The Pharmaceutical Journal
Vol 269 No 7229 p918
21/28 December 2002

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Top tips for inexperienced hospital pharmacists on call this Christmas

Many pharmacists who qualified this year and are working in the hospital sector will be undertaking on-call duties over the Christmas period and it seems only fair to offer a little friendly advice to those who are relatively new to the experience. It may be helpful to read and digest the following (possibly while attempting to overcome the hyperventilation induced by everyone else in the department going home and leaving you unprotected). Since you will never absorb anything in your state I suggest you laminate the following, punch a hole in it, attach it to your wrist with a rubber band and step forward with all the confidence you can muster.

Perfect preparation prevents ...

Make a habit of asking key people, eg, the pharmacists for intensive care and acute admissions, if they know of patients about whom you might be called. It is easier to learn about the management of Stevens-Johnson syndrome or methaemoglobinaemia from a senior pharmacist at 4.30pm than alone at 4.30am. While you are at it, make sure you are aware of local policies for the management of alcohol withdrawal and neutropenic sepsis: common on-call pitfalls.

Do unto others ...

If you deal with a problem that is a little out of the ordinary while on call, remember to hand over the information to the ward pharmacist the next morning. Pharmacists appreciate this, and you may also learn something. Not sure if you should have done more? Now is the time to ask.

Can I phone a friend?

No pharmacist has ever been struck off for telephoning a colleague at 2am. Pharmacists have, however, been struck off for harming patients as a result of inadequate skills or knowledge. If in doubt, look it up. If you cannot find it, call someone who might know.

Just do UIT

Many of your calls will be clinically trivial. A smaller number will be important. A tiny proportion (surprisingly tiny) will be both important and urgent. When you feel overwhelmed, decide into which category each call falls and prioritise accordingly: urgent (U), important (I), trivial (T).

Err on the side of caution

It is better to have done something that could have waited than to have refused to do something that later turns out to be important. If you think that a call was inappropriate, speak to your manager and he or she can deal with the person concerned.

Sticks and stones may break my bones ...

... but name-calling could really hurt me. Never, ever, be rude to a caller, no matter what your opinion of his or her intellect, parentage or evolutionary progress. Every second of that warm, righteous anger will earn you 10 minutes of squirming in the office of someone important.

You may be on call, but you are still human — just

People who are very young, very old, very sick or very close to death deserve your compassion: do not leave it in bed when you get up to answer your bleep. A seemingly trivial request may make a huge difference to a patient's quality of life.

Your colleagues also deserve your compassion, the nurse being harangued by the patient admitted without his or her night sedation will appreciate your help enormously. Deliver the item to the ward personally and there is often a strong possibility of virtue being rewarded with tea and ginger biscuits. If no tea is forthcoming, remember that virtue is its own reward ...

Never underestimate the value of the kettle

Every so often you will get a call that leaves you standing clueless, mouth open, dribbling into that Oxford Handbook of Clinical Medicine you paid £20 for. At this point (provided it is not urgent), say that you will ring the caller back, then fill and switch on the kettle. This will have two positive outcomes. First, you get a cup of tea. Secondly, the time taken to boil a litre of water is exactly the time required for calming down and deciding that either you do know what to do or where to start looking, or that you need help.

You never have to work this night again

Shakespeare knew his stuff when he wrote: "Come what come may, time and the hour runs through the roughest day."

All nights will end and you will eventually get to bed. Trust me on this.