placement log day 1 + 2

For a week I am having placement at my local pharmacy to become acquainted with the nature of community pharmacy. I've started dispensing and (VERY BRIEF) counselling and this is a log of my activities for future reflection.

DAY 1 

At this stage I'd already had several 2hr weekly placements. The advantage of full day placements is that you see a wider spectrum work. Not much happens in 2 hours; if it's a busy hour maybe several scripts come through and you see a mad rush. Maybe 1 or 2 interesting things happen but it's not enough to get a good scope on what the full responsibilities and tasks of a pharmacist entail.

Yesterday I was able to learn the software to dispense from start to end. I found that once I was able to understand the work flow, dispensing became much easier. The data input wasn't always intuitive and I made plenty of mistakes, which brought to my attention all the possible ways a dispensing could go wrong (there are so many). After much hair pulling and stressing, I decided it was time to understand the different types of scripts - pharm+patient copy vs duplicates vs medicare copies vs repeats - and patient claims - C/G/AC/AUG etc. We were flat out busy but the pharmacist found time in between scripts to explain to me the different categorising of patients under medicare, and the safety net for PBS drugs. It's a big picture but he was patient and now that there is some kind of context for the scripts, I feel that it's easier to power through the process.

So yesterday's emphasis was on the dispensing work flow.

I felt uncomfortable being unable to counsel patients on their medications and it doesn't look like there's an easy way into it; I've just got to learn the CMIs I suppose... Oh fun times ahead. It's hard not to notice the disparity between the quality of counselling expected by the university vs the quality of actual counselling IRL. Scenario/hypothetical patients have way more time and patience than real life patients and during busy times, it feels almost impossible to counsel; at my level, anyway. If I could gun through a couple of questions that would probably be enough, but as I mentioned earlier I would have to be able to jump into counselling the medication by heart. So, it looks like I've got some CMIs to read.

I've also got the Competency Standards Framework (PSA) to learn but for now I am tired and the practical learning is much more appealing.

Other things I observed during day 1 included:

• S8 dispensing - patient request for oxycodone slow release 
• compounding - this was also vastly different from uni compounding. I helped make a salicylic acid cream and a glycerol/emulsifying wax moisturiser. It's kinda gritty and we winged it a bit with the packaging but it worked out. The rules are not rules outside of the institution and you are your own medicine's creator. (there are laws though)
• near theft - somebody tried to steal something????? losing the head pharmacist as he left to follow up sneaky people meant that the dispensary fell to near chaos momentarily before picking up again. 

Time goes by quickly in the dispensary and it's not until I finish and I'm on my way home that I realise I am exhausted. 

DAY 2

I wanted to really consolidate the dispensing workflow that I started yesterday and the pharmacist was happy to let me romp around and do my thing. Again, more mistakes made, more lessons learnt. From now on for new patients I think I'll request the medicare card. Although repeats have the MC#, it doesn't have the DOB and it just becomes a hassle moving back and forth from the computer to the patient. Not to mention that they wouldn't always be there, and it looks like I don't have my shit together. When that happened though, one of the girls who worked there stepped in and actually called up Medicare to confirm a patients MC#. It was really good to watch and learn from that. I also met another girl in my cohort - small world! It was so pleasant working with the girls, we shared the workload and helped each other collecting and preparing the medications.

I didn't really have time to look at the domains today but I was busy dispensing, placing stock, and I did some webster packing towards the end of the day. I spoke in Mandarin!!? I don't even speak that language but some patients had no English in them so I forced some rubbish out and they were able to make some sense of it. It was such a funny situation! I might consider practising it properly eventually. 

When medications are out of stock in the dispensary, we sometimes call up the neighbouring one to borrow their stock. Today I did my own run for some prescription cream but forgot to take the exchange slip... Luckily it's only 2 minutes away and I ran back before anyone else realised my mistake. Honestly I feel like I have to make mistakes for something important to be engrained in my mind... As long as the consequences do no harm to anybody I don't really mind. If anything it puts an emphasis on particular processes and considerations. 

There were some mistakes that I wasn't too pleased with making. Towards the end of the day my energy was spent; I hadn't eaten lunch and I was kept busy all day so errors started showing and for one script I hadn't even picked up on the authority number. Some things are more obvious than others, but I knew that the day was going to be done soon, before I made any serious mistakes. 

These 2 days have been a good learning experience. There are still things I want to learn about the system - the typical day too, but I want a picture bigger than that. For now I sleep.