MPharm: Second year Placements

It may shock you to know that pharmacy students get very few placements but thankfully Cardiff University are trying their best to get us some, starting with a week in community pharmacy and two days in a GP practice for second year students.

As I have worked within community pharmacy for a few years now I knew how the pharmacy runs and what to expect. It takes years to figure out the pharmacy but there are other students that had never stepped behind the counter who had to learn the ropes in just five days…good luck. I was allocated Well Pharmacy in Llantwit Major, and I’m naming the pharmacy cause they were absolutely BRILLIANT! I had expected to be on the counter all week, bored out of my mind; but I’ve been so busy and learnt so much it has been incredible.

Volunteering to do something goes a looong way when you’re out on placement.  I hate just standing around so I asked if I could date check, which allowed me into the shop team’s good graces throughout the week.  Even just being in the shop really made the think about processes within community. I have only worked for one community pharmacy company but seeing how Well pharmacy did things it does make you wonder why everyone isn’t doing it that way.

At home, after items are dispensed, they’re placed in a plastic bag and hung by surname alphabetically, and since this is Wales when it comes to finding John Jones’ prescription it takes about an hour to go through all the ‘J’s. Off Site Dispensing (ODS) was also bought in during the summer and patients regularly complained about the 2-3 plastic bags that they were given each month, with the company saying that plastic was used for confidentiality reasons etc. With Well, it’s a little different. And it just makes perfect sense.  All items, including ODS are packaged in paper bags, closed shut with stickers.  Then the bag is scanned with a little hand scanner and allocated an an area to live until its picked up e.g. F9 (shelf F, 9throw down).  Therefore, when John Jones comes in for his prescription, the staff type his name into the scanner and it tells when exactly where it is, so they only have to shift through like 8 other bags to find his. So beautiful, brings tears to my eyes. Plus, environmentally friendly, unlike plastic bags.

On Wednesday afternoon I was allowed into the dispensary and dispensed away the afternoon.  I made a few dispensing errors but the ACT was lovely, and didn’t like condescend me about how I should know better or whatever.

We were given a booklet to complete during our placement and I had thought that I would just be left to fill it in myself but the pharmacist there has been proactive in helping me learn as much as I can, questioning me, making me look up interactions, and allowing me to sit in on consultations.

Before this placement, I was adamant that I was going to avoid a career within community. The daily repetition of checking prescriptions and all the paperwork just…(visibly shivers). I know that I want to become an Independent Prescriber and in my mind I thought that I’d have to specialise in something along the lines of asthma or hypertension but that pharmacist at Well had just qualified as an independent prescriber in contraceptives.  This is an area that I have a strong interest in and suddenly a future where I held clinics within community pharmacy seemed not so bad. I was lucky enough to stand in on a consultation of the ‘morning after pill’ supply.  The pill cannot just be handed over.  Questions must be asked to determine its suitability – how many days have passed since unprotected sex, when their last period was etc.  In this particular case a copper coil was more suitable and so they needed to attend a hospital sexual health clinic.

In some rural areas, taking time off work etc in order to wait for hours at a sexual health/contraceptive clinic which may only occur once a week just isn’t as easy option and so observing such a consultation has shown just how much community pharmacists can help with ease of access to services.

The following week I was at a GP practice and it is only recently that pharmacists have infiltrated GP practices.  They first began as cluster pharmacists – being shared between a group of surgeries but were quickly snapped up due to practices seeing a huge improvement in the management of medicines.  They have quite a varied role and it depends on the skillset of that particular pharmacist.

A new concept that was introduced to me during this placement was that having such a diverse team allowed the practice to triage patients so that they are matched to the healthcare professional which is most qualified/competent for their issue. For example, GP’s were only required to do medicine reconciliation and reviews – something that they (a) don’t have the time for with increased patient lists and pressures, and (b) didn’t know enough about.  Introducing a pharmacist for this role meant that GPs can tackle more complicated patients, leaving the independent prescriber pharmacist to sort less complicated cases, and those related specifically to their medications.

As we are an aging population more and more of us will be on medication, which leads to polypharmacy – a patient won’t just be on one blood pressure medication, they may be on three and a statin and they may need something for joint pain and for bone weakness and type 2 diabetes.  See how quickly patient end up with a shopping list of drugs? This means that its the pharmacists job to decide what is absolutely necessary for them to be on.

We shadowed a nurse while there and she was absolutely incredible.  In pharmacy we are taught things by the book, but in community pharmacy things don’t really work that way.  But this nurse did consultations by the book – she gave all the details to the patient, educated patients on signs of sepsis, and gave resources for patients to help them with their condition. Completely blew me away, AND during consultations made time to explain to us the more intricate details and prescribing issues.

Such experiences deeply enhance student education and allow us to see how knowledge gained within workshops and lectures arise within practice and how they are dealt with.