Oriel Practice SJT PDF

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Pre regplacesBarts Health NHS Trust/North East London/T2/0073: Barts HealthNHS Trust/North East LondonPracticeNumeracyDoses and dose regimensDosage and unit conversionsConcentrations (e. expressed as w/v, % or 1 in x)DilutionsUsing provided formulaeQuantities to supplySection B: Systems of Units1. C...

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Pre reg places Barts Health NHS Trust/North East London/T2/0073: Barts Health NHS Trust/North East London

Practice Numeracy Doses and dose regimens Dosage and unit conversions Concentrations (e.g. expressed as w/v, % or 1 in x) Dilutions Using provided formulae Quantities to supply

Section B: Systems of Units 1. Convert 0.75 g to mg. Give your answer to the nearest whole number. 4. Convert 98.6 degrees Fahrenheit to degrees Celsius. Give your answer to the nearest whole number. Section C: Concentrations 5. Convert the ratio strength of a 1 in 40 solution to a percentage strength. Give your answer to one decimal place. 6. Consider the formula: Drug X 0.3 g Purified water to 100 mL How many mL of a 5% drug X solution could be used in place of the 0.3 g in the above formula? Give your answer to the nearest whole number. 7. How many mg of drug X are required to prepare 150 mL of a 0.07% w/v solution? Give your answer to the nearest whole number. 8. What volume of a 2.5 ppm w/v drug X solution contains 15 mg of drug X? Give your answer in litres to the nearest whole number. Section D: Dilutions 9. What weight of ingredient X is required to produce 200 mL of a solution such that, when 10 mL of it is diluted to 50 mL with water, it gives a 1% w/v solution? Give your answer in g to the nearest whole number. 10. You are asked to provide 500 g of betamethasone valerate cream containing the equivalent of 0.04% (w/w) betamethasone. This is to be made by dilution of a cream containing 0.25% (w/w) betamethasone with a modified cetomacrogol cream. What weight of the more concentrated cream is required? Give your answer in g to the nearest whole number. 11. When 50 mL of drug X 1.5% w/v solution is combined with 75 mL of 2.5% w/v drug X solution what is the final strength of the solution? Give your answer in % to one decimal place. Section F: Calculation of Doses 15. A patient is taking hydrocortisone 20 mg every morning and 10 mg every evening. The patient needs a supply for 21 days when he will be reviewed in clinic. How many of the 10 mg tablets will you need to supply?

16. A patient is on gentamicin 3 mg/kg once daily for 3 days. The patient weighs 54 kg. Gentamicin is available as 80mg/2mL ampoules. How many ampoules will you need to supply for the course of three days? 17. Morphine sulfate injection is available as 20 mg/mL. What volume of injection is needed to give a 7.5 mg dose? Give your answer in mL to one decimal place. 18. A patient pack contains 80 mL of a syrup. How many days will the syrup last if the dose is 4 mL two times a day? Give your answer to the nearest whole number. Page 5 of 9 Section G: Doses in children 19. A 4-month old baby has been prescribed clarithromycin for otitis media. The dose is 7.5 mg/kg twice a day. The baby weighs 6.7 kg. Calculate the dose of clarithromycin required to be given twice a day. Give your answer in mg to one decimal place. 20. A 7-year old child is prescribed cytarabine intravenous infusion for acute lymphoblastic leukaemia. The dose is 75 mg/m2 once daily for 5 days. Cytarabine 500mg/25mL intravenous solution is available. The child weighs 23 kg and has a body surface area of 0.87 m2 . Calculate the volume of intravenous solution required to administer the correct daily dose. Give your answer in mL to one decimal place. 21. The drug amikacin has a dose of 7.5 mg/kg twice daily. Calculate the single dose for a nine month child who weighs 10 kg. Give your answer in mg to the nearest whole number. 22. A baby who is 1 month old and who weighs 2.5 kg has been prescribed ranitidine liquid 75 mg/5mL at a dose of 2 mg/kg three times a day. How many mL of ranitidine liquid should be administered daily to this baby? Give your answer to the nearest whole number.

SJT locum pharmacist -- pharmacist employed on a contractual basis through an agency, rather than having a permanent salaried position Superintendent Pharmacist—Appointed to act on behalf of a corporate body which wishes to conduct a retail pharmacy business. RESPONSIBLE PHARAMCIST Deals with serious enquiries Must be present at the pharmacy for prescription meds to be handed Medicines Counter Assistants  involved in the sale of over-the-counter medicine  works under the supervision of a pharmacist.  Use of the WHAM2 questions to assess suitable medicine sales  trained to offer advice on common ailments and  MUST KNOW WHEN TO REFER A CUSTOMER TO A PHARMACIST:

Pharmacy Technicians, - take drug history explain medications, side effects, and dosages; answer patient questions; and identify medication adherence issues and CI’s pharmacy tutorif necessary, advise their trainee to contact another organisation or person if they need help, advice or support

need trainees consent before disclosing information about trainee to another person or organisation

Physios

Occupational Therapists Nurses

Clinica l Audit

Accurac y Checkin g

A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change A structured process carried out by a pharmacist or appropriately trained technician to ensure the accuracy of dispensed medicines (product and label) matches the prescription.

Inpatient care is for patients whose condition requires admission to a hospital outpatient care is for patients who may need clinical services although don't necessarily need to be admitted to hospital. prescription only medicines (POM) - available only from a pharmacist if prescribed by an appropriate practitioner; pharmacy medicines (P), available only from a pharmacist but w/o a prescription; general sales list (GSL) medicines which may be bought from

grades of doctor (FY1, FY2, Registrar and Consultant) FY1- A junior grade of doctor, usually the first post after graduating medical school. FY2- more involved in patient care than fy1 In post grad training with med degree registrar is the ward's senior doctor and is usually contactable on site, while the senior consultant (or specialist) attends ward rounds and meetings at specific times.

pre reg pharm role-



Demonstrates an awareness of other team members’ workloads and pressures and adapts their interactions accordingly



Demonstrates willingness and ability to actively learn from others

 Demonstrates an awareness of the available resources within the team and makes use of these through appropriate delegation to achieve person-centred outcomes

LIMITATIONS: - cannot speak directly to doctor unless info confirmed with senior pharmacist - Checking appropriateness of dose

 In a situation where a mistake has been made in a community setting: First aim to fix the situation: 1. Apologise and amend mistake 2. investigate 3. Refer to pharmacist The final option would be blaming or telling someone else to deal with the issue as this doesn’t resolve issue!!!!!!! ALSO IMPORTANT TO DOCUIMENT THE ERROR SO NOT REPEATED.

ALTHOUGH THIS IS IMPORTAN T THIS ISNT ALWAYS THE FISRT PRIORTIY [[--FIRST PRIORITY IS RECTIFYINH THE, MISTAKE AMND APOLOGIZING

 If pt is taking med that is contraindicated with another med: 1. Must tell them not to take until it is resolved !!!!!- can be fatal/ dangerous 2. Ask for advice from ward pharm or tutor 3. Try to find/ suggest new alt med – safer option 4. Only inform doctor ONCE YOU HAVE FOUND THE SUITABLE ALT (as pre reg trainee)Do not have expertise to suggest alt to doc w/out supervision of senior pharm 5. Finally don’t play the blame game ----- never do this always final option 6. The FINAL FINAL FINAL option is do nothing. Do not be passive. Must address this as pt life depends on it.

PT prescribed med in drug chart that is CI or allergic? 1. Check Summary care records if pt is acc allergic or med is CI 2. As med has already been prescribed- appropriate to inform nurse not to administer med to pt

In the event another pharmacist or pre reg trainee does something wrong Initially it would be in best interest to confront them first and ask if for confirmation that this incident has occurred seek advice then report incident

 When dealing with people inquiring about other pt med – confidentiality is key 1. Firstly, must aim to solve the situation instead of constantly referring to pharmacist  This means possibly explaining to inquiring party that you cannot discuss this with them 2. Then refer to pharmacist 3. Then advise them to speak with the pt (especially if worried parent) 4. final option would be breaching pt confidentiality and informing them

 what to do if you notice or assume discriminatory behaviour 1. discuss concerns with the ‘aggressor’ 2. attempt to resolve by finding a solution 3. what to do if pt is frustrated with waiting for prescription

1. apologise and explain situation (i.e other pt’s prescription was ready to handover as they had come in earlier..etc) 2. (if they wish to make a complaint) --3. attempt to resolve situation pharmacist can do home visits with particularly older pts

if you are stressed or in pain (this can cause mistakes in pharmacy): 1. make follow up appointment with GP 2. KEEP ERROR LOG 3. Explain situation to tutor

if mistake is made in prescription (hospital setting) when reviewing drug chart: 1. Know limitations of role---- cannot speak to directly to doctor- speak to ward pharm first 2. speak to doc about error-to fix prescription immediately 3. inform nurse 4. make note on drug chart or in patients medical notes (this is approtiate for a pharmacist to do but is not a

resolution for an unrgent situation) --- this can be missed which can be dangerous 5. Do nothing 6. amend error yourself – NOT APPROPRIATE if this is noticed when speaking to pt can tell them not to take until it is addressed – but can never amend dosage

taking DH, and pt says they have stopped taking med. -life threatnening 1. explain why pt must take med 2. ask if another drug would be preferred 3. inform ward pharm- know limitations of role 4. do not just DO NOTHING if you suspect forgery in prescription? 1. Discuss with RP 2. If not available- ask colleagues 3. Call 999 4. Challenge man about legality- confronting customer maY Lead to them leaving= NO RESOLUTION 5. Carry on dispensing- do not dispejnse if you suspect forgery- final If pharmacy student make error in clinical setting that can cause harm to pt

1. Interrupt consultation and correct error- pt safety first priority 2. Discuss with student at the end of the day 3. Inform the education and training pharmacist

CD drugs are mssing from cupboard!!! Crime!!! V. serious? 1. Ask colleaugues if nay of them hav dispense the missing cd drug recently 2. Trac all instances of cd dispensing 3. Report any suspicions (of who it may be) to the pharmacist 4. Pt comes into pharmacy angry at mistake with prescription (pharmacist busy--- cannot be disturbed) 1. Establish the severity by asking if any harm is done 2. Find out what is wrong with prescription 3. Tell pt she can speak to pharmacist shortly

Cannot offer emergency supply w/O being approved by RP

FIRSTLY ASSESS WHICH ATTTRIBUTE IS BEING TESTED IN SCENARIO

PAF consists of nine attributes: 1. 2. 3. 4.

Person-centred care; Multiprofessional working and leadership; Professional integrity and ethics; Problem solving, clinical analysis and decision making;

when necessary for input situation not qualified enough to make a decision must always have infrmatiopn confirmed with pharmacist or senior pjharamcist before consulting a doctor e.g must know alt medicine before advising doctor or

research and understand roles of different pharmacists medicine information,

ward pharmacist- attend ward rounds with doctors and nurses to provide advice on appropriate prescribing and medicines selection. advise appropriate medicine administration routes and procedures, appropriate dosing and provide solutions which are tailored to individual patient's needs.

pharm on duty

to understand there responsibilities and and when appropriate to report to them any issues

Rules with regards to sexual health and young individuals Angela’s lectures review Reporting Sexual Activity in Children (breach confidentiality) • Under 13 – considered too young in law- statutory rape –needs reporting • 13-16 – is an offence but less so if consensual. would need reporting if safeguarding concern e.g.  imbalance in the age  consent was secured by bribery, coercion or overt aggression  young person anxious

 whether the child denies or minimises concerns  whether attempts to secure secrecy have been made by the suspected abusive sexual partner, beyond what would be considered normal in a teenage relationship • Sexual offences legislation does not affect duty of care in any age of child but may affect confidentiality DO NOT (as a pharmacist): • Ignore your concerns and do nothing • Attempt to investigate suspicions or allegations yourself • Necessarily discuss concerns with suspected perpetrator of abuse

Sample sjt qs • You started your preregistration training about 6 months ago in a busy hospital. The Pharmacists and supporting staff within your team are unhelpful. They do not seem to recognise your role as PreReg pharmacist. You are made to undertake duties which you know should be done by other junior staff. You feel burnout and frustrated Select the three attributes you would adopt to show resilience and adaptability? • Reflective ability • Emotional intelligence • Emotional literacy • Social competence • Social support

´ You are doing your preregistration training in a community pharmacy. The Responsible Pharmacist (RP) is on break but in the building somewhere. The RP has advised that no Pharmacy-Only medications (P-

meds) should be sold whilst they are away. You’ve just seen the accuracy checking technician (ACT) selling a P-medication to a patient with a little crying baby, who couldn’t wait for the RP to come back from their break. A. Look for the RP within the building and explain the urgency of the situation and ask their permission to sell the P-meds. B. Check that the correct medication was given and there were no contraindications C. Explain to the ACT that in future she should not sell any P-meds when the RP is on break D. Remind the ACT what the RP said, that no P-Meds should be sold in their absence E. The decision not to sell P-meds in the absence of the RP can be overridden in certain circumstances and this is one of them so do not say anything. F. Do nothing now and wait for the RP to come and inform them about what has just happened Ab 1.

You are working on a geriatrics ward where one of your patients is being discharged. As they are leaving, they try to give you an expensive bottle of Champagne to say thank you. You have only met them a few times. Choose the THREE most appropriate actions to take in this situation:

1.Explain that such a gift is not necessary 2.Refuse, as such a gift is out of proportion to the care provided 3.Ask a senior colleague to accept the Champagne on your behalf to make

o o o it transparent.

4.Give the patient your address so it can be delivered to you overtly 5.Accept the gift and say thank you so as to not cause offence 6.Ask the patient about why they are giving you the gift 7.Accept the Champagne but explain you will share it with the other

o o o o pharmacist 2.

2.Quest i on Category: Situational Judgement Test You are doing your preregistration training in a community pharmacy. The Responsible Pharmacist (RP) is on break but in the building somewhere. The RP has advised that no Pharmacy-Only medications (P-meds) should be sold whilst they are away. You’ve just seen the accuracy checking technician (ACT) selling a P-medication to a patient with a little crying baby, who couldn’t wait for the RP to come back from their break. Rank the actions below in order of most appropriate to least appropriate

o o o o o o 3.

Check that the correct medication was given and there were no contraindications Remind the ACT what the RP said, that no P-Meds should be sold in their absence Explain to the ACT that in future she should not sell any P-meds when the RP is on break Look for the RP within the building and explain the urgency of the situation and ask their permission to sell the P-meds. Do nothing now and wait for the RP to come and inform them about what has just happened The decision not to sell P-meds in the absence of the RP can be overridden in certain circumstances and this is one of them so do not say anything.

3.Quest i on Category: Situational Judgement Test You are coming to the end of your shift in a Psychiatry. One of the patients who you have regularly treated for alcohol addiction to is being discharged. She gives you a thank you card and her contact details. She asks you to get in touch so you can be friends outside of work. Rank the actions below in order of most appropriate to least appropriate:

o o o o o 4.

Explain that because of the nature of their admission it would be inappropriate to have any relationship Explain that they are welcome to send details of how they are getting on to your hospital, but that you cannot use your personal contact information Inform the consultant psychiatrist of the situation Tell the patient you will contact them after they have are fully recovered and are no longer under the care of a psychiatry team Give the patient your contact details so they can get in touch

4.Quest i on Category: Situational Judgement Test You are working in a hospital. One of the patients who you have regularly seen gives you their business card with their contact details. They ask you to keep in contact as they have enjoyed getting to know you. Rank the actions below in order of most appropriate to least appropriate:

o o o o o

5.

Ask your supervisor for advice Tell the patient that any relationship outside the professional environment would mean you can no longer treat them Tell the patient you will contact them if they are no more your patient Agree to let them know how you are getting on, so as to not cause offence but then don’t contact them Agree to contact the patient

5.Quest i on Category: Situational Judgement Test You are working in a sexual health clinic. Your patient has been cheating on his long-term girlfriend by having unprotected sex with another man. He is worried he has a sexually transmitted disease. You discover that he has genital warts. Choose the THREE most appropriate actions to take

1.Advise on safe sexual practices 2.Tell him you will have to contact the man he had sex with so he can get

o o checked o o o o o o

6.

3.Tell the patient’s GP so they can follow up to ensure they have been adequately treated 4.Encourage him to inform his regular partner 5.Tell him you must contact his girlfriend to explain her chances of having the disease 6.Advise him to have an HIV test 7.Test him for HIV as he is in a high-risk group 8.Offer relationship counselling as he is unhappy in his current relationship

6.Quest i on Category: Situational Judgement Test You attend a party with your other co-workers within your department. Your male preregistration tutor ask whether one of your colleagues is single and that she finds her attractive and will like to take her on a date. Rank the actions below in the order of most appropriate to least appropriate:

Say that you find this behaviour inappropriate and walk away Tell your area manager what has happened Explain that you do not know but suggest your supervisor speaks to your

o o o friend himself

Inform your friend what your supervisor has said to you Tell y...