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.

Social media – let’s make it a force for good.

Social media use is always under scrutiny.

Whether it’s the amount of screen time children should have or whether vloggers should be encouraging gambling, the public’s mood seems to be in favour of more regulation, accountability and transparency.

We are fast approaching the 2020 RPS elections! We want everyone to enjoy the experience of being part of the elections, whether as a candidate or as voter, so we will do our best to encourage friendly and professional discussion.

We’ll be encouraging members standing for election to campaign via social media, online forums and blogs. We know this is a great way to reach and engage with voters. If you’re standing for election this year, we will send you specific guidance to help.

The best advice I’ve ever received about testing whether something is suitable to be shared on social media or not is: “If you wouldn’t say it in the ‘real world’, don’t say it in the ‘digital world’.

We love a robust but polite debate. Read more Social media – let’s make it a force for good.

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. 

Parental leave and returning to work

by Elen Jones, Director for RPS Wales, and Robbie Turner, RPS Director of Pharmacy and Member Experience

Elen Jones

Elen: Swapping the baby wipes, nappies and the bottles for policies, business plans and strategic meetings.

Maternity leave is over. In a blink of an eye, my baby boy is babbling away and walking round the furniture. He’s nine months, I just about feel like I’m getting to grips with being a mum of two and all of a sudden, it’s time to go back to work.

It’s been amazing to spend so much time with the boys; watching the little one develop and being able to take my eldest to school every day as he starts nursery has been brilliant. On the flip side, it’s often felt chaotic. The demands of two children are something else!

Three weeks into maternity leave I attended an interview and was fortunate enough to get a new role as Director of RPS Wales. 

It’s such a privilege to be returning to work and starting this role. I definitely had huge anxiety during the days leading up to my return. How will we cope with getting the boys to nursery and all be out the door by 8am? How will I catch up on the last 9 months? RPS think I’m the right person for the job, but what will members and my team really think? Impostor syndrome was creeping in! I did check out the RPS Return to Practice guide which helped allay some of my worries. I’ve been back in work for two weeks, and I miss my boys very much. Fortunately, my youngest has settled into nursery quite well (better than his big brother did!)

If I’m really honest, I’m actually feeling more like me again. I’m back to feeling more in control, enthused by the work and by my colleagues.  I’m full of ideas, getting out there and speaking to like-minded pharmacists. I’ve caught up with lots of our members already, everyone’s been so kind and supportive.

The sleepless nights unfortunately don’t stop when you return to work, but I don’t mind them as much now, time with the boys has become more precious. I so look forward to getting back from work to their big smiles and hugs.

So, a big thank you to all my colleagues and our amazing members for all the support and your patience while I’ve been away! I look forward to working with you all to make sure RPS and pharmacy continue to go from strength to strength.

Robbie Turner

Robbie: This year I’m going to get an extra three months off work. And, I’ve been surprisingly anxious about it.

Not that pre-holiday anxious when you’re trying to work out exactly how much ludicrously expensive sun cream to pack so you don’t need to bring any back with you. No, it’s a feeling that’s hard to describe but I bet there are millions or people (mainly women) who have experienced it even more deeply than me.

My partner Ben and I are soon (everything crossed) going to adopt two children. We’ve been aiming to make this a reality for over a year now. A big thank you to work friends and colleagues who have given me support and advice over the last year. Your words of encouragement have been hugely helpful. But, nobody warned me about this bit – preparing for paternity leave.

I know we’re lucky at RPS to have a good paternity leave entitlement. As part of our work on inclusion and diversity we identified that our gender pay gap was too high and introducing paternity pay was one of the tools we put in place to start to be a better employer for both men and women. Check out this article “Men’s parental leave is key to women’s progression

I’d like to think that I’ve always been supportive of women (and I think it has always been women who’ve taken any form of parental leave in my teams) when they announce the news that they are pregnant. I’ve cried a few times, but that’s always been with excitement rather than thinking about covering their maternity leave! I know this isn’t the experience of lots of women and that’s one of the reasons why I’m committed to taking my full paternity allowance. What I’ve never considered is what could be going through an expectant mother’s mind when they’re thinking about taking parental leave. And I now have a small insight into both their perceptions AND the realities..

I work with a great team who are brilliant at their jobs.  Even then, I’m worried about the added pressure me going off for three months will put on them.  BUT, when I really reflect, my main worry is the complete opposite. It’s that I will get found out as a bit of a fraud. That everyone will cope just fine without me or (arghhhhh) that it will be even better when I’m not here interfering and distracting people. Will I still have a job at the end of it all? How much will the world of pharmacy have moved on – will I be able to catch back up?

So, if I’m feeling like this – a (fairly confident), white man, in a senior role, only going on paternity leave for three months – then what must it be like for others who don’t have the same privilege of gender, colour, or seniority facing up to a year away from the work place?

Now, when women (and increasingly, men) tell me their great news about their pregnancy or adoption I’ll be just as excited but I’ll also understand how stressful planning for parental leave can be. Wish me luck!

Are you returning to practice? Check out our Return to Practice guide which is packed full of practical advice and tips to help you return to the workplace with confidence.

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!

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!

Inclusion and diversity update

by Paul Bennett, RPS Chief Executive

As your professional body, we are now working towards an inclusion and diversity strategy for pharmacy that values difference. We want to recognise, celebrate and encourage all voices and experiences across pharmacy so we can better represent you and our patients.

I’ve had the pleasure of attending three recent events hosted by the RPS to engage with members on this really important issue. The first was a celebration during Black History Month of the BAME community’s contribution to pharmacy and we had fantastic contributions and insights shared on the day.

The second was an Inclusion & Diversity workshop which was a key milestone on the programme of work we’ve embarked on. Being authentic at work, and in turn being able to feel a sense of true belonging, is something that means so much to each of us individually and I’m keen to champion this here at the RPS. I’m a strong believer that you can only be your best self if you are allowed to be the person you truly are in your workplace, so this programme, under the guidance of our excellent Chair, Asif Sadiq MBE, will produce a strategy that we hope will resonate across the profession as well as within the RPS itself.

The third event I attended was the Retired Pharmacist Group of the RPS. It’s clear to me that older age does not mean a decline in drive, energy and enthusiasm for the profession (or for life!) and I came away feeling both inspired and thankful to have among our membership such passionate and professional people who we can all learn so much from. I do hope RPG members take up my invitation to become RPS Mentors!

Our recent I&D survey of members has highlighted that they wish us to do more in the areas of disability, race and age, and we’ll be looking at how we can do this most effectively. We’ve also got a timeline of our activity so you can track our progress.

My view is that we can only be effective at tackling I&D issues if we’re not afraid to hear about the problems and challenges faced and address them. This requires each of us to have the courage to speak up and commit to not walking past inappropriate activity where we see it. Those of us in a position to create the environment for concerns to be raised without fear should do everything we can to enable that to happen.

I said at our I&D workshop that at times I had been self-conscious as a white, middle aged, heterosexual male trying to engage in conversation about BAME and LGBT+ issues as it might be perceived that I had no credibility to do so. Having talked about this with many people, I now realise that I’m not alone in having that concern BUT that it’s better to share my perspective, understand it for what it is, listen to all the other perspectives and actively contribute to this vital agenda. No one individual can profess to speak on behalf of groups of others, as we each have a unique perspective – we are all individuals after all, even though we will identify with certain groups.

RPS can only have credibility in this space if we ‘walk the talk’. Part of our commitment is therefore to do what is right by publishing data that shows our performance as an employer striving to create equal opportunity. We already publish data on our gender pay gap here at RPS and in future I am committing that we will also publish data on ethnicity and pay. We are not required by law to do either but it’s simply the right thing to do, as we believe we should lead by example.

I encourage you to engage with this discussion about inclusion and diversity whenever and wherever you can and to champion everyone’s right to be their authentic self in the workplace. Being authentic, feeling comfortable with who we are and bringing a diversity of perspectives and views to work will enrich the RPS and help us deliver the best possible support for our members, whatever their age, race, gender or sexuality.

Mentoring – a role for retired pharmacists

by Theresa Rutter, FFRPS FRPharmS

Most of us will have done some mentoring and many like me will have no formal qualification. I became interested after being mentored years ago by a non-pharmacist working towards a formal mentoring qualification. I found the process so useful that I wondered why it wasn’t embedded within the profession as a self-development tool.

Mentoring as a retired pharmacist

We retired pharmacists have the experience and skills to support the self-development of pharmacists at all stages of their career.

I started to mentor before retiring and have continued since with up to 6 mentees at varying intervals. They work in different sectors and levels of seniority.

Their areas of focus have included leadership, effective team work, staff management, prioritising, change management, problem solving, negotiating, influencing and work life balance.

The competencies (in the Advanced Pharmacy Framework) relating to these generic skills do not go past their expiry date.

I’ve found that career progression often means that mentees come to value satisfaction about their performance and recognition more highly.

Feedback from my mentees about their experience of mentoring

  • Mentoring provides a safe space and encourages them to explore options and find solutions to challenges
  • Retirees may have more time & flexibility to fit round the working hours of mentees
  • The empathetic relationship helps them to be honest about problems and areas for self-improvement
  • The sessions give them head space for reflection and creative thinking

What’s in it for mentors?

  • Stimulates neuronal pathways (use it or lose it)
  • The opportunity to share expertise and see mentees thrive is rewarding
  • It’s always good to get positive feedback

How you can get involved in mentoring?

It’s easy to sign up – RPS has launched a new mentoring platform which facilitates easy and appropriate matching of mentor to mentee. You need to reflect on the skills you can offer to the mentees, complete your profile and then keep an eye on your emails for requests from potential mentees, which you can either accept or decline.

For mentees, the same principles apply. They need to reflect on what they would like to get from a mentoring relationship and once registered can select a mentor based on their preferred profile of skills and experience, interest and local area (optional).

Sign up at www.rpharms.com/mentoring 

My aspirations for the NHS Community Pharmacist Consultation Service

As the new Community Pharmacist Consultation Service goes live, English Pharmacy Board member Andre Yeung, a key developer of the earlier Digital Minor Illness Referral Service, offers his thoughts on how to make it a success.

How did the Community Pharmacist Consultation Service develop?

My good friend and colleague Mike Maguire and I actually started talking about this right back in the summer of 2014. Back then NHS 111 wasn’t really referring to community pharmacy – they mainly sent patients to GP services, walk-in centres or A&E departments. It got us thinking that community pharmacy could do so much more in this space if we only just connected the network up with NHS 111.

After our NHS Pharmacy Integration-funded pilot in December 2017 we’re now presented with a national roll-out this October. It’s taken some time to get to this point, and it took a little bit of convincing about pharmacists’ role, but I believe the future delivery of this service is really important for community pharmacy and the NHS. We’ve had over 28,000 patients referred into community pharmacies as part of our pilot and community pharmacists have done an absolutely astounding job of clinically assessing, advising, treating, managing and escalating patients within an integrated primary care system. 100% – we’re now the first port of call for minor illnesses here in the North East.

Why do you think the CPCS is so important?

My belief is that Community pharmacy developing a role in acute out of hospital care is more important than the sum of all other commission services that have been commissioned through community pharmacy.

Why? Firstly, because acute care is needed and appreciated by patients! Secondly, it doesn’t just disappear if pharmacy doesn’t do it so it’s needed by the NHS too. Thirdly, the size and scale of this is massive.  It seems to me a ‘no brainer’ that if pharmacy helps out our GP and nurse colleagues they too would start to argue that the right place for managing patients with minor illnesses is within community pharmacy. Pharmacy can provide patients with excellent access to services and because of our scale can take pressure off NHS colleagues as we head into the busy winter season.

What are the considerations that are needed to enable around a national roll-out?

It’s a big task to get the best out of this service. In some respects, this is business as usual for pharmacists, in others it’s completely different. I don’t think there’s been a more challenging service launch in the history of community pharmacy.  As of October 29th we’ll be connected to the NHS in a way that we haven’t been in the past. People will be monitoring and counting on our clinical interventions so we need to ensure the quality of what we deliver is of a really high standard across the board. If we can do that, and I believe we can, then this could be a seminal moment for our profession – a really positive turning point that leads to further developmental opportunities in the clinical arena. How great would it be to achieve amazing results with the spotlight on us like never before?

What message would you give to front-line pharmacists?

These are a few of my top things to remember about CPCS:

  • CPCS about YOUR clinical assessment in the pharmacy. Get the info you need and make your own professional clinical judgement as NHS 111 have only done a triage based on what the patient has reported on the phone. A great clinical assessment keeps the patient safe, is rewarding for the pharmacist and importantly helps patients get well as they have the right plan in place.
  • Three most likely outcomes of your assessment will be a) you can help the patient, b) you need to escalate the patient or c) you can’t help the patient but you don’t need to escalate.
  • Safety net every patient: advice on when to act and how to act if things don’t improve or get worse.
  • Keep decent clinical notes in the IT system, for patient benefit and yours.
  • When you escalate in hours, most times you’ll need to speak to the GP not the receptionist. You’ll be escalating because you have a clinical concern so it’s only natural you’ll want to communicate this to the receiving GP – it’s both helpful and courteous to do so! Out of hours you’ll be going back to NHS 111 via the healthcare professional line so be prepared to request a referral or support from the clinical assessment service.
  • Reflect on your practice. If you need some additional training then sort this out as part of your CPD.

What are my aspirations for the future of the service?

Initially, this is about community pharmacy the sector maximising this opportunity. It’s about us ‘knocking this out of the ballpark’ so to speak. That’s my main aspiration!

If we achieve this then the NHS have already outlined an opportunity to work with GP referrals into community pharmacy for minor illnesses.

In the future, what would be good would be some additional training, access to some POMs and some basic equipment (oximeters, BP monitors, thermometers etc.).  This will allow us to see other types of patients as our functionality increases. Why not see patients with suspected UTIs, with impetigo etc? I know my colleagues at the Royal Pharmaceutical Society will be pleased to hear me say that I think the roll out of Pharmacist Prescribers will eventually come on the back of all of this work. We’ll need them as we do more and more in this domain.

It’s all very exciting! Caveat to all of the above? We MUST deliver this first phase of the service well.  Organisations need to support our front line pharmacists and pharmacy teams to deliver quality. They absolutely have the capability to do it, they’re amazing, but they will need our help and support to make it happen!

Our Mental Health and Wellbeing Campaign

By Jonathan Burton MBE FRPharmS, Chair of the Scottish Pharmacy Board

I think we can all agree that being a pharmacist can often be stressful and demanding. My personal experience of managing my wellbeing, in the context of my work as a community pharmacist, has been a journey.

Early in my career (I’m 20 years qualified now) I often struggled to control stress & anxiety when workload was high in the pharmacy, I could be irritable and looking back I’m sure this was noticed by and affected my work colleagues and patients alike. I co-own the company I work for and this had the added effect of causing me to feel a lot of guilt, even in situations in the pharmacy that I couldn’t really exert any control over, as I inherently felt it was always in part my fault if my team and I were struggling. I seemed to carry this with me all the time. 

Further on in my career now I feel I manage these emotions better, but I still notice the negative impact that busy and stressful days and experiences have on my life & general wellbeing. I can control it at work better, but at home sometimes it’s still a struggle. If you ask my wife and children they’ll tell you, I often find it difficult to switch off from work and it sometimes takes me some time after arriving home before I feel I’m the husband to my wife and father to my boys I think I should be. If it’s a tough week at work I often stop looking after myself, my diet worsens and exercise stops. 

I consider myself lucky, I enjoy my job and have always felt fortunate to be a part of a profession that cares for others. But as health professionals we need to look after ourselves and each other as well as the public and patients we care for. We are human, and we will have our struggles with our wellbeing and mental health, but this does not mean we don’t deserve help to manage these challenges. 

If you are a pharmacist reading this, and haven’t done so already, please help the RPS and Pharmacist Support fight for better access for pharmacists to help with their wellbeing and mental health issues by completing our survey. It really will make a difference, thank you.