In the last 3 years, I was the Lead Clinical Pharmacist for the Emergency Department (Band 8a) at Mid and South Essex NHS Foundation Trust (Broomfield hospital, Chelmsford). My role involved the following:
• Establishing a clinical Pharmacy service within the Emergency Department (ED).
• Undertaking clinical duties; drug history taking, medicines reconciliation, optimisation, facilitating discharges, counselling patients and working as part of a multidisciplinary team.
• Working as an Independent Prescriber within my personal scope of practice, to ensure patients medicines are prescribed in a safe and timely manner.
• Monitor drug expenditure within the ED, produce reports, interpret and provide recommendations.
• Providing teaching sessions to medical students and junior doctors, about safe prescribing,
• Reviewing and managing of stock, e.g. TTA packs
• Writing and reviewing Patient Group Directions (PGDs) for the Urgent treatment centre.
• Reviewing and managing antidotes. e,g, updating guidance and stock shortage.
• Undertaking clinical audits and implementing changes in prescribing practice in line with evidence based medicine where appropriate. e.g. insulin administration, VTE prophylaxis, implementation of hospital FP10 prescriptions.
• Working with specialist teams within the Trust and the Emergency Medicine Care group to develop clinical guidelines and implement evidence based prescribing e.g. Paracetamol overdose (SNAP guideline) and naloxone administration.
• Attending Clinical Governance meetings and presenting the pharmacy service and providing pharmaceutical input.
• Line management responsibilities. Supporting, completing appraisals and setting objectives.
• Participating in the recruitment process, which includes shortlisting and interviewing candidates.

No.

To find locum employment as a hospital pharmacist.

During very busy periods, in the Emergency Department, there are times where patients aware awaiting a significant amount of time to be clerked by a medical doctor and also awaiting a bed on a ward.
There was this one morning where a renal transplant patient was highlighted to me by the night junior doctor. The doctor was unsure if the patient is on any anti-rejection/immunosuppressants, as the patient could not clearly confirm and therefore not prescribed on the drug chart. The patient was unable to confirm and not on the GP record. Whilst trying to undertake a medication history for this patient, I was interrupted by a senior nurse (new to the trust) asking me how to administer tigecycline to a very unwell patient. At the same time, I was also bleeped by a very angry consultant asking for IVIG for a patient with myasthenia gravis crisis, which was delayed from early hours of the morning. At this point, I knew that all of these needed to be actioned immediately, but I needed to prioritise.

I did the following:
1. Drug history for the renal transplant patient, I asked the medicines management technician to complete the drug history, I would then review, complete the medicines reconciliation and prescribe any regular medicines as appropriate (note: I am an independent prescriber).
2. I directed the nurse to Medusa (username and password), where there is information for the administration of tigecycline.
3. I went to sort out and order the IVIG for the patient in myasthenia gravis crisis.

The decisions above, meant that I was able to prioritise, direct and delegate tasks. I was able to utilise the resources I had available to me, ensuring patient safety and preventing a delay in treatment.

The Medicines Act 1968 is a UK law that regulates the manufacture and supply of medicines. It is divided into three categories;
1. Prescription Only Medicines (POM) – this can only be dispensed by a pharmacy if prescribed legally by a registered prescriber. Or under the direction of an authorised Patient Group Direction (PGD).
2. Pharmacy Only Medicine (P) – this can be purchased from a registered pharmacy, provided that the Pharmacist supervises its sale.
3. General Sale List Medicines (GSL) – this does not need a prescription nor the supervision of a pharmacist and can be obtained from retail outlets.

Medicines act is important in relation to medication safety (medicines optimisation, reducing harm, reducing errors, reducing wastage and optimal treatment). Also, all prescribers should act within the laws outlined by the medicines act.

As an independent pharmacist prescriber, I would do the following:
1. Ascertain who is asking me to prescribe the medication.
2. Understand why this medication needs to be prescribed.
3. Explain that it is not clearly documented within the patients notes and medical record. And as a non- medical prescriber it is not within my scope of practice to prescribe without justification and clinical reason.
4. Discuss with the doctor, who is looking after the patient, explain the situation and come to a decision regarding the prescribing of the medicine and any ongoing monitoring, if required.

I would take the following steps:

1. Discuss with supervisor / line manager.
2. Maintain confidentiality as appropriate.
3. Be aware of Trust protocol/ policy in regards to incidents and complaints.
4. Complete the appropriate incident form.
5. Follow up as appropriate or discuss with the people involved, depending on the situation. For example, if I identify a medication error by a nurse or a screening error by a pharmacist, then if appropriate I would feed back to the individual involved, to highlight and as future learning. If it was an incident or complaint about me, then I would expect to be informed in a professional manner.

My understanding of clinical governance is that there are 7 pillars of clinical governance:
1. Audit – to undertake regular audits as part of the pharmacy team to improve the service provided and patient care, against standards. Identifying ways to improve and actioning this, in order to improve patient care.

2. Clinical effectiveness – providing evidence based care. Using evidence based treatment for patient care. E.g. NICE and local guideline.

3. Education, training and continuing professional development (CPD) – have up to date knowledge and skills to provide high quality care. E.g. keeping to date with revalidation, attending training sessions and relevant courses.

4. Governance and leadership / staff management – having clear roles and responsibilities in place to allow a structured high quality delivery of a service, which allows constant improvement for the best outcome of the patients.

5. Performance and monitoring – undertaking regular reviews and audits, assessing performance against established standards. This contributes to improving overall quality of care. Also involving people who use the service.

6. Risk management – this is for both the patient and healthcare professional. Having a robust reporting system in place for incidents. Allowing incidents to be reported, errors to be learnt from, practice to be improved and changes implemented for patients safety.

7. GDPR and data protection – having the correct systems in place for relevant patient care. E.g. access to patient GP records, to see patients regular medicines, and utilise this as a source of medicines reconciliation.

While undertaking medicines reconciliation for a patient, who was admitted into hospital with severe constipation, confusion and query opioid toxicity. I ascertained that the patient's medicines were managed by the daughter. Note: the patient has a blister pack provided by the pharmacy in addition to medicines outside of the blister pack. On speaking to the daughter, I found out that the patient has been started on morphine sulphate modified release 10mg twice a day with regular paracetamol and morphine sulphate liquid when required. Prior to this, the patient was prescribed a buprenorphine patch which was stopped by the GP. The patient's daughter didn't understand that the buprenorphine patch was stopped and morphine started. Therefore, the patient was still wearing a patch and taking morphine sulphate for over a week.
When I spoke to the daughter, she was being difficult and kept to trying to explain to me that her mother should be on both, as she is always in agony. I explained the prescribing decision made by the GP, and as a consequence of both being administered, the patient is now experiencing adverse affects. After a long discussion with the daughter, I managed to make her understand that both are very similar drugs and the importance of effectively managing pain with pain relief, and any adverse affects. Eventually the patients daughter understood, and appreciated that I spent time explaining all this.

Initially this was difficult for me, as the daughter was not willing to understand, as I felt as though I was repeating myself. However, I tried explaining it in different ways and giving examples, and the daughter eventually understood.