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Yorkshire and Humber
Pre-registration Advisory Group
Clinical Training Workbook
Clinical Area:
Leeds Teaching hospitals Clinical Training
package
Trust: Leeds Teaching Hospitals Trust
Trust contact: Clare Roberts
Email address: [email protected]
Last updated: August 2013
Trainee Name:
…………………………………………………………….……….
PRE-REGISTRATION TRAINEE PHARMACIST CLINICAL TRAINING PROGRAMME
These guidelines have been developed to clarify the responsibilities of the pre-registration pharmacist and supervising
pharmacist/ward support technician
UNIT 1 - ACCOMPANIED WEEKLY WARD VISITS
These weekly ward visits cover a variety of specialities and are organised by the advanced clinical pharmacists for the
speciality. They form the introduction to clinical pharmacy for the pre-registration trainee - see timetable for allocation of
ward visits.
UNIT 2 - MEDICINES SUPPLY IN CLINICAL PRACTICE - WARD SUPPORT
Full year pre-registration pharmacists work as part of the ward support team for a 6 week rotation under the training
and supervision of the ward support technicians
Bradford 6 month students and the Leeds Foundation trust pre-reg may spend 1 week observing the ward support
team.
UNIT 3 - SUPERVISED CLINICAL PRACTICE - CLUSTER WORKING
During this unit pre-reg trainees work under the supervision of the cluster pharmacists and are allocated their own
selected group of patients (or ward).
UNIT 4 - PRESCRIPTION VALIDATION
This unit should be worked on throughout the training year. Planning to ensure experience and competence in this area
is the responsibility of the trainee and their tutor.
UNIT 1 - ACCOMPANIED WEEKLY WARD VISITS
AIM & OBJECTIVES
Aim:

To introduce ward and clinic based pharmacy practice within a wide variety of clinical specialities
Objectives:
At the end of this unit the student should be able to:

Describe the main activities undertaken by a pharmacist on a ward.

Demonstrate or provide evidence of a number of clinical skills appropriate to the specialities visited

Demonstrate a pro-active approach to ward based learning

Reflect on their experiences and develop their own learning objectives.

In addition, objectives specific to the clinical speciality may be provided by the supervising pharmacist
GENERAL PRINCIPLES

Ward visits will be 2 hours each morning from 9am - 11am but will be flexible depending on departmental and
pharmacist’s needs.

Ward visits should occur on 3 or 4 days of the allocated week

Pre-reg should contact the named pharmacist at least 2 weeks prior to the ward visits to arrange the times and
dates of the ward visits and to check if any preparatory work is required.

If the weeks allocated are not appropriate for the pharmacist or the pre-reg it is the responsibility of the person for
whom the date is inconvenient to rearrange. There are some “blank” weeks on the ward visit timetable to facilitate
this. The pre-regs’ departmental rotation is highlighted in bold on the timetable.
GUIDELINES FOR WEEKLY WARD VISITS
The pre-reg should be with the pharmacist for 2 hours but should not just follow them about expecting the pharmacist
to do all the teaching. Pre-regs should work alongside the ward pharmacist completing any tasks given to them. They
should be pro-active at using their clinical skills checklist to achieve the required competencies.
PHARMACEUTICAL CARE PLANS
Pre-regs are expected to complete at least 2 pharmaceutical care plans as part of their pre-registration training.
Supervising pharmacists should be able to help identify suitable patients with pharmaceutical care needs eg monitoring
or counselling.
FEEDBACK
Pre-regs should ask the supervising pharmacist for feedback on their performance and ask for a feedback form to be
completed.
UNIT 2 - MEDICINES SUPPLY IN CLINICAL PRACTICE - WARD SUPPORT
The following guidance is in 2 parts:
Part 1: applicable to Bradford University 6 month placements and Leeds Partnerships Foundation Trust pre-regs (who
complete one week shadowing Ward Based Technicians during unit 1),
Part 2: applicable to full year pre-regs, who spend 6 weeks completing their medicines supply in clinical practice
rotation (unit 2).
PART 1: BRADFORD & LEEDS FOUNDATION TRUST 6 MONTH PRE-REGISTRATION STUDENTS
AIM:

To allow the pre-reg to gain an understanding of ward based pharmacy technical services.
OBJECTIVES:
At the end of this unit the pre-reg should be able to:

Describe the main activities undertaken by a ward based technician

Describe common problems in the transcription process, particularly with regard to involvement of different
professions

Describe systems and procedures that can minimise errors in the ordering and transcription processes

See also the Unit 1 objectives that relate to medicines supply experiences
6 month pre-regs do not complete the WS (ward support) training package, so there are a number of restrictions on
their activity. If you are working on a ward with a 6 month pre-reg who is carrying out some shadowing of ward support
they may ask you for advice & supervision on some clinical issues or tasks. At this stage there should be direct
supervision of tasks by a pharmacist (as per unit 1) unless the pharmacist is happy that they are competent in the
given task, in which case indirect supervision may be provided.
SUMMARY OF ACTIVITIES PRE-REGISTRATION STUDENTS CAN UNDERTAKE DURING UNIT 1 WARD VISITS AND PRIOR TO
COMPLETION OF WARD SUPPORT TRAINING
Activity
Further action required & by whom
Activities which
Write orders on yellow sheets for
The order must be checked & signed by a
Pre-regs CAN
medication
pharmacist not a WS technician
Take a medication history
The person they are working with must be
do .
Activities which
pre-regs can
trained to take medication histories AND must
carry out IF
check AND countersign the pre-reg’s work.
UNDER
SUPERVISION
Check a patient's own medicines for
This must be done under the direct supervision
suitability of use on the ward
of a pharmacist or WS-trained technician. The
pharmacist or WS technician must countersign
all documentation.
Annotating drug charts eg with generic
Pharmacist must provide direct supervision and
names, infusion rates and writing in
counter-sign any endorsements/entries in
medical notes in accordance with local
medical notes
policy
Activities which
Validate drug charts in any way
pre-regs must
This includes:
NOT carry out
- signing “Pharm” box on inpatient charts
- signing the medication review level box
on inpatient charts
- signing clinical check box on Discharge
A pharmacist must do this.
If a suitable opportunity arises however, preregs are encouraged to review the whole drug
chart and present their findings to the
pharmacist who should provide feedback to the
pre-reg before the pharmacist signs the chart
Advice Notes (DANs)
Check one-stop or patients own
medication against a validated discharge
advice note ie perform an accuracy check
on a DAN on the ward
An accuracy checker must do this
UNIT 2 - MEDICINES SUPPLY IN CLINICAL PRACTICE – WARD SUPPORT
PART 2: FULL YEAR PRE-REGISTRATION STUDENTS
Unit 2 ward visits should be carried out every day of the week. There is no specific requirement for pre-regs to be back
in their department for a particular time, but they are expected to return to their base dispensary once they have
finished their ward work.
MEDICINES SUPPLY IN CLINICAL PRACTICE: AIM & OBJECTIVES
Aim: To allow the pre-reg to gain an understanding of ward based pharmacy technical services and how these
integrate with the clinical requirements of patients and clinical pharmacy activity on the ward.
Objectives
At the end of this unit the pre-reg should be able to:

Obtain and document an accurate medication history for a patient.

Check Patient’s Own Drugs for accuracy and suitability for use on the ward (but not against a DAN).

Review an inpatient drug chart for drugs that need ordering as a non-stock / one stop supply

Identify any discrepancies between the drug history, what has been prescribed, and/or what needs to be supplied,
and suggest appropriate courses of action.

Liaise with the ward pharmacist over medicine supply

Accurately and legibly write a non-stock / one stop order (yellow sheet)
TRAINING FOR MEDICINES SUPPLY IN CLINICAL PRACTICE
Pre-registration students have to complete the same ward support training packages as ward support technicians
(POD and chart checking) before they are allowed to provide medicines supply services to a ward on their own. We
expect that this training will take no more than 3 weeks, although this time may be reduced if all the background
reading is completed during the in-patient dispensary rotation. Pre-reg students should make sure they get their
assessments booked in good time.
At the beginning of their Unit 2 rotation, pre-regs will initially work with a trained ward support technician to complete
the departmental Non-stock/One-Stop Transcription & Ordering Training, which includes:

Non-stock/One Stop ordering training pack and observation of WS technicians at ward level

Assessment scenarios & questions

A 2 part test (total of 18 charts, including many common errors and transcription related problems)
Once this is completed, pre-regs will undertake the POD training pack & assessment, which includes:

POD training pack (trust procedure)

Assessment questions

20-item log

Simulation test (15 items)
Until the above training packs have been successfully completed, then the pre-reg must work with a trained WS
technician on the wards and adhere to the limitations outlined for 6 month pre-regs above.
Once the training packs have been passed, they will be allocated to provide medicines supply services to a designated
ward for the rest of their Unit 2 rotation. It is the responsibility of the pre-reg to introduce themselves to the ward
pharmacist and ward team on the first day. Pre-reg students may then carry out the following activities on the ward:
SUMMARY OF ACTIVITIES PRE-REGISTRATION STUDENTS CAN UNDERTAKE FOLLOWING COMPLETION OF THEIR WARD SUPPORT
TRAINING
Activity
Activities which Pre-
Check the transcription of an item
regs can do without
ordered by a pharmacist
supervision
Check the transcription of an item
Further action required
None
None
ordered by a WS tech or nurse as
long as the entire chart has been
validated by a pharmacist
Annotate drug charts according to
local SUPPLY policy
Write orders on yellow sheets for
medication
None
Must be checked and signed by a pharmacist,
or if the chart has been validated by a
pharmacist, a qualified WS tech can check
and sign.
Activities that pre-
Any clinical activity including any
Pharmacist must provide direct or indirect
regs must carry out
clinical annotation of drug charts, eg
supervision according to guidance, and
under supervision
generic names, infusion rates or
countersign any written work (see detailed
of a pharmacist*
writing in medical notes
guidance on unit 3)
Activities that pre-
Check the transcription of another
Must be done by a pharmacist or WBT
regs must never
pre-registration student
carry out
Check PODs or OSDs against a
Must be done by an accuracy checker
validated DAN
Validate a drug chart
Must be done by a pharmacist
*For Unit 2, there is no requirement for the pharmacist to be on the ward at the same time as the pre-reg student.
If clinical issues are identified by the pre-reg then these should be highlighted to the ward pharmacist (either verbally or
on the handover sheet) and, where possible, the pre-reg should suggest an appropriate course of action. Examples of
clinical issues include;

A discrepancy between the drug history and what is prescribed

A strange looking dose or frequency on the prescription order form

Any interactions or therapeutic duplications

A missing brand name (if required)

A medicine we do not keep, that there is a manufacturing problem with, or that is non-formulary

Orders for restricted antimicrobials

Solid dosage forms ordered for a patient who is NBM

An important medication has been omitted for a period of time
PRE-REGISTRATION PHARMACISTS AND CLUSTER WORKING
AIM & OBJECTIVES
Aim: At the end of the supervised clinical practice rotation pre-registration pharmacists should be able to demonstrate
the necessary competencies required of a newly qualified pharmacist at ward level.
Objectives
At the end of this unit the pre-reg should be able to:

Identify, document and resolve pharmaceutical care problems

Know their limitations and the sources of help/advice available

Follow all the ward and pharmacy based clinical policies and procedures.

Communicate appropriately with patients, medical staff and other healthcare professionals

Reflect on their experiences and/or feedback and develop a learning plan
GENERAL PRINCIPLES
The pre-registration pharmacist will be on the wards 8.45am-1pm Monday to Friday unless agreed otherwise.
SUPERVISING PHARMACIST RESPONSIBILITIES (BAND 7 OR ABOVE)

Ensure pre-reg is aware of who is the supervising pharmacist, their contact details and what time they will be
present on the ward

Ensure the pre-reg and supervising pharmacist spend at least 20-30minutes overlapping at ward level for a
complete handover of work. Handover should be carried out in person, before the pre-reg leaves the ward, to
minimise the risk of error and to ensure problems are sorted without delay.

Liaise with the pre-registration trainee about following up Pharmaceutical Care issues and any monitoring
associated with specific drugs or the patient’s condition.

Discuss medicine information enquiries with the pre-registration trainee and check that the answer is correct and
that they are prepared for extra associated questions before they feedback the answer at ward level.

Ensure formal (department approved, where available) or informal (observation by the supervising pharmacist)
assessment has taken place to establish that the pre-registration trainee is competent to carry out tasks such as
discussing medicines with the patient, ensure that they have the correct information to counsel patients eg on
warfarin, inhalers, amiodarone, any other new medication etc, and to provide direct supervision where competence
is not established.

Provide the pre-registration pharmacist with a communication or handover sheet to enable them to document any
activities they have undertaken ie drug histories, counselling etc so that you can verify their work where
appropriate. This document should be used during the face to face handover before the pre-reg leaves the ward.

Give regular feedback to the trainee (positive and/or negative) and communicate in writing with the pre-registration
tutor regarding the trainee’s performance at least once a month (email is sufficient). Feedback should always be
given at the earliest opportunity and in a constructive manner.

Inform the trainee of any AL/LT or late nights and which pharmacist will be covering and countersigning their work.
PRE-REGISTRATION PHARMACIST RESPONSIBILITIES

Inform supervising pharmacist well in advance of any AL, LT or late nights.

Before leaving the ward ensure any work that requires a pharmacist counter-signature is counter-signed.

Discuss with the supervising pharmacist any specific training/learning needs. Read relevant policies/evidence
etc.
WORKING ON THE WARD WITH YOUR PRE-REG:
Days 1 & 2: Introductory period of shadowing the pharmacist to gain familiarity with the speciality (and read any
relevant references). Introduce pre-reg to ward staff and location of drug lockers/medicine cupboards etc
Day 3 onwards: 1 bay of patients (increasing to 2 or more bays when appropriate) to be allocated to the pre-reg to
look after for 1-2 months. Pre-regs should carry out the daily pharmaceutical care tasks for these patients, and then
discuss their recommended interventions during the handover or as they go along (depending on the supervising
pharmacist’s preferred way of working). Supervising pharmacists should also “spot check” some of the charts that the
pre-reg says do not require interventions, to check they have not inadvertently missed any issues.
Other useful learning tasks:

The pre-reg should complete detailed 1 or 2 pharmaceutical care profiles for typical patients in your speciality (you
may need to help them identify suitable ones), in a similar way that junior pharmacists would complete care profiles
for a diploma or other learning exercise. We have provided a care profile template for pre-regs to use along with
guidelines for use, but they may need directing to suitable references for your speciality (eg PJ articles or Oxford
Clinical Handbook etc). This is intended as a learning exercise to help them become familiar with the types of
interventions and thought processes required in pharmaceutical care of patients in your speciality. Please set aside
time so that the pre-reg can talk you through their profiles and you can provide feedback.

Set the pre-reg tasks that you (or the pre-reg) have identified, observe them and, if you consider them competent,
allow them to carry out these tasks under indirect supervision in the future.
CLUSTER WORKING SUPERVISION:
Supervision for different activities in cluster working are summarised as follows:
Direct Supervision - Supervising pharmacist MUST be present
Indirect Supervision - Once competency established supervising pharmacist does not have to be present but must be
aware of activity and countersign work where appropriate.
Activities ALWAYS
under DIRECT
supervision
Activity
Action required by pharmacist
Sign the “pharm” box by each medication
Supervising pharmacist to countersign
immediately
Sign that a medication level review has
been undertaken
Supervising pharmacist to countersign
immediately
Writing in patients medical notes (except
when annotating medication histories see below)
Ensure entry is carried out to CPS SOP
standard. Supervising pharmacist to
countersign
Activities INITIALLY
under DIRECT
supervision (and can
change to indirect
supervision when
considered competent)
Verbal advice or counselling
Discuss prior to pre-reg providing
advice/counselling to ensure
competence. Supervise if appropriate
Take a medication history and annotate
medical notes according to policy
Check & countersign (unless DHx
taking package taken & passed, in
which case can do independently and
no countersignature is necessary.
Activities under
INDIRECT supervision
Writing care plans
Check & discuss
Therapeutic monitoring
Check, provide feedback
Endorsing drug charts (eg with generic
name or infusion rate etc)
Check, provide feedback & sign
pharmacy box
Write orders for medication (yellow
sheets)
Check & countersign (WS tech may do
this but only if pre-reg has passed WS
training & test)
Check patients own medicines against a
validated TTO
WS tech or pharmacist must do this
Activities that the prereg must NEVER do
UNIT 4 - PRESCRIPTION VALIDATION
AIM
To provide the pre-registration pharmacist experience of validating and annotating prescriptions
OBJECTIVES
All of the objectives MUST be carried out under the direct supervision of a pharmacist who must countersign
all work
At the end of this unit the student should be able to;

Follow the clinical SOP for Validating and Annotating Prescriptions

From a variety of prescription formats identify problems that require immediate action and note all the potential
problems.

Demonstrate the ability to deal with problems requiring immediate action and any other problems identified.
TRAINING PROVIDED

Theory and examples covered in regional study day in October

Two Tuesday workshops to provide prescription examples in December and May/June

In-house experience working alongside pharmacists
GENERAL GUIDANCE
Full year students and 2nd placement sandwich students (August-Jan);
In addition to validating prescriptions at ward level, validation should form part of the inpatient and outpatient
dispensary rotations. As a guide approximately 12 hours (4 afternoons) should be spent working alongside the
dispensary based pharmacist in each dispensary rotation. Pre-registration pharmacists (with support from their tutor)
should liaise with the lead technician to agree the most appropriate time for this to happen and ensure the agreement
of the supervising dispensary pharmacist
1st Placement sandwich students (Feb-July)
As part of final dispensary based rotation students should spend approximately 3hours (1 afternoon) validating
prescriptions (in addition to ward level validation)
Evidence of competence

Use validation workshops as evidence of prescription validation

Supervising pharmacist to provide a testimonial of the pre-reg’s ability to identify and deal with problems
identified whilst validating prescriptions
CONTACT DETAILS FOR ACCOMPANIED WARD VISITS
Ward visits for the following specialities will be co-ordinated by the following pharmacists. The named
pharmacist should be your initial point of contact. It is recommended that the pharmacists are contacted at
least 2 weeks before the timetabled ward visits to discuss a timetable and establish if any pre-reading or
preparatory work is to be completed.
Pre-reading may be found on the pre-reg folder; I drive; Pre-reg; clinical references 2013
Pharmacists
COMPULSORY SPECIALITIES
PHARMACIST
CONTACT DETAILS (BLEEP)
PHARMACIST
CONTACT DETAILS (BLEEP)
Respiratory
Cardiology
Elderly & Stroke Rehab
Surgery
Paediatrics
Renal
Acute Medicine
SPECIALIST AREAS
Rheumatology
Gastroenterology
Infectious Diseases
Liver
Neurology
Cystic Fibrosis (CF)
A&E/CDU
Vascular
Endocrinology
PRE-REG TIMETABLE FOR ACCOMPANIED WARD VISITS – AUGUST 13-JAN 14
Date
29/709/08
INDUCTION, THEN BASED IN SERVICE ROTATIONS
12/08
LGIP
Elderly
19/8
Cardiology
26/8
A&E/CDU
LGOP
Cardiology
Elderly
02/09
Bexley
Cardiology
SJIP
A&E/CDU
SJOP
Surgery
Bexley
Surgery
LGIP
Paediatrics -1
Surgery
Cardiology
Renal
Renal
Surgery
Liver
Liver
A&E/CDU
Respiratory
Paediatrics -2
Gastro
Cystic Fibrosis
Liver
Neurology
Infectious Dis
Neurology
Cardiology
Cardiology
Aseptics
Aseptics
SJOP
Respiratory
Aseptics
Aseptics
Elderly
Aseptics
Aseptics
Psychiatry
Aseptics
Aseptics
Psychiatry
REGIONAL STUDY DAYS (TUE-THURS)
09/09
Liver
CAH
Paediatrics 1
Elderly
16/09
Surgery
Paediatrics 2
Respiratory
23/09
Infectious Dis
Rheum
30/9
Community
Psychiatry
Aseptics
07/10
Community
Psychiatry
Aseptics
14/10
SJOP
CF
Ward support; Unit
2
LGI
Aseptics
21/10
AS BELOW
Renal
28/10
Respiratory
Elderly
Ward support;
Unit 2
SJ
Aseptics
REGIONAL STUDY DAYS (MON-WED)
MI
Infectious Dis
Vascular
Vascular
Ward support;
Unit 2
MI
Respiratory
MI
Paediatrics 1
Community
Psychiatry
Vascular
Paediatrics 2
Community
Renal
Psychiatry
Elderly
A&E/CDU
SJOP
Gastro
Bexley
Surgery
Community
CAH
Rheumatology
LGIP
Cardiology
Renal
Community
Paediatrics 1
Paediatrics 1
Vascular
09/12
Respiratory
Acute Medicine
Paediatrics 2
Paediatrics 2
Elderly
16/12
CF
Acute Medicine
Neurology
23/12
-
LGIP
-
-
-
-
-
-
-
-
-
06/01
Aseptics
Paediatrics 1
Aseptics
Psychiatry
Acute Medicine
13/01
Aseptics
Paediatrics 2
Aseptics
Psychiatry
Acute Medicine
20/01
Aseptics
A&E/CDU
Aseptics
Community
Community
04/11
Respiratory
11/11
Acute Medicine
18/11
Acute Medicine
25/11
Psychiatry
02/12
Psychiatry
30/12
Ward Support;
Unit 2
LGI
Ward support; Unit
2
SJIP
Endocrinology Acute Medicine
Acute Medicine
Ward support;
Unit 2
LGI
PRE-REG TIMETABLE FOR ACCOMPANIED WARD VISITS – AUGUST 13– JAN 14
Date
29/709/08
INDUCTION, THEN BASED IN SERVICE ROTATIONS
12/08
CAH
Rheum
SJIP
Paediatrics -1
Aseptics
Aseptics
19/8
Neurology
Endocrinology
Aseptics
Aseptics
26/8
Respiratory
Paediatrics 2
Aseptics
Aseptics
02/09
09/09
AS BELOW
Aseptics
Aseptics
Aseptics
REGIONAL STUDY DAYS (TUE-THURS)
LGIOP
A&E/CDU
MI
Elderly
MI
A&E/CDU
MI
Acute Med
16/09
Surgery
Cystic Fibrosis
Acute Med
Renal
Renal
23/09
Renal
Renal
Surgery
Elderly
Surgery
Community
LGIP
Rheumatology
SJIP
Respiratory
Bexley
Cardiology
Community
A&E/CDU
Paediatrics 1
Paediatrics 1
Cardiology
Paediatrics 2
Paediatrics 2
Respiratory
Surgery
Respiratory
30/9
07/10
14/10
21/10
Acute
Medicine
Acute
Medicine
Ward Support
Unit 2
LGI
Acute
Medicine
Acute
Medicine
28/10
LPFT
LPFT
LPFT
REGIONAL STUDY DAYS (MON-WED)
04/11
11/11
LPFT
Ward Support
Unit 2
18/11
LGOP
Neurology
Paediatrics 1
Acute Medicine
Elderly
Cardiology
Paediatrics 2
Cardiology
Gastro
Respiratory
Renal
CF
Liver
25/11
Bexley
Endocrinology
SJIP
Cardiology
LGIP
Neurology
02/12
Cardiology
A&E/CDU
Cardiology
09/12
Gastro
16/12
Liver
23/12
-
30/12
Inf Diseases
Ward Support
Unit 2
SJ
Liver
CLUSTER;
Unit 3.
SJOP
CLUSTER; Unit
3
LGOP
CLUSTER;
Unit 3
LGIP
-
-
-
-
-
06/01
Aseptics
MI
Paediatrics 1
MI
CF
13/01
Aseptics
Paediatrics 2
Elderly
20/01
Aseptics
Psychiatry
Gastro
PRE-REG TIMETABLE FOR ACCOMPANIED WARD VISITS – JAN 14-JULY 14
Date
27/01
Ward support
LGI
03/02
Aseptics
MI
Renal
Psychiatry
MI
Renal
10/02
Aseptics
Neurology
Psychiatry
Gastro
17/02
Aseptics
Endocrinology
24/02
Aseptics
03/03
MI
Paediatrics 1
Community
10/03
Paediatrics 2
Community
17/03
Gastro
24/03
Aseptics
Acute
Medicine
Acute
Medicine
Neurology
Aseptics
Surgery
Ward Support;
Unit 2 LGI
Acute Medicine
Acute Medicine
Community
Acute
Medicine
Acute
Medicine
Community
Psychiatry
28/04
05/05
CLUSTER; Unit 3
(Regional study days; 14th-16th April and 6th-8th May)
26/05
02/06
09/06
16/06
23/06
30/06
07/07
14/07
21/07
Aseptics
Vascular
Psychiatry
21/04
Aseptics
MI
Renal
Community
14/04
19/05
Aseptics
Ward Support;
Unit 2 LGI
07/4
Ward support
LGI
Aseptics
Ward Support;
Unit 2 SJ
31/3
12/05
Community
Cystic Fibrosis
PRE-REG TIMETABLE FOR ACCOMPANIED WARD VISITS – JAN 14-JULY 14
Date
Bexley
-
LGIP
-
SJIP
-
MI
Vascular
LGOP
Vascular
-
-
-
Community
Paediatrics 1
Wards with
Natasha
Wards with
Elaine
Elderly
Community
Paediatrics 2
Renal
Respiratory
Respiratory
Surgery
Gastro
Liver
Surgery
MI
Paediatrics 1
Aseptics
SJIP
Surgery
Aseptics
Aseptics
10/03
Paediatrics 2
Aseptics
Liver
Aseptics
Aseptics
Respiratory
17/03
Elderly
Aseptics
Endocrinology
Aseptics
Aseptics
Elderly
Aseptics
Elderly
Aseptics
Aseptics
Community
31/3
MI
Respiratory
MI
Renal
MI
Renal
Bexley
Endocrinology
CF
Community
07/4
Paediatrics 1
Paediatrics 1
Infectious Dis
Surgery
Acute
Medicine
29/01
Aseptics
03/02
Community
10/02
Community
17/02
Psychiatry
24/02
Psychiatry
03/03
24/03
Psychiatry
MI
Elderly
Infectious
Diseases
14/04
21/04
28/04
Acute
Medicine
Acute
Medicine
SJOP
Renal
Rheumatology
Surgery
Bexley
Renal
Respiratory
REGIONAL STUDY DAY (MON-WED)
CLUSTER; Unit 3
(Regional study days; 14th-16th
April and 6th-8th May)
Paediatrics 2
Paediatrics 2
Vascular
Aseptics
LGIP
Cardiology
Bexley
Acute Medicine
05/05
Acute
Medicine
Aseptics
Aseptics
REGIONAL STUDY DAY (TUE-THURS)
12/05
Aseptics
Elderly
Endocrinology
Aseptics
Aseptics
19/05
Aseptics
Ward support
LGI
Psychiatry MonWed
Aseptics
Aseptics
26/05
Aseptics
Neurology
Ward supp SJ
Aseptics
Aseptics
02/06
LGOP
Cardiology
Ward support
LGI
SJOP
CF
Acute
Medicine
Psychiatry
Mon-Wed
Cardiology
LPFT
LPFT
09/06
16/06
23/06
30/06
07/07
14/07
21/07
CLUSTER; Unit 3
(Regional study days; 14th-16th
April and 6th-8th May)
Rheumatology
Psychiatry
Mon-Wed
Wards with
Natasha
Wards with
Natasha
Wards with
Natasha
Surgery
Wards with
Elaine
Wards with
Elaine
Wards with
Elaine
Paediatrics 1
Paediatrics 2
SJIP
Elderly
Wards with Clare
Wards with Clare
Wards with Clare
COMMON CLINICAL QUESTIONS
PRE-REGISTRATION PHARMACY STUDENTS
NAME……………………………………………….
These should be completed within 4 weeks of commencing pre-registration training. Some answers will be found on
the Trust intranet site, others will require discussing the questions with pharmacists.
1) What is the appropriate antibiotic choice and course length for an elderly male, 82years old, Cr-150,
weight 65kg with a lower urinary tract infection (not catheterised)?
2) What is the antibiotic of first choice for a moderately severe community acquired pneumonia in a
50year old patient allergic to penicillin?
3) How would you deal with a patient on Uniphyllin 300mg bd newly prescribed clarithromycin?
4) What do the following abbreviations stand for and why might they be important to you whilst talking
to patients?
a. MMSE
b. AMTS
c. MEWS score
5) How does the Trust deal with patients on statins newly prescribed a macrolide antibiotic
6) Looking at the injectable medicines guide how should nursing staff administer the following;
(include in your answer a suitable diluent, volume and rate for administration)
a) Flucloxacillin 2g iv?
In which patients are you likely to see the above prescribed?
b) clarithromycin 500mg iv?
In which patients are you likely to see the above prescribed?
c) Pabrinex I and II iv?
In which patients are you likely to see the above prescribed?
7) What is VTE? For the following patients what is the most suitable drug choice (drug and dosage) for
VTE prophylaxis?
a) 36 year old rugby player (weight 80kg), admitted for elective urological surgery,
considered to be a standard risk of VTE? Nil other medical history.
b) 85 year old female, Cr-200, Weight 55kg. PMH; Angina, admitted with community
acquired chest infection
c) 55 year old male, Cr-60, Weight 75kg. Exacerbation of COPD.
8) The ward pharmacist informs you that one of his/her patients has an NG tube for medication and
feeding. They are prescribed amlodipine 5mg daily and ramipril 5mg daily. How can these be safely
administered?
9)
What is the LCP? What drugs are likely to be prescribed for patients on the LCP?
10) Reviewing the NetFormulary what is the equivalent morphine dose for a patient prescribed
Butrans® 20microgram/hour?
b) What breakthrough oromorph dose should be prescribed for this patient?
PRE-REGISTRATION PHARMACIST CLINICAL SKILLS CHECKLIST
It is not expected that you will be competent in all the activities but you should have attempted each activity at least on one occasion
It is not expected that you demonstrate each task 3 times in order to be competent. It is the judgment of the assessing pharmacist who may believe
following one observation competency has been achieved. Similarly, it may be that following 3 observations more practice is needed in order to be
consistently competent.
NAME
PRE-REGISTRATION TUTOR
Clinical Pharmacist Activity
Complete a pharmaceutical care plan with appropriate actions and monitoring
Calculate renal function for a patient and review drug therapy
Calculate body surface area for a patient and review drug therapy
Check doses correctly on a paediatric prescription
Identify a drug interaction and deal with it appropriately
Assess a patients ability to manage medication at home
Deal with a patient unable to manage medication at home
Deal with a patient discharged with a compliance aid
Advise on the appropriate use of anti-microbials
Deal with a patient admitted on weekly methotrexate (follow SOP)
Understand vancomycin prescribing and monitoring
Understand digoxin prescribing and monitoring
Understand gentamicin prescribing and monitoring
Understand aminophylline prescribing and monitoring
Deal with a medicines information enquiry at ward level
Check and endorse a DAN correctly (countersigned by pharmacist)
Contact doctor to discuss a pharmaceutical intervention
Date observed
(Witness to sign and date)
Considered
competent
Date
Clinical Pharmacist Activity
Calculate an intravenous drug infusion rate
Advise on administration of an intravenous drug (fluid volume and diluent)
Warfarin
Attend pre-reg workshop on warfarin counselling
Attend warfarin clinic (2x4hour counseling sessions)
Attend warfarin clinic and provide counselling under supervision of clinic
pharmacist/technician (final sign off)
Inhaler Counselling
Attend pre-reg workshop on inhaler counselling
Only 1 observation required of the following;

Assess patients respiratory flow rate
Undertake counselling under supervision for;

MDI

Turbohaler

Accuhaler

Spiriva Handihaler
Psychiatry
Understand clozapine prescribing and monitoring
Undertake lithium counselling under supervision
Understand aspects of the Mental Health Act relevant to medication / treatment
Date observed
(Witness to sign and date)
Considered
competent
Date
PHARMACEUTICAL CARE PROFILE
During your pre-registration year you will be expected to complete a Pharmaceutical Care profile for
at least 2 patients. It is likely that one of these will be the basis for your case presentation.
The example below illustrates the type of information that goes in each section of the profile, and the sorts of
information to record
Main points to bear in mind:

Remember confidentiality - use initials or keep document secure.

Presenting complaint - can contain brief history of presenting complaint also if you feel it’s appropriate

Drug History section - see the relevant department SOPs on how to carry this out. This is for all
medication being taken prior to admission. You should always record the source(s) you have used to
confirm this history as well as allergies, type of reaction and any compliance aids needed (if none
write “none”)

Currently prescribed medication - all medication currently on the in-patient medication chart. Always
include an aim or indication - if you don’t know what it is, find out, and if you can’t find one, query
whether the patient needs that medication! Stop dates can be put in the comments section.

Blood levels and other monitoring - space for you to record monitoring relevant to your patient’s
condition. You might not need to record all parameters on every day. Record what is relevant and
look at the trend.

Pharmaceutical Care Issues - space for you to record any problems you have noted. Keep these
relevant to pharmaceutical care - don’t get sidetracked with finding out about things that would not
affect pharmaceutical treatment, management or counselling, eg - “needs home care every day nurse to ring social services”.

State what your plan is (you can revise this through that patient’s stay if needed by using a
new entry), and what the outcome measure is, but be specific, eg instead of “monitor BP” put
“aim for BP below 140/85”, or whatever range is relevant for your patient.
Using the profile should help you think about planning and monitoring of patients with the relevant conditions.
It can be used for any ongoing pharmaceutical care interventions you make.
Pre-registration Trainee Pharmacist Clinical Training Programme
Leeds Teaching Hospitals
Pre-registration Trainee Pharmaceutical Care Profile Example
Patient name Jenny Bloggs
DOB
14th Oct 1920
Date of admission
Unit no
10th November
123456
Ward/speciality
33 / Care of the Elderly
Age
87
Weight
74kg
Presenting complaint
Fall.
Felt dizzy, grabbed chair for support, missed and
banged head. Found on floor by neighbour.
Bruise and pain to cheek.
Past Medical History
Osteoarthritis
Falls x 2
# NOF 2 years ago
Osteoporosis
Depression
Hysterectomy age 45
hypertension
GP: North Leeds Medical Centre
Social History
Lives alone. Husband died 4 years ago
Meals on wheels three times weekly
Son does shopping, private cleaner once a week
Community pharmacist: Co-op Main St
Alwoodley
Drug History (include strength, frequency, form, etc)
Paracetamol 1g qds prn (usually only takes once or twice daily)
Alendronate 70mg weekly (weds)
Citalopram 10mg od (? Still taking)
Bendroflumethiazide 2.5mg om
Source(s) used?
GP print out
PODs
Allergies/sensitivities:
Type of reaction?
Penicillin - rash
Currently prescribed medication
OA
OA
OA
Nov 10
Nov 10
Alendronate tabs
Citalopram tabs
Paracetamol tabs
Codeine PO4 tabs
Lactulose liq
Dose
(strength,freq)
70mg weekly
10mg om
1g qds
30mg prn
10ml bd
Nov 12
Calceos tabs
i bd
Date started
Name & form
Compliance aids?
Large print labels please
Indication / intended
therapeutic outcome
Fracture prevention
Depression
Pain control
Pain control
Prevention of
constipation while on
opiates & poor mobility
Fracture prevention in
conjunction with
bisphosphonate
comments
Stopped Nov 14
New
Counselled 
Pre-registration Trainee Pharmacist Clinical Training Programme
Leeds Teaching Hospitals
Blood Levels and Other Monitoring Parameter
Parameter
Date
Na+
K+
Ur
Creatinine
BP (lying)
BP (standing)
Pain score
Nov
10
Nov
12
Nov 15
128
3.8
8.8
182
150/84
120/80
3/5
130
3.9
6.3
149
120/80
116/82
1/5
134
4.1
5.5
130
122/86
118/84
Pharmaceutical Care Issues
Date
What is the problem?
Nov 11
No day for alendronate
prescribed
Ask patient which day normally taken and
amend chart
Nov 11
Postural drop
Nov 11
Na is low; pt may not
be compliant with
citalopram
Nov 11
Urea & Creatinine are
high - ? dehydration
Monitor BP and recommend treatment if
needed. Ensure GP informed of any change
Bendro is already stopped - consider
stopping citalopram if non-compliant or
mood satisfactory. Counsel pt on taking
SSRI if decide to continue. Monitor Na+ to
ensure comes back into range. Review
treatment as necessary.
Ensure pt drinking plenty. Monitor Ur & Cr.
Calculate CrCl and ensure no medication
being given that is renotoxic, or adjust dose
as needed
Nov 12
Pt has osteoporosis
and is on
bisphosphonate but no
calcium/vit D3
Pt due for discharge
Nov 15
How do you plan to address it?
D/W Drs re starting Calceos. Counsel
patient
Ensure TTO written & changes documented
for GP. Provide clinical check and arrange
for POD accuracy check & additional
medications to be dispensed. Ensure in-pt &
community pharmacy aware pt requires
large print labels. Counsel patient on any
changes to medications and answer any
questions.
What is your intended
outcome?
Alendronate to be
prescribed on the
correct day
BP to be below 140/85
with no postural drop
Na to be between 135145. Pt to either take
citalopram as directed
or stop if no benefit.
Ur to be between 3.55.0; Cr to be between
70-100 or relevant
medication doses to be
adjusted as needed
Ensure efficacy of
bisphosphonates in
preventing fractures
Safe & timely discharge
to the community with
all appropriate
medication. That
patient understands
when & how to use
meds safely
Completed?
Nov 11
Nov 15
Nov 12
Pre-registration Trainee Pharmacist Clinical Training Programme
Leeds Teaching Hospitals
Pre-registration Trainee Pharmaceutical Care Profile
Date of admission
Patient name
DOB
Age
Unit No
Weight
Ward/speciality
Presenting complaint
Past Medical History
GP:
Social History
Community pharmacist:
Drug History (include strength, frequency, form, etc)
Source(s) used?
Allergies/sensitivities:
Type of reaction?
Compliance aids?
Currently prescribed medication
Date
started
Name & form
Dose
(strength,freq)
Indication /
intended
therapeutic
outcome
comments
Pre-registration Trainee Pharmacist Clinical Training Programme
Leeds Teaching Hospitals
Blood Levels and Other Monitoring Parameter
Parameter
Date
Pharmaceutical Care Issues
Date
What is the problem?
How do you plan to address
it?
What is your intended
outcome?
Completed?
Pre-registration Trainee Pharmacist Clinical Training Programme
Leeds Teaching Hospitals
PRE-REGISTRATION TRAINEE WARD VISIT FEEDBACK FORM
Trainee:
Speciality:
Pre-Reg. Tutor:
Ward Pharmacist/Supervisor:
No of ward visits with trainee
Excellent
Very Good
Good
Average
Poor
Punctuality/Time-Keeping.
Professional appearance/Manner.
Application, Effort.
Standard of work, Reliability.
Ability to demonstrate Clinical Knowledge.
Communication/Attitude to Patients.
Communication/Attitude to Colleagues.
Response to Advice, Criticism.
General Performance.
Pharmacist/Supervisor’s Comments:
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
Trainee’s Comments:
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
Pre-Reg. Tutor’s Comments:
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
Signed: .....................................
Pharmacist/Supervisor
Tutor
......................................
Trainee
.....................................
Pre-Reg.
Date: .......................................
Please return by e-mail as an attached word document to the trainee’s pre-registration tutor
or hand to the trainee to return to the tutor
Not
assessed