Moving from the community to hospital

By Heena Bhakta

Heena Bhakta recently moved from community pharmacy practice to hospital. In this article, she describes her experiences and the differences between hospital and community pharmacy

I have been a community pharmacy locum for two years and needed a change and wanted routine in my life. So I decided to venture into hospital pharmacy.

After several interviews, I accepted a band 6 clinical rotational pharmacist job (which is a basic starting grade for pharmacists in hospital) at Walsall Manor Hospital. There are so many differences between hospital and community pharmacy: the patients, the team, the dispensary and even the types of medicines dispensed are different.

From my first day of working at the hospital, I realised that a lot more happens in a hospital pharmacy than in any community pharmacy I have worked in. Separate teams work in different areas to make up the dynamics of a hospital pharmacy.

In a community pharmacy, the pharmacist will usually be a dispenser and checker, order medicines, deal with paperwork and counsel patients on their medicines. In hospital, there are different people performing these roles.

One of the positive aspects about hospital pharmacy is that there are other pharmacists with varying degrees of experience to share knowledge. This is especially useful when you are faced with a drug you have never seen or if you need help with an unlicensed medicine that is not in the British National Formulary.

On-call duty

Part of my role includes being on call once every eight weeks. As an on-call pharmacist, I work my regular hours at the hospital, as well as being available at the end of the telephone outside these hours so members of staff at the hospital can contact me with clinical queries.

The on-call pharmacist is equipped with many different resources, ranging from the BNF to the “NEWT guidelines” (which give a guide as to what medicines can be crushed, for example). During a recent on-call shift, queries included the loading dose of intravenous phenytoin and a nurse wanting to know the difference between Zomorph and MST.

Patients

Patients in hospital are, of course, different to those in community. In community, a pharmacist might provide services for patients from when they are babies until they are old. The long-term relationship community pharmacists have with their patients is rare in hospital and I do miss not being able to follow up patients and ask them how they are once they have been discharged (something that could easily be done in community pharmacy).

Most community pharmacists have had the experience of working on a Saturday afternoon, when a patient brings in a prescription and something is not quite right. The GP surgery is closed and you cannot get hold of a doctor. This is rare in hospital — if there is a query, there is always a doctor available who can help.

Often, on the wards, the doctors and nurses will approach pharmacists and ask for advice. Even the dietitians work with pharmacists (eg, when patients require total parenteral nutrition). Medical notes are a useful tool when assessing a patient’s condition. Everyone involved in the patient’s care can write in the notes and document their suggestions regarding treatment, therefore optimising care. Pharmacists, for example, will often write suggestions on doses of medicines.

Medicines

Another difference between hospital and community pharmacy is the range of medicines and also how they are given. The dispensary is full of IV forms of medicines and injections that I had never heard of until I moved into the hospital sector. Now I understand the importance of all those IV calculations in the registration examination. As a community pharmacist, the displacement value of medicines may mean little. However, in hospital, with a range of IV medicines that need to be reconstituted, displacement values are important to ensure patients get the right dose.

Also, the route of administration needs to be considered. Injections can be given as, for example, an IV bolus, IV infusion, subcutaneously or intramuscularly. Needless to say, getting the route of administration right is just as important as getting the dose right.

Patients in hospital often need to be investigated thoroughly — something that is not carried out routinely in the community. For example, patients have their blood taken, which is analysed for urea and electrolytes. I always look out for serum creatinine levels and I use the Cockcroft and Gault equation to work out a patient’s renal function. Based on the renal function, I can then make suggestions to the medical team about dose changes to prevent damage to the kidneys.

In the two years I was a community pharmacist, I never thought about checking a patient’s renal function. However, in hospital, I check this and many other parameters on a daily basis.

Rotation

Every three months, I rotate into a different area of practice. This enables me to experience a variety of patients and conditions. A lot of my time is spent on the wards looking at patients’ notes, blood results and medication charts. Wards I have covered include respiratory, gastroenterology, endocrine, chemotherapy, surgical and admissions. I have also worked in the aseptic laboratory.

This is part of the pharmacy department and is where IV chemotherapy is made. Often, more than one medicine will be used in a chemotherapy regimen. Different regimens are used to treat different types of cancer. Medicines, such as thalidomide, are also used in chemotherapy.

Conclusion

Hospital pharmacy is a great way to work in a multidisciplinary environment and input into patient care. There are many opportunities to specialise and widen your career prospects.

Although I do miss the patient contact that community pharmacy has to offer and treating minor ailments with over-the-counter products, hospital pharmacy offers a different experience.

Am I glad I switched over to hospital pharmacy? I am afraid that will be a topic of discussion in another article.

Heena Bhakta is a clinical rotational hospital pharmacist at Walsall Manor Hospital