Over the last 3 years, I progressed from a Band 6 rotational pharmacist to a Band 7 rotational pharmacist covering a wide range of specialties including: Acute and Emergency Medicine, Neurological and Musculoskeletal Diseases, Critical Care, Palliative and Hospice Care, HIV outpatient clinics, General Medicine, Surgery, Cardiology, Critical Care, Oncology and Haematology, Aseptics, Paediatrics, Ophthalmology, Medicines Information etc. These rotations paired with my clinical diploma assessments have allowed me to develop into a clinically competent and confident well-rounded pharmacist.

I am competent with various clinical informatics systems and I am fully confident in operating multiple systems in my practice when clinically reviewing patients on the ward. Additionally, I have been involved in various teaching and training roles, including completing the Propharmace course for Educational Supervisor this year. I was a Designated Supervisor for a trainee pharmacist in year 2022-2023 and a Band 7 representative in the year 2021-2022. Working alongside my colleagues, I have also completed a QI project in 2021::“Improving medication reviews for patients in ICU prior to discharge to ward". This project focuses on improving discharges from ICU to ward level by looking at whether acute medications (i.e. quetiapine for delirium, melatonin for sleep etc.) are reviewed before step-down or if a plan has been written in the discharge section.

In addition to completing the routine CD, antibiotics and missed doses audits, I completed the Trust’s QI Bronze programme and have received positive feedback for my project in improving the quality of discharge summaries in adult cardiac surgery. I presented a poster and a presentation to cardiac surgeons, specialist nurse practitioners working in cardiac surgery as well as to my colleagues. This entire experience built my confidence in public-speaking as I gained several transferrable skills which I hope to bring to the role of a specialist pharmacist. In the last year, I led the Anticoagulation Monitoring Service alongside two specialist nurses and provided training to junior rotational pharmacists and pharmacist trainees. I have also developed a new vaccine prioritisation process in HIV outpatient clinics to improve patient outcomes.

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TLA representatives have been very friendly and responsive to my queries and have provided me with tailored opportunities which suited my needs.

Situation - Trust declared internal critical incident. Extremely busy Monday morning on the wards with multiple outstanding tasks from the weekend, tasks from today and demands from all different directions from healthcare professionals.

Background - COVID cover for a ward, 1 TTA (discharge) on another ward but also urgent medication request from another ward. Nurse on the ward also requested for expired controlled drugs to be destroyed as it had been in the cupboard for a few weeks. Medicines reconciliation required on all wards.

Action - Gathered information to identify urgency of TTA (home soon, then to prioritise flow of the hospital in light of black escalation). Identified the inpatient order was Parkinsons' meds so I ascertained if the morning doses had been given. Drug history was also done promptly to identify any need for critical meds. Destruction of CDs were the lowest priority.

I remained calm and collected under pressure, stayed positive and used my prioritisation skills whilst I slowly listed the tasks down at hand. I was able to prioritise effectively and met deadlines in a timely manner. I work well under pressure as I believe it challenges me and motivates me to work hard whilst ensuring patient safety remains at utmost priority. I demonstrated time management skills and I also understand that if things starts to become overwhelming, I am able to ask for help as I am working in team.

The Medicines Act 1968 legislates for licensing of all medicinal products with claims of relevant medicinal action or function and encompasses all processes involved in the manufacture, marketing, advertisement, wholesale and supply of medicinal products. A medicinal product is therefore understood as any administered substance that is used in the diagnostic processes or in the treatment and prevention of disease.

As a Pharmacist with no prescribing qualifications, I should not prescribe any medication unless it is an annotation or addition under the 'Pharmacy Enabling Policy' of each relevant Trusts. For example, in some NHS Trusts it is considered acceptable for Pharmacists to prescribe creams/emollients or inhalers and regular medications that is 'obvious that it had been omitted without a clear rationale'.

However, if I am a Prescribing Pharmacist (in the near future), I understand that I shouldn't prescribe if I feel uncomfortable or that I am not familiar with the said patient. This would be even more the case if the need of this medication isn't clearly documented in the patients notes and medical records. If I have been asked by a healthcare professional, I would likely speak to the doctor looking after the patient. In addition to just prescribing, I would need to ensure that it is clinically safe and appropriate for the patient i.e. checking the patients' blood results as some medications would be inappropriate for patients with a significant impairment in their renal/hepatic function.

Prescribing can also lead to medication errors such as the incorrect medication, dose, route, formulation etc. which could all lead to consequences that can cause patient harm. Therefore, it is imperative that we stay vigilant.

First of all, I would ensure that this incident/complaint has been reported in an incident reporting system such as DATIX. I would then take steps to understand my involvement and to investigate what had happened and to properly address the incident/complainant's concerns and work towards a goal of resolving this incident/complaint. I would not adopt a defensive approach and I will reflect on my actions. I believe this will help me identify any of my weaknesses and changes needed to ensure I improve my practice in future situations. I will discuss my response with my senior colleagues/line manager to seek for advice. In cases where I am required to be involved in the response process, I understand that my comments will be fairly represented and will ensure my tone is professional, measured and sympathetic.

Clinical governance is defined as “a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish”. I understand that the principles of clinical governance encompasses a range of monitoring systems/processes set in place for which healthcare professionals should become involved in order to maintain and ensure assurance of patient safety and improvement of quality of care they provide to patients across the organisation.

Situation - patient's parents were increasingly frustrated as they have been waiting for their discharge and discharge medications for over '5 hours'. They believed they were in the process of waiting for the pharmacy to dispense their medications and therefore wanted an explanation from me (the ward pharmacist).

As it became clear to me that the parents were angry, I remained calm and adjusted the style of my communication to try and defuse the situation. Firstly, it is important to show that I acknowledge and understand their frustrations. I used a calm tone, lowered the speed and volume of my voice and remained composed. I spoke clearly and ensured my body language was professional and not defensive or confrontational. I listened to their explanation and responded with empathy, and apologised that they have had to wait for such a long time. I explained that I will keep them updated once I have investigated what is causing the delays and thanked them for their patience.

Upon investigation, I found out that the discharge letter had been processed by the pharmacy team but the clinicians were waiting for receipt of todays' blood reports before discharging the patient. I spoke to the doctor in charge and explained the situation and I also kept the family involved, informing them of the reasons. The doctor was happy to speak to the family in regards to why they are waiting for blood results. Finally, I thanked them for their time and I apologised that they had waited for this long without an explanation.