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Rheinischen Kliniken Langenfeld
A German hospital pharmacist
The Rheinischen Kliniken Langenfeld is a psychiatric hospital with approximately 650 beds. The hospital was built just over 100 years ago, at a time when psychiatric hospitals in Germany were built outside the cities. We therefore have the luxury of being situated in a huge park.
From here we supply not only our hospital but four other psychiatric clinics in Cologne and Dusseldorf with medicine and medical products, 2,100 beds in total. The pharmacy staff consists of 10 people: three pharmacists including myself, two technicians and five assistants, three of whom work part-time. We are all female, which is not unusual in Germany, where the majority of pharmacy staff are women.
I start my work at 7.30am with the usual jobs such as checking the mail. Today I have to sign off the orders for the pharmacy’s medicines. We order directly from the pharmaceutical companies routinely twice a week, plus make special orders for medicines we do not have in stock and need urgently. Before signing the order forms, I check the amounts that the assistants have requested. When ready, the forms are sent by fax to the pharmaceutical companies.
Meanwhile, a nurse from an external hospital calls complaining that in yesterday’s delivery one drug was missing. Usually the reason for this is that they did not order it at all or the fax order arrived too late. But we have to check, so I promise to call back later and then ask one of the technicians to look into it.
After this I write the invitation for the Medicine Commission. There is a group like this in each hospital consisting of the medical superintendents, the chief nurse, a member of the administration and myself. This committee makes the decisions about all matters concerning medicines. I usually do the planning and ask for suggestions.
The nurse from earlier in the day then calls back to tell us that they have found the missing medicine.
It is midmorning and time for our weekly team meeting. We discuss organisational matters, including holiday plans (as I write this it is Christmas – a difficult time as everybody wants to have days off then). In a fortnight we have to close the pharmacy for a day because of our annual stocktaking. Therefore we have to plan now when to do the deliveries to the wards originally on the rota for that day.
There has been a complaint from an external hospital about not receiving the delivery notes regularly. We need to find out why this has happened and how to avoid these problems in the future. In the team meeting minutes are taken so that staff members who are not present can be kept informed.
Back in my office I receive a call from a physician who wants to know about the connection between plasma level and the therapeutic effect of a neuroleptic drug. One of their patients is not showing the desired effect from the treatment, but they are not sure whether he is really taking his medicine. I promise him that I will call back within a day.
I pass this enquiry on to the pharmacist who looks after our documentation department. She will check whether the requested information is already in our archives. If not, she will look for information in literature and databanks. Usually after that we will have some initial information, and if we need more we will call the pharmaceutical company who produces the drug. The newly acquired information is put into our archives for future cases.
Next I have an appointment with some representatives from pharmaceutical companies. The first wishes to tell me about the advantages of his company’s new product – in many words and with the aid of some glossy brochures. The next representative offers new prices for a generic drug. Since these seem to be interesting, I get one of the assistants to ask other companies whether they have new prices for this product.
By now the orders from the wards have arrived in the pharmacy. I check the special orders for those medicines we do not have in stock. A lot of them can be exchanged for alternative medicines that we do have. When this is the case, I fill in a short form for the ward physician so they know which substance they are getting and whether they have to change the dose.
After I have checked the orders I give them to the assistant who will input them into the computer system.
From there the order is sent electronically to our commissioning robot. The boxes for the wards are automatically filled by the robot with the medicines the doctors have ordered. Then a delivery note is printed which lists the packed articles as well as those that are still missing and have to be added by hand.
In the afternoon I go into our analysis laboratory, where the technicians process the substances we receive for our own production of medicines. Since there are certificates of purity and content, they only have to check the identity of each.
The result of the analysis has to be checked by a pharmacist. Usually one of my colleagues does this, but since she is on holiday I have to do it for her.
In our second, larger laboratory we carry out the production of medicines. This consists mainly of solutions such as benperidol solution, methadone solution and tiapride solution.
We developed the production process for the tiapride ourselves following an increase in demand caused by a new therapy. The new therapy requires higher doses of the drug, but rather than giving patients a lot of tablets, we found a liquid version to be more agreeable. There is no fluid form of tiapride available on the market and so we developed the production of the solution, which has both a therapeutic and economic advantage.
We also produce capsules of certain neuroleptic substances that are not available at the dose we require. For each product there is a record that must be checked and signed by a pharmacist.
The end of the day
I had planned to update the medicine list this afternoon. This list contains not only the names of substances but also information about solubility, special requirements for protection against light, humidity or oxygen, whether tablets can be divided and/or dissolved, special dosage instructions, and so on.
Before I finish for the day I call some wards to inform them that I will visit them in the next few days. We have to visit each ward twice a year to check the way they deal with medicines and to give information and advice.
Although it has been a busy day, by the end of the it I find that there are still things I have not managed to do. These will have to wait, like so often, for tomorrow!