Covid-19: Clinical strategies and medication safety in critical care

By Rhona Sloss, Specialist Pharmacist Critical Care and Reena Mehta, Pharmacy Team Leader Critical Care, King’s College Hospital NHS Foundation Trust

Rhona Sloss (left) and Reena Mehta (right)

As part of the King’s Critical Care Team, we have had to respond quickly to a rapidly changing Covid-19 situation, after receiving our first patient on Friday 6th of March.

Over the last three weeks, we have been faced with new challenges on an hourly basis, as we prepare to increase our critical care bed capacity by 380% across two sites. While this brings several operational and logistical challenges, it is also important to prioritise appropriate clinical strategies and medication safety considerations to ensure patient safety is not compromised.

With a variety of consultants from different specialities caring for patients, as well as junior doctors with no prior critical care experience, some consistency in our clinical approach is required. Based on the recognisable pattern of how Covid-positive patients present, we have created an “admission prescribing order set” to ensure key drugs are prescribed quickly and accurately. We have focused on streamlining sedation strategies by devising a flow sheet to guide the choice of appropriate agents, giving options of alternatives if supply of first line drugs becomes difficult. To help with prescribing and administration, all areas have implemented a pre-printed infusion prescription chart. These interventions are necessary in order to ensure patients can be managed safely.

The increasing demand and workload placed on our critical care nurses over the past three weeks has also been evident. As nurse-to-patient ratios increase, it is important as pharmacists to consider reviewing the various medicines management policies and seek opportunities to make safe changes which can help during this period. This may include single nurse checking of injectables (with some exceptions) and reviewing storage of medicines at the bedside where POD lockers may not be available.

Considering strategies to reduce the burden on nurses of continually drawing up multiple infusions is also vital. Ideas we have considered include giving medications as intermittent boluses instead of infusions, using more concentrated solutions and looking at options to source pre-filled syringes, including exploring an in-house CIVAS service.

As pressure on us all undoubtedly increases in the coming weeks, the crucial role of clinical pharmacists will be more vital than ever. As we continue to learn on a daily basis and deal with new challenges, the value of communicating with each other, both locally and nationally, has never been more important.

How to get the most out of a mentoring relationship

By Helen Middleton, MSc (Education), FFRPS, FPharmS

Mentoring can provide opportunities for both mentors and mentees to progress. Read on to find out how to make this relationship work…

Mentoring will have a different meaning for different individuals. For some it will mean a relationship where the mentor guides the mentee on specific topics; for others it will relate to a wider, less directive relationship.

Match expectations

If there is a mismatch of the expectations of the mentor with those of the mentee, the mentoring relationship could be destined for failure. Therefore, it is important to discuss expectations at the outset of any mentoring relationship.

The following questions can be asked by both the mentor and mentee to help decide whether or not they are a suitable match:

  • How would you define mentoring?
  • What do you want to get out of this mentoring process?
  • What do you expect from me?

It is unlikely that the expectations of each party will be identical, so some compromises may be necessary to find common ground. However, if the expectations of each party are quite different then it may be better for the mentee to look for an alternative mentor via the Royal Pharmaceutical Society mentoring platform.

Mentor versus manager?

Some managers think they can mentor individuals at the same time as managing them. This is not recommended because it can be difficult for a manager to balance his or her different roles.

A mentor should focus on:

  • Supporting long-term development for the mentee’s current and future roles
  • Helping the mentee reflect on his or her practice
  • Helping the mentee identify development opportunities and learning needs
  • Setting goals to learn, develop and progress
  • Helping the mentee to monitor his or her own development

In contrast, a manager will tend to focus on: completing tasks and meeting immediate deadlines; assessing performance against standards and carrying out appraisals; enabling the worker to deliver and perform; setting objectives and checking on progress; and monitoring performance to ensure quality.

In addition, managers can be tempted to be directive and give their own answers to the mentee’s problems. It can also be uncomfortable for an individual to discuss their weaknesses and issues in a full and open manner with their manager, particularly if the issues are contentious.

Supportive, not instructive

To be an effective mentor, it is not necessary to be especially senior within an organisation or to have specialist knowledge of the mentee’s area of practice. The mentor should be an enthusiastic “people developer” who facilitates problem solving and action planning.

Mentors need to stand back, be objective and non-judgemental, and be able to put themselves in the mentee’s position. Rather than acting as an expert, mentors take on a supportive role: encouraging mentees to find their own expertise. A mentor can be thought of as a catalyst that stimulates self-directed change, with a belief in the mentee’s ability to solve his or her own problems.

This piece is abridged from an article by Helen Middleton, MSc, MRPharmS, first published in Clinical Pharmacist (2011;3:345).

Sign up on www.rpharms.com/mentoring 

RPS mentoring platform facilitates easy and appropriate matching of mentor to mentee. 

My experience at the RPS Mock Exam Event

by Alya Jassim, Pre-registration trainee 2020

The first day of the event started with an introduction to the course, outlining the important changes that we needed to be aware of, such as the updated de-regulation of medicines. The lecturer, Nadia Bukhari, was great at explaining information and giving lots of little hints and tips along the way. The pre-registration manual evidences were again put to light to ensure the topics were fully covered. We then moved on to calculations. There were quick-fire questions to get us warmed up and I liked how the calculations were categorised into 12 categories highlighting the possible questions that the exam could potentially ask, with slight variations. It made things much simpler. A reflection after each set of questions was particularly useful, as we had the opportunity to think about where we may have gone wrong in the calculation.

There were a few ice breaker sessions which opened conversations with other pre-registration trainees and proved great for networking opportunities. After the break, there was a very thorough clinical session about high risk drugs. The key points were again highlighted, and the speaker did a great job at challenging us to think at a deeper level, which gave me a very clear indication about how in-depth my revision needed to be.

After lunch we had another clinical session, however this was slightly more interactive, with a case study of a patient that had several commodities and risk factors. This was particularly useful as it allowed me to look at a case with a more holistic approach rather than look at one aspect. It gave us the opportunity to speak to other pre-registration trainees and discuss our answers. This was a very enjoyable session.

We then moved on to OTC treatments, another interactive session that I enjoyed. There were lots of example questions that could be asked in the assessment, which I used as guidance about what I should be looking out for when studying OTC medicines.

Day Two was the big day where the assessment took place. The assessment started after a very informative law and ethics lecture. The lecturer, Atif Shamim, gave lots of examples that really resonated and were very applicable to real life. I found it very helpful how the references to the MEP were highlighted on each slide.

Paper 1 was the hour-long calculations paper and then after lunch, we sat the second paper, which was the clinical paper. The feedback session was helpful, as I got to see where I was going wrong and what gaps I needed to address in my revision.

Overall, the experience I had at the event was extremely insightful. The information was well organised, the lecturers were very helpful and I found them greatly inspiring. I highly recommend the event for all pre-registration trainees, an absolute must!

If you’d like to find out more about the RPS Pre-Reg events taking place across the country, take a look at: https://www.rpharms.com/events/pre-registration-mock-exam-and-revision-course

Women in Science

By Dr Amira Guirguis

My entry into Science and Research was a long one as I initially trained and worked as an accountant. After becoming a mother, I decided that I wanted to help people from a healthcare perspective and I undertook the daunting task of training to be a Pharmacist in the UK. I say daunting because I was an Arabic/French speaker but I loved science. Becoming a Pharmacist – it was the best move I ever made! 

Working within community and hospital pharmacies taught me that building a rapport with patients can be magical and can significantly enhance overall patient outcomes.

During my career, I encountered patients chewing Khat claiming that it provides them with alertness and enhance their libido. I encountered patients who self-medicated with cannabis for pain relief. I was formally asked by coroners to comment on why death of a patient who has taken novel psychoactive substances, the so called “legal highs”, could not be prevented.

This failure prompted me to think that despite being an expert in medicines, my knowledge of these new emerging drugs and herbal supplements sold over the internet was limited. So I undertook a PhD in Pharmacy and began my career in Academia at the University of Hertfordshire and now as MPharm Programme Director at the new Pharmacy degree in Swansea which is now being provisionally accredited.

Through my research, I have taken the initiative to a new concept, providing insight among pharmacists and other healthcare professionals in the dynamic area of substance misuse and Novel Psychoactive Substances (NPS). My research focussed on how to identify these drugs to inform clinical decision-making and prevent pre-mature deaths.

I believe I represent the many women who try to balance the Research/Teaching careers as well as being a single mother. I do get a buzz from publishing my research from my group and international collaborations, even more so, when you can see your research shaping policy not only in the UK but other countries such as Australia!

I would like to feel that I can be a role model for many women in academia and one which many women can relate to, and in that perspective, I am also a mentor at Swansea University and RPS, mentoring 3 undergraduate students and 3 pre-registration pharmacists so that they can learn from my experiences in pharmacy.   

As I write this blog, I am preparing for a visit to the Middle East where I will be talking to school children about pharmacy and the varied career opportunities for pharmacists – I am really excited to be given this opportunity as I feel many children would choose pharmacy if they had the opportunity to meet pharmacists earlier on in their educational journey.

I think my enthusiasm for pharmacy is infectious as my daughter has become a fully qualified pharmacist and works in hospital pharmacy – may be it is in our genes, but for me it took a little longer to express itself!

A Reflection On The RPS Pre-Registration January 2020 Mock Exam Event

Pardis Amin-Eshghi

Your Pre-Reg year is a tough one, no question: finally putting all of your hard-earned knowledge to work in the real world. And you still have your Pre-Reg exams to pass at the end of it!

Fortunately, the RPS offers events across the country to ensure you get into practice with a minimum of sleepless nights!

These interactive sessions look at real-life examples to help you pass your exams and be ready for practice. They’re an invaluable opportunity to identify your strengths and weaknesses, highlighting key areas to focus your revision on.

At every event you’ll hear from experienced tutors with top tips, both for exams and challenging practice situations. You’ll also get to know fellow Pre-Reg pharmacists, as well as recruiters looking for their next generation of top pharmacists. We spoke to RPS member Pardis Amin-Eshghi, who told us all about her experience of the two-day event in London.

“I heard about the upcoming RPS event from my tutor, swiftly booked my place and then attended a weekend of intense, focused learning on how to pass my pre-registration exam in order to become a qualified pharmacist.

When it comes down to how to prepare, neither the tutors nor the GPhC recommend making your revision an exercise on how much one can memorise from the resource materials (and there is a lot to memorise). It’s more about how well one can apply that knowledge to the everyday scenarios found in practice, whether it be in hospital or community pharmacy.

The Pre-Reg event is split into two days.  Day 1 revolves around clinical lectures, case studies, calculations, and (my personal favourite) OTC. During the sessions, it was great to have the opportunity to bounce off ideas and then network with the other pre-reg’s. In addition to this, the calculation section (hosted by Simon Harris) involved going through all 12 types of pharmaceutical calculation questions listed in the framework – all in a succinct, step-by-step manner.

Being a big clinical buff, one of the highlights of the event was a clinical lecture hosted by Nadia Bukhari (who’s also the series managing editor of ‘Pharmacy Registration Assessment Questions’, a series that has been a staple in my exam practice). I was enthralled by the way the subject matter was taught, with the key take-home message being that this exam is checking our depth in knowledge. When tackling a scenario, ask yourself, e.g. “Why should a patient be on this medication?”, “Why does this medication cause this side effect?”, “What is the result of this interaction?”, “What other medications should this patient be on?” etc.

Day 2 commenced with an interactive session on Law & Ethics, with the main event being the mock paper (done under strict exam conditions, reflective of the actual day), with the questions representative of the style of questions provided by the GPhC. Once both papers were complete, they went through the answers and the rationale behind them. In the end, we got to take the paper/ resource packs home to go over again, along with our booklet of the slides used throughout the event. Overall, I found these events to be pivotal for the learning and development of any pre-reg that’s on the final hurdle to qualify as a day 1 pharmacist.”

If you’d like to take some of the pain out of your Pre-Reg and boost your chances of passing, there are RPS Pre-Reg events across the country – find out more at :https://www.rpharms.com/events/pre-registration-mock-exam-and-revision-courses

Mentoring is not just about asking an expert

By Helen Middleton, MSc (Education), FFRPS, FPharmS

Mentoring provides opportunities for pharmacists to obtain guidance and support at any time in their career. Those who are new to the profession, changing sector of practice, dealing with difficult work situations or developing a career plan often enlist the help of a mentor.

Mentoring is traditionally defined as “a relationship in which a more experienced or knowledgeable person helps a less experienced or knowledgeable person”. However, there are other definitions of mentoring which describe the mentor’s role to facilitate reflection and learning in relation to the mentee’s agenda rather than acting as an expert or adviser

A mentor supports and encourages another to manage their own development in order that they may maximise their potential, develop their skills, improve their performance and become the professional they want to be”.  Eric Parslow, The Oxford School of Coaching and Mentoring

By taking this approach I do not need to be more experienced that my mentee. It is also not necessary for me to be specialised in his or her area of practice. This approach opens the door for mentees to learn with a wider range of mentors; for example, I have been successfully mentored by a dietitian and even by the director of an art gallery!

Anyone can be a mentor provided they have good communication skills, are able to use a variety of different questioning techniques, are willing to listen and put the mentee’s needs first and view the time spent with their mentee as a valued investment. I hope that this will empower pharmacists who don’t consider themselves as ‘experts’ to sign up to be a Mentor on the Royal Pharmaceutical Society mentoring platform and contribute to the development of other pharmacists.

The four stages of mentoring are:

Getting together involves finding a suitable mentor. The Royal Pharmaceutical Society mentoring platform launched to members in October 2019 facilitates easy and appropriate matching of mentor to mentee. When you join the platform as a Mentor – you create an online profile which describes your experience and what you can offer as a Mentor. Mentees create an online profile which describes what support they are looking for. Then the mentee searches for a Mentor who matches their needs, e.g. the mentee might want to change sector of practice and look for short term mentoring from someone who already works in that sector including CV building and interview practice. Or they might be looking for a longer term mentoring relationship to develop leadership or research skills. The mentoring platform provides a list of potential Mentors and the mentee can view potential Mentors’ profiles, decide on a preferred Mentor/s and send a request for mentoring via the platform.

The first meeting between a Mentor and mentee is a way for you both to check the compatibility of the relationship. You should discuss your preferred mentoring and learning styles with each other, to make sure that you understand how the relationship might work. I ask the mentee two key questions: “How would you define mentoring?” and “What do you want and expect from a mentor?” Mentoring is likely to be ineffective if the mentee is seeking advice and guidance (a directive approach) but the mentor intends to empower the mentee to find their own solutions through questioning and reflection (a non-directive approach). In these situations, it is better for the mentee to search for an alternative Mentor using the RPS mentoring platform. 

All too often mentoring relationships miss the vital step of getting to know each other before launching straight into discussing difficult work situations or developing a career plan. Taking time to get to know the “whole person” (rather than his or her professional persona only) at the start of the mentoring relationship is necessary to establish rapport and trust, otherwise mentees can feel uncomfortable disclosing information. In my opinion, the first and second stages of mentoring are the most important in determining the success of a mentoring relationship. Get these initial aspects right and you will be well on the way to fulfilling the next step: learning together. I believe shared learning within the mentoring relationship brings many benefits for the mentor as well as the mentee.

The final stage is saying goodbye, since all good things must come to an end. My motto is: “Mentoring is like Red Bull — it gives you wings!” One of the hardest things for mentors to do is to let go and let their mentees fly. I always like to end by looking back over the mentoring relationship together and celebrating success.

Join the RPS mentoring platform today and find your perfect match
It’s easy to sign up and the mentoring platform facilitates easy and appropriate matching of mentor to mentee. 

You need to decide what you would like a Mentor to support you with. You can then select a Mentor based on their profile of skills, experience and interests.

Sign up on www.rpharms.com/mentoring 

Championing the wellbeing of the profession

Pharmacist Support Trustees and Staff Chief Executive, Danielle Hunt

By Danielle Hunt, Pharmacist Support

For those unfamiliar with Pharmacist Support – we’re the profession’s independent charity supporting pharmacists and their families, former pharmacists and pharmacy students in times of need.

In the past 10 years we’ve seen the number of acts of support the charity has been called upon to provide increase from over 700 in 2008 to over 7,000 in 2018. As we’ve grown and developed as a charity – so have the pressures. Although this is something we’ve been monitoring over the years through enquiries and service use, in May of this year we felt that the time was right to reach out to the profession once again, and to ask more generally about the issues and the challenges causing you the most stress today.

Through an online survey and series of in-depth interviews you told us that you needed support with stress at work, with work-life balance and with managing your wellbeing. In October we joined forces with the RPS as part of their workforce wellbeing campaign to dig a little deeper into these issues. You highlighted that this stress was linked to unrealistic expectations, leading to concerns around making mistakes and burnout.

Back in 2013 the charity recognised a need for more proactive support and following receipt of a large legacy from Pharmacist Robert Wardley, set about researching, piloting and launching a new wellbeing service. This service – delivered in a workshop format – consisted of information to help individuals understand the importance of wellbeing, recognise the signs and symptoms of stress in themselves and others and to provide tools and techniques to help manage those pressures. To date this service – now made up of workshops covering resilience, time management and assertiveness, webinars and fact sheets – has supported thousands of individuals (students and pharmacists) across the profession – almost 5,000 acts of wellbeing support in total.

Another part of this wellbeing support is our Listening Friends stress helpline. Staffed by trained volunteers who are pharmacists, this service provides a listening ear to individuals struggling with a range of personal and professional issues. In the last 10 years these dedicated volunteers have made over 2,700 calls to colleagues in stress & been able to help them navigate their way through many challenging situations.

Monitoring and understanding these pressures helps us ensure the charity’s services remain relevant and useful and the information we’ve gathered and you’ve provided through these surveys has informed the development our new 5 year strategy. Moving forward Pharmacist Support will be looking to further develop and shape our proactive wellbeing support and will aim to champion the wellbeing of those in the pharmacy profession alongside partners like the RPS.

So, thank you for your input over this past year. We look forward to sharing our new strategy with you and hope that you’ll join us on this new phase of our journey!

Your Mental Health Matters

By Ravi Sharma, Director of England, Royal Pharmaceutical Society

Like with any profession, the mental health and wellbeing of a workforce is paramount to being successful. As pharmacists, we have a duty to provide the best possible care for patients and I realise this means our job becomes very intense and stressful at times. We know that pharmacists continue to work tirelessly on the frontline every single day to help improve patient care, safety and reducing pressures on the NHS.

New research

Our recent research with Pharmacist Support to investigate workplace pressures has been very revealing and shocking. With over 1300 responses to our survey in just two weeks, we know that this is a topic people really care about, with nearly 75% of pharmacist saying their workplace environment has negatively impacted their mental health and wellbeing. As a staggering 80% of respondents also highlighted that they are at high or very high risk of burnout because of exhaustion and a further 44% concerned about potentially making mistakes or providing poor quality to patients, the magnitude of the problem is much more significant. We have released our initial survey findings which indicates the problem and our full report will be published in the spring next year.

What next

This is a real problem which needs to be addressed by the government immediately. The RPS is calling for access to NHS commissioned mental health and wellbeing services to cover all pharmacists working in any area of practice, just like what all doctors and dentists are entitled to. What we need to understand is the root causes to these problems and why the health and wellbeing of pharmacists is compromised. This will enable preventive measures to be put into place. We will be engaging with key stakeholders and our members in the new year to help understand the causes and the best solutions.

Having recently written to the Secretary of State for Health calling for pharmacist’s wellbeing to be supported more proactively, we hope this is a key issue for the government to address. We will continue to lobby and fight for pharmacists and ensure that the newly formed government tackles this as a priority.

Our aim is to ensure we can look after our pharmacists. We need to work with and listen to our members and form key relationships with stakeholders to produce a brighter future for the workforce. Together, we can make a real difference for our profession.

Student placements… what’s the point?

By Holly Hayne – Lead Writer Pharmaceutical Press


Internships, work shadowing or student placements. All necessary of course, but how do you set yourself apart from others in a competitive industry like pharmacy? Lead writer for Pharmaceutical Press, Holly Hayne, answers a few burning questions on what she looks for when filling that ‘student placement’ role.

Can you give us an overview of your role within RPS?

Lead Writer for one of the teams working on BNF content. Our team looks at all the content in the BNF as part of our regular review schedule to make sure it is up to date.

What is the importance of having placements outside of your Pharmacy degree?

To gain experience in a workplace that traditional university placements cannot offer. It is impressive to employers when students have actively sought out work experience beyond those that are mandatory. This indicates motivated students who have taken the initiative to gain additional skills, or further develop existing skills.

What is the number one thing you look for on an application/ CV of a potential intern?

We usually ask students to submit an essay as part of their application. This is an opportunity to really set themselves apart from other applicants. We are looking for people who answer the question well and within the set parameters (e.g. word limit). This tests their written skills, but also their ability to follow instructions.

Can you tell us one piece of advice you’d give to pharmacy students when looking for the right placements for them?

Think of the opportunities that the placement can provide you, and the skills and experience you can gain (e.g. more one-on-one time with supervisors, good exposure to different specialties).

What are the skills/ aspects a student can take from their course into a work place like RPS?

Good communications skills, attention to detail, the ability to work in a team, and enthusiasm – we want people who really want to work for the RPS!

More questions? Get in contact with our support team!

General Election 2019 – A bright future for pharmacy?

By Sandra Gidley, RPS President

The NHS has become a key political battlefield and is featuring prominently in party political manifestos. With the election just a week away, what’s being promised by the parties and what does the future hold for pharmacy?

No crystal ball

We want to ensure that the role of pharmacists and the wider profession in delivering safe and effective healthcare becomes a central tenet of health policy. Our manifesto sets out some of our key campaigns such as patient safety, medicine shortages and growing pressures on the workforce.

We want the next UK Government to invest in pharmacy to maximise its contribution to healthcare. We want to see patient access to medicines secured in a complex global market and a clear future relationship with the EU (and the rest of the rest of the world) to make this happen.

Greater investment in the training and education of pharmacists is also vital. We have made it clear that this should be a key element of any future workforce strategy. We also want to ensure that patients benefit from advances in medicines and therapies. With growing pressures on workforce, the next government must expand health and wellbeing support to pharmacists and all health professionals delivering NHS services.

Positive signs

The political party manifestos offer some hope in achieving our calls to action and for delivering on key issues that we have long campaigned for. Our call to scrap prescription charges in England in line with Scotland and Wales is being echoed in the current political battles. Recognition of the pharmacy workforce across the NHS and particularly in primary care has emerged as a key health policy issue. Acknowledgement of evidence-based medicines and harnessing the potential of new medicinal products is also featuring in political dialogue in the run up to the election.

For further information about the pledges being made on healthcare by the main political parties, please see our handy summary guide.

Your voice counts

The clock is ticking but there is still time to have your voice heard. Why not encourage election candidates to show their support for pharmacy by using the RPS general election toolkit? Get in touch with your local candidates and invite them to a pharmacy visit to discuss the future role of pharmacy. You could also get involved in the social media conversations about the election, look out for #votepharmacy.

This election is a vitally important one. It is crucial that the main political parties back and support pharmacists and pharmacy services. As a pharmacist, please do make your voice heard and together, lets create a bright future for pharmacy.