pharmacy — The 2026/27 CPCF settlement in England brings a 10.3% funding increase to £3.636 billion, NHS-funded independent prescribing from autumn 2026, a SAF rise to £1.52, and up to £239 million of historic medicine margin over-delivery written off.
Teplizumab on the NHS: What Community Pharmacists Need to Know — NICE issued final draft guidance on 23 June 2026 recommending teplizumab (Tzield) for NHS use, the first treatment to delay the onset of symptomatic type 1 diabetes. Community pharmacists will not supply this drug, but patients and families may ask about eligibility, how it works, and where to get screened.