My hospital pharmacy placement experience

This week, I undertook a pharmacy summer placement at a district hospital. Beforehand, I was sitting on the fence of the community vs. hospital dilemma that's been playing on my mind ever since the beginning of second year. Everyone else seems to have made up their mind months ago. Me, I've been to-ing and fro-ing all year. However, I'm happy to report that this placement has almost completely made up my mind for me.

The dispensary is a mad rush of people, basically, with approximately fifteen pharmacists, fifteen technicians and two pre-registration trainees. There are many types of document used in a hospital that constitute the drugs that are needed by a patient, including prescriptions, treatment sheets and order forms. Some don't even need to be signed by a doctor, something I was very shocked at.

After a tour of the impressive renovated pharmacy department, I went onto the first ward. I'd effectively already done this as part of hospital tutorials at university, during which pairs of pharmacy students went onto the wards and obtained drug histories from patients. So just watching the pharmacist doing medicines reconciliation was nothing new to me. However, I saw a whole new side to hospital pharmacy as the week went on.

On my third day, I sat in on the pharmacist-run anticoagulant clinic, a topic that I had learned so much about at university. Patients taking warfarin attended the clinic to have their INR measured and actions taken accordingly if appropriate. One patient had an astronomical INR of 11.4; the pharmacist advised him to take a dose of vitamin K immediately followed by missing the next two doses, before returning to the clinic on Friday to have his INR rechecked. This element of hospital pharmacy, advising patients on their treatment plan and seeing results, is the one I would relish most as a hospital pharmacist.

I also visited a local hospice of twelve beds that the hospital supplied medicines to, one that followed stringent rules on who was accepted as a patient. The hospice was a lovely place, with furnishing similar to a hotel and nurses who were great at making the atmosphere pleasant for the patients and visitors. This saddened me slightly as many of the patients there had been admitted with a terminal diagnosis and three had been put on the "end of life pathway", the point at which their regular medication is stopped and palliative care is started, where the quality of the patient's remaining life is the main aim. Strong opioid analgesics such as diamorphine/heroin were common in these cases.

Overall, even though it was only a week long I had an excellent learning experience and am sorry that it's over. Although, with it taking a 35 to 40 minute drive to travel each way, something I'm totally not used to with university being a ten minute bus ride away, I'm positively knackered and think I need a bit of a break. I hope that when I become a hospital pharmacist in two years time, touch wood, I will get used to the inevitable commuting and enjoy it just as much as I did this week...with an extra dose of responsibility of course.