Out of my depth: some suggestions

Last updated: Thursday, December 27, 2018

Admit you don't know 

You will be asked questions about medicines that you don’t know the answer to, and it is okay to admit it. The amount of information about medicines is vast and you are not expected to know everything, especially when newly qualified. You should advise the nurse that you haven’t come across this situation and that you’ll need to look into it for her.
Courtesy of Siba Majid

Buy yourself some time 

Errors are more likely to occur if you are asked to provide advice or make decisions under pressure. Therefore, rather than the nurse staying on the phone while you try to find the answer, take a contact number and explain that you will phone back. Even buying yourself a few minutes will reduce the risk of you making a mistake. Before you hang up, make sure you’ve asked sufficient questions about the patient and the medicine to find an answer yourself or to decide who else might help.

Unfortunately, when you look through the various resources available to you on-call, it is not straightforward and you’re not sure that you understand how to calculate the dose of THAM.

Ask for help 

This is probably the most important step to take in any unfamiliar situation such as this. If you’ve checked your reference sources and you’re still unsure what to advise, it is not unreasonable to contact one of your specialist pharmacists. Most colleagues would prefer to be contacted (even in the middle of the night) rather than risk you making a decision beyond your competence.

Consider signposting 

In this scenario about THAM, you may not be able to get hold of a paediatric pharmacist locally to help you in the middle of the night. And you're still unsure how to calculate the dose yourself.

However, some decisions aren’t yours to make, and recognising what falls within your remit will come from your training and with experience. When you can't help someone always try to point them in the direction of a person who may be better placed to assist. The decision about the dose of THAM is really the responsibility of the paediatric consultant so if you don't know how to advise the ward sister, you should ask her to speak to the prescriber or another consultant with experience of using the drug.

Following up 

The next day, follow up the patient for your own development and share with your newly-qualified colleagues so that they can learn from your experience. Also ensure that your on-call training programme is completed so that you are as well prepared as possible for the problems you will encounter.