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Medicines Management Technician Interview

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  • Medicines Management Technician Interview

    Hello!

    I have an interview for an MMT position and I’m just wondering if anyone could give me any tips of things to swat up on. It’s in a large, busy primary care hospital.

    Any help would be very helpful, I’ve been for an MMT job before but didn’t get it. My feedback was that my knowledge of the role was quite basic.

    Many thanks
    Sarah

  • #2
    Read the job description, person specification and structural hierarchy carefully. You won’t be expected to know it verbatim, but you should at least be familiar with it.

    The actual job varies depending on which Trust you are working for. Some allow techs to do much more than others. At band 5 in my Trust we are given a ward to look after, either the admission ward or a base ward (specialties such as surgery, stroke, elderly care, respiratory etc.) At the start of the day because we don’t have any band 4’s working on the ward we would get the SCRs (summary care records) for all the patients who have not been med recced (medicine reconciliation.) We would then prioritise these patients as to who we need to see first, such as insulin, warfarin, significant comorbidities or a high number of medicines. The pharmacist usually attends the MDT huddle (multi-disciplinary team), where a handover is given to the doctors, nurses, physios, OTs, speech and language and pharmacy. This is the first point of call for finding out about any discharges for the day, as well as any very ill patients or other relevant issues. If the pharmacist is not on the ward or busy then I will go to the huddle instead.

    The bulk of the work after that is medicine reconciliation and discharges. Do you know the process of a medicine reconciliation?
    The SCR is a useful list of all repeat and recent acute medications from the GP that has been prescribed, but it doesn’t guarantee that they picked it up from the pharmacy, or that they are taking it as per the label. Our primary source is the patient, or whoever administers the medication (relatives, carers or care home.) You may also use PODs (patients own drugs) as a source, by checking the actual drug, the label and how many have been taken out of the box compared to the dispensing date. Did they get their last Salbutamol inhaler a year ago, but they say they use it daily? Something is fishy in that case. We don’t call patients liars obviously, but there are sometimes compliance issues. Alternatively they may be using a once daily inhaler 4-5 times daily PRN!

    MAR charts (medicine administration records used in care homes) are useful, but often don’t include topical preparations. If you can’t talk to the patient and the relatives know nothing, you can ask the community pharmacy what has been dispensed and picked up - this is a last resort, as it only tells you they received it, not that they were taking it. You can also use hospital documentation as a guide, as the SCR won’t include medication such as chemotherapy adjuncts or often methotrexate etc that is prescribed by the hospital. Once you have an accurate list of what they should be taking and what they’re actually doing you write it up in the notes, highlighting differences between prescribing intent and compliance. Then you highlight any differences between what should be prescribed on the drug chart now, and what actually is. Obviously you take into acount any deliberate changes that are written up in the notes. You can also highlight any other errors you note, such as major interactions or dosage errors such as a low body weight and the paracetamol dose. Following this the pharmacist would review your work and the rest of the notes and patient presentation.

    In terms of discharge this varies depending on whether we have a discharge letter yet (probably not.) We compare the medicine reconciliation to what is currently prescribed, noting any issues that are still (or newly) present. Then we find out what supplies the patient has, either on the ward or at home. If the dose has changed we can re-label any PODs that we can get our hands on as long as they are fit for purpose, and there are enough to last a week or more (we are obliged to give a week’s worth on discharge to allow them time to get more off the GP.) If the patient isn’t sure what they have then we have to assume there is none at home for safety’s sake, and we warn them to send back to the chemist any that have changed. It all depends on how sensible the patient is - a young patient with their head screwed on versus somebody with carers and dementia! Once we’re happy that there are no errors to fix (the doctor or prescribing pharmacist can fix things), we can use the electronic ordering system to order what’s needed from the dispensary. Alternatively if you have a discharge letter (and it’s completely correct) the pharmacist can PC (professionally check) it and send it downstairs for the items needed. If the patient is on an MDS (dosette tray) we would try to get a new one from the community pharmacy, with any changes that had been made. If we can get one the same day that’s brilliant, otherwise we have to give them boxes to last until the new MDS arrives. If there have been no changes and they have a tray with them that’s fit for use they can go home with that.

    Other jobs on the ward ward may include CQC inspection audit paperwork, ensuring that the ward is compliant with all issues that a CQC inspection would pick up on such as locked drugs cupboards, appropriate handling and storage of CD’s, fridge items etc. Then you may have further duties such as taking on students for a few hours, dispensing and accuracy checking slots in the hospital dispensary and anything else that you are asked to do.

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    • #3
      That’s great! Thanks so much for your help.

      As far as Meds Rec goes my knowledge is basic; I think this is where I let myself down in my previous interview. I would say it is ensuring that our records for a patient’s medication list is as up to date as possible, getting the information from summary care, patients themselves or any carers involved. Could I go deeper into this if asked of my knowledge in an interview? Perhaps touching on medications that are commonly missed etc?

      Many thanks
      Sarah

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      • #4
        You seem to be concentrating on medicine reconciliation as a tick box exercise - it’s really not, or at least it shouldn’t be. The reason we find out the two components (what was prescribed and what was actually taken) is so that the prescriber can make informed decisions about patient care.

        If somebody doesn’t take their calcium because it tastes foul, or it’s too big for them to swallow, all the lists in the world won’t change the fact that when you send that patient home they will continue to refuse to take it. Your job is to improve patient compliance by counselling and if necessary suggesting that the hospital change what is prescribed to something that the patient can and will take. Another example would be inhalers - if someone with rheumatoid arthritis has an evohaler but they can’t press down hard enough on the device to deliver a dose then you either have to give them an aid device to make it easier, or change the type of inhaler.

        If a patient commonly takes their diuretics at night because they work the night shift then it may be reasonable to prescribe them in the morning while they are an inpatient, but you would then expect it to be changed back to nighttime at discharge, because that patient may not understand why the box says to take it in the morning. If they followed the instructions they would then be getting up during their sleep when there’s no need for that to happen.

        The list itself is the enabling device only, not the be all and end all. After you have the list, what are you going to do with it? How does that list benefit the patient? And who is the appropriate person to act on it?

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        • #5
          That makes sense. Thank you for your help!

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