I have worked as an MCA at a small community pharmacy for the past three years, working Saturdays and holidays. Here are a few things that I have learned that may, or may not, be useful for a pharmacy student who is undertaking their first placement at a community pharmacy.
- First thing that I do is to make the shop floor presentable, such as brushing the mat and bringing stock to the front of the shelves.
- Community pharmacies can be busy and short staffed and so date checking the shop tends not to be their first priority. Knowing that there is a student on the way they may ask you to date check OTC and P medications. All of them.
- When collecting prescriptions from patients either write ‘W’ in the corner of their prescription if they are waiting for it, or ‘CB’ if they are calling back for it.
- You will be asked to retrieve dispensed prescriptions from the area that they are kept. You will get flustered when you can’t find a prescription – don’t worry. There are many places a prescription may be kept – on the shelf, on the owing shelf (Æan item may not have been in stock and so an ‘owing’ label is given to the customer so that they remember to collect the rest of their prescription), blister packs may be kept separately, delivery shelf, or they may have a batch prescription. When giving the items to the customers, ask for their name and address – you would be surprised how many ‘John Jones’ there are so its important to give them the right prescription!
êA batch prescription is where 6 months of prescriptions are kept in the pharmacy, meaning that the customer doesn’t need to re-order their prescription every month.
- Be aware of the services offered at that pharmacy – smoking cessation, travel vaccinations, MUR, blood pressure measuring, morning after pill, etc. If there is a locum pharmacist in that day, make sure to ask them if they offer those services, as sometimes only the regular pharmacist will.
êMUR – ‘Medicines Use reviews’ are annual consultations between a customer and pharmacist.
Target groups include:those on high risk medicines such as anticoagulants, those prescribed respiratory drugs such as theophylline, and those on 6+ medications.
Aim is to increase adherence to medication through making sure that they understand what they are taking for what condition and that they are complying with the dosing regimen. If they have any issues e.g. they forget to take their medication as they may be on 8+ different drugs, then the pharmacist can help by showing them weekly pill boxes or the blister pack scheme.
êweekly pill boxes are organized by the patients (or family members) so that it is easier for them to take their medication. Blister packs are made up in the pharmacy and as they are time consuming not everyone is eligible.
The pharmacy is given a fee of £28 per MUR are are allowed to claim for 400 MURs a year, therefore it is a good source of income for branches.
- Depending on where your placement will be the amount of addicts will significantly vary. They will tell you their name and maybe tell you that they have a ‘daily pick-up’ or methadone. I have not yet been allowed into the CD safe and so I don’t know much about this. The pharmacist will either make up the methadone then and there if they have only a few addicts, or they will be made a week in advance due to the large number of patients. While they wait they may ask for 1ml or 2ml packs. When I first started working at a community pharmacy I had no ideawhat these were. This is part of the needle exchange scheme which helps to reduce transmission of blood-borne viruses etc. Its quite a strange feeling knowing that they are about to be given methadone as a treatment for addiction but at the same time you are supplying them with needles so they can inject themselves. Not giving them needles won’t stop them from taking illicit drugs, but it promotes safer injecting practices. You need to make a note of their gender, initials, date of birth, and what you supplied them on a form or directly input it into the computer.
- CODEINE & DIPHENHYDRAMINE
During your first year of a pharmacy course, or MCA training for that matter, they don’t tell you on how to deal with addicts. From my experience, the two most common drugs that you need to watch out for is codeine and diphenhydramine. I will use codeine as an example.
A patient will come in with perfectly reasonable set of symptoms (back ache; toothache and dentist is closed/appointment in the next few days) and will ask for co-codamol. I have had someone come in complaining of a migraine, they had ‘tried everything but only co-codamol works’. I had recommended sumatriptan and explained that it was specifically for migraine sufferers, they ignored me and repeated that only co-codamol works. What you have learned at University has no effect on some customers – you are younger, inexperienced, and have no authority. You need to be able to develop a way of persuading customers that you know what you’re talking about. If you say co-codamol won’t help them then they need to respect you and take that advice seriously.
You can get staff who will just hand over Nytol and Solpadeine and so the customers get used to getting what they want which means that when you turn up with your WWHAM questions they will get defensive – ‘I usually get them. Why can’t I have them now?’, ‘I’ll just go to the chemist down the road then’. It can make you feel quite powerless when you KNOW what they don’t really need these medications and you just have to hand them over.
Therefore, ask the pharmacist or look online on how to look out for potential addicts and what you can do.
- Ask the WWHAM questions and remember the common interactions (decongestants with anti-hypertensives, fluconazole with anticoagulants, etc).
- Its been a long day and you just want to sit down and have a bit of a break while the shop is quiet. Don’t. Hoover and then mop every 2-3 days and don’t wait for someone to ask you to do it. You’ll be exhausted but you’ll quickly gain a good reputation for being a hard worker.
- Deliveries arrive twice daily, with the largest arriving in the morning. If a pharmacy dispenses ~400 prescriptions daily then the items need to be replenished daily, meaning that there are A LOT of boxes. The good thing is that quite a few will be ‘fast movers’. These are common medications regularly dispensed such as aspirin, atorvastatin, omeprazole, etc. Fast movers are kept above the dispensing benches so that they are easily and quickly reached.
- Different branches have different ways to organizing stock but they all follow the general pattern. Drawers are labelled A-Z but there are exceptions. These include a contraceptives drawer, antibiotics, eyes & ears, HRT (which does not stand for ‘heart’ as I had originally thought). Creams and painkillers will also have a separate designated place.
- Make sure that you keep the right strength in the right place e.g. some medications will be on the ‘fast movers’ shelves and in the drawers, but will have different strengths.
- If you don’t know where a common or obscure drug goes just ask. Don’t just plonk it where you think its supposed to be.
The dispensing process:
In the first year of University they showed us how to label and dispense (electronically) but the process is quite different to what actually happens. (in Wales anyway).
- Prescriptions arrive in large bundles from the surgery (sometimes multiple surgeries) at ~1pm.
- They are then sorted into three categories: 1-2 items, 3-5 items, and 6+. They are then sorted alphabetically, making it easier to find a prescription when someone phones in to see if their prescription is there or not.
- Legality check – a community pharmacy prescription must indlude: age, DOB (if under 12), name, address, written in indelible ink or typed, prescriptions are valid for 6 months (28 days for CD), signed + dated by prescriber, name and contact details of prescriber.
- They are labelled – at University you manually type everything in and have to list all the warnings. Yeah…that’s not how it works. You scan the prescription, it comes up on the screen, and if it’s the same as the previous prescription dispensed for that individual then you can just print out the labels – no warnings included (which doesn’t stress me out at all…).
- Dispensing – retrieving the required medication, sticking the correct label on, and signing it. Dispensing large prescriptions can SERIOUSLY confuse you. The phone is ringing, there’s a queue in the shop and you have to stop and help, and you can bet that there will be at least one awkward item on the prescription. I enclose examples:
The prescription asks for 6 zopiclone 7.5mg tablets so you have to ‘split’ the pack = take the tablets you need out and put them in a blank cardboard box, and them squiggle on the split pack so that other know that its not a full one.
Cyanocalabalamin is requested for 84 tablets and they come in tubs of 50 tablets to you have to take a full one (and usually lots of split packs) to make up the 34 left and place in a tiny brown bottle.
The packs that have been used a split must also be placed in the basket containing the items, so that the ACT or pharmacist checking your work knows exactly whats in there.
Stock – may lines are out of stock for a few weeks or months. Migraleve has been out of stock for at least a few months, in December, naproxen was out of stock causing customers to get quite annoyed, There are currently issues with getting HRT and nifedipine in particular.
- The prescription is checked by a pharmacist or ACT (you will make mistakes, im telling you now).
- Items are bagged and hung on the shelf ready to be collected.
At the end of the day you may be asked to count all the scripts collected, then count the items on the script.