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Published on 4 August 2008

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Good chemistry

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Recently, I have been reflecting on the mechanisms of success in starting a ward-based pharmaceutical service.

In Norway doctors, nurses and patients are in a process of getting used to having pharmacists at their hand on the hospital wards. As in many other countries, they are, for the most part, used to relating to pharmacists in the pharmacy department or by phone.

At some wards the presence of a pharmacist translates into an instant success, while at others it proves difficult to carve out a rational role and function. Why is this so?

The quality of the interplay between the pharmacist, the health professionals and the patients is clearly a very important factor; regardless of how professionally competent the pharmacist is. It is a jungle out there, especially when you travel on your own, not knowing exactly what awaits you round the next bend in the river.

In all cases, it takes some time for the pharmacist to fit into the ward. It may take one week, or it may take years. In one recent case, it took about a year, in practice – even if the pharmacist was formally accepted from day one both by the doctors and the nurses.

For the pharmacist in question this “time lag” has been rather frustrating. On some days she would tell me that she felt overlooked and disregarded, while at other times she would tell me that she felt really uplifted after someone had appreciated her work. Now, finally, she feels that she is really regarded as an ordinary member of the team.

What is rather interesting is that this process also seems to take place also when replacements occur. In one ward they have now had three pharmacists over a ten-year period. All three of them have had to carve out their own niches over different periods of time, though the last two doubtless profited from there having been a predecessor.

In other instances, the pharmacist never successfully integrates. The intriguing part of this is that two consecutive pharmacists on the same ward may endeavour to do the same things in the same manner, but with far different degrees of success, even if their personalities and competencies are comparable.

It may be argued in such cases that the ward has, in some way or other, changed.

Well, that may hold true, but in my experience there is still something more that decides how the interplay will function, both in the short and long term.

This “something more” has, in my view, got something to do with that elusive thing called “chemistry”. If there is a feeling of “good chemistry” from the outset then there is a very high probability of success.

In the opposite case, the best option is to get out before things get nasty!

Frank Joergensen

Your comments: (Terms and conditions apply)

“I started in ward pharmacy in the late 70’s when any form of training was rudimentary. Looking back, it’s clear now that we have to adopt the culture of the clinical team and not the pharmacy. We have to become one of them, but
also identify what their worries are, then help them solve the problems they have struggled with. This will help them deliver a positive clinical outcome or could help them pick
their way through clinical choices by weighing up the pros and cons. The key, as you say, is chemistry. I advise you pick carefully those you use, when starting the services, as they will create the right environment for success. In turn, the demand builds up as everyone wants it, so the outgoing communicators are your first choice and then move on from there. It is also about leaving comfort zones.
I could not imagine a hospital pharmacy without clinical involvement nowadays.
– Ed Freestone, Princess Elizabeth Hospital, Guernsey

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