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Aintree University Hospitals NHS Foundation Trust
Pharmacy Department
Pre-registration Pharmacist Training Plan
Training Manager: Alex Jennings, Deputy Chief Pharmacist
August 2010.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 1
Table of Contents
Page
1.
Introduction
5
2.
Pre-registration Pharmacist Job Description
11
3.
Induction Programme
15
4.
Aintree Hospitals NHS Trust Study Days
21
5.
North West Regional Study Days
31
6.
External Placements
Royal Liverpool Children’s Hospital, Alder Hey
Cross Sectoral (Community) Placement
Aintree Hospitals NHS Trust Clinical Placements
Clinical Placement Leads
Clinical Placement Aims and Objectives
Cardiology
Critical Care
Rheumatology / Haematology
Antibiotic Use
Surgery
Respiratory
Department of Medicine for the Elderly
Medicines Information
Neurology and Neurology
55
61
63
67
71
72
73
74
75
77
79
78
80
81
8.
Aseptic Unit
83
9.
Dispensary placements
89
10.
Project
93
11.
Assessment and Feedback
95
12.
Sample Pre-registration pharmacist timetable
97
7.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 2
1. Introduction
The aim of the pre-registration year at University Hospitals Aintree NHS
Foundation Trust (referred to as Aintree in this document) is to provide the
trainee with the experience and knowledge required to function as a
competent and effective pharmacist. The trainee will gain an understanding of
the specialist functions of the pharmacy department and will gain broad
experience in areas such as the dispensary, professional and legal
responsibilities, clinical roles, medicines information and aseptic services.
Pharmaceutical Services at Aintree Hospitals NHS Trust
The Aintree Hospitals NHS Trust Pharmacy serves two main hospitals and a
number of smaller units.
Aintree Hospitals itself comprises of University Hospital Aintree and Walton
Hospital. University Hospital Aintree has 850 acute beds on site. Out-patients
and a large day case unit continue to operate on the Walton site.
A large new Aseptic Unit was opened in 2002 at University Hospital Aintree
site. This has been granted a Manufacturer’s (Specials) Licence.
The pharmacy department also provides all pharmacy services to The Walton
Centre for Neurology and Neurosurgery which is a small NHS Trust of around
120 beds and Aintree Centre for Women’s Health.
Medicines Information Services are based at The University Hospital Aintree.
The Quality Control Services are provided from the Pharmacy Practice Unit in
Liverpool on a service level agreement.
There are 90 staff in total in the pharmacy department.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 3
1.
Clinical Services
The Pharmacy Department provides clinical pharmacy services to all wards
within the Trust. This comprises daily visits to all acute wards for prescription
review and to ensure high quality individual care. Consultant ward rounds are
also attended and there is active involvement at a directorate level by the
senior pharmacists. There is a Trust wide coverage of electronic prescribing.
Selected non-acute wards are visited two or three times a week.
2.
Medicines Information Service
The Medicines Information Service is led by an experienced Highly Specialist
Pharmacist. Its aim is to support the safe, effective and efficient use of
medicines by the provision of evidence-based information and advice on their
therapeutic use. Training for junior staff and pre-registration students is
provided in-house. The Medicines Information department also run a medicine
Hotline for patients on their return home should they have any queries about
their medicines, and a Safeline service of anonymous drug error reporting.
3.
Aseptic Services
A well equipped Aseptic Unit with professional and technical staff, provides all
reconstituted cytotoxic agents, adult nutrition and a range of other aseptically
prepared items. A range of antibiotics is produced through the CIVAS
service. The unit holds a Manufacturer’s (Specials) Licence.
4.
In and Out-patient Dispensing
A busy fully automated robotic dispensing service is provided for in-patients,
out-patients and discharges, approximately 1,600 items a day. The JAC
integrated computer system is in place and provides stock control, costing,
and management information. An intranet based prescription tracking system
allows wards to track prescriptions through the department.
5.
Top-up Service
All wards and departments have routine technician / assistant top-up service.
6.
Drug and Therapeutics Committee / Medicines Management
Committee.
The Trust has a well-established Drug and Therapeutics Committee /
Medicines Management Committee, which also has representatives from the
purchasers and local GPs. Pharmacy is actively involved in the Committee
and ensures implementation and monitoring of its decisions. The Chief
Pharmacist is secretary to the Committee. The Trust regularly updates its
Formulary for use within the hospital sector.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 4
7.
Training
All staff are encouraged to undertake further education and training. This is
provided in various ways, by in-house training days, journal clubs, lunchtime
training sessions. Many of the pharmacists are undertaking a clinical diploma
at Liverpool John Moores University. Management training is also available
for more senior staff. Some of our more senior technicians have completed, or
are completing, a further diploma at the University of Salford. A clinical
diploma for technicians is supported for senior and clinical technicians.
A number of senior pharmacists have completed the Non Medical Prescribers
Course.
The department has developed a Computer Aided Assessment package for
use by health professionals throughout the Trust covering the Medicines
Policy, Infection Control, Drug calculations, IV medicines and Insulin Safety.
The department has a well developed Continuing Professional Development
system, for pharmacists and technicians.
8.
On-Call / Opening Hours
The Department is open from:
8.30am – 5pm Monday to Friday
9.00am – 12.00pm Saturday morning and Bank Holidays,
2.00pm – 3.00pm Sunday afternoons
An out-of-hours service is provided by emergency duty pharmacists operating
from home on a 1 in 24 rota with a radio pager.
The Pharmacist rota for weekends is currently around 1 in 10
The technician rota for weekends is currently around 1 in 6.
The ATO rota for Sundays is 1 in 6
Staff are expected to cover bank holiday work on a rota basis.
Pre – Reg pharmacists are expected to work some weekends towards the
end of their course.
9.
Research and Development
Audit and research is actively encouraged. Many of the pharmacists are
involved in research projects either as part of a Diploma / MSc or on an
individual basis. Publication of results and / or presentation at conferences is
actively encouraged.
10.
Technician Extended Roles
The department encourages the development of the technician role. We
currently have technicians carrying out final and other checks for dispensed
items, extended ward roles for technicians including patient counselling and
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 5
training, 28 day dispensing (dispensing for discharge), use of Patient’s Own
Drugs, clinical trial management, and several other specialist roles.
11.
ATO Extended Roles
The Assistant Technical Officer role has been extended to include many
dispensary duties typically completed by technicians. We actively support our
ATO’s to complete an NVQ based qualification to ensure they can develop
their own roles.
12. Department Communication
The pharmacy department has a weekly Monday morning meeting to inform
staff of any important issues both within the department and Trust. There is
also a lunchtime educational meeting every Thursday. There is a rolling
program of staff meetings for all staff at least monthly.
General Information
13
Health and Safety
All staff are responsible for maintaining their own safety whilst at work and for
reporting any safety issues immediately to their line manager. All Directorates
undertake risk assessments and formulate action plans to eliminate or reduce
any risks identified. Your line manager will show you your area’s risk
assessment and discuss how those risks are being managed and what your
role is.
14
Clinical Risk/Patient Safety
The organisation is committed to improving the safety of patients in relation to
their treatment or care. You need to be aware of what clinical risks patients
may face when being cared for in your working environment or how your job
can affect patient safety. All staff are responsible for raising any concern
around patient safety immediately with their line manager or Directorate
Clinical Risk Lead. Each Directorate has completed a clinical risk assessment
and you should be made aware of this during your induction along with how
you can contribute to reducing risk to patients. The organisation promotes a
fair blame approach to staff involved in incidents, further details can be found
in the Incident Reporting and Management Policy found on the Trust Intranet
site under clinical subjects or risk managment.
15 Adverse Incident / Near Miss Reporting
It is your responsibility to report any adverse incidents/near misses using the
adverse incident/near miss reporting form. This form can be found on the
intranet.
Following any adverse incident/near miss a form must be completed within 24
hours.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 6
16
Risk Leads
Name
Paula
Lawson
Tracy Gibson
Emma Walsh
Role
Manual
Handling
Health and
Safety
Infection
Control Link
First Aider
Glad
Robinson
Clare Daly
Dennis
Cousins
Alex Jennings Clinical Risk
Lead
Alex Jennings Audit
Lead
Alex Jennings Research and
Development
Link / Mentor
Katrina Jones Fire
Safety
Clinical
Leah Guy
Governance
17
Where to seek help and advice
If you have any problems or require any help do not hesitate to speak to either
the Deputy Chief Pharmacist or Chief Pharmacist.
18
Data Protection/Confidentiality
Members of staff have access to a great deal of information relating to
patients, other staff and Trust business during the course of their duties. All
such information must be treated as confidential and should never be
disclosed either inside or outside work, even to family and friends. Any breach
of confidentiality may be regarded as gross misconduct. Staff should be
aware of the provisions of the Data Protection Act 1998. The provisions are
embodied in the eight principles of the Act which can be summarised as
follows :Personal information must be:
(i) Processed fairly and lawfully.
(ii) Obtained only for one or more specified and lawful purpose(s).
(iii) Adequate, relevant and not excessive.
(iv) Accurate and, where necessary, kept up to date.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
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(v) Not kept for longer than is necessary.
(vi) Processed in accordance with the subjects rights.
(vii) Kept secure using appropriate technological and organisational measures
(viii) Not transferred to a country outside the European Economic Community
area, unless that country ensures an adequate level of protection for the rights
and freedoms of data subjects in relation to the processing of personal data.
19
Bleep/Paging System
Details of the Trust Bleep / Paging System can be found in the New Starters
pack which you will have received during your two day induction. E.g.
Dial 75 wait for message the dial pager number followed by extension
5.2
Resuscitation
The number to call in the event of a cardiac arrest is 2222. You need to state
cardiac arrest and your location and extension number.
Training & Development
20
Development Review
The majority of Trust staff will be required to undergo an appraisal, or
‘development review’ within the first couple of months of starting work.
The development review will measure your performance against the
Knowledge and Skills Framework (KSF). Your post will have a KSF outline
which shows the dimensions and levels you will be expected to meet.
Staff new in post will be expected to perform to these standards and to be
measured against them after 12 months. If you can prove you are meeting
the standards, then you will progress through your first pay point or ‘Gateway’.
Once through your first Gateway, you will then work towards your second
Gateway, which is situated towards the top end of the pay band. At your
annual development review, your manager will prepare a development plan
with you to ensure you are gaining the additional skills and knowledge
necessary to move through this final gateway.
Appraisal system is monitored via the COMPASS database.
23
Policies
There are a number of policies that you will need to be familiar. These policies
are:
Medicines Policy
Absence/sickness procedure
Working time, including hours, flexi-time, etc
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 8
Arrangements for breaks
Holidays/leave
Performance management system
Discipline procedure
Grievance procedure
Internet and email policy
Training and Development Policy
Uniform Policy
Policies can be found on the Trust Intranet.
Useful numbers
Occupational Health
Unison (Peter Ballard)
Human Resources
Training and Development
NHS Pay
Security
Clinical Governance Department
Legal Department
Switchboard
0151 529 3390
0151 529 3231/3232
0151 529 3905
0151 529 6223
0151 529 2075
0151 529 3722 (Manager)
3333 (Emergency No.) 3735 (Pegasus
Manager) 3667 (Transport)
0151 529 5867
0151 529 3459
0151 525 5980 Switch 0
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 9
Pre-registration Pharmacist
Job Description
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 10
Aintree Hospitals NHS Trust
Pharmacy Department
Job Description
Job Title:
Pre-Registration Pharmacist
Job Summary
A one year fixed term contract to meet the requirements of the General
Pharmaceutical Council to register as a pharmacist by:
a) Gaining appropriate training and experience in the provision of pharmaceutical
services within each section of the pharmacy department
b) Demonstrating competence in the Performance Standards identified in the
RPSGB Training Manual.
c) Undertaking the pre-registration pharmacists examination.
Duties and Responsibilities
1. To assist in the dispensing of prescriptions and the supply of pharmaceutical
products including controlled drugs and clinical trial medication.
2. To assist in the provision of ward and clinical pharmacy services in line with the
Clinical Pharmacy standards and implement local prescribing policies and
guidelines.
3. To assist in the provision of medicines information and advice to clinical and
other professional staff
4. To assist in the sterile preparation of certain specified drugs including
chemotherapy using aseptic technique.
5. To assist in the preparation of extemporaneous drugs.
6. To be familiar with and use the computer systems in operation within the different
departments within pharmacy.
7. To participate in the competency based training programme as required by the
General Pharmaceutical Council.
8. To be responsible for self directed learning to support the collection of a portfolio
of evidence to demonstrate competence.
9. To participate in quarterly appraisals with the pre-registration tutor.
10. To visit other hospital sites in order to gain broad training in aspects of hospital
pharmacy practice – i.e. the pharmacy departments at Royal Liverpool University
Children’s Hospital (Alder Hey), and the regional QC department.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 11
11. To participate in a placement of at least two weeks within the community
pharmacy setting.
12. To undertake projects to assist personal development and that of the Pharmacy
Service.
13. To participate in clinical meetings within the department and to prepare and
deliver short presentations for other members of staff as part of the continuing
professional development programme.
14. To attend local and regional study courses organised by the Education
Consortium/Health Authority.
15. To prepare for the pre-registration examination.
16. To be able to follow procedures, current legislation, regulations governing the
Health and Safety at work act and COSHH.
17. To at all times practice in accordance with the Code of Ethics of the General
Pharmaceutical Council.
18. To undertake any other reasonable duties that may be required.
Note
The employee shares with the employer the responsibility for suggestions to alter the
scope of duties to improve the working situation. This document is intended to be a
guide to the general scope of duties and not an inflexible specification.
Relationships
Managed by: Senior pharmacist in charge of designated section
Tutor: Deputy Chief Pharmacist
Accountable to the Chief Pharmacist
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Pre-registration Pharmacist Training Plan 2010
Page 12
PRE-REG PAEDIATRIC PLACEMENT
Alder Hey Children’s Hospital
June 2010
Workbook reproduced with permission (Andrea Leatherbarrow, Principal Pharmacist)
WORKBOOK CONTENTS
Aims of placement
Mentors
2 week programme
Introduction to the Pharmacy Department at Alder Hey
Aims and objectives for training areas
Induction
Dispensary
Clinical
Medicines Information
Aseptic
Aims
The aims of this 4 week placement are to:


give the pre-reg pharmacist an introduction to paediatrics
help the pre-reg pharmacist to identify the differences between adult and
paediatric pharmaceutical care
give a basic understanding of some common areas of paediatric therapeutics

Programme (From 2001 placement)
DATE
AREA OF TRAINING
4 + 5 June
Induction
6 - 8 June
Dispensary
11 + 12 June
QC
13 June
Technician Study Day
14 - 22 June
Clinical
25 + 26 June
Aseptic
27 + 28 June
Medicines information
29 June
Review of training
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 13
Induction
Aim
To introduce the pre-reg pharmacist to the paediatric pharmacy department at Alder Hey.
Objectives
By the end of their induction the pre-reg pharmacist will

be able to find their way around the department

understand the structure of their placement

have an ID badge (9.30-10.30am Tuesday am)

have attended Occupational Health for a medical (9.00am Monday)

have identified some of the areas in which paediatric and adult prescriptions differ

have a basic understanding of the changes in drug handling which may occur in
paediatric patients

have used at least 2 paediatric dosage text books
Task 1
Read the attached paper by Massanari et al. Check your understanding using
the multiple choice questions that follow it.
Task 2
Using Medicines for Children, Alder Hey Book of Children's Doses and the BNF
decide upon the appropriate dose of the following medication for a 1 year old
child weighing 10kg
Trimethoprim for a UTI
Paracetamol for pyrexia
Cefotaxime and Gentamicin for suspected sepsis
Omeprazole for reflux
Promethazine for sedation
Aciclovir for herpes encephalitis
Comment on any differences between the text books. Which one would you
use? Why?
Task 3
Compare the prescription charts to those from your own hospital. What are the
similarities and differences? Can you think of any possible reasons behind the
differences
Dispensary
Objectives
By the end of the training period the pre-reg will

have dispensed a variety of types of paediatric prescriptions

have prepared extemporaneous products from scratch

be aware of possible causes of medication errors in paediatric dispensing and be able to
discuss steps to reduce risks

have experience in counselling children and their parents regarding their drug treatment
Task 1
Dispense at least 10 of each of the following types of prescriptions / items:

in-patients

out-patients

A&E

discharge
Identify at least 5 of these prescriptions which include a drug used outside it's
product license.
Task 2
Prepare at least 5 extemp products.
List 5 factors which need to be considered in paediatric formulation which may
not be as important in adults.
Task 3
Counsel 5 A&E patients on their medication under the supervision of a
pharmacist. List any difference between counselling paediatric and adult
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 14
patients.
Reflect: Read the attached patient information leaflet for drugs used
outside their license. How would you discuss it with a parent? Should all
patients be given one?
Task 4
Consider the following medication errors. What possible causes can you
identify? What action could be taken to prevent a similar error occurring?
a)
patient dispensed Nifedipine 5mg caps instead of 10mg
b)
Frusemide 50mg/5ml suspension labelled as "take 0.5ml twice a day"
when 2.5mg bd was intended
c)
patient received 40mg Tobramycin iv when 10mg was intended
d)
patient dispensed Cyclizine iv when Cyclosporin was intended
Reflect: Consider any dispensing errors you have made. What have you
learnt from them?
Clinical
Objectives
By the end of the training period the pre-reg will

be able to give examples of paediatric patients in whom altered drug handling should be
considered

have an understanding of the common causes of admission to a paediatric hospital and
the drug management of these conditions

be aware of the roles undertaken by paediatric clinical pharmacists
Task 1
List the cause of admission identified during a visit to one general medical and
one general surgical ward.
Identify whether there are any guidelines available for the drug management of
these conditions.
Task 2
Accompany clinical pharmacists to at least 8 wards. On each ward identify 1
patient to review in detail.
ie
identify medical problems and link to drug treatment
discuss any treatment options
how may drug handling be affected in this patient?
check doses, side-effects and interactions
prepare a monitoring plan for the patient
what should be done on discharge?
Discuss your findings with the ward pharmacist.
Ensure 1 of each of the following types of patient are reviewed:
CF, asthma, post-op, infection, neonate.
Task 3
Accompany a pharmacist to a multidisciplinary team meeting. List the
professions represented and note what contribution they make. Discuss their
role with the pharmacist after the meeting.
Medicines Information
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 15
Objectives
By the end of the training period the pre-reg will

have used at least 5 new paediatric reference texts

be able to discuss the types of enquiries received by an paediatric medicines information
unit

have completed 3 mock paediatric medicines information enquiries
Task 1
List the types of enquiries received by MI and DIAL on one day. Who enquired?
How many of the enquiries involved drugs being used outside their product
license?
Task 2
List the types of questions you should ask when receiving a paediatric dosage
enquiry.
Task 3
Complete at least 3 enquiries supplied by MI pharmacist
Reflect: Which paediatric information source would you recommend to a
community collegue? Why?
Aseptic
Objectives
By the end of the training period the pre-reg will

be able to discuss 4 advantages of CIVAS preparation of drugs for children

be able to outline 3 differences between TPN for adults and for children
Task 1
Attend a TPN meeting with a pharmacist. Choose 1 patient to follow up in more
detail. Discuss their TPN requirements with a CIVAS pharmacist. Arrange to
review the patient on the ward with the clinical pharmacist.
Reflect: Are there any areas where communication between the pharmacists
could be improved.
Task 2
Design the TPN regime for the following patient
2 day old baby with gastroschises. Weight 3kg.
Peripheral line only. Fluid allowed - 120ml/kg/day.
Task 3
Observe the preparation of at least 5 CIVAS products. How many stages are
involved between them being ordered and being administered to the patient?
Task 4
List 5 potential hazards of IV drug administration in children. How could these
risk be minimised?
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Pre-registration Pharmacist Training Plan 2010
Page 16
Pre-registration Pharmacist
Cross Sectoral Placement
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 17
Cross Sectoral Placements
The Pharmacy department Pre-registration Pharmacist Training Manager at
Aintree Hospitals NHS Trust will arrange a cross sectoral placement for each
pre-registration pharmacist. Due to the possible geographical and other
requirements of each pre-registration pharmacist, each placement will be
individually arranged.
A regional system is in place to facilitate this.
Each placement will be for two weeks initially, increasing to four weeks as
required. The training will follow the requirements of the General Pharmaceutical
Council as detailed in the resource pack provided in the pre-registration training
manual. The training manager will make assessment visits to the community
pharmacy to ensure training facilities are acceptable and the trainee is receiving
training from a suitable trainer.
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Pre-registration Pharmacist Training Plan 2010
Page 18
Pre-registration Pharmacist
Clinical Placements
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 19
Clinical Placements.
Each pre-registration pharmacist will spend a minimum of one week with each of
the following specialist clinical pharmacists. During this time, the trainee will have
the opportunity to develop their clinical skill and experience during accompanied
ward visits. The placement lead will provide self directed learning material or set
tasks for the trainee.
OBJECTIVES
1. To improve students clinical knowledge in a range of therapeutic areas.
2. To develop students communication, interpersonal and clinical skills.
3. To teach pre-registration pharmacists how to apply these skills and clinical
knowledge in practice.
4. To develop students knowledge of the organisation and delivery of hospital
pharmacy services.
METHODS
Drug Therapy Monitoring
Drug therapy monitoring and evaluation often forms the major part of a
pharmacist's contribution to patient care. A number of activities are necessary for
this process to be carried out efficiently and effectively including:-
Extraction of relevant clinical, biochemical and haematological information
from medical records.
Correct analysis and interpretation of this information.
Anticipation of therapeutic problems and formulation of an appropriate plan
of action.
NOTE: We have ready access to patients' notes. All information obtained from
these records should be treated in confidence. Please remember this at all
times and ensure that patient information is carefully recorded, stored and
discussed.
The Problem-oriented Approach
All trainee will gain experience in compiling clinical pharmacy problem lists and
patient clinical profiles. The profiles will be completed by obtaining information
from a variety of sources, including:-
Medical records (paper based and electronic)
Nursing notes
Prescription charts
Direct communication with the patient
These should be updated daily to incorporate changes in drug therapy, recent
laboratory data and progress of clinical problems.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 20
Ward Rounds
Pharmacists attending ward rounds should have an up-to-date knowledge of the
patient's clinical problems and their treatment. They should be able to make
constructive, informed therapeutic interventions. The preparation work described
in the previous section should enable the trainee to function in this way.
Ward rounds also provide opportunities for:-
Gaining first-hand experience of disease states.
Gaining first-hand experience of the therapeutic and adverse effects of
drugs.
Inter-disciplinary discussion of therapeutic issues.
Patient Interview
A pharmacist may be able to obtain valuable information from a patient by the
use of good interviewing skills. These same skills will also enable pharmacists to
give appropriate advice to patients about their medication. The establishment of
a good pharmacist / patient relationship will also increase awareness of the role
of the pharmacist in the healthcare team.
Medication History Taking
Trainees will have the opportunity to take medication histories and after completing
the programme, should be able to:-
-
Prepare a 'prompt sheet' for a medication history interview.
Conduct a medication history interview in a professional manner, applying
appropriate interview techniques and obtaining all relevant information,
including details of past and current drug therapy.
Compile a comprehensive and accurate medication history.
Patient Education
Trainees will receive instruction and guidance in patient education. This will involve
a sequence of observation, practical experience, self-criticism and guidance.
After completing a programme, pre-registration pharmacists should be able to:
-
Assess the need for education about drug treatment;
Design or obtain such education / concordance aids as may be necessary;
Compile a 'prompt sheet' detailing the most important points which are to be
conveyed during the interview.
Educate the patient in a professional manner:
describing / demonstrating medication in a logical
sequence;
watching for signs of confusion;
checking understanding;
following up problems identified during the education session.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 21
Medicine Information Research
The need to research medicine information may arise when a physician, nurse or
patient asks for information or when the pharmacist identifies the requirement. The
pharmacist should be able to assess the situation and tailor the depth of enquiry
and the level and type of answer accordingly.
After completing the programme, students should be able to:Carry out a literature search to investigate a clinical problem
Give clear, concise verbal answers to queries raised by medical and nursing
staff and patients
Produce clear, concise written answers to specific queries.
Verbal Communication
Not only do pharmacists require good communication skills to be able to interact
with patients, but also with a wide range of health care professionals. This
includes being able to communicate with senior physicians as well as the most
junior nurse. One area of particular importance is the concise, logical
presentation and discussion of information.
Case Presentation
All participants will make at least one verbal presentation during the training
programme. The subject matter will be a case presentation, a therapeutic
problem or a specific drug-related topic. Both tutor and student will use this
presentation to assess the students skills and identify areas of weakness. The
tutor will provide constructive criticism and guidance.
After completing the programme, pre-registration pharmacists should be able to:1. Structure a presentation in a logical sequence, where appropriate, using
information extracted from the medical and pharmaceutical literature.
2. Plan and use suitable visual aids.
3. Present the information in a confident, stimulating manner.
4. Handle questions from the audience competently.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 22
Clinical Placement:
CARDIOLOGY
Placement Lead:
DAVE THORNTON
Aims and Objectives:
To understand the following clinical conditions and their
pharmaceutical management:
(a) Angina.
(b) Myocardial Infarction (including secondary prevention).
(c) Atrial Fibrillation (including anticoagulant therapy).
(d) Heart Failure.
Tasks:
Take a patient medication history and produce a pharmaceutical care plan for a
cardiac patient.
Counsel a patient about warfarin therapy
Discuss an interaction, ADR, or other intervention identified on the ward.
Assessment criteria:
Signed testimonial from the placement lead and / or record of evidence signed by
the placement lead.
References:
Ischaemic Heart Disease
1.
Worrall A, Fletcher G. Acute Coronary Syndromes – assessment and
interventions. Hospital Pharmacist 2007;14:285-92.
2.
Fletcher G, Worrall A. Acute Coronary Syndromes – pharmacological
treatment. Hospital Pharmacist 2007; 14: 295-99.
Heart Failure
1.
Sani M. Chronic Heart Failure – diagnosis of the disease. Hospital
Pharmacist 2004; 11: 87-91.
2.
Sani M. Chronic Heart Failure – management of the disease. Hospital
Pharmacist 2004; 11: 92-100.
Arrhythmias
1.
Williams H. Arrhythmias – overview of the condition. Hospital Pharmacist
2005; 12 (2): 51-56.
2.
Williams H. Arrhythmias – the options for treatment. Hospital Pharmacist
2005; 12 (2): 57-60.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 23
Clinical Placement:
CRITICAL CARE
Placement Lead:
EMMA KAY / Jo Price
Aims
a) To understand the reasons for admission to Critical Care.
b) To understand the principles behind haemodynamic monitoring
and the way in which these parameters are used to aid therapy.
c) To explain the different complications, conditions that may arise as
a result of Critical Care admission and the methods used to rectify
them.
To understand the following clinical conditions and their pharmaceutical
management:
a) Sepsis.
b) Different types of shock.
c) Multisystem organ failure.
d) any other condition that presents during the placement.
Tasks:
 Attend the multidisciplinary ward round daily.
 Produce an outline pharmaceutical care plan for a critically ill patient.
 Improve knowledge of the physiological conditions of patients present on the
critical care unit at the time of placement.
 Observe medical procedures relevant to pharmaceutical care. Eg placement
of arterial lines for blood gas monitoring, haemofiltration.
Assessment criteria:
Signed testimonial from the placement lead and / or record of evidence signed by
the placement lead.
Reference:
Elliott,R. Critical Care Therapeutics. Pharmaceutical Press. 1999
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 24
Clinical Placement:
RHEUMATOLOGY / HAEMATOLOGY
Placement Lead:
PAUL FLYNN
Aims and Objectives:
To understand the following clinical conditions and their management:
a) Rheumatoid arthritis.
b) Related auto immune disorders e.g S.L.E., vasculitis.
c) Gout.
d) Osteo-arthritis.
e) Haematological malignancies e.g. leukaemias, lymphomas, myeloma.
f) Aplastic anaemia.
g) Drug induced blood dyscrasias.
Tasks:
To be able to discuss the diagnosis and treatment of rheumatoid arthritis:
a) profile a patient including DMARD drug history and diagnostic features.
b) Review monitoring requirements for DMARD therapy.
c) Review the use of biological therapies for R.A.
d) Be aware of related auto-immune disorders i.e. symptoms and
treatment.
e) Review the causes ,diagnosis and management of Gout.
f) Review antibiotic protocols used in neutropenic patients.
g) Follow through the monitoring of a gentamicin / vancomicin patient.
h) Review the adverse affects of chemotherapy.
i) Be aware of cytotoxic drug protocols, adjunctive therapies and
treatment of extravasation.
j) Attend the multi-disciplinary rheumatology ward round.
k) Attend Haematology MDT meeting
Assessment criteria:
Signed testimonial from the placement lead and / or record of evidence signed by
the placement lead.
References
1. A.R.C. patient information leaflets published by The Arthritis and Rheumatism
Council.
2. Rheumatoid Arthritis features, causes and diagnosis and management.
Clinical Pharmacist May 2010
3. MCCN website including cytotoxic protocols.
4. Oxford Handbook of Clinical Haematology 2004 2nd edition.
5. University hospitals Aintree antibiotic formulary.
6. Extravasation guidelines Aintree Hospitals drug formulary 2006.
7. NICE guidance on website relating to biologic therapies and haematology
chemotherapies.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 25
8. Thalidomide and Lenalidomide dispensing protocols
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 26
Clinical Placement:
ANTIBIOTIC USE
Placement Lead:
Emma Walsh
Aims and Objectives:
1. Identify the most common causative organisms and suggest the most
appropriate treatment for the following:
a) Lower respiratory tract infection, including
 Community acquired pneumonia / HAP
 Infective exacerbation of bronchitis / COPD
 tuberculosis
b) urinary tract infection.
c) sepsis.
d) Bacterial endocarditis if not covered in cardiology placement.
e) Cellulitis.
2. Describe the antibacterial activity and identify areas of appropriate usage for the
following antibiotics
a) Penicillins
b) Cephalosporins
c) Macrolides
d) Aminoglycosides (gentamicin)
e) Quinolones
f) Metronidazole
g) others e.g. meropenem, vancomycin, teicoplanin.
Tasks:
Visit an appropriate ward, each day and complete the following:
1. Take a patient medication history from a recently admitted patient
2. Identify five patients receiving antibiotic therapy (for different indication) and
produce a written summary for each patient, based on the following:
 Is the antibiotic appropriate? If not, suggest alternative(s) (look at
indication, clinical signs / symptoms, formulary and any
microbiological sensitivity testing performed)
 Is the dose / route appropriate, if not suggest alternative(s)
 Is the course length appropriate? If not why not?
 Are there any patient specific factors influencing the choice of
antibiotic?
 Any interacting medication
 Any patient counselling required
3. Identify any knowledge gaps, when completing the above tasks and act on
them accordingly.
4. Identify a patient with CDT +ve diarrhoea with the ward pharmacist and work
through the risk assessment score and treatment plan
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 27
Assessment criteria:
Signed testimonial from the placement lead and / or record of evidence signed by
the placement lead.
References:
1. Gow GL. Interpreting microbiology reports. Hosp. Pharm. Pract. 1994; 4(6): 252256.
2. Aintree Hospitals NHS Trust Guidelines for antimicrobial therapy.
3. Mannion PT Hospital acquired infection – the current situation. Hosp Pharm
2000; 7(7): 178-182.
4. Binyon D Cooke RPD. Restrictive antibiotic policies – how effective are they?
Hosp Pharm 2000; 7(7): 183-187.
5. www.bsac.org/pyxis
6. Wickens H, Wade P. The right drug for the right bug. PJ 2005 v274 pg 365-368.
7. Wickens H, Wade P. How Pharmacists can promote the sensible use of
antimicrobials PJ 2005 v274 427-430.
8. Wickens H, Wade P. Understanding antibiotic resistance. PJ 2005 v274 501504.
9. Winning ways. Working together to reduce healthcare associated infection
England. DOH. CMO Dec 2003
10. NPC – MeRec Antibiotic resistance + prescribing practice Feb 2003
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 28
Clinical Placement:
SURGERY
Placement Lead:
EMMA WILSON / Colin Brennan
Aims and Objectives:
To understand the pharmaceutical management of the surgical patient::
a) when nil by mouth.
b) pre operative management of routine medication.
c) epidurals and PCAs.
d) management of post operative nausea and vomiting (PONV).
e) the analgesic ladder.
f) Anticoagulation.
g) antibiotic prophylaxis.
And in Addition:
To understand the Patients Own Drug (POD) policy and procedure.
To understand the pharmacists’ role within the Acute pain Team.
To understand how the pharmacist can be involved in pre-admission clinics.
To understand how the pharmacist can be involved with drug budget
management.
Tasks:
Take a patients’ medication history.
To assess the suitability of drugs for re-use in the POD scheme.
To read the Aintree acute pain team protocols for PONV, epidurals and PCAs.
To read the Aintree Antibiotic Hospital Formulary for surgical prophylaxis.
To read about the different surgical procedures seen on the daily ward visits.
To assist in creating a monthly drug expenditure report for the surgical
directorate.
Assessment criteria:
Signed testimonial from the placement lead and / or record of evidence signed by
the placement lead.
References:
Drugs in the Peri-operative period: Series of four articles in the Drug and
Therapeutics Bulletin Vol 37 No 9 August 1999, No 9 September 1999, no 10
October 1999 and No 12 December 1999.
Aintree Hospitals NHS Trust POD Policy 2001.
Aintree Hospitals NHS Trust Antibiotic Formulary.
Aintree Hospitals NHS Trust Acute Pain Service:
a) PCA protocol
b) Epidural Analgesia Protocol
c) Guidance on the Management of Acute Postoperative Pain
d) Guidance on the Management of Postoperative Nausea and Vomiting
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 29
Clinical Placement:
Vascular Surgery Placement
Placement Lead:
Colin Brennan
Aims







To be able to take accurate drug histories.
To be able to assess medication needs of the surgical patient’s in the peri
operative period.
To be able to assess medication needs of the surgical patient in the post
operative period with relevance to vascular surgery.
To learn about the different types of vascular surgery.
To increase understanding of phantom limb pain and its treatments.
To increase understanding and management of Ulceration.
To be able to counsel patient’s on the use of medications commonly
prescribed for the vascular patient.
Objectives





Discuss the types of patient’s admitted to the vascular ward.
Discuss and review the different types of vascular surgery commonly seen on
the ward.
 Examples;
 Abdominal Aortic Aneurysm repair
 Carotid Endarterectomy
 Femoropopliteal bypass grafting
 Stenting
 Amputation
 Ulceration
Review a patient undergoing thrombolysis.
Discuss the different types of hosiery available.
Discuss the current guidance on CVD management.
Tasks








Obtain five witnessed drug histories and review their peri operative and post
operative needs.
Read about and review the above types of surgery.
Read current CMCN and NICE guidance on lipid management.
Read about phantom limb pain and discuss a patient’s treatment.
Spend a morning with the specialist leg ulcer nurse.
Attend a ward round with the vascular surgeon and their team.
Counsel a patient started on warfarin.
Counsel a patient started on a statin.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 30
Assessment Criteria

A signed testimonial for your portfolio.
References



ABC of vascular diseases.
Carotid endarterectomy: Preoperative evaluation; surgical technique; and
complications.
Treatment of chronic critical limb ischemia.
References will be provided.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 31
Clinical Placement:
DEPARTMENT OF MEDICINE FOR THE ELDERLY
Placement Lead:
Yvonne Lim
Aims and Objectives:
To understand the following clinical conditions and their
pharmaceutical management:
a) Elderly Medicine
b) Stroke Management
c) Fall prevention / Management
d) Wound Care
Tasks:
1.
2.
3.
4.
5.
Counsel a patient in the use warfarin.
Take a patient medication history from a stroke patient.
Produce a pharmaceutical care plan for a stroke patient.
Identify factors leading to falls in elderly patients.
Assess patient’s likely medication concordance post discharge.
Assessment criteria:
Signed testimonial from the placement lead and / or record of evidence signed by
the placement lead.
References:
Rudd A. Wolfe C. Aetiology, pathology and Management of stroke. Hospital
Pharmacist February 2002, 9(2) 32-41
NSF – Medicines and Older people March 2001, Department of Health
2004/048 New guidelines for the NHS on the assessment and prevention of falls
in the elderly
Susan Livingstone. Stroke. The Pharmaceutical Journal July m2003 Vol 271 pg
19-21
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 32
Clinical Placement: Respiratory Medicine and Discharge Planning
Placement Lead: Sandra Oliver
Aims and Objectives:
1. To understand the following clinical conditions and their pharmaceutical
management: a) Asthma
b) COPD
c) Pneumonia.
2. To gain awareness of other respiratory conditions eg lung cancer,
bronchiectasis, pulmonary fibrosis, pulmonary embolus, tuberculosis and
pleural effusion.
3. To understand issues involved in discharge planning and writing discharge
prescriptions.
Tasks: (as many as possible of the following:)









Become familiar with methods of delivering drugs by inhalation, including
awareness of oxygen therapy. Assess a patient’s inhaler technique and
counsel accordingly.
Take a patient medication history from an asthma or COPD patient,
particularly with respect to respiratory medication.
Check a TTO for a patient, identifying any checks to be made and issues to
be resolved before it can be completed.
Attend one or more consultant ward rounds.
Spend a session shadowing a clinical nurse specialist in asthma or COPD.
Read and discuss the latest guidelines on the treatment of COPD and
asthma.
Discuss available aids to smoking cessation. If possible, discuss options with
a patient wishing to stop. Shadow smoking cessation nurse.
Produce and discuss a pharmaceutical care plan for a named asthma or
COPD patient.
Record and discuss at least two interventions or activities carried out on the
ward during the week eg a drug interaction requiring intervention, patient
counselling, a prescribing error needing amendment etc.
References:
To include:
1. Latest British Thoracic Society Guidelines on Management of Asthma.
2. Latest National/International Guidelines on Management of COPD.
3. Relevant sections of the latest editions of the BNF and Trust Formulary.
4. CPPE Distance Learning Package on Respiratory Medicine.
Assessment criteria:
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 33
Signed testimonial from the placement lead and / or record of evidence signed by
the placement lead.
Potential areas to cover during week (reading, discussion or experience):
Chest Med:

Asthma: BTS guidelines: stepping up and down. Self management
programmes, role of asthma nurse. Evidence.
 COPD: BTS guidelines, differences between COPD and asthma (disease
and treatment). Evidence
 Spirometry: FVC, FEV1 etc, restrictive vs obstructive disease. PEFR.
 Investigations: bronchoscopy, spiral CT, V/Q scan, D dimer, ABGs, pulse
oximetry.
 TB: treatment, monitoring (pre and during treatment), side effects,
counselling, combination preps.
 Smoking cessation.
 Inhaler devices – CFC issues, spacers, inhaler aids, generic vs brand issues.
 Theophylline – monitoring.
 Pneumonia
 Inhaled drugs – classes, colour coding, differences between drugs etc
Inhaler devices inc spacers.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 34
Clinical Placement:
Nephrology
Placement Lead:
Anne Waddington
Aims:
To understand
a)
The most common causes and treatment of Renal Failure
b)
The causes and treatment of electrolyte disturbances secondary to renal impairment e.g.
hyperkalaemia, hyperphosphataemia, hypocalcaemia
c)
The factors affecting drug removal by dialysis
d)
Dietary restrictions for patients with renal failure
e)
The causes and treatment of renal anaemia
f)
The pharmaceutical care priorities for a patient presenting with acute renal failure
To be aware of
a)
The sources of information and factors affecting dosage adjustment of drugs in renal failure
b)
The reasons why certain drugs should be avoided in renal impairment
c)
Some of the mechanisms of drug induced nephrotoxicity
Tasks:
a)
b)
c)
d)
Discuss a pharmaceutical care plan for a patient with renal failure
Attend a haemodialysis session with one of the specialist nurses
Attend the multidisciplinary nephrology ward round
Take a medication history for a recently admitted patient
Assessment criteria:
Record of evidence signed by the placement lead.
References:
The Renal Drug Handbook, Ashley C and Currie A, 2 nd edition, Radcliffe Medical Press, Oxford 2004
The Beginner’s Guide to Renal Pharmacy reference folder produced by the Renal Pharmacist’s Group
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 35
Clinical Placement:
Medicines Information
Placement Lead:
Susan Fryer / Nicola Durnin
Aims and Objectives:
(Ref: MI Manual)
a) To understand the need to obtain sufficient background information for
effective enquiry answering and to obtain this through good communication
skills.
b) To understand and be aware of the legal and ethical aspects of enquiry
answering and Medicines Information work.
c) To be able to use the paper based and electronic information sources
effectively and appropriately.
d) To gain knowledge of the different types of work carried out by Medicines
Information Pharmacists. To understand how this work is prioritised and
carried out on a daily basis.
Tasks:
1. Read sections A-D in the MI training workbook
2. At least 14 practice enquiries (2 from each section of workbook) must be
completed involving the following types of query : Administration of Medicines
 Adverse Drug Reactions
 Drug Interactions
 Critical Evaluation
 Pregnancy
 Compatibility of parenteral drugs
 Ethical dilemmas
N.B. These queries are taken by the pre registration pharmacist in a role-play manner to
help improve communication skills. The answers are then assessed and discussed with the MI
Pharmacist.
1. To carry out actual enquiries only where appropriate and with full supervision
of the MI Pharmacist.
2. To help in the running of the office, and to listen to enquiry taking and
answering by the MI Pharmacists.
Assessment criteria:
Record of evidence signed by the placement lead.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 36
Clinical Placement:
NEUROLOGY AND NEUROSURGERY
Placement Lead:
Jenny Sparrow / Rachel Unsworth
Aims and Objectives:
To understand the following clinical conditions and their pharmaceutical
management:
 Epilepsy.
 Parkinson’s Disease.
 Haemorrhage (Extradural, subdural and subarachnoid).
 Multiple Sclerosis.
 Myasthenia Gravis.
 Head injury / trauma.
 Neuropathic pain
To gain awareness of other neurological conditions, neurosurgery and
pain procedures.
Tasks:
1. Counsel three patients on their newly prescribed medicine(s) for a
neurological or neurosurgical condition.
2. Take medication histories from an epileptic patient and a Parkinson’s disease
patient.
3. Produce a pharmaceutical care plan for a patient with epilepsy or Parkinson’s
disease.
4. Identify one or more patients with epilepsy, Parkinson’s disease or MS, read
their case notes and prescription chart and where possible interview the
patient about their experience of the disease and its treatment.
5. Work through case study exercises and questions provided and discuss
answers with placement lead.
6. Attend an antimicrobial ward round and feed back comments to each ward
pharmacist.
7. Check a TTO for a surgical patient and identify common medication issues
that arise in this situation.
8. Explain to the lead pharmacist the issues involved in using unlicensed and off
label medicines and give examples of such medicines used at WCNN. Select
one of these which does not have a WCNN patient information leaflet and
outline what you would include when writing one (or counselling a patient on
this medicine).
9. Complete an incident form (at WCNN) for any potentially significant
medication error identified during the placement. Discuss likely cause(s) of
this error and what could be done to prevent recurrence.
Assessment criteria:
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 37
Record of evidence signed by the placement lead.
References
 Evidence based management of neurological disease, CPD resource from
the Northern Ireland Centre for Postgraduate Pharmaceutical Education
and Training, Queen’s University of Belfast. (Jenny to provide)
 Up to date review articles on MS, PD, epilepsy and myasthenia gravis as
provided by Jenny
 Neuro clinical information file available in pharmacy
 WCNN protocols on individual medicines and WCNN antimicrobial
formularies (available on WCNN intranet, Aintree I drive or file in clinical
checking room.)
 Latest NICE guidelines on MS, epilepsy, Parkinson’s disease and
neuropathic pain.
 Neurology and Neurosurgery Illustrated, Third Edition, Lindsay and Bone,
published by Churchill Livingstone. (Located in Medicines Information)
 Essential Neurology, Third Edition, Wilkinson. (Located in Medicines
Information)
 Teaching DVDs on Parkinson’s disease as provided by Jenny.
 Medicines Policy section on unlicensed medicines
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 38
CLINICAL PLACEMENT:
Placement lead:
DIABETES AND ENDOCRINOLOGY
Mark Peasley
Aims and Objectives:
To understand the following clinical conditions resulting from diabetes and other
endocrine organ dysfunction and their pharmaceutical management.
1. Diabetic ketoacidosis (DKA)
2. The diabetic foot/ulcer (and associated diabetic neuropathy).
3. Cardiovascular risk reduction for the diabetic patient (secondary
prevention strategies).
4. Other complication of diabetes:
a. Retinopathy
b. Nephropathy
c. Hypoglycaemia
d. Gastroparesis
5. Endocrine organ disease:
a. Adrenal/pituitary insufficiency
b. Hypo/Hyperthyroidism
c. Hypercalcaemia
Tasks:




Formulate an appropriate pharmaceutical care plan for a patient with an
identified endocrine disease.
Counsel a patient on medication for secondary prevention or counsel a
patient with adrenal insufficiency (both where time allows).
Discuss the current evidence based approaches to reducing/preventing
cardiovascular mortality amongst the type-2-diabetic population.
Discuss the causes and triggers of hyperglycaemia and DKA.
Assessment Criteria:
Signed testimonial from the placement lead and / or record of evidence signed by
the placement lead.
References:



Daneman D: Type 1 diabetes; The Lancet; 2006; 367; 847-858
Prakash R, Peasley M: Managing diabetic emergencies; Pharmacy
Professional; 2010
Hardern RD, Quinn ND: Emergency management of diabetic Ketoacidosis
in adults; Emergency Medicine Journal; 2003; 20; 210-213
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 39


Stratton IM, Adler AI, Neil AW, Matthews DR, Manley SE, Cull CA,
Hadden D, Turner RC, Holman RR: Association of glycaemia with
macrovascular and microvascular complications of type 2 diabetes
(UKPDS 35): prospective observational study; The British Medical Journal;
2000; 321; 405-412
Adler AI, Stratton IM, Neil AW, Yudkin JS, Matthews DR, Cull CA, Wright
AD, Turner RC, Holman RR: Association of systolic blood pressure with
macrovascular and microvascular complications of type 2 diabetes
(UKPDS 36): prospective observational study; The British Medical Journal;
2000; 321; 412-419

Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 40
Clinical Placement:
Clinical Trials
Placement Lead:
Rebecca Tangney/Clare Charters
Aims
a) To be able to explain the reasons for conducting clinical trials, the different
phases of clinical trials and the common terms and abbreviations used
b) To have a brief understanding of the laws and guidelines affecting clinical
trials and to understand why they are necessary
c) To complete brief Good Clinical Practice training (GCP)
d) To be able to effectively utilise the clinical trials room and accurately
complete all necessary paper work required when handling investigational
medicinal product (IMP)
Tasks









Attend GCP training, either ran in-house by trials
pharmacist/technician or to attend seminar at Clinical Sciences and
update training record
Read all Standard operating Procedures (SOPs) and update
training record
Correctly receive and store IMP
Dispense IMP
Record returns of IMP
Attend clinical trial set up meeting and monitor visit (if possible)
Attend any other relevant meeting with the clinical trials pharmacist
that may occur during the placement
Visit with clinical trials technician and trials nurse
Ward visit with trials pharmacist
Assessment Criteria
All paper work completed when handling IMP will be checked for accuracy and
completeness. Certificate of attendance at GCP training should be evident.
Training records should be updated by tutee.
References
1) 10 Golden Rules of GCP - to be supplied by Lindsey before placement
2) Pharmacy Services for Clinical Trials. The Pharmaceutical Journal; 2005.
274:629-630.
3) Harman R, The Regulation of Clinical Trials in the United Kingdom. The
Pharmaceutical Journal, 2003; 271:618-622.
4) Harman R, The Concept and Implementation of Good Clinical Practice in
Trials. The Pharmaceutical Journal 2003; 270:653-657
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 41
5) Practice Guidance on Pharmacy Services for Clinical Trials, June 2005.
Available from www.rpsgb.org
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 42
Clinical Placement: SURGERY
Placement Lead: Emma Wilson
Aims and Objectives:
To pharmaceutical management of the surgical patient with respect to:
Analgesia including epidurals and PCAs
Thromboprophylaxis
Post-operative Nausea and Vomiting
Management of routine medications in the peri-operative period
Antibiotic Prophylaxis
Tasks:
Complete the pre-registration surgical training package (reading and case
studies).
Assessment criteria:
Signed testimonial from the placement lead and/or record of evidence signed by
the placement lead.
References:
Within the surgical training file on Emma Wilsons’ desk.
It would be advisable to read the first section of references regarding
thromboprophylaxis prior to starting the week.
1.
THRIFT Consensus Group Risk of and prophylaxis for venous
thromboembolism BMJ 1992; 305: 567-574
2.
Low molecular weight heparins for venous thrombembolism DTB 1998;
36(4): 25-29 (Excluding the treatment of DVT)
3.
Prophylaxis of VTE SIGN guidelines no 62 Oct 2002 www.sign.ac.uk
4.
Rahman MH, Beattie J Surgery and VTE PJ Nov 2004; 273: 687-689
5.
Rahman MH, Beattie J Drugs used to prevent Surgical VTE PJ Nov 2004;
273: 717-719
6.
Blann, Lip VTE BMJ 2006; 332:215-219
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Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 44
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 45
Pre-registration Pharmacists
Aseptic Unit
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 46
Introduction
Most large Trusts have aseptic units within their pharmacy departments. The
specialist role of these units is to safely prepare sterile injections, either simple
preparation of single drugs such as antibiotics and chemotherapy, or multiple
formulations of intravenous nutrition, cancer chemotherapy or hydration.
Preparation of injections within a carefully controlled and monitored environment,
free from microbiological or particulate contamination, reduces the risk of
infection to the patient and ensures the stability and integrity of the drug is
maintained. Many of the Trust’s patients can be more susceptible to
microbiological contamination than the rest of the population due to their clinical
condition, or other drug treatments.
The Pharmacy Aseptic Unit for this Trust has recently been relocated from
Walton Hospital to University Hospital Aintree following extensive funding
secured from North West Region.
The new facility has state of the art clean room technology exceeding all current
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 47
European Good Manufacturing Practice Guidelines (EGMP). The suite comprises
of four clean rooms and a clean support room all conforming to European GMP
Guidelines, supported by controlled storage, cleaning and computer areas. The
unit is staffed by specialist technicians and assistants and is managed by a
specialist pharmacist.
It is planned that the Trust will apply for a Manufacturer’s (Specials) Licence from
the Medicines Control Agency by summer 2002. This will allow us to prepare a
wider range of products more efficiently and allow faster responses to patient
requirements.
The work of the unit
The unit currently prepares three main types of product, with several other
products prepared occasionally.
1. TPN
TPN (or Total Parenteral Nutrition) is a complex formulation consisting of up
to twenty different individual preparations and is intended to provide all the
nutrients and fluids needed by patients who cannot take oral nutrition.
Patients can require parenteral feeding long term, or just to cover a period of
gut rest eg after surgery.
2. CIVAS
Civas is Central Intravenous Additive Service. Current guidelines state that
when an injection is to be infused over more that four hours (except in
specialist areas such as theatres or intensive care) it must be prepared within
controlled conditions in the pharmacy. The main CIVAS products within the
unit are antibiotics, but it is planned to expand this service to include many
other products.
3. Cytotoxic Drugs
These drugs are mainly used in the treatment of cancers. The patients using
these drugs are often immunocompromised and so it is especially important
that these patients are not exposed to any microbiological contamination.
Because of their actions, accidental exposure can be harmful to staff, so great
care is taken to minimise the possibility of exposure during preparation.
The figure shows the cytotoxic
isolator within one of the clean
rooms in the unit. The protective
clothing worn by the operator is to
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 48
protect the product from any
contamination.
This
particular
contamination from the operator. The
isolator also ensures that the
operator is preparing the drug within
operator is not exposed to any
an isolator, ensuring the product is
possible harmful effects of the drug.
not exposed to any microbiological
All four rooms within the unit have single isolators like the one shown. Each can
be used to prepare any of the products, but only one product at any time is
allowed in the isolator room. This is to ensure no mistakes can occur.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 49
The unit has closed circuit
television cameras in each isolator.
This is to facilitate “in process”
checks by the senior technician or
pharmacist from a remote point.
The figure shows the CCTV
controller, screen and recorder.
Using the intercom system shown
in the upper right hand corner, the
supervisor can communicate with
all operators within the clean rooms
and one person can supervise all
four workstations.
The unit has several monitoring systems. The first, shown on the left below is
the differential air pressure monitoring system. This monitors the difference in
pressure between all the rooms. Using this and the limits set for each reading,
the pharmacist can ensure that the correct amount of filtered air is entering
each room and that contaminated air cannot get into the unit because clean
filtered air is always being forced out under pressure.
The figure to the right below shows the continuous particle monitoring system.
This system will alert the pharmacist to a problem with the filtration system as
it measures the presence of airborne bacterial sized particles.
The investment required for the unit was £480 000, of which £405 000 was
provided by regional support. As well as the plant, equipment, monitoring
systems, safety equipment and fabric of the build, this includes provision of a
maintained power supply for the unit.
The unit can provide all of the specialist aseptic preparation needs of the
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 50
Trust under the conditions required by law and European, national and
regional guidelines. The safety of our patients is ensured by preparing
injections in closely controlled and monitored conditions, by highly trained and
validated staff, using validated techniques under the supervision of a
specialist pharmacist.
The safety of our staff is ensured by the employment of extraction techniques
for noxious or dangerous substances, either the drugs or the cleaning /
disinfection chemicals. This complies with COSHH regulations.
Pre-registration Training
Placement Lead:
Aims and Objectives:
Clare Williams
(See separate Training plan and records for
aseptic unit)
During the four week placement:
a) To know the Law relating to aseptic preparation.
b) To know, understand and comply with the QC procedures in
the unit and understand the reasons for these procedures.
c) To understand TPN formulation and the clinical conditions of
the patients requiring TPN, including liaison with other
professionals and understanding of other possible
treatments.
d) Cytotoxics - to understand the clinical conditions and
management of patients, checking of doses and safe
handling. To be aware of the restrictions of cytotoxic
prescribing, handling, preparation and administration.
e) To understand the benefits of a CIVA service
Tasks:
Successfully complete a broth transfer trial.
Complete all sections of the training file which include practical tasks,
discussion and reading.
Assessment criteria:
Signed testimonial from the placement lead and / or record of evidence signed
by the placement lead.
Checklists at the end of each section of the training file are signed by the
placement lead and the student.
The Aseptic Unit has a large separate training plan, which must be
completed by all staff in the unit. This has not been reproduced in this
document, and will be issued from the aseptic unit shortly before the
placement. All training records are retained in the aseptic unit, so copies
should be made of relevant sections as evidence of compliance with
performance standards.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 51
References:
Aseptic Unit training policy (based on the Guidance Document Training for
Aseptic Dispensing Services, by the Pharmaceutical Technical Services and
Quality Assurance Committee, March 2001.
Guide to Good Manufacturing Practice.
Breckenridge report (HC(76)9 – The Addition of Drugs to IV Fluids).
Aseptic Dispensing for NHS Patients (the “Farwell Report”) 1994, Department
of Health.
Maintaining Asepsis During the Preparation of Pharmaceutical Products,
North West Chief Executives Working Party November 1997.
CIVAS Handbook 1998 Pharmaceutical Press.
Cytotoxic Handbook 4th Edition Radcliffe Medical Press.
Aintree Hospitals NHS Trust Guide to Intravenous Therapy.
Aintree Hospitals NHS Trust Intrathecal Cytotoxic Administration
Aintree Hospitals NHS Trust COSHH file.
Aintree Hospitals NHS Trust Pharmacy Aseptic Unit Standard Operating
Procedures.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 52
Pre-registration Pharmacists
Dispensary Placements
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 53
Dispensary Placements
Trainees will spend an initial two week period based in the dispensary at
University Hospital Aintree, and will then be expected to develop the core
skills gained from this induction period during the rest of the training year.
Trainees will be based in the dispensary when not receiving training in
specialist clinical areas, study days ward work or have time allocated for
project work and assignments.
Whilst based with the clinical pharmacists throughout the year, trainees will be
expected to perform dispensary duties each afternoon. As the year
progresses, these duties will evolve into checking roles (final accuracy checks
after a period of assessment and clinical checks after a further period of
assessment).
FIRST DISPENSARY PLACEMENT
Aims:
the trainee will become familiar with all areas of the dispensary –
inpatient dispensing,
outpatient dispensing,
discharge
dispensing and dispensing for discharge pilot wards.
During this placement the trainee will receive formal training on dispensary
procedures, health and safety and legal and professional aspects. The trainee
will be supervised initially by the dispensary manager (or a suitably authorised
deputy) and will at all times be under the professional supervision of a
pharmacist.
The trainee will complete the dispensary training programme for new staff and
be assessed by the Dispensary Manager
References:
Aintree Hospitals NHS Trust Medicines Policy (5th Edition).
Aintree Hospitals NHS Trust Formulary.
Aintree Hospitals NHS Trust Dispensary Procedures Manual:
 Dispensing.
 Receiving Prescriptions.
 Prescription Monitoring System.
 JAC Computer System.
 Telephone Answering.
Aintree Hospitals NHS Trust COSHH Manual.
Aintree Hospitals NHS Trust Health and Safety Policy.
British National Formulary
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 54
Tasks:
1. Complete JAC training and receive formal instruction on use of the
computer system. (Assessed by the Computer Services Manager or
Assistant)
2. Receive formal training on confidentiality and management of patient
information.
3. Dispense, under supervision, 20 items of each of the following groups of
prescriptions, completing all relevant paperwork correctly (ie testimonial
and dispensing records):
 Outpatient
 Inpatient
 Discharge
4. Receive, under supervision, 20 outpatient prescriptions into the pharmacy.
5. Develop these skills by repetition and assessment with support from the
dispensary manager and the training manager.
Development:
Continue to develop competency at dispensing medicines throughout the
training year, using time allocated into the dispensary to develop the skills
required to progress to checking.
ONGOING DISPENSARY PLACEMENTS
Aim:
The aim of the ongoing placements within the dispensary is to
produce an in-depth knowledge of dispensary issues and the
confidence and ability to supervise the dispensing process once
qualified.
As the training year progresses, a satisfactory level of error free dispensing is
expected. This will be assessed by the dispensary manager, the training
manager and accuracy checking staff (pharmacists and technicians).
Accuracy Checking
Once the required, consistent level is reached, the trainee will then take on
further training to perform a checking role. It is expected that this will be
between 26 and 39 weeks into the training programme.
The trainee will check 200 items, which will then be checked by a pharmacist.
The trainee will keep a record of items checked which the pharmacist will
countersign.
Once 200 items have been checked, without errors, and after authorisation by
the training manager and Chief Pharmacist, the trainee must successfully
complete the checking exam (Ref: technician checking policy). Once this is
complete the trainee can independently perform final accuracy checks on
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 55
items which have been clinically checked by a pharmacist.
The trainee cannot perform accuracy checks on controlled drugs, clinical
trials, extemporaneous preparations, unlicensed medicines or anything
dispensed by another trainee.
Patient Counselling
Throughout the year, the trainee will attend training sessions on counselling
patients on the use of their drugs, in addition to the training delivered on the
clinical placements. These sessions are lead by clinical pharmacists and
address the counselling of patient groups, including asthmatics (including
inhaler technique), diabetics, neurology patients, haematology patients, the
older patient, and general counselling techniques. Once the trainee has
completed these sessions, and been assessed as competent by the training
manager, they may independently counsel patients. Trainees may counsel
patients before completion of this training if supervised by a pharmacist or an
approved patient counsellor.
Counselling Sessions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
General Counselling Techniques – Role play and
communication
Antibiotics – course length, interactions
Parkinson’s Disease
Gastroenerology
Diabetes – insulin, oral hypoglycaemics, diet
Analgesics
Epilepsy
Anticoagulants
Rheumatology
Epilepsy (2)
Respiratory – inhaler techniques and compliance aids
Cardiovascular.
non-verbal
References and Resources:
As in first placement, plus
Aintree Hospitals NHS Trust Dispensary checking procedure
Dispensing errors: Future management – meeting report from
Guild of Healthcare Pharmacists April 2002.
Learning from medication errors – Pharm J., 267 (2001), 287
(http://www.pharmj.com/pdf/features/pj_20010901_errors.pdf)
The centre for medication error prevention, University of Derby
website on:
http://www.medication-errors.org.uk/
Dispensary Manager.
All dispensary staff.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 56
Pre-registration Pharmacists
Projects
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 57
Projects
All pre-registration pharmacists will complete a project, which will ideally
contain an audit aspect. All projects are supervised by a senior clinical
pharmacist and will be presented to the department.
All projects are submitted for the Pharmacia sponsored regional project prize.
The regional training pharmacist will shortlist the projects and decide which
will be presented as a poster and which will be as an oral presentation.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 58
Pre-registration pharmacists
Assessment and Feedback
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 59
Assessment and feedback
All pre-registration pharmacists are supervised at all times by, or are under
the direction of, a qualified pharmacist, fulfilling the criteria for pre-registration
pharmacists tutors.
Assessment and feedback are given through formal records of evidence and
testimonials. These are discussed during regular meetings with the preregistration training manager, where progress is assessed and additional
training needs decided, where indicated.
The training manager is available at all times for advice and support. All other
senior (and junior) staff are also available to support the training and
assessment process.
See the Pre-registration Training Manual and the Tutor’s pack for further
information on this subject.
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 60
Pre-registration Pharmacist
Timetable 2010
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010
Page 61
Aintree Hospitals NHS Trust
Pre-registration Pharmacist Training Plan 2010.
Page 62
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