to be hospital pharmacist 19

Patient services 

‘Patient services’ is a term that is widely used to describe all the pharmacy
services that are provided through the dispensary. For argument’s sake, we
define patient services as everything that happens in the dispensary, and
stores, to effectively enable the patient to walk away with their medication.
Patient services cover all steps involved in screening, receiving, dispensing,
supplying ward stock items, and final checking of all the medicines that
are needed within the hospital, whether as inpatient items, stock items,
controlled drug prescriptions or ward requisitions, trial drugs, unlicensed
drugs, named patient drugs, discharge prescriptions, outpatient prescriptions,
etc.

No matter where pharmacy is going to in the future, it is highly likely
that a major pillar of pharmacy activity is through patient services. We say
repeatedly to our pre-regs that the core skills of a pharmacist are dispensing
and checking – it does not matter how much you think you know clinically, if
the correct medicine is not supplied in the correct regimen with the correct
instructions to the correct patient then the clinical part is useless! This is why
so much importance is put on this at pre-registration trainee level, and why at
least one whole section of the pre-reg performance standards has been dedicated
to these activities – section C1, Managing the Dispensing Process –
consisting of 12 performance standards, not to mention the many performance
standards that dispensing and checking in the dispensary touch on
outside these specific performance standards.

Types of prescriptions and orders seen in a hospital pharmacy department
differ from those of a community pharmacy. There is a wider range of
different documentation which at first is bewildering because the range of
medicines encountered in a hospital dispensary can be vast, especially if your
hospital offers many different specialisms.

In sharp contrast to a community pharmacist, there are many different
types of prescriptions, requisitions and order forms with which you come
into contact. For outpatient prescriptions there may be FP10s, A&E and

outpatient prescriptions, and doctors’ own prescriptions. For inpatient items
there may be inpatient order forms, stock requisitions and discharge prescriptions,
all of which have different formats. It takes a little while to figure
out which form is for what purpose!

As well as handling the medicines available from the dispensary, you
will probably also be handling patients’ own medication, especially if you
dispense and check discharge prescriptions. Remember that, no matter where
the medicines have come from, all items need a stringent check to ensure that
the right medicine has been prescribed to the right patient at the right regimen,
and also that the quality and the physical state are of the highest quality.

Your first day in the dispensary will probably feel like a nightmare,
especially if it has been a particularly busy day and there are lots of people
rushing around with lots of things, and you asking what seem to be silly
questions every few seconds! You will probably have an overwhelming sense
of uselessness and of getting in everybody’s way. Your usefulness will definitely
improve when you slowly identify the systems at work in your hospital
dispensary.

Hopefully you will have attended some kind of induction that enables
you to feel vaguely oriented, and where some friendly and helpful faces have
been identified.

At first, obviously you do not know where things are kept, but, as with
any dispensary, there is a certain logic to how everything is laid out. It may
‘Having had a lot of community experience, I can say that working in a
hospital dispensary is very different. I had a preconceived idea that it was
going to be similar to Boots but it’s so different. It’s busy but it’s a good kind
of pressure and I’m enjoying myself. I’ve completed my dispensing log and
I’m getting there with my screening log. Done my CDs and am in the middle
of doing my counselling log. I’ve learnt a lot. I’m actually looking at what the
drug is and clinically screening – I’ve found out that it is very important to
look at the drug. There’s a lot more to it than I first thought!’


help to follow a prescription from being received, all the way through to it
being given to a patient, to understand the workflow in your dispensary. It
may also be helpful to undertake some stock checks. Although you may think
that this is dispensary staff getting a pre-reg to do a menial task, stock checks
are useful in allowing you to get to know the layout in the dispensary, because
it is not as simple as having drugs put in alphabetical generic name order.
There may be many nooks and crannies where different types and sizes of
products are kept, and the check also allows you to identify drugs that need
refrigeration.
The layout of a hospital dispensary generally has the following rules:

•  Drugs are in alphabetical order of generic name.

•  Oversize items appear on any shelving that can contain that item.

•  Any items that are not on the hospital formulary either appear in a

            separate section or are clearly labelled as non-formulary, clinical trial,
            etc. These should be housed with their associated paperwork nearby,
            because the record-keeping requirements of these items are stringent
            and need to be adhered to.

•  Different formulations of drugs may have their own separate section,

            i.e. tablets and capsules, inhalers, drops, fluids, injections, dressings, etc.

• Controlled drugs are kept in a locked cupboard – or many cupboards in

a dedicated controlled drugs room – ideally with a separate dispensing
area where all the records are also kept.
If your hospital pharmacy dispensary has a dispensing robot, the main
bulk of the dispensary stock is kept there. Note that the robot takes only
unbroken original packs, so there may be additional shelving in the dispensary
for keeping broken packs. The robot is basically an automated stock and
picking system. Although there should be no picking errors when using a
dispensing robot, errors can occur at a number of different stages involving
humans.