For most graduates, community pharmacy is the pinnacle of care – prescribing to patients in a community setting is the cornerstone of societal clinical strategies to improve care and accessibility. But may students don’t consider a role in a clinical environment such as a hospital. The general pharmacy bracket is broad and is often aimed at treating specific conditions and providing services adjunct to GP services (diabetes care, foot care etc). Hospital pharmacy is an attractive option for those looking to specialise in a particular field or vocation. These hospital pharmacy teams (particularly at large clinical groups or hospitals) may take on intriguing cases with several sub specialties which require planning and cross-referencing to improve adherence and outcome. Below are some of the most common specialities in the hospital setting and the intricacies of each.
Hospital pharmacy in gastroenterology often involves supporting care teams and nursing groups who care for patients of special populations with challenging diseases. The hepato-biliary (liver and gall bladder specialties) are amongst the most difficult to prescribe for, and often this is to support post-operative transition and care. Luminal gastroenterology often entails caring for patients with GI disorders such as inflammatory bowel disease and surgical complications. The hospital pharmacist must synchronise well with the primary caregivers and may be involved in clinical decisions in the delivery of treatment. The pharmacist should be well read in areas of current research in gastroenterology and must also aim to streamline delivery amongst nursing and clinical decision teams.
A mental health pharmacist will be working amongst psychiatrists and other caregivers to optimise the correct treatment to the patient, and will also have a responsibility to monitor potential drug interactions which can occur when patients in this demographic are receiving dual or triple therapy. This field is particularly broad in the manner and depth of different diagnoses and treatment plans, and often the pharmacist may have to consider the clinical history of the patient to tailor care and prescribing in a manner which is effective and respectful of medications that have been trialled in the past.
Prescribing in paediatrics is difficult to manage due to the patient group who often have to be counselled into adhering to their treatment plan. This role is often rewarding due to the profound impact proper prescribing can have upon the patient. The paediatric pharmacist may also have a role of interacting with parents and caregivers of young patients to educate on the appropriate timing, dose and regimen of medicine interaction, as well as staying within guideline for childhood regulation of medicine. This role is particularly attractive to pharmacists who are interested in pharmacology and the individual basis of pharmacokinetics which must be considered in young patients who may respond differently to administered medicines. Paediatric pharmacists may be supporting post-operative care in young patients or potentially interacting with young patients in transplant therapy.