Specialized functions in hospital pharmacy
Many pharmacists, especially those in a hospital setting, will specialize in a clinical area. Each of these areas presents its own particular challenges and requires specific expertise and skills. Specialist clinical pharmacists within the NHS are typically in Band 7 of the NHS Pay Scale Agenda, for which the pay scale is between Â£ 31,072 and Â£ 40,964. Below you will find descriptions of some specialties of hospital pharmacy.
Working with the elderly
The population of geriatric patients in the UK is growing – according to the charity Age UK, the percentage of the total population over 60 is expected to rise from around 23% in 2015 to almost 29% in 2034 and 31% in 2058. These patients present a range of challenges to clinicians – they often take many different drugs and may have problems adhering to the drug regimen. As a specialist geriatric pharmacist, Seham Hussein identifies and treats medication management issues in the elderly and helps reduce the number of elderly patients readmitted to hospital due to mismanagement and poor adherence medication.
Hussein, who qualified more than seven years ago, is currently working at Imperial College NHS Trust, London. She developed an interest in geriatric pharmacy after working closely with consulting geriatricians to assess patients over the age of 70 who had been admitted to the short-term medical admissions unit. Hussein says, âI see the challenges of this position as an opportunity to grow professionally and further develop the geriatric services that I help provide. For those who aspire to specialize in geriatrics, she adds that obtaining a postgraduate clinical degree is a must.
Pediatric pharmacists may face similar challenges in helping their patients manage and adhere to medications. Judith Mante is a specialist pharmacist based at Great Ormond Street Hospital (GOSH), London, who treats sick children around the world. Mante started working in pediatrics in 1991, when she took on the role of Rotational Pharmacist at GOSH, as she had always been impressed by the innovative and specialist work done in pediatrics there. She moved to the United States in 1993, where she helped implement pharmacy computer systems at several hospitals. Upon her return to the UK in 2010, she took on a post in pediatric pharmacy drug information and recently changed to a role implementing a new IT system while developing a drug dossier for use in hospitals. pediatric intensive care units.
Mante says: âI am particularly interested in this role as it straddles the boundaries of pharmacy and technology, using both my technological acumen and my clinical knowledge. She adds: “It is imperative that I have a concise understanding of pediatric medications, pediatric intensive care units, and of course, that I am able to train staff in the use of the computer systems that I help. enforce. “
Pediatric health care is made more complex by the use of many unauthorized drugs and the âoff-labelâ prescription, notes Mante, adding that âother difficult issues include: altered pharmacokinetics at different stages of development from childhood ; lack of pediatric information sources; and the lack of formulations adapted to the pediatric population â.
Token Aliti is a mental health pharmacist working at the South Essex Partnership University NHS Foundation Trust. He began his career as a pharmacist at Moorfields Eye Hospital in London, where he obtained his postgraduate clinical degree. He started working in mental health because he wanted to deepen his clinical experience and knowledge in another specialty.
Aliti explains that her current role is varied as mental illness is typically treated across a spectrum, with each patient requiring treatment on an individual basis. Conditions covered by its role include schizophrenia, manic depression, bipolar disorder, Alzheimer’s disease, obsessive-compulsive disorder, and post-traumatic stress disorder.
He says: “I am attracted to this area of ââwork because of the large patient population I encounter on a daily basis.” He explains that he needs a wide range of clinical knowledge, especially since some patients have co-morbidities. In addition, “it is important to stay current with the law and ethics in mental health,” says Aliti. In the future, he hopes to continue his studies in psychiatric therapy and psychiatric pharmacy.
Eyes and infections
The fight against antimicrobial resistance is an important issue for pharmacists in general, and in particular for specialist pharmacist Ed Hindle, who practices at Moorfields Eye Hospital. After studying pharmacy at John Moores University in Liverpool, he accepted a position at Moorfields for his pre-enrollment year and rose through the ranks to become a pharmacist specializing in antimicrobials and forms management. Her job is to attend infection control committees, update antimicrobial policies, and follow antimicrobial prescribing patterns to highlight inappropriate use.
Moorfields is a global center of ophthalmology and patients may present with rare eye infections and conditions. Hindle explains, âWhile these conditions are extremely rare, there may be little or no data available to review before starting treatment, which can cause difficulties. He adds that drugs that are not normally used within the trust (non-formulary drugs) can be requested by a doctor. The physician must submit an application for the use of the drug to Hindle, who then reviews the application and produces an assessment of the drug in terms of efficacy, safety, convenience and cost.
Hindle says: âThe postgraduate clinical degree has been a great help to me in my current role, as has my understanding of evidence-based medicine and my ability to critically appraise trial data and evidence from journals. “
Margaret Kyegombe is a nephrology pharmacist at St George’s University Hospitals NHS Foundation Trust in South London. Having worked in several areas of pharmacy including intensive care and neonatal care, it was while working in renal pharmacy that Kyegombe found the field in which she wanted to specialize. She says, âI fell in love with kidney pharmacy when it dawned on me the difference in the quality of life we ââcan bring to people with chronic kidney disease and [that we can] help them live as normal a life as possible.
Although she took a course in kidney pharmacy, Kyegombe believes that most of her productive learning has been through close contact with other healthcare professionals who specialize in kidney disease. She explains, âThis is because each patient needs treatment on an individual basis, taking into account many other possible problems and co-morbidities. As such, learning takes place on a daily basis and working within a team of specialists allows us to tap into the opinions and experiences of other healthcare professionals. “
Difficulties in providing kidney service include the correct titration of doses in people with kidney failure, according to Kyegombe. She adds that many side effects of drugs are poorly tolerated in patients with kidney failure, which can make it difficult for the healthcare team to assess the adequacy of treatment.
Cancer in Clatterbridge
As a member of the specialist oncology team at the Clatterbridge Cancer Center NHS Foundation Trust in Wirral, pharmacist Marianne Pucsok focuses on developing and managing the dispensary process for the oncology department. With over eight years of experience as a pharmacist in Hungary, she moved to England in 2013 to start a new career alongside her husband.
Pucsok helps patients spot the “warning signs” of problems with certain drugs, such as cytotoxics and immunosuppressants, which carry higher risks than other more commonly used drugs. It also tries to ensure the safe use of drugs with a narrow therapeutic window, which require therapeutic drug monitoring.
Again, Pucsok recommends those wishing to major in oncology undertake a clinical degree and explains that a variety of postgraduate oncology courses are also available.
Rachel Curley, senior clinical pharmacist in gastroenterology at Wirral University Teaching Hospital, graduated from a residency position following pre-registration training there. The role interests him given the varied nature of gastroenterology, which is divided into two specialties; luminal, which includes motility disorders and luminal disorders, and hepatobiliary, which focuses on the liver, gallbladder, and bile ducts. Curley says: âThe ability to support colleagues, students and patients through presentations, study sessions and disease awareness events is a highlight of my role. “
Curley spends most of the working day in the department supporting the wider clinical team, facilitating discharge and counseling patients. Other important aspects of the role include supporting the team of nurses specializing in inflammatory bowel disease, the endoscopy unit and reviewing service guidelines and referrals from patient groups.
The challenges unique to this role include the complexity of the patients in the gastroenterology department and the high patient turnover in the department, says Curley. There is no specific training needed for a pharmacy role in gastroenterology, but internal learning will help improve specialist knowledge in gastroenterology, says Curley. Non-medical prescribing courses, allowing pharmacists to write and modify prescriptions, can also be undertaken to support the clinical team.