Posted by: Annabel Ikwuakolam10 JUL 2013
Week One @ Bethlem Royal..
I was absolutely thrilled todiscover I got a hospital placement, after probably applying to every hospitalin London. I was especially pleased to find it was a specialised mental healthunit as I have distinct interest in this field having studied neuropharmacologyin my third of study. Bethlem Royal is part of SLAM – South London andMaudsley, mental health trust with sites situated across South-East London.Mental health covers a broad range of issues ranging from psychosis, i.e.conditions such as schizophrenia, to dementia, affective disorders, eatingdisorders and specific types of learning difficulties. Bethlem Royal thereforediffers from your standard general or acute hospital. Each ward is specialisedto one of the above mentioned issues and patients are admitted slightlydifferently. Bethlem Royal is picturesque situated in a London suburb borderingKent. Situated over masses of grass, housing a community centre, tennis courtsand a swimming pool.
On my first day, I was introducedto all the pharmacy staff, who all specialised in different areas of pharmacypractice. For example there was a clozapine specialist (Clozapine is anatypical antipsychotic with a specific significant side-effect profile, some ofwhich can prove fatal) on hand to review bloods and dispense clozapine.Throughout the week I was given a list of project objectives to complete, i.e.to be able to outline the pathophysiology of schizophrenia, BPAD (BipolarAffective Disorder) and know the specific pharmacological agents used in theirtreatment. This was an excellent starting point to refresh my knowledge andalso when I went on ward rounds I better understood the patients conditions andhow the drug therapy was relevant.
So what does a ward round looklike in a specialist area such as mental health?
A host of clinicians and staff were present at the round,doctors, nurses, pharmacists, social workers etc, these make up themultidisciplinary team. The ward round was board-meeting style with a scribepresent. Each case is presented to the team and each member of staff is givenan opportunity to comment on the patient, i.e. in terms of any improvements ordeteriorations, or just anything they feel significant enough to mention. Thepatient is then called/brought in and asked some general questions by differentstaff members specific to the individual, i.e. if the patient has been havingcertain issues i.e. trouble sleeping, the nurse may ask if that has improvedetc. the patient also has the opportunity to ask any questions they haveregarding their medication or condition or general wellbeing. These ward roundstend to be incredibly lengthy, typically lasting over 2 hours and seeing 2-6patients at a time. My first visit to a medium security male psychiatric unit wasto sit in on an information session run by two pharmacists about smokingcessation. The ward presented with a myriad of mental health conditions, somewith specific diagnosis, is schizophrenia or an affective disorder and someundiagnosed, I initially felt anxious, but soon settled into the unfamiliarenvironment. My initial thoughts were the ward was very chaotic, patients(depending on their symptomatic presentation) would often engage you in lengthydisorganised conversation, or appear paranoid. The challenge for this type of ward is the fact the each patient's presentations differ so greatly is it wise for them to be grouped together, such environments can often prove deleterious to a patient's condition.
Midweek I sat in on the pharmacy department staff meeting. The staff gave generalfeedback to one another about things they’ve learnt and observed during the week,for example, one of the pharmacists would outline some of the keep points from ateaching session they had recently attended, for example, on asthma and COPD. Itis important for staff who work in mental health to keep up to date withphysical health medications and NICE guidelines.
OnFriday I had a cross-site visit to the Maudsley for a teaching session run bypharmacy staff there. This consisted of a series of journal reviews, fromleading journals such as JAMA Psychiatry and BMJ etc. These journal reviewswere excellent as the studies reviewed in these sessions often held a lot ofweight and sometimes possessed the scope to change clinical practice, otherswere rather controversial so were excellent discussion points. The pharmacystaff at the Maudsley were very passionate about their field, so thediscussions were fuelled with combined years of experience and anecdotalevidence.
Insummary my first week at Bethlem Royal was truly an excellent experience I learnta great deal, going far above and beyond anything I had previously learnt atuniversity. The experience highlighted the importance of each individual moduleI had covered this year, for example, statistics was heavily looked at thejournal review session, and I could strongly see other links between my modulesand clinical practice. I will post two more blogs outlining my time at BethlemRoyal.