Full time employment at a large teaching hospital in london.

12 month rotations completed in women’s health and neonates, surgical specialties, including 12 month secondment in ICU and thoracic services and deputy lead in education.

Completed diploma, IP, and supervisor training.

No

Recommendation from a colleague

We recently had a situation where an elective patient came to hospital without her medications. She had a past medical history of HIV and reported to nursing staff that she was on two antiretrovirals (ARV), although could not recall the names nor doses. The patient was beginning to get impatient and wanted her medicines, which caused the nurses to repeatedly phone me for assistance. Her pre-assessment medication history was documented unclearly, only listing temozolomide. I reviewed the medicine on BNF, which explained temozolomide was a chemotherapy agent in brain tumours . The patient did not have a past medical history of cancer so this was more confusing. I spoke directly to the patient after this, and explained that I would do my best to confirm her medication history before ordering any medicines so we were sure she received the exact medicine she took at home. The patient accepted this and further provided the name of her specialist clinic. After contacting her clinic to explain the dilema, I emailed them from my secure NHS email address, keeping in line with GDPR. Once the clinic replied I was then able to order her medicines from pharmacy stores, and supply them to the ward thus preventing dose omissions.

The Medicines Act 1968 is the legislation that governs the safe and effective use of medicines by regulating manufacturing, distribution, sale and supply of medicines.

As a pharmacist independent prescriber I am obligated to prescribe within my clinical competency. If the medication is not within my clinical competency I would refuse to prescribe and signpost the requesting colleague to contact the patients parent team.

If I am authorised to prescribe, I would hand over to the nursing team that I would not be able to prescribe until confirming what the medication was required for as there are no clinical records. I would query its indication with the requesting team (such as medical doctors, advanced nurse practitioners, specialists etc) and ask them to document the plan for the medication in the patients clinical notes. I would also include the patient in the process by confirming with them if they were aware of this medication and what it was for, and if they weren't, providing counselling and reference materials for reassurance. I would confirm the safety and efficacy of the medication through use of information resources such as BNF, summary of product characteristics, medicinescomplete or up to date before prescribing.

I would gather as much information as possible about the incident from the incident reporter, in order to begin my own reflection and I would invite the reporter to complete an adverse incident report form such as Datix. I would complete a reflective account, for example using the swiss cheese model and three buckets model to outline why the error may have occurred, what factors were involved which could have led to the error, and what I would implement to prevent similar incidents in future. I would also complete a CPD reflection, for my own learning and development. I would also inform my line manager and share my reflection and learning to confirm that I have understood what has happened and request feedback from my line manager and colleagues for how I can continue to improve.

Clinical governance allows healthcare practitioners to continuously evaluate and improve their practices for the betterment of service provision and ultimately, patient care.

It is underpinned by 7 domains:

1. Evidence based care and effectiveness
2. Risk management
3. Patient and public involvement (PPI)
4. Clinical audit
5. Staffing and staff management
6. Education and training
7. Information & IT

I recently had an issue where I had to decline a medicine which was prescribed for a patient. The patient's relatives came to the outpatient pharmacy to collect tadalafil 5mg OD for penile rehabilitation in a patient with Peyronie's disease, unforunately the Trust formulary only approved tadalafil 5mg OD penile rehabilitation regimen for 3 months in patients post-prostatectomy as these patients are predisposed to erectile dysfunction, and patients with nerve sparing prostatectomies may regain their erections through penile rehabilitation with tadalafil 5mg OD.

As this outpatient did not meet the criteria for supply under our formulary, I had to inform the patient and their relatives that I could not supply it. The relatives were very angry on the patients behalf, dismissive of my rationale for being unable to supply and insulting my professional competence for going against the consultants wishes. I explained the purpose of the Trust formulary, which allows healthcare professionals to practice safely under agreed protocols and added that the consultant would need to apply for expansion of the use of tadalafil 5mg OD through the Trust's formulary committee for me to supply in the patient's situation. I had also informed the consultant before refusing to supply and they were understanding, yet when I explained this to the patient and their relatives, they were very upset.

Despite being shouted at, I maintained my professionalism and did my best to solve the issue. I offered alternatives which are allowed under the formulary, such as 5mg or 10mg on alternate days (maximum 3 per week), similar to on-demand therapy, which they accepted. I informed the consultant also, and the prescription was changed to adhere to the formulary requirements. By the end of the interaction, the relatives were much more understanding and apologised for their reaction.