Case study

Senior clinical pharmacist — Nikita Desai

Nikita studied for a Master of Pharmacy (MPharm) at Medway School of Pharmacy, graduating in 2016. She now works in East London as a senior clinical pharmacist

How did you get your job?

As an undergraduate student, I aimed to get a variety of experience in different community and hospital pharmacy teams - this gave me exposure to different specialities, which aided my career decisions.

During one of my summer placements, I worked in a psychiatric hospital and felt that in this speciality, I would be able to make the most difference to my patients' care. I found the patients' cases extremely interesting and due to the time they spend on the ward I am able to see the value and impact of my interventions and medication optimisations on each patient.

I decided to specialise in mental health and undertook my pre-registration year at Essex Partnership University Foundation Trust. The training and experience I gained during my pre-registration year put me in a strong position to start my career as a mental health pharmacist and I began working as a Band 6 junior pharmacist at East London Foundation Trust after passing my pre-registration assessment.

In mental health you usually work within a small team and I believe that, if you have the skill set, you are able to progress quickly. Working as part of a small team gave me the opportunity to take on a number of projects and tasks, which aided my learning as well as allowing me to train and manage others. I progressed within the Trust and I am now working at East London Foundation Trust as a Band 7 senior clinical pharmacist.

What's a typical day like?

As a Mental Healthcare of Older People (MHCOP) pharmacist I am in charge of the older adults wards in my locality. I am also the clozapine pharmacist, which requires me to look after the care of all patients taking clozapine within the Tower Hamlets locality.

Along with this, I am one of the joint leads on a Quality Improvement Project, which looks at reducing the medication waste produced by the wards. Furthermore, I supervise and manage pre-registration pharmacists during their rotations and organise training while they are with our team.

Additionally, I am involved in training new doctors and supporting pharmacy technicians with their training and I also work with The Recovery College, which allows healthcare professionals to work with service users in order to educate them around mental health. Finally, I lead on creating the medicines bulletin, which includes medication-related updates to help ensure the safe use of medicines.

On a typical day on the wards I am shadowed by a trainee pharmacist. The multidisciplinary team (MDT) works closely together and therefore ward rounds usually consist of the consultant, junior doctors, a pharmacist, a ward nurse, the patient and anyone else involved in the patients care. My presence at ward rounds allows me to actively influence the prescribing of medication and ensure the correct monitoring is carried out. I am also able to identify patients who may require medication reviews or opportunities for medicines optimisation; especially surrounding polypharmacy in the elderly.

I will check medication charts on the ward for safety and appropriateness and use these to teach trainees that are shadowing me. I work closely with the doctors to correct medication issues on drug charts. I conduct one-to-one discussions with patients in order to ensure they know what is happening with their care and identify any issues they may have with their medication and answer queries from prescribers. The ward technician and I also work closely with the nursing staff on the ward to ensure medication is being stored and administered in a safe and appropriate manner. It is extremely important to prioritise time effectively in order to complete all of the ward work as well as carry out all my additional responsibilities.

What do you enjoy about your job?

I enjoy working in a patient-facing role and being able to see the progression of a patient's journey from admission, to when they are well enough to go home. We have a diverse group of patients and healthcare professionals that we work with - this allows me work closely with a varied team that I am able to learn a great deal from.

What are the challenges?  

The nature of working in mental health requires you to be able to work with a challenging patient demographic. Patients don't always believe that they are unwell or understand the information being provided. This requires me to adapt to each situation in order to explain things to patients in a way that they feel most comfortable, which is not always simple.

Working closely with a large MDT means you are bound to come across doctors or consultants who prescribe something you do not agree with. When dealing with strong characters it's difficult to challenge their decisions. I have found it's important to remain calm and be assertive when explaining the issues you have identified.

As a pharmacist there is a lot of scope to develop your role and work in novel ways. However, working in a small pharmacy team means that time can be stretched while ensuring the core services are provided. To allow me to expand my role the team must communicate extremely well, I must manage my time effectively and I have to be able to prioritise my work accordingly.

In what way is your degree relevant?

To practice as a qualified pharmacist in the UK you must have a Masters degree in pharmacy. Although I have specialised quite early on in my career, I still have a vast amount of exposure to physical health issues, especially in the elderly where there are a number of co-morbidities to consider.

My knowledge of medicines from my undergraduate degree allows me to identify issues with treatment regimes, monitor patients, answer queries effectively and provide useful and relevant information tailored to each individual patient.   

What are your career ambitions?

My aim in this role is to work closely with the patients, doctors and consultants to ensure patients are receiving optimised treatments for both their physical and mental health. I would like to tackle polypharmacy and optimise medicine regimes where appropriate. I would like to work more closely with the community mental health team and attend their ward rounds where I would be able to give advice on our community outpatients and optimise their treatments and hopefully be able to prevent future hospital admissions.

I aim to become an independent prescriber and hopefully run my own clinic based in the CMHT, reviewing patient treatments and optimising their medication. I also have an avid interest in education and training and hope to become a pre-registration tutor and lead on education and training in the future.

What are your top tips for getting into hospital pharmacy?

  • Get as much exposure as you can to hospital pharmacy. Try to get summer placements or university placements in a variety of specialities so you can find what you enjoy. If you are unable to get a summer placement, call hospitals and ask if you are able to shadow the staff for a day.
  • Show your interest. If you find a speciality you like make links with the pharmacists at the Trusts you have spent time with, let them know you would like to come back or to keep you in mind if they are hiring.
  • Ask questions. There are so many options of what you can do with your career you may find it difficult to decide. To help with this, once you have work experience be sure to ask lots of questions. As well as finding out about the roles and responsibilities of a ward pharmacist, it's important to learn about the processes and procedures of the Trust.

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