Surviving the hospital prereg year

Choosing to undertake your preregistration training in hospital does not mean you are confined to the same dispensary and ward rounds. Nausheen Khan describes her experiences as a preregistration trainee at the Oxford Radcliffe Hospitals NHS Trust

Having applied for a hospital placement through Pharmalife, an online community for pharmacists, and successfully making it through the interview, fate led me to the Oxford Radcliffe Hospitals NHS Trust.
The trust is divided into three hospitals: John Radcliffe and Churchill Hospitals in central Oxford, and the Horton Hospital in Banbury. The year started off with a two-week induction period during which the basic principles of the preregistration year were highlighted.
I was taught how to document evidence to fulfil a variety of performance standards, given an introduction to general medical terms and how to search through medical notes to obtain the information necessary for ward duties. I was also given tutorials on screening drug charts and assessing laboratory results. 

Dispensary

The first rotation was in the dispensary at the Horton Hospital, where I learnt standard operating procedures in dispensing, labelling, stock taking, handling of Controlled Drugs in the hospital environment, production of extemporaneous preparations and making up emergency drug boxes.
Following this, afternoons were spent in the dispensary of each hospital for the remainder of the year, which allowed me to perfect my dispensing procedure and I was also able to complete a 1,000 item checking log. This helped engrave a stringent dispensing and checking method that has helped improve accuracy for my current work practice and, therefore, ensuring patient safety.

Ward visits

Initially, ward visits consisted mainly of shadowing the ward pharmacist in a general medical ward, getting to grips with the layout of drug charts, beginning to identify safe doses of common drugs, slowly progressing to picking out which drugs potentially interact and assessing the effects of particular drugs on urea and electrolytes.
With time, I was given a bay of ward to look after and, as my confidence grew and my competence improved, I was able to carry out all pharmaceutical duties for an entire ward, which included ordering drugs that were not on the ward’s stock list, communicating with prescribers and other healthcare professionals concerning the care of patients and screening TTO (to take out) prescriptions.

Surgery

The surgery rotation involved attending preoperative assessments and ear, nose and throat clinics, along with spending a morning with stoma care and diabetes specialist nurses. I also spent a few days with the total parenteral nutrition team.
The team consisted of a dietitian, specialist nurse, consultant and pharmacist. The team meet on a daily basis to assess patients’ nutritional needs and a new prescription is generated daily that is sent to Baxter to produce. The pharmacist involved is a specialist in this field, and is also an independent prescriber, so she is often responsible for prescribing TPN.

Medicines information

I spent a month in medicines information, during which I answered queries over the telephone for pharmacists on wards requiring information ranging from drug bioavailability, alternative formulations for patients unable to swallow and even the preparation of intravenous drugs.
I also carried out more detailed literature searches to answer queries, such as herbal interactions with conventional drugs. For part of this rotation, I was sent to Southampton General Hospital for a week because it is the regional medicines information centre.
This was a great experience to enhance my research skills and to develop my writing skills because, often, calls came in from members of the public and responses were given in the form of a letter. We were also given the opportunity to answer calls from NHS Direct in order to aid with patients’ queries.

Other specialties and experiences

Given the diversity of specialties in the trust, I was able to visit various specialist wards. I was given the opportunity to observe hip and knee replacement surgery at the Nuffield Orthopaedic Centre, and attend a chemotherapy clinic, where I saw how drugs were administered. Also, I was able to speak to the patients there, which I found a valuable experience. While on my paediatric rotation, I observed the administration of intrathecal methotrexate in children and the strict checking that takes place to prevent life-threatening errors from occurring.
Through my stroke rotation, I got to spend a morning with a speech and language therapist. Prior to this, I did not know the importance of speech and language therapists’ assessment on stroke patients, which involves checking if patients have lost the ability to swallow as a result of damage to the brain from the stroke.
During my time spent with the respiratory pharmacist, I attended a cystic fibrosis clinic. I observed patients as they were given physiotherapy to help with moving fluid in the lungs. Also, the dietitian checks that their diet is providing them with sufficient minerals and vitamins and the pharmacist checks drug compliance and adherence.
The trust does not have its own sterile production department, which is probably the only downside to the year, since this can be an important rotation to undertake if one is pursuing a career in hospital pharmacy. However, I was sent to Baxter’s production unit to observe how it is run.
To fulfil the health promotion performance standard, I teamed up with one my preregistration colleagues to put together a smoking cessation campaign for No Smoking Day. To prepare for this, we contacted the local smoking cessation team to obtain posters, leaflets and various paraphernalia to aid us. We were also able to obtain a small grant to purchase a carbon monoxide monitor to test carbon monoxide levels on the day as a way to motivate smokers to quit.
Through attending the Royal Pharmaceutical Society branch meetings, I was able to arrange a visit to a prison pharmacy. During the visit, I went through security checks and was escorted to the pharmacy (having to go through at least 10 gates before reaching it).
Pharmacy practice in a prison is different from conventional practice because all prescriptions had the patient’s photo as a form of identification for when inmates come to a hatch in the medical centre to collect their medicines. Methadone dispensing is usually supervised and the dispensers are locked into a cage within a consulting room to ensure their safety.

Study days

The Oxford Trust is part of the South Central region, which means, accompanied with local learning sets, I had monthly regional study days. I was given lectures and tutorials throughout the year to help prepare myself for the registration examination.
There were also three residential courses where I went to conference centres for three days of intense tutorials, observed structured clinical examinations and mock examinations. These were beneficial in helping me assess my progress throughout the year and allowed me to prepare for the registration examination.
I was also given monthly quizzes on calculations, over-the-counter medicines and law registration examination questions. These were reviewed with my tutors and any areas that I found difficult I was given extra help with. I believe that the level of support given to me throughout the year was high and my needs were taken into consideration. Also, when problems arose, they were dealt with in a constructive way.
For many, the preregistration year can be a difficult year, having to juggle work and preparation for the registration examination. A good training programme coupled with a strong support network is important in helping to achieve success in the examination.

I believe I was lucky to have got both during my placement and I have learnt many valuable lessons that will benefit me in my future career.

Nausheen Khan is a community pharmacist in Woking

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