to be hospital pharmacist 18

The ward environment is a great learning experience, not just from
patients’ notes and drug charts that you read. The other health care staff on
the ward are a great source of information and learning too.
It is interesting to speak to doctors, nurses and other health care professionals 

because it can be surprising how many different views of one patient different 

professionals have. Remember that different health care professionals have had 

extensive training in their particular field. so do not be afraid to ask them what the
problems are from their points of view, in the same way as them not being
afraid to ask pharmacy about drug-related issues.

One other source of learning is from the patients themselves, especially
those with long-term conditions. There are many ‘expert’ patients out there.
Always acknowledge patients’ expertise in their own conditions and listen to
their points of view, because they are the people who really know about their
own condition and treatment – they are the ones with the condition after all.
When you first get up onto a ward, initially you won’t know what to
do, even if you have been given some clear instructions and there are clear
expectations of your performance. The problem with the ward environment
is that there are so many things going on that it is easy to be distracted and
confused.

You have to recognize that you do not know everything; in fact, you
probably feel like you don’t know ANYTHING – in real life, not much
matches the textbook learning that you were taught on your undergraduate
course.

Your major source of information in the ward environment is your
trusty BNF (British National Formulary). Many of the answers to many
queries on the ward can be answered by referring to this text, but you will
also quickly realize that not everything is contained within this text, and that
you (under the supervision of your pharmacist) need to make decisions on
what to do with the information found in the BNF. This type of decision making
requires some critical thinking on your part, which takes a while to
develop. There are obviously limitations to the information inside the BNF;
when this occurs you need to utilize the vast information resources in the
hospital’s medicines information department.

The major anxiety of ward work is that you cannot predict what people
are going to ask you and you feel useless when you cannot solve somebody’s
problem or give ward staff a satisfactory answer. If you are somebody who
rotation, I could go up on my own and do drug histories and get information
and I was itching for more. It is useful to learn that black and white becomes
grey in certain patients.’

likes to be prepared fully before embarking on anything, you will find working
on the ward difficult at first because you can never predict what is going
to happen on the ward. All you need to remember is that you must act within
your competence at all times and refer everything else appropriately. If you
are undertaking ward work towards the end of your pre-registration training
year, and have had some prior experience of ward work, referring appropriately
becomes more difficult to do, because you may be unsure what you are
and are not competent in and you may not know the boundaries of your
practice. At this point, you need to be careful not to overstep the mark, and
act inappropriately without supervision from a pharmacist.

If you are rotating through different wards, and different specialties,
you have to consider the fact that different wards have different systems of
work, and do not presume that, if things work one way on one ward, the same
applies to a different ward. Also, different pharmacists with whom you are
working all work slightly differently. Don’t let this confuse you; just learn
from all the pharmacists around you and pick out the bits of practice that you
think are great and incorporate them into your own practice.

You might feel anxious before going on to a ward if you think that you
need to know lots of clinical ‘stuff’. The reality of ward work is that anything
you don’t know you can look up. Ward work is not about what and how
much knowledge you have, but about solving problems – about displaying
critical thinking, always looking at everything in a critical manner and
always asking ‘why’. 

Another major issue is figuring out what to do first
and which patient to see first. When you go up to a ward for the first time, it
can be incredibly confusing and disorganised. With increasing time on the
ward, you start to distinguish between things that need to be done urgently
and things that can wait.