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Monday 22 October 2018
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My pharmacy story: Making the move from community to hospital, specialising in critical care

Northern Ireland-based critical care pharmacist Lorna Morrow explains why she decided to move from a community pharmacy setting to hospital
 
I qualified as a pharmacist in 2003 and honestly never initially dreamed that I’d end up working as a hospital pharmacist, as I was very settled in my role as a community pharmacist manager.
 
However, after almost six years in this role, I began to feel that I would like to move into a more clinical role, with the aim of eventually becoming an independent prescriber. With these goals in mind, this led me to apply for a post as a medicines management pharmacist in hospital.
 
This change has taken me so many directions since I first became a hospital pharmacist.  Initially, I worked in the dispensary, before moving into a more clinical role in surgery, renal, antimicrobial, and finally critical care and anaesthetics.
 
Along the way I supplemented my clinical knowledge with multiple post-graduate courses, which incorporated an independent prescribing qualification. In Northern Ireland, there are very few training courses relating to this specialist area for pharmacists, so this has led me to travel to UK Clinical Pharmacy Association (UKCPA) courses in mainland UK to enhance my knowledgebase.
 
Evidence shows that the direct inclusion of pharmacists within critical care reduces medication errors, and improves patient outcomes, by enhancing and individualising drug therapy, in addition to managing costs from drug budgets.  With this in mind, the Western Health and Social Care Trust (WHSCT) created my part-time post, initially as an ‘invest to save’ project, as prior to this there was no pharmacy input within these clinical areas. 
 
Initially, I must admit that it did seem like a daunting task to achieve the >5% efficiency in expenditure expected of me, while ensuring the safe and effective use of evidence-based medicines and optimising patient care.
 
This environment can at times feel very pressured due to the nature of patients’ clinical conditions, but I work in a high-quality and dedicated multidisciplinary team, who respect each other’s qualities and we have great working relationships. I feel this is truly important and that my role within team is valued.
 
My clinical knowledge and prescribing qualification has proved vitally important in my daily practice. I use it during medicines reconciliation on admission/discharge, and during the daily ward rounds, particularly when patients are experiencing multiple organ failure. Our patients within the unit have found it very beneficial to have a pharmacist in the ward to counsel them on their treatment plans, and on changes to their medication during admission.
 
I have also been heavily involved in the quality improvement drive within pharmacy and critical care/theatres to enhance patient safety through improving quality care. In 2016, I completed a project involving expenditure savings on high cost drugs such Sugammadex and Anidulafungin, which made it through to the final of the Health and Social Care (HSC) Safety Forum Awards.
 
I am currently involved in three ongoing quality improvement projects within critical care involving: venous thromboembolism (VTE) risk assessment and appropriate prophylaxis, reducing the number of times doctors are contacted after 5pm and updating our formulary within ICIP to reduce the amount of freeform medication orders. I am also greatly involved in multidisciplinary education within critical care.


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