Preparation for starting band 6

[Asterix]

I think it will be different rather than a big step up. In community, pharmacists often have to make decisions on their own, as the sole responsible pharmacist. Patients come in with difficult problems, often when the surgery is shut and there is no one to ask for help. There is no support network, it all boils down to *you* - in some cases you will have good support staff, in other cases you won't. Clients with incomplete methadone prescriptions may very well turn up near closing time on Saturday afternoon and start kicking off.... or whatever

As far as I know, Band 6 is the basic grade hospital pharmacist and so you will not be expected to know everything about everything from day 1. There will be other pharmacists to ask for help when you need it. Although community pharmacy has had more of a clinical emphasis lately, we do not normally see patients blood results or anything like that. Also, the range of products used is quite different to hospital. Hospitals have a formulary and so the range is restricted, there are many products dispensed in community which will not be on the formularly. On the other hand, hospitals dispense a large range of injectables, cytotoxics and TPN which are rarely, if ever, seen in community pharmacy. You will have plenty of reference sources available if you need to make checks on dosages and other clinical issues.

I think it would be useful to look at the BNF every day. Each day, look at a different group of drugs which are used in hospital but not in the community.

do you feel having no access to blood results makes your job easier. You are effectively bypassin having to make drug dosage changes or witholding drugs.

[hibernia]

do you feel having no access to blood results makes your job easier. You are effectively bypassin having to make drug dosage changes or witholding drugs.

We don't have the option to change doses or hold drugs.
Patients in the community are generally stable. They aren't having bloods done on a daily basis and their condition isn't changing rapidly. In hospital a patient is usually either getting better or getting worse and you manage accordingly. In the community they are generally much the same and you have to be alert for changes. Are they intentional, e.g a hospital discharge or just an admin error?

Most of the work in the community involves managing long-term conditions like diabetes or heart disease, often over many years, in constrast to a hospital where you deal with acute medical or surgical cases over a few days or at most a couple of weeks.
It means you have to use a different skill set.

[bobbin]

Do you feel having no access to blood results makes your job easier? You are effectively bypassing having to make drug dosage changes or withholding drugs.

I'm not entirely sure what you are asking but we don't have the authority to change the dose. The dose is decided by the prescriber. If the dose appears incorrect we will contract the doctor; they will then decide whether they wish to change it. I would only change the dose without contacting the prescriber for certain drugs. For example, if the prescribed dose of paracetamol was obviously in error I would label as per the new guidelines.

Unfortunately, we do not always have enough information to decide whether the dose is correct. Many drugs have a wide therapeutic index but others do not. It would be useful to have more information available when dispensing drugs with a narrow therapeutic index. Even for warfarin, patients often do not bring their yellow book, we can only check that they have had blood tests recently.

I would not 'withhold drugs' (refuse to dispense) unless the circumstances were exceptional. This only happens very rarely. There have been a couple of occasions when I have queried phenomenally high doses only to be told that 'it must be right because it was in the consultant's letter'. The ludicrous attitude that everything must be OK if it has come from the hospital seems highly prevalent. Do consultants not make errors? Do their secretaries not make errors when typing letters? A had to refuse to dispense an item a few years ago because I felt that the dose would be dangerous and the GP would not speak to me. I was not happy with being told via a receptionist that it was absolutely fine because it was in a letter. The patient was advised to return to the GP and have them contact the hospital to ascertain the dose.

[crit care]

i wouldn't go by letters...even in a hospital setting an outpatient letter said the patient was on 200mg MST...it transpired it should have been 20mg...the secretary had slipped in too many zeros!!! and the dose made it onto the drug chart with the doctor saying..its in the letter it must be right....

even in hospital i wouldn't go changing doses unless i had spoken with the doctors, i guess in hospital the doctor is more readily available and accessible than in a community setting