I have spent the last three years working in a specialist and highly specialist oncology pharmacist role in two large, central London cancer centres. During this time, I have worked extensively in outpatient clinics, chemotherapy day units, specialist inpatient wards and hospices. This has enabled me to develop highly specialist clinical and professional skills in the area of haematology and oncology. I have then utilised this knowledge and experience in my role managing the Cancer Research UK (CRUK) regimen-specific systemic anti-cancer therapy (SACT) consent form project.

My roles in outpatient clinics have involved the clinical verification of SACT, patient counselling and provision of medicines and chemotherapy advice to the multi-disciplinary team. My meticulous approach to workload prioritisation has been essential to facilitate the timely preparation of chemotherapy for clinical trial and non-clinical trial patients. I have appropriately managed high-cost drugs in this setting which has required my knowledge of treatment lines and commissioning criteria. I have gained experience as the final releasing pharmacist in aseptic units, providing me with an extensive knowledge of the full patient treatment pathway.

My roles on inpatient wards and hospices have involved ward rounds, drug supplies, medication reconciliation, review of complex medication regimens, therapeutic drug monitoring, interaction and adverse reaction monitoring, patient counselling and discharge planning. Additionally, I have delivered care to some of the most unwell patients in the trust, co-ordinating the safe and timely supply of urgently required chemotherapy. As a highly specialist pharmacist, I have provided advice and support to those more junior to myself in the management of complex cases.

In addition to the delivery of high-quality clinical pharmacy services, I have performed audit and quality improvement projects with a focus on improving service efficiency, capacity and patient experience. I have undertaken cost improvement projects to highlight potential savings within the division. I have presented teaching to pharmacy and multidisciplinary teams locally and nationally and acted as a trainee pharmacist educational supervisor. My dedication to the speciality, driven by a passion to provide the highest quality of care to our patients, has enabled me to become embedded within the teams I work with and implement tangible changes.

No - not applicable.

My current role is fixed-term covering a maternity leave. This role is due to end in March 2024, and I am seeking locum opportunities within oncology after this point. The Locum Agency specifically meets my needs as a professional who strives to deliver the highest quality of care, through their professional but approachable and helpful ethos. In addition, the agency is able to offer posts within a geographical area that is desirable.

I was working on New Year’s Eve, a Sunday, with one band 7 oncology pharmacist. Our roles on a Sunday were to process inpatient medication orders and discharge prescriptions (TTAs) for the 6 haematology and oncology inpatient wards. On a Sunday, the aseptic unit is closed, and there is no emergency on-call service provided. The band 7 was contacted by a haematology consultant requesting urgent chemotherapy for a patient with high risk and rapidly progressing acute myeloid leukaemia (AML). Their chemotherapy had been prepared by the aseptic unit the day before, however their renal function and bilirubin had deteriorated, requiring a dose reduction. A new chemotherapy dose would need to be made by the aseptic unit. The band 7 pharmacist escalated this scenario to me as the senior specialist pharmacist.

I reviewed the patient’s clinical picture and gathered further information from the haematology consultant. I clinically agreed that the patient required chemotherapy urgently, and that this could not wait until the following day when the aseptic unit re-opened. The haematologist was frustrated that there was no emergency on-call service for new chemotherapy doses to be prepared, and the inpatient workload was mounting, at a time close to the dispensary cut off. I recognised that this was a stressful workload, and took a moment to prioritise the tasks required.

I firstly reassured the consultant that I was working to co-ordinate a team to prepare the new dose. During this time, I was conscious of the inpatient workload and time required to resolve the chemotherapy supply. I delegated the discharge prescriptions to the band 7 pharmacist and advised them to process the critical inpatient medication orders. I contacted the lead pharmacist for the aseptic unit who was disagreeable to contacting an aseptic unit technician and pharmacist to make and release the chemotherapy dose. They requested that I inform the haematologist that the dose would be made the following morning. I explained my appreciation that there is no emergency on-call service, however, it was a matter of clinical urgency that the patient received a new dose today, which could not wait until the following day. The patient would be harmed as a result of their rapidly progressing disease. Unfortunately, this scenario could not have been foreseen, but the treatment was urgently required none-the-less. They then agreed to contact a team to come into work.

Having successfully negotiated with the lead aseptic pharmacist, a technician and pharmacist came onto site to prepare and release the new dose of chemotherapy. I delivered the new dose to the intensive care where the patient was admitted, and they were able to receive their dose that evening. I had felt under pressure due to the competing priorities of the ward workload ahead of the bank holiday, aseptic unit lead pharmacist, reduced Sunday staffing, clinical urgency of the chemotherapy and the haematology team. By prioritising and delegating workload and negotiating with the aseptic lead pharmacist and haematologist, the inpatient workload was completed ahead of dispensary cut off times and the new chemotherapy dose was prepared.

The Medicines Act was a key legislation governing the use of medicinal products in the UK. The Medicines Act required that a license, a marketing authorisation, should be held for all medicinal products, and distinguished prescription only medicines, pharmacy medicines and general sales list medicines. It regulated the packaging of medicines, promotion and conduct of pharmacies.

In 2012, much of the Medicines Act was repealed or revoked by the introduction of the Human Medicines Regulations. Both pieces of legislation cover the manufacture, importation, distribution, advertising, sale and supply of medicinal products for human use and pharmacovigilance.

A key aspect of the Medicines Act was the licensing system to regulate the manufacture, distribution and importation of medicinal products. An exemption to Section 10 of the Medicines Act is a significant piece of legislation affecting supply of medicines within hospitals, as it enables pharmacists from the manufacturers license in circumstances where the medicinal product is prepared or dispensed in a hospital by, or under the supervision of a pharmacist and in accordance with a doctor’s prescription, assembling a medicinal product in a hospital under the supervision of a pharmacist, preparing stock of medicinal products by or under the supervision of a pharmacist with a view to dispensing them.

Firstly, I do not hold an independent prescribing qualification, therefore I would advise the requestor that I am unable to prescribe the medication. The query would require referral to the appropriate staff member, e.g. ward doctors who had reviewed the patient. To determine if the medication was appropriate before referring to the ward doctors, I would review the patients past medical history, presenting complaint, allergy status and current clinical status to determine if the medication is clinically indicated. This process would include a review of the patient’s drug history, including confirmation with the patient or their next of kin as a source. I would review the patient's observations, full blood count and biochemical parameters to determine if the medication is safe.

If it remained unclear why this medication was requested, I would speak to the team who had reviewed the patient on the ward round to determine if the medication was intended for the patient, and the clinical indication. If the medication was clinically indicated and appropriate, I would request that they prescribe it. I would document the discussion to ensure that it is clear for other members of staff why the medication has been prescribed. If the medication was not clinically indicated and appropriate, I would ensure that the medication was not prescribed, and document as such.

My management of the scenario would depend on whether the scenario was an incident that had occurred, or a complaint.

My first steps are to assess the impact and safety of the scenario and determine any urgently required actions. If the incident involved a patient, this would be to determine if any actions were imminently required to prevent harm from occurring or any further harm. I would then take the appropriate actions to resolve the incident, including informing the patient of the incident and how this would be resolved, in accordance with a duty of candour. I would report the incident to a member of staff more senior to myself and document the details of the incident. I would also report the incident to the locum agency recruitment consultant. I would also ensure that an incident report was submitted locally for investigation. If a complaint was made, I would inform a member of staff more senior to myself and the locum agency recruitment consultant. I would document a statement in response. Depending on the nature of the incident/complaint, I would also notify and seek the advice of my professional indemnity insurer.

In either circumstance, I would ensure that I acted in a professional, open and honest manner and took accountability for my actions. I would reflect on each scenario and what could have been done better, and apply this learning in my future practice.

Clinical governance is the system through which healthcare organisations are accountable for the continuous improvement of the quality of services and safeguarding high standards of care. It encompasses quality assurance, quality improvement, and risk and incident management.

Medicines are associated with a high level of risk. The role of a pharmacist is to identify and proactively manage such risks, and to take appropriate measures when harm has occurred. In my role as a specialist oncology pharmacist, I was responsible for the investigation of medication-related acute oncology service Datix reports using various incident investigation tools. I attended a monthly multidisciplinary review meeting to discuss incidents, the actions taken, and the learning obtained from incidents. This was an important role in the management of medication-related risk within the service, but also enabled me to participate in the management of non-medication related incidents, too.

The healthcare service, particularly oncology services, are working under an immense amount of pressure. Quality improvement is key to ensure that services are safe, effective, patient-centred, timely, efficient and equitable. Through my role working in both inpatient and outpatient oncology services, I have identified inefficiencies and implemented formal quality improvement projects and informal service improvement initiatives. Once such example, is the digitalisation of prescription delivery from oncology outpatient clinics to the outpatient pharmacy to facilitate the earlier delivery of workload to the pharmacy. A second example, is the harmonisation of irinotecan infusion times, to save both nursing, patient, and chair time on the chemotherapy day units. Assessing the services that we are providing enables a continuous process for improvement, adapting to the changing demands of the healthcare system.

Quality assurance is the process of ensuring service standards are met and encouraging continuous improvement. Clinical and operational audit of services, measured against local and national standards, are key mechanisms to achieve this. Whilst working in my current role, I conducted a national patient experience survey of the consent to SACT process, measured against peer-reviewed national standards. This enabled me to identify areas for improvement across multiple cancer centres, and implement recommendations to improve practice. By measuring our compliance with standards, this enables us to identify areas where improvement is required, and continue to improve our services and assure their quality for patients.

I was working on a haematology ward on a Saturday, when I received a phone call from a patient’s daughter. The patient had been discharged the day before with a weaning course of dexamethasone. The daughter was frustrated because the dexamethasone dosing advised on the discharge summary and medication label was unclear, and an increased dose compared to what the patient had been receiving as an inpatient. I determined if the morning dose had already been given. The daughter had not yet administered this dose. As I was unfamiliar with the patient, I required time to look through their notes and determine what had happened. I explained to the daughter that I would look into the notes and discharge letter and phone them back with an answer within the next hour.

I looked through the patients notes and determined that the patient had incorrectly been prescribed and supplied with a much higher dose of dexamethasone, with an incorrect weaning regimen. The haematology registrar on the ward had worked the previous day and was familiar with the patient. I discussed the dosing with the registrar who confirmed that it was incorrect, and clarified what the correct weaning regimen should be. I phoned the patient’s daughter and confirmed that the dosing of dexamethasone had been incorrectly prescribed and supplied, maintaining a duty of candour. The patient’s daughter was experienced in administration of their mother’s medication and they were happy to administer the correct dose without the medication being re-labelled. I explained the dosing regimen, and asked them to repeat it back to me. I was satisfied that they would administer the correct dosing.

The patient’s daughter was angry that the scenario had happened. I expressed my apologies that the scenario had happened, and reassured the daughter that I would submit an incident report for the error to be investigated and learning to be shared. This satisfied the patient’s daughter, but they remained unhappy with the scenario. I also advised the patient’s daughter that they could contact the patient advice and liaison service (PALS) to lodge a formal complaint if they wished to. I had not been involved in the original error, but I maintained an open and honest approach to resolution of the error. I resolved it promptly and professionally which satisfied the patient’s daughter, informed them of how the incident would be managed and signposted them to PALS.