Critical Care Pharmacist Career Stories
Critical care pharmacists have a wide range of knowledge suited to the variety of patients admitted to the general intensive care unit. They are able to handle complex medication queries in sometimes high-pressure environments. The majority of critical care pharmacists are now independent prescribers and actively contribute on the ward round. They are viewed as an integral part of the multi-disciplinary team, with GPICS 2.1 recommending a minimum of daily weekday attendance of a pharmacist on the multidisciplinary ward round, with plans to extend this to a seven day service. Pharmacists work closely with the MDT as well as the rest of the pharmacy team, including Pharmacy Technicians and Pharmacy Assistants.
Below are some career stories showing the progression from pre-registration to specialist intensive care pharmacist.
Loving chemistry and biology (and not liking the idea of sticking needles in people, so ruling out anaesthesia), pharmacy seemed a straightforward career choice. After initial training in hospital, followed by a short period in industry preparing IV infusions, I took on a surgical pharmacist post in Fife in 1991.
Part of the job involved providing cover to a recently opened 2 bed ICU, tagged onto the main surgical ward. Most of the staff, from all professions, had little experience of ICU, so it was a learning experience for all. For me, the chance to spend time working primarily with infusions was paradise, and I was able to put my knowledge into practice, and develop it to meet the needs of the unit. Of course, the internet was still in its infancy, so learning was not as easy as it is now. In time I built up contacts with other pharmacists in a similar position, and the UKCPA Critical Care Pharmacist Group was set up to give us a forum to discuss and develop the specialty. This continues to go from strength to strength.
The MDT approach to ICU meant I got to know many people passing through as trainees, which helped grow my network of contacts. This brought about various opportunities to get involved with activities at a Scotland-wide level, bringing the pharmacy and medicines viewpoint to the table.
Over time, departmental reorganisations meant that I had to take on more managerial duties, until it got to the point where I had to give up my daily ICU commitment. However I kept in touch with ICU, often being asked for an opinion on a tricky situation, and also with national developments. With the Covid situation, I naturally found myself back on the floor, and this made me realise what I had been missing, contributing to individual patient care, and so I decided I would give up the management activities and return to regular patient care in what is now a 10 bed unit. I was delighted to return to the management of complex, critically ill patients, utilising my unique skills in pharmaceutics and wide knowledge of drug use.
A short time later I was the first ICU pharmacist to be accredited at Consultant level in the UK through a new national credentialing process (several others had already been appointed on local arrangements). I continue to contribute to activities at UK level, particularly in IV fluids and IV formulations and administration.
Having originally chosen to study pharmacy with the aim to own my own community pharmacy, I now find myself as a senior critical care pharmacist at a large teaching hospital. I had a change of heart in the 4th year of my pharmacy degree, and applied to complete my training year in hospital.
After qualifying, hospital pharmacists routinely complete a number of years of speciality rotations and on-call work, which gave me a good overview of various specialities and my first taste of critical care. Alongside full time working, I also completed a postgraduate Clinical Pharmacy Diploma over 2 years, before also completing an independent prescriber course. I took my first senior job role as Lead Education & Training Pharmacist, which I really enjoyed and it allowed me to develop my non-clinical skills but it involved very little ward-based time, which I realised I missed. So I chose to move to another Trust as an Advanced Specialist Pharmacist in Critical Care.
Critical care is brilliantly varied, with lots of different kinds of patients to review and a fab team of doctors, ACCPs, nurses and MDT members to work alongside – I’d never work anywhere else! Pharmacists are able to add so much value, and our team welcome us onto the ward round and value our contributions – which provides so much job satisfaction. We are able to use our prescribing qualifications on a daily basis, as well as contributing to the Rehabilitation team, providing training sessions, and learning something new every day – we’re never short of learning opportunities on critical care!
Whilst working at a large teaching hospital as a rotational pharmacist, an opportunity came up for a pharmacist to join a team of critical care pharmacists, led by a consultant pharmacist. This felt like an opportunity that couldn’t be missed and so I jumped at it. Critical care had always been an area that I had thought sounded interesting, but maybe a little bit intimidating, so this 1-year rotation sounded like a perfect introduction.
When I started working on critical care, I realised the value that we as pharmacists add to a patients care; medications are the commonest intervention that critically unwell patients receive and due to the complexity of our patients and rapidly changing pharmacokinetics and pharmacodynamics, I needed to use my knowledge and experience in a practical way to ensure medications were optimised.
Soon after my rotation, a permanent position (advanced pharmacist) became available in the critical care pharmacy team. I was successfully appointed and spent the next ten years honing my critical care pharmacy expertise and leadership skills. During this time, I completed a post-graduate MSc in clinical pharmacy and became a qualified micro-systems coaching academy coach (quality improvement). More than two years ago now, I was appointed as the Principal Critical Care Pharmacist, leading the pharmacy team.
Over the years I have enjoyed working as part of a team of clinical pharmacists and as a valued member of the wider multiprofessional teams. Working in critical care has allowed me to be the ultimate generalist!
As I have progressed, I have been encouraged to develop both as a clinical pharmacist utilising my expert clinical knowledge, and to develop across the full spectrum of professional support activities that the advanced pharmacist framework identifies. No two days are the same on critical care which means I am continually learning and developing!
My first experience of critical care was as a trainee pharmacist (previously known as a pre-reg). At that point I knew this was where I belonged. I moved to Cornwall in 2005 – and unlike medical trainees, I’ve been fortunate enough to complete most of my career progression in the same place, with a few side steps along the way.
I started as a specialist critical care and peri-operative pharmacist in 2007 and co-trained as a medicines information pharmacist – finding the evidence for complex clinical questions. I finished my diploma in clinical pharmacy a year later. Attending the multi-professional ward rounds consolidated my knowledge. To develop my management and leadership skills, I covered 2 maternity posts as the directorate leads for acute medicine, then trauma & orthopaedics. Sidestep three was as the high-cost drugs pharmacist in the local Clinical Commissioning Group to understand finances. After qualifying as an independent prescriber in 2015, I became the pharmacy lead for ACCT in 2016.
I work within the 4 pillars of advanced practice: (1) patient centred care and professional practice, (2) management and leadership, (3) education and (4) research. I’m fully integrated into the critical care team and it’s a pleasure to work there. My role is varied, and I love it that way.
I help train up budding new critical care pharmacists, deal with the more complex pharmaceutical queries on the unit or in follow-up clinics as well as review the discharged patients. I’ve always enjoyed teaching: I have affiliations with 2 medical and nursing schools and support pharmacy education locally and regionally.
Cornwall has a good reputation for critical care research, and I work alongside the dedicated team to manage all their pharmacy needs. Doing the associate PI training has helped develop my research interest. Supporting local audit and QI projects is key part of my role – I just need to get better at publishing our achievements.
I’m entering the final year of my MSc in clinical critical care and leadership. This was the impetus I needed to start building my consultant portfolio. We all know working full time, studying, and having a non-work life is hard but it’s amazing what you can achieve when you put your mind to it. The Royal Pharmaceutical Society recently approved a consultant critical care pharmacist post for the Trust so fingers crossed I’ll be the successful candidate!