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My first rotation

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It hardly seems like seven months have passed since I started working as a permanent band 6 pharmacist, having hopped around various hospitals as a bank pharmacist before this job. The week beginning 20 October is the first week of the new rotations and so it is with sadness that I said goodbye to the diabetes and complex care wards that I had grown so used to over the past six months.

Usual rotations last between three and four months but, due to the timing of my start date, I didn’t rotate with the rest of the junior pharmacists, instead remaining on my wards for longer. ‘Complex care’ is a fairly sketchy term. Complex care wards are likely to be home to patients with many medical issues and/or social, mobility or other non-medical issues.

The male and female complex care wards that I covered were diabetes wards. Consequently, I learned a lot about diabetes, including learning that you just can’t appreciate at university without seeing it actually happen in a real patient. For example, at university we learned that fluids and insulin were important in the management of diabetic ketoacidosis (DKA). But I didn’t learn about the rationale behind treating hypokalaemia or ECG monitoring in a DKA patient until this year. Insulin drives blood potassium into cells thereby resulting in low blood potassium, which can lead to cardiac arrhythmias. Insulin is also a second-line option for the management of hyperkalaemia on our Trust electrolytes policy.

During my rotation, our Trust guideline on the management of severe hypoglycaemia was updated in line with national guidance due to the commercial availability of the recommended product. The change came into effect at my Trust in August to coincide with the intake of new doctors. Instead of administering 20mls of 50% IV glucose, we switched to using 75-100mls of 20% glucose — 20% glucose is available in 100ml bottles.

I would estimate diabetes to be the main issue for about 50% of patients on my wards. Consequently, I also came across a wealth of other issues. Common issues included acute kidney injury (which sent me running for the renal drug handbook), sepsis, chronic pain and Parkinson’s disease; not-so-common issues that I came across include nephrotic syndrome and re-feeding syndrome.

My next rotation is a split between medicines information and dispensary. Whilst I was initially annoyed at not being given at least one regular ward to cover — ward and multi-disciplinary work is the reason I wanted a job in a hospital, after all — I’m excited about the new skills I’ll be able to develop.

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