Today I finished up my last placement...crazy! I spent this week in the South West Medicines Information office at the Bristol Royal Infirmary...which I will for obvious reasons be referring to as the SWMI and BRI from here on out.
This was a very different experience than my weeks in the community pharmacies. The UK has a very structured Medicines Information service. There are about 250 local MI centers and 16 regional centers, and some centers offer specialty answering services. For example, the BRI has a local MI center that serves the hospital; the SWMI office (which is in the BRI, but not the BRI MI center) is a regional center, and is also responsible for answering questions regarding drugs in renal disease for the entire UK. The main role of the MI service is to answer enquiries, mostly from healthcare professionals. They also publish guidelines and new medication reviews, provide training for pharmacy staff, and sit on Drug & Therapeutics committees.
This week, I spent the majority of my time in the MI office. One of the ladies who works there is on maternity leave, so I got my own desk...it was so nice! They gave me a training workbook that is a sort of "guide" to MI in the UK, so I went through parts of that to learn about the types of questions that are most commonly asked, and what resources are recommended for finding the answers. The NHS has a really nice program for documenting enquiries and responses, and it has a training version, so I got to use that to practice answering queries. I will admit that I thought I would be bored going into this, since Drug Information isn't really my thing, but I actually enjoyed it! It was good practice to have to answer MI questions in a timely manner, and the examples they gave me were practical...a lot of them were actual enquiries they had received...everything from adverse drug reactions and interactions to routes of administration, drugs in pregnancy, and IV compatibility. I actually feel like I am more efficient at answering MI questions now than I was on Monday!
On Tuesday afternoon I rounded on the Care of the Elderly ward with Emma S, the pharmacist who was "in charge" of me for the week. We saw a lot of patients, mostly post-stroke. It was very interesting...the setting and work flow are so much different than in the US! In this particular ward, there are two "bays" (male and female) and about twelve beds lining the outside of each, with blue curtains that can be pulled around the bed when the patient is being bathed. Not a whole lot of privacy...or peace & quiet, for that matter! Suffice it to say that I do not want to end up in the hospital here.
I visited the post-thoracic surgery ward with Julia on Wednesday morning. Most of the patients here had lung cancer and were status-post lobectomy. This ward was set up a little bit differently, with about six rooms and only four patients per room. They also had a couple of private rooms reserved for patients who needed to be isolated due to infection. We rounded on every patient, which took a long time because their information is way spread out. Each patient has a binder at the end of their bed that holds their medication list and daily flow sheets (heart rate, BP, glucose, etc). All of the rest of the information is in the patient file, which is kept at the nurses' station. The only thing on the computer is the patient's labs. A little inefficient, in my opinion, but it seems to work for them.
That afternoon was spent in the cardiac/cardiac surgery ward with Emma T. This ward is in the NEW Bristol Heart Hospital, which was much more pleasant and aesthetically pleasing. The set up was similar to the surgical ward, but the rooms were bigger and each one had a desk and a computer...much more work space, which was nice. On all of the services, we went to each patient's bedside and looked over the medication list to screen for interactions, check renal function, make sure an accurate drug history had been obtained, etc. Very much like what we do in the States. It was funny to see how freely the pharmacists write all over the med list and administration record...notes to the nurses for administration, questions for the doctor to review the indication or duration of therapy, clarifications of the patient's home meds. And when a drug is discontinued...they draw a scribble through it! Some of the charts were an absolute mess! I am pretty sure that if I worked there, I would either go crazy or spend all of my time rewriting medication charts.
I was really happy with my time at the BRI. The time spent on the wards was a real eye-opener, and I very much enjoyed the time in the MI office. Overall, it was a very well-rounded experience and I am taking a ton away from it!
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