I semi-retired in 2019 and since then have worked as a locum pharmacist for a few months each year since then. I have worked three locums on Saint Helena Island covering the only pharmacist which was both interesting and challenging. As well as managing the pharmacy I managed the store staff and also worked on a project with the CMO to improve store supply. I was also involved in the covid vaccination programme. This year I worked a locum for Asprey Medical covering mental health for Southern and Solent mental health trusts. My ward work involved AMH, OPMH, adolescent mental health and a mother and baby unit. I was also involved in clinical audit and staff management.

No

I was impressed with the initial contact from the agency and the regular updates from the recruiter.

The last time I worked on Saint Helena I arrived on the same plane as a visiting ophthalmic surgeon, who was only on the island for a month and had a number of different eye surgeries booked in. He had pre-ordered stock of eye drops etc but when I checked the stock there were a number of items missing. The island only receives a regular order by boat once a month which has to be ordered ahead or weekly by plane from South Africa, which is complex due to the import laws. I went through the items and the operations with him and we managed to substitute some items. We also had some items sent over from South Africa, found some in the clinical room cupboards but were still short. Finally I contacted the clinic in the Ascension Islands and managed t get some items sent on the plane from there. The outcome was good. Although some operations were delayed they were all completed whilst the surgeon was there. We also put a plan in place for his future visits to ensure that he was informed in time of any shortages and substitutions and had a full stock.

The Medicines Act 1968 was an act of parliament brought in after the issues with the drug thalidomide to ensure that there was a system of licensing for both manufacturing and dealing in medicines. It also introduced the legal categories for medicines. There have been various amendments to the act over the years, and also complimentary acts, such as the Misuse of Drugs Act 1971 to ensure it remains relevant and up-to-date.

I think my course of action would depend on who was asking me to prescribe and the rationale behind. In a hospital setting Initially I would want to contact the prescriber or team in charge of the patient’s care. Ideally then I would like to see that a consultation had been written up in the patient’s notes and a new prescription written up before the medication was dispensed. If a doctor was contacting me I would again ask if they could amend the notes and medical record accordingly but I would also pc both and add my own notes to the records to ensure that our conversation was noted, and there was an audit trail for the medication.

Firstly I would like to ensure that there has been a satisfactory outcome to the incident or complaint. I would then enter the incident into the reporting system. From a personal point of view I would like to reflect on my part in the incident and whether I needed to amend my actions or do further training to ensure it didn’t recur. If it was a system error I would like to examine our systems to see where improvements could be made. I would also like to share the incident with the rest of the staff so that they could be aware of a potential problem.

Clinical Governance is a system through which healthcare organisations are accountable for safeguarding and continually improving their service quality. It is often broken down into the 7 pillars Wwhich are:
1. Education and Training
2. Clinical audit
3. Clinical Effectiveness
4. Staff Management
5. Patient and Public involvement
6. Risk Management
7. Information Management

When I was working in mental health earlier this year we had a young patient on the psychiatric intensive care ward who had suffered a manic episode whilst at university. He had been started on medicine for ADHD in India as a young teenager. At the MDT we decided that a good treatment plan would be to stop all his medication, including the stimulant medication for ADHD and then see if what we needed to reinstate. We had a meeting with mum to discuss this and she was initially very upset that we were stopping medication and understandably nervous that we might make his condition worse. I assisted the consultant in explaining the rationale for our decision and to reassure mum that he would be monitored closely. I devised a plan to taper off the medication over a number of days and suffered no I’ll effects. He was moved from the PICU to the AMH ward and his discharge was planned before I finished my locum.