AGENDA FOR CHANGE

Pharmacist

JOB DESCRIPTION

1. JOB IDENTIFICATION

Job Title: Pharmacist Reports to: Pharmacy Team Leader Department: Pharmacy Directorate: North & West Division

Job Reference: NR NCHP CGHL PHARM No of Job Holders: 1 Last Update: April 2020

2. JOB PURPOSE

The function of the pharmacy service is to develop and provide integrated patient-focused pharmaceutical care, which meets the present and anticipated needs of the population of NHS Highland in accordance with the Local Health Plan and national strategies. The intention of the service is to link all branches of the profession in order to better co-ordinate pharmaceutical care for patients and members of the public. The focus is on active participation in, and contribution to multi-disciplinary, multi-professional and multi-agency teams in a fully integrated manner. The main responsibilities are:

The development and operational delivery (managed services) of pharmaceutical care across NHS Highland.

The implementation of robust clinical, corporate and staff governance systems to minimise risk and assure patient and staff safety and well being.

The Pharmacy department based at Caithness General Hospital provides clinical services through direct patient care activities. It also provides some Primary Care clinical services. The aim of the department is to provide safe, efficacious, high-quality, up-to-date Clinical Pharmacy Services to the patients of Caithness and Sutherland. This involves the following areas of pharmacy practice:

Medicines information is a process of providing answers in response to questions about medicines from any health care professional or patient in the Caithness and Sutherland locality. Each answer is

drawn from a systematic search of published literature. The information is then critically appraised and drawn up and formulated using the pharmacist’s professional knowledge. Where there is a lack of information the pharmacist will be called upon to provide advice based on their professional knowledge. Each enquiry varies in the complexity and subject matter and enquiries can take anywhere from 5 minutes to 5 working days to complete, although longer queries are inevitably passed to the Area Medicines Information centre in Raigmore Hospital, due to time constraints. Increasing numbers of enquiries requires the pharmacist to make decisions on a day-to-day basis about priorities and clinical risk in the order in which enquiries are answered, versus the demands of the daily workload. The answer is designed to allow the enquirer to make decisions about treatment (individual patients or about groups of patients) and should ensure safe, effective treatment for the patients involved. Clinical Pharmacy delivers direct pharmaceutical care, through the development and application of

evidence-based models of service provision, in order to improve the quality of patient care and

medicines management processes within a multidisciplinary setting.

The postholder, as a Clinical Pharmacist, provides pharmaceutical care to patients in the Medicine,

Surgery, Care of the Elderly and Midwifery/Obstetrics wards. The development of integrated models of

care within managed care processes is enabling the delivery of evidence-based treatments and

pharmaceutical care at the point of patient contact. The postholder is also involved in training health care

professionals on issues relating to medicines management, to facilitate safe and effective prescribing. The delivery of pharmaceutical care to patients is being systematically developed through the modernisation processes detailed in national strategy documents for pharmacy, in conjunction with the area service (Specialist Services Unit, Raigmore), but adapted for local use. As such, the postholder is (and technicians will be) involved in reviewing patients’ treatment on wards as part of the admission process, applying evidence-based treatment guidelines and formulary processes, planning for discharge, providing patients with information about their treatment and improving communication across health care interfaces and between health care professionals.

The Distribution aspect of the service is crucial to the Hospital wards and units having a supply of all necessary medication for the treatment of patients. This service is fully provided locally with some deliveries coming from elsewhere once orders have been raised. Each ward has its own specially tailored stock levels, and orders are raised on a daily basis. Replenishment of stocks, and maintenance of these, is an essential role of the department, as lack of stock of particular medication can cost lives, due to the hospital’s geographical isolation.

The Quality Assurance provision concentrates on traditional quality assurance functions such as assessment of goods returned from wards, and handling of defective or potentially defective products.

The role of the dispensary is to provide the following:

Discharge dispensing service to all wards.

Out-patient dispensing to OPD, DCU and A&E patients.

Advice to patients and staff regarding dispensed medicines. The following services are area wide and provided via Raigmore Hospital with direct liaison with the Caithness General postholder:

Production & Oncology/Haematology

Quality Assurance (QA)

Procurement

DISPENSARY Practices independently as a pharmacist. Complex tasks will be undertaken without supervision. The Pharmacy Team Leader would provide support for clinical or managerial queries if required. In the absence of the Pharmacy Team Leader, the postholder will provide a lead on dispensary clinical aspects.

Perform clinical and legal checks on immediate discharge letters (IDL), pass medication, oral chemotherapy prescriptions, and out-patient clinic prescriptions. Identify any pharmaceutical care problems and resolve these with the prescriber or nursing staff to ensure that all medicines supplied are appropriate.

Dispense drugs in accordance with ward orders and prescriptions.

Perform labelling inspection and accuracy checks on dispensed prescription items in accordance with standard operating procedures.

Receive into stock controlled drugs (CDs), completing relevant information into the CD registers. Dispense and check controlled drugs in accordance with ward orders and prescriptions, ensuring compliance with the Misuse of Drug Regulations 2001.

Ensure that the necessary checks and documents are completed for medicines where special control dispensing arrangements exist, e.g. unlicensed medicines and named patient medicines.

Promote evidence-based good practice prescribing including the use of the Highland Joint Formulary

Clinical supervision of dispensary staff. Answer dispensary staff queries and telephone enquiries from nursing and medical staff relating to medication to be supplied via the dispensary.

Counsel outpatients attending the pharmacy to collect prescriptions, explaining why their medicines have been prescribed, how they work, warning of possible adverse effects and interactions and how they should be used to maximise benefit.

Supervision and training of less experienced pharmacists, pre-registration pharmacists and students.

CLINICAL Participate in the provision of a retrospective prescription monitoring service, as part of the clinical pharmacy service delivered to the wards. This may entail the postholder covering approximately 50 inpatient beds. The main daily duties would include:

Monitor medicine prescription charts as per standing operating procedure for individual patients which may include e.g.:

Ensuring the prescription is legally valid

Ensuring the doses are accurate and correct.

Assessing the risks involved in using the medicine for both patients and staff.

Establishing whether there are any drug allergies or sensitivities recorded in the notes or kardex

Establishing if there are any clinically significant drug interactions.

Records key interventions accurately in patients’ medical notes e.g. recording information that will prevent harm to the patient.

Sign each entry in the prescription chart to indicate that a full pharmacy check, as detailed above has been completed.

Submit reports of suspected adverse reactions to drugs to the National Committee on Safety of Medicines.

Promoting safe, efficacious, cost effective medicine use and evidence based therapeutic choices through use of Highland Joint Formulary and other publications.

Respond to medicines information enquiries from all grades of medical staff, nurses and

healthcare staff, providing evaluated information, using database information, as appropriate, to enable informed decisions to be made about patients’ therapies. Seek clarification and support from the appropriate Directorate Pharmacist where experience is limited.

Promptly deal with medicines supply issues pertinent to their area or wards, resolving any difficulties, to ensure maintenance of patients’ therapies as effectively as possible.

Participate in workload data analysis by recording individual interventions made on the wards during a defined time period.

Participate in the evaluation and grading of clinical interventions using a SOP.

TARGET CARE PLANNING

When patients with pharmaceutical care plans are transferred to Caithness and Sutherland wards covered by this post, care planning is continued. Targeted Care Planning could also be provided, based on an assessment of clinical need, to a limited number of targeted patients on their own ward. Pharmaceutical care planning involves the following steps:

Construct a full medication history.

Identify patient and medication risk factors.

Prioritise pharmaceutical care issues.

Identify desired outputs and propose pharmaceutical actions (making recommendations on drug selection; preventing, detecting and reporting adverse drug reactions and, where necessary, individualising drug dosage requirements).

Propose a monitoring strategy, including monitoring the prescription and progress towards desired outputs.

Educate and counsel patients on their medication, taking steps where necessary to facilitate compliance in collaboration with community colleagues.

Promote health.

Provide cover for some of the clinical duties of the Pharmacy Team Leader. This involves participating in medicines use evaluation, pre-admission clinics and consultant ward rounds in Caithness General Hospital, once competency has been demonstrated.

EDUCATION AND TRAINING

The postholder undertakes and is personally responsible for their continuing professional development (CPD) as required by the General Pharmaceutical Council.

Demonstrate on-going learning and development of own pharmaceutical practice by participating in annual personal development and review (PDP and R).

Assist Pharmacy Team Leader with induction training of new Pharmacists, Pre-registration Pharmacists, Technicians and Students.

Guide clinical prescribing practice of Junior Medical Staff, and prescribers where appropriate.

Give talks to other healthcare workers on therapeutic practice.

Is willing to develop their skills and knowledge with enrolment in a Clinical Pharmacy diploma

GENERAL DUTIES

The postholder practices as a pharmacist in accordance with Code of Ethics and Standards issued by the General Pharmaceutical Council and relevant legislation and associated regulations.

The postholder is a key holder on behalf of the Pharmacy Department and as such has a shared responsibility for maintaining stock control and the security of medicines as well as the security of the Pharmacy Department.

Take joint responsibility with other pharmacy staff for ensuring the security of medicines is maintained at department level and promoting good practice in the security of medicines during transit to and stored at ward level.

Witness the disposal or destruction of out of date and unwanted Controlled Drugs on wards and record such activities in ward Controlled Drug registers.

Participate in quality initiatives and risk management, including clinical incident and DATIX reporting systems.

Maintain safe systems of work in accordance with Health and Safety.

Comply with departmental standard operating procedures at all times.

Undertake other duties appropriate to the post as required by Pharmacy Team Leader.

4. ORGANISATIONAL POSITION

3. DIMENSIONS

The North & West Division of NHS Highland serves a population of approx 40,000. The department dispenses approx 10,000 items per year and supplies approx 40,000 product lines per year to 5 hospital sites and 21 medical practices. The post holder is managed by the Pharmacy Team Leader. Staff:

Pharmacy Team Leader (1 WTE)

Senior Pharmacist (0.4 WTE),

Pharmacy Technician (0.8 WTE)

Pre-registration Pharmacy Technician (0.5 WTE)

Rural General Hospital Manager

Lead Pharmacist N&W Division

Pharmacy Team Leader

Pharmacist

Pharmacy Technician

Pre-reg Pharmacy Technician

Pharmacy Assistant

= Reports to

= Supervised by

5. MAIN TASKS, DUTIES AND RESPONSIBILITIES

Receive, check and put away supplies coming into the pharmacy department.

Check the expiry dates of all medicines and pharmaceutical sundries on top-up list at the end of each month to ensure expired stock is removed and short dated stock identified for use first.

Assist with the daily stock take by performing counts of the items selected paying particular attention to drug name, form, strength and pack-size, to ensure that the stock and description on the stock take sheet match.

Identify by way of a top-up scheme, stock items for the Acute Surgical, Medical and High Dependency Unit, Step-down and Rehabilitation, Maternity, Accident and Emergency, Renal, Theatre, GP out of hours in accordance with written procedures and timetables

Ensure storage areas are labeled appropriately, detailing the contents in terms of products and stock levels as appropriate.

Supply stock on stock-list to, OPD, X-ray, Physiotherapy, Podiatry and, Dental departments at agreed times as ordered by the department staff.

Chase up out of stock ward top-up items.

Deal with urgent stock drug requests from ward staff

Input stock requisitions into the stock control computer system. A picking list is then generated if the goods are in stock.

Using the picking list, pick the stock from the store shelves, paying particular reference to the name of the item, strength, pack-size, expiry date, form and number of packs to be picked.

Check and pack stock orders for distribution, which have been picked by a different member of staff.

Complete all documentation associated with the above tasks and leave the goods in the appropriate place for delivery.

To raise orders for non-stock sundries and drugs on wards.

Prepare orders for delivery to wards and departments and other destinations such that they are ready for collection by porters and couriers at specified times.

Process returned stock from wards and departments through the stock control computer system. Particular attention must be paid to drug name, strength, form and pack-size.

Ensure shelving is clean and stock is stacked neatly on the shelving.

Occasionally dispense and label prescriptions including discharge, out patients and medicine order forms for wards using the POD system (patients own drugs).

Complete dispensing error forms as appropriate.

Monitor temperatures of the departmental fridges. In the absence of the Pharmacy Technician ensure that specific procedures are carried out, such

as weekly ordering of medical gases and fluids, and daily issue through computer of stock taken from Emergency Drug Cupboard.

Assist the Pharmacy Technician to maintain supply of Emergency drug trays for adults and children, maintaining paperwork to record locations and expiries.

Assist the Pharmacy Technician to carry out stock-take on a daily/annual basis and generally maintain all pharmacy store stock.

Answer the telephone/fax to receive orders and messages, dealing with queries and taking action or referring to the Pharmacy Team Leader where appropriate.

Liaise with staff on stock availability, and assist the Pharmacy Team Leader to deal with issues arising.

Assist the Pharmacy Team Leader and Pharmacy Technician in the review of stock levels, making stock/stock-list alterations as agreed and assisting in the upkeep of computer product files, and top-up order sheets, creating/formatting these on computer.

File paperwork correctly in accordance with statutory requirements for the retention of records.

Provide assistance to pharmacists covering for the Pharmacy Team Leader, and demonstrate activities to work experience students and new pharmacy staff.

To assist in the safe running of the department in line with Health and Safety regulations and requirements:

Completion of DATIX incident reports as required

Involvement in quarterly H&S reviews

Completion of COSHH assessments

Completion of Risk Assessment forms as appropriate

Involvement in updating and sharing H&S information

Upkeep of training requirements (H&S, V&A, M&H, fire, VDU assessment, Risk Assessment, SMS, COSHH, PDP&R)

Ensure the department is kept neat and tidy and secure, opening up, and closing down the department as necessary in line with SOPs.

Participate in internal/external courses or visits/meetings as appropriate

Carry out any other reasonable duties as directed by the Pharmacy Team Leader, or Pharmacy Technician.

7a. EQUIPMENT AND MACHINERY

Equipment used includes:

Use of Visual Display Unit (VDU) and keyboard.

Zebra label printer

Printers for producing picking lists

Telephone

Photocopier

Calculators

Trolley and/or wire baskets to move stock.

Kick stools

Step ladder

Green bags and plastic boxes designed for the transportation of pharmaceutical goods.

Assorted stationery e.g. sellotape dispensers, staplers, scissors etc

Fridges/cold chain storage

Shredder

Assorted dispensing equipment e.g. triangles, tablet cutters

Volumetric measures

7b. SYSTEMS

JAC pharmacy stock control and dispensary IDL computer system to input and retrieve information in connection with clinical and dispensing practice.

Microsoft Office package on a daily basis:

– Word for word processing of letters, guidelines documents etc.

– Access database for cytotoxic stability data.

– PowerPoint for staff presentations.

– Outlook for e-mail.

Intranet – Hospital Information System. To access: E-library for access to databases e-books and e-journals for internet enquiries; WeBNF electronic version of the BNF annotated with local formulary choices; results reporting to access laboratory and microbiology reports for individual patients.

Internet - Search the Internet to obtain quality information that is reputably referenced.

Use IDL (Immediate Discharge Letter) computer system for in-patient discharge prescriptions.

Emergency Care Summaries

Adobe Reader.

8. ASSIGNMENT AND REVIEW OF WORK

The postholder is managed by the Pharmacy Team Leader, Caithness General Hospital.

Work is allocated/assessed by the section head and senior pharmacists for the section as appropriate. Progress is assessed to establish their level of ability to accept additional responsibilities for providing pharmaceutical patient care. The postholder’s progress will be reviewed annually according to NHS Highland’s Personal Development Planning and Review Process.

The postholder will work within each section as allocated in departmental rota.

The postholder will be accountable for own professional actions and outcomes, guided by legislation, national and local protocols/guidelines, local formulary, lead clinicians and peers.

9. DECISIONS AND JUDGEMENTS

The postholder frequently uses their own independent judgement, within the bounds of their professional knowledge, experience and training when dealing with problems, which arise in many aspects of their daily duties. This includes:

Problem solving with regard to the legalities surrounding the supply and dispensing of medication requiring use of personal judgement in interpretation of legal statutes and ethical standards.

Resolving problems in connection with prescribed medicines on discharge and effecting change where required, in liaison with multidisciplinary team.

Advising medical staff on selection of drug, formulation and dose.

Release medication for use in chemotherapy, pre-packing and dispensary including controlled drugs.

Authorise the procurement of non-formulary medications.

Prioritise daily tasks as part of the workload allocation.

Problems may be simple or complex. The postholder will manage these with advice and support from a more senior pharmacist.

10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB

Meeting strict deadlines

Ensuring absolute accuracy with respect to duties associated with medicine stock management.

Ability to work with speed and accuracy.

Required to have an extensive knowledge of operational procedures and the type of work involved in the different sections to enable independent practice.

Required to maintain a high level of knowledge on the use, administration, interactions and side effects of drugs.

To be able to work effectively and efficiently providing a quality service to each section.

Each section provides a different challenge. Adapting to the different sections and meeting the needs of that department and managers.

Providing complex information regarding medications to individuals including those with a limited knowledge.

Working to tight timescales to ensure that deadlines are met and services provided, in particular with regard to processing requisitions for ward stock and meeting delivery deadlines.

Frequent interruptions to deal with issues unrelated to task currently being carried out.

Making judgment as to whether or not an issue needs to be referred to a more senior member of staff.

The ability to make judgment calls when Pharmacy Team Leader is not available for advice and or guidance

Medicines Information

Prioritising own enquiry workload, including having to reprioritise on a regular basis as new enquiries are received, dealing with the inevitable delays to some enquiries which this leads to.

On occasion prioritising MI Section enquiry workload.

Evaluating a wide range of information, which can be conflicting or incomplete to provide a clinically relevant answer to enquiries.

Clinical

Requiring a flexible approach to work load when staffing issues are a problem leading to identifying areas and patients that will require most input e.g. new patients, patients on drugs that require monitoring, patients with renal/liver failure and patients who cannot swallow etc.

Challenging the decisions of medical practitioners to ensure that each patient’s medication regimen is evidence based and in accordance with current clinical pharmacy knowledge.

Dispensary

Frequently high workload creating stressful situation where prioritisation of workload is problematic and demands from wards for speedy turn round of discharges is very high.

Frequent interruptions and need for rapid changes in train of thought when dealing with a variety of problems in quick succession.

11. COMMUNICATIONS AND RELATIONSHIPS

Communicates in a manner in keeping with the professional operation of the Pharmacy Department. There is an ongoing requirement to form strong professional relationships with senior clinicians and nurses to ensure the smooth operation of, and confidence in, the Pharmacy service and staff. The need for interpersonal and communication skills, written and oral, formal and informal, is essential for the level of communication and networking demanded by this post. The postholder will communicate, consult, facilitate, negotiate and influence effectively, to deliver any strategic agenda and establish and maintain good working relationships. Diplomacy, tact and empathy need to be used, as well as an ability to convey highly complex and sensitive information in a form readily understood by a variety of target audiences, including staff, senior managers, professionals, patients and members of the public. Specific advice on medication is often required by consultant surgeons and physicians and by patients for issues where evidence is conflicting or non-existent. The postholder is a local expert on these matters. Advice on complex or contentious matters is often requested by and challenged by consultant clinicians or patients. Training, instructing and educating healthcare staff and patients in Medicines matters is an important part of this post – e.g. in leading educational meetings on a given topic for doctors, training a gathering of nurses on the use of a new product, or devising and carrying out education and instruction for particular client groups such as Cardiac Rehabilitation classes. Communication will be: face to face, by telephone, written, email or fax. Face to Face, by telephone or e-mail. Hospital Pharmacists Pharmacy Technicians

Pharmacy Assistant Technical Officers Porters Storekeeper Procurement Administrative and Clerical Staff Members of the multidisciplinary team including: Nursing Staff – face to face, telephone and e-mail daily Medical Staff – face to face, telephone and e-mail daily, letter twice weekly Patients – face to face daily Patients’ carers – face to face daily Patients’ relatives – face to face daily General Practitioners – telephone daily Community pharmacists – telephone weekly Other Healthcare workers – face to face daily, e-mail twice weekly

12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB

Physical Demands There is frequent requirement for sitting or standing in a restricted position for a substantial proportion of the working time:

Sitting at a VDU for most of the day utilising basic keyboarding skills whilst in the Medicines Information Section.

Standing for most of the day to perform checks on dispensed items or manufactured products.

There is an occasional requirement to exert moderate physical effort for several short periods during a shift.

Walking between wards and pharmacy around wards and departments within pharmacy on a daily basis.

Mental There is frequent requirement for intense concentration.

When interpreting, extracting, compiling and assimilating information for complex enquiries in the Medicines Information Section.

There is a frequent requirement for concentration where the work pattern is unpredictable.

Reviewing prescribed medicines on wards or in dispensary.

Counselling patients or performing checks on dispensed items where an undetected error could result in serious patient harm.

Tasks are frequently interrupted by telephone calls, bleeps etc which entail changing priorities to deal with queries or requests for advice that have to be dealt with immediately. Added distraction of working in an open plan office.

Emotional Frequent exposure to distressing or emotional circumstances when:

In direct contact with patients, who may be physically or emotionally distressed; verbally aggressive; suffering from serious disease/terminal illness; may have disfigurements, handicaps or communication difficulties.

Indirectly when checking prescriptions or answering enquiries in Medicines Information.

Environment Frequent exposure to unpleasant working conditions.

Potential for direct exposure to cytotoxic chemotherapy in both liquid and solid forms. Frequently in

the vicinity of foul smells, body fluids and unpleasant sights on the wards.

13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB

Master of Pharmacy Degree.

1 year pre-registration training and pass registration exam.

Registered as a practising member of the General Pharmaceutical Council.

Must participate in Education and Training as part of continuing professional development (CPD).

Preferably, post registration hospital experience in each of the following sections of hospital pharmacy practice clinical, MI, production, dispensary, QA and Procurement.

Must demonstrate a basic level of clinical pharmacy knowledge, clinical reasoning skills and judgement, further training of this will be given in post.

Advanced arithmetical skills e.g. for accurate calculation of doses, renal clearance, dilution of solutions,

Excellent interpersonal, influencing and persuasive skills (advising medical staff on appropriate dosing/choice of therapy) and communication skills including good presentation skills.

Good keyboard skills required.

Computer literate with knowledge of Microsoft Office Packages

Good English grammar skills.

I agree that the above Job Description is an accurate reflection of my duties and responsibilities at the date of

signing.

Job Holder’s Signature: Date: Manager’s Signature: Date: