A day in the life of a consultant pharmacist
6:45 My day begins by driving to Sobell House listening to Absolute Classic Rock on the way!
7:30 Arrive at the pharmacy office, make myself a coffee, and get my laptop fired up. I always get to work early as the traffic can be busy, and no one needs to start their day fighting for a parking space…
8:00 I check my diary and start to reply to emails – my aim to is to end the day with all emails read.
8:50 Join the palliative care check-in to report on the pharmacy team staffing for the day. This is something that began during the pandemic but has stuck with us as it’s so useful. Today, I will be in outpatients alongside one of our doctors.
9:00 I review the outpatient clinic list and look at each patient’s digital record, so I have a better understanding of who they are and how we can help. If we have seen a patient previously, it is always useful to check if they have since been in touch with our service to discuss any issues, or if they have been in contact with another service, such as oncology, so we have a full picture of where they might be in their journey.
9:30 I have a final year medical student shadowing me today and she arrives in time for a cuppa and an introduction to our clinic. I discuss my role in these clinics; although I am a pharmacist at my roots, over time my role has advanced and developed, so I am very engaged with assessment and symptom management for our patients, not just the medicines. I enjoy teaching and am always happy to have people join me for a few hours.
10:00 We meet Dr Stickland in the outpatient clinic. We have two face-to-face appointments and a telephone follow-up call today. Our first patient is a lady we have met before, and we have been working on her pain management. She is very happy to report to us that the new medication we agreed to try is helping – she can sleep more comfortably, and has even been able to go out on her mobility scooter to meet her friends at the local coffee shop. This feels like a great achievement and we are all very happy for her. I check that she has sufficient medicines at home and explain that we will ask her GP to continue with her prescription going forward. She thanks us for our input and tells us how well supported she feels by the palliative care service (having also had input from the therapies team).
11:10 Our second patient is a gentleman we have not met before, so we spend some time getting a history of his diagnosis and what has brought him to us. From the details we are given, we discuss pain management and the different medications we might use given the description of the pain. He is happy to try something new, so I spend some time explaining how neuropathic pain medicines work, and how these are taken and titrated over time. As we would like him to start on this medication as soon as possible, I prescribe an outpatient prescription for him and give him directions to the pharmacy on the Churchill Hospital site. I print out a ‘working copy’ of the prescription and sign it, then take it up to pharmacy myself – it’s good to get my steps in after all! This is a good opportunity for the medical student and me to talk about prescribing controlled drugs.
12:00 We call our telephone follow-up patient. He has been struggling with uncontrolled pain and constipation which is causing him difficulty with daily life. It sounds as though lots of changes to his medications have been made very quickly, but they haven’t helped. Dr Stickland and I agree that, if possible, an admission to Sobell House for a period of symptom management would be beneficial, and the patient agrees. We call through to the hub doctor to discuss admission, and it is agreed for this afternoon. We call the patient back to explain, and he is relieved to be coming in, although a little worried about what an admission might signify. We discuss this with the patient a little and try to allay his fears.
12:30 Dr Stickland and I divide the job of note and letter writing between us for this morning’s patients, and the medical student and I go back to the pharmacy office. We have a quick drink, and spend some time discussing today’s patients, general prescribing practice, and useful resources to support prescribing in palliative care. I say goodbye to the student and sit down to write up the letter for our second patient of the day.
13:15 My tummy is telling me it is most definitely lunchtime, so I head upstairs to enjoy lunch in the Sobell House staff room. It’s nice to catch up with some of the palliative care nurses who are just finishing their break.
13:50 Another walk up to the Churchill Hospital pharmacy – I’m seriously getting these steps in today! – for my weekly ‘checking slot’.
14:00 Even though I am part of the palliative care team, I am also still part of the pharmacy team, and so take part in the weekly rota to cover the dispensary. This ‘checking slot’ means I am the last person to check the medications are correct before they are either sent to the wards or given to our patients. The dispensary is often very busy and there is a constant background buzz of work. I see lots of different types of prescriptions and medications when I am in the dispensary, as we have so many different wards and specialities at the Churchill Hospital site. Having worked in palliative care for many years now this is still a challenge for me, as there are lots of medications being used in different ways that I am quite unaware of, and I find myself reaching for the British National Formulary and asking huge amounts of questions! It reminds me that every day is a school day and there is always something to learn.
15:30 My checking slot is finished, so I head back down the corridors to Sobell House again. I’ve had a call from one of the community palliative care nurses about availability of Scopoderm Patches (which help ease nausea) whilst I was in the dispensary, so I listen to the voicemail as I walk.
15:40 Back in the office, I have just enough time to email my contacts in pharmacy purchasing about medication supplies. I want a full picture with regards to Scopoderm Patches before I reply to the community palliative care nurse. Having these contacts is invaluable, as I cannot check stock availability for myself – it just goes to show how important teamwork is.
16:00 I join an online call with my committee colleagues from the Association of Supportive and Palliative Care Pharmacy (ASPCP), which is an association for pharmacy professionals working to improve the care of people affected by life-limiting disease. I have the pleasure of being the Chair of the committee, and I am also chairing today’s meeting. We press record and start on the agenda items. Today we are mainly discussing our upcoming conference in November, and we are keen to make it great as travel disruption meant last year’s event had to be cancelled. There are lots of ideas about speakers and poster presentations as we are passionate about what we do.
17:30 I have half an hour left of my working day. I use this time to check and respond to my emails and write a list of the jobs to start on tomorrow. Some days I work on site, others I work from home, so keeping myself organised is important. Tomorrow is a ‘working from home’ day, so I gather together everything I will need from the office, then shut down my computer. My final job is to wash my coffee mug and put it back on the shelf – this one is precious to me as my son helped me paint it, so you’ll never see it in the dishwasher!
18:00 Drive home – once I’m on the A40 I call my mum to say ‘hi’ and have a natter as I drive.
I love my job and the impact that it can have. No two days are the same, but I always remember that the patient is at the heart of everything that we do. I’m proud to play my part in the palliative care service.