By Rhona Sloss, Specialist Pharmacist Critical Care and Reena Mehta, Pharmacy Team Leader Critical Care, King’s College Hospital NHS Foundation Trust
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
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
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’.
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.
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
How would you define
What do you want to
get out of this mentoring process?
What do you expect
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.
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
A mentor should focus on:
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
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
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
by Elen Jones, Director for RPS Wales, and Robbie Turner, RPS Director of Pharmacy and Member Experience
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: 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
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.
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!
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!
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.
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.
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.
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.
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.
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.
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
Mentoring as a
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.
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
provides a safe space and encourages them to explore options and find solutions
may have more time & flexibility to fit round the working hours of mentees
empathetic relationship helps them to be honest about problems and areas for
sessions give them head space for reflection and creative thinking
What’s in it for mentors?
neuronal pathways (use it or lose it)
opportunity to share expertise and see mentees thrive is rewarding
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
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).
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
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:
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.
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.
net every patient: advice on when to act and how to act if things don’t improve
or get worse.
decent clinical notes in the IT system, for patient benefit and yours.
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.
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!
By Jonathan Burton MBE FRPharmS, Chair of the Scottish Pharmacy Board
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.
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.
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.
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
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.
The Royal Pharmaceutical Society is the dedicated professional body for pharmacists and pharmacy in England, Scotland and Wales.
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