Hospital pharmacy as a career

There is a considerable range of options open to those who decide to enter hospital pharmacy. Colin Rodden offers a taste of what a hospital career can entail

There is no longer a single career structure for hospital pharmacy. Instead, there is a myriad of possibilities. Importantly, specialisation in one area does not bar pharmacists from posts in other areas.
Newly recruited basic grade pharmacists rotate through the various sections of the typical hospital pharmacy department, gaining experience of the different specialties. Although most basic training is conducted in the course of normal working, there is usually also the opportunity to study for a clinical diploma or MSc and a commitment to continuing professional development. As your career progresses and you are promoted, you will need to decide in which area you wish to specialise and, possibly, which sub-specialisation within that area.
Clinical pharmacy forms a large part of hospital pharmacy work. Clinical pharmacists are part of the health care team on the ward, working with medical and nursing staff and the various therapy professions. Within the team, they are the experts on drugs and their advice is sought by the other members. Clinical pharmacists work closely with both prescriber and patient. They often attend consultant ward rounds where they can influence prescribing, rather than react to it later.

Some pharmacists are also heavily involved with outpatient treatment in clinics such as anticoagulant, rheumatology and gastroenterology clinics. Clinical pharmacy is very patient-centred and allows use and updating of all the knowledge that has been gained at university. In the majority of grades in most hospitals, clinical pharmacy is part of your job. However, at the highest grades, clinical pharmacy either tends to be a full time occupation or there is little, if any, practical involvement.
A sub-specialisation of clinical pharmacy is palliative care. Palliative care pharmacists work closely with hospices and community pharmacists to ensure that the last days or months of terminally ill patients are as comfortable as possible.
Drug information departments provide great support for clinical pharmacists. Drug information pharmacists critically assess claims made of drugs by their manufacturers or in clinical trial reports. Literature searches have been transformed by the use of computers and the internet. This information is also of use to formulary pharmacists who work closely with local drug and therapeutics committees to ensure that prescribing is rational and cost-effective. Helping guarantee this are audit pharmacists. Monitoring the use and effectiveness of drugs and techniques is very important in today's environment where resources are limited and the introduction of clinical governance has raised the profile of clinical audit.
In recent years there have been moves to cut both the workload of and the hours worked by junior doctors with the result that pharmacists now carry out some of their duties.
Intravenous additives are now more likely to be produced in a pharmacy aseptic unit than on the ward, as are cytotoxic drugs, where the extra dose check by pharmacists leads to improved patient safety. Indeed, studies have shown that it is significantly safer all round if intravenous drugs are prepared in pharmacies. However, working in an aseptic unit involves more than just IV additives.

Pharmaceutical production
If the unit is licensed by the Medicines Control Agency for production, a wide range of products will be manufactured which can include injections and eye drops. There can also be involvement in the preparation of products for use in clinical trials and research is often required in order to produce a stable formulation. Production units also make creams, ointments, lotions and suspensions.
Frequently, commercial manufacturers have details of oral liquid formulations of drugs which they do not market because limited shelf life significantly reduces the commercial viability of the product. This information can be used to prepare the product extemporaneously for use within individual hospitals. Quality assurance pharmacists not only make certain the final products are acceptable, they assess every step in the production process to ensure quality is built in at every stage.
Radiopharmacies are specialised production units which manufacture a range of radioactive therapeutic and diagnostic preparations.
Increasingly, clinical pharmacists are becoming more involved with admission and discharge processes. In the latter, this can range from checking that discharge prescriptions are accurate and clinically optimised to actually writing discharge prescriptions.
From the ward, prescriptions are delivered to the dispensary. Many hospitals have moved away from central departments towards satellite dispensaries in the busiest patient areas, but others retain central dispensaries. In the dispensary, prescriptions are dispensed, checked and returned to wards so that treatment can continue or patients can go home. The dispensary manager's job is to ensure that prescriptions are completed accurately and timeously so that treatment or discharge can proceed smoothly.
Not all specialties can be found in every hospital. Grades within hospital pharmacy range from A to H, with the latter being the most senior. Specialisation usually begins at grade C and extends through to E or F grade (current salary £32,980 to £38,643 pa), although area or regional specialists are often graded G or H (currently £36,755 to £45,250). Generally, the higher grades are in pharmacy management, where you would be responsible for a pharmacy department within a hospital or trust, although in some trusts pharmacy managers are on the National Health Service senior managers pay scale instead.
In conclusion, hospital pharmacy is not static and new specialisms are being introduced all of the time. Who can tell what hospital pharmacy might be like in 10 years time?