A week in my hospital pharmacy: ‘The way children tackle adversity can be very humbling’

Unique environment

Pharmacy is unique within the hospital environment because of the different and complex roles it has. This is even more evident in paediatrics, where the risk of an adverse drug event or medication error can be significantly (ie three to nine times) greater than in the adult environment. We are a clinical department with highly skilled individuals providing pharmaceutical care for both our inpatients and specialised outpatient services.

Clinical pharmacists are an integral part of multidisciplinary teams throughout the hospital. We are also involved in highly specialised aseptic manufacture and dispensing of intravenous medications, including cancer treatments.

I also have to ensure medications are being prescribed and used correctly, and regularly counsel patients and their carers on the correct use of medication. My department provides medicines advice and information, both within OLCHC and nationwide, including the development of formularies, patient information leaflets, electronic prescribing solutions, medication policies and clinical guidelines.

Trials and evaluations

We are involved in clinical trials and ongoing evaluation of medications for use with children, along with education, training and research relating to pharmacy, medicines and therapeutics. Pharmacy also retains the traditional and important role in the cost-effective procurement, quality testing, safe storage and dispensing of medicines.

We are also constantly investigating new technologies and the positive impact they can have in patient care, including e-prescribing, robotics and automated dispensing technologies, app development and so on.

I manage all these activities on behalf of OLCHC to ensure our patients receive a standard of pharmaceutical care that compares favourably with international paediatric centres of excellence.

There is a huge amount of operational requests and pharmacy-related issues to deal with on a continuous basis. Crumlin is so dynamic, you often don’t know what’s coming next, and may have to rearrange priorities at very short notice.

This week started unexpectedly early as I was called in to work late Sunday night in response to an unusual medication query. Normally I get up just before 7am and am at work by 8am. I check emails and deal with anything urgent. I then deal with any resource issues to ensure the service is operating smoothly.

I provide clinical pharmacy cover to the burns unit and, while hugely rewarding, it has made me paranoid about hot liquids around small children. My current postgraduate research is related to paediatric burns and this takes up an element of each day. Financial monitoring is very important with the ever-increasing cost of new drugs and this also takes up more and more of my time.

We deal with medication queries and new product requests daily. And ensuring seamless transitions of patients back into primary care is a time-consuming but extremely important part of our pharmacy activities. I am involved in several projects at the moment related to prescribing and medication safety, and this involves meetings and a lot of background reading.

From a managerial perspective I deal with operational issues on a daily basis to ensure the smooth running of the dispensary and the allocation of clinical and technical staff to wards and departments throughout the hospital. I also review and sign off on patient information leaflets and pharmacy-produced documents on a daily basis. I also ensure the department complies with Hiqa and PSI [pharmacy regulator] standards.

Safety and systems

On top of all of those aspects, there are always other things cropping up. For example, on Monday morning I participated in a teleconference in relation to a national pharmacy computer system upgrade. In the afternoon, I met the corporate management team, to whom I gave a presentation about medication safety and ICT issues.

On Tuesday afternoon, I chaired an internal meeting in relation to medication safety, and prepared reports and analyses of information on medication usage and cost within the hospital. This is an ever-increasing demand.

I attended a smoking cessation meeting on Wednesday morning as part of the hospital committee’s preparations for a smoke-free campus that starts this month. Pharmacy is offering counselling and discounted nicotine-replacement products to help staff who want to use this as an opportunity to quit. That afternoon I met other pharmacists regarding our clinical pharmacy service to intensive care and electronic prescribing issues. We also reviewed a draft new drug cart that we are creating with our colleagues in Temple Street.

On Thursday morning I had a meeting in cardiology about a new electronic patient record they are installing, as there is a significant medication component to this software with which the pharmacy department may become involved.

During Friday lunchtime I attended a Medical Grand Rounds lecture. This occurs every week at the same time. I also participated in the strategic development of the hospital through membership of the drugs and therapeutics and clinical governance committees.

Children’s quality of life

Each week is busy but we are providing a vital service that improves a patient’s quality of life. The medication management of a child is highly complex and pharmacy is an integral part of this. I feel privileged to work with my pharmacist and technician colleagues and the broader family of healthcare professionals, management and support staff.

Their commitment and willingness to go the extra mile for our patients makes OLCHC the amazing and unique place that it is. Working for children is definitely the best part of the job; the way they tackle adversity with such positivity can be very humbling. However, there can also be some difficulties. For example, trying to manage a complex service with limited resources can be very frustrating. Management in OLCHC are very supportive of pharmacy and recognise what it can deliver from a safety and cost perspective. But having said that, there are budgetary restraints across the public health service and I must operate as best I can within this.

Michael Fitzpatrick is expressing his personal views in this article and does not speak for his colleagues, nor for his employer.