Last summer, I undertook a 6-week summer placement at Ropharm Pharmacy in East London. This experience gave me a real insight into how a professional independent pharmacy is run and managed on a daily basis, but more importantly, I got to see first-hand how the role of the community pharmacist has changed over the years. It is evident that there has been a shift in pharmacy practice from technical to clinical and public health services, and medicines optimisation – through development of services like the New Medicines Service, and targeted Medicines Use Reviews. I was told from the very first day there is great emphasis placed in helping patients make the best use of their medicines, whether prescribed or purchased over-the-counter. Medicines optimisation is about ensuring patients get the best possible health outcomes from their medicines. The goal is to engage with individual patients to understand their views, opinions and beliefs about their medication and for the pharmacist to share their clinical and medicines knowledge so that the most appropriate evidence-based care for each individual can be agreed with. Ultimately medicines optimisation can help encourage patients to take ownership of their treatment.
During my placement I conformed to the company’s Standard Operating Procedures (SOPs) to ensure compliance with good pharmacy practice. A SOP is a written document that specifies what should be done, when, where and by whom. In a community pharmacy environment this is used to ensure quality service and good practice are achieved consistently. I therefore signed and dated each SOP I undertook in the pharmacy to acknowledge the SOP had been read and that I understood its implications.
During the first week, I was given the opportunity to work alongside the Medicine Counter Assistant where I was able to enhance my knowledge on OTC medicines and minor ailments. While understanding different conditions and the products that treat them is very important, communication is key to giving patients the best possible advice. As a method of information seeking I used the WWHAM technique. This is a mnemonic which can be used as a prompt to ensure all relevant information has been obtained from the patient:
- W – Who is the patient?
- W – What are the symptoms?
- H – How long have the symptoms been present?
- A – What action has already been taken?
- M – Are they taking any other medication (especially for long term conditions)
It is imperative for the pharmacist to know about all the medicines being taken by the patient because of the potential for interaction with any recommended OTC treatments. It is equally important that consideration is given to the possibility that the patient’s symptoms might be an adverse effect caused by medication they are regularly taking. For example whether constipation might be due to opioid analgesics taken on prescription or indigestion that might be due to a NSAID drug being taken by the patient.
I found these to be a useful set of questions designed to allow an initial understanding of what is wrong with the patient, make an appropriate product recommendation, but also know when to refer if necessary. A typical working day consisted of about 10-15 health-related queries, and on some days it was much more!
The minor ailments patients presented, had problems ranging from headaches, skin care issues, and indigestion, to heart health and foot care complications. I immensely enjoyed interacting with patients of different backgrounds and I was able to respond to symptoms with much more confidence by the end of the 6-week placement, as well as increasing my product knowledge.
Other duties during my placement included taking in prescriptions – ensuring they are legally valid and carrying out point of dispensing checks (checking whether patients have evidence of their entitlement to free prescriptions). I was also involved in counter stock ordering, checking off and putting away medical and dispensing stock, booking in appointments for smoking cessation and vaccinations, filing away invoices correctly, and handing out prescriptions to patients.
In the dispensary I was supervised and taught how to dispense medication correctly and efficiently, allowing me to become familiar with the pharmacy dispensing computer software. I was able to assess prescriptions for legal validity as well as for clinical appropriateness. This advanced professional check involved checking the appropriateness of the medication according to the patient’s clinical parameters (such as age, previous medication), assessing whether the prescription includes an appropriate dosage form and checking for any drug interactions, As an undergraduate, I felt this to be quite daunting especially when placed in such a fast-paced environment. It is imperative however, to remain calm under pressure and focus on doing things right. This was definitely an area where I was able to put all those Pharmacy Practice sessions at university to use! In addition, I was also able to put my ‘final check’ procedure into practice in a real life dispensary setting – under supervision of course. The key objective of the ‘final check’ is to ensure that the prescription has been assembled and labelled accurately, and that any errors are spotted before the medication reaches the patient.
The most interesting aspect of my placement was definitely learning about the range of enhanced services provided by the pharmacy such as the travel health and sexual health clinics, NHS Observed TB Therapy, the Minor Ailment Scheme and many more. Moreover, I was able to appreciate how new services such as the NMS and MUR help patients use their medicines more effectively. Pharmacists are extending their role in medicines optimisation, and thus allowing issues such as medicines adherence to be addressed. This in turn improves symptom control and can delay the progression of disease. Not to mention, it can also reduce emergency hospital admissions due to adverse events from medicines. According to the Royal Pharmaceutical Society adverse drug reactions account for 6.5% of hospital admissions and over 70% of the ADRs are avoidable.
Undertaking a summer placement certainly helped me ‘bridge the gap’ between the acquisition of theoretical knowledge about drugs and its practical application to individual patients. Furthermore, the experiences, skills and knowledge I gained throughout my placement were invaluable when it came to my pre-registration interviews. Interviewers are eager to know what you have learnt, what you enjoyed, how well you worked with the rest of the healthcare team, how you solved problems, and what you found challenging. A placement undoubtedly provides you with a vast array of experiences that you can draw upon when answering interview questions, so it is needless to say, completing a summer placement voluntarily definitely gives you a competitive edge , and may even help you secure that all important pre-registration post!