Intern asked to act as sole pharmacist after hours
A hospital intern pharmacist is rostered to work a late shift until 9 pm in a 180-bed hospital. The after-hours pharmacist calls in sick at 4 pm, and the duty manager asks the intern to stay until 11 pm and cover the wards as the sole pharmacist because the on-call pharmacist is 45 minutes away and there is a backlog of discharges. The intern has completed 9 months of training and has not yet been signed off for independent practice. The hospital policy says interns must have a registered pharmacist on site at all times. The intern calls you, the senior pharmacist off-site, for advice. There are 12 discharge prescriptions waiting, two of which are for controlled drugs, and a nurse is asking for a vancomycin dose. The intern is willing to stay because they need the overtime pay and do not want to let the team down.
1. What should you advise the intern about accepting the sole pharmacist role?
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The intern should not accept the role as sole pharmacist. They are not signed off for independent practice, and hospital policy requires an on-site registered pharmacist. Working alone would breach the supervision requirements of the intern training programme and create unacceptable patient-safety risk, especially with controlled drugs and a vancomycin query. I would advise the intern to tell the duty manager that they cannot be the sole pharmacist, and that the on-call pharmacist must attend or another registered pharmacist must be called in. The intern can continue to work under direct or, if the programme permits, remote supervision while a registered pharmacist is on site, but not as the accountable pharmacist. The intern should not be swayed by overtime pay or team pressure; the consequences of an error or a professional breach are far greater.
2. What immediate actions should be taken to manage the backlog and ensure safe service?
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Escalate to the on-call pharmacist and the pharmacy manager immediately. The duty manager should activate the hospital's escalation policy. Until a registered pharmacist is on site, non-urgent discharges should wait; urgent medicines should be prioritised by the registered nurse/medical team and, if necessary, supplied under the on-call pharmacist's direction. Controlled drug prescriptions must not be dispensed by the intern alone. The vancomycin dose query should go to the on-call pharmacist or an approved antimicrobial resource, not be answered independently by the intern. Document the decisions, times, and who was contacted. If there is any delay in patient care, complete an incident report. The intern can help prepare prescriptions for checking but cannot be the final check.
3. What follow-up should occur after the shift?
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The intern and I would debrief and document the event. I would inform the PSNZ training coordinator and the pharmacy manager that the intern was placed under pressure to work outside the supervision requirements. The hospital should review its after-hours roster and on-call arrangements to prevent a repeat. The intern should write a reflective note about recognising scope-of-practice limits and escalating appropriately. If the duty manager's request was a one-off, an educational conversation may suffice; if it reflects a pattern, a formal report is needed. The intern should be reassured that refusing unsafe work is the correct professional behaviour, not a failure of teamwork.