Kieran Casey-McEvoy
MY pharmacy career so far…
I started my pharmacy career back in 2003, although I didn’t actually know it then!
I was a 16-year-old school leaver, had just completed my Standard Grade’s (Scottish equivalent of GCSE’s) and wasn’t able to do the higher education courses I wanted to, so left school and went to work for the biggest local employer in a town on the outskirts of Edinburgh, very close to home.
The role was within a research company, but back then it was a ‘job’ and I didn’t realise that 13 years later, I’d still be working in a similar field (albeit a different role) or that this job would become a career, and more importantly a profession.
Thinking back, one of our dispensary technicians in the research labs was actually doing the SVQ to become a pharmacy technician, but I just didn’t realise what it was at the time.
I have had a fair few different roles over the years, and somewhat varied.
London bound
When I moved to London in 2008, I stayed within the research field, but more in a quality assurance role, although somewhat briefly before applying for a role within an NHS Pharmacy Manufacturing Unit at St Thomas’ Hospital. It was from there that I realised what pharmacy was. I stayed as a pharmacy assistant for almost 2 years before embarking on the Pre-registration Trainee Pharmacy Technician (PTPT) course within the same Trust. This lead me to understand what being a pharmacy technician was all about, and helped me to link up the ways in which different pharmacy teams work together as part of the wider multidisciplinary team and healthcare system.
Once I completed my 2 year PTPT course, I embarked on a challenge. I joined the Whittington Health NHS Trust working as a pharmacy technician within the district nursing team, and worked to become senior pharmacy technician.
This role is unique – I have been unable to find any other technicians performing the same tasks throughout the UK. Whittington Health is an integrated care organisation providing both hospital and community services. The district nursing service provides 24-hour expert care to housebound adults over the ages of 16 in the London Boroughs of Haringey and Islington.
The teams are multi-disciplinary and made up of nurses, healthcare assistants, assistant practitioners, phlebotomists and administrators, who all carry out a variety of tasks.
Lone ranger
A typical day starts at 8.30am. The allocation of patients to be visited is received the previous afternoon by e-mail on Trust issued iPads. This allows more time for patient care, and less time within the office. As the role is lone working, it is important to ensure we keep in contact with that day’s team’s co-ordinator, in line with lone working policies. The co-ordinator is an experienced nurse, who runs the shift – they are the first point of contact and can provide support or advice when needed.
My first patient is Rose, who recently started on insulin for Type 2 Diabetes. I read through the progress notes, and checked the care plan to ensure I was fully aware of the care to be provided. I checked her blood sugar level using a glucometer, and injected the prescribed dose of insulin subcutaneously into her lower abdomen. I documented my care in the district nursing notes which are kept in the home. I also identified that Rose only had one week’s supply of insulin and needles left, so ordered more using an order form on the iPad. This was sent by e-mail to the GP. I also sent an e-mail to the diabetic specialist nurse to relay the previous week’s blood sugar levels to check if the insulin dose needed to be titrated.
My next visit is to John who was prescribed Dalteparin (Fragmin®) twice daily. It is essential that I visit as early as possible, as this will impact on the time our twilight service can visit to give the evening dose. John was recently discharged from hospital following diagnosis of deep vein thrombosis (DVT).
I then visited Michael, who was discharged from hospital following cataract removal surgery. He came onto the caseload from a nearby team, and I was asked to visit to assess whether he could self-administer his eye drops. He had been prescribed a four week course of four times daily eye drops (dexamethasone and chloramphenicol).
Michael explained his other long term conditions including COPD, and how he manages his oral medications, inhalers and nebulisers. Michael had poor dexterity and struggled to administer the eye drops. We tried using an auto-dropper device, but Michael didn’t have the strength to grip this. I made the decision that Michael was unable to self-administer and would require a visit four times daily. I fed this back to the team over the phone, and documented everything in an e-mail to the team’s co-ordinator and team manager. Back in the office I copied the contents of the e-mail onto Rio, our electronic patient records system.
I completed the rest of my scheduled visits for the morning, returned to the office for lunch, and recorded the outcomes of my visits on our electronic patient records system. We then had our clinical handover after lunch, before seeing our afternoon patients.
In a normal day, we visit around 14 patients, but this is dependent upon the care required. A basic visit would be 15 minutes, but some care or assessments can take around an hour.
Diverse roles
As a pharmacy technician within the district nursing team, my main tasks are:
- Administering medication – including oral, subcutaneous and intramuscular injections, as well as administering intravenous antibiotics via peripherally inserted central catheter (PICC) lines.
- Performing medication use reviews – to ensure patients are able to manage independently and check what interventions we can put in place to aid independence.
- Health promotion activities – we try to encourage patients to live healthier lifestyles, such as stopping smoking, reducing alcohol intake and eating healthily.
- Competency assessment of healthcare assistants and pharmacy technicians – ensuring they meet the necessary competencies to administer medication independently.
- Providing medication advice to our colleagues in the team – answering queries, or re-directing queries to appropriate people (GP’s, community pharmacy, medicines information).
- Project management – I was the lead on a project to change the way in which dressings were supplied to patients, working collaboratively with the CCG and local GPs. Our main vision was to:
- Improve patients’ treatment experience
- Reduce delays in treatment
- Reduce wastage
- Reduce costs
- Reduce workload for general practice, district and community nurses
- Improve formulary compliance.
Moving on up
I moved on from this post in October 2015, and I am now senior pharmacy technician for medicines finance at King’s College Hospital NHS Foundation Trust. I enjoyed my previous role, but it was somewhat difficult being the sole pharmacy technician in a team who didn’t really understand my role as a pharmacy technician, or the remit of my responsibility.
My new role involves leading on the day-to-day tasks required for our homecare services, off tariff drug reporting, some ward based medicines management, and dispensary duties.
As pharmacy technicians, we play an integral role in our own right. We play a vital role in ensuring medication safety, and optimising the use of medication in patient care. As our career path expands, it offers non-traditional roles for pharmacy technicians to be able to further impact upon patient centred care.
In my short time of 3 years as a pharmacy technician, I have already seen how the roles being undertaken have significantly evolved over a few years, who knows what the future holds.
Kieran Casey-McEvoy is senior pharmacy technician, medicines finance at King’s Collegc Hosptial NHS Foundation Trust, website/IT/publicity officer and workstream lead for communications at the Association of Pharmacy Technicians. He is also one of the co-ordinators for @WePharmacists
Follow Kieran @kdcm87