| Nazish Khan is a basic grade pharmacist at Selly Oak Hospital, University Hospital Birmingham NHS Foundation Trust |
My preregistration training was with the Sandwell and West Birmingham NHS Trust. This trust consists of Sandwell General Hospital (my base hospital) and City Hospital (located five miles away). After having experienced working at both sites as a vacation student, I thought that I would get the best training and widest exposure to the many varied aspects of hospital pharmacy by undertaking my preregistration training with the trust. I was one of five preregistration trainees, three of us being at Sandwell and two at City. The training was based on cross-site monthly rotations designed to allow us to gain a wide breadth of experience and to understand the working dynamics of both the staff and the department.
Dispensary
As an introduction to the preregistration year my first rotation was in the dispensary. During this time I worked as an assistant technical officer (ATO) and dispensing technician. I found this particularly helpful as it allowed me to understand the workings of the dispensary, familiarise myself with the computer system and the pharmacy work tracking system on which all work was logged. Performing the everyday duties of the ATOs and technicians helped me meet the performance criteria and competencies relevant to the rotation. Also, it gave me an insight into their roles and responsibilities and how they can alleviate some of the pressures put on pharmacists.
My subsequent dispensary session was more clinically oriented. I was expected to think and work as a pharmacist would. All the prescriptions that came into the department were initially clinically checked, then labelled, dispensed and, finally, accuracy checked. Having covered the dispensing competencies in the first rotation, I was able to focus more on the clinical aspects of the prescriptions. While assisting a senior pharmacist, I clinically screened prescriptions. This was similar to what a pharmacist would do at ward level, the only difference being that neither patients nor their notes were immediately at hand.
Clinically screening prescriptions for appropriateness, dose, frequency and other patient factors, and contacting doctors, allowed me to develop and improve my communication skills. This boosted my confidence and expanded my knowledge base. More importantly, with guidance from senior pharmacists, I was able to develop a methodical routine for screening prescriptions and, in turn, trust my own judgement when it came to making decisions.
Towards the end of the rotation, I started my accuracy checking log. After reading the relevant standard operating procedures, I had to check a set number of items under the supervision of my tutor. As an extension to this, I followed up by handing out medicines to patients and counselling them on their appropriate use. I ensured that I covered a range of different areas, including eye drops, creams, inhalers and patches.
Medicines information
Medicines information was, by far, the most enjoyable and interesting rotation of the year and was the perfect opportunity for me to develop my analytical and problem-solving skills. Again, with support and guidance from pharmacists and technicians, I was able to learn lots of new and interesting facts relating to clinical practice and further develop my confidence and communication skills. Using MiCAL (a computer assisted learning package) and the medicines information training workbook, I was able to receive queries, perform comprehensive literature searches (internet databases and textbooks), evaluate and retrieve the relevant data and provide evidence-based answers. I dealt with a range of queries, both simple and complex, from a diverse source of enquirers including GPs, hospital doctors, nurses, schools, practice pharmacists, community pharmacists and members of the public.
Aseptics
During my time in the production unit, I was able to get involved in the centralised intravenous additive service, to compound adult and neonatal total parenteral nutrition (TPN) and to observe the reconstitution of cytotoxic chemotherapy.
While shadowing the pharmacist, I was able to attend a nutrition ward round, which gave me an insight into the factors that are taken into account when deciding to initiate a patient on TPN, in addition to deciding which regimen would best suit a particular patient. During the rotation I was also able to spend some time in the endoscopy unit at City Hospital, where I observed various endoscopic procedures, biopsies and the insertion of percutaneous endoscopic gastrostomy tubes.
Medicines management
Medicines management was a new rotation in which I covered aspects such as risk management, clinical governance, National Institute for Clinical Excellence guidelines and national service frameworks. Although the rotation involved a considerable amount of reading, it was useful in allowing me to understand how a pharmacist’s role can be used to implement such concepts and how we can become involved in developing formularies and prescribing policies. In addition, I spent some time in the ordering office, observing the procedures through which drugs and other pharmaceuticals are ordered, and then going on to supervise the process myself. Spending large amounts of money, even if it was mainly on medicines, was enjoyable, and also gave me an idea of the huge sums involved.
Community secondment
During my community secondment, I spent a week with an independent pharmacy and three weeks with Boots. I was a given a good insight into how the two differ in practice. At both pharmacies, I gained experience in over-the-counter prescribing and providing advice on the treatment of minor ailments. I was able to take the opportunity to learn how to use, and understand the Drug Tariff, endorse prescriptions, deliver and set up oxygen cylinders, take part in various health promotion initiatives and liaise with GP surgeries. Overall, the training I received was good and was heavily geared towards the requirements for the registration examination.
Miscellaneous (City Hospital)
Eye hospital While at the eye hospital I was able to attend various surgical procedures, including corrective laser eye surgery and cataract operations. I also spent some time in the histology department where I was able to dissect a pig’s eye (great fun!) and study the different anatomical features, that make up the eye, under a high power microscope.
Royal Orthopaedic Hospital This was a short but worthwhile rotation. I was able to attend an magnetic resonance imaging scanning session, an oncology clinic where I shadowed both doctors and nurses and sat in on various consultations, and I was even able to see a biopsy being taken. The best part of my time here was going into theatre to observe knee replacement surgery. I never expected the surgeon to pick up a hammer and chisel though!
Radiopharmacy Here I was able to observe the reconstitution of radiopharmaceuticals and sit in on various treatment sessions.
Mental health This was a busy rotation but I learned a great deal by shadowing the mental health pharmacist. During the rotation, I was able to sit in on various multidisciplinary team meetings, and listen to case reviews of several patients. I then choose the case that most interested me and presented it to my colleagues. It was a good way of meeting a few competencies and gaining some confidence.
Wards During the last few months of the year I was back at my base hospital, where I was able to work alongside pharmacists at ward level. I found that I was now able to tie together the different skills that I had picked up during the year: taking patient drug histories; analysing drug charts for clinical appropriateness, safety and efficacy; using patients’ notes; interpreting laboratory results; and liaising with doctors and nurses. It was during this rotation that I realised that the role of a pharmacist is not one of supply, as some think, but the provision of a pharmaceutical service so that patients receive the best possible care.
It felt as though I was finally getting some responsibility when I was given my own ward to cover (under supervision, of course), namely the stroke rehabilitation unit. Getting to know the doctors and nurses helped to develop my confidence and team working skills as well as allowing me to expand and use my knowledge base to solve many pharmaceutical care issues, eg, alternative dosage forms or routes. This continuity of interaction between myself and other health care professionals promoted a trusting relationship and encouraged dialogue. The flow of information was mutually beneficial.
Finally . . .
Looking back on the year, I can say that I enjoyed my time at Sandwell and West Birmingham. I was presented with a well structured training programme that gave me a good insight into the many different aspects of hospital pharmacy. I was able to make the transition from student to preregistration trainee and build on the knowledge acquired at university. The training received has given me a strong foundation on which to build my future career as a hospital pharmacist.
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