“I love the variety of the role, knowing that we are making a positive impact on the patient’s care”

As we celebrate National Pharmacy Technician Day , I thought I’d take this opportunity to give you an insight into the role we play in patient care.

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I am currently a Student Pharmacy Technician. For me, there isn’t a typical day. I go away to college several times a year to study, learning about subjects like the actions and uses of medicines, human physiology and pharmacy law. My time at work is spent rotating throughout the pharmacy, experiencing a variety of roles undertaken by pharmacy technicians.

 

In order to practise as a pharmacy technician, we must complete an approved qualification and register with the General Pharmaceutical Council. Our initial training usually takes two years, but we will be continuously learning, developing and improving throughout.

 

At the moment I am working with Medicines Management Technicians on the Medical Assessment Unit, taking medicine histories from patients, ensuring any medicines taken pre-admission are documented in the medical notes and prescribing discrepancies are highlighted to the pharmacist. I have found this the most engaging rotation as I love the interaction with patients, and the satisfaction I get from successfully and accurately investigating complex histories.

 

In pharmacy, we have a production unit. Technical Services are responsible for sourcing and producing products such as Monoclonal Antibodies (MABs), Chemotherapy and Parenteral Nutrition, ensuring all products are made in accordance with Good Manufacturing Practice (GMP). Technicians are involved in producing worksheets, assembling the raw materials, accuracy checking, and making the products. Alongside them, Quality Control technicians monitor the cleanliness of our aseptic suites and confirm all unlicensed medicines are safe for use.

 

Technicians in our procurement department are responsible for sourcing genuine products from approved suppliers in accordance with local and regional contracts. They ensure appropriate stock levels are maintained and source a variety of products including unlicensed medicines and controlled drugs.

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The majority of prescriptions and orders comes through the dispensary and distribution and technicians take a leadership role in these areas. Distribution, which deals with stock orders, is usually overseen by a technician. Their role involves issuing and picking orders and advising and supporting the pharmacy ATOs. In the dispensary, technicians label, dispense and accuracy check prescriptions, hand out to and counsel patients on their medicines and liaise with other healthcare professionals and community pharmacies to ensure the timely supply of medicines.

 

Pharmacy technicians don’t only work in hospitals, we can practice in variety of settings, each presenting their own challenges but all providing a rewarding career. Pharmacy technicians play a vital role in primary care, ensuring prescriptions are dispensed accurately and patients understand why and how to take their medicines. In community pharmacies, Technicians advise on over-the-counter medicines and can provide additional public health services such as smoking cessation. Technicians also work in prisons and care homes, dispensing medicines and ensuring patients get the most from their treatments, and for CCGs responsible for commissioning health and care services.

 

With experience, technicians are able to specialise, for example in education and training, IT, Medicines Information or paediatrics and most of our pharmacy managers and senior managers are technicians.

 

I love the variety of the role, knowing that we are making a positive impact on the patient’s care and continually improving and broadening my knowledge and skill set. I wasn’t in a position to be able to go back to university and so this qualification is allowing me to have a rewarding and fulfilling career.

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In the not too distant future, technicians will be more visible on the wards and be able to have a greater and more noticeable impact on patient care, taking some of the pressure off our pharmacists.

“If we don’t get it right at procurement, we can’t ensure the quality of the medicines we are supplying to patients…”

My name is Zoe and I am a Pharmacy Technician working in Procurement for the Trust.pharmacy.

I am proud to work with such hard working and patient focused people in my department. We work in such a variety of roles, from medicines management technicians focusing on medicines reconciliation and safe use of patients own medicines on the ward, to supply technicians who process discharges, inpatient and stock requests daily to ensure the hospital continues to provide excellent patient care.

It is not a job I originally knew anything about before I came to work at the trust five years ago as an ATO in Pharmacy. But I really liked the way that technicians help keep the medicine supply chain flowing and enabling great patient care. I was amazed at how many of my colleagues work hard every single day to make sure that we supply discharge medication, inpatient supplies, clinic specific medication and ward stock to keep the medicine supply chain going through the hospital. Pharmacy Technicians provide a safe, secure and quality supply chain, from procurement all the way through to the patient – through a variety of roles.

I took the opportunity to train as a Pharmacy Technician within my department and learnt what it meant to be a registered professional. During my training I had to work with many different teams, including the procurement team helping to order, receive and source medications. Managing the supply chain effectively allows us to deliver outstanding patient care and I knew that’s where I wanted to work.

My current role enables me to manage supply shortages and issues, support the day to day ordering, maintain our contract compliance as well as support the day to day activities of our busy procurement team. I love my role as if we don’t get it right at procurement, we can’t ensure the quality of the medicines we are supplying to patients.

“We are proud to be in a position of responsibility, where we hold extensive knowledge that allows us to put our patients first”

Blog by Carleen Barry – Band 5 rotational Dietitian covering Gastroenterology/Medical

 

As a newly qualified band 5 Dietitian I often carry a diverse caseload of patients.

I currently cover the band 5 Gastroenterology/Medical rotation at the Trust and I work alongside two part-time band 6 specialist gastroenterology Dietitians and between us we cover a specialised gastroenterology ward. In addition to this I also cover four medical wards including two medical assessment units.

My day-to-day is far from predictable and can all change from one simple phone call at 8:30am. Therefore, I thought I would share with you a regular Thursday of mine.

My days start at 8:30am in the office catching up on emails, checking our online referral system, and liaising with the rest of the Dietitians for a team huddle.

 

Artificially fed patient

My first patient of the day is a patient well known to our community Dietitian’s team whom requires artificial feeding via a tube into the stomach called a Percutaneous Endoscopic placed Gastrostomy (PEG). This patient had been admitted to Derriford for an organised PEG replacement due to complications. So, my role is to work with the broader multidisciplinary team to communicate and organise loose ends. This ensures the wider community team are up-to-date and as prepared as they can be for when the patient is discharged back into the community. Whilst this patient is on the wards I liaise with the multidisciplinary team to ensure particular post procedure checks are carried out and all supplies of feed, syringes, and after care tools are organised. The complexity of this particular patient is heightened due to a severe learning disability. This means all of my information comes from the patient’s parent, and their ability to understand the patient needs. A smooth admission and discharge is reliant on us all working together meticulously.

Complex Eating Disorder patient

Next up was a patient whom had not been under my care as such but had been seen by both the band 6 gastro Dietitians. It was a non-working day for both of them and this highly complex patient was pending discharge upon dietetic review. To prevent delaying discharge I arrived on the ward and spoke with the medical staff and the patient. Together we came to an agreement for the discharge plan and how this particular patient could be further supported in the community. Although eating disorders is a specialist area, we are able to provide the best possible care as a multidisciplinary team. Effective communication and active listening skills are central to successful patient treatment and discharges.

 

Re-feeding Syndrome patient

 

A patient on one of the Medical Assessment Units was referred for dietetic input after presenting with alcohol withdrawal and minimal nutritional intake. Both of these presenting conditions are just two of several factors which could put a patient at risk of re-feeding syndrome. Unless you work as a Dietitian or is someone who works within the clinical setting, it is unlikely you would have heard of this syndrome. Re-feeding syndrome is a serious but potentially preventable syndrome as long as it is identified early enough. A registered Dietitian like me will assess the patient and implement the trust protocol to ensure the risk is minimised. Not all patients who are referred to a Dietitian are at risk of re-feeding syndrome. However, we do rely on trained members of staff to use a specially designed tool to identify those patients at risk of malnutrition. Then I or another member of the dietetics team can carry out a fall nutritional assessment.

 

As with any patient it was vital I worked as part of the multidisciplinary team to highlight this patient as a risk. These includes working with the Doctors to prescribe essential vitamins, check biochemistry daily and treat promptly if any are out of range. I communicate effectively with the nursing staff to ensure they know the precautions they need to take in preventing an increased risk, and document my full assessment in the medical notes. I worked closely with this patient over the next coming days to gradually reintroduce nutrition until they were meeting their nutritional requirements and were no longer at risk of re-feeding syndrome.

 

 

Ulcerative Colitis Patient

 

My last patient of the day was diagnosed with Ulcerative Colitis, a form of irritable bowel disease, 6 months prior to this admission. They presented to the emergency department after disease symptoms had resulted in a minimal nutritional intake and weight loss. Although I am not a specialist gastroenterology Dietitian I can still play an important part in treating this patient whilst they are admitted to the ward.  This patient group can also be at risk of re-feeding syndrome, along with being malnourished, dehydrated and in a great deal of discomfort. I carried out a full nutritional assessment and discussed this with the patient to gain an understanding of their own knowledge of their disease. This particular patient had not had any input from a Dietitian before this admission and was very keen to further their understanding of how best to manage their symptoms and prevent further weight loss. I started them on oral nutritional supplements to support their limited nutritional intake. These are specialist drinks which can provide vital calories, protein, vitamins and minerals, when individuals cannot obtain enough from their diet alone. Again, I also worked alongside the multidisciplinary team to provide prescriptions of much needed vitamins and minerals. Whilst they are an inpatient my aim would be to prevent any further weight loss and support them as best as I can. Once they have been discharged they are often invited to an out-patient appointment to see the specialist gastroenterology Dietitian.

 

As we are registered professionals our patients can expect to be treated with only the most up-to-date evidenced based care. We are proud to be in a position of responsibility, where we hold extensive knowledge that allows us to put our patients first.

Healthcare Scientist in Nuclear Medicine

HSC week blogEver wondered what a career in Nuclear Medicine would look like? Clinical Scientist, Sarah Bell tells us a bit about her role.

I have been working in the Derriford Hospital Nuclear Medicine department for about a year and a half now. When I first started here I was still in the final year of the three year Scientist Training Programme (STP) in medical physics. I qualified as a Clinical Scientist about six months ago – although I’m finding that I still have a lot to learn!

I am part of a team of three qualified Clinical Scientists and generally at least one trainee in Nuclear Medicine. As Clinical Scientists we are actually a part of the Clinical and Radiation Physics group, who are a department within Healthcare Science and Technology, a service line of Clinical Support Services. As Nuclear Medicine specialists our jobs are very varied, and in my opinion very interesting!

Nuclear medicine is a branch of medical imaging that uses drugs labelled with a small amount of radioactive material to image physiological function in the body using special cameras. These images are used to diagnose or determine the severity of a variety of diseases. Radioactive drugs (called radiopharmaceuticals) can also be therapeutic rather than diagnostic and can be used to treat some diseases.

Part of our responsibilities includes the design and implementation of optimal acquisition protocols for specific studies. This means working out the best parameters to set on the camera to obtain the best images possible to send to the consultants to enable the right diagnosis. We are also involved in the computer processing of some of the more complex imaging studies to provide the right information for the consultants.

As I’m sure you can imagine – the work done in Nuclear Medicine could result in serious accidents if the right risk assessments and protocols aren’t in place to ensure the safety of both patients and staff. It is the responsibility of the Radiation Protection Advisor to ensure that there are safe working procedures and contingency plans in place to keep the risk to a minimum. I help the other two physicists, who are both certified Radiation Protection Advisors, by assisting with the risk assessments for new procedures or any modifications to existing ones. For example we are changing the radioactive isotope for one of our studies because the old one is not being manufactured any more. Does this mean that the staff preparing the patient injections will be exposed to a higher level of radiation? Will we need to change our existing procedure? What will be the clinical impact? These are all questions I try to answer before we give the go ahead.

Our responsibilities also include equipment management, which can include the specification and acceptance testing of new equipment, as well as regular quality control testing of existing equipment. We’re also lucky (in my opinion) that we have a radiopharmacy within in our department, which isn’t the case for all Nuclear Medicine departments. The radiopharmacy is where all of the radiopharmaceuticals are made each morning. I’ve recently been learning about quality control of the radiopharmaceuticals we manufacture and how we determine if they are safe to be injected into patients. I’m looking forward to getting more involved in the radiopharmacy side of the work we do here in Nuclear Medicine.

A few of the other responsibilities we have here include, but are not limited to, therapeutic treatments of patients with over-active thyroid, thyroid cancer remnant ablation, and prostate cancer metastases. Also, the management and disposal of all of the radioactive waste we accumulated in the department is managed by physicists. Finally we get involved in research and development and try to stay ahead of the game by attending conferences and courses to find out what everyone else is doing too.

I really enjoy working in Nuclear Medicine. It’s very much a team game where I get to work alongside technologists, consultants, nurses and clerical staff. It’s not just limited to our department either! From my experience Nuclear Medicine departments from other Trusts are more than happy to compare protocols and procedures and discuss new developments and guidelines and how these may best be brought into practice. There’s a great community feel to this field and I would definitely recommend a career in Nuclear Medicine to anyone who may be interested!

Day in the life of an embryologist at the Ocean Suite

HCS weekAverage day in the middle of a treatment week – Rebecca Matthews

From the crack of dawn we are up in the lab, turning on all of the equipment and getting ready for the busy day ahead of us (usually centred on making a strong coffee). Once the lab is cleaned, the eggs which were inseminated the day before are checked for signs of normal fertilisation.

Embryos from earlier in the treatment week are also checked for their development stage and quality. All of our patients from the previous day and earlier in the week are called with updates on their embryos and what the plan is regarding whether we culture the embryos on further, or whether we bring the patients in for their embryo transfer.

It is around this time when our first patient of the day is brought into theatre for their egg collection, my personal favourite job. One member of the embryology team will be in charge of the day’s worth of patients. If any frozen embryos needed to be thawed, this would also occur around this time.

Whilst the female partner is undergoing her egg collection, the semen from the male partner is being cleaned and prepped ready for use later on in the day by a separate embryologist.

The rest of the morning is normally filled with patient’s egg collections and sperm preparations. If any of the patient’s treatment plans need to be changed or decided upon, a member of the team will discuss this with the patients.

Prior to lunch, all of the embryo transfers are performed. This is usually a very exciting and happy time for our patients as well as for the staff.

After lunch and a lot more coffee, all of the mature eggs are fertilised either through IVF (the mixing of sperm and eggs in a dish) or ICSI (injection of one sperm into an egg). Once all of the mature eggs from all the patients are fertilised, they are put away into incubators until the next morning.

The next day’s cases need to be prepared and set up for and all of the paperwork from the day needs to be completed (to which there is many)! After all of our work is completed, the lab is cleaned and shut down for the day until the next morning.

I love my job and working in the embryology team is a great and rewarding job! The very best part of the job is seeing (and cuddling) the babies 9 months later. Being able to change someone’s life for the better is a fulfilling and a wonderful opportunity – definitely worth the mountains of paperwork!

The UHP Radiotherapy Physics Team

One of the least known departments within the hospital, the Radiotherapy Physics team provides a vital role supplying complex scientific and technical support to Plymouth’s Oncology department.  We are a team of 20 staff comprising Clinical Scientists, Dosimetrists and Engineers.

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No Radiotherapy treatments can be carried out without our involvement.  Our Dosimetrists provide a dedicated treatment planning service working closely with Oncologists to produce highly accurate plans for our treatment machines in order that they can deliver targeted doses of radiation with millimetre precision. The radiotherapy treatment plans are highly complex requiring sophisticated computing systems. Although required to deliver 24% of radical plans in this fashion, we regularly achieve over 60%.  Additionally, we are also responsible for designing and producing aids to immobilise patients enabling high levels of accuracy while they undergo treatment.  Our Engineers undertake specialist training to keep the treatment machines running at peak performance and act as a first line of support in the event of a breakdown.  Our HCPC-registered Clinical Scientists are all highly trained Physicists who have responsibility for ensuring that the treatment machines and associated clinical systems are calibrated to deliver the correct amount of radiation to the correct part of the body.  The margin of error between successful treatment and untoward side effects is extremely narrow, so highly precise plans and accurate monitoring are needed to deliver the desired clinical outcomes.

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In addition, we also advise our Oncology colleagues on aspects of radiobiology affecting patient treatments.  Radiotherapy Physics also co-ordinate the Trust’s Brachytherapy services, during which we calibrate and deliver highly radioactive sources within the patient’s body, to treat different types of cancer.  Our Stereotactic Radiotherapy service delivers highly precise treatment to cranial tumours using state of the art software and imaging to ensure that we deliver a fatal dose of radiation to the target whilst minimising damage to healthy surrounding tissue.

We are very involved in training within our section, providing teaching for the next generation of Clinical Scientists in addition to placements for student Radiographers and FRCR tutorials for Oncology Specialist Registrars. Staff also visit local schools as part of the STEM (Science, Technology, Engineering & Maths) programme, engaging students and promoting careers within Medical Physics, which they find extremely rewarding.

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The department has an active research and development programme, participating in national clinical trials and commissioning new cutting edge techniques in the fight against cancer.  Staff members contribute to scientific journals and have submitted posters to international conferences.  Several also sit on scientific committees within professional bodies, helping to shape the current and future direction of Radiotherapy services in the UK and Europe.

We are a sociable and diverse bunch, comprising staff from several countries including Portugal, Poland, Cyprus, Australia and even Scotland!  Above all we meet the challenge of an ever-increasing patient workload in partnership with our Radiographer and Oncologist colleagues with a constant cheery determination.

#WeCare2 – Nystagmus Centre of Excellence

Dom Burdon talks about Nystagmus in our latest blog.

Nystagmus is an eye condition which causes the eyes to involuntarily oscillate in any one direction. It can result in the patient experiencing many problems with different visual functions, for example the time it takes to focus on targets; it can also result in symptoms where patients perceive the world to be moving, when it is actually still.

The aetiology for Nystagmus can range from chronic visual disorders to acute neurological emergency.  It is a lifelong eye condition and will affect a person’s ability to do all activities throughout daily life. Most people might have not heard of Nystagmus, however it is prevalent in 0.3% of the population.burdonsocial

In the Orthoptic department here in Ophthalmology, we pride ourselves on being a centre of excellence for Nystagmus. We are one of three centres nationally who have a clinical eye tracker, a specialist piece of equipment used to identify the type of Nystagmus and in turn, allows for swift investigation, diagnosis, management and support for these patients.

We accept far reaching referrals and are able to do the full workup for these patients, giving them answers relating to their condition which they would not have had available to them before. This support is not only provided during the Ocular Motility clinic which we run for these patients (where we use the eye tracker); we also keep in close contact with our patients even after they are discharged, in case they have any questions or concerns regarding their Nystagmus. To provide this high level of care and support we work with all multidisciplinary teams: Neuroscientists, Ophthalmologists, Optometrists, Imaging teams, Vision scientists, Genetic specialists, Neurologists, Paediatricians, visual impairment teachers and rehabilitation officers.

Through extensive clinical experience via the Ocular Motility clinic, the team here in the Orthoptic department are developing a national Nystagmus Care Pathway, to standardise care provided for patients with Nystagmus within the NHS and address present inconsistencies across the country reported by patients and families to the main nystagmus charity, Nystagmus Network. Thus, the Nystagmus Care Pathway’s purpose is to ensure that an evidence-based multi-disciplinary minimum standard of care is provided in every eye department across the UK.

Research is one of our core initiatives in the Ocular Motility clinic. Currently we are undergoing a literature review relating to the drug treatments for symptomatic Nystagmus patients. This will facilitate clinicians to make clear judgments about which drugs to trial, according to patient’s symptoms. We have exciting plans to develop the research structure in the department with Nystagmus as its core priority. We are working towards many future studies both “in house” and collaboratively with other centres. The UK is currently leading the way in Nystagmus research worldwide.

In summary, the Orthoptic team here in Ophthalmology feel very proud of the impact our centre of excellence for Nystagmus has made to patients.  As we develop our clinic further and progress with our associated research, we hope to be a stellar example of how specialist clinics and research should be represented and driven forward in an allied health profession setting.