Katie Waghorn
As I have progressed through my university career, I have become interested in the idea of working as a hospital pharmacist. Although my university provided me with some mornings in Aberdeen Royal Infirmary, I still felt I did not have enough experience to make a true decision with regards to my future career path, with my pre-registration year coming near. Due to this, I decided to interview for the NHS Scotland Hospital Pharmacy Placement Scheme. I was successful and was placed at Aberdeen Royal Infirmary (ARI) for a week this summer.
Prior to my placement, I was contacted by ARI who asked me if I had a specification with regards to where I spent my week in the hospital. The options were as follows: surgical, general medical, maternity, paediatrics or oncology. I had an interest in oncology, although I was aware it was highly specialised, as I knew I would come across unfamiliar treatments I had not heard of so far at university. As a result of this, my week with the oncology team was confirmed and I was excited to begin my placement.
On arrival at ARI on my first day, I was met by a pre-registration pharmacist who took me to get a hospital ID badge and discussed my timetable for the week. I was then taken on a tour of the hospital, which showed me just how large the hospital was, with each zone being colour coded. Just before lunch, I was taken to a pharmacist who was responsible for calculating and checking doses in chemotherapy regimens for patients. To do this, the pharmacist used data such as the patient’s weight to work out their creatinine clearance. It was important that these values were accurately calculated and approved by the pharmacist, as well as the consultant, to ensure that the patient was receiving both a safe and effective therapeutic dose of chemotherapy. After lunch, I was given a small talk in the clinical trials department of the hospital, where two pharmacists discussed how they manage and run clinical trials not just in ARI, but throughout the country. I found this interesting as I realised that ARI was the main hub for new clinical trials, which also tied into my oncology placement as a substantial number of trials were being used to treat different cancers. At the end of my first day, I was shown how medicines reconciliation is carried out when a new patient arrives at the hospital. I was shown the different resources that can be used for a record of their medication and that a minimum of two is needed to have an accurate representation of this.
On my second day at the hospital, in the morning I shadowed one of the rotational pharmacists on the oncology ward. During this time, the pharmacist discussed what happens after pre-registration in the hospital and the subsequent courses that a pharmacist goes through. She explained the two-year diploma programme and independent prescribing course that follows. Before my lunch break, the quality assurance pharmacist showed me how they keep track of particle counts in an aseptic suite. He showed a scenario from last year where although the particle counts were within limits in the Grade A/B cleanroom, they were slowly increasing and became out of control. He explained that this was fixed through further training of staff and the addition of a rule to ensure staff were changing out of outdoor clothes prior to reaching the Grade C cleanroom. In the afternoon, I was timetabled to visit the radiopharmacy department, where the pharmacist went through some prescriptions for radiopharmaceutical treatments. This activity tied in well with my placement, as many of the treatments were being used for patients prior to chemotherapy. An example of this was the MUGA scan, which checks the ventricles of the heart are pumping properly if they are not then chemotherapy cannot be commenced.
On the Wednesday of my placement, I and the pre-registration pharmacist undertook the task of a mini-audit of chemotherapy prescriptions. The outpatient chemotherapy clinic did not have a regular pharmacist working there at the time, and so the department was interested to see if a pharmacist would be needed. To do this, we looked through prescriptions which went to the dispensary to see how many prescribing or legal issues arose which needed to be changed by another pharmacist, thus keeping the patient in hospital for longer than needed. Once we had sorted through all the prescriptions with issues, we then made a spreadsheet with the data and sent it to the lead pharmacist of oncology for analysis. In the afternoon, I was shown some doses of pain relief for patients in end-of-life care on the oncology ward. The pharmacist with me allowed me to check the doses were appropriate by calculating breakthrough doses needed for the patients and ensuring conversions of quantities between administration routes were correct.
On my fourth day at ARI, I spent the morning in the radiopharmacy suite with two pharmacists where we dispensed radioactive medicines for similar treatments to the ones we looked at on Tuesday. The radiopharmacy preparation room was a Grade C suite and we had to wear specialised clothing which was provided prior to entering. One medicine that we prepared was a radioactive iodine capsule, which we had to ensure had the correct activity level for the patient. The capsule was used to treat thyroid cancer as the thyroid cells absorb the iodine when it is swallowed. Another medicine that was prepared was for a gastric emptying study. A radioactive isotope was prepared in the suite which was then to be incorporated into scrambled eggs for the patient to consume. This would allow the consultant to see how their stomach emptied the food, and if there were any issues. In the afternoon, I travelled to Roxburgh House to meet with the pharmacist who was involved in end-of-life care. Together, we looked through Kardex sheets of the patients currently staying at the house and discussed dosages of pain relief and other drugs. The pharmacist described to me the idea of a ‘just-in-case’ box which included diamorphine for pain, midazolam for agitation, levomepromazine for nausea or vomiting, and hyoscine hydrobromide for respiratory secretions. He explained that these medicines can be used to improve both out-of-hours care and make the patient comfortable when they are at the end of life in hospital.
On the final day of my oncology placement, I was first taken on a ward round with one of the senior pharmacists and the consultant, alongside two junior doctors. The ward round was fast paced and consisted of the consultant reviewing a patient whilst the pharmacist kept them up to date with current drugs the patient was taking alongside her recommendations. After the ward round, I was given a talk by one of the aseptic pharmacists with regards to the aseptic suite at ARI and how this operates. She then went through a prescription for medication for a neonate and explained how many steps must be undertaken to ensure the dose is correct and safe and won’t cause adverse effects. Before lunch, I visited the medicines information department at ARI, where the pharmacists working there discussed some interesting queries they receive throughout the day from healthcare professionals. This once again tied in well with my placement as they explained that many queries involve possible interactions between homeopathic remedies and chemotherapy. In the afternoon, one of the senior pharmacists showed me some common chemotherapy regimens that patients are given for cancer treatments, this was highly specialised as the treatments were constantly changing and new trials were being established.
Overall, I highly recommend trying to spend some time in a hospital setting if you are interested in pursuing hospital pharmacy as a career. I feel that my experience at ARI was valuable to me and has helped me understand the career further, aiding me in my decision with regards to where I would like to work in the future.
Katie Waghorn is a stage 4 MPharm student at the Robert Gordon University Aberdeen.