I am an accomplished Lead Antimicrobial Pharmacist with expertise in antimicrobial stewardship, resistance, and infection control. As a non-medical prescriber, I play a vital role in ensuring optimal patient care and safety.

I have been a lead pharmacist (Band 8) for several years, specialising in microbiology, antimicrobial pharmacology and a non-medical prescriber. I have become a visiting lecturer at Greenwich university, an accomplished diploma supervisor, trainee pharmacist tutor and educator for both medical and non-medical prescribers. I provide public speaking and education sessions for healthcare professionals nationwide on antimicrobial and infection issues.

With a passion for education and knowledge sharing, I engage in lecturing and public speaking engagements on various subjects, specializing in antimicrobial and infection management. I believe that raising awareness and fostering understanding in these areas is crucial for combating the growing global threat of antimicrobial resistance.

In addition to my speaking engagements, I am proud to serve as a tutor for trainee pharmacists and postgraduate pharmacists. By mentoring and guiding aspiring professionals, I contribute to the development of a skilled workforce dedicated to patient-centered care and evidence-based practice.

Throughout my career, I have actively contributed to the advancement of antimicrobial stewardship programs within healthcare institutions. I have collaborated with interdisciplinary teams to develop and implement strategies that promote the appropriate and responsible use of antimicrobials, aiming to reduce the emergence and spread of resistant organisms.

My dedication to patient safety, continuous learning, and fostering collaboration within the healthcare community has earned me a reputation as a trusted expert in the field. I am committed to staying at the forefront of advancements in antimicrobial management and infection control, ensuring that I can provide the most up-to-date information and guidance to fellow professionals and stakeholders.

I have become an experienced antimicrobial pharmacist, lecturer and tutor who is passionate about improving patient outcomes and tackling the challenges of antimicrobial resistance.

No

To complete locum shifts

I found myself under pressure in an out of hours scenario when dealing with a septic overseas patient requiring ceftolozane-tazobactam and aztreonam for a multi-drug resistant pseudomonal infection.
Unfortunately, due to a manufacturing shortage and a lack of stock on-site, I discussed with the on-call consultant microbiologist the need to switch therapy due to the limited available options.

**Actions Taken:**
1. **Assessment of Available Options:**
- Quickly assessed the stock situation and manufacturing shortage to determine the immediate availability of the required antibiotics.

2. **Consultation with Microbiologist:**
- Engaged in a detailed discussion with the consultant microbiologist to explore alternative antibiotic options considering the unavailability of ceftolozane-tazobactam and aztreonam.

3. **Stock Options and Recommendation:**
- Presented available stock options and recommended a therapeutic plan that involved amikacin with concomitant cefiderocol until ceftolozane-tazobactam could be procured.

4. **Enhanced Sensitivity Testing:**
- Suggested putting the bacterial isolate through enhanced sensitivity testing to explore potential alternative options that may be effective against the multi-drug resistant pseudomonal infection.

5. **Communication with Healthcare Team:**
- Maintained open communication with the healthcare team, ensuring that they were informed of the situation, the proposed plan, and the rationale behind the chosen course of action.

**Outcome:**
1. **Resolution of Sepsis:**
- The patient's sepsis resolved by day 2 following the initiation of the recommended antibiotic regimen, including amikacin and cefiderocol.

2. **Transition to Monotherapy:**
- As the patient responded well to the initial therapy, it was possible to transition to monotherapy with ceftazidime-avibactam which was suggested by myself due to the sensitivity panel obtained and accepted by the parent surgical team and Consultant Microbiologist.

3. **Documentation and Compliance:**
- Completed the relevant non-formulary and Blu-Teq forms to ensure compliance with hospital protocols and regulatory requirements.

4. **Referral to Urology Surgeons:**
- Facilitated the referral of the patient to urology surgeons for the removal of the infected ureteric stent, addressing the source of the infection.

5. **Successful Patient Outcome:**
- The patient was successfully cured through the collaborative efforts of the antimicrobial team and the intervention by urology surgeons.

In this scenario with quick and informed decision-making, collaboration with the healthcare team, and consideration of alternative options we contributed to a successful resolution of the patient's sepsis and beneficial long-term outcome.

The Medicines Act 1968 is a piece of legislation in the United Kingdom that regulates the licensing and marketing of medicines.

The primary purpose of the act is to ensure the safety, quality, and efficacy of medicinal products for human use. The act establishes the regulatory framework for the pharmaceutical industry in the UK and provides the legal basis for the control and supervision of medicinal products.

Key aspects of the Medicines Act 1968 include:

1. Licensing of Medicines: The act outlines the procedures for obtaining a marketing authorization for medicinal products. It establishes the Medicines and Healthcare products Regulatory Agency (MHRA) as the regulatory authority responsible for evaluating and granting licenses for medicines.

2. Product Safety and Quality: The act sets standards for the safety, quality, and efficacy of medicines. It includes provisions for Good Manufacturing Practice (GMP) to ensure that pharmaceutical companies maintain high standards in the production and distribution of medicines.

3. Classification of Medicines: The act classifies medicines into different categories, such as prescription-only medicines (POM), pharmacy medicines (P), and general sales list (GSL) medicines. This classification determines the level of access and control over the distribution of the medicine.

4. Advertising and Promotion: The act regulates the advertising and promotion of medicines to ensure that information provided to healthcare professionals and the public is accurate, balanced, and not misleading.

5. Controlled Drugs: The act includes provisions for the control and monitoring of substances classified as controlled drugs, which have the potential for abuse or dependence.

6. Pharmacy and Dispensing Regulations: The act also addresses the role of pharmacists in dispensing medicines and outlines regulations related to pharmacy practices.

Since its enactment, the Medicines Act has undergone various amendments and updates to keep pace with advancements in the pharmaceutical industry and changes in regulatory standards. It plays a crucial role in safeguarding public health by ensuring that only safe and effective medicines are available in the market.

Prescribing medication falls under the responsibilities of a medical doctor or another authorised prescriber. Depending on who made the request, you should ascertain several of the relevant facts regarding the request. This scenario depends on if you are, or are not a Non-medical prescriber with a scope of practice that covers the request.

Before taking any action, verify the prescription request with the prescriber responsible for the patient (e.g. the acting consultant or nominated medical deputy). Contact the prescriber to confirm the details of the prescription and to seek clarification if necessary.

Document the Communication: You should communicate with the prescriber regarding the prescription request, make sure to document the details of the conversation, including the prescriber's instructions and any clarification provided. You should note the urgency of the request and whether or not the prescriber is able to prescribe the request.

Follow Hospital Protocols: Hospitals typically have standard operating protocols and procedures in place for handling situations where prescriptions are unclear or require clarification. These protocols should be followed.

Seek Authorization: You should not dispense the medication until you have obtained proper authorization from the prescriber or relevant medical personnel. Dispensing medications without a valid and clear prescription can lead to serious consequences.

Document Actions Taken: Document all actions taken to verify and clarify the prescription or request, including any communications with the prescriber or medical team. This documentation is important for accountability and legal purposes.

Report to Supervisors: If the issue persists or if there are concerns about patient safety, report the situation to your immediate supervisor or the appropriate chain of command within the hospital.

The safety of patients is paramount and no prescription should be completed unless done by an appropriately responsible prescriber. Any actions taken if not following a prescription should be appropriately documented and reasons for action recorded, following good due diligence and professional judgement.

If you become aware of an incident or complaint in which you, as a hospital pharmacist, are involved or implicated, it's important to handle the situation professionally, ethically, and in accordance with established protocols. The following steps should be undertaken:

Stay Calm and Objective:

Remain calm and composed when you become aware of the incident or complaint.
If patients have come to harm or about to come to harm, ensure immediate remedial action is undertaken to prevent or relieve harm.

Gather all available information about the incident or complaint to fully understand the context and specifics.
Review any relevant documentation, such as patient records, prescriptions, or communication logs.

If the incident involves an error on your part, be open, transparent and honest in addressing and resolving issues.

Report to Supervisor or Manager:

Notify your immediate supervisor or manager about the incident as soon as possible.
Provide a clear and accurate account of the situation, including your involvement.
Cooperate with Investigations:

Cooperate fully with any internal or external investigations that may be initiated.
Provide any necessary information, documentation, or statements to assist in the investigation process.
Learn from the Incident:

Use the incident as an opportunity for learning and improvement.
Identify any contributing factors and consider how similar incidents can be prevented in the future.
Follow Hospital Protocols:

Adhere to the hospital's established protocols for incident reporting and resolution.
Follow any specific procedures outlined by the hospital or regulatory bodies.

Work Toward Resolution:

Collaborate with the appropriate parties to work toward a resolution that addresses any issues identified during the investigation.
Implement corrective actions as necessary.

Document Actions Taken:

Keep detailed records of all actions taken in response to the incident or complaint.
Document any changes or improvements made to prevent similar incidents in the future.

Consider completing a reflective account of the incident to show your insight and learning of an incident.

Clinical Governance is a framework that emphasizes the continuous improvement of quality and safety in healthcare services. It involves a systematic approach to maintaining and improving the quality of patient care within a healthcare organization. As a hospital pharmacist, your role within the Clinical Governance framework would involve various aspects related to medication management and patient safety. Here is an outline of key components and concepts related to Clinical Governance:

1. **Patient-Centred Care:**
- Clinical Governance places a strong emphasis on providing care that is centered around the needs and preferences of patients.
- As a hospital pharmacist, your role involves ensuring that medication-related services contribute to positive patient outcomes and experiences.

2. **Clinical Effectiveness:**
- Focuses on ensuring that healthcare interventions, including medications, are evidence-based and result in the best possible outcomes for patients.
- Pharmacists contribute to clinical effectiveness by promoting the rational and safe use of medications.

3. **Risk Management:**
- Involves identifying, assessing, and managing risks associated with patient care.
- Hospital pharmacists play a crucial role in risk management by addressing issues such as medication errors, adverse drug reactions, and ensuring the safe use of high-risk medications.

4. **Patient Safety:**
- A core aspect of Clinical Governance is the commitment to ensuring patient safety at all levels of healthcare delivery.
- Pharmacists contribute by implementing safety measures in medication processes, participating in error reporting systems, and actively engaging in initiatives to reduce medication-related harm.

5. **Audit and Monitoring:**
- Clinical Governance involves regular auditing and monitoring of healthcare practices to ensure compliance with established standards.
- Hospital pharmacists may participate in audits related to medication storage, dispensing accuracy, and adherence to prescribing guidelines.

6. **Education and Training:**
- Ensures that healthcare professionals, including pharmacists, are adequately trained and educated to deliver high-quality care.
- Hospital pharmacists play a role in ongoing education, training, and professional development to stay current with best practices in medication management.

7. **Clinical Leadership:**
- Encourages strong leadership within clinical teams to drive improvements in patient care.
- Pharmacists may take on leadership roles in medication-related committees, contribute to clinical decision-making, and collaborate with other healthcare professionals to enhance patient outcomes.

8. **Openness and Transparency:**
- Clinical Governance promotes a culture of openness, transparency, and accountability.
- Pharmacists are encouraged to report and learn from errors, contribute to a blame-free culture, and actively participate in quality improvement initiatives.

9. **Patient and Public Involvement:**
- Recognizes the importance of involving patients and the public in decision-making processes.
- Pharmacists can engage with patients to gather feedback, address concerns, and involve them in medication-related education and decision-making.

10. **Continuous Improvement:**
- Clinical Governance is a dynamic process that encourages ongoing reflection, learning, and improvement.
- Hospital pharmacists are expected to actively contribute to continuous improvement initiatives, adopting evidence-based practices and embracing opportunities for learning and development.

In summary, as a hospital pharmacist within the Clinical Governance framework, you play a pivotal role in promoting patient-centred, safe, and effective medication management. Active participation in quality improvement, risk management, education, and leadership activities contributes to the overall goal of enhancing the quality of healthcare services and patient outcomes.

**Situation:**
In the outpatient infection clinic, I was part of a healthcare team involved in managing a patient with an untreatable prosthetic joint infection of the knee. The patient had become resistant to all available antimicrobial options, and after a thorough assessment, it was determined that there was no suitable medical therapy. The only viable management option presented to the patient was an above knee amputation due to the high risk of death from sepsis if left untreated. The patients relative (spouse) was understandably upset and queried did we not have any other alternative options, unfortunately, the organism grown was now fully resistant to all oral options and we had cycled through several intravenous options in the past with limited success. We followed the below process on handling this situation, ensuring the patient and their partner had full access to information to make an informed decision on their care.

**Handling the Situation:**
1. **Delivering the News:**
- We approached the patient with empathy and sensitivity, recognising the emotional impact of the information.
- We clearly communicated the severity of the situation, explaining the reasons behind the recommendation for amputation.

2. **Providing Emotional Support:**
- We acknowledged the emotional distress of the patient and her partner.
- We offered emotional support by expressing empathy and understanding. We allowed them the time and space to process the information.

3. **Offering Information:**
- We provided detailed information about the proposed procedure, including the benefits, risks, and potential outcomes.
- We sought to answer any questions the patient and her partner may have, ensuring that they have a clear understanding of the situation and the proposed intervention.

4. **Assessing Understanding:**
- We assessed the patient and her partner's comprehension of the information provided.
and encouraged them to ask further questions and seek clarification on any aspects they find unclear.

5. **Involving Relatives in the Decision-making Process:**
-We involved the patient's partner in the decision-making process, acknowledging the impact of the decision on both individuals.
- We ensured that both the patient and her partner have an opportunity to express their concerns and preferences.

6. **Consent Process:**
- We clearly outlined the consent process for the proposed procedure.

7. **Documenting Discussions:**
- We documented the discussions and interactions with the patient, her partner, and any decisions made during the encounter.

The patient at the end of the situation was understandably upset and wanted some time to consider the information provided. Eventually, she consented to the operation and was scheduled for an elective above knee amputation. I visited her pre-operatively and prescribed the relevant IV antimicrobials for the procedure and visited her post-operative in the intensive care unit to check how she was getting on. She then consented to our OPAT (outpatient parental antimicrobial) service for a further 6 weeks to ensure adequate clearance of any residual infection due to the procedure.