Hi, can someone please help me with this case . I need to find 3 issues/problems associated with the patient, strategies/management for each issues, discuss monitoring and follow-up required. Case : Emma is a 65 year-old Caribbean woman , had just been discharged from hospital after an orthopaedic surgery (total hip replacement) and she had been reviewed by a multidisciplinary team prior to discharge. In-patient clinical notes details are as below: O/E Feeling much better Pain well controlled on codeine and paracetamol Blood pressure 128/85 Pulse 72 beats per minute Repiratory rate 14 Abdomen SNT, BS present INR 2.2 Hb:99 T-score -2.5 Fully weight bearing; Discharged from physio Plan: Discontinue enoxaparin Add in secondary prevention post # Iron supplementation Home later TTO is written by the doctors: Amlodipine -oral route- 10mg once daily Atorvastatin- oral route- 20mg once daily Digoxin-oral-route- 125 microgram once daily Warfarin- oral route- As directed Hypromellose 0.3% eye drops - use as directed Paracetamol oral -1g up to 4 times a day when required Codeine oral- 30mg up to 4 times a day when required (Dose reduced) Zopiclone oral -3.75mg once a day at night, when required (Dose reduced. To wean off) NEW-Alendronic acid oral- 70mg once a week (Secondary prevention) NEW-Adcal D3 chewable tablets -oral - One tablet twice a day (Secondary prevention) NEW-Ferrous sulphate - oral - One tablet 3 times a day (Anaemia) The carers are worried that Emma will not manage her warfarin at home. Since being in hospital, Emma has become more confused than normal and she is struggling to manage her medications. Emma is worried about remembering all of these new medications. The carers ask if her warfarin could be changed to a fixed dose to make it easier for administration, and to help coincide with when they visit. Scenario 2 Emma's carers came into the community pharmacy. They said that Emma was discharged from hospital yesterday. They have been asked to administer her medications, but would prefer them to be in a dosette box to help Emma remember her medicines throughout the day. They have spoken to doctor who is happy to issue a new prescription for a dosette box, however the carers wanted to check if Emma's tablets would be suitable to be put in a dosette. Please help me to find the 3 key issues, strategies / management for each issues, monitoring and follow-up. Thank you.