Example reflective account

Provide us with a reflective account of how you met one or more of the standards for pharmacy professionals.

My role involves working in several community pharmacies as a locum pharmacist in a large multiple setting. Because of the nature of my role, I see multiple service users across the pharmacies with minimal opportunities to continue repeat interactions.

The pharmacies tend to be in suburban locations and serve a mixture of ages and demographics. Patients and the public form the largest part of my service users.

I have met all three of the required GPhC standards with this reflective account. This example illustrates how I demonstrated leadership by sharing knowledge to ensure staff and the public are kept safe by ensuring COVID-19 safe premises and practice. This required me to communicate effectively during my shifts, utilising the latest, most up-to-date clinical knowledge related to COVID-19 measures, while behaving professionally in accordance with GPhC standards and regulations.

The government’s COVID-19 regulations resulted in an increase in remote consultations over the telephone in community pharmacies. In the past, most people would present in the pharmacy to request advice and medication for self-care, with only a small minority of calls to request advice. This shift in communication style led to a change in my practise to ensure safe and effective support for self-management and remote red flag identification.

During the earliest days of the COVID-19 pandemic, the advice to the public was to isolate if they had a new and continuous cough. However, there was very little guidance around what this might sound like. I felt I would not be equipped to provide effective advice if I did not upskill myself to have a clearer understanding of this advice.

I completed a thorough search of online resources and contacted a colleague who was supporting NHS111 call handling to understand their experiences and update my knowledge using resources that advised that the cough is usually dry, but sputum may not be uncommon (standard 9).

A patient called the pharmacy saying they did not want to bother their GP as they were not sure if they were ill enough and did not believe it could be COVID-19 symptoms as they were living alone and they had not left home, except to “pop to the shops for themselves and their elderly neighbour” once a week.

During the telephone discussion, I could tell that the person was out of breath, speaking in short sentences to catch their breath and struggling in between sentences. I asked further questions about their possible symptoms and they mentioned they had a few aches but that they were not sure if it was just their age, because they were 75.

To rule out any alternative causes for their breathlessness, I asked about their normal respiratory health and they confirmed that they did not normally have any difficulties or other respiratory conditions. I had recently learned the NHS111 questions that would help my conversation and asked her about her breathing, which she confirmed was uncomfortable as she had been experiencing a dry cough. I followed up with questions to determine whether it was worsening, by asking if it was worse today than yesterday and what her breathlessness was preventing her from doing. Her answers indicated that she had experienced a rapid decrease in normal breathing and that she was not able to complete her normal household activities for herself because it had made her feel a bit “jet-lagged”.

I had asked about clinical diagnostic tools she may have at home, but she did not have a thermometer, blood pressure monitor or pulse oximeter, which may have supported a decision for her. I advised her that there were some worrying symptoms that required urgent medical follow up.

The patient had slight hearing difficulties and my mask was muffling the conversation, so I ensured that I moved to a quieter area in the pharmacy so that I could reduce background noise and increase the volume of my conversation to improve my communication, while still acting professionally by not compromising patient confidentiality. Reduced numbers of the public in the pharmacy meant that it was easier for patients to overhear conversations taking place. I also ensured our COVID-19 health and safety regulations were followed in the pharmacy by keeping my mask on (standard 3 and 6).

On reflection from this call, I realised how important visual cues are to a consultation and how important it is to listen very carefully to the patient’s tone, clinical presentations of voice, sound of breath, potential symptoms and risk of contact making mental notes or physical notes to ensure I capture all possible symptoms during a remote consultation.

The pharmacy let me know on my next shift that the patient had called to say thank you for my advice because they had been hospitalised and that they had recovered but were grateful for the advice which led them to seeking urgent help.

I shared my experience with other pharmacy teams to ensure all staff were aware of the questions to determine breathing difficulties to support their learning (standard 9).