My placement at Mile end Hospital

It was nothing of what I expected and everything I now want to be a part. My placement at a hospital, mile end had gone far better than I ever could have hoped for.

From the first moment, I was introduced to the staff, given a run through the dispensary and the roles of all the staff on the multidisciplinary team.  I learnt more about bands and what it takes to get through to reach each one. The years of  dedicated work that were put in to reach their commendable posts left  me with an honour-bound admiration .

Pharmacy in mental health had been something I was inclining towards, not only due to this years closely allied modules “CNS” but due to attending related talks such Mental health awareness by Trudi Hilton - Director, College of Mental Health Pharmacy & International Humanitarian Pharmacy Consultant.  Before now, these conferences honed curiosity for the field, but never on this scale coming face to face with a pharmacist in action.

It was quite accelerating to observe the sheer passion all the shadowed pharmacists displayed for their roles.  Reality sunk in when I was geared with an alarmed belt, before I was permitted on the wards. The Roman ward, one of the acute wards, was one of the first for me to embark upon.  On first glance, I keenly registered the striking similarity with a scene from the awakenings. I began to understand how distinct mental health is to any other speciality, patients deserving the same care but tailored to their specific needs. This rang especially true as I witnessed the ward pharmacist counsel a patient, starting on clozapine for the treatment of their schizophrenia. The information the pharmacist intended to convey was that weekly blood test were required as part of the treatment ( monitor for agranylocytosis) , if they were to stop smoking this would affect absorption of the drug so the dose would need to change, and constipation is one of the common side-effects of this drug. This information was repeated three times, and tested for recall. The pharmacist ventured with unwavering perseverance, despite the patient’s poor state of confusion, difficulty to recall. She reminded me that she celebrates each small victory, and may need to counsel the patient again the following day to ensure their complete understanding.

I was given the drug chart to screen, and learnt that there’s more to this than simply checking for interactions. The pharmacist is responsible for seeing whether the drugs are appropriate for the condition treated fitting with today’s standards  and guidelines of treatment,  drug contraindications (interaction with condition), appropriate for renal function, gender ( pregnancy), age, are there any ways to optimise patient compliance and are there any improvements that can be made to patients’ regular drug regimen.

I was also fortunate today to be taken through the elderly ward, where a patient was concerned that the strength of her medication was reduced and therefore it would not be as effective (they would be under-medicated). The transition was from Haloperidol depot which was of a higher strength taken over the period of 2 weeks to tablets of a lower strength (2mg) to be taken daily. The pharmacist consoled the patient, to trust the condition would be managed, and that the treatments were equivalent.

The same ward brought an elderly woman, who had suffered from queried dementia. I saw how difficult it was to gain a drug history; questioning made the woman anxious, because she could not remember her medicines. After, helpful prompting some information was recovered (no allergies found). Not for a moment, do you forget the unequivocal need to cater to each  individual patient's circumstance. This concept is given new depth of  meaning in the arena of mental health.

That day, I observed firsthand how pharmacy knowledge is implemented. When working as part of a multidisciplinary team, pharmacists are given the opportunity to be a positive influence on daily prescribing. In our national healthcare, pharmacists indisputably carry equally significant roles in both hospital and community settings. But true though that may be,  it is the acute clinical setting, the diversity of patients, the potential to be a part of a great team of allied pharmacists that holds the ever-present appeal for me. I know there will be a time, when I will revisit these welcoming hospital wards, and with a proud smile pronounce " Hello, I will be your pharmacist today."