Induction to Hospital Pharmacy COVID-19

This resource has been compiled to signpost to some useful resources and provide helpful hints for those being re-deployed to Hospital Pharmacy practice from other sectors of practice or non-clinical roles, or for people who are returning from recent retirement in response to the coronavirus (COVID-19) outbreak.

It is likely that priorities will be very different from normal hospital pharmacy practice during this pandemic situation and you should take advice from the lead on the hospital site to identify your role.  Priorities may change as the situation evolves.     

Hospitals may have information packs or induction material available which will be a useful resource to you (if available) at this time.  If after reading this guidance you have any questions or feel you require further information to support your preparation as a hospital pharmacist, please submit your questions/suggestions here.

Induction video

In this short video, Ruth Waters provides some insight in what to expect and what help you can offer, to those returning or redeploying to hospital pharmacy practice.

Please note that this video was recorded on the 24th March 2020.

The Hospital Pharmacy Department and Team

Each hospital site is different and you will be given an overview on arrival.  Some sites will have a main dispensary area whereas others will have small satellite dispensaries closer to ward areas.  Depending on your specific roles and responsibilities, you may need to be set up with passwords (e.g. to access patient records, allow processing of electronic prescriptions and orders, etc.). The person to whom you are reporting to should be able to advise on what is required and request the appropriate access for you.  

individuals should familiarise themselves with local guidance regarding PPE, once they get to the department they’ll be working in. Suitable PPE will be provided for all staff. Local processes will be explained for sickness absence/self-isolation in relation to Test and Protect or close Covid contacts once they arrive too.

All prescriptions will require a professional check by a pharmacist before dispensing.  This check is to establish that the correct medicines are prescribed at the correct dose and are safe for the individual patient.  The discharge prescription acts as an immediate discharge letter (IDL) for the patient’s GP and should detail all medicines, even where a supply is not required on discharge.  Any changes that have been made during the admission should be clearly indicated on the prescription along with a plan – e.g. 'stopped - no longer required', or detail a plan for re-introduction.  Ensuring the detail is present on the discharge prescription helps achieve seamless care and will minimise the need for GP and community pharmacy colleagues to query changes. 

Remember, in the hospital pharmacy department there will be many pharmacists, pharmacy technicians and pharmacy support staff who have a wealth of knowledge and can help you.  Some pharmacists work within specialist areas and you may find that a call to one of these specialist pharmacists for advice can provide a fast answer to something that would have taken you a long time to answer. 

Some useful information to ask for: 

  • List of pharmacists and pharmacy technicians, their specialties and how to contact 

  • List of wards and specialties including contact numbers 

  • Key contacts within the pharmacy team – e.g. for absence reporting 

  • Where can you access local formularies and guidelines – some health boards have an app you can download 

  • Cut-off time for receiving orders the same day and process for obtaining supplies required urgently if past the cut off 

  • Keep up to date with any additional infection control measures as these could change and traffic through certain wards may be restricted 

  • Familiarise yourself with the different modes of ordering and supplying medicines – ward stock supplies will be handled differently from non-stock lines.  Also there may be items that are labelled for individual patient use and supply at discharge.

This document has been produced to provide guidance to pharmacists and registered pharmacy technicians to assist with difficult decisions being made in the exceptional circumstances presented by COVID-19. It contains some guidance on structured decision making and some more specific examples relevant to the current pandemic.

Standard Operating Procedures (SOPs)

On arrival at the pharmacy department, familiarise yourself with essential Standard Operating Procedures (SOP) for your role.  A SOP is a written procedure that specifies what should be done, when, where and by whom.  Please check which SOPs are essential for you.  

SOPs play a fundamental role in continuous quality assurance and ensuring best practice in the pharmacy.  They are a tool to protect the safety of patients, minimise risk and assure the quality and consistency of process and services. Following SOPs protects registrants and also other members of the pharmacy team.  

Controlled Drugs

The UK Health Act 2006 introduced new monitoring and inspection requirements for controlled drugs. These new arrangements are designed to work within and alongside existing governance systems to promote the safe, secure and effective use of controlled drugs. Each healthcare organisation holding stocks of CDs must have standard operating procedures (SOPs) for the use and management of CDs. Please refer to the SOPs of the community you are working in but good practice guidance and additional resources can be accessed via the Controlled Drug pages of the MEP

Recent Changes to Controlled Drug Regulations 

It is worth noting that in recent years Tramadol, pregabalin and gabapentin have been reclassified as schedule 3 control drugs. You must ensure they are ordered appropriately, and all prescriptions must have the legal CD prescription requirements.  They are not subject to safe custody requirements.

Medicines reconciliation

This module describes the purpose and importance of effective medicines reconciliation. In an ideal world this is done robustly both at admission and discharge, however you should become familiar with the processes adopted at the hospital in which you work so that you know what is expected. Please note that these processes may change over the coming weeks.

RPS Q&A sessions on coronavirus and pharmacy

A number of webinars have been produced in light of the COVID-19 pandemic to help support pharmacists in various aspects of patient care.  To date these include an Introduction to Critial Care, Infection Prevention and Control, COVID-19 in Paediatrics, and Supporting the Delivery of Pharmacy Services during COVID-19. 

These webinars are all hosted by the RPS on their website here.  Please note that you will need to register (for free) to watch them unless you are already a member of the RPS.

 

Useful e-learning resources

Your own health board may have additional learning resources on their learning management system (e.g. Learnpro). For example, some boards will have resources related to Vancomycin and Gentamicin, or intraveneous medicines. You could discuss with your colleagues in the hospital to identify all the resources which are available to help you. 

The medicines learning portal will be a good resource for anyone returning to practice or needing a refresher, and in particular those being deployed to acute wards (open access, no passwords required). This resource has been produced by the University Hospital Southampton NHS, and does contain some NHS England specific references. Access to some information sources may differ for NHS Scotland employees. 

 

 

Medicines information resources

You may find some of the following resources useful in hospital pharmacy practice.  Where possible please ensure you have passwords already set up and check log-in is working if you have not used it for some time: 

The Knowledge Network: 

NHS Scotland staff access a range of information sources through The Knowledge Network website.   

Some resources require the use of an Athens username and password. You can register for an Athens user name/password using this link.  

On the front page of The Knowledge Network (TKN), there is a box near the bottom of the page, with a section called “Medicines Information Resources”, many useful resources can be found here.  Ensure you are not logged in to the TKN or this link will not show.  You can also search for eBooks on TKN, however check to ensure you are using the most up to date edition. 

Summary of some useful resources for when you are in practice: 

The Medicines Complete website contains a number of valuable resources, some of which are summarised below: 

  • BNF/BNFC – Quick and concise information on indications, contraindications, dosing and drug interactions. BNF app also available for download 
  • Stockley’s Drug interactions – More detailed information on drug interactions and how to manage them.  
  • Handbook of Drug Administration via Enteral Feeding Tubes – useful for providing advice for patients with feeding tubes 
  • Martindale: The complete Drug Reference – can be useful for an overview of treatment of some conditions.  Also gives some detail of unlicensed treatment options/doses. 

Other resources: 

  • Electronic medicines compendium(eMC) https://www.medicines.org.uk/emc – drug monographs with useful information on licensed doses and indications. Includes information on dose adjustment in renal/liver impairment.  Drug interaction section can be useful and information on administration, especially for IV preparations. 
  • Injectable Medicines Guide (‘Medusa’) https://medusa.wales.nhs.uk/ – provides administration monographs for parenteral drugs which can be printed from the website. You may be able to access via intranet on the hospital site or ask for the local password. 
  • NEWT Guidelines http://www.newtguidelines.com/ – also useful for providing advice for patients with enteral feeding tubes or swallowing difficulties.  You may be able to access via intranet on the hospital site or ask for the local password
  • Briggs Drugs in Pregnancy and Lactation – access via The Knowledge Network for information on prescribing in pregnancy and breastfeeding
  • Renal Drug Database https://renaldrugdatabase.com/ – provides advice on dosing in renal impairment.  Ask in pharmacy department for the username and password. 
Psychosocial mental health and wellbeing support

You can visit the Psychosocial mental health and wellbeing support page on Learn for more information and resources on how to look after yourself, your patients and your colleagues at this difficult time.  We have however selected a few resources below which may be of particular help to you at this time:

Pharmacy staff are likely to feel stressed and under enormous pressure during this outbreak – this is perfectly natural and indeed is a reaction to a very abnormal set of circumstances.  Please see opposite for a helpful visual to assist with information on Stress, Coping and Resilience.  This may be worth bearing in mind or printing out and putting up a copy of in your place of work.

There are a number of apps which you can use to help you manage your feelings.  You may find your own that you prefer, however you will find a list of suggested apps at the end of this document on Learn.

Some apps which normally charge a subscription fee are offering their services free of charge for certain groups in light of the pandemic.  Check the websites for individual apps for more information.

What other support do you need?

If after reading this guidance you have any questions or feel you require further information to support your preparation as a hospital pharmacist, please submit your questions/suggestions here.