Clinical Pharmacy and Medicines Management Service

We have a team of pharmacists and pharmacy technicians working on the wards alongside doctors, nurses and other members of the multi-disciplinary team.

We advise on the correct selection and use of medicines, ensuring that every patient receives appropriate, safe and cost-effective treatment.

Taking a drug history and medication reconciliation

We talk to you on admission to hospital to find out what medication you were taking before you came into hospital and how you usually take it. We then record it on your drug chart.

We ask about prescribed medicines, anything bought over the counter and complementary and alternative medicines.

We use a variety of sources to confirm the prescribed medication details and ensure that medicines are continued and reviewed when appropriate during your inpatient stay.

Patient Own Drug (POD) assessment

Patients’ Own Drugs (PODs) are the medicines that you have brought into the hospital.

We assess whether these are safe to use on the wards and that the directions on the label are still correct.

Clinical check of the drug chart and discharge letter

A pharmacist will thoroughly check all the prescriptions on your drug chart and as often as is necessary during your stay on the ward.

They are looking to make sure each drug is prescribed at the right dose, right time of day and at the right frequency.

They assess whether the drug is right for you as an individual by keeping in mind your medical history, your current condition and any special requirements you might have, for example if you have difficulty swallowing tablets.

They also make sure there are no interactions between medicines that you have been prescribed.

The same check is also done on the list of your medicines you receive at discharge.

Medication ordering

Our team make sure all medicines prescribed on the drug chart are available for nurses to give.

Some are kept in bulk as stock on the ward and some we order for you specifically.

When you are discharged we will make sure you have adequate supply of medicines either already at home or to take with you.

Patient medicine counselling

We discuss any newly started medicines with you to make sure you understand what you are taking, including what it’s for and any potential side effects.

We will make sure you understand how to take your medicines to get the most benefit from your treatment and try to identify if you will have any problems taking them.

We can also talk through the list of medicines at discharge with you to make sure you are confident with how and when to take them when you get home.

Other responsibilities

As well as the tasks above we work closely with the ward teams to provide information on drug expenditure, usage, prescribing trends and risk reduction.

We are also involved in writing and reviewing guidelines that include medicines and some of our pharmacists are able to prescribe medicines directly to patients.